IT IS A PLEASURE FOR ME TO OPEN
THE 2021 ANNUAL BIRCWH MEETING.
IT IS MY PLEASURE TO INTRODUCE
OUR DIRECTOR, DR. JANINE AUSTIN
CLAYTON, WHO WILL GIVE OPENING
REMARKS, THE NIH ASSOCIATE
DIRECTOR FOR RESEARCH ON WOMEN'S
HEALTH.
DR. CLAYTON HAS BEEN AN ADVOCATE
ON SEX AS A BIOLOGICAL VARIABLE
IN WOMEN'S HEALTH RESEARCH IN
GENERAL.
# #
HER FULL BIOIS ON THE ORWH
WEBSITE SO I INVITE YOU TO LOOK
THROUGH THERE.
I WANT TO DRAW YOUR ATTENTION TO
A NEW ACHIEVEMENT, SHE HAS BEEN
ELECTED TO THE BOARD OF
DIRECTORS OF THE AAAS THIS YEAR.
I WOULD LIKE TO CONGRATULATE DR.
CLAYTON ON HER ACHIEVEMENT AND
INVITE HER TO GIVE OPENING
REMARKS.
>> THANK YOU SO MUCH, DR. BEGG,
I'M SO EXCITED TO BE HERE FOR
OUR BIRCWH PROGRAM MEETING.
I'M GOING PROVIDE SOME CONTEXT
FOR THE DAY.
I'M BEGINNING ALMOST ALL OF MY
PRESENTATIONS THESE DAYS WITH AN
ACKNOWLEDGEMENT OF THE MANY
WOMEN WHO HAVE PLAYED CRITICAL
ROLES AS WE ENTER THE SECOND
YEAR OF THE PANDEMIC, WHETHER IT
IS IN A LABORATORY TAKING CARE
OF PATIENTS, TAKING CARE OF OUR
FAMILIES, WE HAVE ALL BEEN
STEPPING UP IN A BIG WAY AND I
WANT TO ACKNOWLEDGE THOSE AT THE
FRONTLINES AND ESSENTIALLY
WORKERS.
NEXT SLIDE.
SO I'M GOING PROVIDE SOME
STATISTICS.
THIS IS FROM THE AMERICAN
ACADEMY OF MEDICAL COLLEGES.
DESPITE THE FACT WOMEN HAVE
REPRESENTED OVER 50% OF MEDICAL
STUDENTS FOR SEVERAL YEARS AND
50% OF LIFE SINCE PH.D.
GRADUATES FOR MANY YEARS, WE
STILL SEE THAT WOMEN PROGRESS,
DO NOT PROGRESS AT THE RATE AS
WE WOULD EXPECT.
ONLY 18% OF CHAIRS AND DEANS ARE
WOMEN.
YOU COULD SAY THIS IS DOUBLE
TROUBLE FOR AFRICAN AMERICAN
WOMEN.
13% OF MEDICAL SCHOOL FACULTY
WITH ALL THE CATEGORIES ADDED
TOGETHER REPRESENTED WOMEN OF
COLOR.
THESE NUMBERS, UNFORTUNATELY,
HAVE NOT CHANGED MUCH IN THE
LAST 10 YEARS.
THE PHRASE UNDERREPRESENTED IN
MEDICINE IS THE PHRASE THEY USE,
12% IN 2009 AND 13% IN 2018.
AND, OF COURSE, THE GREATEST
NUMBER OF UNDERREPRESENTED
MINORITY IN MEDICINE IS
UNFORTUNATELY AT THE LOWER
RANKS.
NEXT SLIDE, PLEASE.
AND EVEN WHEN WOMEN ACHIEVE
SUCCESS IN MEDICAL RESEARCH THEY
HAVE HAD TO DO IT COPING WITH A
VARIETY OF CHALLENGES, INCLUDING
OFTEN HOSTILE WORK ENVIRONMENTS
WHERE SEXUAL HARASSMENT AND
GENDER DISCRIMINATION ARE
COMMON.
IT IS A REFLECTION OF BROADER
SOCIETY THAT IN MANY CASES
DIMINISHES THE STATUS AND
ACHIEVEMENTS OF WOMEN.
THERE IS A REASON TO REDOUBLE
OUR EFFORTS TO SUPPORT AND
PROMOTE WOMEN IN SCIENCE THESE
DAYS.
THE COVID-19 GLOBAL PANDEMIC HAS
HAD A SIGNIFICANT EFFECT ON
WOMEN WHO BARE CARE GIVING AND
HOUSEHOLD RESPONSIBILITIES.
TROUBLING EARLY EVIDENCE
SUGGESTS THAT PRODUCTIVITY FOR
WOMEN SCIENTISTS IN PARTICULAR
HAS DECREASED.
THIS RAISES REAL CONCERNS ABOUT
SETBACKS IN THE PROGRESS THAT
HAD BEEN MADE TOWARD GENDER
EQUITY.
MOREOVER, DESPITE EQUITY IN
SCIENCE HAS TAKEN ON URGENCY,
CONSTANT VIL LANCE IS REQUIRED
TO ELIMINATE BIAS IN THE
WORKPLACE.
NEXT SLIDE, PLEASE.
SEXUAL HARASSMENT IS PERVASIVE,
DESTRUCTIVE AND DEMORALIZING
CHALLENGE IN THE WORKPLACE FOR
MANY WOMEN AND ACTUALLY OVER
HALF OF FEMALE FACULTY AND STAFF
IN ACADEMIA HAVE REPORTED
EXPERIENCING SEXUAL HARASSMENT.
'EVEN WHEN WOMEN ARE STUDENTS
20% TO 50% OF STUDENTS IN
SCIENCE, ENGINEERING AND
MEDICINE REPORT EXPERIENCES
SEXUAL HARASSMENT AND FEMALE
MEDICAL STUDENTS IN PARTICULAR
WERE THE 20 -- 220% MORE LIKELY
TO HAVE FACED THIS, AND GENDER
ROLES, LESBIAN, BISEXUAL AND
OTHER GROUPS ARE MORE LIKELY TO
EXPERIENCE SEXUAL HARASSMENT.
NEXT SLIDE, PLEASE.
SO WHAT ARE SOME OF THE STEPS
THAT NIH IS TAKING?
NEXT.
IN ORDER TO ADVANCE WHAT NIH HAS
TERMED INCLUSIVE EXCELLENCE, WE
HAVE A VARIETY OF INTERVENTIONS
WE ARE TAKING.
AND I'M GOING WALK THROUGH THEM
HERE.
THE FIRST IS ACTION ORIENTED
ACCOUNTABILITY.
BY ACTION ORIENTED
ACCOUNTABILITY WE MEAN TAKING A
STRONG STAND AGAINST SEXUAL
HARASSMENT AT THE HIGHEST LEVELS
OF LEADERSHIP INCLUDING GENDER
HARASSMENT.
INTRAMURALLY, WE HAVE
TRANSPARENT POLICIES AND
INVESTIGATIVE WAYS TO REPORT.
WE HAVE EXTRA MURALLY, WE HAVE
PUBLISHED NOTICES THAT
INSTITUTIONS NOTIFY NIH WHEN
THERE ARE CONCERNS ABOUT SAFETY
ENOUGH TO CHANGE THE STATUS OF A
PI FOR EXAMPLE IN A GRANT.
SAFE WORK ENVIRONMENTS FREE OF
HARASSMENT AND EXPLICIT
CONDITION OF AWARDS AND HAVE
PROVIDED MECHANISMS WHERE
HARASSMENT CAN BE REPORTED.
WE PUBLISHED GUIDELINES FOR SAFE
AND INCLUSIVE GUIDELINES AT NIH
CONFERENCES.
DEMON STRABL LEADERSHIP REPORT,
THE NIH DIRECTOR SIGNALLED THIS
BY DECLARING HE WOULD NOT -- AS
HE HAS TALKED ABOUT MANY TIMES.
HE IS LOOKING AT THE GENDER AND
RACIAL AND ETHNIC DIVERSITY OF
SPEAKERS THAT ARE SELECTED AT
CONFERENCES TO WHICH HE IS
INVITED.
THE NIH DIRECTOR CREATED THE
WORKING GROUP ON BIOMEDICAL
CAREERS AND THE NIH DIRECTOR
CREATED CHIEF OFFICER FOR
SCIENTIFIC WORK FORCE DIVERSITY
POSITION.
THOSE ARE DEMONSTRABLE STEPS.
PROMOTING A CULTURE OF
INCLUSION.
THE NIH RESEARCH PROGRAM IS
TRYING TO MODEL PRACTICES HIRING
COHORTS COMMITTED TO NIH VALUES
OF DIVERSITY.
THAT IS A CRITERION FOR THE
DISTINGUISHED SCHOLARS PROGRAM,
YOU HAVE A COMMITMENT TO
DIVERSITY, EQUITY AND INCLUSION
AND THE ENHANCED RECRUITMENT OF
SENIOR TENURED TRACK POSITIONS,
WE HAVE A LONG WAY TO GO WITH
WOMEN AND OTHER HISTORICALLY
MARGINALIZED GROUPS OF SCIENCE
AND LEADERSHIP WITHIN THE NIH.
SOME OF THE GOOD NEWS IS 11 OF
THE INSTITUTE AND CENTER
DIRECTORS ARE WOMEN, 10 OF WHICH
APPOINTED BY DR. COLLINS.
A NEW EFFORT AT NIH KNOWN AS
UNITE HAS BEEN ESTABLISHED TO
ADDRESS RACIAL INEQUITIES THAT
PREVENTED CERTAIN GROUPS
PARTICIPATING INCLUDING WOMEN.
THIS INITIATIVE INCLUDES A
COMMITMENT TO RECRUIT MORE
SENIOR TENURED SCIENTISTS FOR
UNDERREPRESENTED GROUPS IN THE
INTRAMURAL RESEARCH PROGRAM AND
REMOVE BARRIERS AND POLICIES AND
PRACTICES THAT CONTRIBUTE TO THE
SYSTEMIC RACISM.
NEXT SLIDE, PLEASE.
ENHANCED FLEXIBILITY OPTIONS IN
THE ORANGE BOX INCLUDE SEVERAL
OPPORTUNITIES I WOULD LIKE TO
SHARE WITH YOU.
FIRST, WE HAVE EXPANDED OUR
RE-ENTRY PROGRAM TO INCORPORATE
A REINTEGRATION PROGRAM THAT
EVEN GOES DOWN TO THE PRE-DOC
LEVEL FOR INDIVIDUALS WHOSE
CAREERS HAVE BEEN DERAILED BY
HARASSMENT AND DISCRIMINATION
AND FOCUS ON PERIODS THAT ARE SO
IMPORTANT FOR WOMEN WE CREATED
CONTINUITY SUPPLEMENTS.
WE PARTNERED WITH THE OFFICE --
TO APPLY FOR FLEXIBLE FUNDING TO
MAINTAIN RESEARCH PRODUCTIVITY
WHEN THEY EXPERIENCE A CRITICAL
LIFE EVENT, CHILDBIRTH, ADOPTION
OR PRIMARY CARE GIVING
RESPONSIBILITIES FOR AN ILL
IMMEDIATE FAMILY MEMBER.
NIH ANNOUNCED CHILDCARE SUPPORT
FOR RECIPIENTS OF THE NRSA
AWARDEES AND EXTENSIONS OF THE
TIMELINE FOR APPLYING FOR K
AWARDS TO ENHANCE FLEXIBILITY IN
A TIME WHEN MANY ARE STRUGGLING
BY ADDITIONAL BURDENS BROUGHT ON
BY THE PANDEMIC.
IN TERMS OF BEST PRACTICES AND
RESEARCH INTERVENTION IN THE
GREEN BOX, NIH IS FUNDING
RESEARCH TO UNDERSTAND THE
IMPACTS OF RACISM,
DISCRIMINATION AND HARASSMENT ON
THE BIOMEDICAL WORK FORCE AND TO
IDENTIFY WAYS TO INTERVENE
AGAINST THEM.
WE ARE COMBATING HARASSMENT IN A
WAY THAT AREA HAS BEEN FOCUSED
ON IN A RECENT -- THAT INVIDS
APPLICATIONS ON INTERVENTIONS TO
ADDRESS HARASSMENT.
RESEARCH ON THOSE INTERVENTIONS.
WE ARE WORKING WITH NIDDK TO
ESTABLISH A COORDINATING CENTER
FOR AGIE, TO HELP WOMEN ATTAIN
LEADERSHIP POSITIONS IN MANY
AREAS OF SCIENCE.
THE NIH WORKING GROUP ON WOMEN
AND WORKING CAREERS WHICH I
CO-CHAIRED WITH DR. COLLINS,
NAMED A PRIZE THAT RECOGNIZES
INSTITUTIONS THAT HAVE
SUCCESSFULLY AND SYSTEMICALLY
ADDRESSED GENDER DIVERSITY
ISSUES AMONG FACULTY MEMBERS.
SO WHILE THESE COLLECTIVE
STRATEGIES ARE IMPORTANT AND
REPRESENT POSITIVE PROGRESS,
CONTINUED EFFORT IS NEEDED TO
ACHIEVE A CULTURE OF TRUE EQUITY
AND INCLUSION WHERE WOMEN
SCIENTISTS ARE NOT MARGINALIZED,
DIMINISHED OR HARASSED IN ANY
PROFESSIONAL SETTING OR IN THE
PUBLIC EYE.
THIS REDOUBLING OF EFFORTS IS
PARTICULARLY IMPORTANT GIVEN THE
DISPROPORTIONATE IMPACT OF THE
PANDEMIC ON WOMEN WHICH IS
LIKELY TO CONTINUE WELL INTO THE
FUTURE.
THIS WILL REQUIRE CONTINUOUS
ASSESSMENT OF ENVIRONMENTS,
POLICIES AND PRACTICES AS WELL
AS FLEXIBLE MULTIPRONGED
APPROACHES TO ADDRESS INEQUITIES
AND OBSTACLES AS THEY ARE
IDENTIFIED.
NIH IS COMMITTED TO ACHIEVING
GENDER EQUITY AND DISRUPTING THE
ENVIRONMENTS THAT SERVE AS
BARRIERS TO WOMEN AND OTHER
MARGINALIZED GROUPS.
IT IS CRITICAL TO OUR MISSION TO
FUND AND CONDUCT THE BEST
SCIENCE TO IMPROVE HUMAN HEALTH.
THERE IS ABUNDANT EVIDENCE A
DIVERSE WORK FORCE RESULTS IN
BETTER SCIENCE AND INCREASED
INNOVATION IN THE BIOMEDICAL
ENTERPRISE.
WE OWE IT TO THE AMERICAN
TAXPAYERS TO ENSURE FULL
PARTICIPATION OF WOMEN AND JUNT
REPRESENTED GROUPS IN RESEARCH.
NIH CANNOT DO THIS ALONE.
IT REQUIRES SYSTEMWIDE AND
INSTITUTIONWIDE SOLUTIONS,
CREATIVITY AND ACCOUNTABILITY,
THE HEALTH OF ALL DEPENDS ON IT.
# HERE IS WHERE YOU CAN CONTACT
US.
NEXT.
IT IS MY PLEASURE TO INTRODUCE
OUR RUTH L. KIRSCHSTEIN MEMORIAL
LECTURE.
LET ME TELL YOU ABOUT DR. RUTH
KIRSCHSTEIN.
A RENOWNED PATHOLOGIST, SHE
CONTRIBUTED TO THE SELECTION OF
THE SAVAN VACCINE.
SHE WAS A FIXTURE ON THE NIH
CAMPUS FOR MORE THAN 50 YEARS.
SHE WAS A DYNAMO WHO HAD
TREMENDOUS CONVICTION AND
COURAGE.
SHE WAS THE FIRST WOMAN TO
DIRECT AN NIH INSTITUTE, THE
NATIONAL INSTITUTE OF MEDICAL
SCIENCES.
SHE CHAMPIONED IMPORTANT CAUSES
SUCH AS NIGMS' RESPONSE TO THE
AIDS EPIDEMIC.
SHE SERVED TWICE AS THE NIH
ACTING DIRECTOR AND ACTING
ASSOCIATE DIRECTOR FOR WOMEN'S
RESEARCH AND HEALTH SHE PLAYED A
PIVOT ROLE FOR WOMEN.
SHE MENTORS COUNTLESS
RESEARCHERS MANY HAVE GONE TO
LEADERSHIP POSITIONS AT NIH AND
SCIENCE.
AMONG HER MANY HONORS WAS THE
ELECTION TO THE THEN INSTITUTE
OF MEDICINE AND AMERICAN ACADEMY
OF ARTS AND SCIENCES.
IN 2002, CONGRESS RENAMED THE
NATIONAL RESEARCH SERVICE AWARD,
NRSA PROGRAM, IN HER HONOR.
THIS YEAR'S KIRSCHSTEIN LECTURER
IS MY COLLEAGUE DR. MOLLY
CARNES.
HER NAME AND RECORD OF
ACHIEVEMENT ARE WELL KNOWN, I'M
SURE TO MANY OF YOU.
SHE IS THE VIRGINIA VALIAN
PROFESSOR IN THE DEPARTMENTS OF
MEDICINE, SIGH KAI INDUSTRY AND
INDUSTRIAL AND SYSTEMS
ENGINEERS.
DIRECTOR OF THE CENTER FOR
WOMEN'S HEALTH RESEARCH AND
CO-DIRECTOR WOMEN IN SCIENCE &
ENGINEERING LEADERSHIP INSTITUTE
AT THE UNIVERSITY OF WISCONSIN
AND ONE OF THE WINNERS OF THE
CHALLENGE.
DR. CARNES EARNED HER MD FROM
STATE UNIVERSITY OF NEW YORK,
BUFFALO.
SHE BEGAN HER LIFE'S WORK AT THE
UNIVERSITY OF WISCONSIN MADISON
WHERE SHE COMPLETED RESIDENCIES
IN INTERNAL MEDICINE, A
FELLOWSHIP IN GERIATRICS AND SHE
DEVELOPS, IMPLEMENTS AND
EVALUATES INTERVENTIONS TO
INCREASE DIVERSITY IN STEM
FACULTIES USING QUANTITATIVE AND
QUALITYTIVE MEASURES, SHE TALKS
ABOUT HOW STEREOTYPES ARE -- WE
SOUGHT AN INDIVIDUAL WHO "BEST
HONORS DR. KIRSCHSTEIN'S NEXT
GENERATION OF RESEARCHERS AND
SCIENTISTS, ESPECIALLY FROM
UNDERREPRESENTED POPULATIONS AS
WELL AS HER REMARKABLE
ACHIEVEMENTS AS A SCIENTIST AND
LEADER AT NIH."
WE SOUGHT A SCIENTIST OF
TREMENDOUS ACCOMPLISHMENT AND
DR. CARNES IS A PIONEER IN THE
STUDY OF SCIENTIFIC WORK FORCE
DIVERSITY.
SHE ELOQUENTLY DESCRIBED THE
IMPLICIT BIAS HABIT WHICH SHE
ADDRESSED AT THE WOMEN'S HEALTH
CONFERENCE WE HOSTED IN OCTOBER.
RECIPIENT OF PATH FINDER AWARD
TO RESEARCH TO PROMOTE
SCIENTIFIC DIVERSITY, DR. CARNES
IS RENOWNED FOR HER RIGOROUS
APPROACH TO BIAS.
SHE WON THE JOSEPH T FREEMAN
AWARD, THE 2008 FELLOWSHIP OF
ASSOCIATE FOR WOMEN IN SCIENCE,
THE AMERICAN MEDICAL WOMEN'S
ASSOCIATION PRESIDENTIAL
RECOGNITION AWARD, THE 2019
BERNADINE HEALY WOMEN'S
VISIONARY LEADERSHIP AWARD AND
MANY, MANY OTHERS.
INDEED, SHE IS A PERFECT CHOICE
TO PRESENT THIS YEAR'S
KIRSCHSTEIN MEMORIAL LECTURE.
IT IS MY PRIVILEGE TO INTRODUCE
DR. MOLLY L. CARNES.
DR. CARNES.
I WOULD LIKE TO START BY
THANKING NIH FOR FUNDING MY
RESEARCH AND TAKING SUCH A
LEADERSHIP ROLE IN GENDER EQUITY
AND WOMEN'S HEALTH AND DR.
CLAYTON AND THE FORMER DIRECTOR
OF ORWH, THE NATIONAL SCIENCE
FOUNDATION AND UNIVERSITY OF
WISCONSIN FOR FUNDING MY
RESEARCH.
I WOULD LIKE TO BRIEFLY
ACKNOWLEDGE SOME OF THE MANY
PEOPLE THAT CONTRIBUTED TO SOME
OF MY WORK I WILL BE PRESENTING.
I WILL COVER THESE FOUR POINTS
TODAY.
SO OUR KNOWLEDGE OF GENDER
STEREOTYPES, ANY STEREOTYPE, BUT
WE ARE FOCUSING ON GENDER, EVEN
IF WE DON'T BELIEVE IN THOSE
STEREOTYPES, GIVES RISE TO OVERT
DISCRIMINATION AND UNINTENTIONAL
BIAS, IMPLICIT BIAS.
THE CON FLAGS OF GENDER AND
STATUS PREDICTS THAT HEALTH
CONDITIONS UNIQUE TO OR MORE
COMMON IN WOMEN WOULD BE SEEN AS
LESS IMPORTANT AND GAVE RISE FOR
THE NEED FOR THE CONFERENCE DR.
CLAYTON MENTIONED, THAT RECENT
CONVERSATION.
WOMEN IN STEM ARE MORE LIKELY TO
STUDY ISSUES THAT AFFECT THE
HEALTH OF WOMEN, BUT GENDER BIAS
MAY IMPEDE PUBLICATION OF THAT
RESEARCH, RESEARCH FUNDING,
WILLINGNESS OF SCIENTISTS TO
RESUBMIT GRANTS OR APPLICATION
AND THE ATTAINMENT OF LEADERSHIP
POSITION.
FINALLY, INDIVIDUALS AT ALL
LEVELS OF STEM MUST WORK HARD TO
BREAK THAN OWN BIAS HABITS
BECAUSE POLICY IS SO IMPORTANT,
BUT IT IS NOT SUFFICIENT TO
OVERCOME GENDER BIAS.
I'M GOING BEGIN WITH SOME OF THE
DATA DR. CLAYTON REFERRED TO.
WE ALL LOVE DATA.
WE ARE SCIENTISTS.
IF WE JUST LOOK AT PERCENTAGES
OF VARIOUS STAGES IN A CAREER IN
ACADEMIC SCIENCE OR MEDICINE.
WE CAN SEE THAT INDIVIDUALS WHO
IDENTIFY AS BEING A MEMBER OF
ONE OR THE ETHNIC OR RACIAL
GROUPS HISTORICALLY MARGINALIZED
DR. CLAYTON REFERRED TO,
INDIVIDUALS WHO IDENTIFY AS
BLACK OR AFRICAN AMERICAN, LATIN
X, NATIVE AMERICAN OR ALASKAN A
MEMBER OF INDIGENOUS POPULATION
HAWAII AND GUAM.
OVER A THIRD OF THE U.S.
POPULATION, THE RED BAR SHOWS
UNDERREPRESENTATION IN ALL
CAREER PROFESSIONS.
# IF WE LOOK AT WOMEN,
PREDOMINANTLY WHITE WOMEN, BUT
THERE IS NO DOUBT SINCE TITLE IX
WAS PASSED IN 1972, MAKING THE
PREVIOUS QUOTAS THAT KEPT WOMEN
OUT OF HIGHER EDUCATION ILLEGAL,
ONCE THE DOORS WERE OPEN WOMEN
ESSENTIALLY FLOODED ALL FIELDS
OF SCIENCE AND MEDICINE AT THE
EARLY PIPELINE STAGES.
FOR EXAMPLE, ON THAT FAR LEFT,
WE HAVE HAD GENDER PARITY AMONG
MEDICAL STUDENTS FOR DECADES
NOW, SIMILARLY WITH BIOMEDICAL
PH.D.s.
IF YOU LOOK AT THE PERCENTAGE OF
ASSISTANT PROFESSORS IT IS
ALMOST A GENDER PARITY NOW.
WE SEE A DISPROPORTIONATE LOSS
OF TALENT AMONG WOMEN FACULTY AS
WE MOVE TOWARD LEADERSHIP
POSITIONS.
NO MATTER HOW YOU MODEL THIS, AS
DR. CLAYTON SAID, THIS IS A
DISPROPORTIONATE LOSS OF TALENT.
WE SEE THAT SAME PATTERN IF WE
LOOK AT WELL-REPRESENTED
MINORITIES.
INDIVIDUALS WHO IDENTIFY AS
BEING A MEMBER OF ONE OF THE
MULTIPLE SUBGROUPS THAT ARE
SUBSUMED UNDER THE CATEGORY
ASIAN, THE WAY OUR COUNTRY
COUNTS DEMOGRAPHICS.
WELL REPRESENTATION AT THE EARLY
PIPELINE STAGES, BUT JUST LIKE
WITH WOMEN, WE SEE A
DISPROPORTIONATE LOSS OF TALENT
AS WE MOVE TOWARD LEADERSHIP OR
ACADEMIC SCIENCE OR MEDICINE.
SO IT IS IMPORTANT TO REALIZE WE
KNOW COMMON STEREOTYPES EVEN IF
WE DON'T BELIEVE THE CONTENT.
IF WE JUST START IN A GENDER
CONTEXT.
WE KNOW GENDER DOESN'T EXIST AS
A SIMPLE BINARY, BUT A MORE
NUANCED CONTINUUM.
IF I ASKED YOU OFF THE TOP OF
YOUR HEAD, WHAT ARE SOME COMMON
STEREOTYPES ABOUT MEN?
EVEN IF YOU DON'T BELIEVE THEM,
YOU COULD EASILY GENERATE THEM
AND COME UP WITH THE SAME
STEREOTYPES THAT EVERY STUDY
THAT HAS DONE THIS EXERCISE OVER
THE LAST SEVERAL DECADES HAS
DONE AND YOU WOULD PROBABLY SAY,
STEREOTYPICALLY, MEN ARE STRONG,
DECISIVE, STUB BURN,
COMPETITIVE, TAKE RISKS.
AN ASSUMPTION THEY REQUIRE
INDIVIDUAL HUMAN AGENCY.
SIMILARLY IF I ASKED YOU WHAT
ARE COMMON STEREOTYPES ABOUT
WOMEN, EVEN IF YOU DON'T
CONSCIOUSLY ENDORSE THEM, YOU
COME UP WITH WHAT EVERY OTHER
STUDY HAS COME UP WITH, WOMEN
ARE STEREOTYPICALLY CARING,
NURTURING, FAME ORIENTED,
EMOTIONAL, NICE, DEPENDENT,
THESE ARE TERMED COMMUNAL
BEHAVIORS.
NOW, WE ARE ALSO AWARE OF COMMON
STEREOTYPES ABOUT DIFFERENT
RACIAL AND ETHNIC GROUPS.
THIS WAS DEMONSTRATED QUITE
CLEARLY IN A STUDY FROM UCLA
THAT INVOLVED VERY DIVERSE GROUP
OF PARTICIPANTS OVER 600
PARTICIPANTS.
ONLY 26% IDENTIFIED AS WHITE.
22% SAID THEY WERE BORN OUTSIDE
THE U.S.
AND THE INVESTIGATORS SAID
PLEASE DON'T TELL US WHAT YOU
PERSONALLY THINK, BUT WHAT KINDS
OF STEREOTYPES ARE YOU AWARE OF?
WHAT HAVE YOU SEEN PORTRAYED IN
THE MOVIES AND MEDIA?
I'M GOING LIST THE STEREOTYPES
THEY FOUND AND THESE CAN MAKE
YOU UNCOMFORTABLE, THEY CAN EVEN
BE TRIGGERING, BUT THIS IS WHAT
THE DATA SHOWED.
COMMON STEREOTYPES ABOUT WHITE
PEOPLE, HIGH STATUS, RICH,
INTELLIGENT, BLOND, RACIST, ALL
AMERICAN, IGNORANT.
STEREOTYPES ABOUT ASIAN PEOPLE,
INTELLIGENT, BAD DRIVERS, GOOD
AT MATH, NERDY, SHY, SKINNY,
EDUCATED, QUIET PASSIVE.
NOW I'M GOING PUT UP THE
STEREOTYPES ABOUT BLACK AND
LATIN X PEOPLE.
THESE ARE PAINFUL TO READ.
THEY WILL BE PAINFUL FOR YOU TO
READ WHEN I PUT THEM UP, BUT,
UNFORTUNATELY, JUST LIKE WITH
GENDER, IF YOU LIVE IN THIS
SOCIETY, YOU ARE AWARE OF THEM.
GHETTO, UNREFINED, CRIMINAL,
ATHLETIC, LOUD, GANGSTERS, POOR,
UNINTELLIGENT, UNEDUCATED, LAZY.
LATIN X, POOR, ILLEGAL
IMMIGRANT, UNEDUCATED, FAMILY
ORIENTED, LAZY, UNINTELLIGENT,
LOUD, GANGSTERS.
THESE ARE VERY NEGATIVE
STEREOTYPES AND YOU CAN SEE
STEREOTYPES ABOUT BLACK AND
LATIN X PEOPLE ARE INCONGRUENT
WITH ACADEMIC SUCCESS OR
PROWESZ.
THESE CULTURAL STEREOTYPES ARE
RESPONSIBLE AT THE INSTITUTIONAL
LEVEL FOR WOMEN BEING PAID LESS
THAN MEN FOR THE SAME WORK IN
STUDY AFTER STUDY.
MEN ARE PENALIZED FOR TAKING
FAMILY LEAVE.
THERE IS LOWER RESEARCH FUNDING
FOR CONDITIONS MORE COMMON IN
WOMEN OR MINORITY GROUPS.
AT INTERPERSONAL, GIVE RISE TO
SEXUAL HARASSMENT,
MICROAGGRESSION, DESESSIONS ON
WHO TO HIRE, SPONSOR, REWARD,
PUBLISH, FUND.
THEY ARE INTERNALIZED AND GIF
RISE TO IMPOSTER SYNDROME, AN
INDIVIDUAL'S DECISION WHERE THEY
FIT.
DO THEY FIT AS A NUCLEAR
ENGINEER?
DO THEY FIT AS A NURSE?
WITHIN SCIENCE OR MEDICINE?
DO THEY FIT AS AN ORTHOPEDIC
SURGEON OR PEDIATRICIAN?
AND WHETHER TO RESUBMIT AFTER
HAVING A GRANT PROPOSAL OR MAN
MANUSCRIPT REJECTED.
WE ARE AWARE OF STEREOTYPES
ABOUT RACIAL CATEGORIES, WE HOLD
STEREOTYPES ABOUT DIFFERENT
OCCUPATIONS.
RESEARCH SHOWS STEREOTYPES ABOUT
LEADERS IS COMPETITIVE,
SELF-CONFIDENT, AGGRESSIVE,
AMBITIOUS, POWERFUL, DECISIVE.
NOW REFLECT BACK TO THAT STUDY
FROM UCLA.
WHERE DO YOU GET BETTER GROUP
ALIGNMENT OF STEREOTYPES?
WHERE DO YOU GET A BETTER FIT OR
ROLE CONGRUITY?
PRETTY CLEAR, RIGHT?
YOU GET A MUCH BETTER ALIGNMENT
WITH WHITE.
REFLECT BACK TO THE SLIDE I PUT
BACK WITH THE AAMC DATA SHOWING
DISPROPORTIONAL LOSS OF TALENT
AMONG ASIAN FACULTY MOVING
TOWARD LEADERSHIP.
THE WAY STEREOTYPES FILTER DATA,
ONE WOULD PREDICT THIS PATTERN
OF LOSS OF TALENT BECAUSE WHITE
INDIVIDUALS ARE BENEFITED WHEN
THEY ARE BEING EVALUATED FOR OR
EVALUATED IN A LEADERSHIP
POSITION BECAUSE OF THAT
ALIGNMENT.
THEY LOOK LIKE A LEADER IN WAYS
THAT PERHAPS ASIAN INDIVIDUALS
DO NOT.
SO LET'S RETURN TO THE GENDER
CONTEXT, THE STEREOTYPES
ASSOCIATED WITH MEN, AGENTIC AND
WOMEN COMMUNE AL.
WHERE DO YOU GET A BETTER FIT?
WITH MEN.
THERE IS A THINK MANAGER, THINK
MALE PHENOMENON.
TERMED THAT BY SHINE AND
COLLEAGUES WHO STUDIED THIS,
THEY FOUND THINK MANAGER, THINK
MALE ECONOMY IS CROSS CULTURAL.
IN THE U.S., IN EUROPE, IN ASIA.
IT IS INTERESTING BECAUSE
DESPITE THE TENACITY OF THINK
MANAGER THINK MALE PHENOMENON,
IT FLIES IN THE FACE OF RESEARCH
ON LEADERSHIP.
SO RESEARCH ON LEADERSHIP PRETTY
CONSISTENTLY SHOWS THE MOST
EFFECTIVE LEADERS LEAD WITH A
TRANSFORMATIONAL LEADERSHIP
STYLE, LIKE DR. CLAYTON.
RIGHT?
WHEN YOU THINK ABOUT
TRANSFORMATIONAL LEADERS AND
RESEARCH SHOWS THEY DO ENGAGE IN
SOME AGENTIC BEHAVIORS, STRONG,
TAKE RISKS, LOGICAL, BUT THEY
ENGAGE IN A LOT OF COMMUNAL
BEHAVIORS.
THEY CARE ABOUT MEMBERS OF THE
ORGANIZATION.
THEY NURTURE TALENT.
HOPEFULLY THEY ARE EVEN NICE AND
HELPFUL.
NEVERTHELESS THIS THINK MANAGER
THINK MALE PHENOMENON IS QUITE
TENACIOUS.
WE DEMONSTRATED THIS PHENOMENON
AT THE UNIVERSITY OF WISCONSIN
WITH AN IMPLICIT ASSOCIATION
TEST.
MAYBE OF YOU OR ALL OF YOU ARE
FAMILIAR WITH THIS TIME SORTING
TASK.
IN THIS PARTICULAR TASK WE ASKED
FACULTY AT THE UNIVERSITY OF
WISCONSIN TO SEE ON THEIR
COMPUTER SCREEN MALE OR FEMALE
GENDERED NAMES, IAN OR JENNIFER
AND WORDS ASSOCIATED WITH LEADER
LIKE STRONG DECISIVE OR WORDS
WITH A SUPPORTIVE ROLE LIKE
HELPFUL.
AND TO MATCH THEM AS QUICKLY AS
POSSIBLE BY PUSHING KEYS ON
THEIR COMPUTER KEYBOARD.
AND THE GREEN BARS ON THESE
GRAPHS SHOW THAT OVER 70% OF OUR
MALE AND FEMALE FACULTY
INCLUDING ME MUCH MORE QUICKLY
MATCHED THE MALE NAMES AND THE
LEADER WORDS AND THE FEMALE
NAMES AND THE SUPPORTER WORDS.
BECAUSE THESE -- THIS THINK
MANAGER THINK MALE PHENOMENON IS
REENFORCED CONSTANTLY.
IN THE NEXT YEAR WE WON'T HAVE
ANGELA MERKLE IN THE PICTURE OF
WORLD LEADERS.
IT IS REENFORCED ALL THE TIME.
NOW STAYING IN A GENDER CONTEXT
FOR A MOMENT, SIMPLY KNOWING
THESE GENDERED STEREOTYPES AS WE
SHOWED WE ALL KNOW CREATE THESE
SORT OF PRESCRIPTIVE BOUNDARIES
OR GENDER RULES AND BOTH MEN AND
WOMEN WHO BREAK THESE GENDER
RULES WILL SUFFER SOCIAL
PENTINGS.
WE HAVE WORDS LIKE MEN WHO ARE
TOO COMMUNAL, WIMPY, SISSY, WEAK
AND WE HAVE WORDS THAT DESCRIBE
WOMEN WHO ARE VIEWED AS TOO
AGENTIC, BOSSY, DOMINEERING,
ABRASI
ABRASIVE.
N SHELLY CARILLO DID A RECENT
STUDY, A VERY ELEGANT STUDY.
SHE AND HER TEAM LOOKED AT
WRITTEN PERFORMANCE EVALUATIONS
FOR TENS OF THOUSANDS OF PEOPLE
IN THE TECH INDUSTRY AND FOUND
THERE IS A LOT OF GENDER
POLICING GOING ON.
MEN WERE BEING ADVISED TO TAKE
CHARGE, BE MORE ASSERTIVE.
BE LOUDER.
WOMEN, ON THE OTHER HAND, AS YOU
MIGHT IMAGINE, WERE ADVISED TO
BE MORE COLLABORATIVE, DON'T BE
ABRASI
ABRASIVE.
SMILE MORE: YOU CAN SEE HOW
THIS PUTS WOMEN LEADERS IN A
VERY DIFFICULT SITUATION.
BECAUSE IF THEY BEHAVE IN WAYS
THAT THEY THINK ARE CONGRUENT
WITH STEREOTYPES ABOUT LEADERS,
IT PUTS THEM IN THE POSITION OF
POTENTIALLY VIOLATING THE NORMS
OF WOMEN'S BEHAVIOR.
THE GOOD NEWS TO TAKE HOME IS
RESEARCH SHOWS THERE IS NO
IMPACT ON GENDER OF LEADERSHIP
EFFECTIVENESS.
THAT TRANSFORMATIONAL LEADERS
DO, INDEED, DRAW FROM THE
AGENTIC AND COMMUNAL COLUMNS.
RESEARCH SHOWS WOMEN ARE MORE
LIKELY THAN MEN TO LEAD WITH A
TRANSFORMATIONAL LEADERSHIP
STYLE.
SO THAT IS THE GOOD NEWS.
NOW, THERE IS ABUNDANT EVIDENCE
THAT SOCIETY PLACES A LOWER
VALUE ON WOMEN, ROLES
PREDOMINANTLY OCCUPIED BY WOMEN
AND WORK PERFORMED BY WOMEN THAN
ROLES OCCUPIED BY MEN AND WORK
PERFORMED BY MEN.
EVEN IN THE BIBLE, IN LEVITCUS
GOD SAID A MAN WAS WORTH
50SHEKELS AND A WOMAN WORTH 30
AND A BOY FIVE AND GIRL THREE.
THEY LOOKED AT 50 SURGICAL
PROCEDURES PERFORMED IN MEN AND
WOMEN.
I WOULD ADD MEN USUALLY BY A
MALE UROLOGIST, WOMEN BY A
FEMALE GYNECOLOGIST.
42 OF THOSE IDENTICAL PROCEDURES
HAD HIGHER MEDICARE RVUs AND
WERE REIMBURSED HIGHER WHEN THE
SAME PROCEDURE WAS PERFORMED IN
MEN THAN WHEN IT WAS PERFORMED
IN WOMEN.
WE CAN LOOK BACK AND SEE THAT
WOMEN WERE EXCLUDED COMPLETELY
FROM SO MUCH EARLY FEDERALLY
FUNDED CLINICAL RESEARCH.
WE ARE STILL PLAYING CATCHUP AND
THIS STILL HAPPENS.
BUT JUST OF NOTE, WOMEN WERE
COMPLETELY EXCLUDED FROM ALL THE
EARLY CARDIOVASCULAR TRIALS.
AGAIN, PUBLICLY FUNDED.
SO THEY WERE EXCLUDED FROM THE
CORONARY DRUG PROJECT, THE LIPID
RESEARCH CLINICS PRIMARY
PREVENTION TRIAL, HARVARDS
PREVENTION STYLE MR. FIT, AS THE
ACRONYM WAS.
WOMEN WERE EXCLUDED FROM THE
BALTIMORE LODGE TUESDAYAL STUDY
FOR NORMAL HUMAN AGING FOR 20
YEARS, THIS RESULTED IN THE
PUBLICATION OF TWO VOLUMES
CALLED NORMAL HUMAN AGING VOLUME
1 AND VOLUME 2 WITHOUT A SINGLE
PIECE OF DATA FROM WOMEN.
WOMEN WORK AT THE LOWER ECHELONS
AT ALL ORGANIZATIONS.
MY COLLEAGUE AND I SHOWED THERE
IS A STRONG CORRELATION OF THE
PERCENTAGE OF WOMEN IN MEDICAL
FIELDS AND SALARY.
THIS IS THE GRAPH FROM OUR PAPER
IN ACADEMIC MEDICINE.
OUR STATISTICIAN TOLD US THIS IS
THE KIND OF PICTURE PEOPLE LOVE
TO PUT IN BIOSTATISTICS BOOKS
BECAUSE THE PERCENTAGE OF WOMEN
IN THE DIFFERENT FIELDS EXPLAINS
64% OF THE VARIANTS.
SO GENDER BIAS CAN REDUCE
INVESTMENT IN RESEARCH TO
IMPROVE THE HEALTH OF WOMEN
DIRECTLY, AS WE MENTIONED, BY
NOT FUNDING THE RESEARCH,
INDIRECT LY
INDIRECTLY BY -- STUDY OR
INVENT THINGS TO IMPROVE THE
HEALTH OF WOMEN, REPORT SEX
DIFFERENCES IN THEIR RESEARCH,
PROVIDE A LEAD WOMEN'S HEALTH
CARE AND HAVE BETTER PATIENT
OUTCOMES.
TO DRIVE THIS HOME THERE WERE 11
MILLION PAPERS PUBLISHED OVER 40
YEARS, STILL FOR BIOMEDICAL
RESEARCH SEX RESEARCH IS
UNDERREPORTED, AGAIN,LESS VALUE.
PAPERS WITH FEMALE AUTHORS WERE
MORE SIGNIFICANTLY LIKELY TO
REPORT SEX IN THE RESEARCH, BUT
GETTING TO THE VALUE, WHEN SEX
WAS REPORTED, REGARDLESS OF THE
GENDER OF THE AUTHOR, THE
SCIENCE WAS PUBLISHED IN LOWER
IMPACT JOURNAL.
AGAIN, GETTING TO THE VALUE.
SO WE TOOK THIS PUBLICATION BIAS
AGAINST WOMEN ONE STEP FURTHER.
WHAT IF THE EXACT SAME RESEARCH
WERE CONDUCTED IN MEN OR WOMEN,
WOULD IT BE SEEN LESS VALUABLE
FOR WOMEN?
WE WANTED TO TEST DOUBLE BLIND
IN BIOMEDICAL JOURNALS.
DOUBLE BLIND MEANS THE REVIEWERS
WERE BLINDED TO THE AUTHORS AS
WELL AS THE AUTHORS BLINDED TO
THE REVIEWERS.
SO WE SELECTED OUR PARTICIPANTS
FROM RO1 GRANTEES FROM A
TREMENDOUS RESOURCE BECAUSE WE
FIGURED THESE PEOPLE WOULD BE
REVIEWERS.
THEY WOULD KNOW THE PROTOCOL FOR
REVIEWING.
AND WE ASSURED THEM IN OUR COVER
STORY IT DIDN'T MATTER IF THE
RESEARCH WAS RIGHT IN THEIR
FIELD BECAUSE IT WAS
INTERDISCIPLINARY JOURNEY AND
REVIEWERS WOULD BE CHOSEN FROM
ALL OVER THE PLACE.
ONCE THEY AGREED TO
PARTICIPATION, THEY WERE
RANDOMLY ASSIGNED BY ABSTRACT
FROM WOMEN, MEN OR INDIVIDUALS.
WE ASKED THEM TO EVALUATE THE
RESEARCH ON SCIENTIFIC RIGOR,
CONTRIBUTION TO MEDICAL SCIENCE
AND WHETHER THEY WOULD RECOMMEND
PUBLISHING THE FULL PAPER.
WHEN THE RESEARCH WAS CONDUCTED
IN WOMEN, IT WAS VIEWED AS
MAKING A SIGNIFICANTLY GREATER
CONTRIBUTION TO SCIENCE.
THERE WAS NO DIFFERENCE IN THE
PERCEIVED RIGOR, BUT THE
MANUSCRIPT WAS TWICE AS LIKELY
TO BE PUBLISHED WHEN OTHER
RESEARCH WAS CONDUCTED IN MEN
THAN IN WOMEN OR INDIVIDUALS.
SO COMING TO THE POINT OF THE
LECTURE TOPIC, BIAS IS A HABIT
THAT CAN BE BROKEN.
IN FACT, ONE OF THE FEW
STRATEGIES THAT HAS BEEN PROVEN
EFFECTIVE IN HELPING PEOPLE
CHANGE BEHAVIOR IN RESPONSE TO
THESE IMPLICIT STEREOTYPE BASED
BIASES IS CALLED MOTIVATION
SELF-REGULATION OF BIAS IN THE
FIELD OF SOCIAL PSYCHOLOGY,
INTUITIVE OVERRIDE IN JUDICIAL
REASONING, FORWARD LOOKING
TUNABILITY BY REASON IN THE
FIELD OF PHILOSOPHY AND BREAKING
THE BIAS HABIT BY OUR RESEARCH
TEAM.
AS YOU KNOW, IF YOU HAVE EVER
TRIED TO BREAK A HABIT, IT IS A
MULTI-STEP PROCESS.
IT REQUIRES AWARENESS,
MOTIVATION, SELF-EFFICACY, YOU
HAVE TO FEEL CONFIDENT YOU CAN
ENGAGE IN A NEW BEHAVIOR, THERE
WILL BE SOME BENEFIT AND YOU
HAVE TO DELIBERATELY PRACTICE
THE NEW BEHAVIOR UNTIL IT
BECOMES HABITUAL.
WITH NIH FUNDING WE HAD AN
OPPORTUNITY TO DEVELOP A GENDER
BIAS HABIT REDUCING INTERVENTION
IN THE FORM OF A TWO AND A HALF
HOUR WORKSHOP.
THIS STUDY INVOLVED 92 STEMM
DEPARTMENTS AT UW MADISON OR
FUNCTIONED LIKE DEPARTMENTS.
DIVISIONS IN DEPARTMENTS OF
MEDICINE WERE TREATED AS
DEPARTMENTS.
WE RANDOMLY ALLOCATED 46 OF
THESE DEPARTMENTAL UNITS TO
RECEIVE THIS WORKSHOP AND 46 TO
REMAIN AS CONTROLS.
AND OUTCOMES WERE SELF-REPORTED
SURVEY RESPONSES, SURVEYS AT
BASELINE AND THREE DAYS AFTER
THE WORKSHOP.
ESSENTIALLY ASSESSING THOSE
STAGES OF CHANGE ON THE LAST
SLIDE.
USING MODELS AT BASELINE THREE
DAYS AND THREE MONTHS, FACULTY
RANDOMLY ALLOCATED TO THE
EXPERIMENTAL GROUP WERE
SIGNIFICANTLY MORE LIKELY THAN
THOSE IN THE CONTROL DEPARTMENT
TO BE AWARE OF THEIR OWN
PERSONAL BIAS, TO BE MOTIVATED
AND CONFIDENT THEY COULD ENGAGE
IN BIAS REDUCING ACTIVITIES AND
THEY WERE DOING SO ON A REGULAR
BASIS.
SO YOU MIGHT SAY, OKAY, WELL,
THIS IS STATISTICALLY
SIGNIFICANT, BUT THOSE -- LOOK
AT THAT Y AXIS.
THOSE ARE SMALL CHANGES.
IS THERE ANY REAL-WORLD
SIGNIFICANCE?
IS THERE ANY CLINICAL
SIGNIFICANCE?
IF YOU WILL.
SO WE HAD ANOTHER STUDY THAT WE
LEAD, DR. JENNIFER CHER DAN IS
THE PI.
IT IS CALLED THE STUDY OF
FACULTY WORK LIFE.
THE POSTAL SURVEY SENT TO ALL
FACULTY AT UW MADISON AND WE
TIMED IT SO A WAVE WENT OUT
BEFORE ANY DEPARTMENT GOT A
WORKSHOP AND AFTER ALL 46 HAD
RECEIVED THE WORKSHOP.
IT TURNED OUT THAT FACULTY IN
THE EXPERIMENTAL GROUP WERE
PERCEIVING A MORE INCLUSIVE
DEPARTMENT CLIMATE.
THEY WERE SIGNIFICANTLY MORE
LIKELY TO SAY THEY FELT
RESPECTED FOR THEIR RESEARCH AND
SCHOLARSHIP.
THEY FELT COMFORTABLE RAISING
PERSONAL OR FAMILY ISSUES IF IT
CONFLICTED WITH DEPARTMENTAL
ACTIVITIES.
YOU MIGHT SAY, OKAY, THIS IS A
LITTLE MORE CONVINCING, BUT THIS
IS STILL ALL SELF-REPORT.
DO YOU HAVE HARD INSTITUTIONAL
OUTCOMES?
WE LOOKED AT HIRING OUTCOMES.
THE BLUE BARS ARE TWO YEARS
BEFORE, THE RED BARS ARE TWO
YEARS AFTER THE STUDY.
YOU CAN SEE ON THE LEFT IN TERMS
OF THE PERCENT WOMEN AMONG NEW
FACULTY HIRES, THE EXPERIMENTAL
DEPARTMENTS HAD ESSENTIALLY
ACHIEVED GENDER PARITY.
HALF THE NEW HIRES WERE HALF MEN
AND HALF WOMEN WITH NO CHANGE IN
THE CONTROL DEPARTMENT.
THERE WAS ALSO MORE ETHNIC AND
RACIAL DIVERSITY AMONG NEW
HIRES, WHICH WAS SMALL, THERE
WAS A DECREASE IN THE CONTROL
DEPARTMENT.
IF YOU USE INFERENCE STATISTICS
FOR A SAMPLE, THESE WERE NOT
STATISTICALLY SIGNIFICANT, BUT
BECAUSE WE HAD THE ENTIRE
POPULATION OF STEMM DEPARTMENTS
AT UW MADISON, THIS WAS A REAL
INCREASE IN THE DIVERSITY OF NEW
HIRES.
SO WE WANTED TO SEE WHETHER THIS
APPROACH WORKED BEYOND A SINGLE
INSTITUTION AND BEYOND A FOCUS
ON GENDER BIAS.
SO WITH ANOTHER NIH GRANT WE
DEVELOPED THE BRIM STUDY, BIAS
REDUCTION IN INTERNAL MEDICINE
USING A CLUSTER RANDOMIZED
CONTROLLED DESIGN.
THREE-HOUR BIAS HABIT-REDUCING
WORKSHOP INVOLVING 19
DEPARTMENTS OF MEDICINE AROUND
THE COUNTRY AND THE DIVISIONS
WITHIN EACH DEPARTMENT OF
MEDICINE ARE RANDOMLY ALLOCATED
TO RECEIVE THE WORKSHOP EARLY,
GROUP ONE, OR AT LEAST THREE
MONTHS LATER.
SO THEY REMAIN WEIGHTLESS
CONTROLS AND OUTCOME MEASURES
WERE SELF-REPORTED SURVEYS.
WE HAVE A GOOD DISTRIBUTION OF
PUBLIC AND PRIVATE INSTITUTIONS
AND THE DATA IS REALLY
PRELIMINARY.
IT IS A COMPLEX DATASET TO
ANALYZE ESPECIALLY SINCE THE
PANDEMIC CAME IN THE MIDDLE OF
IT.
LOOKING AT SOME OF OUR
PRELIMINARY ANALYSES, IT LOOKS
LIKE THE WORKSHOP HAD AN EFFECT.
FOR THE QUESTION, I INTERVENE IF
I WITNESS A STUDENT, RESIDENT,
FELLOW OR COLLEAGUE BEING
TREATED IN A BIASED WAY.
RED FACULTY ALLOCATED TO GET THE
WORKSHOP, BLUE CONTROL, SAME AT
BASELINE, THREE MONTHS LATER,
FACULTY IN DIVISIONS THAT GOT TO
WORKSHOP, SIGNIFICANTLY MORE
LIKELY TO SAY THEY ARE ENGAGING
IN THIS ACTION ON A REGULAR
BASIS.
YOU MIGHT SAY THIS IS
SELF-REPORT, JUST AN EXAMPLE OF
DESIRABILITY OR MAYBE THE PEOPLE
ANSWERING THE SURVEY, THEY LIKE
THOSE PEOPLE FROM WISCONSIN SO
TO TRY TO GET AROUND THIS WE
PULLED OUT THE FACULTY WHO
RESPONDED TO THE SURVEY, BUT DID
NOT ATTEND TO WORKSHOP.
IF IT HAD NO EFFECT, IT SHOULD
LOOK LIKE THE CONTROLS.
THEY ACTUALLY LOOKED A LOT MORE
LIKE THE FACULTY ALLOCATED TO
GET THE WORKSHOP WHO CAME TO THE
WORKSHOP.
THE LIGHT PINK LINE SUGGESTING
THE WORKSHOP HAD AN EFFECT, A
DIFFUSION EFFECT.
JUST A COUPLE MORE QUESTIONS IN
TERMS OF I WOULD CHALLENGE A
PERSONNEL DECISION IF I THINK IT
HAS BEEN INFLUENCED BY
STEREOTYPES.
I AM CONFIDENT I CAN DO THIS,
SELF-EFFICACY, I ENGAGE IN THIS
ON A REGULAR BASIS.
THE ARROW SHOWING THE LIGHT PINK
BARS SUGGESTS A DIFFUSION EFFECT
AMONG THOSE WHO DID NOT ATTEND
THE WORKSHOP BUT IN THE
EXPERIMENTAL GROUP.
WHY DO WE THINK THIS APPROACH
WORKED?
BECAUSE WE ENGAGED THOSE
RESPONSIBLE FOR ESTABLISHING THE
ORGANIZATIONAL NORMS, THE
FACULTY.
WE INCORPORATED STRATEGIES SHOWN
TO BE EFFECTIVE IN FOSTERING
SUSTAINED INTENTIONAL CHANGE.
PARTICIPATION WAS VOLUNTARY AND
BECAUSE WE GAVE IT AT THE ENTIRE
DEPARTMENT OR DIVISION LEVEL, IT
ENABLED SOCIAL DIFFUSION.
SO I'M GOING LEAVE ALL OF YOU
WITH TWO OF THE STRATEGIES WE
GIVE PARTICIPANTS IN THE
WORKSHOP SO THAT YOU CAN
PRACTICE THESE ON YOUR OWN TO
HELP YOU BREAK YOUR OWN BIAS
HABIT.
THE FIRST ONE IS ADOPTING A
GROWTH MINDSET.
I'M ASSUMING ALL OF YOU HAVE
HEARD THIS TERM BY NOW.
IT IS BASED ON 20 YEARS OF
ELEGANT RESEARCH BY CAROL DWEK
AT STANFORD.
HER GROUP LOOKEDED A MINDSET OF
CHANGING BEHAVIOR.
AND IT WORKS.
SIMPLY RECITING TO YOURSELF LIKE
A MANTRA, WITH HARD WORK, I CAN
OVERCOME THE INFLUENCE OF
STEREOTYPES ON MY JUDGMENT AND
DECISION MAKING.
WRITE SOMETHING LIKE THAT DOWN
ON A YELLOW STICKY.
STICK ON YOUR BATHROOM MIRROR,
PUT IT ON YOUR COMPUTER SCREEN,
START YOUR DIVISION MEETINGS
WITH IT.
THE SECOND ONE IS PERCEIVING
VARIABILITY.
THIS IS INTENTIONALLY REMINDING
YOURSELF THAT ALL GROUPS ARE
COMPOSED OF MULTIPLE SUBGROUPS
AND TO DO THIS YOU HAVE TO TUNE
YOUR EAR.
SO WHENEVER YOU HEAR SOMEBODY
SAY, MEMBERS OF SOME GROUP
ARE --
WHATEVER THAT GROUP IS, WOMEN
ARE --
MEN ARE --
ASIAN DRIVERS ARE --
PEOPLE FROM WISCONSIN ARE --
THE NEXT WORD IS A STEREOTYPE.
GREAT PRACTICE TO PERCEIVE
VARIABILITY.
I WILL GIVE YOU AN EXAMPLE OF
THIS RECENTLY.
SOMEONE SAID TO ME WOMEN
PHYSICIANS WANT TO WORK PART
TIME.
I SAID, WOW, SOME WANT TO WORK
PART TIME, FULL TIME AND SOME
WORK 24/7.
I REMINDED HIM SOME MEN WANT TO
WORK PART TIME BUT ARE PREVENTED
TO DO SO BY SOCIAL STIGMA.
GENDER STEREOTYPES ARE DEEPLY
ENTRENCHED IN HABITUAL PATTERNS
OF THINKING AND BEHAVIORING IN
ALL OF US.
THE CON FLAGS OF GENDER AND
STATUS NEGATIVELY IMPACTS THE
VALUE PLACED ON STUDYING
CONDITIONS PREVALENT IN WOMEN
AND ADVANCEMENT OF WOMEN IN
STEMM.
WITH HARD WORK AND INTENTIONAL
PRACTICE OF BIAS-REDUCING
STRATEGIES, BIAS IS A HABIT THAT
CAN BE BROKEN AND BREAKING THE
BIAS HABIT SHOULD BENEFIT BOTH
WOMEN IN STEMM AND THE HEALTH OF
WOMEN.
THANK YOU.
I WILL STOP SHARING MY SLIDES
NOW.
>> THANK YOU SO MUCH, DR.
CARNES.
I KNEW YOU WOULD NOT DISAPPOINT.
>> I APOLOGIZE FOR THAT ROUGH
BEGINNING.
THAT TOTALLY SHOCKED ME.
>> IT'S ALL GOOD.
IT IS AMAZING DATA.
INCRED FRAMING.
MAKING US THINK ABOUT THIS
DIFFERENTLY WITH LOTS OF DATA.
SO I AM GOING PULL UP AND SEE
WHERE THE QUESTIONS ARE.
IF THERE AREN'T ANY JUST YET,
I'M GOING START WITH THIS THINK
MANAGER, THINK MALE PHENOMENA
YOU DESCRIBED.
I HAVE HEARD OF IT, OF COURSE,
BUT I WROTE DOWN TODAY IN MY
NOTES, WHAT YOU SAID, WHICH IS
IT IS REENFORCED ALL THE TIME.
HOW DO WE INTERRUPT THOSE ON A
DAY-TO-DAY BASIS?
NOT A WORKSHOP.
YOU DON'T HAVE TO ANNOUNCE YOU
ARE DOING IT.
DO YOU HAVE SOME SUGGESTIONS FOR
US FOR THAT SPECIFIC ONE, THINK
MANAGER, THINK MALE, THAT WE CAN
IMPLEMENT ON A DAY-TO-DAY BASIS?
>> WELL ONE OF THE STRATEGIES
THAT WE SUGGEST IN THE WORKSHOP
IS TO BE VERY INTENTIONAL ABOUT
RECOGNIZING WHEN STEREOTYPES MAY
BE AT PLAY.
AND CHALLENGE WITH DATA.
BECAUSE WE ARE ALL GOING DO
THIS, JANINE, WE ALL MAKE
MISTAKES.
IF YOU FIND YOURSELF THINKING,
SHE IS A SMALL, PETITE WOMAN, I
DON'T KNOW IF SHE CAN LEAD THAT
PROJECT.
YOU CHALLENGE IT WITH DATA.
WHAT AM I THINKING.
THAT IS SUCH A STEREOTYPE.
LOOK AT ALL THE POWERFUL WOMEN
WHO LED PROGRAM PROJECTS.
PULL UP DATA.
CHALLENGE IT WITH DATA.
WE ARE ALL HUMAN.
WE ARE GOING MAKE MISTAKES.
BUT I LOVE TO USE SMOKING
CESSATION AS THE ANALOGY FOR HOW
WE CAN DO THIS.
BECAUSE IF WE CAN CHANGE THE
CULTURE FOR A POWERFULLY
ADDICTING SUBSTANCE LIKE
NICOTINE.
NOBODY SMOKES IN PUBLIC
BUILDINGS, NOBODY SMOKES IN
BARS, FOR PETE'S SAKE.
CAN YOU IMAGINE THAT HAPPENING
50 YEARS AGO.
IF WE ALL WORK HARD YOU WILL SEE
THAT SAME SYNERGY.
WHEN YOU AND I STARTED MAKING
THESE POINTS COULD YOU IMAGINE
THAT THE HEAD OF NIH WOULD
REFUSE TO BE ENGAGED IN PANELS
OR POLICIES YOU WENT OVER THESE
ELEGANT WONDERFUL POLICIES, BUT
ENOUGH PEOPLE HAVE CHANGED THEIR
BIAS HABITS, THEY WERE ABLE TO
CHANGE THE POLICIES AT NIH AND
YOU GET SYNERGY LIKE YOU GOT
WITH SMOKING CESSATION.
>> THOSE ARE GREAT POINTS AND
USING THAT ANALOGY HELPS PEOPLE
TO GET IT RIGHT AWAY.
EVERYONE UNDERSTANDS WHAT HAS
HAPPENED TO WHEN YOU COULD
ACTUALLY SMOKE ON AN AIRPLANE TO
TODAY.
WE ARE TWO MINUTES OUT IN TERMS
OF THE END OF THE SESSION AND IT
IS ABOUT HOW TO ADDRESS THE
PROMOTION IN TENURE PRACTICES
ESPECIALLY AROUND THE IMPORTANCE
OF TEAM SCIENCE AND HOW THERE
ARE MANY MORE WOMEN TYPICALLY
INVOLVED IN TEAM SCIENCE EFFORTS
AND HOW THAT MAY OR MAY NOT BE
RECOGNIZ
RECOGNIZED WITH A SINGLE PERSON
WORKING IN THE LAB WITH A BIG
TEAM OR SMALL TEAM.
THE OVER IS THE SALARY ISSUE.
ANOTHER PAPER CAME OUT RECENTLY.
>> YES.
>> $2 MILLION OVER TIME.
THAT IS A LOT OF MONEY.
WHAT I WAS INTERESTED IN, THAT
WAS PUBLISHED IN HEALTH AFFAIRS.
IT WAS THE FIRST FEW YEARS OF
THE TRAJECTORY OF THE CAREER
THAT MADE THE BIG DIFFERENCE.
IN TERMS OF OVER TIME.
COULD YOU COMMENT ON THOSE TWO
ISSUES, PROMOTION AND TENURE AND
SALARY?
>> HERE IS WHERE YOU SEE THE
SYNERGY BETWEEN INDIVIDUALS
BREAKING THE BIAS HABIT AND
MAKING POLICY THAT ACCELERATES
EQUITY.
RIGHT?
SO YOU HAVE TO HAVE ENOUGH
PEOPLE IN ACADEMIC INSTITUTIONS
RECOGNIZE THAT TEAM SCIENCE IS
GOOD AND BECAUSE WOMEN ARE MORE
LIKELY TO DO IT, IT MAY BE
UNDERVALUED.
YOU HAVE TO SOMEHOW, WE HAVE
BUILT IN ANYBODY WHO IS DOING
DIVERSITY ACTIVITIES, IT IS A
PLUS IN OUR TENURE REVIEWS.
THAT WOULD NEVER HAVE HAPPENED
10 YEARS AGO.
20 YEARS AGO I WAS TOLD BY A
DEPARTMENT CHAIR TO STOP USING
THE WORD DIVERSITY BECAUSE IT
WAS OFFENDING PEOPLE.
THAT WOULD NEVER HAPPEN.
THAT IS THE SYNERGY FOR THE
TENURE.
I FORGOT THE SECOND QUESTION.
>> SALARIES.
SAME KIND OF THING THOUGH.
>> I KNOW WE ARE AT 11:00, BUT
LET ME JUST ASK ONE OF THE
QUESTIONS -- BECAUSE THEY JUST
CAME IN ALL AT ONCE.
I AM SO SORRY.
>> IT IS MY FAULT FOR SCREWING
UP THE SLIDES.
>> GIVEN THE DISCREPANCY OF
ASIAN REPRESENTATION IN ACADEMIA
AND ASIAN ARE THE MODEL MINORITY
WITH NEGATIVE IMPLICATIONS HAS
THE DISCUSSION INCLUDING MORE
ASIANS.
THAT IS NOT A FAIR QUESTION FOR
YOU BECAUSE IT IS AN NIH
QUESTION.
>> I COULD MAKE ONE POINT.
WHAT DOES IT SAY, THERE IS NO
OLYMPICS FOR BIAS AND
DISCRIMINATION.
THE ISSUES MAY BE DIFFERENT,
THERE IS UNDERREPRESENTATION,
BUT THERE IS ALSO
DISCRIMINATION.
SO WE REALLY WANT TO GET AT
BOTH.
>> RIGHT.
>> WE DON'T WANT TO EXCUSE
DISCRIMINATION AGAINST ASIAN
COLLEAGUES BECAUSE ARE NOT
UNDERREPRESENTED AT EARLY
PIPELINE STRATEGIES.
>> NAME BLIND REVIEW, CSR HAS
DONE A STUDY AND THAT
PUBLICATION SHOULD BE COMING OUT
SOON.
DR. BEGG, I THINK WE BETTER MOVE
FORWARD TO GIVE OUR BIRCWH
SCHOLARS THEIR OPPORTUNITY.
DR. CARNES, THANK YOU, YOU GAVE
-- A GREAT TALK.
>> I WOULD LIKE TO THANK DR.
CARNES FOR A VERY IMPORTANT
TALK.
THANK YOU VERY MUCH.
IT IS NOW MY PLEASURE TO
INTRODUCE THE NEXT SESSION WHICH
WE HAVE CALLED THE PODIUM
SESSION FOR THE TOP THREE
SCHOLARS.
TOP THREE SCHOLARS WERE SELECTED
FROM THE 56 ABSTRACTS SUBMITTED
IN JUNE BY COMPETITIVE NAMES.
SO WHAT WE ARE GOING DO BECAUSE
OF THE VIRTUAL PLATFORM, ALL
THREE SCHOLARS WILL GIVE THEIR
TALKS.
THEY WILL BE INTRODUCED BY
PRINCIPLE INVESTIGATORS AND HAVE
A GENERAL Q&A SESSION AT THE
END.
THE TALKS WILL GO FOR 45 MINUTES
AND WE WILL HAVE 15 MINUTES FOR
Q&A.
WE INVITE YOU TO SUBMIT TO THE
Q&A BOX OR THE CHAT BOX ON THE
RIGHT OF YOUR SCREEN.
IDENTIFY WHICH SCHOLAR SHOULD
RECEIVE YOUR QUESTION WE WOULD
BE PREESHTSI APPRECIATIVE THERE.
THE SLIDE HAS JUST COME UP NOW.
MAYBE DURING THE Q&A WE CAN
LEAVE THAT ON OR GO BACK TO IT.
THIS IS THE WORD CLOUD BASED ON
THE 56 ABSTRACTS WERE RECEIVED.
VERY BRIEFLY, YOU CAN SEE WOMEN,
THE VARIOUS TERMS, WOMEN, MEN,
SEX, GENDER, TRANSGENDER,
VARIOUS TERMS FOR HEALTH,
CLINICAL, HEALTH CARE, VARIOUS
TERMS FOR CONDITIONS SUCH AS
CANCER, DEPRESSION,
INFLAMMATION, PREGNANCY,
GYNECOLOGY, INFECTIONS,
CARDIOVASCULAR DISEASE, AGE IS
IN THERE.
SOME LOCATIONS ARE REPRESENTED
BECAUSE THOSE ARE SOME OF OUR
BIRCWH SITES.
I WOULD LIKE TO EMPHASIZE OF THE
19 ACTIVE BIRCWH PROGRAMS THEY
LITERALLY CROSS THE UNITED
STATES AND COVER ALL OF THE
IMPORTANT GEOGRAPHIC AREAS.
SO WITH THAT, I WOULD LIKE TO
ASK FOR THE THREE SCHOLARS TALKS
TO BEGIN AND WE WILL COME BACK
AT END OF THE 45 MINUTES FOR
QUESTIONS AND ANSWERS.
I TURN IT OVER TO OUR VIRTUAL
COLLEAGUES.
THANK YOU.
>> I'M PLEASED AND HONORED TO
INTRODUCE JUDY SIMT KOKS AS A
FEATURED SPEAKER.
IN NINTH GRADE DR. SIMCOX NOTED
12 INDIVIDUALS WITH DOWN
SYNDROME ON HER SISTER'S SPECIAL
OLYMPICS TEAM FOUR HAT DIABETES.
AFTER POST DOCTORAL WORK AT THE
UNIVERSITY OF UTAH IN CHEMISTRY,
SHE JOINED THE UNIVERSITY OF
WISCONSIN AS AN ASSISTANT
PROFESSOR.
HER NATIVE AMERICAN HERITAGE
HELPS HER CONTINUE WEAVE EQUITY
IN HER RESEARCH.
THEY USE MASS SPECTOMETRY TO
IDENTIFY DISPARITIES IN
METABOLIC DISEASES.
HER TALK DEMONSTRATES POWERFUL
GOALS.
IT IS MY DISTINCT PRIF LIDGE TO
PRESENT TO YOU DR. SIMCOX.
>> I WOULD LIKE TO THANK BIRCWH.
BIRCWH IS SO MUCH MORE THAN A
FUNDING SOURCE OR A TALK AT A
CONFERENCE.
IT IS A COMMUNITY OF RESEARCHERS
THAT I HAVE BEEN INSPIRED BY AND
IT IS SUCH A DELIGHT TO BE ABLE
TO SHARE MY LAB'S RESEARCH WHERE
WE USE GLOBAL LIP PIDOMICS TO
IDENTIFY NOVEL CIRCULATING
MARKERS OF CARDIOVASCULAR
DISEASE RISK IN AFRICAN AMERICAN
AND CAUCASIAN SWIM I HAVE DONE
HERE AT THE UNIVERSITY OF
WISCONSIN MADISON.
CVR AND DIABETES ARE BEST
TREATED WITH EARLY PREVENTION
AND CARE.
IT IS BEST DONE WITH EARLY
DIAGNOSIS AND DIAGNOSIS IS FOUND
BY A DIAGNOSIS OF METABOLIC
SYNDROME.
METABOLIC SYNDROME IS A CLUSTER
OF FIVE RISK FACTORS, HIGH BLOOD
PRESSURE, HIGH FASTING BLOOD
GLUCOSE, OBESITY, HDL
CHOLESTEROL AND TRI GLIS RIDES.
THESE MARKERS WERE DEVELOPED
USING POPULATION STUDIES IN ALL
MALE POPULATIONS FROM WESTERN
EUROPEAN DESCENT.
WE FOUND THEY UNDERDOG METABOLIC
DISEASE IN WOMEN AND
UNDERREPRESENTED MINORITY
POPULATIONS, SPECIFICALLY IN
AFRICAN AMERICANS.
SO WHEN I STARTED THIS WORK I
WANTED TO ASK THE QUESTION, CAN
WE EXPAND THE DEFINITION TO
BETTER PREDICT METABOLIC DISEASE
IN AFRICAN AMERICAN POPULATIONS?
NOW, THE REASONS BEHIND WHY WE
STARTED THIS QUESTION ARE BEST
SEEN IN THE DATA.
IN THIS DATA WHAT WE ARE LOOKING
AT IS CAUCASIAN FEMALE
PARTICIPANTS AND AFRICAN
AMERICAN FEMALE PARTICIPANTS AND
A CORRELATION DOT A BLUE DOT
MEANS POSITIVE CORRELATION AND
RED DOT MEANS A NEGATIVE
CORRELATION.
WHAT WE ARE LOOKING AT IS
METABOLIC HEALTH MARKERS SUCH AS
INSULIN AND GLUCOSE LEVELS AND
SIS TOLLIC AND DIASTOLIC BLOOD
PRESSURE.
WE LOOK HOW THEY CORRELATE TO
MARKERS.
WHEN WE LOOK AT HDL CHOLESTEROL,
THE GOOD CHOLESTEROL, NEGATIVELY
CORRELATES WITH THESE MARKERS IN
CAUCASIAN FEMALE PARTICIPANTS AS
WELL AS NEGATIVE IN SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE.
IN AFRICAN AMERICAN WOMEN WE
OBSERVED WE NO LONGER SEE HDL
CORRELATES WITH MARKERS OF
METABOLIC HEALTH AND DOES NOT
CORRELATE AT ALL WITH SYSTOLIC
OR DIASTOLIC BLOOD PRESSURE.
THIS IS INSIDIOUS BECAUSE
AFRICAN AMERICAN WOMEN HAVE
EIGHT TIMES THE MORTALITY
ASSOCIATED WITH CARDIOVASCULAR
DISEASE AND HAVE HIGHER RATES OF
EXTREME INCIDENCES OF SECONDARY
COMPLICATIONS ASSOCIATED WITH
DIABETES, INCLUDING RENAL
FAILURE AS WELL AS LIMB
AMPUTATION.
SO WE WANTED TO ASK IF WE COULD
IDENTIFY BETTER MARKERS OF
METABOLIC DISEASE.
AND TO DO THAT WE COLLABORATED
WITH MID LIFE IN THE U.S. OR
MIDUS, A LONGITUDINAL POPULATION
STUDY FOR 30 YEARS GENEROUSLY
FUNDED BY THE NIH.
WE CHOSE MIDUS BECAUSE THEY HAVE
BANKED PLASMA SAMPLES AND
REFLECTS TRENDS IN THE U.S.
POPULATION FROM AGE MIDUS
PARTICIPANTS FROM LATE 20s TO
LATE 80s AND REFLECT THE U.S.
POPULATION IN TERMS OF OBESITY
WHEN WE LOOK AT THEIR WAIST
CIRCUMFERENCE, THE MAJORITY OF
INDIVIDUALS ARE OBESE AND WE
ALSO OBSERVE THAT AFRICAN
AMERICANS HAVE HIGHER RATES OF
OBESITY THAN THEIR CAUCASIAN
COUNTERPARTS.
MIDUS HAS A LARGE POPULATION OF
AFRICAN AMERICAN WHICH ALLOWED
FOR CIRCULATING BIOMARKERS.
WHEN WE STARTED WE STARTED WITH
LIPID MARKERS.
PART OF THE REASON IS METABOLIC
SYNDROME HAS NUMEROUS LIPIDS
THAT ARE USED AS MARKERS FOR
METABOLIC DISEASE.
MY LAB HAS SPECIALIZED
INSTRUMENTATION FOR THE
MEASUREMENT OF LIPIDS.
MASS SPECS, WHICH ALLOWS TO LOOK
AT THE MASS TO CHARGE RATIO AND
SEPARATE OUT LIPIDS BASED ON
HYDROPHOBIC PRINCIPLES ON A
COLUMN USING RETENTION TIME.
EVERY DOT IS AN INDIVIDUAL
LIPID.
WE SEE 752 LIPIDS IN HUMAN
PLASMA THAT RANGE FROM 26
DIFFERENT CLASSES FROM FREE
FATTY ACIDS TO PHOSPHOLIPIDS AND
WHEN WE LOOK AT INDIVIDUAL
SPECIES, LOOKING AT A VOLCANO
PLOT WHICH ASSESSES SIGNIFICANCE
VERSUS THE RATIO OR FULL CHANGE
OF HYPERTENSIVE VERSUS NORMAL.
ANYTHING IN THIS QUADRANT IS
ASSOCIATED WITH CAUTION
PARTICIPANTS.
529 LIPIDS ARE ASSOCIATED WITH
HYPERTENSION POSITIVELY.
WHEN WE LOOK AT AFRICAN AMERICAN
PARTICIPANTS WE OBSERVE 137
LIPIDS ASSOCIATED WITH
HYPERTENSION.
NOW, THIS WAS SURPRISING BECAUSE
THERE IS A LOT LESS LIPIDS
CHANGING IN TERMS OF
HYPERTENSION AND WE SEE LESS
LIPIDS CHANGING RELATIVE TO
OBESITY.
WHEN WE LOOK AT THE OVERLAP OF
SHARED LIPIDS WHAT WE SEE IS THE
MAJORITY OF LIPIDS, 132, ARE
ASSOCIATED WITH HYPERTENSION IN
CAUCASIAN AND AFRICAN AMERICAN
PARTICIPANTS.
THE LIPIDS COME FROM A NUMBER OF
DIFFERENT CLASSES WHICH MAKES IT
HARD TO USE AS A DIAGNOSTIC
MARKER.
WE WANTED TO DIG INTO THE DATA
AND SEE WHAT LIPIDS ARE CHANGING
AND WHAT THEY COULD POTENTIALLY
MEAN.
TO DO THIS, WE STARTED TAKING
APART THE DATA IN A NUMBER OF
DIFFERENT WAYS INCLUDING LOOKING
AT THE ACYL CHAIN.
WE SEE RANGES FROM 16 CARBONS
ALL THE WAY TO 22 CARBONS WITH
SIX DOUBLE BONDS AND WHAT WE
STARTED TO NOTICE IS THAT MANY
OF THE LIPIDS THAT WE WERE
SEEING ASSOCIATED WITH
HYPERTENSION HAD AN 24ACYL CHAIN
LIPID.
NOW WHEN WE LOOKED AT THE
DIFFERENT SPECIES, THESE ACIDS
WERE IN, THEY WERE IN A NUMBER
OF PHOSPH LIPIDS.
WHAT ARE THESE ACYL CHAINS DOING
AND WHAT DOES THIS MEAN IN TERMS
OF MANIFESTATION OF DISEASE?
LIPID CANS BE PROCESSED INTO
SIGNALLING MODELS.
ARACHIDONIC CAN SIGNAL FOR FEVER
RESPONSE AND IMMUNE CELL
INFILTRATION.
IF YOU TOOK A NONSTEROIDAL
ANTI-INFLAMMATORY DRUG SUCH AS
IBUPROFEN, IT BLOCKS
ARACHIDONICS A DID INTO THESE
INFLAMMATORY -- WE WANTED TO
UNDERSTAND IF THEY WERE CHANGING
SO WE TURNED TO RNA-SEQ DATA AND
COME BINTED OUR LIPIDOMICCS BY
CLEVER STATISTICS.
AND WHAT WE SEE WHEN WE
CORRELATE TWO ARACHIDONIC ACID
CONTAINING LIPIDS IS A NUMBER OF
INFLAMMATORY MARKERS POP UP A
NUMBER OF THESE, A LIPID
OXYGENASE AND ALOX5.
WITH WHAT IS FASCINATING ABOUT
THIS RNA-SEQ DATA TAKES US INTO
HOW THESE LIPIDS ARE PROCESSED.
AS YOU TAKE ARACHIDONIC, IT IS
PROCESSED BY ALOX5 WHICH WE ARE
SEENING IN OUR DATA.
THEY SIGNAL AND ACTIVATE A
SIGNATURE CALL TO PRODUCE
INFLAMMATORY CYTOKINE.
WE WANTED TO KNOW IF THIS LED TO
CHANGES IN THE INFLAMMATORY
STATE IN THESE PARTICIPANTS AND
SO WE STARTED LOOKING AT C
REACTIVE PROTEIN AND INTERLUKIN6
IN THE BLOOD.
WHEN WE LOOKED AT AFRICAN
AMERICAN VERSUS CAUCASIAN
PARTICIPANTS, C REACTIVE PROTEIN
AND INTERLUKIN IS SIX WERE
ELEVATED IN AFRICAN AMERICAN
PARTICIPANTS COMPARED TO
CAUCASIAN PARTICIPANTS.
THESE INFLAMMATORY MARKERS
SHOWED INCREASE WITH HYPERTEX IN
AFRICAN AMERICAN AND CAUCASIAN
PARTICIPANTS.
WE ARE SEEING INCREASES IN
INFLAMMATORY LIPIDS AND
INCREASES IN THESE MARKERS OF
INFLAMMATI
INFLAMMATION, BUT WHAT ABOUT
THESE INFLAMMATORY ACOSINOIDS.
WHAT DO THOSE LOOK LIKE?
WE BEGAN BY LOOKING AT TARGETED
ASSESSMENT OF -- ARACHIDONIC CAN
BE PROCESSED BY ALOX5 OR CYCLO
OXYGENASES.
WE STARTED LOOKING AT
CORRELATIONS WHEN WE DID THESE
MEASUREMENTS.
WE WANTED TO SAY WHEN WE LOOK AT
HYPERTENSION IN AFRICAN AMERICAN
AND CAW PARTICIPANTS, WE
OBSERVED LEUKOTRINE LEVELS WERE
CORRELATED WITH AFRICAN AMERICAN
AND CAUCASIAN, PROSTIGLANDIN
LEVELS WERE UNCHANGED.
THIS LED US TO DELVE INTO MORE
HOW THESE SIGNALLING PATHWAYS
ARE CONTROLLED.
BUT IN SOME WHAT WE HAVE IS THE
OBSERVATION THAT AFRICAN
AMERICAN AND CAUCASIAN
PARTICIPANTS WITH ELEVATED BLOOD
PRESSURE HAVE HIGHER RATES OF
INFLAMMATION, HIGHER RATES OF
INFLAMMATORY LIPIDS AND
ARACHIDONIC LIPIDS AND
DOWNSTREAM INTO LEUKOTRINES.
WE SEE THE TRANSCRIPTS OF THESE
PROCESSING ENZYMES, ALOX5 AND WE
SEE INCREASES IN INFLAMMATORY
CYTOKINES SUCH AS INTERLUKIN6.
THIS BRINGS US TO THE IDEA THAT
POTENTIALLY WE CAN USE
INFLAMMATION AND INFLAMMATORY
LIPIDS AS MARKERS FOR
CARDIOVASCULAR DISEASE AS WELL
AS MARKERS FOR METABOLIC
SYNDROME.
TO REALLY DO THIS WE NEED TO ASK
A NUMBER OF DIFFERENT QUESTIONS
IN THE FUTURE, INCLUDING HOW DO
THESE CIRCULATING LIPIDS CHANGE
WITH DISEASE IN OTHER
POPULATIONS.
DOES THIS HOLD TRUE NOT JUST IN
AFRICAN AMERICAN AND CAUCASIAN
PARTICIPANTS, BUT IN NATIVE
AMERICAN AND CHI CANO POPULATION
POPULATIONS.
WE HAVE STARTED WITH THE NATIVE
AMERICAN POPULATION WITH THE --
TRIBE IN WISCONSIN.
WE WANT TO UNDERSTAND IF THIS
RELATIONSHIP IS CAUSAL AND IF
THE LIPIDS ARE HAVING ANY DIRECT
IMPACT ON BLOOD PRESSURE AND
UNDERSTAND WHERE THESE LIPIDS
ARE COMING FROM.
SO THOSE ARE QUESTIONS WE WILL
PURSUE IN THE FUTURE.
I WANT TO END ON THE NOTE OF
THANKING THE PEOPLE WHO DID THE
RESEARCH, INCLUDING RAGHAV JAIN,
CAMILLE KING, AN UNDERGARAGE
WALTZ RESEARCHER IN MY LAB WHO
MOVED ON.
I ALSO WANT TO REALLY THANK
BIRCWH FOR SUPPORTING THIS
RESEARCH.
IT WAS DONE IN COLLABORATION
WITH SEVERAL OF MY BIRCWH
MENTORS INCLUDING CHRIS COE,
PART OF THE MIDUS STUDY TEAM AND
KRISTEN MALECKI.
I WANT TO THANK THE BIRCWH TEAM
AT THE UNIVERSITY OF WISCONSIN
MADISON, SPECIFICALLY TERRY AS
WELL AS ELIZABETH BURNSIDE.
SO THANK YOU SO MUCH FOR YOUR
ATTENTION.
>> IT IS MY GREAT PLEASURE TO
INTRODUCE LANE DYLLA, ASSISTANT
PROFESSOR OF EMERGENCY MEDICINE
AT THE UNIVERSITY OF COLORADO
AND SCHOLAR IN THE UNIVERSITY OF
COLORADO BIRCWH PROGRAM.
DR. DYLLA'S RESEARCH GOALS ARE
TO GAIN A BETTER UNDERSTANDING
OF HYPEROXIA IN ACUTISH ZLS
CHEMIC STROKE AND LOOK FOR
NEUROPROTECTIVE THERAPIES.
CARDIOVASCULAR DISEASE INCLUDING
STROKE IS A LEADING CAUSE OF
MORBIDITY AND MORTALITY
WORLDWIDE ESPECIALLY IN WOMEN.
THROUGH A BETTER UNDERSTANDING
OF THE SEX-BASED DIFFERENCES AND
UNDERLYING MECHANISMS AND
RESPONSE TO POESHT THERAPEUTICS
WE CAN BETTER UNDERSTAND THE
DISEASE ITSELF.
WE CAN BEGIN TO STUDY MORE
TARGETED NEUROPROTECTIVE
THERAPEUTICS TO IMPROVE PATIENT
OUTCOMES FROM CARDIOVASCULAR
DISEASES.
THANK YOU DR. DYLLA.
>> THANK YOU.
I AM INTERESTED IN THE WAY THAT
MEN AND WOMEN DIFFER FROM
UNDERLYING BIOLOGY TO THE WAY
THEY ARE CAR UHHED FOR IN THE
HOSPITAL AND THE PREHOSPITAL
SETTING WHEN IT COMES TO THEIR
STROKES.
TODAY'S TOPIC WILL LOOK AT
GENDER DISPARITIES IN
PREHOSPITAL STROKE CARE.
STROKE IS LEADING CAUSE OF
MORBIDITY.
WOMEN ARE INCREASED LIFE TIME
RISK OF STROKE, SUFFER GREATER
MORBIDITY AND MORTALITY AND ARE
LESS LIKELY TO RECEIVE GUIDELINE
HOSPITAL CARE.
LESS LIKELY TO RECEIVE
DIAGNOSTIC IMAGES AND
THERAPEUTIC INTERVENTIONS.
MOST PATIENTS PRESENT IN THE EMS
AND LITTLE FOCUS IS PLACED ON
THE ROLE OF THIS PROVIDER.
SO WHAT DO WE KNOW OF THE ROLE
OF THE EMS PROVIDER IN STROKE?
EARLY RECOGNITION IS ASSOCIATED
WITH DECREASED TIME TO IMAGING,
INCREASED RATES OF ALTEPLASE
USE, INCREASED ODDS OF SURVIVAL
TO DISCHARGE.
PRENOTECATION OF SUSPECTED
STROKE AND EMERGENT
TRANSPORTATION IMPROVES STROKE.
IN 2019 AMERICAN STROKE
CLARIFIED THE GUIDELINES,
INCLUDING ASSESSMENT FOR STROKE
USING A STROKE SCREENING TOOL.
THEY SHOULD PROVIDE PREARRIVAL
NOTIFICATION WHEN THAT STROKE
SCREENING TOOL IS POSITIVE,
OBTAIN BLOOD GLUCOSE, OBTAIN
12-LEAD ELECTROCARDIOGRAPH
MONITORING, PROSIDE SUPPLEMENT
OXYGEN TO MAINTAIN OXYGEN
SATURATION GREATER THAN 94%.
DOCUMENT LAST KNOWN WELL.
LIMIT THE ON-SCENE TIME TO LESS
THAN 15 MINUTES.
>> WITH THESE RECOMMENDATIONS IN
MIND WE SOUGHT TO CHARACTERIZE
THE CURRENT EMS PRACTICES WITH
PATIENTS WITH SUSPECTED STROKE
AND ASSESS FOR GENDER BASED
DIFFERENCES IN COMPLIANCE WITH
GUIDELINES FOR PREHOSPITAL
STROKE CARE.
WE DID THIS BY A COHORT STUDY BY
NEMSIS.
VERSION 3 PUBLIC RELEASE
DATABASE.
THIS IS A NATIONWIDE DATABASE
SUPPORTED BY THE NATIONAL
HIGHWAY TRAFFIC SAFETY
ADMINISTRATION AND THE
UNIVERSITY OF UTAH.
IT PRESENTED INFORMATION FROM
11,000 EMS AGENCIES IN 47
STATES.
THE POPULATION WE WERE MOST
INTERESTED IN WERE EMS
ACTIVATIONS THE EMS PROVIDER
DOCUMENTED PRIMARY IMPRESSION OF
STROKE AND A GENDER FOR THEIR
PATIENT.
WE HAD A FINAL POPULATION OF
157,981 ENCOUNTERS INVOLVING
WOMEN AND 142 COUNTS INVOLVE I --
144,592 ENCOUNTERS FOR MEN.
THERE WAS LOW NUMBER BLS
RESPONDING ENCOUNTERS.
12.4% ENCOUNTERS INVOLVED MEN
AND 12% INVOLVING MEN WERE
DISPATCHED WITH A BLS, A BASIC
LIFE SUPPORT CREW.
ALS WERE 80% OR HIGHER.
THE MAJORITY ARE COMING FROM THE
SOUTH OR STROKE BELT.
THE MAJORITY OF ENCOUNTERS ARE
IN URBAN SETTING, 81.5% OF WOMEN
COMPARED TO 84% MEN FROM THE
URBAN SETTING.
WE LOOK AT THE EMS CARE PROVIDED
IN THESE STROKE CASES WE SEE
THAT ONLY ABOUT 37 TO 38% OF
CASES HAD A POSITIVE STROKE
SCALE.
THE MOST COMMON STROKE SCALE
USED TO TEST OR SCREEN FOR A
STROKE WAS THE CINCINNATI
PREHOSPITAL STROKE SCALE.
THIS WAS USED IN 61% OF CASES
INVOLVED BOTH MEN AND WOMEN.
THE NEXT MOST COMMON WAS THE
FACE, ARM, SPEECH SCALE.
MOST CASES, 57% TO 58% ARE
TRANSPORTED AS EMERGENT, A SMALL
PORTION ARE TRANSPORTED DIRECTLY
TO A STROKE CENTER.
THE REASON VARIES, WITH A HIGHER
PROPORTION OF MEN BEING
TRANSPORTED TO THEIR DESTINATION
BECAUSE IT WAS A SPECIALTY
CENTER.
19.2% INVOLVED MEN 17.9 COUNTS
INVOLVING WOMEN.
WHEN WE LOOK AT COMPLIANCE WITH
INDIVIDUAL RECOMMENDATIONS WE
SEE A BROAD RANGE OF COMPLIANCE.
THE COMPLIANCE RANGES IS FROM
32% HAVING AN EKG PERFORMED TO
77% HAVE A DISPATCH TIME LESS
THAN 90 SECONDS.
IN SOME AREAS WOMEN DO BETTER
THAN MEN, WHEN IT COMES TO
OBTAINING BLOOD GLUCOSE.
IN MANY OTHER AREAS THERE IS A
SIGNIFICANTLY WORSE PERFORMANCE
IN WOMEN COMPARED TO MEN.
WHEN IT COMES TO A 12-LEAD EKG,
33% OF ENCOUNTERS INVOLVED MEN
HAD A 12-LEAD EKG PERFORMED.
ON SEEN TIME LESS THAN 15
MINUTES, 47% OF WOMEN HAVE ON
SEEN TIME LESS THAN 15%, 48.3%
INVOLVING MEN HAD ON-SCENE TIME
LESS THAN 15%S.
HOW DOES THIS TRANSLATE INTO OUR
PRIMARY OUTCOME?
WHEN WE LOOK AT THE COMPLIANCE
WITH ALL EIGHT AMERICA STROKE
ASSOCIATION GUIDELINES THE
COMPLIANCE IS VERY LOW.
.15% OF ALL ENCOUNTERS HAVE A
DEFECT FREE CARE ARE COMPLETE
WITH ALL METRICS.
IT IS LOWER IN WOMEN, WITH
ONLY .13% OF ENCOUNTERS
INVOLVING WOMEN HAVING DEFECT
FREE CARE COMPARED TO .17% WITH
MEN HAVING DEFECT FREE CARE.
WHEN WE LOOK AT THE COMPOSITE
SCORE OF THE NUMBER OF METRICS
COMPLETED IT ALSO VARIES
THROUGHOUT THE SPECTRUM.
THE VERY LOW END WHERE ONE
METRIC IS PERFORMED, MEN AND
WOMEN DO SIMILARLY WITH WOMEN
DOING SLIGHTLY BETTER.
.6% OF WOMEN HAVE ONE METRIC
PERFORMED .5% OF ENCOUNTERS WITH
MEN HAVING ONE METRIC PERFORMED.
WE LOOK AT THE MIDDLE.
AGAIN, VERY SIMILAR, 24.5%
OVERALL HAVE FOUR METRICS
PERFORMED, 24.3% SO SLIGHTLY
LOWER IN WOMEN HAVE FOUR METRICS
PERFORMED COMPARED TO MEN WHO
HAVE 24.6% OF ENCOUNTERS HAVE
FOUR METRICS PERFORMED.
WE LOOK AT HIGHER NUMBER OF
METRICS PERFORMED, AGAIN, MEN DO
BETTER.
WHEN IT COMES TO SEVEN OUT OF
THE EIGHT METRICS, 8.2% OF
ENCOUNTERS INVOLVED WOMEN HAVE
7-8, WHERE AS WOMEN HAVE LESS
ENCOUNTERS.
>> WE COMPARED DEFECT FREE CARE
IN MEN AND WOMEN.
.84 WAS THE UNADJUSTED OR WITH
THE CONFIDENCE INTERVAL OF
OF .73- .97.
THE GEOGRAPHICAL REGION, URBAN
VERSUS RURAL, WE HAD AN ADJUSTED
ODDS RATIO OF .81 WITH A 95%
CONFIDENCE INTERVAL OF .7
TO .94.
WILL ARE .81 TIMES THE ODDS OF
MEN FOR HAVING DEFECT FREE CARE.
GIVEN THAT THREE OF OUR
VARIABLES PRENOTIFICATION, EKG
PERFORMANCE AND OXYGEN NATION
WERE MISSING IN ABOUT 30% OR
MORE OF CASES, WE ALSO DID TWO
OTHER SEPARATE ANALYSIS WHERE WE
COUNTED THE MISSING VARIABLES AS
NOT PERFORMED VERSUS PERFORMED.
WE COUNT THE MISSING VARIABLES
AS NOT PERFORMED, SO THE WORST
CASE SCENARIO.
THE ODDS OF HAVING DEFECT FREE
CARE IN WOMEN WAS .73 TIMES THAT
OF MEN FOR ADJUSTED ODDS.
WHEN WE LOOK AT THE BEST CASE
SCENARIO WITH DEFECT FREE CARE
WITH A MISSING VARIABLES COUNTED
AS BEING PERFORMED, WE SAID OUR
ADJUSTED ODDS OF DEFECT FREE
CARE IN WOMEN WAS .85 TIMES THAT
IN MEN WITH 95% CONFIDENCE
INTERVAL .82 TO .89.
WE NEXT LOOKED AT OUR SECONDARY
OUTCOME, THE COMPOSITE SCORE.
AFTER FINDING THE PROPORTIONAL
ODDS MODEL VIOLATED THE
PROPORTIONAL ODDS ASSUMPTION,
THE DIFFERENCE BETWEEN MEN AND
WOMEN ACROSS THE LEVELS IS NOT
CONSTANT.
THE PARTIAL PROPORTIONAL ODDS
MODEL ALLOWS YOU TO HAVE
VARIATION BETWEEN MEN AND WOMEN.
IT COMPARES ANYTHINGLESS THAN 7
OR ABOVE 7 OR LESS THAN 8 VERSUS
8.
WE SEE AT THE HIGHER LEVEL, A
COMPOSITE SCORE OF 8 METRICS,
WOMEN ARE AT LOWER ODDS COMPARED
TO MEN SO ODDS RATIO IS .77 WITH
A CONFIDENCE INTERVAL OF .64
TO .93.
HOWEVER, WHEN YOU GET TO LOWER
COMPOSITE SCORES, SO LESS OF THE
METRICS BEING PERFORMED, THIS
VARIATION BETWEEN MEN AND WOMEN
IS NO LONGER SIGNIFICANT.
A COMPOSITE SCORE OF TWO OR LESS
COMPARED TO TWO OR ABOVE, .89
THAT CROSSES ONE AND IS NOT
SIGNIFICANT OF THE CONFIDENCE
INTERVAL OF .59 TO 1.07.
WHAT YOU CAN TAKE AWAY FROM THIS
EVEN THOUGH IT IS A LITTLE
COMPLICATED MODEL, REALLY, THE
NUMBER OF METRICS, THERE IS
VARIANCE BETWEEN MEN AND WOMEN
IN HOW MANY METRICS ARE BEING
PERFORMED AND IT IS NOT AN ALL
OR NONE DIFFERENCE.
>> THE STUDY HAS IMPORTANT
LIMITATIONS.
THE DIFFERENCES ARE SMALL IN
TERMS OF THE GUIDELINE
CONCORDANCE WITH INDIVIDUAL
METRICS AND OVERALL BETWEEN MEN
AND WOMEN.
WHAT I WOULD ARGUE IS WHILE
THESE DIFFERENCES ARE SMALL AND
STATISTICALLY SIGNIFICANCE GIVEN
THE SMALL SAMPLE SIZE, THEY MAY
HAVE CLINICAL SIGNIFICANCE AS
WELL GIVEN THAT AS YOU START
SOMETHING IN THE PREHOSPITAL
SETTING THAT OFTEN CONTINUES
THROUGH THEIR IN-PATIENT STAY AS
WELL.
FURTHER STUDIES ARE NEEDED TO
TRAINS LATE THE DIFFERENCES WE
SEE WITH CLINICAL OUTCOMES.
THE SECOND LIMITATION IS THIS IS
A CONVENIENT SAMPLE WITH MISSING
DATA FOR SOME VARIABLES.
WE ATTEMPTED TO LIMIT THE BIAS.
WE COUNTED THE MISSING AS BEING
PERFORMED OR NOT PERFORMED AND
THEY ALL HAD SIMILAR OUTCOMES.
THIS IS ONE OF THE LIMITATIONS
OF ANY LARGE DATASET.
BLS PROVIDERS MAY NOT BE ABLE TO
PERFORM ALL METRICS.
THIS REPRESENTS ONLY 12% OF EMS
ENCOUNTERS.
WHEN WE EXCLUDE BLS PROVIDERS,
THE DIFFERENCES DON'T SEEM TO
CHANGE.
WHAT CAN YOU TAKE HOME FROM THIS
PRESENTATION?
THE FIRST AND BIGGEST POINT IS
PREHOSPITAL STROKE CARE VARIES
BY GENDER WITH OVERALL LOW
COMPLIANCE WITH ALL THE AMERICAN
STROKE ASSOCIATION GUIDELINES.
WOMEN ARE 19% LESS LIKELY TO
RECEIVE CARE THAT IS FULLY
COMPLIANT WITH THE AMERICAN
STROKE ASSOCIATION GUIDELINES.
SO WHERE DO WE GO FROM HERE?
WE KNOW BASED ON THIS
INFORMATION THAT THERE PROBABLY
ARE AT LEAST MINOR DIFFERENCES
IN PREHOSPITAL CARE FOR WOMEN
VERSUS MEN.
HOWEVER WE NEED FURTHER STUDIES
TO DETERMINE IF GENDER BASED
DIFFERENCES IN PREHOSPITAL CARE
TRANSLATE TO DIFFERENCES IN
PATIENT OUTCOMES.
SPECIFICALLY TO IDENTIFY WHICH
GUIDELINES ARE MOST IMPORTANT
FOR PATIENT OUTCOMES.
IF WE DO THIS, IT IS POSSIBLE WE
CAN DESIGN TARGETED EDUCATIONAL
INTERVENTIONS TO INCREASE
INTERVENTIONS WITH THOSE SELECT
ASA RECOMMENDATIONS TO IMPROVE
OUTCOMES FOR BOTH MEN AND WOMEN.
WE NEED TO UNDERSTAND WHY THESE
GENDER BASED DISPARITIES IN CARE
EXIST.
ARE THERE DIFFERENT
PRESENTATIONS FOR STROKE IN MEN
AND WOMEN OR SOME OTHER BARRIER
TO CARE WE ARE NOT ACCOUNTING
FOR IN THIS STUDY?
WITH THAT IN MIND, WE CAN PLACE
EMPHASIS ON QUALITY OF CARE IN
THE PREHOSPITAL AND HOSPITAL
SETTING FOR BOTH MEN AND WOMEN.
AND WITH THAT, I WOULD LIKE TO
THANK THE OFFICE OF RESEARCH FOR
WOMEN'S HEALTH, MY MENTORS FOR
ALL THEIR GUIDANCE AS I WORKED
THROUGH BEGINNING TO UNDERSTAND
MORE ABOUT THE GENDER AND
SEX-BASED DIFFERENCES IN STROKE
AND THE FUNDING THAT AFFORDS ME
THE TIME TO DO THIS, THE BIRCWH
K12 AWARD, AMERICAN HEART
ASSOCIATION CAREER AWARD AND
LUDEMAN FAMILY CENTER FOR
WOMEN'S HEALTH RESEARCH COVID-19
SUPPLEMENT.
>> MARIA GIRALDO SHE OBTAINED A
BACHELOR DEGREE IN BIOLOGY AND
ENVIRONMENTAL EDUCATION.
DR. GIRALDO THEN CONTINUED ON
WITH HER GRADUATE STUDIES AND
OBTAINED A MASTERS AND PH.D.
DEGREE IN BIOMEDICAL SCIENCES.
FOLLOWING THIS, MARIA BECAME A
POST DOCTORAL FELLOW UNIVERSITY
OF TEXAS MEDICAL BRANCH.
DURING HER POST DOCTORAL
FELLOWSHIP SHE PUBLISHED A PAPER
ON THE PATHOGENSIS OF ZIKA.
SHE BECAME A BIRCWH SCHOLAR IN
2020 AND IS CURRENTLY WORKING
UNDER THE MENTORSHIP OF DR.
RAJSBAUM AND DR. SHI.
HER MAIN INTEREST IS VIRAL
INFECTION IN REP LIGCATION AND
THE REP PLICATION OF VIRUSS SUCH
AS ZIKA AND THE ROLE OF ESPNU
-- ROLE OF UBIQUITINATION.
>> ZIKA VIRUS CONTINUES TO
CIRCUMSTANCE LAUL I LATE IN
TROPICAL AND SUBTROPICAL REGIONS
TRANSMITTED BY MOSQUITOS AND
THROUGH SEXUAL CONTACT.
IT CAN INFECT PREGNANT WOMEN AND
LEAD TO MICROCEPHALY AND SEVERE
NEUROLOGIC COMPLICATIONS IN THE
FETUS.
THERE IS NO VACCINE ORFECTIVE
TREATMENT.
ALTHOUGH ZIKA IS CLOSELY RELATED
TO OTHER VIRUSS THAT CAUSE
DENGUE AND WEST NILE VIRUS, ZIKA
CAN CAUSE NEUROLOGICAL
DISORDERS.
IN OUR LAB WE ARE INTERESTED IN
HOW DIFFERENT VIRUSS USE THE
TRANSLATION AND REPLICATION
CYCLE AND WEST NILE USES CELL
MACHINERY TO ENHANCE REPLICATION
REPLICATION.
WHY DOES ZIKA LIKE TO REPLICATE
ON SKPREFBLGS AND TISSUES.
VIRUS NEEDS TO REPLICATE AND
CELLS HAVE AN IMPORTANT QUALITY
THAT REQUIRES DIFFERENT
[ INAUDIBLE ]
ENZYME 1, ENZYME 2, ENZYME 3,
TRANSFERS AND MARKS THE PROTEINS
FOR DIFFERENCE CELLULAR
ACTIVITY.
THIS PLAYS AN IMPORTANT ROLE IN
PROTECTING THE HOST FROM VIRAL
INFECTION, ACTIVATING AENGT
VIRAL FACTORS.
HOWEVER, THE VIRUS PROTECTS THE
HOST TO ACTIVATE ANTI-VIRAL
SIGNALLING FACTORS.
[ INAUDIBLE ]
WE PROVIDE SAMPLES INFECTED WITH
ZIKA.
THIS ANALYSIS IDENTIFIED TWO --
THAT ARE K38 THAT ARE CONCERNED
AMONG SEVERAL VIRUSS AND K31
THAT IS NOT IN ZIKA VIRUS.
[ INAUDIBLE ]
WITH 180 MOLECULES AND HAVE
VIRION SURFACE OF 180 MOLECULES.
[ INAUDIBLE ]
WHAT IS THE FUNCTION OF E-K38
AND E-K381 TO CHANGE?
[ INAUDIBLE ]
WE CONFIRM THE REDUCTION OF --
ON K38 AND K281 VIRUS.
COMPARING BOTH AND BOTH K38 AND
K31 WERE HIGHLY IN PLACENTA
CELLS.
WE FOUND THAT THE K38 MUTANT
INFECTION WERE SIGNIFICANTLY
[ INAUDIBLE ]
BUT THE K281 WAS NO SIGNIFICANT
REDUCED.
[ INAUDIBLE ]
PLAYS AND IMPORTANT ROLE.
THE MOSQUITO BITES THE HUMAN,
THE VIRUS INFECTS DIFFERENT
CELLS INSIDE THE CELL THE VIRUS
IS [ INAUDIBLE ]
THE VIRUS IS LEASED WITH -- AND
TOGETHER OTHER FACTORS CREATE --
ENVIRONMENT FOR ATTACHMENT TO
THE CELLS AND CONSEQUENTLY
IMPROVE THE REPLICATION IN A
SPECIFIC CELL AND TISSUES.
THOSE TISSUES THAT ARE
EXPRESSING HIGH LEVELS OF
[ INAUDIBLE ]
ARE GOING CONTINUE WITH THE
REPLICATION.
BUT THOSE [ INAUDIBLE ]
ARE GOING REPLICATE NORMAL.
AND CONTINUE THE CYCLE AND GO TO
DIFFERENT TISSUES AND CELLS.
IN THE CASE OF THE K281
INFECTION, THE INFECTION WAS
SIGNIFICANTLY SEEN IN THE CELLS
BUT NOT IN ANY CELLS OF INFECTED
ANIMALS.
REDUCTION OF FUSION AND
UNCOATING IN PLA SENTAL CELLS.
TOGETHER THIS DATA LED US TO THE
UBIQUITINATION ON E-K281 RESIDUE
PROVIDED ZIKA VIRUS ABILITY TO
REPLICATE EFFICIENTLY IN PLA
SENTAL TISSUES DURING PREGNANCY.
IT IS POSSIBLE [ INAUDIBLE ]
THEN WE CAN HAVE OUR CRITICAL
QUESTION, WHY?
DOES ZIKA DEVELOPMENT UNIQUE
CHARACTERISTICS?
TO ANSWER THIS QUESTION, WE
ESTABLISHED A PREGNANCY MODEL IN
A 129 MICE MALE AND FEMALE WERE
PUT TOGETHER AND 10.5 IS THE
TIME OF IMPLANTATION IN THE
FEMALES WERE INFECTED AND K281
MUTANT VIRUS AND THEN THEY 18.5
THE MOTHERS WERE UETHANIZED AND
HARVEST THE TISSUES AND FETUS
FOR COMPARISON.
AND WE PROCESSED FOR VIRAL TITER
AND SEQUENCE.
HERE YOU CAN OBSERVE THAT
INFECTED WITH THE K281 HAVE LESS
[ INAUDIBLE ]
COMPARING THESE RESULTS WITH OUR
PREVIOUS RESULTS WERE K281 VIRUS
HAD THE SAME BEHAVIOR AS
[ INAUDIBLE ]
BUT HERE WE OBSERVED THE EFFECTS
OF IN K281 ARE RESTRICTED TO
BRAINS HERE.
YOU CAN REPLICATE THE PATHOLOGY
IN FETUS INDICATING CAN
INFECTION WITH K281 RESULTED IN
NOT PRESENT OF -- AS COMPARED
WITH MULTIINFECTED FETUS.
THE MOST PROM NANT FETAL
ABNORMALITY WAS OBSERVED IN
FETUS INFECTED WITH 47% OF
REDUCTION IN FETAL SIZE.
ALSO THE VIRUS IN PLACENTA WERE
SIGNIFICANTLY LOWER THAN --
[ INAUDIBLE ]
THE PLACENTA WAS NOT
SIGNIFICANTLY DIFFERENT, BOTH
VIRUSS REPLICATE AND DISSEMINATE
SIMILARLY.
ON THE OTHER HAND, TO GAIN MORE
INFORMATION REGARDING HOW
[ INAUDIBLE ]
ON K-281 MAY AFFECT THE RESPONSE
OF PLACENTA, WE USE A DNA
SEQUENCING APPROACH.
INDUCING DOWN REGULATION OF
GENES ARE NOT KNOWN TO BE WITH
LIPID METABOLISM.
OUR INITIATE ANALYSIS IDENTIFIED
CHANGES IN EXPRESSIONS.
THERE WAS SIMILARLY BETWEEN ZIKA
AND K281 VIRUSES, BUT SOME OF
THE GENES IN PLACENTA INFECTED
[ INAUDIBLE ]
JUST IN PLACENTA AFFECTED WITH
MULTIVIRUS THAT ARE IMPORTANT AS
I MENTIONED BEFORE.
IDENTIFY THOSE CHAINS TO BE
IMPORTANT IN PLACENTA
DEVELOPMENT, FOR THE BRAIN AND
RETINA.
ALSO WE FOUND THAT PREVIOUS
REPORT THAT THE ZIKA MODIFIED
THE HOST METABOLISM.
THESE RESULTS HELP US TO
DETERMINE WHETHER THESE GENES
ARE INVOLVED IN LIPID ME TAL
LICHL AND IF THIS REQUIRES
[ INAUDIBLE ]
PROTEIN.
[ INAUDIBLE ]
WHICH WERE PREVIOUSLY KNOWN TO
BE ASSOCIATED WITH MICROCEPHALY.
WE OBSERVED A SIGNIFICANT
REDUCTION AND EXPRESSION OF THE
[ INAUDIBLE ]
INFECTED WITH WEST NILE COMPARED
WITH THE MUTANT VIRUS.
IN CONCLUSION, WE CAN SAY THAT
ZIKA AND K281 REPLICATE AND
DISSE
DISSEMINATE SIMILARLY IN ADULT
MOTHERS.
ZIKA INFECTION CAUSES LESS
PATHOLOGY IN THE INFECTED FETUS
AND PROMOTES A REDUCED HOST
RESPONSE THAT IS ASSOCIATED WITH
DAMAGE TO THE EMBRYO.
OUR FUTURE DIRECTION IS ENHANCE
KNOWLEDGE OF ZIKA REPLICATION
MECHANISMS DETERMINE THE
FUNCTION OF UBIQUITINATION IN
ZIKA REPLICATION DURING
PREGNANCY AND DETERMINE THE ROLE
OF TRIM 7 IN ZIKA REPLICATION
AND HOW THESE TRIM 7 AS A
PROVIRAL FAK FORFOR ZIKA DURING
PREGNANCY.
THIS IS NEEDED TO DEVELOP NOEFL
ANTI-VIRAL THERAPIES AGAINST
ZIKA VIRUS.
I WANT TO GIVE A SPECIAL THANKS
TO ALL THE PEOPLE THAT ARE
INVOLVED IN THIS PROJECT.
A SPECIAL THINGS TO THE PROGRAM
FOR THAT PART AND THE FUNDING
AND FOR THE SUPPORT AND THANK
YOU FOR YOUR ATTENTION.
THANK YOU SO MUCH.
>> THAT WAS A LOT OF SCIENCE.
SO THANK YOU TO THE BIRCWH
SCHOLARS WHO GAVE THEIR TALKS.
WE DO HAVE SOME QUESTIONS
WAITING IN THE CHAT BOX.
WE HAVE ABOUT 10 MINUTES FOR THE
Q&A.
THE FIRST QUESTION IS DIRECTED
AT DR. SIMCOX.
DR. SIMCOX, YOU LOOKED AT THE
RELATIONSHIP BETWEEN BLOOD
PRESSURE AND LIPIDS.
WHAT ABOUT OBESITY AS A
CONFOUNDER?
>> YEAH.
WE ENDED UP INTERPRETING OBESITY
AS A CO-VARIANT, HOWEVER, WE
LOOKED AT IT AS AN INDEPENDENT
VARIABLE.
WHAT WAS REALLY INTERESTING TO
ME IS LIPIDS THAT WERE
ASSOCIATED WITH OBESITY WERE
COMPLETELY DIFFERENT BETWEEN
CAUCASIAN AND AFRICAN AMERICAN
PARTICIPANTS.
I THINK THIS HIGHLIGHTS THE
DIFFICULTIES WE FACED IN A LOT
OF THE DATASETS THAT WHAT WE
HAVE FOR HISTORIC DATA DID NOT
HOLD TRUE INCLUDING HDL AND LDL
CHOLESTEROL AND TRIGLIS RIDES
WERE NOT ASSOCIATED WITH OBESITY
IN AFRICAN AMERICAN
PARTICIPANTS.
WE STARTED WITH BLOOD PRESSURE
BECAUSE IT HAD THE LOWEST NUMBER
OF LIPIDS ASSOCIATED.
AND WE HAVE DATA ON
CARDIOVASCULAR DISEASE ON
MORTALITY SINCE THIS IS A
LONGITUDINAL STUDY.
>> THANK YOU.
AS WE ARE WAITING FOR OTHER
QUESTIONS TO COME IN, DR. SIM
SKOKS, HAVE YOU --
>> THAT IS A REALLY GREAT
QUESTION.
SO WE HAVE STARTED USING
DIFFERENT EO6 ANTIBODIES TO LOOK
AT OXIDIZED LIPIDS.
WHAT I WILL SAY IS THEY CLEARLY
HAVE A STRONG PREDICTIVE POWER
FOR BLOOD PRESSURE, HYPER
HYPERGLYCEMIA.
I THINK WE ARE EXCITED TO
CONTINUING TO PURSUE THAT AND IT
MAKES SENSE WE ARE SEEING
DIFFERENCES BECAUSE WE SEE
DIFFERENCE IN ARACHIDONIC ACID
AND -- ACID.
TO FINISH AND WE WILL GO TO THE
NEXT TWO SCHOLARS.
DR. SIMCOX, DO YOU EXCEPT THESE
CORRELATIONS TO CHANGE WITH AGE?
>> MIDUS IS A LONGITUDINAL STUDY
SO WE HAVE A LARGE AGE RANGE AND
PARTICIPANTS WHO COME BACK.
THESE LIPIDS DO CHANGE WITH AGE
AND, IN FACT, ACTUALLY
ARACHIDONIC ACID CONTAINED
LIPIDS INCREASE IN AFRICAN
AMERICAN WITH AGE AND
ASSOCIATION WITH METABOLIC
DISEASE.
GOOD.
THANK YOU.
QUESTION FOR DR. DYLLA.
CLEARLY YOUR RESEARCH HAS SHOWN
SEX DIFFERENCES IN TERMS OF
STROKE CARE, PREHOSPITALIZATION.
IT HAS POLICY IMPLICATIONS.
NOW, YOU ARE OBVIOUSLY A YOUNG
BIRCWH SCHOLAR.
WHAT WOULD BE YOUR FUTURE PLANS?
YOU MENTIONED TARGETED
EDUCATION.
WOULD YOU WANT TO COMMENT
FURTHER ON THINGS YOU MAY DO OR
OTHERS MAY DO SINCE YOU ARE ALSO
ASSOCIATED WITH THE AMERICAN
HEART ASSOCIATION, PLEASE?
>> SO.
THAT IS A GOOD QUESTION.
SO THE AMERICAN STROKE
ASSOCIATION AND AMERICAN HEART
ASSOCIATION HAS COME OUT WITH
THESE RECOMMENDATIONS, THE
PROBLEM IS THEY ARE --
[ INAUDIBLE ]
AND THESE RECOMMENDATIONS
HAVEN'T CHANGED OVER TIME.
BUT EMS IS ALSO A GROUP THAT
DOESN'T ALWAYS OBTAIN TARGETED
EDUCATION REGULARLY.
THE FIRST STEP IS REALLY TO LOOK
AT WHICH ARE THE KEY METRICS?
WE PUT A LOT ON OUR EMS
PROVIDERS AND HAVE TO RECOGNIZE
THE WHOLE HOST OF PRESENTATIONS
IN A VERY SHORT PERIOD OF TIME.
WE NEED TO KNOW WHAT OF THE
EIGHT METRICS ARE REALLY
IMPORTANT SO WE CAN TARGET THEM
AND SAY THIS IS THE STANDARD WE
HAVE TO HOLD YOU TO IN THIS
METRIC AND EDUCATE THEM IN THOSE
THINGS.
>> THANK YOU.
THAT IS A GOOD APPROACH.
I HAVE A QUESTION FOR DR.
GIRALDO ON ZIKA.
YOU WERE THE FIRST AUTHOR ABOUT
PATHOGENESIS OF ZIKA.
AS EMERGING INFECTIONS IN YOUNG
RESEARCHERS, DO YOU HAVE TIPS
FOR COLLEAGUES IN HOW YOU
CLEARLY HAVE TO HAVE MENTORS AND
HAVE LEADERS WITH YOU, BUT ANY
TIPS FOR YOUNG INVESTIGATORS WHO
ARE INTERESTED IN EMERGING
INFECTIONS AND STUDYING THEM.
PLEASE.
>> HELLO TO EVERYONE.
YES.
I THINK YOU NEED TO PROCEED AND
FIND MENTORS AND IF YOU YOU HAVE
A DREAM, MAYBE FIND A NEW
RESEARCH.
FOLLOW THE PATH AND FINDING THE
NEW RESEARCH THAT ARE ALSO
IMPORTANT IN YOUR CAREER.
IN MY CASE -- TELL ME TO FOLLOW
MY PATH.
HE WAS ALSO A JUNIOR
INVESTIGATOR AT THIS COLLEGE.
AND THESE WONDERFUL FINDINGS IN
ZIKA VIRUS AND BUT THE MOST
IMPORTANT THING IS FOLLOW.
FOLLOW EVERYTHING THAT YOU WANT
AND THE CORRECT MENTOR.
>> THANK YOU.
IF I COULD HAVE THE SLIDES NOW,
I WANTED TO JUST REENFORCE SOME
POINTS.
THE OTHER COMMENT I WANT TO MAKE
TO TO OUR AUDIENCE, THIS PLENARY
SESSION UNTIL 1:00 P.M. IS BEING
VIDEOCAST ON THE NIH SYSTEM
WHICH WILL PERMANENTLY ARCHIVE
IT.
FOR THOSE OF YOU WHO MAY HAVE
TUNED IN LATE BECAUSE OF
REGISTRATION, YOU CAN ACCESS
LATER THIS WEEK WITH CAPTIONING
AND YOU CAN SHARE THE LINK ONCE
IT GOES INTO THE ARCHIVE SYSTEM.
I WILL SHARE IT WITH ALL THE
BIRCWH PIs.
THIS IS OPEN WORLDWIDE AND WE
INVITE THOSE OF YOU TO ACCESS
THIS AND SHARE IT FURTHER.
THESE ARE THREE IMPORTANT AREAS
OF SCIENCE AND WE ARE VERY, VERY
PROUD OF OUR THREE PODIUM
SPEAKERS, THE BIRCWH SCHOLARS,
ALL 56 BIRCWH SCHOLARS.
SO THE SLIDE IS THERE IN TERMS
OF THE AFTERNOON.
THE E-POSTER SESSION AGAIN
TOTALLY VIRTUAL, STARTS AT 1:30
TO 3:00.
THE E-POSTERS ARE OPEN, THEY
HAVE BEEN OPEN SINCE 8:00 A.M.
TODAY.
BUT THERE IS A WAY TO
COMMUNICATE WITH THE SCHOLARS SO
THAT IT CAN AT LEAST SIMULATE
WHAT IT WOULD BE IF WE WERE IN
THE ATRIUM SECTION OF THE
CONFERENCE CENTER ON THE MAIN
NIH CAMPUS WHICH EVENTUALLY WE
WILL BE BACK TO SOON.
SO UNLESS I SEE ANY NEW
QUESTIONS HERE, I WOULD LIKE TO
GET PREPARED TO TURN IT OIFR TO
MY COLLEAGUE, DR. XENIA TIGNO
WHO WOULD INTRODUCE CLAIRE POM
ROY.
>> THANK YOU, DR. BEGG.
GOOD MORNING, MY NAME IS XENIA
TIGNO, ASSOCIATE DIRECTOR FOR
CAREERS AT THE OFFICE FOR
RESEARCH ON WOMEN'S HEALTH AND
TODAY I HAVE THE EXTREME
PLEASURE OF INTRODUCING OUR
LEGACY OF LEADERSHIP LECTURER
CLAIRE POM ROYER.
LEGACY OF LEADERSHIP LECTURE WAS
CREATED AT THE 20th ANNIVERSARY
OF BIRCWH LAST YEAR TO HONOR
WOMEN LEADERS IN HEALTH AND
SCIENCE.
OUR SPEAKER WAS DRZ BURK OF
EMORY.
WE ARE PRIVILEGED THIS YEAR
BECAUSE WE HAVE DR. CLAIRE POM
ROY.
PRESIDENT AND CEO OF THE ALBERT
AND MARY LASKER FOUNDATION.
THE MISSION OF THE LASKER
FOUNDATION IS TO IMPROVE HEALTH
BY ACCELERATING SUPPORT FOR
MEDICAL RESEARCH FOR RECOGNITION
OF RESEARCH EXCELLENCE ADVOCACY
AND EDUCATION.
DR. POM ROY OBTAINED HER
UNDERGRAD DEGREE IN BIOLOGY WITH
HONORS AND MEDICAL DOCTORATE
FROM THE UNIVERSITY OF MICHIGAN.
FROM THERE, SHE MOVED TO THE
UNIVERSITY OF MN -- MINNESOTA
TO DO INTERNSHIP IN INFECTIOUS
DISEASES.
AT THE UNIVERSITY OF MINNESOTA
SHE BECAME CHIEF RESIDENT AND
ROSE TO BE AN ASSOCIATE
PROFESSOR.
DR. POMEROY EARNED AND MBA.
IN 2003 DR. POMEROY JOINED
PROFESSOR OF MICROBIOLOGY AND
IMMUNOLOGY AT UC DAVIS.
SHE TOOK ON THE REINS IN 2005 OF
THE UC DAVIS HEALTH SYSTEM, VICE
CHANCELLOR FOR HUMAN HEALTH
RESEARCH AS WELL AS DEANSHIP OF
THE SCHOOL OF MEDICINE.
IN 2013 SHE BECAME PRESIDENT OF
THE LASKER FOUNDATION AND
CONTINUES TO SERVE IN THAT
CAPACITY.
AN SPERPT IN INFECTIOUS
DISEASES, SHE IS A LONG TIME
ADVOCATE FOR PATIENTS FOR THE
UNDERSERVED AND THOSE WITH
HIV-AIDS.
SHE SUPPORTS ONGOING INVESTMENT
IN FULL RESEARCH, BUT HER
SPECIAL INTEREST IN PUBLIC
HEALTH, HEALTH CARE POLICY AND
THE FOCUS ON THE IMPORTANCE OF
SOCIAL DETERMINANTS OF HEALTH.
SHE PUBLISHED MORE THAN 100
ARTICLES AND BOOK CHAPTERS AND
EDITED THREE BOOKS.
DR. POMEROY SERVES ON THE BOARD
OF TRUSTEES FOR MOREHOUSE SCHOOL
OF MEDICINE, DEAN TO INDIANA
PUBLIC HEALTH, EXTERNAL ADVISORY
OF THE BIRCWH AT EX-MORY AND THE
BOARD OF DIRECTORS FOR THE
SCIENCE PHILANTHROPY ALLIANCE.
SHE CHAIRS THE CENTER FOR WOMEN
IN ACADEMIC MEDICINE IN SCIENCE
OR CUMs.
DR. POMEROY HAS RECEIVED
COUNTLESS HONORS, INCLUDING THE
DISTINGUISHED LEADERSHIP AWARD
FROM HUNTINGTON'S SOCIETY OF
AMERICA, THE PRESIDENT'S AWARD
FROM SACRAMENTO, THE HISPANIC
HEALTH LEADERSHIP AWARD FROM
NATIONAL HISPANIC HEALTH
FOUNDATION AND AN AWARD FOR
INNOVATION IN HEALTH AND SOCIAL
RESPONSIBILITY FROM THE
BRAZILIAN RESEARCH NETWORK.
SHE SERVED AS GRANT REVIEWER FOR
NIH.
SHE WAS INDUCTED INTO THE
NATIONAL ACADEMY OF MEDICINE AND
RECEIVED AN HONORARY DOCTORATE
IN 2016.
ON BEHALF OF ORWH, PLEASE JOIN
ME IN WELCOMING DR. CLAIRE
POMEROY, A RESILIENT AND
IMPACTFUL LEADER WHO DESERVED TO
BE EMULATED FOR ALL SEASONS.
DR. POMEROY.
>> THANK YOU, DR. TIGNO.
IT IS GREAT TO BE BACK AT THE
ANNUAL BIRCWH MEETING.
I'M HONORED TO DELIVER THE
LEGACY OF LEADERSHIP ADDRESS AND
SHARE WHAT I HAVE LEARNED IN MY
LIFE AND PROFESSIONAL CAREER.
MY CENTRAL TENET IS THE CORE
VALUES WE HOLD MUST BE THE
FOUNDATION UPON WHICH WE RELY
AND WE RESPOND TO THE MULTIPLE
OFTEN DAUNTING CHALLENGES
CURRENTLY FACING THE WORLD.
MY TAKE HOME MESSAGE IS A CALL
TO ACTION BASED ON OUR CORE
VALUES.
A CALL TO SEIZE THIS MOMENT TO
ADVANCE HEALTH EQUITY.
THE INSIGHTS I WILL CONVEY TODAY
I LEARNED FROM THE EXPERIENCES
OF THIS YOUNG GIRL.
GROWING UP IN A HOME FILLED WITH
ABUSE, SHE RAN INTO THE NIGHT,
INTO THE UNKNOWN, UNCERTAIN OF
WHERE SHE WOULD SLEEP, WHERE SHE
WOULD GET FOOD TO EAT, HOW SHE
WOULD SURVIVE.
FORTUNATELY, SHE FOUND STRANGERS
WHO HELPED HER, OFFERING A
QUARTER TO CALL THE LOCAL TEEN
SHELTER, PROVIDING A SAFE PLACE
TO STAY THAT FIRST NIGHT.
AND EVENTUALLY PLACING HER IN
FOSTER CARE.
HER LIFE WAS SAVED BY TWO
POWERFUL FORCES.
GOOD PEOPLE WHO CARED AND
SYSTEMS DESIGNED WITH BOTH
EXPERTISE AND COMPASSION.
NOW, AS YOU MAY HAVE SURMISED, I
WAS THAT GIRL.
AND THOSE EXPERIENCES HAVE
SHAPED ALL THAT I HAVE DONE IN
MY CAREER AS A PHYSICIAN,
RESEARCHER, AND HEALTH CARE
LEADER.
TODAY WE FACE SUFFERING AND FEAR
ON A GLOBAL SCALE WITH MORE THAN
5 MILLION DEATHS FROM COVID
WORLDWIDE, INCLUDING MORE THAN
750,000 IN THE UNITED STATES.
SOCIETY LOOKS TO US AS
SCIENTISTS AND CLINICIANS AND
RESEARCHERS FOR THE ANSWERS.
ALL OF US HAVE EXPERIENCED THE
IMPACT OF COVID ON A PERSONAL
LEVEL WITH SOME OF US SUFFERING
ILLNESS OURSELVES AND FOR TOO
MANY THE DEVASTATING LOSSES OF
LOVED ONES.
AND ON A PROFESSIONAL BASIS,
MANY OF US SAW OUR LABS SHUT
DOWN, RESEARCH PROJECTS DELAYED
AND THE IMPACT PARTICULARLY
DELETERIOUS FOR WOMEN
SCIENTISTS, ESPECIALLY THOSE
WITH YOUNG CHILDREN.
IN THIS PANDEMIC IS NOT
HAPPENING IN ISOLATION.
IT COMBINES WITH OTHER
REALITIES, ESPECIALLY DEADLY
RACIAL INJUSTICES TO CAUSE
FURTHER PAIN CALLING ON US TO
RESPOND WITH NEW URGENCY AND
PASSION.
IN THIS MOMENT, IT IS IMPERATIVE
TO REMEMBER THAT THERE ARE GOOD
PEOPLE.
THERE ARE COMPASSIONATE SYSTEMS
OF CARE THAT PROVIDE HOPE.
TODAY I URGE THAT WE ALL THINK
ABOUT HOW WE CAN BE A SOURCE OF
THAT HOPE AND A PART OF THE
SOLUTION.
EVERYONE HERE IS A LEADER.
AND AS CLYDE YANCY, DEAN AT
NORTHWESTERN SCHOOL OF MEDICINE
ARTICULATED, LEADERSHIP DEEPLY
MATTERS.
MEDICINE IS THE NOBLE
PROFESSION, BUT NOW PERHAPS MORE
THAN EVER BEFORE THAT NOBILITY
WILL BE PUT TO THE TEST.
AS ONE PHYSICIAN BLOGGED, WHEN
THE FOG OF BATTLE CLEARS WE HAVE
TO ASK OURSELVES HOW A HISTORY
WILL REMEMBER US, A PROFESSION
THAT ABANDONED MORAL COME
COMPASS OR RESOLUTE.
MANAGEMENT IS DOING THINGS
RIGHT, LEADERSHIP IS DOING THE
RIGHT THINGS.
NOW IS THE TIME FOR EACH OF US
TO RESILIENTLY RISE TO THE
CHALLENGE AND EMBRACE OUR
LEADERSHIP ROLES.
THIS CAN, OF COURSE, BE
DIFFICULT GIVING THE
PANDEMIC-INDUCED DEMANDS ON OUR
TIME FROM INCREASED PATIENT
LOADS TO LEARNING TO DELIVER
CARE IN NEW WAYS LIKE
TELEMEDICINE, TO ADDRESS
PATIENTS' MENTAL HEALTH DUE TO
COVID AND STRUGGLE COLLEAGUES.
THE COVID-19 PANDEMIC AND RACIAL
INJUSTICE HAVE LAID BARE THE
INEQUITIES IN OUR SYSTEM.
WE KNOW THESE INEQUITIES ARE
LONG STANDING FOR TOO MANY.
CLINICAL SERVICES ARE NEITHER
ACCESSIBLE NOR AFFORDABLE.
OUTCOMES ARE UNEQUAL AND
CHARACTERIZED BY SHAMEFUL
DISPARITIES ON GENDER, RACE,
ETHNICITY, SOCIOECONOMIC STATUS,
SEXUAL ORIENTATION, GEOGRAPHY,
IMMIGRATION STATUS OR
INCARCERATION.
HEALTH EQUITY, THE OPPORTUNITY
FOR EVERYONE TO EXPERIENCE THE
BEST HEALTH POSSIBLE SHOULD BE A
FUNDAMENTAL RIGHT AND AS WOMEN'S
HEALTH RESEARCHERS, OUR VOICES,
OUR ACTIONS SHOULD BE IN THE
FOREFRONT TO ACHIEVE THAT GOAL.
SO THE CALL TO ACTION IS TO
RE-EXAMINE OURSELVES, OUR HEALTH
SYSTEMS, AND OUR SOCIETY.
TO SUPPORT BETTER HEALTH FOR
ALL.
AND I BELIEVE THAT THIS REQUIRES
WORK ON THREE FRONTS.
FIRST, INDIVIDUAL INTROSPECTION
AND ACTION.
SECOND, ACTIONS TO CHANGE OUR
HEALTH SYSTEMS AND PROFESSIONAL
SOCIETIES AND THIRD, COMMUNITY
AND SOCIAL ADVOCACY.
FUNDAMENTAL CHANGE STARTS WITH
INDIVIDUALS, WITH THE HARD WORK
OF EXAMINING OURSELVES AND OUR
PRIORITIES, CHANGE REQUIRES
SELF-AWARENESS.
BY LOOKING INSIDE OF OURSELVES,
WE CAN IDENTIFY AND UNDERSTAND
OUR CORE VALUES, THE GUIDING
PRINCIPLES THAT DICTATE OUR
BELIEFS, DECISIONS AND ACTIONS.
OUR CORE VALUES CREATE A
CONSTANT AND UNWAVERING GUIDE
FOR US AND HELP US CHART OUR
PATHS, PROVIDE LEADERSHIP AND
ASSESS HOW WELL WE ARE ACHIEVING
OUR MOST IMPORTANT GOALS.
AND OUR CORE VALUES ARE SHAPED
BY OUR LIFE EXPERIENCES, YET TOO
OFTEN WE DON'T TAKE ENOUGH TIME
TO CONTEMPLATE THEM AND TOO
OFTEN WE REACT WITH SHORT-TERM
IMPULSES RATHER THAN WITH THESE
LARGER VALUES IN MIND.
FOR ME, THE EXPERIENCES I HAD AS
A CHILD AS I NAVIGATED FOUR
FOSTER HOMES, AS I SUPPORTED
MYSELF THROUGH HIGH SCHOOL AND
UNIVERSITY AND AS I COMPLETED MY
MEDICAL TRAINING DID INDEED
SHAPE MY CORE VALUES.
FROM MY CHILDHOOD CAME THE CORE
VALUE OF CARING FOR THE
VULNERABLE.
FROM MY AFRICAN AMERICAN FOSTER
PARENTS, THE CENTRALITY OF
SOCIAL JUSTICE AND DIVERSITY,
FROM THE TEACHERS WHO GUIDED MY
EDUCATION, THE ALLURE OF
PURSUING NEW KNOWLEDGE, AND FROM
THEM ALL THE NEED FOR RESILIENCE
AND PERSISTENCE AND MOST
IMPORTANTLY, LOVE.
OUR CORE VALUES CREATE AN
INTERNAL COMPASS THAT CAN
NAVIGATE HOUR WE MAKE OUR
DECISION AND IF WE COMPROMISE
OUR CORE VALUES WE GO NOWHERE.
MY CORE VALUES IMPACTED CHOICES
I MADE FROM EARLY IN MY CAREER.
MY FIRST FACULTY JOB WAS IN THE
EATING DISORDER CLINIC.
THE GIRLS AND WOMEN I SAW THERE
FREQUENTLY STRUGGLED WITH
PAINFUL PSYCHOLOGICAL ISSUES AND
THE REALITY THAT THEIR HEALTH
INSURANCE WOULDN'T PAY FOR THEIR
TREATMENT.
I LEARNED A LOT ABOUT THE
MIND/BODY CONNECTION AND HOW
SOCIETAL PRESSURES CAN SO EASILY
DISTORT THE VISION OF WHO WE
WANT TO BE.
THOUGH I TOO OFTEN COULDN'T
SIGNIFICANTLY CHANGE SOCIETY OR
THE INSURANCE SYSTEM, I FOUGHT
FOR EVERY ONE OF MY PATIENTS AS
THEY STRUGGLED FOR FAIRNESS.
AND A FEW YEARS LATER, AFTER
FINISHING MY INFECTIOUS DISEASE
TRAINING, I AGAIN RELIED ON MY
CORE VALUES TO GUIDE ME.
AT A TIME WHEN MANY CLINICIANS
FEARED THE EMERGENCE OF A NEW
ILLNESS KILLING YOUNG GAY MEN,
PATIENTS STARTED TO ARRIVE AT
THE VETERANS HOSPITAL WHERE I
WORKED.
I SAW THESE MEN STRUGGLING WITH
AN INEXORABLE DISEASE AND YET
RETRIEVING MEAL TRAYS LEFT
OUTSIDE CLOSED HOSPITAL ROOM
DOORS, BEING DENIED BATHS BY
NURSES AFRAID OF CONTAMINATION.
AND DYING, OFTEN ALONE AND
ABANDONED BY THEIR FAMILIES.
SO I ASSEMBLED A DEEM OF
VOLUNTEERS, NURSES, SOCIAL
WORKERS AND OTHER DOCTORS AND
OPENED THE HOSPITAL'S FIRST
HIV-AIDS CLINIC.
OVER THE YEARS AS HIV CARE
TRANSITIONED FROM COMFORTING AND
THE TRAGEDY OF ATTENDING
FUNERALS, TO THE INSPIRING
RESTORATION OF NORMAL QUALITY OF
LIFE WITH TRIPLE DRUG THERAPY, I
KNEW THE DECISION HAD BEEN RIGHT
FOR ME.
I FOUND A FOCUS FOR MY WORK, A
DEEPLY FULFILLING COMMITMENT TO
HEALTH EQUITY, ESPECIALLY FOR
THOSE WHOM SOCIETY HAD BEEN
WILLING TO SHUN AND STIGMATIZE.
SO I LEARNED THIS, YOUR VISION
WILL BECOME CLEAR ONLY WHEN YOU
LOOK INTO YOUR HEART.
WHO LOOKS OUTSIDE, DREAMS, WHO
LOOKS INSIDE, AWAKENS.
PUT SIMPLY, KNOW THYSELF.
IT WASN'T HARD FOR ME TO DECIDE
TO TRANSITION FROM MY ORIGINAL
PLANS FOR MY INFECTIOUS DISEASE
CAREER TO INSTEAD BECOME AN HIV
DOCTOR.
INDEED, IT IS TRUE THAT IT IS
NOT HARD TO MAKE DECISIONS WHEN
YOU KNOW WHAT YOUR VALUES ARE.
THIS ISN'T TO SAY IT IS ALWAYS
EASY.
WE CAN LOSE OUR WAY.
AS TIGER WOODS SHARED, I STOPPED
LIVING ACCORDING TO MY CORE
VALUES.
I KNEW WHAT I WAS DOING WAS
WRONG, BUT THOUGHT ONLY ABOUT
MYSELF AND THOUGHT I COULD GET
AWAY WITH WHATEVER I WANTED.
AND THERE CAN BE COSTS, BUT AS
TONY BLAIR POINTED OUT,
SOMETIMES IT IS BETTER TO LOSE
AND DO THE RIGHT THING THAN TO
WIN BY DOING THE WRONG THING.
TO ACCOMPLISH THE CHANGE THAT IS
NEEDED TO ACHIEVE HEALTH EQUITY,
CHANGE MUST ALSO HAPPEN AT THE
INSTITUTIONAL LEVEL IN BOTH
HEALTH SYSTEMS AND PROFESSIONAL
SOCIE
SOCIETIES AND, YES, EVEN THE
NIH.
IT IS A HARSH REALITY THAT THE
U.S. HEALTH CARE SYSTEM IS HIGH
COST WITH HEALTH CARE SPENDING
NEARLY TWICE THE AVERAGE OF
OTHER DEVELOPED COUNTRIES,
CO-PAYS THAT OFTEN RESULT IN
DELAYED CARE AND THE TRAGEDY OF
MEDICAL BANKRUPTCIES.
ACCORDING TO A RECENT
COMMONWEALTH REPORT THE U.S.
RANKS LAST AMONG HIGH-INCOME
COUNTRIES IN ACCESS TO CARE,
ADMINISTRATIVE EFFICIENCY, AND
EQUITY.
AND IT IS A HARSH REALITY THAT
THE HEALTH OUTCOMES FOR OUR
PATIENTS LAG FAR BEHIND RANKING
AT THE LIST OF DEVELOPED
COUNTRIES IN INDICATORS LIKE
INFANT MORTALITY AND LIFE
EXPECTA
EXPECTANTCY.
OUR HEALTH SYSTEM IS
CHARACTERIZED BY GENDER
DISPARITIES IN HEALTH.
THEY ARE WELL KNOWN TO THE
PARTICIPANTS IN THIS MEETING,
FROM THE HISTORICAL AND SYSTEMIC
EXCLUSION OF WOMEN FROM CLINICAL
TRIALS TO THE DEFAULT USE OF
MALE ANIMAL MODELS AND CELL
LINES FOR FUNDAMENTAL RESEARCH,
TO THE MINIMIZIZATION OF WOMEN'S
SYMPTOMS TO UNDERUTILIZATION OF
DIAGNOSTICS WITH WOMEN SUCH AS
CARDIOVASCULAR DISEASE.
WE GET THIS CARTOON, STUDIES OF
FRUIT FLIES, MICE, HAMSTERS AND
MEN WITH THESE CONDITION,
MEDICAL RESEARCH USING WOMEN AS
SUBJECTS JUST NEVER OCCURRED TO
ANYBODY?
A PAINFUL JOKE AS ARTICULATED BY
OUR LEADER DR. JANINE CLAYTON IN
A RECENT ARTICLE.
BECAUSE WE HAVE STUDIED WOMEN
LESS, WE KNOW LESS ABOUT THEM.
THE RESULT IS THAT WOMEN MAY NOT
ALWAYS RECEIVE THE MOST OPTIMAL
CARE.
FURTHER, OUR HEALTH SYSTEM IS
CHARACTERIZED BY SHAMEFUL RACIAL
DISPARITIES WITH FOR EXAMPLE
MATERNAL MORTALITY STLEE TO FOUR
TIMES HIGHER FOR AFRICAN
AMERICAN WOMEN THAN WHITES.
AND LIFE EXPECTANCY GAPS UP TO
EIGHT YEARS BASED ON RACE AND
ETHNICITY.
WE SEE THIS IN THE CURRENT
PANDEMIC WITH RATES OF
INFECTION, HOSPITALIZATION, AND
DEATHS SIGNIFICANTLY GREATER FOR
PEOPLE OF COLOR THAN FOR WHITES.
AND IN THE RICHEST COUNTRY IN
THE WORLD LIFE EXPECTY DIRECTLY
AND CONTINUOUSLY CORRELATES WITH
INCOME.
FOR EXAMPLE, IN MY HOMETOWN OF
NEW YORK CITY, VARIES BY MANY
YEARS AS ONE TRAVELS ONLY A FEW
SUBWAY STOPS FROM MY PRIVILEGED
EASTSIDE HOME UP TO HARLEM.
AS WE EXAMINE THESE FACTS ABOUT
OUR NATIONAL HEALTH CARE SYSTEM,
AND ASSESS THEM IN LIGHT OF OUR
CORE VALUES, IT BECOMES CLEAR TO
ME THAT A REVISIONING IS
WARRANTED.
WE MUST TRANSFORM OUR SYSTEM
FROM ONE OF SICK CARE TO ONE OF
WELL CARE.
WE MUST BECOME PRO ACTIVE NOT
REACTIVE AND FOCUS ON
PREVENTION, PRIMARY CARE,
POPULATIONS AND COORDINATED CARE
ACROSS THE LIFE SPAN.
AND PERHAPS MOST IMPORTANTLY, WE
MUST MOVE FROM AN EXCLUSIVELY
MEDICAL MODEL TO ONE THAT
EMBRACES ADDRESSING THE SOCIAL
DETERMINANTS OF HEALTH.
THE NEED TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH IS
INCREASINGLY ARTICULATED BY
HEALTH CARE PROVIDERS AND
POLITICIANS ALIKE.
IT IS UNDERSTOOD THAT FACTORS
SUCH AS POVERTY, LOW EDUCATION,
JOB INSECURITY, POORHOUSING,
CONTAMINATED WATER, LOW SOCIAL
COHESION AND COMMUNITY SUPPORT
ARE POWERFUL DRIVERS OF HEALTH.
AND THAT THEY ACCOUNT FOR A
SIGNIFICANTLY LARGER SHARE OF
HEALTH STATUS THAN DOES CLINICAL
CARE.
YET WE HAVE NOT ROUTINELY
FOCUSED OUR RESEARCH QUESTIONS
OR OUR RESEARCH INVESTMENTS
ACCORDINGLY.
WE MUST UNDERSTAND THAT ONE'S
ZIP CODE IS A MORE POWERFUL
DRIVER OF HEALTH STATUS THAN
GENETIC FACTORS AND SOCIAL
FACTORS ACCOUNT FOR ONE-THIRD OF
TOTAL U.S. DEATHS.
WE KNOW WE MUST MOVE UPSTREAM TO
ADDRESS THESE FACTORS BUT FOR
MANY REASONS FAILED TO
CONSISTENTLY DO SO, MOST OF THE
TIME LIMITED TO PILOT STUDIES OR
SHORT-TERM PROJECTS.
AND AS A RESULT, WE SEE OUTCOMES
LIKE THOSE IN THE CURRENT
PANDEMIC WITH DRAMATICALLY
HIGHER DEATH RATES WITH THOSE
LIVING IN SUB STANDARD HOUSING,
UNEMPLOYED, INCARCERATED AND
THOSE LIVING IN POVERTY.
NOW, CONCERN HAS BEEN RAISED
THAT ADDRESSING THE SOCIAL
DETERMINANTS WILL COST TOO MUCH
FOR A SYSTEM THAT IS ALREADY
VERY EXPENSIVE.
THIS GRAPH COMPARES CLINICAL
CARE SPENDING IN THE LIGHT BLUE
BARS AND SPENDING ON SOCIAL
SERVICES IN THE DARK BLUE BARS
AMONG DEVELOPED COUNTRIES.
AND AS YOU CAN SEE AT THE RED
ARROW, THE U.S. SPENDS FAR MORE
THAN OTHER NATIONS ON CLINICAL
CARE, BUT TOTAL U.S. SPENDING IS
NEAR THE MIDDLE OF THE PACK.
IT IS NOT A QUESTION OF SPENDING
MORE MONEY.
IT IS A QUESTION OF HOW WE
CHOOSE TO SPEND OUR DOLLARS.
EARLY AND UPSTREAM INTERVENTIONS
OR DOWNSTREAM AND CLINICAL
SERVICES.
A SOCIAL DETERMINANT APPROACH IS
NOT CHARITY, IT IS AN
EVIDENCE-BASED STRATEGY.
AS WE STRIVE TO ACHIEVE HEALTH
EQUITY, WE MUST ALSO LOOK IN THE
MIRROR.
WE MAY NOT LIKE WHAT WE SEE.
WE NEED TO EXAMINE OUR HEALTH
CARE INSTITUTIONS AND ASK IF
THEY REFLECT OUR CORE VALUES
THOSE WE HOLD AS INDIVIDUALS AND
THOSE WE HOLD AS A PROFESSION.
WHEN WE LOOK IN THE MIRROR AS
THE PEOPLE IN THIS CONFERENCE
KNOW, WE SEE THAT THE PIPELINE
CONTINUES TO LEAK FOR WOMEN IN
ACADEMIC MEDICINE AND HEALTH
CARE LEADERSHIP POSITIONS AND
THIS IS TRUE EVEN AT A TIME WHEN
WOMEN REPRESENT MORE THAN HALF
OF MEDICAL STUDENTS.
AND YET WE SEE THAT THE PERCENT
OF WOMEN MEDICAL SCHOOL DEANS
REMAINS ESSENTIALLY STAGNANT AT
LESS THAN 20%.
AND WHEN WE LOOK IN THE MIRROR,
WE CAN SEE THE REALITY THAT THE
PERCENTAGE OF PHYSICIANS, AK
ACADEMICIANS, AND STUDENTS OF
COLOR LAG BEHIND THE U.S.
POPULATION.
TODAY IN OUR ACADEMIC HEALTH
SYSTEMS FACULTY DO NOT LOOK THE
SAME AS THE COMMUNITIES WE STUDY
AND THE PATIENTS WE SERVE.
WE SEE THE NUMBER OF BLACK MEN
IN MEDICAL SCHOOL IS THE SAME
TODAY AS IT WAS IN THE 1970s AND
THIS IS TRUE EVEN AT A TIME WHEN
THE TRAGEDY AND SUFFERING OF
RACIAL INJUSTICE IS ON THE NEWS
EVERY NIGHT.
AND WE SEE THAT MEDICAL STUDENTS
CONTINUE TO COME PREDOMINANTLY
FROM THE TOP QUINTILE OF FAMILY
INCOME, A REALITY THAT MEANT MY
EXPERIENCES AS A FOSTER KID
CONTRIBUTED TO MY SENSE OF
OTHERNESS IN MEDICAL SCHOOL.
AND ALL OF THIS IS TRUE AT A
TIME WHEN SOCIAL SCIENCE
RESEARCH HAS DOCUMENTED THAT
DIVERSE TEAMS PERFORM BETTER,
DIVERSE BOARDS ARE ASSOCIATED
WITH CORPORATE SUCCESS AND RACE
CONGRUENT CLINICAL CARE
CORRELATES WITH BETTER HEALTH
OUTCOMES.
IT IS INDEED TRUE THAT DIVERSITY
TRUMPS ABILITY.
DIVERSITY IS CENTRAL TO ACHIEVE
ACHIEVING EXCELLENCE.
WITH DIVERSE VOICES NOT ONLY AT
THE TABLE OR IN THE LAB, BUT
RATHER WHEN THOSE DIVERSE VOICES
ARE LEADING THE DISCUSSIONS WE
ASK DIFFERENT QUESTIONS AND
BRING MORE PERSPECTIVES TO
FINDING SOLUTIONS.
OUR PERSONAL AND PROFESSIONAL
CORE VALUES SHOULD PROMPT US TO
IMAGINE THE ANSWER TO THE
QUESTION POSED BY THE DEAN OF
TRINITY COLLEGE AT DUKE, VALLEY
ASHBY, IN A RECENT ARTICLE ON
SCIENCE.
HOW MUCH CREATIVITY ARE WE
LEAVING ON THE TABLE BECAUSE
SCIENCE REPEATEDLY FAILS TO COME
TO TERMS WITH OUR NARROWLY
DEFINED PROCESSES AND OUR
LIMITED WAYS OF DETERMINING
SUCCESS?
AND THESE CONSIDERATIONS OF HOW
WE CAN DO RESEARCH GOING FORWARD
ALSO SUGGEST THAT WE CAN EMBRACE
NEW WAYS OF IDENTIFYI INING
COLLABORATORS FROM DIFFERENT
BACKGROUNDS AND DISCIPLINE.
AS HIGHLIGHTED FROM THE BIRCWH
PROGRAM, WE CAN CREATE
INTERDISCIPLINARY RESEARCH
TEAMS.
LIFE SCIENCE RESEARCHERS CAN
REACH OUT TO ENGINEERS,
FIZZISTS, SOCIAL SCIENTISTS AND
OTHERS AND PROPEL WOMEN'S
RESEARCH, WOMEN'S HEALTH
RESEARCH INTO NEW REALMS.
THE THIRD PILLAR TO ACHIEVE
HEALTH EQUITY IS COMMUNITY AND
SOCIAL ADVOCACY.
GAPS IN PUBLIC TRUST OF SCIENCE
ARE DEEP SEATED AND IN URGENT
NEED OF OUR ATTENTION.
WHEN WE LOOK IN THAT MIRROR, WE
DON'T ALWAYS SEE WHAT OTHERS
SEE.
WE SEE THE SELFLESS WORK AND
DEDICATION OF OUR COLLEAGUES,
BUT OTHERS, OFTEN INSTEAD SEE
THE LEGACY OF HENRIETTA LACKS,
WHOSE CELLS BECAME A RESEARCH
MAIN STAY WITHOUT CONSENT OR
COMPENSATION.
THEY SEE THE INFAMOUS TUSKEGEE
EXPERIMENTS OR THE CAREER OF
CHARLES DREW WHO DEVELOPED THE
FIRST LARGE-SCALE BLOOD BANKS,
BUT RE-SIGNED FROM HIS POSITION
WITH THE AMERICAN RED CROSS IN
PROTEST OF THEIR RACIALLY
SEGREGATED BLOOD DONATION
POLICIES WHICH WERE MAINTAINED
UNTIL 1950.
AND THESE NEGATIVE PERCEPTIONS
ARE, UNFORTUNATELY, REENFORCED
BY THE NEGATIVE EXPERIENCES MANY
PEOPLE, ESPECIALLY WOMEN, PEOPLE
OF COLOR, AND THE POOR HAVE EACH
TIME THEY INTERACT WITH OUR
HEALTH CARE SYSTEMS.
TO MOVE FORWARD HEALTH
COMMUNICATION IS KEY.
AS A RESEARCHER, I THOUGHT THAT
SCIENCE WOULD BE THE ANSWER TO
ENDING THIS PANDEMIC.
AND AS IMPORTANT AND INSPIRING
AS IT HAS BEEN, I NOW BELIEVE
THE SOLUTION RESTS ON BUILDING
TRUST, EMPATHY AND GAILT WITH
ALL OUR COMMUNITIES.
WE NEED TO CONNECT IN INNOVATIVE
WAYS AS MODELLED BY TONY FAUCI,
WHO SEEMS TO HAVE INTUITIVELY
UNDERSTOOD THIS, I DO INSTAGRAM
INTERVIEWS, INTERVIEWS WITH RAP
ARTISTS AND ENTERTAINERS BECAUSE
YOU GET TO A GROUP OF PEOPLE
THAT YOU NEVER WOULD OTHERWISE.
PLUS YOU MIGHT GET A BOBBLEHEAD
MADE.
AND WE CAN COMMUNICATE
INNOVATIVELY LIKE FRANCES
COLLINS WHO USED MUSIC.
*
CORONAVIRUS HOW QUICKLY IT HAS
GROWN WE WILL ALL GET THROUGH IT
BUT THINGS WON'T BE THE SAME
WHAT WILL WE LEARN FROM THIS
DARK TURN HOW WILL OUR LIVES BE
CHANGED *
* COVID MIGHT BE SCARY, BUT HOPE
IS ON THE SCENE.
WE'LL BEAT CORONAVIRUS WHEN WE
HAVE THAT VACCINE *
>> THE POWER OF ADVOCACY TO
DRIVE CHANGE IS CLEAR.
THE CHOICES OF SCIENTISTS ARE
NEEDED.
WE CAN SHARE STORIES.
WE CAN WRITE BLOGS OR OP-EDS.
WHEN I WROTE THIS VIEWPOINT IN
JAMA, I HEARD FROM COLLEAGUES
ALL OVER THE COUNTRY.
JUST AS I DID WHEN I WROTE
SEVERAL YEARS AGO IN SCIENTIFIC
AMERICAN ABOUT MY EXPERIENCES
WITH SEXUAL HARASSMENT IN
MEDICAL SCHOOL.
AND AS I CONTINUE TO TRY TO DO
TODAY BY MY INVOLVEMENT WITH
ORGANIZATIONS SUCH AS THE CENTER
FOR WOMEN IN ACADEMIC MEDICINE
AND SCIENCE, WHERE I GET TO
SERVE AS BOARD CHAIR, AS WE WORK
TO CHANGE INSTITUTIONAL CULTURE,
RATHER THAN USING THE OUTMODED
APPROACH OF TRYING TO CHANGE
WOMEN TO FIT INTO THE
TRADITIONAL MALE-DOMINATED
CULTURE AND MY WORK THROUGH
MENTORING PROGRAMS SUCH AS THE
CAROL EMMOTT FELLOWSHIP AND MY
JOB WHERE WE STRIVE TO HIGHLIGHT
WOMEN SPEAKERS AT OUR
EDUCATIONAL PRESENTATIONS.
OUR COLLEAGUES ARE RAISING THEIR
VOICES.
WE MARCH FOR SCIENCE.
WE FORM GROUPS SUCH AS WHITE
COATS FOR BLACK LIVES.
WE PARTICIPATE IN STEM PROGRAMS.
THERE ARE MANY VENUES TO EXPRESS
OUR CORE VALUES AND THROUGH
WHICH WE CAN ACHIEVE REAL CHANGE
EVEN THE BOLD GOAL OF HEALTH
EQUITY.
WOMEN'S HEALTH RESEARCHERS AND
OTHER SCIENTISTS ARE POWERFUL
VOICES.
LET'S ENSURE THAT WE RISE TO THE
RESPONSIBILITY INHERENT IN THAT
POWER BY BEING AN ADVOCATE FOR
WOMEN, FOR OUR PATIENTS, AND FOR
SCIENCE.
WE SHOULD REMEMBER THAT EACH
TIME YOU STAND UP FOR AN IDEAL
OR ACT TO IMPROVE THE LOT OF
OTHERS, OR STRIKE OUT AGAINST
INJUSTICE, YOU SEND FORTH A TINY
RIPPLE OF HOPE.
AND OUR VOICES TOGETHER CAN
ACHIEVE MULTIPLE RIPPLES THAT
COMBINES TO ACHIEVE A BETTER
FUTURE.
IF WE DO ALL THIS, I BELIEVE WE
CAN MOVE FROM A MINDSET OF
TALKING ABOUT EQUALITY AND
INEQUALITY, EQUALITY IN WHICH
EACH CHILD GETS THE SAME BOX,
BUT THIS LITTLE GUY, SOMEONE I
HAVE GREAT EMPATHY WITH, THE
LITTLE GUY STILL CAN'T SEE THE
FIELD.
WE CAN MOVE TO TALKING ABOUT
EQUITY, IN WHICH EACH CHILD GETS
WHAT HE OR SHE NEEDS TO WATCH
THE GAME OR IN OUR CASE, WHAT
EACH PATIENT NEEDS TO OPTIMIZE
THEIR HEALTH.
I ENCOURAGE ALL OF YOU TO TAKE
THE TIME TO STEP BACK,
CONTEMPLATE YOUR CORE VALUES,
THINK ABOUT HOW YOU WANT THEM TO
SHAPE YOUR CAREER CHOICES.
WHEN I DO SO, AFTER FOUR DECADES
IN MEDICINE, I UNDERSTAND THAT
THE COMMON THREAD FOR ME WAS THE
FOUNDATION OF WORKING FOR SOCIAL
JUSTICE AND EQUITY.
EARLY I DID THIS BY FIGHTING FOR
MY PATIENTS INCLUDING THOSE WITH
ANOREXIA AND THOSE WITH HIV ON
AN INDIVIDUAL LEVEL.
AND THEN LATER, I DID THIS BY
STRIVING TO INCULCATE THESE
VALUES IN THE DEPARTMENTS AND
INSTITUTIONS WHICH I WAS
FORTUNATE TO LEAD.
AND MOST RECENTLY, ON A NATIONAL
LEVEL, IN MY JOB ATLAS KER WHERE
OUR MISSION IS TO INCREASE
SUPPORT FOR THE MEDICAL -- AT
LASKER, WHERE OUR MISSION IS TO
INCREASE SUPPORT FOR THOSE LIKE
YOURSELVES WHO BRING HOPE FOR
OUR FUTURE.
I WANT TO LEAVE YOU WITH ONE
FINAL THOUGHT ON LIVING OUR CORE
VALUES AND ONE FINAL PERSONAL
STORY.
THE FINAL THOUGHT.
AT THIS DIFFICULT TIME WE MUST
TAKE CARE OF EACH OTHER.
NEVER HAS THE NEED BEEN GREATER
TO CARE FOR OUR COLLEAGUES.
AS ONE FRONTLINE WORKER SAID
ABOUT THE TOLL OF THIS PANDEMIC,
THOSE OF US IN HEALTH CARE FIND
OURSELVES STARING DOWN A DEEP
CHASM, ONE FILLED WITH
FRUSTRATION AND BURNOUT.
WE SHOULD REACH OUT TO ONE
ANOTHER DURING THESE STRESSFUL
TIMES.
WE CAN ADDRESS BURNOUT FROM WHAT
OFTEN FEELS LIKE OVERWHELMING
WORKLOADS.
WE CAN STRIVE TO HELP EACH OTHER
RECOVER FROM TRAGIC LOSSES AND
ONGOING CHALLENGES.
AND THE PERSONAL STORY, SIX
YEARS AGO, A SHORT WHILE AFTER I
HAD TAKEN MY JOB AT LASKER, I
WAS DIAGNOSED WITH RENAL CANCER.
COLLEAGUES STEPPED UP.
THE LASKER BOARD OF DIRECTORS
GAVE ME TIME I NEEDED FOR
SEVERAL SURGERIES AND FRIENDS
MATERIALIZED FROM DISTANT STATES
TO VOICE THEIR SUPPORT.
TODAY I'M CANCER FREE, BUT
ALWAYS INDEBTED TO EVERYONE WHO
CAME TOGETHER FOR ME DURING A
FRIGHTENING TIME AND TO THE
RESEARCHERS WHO MADE MY RECOVERY
POSSIBLE.
IN CONCLUSION, I BELIEVE THAT
GUIDED BY OUR CORE VALUES, WE
CAN EMBRACE OUR LEADERSHIP
RESPONSIBILITY TO DRIVE THE
CHANGE TO HEALTH EQUITY.
AS MARTIN LUTHER KING SAID, THE
ARC OF THE MORAL UNIVERSE IS
LONG, BUT IT BENDS TOWARDS
JUSTICE.
YET AS ANOTHER GREAT LEADER
POINTED OUT, THE ARC OF THE
MORAL UNIVERSE MAY BEND TOWARDS
JUSTICE, BUT IT DOESN'T BEND ON
ITS OWN.
IT TAKES GOOD PEOPLE.
LEADERS WHO LIVE BY THEIR CORE
VALUES, SCIENTISTS WHO SPEAK OUT
AND WORK TO CHANGE HEALTH CARE
INSTITUTIONS, SYSTEMS AND
POLICIES.
RESEARCHERS WHO DARE TO ANSWER
NEW QUESTIONS, BRAVE SOULS WHO
TIRELESSLY ADVOCATE TO CREATE A
BETTER, HEALTHIER FUTURE.
TOGETHER I BELIEVE THAT WE CAN
MAKE THE CHANGE THAT IS NEEDED
TO ACHIEVE HEALTH EQUITY.
AS HARRIET TUBMAN SAID, EVERY
DREAM BEGINS WITH A DREAMER.
YOU HAVE WITHIN YOU THE
STRENGTH, THE PATIENCE, AND THE
PASSION TO REACH FOR THE STARS
TO CHANGE THE WORLD.
REPAIRING THE DAMAGES CAUSED BY
HEALTH INEQUITIES WILL NOT BE
EASY AND WILL NOT HAPPEN
IMMEDIATELY, BUT WE MUST NOT
PERPETUATE INEQUITY BY INACTION.
HEALTH EQUITY IS TOO IMPORTANT.
LET'S FOLLOW OUR CORE VALUES AND
DO IT NOW.
THANK YOU.
>> WOW, THANK YOU DR. POMEROY
FOR THAT VERY INSPIRING AND
POWERFUL MESSAGE AND IN THE
SPIRIT OF CRISIS AND TURMOIL, IT
IS INDEED VERY TIMELY WE SHOULD
REMIND OURSELVES TO FIND A
MOMENT OF INTROSPECTION AND FIND
OUR CORE VALUES AND ADVOCATE FOR
A BETTER AND HEALTHIER FUTURE.
MOREOVER, IN THIS STAGE IN MY
LIFE I'M RARELY MOVED TO DARE TO
DREAM AGAIN AND TO REMIND MYSELF
THERE IS STILL GOOD PEOPLE AND
WE NEED GOOD PEOPLE TO ACHIEVE
EQUITY AND SOCIAL JUSTICE AND
NEVER FORGET TO CARE FOR THE
VULNERABLE.
NOW WE HAVE SOME TIME FOR Q&A.
I WILL BE READING YOU SOME OF
THE QUESTIONS FROM YOUR Q&A BOX.
SO FIRST ONE IS, THANKS SO MUCH
FOR YOUR INSIGHTFUL TALK.
CAN YOU SPEAK MORE ABOUT
SYSTEMIC RACISM WITHIN OUR OWN
INSTITUTIONS AND STRATEGIES TO
AMELIORATE THEM.
>> IT IS ONE OF THE CHALLENGES
OF OUR TIMES TO LOOK AT OUR OWN
SUBSTITUTIONS AND WORK TO
ADDRESS THE SYSTEMIC RACISM THAT
STILL CHARACTERIZES THEM.
I THINK THIS STARTS WITH
EDUCATION AND SO SO EVERYONE
SHOULD KNOW WHETHER THEIR
INSTITUTION REQUIRES TRAINING
AND UNCONSCIOUS BIAS.
YOU SHOULD ASK YOUR
INSTITUTIONAL LEADERS, WHAT IS
THE RACIAL COMPOSITION OF THE WA
SPEAKERS AT GRAND RONDE.
AND THEN WE CAN LOOK AT THINGS
LIKE SUPPORT STUDENT INTEREST
GROUPS THAT ARE DEDICATED TO
RACIAL DIVERSITY.
WE CAN DO ANALYSES OF OUR OWN
FACULTY.
WE CAN ASK QUESTIONS ABOUT HOW
WE ARE REACHING OUT TO THE
COMMUNITIES AROUND US AND
DELIVERING CLINICAL CARE THAT IS
DESIGNED TO ADDRESS DISPARITIES.
BUT FOR THE PEOPLE ON THIS CALL,
ONE OF THE BIG QUESTIONS IS, IS
THERE RACIAL EQUITY IN OUR
RESEARCH PROGRAMS?
AND WE CAN START BY LOOKING AT
OUR OWN RESEARCH PROGRAMS, BUT
ALSO ASKING QUESTIONS ABOUT THE
PORTFOLIO AT OUR OWN
INSTITUTIONS.
HOW MANY OF THEM -- HOW MANY OF
OUR RESEARCH STUDIES ADDRESS
DISPARITIES?
DO WE HAVE GOOD REPRESENTATION
OF ALL RACIAL AND ETHNIC GROUPS
IN OUR CLINICAL TRIALS?
THESE ARE THE KINDS OF
CONVERSATIONS THAT WE NEED TO BE
HAVING IN OUR INSTITUTIONS.
I THINK THE NIH HAS STARTED TO
ASK THESE SAME KIND OF QUESTIONS
WITH PEOPLE LIKE DIRECTOR
COLLINS SAYING HE WON'T ATTEND
MEETINGS WHEN THERE ISN'T GOOD
REPRESENTATION ON THE SPEAKER
PANEL.
SO THERE'S SO MUCH WORK TO BE
DONE AND ONE OF THE CHALLENGES
IS NOT TO BE OVERWHELMED BY
THIS, BUT PICK ONE SMALL AREA
YOU CAN WORK ON AS AN
INDIVIDUAL.
I RECENTLY GOT A COMMUNICATION
FROM SOMEBODY AFTER I GAVE A
TALK AND SAID, YOU INSPIRED ME
TO MENTOR A HIGH SCHOOL STUDENT,
AN AFRICAN AMERICAN HIGH SCHOOL
STUDENT AND I WOULDN'T HAVE DONE
THAT IF I HADN'T BEEN LOOKING
INSIDE MYSELF AND ASKING WHAT I
COULD DO TO ADDRESS SYSTEMIC
RACISM IN OUR HEALTH CARE
SYSTEMS.
WE'LL EACH FIND THE ANSWERS FOR
OURSELVES, BUT I HOPE THIS MAKES
US ASK THOSE QUESTIONS.
>> THANK YOU.
DR. CLAYTON WOULD LIKE TO REMIND
EVERYBODY THAT DR. POMEROY IS
WITH THE CENTER FOR WOMEN IN
ACADEMIC MEDICINE AND SCIENCE.
AND SO I THINK ONE OF THE KEY
MESSAGES IS THAT WE SHOULD AIM
TO CHANGE THE CULTURE AND THE
CLIMATE RATHER THAN JUST THE
WOMEN AS WE USE WHAT WE DO IF IT
IS NOT A SYSTEMIC APPROACH.
>> IF I COULD JUST FOLLOW UP ON
THAT COMMENT, FIRST OF ALL TO
THANK DR. CLAYTON, BUT EARLY IN
MY CAREER I DID A LOT OF
TRAINING SESSIONS WHERE WE
TAUGHT WOMEN ABOUT NEGOTIATION
SKILLS AND WE TAUGHT WOMEN
CONFLICT RESOLUTION STYLES.
AND WHILE THESE CAN BE
SHORT-TERM FIXES, WHAT WE WERE
REALLY DOING WAS TRYING TO MOLD
WOMEN SO THAT THEY COULD SUCCEED
IN A MALE-DOMINATED,
MALE-DEFINED CULTURE.
AND WHAT WE NEED TO DO IS LOOK
AT OUR INSTITUTIONAL CULTURES
AND CHANGE THE CULTURE SO THAT
EVERYBODY CAN THRIVE.
AND THAT IS WHAT ORWH HAS BEEN
ABOUT FOR A LONG TIME AND I HOPE
IT IS WHAT THE PEOPLE ON THIS
CONFERENCE CALL BELIEVE IN AS
WELL.
>> THANK YOU.
THE NEXT QUESTION IS THIS.
WOMEN ARE MORE LIKELY TO STUDY
WOMEN'S HEALTH OR SEX
DIFFERENCES, DIVERSE
INVESTIGATORS ARE MORE LIKELY TO
STUDY HEALTH INEQUITY OR
INEQUALITY, BUT WOMEN AND
UNDERREPRESENTED PEOPLE ARE LESS
LIKELY TO GET FUNDED AND
RESEARCH ON WOMEN'S HEALTH OR
HEALTH EQUITY ARE ALSO LESS
LIKELY TO GET PUBLISHED OR
RECOGNIZED.
SO WHAT IS THE CHICKEN OR THE
EGG AND WHAT IS -- HOW OR WHERE
IS IT BEST TO INTERRUPT THE
CYCLE?
>> REALLY IMPORTANT OBSERVATION
AND TOLDLY TRUE OBSERVATION AND
ONE THING THAT WE NEED TO GUARD
AGAINST IS SILOING OUR RESEARCH
QUESTIONS ABOUT GENDER
INEQUITIES OR RACIAL INEQUITIES.
I THINK THAT TO GET TO TRUE
HEALTH FOR ALL, EVERYBODY HAS TO
BE ADDRESSING THESE ISSUES.
IT IS IMPORTANT THAT ALL
RESEARCHERS ASK THESE QUESTIONS,
BUT WE NEED TO BE VERY ATTENTIVE
TO THE FACT THAT THE MINORITY
TAX OR WOMEN'S TAX, WHERE WE
EXPECT WOMEN AND
UNDERREPRESENTED MINORITIES TO
TAKE ON THE BURDEN OF EXPLAINING
GENDER INEQUITIES OR RACIAL
INEQUITIES, TO TAKE ON THE FULL
RESPONSIBILITY FOR ADDRESSING
THE EDUCATION OR THE RESEARCH IN
THESE AREAS, THIS IS NOT A
SUSTAINABLE MODEL.
SO I THINK THAT WOMEN AND PEOPLE
OF COLOR CAN RAISE THE ISSUES,
THEY MUST RAISE THE ISSUES, BUT
THEY HAVE TO BE RAISED AS ISSUES
THAT IMPACT EVERYBODY AND WE
NEED TO WORK FOR INSTITUTIONAL
CHANGE.
I DON'T KNOW WHICH IS THE
CHICKEN AND THE EGG, BUT I DO
KNOW THAT WE NEED TO INTERVENE
WITH APPROPRIATE FUNDING AND
WITH LEADERSHIP THAT CELEBRATES
RESEARCH, FOR EXAMPLE, THAT
INVESTIGATES GENDER AND RACIAL
DISPARITIES.
HOPEFULLY THIS WILL SET UP A
VIRTUOUS CYCLE IN WHICH PEOPLE
BEGIN TO VALUE RESEARCH IN THESE
AREAS, THEREFORE MORE MONEY IS
PUT IN AND WE ACCELERATE THE
CHANGE THAT WE ARE ALL WORKING
FOR.
>> THANK YOU VERY MUCH.
THERE DOESN'T APPEAR TO BE ANY
MORE QUESTIONS FROM OUR
AUDIENCE.
SO I WOULD LIKE TO THANK YOU,
DR. POMEROY, AND ALSO ALL OF THE
PEOPLE WHO ATTENDED THIS
SESSION.