I HOPE EVERYBODY HAD A GOOD
NETWORKING EXPERIENCE TODAY AND
THAT EVERYONE HAS BEEN ENJOYING
THE MEETING SO FAR.
AND I KNOW THAT WE SWITCHED
AROUND THE SCHEDULE A BIT BUT I
HOPE THAT WORKED FOR EVERYONE.
SO WELCOME, EVERYONE, TO THE
2024 BIRCWH ANNUAL MEETING.
IT'S ALWAYS A PLEASURE TO MEET
THE IN-PERSON, AFTER SO MANY
YEARS OF HAVING BEEN
COVID-BOUND.
LAST YEAR AND THIS YEAR, SEEING
THE NEW EMERGING LEADERS IN
WOMEN'S HEALTH RESEARCH AS WELL
AS THE CURRENT, THE PRESENT
ONES.
AND TODAY I'M HAPPY TO EXHIBIT E
OUR NEW PROGRAM OFFICER FOR ONE
OF THE EARLIEST AND THE MOST
HIGHLY ACCLAIMED SIGNATURE
PROGRAMS OF THE ORWH, WHICH IS
THE BIRCWH.
DR. MARQUITTA WHITE RECENTLY
JOINED US FROM NHLBI, WHERE SHE
MANAGED AN EXTENSIVE PORTFOLIO
OF INSTITUTIONAL AND INDIVIDUAL
TRAINING GRANTS.
PRIOR TO THAT, MARQUITTA WAS AN
ASSISTANT PROFESSOR AT UCSF,
WHERE SHE PUT TO TASK HER
MASTER'S DEGREE IN APPLIED
STATISTICS AND DOCTORATE IN
HUMAN GENETICS.
BOTH OF WHICH SHE EARNED FROM
VANDERBILT.
THESE PAST FEW MONTHS YOU HAVE
HAD THE CHANCE TO INTERACT WITH
HER AS SHE SEAMLESSLY OVERSAW
THE REISSUANCE OF ALL OF YOUR
GRANTS WITH OUR NEW IC PARTNER,
THE NIAMS, AND ALSO SUCCESSFULLY
NAVIGATED THE AWARDING OF THE
ADMINISTRATIVE SUPPLEMENTS IN
THE FACE OF AN APPROACHING AND
OF THE FISCAL YEAR.
PLEASE WELCOME DR. MARQUITTA
WHITE.
>> GOOD AFTERNOON, ERVE.
EVERYBODY.
MY NAME IS DR. MARQUITTA WHITE
AND I WILL BE STEPPING INTO THE
ROLE AS A PROGRAM OFFICIAL
OVERSEEING THE BIRCWH PROGRAM.
HAVING MET THE FORMER PROGRAM
OFFICIAL OF THE BIRCWH PROGRAM,
DR. LISA BAGG, I CAN CONFIDENTLY
SAY THAT I WILL NOT BE REPLACING
HER.
THAT'S NOT A THING.
WHAT I WILL BE DOING IS ACTUALLY
CONTINUING HER EXAMPLE OF JUST
THE PASSIONATE SUPPORT AND
ADVOCACY FOR THE MAINTENANCE AND
EXPANSION OF THIS WONDERFUL
BIRCWH PROGRAM.
SO WHAT I'M GOING TO DO NOW IS
INTRODUCE DR. JANINE CLAYTON,
WHO WILL BE ACTUALLY BEGINNING
OUR PLENARY SESSIONS.
AS MOST OF YOU ALREADY KNOW, DRF
ORWH, THE OFFICE FOR RESEARCH IN
WOMEN'S HEALTH, AND ALSO THE
ASSISTANT DIRECTOR OF RESEARCH
ON WOMEN'S HEALTH HERE AT NIH.
SHE'S A BOARD CERTIFIED
OPHTHALMOLOGIST WITH OVER 120
PEER REVIEWED PUBLICATIONS, AND
SEVERAL OTHER ACCOLADES BOTH IN
HER FIELD AND AT NIH.
AND ONE OF THE THINGS THAT STOOD
OUT FOR ME AND ACTUALLY ONE OF
THE REASONS WHY I MYSELF
EVENTUALLY DECIDED TO JOIN ORWH
IS THE FACT THAT THROUGHOUT
DR. CLAYTON'S TENURE AT NIH, SHE
HAS WORKED TO STRENGTHEN NIH'S
SUPPORT OF RESEARCH IN WOMEN'S
HEALTH AND ALSO THEIR SUPPORT OF
RECRUITMENT, RETENTION AND
ADVANCEMENT OF WOMEN IN
BIOMEDICAL CAREERS.
DR. CLAYTON WAS ACTUALLY THE
ARCHITECT AND DRIVING FORCE
BEHIND NIH'S POLICY TO CONSIDER
SEX AS A BIOLOGICAL VARIABLE
ACROSS THE RESEARCH SPECTRUM AS
A PART OF NIH'S INITIATIVE TO
INCREASE OUR TRANSPARENCY,
REPRODUCIBILITY AND RIGOR IN
RESEARCH.
AND I BELIEVE THAT THE BIRCWH
PROGRAM BENEFITS GREATLY FROM
HER EXPERIENCE AND GUIDANCE AS
WE WORK TOGETHER TOWARDS
BIRCWH'S ULTIMATE GOAL OF
INCREASING KNOWLEDGE, WORK AND
RECOGNITION IN THE REALM OF
WOMEN'S HEALTH RESEARCH.
SO WITHOUT FURTHER ADO, I'D LIKE
TO INVITE DR. CLAYTON TO THE
PODIUM TO BEGIN OUR PLENARY
SESSION.
[APPLAUSE]
>> THANK YOU, DR. WHITE, FOR
THAT REALLY LOVELY INTRODUCTION,
AND WELCOME TO THE 2024 BIRCWH
MEETING.
I AM THRILLED THAT WE'RE DOING
THIS IN PERSON.
IT'S SO GOOD TO SEE YOU ALL.
I ENJOYED EARLIER SESSIONS
TODAY, AND LOOKING FORWARD TO
THE PODIUM PRESENTATIONS LATER
TODAY.
BUT LET ME BEGIN BY GIVING
THANKS AND EXPRESSING MY
GRATITUDE TO BOTH DR. TIGNO,
ORWH'S ASSOCIATE DIRECTOR FOR
CAREERS, AND DR. MARQUITTA
WHITE, WHO YOU JUST MET, THE NEW
BIRCWH PROGRAM OFFICER.
I JUST WANT TO HIGHLIGHT AS WELL
OUR PROGRAM PARTNERS AROUND THE
COUNTRY, AND TO SHOW YOU WE ARE
WELL REPRESENTED ACROSS THE
COUNTRY, AND TO RECOGNIZE OUR
INSTITUTE AND CENTER PARTNERS
HERE AT NIH.
EVERYTHING WE DO WITH ORWH
ADDRESSING WOMEN'S HEALTH IS A
CROSS-CUTTING TOPIC HERE AT THE
NATIONAL INSTITUTES OF HEALTH,
IS DONE IN COLLABORATION AND
PARTNERSHIP WITH THE INS TAWTS
-- THEINSTITUTES AND CENTERS SO
THROUGH.
JUST TO GIVE YOU A QUICK
SNAPSHOT OF THE BIRCWH PROGRAM
IN TERMS OF DEMOGRAPHICS, YOU
WOULD NOT BE SURPRISED TO SEE
ABOUT 80% OF THE BIRCWH SCHOLARS
ARE FEMALE.
AND THE BREAK DOWN REGARDING
PRIMARY KE GREES IS SHOWN IN THE
PIE CHART AND YOU CAN SEE OVER
HALF ARE PH.D.s, AND YOU CAN
SEE THE M.D. PART OF THE PIE, I
THINK THIS IS INCREASING A BIT,
AT 36%, MD PH.D. AT 10%, AND A
FEW OTHER DOCTORAL DEGREE
RECIPIENTS THERE AS WELL.
THIS YEAR WE ARE AGAIN EXPANDING
THE CADRE OF WOMEN'S HEALTH
RESEARCHERS, THE STATED PURPOSE
OF THE BIRCWH AND THE PROGRAM IS
SLIGHTLY DIFFERENT.
WE HAVE A NEW ORDER, WE HAVE TWO
KEY NOTES, WE HAVE MULTIPLE
PODIUM TALKS, AND AS ALWAYS, WE
ARE REALLY THRILLED ABOUT THE
WORK THAT THE SCHOLARS ARE
PRESENTING IN THEIR POSTERS AND
IN THEIR ABSTRACTS, AND WE HAVE
A RANGE OF TOPICS FOR YOU TODAY.
2025 WILL REPRESENT BIRCWH'S
25TH BIRTHDAY AND THIS PROGRAMS,
PROGRAMWAS CREATED BY DR. VIVIA,
I HAD THE PRIVILEGE TO CALL HER
A MENTOR AND FRIEND.
THE EVALUATION IS GOING TO
INCLUDE ONLANE SURVEYS OF THE
PAST AND PRESENT BIRCWH SCHOLARS
AND PIs, IN DEPTH INTERVIEWS,
AS WELL AS FOCUS GROUPS AND
REVIEW OF DATA IN NIH SYSTEMS.
THE PRIMARY EVALUATION QUESTIONS
ARE WAS THE BIRCWH PROGRAM ABLE
TO ACHIEVE ITS STATED PURPOSE,
BUILD A CADRE OF SCIENTISTS
PURSUING WOMEN'S HEALTH
RESEARCH, WHAT ARE THE PROGRAM
OUTCOMES OF THE BIRCWH, AND HOW
HAS THE BIRCWH PROGRAM BENEFITED
THE SCHOLARS.
SO I WANTED TO GIVE YOU A HEADS
UP ABOUT THAT COMING NEXT YEAR,
AND WE'RE EXCITED TO LEARN MORE
ABOUT THE IMPACT OF THE BIRCWH
PROGRAM.
AND AS ALWAYS, WAYS THAT WE CAN
CONTINUE TO EXPAND AND GROW AND
MAKE IT EVEN BETTER.
I'M ALSO REALLY THRILLED TO
SHARE WITH YOU THAT WE HAVE --
NIH HAS AWARDED ITS FIRST EVER
ADVANCING GENDER INCLUSIVE
EXCELLENCE OR AGIE COORDINATING
CENTER AWARD TO VIRGINIA
COMMONWEALTH UNIVERSITY.
SO EXCITED TO BE ABLE TO
ANNOUNCE THIS TO YOU.
THE COORDINATING CENTER IS GOING
TO BE DEVELOPING A RESEARCH
STRATEGY, SERVE AS A CENTRALIZED
RESOURCE HUB, DEVELOP AND
IMPLEMENT COMMUNICATION
DISSEMINATION PLANS AND
ADMINISTER AND MANAGE PILOT
FEASIBILITY STUDIES AROUND
SYSTEMIC GENDER-BASED
INEQUITIES.
THIS PROGRAM HAD ITS ORIGIN IN
IDEAS THAT CAME FROM THE WORKING
GROUP ON WOMEN IN BIOMEDICAL
CAREERS THAT I CO-CHAIR WITH THE
NIH DIRECTOR.
I WAS REALLY HONORED AND MOVED
AND SO DELIGHTED TO BE IN THE
WHITE HOUSE WHEN PRESIDENT JOE
BIDEN SIGNED EXECUTIVE ORDER
14120 IN MARCH OF THIS YEAR.
THIS EXECUTIVE ORDER IS TO
ADVANCE WOMEN'S HEALTH RESEARCH
AND INNOVATION, AND I'M JUST
GOING TO HIGHLIGHT A COUPLE OF
KEY POINTS FROM IT.
IT AIMS TO PRIORITIZE
INVESTMENTS IN WOMEN'S HEALTH
RESEARCH, INTEGRATE WOMEN'S
HEALTH ACROSS THE FEDERAL
RESEARCH PORTFOLIO, GALVANIZE
NEW RESEARCH SPECIFICALLY
FOCUSED ON WOMEN'S MID LIFE
HEALTH, AND ASSESS UNMET NEEDS
SO THAT WE CAN SUPPORT WOMEN'S
HEALTH RESEARCH BETTER.
THERE ARE MULTIPLE SECTIONS IN
THIS EXECUTIVE ORDER, AND I'M
NOT GOING TO GO OVER THEM IN
DETAIL BUT JUST TO SHARE WITH
YOU IN A MOMENT ABOUT A NOTICE
OF SPECIAL INTEREST ABOUT
LOOKING AT FEMALE-SPECIFIC
CDEs, COMMON DATA ELEMENTS
LIKE ON MENOPAUSE STATUS,
LOOKING AT SYSTEM-WIDEN
HANSMENTS IN THE GRANT LIFECYCLE
TO MAKE SURE THAT WOMEN'S HEALTH
AND SABB RL PRIORITIZED AND OF
COURSE THE WAYS THAT WE CAN LOOK
AT OUR FUNDING TO MAKE SURE
WE'RE SUPPORTING THE RESEARCH TO
ADDRESS THE NEEDS OF TODAY'S
WOMEN.
THE BIRCWH PROGRAM ALIGNS VERY
WELL WITH SECTION 4 OF E
EO12140 ON PRIORITIZING
INVESTMENTS IN WOMEN'S HEALTH
RESEARCH AND IF YOU LOOK AT THAT
SECOND ONE DOWN, PROMOTING
COLLABORATIVE, INTERDISCIPLINARY
RESEARCH ACROSS FIELDS AND AREAS
OF EXPERTISE.
WHICH IS INHERENTLY PART OF THE
BIRCWH.
WE'RE ALSO REVISIONING WOMEN'S
HEALTH RESEARCH FUNDING AND DATA
THROUGH THE EXECUTIVE ORDER, AND
WE HAVE LAUNCHED SOME NEW
EFFORTS HERE AND WE ARE
STIMULATING INNOVATION THROUGH
OUR SBIR, SMALL BUSINESS
INNOVATION AND TECH TRANSFER
AWARDS.
I MENTIONED THE CDEs, AND WE
ANNOUNCED NIH'S FIRST EVER
PATHWAYS TO PREVENTION PROGRAM
COMMITTED TO MENOPAUSE,
MENOPAUSE SYMPTOMS, AND ITS
RELATIONSHIP TO CHRONIC
DISEASES.
PRESIDENT BIDEN ANNOUNCED IN HIS
STATE OF THE UNION ADDRESS HIS
CALL TO CONGRESS TO SUPPORT AN
NIH CENTRAL FUND THAT WOULD
SUPPORT RESEARCH THAT WOULD
COVER TOPICS THAT OVERLAP
MULTIPLE INSTITUTES AND CENTERS
OR FALL BETWEEN THE CRACKS OF
THE INSTITUTE AND CENTER MISSION
AREAS.
AND THE FACT SHEET THAT WAS
RELEASED ALONG WITH THE
EXECUTIVE ORDER HIGHLIGHTS A
VARIETY OF STEPS THAT HAVE
ALREADY BEEN TAKEN AT THAT TIME.
I'M EXCITED TO SHARE WITH YOU
THAT YOU CAN NOW ACCESS ALL NIH
FUNDING OPPORTUNITIES, INCLUDING
THOSE THAT ORWH PUTS OUT, SIGNS
INTO AND THOSE THAT THE
INSTITUTES AND CENTERS ARE
LEADING AT THE SINGLE WEBSITE ON
THE ORWH WEBPAGE.
SO NOW WE HAVE A SINGLE FRONT
DOOR TO ENTER THE NIH WORLD OF
WOMEN'S HEALTH RESEARCH, AND YOU
CAN SEE THE CURRENT NUMBER OF
FUNDING OPPORTUNITIES THAT ARE
AVAILABLE TO YOU COVERING A WIDE
RANGE OF TOPICS.
IT WAS REALLY HEARTWARMING TO
SEE WHEN THE INSTITUTES AND
CENTERS, EVERY SINGLE ELIGIBLE
INSTITUTE WAS STEPPED UP IN
RECORD TIME, SIGNED ON TO A
NOTICE OF SPECIAL INTEREST
SPECIFICALLY FOCUSED ON WOMEN'S
HEALTH RESEARCH THAT WAS LINKED
TO ALL OF THE STANDING FUNDING,
STANDING PARENT FUNDING
OPPORTUNITIES.
SO INVESTIGATOR INITIATED AWARDS
THAT WERE ALREADY ON THE STREET,
AND SO NOW WE HAVE 30
PARTICIPATING INSTITUTES,
CENTERS AND OFFICES AND EACH OF
THOSE ARTICULATED PRIORITIES OF
WOMEN'S HEALTH RESEARCH IN THEIR
MISSION AREAS.
SO COLLECTIVELY, THAT REPRESENTS
175 TOPICS OF WOMEN'S HEALTH
RESEARCH THAT HAVE BEEN
ARTICULATED BY THE INSTITUTES,
CENTERS AND OFFICES, AND THROUGH
THIS NOSY, NOSI, YOU CAN APPLYO
GRANTS AND THE TOTAL NUMBER ARE
LISTED THERE ON THE RIGHT.
THE TERMS THAT COME UP IN THIS
WORD CLOUD REPRESENT SOME OF THE
TOPICS THAT WERE HIGHLIGHTED IN
THOSE PRIORITIES IDENTIFIED BY
THE ICOs AND THEY RANGE FROM
MENOPAUSE AS A USUAL SUSPECT TO
SOCIAL STUDIES, AS WELL AS
INTERVENTIONS RELATED TO HIV,
AND A VARIETY OF OTHER TOPICS.
SO THESE -- THROUGH THIS
MECHANISM, THERE ARE MANY WAYS
FOR INDIVIDUALS TO APPLY TO
WOMEN'S HEALTH RESEARCH FUNDING
ACROSS MANY TOPICS TO ALL THE
INSTITUTES AND CENTERS THAT ARE
ELIGIBLE, AND ACROSS MULTIPLE
GRANTING MECHANISMS.
LAST YEAR, ORWH PARTNERED WITH
THE BILL AND MELINDA GATES
FOUNDATION TO HOST AN INNOVATION
EQUITY FORUM ATTENDED BY
250 INDIVIDUALS FROM OVER 50
COUNTRIES, WHERE WE EVALUATED
POTENTIAL RID OPPORTUNITIES TO
DRIVE INNOVATION IN WOMEN'S
HEALTH GLOBALLY, AND TRAINING
AND CAREER OPPORTUNITIES ARE A
SECTION OF -- PART OF THE GOALS
OF THIS WOMEN'S HEALTH
INNOVATION OPPORTUNITY MAP THAT
WAS ALSO FLAGGED IN THE NOTICE
OF SPECIAL INTEREST.
THE QR CODE IS THERE ON THE
SLIDE.
THE MAP INCLUDES 50 HIGH RETURN
OPPORTUNITIES FOR R & D.
SO IF YOU HAVEN'T HAD A CHANCE
TO SEE THAT, PLEASE DO TAKE A
LOOK AT IT.
I MENTIONED THAT THE BIRCWH ALSO
ALIGNS WITH EO12140 IN SOME OF
THE RESEARCH BEING TON BY BIRCWH
SCHOLARS AND PIs IS FOCUSED ON
WOMEN'S MID LIFE HEALTH AND
GALVANIZING INFORMATION IS AN
IMPORTANT ASPECT OF THE
EXECUTIVE ORDER.%
HERE'S OUR MENOPAUSE WEBPAGE
WHERE CAN YOU FIND A VARIETY OF
RESOURCES AND INFORMATION
RELATED TO THE MULTIPLE
INSTITUTES AND CENTERS THAT ARE
FOCUSED ON DISEASES AND
CONDITIONS RELATED TO MENOPAUSE
AND MENOPAUSAL TRANSITION
ITSELF, AND THEN YOU CAN ACCESS
THE MY MENOPLAN WEBPAGE TO
RECEIVE EVIDENCE-BASED
INFORMATION ABOUT TREATMENT OF
MENOPAUSE SYMPTOMS.
SO THAT INFORMATION THAT'S BEEN
VETTED IS PROVIDED TOLL THE
CONSUMER HERE.
IT'S BEEN A BUSY YEAR, AND
DURING NATIONAL WOMEN'S HEALTH
WEEK IS SECOND WEEK IN MAY.
WE PUT OUT A VARIETY OF
MATERIALS.
IN ADDITION TO THE NOSI WHICH
CAME OUT EARLIER, A REPORT FROM
THE NATIONAL ACADEMIES ON THE
FRAMEWORK TO ADDRESS CHRONIC
CONDITIONS IN WOMEN, WHICH WAS
SUPPORTED BY ORWH.
THE FIRST TIME EVER WE PUT OUT
FACT SHEETS, NIH FACT SHEETS
WHICH ARE SHORT, TWO PAGES,
WHERE WE ASSESS OUR FUNDING IN
THAT AREA, THAT TOPIC, AND WE
IDENTIFY SOME GAP PS IN THAT
AREA.
OUR BUY ENG YELL REPORT ARE
UNDER STUDIED, UNDERREPRESENTED,
UNDERREPORTED POPULATIONS OF
WOMEN ARE U3 DATA REPORT, WHERE
WE HAD INFORMATION AVAILABLE TO
YOU ABOUT POPULATIONS OF WOMEN,
RURAL WOMEN.
WOMEN WITH DIFFERENT RACIAL AND
ETHNIC IDENTITIES, WOMEN WITH
DISABILITIES AND THE LIKE.
SO YOU HAVE A RICH BODY OF DATA
UPON WHICH TO GENERATE NEW IDEAS
AND NEW HYPOTHESES FOR FUTURE
STUDIES.
AND IMPORTANTLY, THE NEW NIH
STRATEGIC PLAN FOR RESEARCH ON
THE HEALTH OF WOMEN WAS LAUNCHED
THAT SAME WEEK.
DR. BERTAGNOLLI'S VIDEO
LAUNCHING THAT IS ACTUALLY THE
MOST VIEWED NIH YOUTUBE VIDEO
FOR THE YEAR.
SO PEOPLE ARE DEFINITELY
INTERESTED IN WOMEN'S HEALTH AND
WHAT WE HAVE TO SAY.
THE ANNUAL VIVIAN PINN SYMPOSIUM
THAT YEAR FOCUSED ON THE
IMPORTANT TOPIC OF AU AUTOIMMUNE
DISEASES AND LAST YEAR CONGRESS
APPROPRIATED FUNDS FOR US TO
FORM AN OFFICE OF AUTOIMMUNE
DISEASE RESEARCH WITHIN ORWH.
AND WE ALSO INITIATED A
ROUNDTABLE SERIES ON WOMEN'S
HEALTH RESEARCH TOPICS, AND
THESE HAVE BEEN INCREDIBLY WELL
ATTENDED, VERY HIGH REGISTRATION
RATES, ON A VARIETY OF TOPICS.
YOU CAN CONNECT WITH US HERE
WITH OUR ONLINE ELEARNING
MODULES AVAILABLE HERE AND OUR
QUARTERLY PUBLICATIONS, WOMEN'S
HEALTH IN FOCUS, MONTHLY EMAIL,
AND SANEAND SIGN UP TO RECEIVE R
EVENTS HERE.
WITH THAT, I'M GOING TO MOVE
FORWARD SO THAT YOU CAN RECEIVE
A WELCOME FROM DR. MONICA
BERTAGNOLLI.
DR. BERTAGNOLLI IS THE 17TH
DIRECTOR OF THE NATIONAL
INSTITUTES OF HEALTH.
SHE WAS NOMINATED BY PRESIDENT
JOE BIDEN ON MAY 15TH, 2023,
CONFIRMED BY THE U.S. SENATE ON
NOVEMBER 7TH, 2023, AND TOOK
OFFICE ON NOVEMBER 9TH, 2023.
SHE PREVIOUSLY SERVED AS THE
16TH DIRECTOR OF THE NATIONAL
CANCER INSTITUTE, THE RICHARD E
WILSON PROFESSOR OF SURGERY IN
SURGICAL ONCOLOGY AT HARVARD
MEDICAL SCHOOL, A SURGEON AT
BRIGHAM AND WOMEN'S HOSPITAL,
AND A MEMBER OF THE
GASTROINTESTINAL CANCER
TREATMENT AND SARCOMA CENTERS AT
DANA FARBER CANCER INSTITUTE.
THROUGHOUT HER CAREER,
DR. BERTAGNOLLI HAS BEEN AT THE
FOREFRONT OF THE FIELD OF
SURGICAL AND CLINICAL ONCOLOGY.
SHE GRADUATED FROM PRINCETON
EURT WITH A BACHELOR OF SCIENCE
IN ENGINEERING AND ATTENDED
MEDICAL SCAL AT THE UNIVERSITY
OF UTAH.
SHE TRAINED IN SURGE REA AT
BRIGHAM AND WAS A RESEARCH
FELLOW IN TUMOR IMMUNOLOGY AT
THE DANA FARBER CANCER
INSTITUTE.
SO WITH THAT, I THINK WE CAN GO
AHEAD AND START THE VIDEO SO YOU
CAN RECEIVE A WELCOME FROM
DR. BERTAGNOLLI.
>> HELLO, EVERYONE.
I'M NIH DIRECTOR DR. MONICA
BERTAGNOLLI.
WHILE I WAS NOT ABLE TO BE WITH
YOU IN PERSON TODAY, I WANTED TO
BE SURE TO SEND MY
CONGRATULATIONS TO THE BIRCWH
SCHOLARS.
I HOPE THAT THIS PROGRAM HAS
EXPOSED YOU TO AN ARRAY OF
DISCIPLINES AND HAS HELPED YOU
ACHIEVE SOME OF YOUR GOALS AS
YOU WORK TOWARD AN INDEPENDENCE
SCIENTIFIC CAREER.
I'D ALSO LIKE TO THANK THE
PROGRAM MENTORS FOR THEIR
DEDICATION TO FOSTERING THE NEXT
GENERATION OF WOMEN'S HEALTH
SCIENTISTS, AND TO THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH FOR
THEIR STEWARDSHIP OF THIS
SIGNATURE CAREER DEVELOPMENT
PROGRAM.
BUILDING A CAREER IN BIOMEDICAL
RESEARCH CAN BE CHALLENGING.
BUT FROM MY OWN EXPERIENCE, YOU
CAN MAKE IT EASIER WHEN YOU FIND
EXCEPTIONAL MENTORS.
YOUR WORK TO ADVANCE RESEARCH ON
SEX AND GENDER IN WOMEN'S HEALTH
IS AS CRITICAL AS EVER.
WE'VE SEEN A NUMBER OF EXCITING
ADVANCES IN WOMEN'S HEALTH
RESEARCH IN THE PAST YEAR ALONE.
FROM UNCOVERING DRIVERS OF
AUTOIMMUNITY IN WOMEN TO FINDING
BETTER DRUGS FOR ENDOMETRIOSIS
PAIN.
HOWEVER, WE STILL HAVE SO MUCH
MORE WORK TO DO TO CLOSE THE GAP
IN WOMEN'S HEALTH RESEARCH.
THIS CROSS-CUTTING APPROACH TO
DRIVING INNOVATIONS IS SOMETHING
THAT THE BIRCWH PROGRAM HAS
CULTIVATED SUCCESSFULLY FOR
NEARLY 25 YEARS NOW.
BY CONNECTING BASIC AND CLINICAL
RESEARCHERS, AND BY FOSTERING
COLLABORATIONS ACROSS
DISCIPLINES FROM ENDOCRINOLOGY
TO CARDIOLOGY TO IMMUNOLOGY TO
ONCOLOGY, AND MORE, THE PROGRAM
ALIGNS WELL WITH THE WHITE HOUSE
INITIATIVE.
AS THE BIRCWH PROGRAM APPROACHES
ITS 25TH ANNIVERSARY NEXT YEAR,
I ENCOURAGE EVERYONE TO REFLECT
ON THE PROGRAM'S ACHIEVEMENTS
AND TO LOOK AHEAD TO FUTURE
POSSIBILITIES.
AT NIH, WE REMAIN STEADFAST IN
OUR EFFORTS TO NURTURE THE NEXT
GENERATION OF SCIENTISTS, AND I
WISH YOU ALL THE VERY BEST AS
YOU ESTABLISH YOUR CAREER.
THANK YOU, AND I HOPE THAT YOU
ENJOY THE REST OF TODAY'S
MEETING.
[APPLAUSE]
>> IT'S NOW MY PLEASURE TO
INTRODUCE THIS YEAR'S RUTH L.
L.KIRSCHSTEIN MEMORIAL SCHOLARS.
THIS YEAR'S RUTH KIRSCHSTEIN
KEYNOTE SPEAKER IS DR. ABBEY
BERENSON.
DR. BERENSON IS DIRECTOR OF THE
UTMB CENTER FOR
INTERDISCIPLINARY RESEARCH OND
WOMEN'S HEALTH AND DIRECTOR OF
THE DIVISION OF POPULATION AND
PREVENTIVE HEALTH IN THE
DEPARTMENT OF OB-GYN.
SHE'S A SENIOR CLINICAL
RESEARCHER, GYNECOLOGIST,
OBSTETRICIAN AND DISTINGUISHED
MENTOR WITH AN INTERNATIONAL
REPUTATION FOR HER STUDIES OF
HEALTH ISSUES AMONG
REPRODUCTIVE-AGED WOMEN.
SHE'S PUBLISHED MORE THAN 260
PEER REVIEWED PAPERS AND HAS
BEEN CONTINUOUSLY FUNDED BY
VARIOUS SPONSORS INCLUDING NIH,
THE HEALTH RESOURCES AND
SERVICES ADMINISTRATION OR HRSA,
DEPARTMENT OF DEFENSE, CANCER
PREVENTION AND RESEARCH
INSTITUTE OF TEXAS AND SEVERAL
PRIVATE FOUNDATIONS.
DR. BERENSON'S CURRENT RESEARCH
CENTERS AROUND THE PREVENTION OF
HUMAN PAPILLOMAVIRUS RELATED
CANCERS.
SHE HAS 10 ONGOING PROJECTS THAT
TOTAL MORE THAN $18 MILLION IN
EXTERNAL FUNDING.
8 OF THE 10 PROJECTS AIM TO
INCREASE HPV VACCINATION RATES
AMONG MEDICALLY UNDERSERVED AND
RURAL POPULATIONS, AND TWO, OUR
CLINICAL TRIALS DESIGNED TO
COMPARE THE IMMUNOGENICITY OF
TWO DOSES OF THE HPV VACCINE TO
THE STANDARD THREE DOSES IN
MALES AGED 15 TO 26 AND FEMALES
AGED 27 TO 45.
DR. BERENSON FOUND THE THE UTMB
CENTER FOR INTERDISCIPLINARY
RESEARCH ON WOMEN'S HEALTH IN
2002 TO PROMOTE, STIMULATE AND
SUPPORT INTERDISCIPLINARY
RESEARCH RELATED TO THE HEALTH
OF WOMEN ACROSS THE LIFESPAN.
SHE OBTAINED HER MEDICAL DEGREE
AT THE BAYLOR COLLEGE OF
MEDICINE, WHERE SHE ALSO
COMPLETED INTERNSHIP AND RES KEN
SEE IN OB-GYN.
WE ARE EXCITE TODAY HAVE
DR. BERENSON PRESENT THE 2024
RUTH L. KIRSCHSTEIN MEMORIAL
LECTURE ENTITLED "STANDING ON
THE SHOULDERS OF GIANTS."
RUTH L. KIRSCHSTEIN, ORWH AND
THE BIRCWH INITIATIVE, PLEASE
HELP ME WELCOME DR. ABBEY
BERENSON.
[APPLAUSE]
>> GOOD AFTERNOON.
IT IS SUCH A DELIGHT TO GIVE
THIS LECTURE THIS AFTERNOON.
AS BIRCWH HAS BEEN SUCH AN
IMPORTANT PART OF MY CAREER.
AS I WAS THINKING ABOUT WHAT I
WANTED TO SPEAK ABOUT TODAY, I
BEGAN TO LOOK INTO THE HISTORY
OF SOME OF THE INDIVIDUALS THAT
MADE IT POSSIBLE FOR US TO MEET
ON THIS TOPIC IN THIS ROOM
TODAY.
AND I BECAME SO FASCINATED BY
THEIR STORIES, AND THE BARRIERS
THEY OVERCAME, THAT I DECIDED I
WANTED TO SHARE THESE WITH YOU.
SO AS I START TODAY, I'M GOING
TO PUT YOU ALL IN A TIME MACHINE
AND YOU'RE GOING TO GO BACK TO
WHEN THE COUNTRY WAS FIRST BEING
FORMED IN THE LATE 1700s.
AND YOU'RE GOING TO STEP OUT OF
THE TIME MACHINE AND YOU'RE
GOING TO TAKE A LOOK AT
HEALTHCARE.
AND YOU'RE GOING TO SEE THAT
IT'S REALLY ADMINISTERED BY
WOMEN, IN THE HOME, SUCH AS THE
MEDICAL CARE THAT THEY HAD
AVAILABLE.
SO THEY WERE THE PROVIDERS OF
HEALTHCARE.
BUT MEDICAL SCHOOLS WERE
FORMING, AND THEY WERE ONLY
PUTTING OUT MALE GRADUATES.
AND HOSPITALS BEGAN TO OPEN.
BY 1811, THERE WERE FOUR
HOSPITALS IN THE UNITED STATES,
AND AS THESE HOSPITALS BEGAN TO
OPEN, THE MALE PHYSICIANS WERE
NOT SO HAPPY ABOUT THE IDEA THAT
WOMEN WERE REALLY IN CHARGE OF
HEALTHCARE.
AND SO THEY BEGAN TO REPLACE
THEM AND THE ATTITUDES WERE NOT
GOOD.
AND THIS IS JUST A QUOTE I FOUND
FROM A FACULTY MEMBER AT HARVARD
MEDICAL SCHOOL.
I THOUGHT IT WAS AMUSING BECAUSE
THE FIRST PART OF IT IS ACTUALLY
STILL TRUE TODAY.
ALTHOUGH THE SECOND PART IN RED,
I DO HAVE OBJECTIONS TO.
THEY SAID IN BOTH SEXES, TOO
MUCH SCHOOL WORK COULD RESULT IN
MONSTROUS BRAINS AND PEW KNEE P
BODIES, WEAK DIGESTION, FLOWING
THOUGHT AND CONSTIPATED BOWELS.
SO IF YOU THINK ABOUT WORKING ON
YOUR GRANT OR BEING IN MEDICAL
SCHOOL, I THINK SOME OF THAT IS
STILL TRUE.
BUT THE SECOND PART, "BUT GIRLS,
OWING TO THEIR MORE COMPLEX AND
DEMANDING REPRODUCTIVE
ORGANIZATION ARE AT SPECIAL
RISK."
SO FOR SOME REASON, HE FELT THAT
WOMEN, BIOLOGICALLY, JUST WERE
NOT UP TO THE TASK AND COULD NOT
BE PHYSICIANS AND CARE
PROVIDERS.
BUT THERE WAS ONE WOMAN WHO
DARED TO CHALLENGE THIS.
ELIZABETH BLACKWELL ACTUALLY WAS
LEFT WITH VERY LITTLE MONEY WHEN
HER FATHER DIED WHEN SHE WAS A
TEENAGER.
THERE WERE SO FEW JOBS OPEN TO
WOMEN IN SO FEW FIELDS THAT SHE
AND HER SISTERS ALL BECAME
SCHOOL TEACHERS TO EARN A
LIVING.
BUT AS IT TURNS OUT, SHE ENDED
UP TAKING CARE OF A VERY SICK
FRIEND WHO COMPLIMENTED HER ON
THE CARE THAT SHE PROVIDED, AND
EXPRESSED THE WISH THAT THERE
WERE MORE WOMEN THAT COULD DO
THAT.
AND THAT REALLY INSPIRED
ELIZABETH BLACKWELL, AT A TIME
THAT THERE WAS NOT A SINGLE
FEMALE IN MEDICAL SCHOOL IN THE
UNITED STATES, IF YOU CAN JUST
THINK ABOUT THAT FOR A MINUTE,
ZERO, AND SHE DECIDED SHE WAS
GOING TO BECOME A DOCTOR.
NOW SHE COULD HAVE GONE TO
EUROPE.
WOMEN WERE ALLOWED IN MEDICAL
SCHOOL IN EUROPE.
BUT NO DEGREE AFTERWARDS.
AND THAT'S NOT WHAT SHE WANTED.
SHE WANTED TO BE ABLE TO
PRACTICE MEDICINE.
SO SHE WENT TO SPONSORS, SHE
ASKED THEM HOW SHE COULD GET
INTO MEDICAL SCHOOL, AND THEY
BASICALLY TOLD HER, FORGET IT,
THIS IS A PIPE DREAM.
THIS ISN'T GOING TO HAPPEN.
SHE DIDN'T LISTEN TO THEM
EITHER.
SHE APLAY APPLIED TO MEDICAL SCS
ALL OVER.
SHE WAS REJECTED BY ALL OF THEM,
EXCEPT ONE.
GENEVA COLLEGE OF MEDICINE IN
NEW YORK.
AND THE ONLY REASON SHE WASN'T
OUTRIGHT OBJECTED WAS THAT THE
DEAN OF THIS PARTICULAR MEDICAL
SCHOOL WAS A BIT INTIMIDATED BY
THE SPONSOR THAT SHE HAD FOUND,
AND DIDN'T WANT TO ALIENATE THE
SPONSOR.
SO THE DEAN CAME UP WITH AN IDEA
THAT HE WOULD ALLOW THE 150 MALE
MEDICAL STUDENTS TO VOTE ON
WHETHER OR NOT SHE WOULD BE
ADMITTED.
HAVE YOU EVER HEARD OF SUCH AN
IDEA?
THESE STUDENTS THOUGHT THIS WAS
A GREAT JOKE.
THEY ALL GOT TOGETHER.
THE DEAN TOLD THEM IT HAD TO BE
UNANIMOUS.
THIS IS ACTUALLY WRITTEN UP.
THEY HAD A PARTY WHERE THERE WAS
ALCOHOL INVOLVED, THEY WERE ALL
LAUGHING AND JOKING.
APPARENTLY THERE WAS ONE PERSON
IN THE BACK THAT VOTED NO THAT
SAID THAT THEY PULLED HIM BY HIS
BRITCHES UP TO THE CENTER OF THE
ROOM UNTIL HE SAID AYE, AYE,
AYE.
AND THIS IS HOW SHE GETS INTO
MEDICAL SCHOOL.
SHE GETS HER LETTER OF
ACCEPTANCE, AND SHE ENROLLS.
NO ONE REALLY THOUGHT SHE WOULD
GO THROUGH WITH IT.
BUT SHE WAS SERIOUS.
EVEN AFTER SHE ENROLLS, THEY
DON'T LET HER DO THE WHOLE
CURRICULUM.
SHE'S EXCLUDED FROM OBSERVING
SURGICAL DEMONSTRATIONS BECAUSE
THAT JUST WOULDN'T BE BEFITTING
A YOUNG LADY.
BUT SHE GRADUATED AND THEN SHE
DECIDED TO GO OVERSEAS AND GET
EVEN MORE TRAINING AND SHE CAME
BACK ONE OF THE BEST TRAINED
PHYSICIANS IN THE UNITED STATES.
BUT NO ONE WOULD HIRE HER
BECAUSE SHE WAS FEMALE, SHE WAS
THE ONLY FEMALE DOCTOR.
SO WHAT DID SHE DO?
AGAIN, SHE DID NOT LET ANYONE
TELL HER NO.
SHE ESTABLISHED HER OWN
INFIRMARY IN NEW YORK FOR WOMEN
AND CHILDREN, ALONG WITH HER
SISTER, WHO MANAGED TO GO TO
MEDICAL SCHOOL AFTER HER, AND
TOGETHER, THEY DEVELOPED A
MEDICAL COLLEGE JUST FOR WOMEN.
THAT STORY INSPIRED ME LIKE NO
STORY I'VE EVER HEARD BEFORE.
AFTER THAT, I THOUGHT, I CAN
REAPPLY FOR MIGRANTS.
FOR MY GRANTS.
I CAN REWRITE THESE PAPERS.
I DON'T HAVE TO GO THROUGH WHAT
ELIZABETH BLACKWELL WENT
THROUGH.
25% OF MY CLASS WAS WOMEN.
SO I JUST PUT THIS OUT THERE FOR
YOU FOR INSPIRATION AS TO WHAT
SOME OF OUR PREDECESSORS, WHAT
THEY HAVE GONE THROUGH.
AND I HAVE SOME MORE STORIES FOR
YOU TOO THAT WILL INSPIRE YOU.
SO BY THE MID 1800s, THERE IS
A FEW MEDICAL SCHOOLS OPENING UP
FOR WOMEN.
OFTEN IT WAS BECAUSE THEY FELT
THAT MIDWIVES SHOULD BE WOMEN,
THAT IT WAS MORE APPROPRIATE
THAT WOMEN ATTEND OTHER WOMEN
DURING CHILDBIRTH.
SOMETIMES THIS WOULD GROW INTO
FULL BLOWN MEDICAL SCHOOLS, BUT
THE MEDICAL SOCIETIES OBJECTED
TO THIS.
THEY DID NOT LIKE TO SEE THESE
NEW MEDICAL SCHOOLS FOR WOMEN
OPENING, AND SO THEY BEGAN TO
CLOSE.
AND ONLY TWO REMAINED BY 1910.
EVERYONE THOUGHT MAYBE IT
WOULDN'T BE A PROBLEM BECAUSE
THE ALL-MALE MEDICAL SCHOOLS
SAID, WE WILL ACCEPT WOMEN
STUDENTS.
SO YOU DON'T NEED THESE
ALL-WOMEN MEDICAL SCHOOLS.
BUT BY THE MID 1960s, THIS IS
MORE THAN 100 YEARS AFTER
ELIZABETH BLACKWELL HAS
GRADUATED, FIVE GENERATIONS,
ONLY 6% OF PEOPLE GOING TO
MEDICAL SCHOOL ARE WOMEN.
AND I THINK WITHOUT WOMEN
PROVIDERS, IT'S VERY HARD TO
HAVE WOMEN'S HEALTH RESEARCH.
TO EVEN GET IT ON THE RADAR
SCREEN.
SO WHAT'S GOING ON IN THE EARLY
1900s?
WELL, THIS IS A VERY INTERESTING
TIME BECAUSE SEVERAL MEN EMERGE
WHO ARE REALLY PIONEERS AND
HEROS IN WOMEN'S HEALTH
RESEARCH.
IN 1913, ALBERT SOLOMON FIGURED
OUT THAT WHEN X-RAYS ARE TAKEN
OF BREAST, ONES THAT WERE
REMOVED FOR BREAST CANCER HAD
MICROCALCIFICATIONS, WHILE THOSE
THAT WERE REMOVED FOR OTHER
REASONS DO NOT.
SO THAT WAS THE BEGINNING OF
MAMMOGRAPHY.
BUT EVEN THOUGH IT WAS FIGURED
OUT IN 1913, IT WASN'T UNTIL
1959 THAT SOMEONE ACTUALLY
FIGURED OUT HOW TO MAKE IT A
CLINICAL PRACTICE AT MD ANDERSON
CANCER CENTER.
THIS IS WHY YOU NEED WOMEN IN
MEDICINE.
NOW YOU'VE GOT THIS WONDERFUL
NEW TOOL TO DIAGNOSE A
HORRENDOUS DISEASE EARLY, BUT NO
ONE IS COMING IN TO USE IT.
THIS IS FROM THE EX-CHAIR OF
RADIOLOGY AT M.D. ANDERSON.
HE SAID, YOU DIDN'T TALK ABOUT
BREAST, AND WOMEN WEREN'T
COMFORTABLE BRINGING PROBLEMS TO
THEIR DOCTOR'S ATTENTION BECAUSE
THEY WERE AFRAID IT WOULD LEAD
TO AN EXAMINATION BY A MALE
PHYSICIAN.
, WHICH MOST DIDN'T WANT.
SO THAT'S ANOTHER PROBLEM WE SEE
EMERGING.
THIS IS WAY BEFORE
IMPLEMENTATION SCIENCE, AND YOU
JUST SEE THESE PRACTICES NOT
BEING ADOPTED.
YOU ALSO SEE GEORGE
PAPANICOLAOU, WHO WAS JUST
TRYING TO FIGURE OUT WHEN HIS
GUINEA PIGS IN HIS LAB WERE OFF
LATING, FIGURES OUT YOU CAN USE
VAGINAL SAMPLES FOR THAT, GETS
VERY INTERESTED IN WHAT'S GOING
ON IN ANOTHER COUNTRY WITH
CERVICAL SAMPLES AND FINDS OUT
YOU CAN USE TO DIAGNOSE CERVICAL
CANCER EARLY, AND HE MAKES A BIG
PUSH TO INTRODUCE AND POPULARIZE
THIS SCREENING TECHNOLOGY, AND
EVEN TODAY, WE OWE A GREAT DEBT
OF GRATITUDE TO HIM.
BUT EVEN THOUGH HE DEVELOPED
THIS AND TRADE TRIED TO POPULAR,
THE CANCER SOCIETIES CAN DIDN'T
ADOPT IT FOR MANY YEARS AND YOU
HAVE, IN 1967, ONLY ABOUT 1 IN T
HAS ALREADY BEEN DEVELOPED.
SO LET'S GO TO THE 1960s.
THE 1960s ARE KNOWN FOR MANY
THINGS, BUT PROBABLY MOST PEOPLE
DON'T REALIZE THAT THAT'S WHEN
THE THALIDOMIDE TRAGEDY
HAPPENED.
MOST OF YOU ARE PROBABLY
FAMILIAR WITH THALIDOMIDE.
IT WAS A DRUG COMMONLY
PRESCRIBED FOR MORNING SICKNESS
IN THE FIRST TRIMESTER IN
EUROPE.
AND IT TOOK ALMOST A DECADE
BEFORE THEY BEGAN TO REALIZE
THAT IT WAS ASSOCIATED WITH
SEVERE LIMB DEFORMITIES IN THE
NEWBORNS.
OUR HERO AT THIS TIME IS FRANCES
KELSEY, NOT BECAUSE SHE
DISCOVERED SOMETHING, BUT
BECAUSE SHE DEMANDED THAT THERE
BE GOOD DATA BEFORE THE DRUG WAS
APPROVED.
SHE WAS AN FDA REVIEWER AND SHE
DUG HER HEELS IN AND SHE SAID
THAT SHE WOULD NOT APPROVE THIS
DRUG IN THE UNITED STATES UNTIL
SHE SAW MORE DATA.
SO WE DIDN'T HAVE A THALIDOMIDE
PROBLEM IN THE UNITED STATES
LAKE THEY DID IN EUROPE, AND SHE
SAFED HER AWARD FROM JOHN F.
KENNEDY FOR HER WORK.
SO SOMETIMES JUST DEMANDING MORE
DATA IS A HEROIC THING TO DO.
UNFORTUNATELY, THALIDOMIDE, EVEN
THOUGH IT WASN'T HAVING A BIG
IMPACT IN THE UNITED STATES, HAD
A BIG IMPACT ON WOMEN'S HEALTH
RESEARCH.
BECAUSE PEOPLE BEGAN TO SAY IT'S
WAY TOO DANGEROUS TO GIVE
PREGNANT WOMEN DRUGS.
AND THIS IDEA KIND OF EXPLODED
TO WHERE THE FDA ENDED UP
BANNING PREGNANT WOMEN AND WOMEN
OF CHILD BEARING POTENTIAL FROM
PARTICIPATING IN CLINICAL
TRIALS.
THIS LASTED FOR 15 YEARS.
AND FOR THOSE OF YOU THAT DON'T
REMEMBER IT, CHILD BEARING
POTENTIAL PRETTY MUCH MEANT
ANYONE BETWEEN THE AGES OF 12
AND 50 WHO HAD A UTERUS.
SO PRETTY MUCH ALL WOMEN BANNED
FROM CLINICAL TRIALS.
THIS IS HOW WE ENDED UP WITH NO
DATA ON WOMEN.
IN FACT, EVEN THOUGH THIS WAS
OVERTURNED IN 1993, THIS STIGMA
HAS STILL PERSISTED, AND I KNOW
WE CAN ALL REMEMBER THE COVID
VACCINE CLINICAL TRIALS.
AS AN OBSTETRICIAN, I WAS VERY
ALARMED ABOUT THE PREGNANT WOMEN
AND SEVERE COMPLICATIONS THEY
COULD HAVE IF THEY WERE INFECTED
WITH COVID DURING PREGNANCY.
BUT EVEN WITH THAT MARKETEDLY
INCREASED RISK, PREGNANT WOMEN
WERE NOT INCLUDED IN THE INITIAL
COVID-19 VACCINE TRAILS.
TRIALS.
SO EVEN TODAY, STILL A BARRIER
WE ARE FIGHTING.
OKAY, LET'S GO IN OUR TIME
MACHINE NOW TO THE 1970s, AND
THIS IS WHERE I'M GOING TO
DISCUSS ABOUT RUTH KIRSCHSTEIN.
IT IS SO APPROPRIATE THAT THIS
TALK IS NAMED AFTER HER, BECAUSE
OF ALL THAT SHE DID FOR WOMEN'S
HEALTH AND FOR TRAINING.
NOW I TOLD YOU THAT IT TOOK A
LONG TIME BEFORE WOMEN WERE
REPRESENTED IN MEDICAL SCHOOL,
AND SHE WAS ONE OF THE EARLY
ACCEPTANCES.
SHE RECEIVED HER M.D. FROM
TULANE, THERE WERE ONLY 10 WOMEN
IN OUR CLASS OUT OF 110
STUDENTS.
SO YOU CAN JUST IMAGINE WHAT THE
BAR MUST HAVE BEEN LIKE TO GET
IN.
I SPOKE TO SOMEONE THAT WENT TO
MEDICAL SCHOOL AT HARVARD DURING
THIS TIME.
SHE WROTE A BOOK BEFORE SHE GOT
INTO HARVARD MEDICAL SCHOOL.
THAT'S KIND OF WHAT THE BAR WAS
FOR THE WOMEN TRYING TO GET IN.
SHE DID THREE RES D RESIDENCIESN
PATHOLOGY.
THAT'S ANOTHER COMMON PATTERN
YOU SEE, JUST LIKE ELIZABETH
BLACKWELL, DEMONSTRATING HOW
QUALIFIED THEY ARE BY THIS
INCREDIBLE TRAINING RECORD.
AND THEN SHE CAME TO THE NIH,
WHERE SHE DEVELOPED A SAFETY
TEST FOR THE POLIO VACCINE AFTER
CUTTER INDUSTRIES ACCIDENTALLY
DISTRIBUTED LIVE POLIO VIRUS IN
SOME OF THEIR VACCINES AND
UNFORTUNATELY SOME CHILDREN
BECAME IB FEC INFECTED WITH POLA
RESULT.
BECAUSE OF HER INCREDIBLE
RECORD, SHE BECAME THE FIRST
WOMAN TO DIRECT AN NIH
INSTITUTE.
BUT I THINK RUTH KIRSCHSTEIN IS
PROBABLY EVEN BETTER KNOWN FOR
HER COMPASSION.
SHE STATED THAT AS A YOUNG
JEWISH WOMEN, SHE WAS WELL
FAMILIAR WITH DISCRIMINATION
HERSELF.
AND SHE ALSO SAID, TRAINING IN
NEW ORLEANS EXPOSED HER TO A
LARGE AMOUNT OF DISCRIMINATION
AGAINST THE AFRICAN AMERICANS.
AND IN A ROLE AT THE NIH, SHE
NOTICED THAT TECHNICIANS WHO ARE
OFTEN AFRICAN AMERICANS, OR
OTHER UNDERREPRESENTED GROUPS,
WERE KEPT AT VERY LOW GS RANKS,
MADE VERY LITTLE MONEY, EVEN
THOUGH THEY WERE MAKING MAJOR
CONTRIBUTIONS.
IN FACT, ONE OF THESE PEOPLE
HELPED TRAIN HER.
SO SHE MADE IT A PASSION TO HELP
THESE TECHNICIANS MOVE UP THE
RANK AT THE NIH.
AS DIRECTOR OF AN INSTITUTE, SHE
ESTABLISHED A MINORITY ACCESS TO
RESEARCH CAREERS PROGRAM AT
UNDERGRADUATE INSTITUTIONS,
WHICH HAS BEEN SO SUCCESSFUL
THAT THE PROGRAM IS STILL IN
EXISTENCE TODAY.
AND YOU KNOW THE NRSA AWARDS
WERE RENAMED IN HER HONOR.
MARY CLAIRE KING IS ANOTHER ONE
OF MY HEROS, AND I HOPE SHE
INSPIRES YOU TOO BECAUSE I'M
GOING TO SHOW YOU WHAT SMALL
THINGS SHE DID AND WHAT AN
ENORMOUS IMPACT SHE MADE.
SO SHE WAS A GENIUS.
SHE WAS STUDYING STATISTICS,
WHICH IS CERTAINLY NOT AN EASY
FIELD, BUT THEN SHE TRANSFERRED
OVER TO GENETICS, ANOTHER RATHER
DIFFICULT FIELD, BECAUSE SHE
LIKED THE INTERSECTION OF
GENETICS AND STATISTICS AND SHE
FELT THAT'S WHERE SHE COULD MAKE
HER CONTRIBUTION.
SHE WAS SO SUCCESSFUL AS A
GRADUATE STUDENT THAT HER
DOCTORAL THESIS MADE THE COVER
OF SCIENCE.
OKAY, MOST OF US WILL SPEND OUR
ENTIRE CAREERS IN RESEARCH, AND
PROBABLY NEVER GET AN ARTICLE IN
SCIENCE, MUCH LESS MAKE THE
COVER, AND SHE'S A GRADUATE
STUDENT.
SO YOU WOULD THINK THAT SHE
WOULD BE GETTING LETTERS AND
INTERVIEWS AND PEOPLE CLAMORING
TO HIRE HER.
BUT IT WAS THE 1970s AND SHE
WAS A FEMALE.
SHE JUST WANTED TO STAY AT HER
HOME INSTITUTION AND SHE APPLIED
FOR A TENURE TRACK ASSISTANT
PROFESSORSHIP IN THE SCHOOL OF
PUBLIC HEALTH.
AND SHE PUBLISHED WHAT THEY SAID
TO HER BECAUSE I'M SURE IT WAS
SO HURTFUL.
SHE SAID, AFTER I ACCEPTED THE
JOB, THE DIVISION HEAD SAID TO
ME, I JUST WANT YOU TO KNOW THAT
YOU ARE ONLY HERE BECAUSE OF ALL
THESE NEW REGULATIONS, AND WE
ARE REALLY SCRAPING THE BOTTOM
OF THE BARREL IN HIRING YOU.
YOU COULDN'T EVEN SAY ANYTHING
LIKE THAT TODAY AND KEEP YOUR
JOB.
TO ANYBODY!
BUT IN THE 1970s, THEY COULD,
AND THEY DID.
AND WELL BEYOND THE 1970s.
BUT WHAT I LOVE WAS HER
RESPONSE.
SHE SAID, WE'LL SEE HOW LONG YOU
FEEL THAT WAY.
SO THAT WAS ANOTHER COMMON THEME
OF THESE HEROS, THESE GIANTS.
THEY DID NOT GET DISCOURAGED BY
PEOPLE MAKING THESE NEGATIVE
COMMENTS.
THEY JUST KNEW THAT THEY HAD
PASSION FOR A CERTAIN FIELD,
THEY WERE GOING TO MAKE A
CONTRIBUTION, AND THEY JUST
WANTED A CHANCE.
AND WHAT DID SHE CONTRIBUTE?
WELL, SHE HAD AN NIH FUNDED
STUDY ON ORAL CONTRACEPTIVES AND
BREAST CANCER RISK.
AND SHE DECIDED TO ADD A SINGLE
QUESTION ON FAMILY HISTORY TO
HER SURVEY.
ONE QUESTION.
SO FOR THOSE OF YOU THAT DO
SURVEY RESEARCH, DON'T
UNDERESTIMATE WHAT YOU ARE
DOING.
THAT QUESTION SHOWED HER THAT
THESE WOMEN WITH EARLY ONSET
BREAST AND OVARIAN CANCERS WERE
MORE COMMON IF THEY BELONGED TO
CERTAIN GROUPS.
MOST COMMONLY ASHKANAZI JEWS.
SHE WENT ON TO DEVELOP A MODEL
SUPPORTING HER HYPOTHESIS THAT
ERRORS, MUTATIONS IN INHERITED
GENES CAUSED AN INCREASED RISK.
AND THANKS TO THIS WORK, LATER
ON, BECAUSE PEOPLE WERE LOOKING
FOR THE MUTATION, THEY FOUND THE
BRCA1 GENE.
AND NOW YOU KNOW WOMEN WHO WOULD
HAVE BEEN DESTINED TO QUITE AN
EARLY DEATH CAN HAVE
PROPHYLACTIC OOPHORECTOMIES,
MASTECTOMIES, CAN LIVE LONG
LIVES, THEY CAN HAVE THEIR
UNBORN CHILD, THEIR EMBRYO
TESTED FOR BRCA, THEY CAN
PURPOSEFULLY HAVE A CHILD THAT
DOES NOT HAVE THE BRCA GENE.
IT'S AMAZING WHAT SHE DID, THE
ELIMINATION OF A TERRIBLE RISK
FACTOR.
OVER TIME.
SO WHAT ABOUT THE 1980s?
WELL, I WENT TO MED SCHOOL IN
THE 1980s.
AND WHEN I LOOKED AROUND, I SAW
THERE WERE MORE WOMEN THAN 6% IN
MY MED SCHOOL CLASS.
THERE WERE 25%.
WE WERE STILL THE MINORITY.
IT WAS USUALLY OLDER WOMEN THAT
HAD HAD ANOTHER CAREER BEFORE
THEY COULD GET INTO MEDICINE.
THERE WERE NONE IN LEADERSHIP
POSITIONS.
SO DIVISION CHIEF WAS CONSIDERED
QUITE A HIGH ROLE FOR WOMEN IN
THOSE DAYS.
WOMEN WERE NOT CHAIRS, THEY WERE
NOT DEANS, THEY WERE NOT
PROVOSTS, THEY WERE NOT
PRESIDENTS.
WOMEN'S HEALTH RESEARCH, WHICH I
HAD A PASSION FOR, MEANT YOU
NEEDED TO GO INTO OB-GYN BECAUSE
THAT WAS THE ONLY PLACE THAT YOU
COULD DO WOMEN'S HEALTH
RESEARCH.
AND EVEN WHEN YOU WENT INTO
OB-GYN, YOU WEREN'T EXACTLY
ENCOURAGED TO BE A RESEARCHER.
SO I JUST HAVE MY OWN LITTLE
ANECDOTE LIKE MARY CLAIRE KING.
I MET WITH MY DIVISION CHIEF
AFTER MY FIRST YEAR ON FACULTY
AND I WAS VERY PASSIONATE ABOUT
RESEARCH FROM THE VERY BEGINNING
AND STARTED DOING IT IN
RESIDENCY.
AND SO I WENT IN THERE ALL
EXCITED, WIDE EYED AND BUSHY
TAILED FOR MY REVIEW THINKING I
WAS GOING TO GET ALL THESE KUDOS
FOR THESE PAPERS AND
PRESENTATIONS THAT I HAD DONE.
AND HE TOOK A LOOK AT MY REPORT
AND HE AND I THINK THIS IS A
PRETTY EXACT QUOTE: WELL,
ABBEY, YOU LOOK PRETTY GOOD ON
PAPER.
BUT WHAT YOU WERE HIRED TO DO
HERE WAS TO TEACH RESIDENTS HOW
TO SEW UP EE PEAZ YOT UP EPISIE
KEEP THAT IN MIND.
LUCKILY FOR ME, I HAD A GREAT
RELATIONSHIP WITH MY CHAIR, I
WENT AND HAD A CONVERSATION WITH
MY CHAIR ABOUT IT, AND WITHIN A
COUPLE OF MONTHS, I HAD MY OWN
DIVISION.
[LAUGHTER]
[APPLAUSE]
THANK YOU.
WHERE WERE YOU BACK IN THE
80s?
OKAY.
SO THEN SOME EXCITING THINGS DO
START TO HAPPEN IN THE 80s,
ALTHOUGH THEY WERE BABY STEPS.
YOU HAVE THE PUBLIC HEALTH
SERVICE TASK FORCE ON WOMEN'S
HEALTH ISSUES ESTABLISHED, AND
THEIR JOB WAS TO GET MORE WOMEN
IN THESE NIH-FUNDED CLINICAL
TRIALS, ALTHOUGH I DON'T KNOW
HOW THEY WERE GOING TO DO THAT,
BECAUSE REMEMBER YOU HAD THE
BACKLASH WHERE THE FDA WAS
SAYING NO.
AND TO ADVOCATE FOR MORE
RESEARCH ON CONDITIONS AND
DISEASES AFFECTING WOMEN.
RUTH KIRSCHSTEIN STEPS UP TO THE
PLATE AGAIN.
SHE STEPS UP AGAIN AND AGAIN AND
AGAIN.
SO I AM SO GLAD SHE'S
REMEMBERED.
THEY ASKED HER TO CHAIR THE
GROUP.
AND THEY GAVE HER A LIST OF ALL
WOMEN WHO COULD BE ON THE TASK
FORCE.
SHE WAS POLITICALLY VERY SAVVY.
VERY REALIZED IF SHE HAD A TASK
FORCE OF ALL WOMEN, PROBABLY
THEY WOULDN'T HAVE MUCH CLOUT.
SO SHE SAID, WE ARE NOT GOING TO
HAVE ANY OF THAT.
WOMEN'S HEALTH IS IMPORTANT TO
MEN AS IT IS TO WOMEN, AND SHE
PUT MEN ON THE COMMITTEE.
AND FOR THE MEN THAT ARE HERE
TODAY, I WANT TO SAY THANK YOU.
WOMEN'S HEALTH CANNOT MOVE
FORWARD WITHOUT THE SUPPORT OF
MEN, SO GIVE THEM A ROUND OF
APPLAUSE.
[APPLAUSE]
ALSO THERE WAS JUST A HANDFUL OF
WOMEN IN CONGRESS.
REMEMBER WHEN THEY TALKED ABOUT
THE SIX WOMEN IN THE SENATE.
YOU WOULDN'T BELIEVE IT TODAY,
BUT IT WAS -- THAT'S HOW IT
STARTED OUT.
AND THERE WAS THIS CONGRESSIONAL
CAUCUS FOR WOMEN'S ISSUES, AND
THEY WERE ACTUALLY PUSHING FOR
THE INCLUSION OF MORE WOMEN IN
CLINICAL TRIALS.
SO THE NIH DIDN'T THINK IT WOULD
BE THAT HARD A PROBLEM TO SOLVE.
THEY PUT OUT A POLICY THAT SAID
IF YOU'RE WRITING A GRANT, YOU
REALLY NEED TO INCLUDE WOMEN AND
MINORITY IN YOUR STUDIES.
BUT IT WASN'T REQUIRED, IT WAS
JUST RECOMMENDED.
AND A FEW YEARS LATER, THE GAO
DID AN AUDIT AND THEY FOUND OUT
THAT OVER 25% OF PEOPLE WERE
JUST IGNORING THE
RECOMMENDATION. SO THE
CONGRESSIONAL CAUCUS FOR WOMEN'S
ISSUES WENT STRAIGHT BACK TO THE
NIH AND SAID, THIS ISN'T
WORKING.
AND THAT WAS THE DAY, OR I
BELIEVE IT WAS THE NEXT DAY THAT
ACTUALLY ORWH WAS FOUNDED.
SO RUTH KIRSCHSTEIN WAS AGAIN
APPOINTED AS ITS FIRST ACTING
DIRECTOR.
AND AGAIN, SHE USED HER
POLITICAL INTELLIGENCE TO MAKE A
DIFFERENCE.
THEY DIDN'T WANT TO CALL IT
ORWH.
THEY WANTED TO CALL IT OWHR.
THEY WANTED RESEARCH TO BE AT
THE END OF THE TITLE.
AND SHE SAID NO, FOR TWO
REASONS.
ONE, SHE SAID IF WE PUT RESEARCH
AT THE END OF THE TITLE, THEY'RE
PROBABLY GOING TO FIGURE OUT A
WAY TO DROP IT FROM THE NAME
OVER TIME, AND RESEARCH HAS TO
BE CENTRAL TO THE MISSION.
OF
WHAT THIS OFFICE DOES.
AND SHE ALSO SAID, IT NEEDED TO
FOCUS ON THE NUMBER OF WOMEN IN
BIOMEDICAL CAREERS.
SO SHE JUST FELT THAT RESEARCH
HAD TO BE CENTRAL.
OKAY, WHAT ABOUT THE 1990s?
WELL, I'M GOING TO ADMIT THAT I
REALLY DIDN'T KNOW VERY MUCH
ABOUT THE LEADERSHIP OF ORWH
UNTIL I STARTED WORKING ON THIS
TALK.
AND I WAS THRILLED AND
FASCINATED TO LEARN MORE ABOUT
THE PEOPLE THAT MADE THE BIRCWH
PROGRAM POSSIBLE.
SO IT FOLLOWS THE THEME THAT I'D
BEEN OUTLINING ALL ALONG, VERY
WELL TRAINED, DON'T EVER TAKE NO
FOR AN ANSWER, WANT TO MAKE A
CONTRIBUTION.
THESE ALL FIT VIVIAN PINN, WHO
WAS THE FIRST PERMANENT ORWH
DIRECTOR APPOINTED IN 1991.
NOW I GREW UP IN THE DEEP SOUTH,
SO I UNDERSTOOD WHAT THE SCHOOL
SYSTEM WAS LIKE IN THE 1960s,
AND THEY USED TO ALWAYS SAY WHEN
I WAS A KID, SEPARATE BUT EQUAL.
BUT I CAN TELL YOU, EVEN AS A
VERY YOUNG CHILD, IT WAS
APPARENT TO ME THAT THERE WAS NO
EQUAL IN THE SEPARATE BUT EQUAL
WHEN IT CAME TO THE SCHOOLS.
I FOUND THAT OUT ACTUALLY WHEN
THEY INTEGRATED THE SCHOOLS, AND
WHEN I SAW THE EDUCATION THAT
HAD BEEN OFFERED BOTH SIDES, AND
WAS PRETTY APPALLED.
WHEN YOU CAN'T FOOL A CHILD,
THAT'S REALLY SAYING SOMETHING.
SO SHE WENT TO SEGREGATED
SCHOOLS IN THE SOUTH IN THE
1940s.
I CAN'T IMAGINE THE BARRIERS
THAT SHE MUST HAVE FACED, BUT
SHE EXPRESSED INTEREST IN
MEDICINE AT A YOUNG AGE.
THANK GOODNESS WE WERE NO LONGER
IN THE TIMES OF ELIZABETH
BLACKWELL, SO SHE WAS TOLD SHE
SHOULD PURSUE HER DREAM BY HER
PARENTS THAT HAD QUITE THE
VISION.
SHE WORKED EXTREMELY HARD, WAS
VALEDICTORIAN OF HER HIGH SCHOOL
CLASS, THEN WENT TO WELLESLEY ON
SCHOLARSHIP.
WHO WOULDN'T LOVE TO GO TO
WELLESLEY?
SHE THEN BECAME THE ONLY WOMAN
AND ONLY AFRICAN AMERICAN IN HER
CLASS AT UNIVERSITY OF VIRGINIA.
IF THAT WASN'T ENOUGH OF AN
ACCOMPLISHMENT, SHE DIDN'T STOP
THERE.
SHE DECIDED THAT SHE WANTED TO
DO SUMMER INTERNSHIP AT NASH
GENERAL IN BOSTON IN PATHOLOGY.
AND I CAN TELL YOU, AT THOSE
TIMES, NOT EVEN ALL THE FIELDS
WERE OPEN TO WOMEN IN MEDICINE.
WOMEN DIDN'T GO INTO THE
SURGICAL FIELDS, BUT PATHOLOGY
WAS OPEN.
AND SHE DID THIS INTERNSHIP, AND
SHE IMPRESSED THEM ENOUGH THAT
SHE GOT HER RES DEN SATISFY
THERE.
SO FOR THESE INCREDIBLE
ACCOMPLISHMENTS, SHE GAME THE
FIRST AFRICAN AMERICAN WOMAN TO
CHAIR AN ACADEMIC PATHOLOGY
DEPARTMENT.
AND THEN SHE BECAME HEAD OF
ORWH, AND SHE FOUNDED THE BIRCWH
AND SCORE INITIATIVES.
SO SHE IS THE REASON WE'RE ALL
SITTING HERE TODAY.
I LOVE THIS QUOTE WHERE SHE
REFLECTS ON HER CAREER.
SHE SAYS, ORWH HELPED DEFINE
WOMEN'S HEALTH AS BEYOND THE
REPRODUCTIVE SYSTEM, WHICH
TRADITIONALLY WAS HOW WOMEN'S
HEALTH WAS VIEWED.
THE BIKINI FIELD OF MEDICINE,
OBVIOUSLY REFERRING TO THE
BREAST AND REPRO D REPRODUCTIVEM
AND THE OB-GYN DEPARTMENT.
I SAW POSTERS ON KIDNEY DISEASE,
ON BRAIN HEALTH, ON AUTOIMMUNE
DISEASE, ON CARDIOVASCULAR
DISEASE, ALL DIFFERENT ORGAN
SYSTEMS ACROSS THE BODY.
SO BIRCWH HAS DEFINITELY MADE IT
POSSIBLE TO STUDY THE ENTIRE
PATIENT.
IN THE 90s, WE DO FINALLY GET
THE ABILITY TO INCLUDE WOMEN IN
CLINICAL TRIALS AFTER 15 YEARS
OF EXCLUSION, AND I CAN TELL YOU
THIS WAS SO CONTROVERSIAL.
THINGS LIKE THIS DID NOT HAPPEN
EASILY.
ANOTHER LITTLE ANECDOTE.
I WAS A YOUNG FACULTY MEMBER ON
THE IRB, AND THE CHAIR OF THE
IRB, WHO WAS OBVIOUSLY VERY
SENIOR, ASKED TO MEET WITH ME
AFTER THE MEETING, AND THEN HE
TOLD ME THAT AS AN OB-GYN, I
MUST UNDERSTAND WHAT A DANGEROUS
LAW THIS WAS, AND HOW THIS COULD
HURT WOMEN AND UNBORN CHILDREN.
AND SURELY, I WOULD BE WILLING
TO WRITE A LETTER TO CONGRESS,
AND A LETTER TO THE NIH
EXPLAINING THIS TO THEM.
I NEVER WROTE THAT LETTER.
BERNADINE HEALY IS ANOTHER ONE
I'VE INCLUDED IN OUR GIANTS.
AGAIN AMAZING TRAINING.
WENT TO VASSAR AND HARVARD ON
FULL SCHOLARSHIPS.
AGAIN ONE OF ONLY 10 WOMEN IN A
CLASS OF 120.
SHE WAS THE FIRST WOMAN TO SERVE
AS DIRECTOR OF THE NIH AND WHAT
SHE'S KNOWN FOR IS ACTUALLY THE
WOMEN'S HEALTH INITIATIVE.
SO WHY IS THE WOMEN'S HEALTH
INITIATIVE IMPORTANT?
I MEAN, NOWADAYS, YOU START TO
SEE IT CRITICIZED, BUT YOU NEED
TO UNDERSTAND THEY WERE JUST
STUDYING ONE REGIMEN FOR HRT.
THEY WERE STUDYING ORAL ESTROGEN
AND ORAL PROGESTERONE.
BUT WHAT IS SO IMPORTANT ABOUT
IT WAS, BEFORE THE WHI, ALL
WOMEN WERE TOLD AFTER MENOPAUSE
THAT THEY MUST TAKE CYCLIC HRT,
OR THEY WOULD BE RISKING THEIR
LIVES.
I WOULD GO TO GET MY NAILS DONE,
TO GET MY HAIR DONE, AND THE
FIRST QUESTION THEY WOULD ALWAYS
WANT TO ASK ME WHEN THEY FOUND
OUT WAS WHEN I WAS AN OB-GYN, DO
I HAVE TO TAKE THIS HRT?
I AM SO TIRED OF HAVING PERIODS.
I DON'T UNDERSTAND WHY I HAVE TO
TAKE THIS.
AND I WOULD JUST SAY AS I HAD
BEEN TRAINED, WELL, WE THINK
IT'S A GOOD IDEA.
THERE WAS THIS BOOK WRITTEN
CALLED "FOREVER FEMININE" ABOUT
HOW IMPORTANT IT WAS TO BE ON
HRT FOR LIFE.
SO BERNADINE HEALY WAS THE FIRST
PERSON THAT SAID, HEY, MAYBE WE
OUGHT TO STUDY IT.
MAYBE WE OUGHT TO SEE IF IT DOES
ANY BENEFIT.
AND THE REGIMEN THEY STUDIED,
THEY ENROLLED OVER 27,000 WOMEN,
AND THEY FOUND OUT THAT THAT
REGIMEN SEEMED TO RAISE THE RISK
OF HEART DISEASE, STROKE, BLOOD
CLOTS, BREAST CANCER AND
DEMENTIA.
THESE MEDICATIONS THAT THEY'D
BEEN TELLING ALL WOMEN, YOU MUST
TAKE, AND AS A RESULT, WOMEN
WERE THEN ALLOWED TO WEIGH THE
PROS AND CONS, AND FIGURE OUT
WHETHER OR NOT THEY WANTED OR
NEEDED THIS MEDICATION AND MANY
DECIDED THAT THEY NO LONGER
WANTED TO TAKE IT.
THEY SAY IT'S LED TO A LOT FEWER
CASES OF CARDIOVASCULAR DISEASE,
FEWER CASES OF BREAST CANCER,
ALTHOUGH THERE IS AN INCREASED
RISK OF FRACTURES BECAUSE
ESTROGEN DOES PREVENT FRACTURES
AFTER MENOPAUSE.
BUT THAT'S THE PROS AND CONS.
THAT'S WHAT WE TRY TO FIND OUT
IN RESEARCH, WHAT WE CAN PRESENT
TO OUR PATIENTS.
THE DATA HAS LED TO OVER 700
PUBLICATIONS, AND THEY'RE STILL
DOING FOLLOW-UP QUESTIONNAIRES
AND GATHERING DATA.
DURING THIS DECADE ALSO, THE NIH
DID WORK ON BISPHOSPHONATE,
FOUND THAT THEY COULD HAVE A
GREAT IMPACT ON PREVENTING OR
REVERSING OSTEOPOROSIS, AND THEY
FOUND OUT THAT AZT COULD PREVENT
TRANSMISSION FROM THE MOTHER TO
THE BABY OF HIV.
SO WHAT ABOUT THE 2,000s,
GETTING INTO THIS CENTRI?
WELL, I'M A RESEARCHER ON THE
HPV VACCINE SO I HAVE A LOT OF
PASSION FOR THIS DISCOVERY.
IT WILL PROBABLY END UP BEING
ONE OF THE GREATEST DISCOVERIES
EVER, BECAUSE WHAT DO WE HAVE
THAT CAN PREVENT THESE CANCERS
OTHER THAN THIS?
SINCE 2006, HPV INFECTIONS HAVE
DROPPED 88% AMONG TEENAGE GIRLS
AND 81% AMONG ADULT WOMEN IN A
SWEDISH STUDY OF OVER
1.6 MILLION FEMALES, FOUND A
DRAMATIC DIFFERENCE IN THE RATE
OF CERVICAL CANCER BETWEEN THOSE
VACCINATED AND UNVACCINATED.
SO WE DO HAVE GREAT DATA NOW TO
PRESENT TO OUR PATIENTS.
BUT EVEN WITH ALL OF THIS, EVEN
AS WE GET INTO THE 2000s,
WOMEN'S HEALTH RESEARCH OUTSIDE
OF REPRODUCTION CONTINUED TO
STRUGGLE.
IT'S GONE MUCH FURTHER, I THINK,
IN THE LAST DECADE THAN ANY TIME
BEFORE THAT.
WHY DID IT TAKE SO LONG?
WELL, THE CLINICIANS SAID THERE
REALLY WAS NO REASON TO EVEN
STUDY IT BECAUSE WHY WOULD YOU
THINK THAT MEN AND WOMEN
DIFFERED IN ANY WAY AT ALL OTHER
THAN THEIR REPRODUCTIVE TRACT?
S?
I THINK IT'S INTERESTING BECAUSE
THERE WAS THIS BOOK A LONG TIME
AGO, "WOMEN ARE FROM VENOUS, MEN
ARE FROM MARS."
SO WE ALREADY KNEW THAT WE
THOUGHT DIFFERENTLY, WE CON GRE
GATED AT PARTIES DIFFERENTLY,
BUT IT TOOK A LONG TIME FOR THAT
JUMP TO FIGURE OUT, HEY, THE
BRAINS ARE DIFFERENT.
MAYBE NOT MAJOR DIFFERENT, BUT
DEFINITELY DIFFERENT.
AND THE BASIC SCIENCE
RESEARCHERS.
I HAD A CENTER AND I WENT AROUND
AND TALKED TO BASIC SCIENCE
RESEARCHERS ABOUT HOW THEY
NEEDED TO DO SEX DIFFERENCES
WORK.
AND THEY SAID, WE CAN'T DO THAT.
I SAID WHY NOT?
THEY SAID, WELL, WE ONLY STUDY
FEMALE MICE OR WE ONLY STUDY
MALE MICE.
I SAID WAIT A MINUTE, WHAT ARE
YOU TALKING ABOUT?
THEY SAID WHY WOULD WE INCLUDE
TWO SEXES IN OUR MICE?
THAT'S GOING TO MESS UP THE
WHOLE STUDY.
THOSE HORMONES ARE GOING TO MESS
UP EVERYTHING.
I ACTUALLY WENT TO MY DEAN BACK
IN 2002 AND SAID, I'M SO
PASSIONATE ABOUT WOMEN'S HEALTH
RESEARCH, I WANT EVERY
DEPARTMENT ON CAMPUS TO BE DOING
THIS.
AND HE SAID WHAT DO YOU MEAN?
I SAID I WANT US ALL TO SIT
DOWN, FIGURING OUT WHAT GRANTS
TO GO FOR, HE HEARD THAT WORD
GRANTS AND HE SAID GREAT IDEA!
SO HE GAVE ME A SMALL AMOUNT OF
MONEY AND I STARTED GETTING
TOGETHER WITH THE OTHER CENTER
DIRECTORS, AND WE BEGAN TO DO
GRANTS TOGETHER.
NOW ALMOST EVERY INSTITUTION HAS
SOME SORT OF CENTER LIKE THIS.
SO WOMEN'S HEALTH RESEARCH IS NO
LONGER SILOED.
AND THAT IS WONDERFUL.
LET'S GET INTO THE 2010s, AND
I WILL TELL YOU THIS WAS MY
FAVORITE PART OF DOING THE TALK
BECAUSE I DID NOT KNOW THAT MUCH
ABOUT JANINE CLAYTON BEFORE I
DID THIS TALK.
SO JUST LIKE EVERYBODY I'VE
PRESENTED, INCREDIBLE
CREDENTIALS, B.S. DEGREE FROM
HOPKINS, M.D. FROM HOWARD, THEN
WENT INTO OPHTHALMOLOGY, WE ALL
KNOW OPHTHALMOLOGY IS A FIELD
THAT NOBODY CAN GET A RESIDENCY
IN UNLESS YOU'RE AOA TO BEGIN
WITH.
THEN SHE GOES TO FELLOWSHIPS AT
WILMER I AND NEI.
MY DAUGHTER ACTUALLY IS AN
OPHTHALMOLOGIST SO I KNOW ALL
THESE EYE INSTITUTES BY NAME
NOW, AND I CAN TELL YOU THOSE
NAMES JUMPED OUT AT ME.
WILMER IS A TOP EYE INSTITUTE.
THEN SHE WENT TO THE NEI AND
SHE'LL HAVE TO FILL IN A LITTLE
BIT OF THE DETAILS BECAUSE I
HAVE TO ADMIT, I DIDN'T TALK TO
HER ABOUT THIS, AND I GOT SOME
OF IT ON WIKIPEDIA.
[LAUGHTER]
SHE WAS THE DEPUTY CLINICAL
DIRECTOR AT NEI, AND SHE HAD
ALREADY AUTHORED 80
PUBLICATIONS.
OBVIOUSLY WAY MORE THAN THAT
NOW.
AND I IMAGINE SHE COULD HAVE
GONE UP TO BE AN INSTITUTE
DIRECTOR AT NEI.
BUT IT WAS OUR GOOD FOREIGN THAT
SHE GOT A SIDETRACK, AND SHE WAS
DOING WORK ON OCULAR DISEASE
THAT WAS ASSOCIATED WITH
PREMATURE OVARIAN INSUFFICIENCY,
AND THAT MADE HER REALIZE THAT
THERE WAS SEX AND GENDER
DIFFERENCES IN OPHTHALMOLOGY.
AND SOMEWHERE ALONG THE WAY, SHE
ENDED UP BEING THE ASSOCIATE
DIRECTOR AT ORWH AND THEN IN
2012, BECOMING THE DIRECTOR OF
ORWH.
AND I'M GOING TO TELL YOU THAT
WAS A LUCKY DAY FOR US.
BECAUSE SHE IS A BIG PICTURE
THINKER.
I TEND TO BE A BIG PICTURE
THINKER SO I RECOGNIZE WHEN
SOMEBODY IS A VERY BIG PICTURE
THINKER.
I WOULD NEVER HAVE THOUGHT OF
THESE THINGS.
SO WHAT SHE DID WAS SHE LEARNED
TO TAKE A SMALL BUDGET, BECAUSE
ORWH IS AN OFFICE, IT'S NOT AN
INSTITUTE, AND LEVERAGE THIS
MONEY TO GET BIG RESULTS.
THE FIRST THING THAT I WAS AWARE
OF WAS THE ONE YEAR
ADMINISTRATIVE SUPPLEMENTS.
JUST $100,000.
BUT SHE FIGURED OUT SHE COULD
TAKE SOMEONE THAT HAD A GRANT
FOR MILLIONS, AND MAYBE THEY'D
ONLY DONE THE WORK ON ONE
GENDER, SEX, AND THEY WERE
WILLING TO GET SOME DATA ON THE
OTHER.
OR MAYBE THEY HAD IT ON BOTH,
AND IT NEVER STRATIFIED.
AND YOU COULD GET ALL THIS
INFORMATION FOR $100,000.
YOYOU'RE REALLY LEVERAGING
MILLIONS OF DOLLARS OF DATA.
SO THAT'S BEEN SO SUCCESSFUL
THAT THEY HAVE SUPPORTED
383 INVESTIGATORS UNDER THAT
MECHANISM.
BUT THIS IS MY FAVORITE PART,
BECAUSE I JUST CAN'T EVEN DREAM
OF THINKING THIS BIG PICTURE.
SO SHE WENT TO FRANCIS COLLINS,
OF COURSE SHE GOES TO THE
DIRECTOR OF THE NIH, AND
TOGETHER, THEY WRITE AN ARTICLE
WHICH OF COURSE IS IN NATURE,
AND THEY SAY THAT WHILE THE NIH
REVITALIZATION ACT OF '93 WAS
GREAT, BECAUSE WOMEN WERE
FINALLY ALLOWED IN CLINICAL
TRIALS, THERE REALLY HAS NOT
BEEN A CORRESPONDING REVOLUTION
IN THE DESIGN AND ANALYSIS IN
RESEARCH.
AND THEY SAY OUR GOAL IS TO
TRANSFORM HOW SCIENCE IS DONE.
I WANT YOU TO THINK ABOUT THOSE
FEW WORDS AND HOW BOLD THAT WAS.
FROM THAT, IT WENT TO A NOTICE
THAT JUST BASICALLY SAID IF YOU
WANTED NIH MONEY, YOU HAD TO DO
THIS.
SO WHO'S NOT GOING TO DO IT?
THEY SAID SABV WOULD BE FACTORED
INTO THE RESEARCH DESIGNS,
ANALYSIS AND REPORTING AND
ANIMAL AND HUMAN STUDIES.
AND IF YOU DON'T THINK THERE WAS
AN OUTCRY ABOUT THIS, I'M
SURE -- DID YOU RECEIVE A FEW
EMAILS?
I'M SURE THERE WAS A MAJOR
OUTCRY BUT PEOPLE JUST HAD TO DO
IT.
AND YOU HAD TO JUSTIFY IF YOU
WERE JUST LOOKING AT ONLY ONE
SEX, AND YOU HAD TO JUSTIFY IT
SO MUCH THAT WHEN I WAS DOING
RESEARCH ON THE HYMEN, I HAD TO
JUSTIFY ONLY INCLUDING WOMEN.
THERE'S MANY OTHER PROGRAMS SHE
TOLD YOU ABOUT IN HER TALK.
ONE IS THE ADMINISTRATIVE
SUPPLEMENT ON WOMEN THAT HAVE
BEEN UNDERSTUDIED,
UNDERREPRESENTED AND
UNDERREPORTED.
STILL THE ONLY PROGRAM THAT DOES
THIS.
AND ALSO CHANGING THE SCORE INTO
A PROGRAM THAT FOCUSES ON SEX
AND GENDER DIFFERENCES, AND THEN
WE'VE HEARD ABOUT THE R01 AND
THE NEW EDUCATION GRANT, AND IT
GOES ON AND ON, I CAN'T WAIT TO
HEAR ABOUT MORE OF THEM.
SO HAS SEX AND GENDER
DIFFERENCES CAUGHT ON?
WELL THAT WOULD AN UNDERSTATE M.
THERE'S JOURNALS ON IT NOW,
THERE'S ARTICLES ALL THE TIME ON
IT NOW.
EXAMPLES HERE FOR FUN, IF YOU
WANT TO REALLY SEE EXAMPLES, GO
UP TO THE POSTER SESSION.
BUT THERE'S SEX DIFFERENCES IN
IMMUNE RESPONSES, THERE'S SEX
DIFFERENCES IN DRUG USE, THERE'S
SEX DIFFERENCES IN PAIN.
THERE'S SEX DIFFERENCES IN
KIDNEY METABOLISM.
WE'RE FINDING LOTS OF SEX
DIFFERENCES IN THE CANCER FEALD.
THIS ARTICLE WAS ON HIGHER LUNG
CANCER INCIDENCE IN YOUNG WOMEN
WE KNOW OROPHARYNGEAL CANCERS
ARE MUCH HIGHER IN MEN THAT ARE
HPV-RELATED.
AND THERE'S A LOT OF SEX
DIFFERENCES IN VACCINES.
IF YOU'RE WORRIED ABOUT GETTING
GUILLAIN-BARRE, YOU PROBABLY
DON'T HAVE TO WORRY ABOUT THAT
AS MUCH IF YOU'RE A MALE BECAUSE
THAT'S MORE LIKELY TO POP UP IN
A FEMALE.
SO THERE'S BEEN SOME GREAT
ACHIEVEMENTS IN THE LAST 10
YEARS.
ONE IS THAT WOMEN ARE NOW MORE
THAN HALF OF ALL PARTICIPANTS IN
CLINICAL TRIALS.
HERE'S A META-ANALYSIS
ONCOINDIVIDUAL TRIALS AND THEY
FOUND OUT THAT FEMALES WERE 45%
OF ALL ENROLLEES.
SO HOORAY, IT WAS DONE.
AND THERE'S SOME OTHER TRIALS
I'VE LISTED HERE WHERE WOMEN
WERE 50% OR MORE.
SO THAT BATTLE HAS BEEN WON.
OF COURSE EVERYTHING ISN'T
PERFECT.
THERE'S LOTS OF WORK TO DO.
ONE IS THAT WOMEN REALLY DON'T
WRITE NIH FUNDED CLINICAL TRIALS
IN THEIR GRANTS AS MUCH AND THEY
FOUND OUT IN THE CARDIOVASCULAR
WORLD, ONLY 18% WERE LED BY
WOMEN.
THERE'S MANY TOPICS THAT STILL
NEED A LOT MORE WORK.
CON EXCONTRACEPTION, I DON'T EVN
THINK VERY MUCH IS BEING FUNDED
ON THAT AT ALL ANYMORE.
MEDICAL NEEDS OF TRANSGENDER
WOMEN ARE OFTEN OVERLOOKED.
THERE'S LITTLE RESEARCH ON
NEUROLOGICAL DISEASES IN WOMEN,
AND MATERNAL MORTALITY CONTINUES
TO GO UP IN THE COUNTRY THAT IS
SPENDING MORE ON HEALTHCARE THAN
ANY OTHER COUNTRY.
BUT WHAT DO WE SEE OF THESE
GIANTS?
WHAT DO WE HAVE IN COMMON THAT
WE CAN GAIN INSPIRATION FROM?
WELL, THEY OVERCAME ENORMOUS
HURDLES.
STARTING BACK WITH ELIZABETH
BLACKWELL, LOOKING AT THIS
ATMOSPHERE WHERE WOMEN WEREN'T
EVEN ALLOWED IN MEDICAL SCHOOL
AND STILL HAVING THE NERVE TO
APPLY.
DRIVEN TO MAKE A DIFFERENCE IN
WOMEN'S HEALTH, THEY ALL HAD A
GREAT DEAL OF PASSION.
THEY MADE SURE THEY WERE WELL
TRAINED AND HIGHLY QUALIFIED FOR
THEIR POSITIONS.
THERE WERE NO GIFTS HERE.
NOBODY GOT THESE POSITIONS
BECAUSE THEY WERE FEMALE.
THEY WERE THE MOST QUALIFIED.
AND THEY HAD CAN-DO ATTITUDES
LIKE MARY CLAIRE SAID, WE'LL
JUST SEE HOW LONG YOU FEEL THAT
WAY.
SO WE'VE HEARD ABOUT THE WHITE
HOUSE INITIATIVE ON WOMEN'S
HEALTH RESEARCH, AND I LIKE WHAT
JOE BIDEN SAID, THAT NO WOMEN OR
GIRL WILL EVER HAVE TO HEAR
ANYMORE, "IT'S ALL IN YOUR
HEAD," OR "IT'S JUST STRESS."
WHERE WOMEN AREN'T JUST AN
AFTER-THOUGHT BUT A FIRST
THOUGHT.
WHERE WOMEN JUST DON'T SURVIVE
WITH CHRONIC CONDITIONS, BUT
LEAD LONG AND HEALTHY LIVES.
SO I WANT TO LEAVE YOU TODAY,
ESPECIALLY THE SCHOLARS BUT ALSO
THE MENTORS AND THE PIs, AND
THE RESEARCH DIRECTORS, THAT YOU
ARE THE FUTURE OF WOMEN'S HEALTH
RESEARCH.
THE BIRCWH AND SCORE PROGRAMS
ARE LEADING THE EFFORTS TO STUDY
SEX AND GENDER DIFFERENCES IN
DISEASES MORE COMMON IN WOMEN.
THE TOPICS THAT ARE NOW BEING
UNDERTAKEN ARE DIVERSE, AND WE
ARE WAY BEYOND THE REPRODUCTIVE
TRACT.
THE PUBLICATIONS ARE GETTING IN
HIGH IMPACT JOURNALS, SO THE
EDITORS ARE RECOGNIZING THE
IMPORTANCE OF THIS WORK.
BUT OVERALL WE STAND ON THE
SHOULDERS OF THESE GIANTS.
WE CAN'T FORGET ALL OF THESE
PEOPLE THAT MADE IT POSSIBLE FOR
US TO SIT IN AN AUDITORIUM
TODAY, AND TALK ABOUT WHAT WE
NEED TO DO IN WOMEN'S HEALTH
RESEARCH.
THEIR HEROIC EFFORTS HAVE GIVEN
YOU THE TOOLS AND RESOURCES YOU
NEED TO MAKE MAJOR ADVANCES IN
WOMEN'S HEALTH RESEARCH AND
BECOME THE LEADERS OF TOMORROW.
AND SOME OF YOU WILL BE GIANTS.
SO THIS IS A PICTURE OF
GALVESTON.
A LOT OF PEOPLE DON'T KNOW WHERE
IT IS.
IT'S ON THE GULF OF MEXICO, SO
WHEN YOU ARE IN HURRICANE
SEASON, YOU'LL KNOW WE'RE BITING
OUR NAILS.
BUT IN THE WINTERTIME, WE HAVE
BEAUTIFUL 70 DEGREE DAYS.
WE GO OUT AND WE TAKE WALKS ON
THE BEACH AFTER WORK, AND IT'S A
LOVELY PLACE TO LIVE AND WORK.
I HOPE YOU CAN VISIT US THERE
SOMEDAY.
THANK YOU.
[APPLAUSE]
>> THANK YOU, DR. BERENSON.
ACTUALLY I MIGHT ASK YOU TO STAY
AT THE PODIUM FOR JUST A MOMENT
FOR YOUR Q & A SESSION.
WE'RE RUNNING A LITTLE BIT
BEHIND, BUT I DID WANT TO OPEN
THE FLOOR UP TO MAYBE JUST LIKE
ONE OR TWO QUESTIONS OR COMMENTS
FROM THE AUDIENCE.
>> FROM TULANE.
OUTSTANDING PRESENTATION,
DR. BERENSON.
JUST OUTSTANDING.
[APPLAUSE]
>> THANK YOU.
IT WAS A PLEASURE.
>> YOU KNOW, YOU GAVE SO MANY
INSPIRATIONAL INSIGHTS ON WHAT
LEADERS BEFORE HAVE DONE, AND
ALSO AT THE VERY END GAVE
SOME -- YOU KNOW, SOME
ACCOLADES, WHAT OUR CURRENT
SCHOLARS COULD DO.
BUT IF YOU HAD TO REFLECT ON ONE
THING YOU THINK MADE A
DIFFERENCE IN YOUR CAREER, WHICH
I THINK COULD REALLY BENEFIT OUR
CURRENT SCHOLARS, BECAUSE
THEY'RE COMING UP IN A DIFFERENT
TIME AND A DIFFERENT AGE, BUT IT
WOULD BE WONDERFUL FOR YOU TO
SHARE THAT.
COULD YOU SHARE THAT?
>> YES, ACTUALLY I AM GOING TO
SHARE SOMETHING KIND OF
PERSONAL.
AS A RESEARCHER GOING THROUGH
THE RANKS, I HAD A LOT OF
PRESSURE TO APPLY FOR AND ACCEPT
A CHAIR POSITION.
THAT WAS CONSIDERED THE GOLD
STANDARD, AND I WOULDN'T HAVE
MADE IF I DIDN'T BECOME A CHAIR.
BUT I KNEW THAT REALLY WASN'T MY
PASSION, THAT MY PASSION WAS
LOOKING AT THE DATA, WRITING THE
PAPERS, CONCEIVING OF THE
STUDIES, EVEN WRITING THE
GRANTS.
AND IT WAS QUITE DIFFICULT FOR
ME IT OVERCOME ALL OF THAT
PRESSURE AND JUST SAY, HEY, I
LIKE WHAT I'M DOING, AND WHERE
I'M DOING IT IS INCREDIBLY
SUPPORTIVE, SO IT MAY NOT BE
WHERE YOU CHOOSE TO WORK, BUT
IT'S A GREAT PLACE FOR ME,
THEY'RE GIVING ME ENORMOUS
AMOUNTS OF PROTECTED TIME.
REMEMBER, WE DIDN'T HAVE A
BIRCWH PROGRAM.
WE DIDN'T EVEN HAVE K23s.
SO USUALLY THE WOMEN WERE BEING
ASKED TO DO A LOT OF CLINICAL.
SO IF I COULD GIVE ONE PIECE OF
ADVICE TO THE SCHOLARS ON THAT,
I WOULD SAY PURSUE YOUR PASSION.
YOU WILL NEVER HAVE A DAY OF
WORK IF YOU LOVE WHAT YOU DO.
AND I COULD RETIRE TOMORROW.
I DON'T WORK FOR MONEY ANYMORE.
I WORK BECAUSE I LOVE WHAT I DO.
[APPLAUSE]
>> WE'LL TAKE ONE MORE COMMENT
OR QUESTION FROM THE AUDIENCE.
>> HI, JENNIFER, ONE OF THE
BIRCWH SCHOLARS FROM DUKE.
I WAS INTERESTED IN YOUR COMMENT
ABOUT TRYING TO BE MORE
INCLUSIVE IN RESEARCH STUDY SO
IS THAT THEY INCLUDE BOTH MEN
AND WOMEN OR AT LEAST ASSIGNED
MALE OR FEMALE SEX AND BIRTH IN
STUDIES, AND I HAPPEN TO BE A
BREAST CANCER RESEARCHER WHERE
FUNNY ENOUGH, WE HAVE THE
OPPOSITE PROBLEM, THAT MEN ARE
CONSTANTLY EXCLUDED FROM
RESEARCH IN BREAST CANCER, AND I
REVIEW A FAIR NUMBER OF
ARTICLES, COMMONLY THEY SAY WE
LIMITED TO WOMEN AND I CAN'T
HELP BUT ASK EVERY TIME, WHY,
PLEASE JUSTIFY.
THIS IS A RETROSPECTIVE STUDY,
THERE'S NO REASON YOU CAN'T GO
BACK AND INCLUDE MEN, AND THEY
NEVER DO, RIGHT?
THEY JUST SAY OH, WELL, YOU
KNOW, WOMEN'S HORMONES, BLAH,
BLAH, BLAH.
SAME REASON THEY USED TO BE
EXCLUDED IS NOW WHY WE'RE
EXCLUDING MALES.
SO I WAS CURIOUS, WHAT DO YOU
THINK WE SHOULD SAY TO THEM?
SHOULD WE TAKE A STRONGER STANCE
THAT MEN SHOULD BE INCLUDED IN
SOME OF THESE STUDIES?
SHOULD WE JUST MAKE A BIGGER
POINT OF RECOGNIZING THE STUDY
LIMITATIONS THAT, YOU KNOW,
WE'RE NOT INCLUDING THIS
POPULATION.
I FIND IT VERY BIZARRE.
>> I WOULD SUGGEST TO THEM THAT
THEY DO A FOLLOW-UP PAPER ON SEX
AND GENDER DIFFERENCES, BECAUSE
PEOPLE ALWAYS LAKE IDEAS FOR NEW
PAPERS.
SO MAYBE THEY WON'T REVISE THAT
ONE BECAUSE THEY'VE ALREADY DONE
98% OF THE WORK AND THEY WANT IT
OUT THE DOOR, BUT THEY'LL BE
LIKE, OH, YEAH, ANOTHER PAPER,
AND MAYBE THE JOURNAL WOULD BE
INTERESTED IN THAT PAPER.
IT'S ABOUT GETTING THE WORK
DONE.
>> I JUST HAVE TO SAY THANK YOU
AGAIN FOR JUST A REALLY
INFORMATIVE AND INSPIRING
PRESENTATION.
THANK YOU SO MUCH.
[APPLAUSE]
>> SO LAST YEAR, WHEN DR. LISA
BAGG INTRODUCED OUR PODIUM
SPEAKER SCHOLARS, SHE POINTED TO
LAST YEAR'S VERSION OF THIS
PICTURE AND EXPRESSED HER
APPRECIATION FOR THE DEDICATION
AND PERSEVERANCE THAT HAVE BEEN
SHOWN BY THE CURRENT AND FORMER
BIRCWH SCHOLARS.
AS I'M THE INCOMING P.O., IT
DIDN'T REALLY SOUND GENUINE TO
ME TO SAY THAT I REALLY COULD
APPRECIATE YOUR PERSEVERANCE AND
YOUR DEDICATION, I WASN'T HERE
TO WITNESS IT.
BUT WHAT I CAN SAY IS THAT I AM
AWED AND INSPIRED BY THE
OUTCOMES OF THE BIRCWH PROGRAM,
WHICH I ACTUALLY BECAME VERY
FAMILIAR WITH WHEN I LOOKED AT
THE PROGRESS REPORTS, AND I SAW
HOW OUR CURRENT AND FORMER
BIRCWH SCHOLARS WERE PERFORMING
IN TERMS OF PUBLICATIONS,
PRESENTATIONS, IN TERMS OF REA
TENSION IN THE FIELD, 10 TOUR TE
TRACK FACULTY OPINIONS, GETTING
RESEARCH AWARDS.
I WAS DEFINITELY HONORED AND
HUMBLED TO BE ABLE TO BE A PART
OF A PROGRAM THAT WAS TRULY
FOLLOWING THE TENETS OF
EMPOWERING, ENHANCING AND
IMPROVING OUTCOMES FOR WOMEN IN
BIOMEDICAL CAREERS.
SO I AM GOING TO GO AHEAD AND
INTRODUCE OUR BIRCWH SCHOLAR
PODIUM SPEAKERS NOW.
WE HAVE THREE SPEAKERS THIS
YEAR.
THESE SPEAKERS WERE CHOSEN FROM
AMONG THE ABSTRACTS THAT WERE
SUBMITTED FOR POTENTIAL POSTER
AND PODIUM PRESENTATIONS.
WE CHOSE THESE PRESENTATIONS
BECAUSE OF THE INNOVATION AND
IMPACT THAT THEY HAD ON WOMEN'S
HEALTH IN GENERAL, AND I KNOW
THAT YOU ALL WILL DEFINITELY
ENJOY OUR PRESENTERS AS THEY
REALLY SHOWCASE THE WORK THAT
THEY HAVE PUT SO MUCH EFFORT
INTO.
WHAT I'M GOING TO DO NOW IS
INVITE THE PIs OF EACH SCHOLAR
TO COME UP AND GIVE THEM A BRIEF
INTRODUCTION BEFORE THEY BEGIN
THEIR PRESENTATION.
EACH WILL HAVE 15 MINUTES TO
PRESENT ANTIA SHORT Q & A
AFTERWARDS.
WE ARE GOING TO TRY TO STAY ON
TIME.
WITH THAT LITTLE CAVEAT.
I DO WANT TO GO AHEAD AND
INTRODUCE OUR FIRST SPEAKER BY
INVITING DR. JILL GOLDSTEIN, HR
P.I., UP TO THE PODIUM, TO GIVE
A NICE INTRODUCTION.
>> WELL, I AM INCREDIBLY HONORED
TO BE INTRODUCING OUR SCHOLAR,
DR. REBECCA HARRIS.
SHE'S A WONDERFUL REPRESENTATION
OF OUR BIRCWH BECAUSE OUR BIRCWH
IS -- YESTERDAY WAS SCORE.
I'M GETTING CONFUSED.
BUT THEY SHARE TRAINING GOALS.
AND OUR TRAINING GOAL FOR OUR
HARVARD BIRCWH IS FOCUSED ON THE
IMPACT OF HORMONES IN GENES IN
UNDERSTANDING SEX EFFECTS IN
MEDICINE BUT ALSO WOMEN'S
DISEASES SPECIFICALLY.
AND SHE'S A FANTASTIC
REPRESENTATION OF THIS BECAUSE
SHE REALLY ACTUALLY COMBINES
BOTH IN VERY INNOVATIVE WAYS TO
TRY TO UNDERSTAND DISEASE.
SHE ATTENDED THE UNIVERSITY OF
ILLINOIS AT URBANA-CHAMPAIGN,
WHERE SHE RECEIVED THE BARRY
GOLDWATER SCHOLARSHIP AND
GRADUATED SUMMA CUM LAUDE AND
PHI BETA KAPPA WITH DUAL
B.A. DEGREES IN BIOCHEMISTRY AND
BIOLOGY.
SHE WAS ACCEPTED TO BE A MEDICAL
SCIENCE TRAINING PROGRAM AT
NORTHWESTERN UNIVERSITY, AND
COMPLETED HER DOCTORAL TRAINING
IN ENDOCRINOLOGY IN THE
LABORATORY OF LARRY JAIM SON,
WHERE SHE WAS INVESTIGATING THE
GENETICS OF MALE INFERTILITY IN
MICE.
AND THE HOMOLOGUE OF THE GENE
SHE IDENTIFIED IS ESSENTIAL FOR
SPERMATOGENESIS IN MICE WAS
LATER FOUND TO BE IMPORTANT TO
GENESIS IN HUMANS.
THERE WERE MANY ETHICAL ISSUES
IN LOOKING AT GENETICS AND
REPRODUCTIVE ENDOCRINE, SO SHE
ADDITIONALLY PURSUED A
MASTER'S DEGREE IN MEDICAL
HUMANITIES IN BIOETHICS AT
NORTHWESTERN UNIVERSITY,
CONCURRENTLY WITH HER PH.D., SHE
IS AN M.D. PH.D. WITH AN
ADDITIONAL MASTERS IN ETHICS.
SHE COMPLETED RESIDENCY TRAINING
IN PEDIATRICS BECAUSE SHE'S A
PEDIATRIC ENDOCRINOLOGIST, AND
SHE WORKED INVESTIGATING THE
EPIGENETIC LANDSCAPE OF PATIENTS
WITH DIFFERENCES IN SEXUAL
DEVELOPMENT.
AFTER HER RESIDENCY, SHE WAS A
FELLOW AT THE A ACADEMIC GENERAL
PEDIATRICS AT LURE EE
CHILDREN'S, WHERE SHE CONDUCTED
QUALITATIVE RESEARCH ON SOME OF
THESE ETHICAL ISSUES IN
TRANSGENDER YOUTH.
AND DURING THAT TIME, SHE
COMPLETED THE ETHICS FELLOWSHIP
AT MCCAIN CENTER FOR CLINICAL
ETHICS AT THE UNIVERSITY OF
CHICAGO.
SHE MOVED TO BOSTON, FORTUNATE
FOR US, AND COMPLETED A
FELLOWSHIP IN PEDIATRIC
ENDOCRINOLOGY AT BOSTON
CHILDREN'S.
WHICH IS ONE OF THE HARVARD
HOSPITALS.
SHE SPECIALIZES IN PROVIDING
MEDICAL CARE TO CHILDREN WITH
DIFFERENCES IN SEX DEVELOPMENT
AND TRANSGENDER AND GENDER
DIVERSE YOUTH, WHICH HAS DRIVEN
HER DESIRE TO REALLY UNDERSTAND
THE MECHANISMS AROUND HORMONES
IN GENES IN UNDERSTANDING HEALTH
AND DISEASE.
AT THAT SAME TIME, SHE THEN
DECIDED BECAUSE SHE'S ALSO BOTH
A BASIC SCIENTIST AND A CLINICAL
SCIENTIST WHICH ALSO REPRESENTS
OUR BIRCWH PROGRAM, AND SHE
JOINED THE LABORATORY OF
DR. DAVID PAIGE, WHO'S AN EXPERT
MANY OF YOU MAY KNOW ON THE Y
CHROMOSOME, AND SHE HAS BEEN
ALSO WORKING AT THE WHITEHEAD
INSTITUTE THERE WITH DR. PAIGE.
SHE IS GOING TO TELL YOU A BIT
ABOUT THESE INITIATIVES THAT SHE
HAS LAUNCHED, A BIOBANK AND
LONGITUDAL COHORT OF OVER 400
INDIVIDUALS WITH DIFFERENT
COMBINATIONS OF SEX HORMONES AND
SEX CHROMOSOMES, AND THEN SHE
WILL TELL YOU ABOUT THAT TODAY,
THIS INITIATIVE CALLED THE GENES
AND HORMONES INITIATIVE IS SUCH
A WONDERFUL REPRESENTATION,
AGAIN, OF SOME OF THE SCIENCE
THAT WE TRY TO ENGENDER AND GROW
AT THE BIRCWH PROGRAM.
SO WITHOUT FURTHER ADO,
DR. HARRIS.
[APPLAUSE]
>> THANK YOU SO MUCH FOR HAVING
ME THIS AFTERNOON.
IT'S REALLY A PLEASURE.
TODAY I'M GOING TO TALK ABOUT MY
PROJECT WHICH IS TRYING TO
REALLY UNTANGLE THE INDEPENDENT
EFFECTS OF TESTOSTERONE,
ESTRADIOL, AND SEX CHROMOSOMES
ON GENE EXPRESSION.
I LOOK AT IMMUNE CELLS, I'LL
EXPLAIN THAT IN A LITTLE BIT,
AND MY PROJECT INCLUDES BOTH
TRANS AND CISGENDER INDIVIDUALS,
WHICH HAS ALLOWED ME TO LOOK AT
THE INDEPENDENT EFFECTS OF ALL
THESE VARIABLES.
SO I ALL THE ALWAYS LIKE TO SHS
SLIDE AT THE BEGINNING OF MY
PRESENTATIONS.
THIS IS FROM A PAPER IN 2012, SO
YOU CAN ONLY IMAGINE HOW OVER
THE LAST 12 YEARS, THIS HAS
CHANGED.
EACH COLUMN IS AN ORGAN SYSTEM,
AND UNDER EACH COLUMN YOU SEE A
DISEASE THAT HAS SOME SORT OF
SEX DIFFERENCE.
AND THE NUMBER IN PARENTHESES IS
THE NUMBER OF PUBLICATIONS IN
2012 THAT DEMONSTRATED A SEX
DIFFERENCE IN THAT DISEASE.
SO YOU CAN ONLY IMAGINE HOW
THOSE NUMBERS HAVE INCREASED
OVER THE LAST DECADE.
AS DR. GOLDSTEIN SAID, I'M A
PEDIATRIC ENDOCRINOLOGIST SO
OBVIOUSLY SHOUT OUT TO THE
ENDOCRINE SYSTEM AND MY WORK IS
IN IMMUNOLOGY AS WELL AND WE
KNOW THERE ARE A LOT OF SEX
DIFFERENTIAL DISEASES IN
IMMUNOLOGY.
SO ONE OF THE BIGGEST QUESTIONS
IN THIS FIELD IS WHAT ARE THE
CONTRIBUTIONS OF THE SEX
HORMONES AND THE SEX CHROMOSOMES
TO HUMAN HEALTH AND DISEASE?
TODAY I'M REALLY GOING TO FOCUS
ON THE INDEPENDENT ACTIONS OF
EACH.
AND AS A READOUT FOR HUMAN
HEALTH AND DISEASE, I LOOK AT
CHANGES IN GENE EXPRESSION SO
THAT'S WHAT I'LL BE DISCUSSING
TODAY.
AS DR. GOLDSTEIN SAID, THE
ANSWER TO THIS QUESTION FOR ME
HAS TAKEN THE FORM OF A
TRANSLATIONAL RESEARCH PROGRAM
CALLED THE GENES AND HORMONES
INITIATIVE, WHICH I STARTED SIX
OR SEVEN YEARS AGO.
SO AT BOSTON CHILDREN'S
HOSPITAL, I HAVE THE PRIVILEGE
OF CARING FOR MANY DIFFERENT
PATIENT POPULATIONS, INCLUDING
PATIENTS IN OUR GENDER
MULTI-SPECIALTY CLINIC, OUR GMS
CLINIC, ONE OF THE LARGEST
PEDIATRIC GENDER CLINICS IN THE
UNITED STATES.
I ALSO AM AN ATTENDING PHYSICIAN
IN OUR BEING YOU CLINIC, WHICH
IS A VERY CUTE ACRONYM FOR
PATIENTS WITH DIFFERENCES IN SEX
DEVELOPMENT.
AND FROM THESE TWO CLINICS AS
WELL AS THE GENERAL POPULATION,
I'VE DEVELOPED A LONGITUDAL
COHORT WHICH IS A BIOREPOSITORY,
SO WE HAVE BLOOD, URINE,
SOMETIMES STOOL, AS WELL AS DEEP
CLINICAL PHENOTYPING DATA FROM
OVER 400 INDIVIDUALS WITH
DIFFERENT COMBINATIONS OF SEX
HORMONES AND SEX CHROMOSOMES,
AND WE FOLLOW THEM
LONGITUDINALLY OVER TIME.
THE FIRST PAPER WE'VE PUBLISHED
FROM THIS COHORT ODDLY ENOUGH
WAS A MICROBIOME PAPER LOOKING
AT THE EFFECT OF TESTOSTERONE
TREATMENT ON THE STOOL
MICROBIOME IN TRANSGENDER
INDIVIDUALS.
TODAY I'M GOING TO TALK ABOUT A
DIFFERENT STUDY, A DIFFERENT
PILOT STUDY THAT WE UNDERTOOK
SEVERAL YEARS AGO WHICH IS A
FOUR-STATE STUDY, SOMEWHAT
RECOMMEND NE SINT OF THE FOUR
CORE JEA KNOW GENOTYPE MODEL I.
BUT THIS IS IN HUMANS.
SO WE HAVE 6 69 INDIVIDUALS,
21 WHO ARE XX TRANSGENDER AND
HAVE BEEN ON EXOGENOUS
TESTOSTERONE AS PART OF THEIR
GENDER-AFFIRMING HORMONE THERAPY
FOR AT LEAST A YEAR.
13 INDIVIDUALS WHO ARE XY
INDIVIDUALS WHO HAD BEEN ON
ESTRADIOL FOR AT LEAST A YEAR,
20 CISGENDER WOMEN WHO ARE XX
AND 15 CISGENDER MEN WHO WERE
XY.
FROM ALL OF THESE PEOPLE WE DREW
BLOOD, WE ISOLATED P BMCs,
PERIPHERAL BLOOD MONO NUCLEAR
CELLS SO TYPES OF WHITE BLOOD
CELLS AND WE DID THREE PRIME
SINGLE CELL RNA SEQUENCING.
TET ATTHE SAME TIME WE ICE WHRA,
WE USED ALL THAT INFORMATION
TOGETHER TO LOOK AT THE EFFECTS
OF TESTOSTERONE, ESTRADIOL, AND
SEX CHROMOSOMES ON CELL TYPE
ABUNDANCES AND CHANGES IN GENE
EXPRESSION.
NOW I WANT TO BE VERY CLEAR,
MOST OF THE TIME WHEN I DISCUSS
MY RESEARCH PEOPLE ASSUME YOU DO
PAIR WISE COMPARISONS BETWEEN
THE GROUPS.
WE DIDN'T.
WE PUT ALL 69 PEOPLE IN ONE
MODEL, ONE INCLUSIVE MODEL, AND
THAT'S THE WAY WE WERE ABLE TO
UNTANGLE THE EFFECTS OF
TESTOSTERONE, ESTRADIOL, AND THE
SEX CHROMOSOMES.
OKAY.
SO THIS IS THE TYPICAL U MAP
THAT YOU SEE IN SINGLE CELL
SEQUENCING.
WE SEQUENCED OVER 350,000 WHITE
BLOOD CELLS, WHICH IS A VERY
ROBUST SINGLE CELL DATASET AND
WE IDENTIFIED 18 DISTINCT CELL
TYPES.
YOU CAN SEE DIFFERENT CONTINENTS
OF CELLS SO HE IT TOP AT THE TON
SEE CD16, CD14 MONOCYTES.
EACH DOT IS AN INDIVIDUAL CELL.
IN THE MIDDLE THERE'S A
CONTINENT OF T CELLS, CD4 AND
CD8 T CELLS IN DIFFERENT
SUBSETS, AT THE BOTTOM, NATURAL
KILLER CELLS.
OVER TO THE RIGHT THERE'S AN
ISLAND OF B CELLS.
SO IN TOTAL, 18 CELL TYPES AND
SEVERAL HUNDRED THOUSAND CELLS.
THE FIRST QUESTION WE ASKED WAS,
DOES TESTOSTERONE, E ESTRADIOL R
THE SEX CHROMOSOMES AFFECT
NUMBERS OF THESE CELL TYPES?
THIS PLOT IS LOOKING AT NAIVE
CD4 T CELLS DIVIDED INTO THE
FOUR GROUPS.
AND WHAT YOU CAN SEE IS THE
GROUPS THAT PREDOMINANTLY HAD
TESTOSTERONE ON THE RIGHT HAVE A
DECREASE IN NAIVE CD4 T CELLS
COMPARED TO THE GROUPS WITH
PREDOMINANTLY ESTRADIOL ON THE
LEFT.
SO TESTOSTERONE DECREASES THE
PROPORTIONAL ABUNDANCE OF CD4 T
CELLS.
THIS IS ALSO TRUE FOR CD8 T
CELLS IN THE MIDDLE, AND ON THE
RIGHT, TESTOSTERONE ACTUALLY
INCREASES THE ABUNDANCE OF CD14
MONOCYTES.
NOW IT'S VERY INTERESTING BUT WE
DID NOT SEE AN EFFECT OF THE SEX
CHROMOSOMES ON CELL ABUNDANCES.
IT WAS REALLY TESTOSTERONE THAT
DROVE THOSE CHANGES ACROSS THEIR
18 CELL TYPES, REALLY ONLY THESE
THREE.
SO NOW WE'RE GOING TO PUT CELL
COUNTS ASIDE AND FOR THE REST OF
THE TALK WE'RE GOING TO FOCUS ON
CHANGES IN GENE EXPRESSION.
SOMETHING THAT I WANT TO EXPLAIN
IS THAT SEX DIFFERENTIAL GENE
EXPRESSION MANIFESTS DIFFERENTLY
ON THE AUTOSOMES COMPARED TO THE
SEX CHROMOSOMES.
SO WE DO ONE BIG ANALYSIS BUT WE
LOOK AT THESE TWO SETS OF GENES
SEPARATELY.
I'LL EXPLAIN WHY IN A LITTLE
BIT.
HERE WE'RE GOING TO START WITH
AUTOSOMAL GENE EXPRESSION.
AND WHAT WE FOUND IS THAT
TESTOSTERONE, ESTRADIOL AND THE
SEX CHROMOSOMES REGULATE
DISTINCT, SO NON-OVERLAPPING
SETS OF AUTOSOMAL GENES.
FIRST I'M SHOWING YOU A VOLCANO
PLOT OF THE EFFECTS OF
TESTOSTERONE ON GENE EXPRESSION
IN A SUBTYPE OF CD8 T CELLS.
AND THE GENES IN BLUE ARE GENES
THAT WERE DOWNREGULATED WITH
TESTOSTERONE THAT WERE
SIGNIFICANTLY DOWNREGULATED.
WE CAN DO THE SAME THING FORESTR
ESTRADIOL, AND ON THE RIGHT
WE'RE LOOKING AT MUCOSAL
ASSOCIATED ABERRANT T CELLS AND
WE'RE LOOKING AT THE EFFECTS OF
SE CHROMOSOMES.
SO THIS IS TAKING ALL 69 PEOPLE
AND SAYING IF YOU'RE XX OR XY,
WHAT IS THE DIFFERENCE IN
EXPRESSION OF GENES INDEPENDENT
OF THE SEX HO HORMONES, ONLY THE
SEX CHROMOSOMES.
YOU CAN SEE GENES THAT ARE
UPREGULATED IN XX INDIVIDUALS ON
THE RIGHT, GENES THAT ARE
UPREGULATED IN XY INDIVIDUALS ON
THE LEFT.
SOMETHING INTERESTING THAT WE
FOUND IS THAT WE DID NOT
IDENTIFY A SHARED RESPONSE
BETWEEN TESTOSTERONE, ESTRADIOL
AND THE SEX CHROMOSOMES IN ANY
OF OUR 18 CELL TYPES.
I WILL HIGHLIGHT ONE GENE HERE
WHICH WAS UPREGULATED IN XX
INDIVIDUALS IN SIX OUT OF OUR 18
CELL TYPES, SIDEROFLEXIN.
NORMALLY WE MIGHT HAVE FOUND A
GENE TO BE UPRATED IN WUG CELL
TYPE, MAYBE TWO.
THIS WAS REGULATED IN SIX OUT OF
THE 18 WHICH REALLY STOOD OUT TO
US.
IT'S A TRANSPORTER ON THE INNER
MITOCHONDRIAL MEMBRANE INVOLVED
IN 1 CARBON METABOLISM WHICH CAN
BE A FUEL FOR DIFFERENT CANCERS.
IT HAS ACTUALLY BEEN ASSOCIATED
WITH MANY SEX DIFFERENTIAL
CANCERS, AML, COLORECTAL CANCER,
PAPILLARY, THYROID, BREAST, HEAD
AND NECK SQUAMOUS CELL AND ORAL
SQUAMOUS CELLS.
BUT THE MECHANISMS OF SEX
DIFFERENCES IN THESE CANCERS AND
THE ASSOCIATION IS NOT KNOWN.
FINALLY FOR THE AUTOSOMAL GENES
WE LOOKED AT PATHWAY ANALYSIS TO
LOOK AT ENTIRE BIOLOGICAL
PATHWAYS AND WHAT TESTOSTERONE,
ESTRADIOL AND THE SEX
CHROMOSOMES DO AT THE LEVEL OF
PATHWAYS.
HERE IS A HEAT MAP BASICALLY
EACH COLUMN IS ONE OF THE CELL
TYPES.
AND EACH ROW IS A PATHWAY AND
YOU'RE SEEING THE EFFECT OF
TESTOSTERONE.
THE PATHWAYS THAT REALLY RISE TO
THE SURFACE ARE TESTOSTERONE ARE
THE INTERFERON PATHWAYS,
INTERFERON ALPHA AND GAMMA,
WHICH WE KNOW ARE INVOLVED IN
AUTOIMMUNITY AND INFLAMMATION.
IN THE HEALTHY STATE WHICH IS
WHAT WE'RE LOOKING AT, THEY'RE
ACTUALLY UPREGULATED BY
TESTOSTERONE.
WE CAN DO THE SAME THING FOREST
DIE OL AND THOSE SAME TWO
PATHWAYS FLOAT TO THE TOP BUT AS
DOWNREGULATED WITH ESTRADIOL.
LOOKING ONLY AT THE SEX
CHROMOSOMES, SAME THING.
THE INTERFERON PATHWAYS FLOAT TO
THE TOP BUT THEY'RE XY-BIASED.
NOW YOU MIGHT SAY, REBECCA, THIS
DOESN'T MAKE ANY SENSE, WE KNOW
AUTOIMMUNITY HAS A FEMALE SEX
BUY A THEY SHOULD BE UP WITH
ESTROGEN, THEY SHOULD BE UP IN
XX INDIVIDUALS.
BUT I'LL REMIND YOU THIS IS THE
HEALTHY STATE AND I THINK THAT
THERE MIGHT BE A FLIP WHEN YOU
HAVE KIND OF IMMUNOREACTIVITY
THAT YOU ACTUALLY SEE A CHANGE
FROM TESTOSTERONE TO ESTRADIOL
AND WHAT IS STIMULATING THESE
PATHWAYS WITH AUTOIMMUNE
DISEASE.
OUR MODELS ACTUALLY ALLOWED US
TO LOOK AT THESE PATHWAYS IN A
VERY GRANULAR LEVEL, SO THESE
VENN DIAGRAMS ARE LOOKING AT
THREE CELL TYPES.
CD14 MONOCYTES, CD16 MONOCYTES
AND MAIT CELLS AND WE'RE LOOKING
AT THE LEADING EDGE GENES THAT
ARE DRIVING THE INTERFERON
PATHWAY RESPONSES IN THOSE THREE
CELL TYPES.
THOSE CELL TYPES WERE THE THREE
CELL TYPES WHERE TESTOSTERONE,
ES DAY OL AND THE SEX
CHROMOSOMES ALL HAD A
SIGNIFICANT EFFECT ON THE
INTERFERON PATHWAYS.
AND WE CAN SAY FOR ANY GIVEN
GENE, IS IT AFFECTED ONLY BY
TESTOSTERONE, ONLY BY ESTRADIOL,
OR ONLY BY SEX CHROMOSOME
COMPLEMENT, OR A COMBINATION?
AND AS YOU CAN SEE, THERE ARE
SOME THAT ARE AFFECTED BY ONLY
ONE OF THOSE, SOME BY TWO, AND
SOME BY ALL THREE.
OKAY.
SO NOW WE'RE GOING TO MOVE FROM
AUTOSOMAL GENES INTO SEX
CHROMOSOMAL GENES, AND I
PROBABLY DON'T HAVE TO REMIND
EVERYONE IN THE AUDIENCE HERE,
BUT FOR INDIVIDUALS THAT HAVE 2X
CHROMOSOMES, ONE IS ACTIVE, ONE
IS INACTIVE, BUT THE INACTIVE X,
XI, ABOUT A QUARTER TO A THIRD
OF GENES ARE ACTUALLY EXPRESSED
FROM XI.
SO THIS IS HARD FOR ME AS AN
ENDOCRINOLOGIST BUT WE'RE GOING
TO THROW HORMONES OUT THE WINDOW
AND LOOK ONLY AT THE SEX
CHROMOSOMES RIGHT NOWMENT AND
WEAR GOING TO LOOK SPECIFICALLY
AT GENES ON THE X CHROMOSOME.
SO THIS IS SAYING IF YOU TAKE
ALL OF THE PEOPLE WHO ARE XX AND
COMPARE THEM TO ALL PEOPLE WHO
ARE XY, WHAT HAPPENS TO
EXPRESSION OF THE X CHROMOSOMAL
GENES?
IN THIS VOLCANO PLOT, YOU CAN
SEE A BUNCH OF ORANGE GENES ON
THE RIGHT THAT ARE X CHROMOSOMAL
GENES THAT ARE UPREGULATED IN
INDIVIDUALS WHO ARE XX.
COMPARED TO XY.
THIS IS NATURAL KILLER CELLS.
WE CAN DO THE SAME THING IN MAIT
CELLS AND WHAT YOU START SEEING
IS A PATTERN.
YOU SEE THE SAME GENES, AND
SOMETIMES YOU EVEN SEE THE SAME
LOG TWOFOLD CHANGE IN EXPRESSION
OF KNOWS GENES.
SO WE STARTED THINKING WHAT'S
GOING ON THAT ACROSS OUR 18 CELL
TYPES, WIESE WE'RE SEEING THE SE
CHROMOSOMAL GENES EXPRESSED IN
VERY SIMILAR WAYS?
A QUICK TANGENT BEFORE I ANSWER
THAT QUESTION.
WE DID NOT IDENTIFY ANY X OR Y
CHROMOSOMAL GENES REGULATED BY
THE SEX HORMONES.
OKAY.
SO BACK TO THE QUESTION OF WHAT
THESE GENES ARE DOING ON THE X
CHROMOSOME, WHY THEY'RE SO
PRESERVED ACROSS CELL TYPES.
WE USED A QAWPT TAITIVE METRIC
CALLED THE COEFFICIENT OF
VARIATION WHICH BASICALLY SAYS
IF YOU TAKE ONE GENE AND YOU
LOOK AT ITS EXPRESSION ACROSS
CELL TYPES, IS THAT EXPRESSION
SIMILAR OR DIFFERENT?
IS THE EXPRESSION PRESERVED?
IF IT'S PRESERVED, IF IT'S
SIMILAR, YOU HAVE A VERY LOCO
EFFICIENT OF VARIATION.
IF IT'S VERY DIFFERENT ACROSS
CELL TYPES, YOU HAVE A HIGH
COEFFICIENT OF VARIATION.
SO WE SEPARATED OUR GENES INTO
GENES EXPRESSED FROM THE
INACTIVE X, FROM THE ACTIVE X,
OR AUTOSOMAL GENES.
AND WHAT WE SAW IS IT'S REALLY
THE GENES EXPRESSED FROM THE
INACTIVE X THAT HAVE LOCO EE
FILOWCOEFFICIENTS OF EXPRESSION.
THEIR EXPRESSION IS CAREFULLY
PRESERVED ACROSS CELL TYPES.
THIS BOX PLOT WAS LOOKING AT
GENES EXPRESSED IN ANYWHERE FROM
FIVE TO 18 OF OUR CELL TYPES,
BUT WE THEN SAID WHAT IF WE TAKE
GENES EXPRESSED UBIQUITOUSLY
ACROSS ALL 17 OR 18 CELL TYPES,
ARE THEY PARTICULARLY PRESERVED?
AND WE FOUND THE SAME PATTERN,
EVEN LOWER LEVELS OF THE
COEFFICIENT OF VARIATION, SO
EVEN ENTIRE CONTROL OF GENE
EXPRESSION, PARTICULARLY OF
THESE 23 GENES ON THE --
EXPRESSED FROM THE INACTIVE
EXSM.
AND WHAT ARE THOSE GENES?
THERE ARE GENES INVOLVED IN
PROCESSES THAT EVERY CELL NEEDS.
SO UBIQUINIATION, CHROMATIN
MODIFICATION, SPLICING, PROTEIN
TRANSLATION AND MODIFICATION,
VESICLE TRAFFICKING,
TRANSCRIPTION.
THESE 23 GENES ARE INCREASED
ACROSS ALL 18 CELLS IN XX
INDIVIDUALS COMPARED TO XY
INDIVIDUALS, AND SO THEY COULD
BE CANDIDATES TO EXPLAIN SEX
DIFFERENCES THROUGHOUT THE BODY.
SO IN CONCLUSION, WE USED A
FOUR-STATE INCLUSIVE MODEL,
WHICH IS WHAT ALLOWED US TO
REALLY PARSE OUT THE EFFECTS OF
TESS TO THE TROAN, ESTRADIOL AND
SEX CHROMOSOMES.
WE SHOWED THAT TESTOSTERONE
INFLUENCES IMMUNE CELL
ABUNDANCES.
THAT TESTOSTERONE, ESTRADIOL AND
THE SEX CHROMOSOMES REGULATE
DISTINCT NON-OVERLAPPING SETS OF
AUTOSOMAL GENES.
BUT THAT AT THE LEVEL OF
PATHWAYS, TESTOSTERONE,
ESTRADIOL AND SEX CHROMOSOMES
REGULATE SOME DISTINCT BUT ALSO
SOME OVERLAPPING GENES.
IN PARTICULAR, THE INTERFERON
PATHWAYS, AND THAT BROADLY
EXPRESSED GENES EXPRESSED FROM
THE INACTIVE X HAVE HIGHLY
STABLE PRESERVED RESPONSES TO
SECTION CHROMOSOMES, AND THEY'RE
CANDIDATES TO EXPLAIN SEX
DIFFERENCES.
SO WITH THAT, I WOULD THANK YOU.
I WILL IN PARTICULAR THANK ALL
THE PATIENTS WHO CONTRIBUTED TO
OUR BIOBANK, AS WELL AS MY
MENTORS, THE HARVARD BIRCWH, AND
MY FUNDING AS WELL AS THE BIRCWH
PROGRAM IN GENERAL.
THANK YOU.
[APPLAUSE]
>> THANK YOU, DR. HARRIS.
WONDERFUL TALK.
I DO WANT TO OPEN UP YOUR Q & A
SESSION.
SO ANYONE WHO HAS QUESTIONS, CAN
YOU PLEASE COME TO ONE OF THESE
TWO MICROPHONES DOWN THE CENTER?
>> HI.
PRIL YANT.
BRILLIANT.
TWO KNEW THAT LITTLE GUY WAS
DOING ALL THAT WORK.
SO MY QUESTION FOR YOU IS ON THE
DURATION AND TIMING OF
INITIATION OF TESTOSTERONE IN
THE XXT GROUP, BECAUSE I'M
WONDERING AS A MENOPAUSE
RESEARCHER WHETHER THE RESULTS
MAY BE GENERALIZABLE TO THOSE
WOMEN WHO ARE GETTING SUPER --
PHYSIOLOGICAL LEVELS OF
TESTOSTERONE FROM COMPOUNDING
PHARMACIES.
>> THAT'S AN INTERESTING
QUESTION AND AS A PEDIATRIC
ENDOCRINOLOGIST, NOT ONE THAT I
THINK ABOUT VERY MUCH.
THESE INDIVIDUALS HAD BEEN ON
HORMONES SOMEWHERE BETWEEN ON
AVERAGE 2 1/2 TO 3 YEARS.
BOTH FOR THE ESTRADIOL AND
TESTOSTERONE GROUPS.
>> STARTING AT AGE?
>> SO IT WAS VARIABLE.
OUR AGE RANGE WAS 14 TO 30, SO
MUCH YOUNGER, SINCE WE'RE A
PEDIATRIC CLINIC.
BUT ON AVERAGE, I WOULD SAY
ABOUT AGE 18 TO 20.
>> AND SO YOU ARE VIEWING THESE
AS ACTIVATIONAL EFFECTS OF THE
HORMONES?
>> SAY THAT ONE MORE TIME.
>> ARE YOU VIEWING THESE AS
ACTIVATIONAL EFFECTS OF THE
HORMONES THEN?
>> YEAH, SO I THINK THAT'S A
VERY GOOD QUESTION AND SOMETHING
I'M HOPING TO LOOK AT BOTH THE
REVERSIBLE AND IRREVERSIBLE
EFFECTS BUT WE HAVEN'T DONE THAT
YET.
>> REALLY BEAUTIFUL WORK.
CONGRATS.
>> THANK YOU.
>> HI.
SO THIS WAS A VERY INTERESTING
PRESENTATION AND KIND OF
EXPLAINS THE HORMONES AND THEIR
INTERACTION WITH CHROMOSOMES A
LITTLE BIT.
MY QUESTION IS, WHEN YOU HAVE
MALES WHO ARE, YOU KNOW, XY
UNDERGOING ESTRADIOL THERAPY, I
EXPECT THEIR TESTOSTERONE
LEVELS, ARE THEY DROPPING?
>> THIS IS A VERY GOOD QUESTION.
SO EXOGENOUS ESTRADIOL DECREASES
YOUR ENDOGENOUS TESTOSTERONE A
LITTLE BIT, BUT OFTENTIMES WE
ALSO NEED TO TREAT WITH EITHER
AN ANTIANDROGEN OR GNI AGONIST
TO REALLY FULLY BLOCK
TESTOSTERONE.
>> OKAY.
SO DO YOU SEE THAT IN THOSE
INDIVIDUALS, THERE IS A DECREASE
IN THE INTERFERON PATHWAYS AND
OTHER THINGS AS WELL?
>> THAT'S A REALLY GOOD QUESTION
AND SOMETHING WE HAVE TO
EXPLORE.
SO THE WAY THIS PROJECT IS LAID
OUT, WE'RE LOOKING AT THE
INDEPENDENT EFFECTS OF EACH SEX
HORMONE AND THE SEX CHROMOSOMES.
WE DON'T LOOK AT THE
INTERDEPENDENT EFFECTS.
SO TAKE SOMEONE WHO'S XY AND
RECEIVING EX- EXOGENOUS ESTRADI,
THAT'S KIND OF THE NEXT LEVEL
FOR MY K THAT I'M SUBMITTING
NEXT WEEK.
JUST SAYING.
>> THIS IS GREAT.
YEAH, THE INTERACTION WOULD BE
VERY INTERESTING.
LIKE MAYBE THERE'S NOT ENOUGH --
DO THE INTERACTION TERM.
>> EXACTLY.
>> PAM STRATTON, ORWH.
I'VE SPENT A LOT OF TIME SORT OF
THINKING IN THIS AREA ADJACENTLY
AND HAVE WONDERED, GIVEN THIS
OBSERVATION, HOW THIS RELATES TO
MUCOSAL IMMUNITY, THINKING ABOUT
CD4, CD8 THINGS BECAUSE OF THE
DIFFERENCES THAT HAPPEN BY
ANATOMY FOR SEX.
>> YOU'RE SAYING THE LOCATIONS
OF THOSE CELLS IN PARTICULAR OR
SOMETHING ELSE?
>> WELL, NO, THE INTERACTION
BETWEEN THESE CELLS AND THE
MUCOSA ITSELF.
>> I THINK IT'S A WE HAVE GOOD
QUESTION.
OUR STUDY IS JUST TAKING THEM
FROM THE PERIPHERAL BLOOD SO
WE'RE NOT ABLE TO LOOK KIND OF
AT SPECIFIC ORGANS REALLY IN
VIVO IN THAT WAY, BUT I THINK IT
WOULD BE A VERY INTERESTING
QUESTION.
>> I'M THINKING ABOUT WE'VE
RECENTLY PUBLISHED ON SOME WORK
THAT WE DID ON A
GATA2 DEFICIENCY WHERE THE
FEMALES HAD MUCH GREATER
PROPENSITY TO GET HPV DISEASE
THAT WAS HIGH GRADE AND
DIFFICULT TO TREAT IN THE LOWER
GENITAL TRACT.
AND THERE WERE IMMUNE
DIFFERENCES, SOME OF WHICH WERE
BIOLOGIC AND RELATED PROBABLY TO
GATA2 DEFICIENCY, BUT SOME OF IT
WERE SEX DIFFERENCES BETWEEN THE
TWO COHORTS.
SO THE INTERPLAY FROM THE IMMUNE
SYSTEM TO THINKING HOLISTICALLY
ACROSS THE BODY, AS ONE HAS TO,
BUT IS DIFFICULT, THINKING ABOUT
HOW THAT INTERRELATES TO THE
MUCOSAL IMMUNITY IS AN
INTERESTING IDEA.
>> A VERY INTERESTING QUESTION.
I KNOW IN THE FUTURE, WE'RE
HOPING TO TAKE THIS KIND OF
FOUR-STATE MODEL AND LOOK AT
OTHER TISSUES, SURGICAL SAMPLES,
BUT WE HAVEN'T DONE THAT YET.
BUT I THINK IT WOULD BE REALLY
INTERESTING.
>> BUT YOU ALSO WILL WANT TO
MANIPULATE THEM IN VIVO AND WANT
TO BIOPSY THEM AT SOME LEVEL.
>> I APPRECIATE IT.
THANK YOU.
>> ALL RIGHT.
THANK YOU AGAIN, DR. HARRIS, FOR
A WONDERFUL TALK.
WE'RE GOING TO END YOUR Q & A
SESSION NOW.
[APPLAUSE]
SO I'D NOW LIKE TO INVITE
DR. CYNTHIA HARPER UP TO THE
PODIUM TO INTRODUCE OUR NEXT
SCHOLAR SPEAKER.
>> ON BEHALF OF THE BIRCWH
PROGRAM AT THE UNIVERSITY OF
CALIFORNIA SAN FRANCISCO AND
KAISER PERMANENTE, DR. BRINDIS
AND I ARE DELIGHTED TO INTRODUCE
DR. ANITA HAR GRAVE.
SHE IS A SECOND-YEAR BIRCWH
SCHOLAR AND AN ASSISTANT
PROFESSOR IN THE UCSF DEPARTMENT
OF MEDICINE.
SHE'S AN INTERNAL MEDICINE
PHYSICIAN DEDICATED TO IMPROVING
HEALTH OUTCOMES FOR WOMEN WHO
HAVE EXPERIENCED TRAUMA THROUGH
PATIENT ORIENTED RESEARCH.
DR. HARGRAVE COMES TO US FROM
THE SAN FRANCISCO V.A. AND HER
BIRCWH RESEARCH EVALUATES THE
IMPACT OF TRAUMATIC EXPERIENCES
ON LEADING CAUSES OF MORTALITY
AND MORBIDITY FOR WOMEN
INCLUDING CARDIOVASCULAR
DISEASE, CANCER, AND ALSO TODAY
WE'LL HEAR ABOUT SUICIDE IN
OVERDOSE.
SHE ALSO HAS HAD NOTEWORTHY WORK
ON INTIMATE PARTNER VIOLENCE.
DR. HARGRAVE HAS CONSTRUCTED A
COHORT STUDY OF MILLIONS OF
VETERANS SEEN REGULARLY AT THE
V.A. OVER 10 YEARS, AND TODAY
WE'RE GOING TO HEAR FROM HER ON
A VERY UNDERRESEARCHED TOPIC IN
WOMEN'S HEALTH, AND EVEN A VERY
UNDERDISCUSSED TOPIC IN OTHER
AREAS OUTSIDE OF HEALTH AND
POLICIES EVERY, AND I THINK IT
TAKES COURAGE TO STUDY THIS AND
I'M SO EXCITED THAT OUR SCHOLAR
IS DOING THIS AND LOOKING AT IT
WITH GREAT RIGOR, AND I WELCOME
DR. HARGRAVE TO PRESENT TODAY ON
MILITARY SEXUAL TRAUMA, AND
LATER RISK OF SUICIDE AND
OVERDOSE, COMPARING RISK BY
GENDER.
DR. HARGRAVE.
[APPLAUSE]
>> ALL RIGHT.
THANK YOU, DR. HARPER.
I WANT TO START OFF BY THANKING
THE BIRCWH PROGRAM, THE UCSF
KAISER PROGRAM, DR. BRINDIS
WHO'S HERE AS WELL AND
MYCOAUTHORS WHO WORKED WITH ME
ON THIS RESEARCH THAT I'LL BE
TALKING ABOUT TODAY.
I HAVE NO DISCLOSURES AND THE
INFORMATION AND CONCLUSIONS
SHARED HERE TODAY ARE NOT THE
OFFICIAL POSITION OF THE V.A. OR
THE U.S. GOVERNMENT.
TODAY I'LL BE USING THE TERM
MILITARY SEXUAL TRAUMA, OR MST,
WHICH IS DEFINED AS SEXUAL
ASSAULT AND/OR SEXUAL HARASSMENT
DURING MILITARY SERVICE.
THE V.A. HAS BEEN SCREENING FOR
MILITARY SEXUAL TRAUMA FOR ABOUT
20 YEARS NOW.
IT'S THE ONLY NATIONWIDE
HOSPITAL SYSTEM OR HEALTHCARE
SYSTEM THAT ASKS UNIVERSALLY
ABOUT ANY TYPE OF SEXUAL TRAUMA.
AND IT ASKS IT THROUGH TWO
QUESTIONS.
ONE, WHILE YOU WERE IN THE
MILITARY, DID YOU RECEIVE
UNWANTED SEXUAL ATTENTION THAT
YOU FOUND THREATENING?
AND THE SECOND, WHEN YOU WERE IN
THE MILITARY, DID YOU HAVE
SEXUAL CONTACT AGAINST YOUR WILL
OR WHEN YOU WERE UNABLE TO SAY
NO?
PATIENTS ARE POSITIVE FOR SEXUAL
MILITARY TRAUMA IF THEY ANSWER
YES TO EITHER OF THOSE TWO
QUESTIONS.
THEY CAN ALSO DECLINE TO ANSWER,
AND IF THEY DECLINE, THEY ARE
SCREENED AGAIN ANNUALLY UNTIL
THEY GIVE A YES OR NO ANSWER.
CLINICIANS CAN SCREEN AGAIN
AFTER A YES OR NO ANSWER BUT IT
IS NOT REQUIRED OR IT DOES NOT
POP UP IN THE ELECTRONIC MEDICAL
SYSTEM.
MILITARY SEC YOU SEXUAL TRAUMA S
OVER A MILLION PEOPLE IN THE
UNITED STATES AND
DISPROPORTIONATELY AFFECTS
WOMEN.
PREVIOUS NATIONAL DATA FROM THE
MST SCREENING PROGRAM SHOWS THAT
1 IN 3 WOMEN AND 1 IN 50 MEN
REPORT EXPERIENCES OF MILITARY
SECTION ALL TRAUMA.
--
MILITARY SEXUAL TRAUMA.
A GROWING BODY OF EVIDENCE
SUGGESTS THAT MST HAS LONG
LASTING EFFECTS ON NOT ONLY
PHYSICAL HEALTH BUT ALSO MENTAL
HEALTH.
I'VE LISTED JUST A FEW ON THIS
PAGE HERE, AND I'LL HIGHLIGHT
THAT MST IS PARTICULARLY
ASSOCIATED WITH POST-TRAUMATIC
STRESS DISORDER, OR PTSD.
AND ALTHOUGH THE VETERAN
POPULATION, THE MAJORITY OF THE
VETERAN POPULATION IS 50 YEARS
OR OLDER IN AGE, MOST MST
RESEARCH HAS INVOLVED ACTIVE
MILITARY PERSONNEL, YOUNGER VERY
TRANS, OR REPRODUCTIVE AGE
WOMEN.
AND THIS LEAVES A REAL GAP IN
OUR UNDERSTANDING OF THE
PREVALENCE AND THE CORRELATES OF
MST AMONG WOMEN IN MID TO LATE
LIFE, COMPARED TO THEIR MALE
PEERS.
LIKEWISE, PTSD HAS BEEN FOUND TO
BE ASSOCIATED WITH LATE LIFE
SUICIDE RISK AND UP TO 70% OF
VETERANS WHO DIE OF SUICIDE ARE
OLDER ADULTS.
HOWEVER, RESEARCH EVALUATING MST
AND SUICIDAL BEHAVIOR HAS
LARGELY BEEN LIMITED TO
CROSS-SECTIONAL STUDIES, SMALL
CROSS-SECTIONAL STUDIES,
RESEARCH ON SUICIDAL THOUGHTS
BUT NOT LOOKING AT SUICIDAL
MORTALITY OR DEATH, OR TO
YOUNGER VERY TRANS.
SO OUR RESEARCH AIM TO EXAMINE
AND UNDERSTAND THE LONG LASTING
IMPACT OF MILITARY SEXUAL TRAUMA
ON SUICIDE ATTEMPT ON OVERDOSE
AND ASSOCIATED MORTALITY LATER
IN LIFE.
WE LOOKED AT THIS AMONG WOMEN
VETERANS COMPARED TO MEN.
WE ALSO INVESTIGATED IF PTSD
EXACERBATES THE RISK FOR THESE
ADVERSE OUTCOMES.
AND IN DOING SO, OUR RESEARCH IS
THE FIRST TO USE NATIONAL COHORT
DATA TO EVALUATE LATER LIFE
FATAL AND NON-FATAL SUICIDE
ATTEMPT, AS WELL AS DEATH FROM
SUICIDE AND DRUG OVERDOSE AS IS
ASSOCIATED TO MILITARY SEXUAL
TRAUMA.
WE CONDUCTED A NATIONAL
LONGITUDINAL COHORT STUDY OF
OVER 5 MILLION WOMEN AND MEN
VETERANS AGED 50 YEARS AND
OLDER, USING BASELINE DATA FROM
2012 TO 2013, AND THEN FOLLOWED
UP THROUGH DECEMBER 31ST OF
2020, RIGHT BEFORE THE COVID
PANDEPANDEMIC INITIATED HERE INE
UNITED STATES.
WE INCLUDED ALL V.A. MEDICAL
CENTERS IN THE UNITED STATES AND
WE INTEGRATED DATA FROM FOUR
NATIONAL DATABASES.
THE V.A. NATIONAL PATIENT CARE
DATABASE, THE CENTERS FOR
MEDICARE AND MEDICAID DATABASES,
THE V.A. NATIONAL CONSOLIDATED
SUICIDE BEHAVIOR AND OUT COME --
SORRY -- BEHAVIOR AND OVERDOSE
REPORT, AND THE MORTALITY DATA
REPOSITORY.
OUR MEASURE OF MILITARY SEC
YOU'LL TRAUMA EXPOSURE INCLUDED
ANY POSITIVE MST SCREEN THAT
OCCURRED IN THE MEDICAL -- THE
MEDICAL HEALTH RECORD OVER THE
STUDY PERIOD.
WE USED THE SUICIDE PREVENTION
APPLICATIONS NETWORK OR SPAN AND
THE MORTALITY DATA REPOSITORY OR
MDR DATABASES TO OBTAIN SUICIDE
ATTEMPT INCLUDING NON-FATAL
ATTEMPTS AND SUICIDE DEATH
OUTCOMES.
WE OBTAINED NON-FATAL SUICIDE
DATA FROM THE CDC SELF-DIRECTED
VIOLENCE CLASSIFICATION SYSTEM.
WE CAPTURED DEATH BY SUICIDE
USING ICD10 DEATH CODES, AND WE
LOOKED AT NOT ONLY OVERALL DEATH
BY SUICIDE BUT ALSO CERTAIN
INDICATIONS FOR DEATH BY
SUICIDE, INCLUDING BY FIREARMS,
HANGING, SUICIDE DEATH BY DRUG
OVERDOSE AND SUICIDE DEATH FROM
ANY OTHER REASONS.
WE OBTAINED DATA ON DEATH BY
DRUG OVERDOSE AND THEIR DATE OF
OCCURRENCE FROM THE MDR.
FOR DEATH BY DRUG OVERDOSE, WE
INCLUDED SUICIDE DEATHS BY DRUG
OVERDOAS, UNINTENTIONAL DEATH BY
DRUG OVERDOSE AND UNDETERMINED
DEATH BY DRUG OVERDOSE.
WE OBTAINED BASELINE DATA ON
SOCIODEMOGRAPHIC
CHARACTERISTICS, MELT DISORDERS,
MEDICAL COMORBIDITIES USING THE
CHARL STON CO-MORBIDITY INDEX,
INCOME, EDUCATION AND
HOMELESSNESS.
AND WE DECIDED TO USE THE WORD
GENDER RATHER THAN SEX BECAUSE
WE ARE FOCUSING ON PSYCHOSOCIAL
AND CULTURAL FACTORS, RATHER
THAN BIOLOGICAL FACTORS, THAT
INFLUENCE THE RELATIONSHIP
BETWEEN MILITARY SE SEXUAL TRAUA
AND SUICIDE.
AS SUCH, WE INCLUDED ANY
TRANSGENDER WOMAN AS A WOMAN AND
ANY TRANSGENDER MAN AS A MAN.
WE USED BIVARIABLE ANALYSES TO
CHARACTERIZE OUR STUDY COHORT
STRATIFYING BY GENDER AND MST
EXPOSURE.
WE USED COX PROPORTIONAL HAZARD
MODELS WITH TIME AS A TIME SCALE
TO ESTIMATE TIME TO ANY SUICIDE
ATTEMPT, NON-FATAL SUICIDE
ATTEMPT, FATAL SUICIDE AND
OVERDOSE DEATH.
AND WE STRATIFIED OUR MODELS BY
GENDER AND ADJUSTED FOR
SOCIODEMOGRAPHIC CHARACTERISTICS
FOR CHARLESTON CO-MORBIDITY
INDEX -- SORRY -- FOR
SOCIODEMOGRAPHIC CHARACTERISTICS
AND THE CCI, OR CHARLESTON
CO-MORBIDITY INDEX.
WE ALSO PLOTTED THE ADJUSTED
CUMULATIVE INCIDENTS FOR ANY
FATAL O OR NON-FATAL SUICIDE
ATTEMPT BASED ON AGE AND ATTEMPT
AS A FUNCTION OF MILITARY SEXUAL
TRAUMA.
WE ALSO LOOKED AT THE POTENTIAL
ADDED INTERACTIONS BETWEEN MST
AND PTSD AND FULLY ADJUSTED
MODELS, AND THEN WE FINALLY RAN
SENSITIVITY ANALYSES WITH FINE
GREY MODELS WITH SHIELDED
SIMILAR RESULTS TO VERIFY OUR
FINDINGS.
WHAT WE FOUND WAS THAT AM OUR
PARTICIPANTS, THE MEAN AGE WAS
YOUNGEST AMONG WOMEN WHO HAD
EXPERIENCED MST.
RIGHT HERE.
BUT OVERALL, OUR DATA SHOWED
DIFFERENCES IN SOCIODEMOGRAPHIC
CHARACTERISTICS AND HEALTH
CONDITIONS BY MST EXPOSURE WERE
COMPARABLE ACROSS MEN AND WOMEN.
WHEN WE EVALUATED THE PREVALENCE
OF MST BY GENDER, WE FOUND THAT
MILITARY SEXUAL TRAUMA EXPOSURE
WAS DOCUMENTED IN 16% OF MID AND
LATER LIFE WOMEN, AND 1.3% OF
MEN.
THEREFORE, MILITARY SEXUAL
TRAUMA WAS 10 TIMES MORE
PREVALENT AMONG WOMEN THAN MEN
AT THIS AGE -- THIS TIME OF
LIFE.
IN THIS SLIDE, I SHOW THE
ADJUSTED CUMULATIVE INCIDENCE
FOR ANY FATAL OH NON-FATAL
SUICIDE ATTEMPT AS A FUNCTION OF
MILITARY SEXUAL TRAUMA.
ON THE LEFT, THE GRAPH SHOWS
WOMEN AND ON THE RIGHT, I SHOW
THE CUMULATIVE INCIDENCE FOR
MEN.
THE RED CURVE REPRESENTS THOSE
WHO HAVE NO HISTORY OF MILITARY
SEXUAL TRAUMA AND THE BLUE CURVE
REPRESENTS THOSE WHO HAVE
EXPERIENCED MST.
IN THESE MODELS WHICH WERE
ADJUSTED FOR RACE AND ETHNICITY,
EDUCATION, INCOME, HOMELESSNESS,
SERVICE CONNECTION, AND THE
CHARLESTON CO-MORBIDITY INDEX,
WE SEE THAT RATES OF ANY SUICIDE
ATTEMPT WERE THREE FOLD HIGHER
FOR WOMEN AS WELL AS MEN WHO HAD
EXPERIENCED MILITARY SEXUAL
TRAUMA.
IN THIS BAR GRAPH, I'M
DEMONSTRATING THE HAZARD RATIOS
FOR WOMEN IN LIGHT BLUE AND MEN
IN DARK BLUE.
THE GRAPHS SHOW THAT MUCH OF THE
MAGNITUDE OF RISK FOR ANY
SUICIDE ATTEMPT WAS ASSOCIATED
WITH NON-FATAL ATTEMPTS.
IN THESE TWO BARS.
THOUGH ATTENUATED, THE MST WAS
ALSO ASSOCIATED WITH INCREASED
RISK OF DEATH BY SUICIDE, FOR
BOTH GENDERS.
RISK OF DEATH BY SUE SAID ROSE
BY 37% FOR WOMEN AND 18% FOR
MEN.
MST WAS ALSO ASSOCIATED WITH A
NEARLY 80% INCREASED RISK OF
DEATH BY DRUG OVERDOSE IN MEN
AND IN WOMEN.
THIS INDICATES THAT MST MAY
SUPERSEDE POTENTIAL GENDER
PROTECTIONS AGAINST SUICIDE AND
DRUG OVERDOSE MORTALITY FOR
WOMEN AT LEAST IN LATER LIFE.
OUR FINDINGS ALSO SUGGEST AN
ADDITIVE EFFECT OF PTSD, WHICH
DRAMATICALLY INCREASED THE RISK
FOR SUICIDE BEHAVIOR, DEATH AND
OVERDOSE AMONG THOSE WITH BOTH A
HISTORY OF MILITARY SEXUAL
TRAUMA AND A DIAGNOSIS OF PTSD.
CO-MORBID MST EXPOSURE AND PTSD
DIAGNOSIS INCURRED A 6 TO 7-FOLD
INCREASE IN THE RISK OF ANY
SUICIDE ATTEMPT COMPARED TO
THOSE WHO HAD NO MST OR PTSD
EXPOSURE.
THIS DEMONSTRATES THAT OLDER
ADULTS WITH BOTH BTST AND MST
EXPOSURE ARE AN EXTREMELY HIGH
RISK POPULATION FOR SUICIDAL
POPULATION.
WE ALSO FOUND, ALTHOUGH NOT
DEMONSTRATED IN THIS FIGURE,
THAT WOMEN WITH BOTH MST
EXPOSURE AND PTSD DIAGNOSIS HAD
A SIGNIFICANTLY INCREASED RISK
OF DEATH BY FIREARMS AND
UNINTENTIONAL OVERDOSE.
OUR RESEARCH HAS SOME
LIMITATIONS THAT I'LL TALK ABOUT
NOW.
OUR COHORT WAS COMPOSED OF
VETERANS WHO RECEIVED CARE
WITHIN THE V.A.
THUS OUR FINDINGS MAY BE LESS
GENERALIZABLE TO NON-V.A. VET
TRANS, AND IT'S POSSIBLE THAT
VETERANS WHO CHOOSE NOT TO
PURSUE CARE WITHIN THE V.A.
SYSTEM ARE MORE LIKELY TO HAVE
EXPERIENCED MILITARY SEXUAL
TRAUMA, AND, THEREFORE, HAVE A
SENSE OF INSTITUTIONAL BETRAYAL
AND MISTRUST WITHIN THE V.A.
STUDIES ALSO INDICATE THAT THE
V.A. SCREENING MAY UNDERREPORT
MST, SUGGESTING THAT THE
PREVALENCE IS SIGNIFICANTLY
HIGHER.
AND THIS LIMITATION WOULD LIKELY
SKEW OUR RESULTS TOWARDS THE NO.
IT'S ALSO POSSIBLE THAT THERE IS
UNMEASURED CONFOUNDING AND
MISSINGNESS IN OUR DATA.
AND FINALLY, WE ACKNOWLEDGE THAT
PEOPLE WHO DO NOT IDENTIFY ON
THE GENDER BINARY AND
TRANSGENDER INDIVIDUALS ARE
DISPROPORTIONATELY IMPACTED BY
MILITARY SEXUAL TRAUMA AND OTHER
TYPES OF SEXUAL TRAUMAS.
AS WELL AS SUICIDE.
OUR STUDY DIDN'T HAVE THE POWER
TO EVALUATE THESE HIGH RISK
GROUPS SUFFICIENTLY SO I'M NOT
ABLE TO SPEAK TO THEM, BUT I
THINK THAT FURTHER RESEARCH IS
REALLY NEEDED TO UNDERSTAND HOW
MST IS ASSOCIATED WITH SUICIDE
RISK AMONG LGBTQ I COMMUNITIES.
DESPITE THESE LIMITATIONS, OUR
STUDY HAS SIGNIFICANT STRENGTHS
THAT I THINK ARE IMPORTANT TO
HIGHLIGHT HERE, INCLUDING
MERGING DATA FROM FOUR NATIONAL
DATABASES TO OBTAIN THE MOST
COMPREHENSIVE EVALUATION OF
MILITARY SEXUAL TRAUMA AS A RISK
FACTOR FOR SUICIDE ATTEMPT AND
MORTALITY IN OLDER ADULTS.
TO SUMMARIZE OUR CONCLUSIONS, WE
FOUND PHTHALATE LIFE SUICIDE
ATTEMPT AN DEATH BY SUICIDE OR
OVERDOSE WERE SIGNIFICANTLY
ASSOCIATED WITH PRIOR MILITARY
SEXUAL TRAUMA, WHICH ADVANCES
OUR UNDERSTANDING OF THE LASTING
IMPACT OF SEXUAL TRAUMA ON
SUICIDE RISK AND MORTALITY.
AND PREVENTING MST, PROVIDING
CARE FOR MILITARY SEXUAL TRAUMA
EXPOSURE AND TREATING ITS
PSYCHOLOGICAL SEQUELAE, LIKE
PTSD, ARE IMPORTANT FOR
PREVENTION OF SUICIDE IN LATER
LIFE.
OUR STUDY IS REALLY A CALL TO
ACTION TO REDUCE MILITARY SEXUAL
TRAUMA EXPOSURE DURING SERVICE.
OUR RESEARCH ALSO SUPPORTS
BOLSTERING TRAINING IN AND
INSTITUTIONAL SUPPORT FOR,
INTEGRATING TREATMENT OF MST AND
PTSD INTO GERIATRIC CARE FOR
WOMEN, AND FOR MEN.
AS MANY VETERANS RECEIVE THEIR
CARE OUTSIDE OF THE V.A., IT'S
IMPORTANT THAT THESE CHANGES ARE
IMPLEMENTED IN V.A. AND IN
NON-V.A. INSTITUTIONS.
AND FINALLY, FURTHER RESEARCH IS
NEEDED ON VARIOUS OTHER FORMS OF
SEXUAL TRAUMA, AND HOW IT
IMPACTS SUICIDE AND OVERDOSE IN
AGING POPULATIONS.
THANK YOU FOR YOUR TIME, AND I
LOOK FORWARD TO YOUR QUESTIONS.
I ALSO EXTEND MY DEEP GRATITUDE
TO ALL OF THE VETERANS WHO
PARTICIPATED IN THIS STUDY.
[APPLAUSE]
>> THANK YOU SO MUCH,
DR. HARGRAVE.
WHAT A WONDERFUL TALK.
AS YOU JUST SAID, I'D LIKE TO GO
AHEAD AND OPEN THE FLOOR FOR ANY
QUESTIONS.
THE MICROPHONES ARE RIGHT HERE
IN THE CENTER.
I ACTUALLY DO HAVE A QUESTION
WHILE WE WAIT.
I KNOW YOU WERE LOOKING AT MID
TO LATE TERM INDIVIDUALS IN
TERMS OF LIKE LIFE.
AFTER CONTROLLING FOR EXPOSURE
TO MST AND ALSO TO PTSD, WAS
THERE A DIFFERENCE IN, I GUESS,
SUICIDE ATTEMPTS BETWEEN THE TWO
AGE GROUPS, IF YOU SEPARATE
BETWEEN MID AND LATE?
>> AND LATE LIFE, IF YOU
STRATIFY AND FURTHER LOOKED AT
50 TO 65 AND 65 AND OVER?
THAT'S AN EXCELLENT QUESTION.
WE HAVEN'T DONE THAT
STRATIFICATION YET, BUT I THINK
THAT IT'S -- WHAT WE WERE ALSO
LIMITED IN BEING ABLE TO DO WAS
LOOK AT MILITARY SERVICE, BUT WE
KNOW THAT PEOPLE EXPERIENCED
MILITARY SEXUAL TRAUMA BEFORE
ENTERING THE MILITARY V.A.
SYSTEM, BECAUSE YOU HAVE TO
LEAVE ACTIVE DUTY SERVICE TO
THEN ENTER THE V.A. AND WE'RE
LOOKING AT MID TO LATE LIFE, SO
THESE EXPOSURES TO MST WERE ON
AVERAGE HAPPENING TO 20 TO 30
YEARS BEFORE THEIR SUICIDE
ATTEMPTS.
BUT THE OTHER DIFFERENCE IN
LOOKING AT AGE GROUPS IS THEIR
EXPOSURE TO CONFLICT.
>> RIGHT, THAT'S WHAT I WAS
THINKING.
>> THEY'VE SERVED THEIR -- HOW
THEY SERVED, WHAT RANK POSITION
THEY WERE IN WITHIN THEIR
MILITARY SERVICE IS ALSO A
DIFFERENT TYPE OF RISK FACTOR.
AND UNFORTUNATELY BECAUSE WE'RE
LOOKING AT MID TO LATER LIFE, WE
DIDN'T HAVE ENOUGH DATA IN THE
V.A. SYSTEM, THEY STARTED
COLLECTING MORE DATA ON CONFLICT
EXPOSURE FOR MORE RECENT
GENERATIONS BUT NOT FOR THE
OLDER GENERATIONS.
SO WE DON'T HAVE THAT BUT I
THINK THAT'S AN EXCELLENT POINT
THAT WE COULD LOOK AT -- IT
COULD BE A WAY OF LOOKING AT
THAT, IS BY LOOKING AT MID LIFE
VERSUS LATE LIFE.
>> JUST IN TERMS OF SEEING IF
THERE IS AN IMPACT WHAT WAS
GOING ON MILITARY-WISE WHILE
THEY SERVED AND WHETHER OR NOT
THAT ACTUALLY HAS AN IMPACT ON
SUICIDE INCIDENCE.
>> THAT'S SUCH AN IMPORTANT
POINT, AND I THINK THAT WE DON'T
HAVE -- THE PROBLEM -- YOU HAVE
A LOT OF STRENGTHS FOR USING
LARGE DATASET LIKE THE V.A.
DATABASE WHERE YOU CAN LOOK AT
5 MILLION PEOPLE, BUT YOU'RE
ALSO LIMITED IN WHAT YOU -- YOU
CAN LOOK AT WHAT HAS BEEN
MEASURED, AND SO IF IT HASN'T
BEEN MEASURED, THEN -- IF IT
HASN'T BEEN ASKED ABOUT, THEN
YOU CAN'T LOOK AT IT, SO THAT
WAS SOMETHING WE WANTED TO LOOK
AT BUT WE COULDN'T GET THAT DATA
FOR OUR FULL COHORT.
>> I THINK ONE OF THE OTHER
STRENGTHS OF YOUR STUDY WILL BE
LETTING US KNOW WHAT WE DON'T
KNOW AND WHAT WE COULD BE
INCLUDING WHEN IT COMES TO
INFORMATION GATHERING AND MOVING
FORWARD.
>> CERTAINLY.
THANK YOU FOR THAT QUESTION.
APPRECIATE IT.
>> HI, KELSEY GABLE, UNIVERSITY
OF ILLINOIS-CHICAGO.
THANK YOU SO MUCH FOR THIS
IMPORTANT WORK.
I DID HAVE A QUESTION ABOUT MST.
IS THE PTSD SECONDARY TO THE MST
OR IS THAT -- I WOULD ASSUME
THERE IS PTSD DUE TO THE MST, SO
IS THAT SECONDARY BECAUSE OF
SERVICE OR SOMETHING ELSE, OR
ARE THOSE CONSIDERED COMBINED?
>> THAT'S A GREAT QUESTION, IN
THAT TEMPORALITY IS HARD TO KNOW
IN EXPOSURE TO MILITARY SEXUAL
TRAUMA AND PTSD.
THERE HAVE BEEN STUDIES THAT
LOOKED AT PTSD TIED TO MST AND
THEY ARE VERY HIGHLY CORRELATED,
HIGHLY LINKED.
BUT IN OUR STUDY, WE WOULD HAVE
TO DO MORE OF A CHART BIOPSY TO
MAKE SURE THAT WE COULD
UNDERSTAND IF THE MST WAS --
SORRY, IF THE PTSD WAS
SPECIFICALLY ATTRIBUTED TO THEIR
MST OR NOT.
>> THANK YOU.
>> PAM STRATTON, ORWH.
AS A FORMER ACTIVE DUTY NAVY
OFFICER --
>> THANK YOU FOR YOUR SERVICE.
APPRECIATE THAT.
>> -- I'D LIKE TO GIVE YOU A
FRAME OF REFERENCE, BECAUSE I
CAME ON DUTY IN 1986.
YOU REALIZE THAT WOMEN, LIKE IN
THE 70s, WOMEN COULD ONLY BE
ON ACTIVE DUTY IF THEY HAD NO
DEPENDENTS.
SO IT MIGHT BE -- THERE ARE SOME
INTERSECTIONAL THINGS THAT YOU
MIGHT WANT TO LOOK AT RELATED
TO -- AND THEN THERE ARE TIMES
WHETHER OR NOT THEY COULD BE IN
COMBATANT SITUATIONS OR DEPLOYED
ON -- YOU KNOW, THERE WOULD BE
COED THINGS ON SHIPS.
THERE ARE A SERIES OF THINGS
THAT END UP REALLY ADDING
WRINKLES TO YOUR STORY THAT ARE
WORTH CONSIDERING, AND SO I
SUGGEST THAT YOU MIGHT WANT TO
LOOK AT SOME OF THOSE MILESTONES
FOR ACTIVE DUTY WOMEN.
>> THAT'S A GREAT POINT.
YEAH, I'D LOVE TO TALK TO YOU
MORE IF YOU DON'T MIND.
>> OH, I'M HAPPY TO TALK TO YOU.
YOU KNOW, ANOTHER THING TO THINK
ABOUT, AS AN OB-GYN, AND WHEN I
CAME ON THE ACTIVE DUTY, THE
MOST COMMON DISCHARGE DIAGNOSIS
IN 1986, AFTER THIS CHANGE, FOR
MILITARY TREATMENT FACILITY WAS
ACTIVE DUTY DELIVERED.
SO THERE'S A HUGE SOCIAL
CULTURAL SHIFT THAT HAS
HAPPENED.
SO I WOULD BE HAPPY TO TALK TO
YOU.
>> I WOULD LOVE THAT.
THANK YOU SO MUCH.
APPRECIATE THAT COMMENT.
>> ALL RIGHT.
I WANT TO GO AHEAD AND THANK YOU
ONCE AGAIN, CLOSE UP YOUR Q & A.
[APPLAUSE]
I'D NOW LIKE TO INVITE
DR. LESLIE MYATT TO THE STAGE TO
INTRODUCE OUR LAST SCHOLAR
SPEAKER.
>> SO THANK YOU.
IT'S A DISTINCT PLEASURE TO
INTRODUCE TO YOU DR. ELIZABETH
WOOD, WHO'S A POSTDOCTORAL
FELLOW IN THE DEPARTMENT OF
PSYCHIATRY AT OREGON HEALTH AND
SCIENCE UNIVERSITY.
AND ELIZABETH JOINED THE BIRCWH
PROGRAM IN SEPTEMBER 2023 AS OUR
POSTDOCTORAL SCHOLAR, AND I
THINK WHAT SHE'S GOING TO TALK
TO YOU ABOUT TODAY ILLUSTRATES
THE UTILITY OF THIS PATHWAY
WHICH WE THANK NIH FOR
SUPPORTING THE OFFICE OF
RESEARCH ON WOMEN'S HEALTH IN
PARTICULAR.
SO ELIZABETH RECEIVED HER BSC IN
PSYCHOLOGY AND PH.D. IN
DEVELOPMENTAL PSYCHOLOGY FROM
BRIGHAM YOUNG UNIVERSITY IN UTAH
AND THEN UNDERTOOK A SHORT
POSTDOCTORAL FELLOWSHIP AT THE
UNIVERSITY OF WISCONSIN, BEFORE
SHE ARRIVED AT OSHU IN 2021,
JUST AS THE PANDEMIC WAS GETTING
STARTED.
SHE CAME ON A T32 POSTDOCTORAL
GRANT FROM NIAAA, AND THEN ALSO
TRANSITIONED AS A TL1 OSLER
POSTDOCTORAL FELLOW IN 2023.
SHE CURRENTLY LISTS 27 PAPERS,
19 OF WHICH SHE IS FIRST AUTHOR,
WHICH I THINK REALLY ILLUSTRATES
THE LEADERSHIP ROLE SHE TAKES IN
DIRECTING WORK THAT SHE'S
INVOLVED IN AND DELIVERING THE
GOODS, SO TO SPEAK.
SHE'S IN HER POSTDOCTORAL.
PH.D. WORK, SHE USED THE
NON-HUMAN PRIMATE LOOKING AT
STRESS RESPONSES AND BEHAVIOR IN
MOTHERS AND OFFSPRINGS AND
RELATIONSHIP TO EACH OTHER AND
THE EFFECT OF EXPOSURE TO
ALCOHOL ON GENE ENVIRONMENT
INTERACTIONS.
WHEN SHE MOVED TO OHSU, SHE
BEGAN TO APLAY THE EXPERTISE
WORKING IN HUMAN SUBJECTS,
WORKING WITH MY COLLEAGUE JAMIE
LOWE AND LOOKING AT A PROGRAM OF
OFFSPRING BEHAVIORAL HEALTH AND
THE ROLE OF INFLAMMATION,
PARTICULARLY PLACENTAL
INFLAMMATION, AND SHE ARRIVED
DURING COVID SO SHE HAD TO PIVOT
QUITE QUICKLY BECAUSE SHE
COULDN'T DO SOME OF THE STUDIES
SHE WAS INTENDING TO DO BUT
ACTUALLY BEGAN TO LOOK AT THE
EFFECT OF THE PANDEMIC ON DIET
AND WEIGHT GAIN AND THE EFFECT
THEN ON NEGATIVE AFFECT IN THE
OFFSPRING.
SO SHE TOOK ADVANTAGE OF THE
SCENARIO SHE WAS PRESENTED WITH.
WHEN I TALK ABOUT THE PLACENTA,
I'M JUST GOING TO EMPHASIZE THE
PLACENTA TO YOU.
MY COLLEAGUES FROM OREGON ARE
ALL LAUGHING HERE.
THEY KNOW ME TOO WELL.
IT AN ORGAN WE ALL HAD AND NONE
OF US REMEMBER, IT'S THE MOST
IMPORTANT ORGAN WE ALL HAD, IT
MADE US ALL WHAT WE ARE, FOR
BETTER, FOR WORSE, I SUPPOSE,
BUT WAS INVOLVED IN THE
DEVELOPMENT OF ALL OUR ORGAN
SYSTEMS AND OUR -- DETERMINES
OUR RISK OF HEALTH IN ADULT LIFE
AND OUR RIX OF CHRONIC DISEASE
IN ADULT LIFE.
SO I SAYS AS THE MOST IMPORTANT
ORGAN WE EVER HAD, DON'T FORGET
THAT.
ANOTHER WAY TO LOOK AT ITS
IMPORTANCE IS TO SAY IT'S ONLY
SECOND TO THE BRAIN IN THE
NUMBER OF TRANSCRIPTS IT
EXPRESSES SO ALL YOU HEART
PEOPLE, ET CETERA, ET CETERA,
I'M SORRY, PLACENTA RULES.
SO IT ALSO HAS A SEX, AND WITH
SABV, THAT ABBEY REMINDED US
ABOUT, ABOUT 15 YEARS AGO,
PEOPLE BEGAN TO REALIZE THAT A
MALE PLACENTA AND A FEMALE
PLACENTA MIGHT BE DIFFERENT AND
INDEED, THEY ARE VERY, VERY
DIFFERENT SO EVERYTHING WE DO
NOW, YOU'VE GOT TO LOOK AT MALE
AND FEMALE PLACENTAS SEPARATELY,
AND YOU'LL BE -- YOU'LL BE
PLEASED TO KNOW OBVIOUSLY IT'S
MUCH BETTER TO BE FEMALE IN
UTERO THAN MALE.
SO I'M A CARD CARRYING -- WHEN I
MET ELIZABETH I REALIZED HERE
WAS SOMEONE THAT WAS EVEN MORE
ENTHUSIASTIC ABOUT THE PLACENTA
THAN I AM, OKAY, AND HOPEFULLY
SHE'LL CONVEY THAT TO YOU, I'M
SURE.
WE'RE PLEASED TO SAY THAT SHE'S
GOT ONGOING SUCCESS IN 2025, SHE
WILL JOIN OUR NIH NCATS PROGRAM
THAT'S RUN BY THE OREGON
CLINICAL TRANSLATIONAL RESEARCH
INSTITUTE AS A KL2 FELLOW, AND
WE'RE LOOKING FORWARD TO HEARING
HER TALK TODAY.
ELIZABETH.
[APPLAUSE]
>> OKAY, SO YES, AS MENTIONED,
MY NAME IS ELIZABETH WOOD.
I'M A POSTDOC IN THE PSYCHIATRY
DEPARTMENT AT OREGON HEALTH AND
SCIENCE UNIVERSITY AND TODAY I
AM EXCITED TO SHARE WITH YOU
SOME RECENT FINDINGS FROM MY
BIRCWH PROJECT RELATED TO
PLACENTAL INFORMATION AND INFANT
BRAIN AND BEHAVIORAL HEALTH.
SO FOR MY TALK I WILL FIRST
DESCRIBE THE THEORETICAL
FRAMEWORK THAT I USE TO THINK
ABOUT MY WORK.
THEN I WILL REVIEW THE STUDY
POPULATION FROM WHICH THESE DATA
DERIVE.
I WILL THEN DETAIL MY WORK,
EXAMINING THE ASSOCIATION
BETWEEN PLACENTAL INFLAMMATION
AND INFANT BRAIN GROWTH.
BRAIN ACTIVITY PATTERNS, AND
INFANT BEHAVIORAL HEALTH.
FINAL LILY DISCUSS THE FUTURE
DIRECTIONS FOR THIS PROJECT.
AND IT IS IMPORTANT TO NOTE THAT
IN THIS PRESENTATION, I'LL USE
THE TERM MATERNAL AS A
SHORTHAND, BUT IT'S ESSENTIAL TO
RECOGNIZE THAT IT DOESN'T FULLY
ENCOMPASS THE EXPERIENCES OF ALL
BIRTHING INDIVIDUALS.
SO I WANT TO START WITH THE WHY
BEHIND MY RESEARCH.
THIS IS WHY I CARE.
1 IN 6 CHILDREN AGES 2 TO
8 YEARS OLD HAS A MENTAL,
BEHAVIORAL OR DEVELOPMENTAL
DISORDER.
WITH THE AGE OF ONSET AROUND
5 1/2 YEARS OLD.
DIAGNOSES OF ADHD, ANXIETY AND
DEPRESSION BECOME MORE COMMON
WITH INCREASED AGE, AND SO THIS
MEANS THAT THE TIMING OF GOOD
MENTAL HEALTH PROMOTION AS WELL
AS INTERVENTION AND PREVENTION
NEEDS TO OCCUR REALLY EARLY, AND
THAT'S WHY WE'RE THINKING ABOUT
WHAT ARE THE PRENATAL MECHANISMS
AT PLAY AND HOW CAN WE INFLUENCE
THEM.
MY WORK AND INTERESTS CENTER ON
EXAMINING HOW THE PLACENTA
PROGRAMS FUTURE HEALTH.
INTRAUTERINE INFLAMMATION IS ONE
PATHWAY BY WHICH THESE
PROGRAMMING EFFECTS ARE THOUGHT
TO OCCUR.
PRE-CLINICAL EVIDENCE AND
EMERGING CLINICAL EVIDENCE HAS
LINKED INTRAEUTD RIN
INFLAMMATION TO INFANT RISK FOR
CARDIOMETABOLIC DISEASE, ASTHMA
AND ALLERGIES, MICROBIOME
CHANGES AND MORE RECENTLY, RISK
FOR DEVELOPMENTAL DISORDERS.
THIS IS A DIAGRAM OF THE
DEVELOPMENTAL PROGRAMMING
HYPOTHESIS, WHICH SUGGESTS THAT
MATERNAL EXPOSURES EXERT
DEVELOPMENTAL PROGRAMMING
EFFECTS ON THE FETUS, WHICH ARE
BORNE OUT VIA PHYSIOLOGICAL
ADAPTATIONS IN THE VARIOUS
SYSTEMS.
THERE ARE DIFFERENT PROPOSED
MECHANISMS BY WHICH THESE
PROGRAMMING EFFECTS ARE THOUGHT
TO OCCUR, AS WELL AS MANY
POTENTIAL INFANT OUTCOMES THAT
WE COULD STUDY, AND TODAY, I
WANT TO TALK TO YOU ABOUT MY
WORK LOOKING AT INFLAMMATORY
MECHANISMS OF INFANT BRAIN
HEALTH AND NEURODEVELOPMENT.
AND WHEN I SAY BRAIN HEALTH, I'M
REALLY THINKING ABOUT RISK FOR
FUTURE PSYCHOPATHOLOGY AND
CLINICAL DIAGNOSES.
AND JUST A POINT TO MY INTEREST
IN THINKING ABOUT THE UPSTREAM
MATERNAL FACTORS THAT RESULT IN
INFLAMMATION TO WHICH THE FETUS
IS EXPOSED, HERE I HIGHLIGHT
THAT IN MY WORK, I CONSIDER
MATERNAL DIET AND BODY
COMPOSITION AS BEING PREDICTORS
AND PRECURSORS OF INFLAMMATION
LEVELS DURING PREGNANCY ALTHOUGH
I WON'T TALK MUCH ABOUT THAT
TODAY.
THE OVERARCHING QUESTION FOR MY
WORK IS, ARE THERE PLACENTAL
INFLAMMATORY PATHWAYS BY WHICH
DEVELOPMENTAL PROGRAMMING
OCCURS.
USING DATA FROM AN ONGOING
LONGITUDAL STUDY CALLED THE
PRENATAL ENVIRONMENT IN
CHILDHOOD HEALTH OR PEACH STUDY,
I AM EXAMINING THE EFFECTS OF
PLACENTAL INFLAMMATION ON CHILD
BRAIN AND BEHAVIORAL OUTCOMES.
THE STUDY COMPRISES 310
MOTHER-INFANT DYADS WITH LOW
RISK PREGNANCIES IN THE PORTLAND
OREGON AREA.
THIS STUDY BEGAN IN 2018, WHEN
WE EXAMINED PREGNANT WOMEN
DURING THE SECOND AND THIRD
TRIMESTERS OF PREGNANCY, AND NOW
THE INFANTS ARE PARTICIPATING IN
ONGOING FOLLOW-UPS EXAMINING
THEIR GROWTH AND DEVELOPMENTAL
HEALTH UNTIL THEY REACH 5 YEARS
OLD.
HERE IS AN OVERVIEW OF THE STUDY
TIMELINE.
WE TRACKED THE MOTHERS ACROSS
PREGNANCY, CAPTURED INFORMATION
ABOUT THEIR DIETS AND SUPPLEMENT
USAGE, AS WELL AS THEIR STRESS
AND MENTAL HEALTH.
WE ALSO COLLECTED DETAILED BODY
COMPOSITION ASSESSMENTS AND
PERIODIC BLOOD SAMPLES.
AT DELIVERY, WE COLLECTED THE
PLACENTAS AND COLLECTED THE
PLACENTAS AND BANKED UMBILICAL
CORD BLOOD.
THE INFANTS THEN CAME IN TO THE
LAB AT ONE MONTH AND SIX MONTHS
POST-DELIVERY FOR A BATTERY OF
TESTS THAT CAPTURE INFANT
BEHAVIOR, AND AT ONE YEAR UNTIL
THE INFANT'S FIFTH BIRD DAY, WE
BRING THE INFANTS INTO THE LAB
ALL YOU'LLLY AND USE THAT SAME
BATTERY OF TESTS RELATED TO
PHYSICAL AND PSYCHOLOGICAL
HEALTH.
TO DATE MY WORK HAS FOCUSED ON
THE PRENATAL PERIOD AND UP TO
THE FIRST YEAR OF INFANT LIFE.
SOME THINGS TO NOTE ABOUT THE
SAMPLE DEMOGRAPHICS ARE THAT WE
HAVE A FAIRLY WELL EDUCATED
SAMPLE WHO IS LARGELY WHITE AND
NON-HISPANIC.
THIS IS LARGELY REPRESENTATIVE
OF THE PORTLAND OREGON AREA BUT
STILL YOU SHOULD CONSIDER THESE
ASPECTS OF THE DATA AS I DISCUSS
MY RESULTS.
THE SAMPLE ALSO HAD RELATIVELY
HEALTHY PREGNANCIES WITH FEWER
THAN 10% OF THE SAMPLE HAVING A
GESTATIONAL DIABETES DIAGNOSIS
OR PREECLAMPSIA DIAGNOSIS AND
FEWER THAN 5% OF INFANTS
DELIVERING PRETERM, WITH FEWER
THAN 10% NEEDING A STAY IN THE
NICU.
THIS IS AN EXPERIMENTAL
OVERVIEW.
WE BEGAN BY CHARACTERIZING THE
PREGNANCIES AND BANKING BIOPSIED
PLACENTAS AT DELIVERY.
THEN WE CONDUCTED A 37-FACTOR
INFLAMMATORY MARKER PANEL ON
PLACENTAL TISSUE.
AS PART OF THE LONG-TERM INFANT
FOLLOW-UPS, WE EXAMINED BRAIN
AND BEHAVIORAL HEALTH BY
ASSESSING BRAIN GROWTH, BRAIN
ACTIVITY AND BEHAVIORAL HEALTH.
TODAY I'M GOING TO SHOW YOU MY
WORK EXAMINING ONE INFLAMMATORY
MARKER, INTERLEUKIN 6.
I CHOSE TO EXAMINE ILLINOIS
6 BEIL-6 BECAUSEIT PLAYS A CENTN
INFLAMMATION AND IN REGULATING
PHYSIOLOGICAL PROCESSES.
ELEVATED IL-6 LEVELS HAVE BEEN
PREVIOUSLY RYE LATED TO INFANT
BRAIN DEVELOPMENT CHANGES.
SO WE FIRST ASKED WHETHER
PLACENTAL INFLAMMATION IS
RELATED TO INFANT BRAIN GROWTH,
INFLUENCED BY EARLY NUTRITION
AND THE PRENATAL ENVIRONMENT.
AND ALTERATIONS IN HEAD
CIRCUMFERENCE TRAJECTORIES ARE
ASSOCIATED WITH DIFFERENCES IN
COGNITIVE AND DEVELOPMENTAL
MILESTONES.
WE CAPTURED UNFANT HEAD
CIRCUMFERENCE REPEATEDLY BOTH
THROUGH PULLING DATA FROM THEIR
ELECTRONIC MEDICAL RECORDS AND
AT OUR STUDY VISITS.
AND WE CALCULATED PERCENTILES
AGE AND SEX ADJUSTED USING
STANDARD EQUATIONS.
SO I WILL SHOW YOU MY WORK
EXAMINING HEAD CIRCUMFERENCE
PERCENTILES AT BIRTH, SIX MONTHS
AND ONE YEAR.
WHAT I INITIALLY NOTED IN THE
RESULTS FROM PATH ANALYSES WAS
THAT THERE WAS NOT A
RELATIONSHIP BETWEEN PLACENTAL
IL-6 AND HEAD CIRCUMFERENCE AT
BIRTH.
HOWEVER, WHEN I EXAMINED THEIR
HEAD CIRCUMFERENCES AT 6 MONTHS
AND 12 MONTHS, I STARTED TO SEE
A RELATIONSHIP TWEAN PLACENTAL
IL-6 AND LARGER HEAD
CIRCUMFERENCE EMERGE.
AND WHEN I SAW THAT, IT MADE ME
THINK THERE MAY BE SOMETHING
ABOUT THE TRAJECTORY OF HEAD
CIRCUMFERENCE GROWTH.
SO I EXAMINED THE CHANGE IN HEAD
CIRCUMFERENCE FROM BIRTH TO
6 MONTHS AND BIRTH TO 12 MONTHS,
AND I SAW THE INFANTS THAT HAD
HIGHER PLACENTAL IL-6 EXPOSURE
HAD GREATER CHANGE IN HEAD
CIRCUMFERENCES OVER THE FIRST
YEAR OF LIFE.
NOTABLY ALL OF THESE ESTIMATES
WERE ADJUST THE FOED FOR A NUMBF
COVARIATES.
THESE CHANGES TRACK WITH THE
NEURODEVELOPMENTAL LITERATURE
THAT SHOWS THAT NEONATES THAT
LATER DEVELOP AUTISM AND OTHER
NEURODEVELOPMENTAL DISORDERS
TEND TO DISPLAY NORMAL HEAD
CIRCUMFERENCES AT BIRTH, BUT
THAT THEIR HEAD GROWTH RATES
BEGAN ACCELERATING DURING THE
FIRST YEAR OF LIFE AND
CONTINUING THROUGH EARLY
CHILDHOOD.
SO WE FOUND THAT PLACENTAL IL-6
IS ASSOCIATED WITH ACCELERATED
HEAD CIRCUMFERENCE GROWTH IN THE
FIRST YEAR.
SUGGESTING POTENTIAL IMPACTS ON
NEURODEVELOPMENTAL PROCESSES,
WHICH HAS IMPLICATIONS FOR EARLY
NEURODEVELOPMENT AND ITS
LONG-TERM CONSEQUENCES, AND
THERE IS A NOVEL NOVELTY IN LING
PLACENTAL IL-6 TO POSE NATAL
GROWTH OUTCOMES THAT WE HAVEN'T
REALLY SEEN BEFORE.
SO THESE FINDINGS WERE VERY
INTERESTING BUT HEAD
CIRCUMFERENCE IS A VERY CRUDE
MEASURE OF THE BRAIN SO I WANTED
TO EXAMINE THE BRAIN IN MORE
DETAIL.
BUILDING ON THE HEAD
CIRCUMFERENCE FINDINGS, WE NEXT
ASKED WHETHER THE ACTUAL BRAIN
ACTIVITY OF THE INFANTS DIFFERED
BASED ON PLACENTAL IL-6 LEVELS.
WE ASSESSED WHETHER PLACENTAL
ILIL-6 HAS AN ASSOCIATION WITH
INFANT BRAIN ACTIVITY PATTERNS
BY EXAMINING INFANT FRONTAL
ASYMMETRY FROM A RESTING EEG
SCAN AT ONE MONTH.
DEVIATIONS FROM SYMMETRIC
ACTIVITY POTENTIALLY INDICATING
FUTURE MENTAL HEALTH RISKS.
IT IS ALSO KNOWN TO BE SENSITIVE
TO PERINATAL INFLUENCES.
UNDERSTANDING THIS ASSOCIATION
IS IMPORTANT FOR EARLY
IDENTIFICATION AND INTERVENTION
STRATEGIES TO MITIGATE LONG TERM
ADVERSE OUTCOMES.
RESULTS FROM STRUCTURAL EQUATION
MODELS ASSESSING THE MODERATING
ROLE OF CHILD SEX SHOWED THAT
FOR ONE MONTH OLD MALES BUT NOT
FEMALES, PLACENTAL IL-6 LEVELS
WERE ASSOCIATED WITH GREATER
FRONTAL ASYMMETRY.
A NEURAL SIGNATURE KNOWN TO BE
ASSOCIATED WITH NEGATIVE
EMOTIONS AND ASSOCIATED WITH
PSYCHOPATHOLOGY RISK.
MALES AND FEMALES EXHIBIT
DIFFERENT SUSCEPTIBILITIES TO
PRENATAL ENVIRONMENTAL FACTORS,
INCLUDING INFLAMMATION.
MALES ARE OFTEN MORE VULNERABLE
TO ADVERSE PRENATAL CONDITIONS
WHICH CAN LEAD TO DISTINCT
NEURODEVELOPMENTAL TRAJECTORIES,
WHICH . WE FOUND AN EARLY RISK R
FOR MENTAL HEALTH CONCERNS,
WHICH ALIGNS WITH RECENT WORK
SUGGESTING THAT FETAL SEX
MODERATES THE PLACENTA'S
INFLAMMATORY RESPONSE, WITH
FEMALE FETUSES HAVING A MORE
REGULATORY IMMUNE RESPONSE
PRODUCE MORE AND INFLAMMATORY
CYTOKINES THAT CONTROL THE
IMMUNE RESPONSE AND REDUCE
INFLAMMATION, WHILE MALE FETUSES
HAVE A MORE AGGRESSIVE
INFLAMMATORY RESPONSE, AND
PROMOTING INFLAMMATION.
AFTER SEEING THAT PLACENTAL IL-6
IS ASSOCIATED WITH INFANT BRAIN
GROWTH AND ACTIVITY, WE THEN
ASKED WHETHER THERE IS A LINK
BETWEEN PLACENTAL IL-6 AND
INFANT BEHAVIOR.
WE EXAMINED NEGATIVE AFFECT
WHICH IS A PRECURSOR FOR
DEVELOPMENTAL PSYCHOPATHOLOGY.
NEGATIVE AFFECT IN A CHILD LOOKS
LIKE A BABY THAT CRIES A LOT,
AND ONE THAT GETS DISTRESSED
EASILY AND HAS BIG REACTIONS TO
THAT EFFECT.
A LARGER PROPORTION OF CHILDREN
WITH NEGATIVE AFFECT DO GO ON TO
RECEIVE CLINICAL DIAGNOSES
COMPARED TO THOSE WITHOUT.
SO WE USE A STANDARDIZED
LABORATORY TASK CALLED THE
GENTLE ARMORY STRAINT.
IN THIS TASK WE LET A CHILD PLAY
WITH A DESIRABLE AND ATTRACTIVE
TOY FOR THR SECONDS, AND THEN
THEIR CAREGIVER GENTLY RESTRAINS
THEIR ARMS SO THEY CANNOT ACCESS
THE TOY FOR 30 SECONDS.
WE RECORD THEIR REACTIONS TO
THIS TASK.
AND IF YOU HAVE CHILDREN OR IF
YOU INTERACT WITH THEM, THEN YOU
PROBABLY KNOW HOW THIS GOES.
MOST CHILDREN GET VERY UPSET BY
THIS BUT SOME GET MORE UPSET
THAN OTHERS AND THAT RANGE IS
WHAT WE'RE INTERESTED IN.
RESULTS FROM STRUCTURAL EQUATION
MODELS RELATING THEIR PLACENTAL
IL-6 EXPOSURE TO THEIR NEGATIVE
AFFECT SCORES AT SIX MONTHS YOU
WHICH WE MEASURED AS THEIR
BODILY DISTRESS, VOCAL DISTRESS
AND FACIAL DISTRESS, SHOWED THAT
THE HIGHER THE PLACENTAL IL-6
LEVELS, THE GREATER THE DISPLAY
OF NEGATIVE AFFECT DURING THE
GENTLE ARMORY STRAINT TASK.
SUGGESTING THAT PLACENTAL
INFLAMMATION AS MEASURED BY IL-6
LEVELS ARE PROGRAMMING NEGATIVE
AFFECT AT 6 MONTHS OF AGE.
NOTE THRINOTABLY THESE SURVIVED
HIGHLIGHTING THE ROBUSTNESS OF
THESE FINDINGS AND TAKEN
TOGETHER, THESE RESULTS SUGGEST
THAT PLACENTAL INFLAMMATION NOT
ONLY HAS CONSEQUENCES FOR BRAIN
GROWTH AND ACTIVITY BUT ALSO FOR
ITS BEHAVIORAL OUTPUT.
IN SUMMARY, I FOUND THAT
PLACENTAL INFLAMMATION AS
MEASURED BY IL-6 LEVELS APPEARS
TO INFLUENCE THE
NEURODEVELOPMENTAL PATHWAYS
ASSOCIATED WITH EMOTIONAL
REGULATION AT 6 MONTHS OF AGE.
THIS SUGGESTS THAT PLACENTAL
IL-6 MAY BE AN IMPORTANT
BIOMARKER OF RISK FOR
PSYCHOPATHOLOGY AND FUTURE
MENTAL HEALTH CONCERNS.
WE FOUND THAT PLACENTAL IL-6
CORRELATES WITH KEY METRICS
INCLUDING ALTERED HEAD
CIRCUMFERENCE TRAJECTORIES,
GREATER FRONTAL ASYMMETRY IN
MALES AND HEIGHTENED TENDENCIES
FOR NEGATIVE AFFECT.
AND I HAVE MANY FUTURE DIRECTS
AND QUESTIONS FOR THIS WORK.
WE WANT TO AVEST THESE OUTCOMES
LONGITUDALLY AT CHILDREN AGE.
WE PLAN TO EXAMINE OTHER
DEVELOPMENTAL OUTCOMES AND
WHETHER CHILDREN DO ACTUALLY GO
ON TO RECEIVE A CLINICAL
DIAGNOSIS.
WE'RE ALSO INTERESTED IN A MORE
DETAILED CHARACTERIZATION OF
PLACENTAL INFLAMMATION AND OF
COURSE WE'RE THINKING ABOUT THE
POTENTIAL UPSTREAM FACTORS
INVOLVED IN PLACENTAL
INFLAMMATION.
THIS WORK HAS GREAT POTENTIAL TO
INFORM EARLY RISK DETECTION FOR
FUTURE PSYCHOPATHOLOGY.
THESE FINDINGS SUGGEST THAT
PLACENTAL IMMUNE MARKER
IDENTIFICATION MAY ENABLE EARLY
DETECTION OF PSYCHOPATHOLOGY AND
LEAD TO TARGETED INTERVENTIONS
FOR IMPROVING INFANT HEALTH.
AND IT IS ESPECIALLY EXCITING TO
THINK ABOUT THE PLACENTA AS A
BIOMARKER FOR LATER PSYCHOPATH
LOGICAL RISK.
I WANT TO REMIND YOU WHY I CARE
ABOUT THIS.
SO REMEMBER THE 1 IN 6.
THIS WORK REPRESENTS AN
IMPORTANT OPPORTUNITY FOR
INTERVENTION.
WHAT WE WERE SHOWING IS THAT THE
PLACENTA, WHICH IS TYPICALLY
DISCARDED AT BIRTH, COULD
POTENTIALLY BE USED TO PREDICT
WHO IS AT RISK WITHOUT EVER
HAVING TO SEE THE CHILD FIRST,
MEANING WE COULD POTENTIALLY
PROVIDE SUPPORT MUCH EARLIER.
THESE RESULTS INFORM THE TIMING
OF GOOD MENTAL HEALTH PROMOTION,
UPDATING THE CURRENT MENTAL
HEALTH SYSTEM, STRUCTURED AROUND
A CHILD ADULT SERVICE SCHISM IN
LATE ADOLESCENCE AND EARLY
ADULTHOOD TO EARLY RISK
DETECTION IN INFANCY AND
PROVIDING MENTAL HEALTH SUPPORT
IN EARLY CHILDHOOD.
BEFORE I CLOSE I WANT TO RESTATE
THE IMPORTANT SAYING THAT NO ONE
EVER DOES ANYTHING ALONE.
THIS WORK WAS DONE WITH THE
SUPPORT OF AN AMAZING TEAM AND
WITH THE SUPPORT OF MENTORS AND
MY FUNDERS, INCLUDING THE OREGON
BIRCWH AND THE NATIONAL
INSTITUTE OF ARTHRITIS AND
MUSCULOSKELETAL DISEASE AND THE
NIH OFFICE OF RESEARCH ON
WOMEN'S HEALTH.
SO IF YOU QUESTIONS, IDEAS OR
YOU WANT TO COLLABORATE, PLEASE
REACH OUT TO ME AT MY EMAIL
ADDRESS ON THE SCREEN, AND I
ALSO WANT TO POINT YOU TO OUR
STUDY WEBSITE WHICH CAN BE FOUND
AT THE QR CODE AT THE BOTTOM
LEFT.
THANK YOU.
[APPLAUSE]
>> THANK YOU SO MUCH, DR. WOOD.
WE'RE GOING TO GO AHEAD AND OPEN
UP OUR LAST Q & A SESSION FOR
OUR SPEAKER.
GO RIGHT AHEAD.
>> THANKS FOR A GREAT TALK.
I'M ANNA, I'M AT THE V.A. AND I
HAD A QUESTION ABOUT THE
STABILITY OF THE FRONTAL
ASYMMETRY MEASURE AND WHETHER
YOU'VE LOOKED AT HOW STABLE IT
IS EITHER WITHIN A SESSION OR
ACROSS SESSIONS AND THEN ALSO
STABILITY RELATED TO IF YOU
LOOKED AT LIKE SLIGHTLY
DIFFERENT COMBINATIONS OF
ELECTRODES AND JUST GENERALLY
HOW STABLE THAT MEASURE IS.
>> YES, I DID LOOK AT SOME OTHER
ELECTRODES.
I THINK I LOOKED AT F3 AND F4.
WE SAW RESULTS IN SIMILAR
DIRECTIONS BUT NOT -- THEY WERE
NOT AS ROBUST AS THE FINDINGS IN
THE F7 AND F8 ELECTRODES.
WE DO HAVE EEG SCANS BOTH
RESTING AND DURING DIFFERENT
TASKS AT OTHER AGES.
IT'S NOT SOMETHING THAT I HAVE
LOOKED AT YET, BUT SOMETHING
THAT I WOULD LIKE TO LOOK AT.
AND I HAVE A COLLEAGUE WHO --
SHE WAS ALSO A POSTDOC WITH ME
AND SHE WAS KIND OF OUR EEG
EXPERT.
SHE'S NOW TRANSITIONED TO
FACULTY THAT I KNOW IS LOOKING
INTO THIS IN MORE DEPTH.
SO I WOULD LOVE TO ALSO CONNECT
YOU WITH HER IF THAT'S OF
INTEREST.
>> GREAT.
THANK YOU.
>> THANK YOU FOR AN EXCELLENT
TALK.
I'M WONDERING ABOUT THE
SPECIFICITY OF THE ORIGIN OF THE
IL-6 AND WHETHER YOU KNOW
PLACENTAL IL-6 ASSOCIATES WITH
INFANT IL-6 POSTNATALLY AND WITH
MOM'S IL-6 DURING PREGNANCY.
>> YES, WHAT AN EXCELLENT
QUESTION.
IT IS SOMETHING THAT WE HAVE
THOUGHT ABOUT A LOT.
WE HAVE MEASURED INFLAMMATION
MARKERS IN MATERNAL BLOOD
COLLECTED DURING PREGNANCY AND
THEN ALSO A CORD BLOOD AT BIRTH.
WE ALSO HAVE ATTEMPTED TO
COLLECT BLOOD SAMPLES ON OUR
INFANTS, USING A TASSO DEVICE,
IT'S CAPILLARY BLOOD.
NOT MANY PARENTS CONSENT TO LET
US COLLECT THEIR INFANT'S BLOOD,
WHICH MAKES SENSE, I THINK,
HAVING MY OWN CHILDREN, SO WE'RE
NOT ABLE TO LOOK AT THOSE
POSTNATAL BLOOD SAMPLES.
I THINK WE HAVE SOMETHING LIKE
17 SAMPLES OR SOMETHING FOR THE
WHOLE COHORT, SO IT'S NOT VERY
MUCH.
BUT I WILL SAY THAT I HAVE DONE
SOME PRELIMINARY WORK LOOKING AT
THE IL-6 LEVELS IN PERIPHERAL
BLOOD IN THE MOMS DURING
PREGNANCY AND ALSO IN THE CORD
BLOOD AT BIRTH.
AND I DID NOT SEE THAT THEY
CORRELATED WITH PLACENTAL IL-6
LEVELS.
I REALLY THOUGHT IT WAS GOING TO
BE MAYBE NOT ONE TO ONE BUT I
THOUGHT THEY WOULD BE ASSOCIATED
AND I SO FAR HAVE NOT SEEN THAT.
I THINK THAT BIRTH IS A
TRAUMATIC EVENT FOR THE
PLACENTA, SO THERE'S A LOT THAT
GOES INTO WHAT THE INFLAMMATORY
PROFILE OF THE PLACENTA LOOKS
LIKE DURING THAT PROCESS.
>> REALLY INTERESTING.
WHAT'S THE STATE OF THE SCIENCE
OF SALIVARY CYTOKINES?
I DID SOME WORK IN THIS IN HIV
ABOUT FIVE YEARS AGO AND I KNOW
IT WAS KIND OF COMING OF AGE,
BUT I WONDER IF THAT MIGHT BE AN
ALTERNATE APPROACH FOR YOU.
>> THAT IS A GREAT QUESTION.
WE DO HAVE SALIVARY SAMPLES ON
OUR MOMS AND OUR BABIES, SO
DEFINITELY SOMETHING TO EXPLORE.
I DON'T KNOW IF YOU CAN MEASURE
IT.
IT SOUNDS LIKE YOU CAN.
THANK YOU FOR THE SUGGESTION.
>> THAT'S A GREAT TALK.
I KNOW YOU DIDN'T TALK ABOUT THE
DIET, YOU KNOW THAT'S WHAT I'M
INTERESTED IN BUT I'M WONDERING
IF THESE BABIES WERE BREAST-FED
OR NOT BREAST-FED AND IF THAT
INFLUENCED THE DATA OR IF YOU
HAVE IT IN THIS TALK OR ANOTHER
TALK, IF YOU SEE ANY DIFFERENCES
WITH THAT.
>> YEAH, THAT'S A GREAT
QUESTION.
YOU KNOW, THE PORTLAND, OREGON
AREA, I THINK IS AN AREA THAT
ATTRACTS PEOPLE WHO TEND TO
BREASTFEED.
SO WE HAVE SOMETHING LIKE 98% OF
OUR MOMS ARE BREASTFEEDING BY
ONE YEAR.
STILL BY ONE YEAR OF AGE.
>> FANTASTIC TALK.
I WAS CURIOUS ABOUT WHETHER YOU
LOOKED AT ANY SEX DIFFERENCES IN
THE GENTLE ARM RESTRAINT TASK
SINCE YOU FOUND DIFFERENCES AT
THE ONE MONTH POINT IN YOUR EEG
DATA.
>> YES, WHAT A GREAT QUESTION.
I DID SEE THAT THERE ARE SEX
DIFFERENCES IN NEGATIVE AFFECTS
SO MALES TENDED TO EXPRESS
HIGHER RATES OF NEGATIVE AFFECT
THAN FEMALES.
I DID NOT LOOK AT SEX AS A
MODERATING FACTOR YET.
SO THAT IS A NEXT STEP TO
REANALYZE MY DATA WITH SEX AS A
MODERATOR WHICH IS WHAT WE SAW
WITH THE EEG.
>> ALL RIGHT, THANK YOU ONCE
AGAIN FOR YOUR WONDERFUL TALK.
[APPLAUSE]
>> SO WE ARE GOING TO HAVE A
SHORT BREAK, JUST TO STRETCH OUR
LEGS AND MAYBE GET SOME -- A
LITTLE BIT OF NETWORKING IN
THERE, AND WE WILL COME BACK AT
4:05.
BEFORE ANYTHING ELSE, I WOULD
LIKE TO ANNOUNCE TO OUR BIRCWH
SCHOLARS, OUR ACTIVE BIRCWH
SCHOLARS, AND TO THEIR MENTORS,
THAT WHEN YOU GO TO THE ORWH
WEBSITE AND SEARCH FOR BIRCWH WE
NOW HAVE A WEBSITE, LOOK AT
YOURSELF THERE AND YOUR PICTURES
AND YOU CAN CITE THAT IN YOUR CV
AS A WEBSITE WHERE YOU ARE.
SO WE ARE VERY HAPPY THAT IT
BECAME ACTIVE TODAY, OR
YESTERDAY, SO THAT WE CAN SHARE
OUR JOY AND OUR PRIDE IN HAVING
YOU AS OUR SCHOLARS.
SO PLEASE DO CHECK IT OUT ON THE
ORWH WEBSITE.
WE HAVE A VERY DISTINGUISHED
SPEAKER TODAY AND I AM EXTREMELY
PRIVILEGED TO INTRODUCE THIS
YEAR'S LEGACY OF LEADERSHIP
INAUGURATED AND INSTITUTED BY
DR. JANINE CLAYTON DURING THE
DECEMBER 20TH BERKESHIRE
MEETING.
THE LECTURESHIP SHOWCASED A
REMARKABLE ACCOMPLISHMENT -- WHO
HAVE DEMONSTRATED LEADERSHIP AND
VISION ACROSS A VARIETY OF
SCIENTIFIC ENVIRONMENTS.
WE HAVE BEEN FORTUNATE TO
WELCOME IN OUR MIDST SUCH
EMINENT SCIENTISTS AND LEADERS,
AND INCIDENTALLY ALSO A BIRCWH
P.I.
WE HAD DR. CLAIRE POMEROY,
PRESIDENT OF THE ALBERT AND MARY
LASKER FOUNDATION, DR. JUDITH
JAMES, ASSOCIATE VICE PROVOST
AND PROFESSOR OF MEDICINE,
PATHOLOGY, MICROBIOLOGY AND
IMMUNOLOGY AT THE OKLAHOMA
UNIVERSITY HEALTH SCIENCES
CENTER, AND LAST YEAR, WE HAD
DR. LINDSAY CRISWELL, THE
DIRECTOR OF THE NATIONAL
INSTITUTE OF ARTHRITIS AND
MUSCULOSKELETAL AND SKIN
DISEASES.
TODAY TO INSPARE ALL OF US TO
REALIZE OUR ASPIRATIONS AND
ACHIEVE HEIGHT WE DID NOT
REALIZE WE COULD ATTAIN, WE HAVE
THE PR PRIVILEGE OF LEARNING FRA
CONSUMMATE SCIENTIST AND LEADER.
NINA SCHOR, M.D. PH.D.
DR. NINA SCHOR IS THE NIH DEPUTY
DIRECTOR FOR INTRAMURAL
RESEARCH.
IN THIS ROLE SHE OVERSEES
FACULTY RECRUITMENT AND
DEVELOPMENT, RESEARCH REGULATORY
AFFAIRS, TECHNOLOGY TRANSFER,
TRAINING AND EDUCATION, AND
RESEARCH INTEGRITY FOR THE
ENTIRE NIH INTRAMURAL RESEARCH
PROGRAM.
PRIOR TO LIFE AT THE NIH,
DR. SCHOR HAD ENJOYED IMMENSE
SUCCESS AS AN ACADEMIC,
CLINICIAN, AND SCIENTIST.
DR. SCHOR WAS ON THE FACULTY OF
THE UNIVERSITY OF PITTSBURGH FOR
20 YEARS, ULTIMATELY BECOMING
THE PROFESSOR OF PEDIATRIC
RESEARCH, CHIEF OF THE DIVISION
OF CHILD NEUROLOGY IN THE
DEPARTMENT OF PEDIATRICS, AND
ASSOCIATE DEAN FOR MEDICAL
STUDENT RESEARCH IN THE MEDICAL
SCHOOL AT PITTSBURGH.
IN 2006, DR. SCHOR GAME THE
WILLIAM H. IVINGER CHAIR OF
PEDIATRICS AND PEDIATRICIAN IN
CHIEF OF THE GOLISANO CHILDREN'S
HOSPITAL AT THE UNIVERSITY OF
ROCHESTER.
AS A SCIENTIST, SHE WAS
CONTINUOUSLY FUNDED BY NIH.
TO PURSUE HER RESEARCH ON NEURAL
CREST DEVELOPMENT.
IN JANUARY 2018 SHE WAS
RECRUITED TO BECOME THE DEPUTY
DIRECTOR OF THE NATIONAL
INSTITUTE OF NEUROLOGICAL
DISORDERS AND STROKE, WHICH WE
CALL NINDS, WHERE SHE HAD LED
THE DIVISION OF INTRAMURAL
RESEARCH AND THE ULTRA-RARE GENE
TARGETED THERAPIES NETWORK, AND
ALSO STRATEGIC PLANNING AND
CAREER DEVELOPMENT PROGRAMS.
THIS WAS UNTIL SHE WAS APPOINTED
TO BECOME THE NIH DEPUTY
DIRECTOR FOR INTRAMURAL
RESEARCH.
SINCE ASSUMING THIS VERY AGEST
POSITION IN THE HALLOWED HALLS
OF THE NIH CAMPUS SINCE
AUGUST 2022, SHE HAS BEEN
TRANSFORMATIVE IN CREATING A
CONDUCIVE WORKPLACE WHERE WOMEN
SCIENTISTS FEEL THEY HAVE A
VOICE.
THE VOICE THAT IS HEARD AND
THOUGHTFULLY CONSIDERED, A
COLLEAGUE THEY CAN TRUST,
RESPECT, AND BELIEVE IN.
DESPITE HER IMMENSE AUTHORITY IN
THIS ROLE, DR. SCHOR LEADS WITH
HUMILITY, IS APPROACHABLE BUT
FIRM, SYMPATHETIC BUT
PRINCIPLED.
TRULY A LEADER ONE CAN WILLINGLY
FOLLOW, A LEADER ONE CAN
HOPEFULLY EMULATE.
DR. SCHOR IS THE CURRENT CHAIR
OF THE BOARD OF DIRECTORS OF THE
AMERICAN BOARD OF PSYCHIATRY AND
NEUROLOGY, AND A 2024 RECIPIENT
OF THE BERNICE GRAPHSTEIN AWARD
FOR OUTSTANDING MENTORING FROM
THE SOCIETY FOR NEUROSCIENCE.
COLLEAGUES, PLEASE WELCOME
DR. NINA SCHOR.
>> THANK YOU SO MUCH FOR THAT
REALLY WONDERFUL INTRODUCTION,
AND THANKS TO ALL OF YOU FOR
BEING HERE.
I TRIED REALLY HARD TO ARRANGE
THE WEATHER, AND I REALLY MESSED
UP BIG TIME IN THAT.
I AM SO HONORED TO BE IN FRONT
OF YOU AND TO BE ABLE TO TELL
YOU A LITTLE BIT ABOUT REALLY MY
OWN CAREER JOURNEY, BUT I WILL
TELL YOU THAT THERE IS NO
COOKBOOK FOR THIS.
YOU WILL FIND YOUR OWN PATH,
PERHAPS WITH SUGGESTIONS WITH
MENTORING AND IDEAS YOU WILL GET
FROM OTHERS, YOU WILL HEAR IDEAS
THAT YOU SAY YOU KNOW WHAT, GOOD
FOR YOU, THAT'S NOT FOR ME,
THAT'S MENTORING TOO.
AND SO I THOUGHT WHAT I WOULD DO
IS TALK A LITTLE BIT ABOUT
ESPECIALLY AS A CHILD
NEUROLOGIST, THE NOTION THAT
DEVELOPMENT IS FOREVER, AND I
WILL TELL YOU THAT IF THERE IS
AN AGE AT WHICH WE STOP
DEVELOPING, I'M NOT THERE YET.
SO I THINK IT'S VERY, VERY
IMPORTANT TO REALIZE THAT YOU
CAN ACHIEVE YOUR DREAMS, YOUR
ASPIRATIONS, BUT IT DOESN'T
HAPPEN ALL AT ONCE.
AND THERE IS A RIGHT MOMENT FOR
EVERYTHING THAT COMES ABOUT, AND
SO WITH THAT, I WILL TELL YOU I
AM NOT NEARLY ENTREPRENEURIAL
ENOUGH TO HAVE ANY CONFLICTS OF
INTEREST.
SO I HAVE ALWAYS SEEMED TO BE
WORKING AT THE INTERFACE BETWEEN
FIELDS, AND IT HAS PLUSES AND
MINUSES TO DO THIS.
YOU GO AROUND A LOT LIKE MAN
WITHOUT A COUNTRY, BUT I WILL
TELL YOU THAT IF I HAD TO DO
OVER AGAIN, I WOULD NOT DO IT
ANY OTHER WAY.
I THINK WORKING AT THE INTERFACE
BETWEEN FIELDS, FOR ME, HAS BEEN
A WAY TO JUXTAPOSED THINGS AND
SYNTHESIZE THINGS THAT OFTEN
CREATES NEW IDEAS.
SO LET ME TELL YOU A LITTLE BIT
ABOUT HOW THIS CAME ABOUT.
IT WAS DEFINITELY NOT ALL AT
ONCE.
SO I DID MY UNDERGRADUATE DEGREE
AT YALE.
I WAS A MAJOR IN MOLECULAR
BIOPHYSICS AND BIOCHEMISTRY.
AND I REALLY LEARNED AT THAT
POINT THAT ONE COULD BRING VERY,
VERY BASIC CHEMISTRY TO BEAR ON
UNDERSTANDING OF BIOLOGICAL
SYSTEMS.
I WORKED IN THE LABORATORY OF
WONDERFUL PHYSICAL BIOCHEMISTS.
YOU CAN TELL HE PUT TOGETHER ALL
THREE BRANCHES OF SCIENCE IN ONE
VERY LONG WORD.
A MAN BY THE NAME OF DR. JULIAN
STURTEVANT, AND WORKING IN HIS
LAB REALLY TAUGHT ME A WHOLE
BUNCH OF LESSONS, VERY, VERY
EARLY IN MY ACADEMIC LIFE.
THE MOLECULE THAT YOU SEE
DIAGRAMMED THERE IS A PROTEIN,
IN BLUE IS THE PROTEIN, IN RED
IS THE SUBSTRATE.
AND THE IMPORTANT THING ABOUT
THIS AND THE LESSON THAT I
LEARNED IS THAT ABOUT 10% OF
THIS MOLECULE IS IN THAT LITTLE
TURQUOISE BOX NEAR THE END
TERMINUS OF THE PROTEIN.
IF YOU TAKE THIS VERY COMPLEX
PROTEIN AND YOU CHOP OFF THAT
END TERMINAL 10%, WHICH IS
NOWHERE NEAR THE ACTIVE SITE
WHERE THE SUBSTRATE IS BOUND,
YOU COMPLETELY PAIR LASE THIS PS
ENZYME FROM DOING ANYTHING
USEFUL.
THAT END TERMINAL TEENY-WEENY
10% WHICH IN THE WORLD OF
GENOMICS NOW WE MIGHT -- WHEN WE
TALK ABOUT JUNK DNA, THE
STUFF -- I MEAN, HONESTLY IT'S A
MISSION THAT WE DON'T HAVE ANY
CLUE WHAT IT'S DOING SO WE CALL
IT JUNK BECAUSE IT MAKES US FEEL
BETTER.
BACK IN THOSE DAYS, THAT 10% OF
THE MOLECULE FAR AWAY FROM THE
ACTIVE SITE WAS THE PROTEIN
ANALOG OF JUNK DNA TODAY.
BUT THE FACT OF THE MATTER IS
THAT THAT LITTLE PIECE IS
ABSOLUTELY CRITICAL TO POSITION
THE ACTIVE SITE IN THE RIGHT
STEREO CHEMICAL CONFIGURATION SO
THAT THE SUBSTRATE COMBINED.
AND I REALLY LEARNED THAT THE
SIZE OF AN ENTITY OR THE
PERCENTAGE OF THE CHEMICAL
UNIVERSE THAT IT MAKES UP MAY
HAVE ABSOLUTELY NO RELATIONSHIP
BETWEEN THAT MOLECULE AND ITS
BIOLOGICAL FUNCTION.
AND I REALLY LEARNED THAT
LEARNING THE STRUCTURE AND THE
IMPORTANCE OF EACH PIECE OF A
CHEMICAL ENTITY MIGHT ACTUALLY
HOLD THE KEY TO BIOLOGICAL
FUNCTION AND DYSFUNCTION.
NOW THE OTHER THING I LEARNED IN
JULIAN STURTEVANT'S LAB, I THINK
SOME WHAT SAY ISN'T SCIENCE.
THE FIRST ASPECT OF THAT IS THAT
THE MACHINE THAT YOU SEE THERE
IS A CALORIMETER.
IT HAD SEER YOE NUMBER 000003.
IT WAS THE THIRD ONE OF ITS KIND
MADE, AND DURING THE COLD WAR,
THAT WAS MADE IN MOSCOW IN THE
LABORATORY OF DR. PEA TER
PRIVILOV.
AND DR. PRIVILOV AND
DR. STURTEVANT, WITH WHOM I WAS
WORKING IN NEW HAVEN,
CONNECTICUT, WERE VERY, VERY
CLOSE FRIENDS.
YOU KNOW, I OFTEN FEEL THAT THAT
WAS MY FIRST EXHIBIT FIRST INTE
NOTION THAT IF THE LEADERS
POLITICALLY OF THE WORLD WANT TO
LEARN HOW TO GET ALONG, THEY
SHOULD TAKE SOME INFORMATION
FROM THE SCIENTISTS OF THE
WORLD.
THIS COLLABORATION AT A TIME
WHEN IT WAS NOT POPULAR TO BE
COLLABORATING WITH SOMEBODY FROM
THE FORMER SOVIET UNION WAS AN
IMMENSELY, IMMENSELY PRODUCTIVE
COLLABORATION.
AND THE PEOPLE THAT YOU SEE IN
THE PICTURE CAME FROM SIX
DIFFERENT COUNTRIES AROUND THE
WORLD.
WE DID NOT HAVE A COMMON PRIMARY
LANGUAGE AMONG US BECAUSE EVEN
THE ONES THAT CAME FROM THE SAME
COUNTRY CAME FROM DIFFERENT
REGIONS AND COULDN'T -- ENGLISH
WAS OUR COMMON LANGUAGE AND WE
SPOKE IT MORE OR LESS WELL
DEPENDING ON HOW LONG WE HAD
BEEN IN THE U.S. OR THE U.K. OR
CANADA.
BUT I DON'T REMEMBER AN ARGUMENT
AMONG US EXCEPT AS TO WHETHER A
HYPOTHESIS WAS OR WAS NOT
SUPPORTED BY THE DATA.
REALLY, THE SCIENTIFIC COMMUNITY
IS AN INTERNATIONAL COMMUNITY,
AND IT HAS TO BE IN ORDER FOR TO
BE MAXIMALLY EFFECTIVE FOR WHAT
IT HAS TO DO FOR THE WORLD.
SO I LEARNED ABOUT STRUCTURE AND
FUNCTION AND FUNCTION AND
STRUCTURE, AND I REALLY LEARNED
HOW TO CONTRIBUTE TO A GROUP AND
HOW TO BE PART OF AN ENTERPRISE
MUCH BIGGER THAN WHAT I COULD DO
IN MY OWN LAB.
SO THEN I WENT FOR MY GRADUATE
WORK TO ROCKEFELLER UNIVERSITY.
I DID AN M.D. PH.D. PROGRAM THAT
WAS -- IT'S NOW CALLED THE
TRIINSTITUTIONAL PROGRAM.
BACK THEN IT WAS CORNELL MEDICAL
SCHOOL AND ROCKEFELLER
UNIVERSITY.
AND I WORKED WITH DR. ANTHONY
CIRAMI, WHO TO THIS DAY I WOULD
SAY WAS THE MOST CREATIVE
SCIENTIST WITH WHOM I'VE EVER
WORKED.
AND WHEN I THINK THROUGH A
PROBLEM NOW, I THINK IT THROUGH
BECAUSE OF THE WAY HE TAUGHT ME
TO DO THAT.
AND HE WAS AN INDIVIDUAL WHO
SAID, WELL, IF YOU CAN TAKE
CHEMISTRY AND BRING TO BEAR ON
BIOLOGICAL SYSTEMS, THEN YOU CAN
LEARN THE BIOCHEMISTRY OF AN
ABERRANT SYSTEM AND DESIGN WAYS
TO TREAT DISEASE.
AND SO I WENT FROM JUXTAPOSING
BIOLOGY AND CHEMISTRY TO
JUXTAPOSING VERY BASIC SCIENCE
WITH MEDICINE.
I WORKED -- EVEN THOUGH I KNEW
AT THAT TIME I ULTIMATELY WANTED
TO GO INTO NEUROLOGY, THE
NEUROLOGY AT ROCKEFELLER WAS
SQUID AXON NEUROLOGY.
I KNEW I DIDN'T WANT TO DO THAT.
I STILL KNOW THAT TODAY.
AND I DECIDED TO WORK ON
SOMETHING OTHER THAN
NEUROSCIENCE BUT TO LEARN THE
APPROACH, THE TECHNIQUES, THE
WAY OF THINKING ABOUT A
BIOLOGICAL PROBLEM, AND
TRANSLATING THAT INTO MEDICINE
WITH THE HOPE THAT DOWN THE
ROAD, I WOULD BE ABLE TO APPLY
THIS TO NEUROLOGY.
SO I WORKED ON CYSTIC FIBROSIS,
WHICH WAS KNOWN AT THAT TIME TO
BE AN AUTOSOMAL RECESSIVE
GENETIC DISORDER, BUT THE GENE
WAS NOT KNOWN AT ALL.
AND THE QUESTION WAS, COULD WE
MAKE A DENT IN THE SYMPTOMS THAT
UNDERLIED THESE PATIENTS'
PROPENSITY FOR INFECTION AND FOR
PULMONARY DYSFUNCTION BY
UNDERSTANDING THE BIOCHEMISTRY
OF THAT DYSFUNCTION.
AND I STUDIED WITH THE HELP OF
STANFORD MOORE, WHO WAS A
RENOWNED PROTEIN BIOCHEMIST, AND
AN INSTRUMENT CALLED A RIOME TE
WHICH WAS A VERY PRIMITIVE WAY
OF MEASURING THE VISCOSITY OF
FLUIDS.
A LOT OF THINGS WERE DONE BY
HAND THAT NOW WOULD BE AUTOMA
AUTOMATED.
WE WERE ABLE TO DETERMINE THE
BIOCHEMICAL UNDERPINNINGS OF THE
VISCOSITY OF THE SECRETIONS OF
PEOPLE WITH CYSTIC FIBROSIS.
AND THROUGH THAT, TO SAY IS
THERE SOMETHING WE COULD USE TO
INTERRUPT, TO DISRUPT THIS
VISCOSITY THAT WOULD HELP THESE
PATIENTS.
AND WE DESIGNED AND TESTED IN AN
N OF 4 CLINICAL STUDY.
I MEAN, IT'S FUNNY TO ME NOW,
BUT IT WAS REALLY EXHILARATING
TO ME AT THAT TIME AS A GRADUATE
STUDENT.
WE ACTUALLY DEMONSTRATED CHANGES
IN PULMONARY FUNCTION TESTS, AT
LEAST IN THE SHORT TERM AS A
RESULT OF REDUCING THE VISCOSITY
OF SUSPENSIONS OF THIS VERY
INSOLUBLE PROTEIN.
AND FOR ME, THAT WAS THE
BEGINNING OF JUXTAPOSING
BIOCHEMISTRY AND MEDICINE.
SO AFTER I GOT MY PH.D., I WENT
BACK TO CORNELL MEDICAL SCHOOL,
AND I REAFFIRMED FOR MYSELF MY
INTEREST IN GOING INTO NEUROLOGY
AND APPLYING THE PRINCIPLES I
HAD LEARNED IN THE BIOCHEMISTRY
LAB TO NEUROLOGICAL DISEASE.
AND I MET A WHOLE SLEW OF PEOPLE
THAT REMAINED REALLY THROUGHOUT
MY CAREER MENTORS, COLLEAGUES,
FRIENDS.
HARP PETERSON WAS THE CHAIR OF
PEDIATRIC NEUROLOGY AT CORNELL
AT THE TIME.
WILLIAM SHAPIRO WAS ONE OF THE
CLINICAL LEADERS AND RESEARCH
LEADERS AT MEMORIAL SLOAN
KETTERING, AND HE WAS IN THE
DEPARTMENT OF -- I THINK OF HIM
AS A NEURO-ONCOLOGY LUMINARY,
JEROME POSNER, AND DAVID NATHAN,
I MET WHEN I WENT OFF TO DO MY
PEDIATRIC RESIDENCY.
AT BOSTON
CHILDREN'S, AND IT WAS THROUGH
THIS REMARKABLE GROUP OF PEOPLE
WHO WERE NOT JUST GREAT
PHYSICIANS AND SCIENTISTS, BUT
FROM MY STANDPOINT, THE MOST
IMPORTANT THING WAS THAT THEY
WERE EXTRAORDINARILY GENEROUS
MENTORS, AND NO IDEA WAS TOO
SIMPLE OR TOO SILLY TO RUN IT BY
THEM.
I REALLY MET WITH EXCITEMENT AND
ACCEPTANCE WHEN I WOULD PRESENT
MY -- YOU KNOW, SOME OF THESE
IDEAS WERE PIE IN THE SKY KIND
OF THINGS.
I WAS UNENCUMBERED BY DATA AT
THIS STAGE IN MY LIFE, AND
RUNNING IDEAS BY THEM AND
MEETING WITH NOT ONLY ACCEPTANCE
BUT EXCITEMENT ABOUT A NEW WAY
TO LOOK AT SOMETHING WAS REALLY
EMPOWERING TO ME, AND I HAVE
TAKEN THAT WITH ME AS I'VE
MENTORED YOUNG PEOPLE, STUDENTS
AND RESIDENTS AS I'VE GONE
ALONG.
BUT THE NOTION FOR ME WAS, WAS
THERE SOME WAY I COULD LOOK AT
THE BIOCHEMISTRY AND THE
NEUROSCIENCE OF TUMORS OF THE
NERVOUS SYSTEM AND MAKE A DENT
IN THIS PROBLEM THAT THE
ONCOLOGY WORLD HAD NOT YET MADE
A DENT IN.
WAS THERE SOMETHING ABOUT, FOR
EXAMPLE, NEUROBLASTOMA, WHICH IS
A TUMOR OF THE NERVOUS SYSTEM IN
CHILDHOOD, AND THIS TUMOR IS --
YOU KNOW, WHEN WE THINK OF ADULT
CANCERS, WE THINK OF NORMAL
MATURE CELLS THAT SOMEHOW GET A
HIT THAT TRANSFORMS THEM INTO
PROLIFERATING ABERRANT CANCER
CELLS.
IN CHILDREN, OFTEN THAT ISN'T
THE MECHANISM.
IN CHILDREN, OFTEN CELLS UNDERGO
DEVELOPMENTAL ARREST.
THEY NEVER BECOME MATURE, AND
THEY JUST RETAIN WHAT WOULD BE
NORMAL AS THE NERVOUS SYSTEM IS
DEVELOPING.
THEY RETAIN THEIR PROLIFERATIVE
POTENTIAL.
AND I WONDERED IF I'VE LOOKED AT
THIS AS A DEVELOPMENTAL
NEUROBIOLOGIST RATHER THAN AS AN
ONCOLOGIST, COULD I COME UP WITH
A NEW WAY TO PREVENT THESE CELLS
FROM DIVIDING.
SO I FOUND MYSELF AT THE
INTERFACE BETWEEN NEUROSCIENCE
AND CANCER BIOLOGY.
AND IT WAS REALLY THE
ENCOURAGEMENT OF THESE FOUR
MENTORS OF MINE THAT ALLOWED ME
TO DO THIS, BECAUSE AS YOU MAY
KNOW, FIELDS TEND --
PARTICULARLY IN MEDICINE, I
THINK -- TO BE RELATIVELY SILOED
FROM ONE ANOTHER.
AND YOU KNOW YOU APPLY FOR A
RESIDENCY IN NEUROLOGY AND THEY
SEE YOUR RESEARCH WAS ON CYSTIC
FIBROSIS, THAT RESEARCH DOESN'T
SEEM TO MATTER TO THE PEOPLE
YOU'RE APPLYING TO.
THESE PEOPLE DARED TO TELL ME
THAT THAT WAS NOT TRUE, AND THAT
PERHAPS I WOULD THINK SOMETHING
NEW AND FRESH AND MORE EFFECTIVE
BY SITTING AT THE INTERFACE
BETWEEN FIELDS.
WELL, SO MANY YEARS LATER, I HAD
BEEN WORKING ON A RECEPTOR
THAT'S ON THE SURFACE OF MOST
NEUROBLASTOMA CELLS, AND IT'S
THE P75 NEUROTROPHIN RECEPTOR.
IT BINDS -- IT'S OFTEN CALLED A
PROMISCUOUS RECEPTOR BECAUSE IT
BINDS MANY LIGANDS, ALL OF WHICH
ARE NEUROTROPHINS.
PROBABLY THE MOST PREVALENT OF
THEM IS NGF, AND IT PLAYS A ROLE
IN THE MAINTENANCE OF
PROLIFERATIVE POTENTIAL IN
NEUROBLASTOMA.
SO I HAD BEEN WORKING ON IT, AND
A GRADUATE STUDENT CAME TO ME
AND SAID I REALLY, REALLY WANT
TO WORK IN YOUR LAB.
I'M REALLY EXCITED ABOUT DOING
MY WORK IN YOUR LAB.
AND I'M GOING TO GET MY PH.D. IN
THE NEXT FEW MONTHS, I WANT TO
DO A POSTDOC WITH YOU.
I WAS DELIGHTED.
I KNEW HER FROM BEING ON HER
THESIS COMMITTEE, AND I KNEW
THAT SHE WAS HARD WORKING AND
BRIGHT AND CREATIVE, AND SHE
SAID, WELL, BEFORE YOU SAY YES,
LET ME TELL YOU WHAT I REALLY
WANT TO DO.
AND I THOUGHT THAT WAS A LITTLE
ODD, BUT I SAID GO AHEAD.
AND SHE SAID, WELL, YOU KNOW, I
REALLY, REALLY WANT TO WORK ON
ALZHEIMER'S DISEASE.
NOW I MEAN, WHO GOES TO A
PEDIATRIC NEUROLOGIST WHO WORKS
ON A TUMOR OF THE DEVELOPING
NERVOUS SYSTEM AND SAYS I'M
COMING TO YOU TO WORK ON
ALZHEIMER'S DISEASE?
I MEAN, THAT'S CRAZY, RIGHT?
I SAID, OKAY, I WANT TO HEAR YOU
OUT.
TELL ME WHY -- I MEAN, I'LL HELP
YOU FIND THE RIGHT PERSON.
NO, NO, NO, SHE SAID, YOU ARE
THE RIGHT PERSON.
AND SHE PROCEEDED TO TELL ME
THAT -- SOMETHING I KNEW
INITIALLY THAT THE P75 RECEPTOR
IS TRANSMEMBRANE, AND IT GETS
CLEAVED, AND THE WAY IT WORKS,
WHEN A LIGAND BINDS, THE
P75 RECEPTOR GETS CLEAVED BY AN
ENZYME, AND THE INTRACELLULAR
PART GOES OFF TO THE NUCLEUS AND
ACTS AS A TRANSCRIPTION FACTOR.
OKAY, WHAT DOES THAT HAVE TO DO
WITH ALZHEIMER'S DISEASE?
WELL, IT GETS CLEAVED BY REALLY
A FAMILY OF ENZYMES CALLED GAMMA
SECRETASES, AND PRESENILLIN,
WHICH IS MUTATED IN FAMILIAL
ALZHEIMER'S DISEASE, IS A GAMMA
SECRETASE.
AND SHE SAID MAYBE THE WHOLE
PROBLEM IN ALZHEIMER'S DISEASE
IS THE ABERRANT CLEAVAGE OF THIS
MOLECULE IN THE MEMBRANE.
YOU KNOW IT'S A HYPOTHESIS, IT'S
STARTING TO SOUND LIKE MAYBE IT
HAS TO DO WITH WHAT I DO IN MY
LAB.
SO I DID A LITTLE READING
MYSELF, AND IT TURNS OUT THAT AS
THE NERVOUS SYSTEM DEVELOPS, THE
P75 RECEPTOR, ITS EXPRESSION
GETS MORE AND MORE RESTRICTIVE
IN THE NERVOUS SYSTEM.
WHEN AN EMBRYO DEVELOPS, THE
ENTIRE NEURAXIS IS FILLED WITH
P75.
AND AS YOU GET OLDER, THE
EXPRESSION OF P75 BECOMES LESS
AND LESS IN MOST OF THE NEURAXIS
BUT THE PLACES IT REMAINS IN
HIGH CONCENTRATION ARE THE
PLACES IMPLICATED IN ALZHEIMER'S
DISEASE.
THE NUCLEUS BASALIS OF MINOR,
THE CEREBELLUM, THE FRONTAL
LOBE, THE PLACES WHERE WE TALK
ABOUT ABERRANCY IN ALZHEIMER'S
DISEASE.
HONESTLY, YOU NEVER SAY THAT'S
DEFINITELY THE MECHANISM UNTIL
YOU DO THE EXPERIMENTS, BUT I
BECAME ENOUGH OF A BELIEVER THAT
I BROUGHT THIS WOMAN INTO MY
LABORATORY.
AND SHE DID A POSTDOC WITH ME,
AND SHE ACTUALLY DEMONSTRATED
THAT, IN FACT, YOU CAN CREATE
WHEREVER P75 IS EXPRESSED,
PRESINILLIN, IF IT'S MUTATED,
CLEAVES THIS P75 AB RAPTLY AND
MAKES ITS FUNCTION NOT NORMAL.
AND IF YOU TAKE THE HIPPOCAMPUS
FROM PATIENTS WHO HAVE DIED OF
ALZHEIMER'S DISEASE, YOU CAN
SHOW THAT SAME ABARENCY.
NOW MOST PATIENTS WITH
ALZHEIMER'S DISEASE DO NOT HAVE
THIS MUTATION AND DO NOT HAVE A
FAMILIAL CLEARLY GENETIC
DISORDER.
SO IS THIS THE MECHANISM BEHIND
SPORADIC ALZHEIMER'S DISEASE?
I DON'T YET KNOW.
AND I CAN TELL YOU THAT THE
P75 FROM PEOPLE WITH SPORADIC
ALZHEIMER'S DISEASE IS CLEAVED
PERFECTLY NORMALLY.
SO MAYBE THIS IS A SUBSET, BUT
AGAIN, FINDING SOMETHING NEW AT
THE INTERFACE BETWEEN FIELDS AND
BEING WILLING TO ENTERTAIN AN
IDEA THAT COMES ABOUT FROM OUT
OF LEFT FIELD, I THINK SOMETIMES
YOU HIT PAYDIRT AND CERTAINLY
GAVE US MORE INFORMATION THAN WE
HAD BEFORE.
I DON'T THINK I WOULD HAVE
THOUGHT OF LOOKING AT P75 IN
ALZHEIMER'S DISEASE, EVER.
SO I MOVED FROM -- THIS WORK WAS
DONE IN PITTSBURGH, AND I MOVED
FROM THERE TO THE UNIVERSITY OF
ROCHESTER, AND THE UNIVERSITY OF
ROCHESTER, DEPARTMENT OF
PEDIATRICS, HAS THE LARGEST
DIVISION IN MY DEPARTMENT WAS
THE DIVISION OF DEVELOPMENTAL
AND BEHAVIORAL PEDIATRICS.
AND THEY HAD AN ENORMOUS FOCUS
AS ONE MIGHT EXPECT GIVEN THE
PRIF LANCPREVALENCE OF THIS DISN
AUTISM.
IT IS ONE OF THE FOREMOST
CLINICAL CENTERS FOR THE CARE OF
CHILDREN WITH AUTISM.
AND WHAT WAS INTERESTING TO ME
WAS, THERE WAS AN INVESTIGATOR
AT THE UNIVERSITY OF MICHIGAN
WHO HAD MADE MICE THAT HAD THE
P75 RECEPTOR DELETED FROM THEIR
BRAINS DURING -- IT WAS A
KNOCKOUT MOUSE, AND SO THESE
MICE DEVELOP WITHOUT P75.
I ONLY READ THE PAPER BECAUSE MY
LAB WAS WORKING ON THIS
RECEPTOR.
I WAS NOT READING TO LOOK UP
ANYTHING ABOUT AUTISM.
AND THE BRAINS ARE ABNORMAL, AND
THEY'RE PARTICULARLY ABNORMAL IN
THE ABERRANT ARRANGEMENT OF THE
CELLS IN THE CEREBELLUM.
AND I MENTIONED THIS TO A
COLLEAGUE OF MINE IN
DEVELOPMENTAL AND BEHAVIORAL
PEDIATRICS.
AND SHE SAID THAT'S SO FUNNY,
BECAUSE I JUST READ A PAPER THAT
SAID THAT THAT'S WHAT THE CELLS
LACK LIKE IN THE ABERRANT -- I
MEAN, IT'S LONG BEEN KNOWN THAT
THE CEREBELLUM OF CHILDREN WITH
AUTISM IS ABNORMAL IN SIZE AND
CONFIGURATION OFTEN ON GROSS MRI
STUDIES.
SHE SAID I JUST READ A THING
THAT THEY LOOKED AT ADULTS WHO
HAD HAD THE AUTISM DIAGNOSED AS
CHILDREN AND THEY LOOKED AT
THESE ELDERLY ADULTS AND THAT'S
EXACTLY WHAT THEY SAY THE
CEREBELLUM LOOKS LIKE MIC MIC
MICROSCOPICALLY IN THESE ADULTS.
I THOUGHT, WHAT THE HECK, I
DON'T HAVE TO MADE THE KNOCKOUT
MOUSE, THE GUY ALREADY MADE THEM
IN MICHIGAN, MAYBE I CAN GET
THEM AND WE CAN BREED THEM, AND
WE CAN LOOK AT THE CEREBELLUM
AND LOOK AT THE BEHAVIOR OF
THESE MICE.
THIS WAS VERY MUCH A SIDE
PROJECT.
I HAD A STUDENT WITH ME, HI A
TECH THAT HAD A CHILD WITH
AUTISM.
THEY WERE THRILLED TO DO THIS,
AND I SAID, LOOK, YOU KNOW, IF
DOWN THE ROAD THIS DOESN'T WORK
OUT, REALLY NOTHING VENTURED,
NOTHING GAINED, BUT WE HAVEN'T
LOST MUCH EITHER.
WE WILL SPEND THE SUMMER
DECIDING IF THIS IS A FRUITFUL
WAY TO PROCEED.
INITIALLY FROM DEVELOPMENT TO
SENESCENCE, AND NOW FROM
SENESCENCE, THE ALZHEIMER'S
STUDIES BACK INTO DEVELOPMENT.
AGAIN, AN INTERFACE, RIGHT?
LO AND BEHOLD, THESE MICE, NOT
SURPRISING, YOU TAKE OUT THE
CEREBELLUM DURING -- YOU TAKE
OUT THE P75 RECEPTOR DURING
EMBRYONIC LIFE, AND THE
CEREBELLUM DOES NOT DEVELOP
NORMALLY.
IT'S ONE OF THE FEW PLACES
WHEREAS YOU AGE, P75 PERSISTS.
SO IT REALLY WASN'T SURPRISING
THAT THE MICROSCOPY WAS
ABNORMAL.
WHAT WAS AMAZING TO US IS THAT
THESE MICE VERY, VERY MUCH LIKE
CHILDREN WITH AUTISM.
IF YOU PUT A STRANGER MOUSE IN
THE CAGE WITH THE MOUSE, A
NORMAL MOUSE WILL EXPLORE THAT
STRANGER MOUSE AND WILL GROOM OR
FIGHT WITH THAT MOUSE.
THESE P75 KNOCKOUT MICE COULD
CARE LESS, THAT THERE WAS A
STRANGER MOUSE IN THE CAGE.
THEY TOTALLY IGNORED THE
UNFAMILIAR MOUSE.
THEY ALSO HAVE AUTONMONISM, IT'S
AN ODD STERODDITY BECAUSE THEY
ARE OTHERWISE MOTORICALLY
COMPLETELY NORMAL BUT THEY JUMP.
THEY JUST SPONTANEOUSLY START TO
JUMP AROUND THE CAGE.
THEY DON'T DO INVESTIGATION --
IF YOU PUT THEM IN A NEW CAGE,
THEY DON'T DO SOCIAL
INVESTIGATION.
THEY DON'T EXPLORE THEIR
ENVIRONMENT.
AND YET THEY'RE PERFECTLY
CAPABLE OF WALKING AROUND, OF
CLIMBING ON THINGS, BUT THEY
SEEM OBLIVIOUS TO A NEW
ENVIRONMENT.
THEY JUST STAY IN A CORNER.
AND YOU KNOW, I HESITATE TO SAY
THAT WE CREATED AN AUTISTIC
MOUSE.
AGAIN, I CANNOT ASCRIBE
MECHANISM TO THIS.
BUT AGAIN, THIS IS A MODEL NOW
THAT ONE CAN USE TO STUDY
INTERVENTIONS.
SO AGAIN, SOMETHING FRUITFUL
THAT CAME OUT OF A JUX JUXTAPON
OF THINGS THAT MOST SANE PEOPLE
WOULD NOT HAVE THOUGHT TO
JUXTAPOSED.
AND I THINK THE HARDEST
DECISIONS THAT WE MAKE IN
SCIENCE AND SOMETIMES IN
MEDICINE IS WHICH OF THESE
THINGS THAT ARE OUTSIDE OF OUR
BOX ARE WE GOING TO EXPLORE, AND
WHICH ARE WE GOING TO LEAVE FOR
SOMEONE ELSE?
BECAUSE THERE'S NO GUARANTEE, I
COULD ALSO HAVE SHOWN YOU
EXAMPLES OF THINGS THAT DIDN'T
PAN OUT WHEN WE EXPLORED THEM.
BUT THE FACT OF THE MATTER IS,
WHAT HAS WORKED FOR ME IS I HAVE
ALWAYS GIVEN MYSELF A TIME
LIMIT.
I'M GOING TO SPEND THE NEXT SIX
MONTHS OR A YEAR DOING THIS.
AND IF IT DOES NOT PAN OUT AT
THIS POINT, I AM NOT GOING TO
WORK ON THIS ANY FURTHER, I'M
GOING BACK TO MY DAY JOB.
AND THE FACT IS ALSO THAT I'VE
ALWAYS HAD A LAB THAT ON THE ONE
HAND IS SMALL ENOUGH THAT I FEEL
COMFORTABLE THAT I KNOW
EVERYBODY AND WHAT EVERYBODY IS
DOING AT ANY GIVEN TIME, BUT ON
THE OTHER HAND, THAT IS LARGE
ENOUGH THAT I COULD TAKE A
SUBSET OF MY LAB TO DO THIS AND
KEEP OUR MAIN DIRECTION GOING.
AND I THINK THAT HAS WORKED
VERY, VERY WELL.
I THINK THIS NOTION OF HOW DO
YOU HAVE BREADTH AS A SCIENTIST
AND AS A PHYSICIAN, AND YET KEEP
YOUR FOCUS ON SOMETHING SO THAT
EVERYBODY KNOWS THAT YOU'RE THE
EXPERT IN A PARTICULAR AREA, I
THINK IT'S CHALLENGING TO DO
THAT.
BUT I ALSO THINK THAT WORKING AT
THE INTERFACE BETWEEN FIELDS CAN
LEVERAGE THE SYNERGIES BETWEEN
THOSE FIELDS TO CREATE SOMETHING
NEW THAT NEVER EXISTED BEFORE.
SO THE SECOND LESSON THAT I
THINK IS IMPORTANT TO LEARN IS
THAT NO MATTER WHAT YOU DO WITH
YOUR LIFE, AND ESPECIALLY IF YOU
DECIDE TO HAVE A
RESEARCH-INTENSIVE CAREER, THERE
ARE ALWAYS GOING TO BE BUMPS IN
THE ROAD.
I REMEMBER THE FIRST TIME I
TESTED A HYPOTHESIS WITH WHICH I
HAD FALLEN IN LOVE, THAT'S A
VERY DANGEROUS THING, AND MY
DATA WERE COMPLETELY
INCONSISTENT WITH THAT
HYPOTHESIS, I WENT HOME THAT
NIGHT AND SAID TO MY HUSBAND,
WHAT IF THAT WAS MY LAST REALLY
GOOD IDEA?
AND I NEVER THINK OF ANYTHING
EXCITING AGAIN.
AND HE WAS A LITTLE FURTHER
ALONG IN HIS CAREER AND HE BURST
OUT LAUGHING, WHICH I WILL TELL
YOU WAS NOT HELPFUL.
DO NOT DO THAT TO ANYBODY.
BUT NOW I KNOW WHY HE LAUGHED.
BECAUSE THAT IS NOT GOING TO
HAPPEN TO ANY OF YOU, AND IT HAS
NEVER HAPPENED TO ME YET.
SO HERE'S A DIAGRAM OF I GUESS
MY CAREER.
SO THE RED ARROW TOWARDS THE
LEFT OF THE SLIDE IS WHERE I
STARTED.
I WENT TO SCHOOL LIKE EVERYBODY
ELSE, FELT LIKE A HUNDRED YEARS.
THEN I SOUGHT THE BEST TRAINING
AND I DID A RESIDENCY AND SO
FORTH, I MANAGED TO BUNCH UP SIX
MONTHS OF MY RESIDENCY ELECTIVE
TIME AND DO SIX MONTHS STRAIT OF
RESEARCH AT THE VERY END OF MY
RESIDENCY.
AND THEN I WANTED TO LOOK FOR
THE BEST JOB AND BY THAT POINT,
I WAS MARRIED AND MY HUSBAND AND
I LIVED FOR THE FIRST TWO YEARS
OF OUR MARRIAGE IN TWO DIFFERENT
CITIES, AND WE DECIDED WE WOULD
GO WHEREVER THE BOTH OF US COULD
FIND A JOB, AND WE ENDED UP AT
THE UNIVERSITY OF PITTSBURGH.
IT WAS VERY, VERY FRUITFUL FOR
US BOTH.
AND I LITERALLY CLIMBED THE
ACADEMIC LADDER THE WAY ONE DOES
AND TOOK ON SUCCESSIVELY MORE
COMPLEX AND LARGER LEADERSHIP
OPPORTUNITIES, AND THAT WAS A
VERY IMPORTANT PART OF MY
CAREER, BUT EVENTUALLY I LIKE TO
SAY THAT THE TOP OF MY HEAD HIT
THE UNDERSIDE OF THE GLASS
CEILING.
IT WAS VERY CLEAR, IT WAS OKAY
FOR ME AS A WOMAN TO BE A
DIVISION CHIEF, BUT IT WASN'T A
GOOD IDEA FOR ME TO BE A
DEPARTMENT CHAIR, OR TO BE A
DIRECTOR OF A RESEARCH CENTER.
I KEPT BEING TOLD, NO, THAT'S MY
JOB, YOU CAN'T HAVE THAT, OR NO,
I ALREADY KNOW WHO I WANT IN
THAT POSITION.
AND I BEGAN LOOKING FOR ANOTHER
POSITION.
AND CHANGE IS HARD, BUT
HONESTLY, CHANGE IS GOOD TOO
SOMETIMES.
IT HAS TO COME AT THE RIGHT
TIME, AND AGAIN, WE WERE A
TWO-BODY PROBLEM.
MY HUSBAND AND I.
SO WE HAD TO FIND A PLACE WHERE
BOTH OF US HAD POSITIONS.
BUT I MOVED TO THE UNIVERSITY OF
ROCHESTER.
THAT WAS ACADEMIC JOB NUMBER
TWO.
AND SPENT 11 1/2 YEARS AS A
DEPARTMENT CHAIR, AND REALLY,
REALLY ENJOYED IT AND MANAGED
REALLY BECAUSE OF THE STRUCTURE
OF THAT UNIVERSITY AND THE
WONDERFUL PEOPLE AROUND ME TO
ALSO KEEP MY LABORATORY GOING.
I GUESS I BEGAN AT THAT POINT TO
GET KIND OF RESTLESS, I GUESS IS
THE RIGHT WORD.
I THOUGHT OKAY, I'VE LEARNED AN
ENORMOUS AMOUNT, I HAVE SKILLS I
NEVER THOUGHT I WOULD HAVE, BUT
NOW I WOULD LIKE TO APPLY THEM
ACROSS A BROADER OR DIFFERENT
PLATFORM.
I'D LIKE TO BRING THEM TO BEAR
ON SOMETHING ELSE.
AND THE INTERESTING THING WAS, I
HAD A DEAN WITH WHOM I'M STILL
VERY CLOSE FRIENDS, LOVELY,
LOVELY PERSON, VERY BRIGHT
PERSON, A CLINICIAN-SCIENTIST AS
WELL.
BUT I MET WITH HIM FOUR TIMES
AND COULD NOT GET HIM TO
UNDERSTAND THE VALUE OF WHAT I
HOPED I'D BE ABLE TO BUILD.
I WANTED TO DO THINGS ACROSS
DISCIPLINES, ACROSS THE ENTIRE
UNIVERSITY, AND HE SAID, YOU
KNOW, I HAVE THE FUNDING FOR
THAT BUT I DON'T HAVE AN
UNDERSTANDING OF WHY YOU WOULD
PARTNER WITH THE UNDERGRADUATE
CAMPUS.
MY JOB IS TO BUILD A BIGGER AND
BIGGER AND BIGGER CLINICAL
ENTERPRISE, AND YOU CAN DO THAT
AS THE PEDIATRICIAN IN CHIEF.
I THOUGHT, I JUST SPENT ALMOST
12 YEARS AS THE PEDIATRICIAN IN
CHIEF.
IT'S TIME FOR SOMEBODY ELSE TO
DO THAT, AND IT'S TIME FOR ME TO
DO THAT IN ANOTHER ARENA.
SO AT ONE POINT IN THIS RATHER
FRUSTRATING ENTERPRISE, I WAS AT
A NEUROLOGY MEETING AND I RAN
INTO DR. WALTER KOROSHETZ, WHO I
KNEW FROM COMMITTEES AND THINGS
LIKE THAT, AND FROM MY GRANT
FUNDING AND SO FORTH, AND HE
MENTIONED HE WAS LOOKING FOR A
DEPUTY DIRECTOR, AND I CALLED
HIM A FEW MONTHS LATER, IT TOOK
A LONG TIME FOR ME TO EVEN THINK
OF -- I MEAN, WHO WANTS TO WORK
WITH THE GOVERNMENT, RIGHT?
WE'RE FROM THE GOVERNMENT, WE'RE
HERE TO HELP YOU?
AND I CALLED HIM AND I SAID, ARE
YOU STILL LOOKING FOR A DEPUTY
DIRECTOR?
AND HE SAID, ABSOLUTELY.
I MEAN, THESE THINGS, YOU KNOW,
SEARCHES, YOU WERE A CHAIR, THEY
DON'T GO QUICKLY ANYWHERE.
SO I APPLIED FOR THE POSITION.
AND GOT THE POSITION, AND HERE I
AM, YOU KNOW, IN A GOVERNMENT
JOB, AND BRINGING EVERYTHING
THAT I LEARNED IN ACADEMIA IS
RELEVANT TO WHAT I DO NOW.
PEOPLE ARE PEOPLE, MANAGING AN
ENTERPRISE IS MANAGING AN
ENTERPRISE, AND YET I LEARN NEW
THINGS BECAUSE THERE ARE NEW
CAPABILITIES AND NEW
RESTRICTIONS THAT COME AS A
RESULT OF BEING IN A GOVERNMENT
ENVIRONMENT.
AND SO YOU KNOW, THIS NOTION
THAT DEVELOPMENT IS FOREVER IS A
VERY IMPORTANT ONE.
BUT SO I WOULD SAY WHEN THE
BUMPS COME ALONG, SOMEBODY SAYS
NO, YOU CAN'T DO WHAT YOU WANT
TO DO WHERE YOU ARE, JUST STAY
ENGAGED, LOOK FOR A PLACE OR A
SITUATION.
IT MAY BE RIGHT WHERE YOU ARE
THAT YOU CAN DO SOMETHING
DIFFERENT.
STAY CHALLENGED, STAY USEFUL,
STAY IMPORTANT.
SYNTHESIZE AND SYNERGIZE.
IT'S THE ONLY WAY TO THINK OF
SOMETHING NEW.
AND ALWAYS REMEMBER, YOU'RE
PHYSICIAN SCIENTISTS, RIGHT?
THE WHOLE IDEA IS TO LEAVE THE
WORLD JUST A LITTLE BIT BETTER
THAN IT WAS WHEN YOU GOT HERE.
SO I DO WANT TO MAKE SOME POINTS
ABOUT SERENDIPITY FAVORING THE
PREPARED MIND.
SO WHEN WE WERE LOOKING AT
ALZHEIMER'S DISEASE, I HAD TWO
POSTDOCS IN MY LAB.
THE ONE I TOLD YOU ABOUT WHO
WORKED ON FAMILIAL ALZHEIMER'S
DISEASE, AND THEN I HAD A
POSTDOC WHO WAS WORKING ON
NEUROBLASTOMA.
AND THE WOMAN WHO WORKED ON
ALZHEIMER'S DISEASE HAD A SKILL
THAT WE DIDN'T HAVE IN MY LAB,
AND SHE HAD DONE TRANSCRIPTOMICS
AND SHE HAD ACTUALLY DONE MICRO
ARRAYS AND THINGS OF THAT
NATURE.
WE HAD NEVER DONE THEM.
AND SO I PAIRED THE TWO POSTDOCS
AND SAID OKAY, YOU'RE GOING TO
TAKE YOUR NEUROBLASTOMA CELLS
AND CONTROL CELLS, AND YOU'RE
GOING TO TAKE ALZHEIMER'S BRAIN
AND P75 DELETED ALZHEIMER'S --
OR ABERRANT ALZHEIMER'S BRAIN
AND I'M JUST PAIRING YOU NOT
BECAUSE THE PROJECTS HAVE
ANYTHING TO DO WITH ONE ANOTHER,
BUT BECAUSE I WANT YOU TO SHARE
TECHNIQUES BACK AND FORTH.
AND THEY LOVED IT, THEY WERE
VERY FRIENDLY AND SO THEY HAD A
GOOD TIME AND THEY DID THIS IN
PARALLEL WITH THEIR VERY
DIFFERENT SYSTEMS.
WE SAT DOWN AT LAB MEETING.
WHEN THEY FINISHED, WOT OF THEM,
BOTH OFTHEM, THEIR STUDIES, ANDE
COMPARED THE MOST ALTERED GENE
EXPRESSION IN THE TWO SYSTEMS,
HONEST TO GOD, I COULD NOT MAKE
THIS UP, THEY WERE
SUPERIMPOSABLE.
AND I THOUGHT, WHAT THE HECK IS
GOING ON?
YOU HAVE TO BE KIDDING ME.
IT'S TWO SYSTEMS, AND I
IMMEDIATELY ACCUSED THEM OF
MIBGING UP WHICH SAMPLES THEY
HAD.
I SAID YOU TOOK HER TEST TUBES
AND -- THEY DID IT BEGIN, WE GOY
DID IT AGAIN, WE GOT THE SAME
THING.
IT TURNS OUT THAT THE MOST
CHANGED GENES IN THESE ARE
CHOLESTEROL SYNTHETIC ENZYME
GENES.
NOW WHO CONNECT -- I MEAN, YES,
APOE, BUT THAT'S NOT CHOLESTEROL
SYNTHESIS.
IN ALZHEIMER'S
DISEASE, AND NOBODY CONNECTS
CHOLESTEROL WITH NEUROBLASTOMA.
IT TURNS OUT, AND NO ONE HAD
KNOWN THIS, THAT THE
P75 RECEPTOR, WHICH WAS INVOLVED
IN BOTH OF THESE, HAS TO GET FAR
NIS LATED AND THE THIRD STEP IS
THE MANUFACTURER OF FARNESYL
DIPHOSPHATE.
SO IT TURNED OUT THAT SOMETHING
THAT WAS IMPORTANT FOR THE
P75 RECEPTOR TO FUNCTION THAT
HAD TO PUT A FARNESYL GROUP ON
THE P75 WAS CRITICALLY AFFECTED
IN BOTH OF THESE SYSTEMS.
NOW, THAT'S VERY BASIC
BIOCHEMISTRY.
WE'RE NOT GOING TO CURE ANYBODY
BY DOING GENE THERAPY FOR
FARNESYL DIPHOSPHATE SYNTHESIS,
BUT AGAIN, HAD WE NOT BEEN ALERT
TO THESE CRAZINESS THAT THESE
TWO SYSTEMS HAD EXACTLY THE SAME
GENE ALTERATIONS, WE NEVER WOULD
HAVE FOUND THE FARNESYLATION OF
P75.
WE JUST NEVER WOULD HAVE
UNDERSTOOD THAT ABOUT THIS
RECEPTOR.
AND I JUST THINK PEOPLE JUST --
SOMETIMES GREAT SCIENCE COMES
OUT OF THINGS THAT YOU DON'T
EXPECT.
I THINK ANOTHER EXAMPLE OF THIS
IS IN OUR NEUROBLASTOMA STUDIES.
WE KNEW THAT THE MIC PROTEIN
NMYC IS A VERY, VERY IMPORTANT
MEDIATOR OF THE VIRULENCE OF THE
NEUROBLASTOMA, AND WE KNEW THIS
CASCADE THAT I'M SHOWING HERE IN
THE PRECISE EXAMPLE OF WHAT
THESE PROTEINS ARE IS NOT
IMPORTANT.
WE KNEW THAT THESE WERE
TRANSCRIPTION FACTORS THAT MADE
YOU MAKE MORE NMYC PROTEIN AND
MADE YOUR NEUROBLASTOMA WORSE
PROGNOSIS.
BUT A GRADUATE STUDENT IN MY LAB
SAID TO ME, I HAVE AN INCREDIBLY
DUMB QUESTION, AND THAT'S
ANOTHER LESSON I LEARNED.
EVERY TIME SOMEBODY SAYS "I HAVE
A DUMB QUESTION," IS GOING TO
END UP BEING THE BEST QUESTION
ANYBODY ASKED.
AND SHE SAID, YOU KNOW, WHY IS
IT THAT WHEN YOU HAVE -- WHEN
YOU HAVE TWO TIMES AS MUCH
METHYLATION OF A TRANSCRIPTION
FACTOR THAT MAKES IT ACTIVE AND
MAKES IT GO TO THE NUCLEUS AND
YOU MAKE NMYC MORE, YOU DON'T
MAKE TWO TIMES AS MUCH NMYC.
YOU MAKE 10 TIMES AS MUCH NMYC.
SO WHY IS THAT?
AND I THOUGHT, YEAH, I NEVER
NOTICED THAT, BUT YEAH, WHEN I
LOOK BACK ON ALL THE WESTERN
BLOTS WE DID, WE DID MAKE 10
TIMES AS MUCH NMYC, WITH ONLY
TWO TIMES AS MUCH OF THE
TRANSCRIPTION FACTOR THAT MADE
IT GET MANUFACTURED.
I HAVE NO IDEA WHY NOT.
AND I TOLD HER SHE WAS GOING TO
FIGURE THAT OUT.
BECAUSE I JUST DEPARTMENT KNOW.
IT TURNS OUT THAT NOT ONLY DO
YOU METHYLATE THE TRANSCRIPTION
FACTOR, BUT YOU ALSO METHYLATE
THE NMYC, AND METHYL NMYC HAS A
HALF-LIFE IN THE CELL THAT'S AT
LEAST 10 TIMES AS LONG AS
UNMETHYLATED NMYC.
AGAIN, DID I EXPECT THIS, DID I
HAVE A HYPOTHESIS?
NO.
SO SOMETIMES REALLY GOOD THINGS
GROW OUT OF UNEXPECTED FINDINGS
AND AGAIN THIS MOTI NOTION OF WO
YOU CHASE AND WHAT DO YOU PUT IN
THE LITERATURE SO SOMEBODY ELSE
CAN DO THAT EXPERIMENT, IS THE
HARDEST THING YOU WILL DO AS A
SCIENTIST.
SO I THINK YOU HAVE TO EXPECT
THE UNEXPECTED AND YOU SHOULD
BELIEVE IN YOUR DATA ENOUGH THAT
YOU AT LEAST LOOK TO SEE IF THIS
IS REAL OR NOT.
IF IT'S NOT, YOU DROP IT
QUICKLY.
WE ALWAYS SAY "FAIL QUICKLY."
IF IF IT IS REAL, IT MAY BE JUST
AS EXCITING AS YOUR MAIN LINE OF
INQUIRY.
SO THEN THE FINAL THING IS THE
NOTION THAT THERE'S A LOT OF
LEMONS IN THIS BUSINESS.
THERE'S A LOT OF DAYS YOU GO
HOME AND SAY, GOD, I JUST -- I
WASTED A WHOLE DAY ON WHATEVER
IT IS.
LEARN TO MAKE LEMONADE OUT OF
EVERY LEMON.
SO I TOOK THIS GREAT JOB IN
GOVERNMENT, BUT I DIDN'T BRING
MY LAB WITH ME BECAUSE I SPENT
THE FIRST THREE YEARS THAT I WAS
HERE MENTORING THE PERSON WHO
TOOK OVER WHAT WAS MY LAB AND I
REALLY LOVED IT.
ONE DAY HE WAS AN ASSOCIATE
PROFESSOR ABOUT TO GO FOR A NEW
JOB AS A TENURED ASSOCIATE
PROFESSOR, AND I THOUGHT OKAY,
THAT WAS THE LAST PAPER WE EVER
PUBLISHED TOGETHER BECAUSE I
DON'T HAVE LAB HERE AND HE
DOESN'T NEED ME TO DO ANYTHING
WITH HIS LAB.
AND I REALIZED THAT ON A SUNDAY
AFTERNOON SITTING AT HOME, I
DIDN'T HAVE A DATASET TO
ANALYZE.
AND IT WAS SAD.
IT WAS REALLY SAD.
AND I COULDN'T GET ANYBODY TO
UNDERSTAND WHY THAT WAS SUCH A
SAD THING.
AND THEN I REALIZE THAT AT
NINDS, I SATONICS R SAT ON REAMA
ABOUT WHO GETS FUNDED, WHO DOES
WHAT JOB, ABOUT WHO'S DOING WHAT
KIND OF RESEARCH IN ACADEMIA,
AND NO ONE WAS ANALYZING THOSE
DATA.
SO I DECIDED TO REINVENT MYSELF,
AND I AM STILL -- I WOULD STILL
NOT SAY THAT I AM A SOCIAL
SCIENTIST OR A PSYCHOLOGIST, BUT
I REALLY HAD A TON OF FUN DOING
THIS.
AND I'M JUST GOING TO SHOW YOU A
COUPLE OF THINGS THAT CAME OUT
OF THAT.
SO THE FIRST IS A STUDY THAT I
DID WHERE I REALIZED THAT
THERE'S NO QUESTION, THERE ARE
MORE WOMEN NOW IN DEANS OFFICE
LEVEL POSITIONS THAN THERE EVER
WERE BEFORE.
BUT I KEEP HEARING PEOPLE SAYING
THAT THE DEAN IS STILL A
POSITION THAT'S RESERVED FOR MEN
PRIMARILY.
STILL, IT'S 18% OR SOMETHING
LIKE THAT OF DEANS ARE WOMEN.
AND I WONDERED, WHAT ARE ALL
THESE WOMEN IN DEAN'S OFFICE
LEVEL POSITIONS DOING?
AND IT BECAME VERY CLEAR THAT
THE MAJORITY OF THEM WERE IN
EDUCATION OR IN WHAT I CALL
IMAGE-MAKING, THE FUNDRAISING,
COMMUNICATIONS, THE PUBLIC
RELATIONS, MEDIA KINDS OF
THINGS, AND NOT IN THE DEAN
POSITION, THE GENERAL
LEADERSHIP, NOT IN CLINICAL
ENTERPRISE KINDS OF POSITIONS,
NOT IN RESEARCH OR CORPORATE
DECISION-MAKING.
IT WAS AS IF THE WOMEN WERE TYPE
CAST, AND YES, YOU CAN HAVE A
LEADERSHIP POSITION BETTER THAN
NOTHING, BUT THIS IS WHAT YOU DO
WITH YOUR LIFE.
THAT WAS A REVELATION TO ME.
THE OTHER THING THAT WAS REALLY,
REALLY INTERESTING, AND I STILL
DON'T HAVE AN EXPLANATION FOR IT
BECAUSE IT DOESN'T MAKE A LOT OF
SENSE.
SO IF YOU LOOK AT INSTITUTIONS
THAT HAVE WOMEN WHO ARE THE VICE
DEAN FOR RESEARCH, AND THERE
AREN'T A LOT OF THEM, YOU LOOK
AT INSTITUTIONS THAT HAVE MEN
FOR VICE DEAN FOR RESEARCH, AND
YOU LOOK AT INSTITUTIONS WHERE
ON THE WEBSITE THEY DON'T
SPECIFIC WHETHER IT'S A MAN OR A
WOMAN, THEY JUST SAY WE HAVE AN
OFFICE OF RESEARCH.
WHERE IT'S A MAN, THE NIH FUNDED
RESEARCH PORTFOLIO OF THAT
MEDICAL SCHOOL PREDOMINATES WITH
BASIC AND CLINICAL RESEARCH.
BUT WHERE IT'S A WOMAN, THE NIH
FUNDED PORTFOLIO PREDOMINATES
WITH EPIDEMIOLOGICAL AND
TRAINING-TYPE GRANTS, AND WHY
THE PREDILECTION, IF YOU WILL,
OR THE FORMER ROLE OR WHAT HAVE
YOU OF THE VICE DEAN FOR
RESEARCH WOULD DETERMINE WHAT
KINDS OF GRANTS THE PEOPLE IN
THEIR ENTERPRISE APPLIED FOR.
I GUESS THOSE PEOPLE HAVE MUCH
MORE INFLUENCE THAN THEY THINK
OR SUBLIMINAL LISTENED THE
MESSAGE THAT THIS IS WHAT'S
VALUED.
IT IS A VERY CURIOUS PHENOMENON.
BUT AT LEAST ON SUNDAY AFTERN
AFTERNOON, I HAD MY DATASET TO
WORK WITH.
I WOULD SAY THIS WAS A MINOR
NEGATIVE FOR MY HAVING MOVED
INTO THIS ENVIRONMENT, BUT I
TRIED TO MAKE ADVANTAGE OUT OF
THAT NEGATIVE AND REALLY MOVING
OUT OF YOUR COMFORT ZONE CAN BE
TOTALLY EXHILARATING.
SO YOU MAY BE THINKING NOW, I'M
TELLING YOU ABOUT BUMPS IN THE
ROAD AND ADVANTAGE OUT OF
ADVERSITY AND WHY WOULD I DO
THAT IF I WANT TO ENCOURAGE YOU
TO GO INTO RESEARCH-INTENSIVE
CAREERS.
WELL, HONESTLY LIKE EVERYTHING
ELSE IN LIFE, IT'S ABOUT THE
PEOPLE YOU GET TO ENGAGE WITH.
ANDED PEOPLE YOU GET TO EMPOWER.
MENTORS, COLLABORATORS, PEOPLE
THAT YOU'VE WORKED WITH THAT
HAVE REALLY PUT THE WIND
UNDERNEATH YOUR SAILS,
ESPECIALLY FOR ME AT THIS STAGE
OF MY CAREER, THIS SORT OF
LEAGUE OF NATIONS THAT IS --
THIS IS A VERY SMALL FRACTION,
ABOUT -- I ACTUALLY HAD TO PUT
THIS TOGETHER FOR SOMETHING
RECENTLY.
ABOUT 80 PEOPLE HAVE COME
THROUGH MY LABS AND MY CLINICS
AT THIS POINT, AND HONESTLY, THE
CAREERS THAT THEY HAVE EMBARKED
UPON GO WAY BEYOND WHAT I COULD
HAVE IMAGINED.
I MEAN, MANY, MANY OF THEM ARE
ACADEMICS.
THAT'S NOT SURPRISING, BUT I
HAVE PEOPLE IN VENTURE CAPITAL
THAT THE SCIENCE THAT THEY KNOW
IS IMPORTANT FOR WHAT THEY
INVEST IN.
I HAVE PEOPLE THAT ARE
PRACTICING PEDIATRICIANS, I
HAVE -- MAYBE BECAUSE I'M A
NEUROLOGIST, I HAVE THREE OR
FOUR PHYSICAL THERAPISTS THAT
WORK WITH PEOPLE WITH STROKE.
JUST REMARKABLE PEOPLE WHO STILL
THEY SEND ME BABY PICTURES ORCID
PICTURES.
IT'S FANTASTIC.
IT IS ABSOLUTELY INVIGORATING.
AND A WORD ABOUT FAMILY AND
CAREERS.
I KNOW MANY PEOPLE SAY THAT YOU
HAVE TO PULL YOURSELF AWAY FROM
YOUR WORK TO GIVE YOUR CHILDREN
QUALITY TIME.
I HAVE TO TELL YOU THAT MY
HUSBAND AND I ARE VERY BAD
EXAMPLES OF THAT, BUT WE HAVE
ALWAYS ENGAGED AND INVOLVED OUR
CHILDREN IN WHAT WE'RE DOING.
THEY DID THEIR HOMEWORK IN THE
SAME ROOM WHERE WE MADE OUR
POWERPOINT SLIDE PRESENTATIONS.
AND THEY PICKED THE COLORS FOR
THE BACKGROUNDS, SO -- I MEAN, I
JUST THINK THAT IT IS IMPORTANT
TO MAKE FAMILY AND CAREER PART
OF WHO YOU ARE, AND YOU ARE BOTH
OF THOSE THINGS.
SO THE TAKE-HOME LESSONS,
SCIENCE AND ART, VERY MUCH TWO
SIDES OF THE SAME COIN.
DON'T BE AFRAID TO MIX THEM.
THAT PROTEIN CONFIGURATION WAS
REALLY A BEAUTIFUL WORK OF ART.
STRUCTURE AND FUNCTION, IF YOU
FIGURE OUT ONE, YOU CAN USE THEM
BOTH TO CURE HUMAN DISEASE, AND
LEGACY IS EVERYTHING.
IF YOU HONOR WHAT IS GOOD IN THE
PAST, FUEL WHAT IS PROMISING IN
THE FUTURE, YOU WILL BRING
MEANING AND SUBSTANCE TO THE
PRESENT.
SO I THANK YOU ALL FOR YOUR
ATTENTION AND REALLY FOR THE
HONOR OF GIVING THIS LECTURE.
[APPLAUSE]
>> THANK YOU, DR. SCHOR.
WONDERFUL LECTURE.
WE ARE A LITTLE OVER TIME SO I
AM GOING TO INVITE --
>> SORRY, I APOLOGIZE.
>> THAT'S OKAY.
I WILL INVITE DR. TIGNO UP TO
GIVE CLOSING REMARKS.
>> SO THANK YOU, EVERYONE, FOR
STAYING UP TO THE VERY END, AND
I KNOW THAT MANY OF YOU ARE
RUNNING AFTER YOUR FLIGHT, AND I
WAS JUST SO PLEASED WE COULD
HAVE THIS MEETING, BECAUSE AT
ONE POINT, WE WERE THINKING WHAT
WILL WE DO IF WE DIDN'T HAVE A
BUDGET.
SO I AM JUST SO HAPPY THAT WE
DIDN'T NEED TO GO VIRTUAL THIS
YEAR, AND WE LOOK FORWARD TO
SEEING YOU AGAIN NEXT YEAR WHEN
WE CELEBRATE OUR 25TH
ANNIVERSARY.
SO GOODBYE, SAFE TRAVELS TO YOU,
AND THANK YOU FOR STAYING AND
BEING WITH US TODAY AND SHARING
WITH US YOUR KNOWLEDGE.
[APPLAUSE]
MEETING IS ADJOURNED.