Leading nephrologist Sumit Mohan, MD, MPH, has combined his love of data visualization with his sense of effective presentations to become a proponent of creating compelling data visualizations that can tell a story.
Mohan, professor of medicine and epidemiology at Columbia University, leads the Columbia University Renal Epidemiology Group, which focuses on the epidemiological and clinical challenges in kidney disease, including kidney transplantation. His research findings have directly informed public policy at the federal level related to patients with kidney disease, including access to outpatient dialysis for patients with acute kidney injury and the elimination of early outcomes as a regulatory measure for transplant center recertification. His work on the inappropriate discard of deceased donor kidneys has helped bring significant attention to the problem nationally.
In 2022, he received the Clinical Science Investigator Award from the American Society of Transplantation and the 2022 Excellence in Kidney Transplantation from the National Kidney Foundation, which recognizes exceptional research that has contributed novel insights to improved access to kidney transplantation.
“I’ve always known that you can play with the axis of a figure to change what the slope appears to be of a line without changing the actual data points within that line. As a result, you can very easily create an impression because people make very quick assumptions about the data as soon as they glance at the graph. When I attended talks as a student or trainee, the only talks that I found compelling was when there was a single figure on the slide, and the speaker walked the audience through it like they were talking to you as opposed to reading.”
“So, when you link those two things together, you start to realize that a good storytelling technique is to create data visualizations that help tell the story. It can help make the findings easier to appreciate or help you tell the story in a manner that can be much more compelling.”
For the past year, Mohan has served on the Organ Donation and Transplantation Alliance (The Alliance) Board of Directors as the representative of the American Society of Transplantation. In November 2022, he presented a Conversation Series program for The Alliance on “Expanding Kidney Transplantation: The Need to Improve Utilization.” It is available as an on-demand webinar.
Mohan says he’s always been numerically inclined and loved math puzzles as a child. “Being quantitative is a characteristic that has always just appealed to me,” he says. But it was a fantastic math teacher who had a love for geometry that created his zeal for visualization. “A lot of his teaching was around these visual challenges and geometry problems,” he says. “I’ve always leaned towards using visual examples of math problems and the fact that you can solve a math problem if you have a good visualization.”
Mohan says that his entire research team shares that proclivity. “My research team would say we’ve recognized that it’s not enough to do a study if nobody reads or understands it. What we want to try to do is tell a story with the analyses that we do because if you tell a story, then it’s easier for people to read, easier for it to stick, and easier for it to drive behavior change. In my research group, one of our goals is to create compelling visualizations of the findings that tell a story… and make it intuitive.”
Mohan grew up and did his medical training in India. “If you train in a low resource setting like India was 20 years ago, one of the things that that I saw was that people would come to the hospital very late in their disease process,” says Mohan. “You realize that for both acute and chronic illnesses, there was a large function of education that was impeding getting timely care or adequate care, even when you had a social infrastructure that provided public health at little or no cost. The role of an educated, informed patient is central and critical to having good outcomes.”
Mohan says he appreciates the role that The Alliance plays in making that happen. “The Alliance does a fantastic job in terms of disseminating information both to providers and patients. And doing it so effectively has been quite impressive.”
He headed to medical school, fascinated by the idea of surgery. However, that changed. “My first week in clinical rotations was on the medicine wards, and I was completely blown away. I knew I wanted to do medicine at that point.”
After he finished his medical training in India, an opportunity to do a course in public health brought him to the U.S. in 2000 for a master’s degree in public health, a degree which at the time was not available in India. After finishing most of the public health degree coursework, Mohan then did his internal medicine residency at Harlem Hospital Center in New York City.
Becoming a Nephrologist
“Nephrology wasn’t a prominent specialty in India when I was training because the primary driver for nephrology is you either get a transplant or you get dialysis,” he says. “The primary limitation of dialysis is clean water, and a single session can use over 100 gallons of water. That’s the real resource barrier. The medical school I went to was in a rural setting with no real exposure to nephrology to students at the time. As a medical student, I didn’t even know it existed.”
All that changed when he met Nephrologist Jen-tse Cheng, MD, during his residency at Harlem Hospital.
“When I was doing my medicine rotation, I came across a nephrologist who would just look at the lab work and say, ‘Here’s what’s happening with the patient.’ And we’d say, ‘But you haven’t even seen the patient.’ And he’d say, ‘I’ve looked at the lab results, and it’s obvious.’ And it always blew me away. Nephrology is probably the most objective of the subspecialties. It’s nuanced, and it’s very quantitative. You have to love numbers to be a good nephrologist. And that just became a natural fit for me.”
He goes on to say that Dr. Cheng inspired him. “He was this very down-to-earth, unassuming, incredibly brilliant person—a person you’d want to work with and to be like. He flipped a switch in my head that said this is the type of clinician I want to be. He was special.”
After his residency, Mohan finished his MPH from the University of Northern Colorado in 2004. He then did his nephrology training at Harlem Hospital Center and remained on the faculty for several years.
“One of the things that I realized while I was on faculty is the best outcomes for patients with end-stage kidney disease was getting a transplant… and that none of my patients in the Dialysis unit at Harlem were getting transplants. What people forget is that if you’re not working at a transplant center, the entire transplant system is one big black box. You don’t fully understand the nuances of allocation. You don’t understand how the waitlisting process works. You don’t understand any of the system.”
He took another unusual step and did an additional fellowship year at Columbia University for kidney transplantation and has been there ever since. He was recently named medical director of Columbia’s kidney transplant program.
Mohan says he’s obsessed with podcasts about communication strategies and storytelling, and some of his favorites include “Freakonomics,” “Cautionary Tales,” “And Against the Rules, among others. In November 2021, Freakonomics MD devoted an entire episode to Mohan’s research on kidney discards.
That love of podcasts has rubbed off on Mohan’s two daughters, ages 7 and 12, who listen to NPR’s “Wait, Wait… Don’t Tell Me” when they’re in the car with him. Mohan’s wife is a critical care physician at Columbia. His parents and two brothers live in India.
He serves as deputy editor of Kidney International Reports, a peer-reviewed, online-only, open-access journal published by the International Society of Nephrology. His mentor, Jai Radhakrishnan, MD, professor of medicine at Columbia University, serves as editor-in-chief and asked Mohan to help him get the new journal off the ground several years ago.
He says the journal’s mission is two-fold. “Our mission is very clinically focused in terms of the articles that we publish. First, we want to give access to good science for nephrologists and clinicians across the globe without a paywall. Secondly, we try to encourage more science coming out of different parts of the world because we think they have a story to tell. To improve care, there has to be a democratization of information. For people to adopt the science, they have to have access to the science and the results. We want to help share that knowledge with the world.”
“One of the things my dad inculcated in us as kids is that it was important to do the right thing, but it was important to do the right thing for the right reasons. And if your motives are right, you’ll be okay. I found that not an easy standard to live by, but it’s certainly an easy standard to try to hold myself to.”
Regarding his work on the inappropriate discard of deceased donor kidneys, he says the discard story is unfinished. “We’ve recognized discards is not a primary problem, but it is a symptom of a bigger problem. The bigger problem is the way our system is set up. We’ve clearly have a design flaw issue.”
“So, the question then becomes, how do you redesign a system that allows for improved utilization and improved patient outcomes? Utilization isn’t the end goal. Better patient outcomes are the end goal. Can we get to better patient outcomes with better utilization? Absolutely. So that’s what we need to work towards.”