Arlene studied mathematics first at Harvard and then at the University of Illinois, Chicago, where she earned her Ph.D. in 1977. After a postdoctoral fellowship, she worked for the Boston University School of Medicine. Late last year, she began a new position as a division chief in the Department of Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester. She sat down with Under the Microscope to talk about how she has shaped her unique career.

Under the Microscope: What sorts of projects do you work on?

Arlene Ash: Fundamentally, [biostatistics is] quantitative tools that are applied to life sciences problems, and biostatistics departments would typically help researchers run clinical trials, to be able to answer questions like, "Is this an effective therapy?" And usually they're involved in designing experiments which would give a definitive answer to a question that you ask prospectively, [such as,] "How do we assemble the data that will help answer the question about whether this method or that method of dealing with the problem is better?"

Health-services researchers actually tend to start with just observational data, so they don't get to build their experiments from scratch. They look at very large databases that are generated when populations receive their health care -- what medical problems they have, ... what doctors they've seen, ... whether they're older or younger, whether they're women or men, whether they come from poor areas or rich areas, whatever race or ethnicity they have -- and they try to infer from these very large, complicated, somewhat rich databases answers to questions like, "If two people have the same medical problems but their demographics are different, why do they receive different treatment for that problem?"

UTM: What are some memorable problems that you've helped to solve?

AA: I do have sort of a signature body of work that I started on in 1984. ... The federal government was opening [Medicare] up to HMOs [health maintenance organizations] being able to sign these "risk contracts" -- which is to say they'd agree for a certain amount of money to take this group of people and they'd agree to deal with all their health problems. And the question that the federal government was trying to solve ... was, "How do we find out how to pay more money to the HMOs that take sicker people?" 'Cause it's clear that there's a problem with this system. If the same amount of money is handed out for every person who signs up, the HMO can make a ton of money by signing up very healthy people and it will lose money if it signs up sick people.

So the government ... funded about five different science teams around the country to try to solve that problem, and my group solved the problem and that became the method that Medicare uses today.

The devil is in the details, but the broad solution is incredibly natural. ... You can create models which predict the total cost that would be expected to be spent on a person ... as a function of their age, their sex, and the medical problems that were present this year. ... And this is the only way the HMO model can work well for society. Because otherwise every sick person is sort of a medical orphan. No one would want to sign them up because there's a predictable loss.

UTM: Did you always know you wanted to be a mathematician?

AA: It sort of came to me naturally within my family. I'm the youngest of three kids; It turns out I'm one of three Ph.D.s in mathematics, and I guess it was just easy. My oldest brother was six years older than I, and he loved to teach me math. And so when we got to things in school, I just sort of knew them before other people, and I got the reputation for being a math whiz.

I was on track to become a pure mathematician and work in a math department, and I had a very striking, tragic personal event that caused me to rethink that. My college roommate committed suicide seven years after we left college. That was the point at which I was in a math department, and I was not sure how happy I was with continuing to work on my doctorate, and I was very engaged in some feminist radical politics at the time. ... I was finding that to be very empowering, and I was finding it kinda hard for me to go sit in the library and try to work on my math thesis. And so when my friend committed suicide, I took the summer off and I sat around in the dirt in a garden doing some gardening all summer, trying to just wrap my mind around, "OK, what did I really want to do with my life?"

And when the summer was over I got up from the dirt and I went to talk to my thesis adviser who was a very nice man, and I said, "I don't think I can do this anymore. I think I've decided that I need to do something which feels more directly related to a public service. ... I realize that the skills I have are actually kind of absent in people who come through medical school, and they can't answer very straightforward questions that involve looking at populations quantitatively, and that I think I could add something there. And that's what I think I want to do." Interestingly, I said to myself pretty explicitly, "If this country ever gets itself together to try to reform the way we do health care, I'd like to be one of the people who has the skill set to help them do it right." And then 10 years later, I was helping the Medicare program figure out how to pay for health care better.

UTM: Women Ph.D.s are rare in math. Did that affect you during your education? Does it still?

AA: Usually, I thought it was kinda fun that I was one of a small number of women in a group. ... I had only two women in my classes in math at Harvard. I did find that some of the professors were really quick to say, "Girls can't do math." But I found that the same professor who actually said that had been pretty discouraging about the careers of some of my male friends just using different language -- you know, friends who went on to be professors of math at major universities. So there's a culture of intellectual superiority about people who are really good at math, so they often put people down, but women more than men.

I think being in a medical school is perhaps very different from being in a math department. I have a skill that most of my colleagues really respect. So I feel as if I walk into the room and I put on my magic cloak. That when I speak to my expertise as a person who really understands quantitative data, that I get respect. It's pretty cool.

UTM: What is your lifestyle like?

AA: You get to travel as much as you like, and I do enjoy international travel. I went last summer to Beijing ... and I talked with a relatively high minister there whose charge it is to figure out how to give health care to the 800 million rural Chinese.

I was invited to give a talk at a charter school in Boston which takes some really disadvantaged kids and does wonderful things for them. ... I was talking about my career and one of the kids raised his hand and said, "So, how much money do you make?" ... I said, "Well, let me tell you this. When I put down the work I was working on to come and give you this talk, it was work I was being paid $400 an hour to do." And, woooah, the room went really quiet. And so then somebody else raised their hand and said, "Yeah, but, how much school did you have to do?" And I said, "I was in school a long time." And again, the room went quiet thinking about it. 

I overwork, but it's because the work is so exciting, and it really draws me to it. And if it were less exciting, I might have a more rounded life, but I have a very good life.

Photo courtesy of Arlene Ash. 

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