Dr. Kathryn T. Hall, Molecular Biologist

Kathryn Tayo Hall, PhD, MPH, is a molecular biologist and deputy commissioner of the Boston Public Health Commission. Her work is multifaceted and entails leading the Center for Public Health, Science, Technology and Innovation and collaborating with the Office of Racial Equity and Diversity and the Child and Family Health Bureau. She works closely with the Commission’s human resources department as well, launching the Emerging Leaders Program to provide professional development opportunities for public health employees.

Dr. Hall is also an assistant professor of medicine part-time at Harvard Medical School. In addition to holding a BSc in biochemistry (University of Miami) and a PhD in microbiology and molecular genetics (Harvard University), she holds two master’s degrees: an MPH from the Harvard T.H. Chan School of Public Health and an MA in documentary film from Emerson College.

Dr. Hall’s forthcoming book, Placebos, part of the MIT Essential Knowledge Series, explores the biological power of the placebo effect.

Please note that this interview has been lightly edited for length and clarity.

[OnlineEducation.com] Dr. Hall, you’ve done a lot of different kinds of work, both in industry and academia, from drug discovery and development to research and teaching and now leadership. You’ve studied a variety of disciplines as well: biochemistry for your undergrad, and then microbiology and molecular genetics, public health, and even documentary film. Can you tell us about your current work and how your career path led to these roles?

[Dr. Kathryn Hall] My current work is as deputy commissioner at the Boston Public Health Commission. So what I do there is work really closely with our commissioner and with several of the groups and departments and bureaus to basically protect, promote and preserve the public health of Boston.

With Covid right now and for the last three years, that’s been a large part of our focus and my focus most recently. We also have to deal with issues around substance use, homelessness, health inequities, and several other issues that are faced by public health agencies in large cities. My work focuses on leading what we call the Center for Public Health, Science, Technology, and Innovation. That is a group of epidemiologists, biostatisticians, evaluators, and surveillance people, as well as the IT groups and the information technology systems groups, that develop a lot of enterprise solutions that we use to do the work of the Commission.

I also work closely with human resources. I never thought there was so much complexity to working with employees. I think with Covid, people are under great stress, and in a public health agency where people are historically underpaid and overworked, it’s been a really tough road for many people. We’re really working with the city to correct some of these issues and enhance the workforce and offer professional development for people.

There are so many amazingly talented people in the Commission who are under the gun to get the work done, and they haven’t had a chance to develop their own professions. I’m very passionate about professional development, so we started a program called Emerging Leaders, where people are doing courses at Harvard Business School, doing ropes courses to do team bonding, and getting some professional coaching. We’re really trying to mix it up.

In addition to that, I also work with the Office of Racial Equity and Diversity. There, we are really focused on this issue of how we address the structural issues wrought by structural racism.

Finally, I work for the Child and Family Health Bureau. We work with people in Boston from birth, even pre-birth, all the way through the lifecycle to help with improving maternal and child health early on, and we have lots of opportunities for youth to come and learn about public health through summer programs. We have a violence prevention program during summer. It’s really taxed because of the increase in violence we see during the summer.

So those are some of the things I do at the Commission. It’s a really amazing job.

Believe it or not, I still get to do some videotaping. We have this program, which we call “This is Us” or “We Are BPHC.” We’re doing videos of each of our departments and our divisions, and sharing them with everybody. It’s a little bit of a competition, so it’s fun as well. But some people, they’ve never really thought about videotaping, so I’ve gone and helped people get set up with this. And it’s fun, but it’s also an opportunity to visit people, staff, and employees, working where they’re at and seeing who they’re interacting with in the communities in Boston.

This is a long-winded way to tell you how I got on this path. Some youth were learning about substance use and they were getting trained on the different types of drugs and their effects— whether people can have an addiction to some of these drugs or not, marijuana, mushrooms and so on.

As I was sitting there looking at these young people, I realized that when I was in high school, I was that kid who had done all this research on tetrahydrocannabinol, THC, and marijuana. I grew up in Jamaica, and I was going from classroom to classroom, giving these lectures on marijuana use and, of course, getting all these blank stares from my classmates, like “Why are you doing this?” I was really passionate about it! And so that memory took me back.

It took me a while to own all the different parts of me, and I remember one of my mentors saying to me that I needed to pick one thing because people are going to think you’re all over the place. And it’s interesting because the thing I picked was whether or not genes can influence placebo response.

I ended up working on one of the genes that I got really interested in, this gene that had pleiotropic effects in cardiovascular disease, cancer, placebo, substance use, and depression. So I got very focused and then exploded into a whole other world. I think I just am not able to stay with one topic.

It’s really important to learn about all the intersections that exist. Life is really a network and a series of interaction effects that are constant and changing over time. The more that we can immerse ourselves in that network and understand what it all means, I think we’re going to be able to start to have an impact on some of the diseases and some of the conditions that plague us as human beings.

[OnlineEducation.com] Can you tell us about placebo genetics and what sparked your interest in this specific subject field?

[Dr. Kathryn Hall] Placebo genetics is literally the examination of the impact that genetic variation might have on response to inert or placebo treatments. I should underscore here that placebos are positive responses, but there’s this other side of placebos that is a negative response. I think statins or even Covid vaccines are a classic example where people get told they’re gonna have a lot of pain and that vaccine is gonna make them really sick. People go in and they report a lot of side effects.

When they’ve studied these with inert, placebo vaccinations, or controls, they find just as many side effects with the control as they find with the actual drug. So placebos can be positive or negative, and then they’re called “nocebos.”

I was really curious to know whether or not there was any influence of genes on placebo effects. I came to that through one of my mentors, Ted Kaptchuk, who’s been a placebo researcher for years. He was asking what are the factors that drive placebo response. Having a genetics background, you look at the thing with the lens that you’ve been given or you adapted. Since then, I’ve come to realize it’s obviously very complex. It’s a network of many factors driving it.

Certainly, there’s a piece that can be attributed to genetics, but it’s not the primary or only part of these effects.

[OnlineEducation.com] After earning your PhD, you spent ten years in industry and became the associate director of drug development at one point. What was that like: your decade working in biotech?

[Dr. Kathryn Hall] I loved it. I love industry, period. Why? Because when I was a kid growing up in Jamaica, it really became clear to me, for better or for worse, the system that we’ve set up really is designed for people to work: to make money, to take care of their children, to take care of their family, and to take care of their health.

And I was really struck by the different types of work that people do and felt that it would be great if people could really love their work no matter what they did—if they could find the joy in work. My vision as a little kid when I saw all the cans of condensed milk coming by and getting a dollop of condensed milk, getting sealed, and getting the Nestle label on top. And it just goes by one by one.

And in my little girl brain, I thought it would be great. I also had this kind of scientist’s bent to make drugs for treatments for people with disease. [I thought] wouldn’t it be great: people would have jobs. They would really enjoy these jobs, and they’d be stacking up pills instead of cans.

From an early age, I wanted to have my own pharmaceutical company. And I mapped this path in Jamaica going to the library reading these books. I’d go and do a PhD in pharmacology or biochemistry, or something related, and then set up a very simple pharma company in Jamaica.

When I was in graduate school, it was very taboo to want to go into the industry. It wasn’t cool, but I loved the idea of being able to make something—that it could be a day’s work you get paid for but you also help somebody. So I followed that path all along, and I really learned a lot about the pharmaceutical industry. We’re doing this amazing work, identifying these really cool targets in these large screens. We’re doing this really complex analysis. We’re demonstrating that these small molecules hit the target. In these animal models, they seem to be effective, and we would figure out how to make them the same way every time and then ship them up for a clinical trial. Low and behold, they couldn’t beat a placebo; they couldn’t beat a sugar pill.

At the same time, I was on and off the bench, but doing a lot of repetitive [tasks]. I was getting crazy pains in my hands. First, I started with my primary care physician, who gave me ibuprofen and then sent me on to the rheumatologist, the surgeon, the sports medicine doc, everything. I had the cortisone shots, and finally, they were like, “Okay, we’re gonna need to do surgery.” And I was like, “I don’t I don’t want to do surgery” because my colleagues had this scarring.

I decided to go to acupuncture because this friend of mine was an Aikido master, and she told me, “All you need is acupuncture.” I actually just finished a book, which describes this whole experience. For me, it was very wild because I’d never done anything like this. It didn’t make any sense. Why am I doing this? I’m so desperate. The woman puts a needle in the back of my arm here, and this pain shot through me, and then I was like, where did the pain go? What just happened? I pondered that for years. How did that even happen? Wait, is this the placebo effect? What is going on? And why did all these drugs not work? And so I started to ask a lot of questions.

And that’s around the time I took a step away from the pharmaceutical industry just to broaden my thinking, broaden my horizons. I’d always loved to make films, so I thought this would be a great thing to do.

I made a documentary about HIV/AIDS in the Boston community. It was very much like a public health piece. Very scientific. It read like a scientific paper. I realized that maybe I should go back and bring all of this to my research. Placebos seemed like the perfect place to start with all that. And that brought me back.

[OnlineEducation.com] You actually anticipated my next question, which is what prompted your return [to academia]? When you went back for your master’s in public health?

[Dr. Kathryn Hall] So around that time, I met Ted Kaptchuk, and I was just talking to him about these ideas and this journey that I’ve been on. He was telling me about placebos, and it all started to add up. He said, “Well, we have a project where we’re trying to look for molecules that might influence placebo.” I was like, “I could do that.”

I started part-time while doing some film work, and soon I was all-in because it was just so interesting. I restarted my career. To do that, you have the NIH clock—and you have to restart your clock. So I literally had to go back and become a postdoc again, which was very humbling, by the way. It was tough to go back, but sometimes you have to go back to move forward, and I just did it. And, no regrets. It was really good to take a different look at this question.

In the integrative medicine fellowship at Beth Israel Deaconess Medical Center and Harvard Medical School, I became affiliated with OSHER and learned a lot about integrative medicine. Part of the fellowship is to do an MPH. When I was in pharma, I had a great friend who got into Harvard School of Public Health, which is what it was called then. Now it’s called Harvard T.H. Chan School of Public Health.

When I was at Millennium, this really good friend of mine and colleague got into the Harvard School of Public Health to do an MPH and she was like, “I don’t know if I’m gonna do it,” and I’m like, “What do you mean you don’t know if you’re gonna do it?” And I was so angry at her because she decided not to go, not knowing that that was because I wanted to do that. If you want to learn something about yourself, look at the people who annoy you.

[OnlineEducation.com] So would you say that your experience with acupuncture and then going for the MPH was your trajectory into Integrative Health?

Yeah, absolutely.

[OnlineEducation.com] Pivoting a little bit, this series is called breaking “Women Breaking Barriers.” Would you like to talk about any challenges you may have faced as a woman pursuing this work and what helped you navigate them?

[Dr. Kathryn Hall] I would love to talk about being a black woman. I don’t know if you have anybody talking about that, but for me, the invisibility that I’ve experienced throughout my career has been profound.

One of the things that we learn while studying placebos is how the brain works relative to an interaction, relative to the symbol of a pill or a ritual of the patient-doctor relationship. And that’s a very constrained example of how our brains work. But, our brains are not compartmentalized the way we like to study them. Our brains are literally this amazing computational instrument that’s integrating a lot of information from a lot of different places and deciding how we’re going to move forward.

In preparing for the book, Placebos, I had to really immerse in the neurobiology of placebos because I had a chapter on that. I was like, “Okay, now I’m gonna have to do a really deep dive, and I’m not a neurobiologist.” So I had to do a lot of reading and thinking. I had my picture of the brain here as I read.

And it’s really funny because you’re trying to tell the story, but there are many stories. We’re only scratching the surface of the brain. One of the things that was really striking is our ability to predict what we think is about to happen. And in doing so, we’re not necessarily paying attention to what is actually happening. We’re more focused on our prediction.

For instance, in the early days, when you see your cellphone, you think, the surface of my cell phone is bouncing light to my eye, my retina, optic nerve, up in the brain, and my brain makes this image—and now I see a cell phone. No! It’s that I expect to see a cell phone. I expect [how] this cell phone will look, so I’m actually projecting my expectation onto it. And it’s only when there’s a delta—a difference between what I predict and what’s actually coming in—that I start to pay attention.

And so you’re wondering, what does this have to do with the invisibility of being a black woman in science?

Well, people don’t expect to see me as a scientist, right? I’ll give you a classic example of this.

I was invited to give a talk at my institution. And I wasn’t sure where this particular room was or how the thing was going to be set up. The person who introduced me said they’d meet me outside the lecture hall. So I get to the lecture hall. I see this person, and they’re obviously looking for somebody. And I walk up to them, and I stand…waiting…and they don’t see me. They don’t look to me. They kind of looked past me.

In the book Caste, Isabel Wilkerson has a really amazing example of this phenomenon. She was invited by The New York Times to do an interview. They were going to meet her at a gallery. The reporter shows up and said, “I can’t talk to you right now; I’m waiting for Isabel Wilkerson.” When she said she was Isabel Wilkerson, the person asked her for her ID.

This is invisibility is a very profound thing. I’m not excusing it because it’s how our brains work—I’m drawing attention to it because we need to transcend and do better. We need to do the work that our brains are not doing. We need to transcend the default.

So that woman never saw me, and I said, “Is this where the talk is on placebos?” And she says, “Yes, it’s in here. You can go in.”

I have a sense of humor. I’m obviously a scientist—very curious—so I stood in front of her and waited. And I watched her waiting. I was wondering, “How long should I do this? How long will this take?” And finally, it was a few minutes to the hour when I was supposed to talk, and I said, “Are you so-and-so?” She said yes, and I said, “I’m Kathryn Hall.”

But here’s the thing. I have a formula for this.

Another time I was at a conference, and I said, “I’d like to register.” This white woman looks at at me and says, “Who are you registering for?” This is my line: “What is it about me that makes you think I’m not registering for myself? What is it about me that makes you think that I can fix your video screen at this conference? I’m supposed to be giving a talk over here, and you’re calling me over to fix your computer because you think I’m an audio-visual [person]. No shame in that; I’ve been audio-visual person. I’m proud to be an audio-visual person. But what is it about me that makes you think I’m not one of the speakers?”

This invisibility has been really hard for me, and sometimes it hurts. If I didn’t know as much as I knew about the brain, I think it would hurt more. I’m not excusing it. I have a call to action that we need to wake up and see who’s in front of us and examine our biases for why we can’t see people. Examine the biases that drove our assumption and ask the question, “What am I missing in this moment?”

I have people I work with who live in my neighborhood who have never seen me walk right by them. What can you do? So that’s why invisibility is a tough one.

[OnlineEducation.com] I love how you put this, “I have a call to action that we need to wake up.” I think it’s really gracious of you to say that your knowledge of the brain helps to some extent. On the flip side, it’s chilling, that wiring…”

I remember I was going to give a talk. I had a new position, and the people in the elevator were talking about this new person who was going to give this talk, talking on and on about them, about their background, everything.

They didn’t see me, in the elevator, right there. And we all walk into the room together. They still don’t see me, but I walk all the way to the front, and then they have this, “Wait, what?” And I look at them, not with judgment, not with anger, just with presence. What can you do?

The good thing is when you’re invisible—the bad thing is when you’re a target. And it’s the same mechanism, right? It’s the same mechanism that led to harm that is done in the name of racism.

One of the most difficult things to look at and think about every day is:

How on earth are we going to impact equity and inequity? How are we going to make an impact on structural racism?