Working Across Silos with Faith in a Better Future

Freya Gulamali reflects on the career talk of Dr. Mark McClellan, Director of the Margolis Center for Health Policy.

In a time as politically polarized as the present, siloes have led to gridlock in this country with seemingly no end in sight. Having grown up witnessing this highly polarized atmosphere, it is hard to imagine a future where people work together across party lines to address the issues that plague us all—from high insulin costs to climate change. In his talk, Mark McClellan, Director of the Margolis Center for Health Policy and former head of the Food and Drug Administration and Center for Medicare & Medicaid Services, reminded us that bipartisan actions still occur behind antagonizing rhetoric. It is during these times when people come together, though, that their actions are not controversial enough to make headlines. Through this reminder, Mark gave us hope that collaboration will continue to occur on the federal level, perhaps even to a larger extent, in the future.

To get to that level of understanding what change to create and how, Mark notes that it is important to have an attitude that healthcare can and will transform in the next 5-10 years. We thus must remove ourselves from the box of what “looks good” today and imagine what skillsets will be important tomorrow. Oftentimes, pre-health students are taught to check off a sequence of boxes for admission into medical school, or high school students for admission into college. Mark, however, pushed us to think beyond this checklist and embrace a futuristic path of uncertainty. Even though Mark took a traditional path in the sense that he went to medical school and completed his residency in Internal Medicine, he also received a PhD in economics. Recognizing that cost may become an essential part of considering how to expand access and affordability in the future, Mark focused his career away from the clinic, determining how economics could play are role in improving medical practices.

“We thus must remove ourselves from the box of what “looks good” today and imagine what skillsets will be important tomorrow.”


Mark hopes that these unconventional paths may lead us to not just spend time in, but also learn from government. He claims that even those who seek to join the private sector should take time to gain an appreciation for why government policies matter, as well as how to interact with and make policy. Oftentimes, it feels like the government moves too slowly, especially in contrast to the rapid pace of health innovation, prompting industry to take the lead in creating regulatory standards. When I asked Mark why he kept his faith in government action at the FDA and CMS, he reminded me that both organizations have taken significant steps in recent years to expand access to healthcare and have played a fundamental role in promoting the safe, responsible, and effective use of health technologies in patient care while collaborating with industry players.

The significance of collaborating across silos created within government and academic institutions like Duke is evident in how Mark runs the Margolis Center. Core faculty members are drawn from all sectors of campus, multistakeholder meetings are run frequently with industry, government, and academic collaborators, and students can participate in internships, research experiences, and classes to engage their economics, statistics, or social science skills. Through these endeavors, Margolis is stepping into the future of healthcare, because as Mark says, the biggest problems are not going to be solved in siloes.

“Margolis is stepping into the future of healthcare, because… the biggest problems are not going to be solved in siloes.”

Freya Gulamali, Huang Fellow ’25

Freya GulamaliFreya is a rising sophomore from Bellevue, Washington, planning to major in Computer Science on the pre-med track.