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A health economist adding value and heart to research: In conversation with Dr Peter May

Dr Peter May is a health economist based in the Centre for Health Policy and Management in Trinity College Dublin. Dr May’s research focuses on care for people with advanced medical illness, such as incurable cancer, organ failure and Alzheimer’s disease. Along with colleagues in the Palliative Care Economics (PaCE) research group, and The Irish Longitudinal Study on Ageing (TILDA), Dr May generates evidence that improves the care received by people and their families, and the experience they have, as they live and die with serious illness.

Dr May is the principal investigator on two studies in Ireland. He works with the Department of Health and Health Service Executive to predict future needs as our population ages, and to estimate the costs and benefits of different policy options (www.pelci.ie). He also works with a large network of collaborators in studies across Europe and the United States. Dr May spoke to us about his background, his thoughtful advice to those in the early stages of an academic career, and how end-of-life care should be an integral activity of the health care system.

How did you become interested in this area of research?

After an undergrad degree in economics and an MSc in public policy, I worked for a few years in very wide-ranging research roles: transport, education, social care, sport and others. In 2010 Trinity’s School of Nursing and Midwifery wanted a researcher for policy analysis and literature reviews in ‘palliative and end-of-life care’. I had the methods skills but had never heard of palliative care – I began my interview prep by reading the Wikipedia article. Fortunately, I got the job and it very quickly became apparent that this was a uniquely challenging and rewarding field, with not nearly enough research activity. I’ve been immersed ever since.

It is increasingly imperative that we demonstrate impact in our research. How do you see your work impacting health?

Everybody dies, and most of us die from advanced medical illness. This is a unique life event not only for the person who dies, but for those closest to them. As much as possible we should ensure that people feel comfortable and supported, with their needs and preferences met. Historically, health services were designed to provide acute, episodic care to a population with a life expectancy around 70. They were not thinking about an ageing population where a lot of people live for a long time needing care for complex multimorbidity, or supporting people through the end-of-life phase.

End-of-life care should be a core activity of the health care system, and we hope that our work improves the training, funding and availability of better supports for better outcomes. For example, we recently published a report with the Irish Hospice Foundation on what we currently measure about dying and death in Ireland (https://hospicefoundation.ie/wp-content/uploads/2021/11/Dying-and-Death-in-Ireland-what-do-we-routinely-measure-how-can-we-improve-2021.pdf). We identify a number of encouraging issues – Ireland provides strong end-of-life care in international comparisons – but also areas for improvement. If Government, the Department of Health and the HSE, and researchers can address these issues then hopefully we continue to improve care and experiences into the future.

What is your proudest achievement?

Our studies feature regularly in policy documents in Ireland, the UK, the EU, the US and further afield as the world grapples with the challenges of an ageing population. That’s always gratifying, because our main aim has to be providing the best possible evidence to improve decision-making.

That said, I spend no time whatsoever reflecting on past achievements unless they inform our current and future efforts. I am much more preoccupied with the countless things we didn’t get to yet.

What is your best advice to early-stage researchers?

In terms of the substance of the work I always quote my PhD supervisor, Professor Charles Normand. At our first meeting I asked Charles how I should think about the task of producing a thesis. He said, “We don’t weigh them. Any fool can advance knowledge, you’re here to advance understanding.” Ten years on, I repeat it to someone at least once a month.

More broadly, it is vital to surround yourself with good people. Early-career research is by turns thrilling and thankless, and can be lonely. Researchers put a lot of pressure on themselves. The system of academia is not always responsive or respectful. Find people within academia who can offer different perspectives and help you make sense of the journey. This won’t solve every problem – indeed, if you are getting good advice then you won’t always like it! Nevertheless, constructive, good faith advice from different sources is essential to navigating early career research. Needless to say, good people from outside academia are essential too if you want to keep a grip on reality!

Who are/were your mentors?

When I started in Trinity’s School of Nursing and Midwifery, my manager was Professor Geralyn Hynes. Geralyn was a brilliant first mentor. She has a mix of qualities that is perhaps particularly common in nurses: smart, industrious, protective of her team, and flintily sceptical in the face of those with too high an opinion of themselves. I learned a lot about palliative care, but also about following the evidence and not the agendas of others.

My PhD and post-doc mentor in Trinity was Professor Normand, who more or less started the economics of palliative care as a field and has been a huge influence. I was very fortunate to spend two years of my PhD study at the Mount Sinai School of Medicine in New York. I worked for Professor Diane Meier and Professor R. Sean Morrison, two major leaders in medical care for serious illness in the US and internationally, and they have been endlessly generous in supporting me.

Life is not all about work… When you are not in the lab, where could we find you?

As a parent of young children, I am unfamiliar with the concept of ‘free time’ as such. At weekends my natural habitat is refereeing a chaotic game of cricket/football/hurling in the road outside our house.

Professor May’s work has been supported by Health Research Board (HRB) in Ireland and National Institutes of Health (NIH) in the United States. He works in TILDA, which is funded by the HRB, the Department of Health, The Atlantic Philanthropies and Irish Life, and on international studies funded by the NIH, American Cancer Society and European Commission.