Elizabeth Merrall

Consultant Statistician, S-cubed ApS

Joining S-cubed

I have worked at S-cubed for 3 and a half years now. Scott McGregor was very convincing when he interviewed me that it is a great place to be. I had also already heard good things about S-cubed’s Charlotte Hindsberger thanks to the lively and diverse statistics community in Copenhagen. So for me S-cubed has offered an opportunity to join a great team, to learn and be exposed to a wide variety of work.

The Road to Becoming a Statistician

Originally, I applied to do medicine at university, but it wasn’t to be, and I took a year off to do some travelling. I went to China to teach English, as I have an ethnic Chinese background. I wanted to explore my roots; a voyage of self-discovery if you like, especially as it was the first time I had travelled so far away from home on my own. I enjoyed teaching very much. The Chinese students were a pleasure to teach, incredibly diligent and motivated. It was a wonderful experience and I went back during university vacations.

Once I was back after my gap year, I went to Imperial College, London to study maths and computing. I loved being in London, there was so much going on and you really felt like you were at the centre of things. After that, I spent a year working for the Ministry of Defence in Policy Operational Research. One project I really enjoyed whilst working there, was investigating predictors of drop-out among army recruits – which reignited learnings from my statistics lectures and also my dissertation, which had a more medical application (predicting myocardial infarctions). It confirmed my move into the biostatistics world. From there, I went to Southampton University to take an MSc in medical statistics and I was hooked!

Working with the Prison Population

My next role was as a research assistant at the MRC Biostatistics Unit in Cambridge and I was taken on as a PhD student. My supervisor had a keen interest in using good statistical methods to highlight health issues affecting the prison population, particularly related to mental health and drug dependency. I was fortunate enough to be involved in the piloting of a prison-based clinical trial designed to evaluate the effectiveness of providing naloxone (antidote to heroin) upon release in reducing drug-related deaths. This included visiting several prisons and talking with prisoners about the trial and their potential participation. It was a revelation. I think most of us assume that prisoners are scary people; actually, they’re just the same as everyone else but have lost their way in life.

The other side of my work was using real world data – including a meta-analysis that showed the increased risk that drug-dependent prisoners were exposed to upon release from prison (and hence the need for such a study). Whilst in prison, prisoners with drug dependencies have had more limited access to drugs and their tolerance reduces, and so when they are released and able to access drugs more readily – the risk of overdose is high. It was fascinating to see this trend so clearly in the data. We also had access to very good administrative data in Scotland – drug treatment registrations, hospital admissions and death records and linkage between them – so for individuals who registered for drug treatment, we also identified increased risks upon discharge from hospital, signalling a cry for help and more importantly, a chance to intervene.

Vaccines in Amsterdam

Despite enjoying the research, I really did want to get back to London or a big city. I was missing the hustle and bustle of city life. Having secured a place at Novartis Vaccines working on the statistical side, I found myself in Europe equally enjoying the hustle and bustle of vaccine development and its statistical challenges and I haven’t really looked back. Vaccine studies typically move quickly because they recruit healthy subjects and I was also “fortunate” enough to find myself in the meningitis team during a period of intense regulatory (and payer) activity, just as the meningitis B vaccine received approval for use in infants in Europe and, among other things, there was a subsequent Meningitis B outbreak in a university in the US. This was somewhat unexpected and suddenly required a speedy collation of adult/adolescent study data – for fast-track consideration by US regulators. It was a chaotic time but also very rewarding and filled with camaraderie.  

Real World Evidence and Machine Learning

I can see that the drive to generate more real world evidence is where statistics is heading. It makes sense as it will bring down costs as the data are collected anyway which reduces the overheads. Mining health records would also be more reflective of what’s actually happening in clinical practice. Of course, there are plenty of barriers to using these to generate evidence in clinical trials such as data standardization, quality and completeness as these records will not have been as tightly controlled when specifically collected for a trial.

On the topic of machine learning, it’s also interesting to see it having a role in clinical trial analyses and getting a better understanding of the effects of treatments. I recently attended a great webinar series jointly hosted by Novo Nordisk and the Universities of Copenhagen and California, Berkeley, who introduced the idea of using machine learning to analyse clinical trial data – beyond the randomized comparisons one is most familiar with. There is no doubt that the job of a statistician is evolving and that’s great as it means you never stop learning.

Enjoying the Work

My colleagues at S-cubed are a major part of why I enjoy my work. We always have such insightful discussions about a whole array of statistical issues, and I learn a lot from them. I have a great deal of independence and the team at S-cubed trust me to deliver the work, but I also know I have great support. At the moment, I am working for Leo Pharma working in market access. It’s another side to our statistical work; preparing more exploratory analyses for presentation at conferences and publications in scientific journals as well as making indirect comparisons with what’s on the market. It’s an exciting area to be working with new and different challenges, often analysing datasets for purposes besides those they were originally collected for.

Home and COVID-19

Liz_Our_stories_Jan2021In February, just before the corona crisis hit, we were blessed with the arrival of our daughter Frida. She was born in Amsterdam as my partner is Dutch. So, this year has been different in many ways! I have been back to work for three months now whilst Frida has started nursery – probably the best place for her to be under all the restrictions. Copenhagen is a wonderful city for families, and we are for sure looking forward to exploring all that it has to offer as the restrictions ease.

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