Q&A with Damien Fair: OHBM 2017 Keynote Series

BY SHRUTI GOPAL VIJ
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"Children are not things to be molded, but are people to be unfolded." — Jess Lair
This is not just a philosophy, but more a way of life. Extend this to science and it gives us a turnkey question that researchers world over are trying to answer – how does the brain develop? One of the many scientists trying to contribute to this question by using functional brain imaging is Damien Fair at Oregon Health & Science University. His research team focuses not only on teasing apart the developmental trajectories in typical and atypical populations using functional imaging, but they also test the feasibility of using various structural and functional imaging techniques in translational studies of development. His OHBM keynote address in Vancouver highlighted some of his team’s key research findings. I had the chance to have a tete-a-tete with him and here are his unique insights and experiences for you all to enjoy.

Shruti Gopal Vij (SGV): You have made a name for yourself in ADHD and Autism research. How did that come by and why do you feel strongly about these disorders?
Damien Fair (DF): As many folks know, I started off in graduate school, working with Brad Schlager and Steven Petersen on pediatric and perinatal stroke. But at the time I was starting my thesis, the connectivity craze took off. One of my classmates, Mike Fox, down the hall was working with Mark Raichle on this connectivity business and my mentors told me to take a break and go see what they were doing. I did, figured it out, and found a way to apply it to our lab’s research and my research in stroke and brain development. The rest is history.

My thesis plans essentially went down the tubes at this point and changed paths immediately. After that point in graduate school, I studied typical development with resting-state functional connectivity and it was very productive for me. We did a lot of cool things. With that said, I was always very interested in clinical questions and I realized quite quickly that in psychiatry, unlike neurologic disorders, functional information is really needed. That was sort of the turning point for me to focus on using functional neuroimaging to answer clinical questions of development such as ADHD. Now, I am not an ADHD guy per se,  but I definitely use ADHD as a model to develop tools that can be used in a lot of developmental disorders.

SGV: In neuroimaging, which overarching research question do you feel is the most important to be addressed?
DF: Ah! That is a very interesting question! There are a couple of things I think are extremely important for studying typical and atypical development. One is that we need to get a better idea of what the variance means in the data. When we conduct studies of development, there are a couple of presumptions that we make that are likely limiting progress. We assume that the clinical samples we study belong to one big homogeneous sample. That is likely incorrect. It’s very likely that there exist many different mechanisms in play leading to the similar phenotypes we measure clinically. As an example, in Neurology and cerebrovascular disease, when someone comes in with hemiparesis and facial droop, we immediately place the patient in the CT scanner. The reason is that the same symptoms can be caused by ischemic stroke and hemorrhagic stroke. The mechanisms are distinct and the treatment completely differently, despite similar symptoms when patients come in. In fact, a person with ischemic stroke can be treated with Aspirin as a good secondary prevention but give that to someone with hemorrhagic stroke and it will make the situation worse. We believe that developmental psychopathologies might have parallels. So, one of the key questions in psychiatry is to understand what the variance means in the imaging data because not all of it is noise. Some of it might lead to discovery of hidden profiles or mechanisms of the phenotype.

Another assumption is that the typically developing kids are also all the same. This is also likely incorrect and we need to understand the context of variance in typical development in order to understand atypical development.

Our lab is developing new tools to parse out this heterogeneity in typical and atypical development. How you do that maybe sounds very simple but it’s actually quite complex. Computationally it is a very hard problem because of the amount of possible permutations of the data in the samples we study. We believe the tools developed to parse the variance should be efficient in not only doing so but should also be trained toward answering specific scientific or clinical questions. Importantly, no matter how good the tools, the measurements we make need to be precise. How to do this is highly debated, but nonetheless it’s of critical importance.

The other thing that we are doing and what my keynote is primarily about is to understand the factors that lead up to certain trajectories of development rather than just looking at childhood,when these profiles are already well underway. Along the same lines, we need to do a better job collaborating with our neuroscience colleagues who do work in animal models. Work in the animal models is important to assist in designing the experiments that can actually test specified mechanisms. Having the same non-invasive measurements in humans in these models can help relate the findings across the species.

SGV: In line with one of your points, there is a huge discussion on replicability of science. What do you feel about that and what are you in your lab implementing to improve the replicability of your science?
DF: This is incredibly important. In fact, it doesn’t get as much emphasis as it should. We spend so much time discussing the details regarding the specific statistics and methods that we use but nothing compares the ability to replicate results in an independent sample.

In my lab, we have been lucky in being awarded several grants for large-scale data collection in developing samples. These awards allow for true replication across independent samples.  What we do is use these resources to not only develop our models but also test the models in an independent sample. This allows us to verify that the model developed is not completely dependent on the cohort we use. Given the extensive availability of large public datasets especially in development, I think others should be using these open resources for validation as well.

Fair Neuroimaging Lab at OHSU includes six research assistants, five postdoctoral fellows, two graduate students.

SGV: To take off from the scientific discussion a little bit, diversity has been a hugely discussed issue in OHBM in the last few years. Have you faced discriminatory behaviors during your career? If so, how do you address it either towards yourself or colleagues that you work with?
DF: That is a really good question. It is a big problem throughout academia. The diversity in background and ideas are not fully represented in our field. As far as discrimination, during my journey there have certainly been instances regarding assumptions about my abilities because of how I look. It’s disappointing, of course, but often you can use that ignorance as leverage. But I think the most important thing for anybody that falls in these categories are two things that my mentors taught me over the years: 1) You need to be really confident and 2) be very competent in the way you do your work. Confidence and competence. Everyone in science will come to a time when they are doubted. Stay confident and be competent, and you will be able to overcome these issues. It is not easy, of course,  it takes self awareness and practice.

Now, for me, issues related to diversity in academia has been an important part of my trajectory. I have had a lot of different kinds of mentors that have helped me over the years in so many ways reach my goals. Often times pulling me up and believing in me that has allowed me to progress. For this reason, in my lab, we have made it a part of the lab’s identity to a) embrace diversity and b) develop some programs that can assist in the mission.  So, in the end, it will be up to folks like you and other students and postdocs, as you all start making it and advancing in your careers, that you also remember where you came from and also assist the next generation along their journey.

“There is no exercise better for the heart than reaching down and lifting people up.” ― John Holmes 
Watch this video excerpt to hear about Dr. Fair’s diversity programs and how he is reaching out and lifting people up.

SGV: Have people been receptive of your ideas of diversity and your programs?
DF: Yeah. Most everybody has been receptive. Often times though people are receptive in talk and less in action. But that is the case in almost everything where you are asking people to do things for you. Persistence is the key to getting things done. Staying persistent and on top of stuff can usually convince people to follow the talk and get involved. In fact, OHSU after a lot of persistence has pledged its support to many of my diversity programs, and I am very appreciative of this support.

SGV: Seems like mentorship is personally important to you. Given this year’s push towards mentorship and career development for the trainees of OHBM do you have any significant advice for them?
DF: Well, I would say one of the most important things for students is to be sure to have more than one mentor. You always have your scientific mentors but it is also important to have professional and other mentors that might not have anything to do with your work but that you can talk about goals and life events and other things. Another thing to remember is that everyone has opinions. Sometimes these opinions will be right, and sometimes these opinions are wrong. You just have to be able to get advice from lots of people and filter that information to do what’s best for you.

SGV: Do you have any grant writing tips for our readership?
DF: Grant writing is an exercise in frustration!  You have to go in recognizing that and again this comes back to confidence, competence, and persistence. But it is also very strategic since sometimes the grants that get funded aren’t always the best science. It’s unfortunate of course, but it’s important to recognize. Even if you think you know what you are doing, play the game intelligently, know who your audience is, and know that not every audience will think “you’re the greatest.”

So be smart and have more than one horse (i.e., grant)  in the race. This will help keep ahead of the game, and if you do, most times it works out. But learn about how to navigate the system and get familiar with the ins and outs. The process isn’t always linear - recognize that and talk to program officers, other grant officials, and mentors often. Ask a lot of questions!

SGV: You have sort of travelled around the country and ended up in Portland. How did that come about?
​DF: I ended up in Portland because of my wife. She is a physician scientist and she got matched a uro-gynecology fellowship in Portland. So, that’s where we were going. I had to find a lab and I did and it has been great! I found Dr. Joel Nigg who is a clinical psychologist who is very famous for his ability to phenotype clinical populations, which was what I needed to learn. After a short postdoc, we were exploring our options outside of Portland but we liked Portland enough to want to stay on.

SGV: Lastly, do you have hobbies that you feel passionately about?
DF: I do have hobbies but I don’t get much time to spend on them. I have two kids and I typically spend time outside of work with my family. I feel strongly that it is important for my sanity to take time off from work and enjoy my family and I encourage others to do the same too.

As the interview ended, Dr. Fair prepared for his keynote lecture and I as a postdoc was left with so much information and inspiration. It is the blood, sweat and tears that make the man but it is his passion to spread his wealth of knowledge and to help others that was the highlight.