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Posted July 30, 2013
Ernest Amankwah, Ph.D. Joins All Children’s to Study Disease Mysteries

Dr. Ernest Amankwah has made a distinguished career out of studying the distribution and determinants of disease and its outcomes through biomarkers -and how to use that knowledge to prevent and treat diseases.
Dr. Amankwah shares a story in the lobby of All Children's research building.

Like any parent of young children, Dr. Ernest Amankwah has occasionally been asked by his three kids what he does for a living. And he's discovered an easy way to describe a most complex line of work.

"I tell them that I'm a disease detective," he says with a smile. "I try to understand causes of diseases by finding out which people the diseases are affecting, when they affect people, and how we can use that knowledge to prevent the disease from reoccurring."

His real title - Epidemiologist/Biostatistician - may not pack quite the same pizzazz. But like a true detective, he has been playing a vital, behind-the-scenes role since joining All Children's Hospital Johns Hopkins Medicine in April as a member of the hospital's newly created Clinical and Translational Research Organization (CTRO), led by Director of Research Neil Goldenberg, M.D., Ph.D.

The native of Ghana, who earned his doctorate in epidemiology at the University of Calgary, has made a distinguished career out of studying the distribution and determinants of disease and its outcomes through biomarkers -and how to use that knowledge to prevent and treat diseases.

And now - after honing his skills in Canada and at the Moffitt Cancer Center in Tampa - Dr. Amankwah is helping design important new studies by All Children's physicians to ensure the projects will yield meaningful and constructive results.

His training and body of work are a perfect fit for the mission All Children's Hospital Johns Hopkins Medicine has undertaken in the new world of population health and personalized, preventative medicine.

"I've always been fascinated with medicine and how we could prevent and treat diseases, so at an early age I was really curious about how people did this," he said on a recent morning at the All Children's research department. "That was my motivation for getting into this field."

Though his dream of attending medical school didn't materialize in Ghana, he was determined to follow his passion in another way. His path to St. Petersburg unfolded with a series of key steps along the way.

First came an undergraduate degree at Ghana's University of Science and Technology, where he conducted a project on factors that influenced the age children reached puberty in his country. He stayed on after graduating to do research on children suffering from parasite infection, working to understand the origin of the problem, its prevalence and intensity.

Next came B.S. and M.S. degrees in bio-technology and molecular biology, respectively, at the University of Bergen in Norway, and then a move to Western Canada, where he did research in molecular biology labs prior to earning his Ph.D in epidemiology in 2007. His doctoral work allowed him to delve into the field that combines molecular biology and epidemiology: molecular epidemiology.

"It gives you a new basis of understanding because now you're able to use biomarkers when you are doing epidemiology," he explains. "In traditional epidemiology, what we do is ask people for risk factors. If I want to look at how smoking causes cancer, what I would do is ask people, ‘Do you smoke?' How many cigarettes do you smoke?' But if you are able to find a biomarker, for example, in the urine of a person, that can be a better way to obtain the answers you are looking for."

The reason is that people don't always remember with accuracy the events in their life, or a bias could exist in how they report the information. "But if you're able to use a biological marker, then you don't have to ask how long have you been smoking," he says. "That one marker can tell you the status."

Dr. Amankwah continued to build on his foundation by working at Health Canada - the country's national health agency - to look at an array of diseases, including heart disease and diabetes. Through a partnership established with Alberta Health and Wellness, he gained access to a comprehensive administrative data base of health records for all Alberta residents.

"It was really nice to use their database to look at different health conditions," he says. "Mostly, we looked at diabetes and injury. And I also provided expert epidemiological support to community medicine specialists at Health Canada. I worked with them to design studies to help answer key clinical questions."

But if you're able to use a biological marker, then you don't have to ask how long have you been smoking," Amankwah says. "That one marker can tell you the status."

His work on that front was so good, in fact, that he was honored with a gold medal award for excellence in government service delivery for his team at Health Canada in 2008.

After 13 years north of the border, Dr. Amankwah took a job first at Moffitt in 2011 studying the association between genetic variants for cancer risk and outcomes. He learned about the position at All Children's on the Internet and soon had conversations with a summer lab student he was mentoring - the daughter of Gregory Hale, M.D., Medical Director of Pediatric Hematology and Oncology and Bone Marrow Transplant at All Children's.

That opened the door. A phone call ensued with Dr. Goldenberg, who described the academic and research work being done at All Children's - and Dr. Amankwah immediately liked what he heard. Face-to-face interviews followed and he was eventually hired from a talented, national pool of applicants. The selection was no surprise, given his impressive resume - highlighted by numerous prestigious awards for his previous work and some two-dozen articles published in peer reviewed journals.

"I've been working with community medicine specialists and MDs in the past," he says, "so that is the kind of skill set that I bring here - working with clinicians and helping them design studies."

In that capacity, he is currently helping Raquel Hernandez, M.D., M.P.H. to examine growth and obesity in school-age children, and assisting Sheila Devanesan, M.D. on an ACH Foundation-funded study about how interventions can reduce weight gain during pregnancy.

Not surprisingly, Dr. Amankwah's arrival has been hailed as an important addition to the research mission - especially by Dr. Goldenberg.

"Ernest has a pretty critical position that fits into the larger issue of how we've reorganized and developed research infrastructure," Dr. Goldenberg says. "We now have what we call a Clinical and Translational Research Organization, and it's comprised of seven different cores, which are based on different kinds of expertise and resources that you need to successfully design and conduct research. Ernest's core is in Research Design and Analysis."

That means that at the conception of a research study, Dr. Amankwah is at the table with ACH clinician researchers and other team members to help formulate the study design.

"He does it with an eye for what we are going to be doing on the analysis side, in terms of statistical testing, that influences the way we should set up the actual design," Dr. Goldenberg adds. "He helps to think about what the variables are that we'll need to look at, which is also critically informed by the clinical experts. But the way we structure those variables and the way you ask the question - a way that it will be testable statistically - is where his expertise really comes into play."

Second, Dr. Amankwah plays a part in determining how big the study needs to be and how long it needs to run in order to answer questions with validity. His input influences how many patients need to be enrolled in a study and followed before it's appropriate to analyze the results.

"The third piece he adds is actually developing the statistical analysis plan for the research, which is important to have up front," Dr. Goldenberg explains. "As you get more advanced in doing research as an organization, and this is something we'll be doing more and more often, you really develop those plans at the beginning. So it's very transparent that you didn't let the results influence the way you were going to ask questions. You came with a very unbiased approach - and it makes it very rigorous in the way you're conducting the research."

When all the results have come in, the target sample size has been reached and the patients have been followed to final assessment, Dr. Amankwah executes his statistical analysis plan using biostatistical software and the appropriate tests.

"That's really critical when you go to write up the results for publication," Dr. Goldenberg said. "And Ernest also has experience in writing that part of the method section you need in a scientific paper, as well as helping to organize the results through data tables, etc. So this is really a key position in a research organization, led by an epidemiologist or biostatistician. And he has both of those skill sets."

On top of all of that, Dr. Amankwah is also connected informally with a group of epidemiologists and biostatisticians at Johns Hopkins ACH president at the Center for Child and Community Health Research on the Bayview Campus, which was led by Jonathan Ellen, M.D., prior to his becoming president of All Children's. He's part of the CCHR's BEAD Core, aligned with its biostatistics, epidemiology and data management professionals, providing an important tie to similar work being done in Baltimore.

In addition, he plays a mentor/collaborator role for ACH researchers, many of whom are researchers in the Designing Clinical Research (DCR) program. Every 18 months, 12 different ACH researchers apply and are selected to have a mentored research experience to help them develop study ideas and carry them out to completion.

"Ernest is going to be a critical member of the DCR program, because he's going to help provide the continuity here," Dr. Goldenberg notes. "He's ACH-based, as I am, while most of the other mentors from the program are in Baltimore. This also helps to provide the right ingredients for cross-fertilization between the campuses."

While the subject matter he deals with is complicated and high-minded, Dr. Amankwah comes across as easy-going and low-key, with a friendly laugh that punctuates conversations. His father worked in Ghana as an electrician while his mother, who traded small goods, usually stayed home with the eight children. His oldest sister became a registered nurse, while his other siblings went into business in the U.S. and Ghana.

He's become an avid fan of the Tampa Bay Lightning, due to his years watching hockey in Canada. And he's gradually learning about the Rays and Bucs. "My boys are helping me with that," he says.

He played soccer through college, a midfielder with good ball-control skills. And he still enjoys heading to the park with his kids (15, 12 and 7) to kick the ball around. After all, he deserves a little time to unwind from a demanding job as a disease detective.