Rice360 Institute for Global Health Technologies caught up with program alumns to discuss their experiences beyond the hedges. Nicky Mehtani '11 shares insights from her time at Rice University and how her hands on experiences in the Rice360 program have shaped her since graduating.
Nicky Mehtani, MD, MPH is an assistant professor in the UCSF Division of General Internal Medicine at San Francisco General Hospital. Her research explores the potential of psychedelic therapies to address addiction and psychological trauma, with a focus on improving accessibility to these novel therapeutics among medically and socially complex populations. She is also a faculty affiliate of UCSF Neuroscape, the UC Berkeley Center for the Science of Psychedelics, and the San Francisco Department of Public Health's (SFDPH) Center on Substance Use and Health.
Clinically, Dr. Mehtani specializes in addiction medicine and HIV. She serves as a primary care provider at the SFDPH Maria X. Martinez Health Resource Center, a low-barrier municipal clinic focused on serving homeless and unstably housed patients in San Francisco, where she has led the implementation of recently FDA-approved long-acting injectable antiretroviral medications for the treatment and prevention of HIV.
What led you to get involved with Rice360?
Rice360 was just starting when I was a Rice University undergraduate. I belonged to one of the first cohorts in the Rice360 Institute of Global Health Technologies to graduate with a minor in Global Health Technologies (GLHT) in 2011. As a Biochemistry Major, I was drawn to the GLHT minor because it offered courses that supported my interests in global health, which I developed at a very young age.
The Rice360 courses gave me an opportunity to think for myself and actively collaborate with other students in an attempt to address real global health needs. When I think back to my time at Rice as an undergraduate, the experiential learning process afforded by the GLHT minor is one that I have come to value the most.
What Rice360 projects and programs did you take part in?
My Rice360 senior design project aimed to fit a comprehensive toolkit to support neonatal health into a single backpack for use by mobile community health workers serving villages across East Africa.
This project inspired me because it had the potential for real-world impact. The Rice360 classes were always about tangible goals, and this project was among the first times I recall working on something that I felt passionate about. It really shifted the way I approached work and school in general. I started caring a lot less about things like good grades, and way more about diving deep into projects that genuinely inspired me for their intrinsic feelings of worth. but my work in other subjects did not inspire me the way this project did.
How did your experiences at Rice360 prepare you for post-grad, especially when you began pursuing your career?
While at Rice, I had opportunities to study and work abroad in India, Mexico, and Tanzania. Each of my experiences overseas was focused on innovating for global health and working with local communities to address healthcare challenges.
What I most appreciated about studying abroad was that, during these trips, instead of studying cases out of a book, I had the opportunity to interact with people directly to better understand the complexities of their health challenges. These experiences ultimately inspired me to apply to medical school. One thing that drew me to Johns Hopkins for medical training was falling in love with East Baltimore. I remember interviewing there and realizing that this city shared some of the challenges experienced by people in global health settings—including many of the systemic forces underlying the War on Drugs. While living in Baltimore, I volunteered at Charm City Care Connection (CCCC)—a case management non-profit that assisted people in applying for health insurance and accessing various low-barrier care options when the traditional healthcare system became too challenging to navigate. Accompanying patients through the complex processes associated with trying to access medical care helped me appreciate the multitude of challenges faced by people living in East Baltimore, particularly by people who use drugs. My work with CCCC inspired me to stay in Baltimore for my Master of Public Health (MPH) degree and medical residency training. During my MPH, my research primarily focused on global health and HIV epidemiology. However, as an internal medicine resident, my interests grew around understanding the reasons why some people with HIV did not seem to be getting better, even in places that have been afforded robust access to highly effective treatments for HIV. A key difference between Baltimore and other areas of the world in which I had worked was the existence of a clear intersection of HIV with the concurrent epidemic of substance use disorders.
Based on my experiences as a resident, I applied to clinical fellowships in Addiction Medicine and ended up completing a one-year combined HIV and addiction fellowship at UCSF, after which I served as the Lead HIV Clinical provider at a low-barrier, municipal clinic for people experiencing homelessness in San Francisco. Working with some of our city’s most vulnerable patients made it easy to see how many of our existing pharmacotherapies for treating substance use disorders fall short. While most of our existing treatments for addictions are specific to individual substance use disorders—such as buprenorphine or methadone for the treatment of opioid use disorder—it was clear that the substance use itself was merely a symptom of something deeper: underlying psychological and intergenerational trauma that often underlies peoples’ motivation to use substances as a means of ‘self-medicating’ and coping. Or, as one of my patient’s once put it: “Addiction isn’t really about drugs at all; it’s about ontological unworthiness.” These insights I gained through direct experiences with patients ultimately motivated me to return to the academic world to pursue a postdoctoral research fellowship and study avenues through which we can implement novel therapies—including psychedelics—to more holistically treat and address substance use disorders among low-income and medically complex patients.
Last year, I started my current role as an assistant professor at UCSF, where I lead a variety of studies within this research niche. These include a pilot clinical trial of ketamine-assisted therapy for methamphetamine use disorder that's specifically designed for publicly insured patients who have or are at risk for HIV.
How have you used your background in global health in your various roles?
The psychedelics research field is a bit crowded, and there are a lot of different players. However, my personal interest in the field stemmed from the fact that I didn't see many people doing the types of research that I wanted to engage in—specifically, studying how we can reasonably improve access to psychedelic therapies to treat addiction among patients who already feel stigmatized and alienated from existing models of Western medical practice.
Most of my clinical work from over the past decade has involved working with patients domestically who have experienced significant trauma and have, therefore, been at an increased risk for substance use disorders.
Yet, I didn’t see any patients that resembled my own enrolled in any existing psychedelic clinical trials. And it felt disingenuous to be studying these novel therapies that have demonstrated potential for treating addiction only among relatively affluent patient populations.
In addition, while I had several phenomenal faculty mentors to look up to who are leaders within their respective fields of HIV, global health, addiction neuroscience, and psychedelic therapies—I couldn’t find any mentors who singularly bridged these fields. So, having entered the field with a background in global health allowed me to develop my own path forward, even if it required going outside the of the traditional academic paths and doing things out of order—like returning to a postdoc after being a Street Medicine attending for a few years.
What advice would you give to current students or recent graduates who want to pursue a career in global health?
My advice would be to make sure that you're investing in a career you feel genuinely passionate about. It’s important that you feel aligned with the values behind the work you're pursuing, and there's no rush to the next steps when you don't know what they should be. To some extent, letting your intuition guide your actions requires slowing down enough to be able to intuit what those goals should be. If you do that, the pieces will fall into place. It might not be precisely what you predicted, but it’s important that it be aligned to avoid burnout and feeling lost in your work.