October 11, 2019
A twisty career path to improve care for smokers
October 11, 2019
When Jason Melehani, MD, PhD, grew up in a small town in the Sierra Nevada foothills, he didn't know any scientists or doctors.
That all changed when he went to college at the University of California, Los Angeles and discovered the world of research. Now, Melehani is a resident in internal medicine at Stanford and his career path is headed toward a future helping people who have struggled with tobacco use.
At UCLA as a freshman, he joined a lab and began investigating an unusual parasite called Trypanosoma brucei that is transmitted via the bite of a tsetse fly to humans and cattle, causing an often fatal sleeping sickness in Saharan Africa.
"African sleeping sickness exclusively affects very impoverished regions of the world, so there wasn't much interest from the pharmaceutical industry to develop medicines for this disease," said Melehani. "A new therapy was recently approved, but it was spearheaded by a nonprofit initiative."
This research experience inspired his career plan -- with the ultimate goal of developing therapies for diseases affecting socioeconomically disadvantaged populations.
First, Melehani headed to the University of North Carolina, Chapel Hill, to earn both a medical degree and doctorate in pharmacology. This program included two years of preclinical medical courses, four years of research and two years of clinical training.
After completing the MD-PhD program, Melehani took an unconventional approach.
"Developing new treatments for patients is incredibly challenging especially from an academic lab. You can get things started, but there is a whole world of skills and people required to take things all the way to the clinic," said Melehani. "I felt like I was experiencing only a thin sliver of the entire process in a research lab."
To broaden his exposure, he next worked as a fellow at a venture capital firm in North Carolina focusing on health care and biotechnology.
"In seven months, I evaluated 500 companies and helped pick the most promising ones, which each received an investment of between half a million to eight million dollars," said Melehani. "I worked with leaders of major health care organizations who valued my opinion despite my junior position. I learned a lot about how new drugs are developed and the role venture capital plays."
The contacts and insights he gained through this venture capital training and a separate internship in the pharmaceutical industry will likely come in handy in the future when he is running his own academic research lab. "My hope is that this training will help me better select and position future discoveries so I can move them out of my lab to startup companies and ultimately to patients," he said.
Even at Stanford, Melehani is making his own path. Melehani has applied to do fellowship training next year in both rheumatology and pulmonary medicine, which no one has done before in recent memory.
Melehani plans to research how smoking tobacco affects the immune system and leads to severe health consequences, such as chronic obstructive pulmonary disease, rheumatoid arthritis or heart disease.
"Smoking has disastrous immediate and long term effects on nearly every system in the body," he said. "And it's deeply tragic because 90% of people who smoke start before the age of 18 and it's highly addictive. So even though 70% of people want to quit, the success rates are dismal -- around 10%."
The health impacts of smoking have been on Melehani's mind for a long time. Many of his friends started smoking in high school. He was exposed to a lot of patients in North Carolina who were smokers. And now at Stanford, he sees many patients who are former smokers and dealing with a wide range of health problems.
Smoking fits his goal of addressing a major socioeconomic health problem -- the highest rates of smoking in the United States are in the poorest areas with the lowest education rates. And these are the people who don't have the resources to face the disastrous health consequences that result, he said.
Melehani hopes to tackle this problem by running his own lab doing fundamental research into how the immune system is affected by cigarette smoke and turning that research into meaningful changes in medical care for his patients.
For now, he is focusing on his patients and getting through his night shifts in the intensive care unit.
Photo by Margarita Gallardo
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