>> WELCOME, EVERYONE. THANK YOU FOR JOINING US FOR THE SPECIAL EVENT CELEBRATING THE 30th ANNIVERSARY, MARKING THE ACCOMPLISHMENTS AND CHALLENGES OF WOMEN'S HEALTH RESEARCH. I'M OFTEN ASKED, WHAT IS THE STORY BEHIND ORWH? EVEN ON AN ELEVATOR WHO 20-SECOND ANSWERS ARE DERIGEUR, HOW MANY FLOORS ARE YOU GOING? IT'S RICH, IT'S A CREATION OF ORGANIC AND COMMUNITY DRIVEN IN RESPONSE TO REACTION TO INEQUITIES IN SOCIETY. ORWH'S ORGANIC IN OTHER WAY, HOW IT RESPONDS AND ADJUSTS TO THE EMERGENCE OF KNOWLEDGE AND DISEASES AND CHANGES IN SOCIETY. THIS SLIDE, I'M GOING TO START OUR CHAPTER, TALKING ABOUT THE FOUNDING OF ORWH AND SEATS FOR THE OFFICE PLANTED MANY YEARS AGO. IT STARTED WITH AN AWAKENING, CIVIL RIGHTS AND WOMEN'S RIGHTS MOVEMENTS OF THE 1960s, WITH THEIR CONCERNS ABOUT SOCIAL JUSTICE, INEQUALITY, CREATED GROUND FOR THE RISE OF ANOTHER MOVEMENT, WOMEN'S HEALTH MOVEMENT. WOMEN'S AND MINORITY ADVOCACY GROUPS DREW ATTENTION TO INEQUITIES IN RESEARCH AND HEALTH CARE, IN THE EARLY 1970s THE BOSTON WOMEN'S HEALTH COLLECTIVE PUBLISHED PROFOUNDLY INFLUENTIAL BOOK, "OUR BODIES, OURSELVES." HEALTH CARE ACTIVISTS BILLIE AVERY ESTABLISHED THE BLACK WOMEN'S HEALTH IMPERATIVE. MEMBERS OF THE CONGRESSIONAL CAUCUS FOR WOMEN'S HEALTH ISSUES WEIGHED IN, IN PARTICULAR SENATOR BARBARA MIKULSKI AND OLIMPIA SNOW AND PAT SCHROEDER PUSHED FOR INCREASED RESEARCH OF WOMEN AND EXPANDING RESEARCH ON DISEASES AND CONDITIONS AFFECTING WOMEN, ALSO INFLUENTIAL WERE PATIENT ADVOCACY ORGANIZATIONS, RESEARCH INSTITUTIONS, EVEN MEDICAL SOCIETIES AND WOMEN'S HEALTH GROUPS. FINALLY, THE SCIENTIFIC COMMUNITY TOOK NOTE OF THE GAPS IN MEDICAL RESEARCH, MORE AND MORE BIOMEDICAL RESEARCH WAS FINDING SEX DIFFERENCES AND DISEASE MANIFESTATIONS, RESPONSES TO TREATMENT. THE SCIENCE COULD NO LONGER BE IGNORED. NOR COULD THE INEQUITIES IN RESEARCH AND HEALTH CARE. NIH RESPONDED, LED PRINCIPALLY BY FOR WARD-THINKING LEADERS, DR. EDWARD BRANT, ESTABLISHED THE PUBLIC HEALTH SERVICE TASK FORCE ON WOMEN'S HEALTH ISSUESI APPOINTING DR. RUTH KIRSCHSTEIN, THE FORCE ADVOCATED GREATER INCLUSION OF WOMEN IN NIH-FUNDED CLINICAL RESEARCH, ALSO RECOMMENDED MORE BIOMEDICAL AND BIOBEHAVIORAL RESEARCH BE DONE ON CONDITIONS AND DISEASES UNIQUE TO OR MORE PREVALENT IN WOMEN. IN 1990 IN RESPONSE TO CONCERNS ABOUT UNDERREPRESENTATION OF WOMEN IN CLINICAL STUDIES, ON CAPITOL HILL AND ELSEWHERE, NIH ESTABLISHED ORWH AND APPOINTED DR. KIRSCHSTEIN ACTING DIRECTOR. SUPPORTIVE OF HER LEADERSHIP WAS DR. BERNADINE HEALEY, AN ADVOCATE FOR WOMEN'S HEALTH RESEARCH, THE FIRST AND TO DATE ONLY WOMAN TO HOLD THE POSITION. A YEAR LATER DR. VIVIAN PINN BECAME THE FIRST FULL-TIME DIRECTOR, A POSITION SHE HELD UNTIL 2011. LET ME TAKE A MOMENT AND ACKNOWLEDGE THE CONTRIBUTIONS OF EVERYONE WHO PLAYED A ROLE IN O RWH'S FOUNDING, WHO PRESSED FOR INCREASE IN WOMEN'S HEALTH RESEARCH. THANK YOU. THE NEXT CHAPTER OF MY PRESENTATION WILL REVIEW JUST A HANDFUL OF MAJOR ACHIEVEMENTS IN WOMEN'S HEALTH OF THE LAST 30 YEARS. EACH OF THESE EXAMPLES HAPPENS TO RELATE TO A DISEASE OR CONDITION THAT IS SPECIFIC TO WOMEN. FIRST THE WOMEN'S HEALTH INITIATIVE. A MONUMENTAL UNDERTAKING LAUNCHED IN 1993, BY DR. BERNADINE HEALEY WITH FUNDING FROM THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE. IT WAS AND IS ONE OF THE LARGEST DISEASE PREVENTION AND CLINICAL STUDIES EVER CONDUCTED ON WOMEN'S HEALTH. IT'S STILL CONTRIBUTING KNOWLEDGE ABOUT CARDIOVASCULAR DISEASE AND AGING. THE WOMEN'S HEALTH INITIATIVE FOUND MENOPAUSAL HORMONE THERAPY DID NOT PREVENT HEART DISEASE IN POST-MENOPAUSAL WOMEN, DEMONSTRATING USE OF ESTROGEN THERON AFTER MENOPAUSE INCREASED RISK FOR BLOOD CLOT DISEASE, STROKE, AND BREAST CANCER. THE INVESTMENT IN WHI RESULTED IN A RETURN OF $140 IN NET INCOME VALUE FOR EACH DOLLAR INVESTED IN THE TRIAL. I THINK YOU'LL BE HEARING MORE ABOUT MAXIMIZING ORI IN THE FUTURE. AROUND THE SAME TIME, IN 1994, NIH LED THE DISCOVERY OF THE FIRST GENE SHOWN TO BE RESPONSIBLE FOR SOME INHERITED BREAST AND OVARIAN CANCERS. DISCOVERIES IN BREAST CANCER GENETICS, WHI RESULTS, AND OTHER DISCOVERIES HAVE LED TO IMPORTANT IMPROVEMENTS IN SCREENING, GENETIC TESTING, RISK ASSESSMENT MODELS, AND CLINICAL MANAGEMENT DECISIONS. THEY HAVE HELPED US MAKE CONTINUOUS PROGRESS ON REDUCING DEATH RATES DUE TO BREAST CANCER OVER THE PAST THREE DECADES. IN 1992, THE AGE-ADJUSTED DEATH RATE DUE TO BREAST CANCER IN U.S. WOMEN HAD FALLEN FROM NEARLY 32 DEATHS PER 100,000 WOMEN TO ABOUT 20 PER 100,000. PUTTING THIS DECLINE INTO CONTEXT, TAKE A LOOK AT THE CHART ON THE RIGHT. IT DEMONSTRATES JUST HOW DRAMATIC A DECLINE THAT IS, FOR MORE THAN HALF A CENTURY DEATH RATES WERE HOLDING STEADY AT ABOUT 30 TO 35 DEATHS PER 100,000. ONE OF THE MOST EXTRAORDINARY DISCOVERIES OF THE PAST 30 YEARS IS THE HUMAN PAPILLOMAVIRUS VACCINE. WE HAVE A VACCINE AGAINST CANCER. THE HPV VACCINATION OFFERS DURABLE PROTECTION AGAINST THE TYPES OF HPV, HUMAN PAPILLOMAVIRUS, THAT CAUSE ALMOST ALL CERVICAL CANCER. MORE EXCITING NEWS WITH COSTS AND OTHER BARRIERS IMPEDING MANY FROM GETTING BOOSTER SHOTS, A STUDY TESTS A SINGLE-DOSE VACCINE, INTERIM RESULTS INDICATE LONG LASTING PROTECTION. THIS VACCINE BENEFITS MEN, MORE THAN 1/3 OF HPV-ASSOCIATED CANCERS ARE DIAGNOSED IN MALES, AND MORE THAN HALF OF OROPHARYNGEAL CANCERS ARE TYPE 16. THE NEXT ADVANCE IS NOT ONLY IMPORTANT SCIENTIFICALLY, IT'S PRETTY DARN COOL. IN 2012 THE NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES, DEFENSE ADVANCE RESEARCH PROJECT AGENCY, AND FOOD AND DRUG ADMINISTRATION BEGAN WORK ON DEVELOPING 3D CHIPS WITH LIVING CELLS AND TISSUES. ITS GOAL, TO DEVELOP A DEVICE THAT COULD MORE ACCURATELY MODEL HUMAN ORGANS, AND THE WHY TO ADDRESS THE HIGH RATE OF FAILURE OF CANDIDATE MEDICATIONS DUE TO TOXICITY OR LACK OF EFFICACY WHEN THEY REACH HUMAN TRIALS.. BESIDES TESTING CANDIDATE MEN, EVATAR IS USED TO MODEL PCOS. IT PAVES THE WAY TOWARD IMPROVED REPRODUCTIVE HEALTH TESTING FOR CONDITIONS LIKE INFERTILITY, ENDOMETRIOSIS, UTERINE FIBROIDS, AND FEMALE CANCERS, THESE ARE ALL VERY IMPORTANT AREAS. MY FINAL EXAMPLE INVOLVES A RECENT ADVANCE IN CLINICAL APPLICATION. POSTPARTUM DEPRESSION IS A MOOD DISORDER THAT AFFECTS SOME WOMEN AFTER CHILD BIRTH. THERE WAS NO TREATMENT SPECIFICALLY APPROVED. MANY YEARS OF NIH-FUNDED RESEARCH LED TO THE DEVELOPMENT OF THIS BREAKTHROUGH DRUG, WITH FDA APPROVAL FROM POSTPARTUM DEPRESSION FOR THE FIRST TIME EVER HAD EFFECTIVE RELIEF. THESE ARE JUST FOUR EXAMPLES OVER THE PAST 30 YEARS. THEY REPRESENT THE BRILLIANCE, DEDICATION, INSPIRATION OF MANY SCIENTISTS, WOMEN AND MEN BEHIND THEM. I WOULD LIKE TO THANK THE INVESTIGATORS WHO CONCEPTUALIZED THESE ADVANCES, VALIDATED, TESTS AND ULTIMATELY EXECUTED ON THEIR DESIGNS. WE HAVE SO MUCH FOR WHICH TO BE THANKFUL TO THEM. IT'S NOT JUST RESEARCH THAT ORWH ADVANCES THE HEALTH OF WOMEN. I'M PROUD TO SAY THAT ORWH HAS BEEN A LEADER IN IMPLEMENTING INNOVATIVE POLICIES THAT HAVE MADE A REAL DIFFERENCE. THE FIRST IS INCLUSION WHICH TRULY IS IN ORWH'S DNA. MANY RESEARCHERS DID NOT INCLUDE WOMEN IN CLINICAL TRIALS FOR YEARS, OR FEMALE ANIMALS IN PRE-CLINICAL RESEARCH. THERE WERE A NUMBER OF REASONS. NONE OF THEM GOOD. RESEARCHERS BELIEVED THERE WERE NO SIGNIFICANT DIFFERENCES BETWEEN FEMALES AND MALES OTHER THAN REPRODUCIVE FUNCTION, PREGNANT WOMEN WERE CONSIDERED A VULNERABLE POPULATION, VALID CONCERNS THERE. ANOTHER REASON WAS THE CONCERN THAT WOMEN'S VARIABLE HORMONAL STATUS COULD NOT BE ADEQUATELY CONTROLLED FOR. UNFORTUNATELY, AS A RESULT, MEDICATIONS THAT WERE PRESCRIBED TO WOMEN WERE ROUTINELY TESTED IN MEN. IN OTHER WORDS, UNISEX RESEARCH. SEX WORKS IN FASHION, SOMETIMES, IN EYEGLASSES, NOT SO WELL IN BIOMEDICAL RESEARCH. OMISSION OF WOMEN FROM STUDIES CREATED CRITICAL GAPS IN SCIENTIFIC KNOWLEDGE ABOUT CONDITIONS THAT AFFECT WOMEN MORE FREQUENTLY THAN MEN, OR DIFFERENTLY. IT COMPROMISED OUR FUNDAMENTAL UNDERSTANDING OF FEMALE BIOLOGY. BEGINNING IN THE 1980s, NIH AND CONGRESS ESTABLISHED, FORMALIZED EXPANDED INCLUSION POLICIES TO ADDRESS WOMEN AND RACIAL AND ETHNIC MINORITY GROUPS. MORE RECENTLY, THE 21ST CENTURY CURES ACT EXPANDED INCLUSION TO INCLUDE INDIVIDUALS OF ALL AGES, ALSO CLEARED THE PATH TO INCLUDING PREGNANT AND LACTATING WOMEN. TWO OTHER POLL I POLICY DEVELOPMENTS ARE HELPING. CURES ACT REQUIRES NIH TO FIND APPLICABLE PHASE 3 CLINICAL TRIALS TO REPORT THEIR RESULTS, DISAGGREGATED INTO clinicaltrials.gov. INCLUSION DATA FOR SPECIFIC DISEASE GROUPS ARE NOW REPORTED BY SEX, GENDER, RATE, ETHNICITY, IN THE NIH RESEARCH, CONDITION, DISEASES CATEGORIZATION REPORT. OF COURSE, THE $64,000 QUESTION IS DID NIH INCLUSION POLICY WORK? FOR THE MOST PART, YES. TODAY ABOUT HALF OF NIH-SUPPORTED CLINICAL TRIAL AND CLINICAL RESEARCH PARTICIPANTS ARE WOMEN. MOREOVER, WOMEN ARE LESS LIKELY TO RECEIVE BENEFICIAL TREATMENTS THAN MEN WITH CARDIOVASCULAR DISEASE. WOMEN WHO PRESENT WITH HEART ATTACK SYMPTOMS ARE LESS LIKELY THAN MEN TO RECEIVE DRUGS, STINTS AND THERAPIES. WOMEN WITH THIS CONDITION ARE LESS LIKELY TO RECEIVE SEVERAL OF THE INDICATED MEDICAL TREATMENTS SUCH AS CORONARY REVASCULARIZATION, STATINS, BETA BLOCKERS, ASPIRIN, EVEN THERAPEUTIC LIFESTYLE COACHING. THE FACT IS THAT EPIDEMIOLOGY SYMPTOMS, PATHOPHYSIOLOGY AND OUTCOMES OF HEART DISEASE DIFFER BETWEEN THE SEXES. WOMEN HAVE BEEN UNDERREPRESENTED IN THESE AREAS OF RESEARCH, OFTEN DUE TO POORLY JUSTIFIED INCLUSION OR EXCLUSION CRITERIA, INCLUDING ARBITRARY PARTICIPANT AGE LIMITS, AND WOMEN WHO ARE ENROLLED OFTEN DO NOT ACCURATELY REPRESENT THE WOMEN IN THE GENERAL POPULATION WITH THE CARDIOVASCULAR CONDITION. SO SUCCESSFUL RESEARCH AND TREATMENT OF DISEASES REQUIRES INCLUSION OF INDIVIDUALS REPRESENTING POPULATION WITH THE HIGHEST DISEASE BURDEN. THIS MUST INCLUDE EQUITABLE PARTICIPATION OF BOTH SEXES AND ALL RACES AND ETHNICITIES. AND SEX AND GENDER CONSIDERATIONS MUST BE THREADED THROUGHOUT THE ENTIRE RESEARCH CONTINUUM. THIS REQUIRES BALANCED, MIXED SEX RESEARCH DESIGN, STRATIFICATION OF SAMPLES BY SEX, ANALYSIS OF DATA BY SEX, AND SEX-SPECIFIC REPORTING OF RESULTS IN PRE-CLINICAL, TRANSLATIONAL AND CLINICAL RESEARCH. PLUS, THE PRE-CLINICAL RESEARCH WHERE BUILDING BLOCKS OF SCIENCE ARE CREATED CONS TO OVERRELY ON MALE ANIMALS. FINALLY, THERE'S BEEN MINIMAL PROGRESS IN ONE AREA WHERE IT REALLY COUNTS. THE DISAGGREGATION, ANALYSIS AND REPORTING OF DATA BY SEX AND PUBLICATION. ON THIS SCORE, THERE'S SO MUCH WORK TO BE DONE. BUT MORE ON THAT LATER. THE SECOND GREAT INNOVATION HAS BEEN TRANSFORMATION OF MEANING OF WOMEN'S HEALTH. FOR DECADES IT MEANT MATERNAL AND REPRODUCTIVE HEALTH. THE FOCUS BEGAN TO SHIFT OR BROADEN, TODAY ENCOMPASSING THE WHOLE WOMEN. THE APPROACH TO HEALTH OF WOMEN TOOK ON MULTI-DIMENSIONAL ASPECT. YES, IT INCLUDES BIOLOGY. IT OF BUT IT ALSO INCLUDES ALL DISEASES, CONDITIONS THAT AFFECT WOMEN, RECOGNIZES DISEASES, MANIFESTATION, DIAGNOSIS, AND TREATMENT MIGHT DIFFER FOR WOMEN, BUT IT ALSO INCLUDES EXTERNAL FACTORS DUE TO THE IMPORTANT RESEARCH DONE BY NIH AND OTHERS WE NOW NOW THE HEALTH OF WOMEN IS AFFECTED BY MANY FACTORS THAT INTERACT, NOT JUST THE INDIVIDUAL'S BIOLOGY OR GENETICS BUT ENVIRONMENT, COMMUNITY, LARGER SOCIETY SHE LIVES IN. IN FACT, WE'RE INCREASINGLY DISCOVERING HOW BIOLOGICAL INTERNAL FACTORS, THOSE OF THE BOTTOM OF THE GRAPHIC, INTERSECT WITH THE SOCIAL AND CONTEXTUAL ASPECTS FOUND AT THE TOP OF THE GRAPHIC. MOREOVER THEY EFFECT A HOST OF AREAS SUCH AS HEALTH DATA, DISEASE PRESENTATION AND TREATMENT RESPONSE, AS WELL AS EFFECTS OF DISEASES AND CONDITIONS ON QUALITY OF LIFE. THE THIRD INNOVATIVE POLICY MAY END UP BEING THE MOST TRANSFORMATIONAL. IN THE LAST 30 YEARS, RESEARCH ON WOMEN'S HEALTH HAS COME A LONG WAY. WOMEN NOW MAKE UP HALF PARTICIPANTS OF NIH-FUNDED STUDIES AND WE'RE MAKING PROGRESS IN USE OF FEMALE ANIMALS IN PRE-CLINICAL RESEARCH. BUT THE INCLUSION OF WOMEN IN CLINICAL STUDIES AND USE OF FEMALE ANIMALS IN PRE-CLINICAL RESEARCH ARE JUST THE INITIAL STEPS. WE NOW KNOW SEX AFFECTS CELL PHYSIOLOGY, METABOLISM, AND MANY OTHER FUNDAMENTAL BIOLOGICAL FUNCTIONS. THE SYMPTOMS OF DISEASE AND MEDICATION SIDE EFFECTS. BUT UNLESS BIOMEDICAL RESEARCH ACCOUNTS FOR SEX AT EVERY LEVEL FROM THE LABORATORY TO THE CLINIC, YOU COULD SAY THAT WE ARE MISSING AT LEAST HALF OF THE STORY. NIH WAS ALSO CONCERNED ABOUT THE LACK OF REPRODUCIBILITY REPORTED. SO WE HEIGHTENED OUR FOCUS ON THE NEED FOR RIGOR AND REPRODUCIBILITY AND TRANSPARENCY, WHICH INCLUDED THE NEXT BIG STEP IN WOMEN'S HEALTH. FIVE YEARS AREAS ISSUED A LANDMARK POLICY PART OF A GLOBAL MOVEMENT TO INTEGRATE STUDY OF SEX IN THE RESEARCH PROCESS. IT STATES NIH EXPECTS THAT SEX AS A BIOLOGICAL VARIABLE WOULD BE FACTORED INTO RESEARCH DESIGNED, ANALYSES, AND REPORTING, IN VERTEBRATE ANIMAL AND HUMAN STUDIES. ACCOUNTING FOR SEX AS A BIOLOGICAL VARIABLE OR SABV BEGINS WITH DEVELOPMENT OF RESEARCH QUESTION AND STUDY DESIGN, INCLUDES DATA COLLECTION, ANALYSIS OF RESULTS AND REPORTING FINDINGS. MULTI-FACETED, EACH AS IMPORTANT AS THE OTHER. WHY DOES IT MATTER? CONSIDERING SABV WILL BUILT A COMPLETE KNOWLEDGE BASE WITH IMPORTANT BENEFITS. RANGING FROM IMPROVE DESIGN OF CLINICAL RESEARCH AND TRIALS, INFORMING AWARENESS, ENABLING INDIVIDUALIZED APPROACHES, FOSTERING SYSTEM-BASED UNDERSTANDING. ORWH IS TAKING A LEADING ROLE. ONE OF THE PRINCIPAL WAYS IS THROUGH RESOURCES, WE AT ORWH ARE VERY PLEASED WITH THREE RECENT ADDITIONS TO INTERPROFESSIONAL EDUCATION COURSES, ONLINE AND FREE. I'LL BRIEFLY MENTION TWO OF THEM. FIRST, BENCH TO BEDSIDE, INTEGRATING SEX AND GENDER TO IMPROVE HUMAN HEALTH COURSE, DEVELOPED WITH THE FDA OFFICE WOMEN'S HEALTH, GIVES A THOROUGH OH UNDERSTANDING OF SEX AND GENDER INFLUENCES ON HEALTH AND DISEASE. TO DATE BENCH TO BEDSIDE HAS BEEN WELL RECEIVED FROM SEPTEMBER 1 TO DECEMBER 1, 2020, WE HAD OVER 750 UNIQUE VIEWERS TO THE ORWH'S COURSES WEB PAGE. THE SECOND COURSE IS TITLED SEX AS A BIOLOGICAL VARIABLE PRIMER, DEVELOPED BY ORWH WITH FUNDING SUPPORT FROM THE NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES, A CADRE OF SUBJECT MATTER EXPERTS. ITS FOUR INDEPENDENT MODELS ARE DESIGNED TO HELP THE BIOMEDICAL RESEARCH COMMUNITY INCLUDING RESEARCHERS, NIH GRANT APPLICANTS, AND PEER REVIEWERS ACCOUNT FOR AND INTEGRATE SABV ACROSS THE SPECTRUM OF BIOMEDICAL SCIENCES. AS I SAID EARLIER, WOMEN'S HEALTH RESEARCH IS NIH WIDE ENDEAVOR. THE PRINCIPAL WAY ORWH SUPPORTS AND FUNDS RESEARCH IS THROUGH OUR SIGNATURE PROGRAMS. EACH INVOLVE RESEARCH COLLABORATIONS WITH THE INSTITUTE CENTERS AND OFFICES ACROSS NIH. THERE'S BIRCWH, BUILDING INTERDISCIPLINARY RESEARCH PROGRAM WHICH CELEBRATES ITS 20th ANNIVERSARY YEAR, THIS PROGRAM CONNECTS JUNIOR FACULTY KNOWN AS BIRCWH SCHOLARS TO SENIOR RESEARCHERS. SINCE 2000, 88 GRANTS SUPPORTING 700 JUNIOR FACULTY HAVE BEEN AWARD. SECOND, THE SCORE PROGRAM IS NIH'S ONLY DISEASE AGNOSTIC CENTER LEVEL SEX DIFFERENCES GRANTS PROGRAM. THE SEX AND GENDER PROGRAM ALLOWS INVESTIGATORS TO EXPAND SEX AND GENDER DATA ADDING TO EXISTING EFFORTS, AND FINALLY NIH'S FIRST EVER R 01 ON THE INTERSECTION OF SEX AND GENDER IN INFLUENCER ON HEALTH AND DISEASE IS IN YEAR TWO. ONE OF THE GREATEST HEALTH CHALLENGES FACING THE UNITED STATES APART FROM THE CORONAVIRUS PANDEMIC IS STATE OF MATERNAL HEALTH. IT'S ABYSMAL. OUR NATION'S MATERNAL MORTALITY RATE WHICH CONTINUES TO CLIMB IS THE HIGHEST AMONG WORLD HIGH INCOME COUNTRIES, WHOSE RATES ARE DECLINING. TRAGICALLY, UP TO 60% OF THESE DEATHS ARE PREVENTIBLE, IN MATERNAL HEALTH AS IN OTHER AREAS OF RESEARCH, SIGNIFICANT DISPARITIES EXIST AMONG POPULATIONS OF WOMEN. FOR EXAMPLE, MATERNAL MORTALITY RATES ARE THREE TIMES HIGHER FOR BLACK WOMEN THAN WHITE WOMEN. THE SITUATION REGARDING SEVERE MATERNAL MORBIDITY IS EQUALLY DIRE. IT AFFECTS OVER 50,000 WOMEN ANNUALLY IN THE UNITED STATES, AT A RATE THAT HAS NEARLY DOUBLED DURING THE PAST DECADE. INCIDENTS OF SEVERE MATERNAL MORBIDITY AMONG BLACK WOMEN IS ESPECIALLY SERIOUS, COMPARED TO WHITE WOMEN, THE RATE FOR SMM IS 166% HIGHER FOR BLACK WOMEN. NIH'S RESPONSE TO MATERNAL HEALTH DISPARITIES HAS BEEN ROBUST. HERE ARE A FEW EXAMPLES. THE NIH MATERNAL MORTALITY TASK FORCE HAS ISSUED AND INITIATIVE, IMPROVE FUNDING $7 MILLION IN FY 2020, WHY THE STATES PROGRAM PARTNERED WITH NIGMS TO EXPAND WOMEN'S HEALTH RESEARCH IN IDeA STATES, THE NIMHD LET R01 FOCUSED ON MATERNAL HEALTH DISPARITIES, AND ORWH'S OWN YOUTH PROGRAM, PROVIDING SUPPORT FOR MATERNAL HEALTH RELEVANT TOPICS AS LISTED HERE. I WOULD BE REMISS NOT TO ADDRESS NIH'S RESPONSE TO COVID-19. WE RECENTLY RELEASED NIH-WIDE STRATEGIC PLAN, PROVIDING A MUCH NEEDED FRAMEWORK FOR ACCELERATING DEVELOPMENT OF THERAPIES, VACCINES, DIAGNOSTICS. I CALL YOUR ATTENTION TO PRIORITY FIVE, WHICH COMMITS NIH TO ADDRESSING THE NEEDS OF HEALTH DISPARITY AND VULNERABLE POPULATIONS, SPECIFICALLY UNDERSTANDING AND ADDRESSING COVID-19 AS IT RELATES TO THESE POPULATIONS, AND UNDERSTANDING AND ADDRESSING COVID-19 MATERNAL HEALTH AND PREGNANCY OUTCOMES. THIS IS MY LAST CHAPTER OF MY PRESENTATION, FOCUSING ON CAREERS. ADVANCING WOMEN IN BIOMEDICAL CAREERS WAS ONE OF ORWH'S ORIGINAL CHARGES FROM THE NIH, AND THEN LATER FROM CONGRESS. THIS WORK BEGAN IN EARNEST RIGHT AWAY, WITH THE CREATION OF THE REENTRY SUPPLEMENT IN 1992. BUT PERHAPS ONE OF THE MOST SEMINAL MOMENTS IN THE HISTORY OF ORWH WAS THE RELEASE IN 2008 OF A SPECIFIC FUNDING OPPORTUNITY ANNOUNCEMENT, THE CAUSAL FACTORS AND INTERVENTIONS FOR WOMEN IN BIOMEDICAL AND BIOENGINEERING RESEARCH RFA. NEVER BEFORE HAD NIH INVESTIGATED WHY WOMEN WERE NEITHER ENTERING NOR ADVANCING IN S.T.E.M. FIELDS. IT WAS A BOLD STEP BUT A NATURAL ONE FOR NIH TO ASSEMBLE EVIDENCE OF WHAT BARRIERS EXIST AND WHAT INTERVENTIONS WORK. RESULT OF THIS PHASE, A VOLUME OF EVIDENCE EXPANDED SIGNIFICANTLY. EFFECT OF WHICH WAS TO ACCELERATE CHANGE IN THE WORKPLACE IN ACADEMIA. MORE RECENTLY, THE NATIONAL ACADEMIES OF SCIENCE, ENGINEERING AND MEDICINE REPORT ON PROMISING PRACTICES TOOK THE DISCUSSION TO ANOTHER LEVEL. IF WE KNOW IT WORKS, THEN WHY AREN'T INSTITUTIONS ADOPTING THESE BEST EVIDENCE-BASED PRACTICES? WHAT ARE INSTITUTIONAL BARRIERS, WHAT NEEDS TO BE DONE TO ADVANCE SPECIFIC GROUPS LIKE WOMEN OF COLOR? THE LAST THREE DECADES WE'VE SEEN DRAMATIC AND EXCITING GAINS IN WOMEN'S ENTRY INTO SCIENTIFIC FIELDS OF STUDY. YOU CAN SEE HERE ABOUT HALF OF ALL MEDICAL DEGREE AND LIFE SCIENCES Ph.D. RECIPIENTS IN S.T.E.M. FIELDS ARE WOMEN. AT THE SAME TIME THERE'S MUCH MORE WORK THAT NEEDS TO BE DONE. WOMEN CONTINUE TO FACE PERSISTENT AND DEEP-ROOTED BARRIERS TO THEIR ADVANCEMENT. IN 2020, THE NIH WORKING GROUP ON BIOMEDICAL CAREERS AND THE ORWH UNDERTOOK SEVERAL MAJOR INITIATIVES, TWO OF WHICH ADDRESS CRITICAL JUNCTURES IN WOMEN SCIENTIST CAREERS. THE OVERARCHING GOAL OF THE CONTINUITY SUPPLEMENTS IS TO SUPPORT THE TRANSITION AND RETENTION OF INVESTIGATORS TO MINIMIZE DEPARTURES FROM BIOMEDICAL RESEARCH AT THESE CRITICAL JUNCTURES. ONE BEING THE TRANSITION FROM A MENTOR CAREER DEVELOPMENT OR K AWARD TO INDEPENDENT RESEARCH PROJECT AWARD, AND THE OTHER BEING THE TRANSITION FROM FIRST INDEPENDENT RESEARCH PROJECT AWARD SUSTAINED FUNDING IN RENEWAL OR SECOND INDEPENDENT RESEARCH AWARD. THESE PROGRAMS ARE OPEN TO WOMEN AND MEN BUT BECAUSE ELIGIBILITY IS TIED TO CRITICAL LIFE EVENTS DURING THE PROJECT PERIOD, EVENTS SUCH AS CHILD BIRTH, ADOPTION, PRIMARY CAREGIVING RESPONSIBILITIES OF AILING SPOUSE, CHILD, PARTNER OR MEMBER OF THE IMMEDIATE FAMILY, THESE ARE EXPECTED TO IMPROVE THE SITUATION FOR WOMEN SCIENTISTS. THE LAST MAJOR INITIATIVE IS THE CHALLENGE PRIZE CALLED THE NIH PRIZE FOR ENHANCING FACULTY GENDER DIVERSITY IN BIOMEDICAL AND BEHAVIORAL SCIENCE. ITS GOAL TO RECOGNIZE AND DISSEMINATE TRANSFORMATIVE INSTITUTIONAL APPROACHES THAT SUCCESSFULLY ADDRESS FACULTY DIVERSITY IN BIOMEDICAL AND BEHAVIORAL SCIENCE DEPARTMENTS. THE PRIZE IS NOTEWORTHY BECAUSE IT ALIGNS WITH WORK INSIDE AND OUTSIDE NIH. ONE OF FOUR CONCEPTS DEVELOPED OUT OF THE WORKING GROUP ON WOMEN IN BIOMEDICAL CAREERS, ALIGNS WITH NATIONAL ACADEMIES OF SCIENCE, ENGINEERING AND MEDICINE PROMISING PRACTICES REPORT, AND NIH ADVISORY COMMITTEE WORKING GROUP ON CHANGING CULTURE TO END SEXUAL HARASSMENT, RECOMMENDATIONS AS WELL AS OTHER NIH POLICY CHANGES AND PROGRAMS. WHAT EXACTLY ARE THE KINDS OF INTERVENTIONS THE PRIZE HAS IN MIND? COULD INCLUDE INTERVENTIONS THAT ADDRESS BARRIERS CAREER ENHANCEMENT, PATHWAYS, CHANGE WORKPLACE CULTURE, WORK/LIFE INTEGRATION PROGRAMS AND CAREER FLEXIBILITY OPTIONS. THE CORONAVIRUS PANDEMIC WREAKED HAVOC ON SOCIETY. THE IMPACT ON EARLY CAREER INVESTIGATORS IS ESPECIALLY DEVASTATING. WOMEN'S DEPARTURE WILL AFFECT DIRECTION OF RESEARCH FOR MANY YEARS. ITS IMPACT IS LIKELY TO CHANGE THE FACE AND WORK OF BIOMEDICAL RESEARCH FOR YEARS TO COME. SO MANY HARD-FOUGHT GAINS ARE NOW AT RISK. ESPECIALLY AMONG WOMEN IN ACADEMIA AND S.T.E.M. FIELDS. WHILE MANY INSTITUTIONS HAVE BEGUN TO ADDRESS UNIQUE CHALLENGES THAT WOMEN FACE, MORE INSTITUTIONS MUST STEP UP TO THE PLATE. BEFORE I FINISH I WOULD LIKE TO EXTEND A SPECIAL THANK YOU TO THE UNSUNG HEROINES, WOMEN WHO PARTICIPATE IN CLINICAL TRIALS. USUALLY AT SOME EXPENSE AND INCONVENIENCE, OFTEN AT GREAT RISK TO THEIR HEALTH, THESE TENS OF THOUSANDS OF WOMEN HAVE BEEN INDISPENSABLE TO THE WORK OF BIOMEDICAL RESEARCHERS. WITHOUT THEM OUR KNOWLEDGE BASE WOULD BE A FRACTION OF WHAT IT IS TODAY. THANK YOU. THE CURRENT PANDEMIC UNDERSCORES THE CRITICAL ROLE OF INCLUSION OF WOMEN OF ALL BACKGROUNDS IN CLINICAL STUDIES. WITH WOMEN BEING HALF OF THE POPULATION AND PLAYING PIVOTAL ROLES IN SOCIETY, THESE TWO QUESTIONS ARE JUST NOT ACADEMIC ONES. HOW DOES COVID MANIFEST ITSELF IN WOMEN AND HOW DO WOMEN RESPOND TO THERAPIES? THE WOMEN WHO PARTICIPATE IN COVID-19 CLINICAL TRIALS WILL HELP US ANSWER THOSE QUESTIONS. LASTLY I INVITE YOU TO CONNECT WITH ORWH ONLINE, AND THROUGH ITS MANY COMMUNICATIONS CHANNELS. EACH ISSUE OF OUR PUBLICATION COVERS A CORE AREA OF WOMEN'S HEALTH RESEARCH, FROM INCLUSION TO SABV, WOMEN IN BIOMEDICAL CAREERS, SPECIFIC CONDITIONS THAT AFFECT WOMEN. OUR MONTHLY PULSE E-MAIL KEEPS YOU UP TO DATE, ON BREAKING DEVELOPMENTS IN RESEARCH AT ORWH AND NIH'S PROGRAMS. OF COURSE, WE'RE ON SOCIAL MEDIA. PLEASE JOIN US FOR RICH CONVERSATIONS ABOUT WOMEN'S HEALTH TOPICS. SINCE 1990 THE NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH HAS BEEN AT THE FOREFRONT OF ADVANCING BIOMEDICAL RESEARCH TO IMPROVE HEALTH OF WOMEN. BECAUSE OF ORWH'S LEADERSHIP ACROSS NIH, AND THE ENTIRE BIOMEDICAL RESEARCH ENTERPRISE, BECAUSE OF ITS SUPPORT OF BIOMEDICAL RESEARCH, WOMEN TODAY ARE LIVING LONGER, HEALTHIER LIVES. MORE WORK THOUGH NEEDS TO BE DONE. FOR ORWH, THE PATH FORWARD HOLDS GREAT PROMISE. WE BELIEVE THAT THE MORE WE STUDY SEX AND GENDER, THE BETTER THE SCIENCE , AND THE BETTER THE SCIENCE THE BETTER OF HEALTH OF EVERYONE. 30 MINUTES IS NOT ENOUGH TIME TO COVER THE ACCOMPLISH. M ENTS OF WOMEN, DR. FRANCIS COLLINS IS A GIANT AMONG GIANTS. AT GETTING A Ph.D. AT YALE, MEDICAL DEGREE AT UNC MADE GENETICS HIS AREA OF CONCENTRATION, NOTED FOR GROUND BREAKING DISCOVERS OF DISEASE-CAUSING MUTATIONS AND LATER LEADERSHIP OF THE HUMAN GENOME PROJECT WHICH CAME TO A CONCLUSION IN 2003 WITH THE FINISHED SEQUENCE OF THE HUMAN GENOME. THESE ACHIEVEMENTS AND A LIFETIME OF CONTRIBUTIONS TO BIOMEDICAL RESEARCH HE WAS AWARDED PRESIDENTIAL MEDAL OF FREEDOM, IN 2007, AND RECEIVED THE NATIONAL MEDAL OF SCIENCE IN 2009. THIS YEAR HE WAS ELECTED AS FOREIGN MEMBER OF THE ROYAL SOCIETY. IN 2020 WAS NAMED 50th WINNER OF THE TEMPLETON PRIZE WHICH CELEBRATES SCIENTIFIC AND SPIRITUAL CURIOSITY. THERE'S BEEN TREMENDOUS GROWTH IN WOMEN'S HEALTH, FROM HEAD TO TOE, ACROSS THE LIFE COURSE, NIH'S FUNDED RESEARCH THAT PRODUCED MONUMENTAL WORK THAT CONTRIBUTED TO UNDERSTANDING DISEASE ANDS CONDITIONS THAT AFFECT WOMEN. HE'S BEEN A CHAMPION OF POLICIES THAT HAVE HELPED ADVANCE HEALTH OF WOMEN. HE'S BEEN STRONG SUPPORTER OF INCREASING WOMEN'S PARTICIPATION IN CLINICAL TRIALS, AS WELL AS PARTICIPATION OF UNDERREPRESENTED POPULATIONS. ARE DR. DR. COLLINS IS A LEADER IN THE WAY WE CONDUCT SCIENCE, I HAVE THE PRIVILEGE OF COLLABORATING ON THE DEVELOPMENT OF THE NIH POLICY ON SEX AS A BIOLOGICAL VARIABLE, WHAT WE CALL SABV. I LOOK FORWARD TO OUR CONTINUED WORK ON IMPLEMENTING SABV ACROSS NIH, AND THROUGHOUT THE NIH COMMUNITY. LIKEWISE, LEADING TO OPPORTUNITIES FOR WOMEN SCIENTISTS TO SHINE, CONTRIBUTE, AND BE RECOGNIZED. CLEAR IS HIS COMMITMENT TO RECRUITMENT, RETENTION AND ADVANCEMENT OF WOMEN AND PEOPLE OF COLOR IN BIOMEDICAL RESEARCH CAREERS. THESE ARE A FEW EXAMPLES OF HIS COMMITMENT TO A DIVERSE SCIENTIFIC WORKFORCE AS A NECESSARY MEANS TO PRODUCING EXCELLENT SCIENCE. FINALLY, A PERSONAL LEVEL THROUGHOUT MY TENURE, HE'S BEEN A MENTOR, VISIONARY COLLEAGUE AND ALLY. WE AT ORWH HAVE BEEN SO FORTUNATE TO HAVE AS NIH DIRECTOR ACHIEVING ORWH'S VISION, A VISION IN WHICH SEX AND GENDER INFLUENCES ARE INTEGRATED THROUGHOUT THE BIOMEDICAL RESEARCH ENTERPRISE, EVERY WOMAN RECEIVES EVIDENCE-BASED DISEASE PREVENTION AND TREATMENT TAILORED TO HER OWN NEEDS AND GOALS AND ALL WOMEN IN SCIENCE CAREERS REACH FULL POTENTIAL. LADIES AND GENTLEMEN, IT IS MY HONOR TO INTRODUCE THE 16th DIRECTOR OF THE NATIONAL INSTITUTES OF HEALTH, DR. FRANCIS COLLINS. >> THANKS, DR. CLAYTON. THANKS TO EVERYBODY WHO HAS JOINED TODAY TO CELEBRATE 30 YEARS OF THE NATIONAL INSTITUTES OF HEALTH AND ITS OFFICE ON ORWH. ANNIVERSARIES ARE CAUSE TO CELEBRATE, REFLECT, TAKE STOCK AS WE LOOK FORWARD, OF COURSE COVID-19 HAS MANAGED TO INTERRUPT A LOT OF THESE CELEBRATIONS BUT IT WILL NOT PREVENT US TODAY FROM HAVING THIS VIRTUAL MOMENT TO SEE WHAT HAS BEEN ACCOMPLISHED, WHAT STILL LIES AHEAD, AND TO COLLECTIVELY CELEBRATE THESE THREE DECADES OF PROGRESS. A WORD ABOUT THE HISTORY. ORWH HAS FORMED IN RESPONSE TO A GROWING OUTCRY. IT COULD BE CALLED CALL FOR SOCIAL SENTENCE -- SOCIAL JUSTICE, WOMEN WERE UNDERREPRESENTED IN CLINICAL RESEARCH, THEREFORE CONCLUSIONS WERE BEING DRAWN BASED ON RESEARCH ON MEN MAY OR MAY NOT HAVE BEEN APPROPRIATE FOR HALF THE POPULATION. IN THE 1970s, 1980s, CITIZENS, SCIENTISTS, POLICYMAKERS COMING TO THE SAME CONCLUSION AND BEGINNING TO GET SOME TRACTION, THE HEALTH OF WOMEN WAS SHORT-CHANGED, A STEP FORWARD WAS FORMATION OF OUR OFFICE OF RESEARCH ON WOMEN'S HEALTH. IN THE EARLY 1990s, DR. BERNADINE HEALEY, WHO RECRUITED ME TO NIH TO RUN THE GENOME PROJECT, THE FIRST WOMAN DIRECTOR OF NIH, SHE SAW THIS AS BOTH AN OPPORTUNITY AND RESPONSIBILITY AND MANDATE, IN 1993 SHE LAUNCHED THE WOMEN'S HEALTH INITIATIVE, ONE OF THE LARGEST DISEASE PREVENTION AND CLINICAL STUDIES EVER CONDUCTED ON WOMEN'S HEALTH. THIS WAS CHALLENGING TO PUT TOGETHER SOMETHING AT THIS SCALE, BUT THE RESULTS HAVE BEEN STUNNING. THEY CONCLUDED IN FACT THAT HORMONE TREATMENTS FOR WOMEN SHOULD BE BASED ON RESEARCH THAT INCLUDES WOMEN, NOT CLINICAL ASSUMPTION, AND RESULTS HAVE LED TO 126,000 FEWER CASES OF BREAST CANCER, 76,000 FEWER CASES OF CARDIOVASCULAR DISEASE, BECAUSE OF WHAT WE LEARNED ABOUT HORMONE TREATMENTS AND WHEN THEY ARE SAFE AND WHEN THEY ARE NOT. THINK OF ALL THE LIVES SAVED BY THAT INITIATIVE. AND PUTTING ON MY ECONOMIC HAT FOR A MINUTE, CONSIDER THE ECONOMIC BENEFITS, WOMEN'S HEALTH INITIATIVE HELPED SAVE APPROXIMATELY $35 BILLION IN DIRECT MEDICAL COSTS IN THE U.S. SO IF YOU WANT TO DO THIS RETURN ON INVESTMENT CALCULATION FOR NIH INVESTMENT IN RESEARCH, THAT'S ABOUT 140:1 FOR THE MONEY THAT WAS SPENT ON THIS RESEARCH EFFORT. PRETTY DARN GOOD INVESTMENT. AND SHOWING THE WAY TO HOW THESE KINDS OF INITIATIVES FOCUSING ON SEX DIFFERENCES ARE NOT JUST A NICE THING TO DO; THEY ARE ESSENTIAL. ALL ORWH TODAY CONTINUES THE FOCUS ON AFFECTING TRANSFORMATIONAL CHANGE, ORWH IS A LEADING VOICE FOR SEX DIFFERENCES RESEARCH, AND HELPING TRAIN THE NEXT GENERATION OF RESEARCHERS TO INCLUDE THAT KIND OF INSIGHT IN WHATEVER THEY DO. ALSO, TO ENACT RESEARCH CHANGING POLICY INNOVATIONS, JANINE CLAYTON AND I FOCUSED ON THIS ISSUE PARTICULARLY ON THE LACK OF RIGOR AND REPRODUCIBILITY IN NIH RESEARCH, AND A MAJOR PART OF THAT TURNS OUT TO BE THE FAILURE TO CONSIDER SEX AS A BIOLOGICAL VARIABLE, IN MANY ANIMAL MODEL EXPERIENCES, YET PRE-CLINICAL RESEARCH RELIES ON THAT DECIDING HOW TO TAKE THINGS FORWARD INTO HUMAN APPLICATION. IF THAT HAD NOT CONSIDERED SEX DIFFERENCES, THEN WE'RE NOT WELL PREPARED FOR MAKING THAT LEAP INTO HUMAN APPLICATIONS. SO, WE WORKED HARD ON THAT AND PUT FORWARD A POLICY WHICH HAS NOW BEEN EMBRACED, ADOPTED, ENFORCED, EVEN BY NIH, THAT THAT IS NOT JUST AN OPTION, IT IS ABSOLUTELY ESSENTIAL IN PRE-CLINICAL STUDIES OF ANIMALS THAT THERE WILL BE AN UNDERSTANDING OF SEX DIFFERENCES WHICH MEANS RECORDING THAT AND MAKING SURE MALES AND FEMALES ARE INCLUDED AND THAT IT'S POSSIBLE TO BE ABLE TO SEE IF THERE'S A SIGNIFICANT DIFFERENCE, THAT THAT DOESN'T JUST GET SWEPT TOGETHER IN SOME KIND OF AVERAGE FINDING. SO, WHEN YOU START LOOKING FOR SEX INFLUENCES YOU'RE MORE LIKELY TO FIND THEM. PEOPLE HAVE BEEN DOING SO RIGHT AND LEFT. A RECENT STUDY THAT REALLY UNDERLINES THE BIOLOGY HERE RELATES TO THE PROGRAM CALLED GTEx THAT IS FUNDED BY THE COMMON FUND, GTEx AIMS TO LOOK AT GENE EXPRESSION ACROSS DOZENS OF TISSUES IN HUNDREDS OF RAPID AUTOPSIES IN ORDER TO DISCERN WHAT IS THE PATTERN OF GENE EXPRESSION IN THE HUMAN BODY. WHEN YOU LOOK AT THE DIFFERENCES BETWEEN MEN AND WOMEN, THEY FOUND MORE THAN 13,000 GENES, THAT'S A PRETTY SIGNIFICANT FRACTION OF THE TOTAL, A LITTLE OVER HALF, THAT ARE EXPRESSED DIFFERENTLY BETWEEN THE SEXES. THAT CLEARLY AFFECTS SOME 50 BODILY TRAITS AND FUNCTIONS. YOU SIMPLY CAN'T DO HUMAN RESEARCH EVEN IF YOU THINK YOU'RE JUST LOOKING AT SOMETHING AS BASIC AS GENE EXPRESSION WITHOUT CONSIDERING SEX DIFFERENCES. IT'S A FUNDAMENTAL PART OF HOW BIOLOGY WORKS. I GUESS WE SORT OF KNEW THAT BUT YET SOMETIMES IT GOT PUSHED ASIDE IN AN EFFORT TO TRY TO CARRY OUT EXPERIMENTS THAT DIDN'T REALLY HAVE THAT KIND OF CONSIDERATION ABOUT SEX DIFFERENCES. ORWH IS DETERMINED TO MAKE SURE THAT PEOPLE DON'T MAKE THAT MISTAKE. ON TOP OF THE WAY IN WHICH ORWH HAS PLAYED ITS ROLE IN MAKING SURE THAT THE SCIENCE PAYS ATTENTION TO SEX DIFFERENCES, THEY HAVE BEEN IMPORTANT IN ADVANCING WOMEN TO LEADERSHIP ROLES IN THE SCIENCES, AND THROUGHOUT THE BIOMEDICAL RESEARCH WORKFORCE. AND I'VE BEEN FORTUNATE TO BE AN ALLY IN THIS EFFORT IN MY 11 YEARS AS NIH DIRECTOR, WORKING WITH THE NIH WORKING GROUP ON WOMEN IN BIOMEDICAL CAREERS, WHICH I CO-CHAIR WITH JANINE, COMING UP WITH A WIDE VARIETY OF APPROACHES TO TRY TO UNDERSTAND WHY WE STILL SEEM TO HAVE DIFFICULTIES WITH APPROPRIATE PROMOTION, RETENTION, AND ADVANCEMENT OF WOMEN TO SENIOR POSITIONS, EVEN THOUGH WE'RE DOING BETTER IN TERMS OF WOMEN RECEIVING DOCTORAL DEGREES IN THE LIFE SCIENCES. FOR MY PART, I'VE TRIED TO DO WHAT I CAN TO EMPHASIZE THE IMPORTANCE OF WOMEN LEADERS IN OTHER WAYS. I ANNOUNCED A YEAR AND A HALF AGO AND GOT A LOT MORE ATTENTION THAN I EXPECTED THAT I WOULD NO LONGER TAKE PART IN SYMPOSIA OR MEETING PANELS THAT WERE COMPOSED ENTIRELY OF MEN, SO CALLED MANELS, WHICH UNFORTUNATELY SEEM TO BE THE CASE WHEN PEOPLE WEREN'T THINKING ABOUT THE FACT THERE'S A GREAT DEAL OF TALENT IN DIVERSITY, YET OFTENTIMES THAT TALENT WAS NOT WELL REPRESENTED IN THOSE GATHERINGS AND SO-CALLED MANELS AND SYMPOSIA BECAME THE NORM. I STUCK TO THAT. I DON'T THINK I'VE MADE MISTAKES IN THE LAST YEAR AND A HALF. WHEN I GET SENT AN INVITATION, THE FIRST QUESTION IS, OKAY, WHAT IS THE DIVERSITY IN YOUR SYMPOSIUM OR YOUR PANEL OF PARTICIPATION? AND IF THE ANSWER DOESN'T LOOK AS IF THEY GOT IT ABOUT THE ESSENTIAL NATURE OF DIVERSITY, BOTH WOMEN AND UNDERREPRESENTED GROUPS, THEY GET A MESSAGE BACK THAT SAYS, DR. COLLINS THINKS YOUR MEETING SOUNDS INTERESTING BUT HE WILL NOT BE ABLE TO ATTEND UNLESS YOU PAY MORE ATTENTION TO THIS ISSUE. AND, YOU KNOW, MOST OF THE REACTIONS AT THAT POINT ARE PRETTY INTERESTING. IT'S NOT THAT THEY SAY, OH, YOU'RE ONE OF THOSE PEOPLE WHO ARE GOING TO MAKE US DO SOMETHING YOU WANT TO DO. NO, THEY GO, YOU KNOW, YOU'RE RIGHT. I GUESS WE DIDN'T THINK ABOUT THAT. SO, MAYBE BY THIS LITTLE TRIGGERING OF THE THOUGHT PROCESS, SOMETHING CAN HAPPEN. I WOULD ENCOURAGE ALL OF YOU INVOLVED IN MEETINGS AND SYMPOSIA TO TAKE THE SAME APPROACH AND THE DIFFERENCES CAN BE SIGNIFICANT AND THE WAY IN WHICH THIS INFLUENCES THE RICHNESS OF OUR SCIENTIFIC CONVERSATION SHOULD NOT BE UNDERSTATED. OF COURSE WHEN IT COMES TO RECRUITING LEADERS I ALSO HAD A CHANCE AS NIH DIRECTOR TO RECRUIT NEW INSTITUTE DIRECTORS, SINCE WE HAVE 27 INSTITUTES AND CENTERS, THE AVERAGE TIME FOR SOMEBODY TO STAY ON BOARD IS IN THE NEIGHBORHOOD OF A DECADE, SO OVER THIS TIME THERE HAVE BEEN TURNOVERS. I'M VERY HAPPY TO TELL YOU THAT NOW WE HAVE NO LESS THAN 10 OF OUR 27 INSTITUTES AND CENTERS THAT ARE WOMEN, BY FAR THE LARGEST NUMBER IN OUR HISTORY, AND I'D LOVE TO SEE IT GO EVEN A LITTLE HIGHER. SO, WE'RE TRYING TO DO EVERYTHING WE CAN TO ENCOURAGE WOMEN'S PARTICIPATION IN CLINICAL RESEARCH, IMPORTANCE OF DIVERSITY. ONE FINAL THING I WOULD SAY, THE "ALL OF US" PROGRAM, WHICH IS ENROLLING ONE MILLION AMERICANS IN THE MOST AMBITIOUS LONG-TERM COHORT STUDY ON HEALTH AND ILLNESS, HAS ONE OF ITS MAJOR DEFINING POINTS, ATTENTIONS AND DIVERSITY IT WILL BE SEX BALANCED, ROUGHLY 50-50 AND WILL HAVE REACHED OUT AND HAS REACHED OUT IN THE FIRST 380,000 PARTICIPANTS TO ENCONTROL FROM TRADITIONALLY UNDERREPRESENTED GROUPS, PEOPLE FROM RURAL COMMUNITIES AND PEOPLE OF LOWER SOCIOECONOMIC STATUS, AND LOWER EDUCATIONAL LEVEL, GROUPS THAT OFTEN DON'T GET INCLUDED, WE WANT THAT TO BE A SIGNATURE ASPECT OF "ALL OF US" AND THE TEAM THAT IS DOING THAT HAS SUCCEEDED IN THAT IN WAYS THAT ARE QUITE IMPRESSIVE. SO HERE WE ARE IN ORWH'S 30th YEAR, A YEAR THAT HAS BEEN MARKED OF COURSE BY SOMETHING ELSE CALLED COVID-19, WHICH HAS FORCED A LOT OF US TO CARRY OUT OUR MISSION IN FASHIONS WE HADN'T ANTICIPATED. YES, I'M SPEAKING FROM MY HOME OFFICE IN CHEVY CHASE WHERE I'VE BEEN HOLED UP SINCE MARCH, TRYING TO RUN NIH. PEOPLE HAVE BEEN REMARKABLY WILLING TO DROP EVERYTHING AND FIGURE OUT HOW TO MAKE THAT WORK. AND BOY, IF I HAD ANY DOUBTS ABOUT THE DEDICATION OF THE BIOMEDICAL RESEARCH COMMUNITY TO RISE TO THE OCCASION, TO RISE TO A CHALLENGE, TO STICK TO THEIR NOBLE ENTERPRISE OF TRYING TO FIGURE OUT A WAY TO MAKE THE WORLD A BETTER PLACE, THEY HAVE ALL THE DONE THAT THIS YEAR, IN REMARKABLE PARTNERSHIPS, COLLABORATIONS, JUST TO MAKE EVERY POSSIBLE SCIENTIFIC ADVANCE HAPPEN AS QUICKLY AS IT POSSIBLY COULD. HERE WE ARE NOW, IN THE CIRCUMSTANCE WHERE VACCINES ARE GOING TO BE IN THE ARMS OF HIGH-RISK PEOPLE EVEN BEFORE THE END OF 2020, SOMETHING THAT ONE COULD NOT HAVE IMAGINED A FEW YEARS AGO BECAUSE THIS GENERALLY WOULD BE A 10-YEAR PROJECT, INSTEAD IT'S BEEN DONE IN LESS THAN A YEAR. THAT SHOULD GIVE US ENTHUSIASTIC HOPE AND OPTIMISM THAT WE CAN DO OTHER THINGS FASTER THAN ANYBODY THOUGHT, AND THERE ARE LESSONS WE WILL NEED TO INCORPORATE INTO HOW NIH DOES THINGS. MOST OF ALL WE WANT TO DO THINGS IN THE FASHION THAT IS RIGHT AND GOOD, AND THAT MEANS PAY ATTENTION TO SEX DIFFERENCES, DOING THE BEST POSSIBLE RIGOROUS RESEARCH TO HELP ALL OF THOSE FOLKS WHO ARE OUT THERE WAITING FOR US TO COME UP WITH ANSWERS TO MEDICAL CONDITIONS THAT HAVEN'T BEEN SORTED OUT. ORWH IS A CRITICAL PART OF THAT. SO, FINALLY, I WANT TO SAY THANK YOU TO ALL OF YOU WHO HAVE BEEN PART OF THIS ADVENTURE, THE ADVENTURE WILL CONTINUE. WE'RE MARKING THIS MILESTONE AND THEN PREPARING FOR WHAT'S NEXT. WE HAVE A LOT OF POTENTIALLY EXCITING SCIENCE TO DO GOING FORWARD TO IMPROVE THE HEALTH OF WOMEN. THAT IS WHAT I'M DEDICATED TO AND I KNOW YOU ARE AS WELL. SO THANK YOU. AND 30 YEARS, WOW! CELEBRATE! I'M CELEBRATING WITH YOU ALTHOUGH I WISH I COULD BE THERE IN PERSON TO DO IT, MAYBE NEXT YEAR, AT THE 31st WE'LL HAVE A BETTER CHANCE FOR THAT. MANY THANKS. [ MUSIC ] >> SINCE 1990 NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH HAS BEEN DEDICATED SPECIFICALLY TO PROMOTING WOMEN'S HEALTH RESEARCH. THE OFFICE HAS SERVED AS FOCAL POINT AT NIH FOR RESEARCH RELEVANT TO THE HEALTH OF WOMEN AND HAS PROMOTED AND SUPPORTED WOMEN'S HEALTH RESEARCH IN THE GREATER BIOMEDICAL COMMUNITY AS WELL. ONE OF THE MOST IMPORTANT DEVELOPMENTS OF THE PAST 30 YEARS HAS BEEN TRANSFORMATION OF THE TERM "WOMEN'S HEALTH" FROM NARROW FOCUS ON MATERNAL AND REPRODUCTIVE HEALTH TO A BROADER HOLISTIC AND MULTI-DIMENSIONAL CONCEPT INVOLVING THE HEALTH OF WOMEN FROM HEAD TO TOE, ACROSS THEIR LIFESPANS. ORWH IS ADDRESSING THE COMPLEX INTERSECTION OF FACTORS THAT AFFECT WOMEN'S HEALTH FROM BIOLOGICAL VARIABLES TO GENDER ROLES, POLICIES, SOCIAL DETERMINANTS OF HEALTH. THIS TRANSFORMATION EVOLVED OVER YEARS. DURING THE '60s GIVING RISE TO THE WOMEN'S HEALTH MOVEMENT DRAWING ATTENTION TO INEQUITIES AND HEALTH CARE, LATER A SERIES OF DRUG RECALLS REVEALED MANY DRAWINGS POSED HEALTH RISKS TO WOMEN THAN TO MEN. MOREOVER, NEARLY ALL MEDICATIONS WERE TESTED ONLY IN MEN. THE SCIENTIFIC COMMUNITY TOOK NOTE AND RESPONDED. LED BY FORWARD THINKING LEADERS SUCH AS BERNADINE HEALEY, RUTH KIRSCHSTEIN, VIVIAN PENN AND JANINE CLAYTON AND FRANCIS COLLINS. ALSO PATIENT ADVOCACY, RESEARCH INSTITUTIONS, WOMEN'S SOCIETIES, HEALTH GROUPS. IN THE LATE 1980s AND '90s, NIH ADOPTED INCLUSION POLICIES BUT ACCELERATED MOVEMENT TOWARD MULTI-DIMENSIONAL APPROACH TO WOMEN'S HEALTH. A FEW YEARS LATER, THE NIH REVITALIZATION ACT OF 1993 REQUIRED THE INCLUSION OF WOMEN AND MINORITIES IN NIH-FUNDED CLINICAL RESEARCH, TODAY ABOUT HALF OF PARTICIPANTS IN NIH CLINICAL TRIALS ARE WOMEN. MORE RECENTLY, THE 21ST CENTURY CURES ACT REQUIRED NIH TO REVISE ITS POLICY ON THE INCLUSION OF CHILDREN IN CLINICAL RESEARCH, EXPANDING THE POLICY TO INCLUDE INDIVIDUALS OF ALL AGES. BUT INCLUSION DIDN'T GO FAR ENOUGH. FOR WOMEN TO RECEIVE OPTIMAL CLINICAL CARE, CLINICIANS NEED TO UNDERSTAND HOW SEX AND GENDER AFFECT DISEASE MANIFESTATION, DIAGNOSIS, AND TREATMENT. IN 2016, THE NIH'S LANDMARK SEX AS A BIOLOGICAL VARIABLE POLICY, DEVELOPMENT OF WHICH WAS LED BY ORWH, FURTHER ADVANCED WOMEN'S HEALTH, HELPING ENSURE POTENTIAL INFLUENCE OF SEX ON HEALTHS AND DISEASE ARE CONSIDERED EARLY, AND THROUGHOUT RESEARCH PROCESS. THIS WORK HELPS ADVANCE WOMEN'S HEALTH TOWARD A HOLISTIC MULTI-DIMENSIONAL FRAMEWORK. THROUGH THE YEARS, ORWH'S SIGNATURE RESEARCH PROGRAMS HAVE ADDED TO THE BODY OF KNOWLEDGE THAT IS INFORMING THIS APPROACH TO WOMEN'S HEALTH. AMONG THESE ARE THE BIRCWH PROGRAM LAUNCHED IN 2011 WHICH CONNECTS THE JUNIOR AND SENIOR FACULTY. CENTERS OF RESEARCH EXCELLENCE, SCORE PROGRAM, TRANSLATES SCIENTIFIC KNOWLEDGE ABOUT HOW DISEASES AFFECT WOMEN AND MEN DIFFERENTLY INTO NEW TREATMENT THAT IMPROVES CLINICAL CARE. THE U3 PROGRAM ON RESEARCHING HEALTH DISPARITIES AMONG POPULATIONS OF WOMEN THAT HAVE BEEN UNDERSTUDIED, UNDERREPRESENTED, AND UNDERREPORTED IN BIOMEDICAL RESEARCH. NIH'S FIRST RESEARCH PROJECT GRANT THAT FOCUSES ON SEX AND GENDER IN HEALTH AND DISEASE, AND ORWH-FUNDED RESEARCH AND PROGRAMS ADDRESSING PRESSING ISSUES WOMEN CURRENTLY FACE SUCH AS MATERNAL MORBIDITY AND MORTALITY, AND OPIOID USE DISORDER. SUPPORTING THE ADVANCEMENT OF WOMEN IN BIOMEDICAL CAREERS HAS BEEN A KEY ASPECT, THE OFFICE PLAYED A VITAL ROLE SUPPORTING DIVERSE BIOMEDICAL RESEARCH WORKFORCE INCLUDING WOMEN AND MEN THAT ADDRESSES THE HEALTH OF WOMEN. IN 2007, NIH DIRECTOR ESTABLISHED THE WORKING GROUP ON WOMEN IN BIOMEDICAL CAREERS, LANDMARK CAUSAL FACTORS AND INTERVENTIONS PRODUCED RESEARCH THAT HAS EXPANDED OPPORTUNITIES AND REDUCED BARRIERS FOR WOMEN IN BIOMEDICAL RESEARCH. THIS DIVERSITY PRODUCED BETTER SCIENCE, STUDIES SHOW WOMEN RESEARCHERS ARE MORE LIKELY TO STUDY SEX AS A BIOLOGICAL VARIABLE, FURTHER EXPANDING THE KNOWLEDGE BASE OF SEX EFFECTS. DIVERSITY AMONG RESERVERS HELPED GENERATE MORE INNOVATION. OVER THE YEARS, ORWH HAS SUPPORTED CRITICAL TRANS-NIH AND EXTRAMURAL RESEARCH THAT HAS PROFOUNDLY INCREASED OUR UNDERSTANDING OF WOMEN'S HEALTH. AND PRODUCED GROUND BREAKING CLINICAL INTERVENTIONS. AMONG THIS WORK ARE THE WOMEN'S HEALTH INITIATIVE, STUDY OF WOMEN'S HEALTH ACROSS THE NATION, AND NUMEROUS DISCOVERIES THAT HAVE DRAMATICALLY REDUCED BREAST CANCER DEATH RATES, LED TO THE HPV VACCINE, AND MORE RECENTLY CONTRIBUTED TO THE DEVELOPMENT OF A 3D MODELING SYSTEM OF THE FEMALE REPRODUCTIVE ORGANS TRACT. THE PATH FORWARD HOLDS GREAT PROMISE. SINCE 1990, ORWH-SUPPORTED RESEARCH, POLICY, INNOVATION HELPED BROADEN, TO INCLUDE ALL DISEASES AND CONDITIONS THAT AFFECT THE HEALTH OF WOMEN FROM HEAD TO TOE AND ACROSS THE LIFE COURSE, ORWH IS HELPING TO IMPROVE THE HEALTH OF WOMEN. AND THE FAMILIES AND COMMUNITIES TO WHICH THEY BELONG. I'M SENIOR MEDICAL OFFICER OF THE NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH. IT IS MY GREAT PLEASURE TO INTRODUCE OUR MORNING KEYNOTE SPEAKER, DR. PAULINE MAKI, PROFESSOR AND DIRECTOR OF THE WOMEN'S RESEARCH PROGRAM AT UNIVERSITY OF ILLINOIS AT CHICAGO, ASSOCIATED DEAN AT THE UNIVERSITY. RECEIVED HER Ph.D. IN EXPERIMENTAL PSYCHOLOGY FROM UNIVERSITY OF MINNESOTA. SHE RECEIVED POST GRADUATE TRAINING AT THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE IN AGING AND NATIONAL INSTITUTE ON AGING AND NEUROIMAGING. IN 1999 DR. MAKI JOINED THE INTRAMURAL RESEARCH PROGRAM AT THE NATIONAL INSTITUTE OF AGING, AND IN 2002 JOINED FACULTY AT THE UNIVERSITY OF ILLINOIS AT CHICAGO. THE GOAL OF THE WORK HAS BEEN TO IMPROVE THE LIVES OF WOMEN BY IDENTIFYING FACTORS THAT ADD TO RISK OF DEVINE AND AFFECTIVE DISORDERS, ESSENTIAL IS EFFECT OF MENOPAUSE AND HORMONES IN WOMEN. SHE IS CREDITED WITH CONDUCTING FIRST NEUROIMAGING STUDIES ON HORMONE THERAPY AND BRAIN FUNCTION IN WOMEN, WORK ELICITED COMPLEX EFFECTS OF HORMONE THERAPY ON BRAIN FUNCTION. AS AN EXPERT MEMBER CONTRIBUTED TO GUIDELINES ON HORMONE THERAPY AND TREATMENT FOR MENOPAUSAL SYMPTOMS. WITH NORTH AMERICAN MENOPAUSAL SOCIETY AND NATIONAL NETWORK OF DEPRESSION CENTERS, SHE CO-LED THE FIRST GUIDELINES FOR THE IDENTIFICATION. DR. MAKI IS CREDITED WITH SPEARHEADING NATION'S FIRST LONGITUDINAL STUDY OF BRAIN HEALTH IN WOMEN WITH HIV, WHICH IS NOW IN ITS 14th YEAR. WELCOME, DR. MAKI. >> HELLO, THANK YOU FOR THE OPPORTUNITY TO BE THE PLENARY SPEAKER ATORWH'S 30th ANNIVERSARY. A GREAT HONOR TO PRESENT ON WOMEN'S MENTAL HEALTH ACROSS THE LIFESPAN. I'D LIKE TO DISCLOSE THAT I HAVE BEEN A CONSULTANT, ALL MY RESEARCH FOR 25 YEARS SUPPORTED BY NATIONAL INSTITUTES OF HEALTH AND ILLINOIS DEPARTMENT OF PUBLIC HEALTH. TODAY IN MY TALKS I WOULD LIKE TO TALK ABOUT SEX AND GENDER DIFFERENCES IN WOMEN'S MENTAL HEALTH, WITH PARTICULAR FOCUS AT PARTICULAR MILESTONES IN A WOMAN'S LIFE, SO TODAY WE'LL TALK ABOUT CHILDHOOD, PUBERTY, COLLEGE, PREGNANCY, ADULTHOOD, MENOPAUSE, AND THE LATER YEARS, RECOGNIZING THAT A LIFESPAN PERSPECTIVE IS VERY IMPORTANT. THIS SLIDE ILLUSTRATES LIFETIME PREVALENCE OF MENTAL HEALTH DISORDERS BY SEX, WHAT WE CAN SEE IS THAT WOMEN HAVE A HIGHER PREVALENCE OF ANXIETY DISORDERS AND MOOD DISORDERS COMPARED TO MEN, WHEREAS MEN HAVE A HIGHER PREVALENCE OF IMPULSE DISORDERS AND SUBSTANCE USE DISORDERS. WHY DO WE CARE ABOUT WOMEN'S MENTAL HEALTH? A 2020 PUBLICATION IN "THE LANCET" HIGHLIGHTED FINDINGS FROM THE WORLD HEALTH ORGANIZATION REPORTING THAT IN 2019, DEPRESSIVE DISORDERS AND ANXIETY DISORDERS WERE AMONG THE TOP TEN LEADING CAUSES OF DISABILITY WORLDWIDE, THIS WAS TRUE FOR FEMALES BUT NOT FOR MALES. AND IN 2019, 21.8% OF AMERICAN WOMEN AGED 20 OR OLDER HAD DEPRESSION BASED ON A SURVEY USING THE PATIENT HEALTH QUESTIONNAIRE IN A GIVEN TWO-WEEK PERIOD COMPARED TO 15% OF MEN, SO THE TRENDS WORLDWIDE WE SEE AS WELL IN THE UNITED STATES. IT'S WELL KNOWN THAT THE RISK FOR MAJOR DEPRESSION IN FEMALES EMERGES AT PUBERTY, AND BACK IN 1993 THE GOLD STANDARD PSYCHIATRIC DIAGNOSTIC INTERVIEW WAS PERFORMED ON A NATIONALLY REPRESENTATIVE SAMPLE OF INDIVIDUALS FROM THE UNITED STATES, AND IN THAT STUDY IT WAS CLEAR THAT FEMALES BEGINNING AT PUBERTY SHOWED A HIGHER PREVALENCE OF MAJOR DEPRESSIVE DISORDER, THE OTHER PEAK OF THE SEX DIFFERENCE EMERGES IN THE '40s TO SHOW ON THE GRAPH, WHAT YOU CAN SEE THIS IS A TIME IN A WOMAN'S LIFE THAT CORRESPONDS WITH PERIMENOPAUSE WHICH WE'LL TALK ABOUT LATER. IT'S ALSO NOTABLE THAT THIS KIND OF GOLD STANDARD REPRESENTATIVE STUDY HAS NOT BEEN UNDERTAKEN UNTIL NOW, SO THERE IS A SIMILAR STUDY UNDERWAY RIGHT NOW IMPORTANT BECAUSE THE SOCIODEMOGRAPHIC CHARACTERISTICS OF OUR COUNTRY HAVE CHANGED DRAMATICALLY, AND WE NEED UPDATED EPIDEMIOLOGICAL DATA ON SEX DIFFERENCES AND MENTAL HEALTH DISORDERS. NOW, THE EMERGENCE OF THE SEX DIFFERENCE AT PUBERTY FOCUSES US ON HORMONES. WE LOOK AT HORMONAL CHANGES AT DIFFERENT PERIODS OF A WOMAN'S LIFE SO THAT AT ADOLESCENCE AND PUBERTY THE FEMALE INCREASE IN OVARIAN SEX STEROID HORMONES AS WELL AS METABOLITES WHICH BECOME WHAT WE CALL NEUROACID STEROIDS INCREASE. STUDIES OF PRE-MENSTRUAL DYSPHORIC DISORDER, PERINATAL PERIOD, IN POSTPARTUM DEPRESSION, WE ALSO HAVE A NEW FOUND APPRECIATION FOR THE PERIMENOPAUSE AS WINDOW OF HORMONAL VULNERABILITY. IT'S NOT ALL HARMONIES AND NOT ALL DEPRESSION. THE LIFETIME RISK OF POSTTRAUMATIC STRESS DISORDER ALSO SHOWS SEX DIFFERENCE, TWO TO THREE TIMES HIGHER IN WOMEN THAN IN MEN. AND IN PART THIS IS DUE TO ENVIRONMENTAL EXPOSURES, SO WOMEN ARE EXPOSED TO MORE HIGH IMPACT TRAUMA SUCH AS SEXUAL TRAUMA, COMPARED TO MEN. AND THIS OCCURS AT EARLIER AGES. IN WORK SUPPORTED BY NIH EARLY LIFE TRAUMA AFFECTS THE DEVELOPMENT OF BRAIN CIRCUITS UNDERLYING EMOTIONAL REGULATION, AND MOOD. THE LIFETIME PREVALENCE OF GENERALIZED ANXIETY DISORDER, TENDENCY TO WORRY, ALSO SHOWS SEX DIFFERENCE AND THIS IS EVIDENCED ACROSS THE LIFESPAN BUT NOTE HERE THAT THIS IS PARTICULARLY HIGH IN MAGNITUDE AT THE TIME OF PERIMENOPAUSE WHEN WOMEN AND MEN ARE OLDER THAN AGE 44. NOW, WOMEN COMPARED TO MEN HAVE LOWER RATES OF SUBSTANCE USE DISORDER, SO THESE ARE DATA FROM THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE ADMINISTRATION, SAMHSA, SHOWING MALES AND FEMALES SUBSTANCE USE DISORDERS WITHIN THE LAST 12 MONTHS. YOU CAN SEE THAT THE ONE EXCEPTION TO THIS WOMEN HAVING LOWER RATES OF SUBSTANCE USE DISORDER IS EVIDENCED AT THE YOUNGEST AGES, BETWEEN THE AGE OF 12 TO 17. AND INDEED, 2019 TRENDS COMPARED TO 2018 TRENDS SHOWED SUBSTANCE USE DISORDER IS INCREASING AMONG THOSE AGED 12 TO 17 YEARS, PARTICULARLY FOR FEMALES, WHY IS THIS IMPORTANT? WHEN WE TAKE A LIFESPAN IN NEURODEVELOPMENTAL PERSPECTIVE WE KNOW EXPOSURE TO SUBSTANCES, ILLICIT SUBSTANCES, CHANGES BRAIN CIRCUITS INVOLVED IN REWARD AND IN PLEASURE TAKING OF SUBSTANCES, MAKING IT VERY DIFFICULT, MUCH MORE DIFFICULT FOR PEOPLE WHO OVERCOME SUBSTANCE USE DISORDERS. WHEN WE LOOK AT EPIDEMIOLOGICAL TRENDS, THE USE SUBSTANCES IN MARIJUANA IN 12 AND OLDER INCREASED FOR FEMALES BUT NOT MALES, ALTHOUGH USE IN THE PAST YEAR AND PAST MONTH INCREASED FOR BOTH SEXES. NOW, SUBSTANCE USE DISORDERS ARE MORE COMMON IN MEN THAN WOMEN BUT THERE ARE VERY IMPORTANT SEX DIFFERENCES IN SUBSTANCE USE DISORDERS, WORK FUNDED BY NIDA, WOMEN MORE LIKELY TO HAVE A CO-OCCURRING MOOD DISORDER, 7.5 TIMES GREATER, OR ANXIETY DISORDER 4.2 TIMES GREATER. NEVERTHELESS, THEY ARE FACING BARRIERS INCLUDING STIGMA SURROUNDING TREATMENT OF SUBSTANCE USE DISORDERS OF PREGNANCY. WE KNOW THAT STRESS INDUCES CRAVING, WORK BY NIDA SHOWS DIFFERENCES IN STRESS INDUCED DOPAMINE, TRANSMISSION, AND WOMEN SHOW GREATER CRAVINGS WITH STRESS, COMPARED TO MEN. IMPORTANTLY IN WOMEN AGAIN WITH LIFESPAN PERSPECTIVE THE COURSE OF SUBSTANCE USE DISORDER IN WOMEN IS MORE STRONGLY LINKED TO CHILDHOOD TRAUMA. NOW, IN WOMEN, THERE IS A CIRCLE OF MENTAL HEALTH INTERSECTING WITH TRAUMA THAT SUSTAINS AND PERPETUATES SUBSTANCE USE DISORDERS SO THAT TRAUMA, PARTICULARLY EARLY LIFE TRAUMA, AND ITS RELATED MENTAL HEALTH PROBLEMS, LEAD TO SELF MEDICATION OF FEMALES, AND THAT IN TURN LEADS TO ADDICTION, WHICH MAKES WOMEN MORE VULNERABLE, WHICH INFLUENCES OR INCREASES THEIR EXPOSURE TO ADDITIONAL TRAUMA AND MENTAL HEALTH PROBLEMS, SO THIS IS A VICIOUS CIRCLE FOR WOMEN AND ONE THAT ILLUSTRATES THE IMPORTANCE OF THE INTERSECTION BETWEEN SUBSTANCE USE DISORDERS AND MENTAL HEALTH DISORDERS WITH CHILDHOOD EXPOSURES AND CONTINUED TRAUMA IN WOMEN. SO LET'S TALK A BIT ABOUT CHILDHOOD. WORK IN ADVERSE CHILDHOOD EXPERIENCES SHOWS SOME SEX DIFFERENCES IN THAT WOMEN EXPERIENCE A GREATER NUMBER OF FREQUENCY, WOMEN WERE MORE LIKELY TO HAVE MORE THAN FOUR ACEs, IN WORK DONE INCREASINGLY ACROSS THE UNITED STATES, FUNDED BY THE NATIONAL INSTITUTES OF HEALTH, INCLUDING BEAUTIFUL WORK BY EPPERSON, SHOWS THAT THESE ACEs, ESPECIALLY EARLY IN LIFE, HAVE LONGSTANDING INFLUENCE ON BRAIN CIRCUITS, AND VULNERABILITY TO MOOD DISORDERS. WE THINK AS INFLUENCING SUBSTANCE USE DISORDER BUT WHEN WE LOOK AT PROPORTION THAT'S EXPLAINED BY THESE ACEs. SO, FOR EXAMPLE, 24% OF THE INDIVIDUAL DIFFERENCES IN HEAVY DRINKING ARE ATTRIBUTABLE TO ACEs, IN DEPRESSION 44% EXPLAINED BY ACEs, ACCOUNTING FOR MUCH OF THE RISK OF THESE DISORDERS. IT'S NOT JUST MENTAL HEALTH DISORDERS. WHEN WE LOOK AT CORONARY HEART DISEASE OR CHD HERE WE SEE ADVERSE CHILDHOOD EVENTS INFLUENCE CARDIOVASCULAR HEALTH, SHOWING IMPORTANCE OF WORK BY NHLBI IN MENTAL HEALTH AS WELL. CHILDHOOD SEXUAL ABUSE IS PARTICULARLY IMPORTANT TRAUMATIC EVENT TO CONSIDER IN A LIFESPAN PERSPECTIVE ON WOMEN'S MENTAL HEALTH, AND THERE IS A BIG DIFFERENCE IN THE FREQUENCY OF SEXUAL ABUSE BETWEEN GIRLS AND BOYS. INDEED 1 IN 4 WOMEN COMPARED TO 1 IN 13 MEN REPORT HAVING BEEN SEXUALLY ABUSED AS A CHILD. A CONSIDERABLE DIFFERENCE. IN WOMEN, WOMEN WITH A HISTORY OF CHILDHOOD SEXUAL ABUSE ARE AT INCREASED RISK OF DEVELOPING A VARIETY OF DIFFERENT MENTAL HEALTH DISORDERS, AND THEY ARE TWICE AS LIKELY FOR EXAMPLE TO DEVELOP ANXIETY DISORDERS, MAJOR DEPRESSION, ALCOHOL USE DISORDERS, DRUG DEPENDENCE AND THE LIKE. THEY ARE ALSO LIKELY TO HAVE MORE COMORBIDITIES, EXPOSURE TO INTERCOURSE DURING CHILDHOOD IS PARTICULARLY TOXIC WITH THESE ODDS RATIOS OVER 5, SO THAT WOMEN WITH THIS EXPOSURE EARLY IN LIFE HAVE A FIVE-FOLD INCREASE RISK OF DRUG DEPENDENCE AND HAVING MORE THAN ONE DISORDER. SO THIS IS AN IMPORTANT EXAMPLE OF HOW WE NEED TO FOCUS ON CHILDHOOD TRAUMA AND SEXUAL ABUSE FROM A PUBLIC HEALTH PERSPECTIVE IF WE WANT TO OPTIMIZE WOMEN'S MENTAL HEALTH ACROSS THE LIFESPAN. LET'S TALK ABOUT PUBERTY NOW. SO WE KNOW THAT THE SEX DIFFERENCE, MAJOR DEPRESSIVE DISORDER, BEGINS AT PUBERTY. AND THERE'S WORK THAT ALSO SHOWS SEX DIFFERENCES IN THE TRAJECTORIES OF DEPRESSIVE SYMPTOMS. SO, FOR EXAMPLE, IN GIRLS THE AGE AT PEAK VELOCITY OF DEPRESSIVE SYMPTOMS IS YOUNGER THAN THAT OF BOYS, EARLIER, SO IT STARTS 13.5 YEARS IN GIRLS, COMPARED TO 16.4 YEARS IN BOYS. THIS KIND OF RESEARCH INFORMS SCREENING EFFORTS TO SUGGEST WOMEN, GIRLS, NEED TO BE SCREENED EARLIER THAN BOYS. NOW, WORK DONE BY MONIQUE ERNST IN THE INTRAMURAL RESEARCH PROGRAM IN NATIONAL INSTITUTES OF HEALTH SHOWS THAT PUBERTY IS ACCOMPANIED BY MEASURABLE CHANGES IN BRAIN CIRCUITS THAT AREN'T EXPLAINED BY AGE ALONE. THESE BRAIN CIRCUITS UNDERLIE EMOTIONAL REGULATION IN BRAIN SYSTEMS THAT ARE IMPLICATED IN DEPRESSION, AND ANXIETY. SO WHEN WE LOOK AT THESE DIFFERENT BRAIN CIRCUITS WHAT WE CAN SEE AT PUBERTY IS THAT GIRLS' BRAIN CONNECTIVITY, THE EXTENT TO WHICH ONE REGION OF THE BRAIN IS SPEAKING, IF YOU WILL, TO ANOTHER AREA OF THE BRAIN, THAT DECREASES IN BRAIN SYSTEMS THAT UNDERLIE EMOTIONAL REGULATION, WHEREAS BOYS SHOW INCREASE IN ACTIVITY IN THOSE BRAIN CIRCUITS. SO HOW DO WE KNOW THAT THIS IS AN IMPORTANT NEURAL BIOLOGICAL DIFFERENCE? WELL, LOWER CONNECTIVITY IN THESE BRAIN CIRCUITS IN GIRLS WAS ASSOCIATED WITH MORE SEVERE INTERNALIZING PROBLEMS LATER IN ADOLESCENCE. THESE BRAIN CHANGES WERE PREDICTIVE OF DEPRESSION AND ANXIETY LATER IN ADOLESCENCE, THIS KIND OF WORK FUNDED BY THE NIH ILLUSTRATES HOW PUBERTY MIGHT AMPLIFY RISK FOR INTERNALIZING SYMPTOMS IN GIRLS, LEADING AGAIN WITH LIFESPAN PERSPECTIVE TO INCREASED VULNERABILITY TO INCREASED DEPRESSION AND ANXIETY. LET'S GO TO COLLEGE. WE KNOW THAT NATIONALLY THERE'S AN INCREASE IN PREVALENCE OF ANXIETY, DEPRESSIVE DISORDERS AND PANIC ATTACKS AMONG AMERICAN COLLEGE STUDENTS, INDEED PREVALENCE IS ASTOUNDING, PARTICULARLY FOR FEMALES ALMOST 28% OF FEMALES HAVING AN ANXIETY DISORDER, 22% OF FEMALES HAVING DEPRESSIVE DISORDER AND PANIC ATTACKS AT 14.8%, COMPARED TO MUCH LOWER RATES, HALF OF THAT IN MALES. AGAIN, SHOWING COLLEGE IS AN IMPORTANT INFLECTION POINT IN WOMEN'S MENTAL HEALTH. WE'RE IN THE MIDDLE OF A GLOBAL PANDEMIC, STUDENTS ARE WORKING FROM HOME, IT'S INTERESTING THAT NEW SURVEY RESEARCH FROM THE HEALTHY MIND STUDENTS, A LARGE SAMPLE OF INDIVIDUALS FROM 14 CAMPUSES, SHOWS INTERESTING CHANGE IN SUBSTANCE USE DISORDERS. EXCUSE ME. THERE'S AN INCREASE IN DEPRESSIVE DISORDERS, BUT A DECREASE IN SUICIDAL IDEATION, DECREASE IN ILLICIT SUBSTANCE ABUSE AND BINGE DRINKING, AND SOCIALED WITH IMPAIRMENT IN ACADEMIC PERFORMANCE SHOWING IMPORTANCE OF MENTAL HEALTH DISORDERS TO DAILY FUNCTIONING, IN THIS CASE IN COLLEGE STUDENTS. IN THE LAST FEW YEARS, THERE'S BEEN A LOT OF APPROPRIATE TAGS TO SEXUAL ASSAULT IN WOMEN WITH THE #MeToo MOVEMENT, THE PREVALENCE OF SEXUAL ASSAULT IN COLLEGE-AGE STUDENTS IS CONSIDERABLY HIGHER IN FEMALES COMPARED TO MALES. NOW, MENTAL HEALTH IN COLLEGE IS A GENERAL ISSUE, BUT IT'S IMPORTANT TO RECOGNIZE THAT SEXUAL MINORITIES SHOW HIGHER PREVALENCE OF THESE DISORDERS, INDEED SHOW A 4 TO 5-FOLD INCREASED RISK IN SELF HARM, SUICIDAL THOUGHTS AND SUICIDAL ATTEMPTS, MOST SEVERE FORMS OF MENTAL HEALTH ARE HIGHER IN SEXUAL MINORITIES, PARTICULARLY WOMEN, SO THIS UNDERSCORES THE IMPORTANCE OF TARGETED EFFORTS AT PREVENTION. LET'S TALK ABOUT PREGNANCY. WHEN A LOT OF PEOPLE THINK ABOUT WOMEN'S MENTAL HEALTH, THEY THINK ABOUT POSTPARTUM DEPRESSION, THERE ARE A LOT OF LESSONS WE LEARNED BY STUDYING PREGNANCY, THAT CAN INFORM OUR UNDERSTANDING AT OTHER REPRODUCTIVE MILESTONES IN A WOMAN'S LIFE. WHAT'S PARTICULARLY IMPORTANT I THINK IS TO CONSIDER THE PERINATAL PERIOD, A WINDOW OF OPPORTUNITY FOR THE IDENTIFICATION AND TREATMENT OF A VARIETY OF DIFFERENT MENTAL HEALTH DISORDERS, EVEN IF THOSE ARE NOT NEW DISORDERS, IN OTHER WORDS EVEN IF THEY DID NOT ARISE DE NOVO DURING PREGNANCY. WOMEN OF COLOR, RURAL WOMEN IN PARTICULAR, HAVE LIMITED ACCESS TO MENTAL HEALTH SERVICES. AND BY IMPLEMENTING MENTAL HEALTH SCREENINGS IN THE PERINATAL PERIOD WE CAN OFTENTIMES FOR THE FIRST TIME BEGIN TO SCREEN AND IDENTIFY THESE DISORDERS IN THESE DISADVANTAGED POPULATIONS. CDC DATA SHOW THE RATES OF PREGNANT WOMEN WITH DEPRESSION DIAGNOSIS AT DELIVERY INCREASE BY SEVEN-FOLD FROM 2000 TO 2015, SUBSEQUENT DATA SHOWED THIS TREND CONTINUES. SO WOMEN IN THE PERINATAL PERIOD SHOW A VERY HIGH PREVALENCE OF DEPRESSION. NOW, THIS IS PARTICULARLY IMPORTANT TO CONSIDER FOR WOMEN OF COLOR BECAUSE COMPARED TO WHITE WOMEN, THE ODDS OF DEPRESSION PRIOR TO DELIVERY WERE FIVE-FOLD HIGHER IN BLACK WOMEN, TWO-FOLD HIGHER IN LATINAS, AND THIS DISPARITY PERSISTS IN THE POSTPARTUM PERIOD, DISPARITIES CONTINUE WHEN WE EXAMINE DELIVERY OF MENTAL HEALTH CARE. NOW, DELIVERY OF MENTAL HEALTH CARE IS POOR ALL AROUND, BUT IT'S EVEN WORSE FOR WOMEN OF COLOR. WHY IS THIS IMPORTANT? MATERNAL MORTALITY IN THE UNITED STATES IS INCREASING, WHILE IT'S DECREASING IN OTHER COUNTRIES. AND WE THINK ABOUT DEPRESSION AND IN PARTICULAR SUICIDALITY AS BEING AN IMPORTANT CONTRIBUTOR TO MATERNAL MORBIDITY. INDEED, A VERY RECENT STUDY IN JAMA PSYCHIATRY SHOWED A CONSIDERABLE INCREASE IN SUICIDAL IDEATION, AND IN SELF-HARM OVER THE LAST DECADE. THIS WAS PARTICULARLY TRUE FOR YOUNG WOMEN, AND WOMEN OF COLOR, AS WELL AS WOMEN WITH PSYCHIATRIC COMORBIDITIES, INCLUDING ANXIETY, DEPRESSION, COMORBID PSYCHOSIS. SO, MATERNAL MORTALITY IN THE UNITED STATES IS AN IMPORTANT CONSIDERATION IN WOMEN'S MENTAL HEALTH. SMALL EFFORTS, EFFORTS AT SIMPLY SCREENING WOMEN DURING THE PERINATAL PERIOD PAY OFF. SO IN ABSOLUTE TERMS, JUST THE IMPLEMENTATION OF MENTAL HEALTH SCREENINGS IN THE PERINATAL PERIOD REDUCES DEPRESSION PREVALENCE BY TWO TO NINE PER CENT, IN TERMS OF WOMEN WITH PSYCHIATRIC DIAGNOSIS, THE SCREENING CAN REDUCE REMISSION 10 TO 34% IN ABSOLUTE TERMS, SO THE IMPORTANCE OF SCREENING CAN'T BE UNDERESTIMATED. NOW, SCIENCE HAS ADVANCED OUR UNDERSTANDING OF HOW TO BETTER DETECT PSYCHIATRIC DIAGNOSES IN WOMEN, SO ONE APPROACH IS COMPUTERIZED ADAPTIVE DIAGNOSTICS, HERE HIGHLIGHT THE WORK OF ROBERT GIBBONS, A COLLEAGUE FROM UNIVERSITY OF CHICAGO, WHO IS IMPLEMENTING A NEW APPROACH TO THE IDENTIFICATION OF MENTAL HEALTH DISORDERS, ESSENTIALLY THIS IS A TECHNOLOGY-BASED APPROACH THAT DRAWS ITEMS IN A SCREENER FROM A VERY DEEP ITEM BANK, TAILORS THE SCREENING TO EACH WOMAN DEPENDING UPON HER RESPONSE TO THE PREVIOUS QUESTION. WE HAVE IMPLEMENTED THIS WORK IN OUR OWN PERINATAL RESEARCH STUDY, AND I'D LIKE TO SHOW YOU SOME INITIAL DATA TO ILLUSTRATE TO YOU THE IMPORTANCE OF SCREENING AS WELL AS IMPORTANCE OF SCREENING FOR MORE THAN ONE PSYCHIATRIC DIAGNOSIS IN THE PERINATAL PERIOD. SO IN OUR CLINIC, WHICH SERVES WOMEN OF COLOR, LIVING IN CHICAGO, WE FIND THAT 21% OF WOMEN ACTUALLY SCREEN POSITIVE FOR MAJOR DEPRESSIVE DISORDER AT SOME POINT IN PREGNANCY OR VERY EARLY POSTPARTUM PERIOD. SO AMONG THE WOMEN WITH DEPRESSION, YOU CAN SEE THE MAJORITY HAD ONLY MAJOR DEPRESSIVE DISORDER BUT LOOK AT THE PERCENTAGE OF WOMEN WHO HAD A COMORBID DIAGNOSIS, 6% OF WOMEN, FOR EXAMPLE, HAD MDD, GENERALIZED ANXIETY DISORDER, POSTTRAUMATIC, DEMONSTRATING COMORBIDITY AS A DEMONSTRATION, AND ILLUSTRATING THE VALUE OF TECHNIQUES LIKE COMPUTERIZED ADAPTED DIAGNOSTICS FOR EFFICIENTLY, QUICKLY AND SENSITIVELY DETECTING DIFFERENT MENTAL HEALTH DISORDERS, IN THE CLINIC SETTING. THERE ARE ALSO NOVEL APPROVALS TO TREATMENT DELIVERY, HERE I HIGHLIGHT WORK OF OF AN EVIDENCE-BASED COGNITIVE BEHAVIOR THERAPY APPROACHED DELIVERED ON THE INTERNET FREE OF CHARGE WITHOUT STIGMA OF CLINIC VISIT, WITHOUT NEEDING TO GET A BABY-SITTER, AND IT'S BEEN SHOWN TO PREVENT PERINATAL DEPRESSION, IN THE POPULATION, SO TECHNOLOGICAL ADVANCES IN SCREENING AND IN THE TREATMENT OF PSYCHIATRIC DIAGNOSES ARE VERY IMPORTANT, AND EVIDENCE SHOWS MANY OF THESE STUDIES SUPPORTED BY THE NIH THAT THESE ONLINE TREATMENTS ARE AS EFFECTIVE AS BRIEF FACE-TO-FACE TREATMENTS. OF COURSE IT'S NOT ENOUGH TO USE COGNITIVE BEHAVIOR THERAPY. SOME WOMEN NEED PHARMACOLOGIC TREATMENT. ONE SUCCESS OVER THE DECADE WAS DEVELOPMENT OF A TREATMENT, METABOLITE OF PROGESTERONE, FOR POSTPARTUM DEPRESSION, QUICKLY AND EFFECTIVELY TREATING POSTPARTUM DEPRESSION, NOW AVAILABLE IN PILL FORM, ALSO SHOWING GREAT EFFECTIVENESS. SO WHAT THIS SHOWS US IS THAT UNDERSTANDING THE NEUROBIOLOGICAL UNDERPINNINGS, THE HORMONAL NEUROACTIVE STEROID UNDERPINNINGS OF MENTAL HEALTH DISORDERS AT CRITICAL TIMES LIKE THE PERINATAL PERIOD CAN INFORM NOVEL TREATMENTS FOR MENTAL HEALTH DISORDERS. IT'S IMPORTANT TO TREAT MENTAL HEALTH DISORDERS IN PREGNANCY NOT JUST FOR MOM BUT ALSO FOR HER OFFSPRING. THIS IS NEURAL IMAGING WORK, FUNCTIONAL MAGNETIC RESONANCE WORK DONE IN 6-MONTH-OLD CHILDREN OF MOMS WITH OR WITHOUT PERINATAL DEPRESSION. WHAT THEY SHOWED IS THAT SIX MONTHS OF AGE IN THESE OFFSPRING YOU COULD DETECT DIFFERENCES IN THE EMOTIONAL REGULATION CIRCUITRY, SHOWING IMPORTANCE, AGAIN, OF TREATING ANTENATAL MOOD DISORDERS IN WOMEN TO BENEFIT OFFSPRING. LET'S MOVE TO ADULTHOOD. THERE'S BEEN A LOT OF TALK ABOUT HARASSMENT AND DISCRIMINATION IN THE WORKPLACE, AND THIS IS VERY COMMON. BUT ONE THING I'D LIKE TO POINT OUT IS THE INTERSECTION ALITY SO THAT WOMEN OF MIXED RACE OR ETHNICITY EXPERIENCE HIGHEST LEVELS OF THIS EXPOSURE OVERALL. AND THIS EXPOSURE, HARASSMENT AND DISCRIMINATION, IN TURN LEADS TO INCREASES IN PROBLEM DRINKING, MENTAL HEALTH DISORDERS, PARTICULARLY AMONG WOMEN. WORK BY MY GOOD COLLEAGUE REBECCA THURSTON AT THE UNIVERSITY OF PITTSBURGH HAS SHOWN IMPORTANCE OF THESE EXPOSURES NOT MENTAL HEALTH SPECIFICALLY BUT RATHER PHYSICAL HEALTH, SO THAT THERE WAS A TWO-FOLD HIGHER ODDS OF WOMEN HAVING HYPERTENSION IF THEY HAD HIGH LEVELS OF HARASSMENT IN THEIR DAILY LIFE. ONE OF THE SIGNATURE PROGRAMS OF THE OFFICE OF RESEARCH ON WOMEN'S HEALTH IS THE BUILDING INTERDISCIPLINARY RESEARCH CAREERS, THE BIRCWH K12 PROGRAM WHICH FUNDS YOUNG INVESTIGATORS TO PURSUE STUDIES OF WOMEN'S HEALTH, SEX AND GENDER-BASED MEDICINE IN HEALTH. OUR BIRCWH COLLEAGUES AND MY CO-P.I. COMPLETED A SURVEY OF OVER 500 FACULTY AT OUR OWN INSTITUTION TO LOOK AT WORK LIFE AND STRESS BEFORE AND AFTER COVID. WHAT YOU CAN SEE THERE'S HIGH LEVELS OF STRESS BUT WOMEN CARRY MORE. IT'S IMPACT TO SCHOLARLY PRODUCTIVITY, TEACHING, ADVISING, COMMITTEE RESPONSIBILITIES, AND THEIR OWN PERSONAL HEALTH. SO, WORK STRESS IS AN IMPORTANT CONSIDERATION. MENOPAUSE IS ALSO IMPORTANT. THE PERIMENOPAUSE IS A WINDOW OF VULNERABILITY FOR DEPRESSION, AND FOR SUBCLINICAL DEPRESSIVE SYMPTOMS, AND WE CAN SEE HERE IN WORK, A DOUBLING AT ANY POINT IN TIME OF THE PREVALENCE OF DEPRESSION IN A PERIMENOPAUSE AND POST MENOPAUSE COMPARED TO PRE-MENOPAUSE. MOST WOMEN WHO EXPERIENCE DEPRESSION AT THIS TIME IN LIFE ARE WOMEN WITH A HISTORY OF DEPRESSION, PRIOR TO THE MENOPAUSE, AND SO THIS REPRESENTS A RECURRENCE OF THEIR DEPRESSIVE DISORDERS BUT NOT JUST DEPRESSION. AN EXCELLENT ARTICLE PUBLISHED IN THE POPULAR PRESS BY LISA MILLER PUBLISHED IN "NEW YORK" MAGAZINE HIGHLIGHTED IMPORTANCE OF PSYCHOTIC DISORDERS IN WOMEN AT THE TIME OF THE MENOPAUSE, AND EPIDEMIOLOGICAL STUDIES SHOW SECOND INCREASE IN THE PREVALENCE OF THESE DISORDERS, RISK OF THESE DISORDERS, AT THE MENOPAUSE. SO WE NEED TO TAKE OUR LENS BEYOND DEPRESSION AND LOOK AT OTHER PSYCHIATRIC DIAGNOSES. HORMONAL CONTRIBUTIONS ARE IMPORTANT, PROOF OF CONCEPT FOR EXAMPLE USE OF ESTROGEN CAN DAMPEN PSYCHOTIC SYMPTOMS IN WOMEN AT THIS TIME BUT NOT JUST HORMONAL CHANGES AT MENOPAUSE. IT'S VARIETY OF THINGS, BIOLOGICAL FACTORS, HEALTH-RELATED AND PSYCHOSOCIAL FACTORS THAT AFFECT A WOMAN'S MENTAL HEALTH. WE HAVE LATER YEARS IN A WOMAN'S LIFE, THIS IS A GENDER DIFFERENCE, CAREGIVING TYPICALLY FALLS TO WOMEN, TWO-THIRDS OF CAREGIVERS ARE WOMEN. PARTICULARLY IN THE FIELD OF DEMENTIA. SO WIVES TAKE CARE OF THEIR HUSBANDS WITH DEMENTIA AND DAUGHTERS DO THE SAME. WOMEN SPEND MORE TIME CAREGIVING THAN MEN WHEN THEY ARE CAREGIVERS. THESE WOMEN WHO PROVIDE THIS CAREGIVING REQUEST MORE MENTAL HEALTH SERVICES, AND THEY ARE NOT WIDELY AVAILABLE. THE IRONY IS THAT DEPRESSION IS ASSOCIATED WITH 36% RISK OF SUBSEQUENT DECLINE, WOMEN CARING FOR HUSBANDS WITH ALZHEIMER'S DISEASE, NEVERTHELESS MENTAL HEALTH SEQUELAE CONTRIBUTE TO THEIR OWN RISK FOR COGNITIVE DISORDERS. SO IT'S IMPORTANT TO RECOGNIZE INTERSECTION BETWEEN MENTAL HEALTH AND COGNITIVE HEALTH. SO TODAY WE'VE DONE A SURVEY OF WOMEN'S MENTAL HEALTH ACROSS THE LIFESPAN, WE TALKED ABOUT CHILDHOOD, PUBERTY, COLLEGE, PREGNANCY, ADULTHOOD, MENOPAUSE, LATER YEARS, LIFESPAN PERSPECTIVE, ILLUSTRATING SUCCESS AND IMPORTANCE OF THE WORK BEING DONE AT THE NIH AND THIS IMPORTANT QUESTION AND HOW IT INTERSECTS WITH OTHER INSTITUTES INCLUDING NATIONAL INSTITUTE ON DRUG ABUSE AND THE NHLBI.. I'M INDEBTED TO MY COLLEAGUES AND WANT TO CONGRATULATE DR. CLAYTON AND DR. VIVIAN PINN ON THE 30th ANNIVERSARY OF THE OFFICE OF RESEARCH ON WOMEN'S HEALTH, A SPECIAL THANKS TO TO REGINE DOUTHARD FOR INVITING ME TO COME HERE. IT'S BEEN A GREAT HONOR. THANK YOU. >> THANK YOU, DR. MAKI. THE FIRST QUESTION, WE HEAR ABOUT MENTAL HEALTH AND PREGNANCY, NOT SO MUCH ABOUT MENTAL HEALTH AND MENOPAUSE. WHY IS THAT AND WHAT DO WE KNOW? >> THANK YOU FOR THE QUESTION. WE'VE MADE GREAT STRIDES UNDERRING PERINATAL DEPRESSION, ITS PREVALENCE, ITS LIFE COURSE, DIFFERENCES IN RACE AND ETHNICITY, ALSO DEVELOPMENT OF NEW TREATMENT INCLUDING BREXANALONE, I THINK THAT HOLDS A LOT OF PROMISE FOR EXPANDING RESEARCH TO THE MENOPAUSE. THE QUESTION IS RIGHT, WE HAVEN'T DONE THAT. IN PART I THINK IT'S ASSOCIATED WITH SOME STIGMA ASSOCIATED WITH MENOPAUSE. WE DON'T TALK ABOUT MENOPAUSE IN THIS COUNTRY SO MUCH, AND IN ADDITION PROVIDERS AREN'T REALLY TRAINED IN THE IMPORTANCE OF SCREENING FOR DEPRESSIVE SYMPTOMS, ANXIETY AND PSYCHOSIS AT THE TIME OF MENOPAUSE. PART IS PERCEPTION AND I WOULD SAY PERHAPS MISPERCEPTION, ALL THE CHANGES AT MENOPAUSE HAVE TO DO WITH HORMONAL CHANGES. CLEARLY HORMONAL CHANGES CONTRIBUTE TO PERIMENOPAUSAL DEPRESSION, BUT THEY ARE NOT THE ONLY FACTOR. SO PART OF THIS STIGMA AND FOCUS ON HORMONE THERAPY IS BE ALL AND END ALL OF MENOPAUSE HAVE BEEN BARRIERS TO UNDERSTANDING THE NIH'S FUNDED STUDY OF WOMEN'S HEALTH ACROSS THE NATION AND BEAUTIFUL WORK HAS SHOWN HOW NORMATIVE AND COMMON IT IS FOR WOMEN TO EXPERIENCE DEPRESSIVE SYMPTOMS AT THIS TIME. FEWER WOMEN EXPERIENCE MAJOR DEPRESSIVE EPISODES AT THIS TIME BUT FOR WOMEN WHO HAVE A HISTORY OF DEPRESSION AND LET'S REMEMBER THAT WOMEN ARE AT TWICE OF RISK, THOSE WOMEN WHO COME INTO MENOPAUSE WITH THE HISTORY, 57% OF THEM, A MAJORITY, WILL HAVE RECURRENCE OF MAJOR DEPRESSION. THEY WILL HAVE A MAJOR DEPRESSIVE EPISODE DURING MENOPAUSAL TRANSITION. SO IT'S REALLY IMPORTANT THAT WE BEGIN TO STUDY MENOPAUSE, A BIT MORE, UNDERSTAND WHO IS AT RISK, UNDERSTAND WHAT KINDS OF THERAPIES MIGHT BE HELPFUL FOR WOMEN, UNDERSTAND THE ROLE OF HORMONAL THERAPIES IN TREATING PERIMENOPAUSAL DEPRESSION, THERE IS EVIDENCE, SOME SMALLER CLINICAL TRIALS AND NEW WORK BY GORDON AT THE UNIVERSITY OF NORTH CAROLINA SHOWING THAT PERHAPS TREATING WOMEN WITH HORMONE THERAPY CAN PREVENT EXACERBATION OF THESE SYMPTOMS AT THE PERIMENOPAUSE, BUT THAT'S HYPOTHESIS GENERATING WORK, IT'S EXCITING, IT SHOWS HOW WE NEED TO PURSUE THIS FURTHER. >> THANK YOU. THIS MIGHT SEGUE INTO THE NEXT QUESTION FOR YOU. DOESN'T ALL THIS RESEARCH ON HORMONAL FACTORS PLAY INTO STEREOTYPES OF WOMEN BEING HORMONAL AND DO A DISFAVOR TO WOMEN? >> SUCH AN IMPORTANT QUESTION. THERE'S STIGMA ABOUT MENTAL HEALTH IN WOMEN, ISN'T THERE? WOMEN ARE OFTEN TOLD THEY ARE BEING HORMONAL IF THEY EXPRESS EMOTIONS. I LIKE TO SAY THAT PART OF THE STRENGTH OF BEING A WOMAN IS OUR ABILITY TO EXPERIENCE AND EXPRESS EMOTION. AND UNFORTUNATELY, SOCIETY CAN PUNISH WOMEN, CAN INDUCE STIGMA IN WOMEN FOR THE DIFFERENCES IN EMOTIONAL REGULATION AND IN THE EMOTIONAL BRAIN. THERE ARE FUNDAMENTAL DIFFERENCES IN THE WAY THAT MEN AND WOMEN'S BRAINS ARE WIRED WITH RESPECT TO EMOTION. AND SO, YEAH, I THINK THERE'S A CONCERN ABOUT HOW FOCUSING ON HORMONAL FACTORS COULD CONTRIBUTE TO SOME OF THAT STIGMA. I WOULD SAY THE EXPERIENCE OF BREXAN ALON, SHOWING A METABOLITE, IS LOW IN POSTPARTUM DEPRESSION AND WHEN YOU AUGMENT YOU TREAT POSTPARTUM DEPRESSION SO THAT DEMONSTRATES THE IMPORTANCE TO WOMEN'S MENTAL HEALTH, REALLY UNDERSTANDING HOW HORMONAL FACTORS CONTRIBUTE TO MENTAL HEALTH DISORDERS BECAUSE WE CAN ADAPT OUR TREATMENTS, DEVELOP NEW TREATMENTS, FOR THESE DISORDERS IN WOMEN. RECOGNIZING THERE'S MENTAL HEALTH STIGMA FOR BOTH SEXES. IT'S THE HORMONAL FACTORS THAT CAN DIFFERENTIATE AFFECT WOMEN. I'M SORRY, I'M NOT HEARING QUESTIONS RIGHT NOW. I WILL GO ON TO ANOTHER QUESTION THAT I SEE WAS ASKED EARLIER. THAT HAS TO DO WITH UNDERSTANDING THE ROLE OF EXPERIENCE OF EARLY LIFE TRAUMA AND MENTAL HEALTH. IT'S WELL RECOGNIZED THAT THERE IS THIS ASSOCIATION BETWEEN EARLY LIFE EVENTS AND MENTAL HEALTH, AND THERE WAS A QUESTION, WELL, WHAT ABOUT PHYSICAL HEALTH? WHAT ABOUT THE CORONARY HEART DISEASE? AND I THINK IT'S REALLY IMPORTANT THAT WE UNDERSTAND HOW EARLY LIFE EVENTS CAN CONTRIBUTE TO WOMEN'S HEALTH BEYOND THEIR MENTAL HEALTH. AND THAT SLIDE I SHOWED LINKING EARLY CHILDHOOD EXPERIENCES WITH CORONARY HEART DISEASE IS ONE ILLUSTRATION OF THAT. THERE ARE DIFFERENCES BETWEEN MEN AND WOMEN IN THE WAY THAT OUR BODIES REGULATE STRESS, THROUGH SOMETHING CALLED HYPOTHALAMIC PITUITARY ADRENAL ACCESS, WE KNOW WORK IN MY LAB AND OTHERS' LABS HAVE SHOWN THAT MEN AND WOMEN SHOW DIFFERENCES IN THE HPA ACCESS, AND THEIR REACTIONS TO STRESS, HORMONAL FACTORS CAN REGULATE THAT BUT IN A VERY COMPLEX WAY. IN ADDITION, THERE ARE CONSIDERABLE DIFFERENCES BETWEEN MEN AND WOMEN IN INFLAMMATORY RESPONSES, AND INFLAMMATORY RESPONSES CONTRIBUTE TO DIFFERENCES BETWEEN THE SEXES, IN BRAIN -- IN MENTAL WELL BEING. SO THAT'S JUST AN ILLUSTRATION OF SOME OF THE WAYS THAT BIOLOGICAL DIFFERENCES BETWEEN MEN AND WOMEN AND THE WAY THEY RESPOND TO STRESS CAN CONTRIBUTE TO SOME OF THE DIFFERENCES IN PHYSICAL HEALTH AS WELL. >> THANK YOU FOR HANDLING THAT QUESTION. ANOTHER QUESTION THAT HAS COME IN, CAN INTERVENTION AS LATE AS MENOPAUSE HELP IN RECOVERING WITH DEPRESSIVE DISORDERS CLOSE TO NORMAL IS THE QUESTION THAT JUST CAME IN. >> YEAH, THANK YOU FOR THAT REALLY IMPORTANT QUESTION. I THINK ONE OF THE BIG LESSONS THAT WE LEARNED OVER THE PAST DECADE INCLUDING FROM THE WOMEN'S HEALTH INITIATIVE IS THE IMPORTANCE OF CONSIDERING THE TIMING OF HORMONE EXPOSURE IN RELATION TO MYRIAD HEALTH OUTCOMES. STUDIES SHOW IF YOU WANT TO MINIMIZE EFFECTS OF THE MENOPAUSE ON DEPRESSIVE SYMPTOMS IN WOMEN, YOU REALLY NEED TO START IN THE PERIMENOPAUSE. IN OTHER WORDS, YOU NEED TO START WHEN HORMONAL -- THE HORMONE LEVELS IN WOMEN ARE FLUCTUATING AND THEN ULTIMATELY DECLINING. IT'S DURING THAT PERIOD OF HORMONAL FLUX THAT INTERVENTION APPEARS TO BE MOST EFFECTIVE. STUDIES SHOW IF YOU INTERVENE, RANDOMIZED TRIALS, CANES PROGENIC FORMULATION IN POST-MENOPAUSE IT'S TOO LATE. THERE'S NO EVIDENCE OF BENEFIT ONCE THE WOMAN HAD HER FINAL MENSTRUAL PERIOD HORMONAL FACTORS CAN HELP HER MENTAL HEALTH. >> THANK YOU FOR THAT. WE HAVE ANOTHER QUESTION, CAN YOU TALK ABOUT EATING DISORDERS THROUGHOUT THE LIFESPAN? THEY DISPROPORTIONALLY AFFECT WOMEN, NOT A YOUNG WHITE TEENAGER OCCURRENCE. >> WE KNOW EATING DISORDERS ALSO DIFFER BY SEX. INTERESTING RACE AND ETHNICITY ISSUES, WITH EATING DISORDERS. I LIKE TO USE EATING DISORDERS AS ONE KEY EXAMPLE OF THE SUCCESS OF DR. CLAYTON AND DR. COLLINS' EFFORTS TO INCLUDE SEX AS A BIOLOGICAL VARIABLE IN RESEARCH STUDIES SO THERE ARE NOW ANIMAL MODELS, FOR EXAMPLE, ANOREXIA WHICH DISPROPORTIONATELY AFFECTS FEMALES COMPARED TO MALES. AND THERE ARE A VARIETY OF DIFFERENT MECHANISMS UNDERLYING THAT DIFFERENCE, BUT IMAGINE THAT DESPITE THE FACT THAT THE LARGE MAJORITY OF INDIVIDUALS WITH ANOREXIA ARE FEMALE, THE BASIC SCIENCE MODELS, ANIMAL MODELS THAT ARE USED TO STUDY THE DISORDER WERE ALMOST EXCLUSIVELY DONE ON MALE MICE, MALE RATS. AND SO HORMONAL EFFECTS THAT CAN PLAY INTO THIS DISORDER WERE COMPLETELY IGNORED. NOW WITH THE MANDATE TO INCLUDE SEX AS A BIOLOGICAL VARIABLE, TO INCLUDE FEMALE MICE, WE'RE NOW BEGINNING TO UNDERSTAND THOSE KINDS OF FACTORS. THERE ARE DIFFERENCES IN THE BIOLOGY OF REWARD, AND THERE'S FOR EXAMPLE EVIDENCE TO SHOW THAT WOMEN'S BRAINS WHEN THEY HAVE ANOREXIA PROCESS FOOD AS REWARDING. WE LIKE TO EAT. WE ENJOY EATING FOOD TOGETHER. IT INDUCES PLEASURE. THAT IS NOT -- THAT'S DISRUPTED IN ANOREXIA. SOME HAS TO DO WITH BRAIN CIRCUITY UNDERLYING REWARD. BUT IT'S A VERY IMPORTANT QUESTION. THANK YOU FOR ASKING IT. >> THANK YOU. ANOTHER QUESTION HAS COME IN. ARE THERE ANY STUDIES THAT SUGGEST INCREASED RISK OF ALZHEIMER'S ASSOCIATED WITH HORMONE THERAPY? >> OH, THANK YOU FOR THE QUESTION. SO, THIS IS A COMPLEX QUESTION BUT I SPENT THE MAJORITY OF MY LIFE'S WORK ON THIS PARTICULAR QUESTION. SO, WE HAVE ONE RANDOMIZED TRIAL, WOMEN'S HEALTH INITIATIVE MEMORY STUDY, WHICH WAS AN ADD-ON TO THE WOMEN'S HEALTH INITIATIVE STUDY WHICH WAS A KEY TRIAL TO SEE IF THE USE OF HORMONE THERAPY COULD PREVENT THE DEVELOPMENT OF ALZHEIMER'S DISEASE. NOW, AS WE MIGHT KNOW STUDY ENDED EARLY DUE TO EVIDENCE AT HARM AT LEAST FOR THE PART OF THE STUDY THAT HAD ESTROGEN PLUS PROGESTERONE. AT THE TIME THE STUDY ENDED DATA SHOWED THAT IN FACT WOMEN WHO HAD BEEN RANDOMIZED TO THE FORMULATION, ESTROGEN PLUS PROGESTERONE ARE DOUBLING OF THE RISK, THAT LOOKS HARMFUL, THAT WAS NOT TRUE FOR THE ESTROGEN ALONE ARM. THERE WAS NO INCREASED RISK OF DEMENTIA, NO DECREASED RISK WITH THAT. SO IMPORTANT FOLLOW-UP WORK AT WINSTON-SALEM DEMONSTRATED VERY IMPORTANT CAVEAT TO THAT FINDING, WHAT THEY DID IS LOOKED AT THE RELATIONSHIP BETWEEN HORMONE THERAPY IN THAT STUDY AND COGNITION IN YOUNGER WOMEN, SO THE STUDY THAT I JUST DESCRIBED ON DEMENTIA WAS DONE IN WOMEN WHO WERE AT LEAST 65 YEARS BUT ON AVERAGE 72 YEARS OF AGE, WHEN THEY HAD BEEN GIVEN HORMONE THERAPY. AND SO IF YOU WILL, THE BRAINS HADN'T SEEN HORMONES REGULARLY FOR 22 YEARS, ON AVERAGE. NOW, WHEN COLLEAGUES DID A SIMILAR STUDY IN YOUNGER WOMEN LOOKING TO SEE IF WOMEN IN THEIR 50s SHOWED ADVERSE EFFECT OF HORMONE THERAPY, THEY FOUND NO EVIDENCE OF THAT. IN STUDY SECTIONS THAT AS WELL AS EVIDENCE FROM GLEASON'S STUDY AND EVIDENCE FROM HENDERSON, THE THREE VERY LARGE RANDOMIZED TRIALS, MANY FUNDED BY THE NATIONAL INSTITUTE ON AGING, SHOWED THAT YOUNGER WOMEN'S BRAINS APPEAR NOT TO SHOW THAT ADVERSE EFFECT OF HORMONE THERAPY, AND THEN FINALLY THERE'S SOME REALLY INTERESTING WORK BY CANTARSE AT MAYO CLINIC THAT SUGGESTS IN YOUNGER WOMEN IT MIGHT ACTUALLY DECREASE MANIFESTATIONS OF ALZHEIMER'S PATHOLOGY IN THE BRAIN, IF GIVEN EARLY. SO THE STORY ON HARMONY THERAPY AND DEPARTMENT IS IN NO WAY CLOSED. IT'S NOT THE SAME THING IF YOU'RE OLDER AS WHEN YOU'RE YOUNGER, NOT THE SAME A LITTLE IF YOU TAKE PROGESTERONE OR IF YOU DON'T. IT'S COMPLEX. THANKS TO THE NIH WE'RE CONTINUING TO LEARN MORE ABOUT IT. >> THANK YOU. AND IT APPEARS THAT WE MAY BE THROUGH ALL OF THE QUESTIONS. WE DO HAVE ONE MORE. I CAN UNDERSTAND HOW SEXUAL AND HARASSMENT AND DISCRIMINATION INFLUENCE MENTAL HEALTH. BUT HOW CAN THEY INFLUENCE PHYSICAL HEALTH? >> YEAH, THANK YOU FOR THE QUESTION. WE TALKED A BIT ABOUT THAT EARLIER WHEN WE TALKED ABOUT THE DIFFERENCES BETWEEN MEN AND WOMEN, IN THE STRESS HORMONE REGULATORY RESPONSE, HYPOTHALAMIC PITUITARY ADRENAL AND IMMUNE FUNCTION. SOME LESSONS WE'VE LEARNED OVER THE PAST DECADES IN DIFFERENCE IN STRESS RESPONSIVITY AND DIFFERENCES IN IMMUNE FUNCTION HAVE CONTRIBUTED TO OUR UNDERSTANDING OF HOW EXPOSURES TO WORKPLACE HARASSMENT AND TRAUMA CAN INFLUENCE PHYSICAL HEALTH. THIS IS A PLUG FOR THE BENCH TO BEDSIDE MODULE OF THE NIH, THE ORWH'S TUTORIAL ON SEX DIFFERENCE AND IMMUNE FUNCTION IS VERY WELL DONE. AND YOU CAN SEE HOW DIFFERENCES IN IMMUNE FUNCTION CAN CONTRIBUTE TO MYRIAD DIFFERENT DISORDERS IN WOMEN AND MEN AND HOW DIFFERENCE IN IMMUNE FUNCTION CONTRIBUTE TO DIFFERENCES IN OTHER NEUROLOGICAL ILLNESSES AS WELL. SO IT'S VERY COMPLEX MULTI-SYSTEM KIND OF APPROACH. I ALSO JUST WANT TO ADD IT'S NOT ALL BIOLOGICAL. ONE OF THE THINGS THAT WOMEN DO WHEN THEY FACE WORKPLACE HARASSMENT IS CHANGE BEHAVIOR. WOMEN SELF MEDICATE WITH ALCOHOL, STOP ENGAGING IN SELF-CARE, LIFESTYLE FACTORRORS CAN EXACERBATE EFFECTS OF TRAUMATIC EXPOSURES IN HARASSMENT ON PHYSICAL AND MENTAL WELL BEING. >> THANK YOU FOR THAT. WE HAVE AT TIME. WE DO HAVE ONE ADDITIONAL REQUEST FOR REFERENCE THAT WE CAN FOLLOW UP WITH YOU VIA E-MAIL, IF YOU HAVE ANY FINAL WORDS WE HAVE ONE MINUTE REMAINING. >> YEAH, THANK YOU. SO I THINK THAT THE WORK THAT WE'VE DISCUSSED TODAY ACROSS THE LIFESPAN SHOWS THE IMPORTANCE OF RECOGNIZING SEX DIFFERENCES IN MENTAL HEALTH. IT SHOWS THE IMPORTANCE OF RECOGNIZING A LIFESPAN PERSPECTIVE SO THAT UNDERSTANDING HOW EXPOSURES DURING EARLY CHILDHOOD ALTER CIRCUITRY OF THE BRAIN, AND HOW ENVIRONMENTAL EXPOSURES SUCH AS HARASSMENT AND CHILDHOOD TRAUMA CAN ENGENDER, CAN ACTUALLY FIRM UP THE BIOLOGICAL UNDERPINNINGS OF MENTAL HEALTH. THAT ARE KIND OF WORK ILLUSTRATES THE IMPORTANCE OF THIS LIFESPAN PERSPECTIVE, AND THE NEED FOR SCREENING EFFORTS ACROSS THE LIFESPAN, THE NEED FOR SCREENING EFFORTS THAT ARE INFORMED BY DIFFERENCES IN THE TIMING OF THE ONSET OF THESE DISORDERS, TIMING OF THE ROLE OF PUBERTY, ONSET OF MENOPAUSE WHICH OF COURSE 100% OF WOMEN WILL BE EXPOSED TO, RIGHT? BECAUSE ALL WOMEN TRANSITION THROUGH MENOPAUSE. AND I JUST THINK THIS IS A SHOUT OUT TO ORWH AND NIH FOR ALL THE WORK THAT THEY HAVE DONE. >> THANK YOU. I'M FROM THE OFFICE OF RESEARCH ON WOMEN'S HEALTH, PLEASED TO INTRODUCE OUR NEXT SPEAKER, DR. JOHN BALBUS, SENIOR ADVISER FOR PUBLIC HEALTH, DIRECTOR OF THE NATIONAL INSTITUTE OF HEALTH SCIENCES, NIEHS, AND NIEHS'S LIAISON TO EXTERNAL CONSTITUENCIES AND DIRECTS THE NIEHS W.H.O. COLLABORATING CENTER FOR ENVIRONMENTAL HEALTH SCIENCES, SERVES AS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINCIPAL TO U.S. GLOBAL CHANGE RESEARCH PROGRAM, USGCRP, CO-COMPARES WORKING GROUPS ON CLIMATE CHANGE AND HEALTH HEALTH, SERVED ON NATIONAL ACADEMY OF SCIENCE COMMITTEES RELATED TO TOXICOLOGY AND RISK ASSESSMENT AND HAS AUTHORED NUMEROUS PAPERS ON VULNERABLE POPULATIONS FOR ENVIRONMENTAL EXPOSURES. BEFORE JOINING NIEHS, DR. BALBUS WAS CHIEF HEALTH SCIENTIST FOR NON-GOVERNMENTAL ORGANIZATION ENVIRONMENTAL DEFENSE FUND, FOR SEVEN YEARS. HE WAS ALSO ON FACULTY OF GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE AND HEALTH SCIENCES, AND MILKEN INSTITUTE OF PUBLIC HEALTH, FOUNDING DIRECTOR OF CENTER FOR RISK SCIENCE AND PUBLIC HEALTH AND ACTING CHAIRMAN OF THE DEPARTMENT OF ENVIRONMENTAL AND OCCUPATIONAL HEALTH. DR. BALBUS RECEIVED M.D. FROM UNIVERSITY OF PENNSYLVANIA, MPH FROM JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH. PLEASE WELCOME JOHN BALBUS. >> IT'S A PLEASURE TO BE WITH YOU. I WANT TO THANK THE OFFICE OF RESEARCH ON WOMEN'S HEALTH FOR INVITING ME TO GIVE THIS TALK TO YOU ON WOMEN'S ENVIRONMENT AND HEALTH. I APPROACH THIS TALK WITH A LOT OF GRATITUDE BUT ALSO TREPIDATION AS A WHITE MALE, AS SO MANY WITH CAUGHT IN HARM'S WAY BY COLOR OF THEIR SKIN AND HOPE I'M ABLE TO CONVEY SCIENCE AND ALSO THESE PERSPECTIVES WITH MEANING AND WITHOUT BIAS. HERE'S THE OUTLINE, FOCUSING ON ENDOCRINE DISRUPTING CHEMICALS, AIR POLLUTION AND CLIMATE CHANGE. BEFORE THAT I WANT TO START AT THE BEGINNING BASED ON THE PICTURE THAT YOU SEE THERE. I WANT TO START WITH THE CREATION OF THE WORLD IN FACT, HONOR THE MANY CULTURES WHOSE CREATION STORIES ATTRIBUTE OUR VERY EXISTENCE TO WOMEN. THIS IS AN IMAGE OF SKY WOMAN FALLING FROM THE HURON CREATION STORY, HOW SKY WOMAN FELL THROUGH A RIP IN THE SKY AND WAS CAUGHT BEFORE FALLING INTO THE WATERY SURFACE OF THE PLANET BY BIRDS, SKY WOMAN CREATED LAND ON THE BACK OF A TURTLE, REQUIRING TWO THINGS, REQUIRED SACRIFICES OF ALL OF THE ANIMALS THAT SHE CAME TO SEE WHEN SHE LANDED, AND ALSO CAME ABOUT BECAUSE OF SKY WOMAN'S DANCE THAT BROUGHT THE WORLD INTO EXISTENCE. SO OUR TIMELINE BEGINS WITH THE STORY OF THE FIRST WOMAN IN HARMONY WITH THE PLANET AND THE ENVIRONMENT. OUR TIMELINE JUMPS TO 110 YEARS AGO, 1911, IT PICKS UP THE STORY OF WOMEN OUT OF HARMONY AND IN HARM'S WAY FROM THEIR ENVIRONMENT. I'VE CHOSEN THE TRIANGLE SHIRTWAIST FACTORY FIRE, THIS IS A VERY -- I'M AN OCCUPATIONAL PHYSICIAN BY TRAINING, THIS IS A MOMENTOUS EVENT IN THE HISTORY OF OCCUPATIONAL HEALTH, SHIRTWAISTS WERE THE WORDS USED FOR WOMEN'S BLOUSES AT THE TIME. I'VE CHOSEN THIS FACTORY FIRE BECAUSE IT ILLUSTRATES THE DUALITY, CULMINATION OF YEARS OF POOR CONDITIONS, EXPLOIT EXPLOITATION FROM WOMEN IN THIS CASE FROM EASTERN EUROPE, THE FIRE STARTED, WOMEN WERE UP ABLE TO ESCAPE BECAUSE OWNERS LOCKED THE FIRE EXITS. SO IT'S AN ILLUSTRATION OF HOW HARMFUL EXPOSURES ARE OFTEN ASSOCIATED WITH DISADVANTAGE AND EMPLOYEDATION, PHYSICAL STRESSORS ARE ASSOCIATED WITH PSYCHOSOCIAL STRESSORS, AND ON THE FLIP SEIDELS THE STORY OF HOW WOMEN ORGANIZING THE CHALLENGE, STATUS QUO, JOINING LABOR UNIONS ULTIMATELY WERE ABLE TO GALVANIZE INTERNATIONAL WOMEN'S DAY IN RESPONSE TO THE TRAGEDY. IN 1962 RACHEL CARSON PUBLISHED "SILENT SPRING," RAISING AWARENESS OF ENVIRONMENTAL TOXICITY WITH DDT. IN 1976, EXPOSE IN ITALY LED TO MASSIVE COMMUNITY EXPOSURE TO CHEMICAL DIOXIN, AWARENESS OF THE POTENTIAL RISKS COMING FROM SUCH EXPLOSION LED TO MASSIVE STUDY, SCIENTISTS IN THAT AREA WERE ABLE TO COLLECT A LOT OF BLOOD SAMPLES AND SET UP A COHORT STUDY THAT'S NOW BEEN IN OPERATION FOR NEARLY 40 YEARS, THIS STUDY IS ONE OF THE KEY MARK STUDIES TO DEMONSTRATE THE ROLE OF ENDOCRINE-DISRUPTING CHEMICALS IN THE HEALTH OF WOMEN AND CHILDREN THAT THEY BEAR, AS WELL AS NATURE OF INHERITTANTS OF ENVIRONMENTAL TOXICITY. THE 1980s SAW USE OF CHEMICALS WITH UNIQUE PROPERTIES OF PERSISTENCE AND ALSO ABILITY TO MIMIC ENDOCRINE HORMONES. THESE CHEMICALS SUCH AS TEFLON AND GORE-TEX FOUND THEIR WAY INTO FROM THE COATING OF FURNITURE TO STUFFING, TO THE FOOD PACKAGING WE USE, EVEN OUR COOKWARE. IN THE SAME DECADE, RESEARCHERS NOTING EARLIER AND EARLIER AGE OF MENARCHE AND DECLINING SPERM COUNTS IN MEN STARTED RAISING QUESTIONS ABOUT RATHER THESE PERSISTING CHEMICALS STARTING TO ALTER ENDOCRINE AND REPRODUCTIVE SYSTEMS IN HUMANS. 1990s, NEW STORIES SHIFTED FROM HUMANS TO AMPHIBIANS AND REPTILES. THESE MALFORMATIONS WERE LINKED TO ENDOCRINE-DISRUPTING CHEMICALS RELEASED INTO WATERWAYS IN THE AMBIENT ENVIRONMENT. THE 2000s SAW EXPANSION IN SCIENTIFIC ACTIVITIES AROUND ENDOCRINE-DISRUPTING CHEMICALS AND REPRODUCTIVE HEALTH, ADULT DISEASES COULD BE ASSOCIATED WITH ENVIRONMENTAL EXPOSURES EARLY IN LIFE AND EVEN EXPOSURES TO PREVIOUS GENERATIONS. THIS LED TO SOMETHING CALLED THE DOHAD HYPOTHESIS, DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE. 2000s SAW EXPANSION OF THE CDC BIOMONITORING PROGRAM, LOOKING FOR HUNDREDS OF CHEMICALS IN BLOOD OF AMERICANS, AND UNFORTUNATELY FINDING THEM IN MEN, WOMEN, AND CHILDREN, VERY FREQUENTLY IN SOME CASES SURPRISINGLY FREQUENTLY. LASTLY, I HIGHLIGHT RECOGNITION OF THE IMPORTANCE OF GENDER FOR UNDERSTANDING THE IMPACTS OF AND MS COMBATING EFFECTS OF CLIMATE CHANGE AND ENVIRONMENTAL CHANGES MORE BROADLY, AND I PICKED THE DATE OF 2014, THIS IS HALLMARK DATE IN THE U.N. FRAMEWORK CONVENTION ON CLIMATE CHANGE WHICH MONITORS GLOBAL RESPONSE TO CLIMATE CHANGE WHEN IT ADOPTED SOMETHING CALLED LIMA WORK PROGRAM ON GENDER, WHICH REQUIRES ALL COUNTRIES TAKE A GENDERED PERSPECTIVE AND LOOK AT GENDER IN THE IMPACTS OF CLIMATE CHANGE AND ALSO SOLUTION SPACE. SO THE STORY OF ENDOCRINE-DISRUPTING CHEMICALS STARTS WITH DIETHYL SYLBESTROO, DES, MILLIONS OF WOMEN WERE EXPOSED IN THE UNITED STATES IN EUROPE AND ALSO IN AUSTRALIA PRIOR TO THE 1960s, THALIDOMIDE AWAKENED PHYSICIANS THAT FETUSES ARE NOT PROTECTEDDED BY PLACENTA BUT WERE VULNERABLE, IT WAS THE DES CATASTROPHE IN THE 1960s AND '70s THAT BROAD GREATER AWARENESS TO THE PHENOMENON OF ENDOCRINE DISRUPTION AND MULTI-GENERATIONAL IMPACTS OF IN UTERO EXPOSURE TO FEMALE CHILDREN IN PARTICULAR. BEYOND SENTINEL FINDINGS, CHILDREN SUFFERED DISRUPTIONAL PROJECTS AND DES WAS STILL GIVEN TO LIFE LIVESTOCK IN THE 1979 AS A FEED ADDITIVE. YOU REMEMBER THE TIMELINE I SHOWED MENTIONED BIOMONITORING, AND HERE IS ONE GRAPH DEMONSTRATING HOW WIDESPREAD EXPOSURES WERE, ON THIS GRAPH FROM 2004, SHOWING POPULATION OF PREGNANT WOMEN, I MENTIONED SOME OF THESE FINDINGS WERE KIND OF SURPRISING, THIS WOULD BE ONE OF THEM. THE CHEMICALS REPRESENTED BY THOSE BLUE, ORANGE, GREEN AND PURPLE BARS HAVE ENDOCRINE DISRUPTING POTENTIAL, LIKE ORGANOCHLORINE PESTICIDES, THALLATES, PFAS, EVEN THE LEAST EXPOSED WOMAN REPRESENTED BY THE BAR AT THE FAR LEFT OF THIS GRAPH HAS WELL OVER 25 OF THESE CHEMICALS IN HER BODY, EVEN THE MOST EXPOSED WOMAN IN THIS SET HAS MORE, EXPOSURES WERE COMMON, MULTIPLE, PRETTY UNIVERSAL. MOST ENDOCRINE-DISRUPTING CHEMICALS HAVE CHEMICALS STRUCTURES SIMILAR TO THE BODY'S HORMONES. THIS SLIDE SHOWS MANY MECHANISM SHOWS HOW THEY MIMIC AND CAN STIMULATE OR BLOCK HORMONE RECEPTORS, CHANGE A CELL'S SIGNALING MECHANISMS WHICH LEADS TO DOWNSTREAM KIND OF EFFECTS, AND IN SOME CASES EVEN CAUSE CHANGES TO THE EXPRESSION OF DNA, THROUGH SOMETHING CALLED EPIGENETIC ALTERATIONS, EPIDEMIC ALTERATIONS ARE METHYLATION OF THE DNA MOLECULE, WHICH AFFECTS ITS EXPRESSION AND ALSO CHANGES TO THE HISTONE STRUCTURES AND HISTONES ARE PROTEINS THAT HELP TO COIL UP OR UNRAVEL DNA AND CONTROL ITS EXPRESSION AS WELL. THESE EPIGENETIC MECHANISMS, CHANGES TO METHYLATION OR HISTONES, CAN BE INHERITED AND THEY ARE ONE OF THE WAYS THESE EXPOSURES CAN PROPAGATE HEALTH EFFECTS ACROSS MULTIPLE GENERATIONS. THIS ILLUSTRATION ILLUSTRATES THIS KIND OF TRANSGENERATIONAL EFFECTS IN A MORE VISUAL WAY. YOU CAN SEE IN THE RIGHT PICTURE WILL BECOME MATURE OOCYTES WHEN THE FETUS IS BORN, BECOMES A WOMAN OF REPRODUCTIVE AGE AND THAT WOMAN'S CHILD, DIRECT EFFECT ON OOCYTES CAN MANIFEST IN THE GRANDCHILD EXPOSED PREGNANT WOMAN. IN ORDER TO REACH THE GREAT GRANDCHILD, F3 GENERATION, THERE HAS TO BE HERITABLE CHANGE SUCH AS CHANGES I JUST MENTIONED, INCREASINGLY UNDERSTOOD THROUGH STUDYING EPIGENETIC ALTERATIONS I JUST MENTIONED. MOST EFFECTS OF DES WE'VE BEEN TALKING ABOUT WERE OBSERVED THROUGH F2 GENERATION, THROUGH THE GRANDCHILD, BUT AS THE F3 GENERATION IS BORN, GROWS, MATURES, FURTHER STUDY MAY FIND MORE EFFECTS BEING INHERITED IN THIS FASHION. THIS TABLE ILLUSTRATES THE MULTIPLICITY OF EFFECTS OF ENDOCRINE-DISRUPTING CHEMICALS IN THE FACT THAT DIFFERENT CHEMICALS CAN CAUSE SLIGHTLY DIFFERENCE RESPONSES FROM ENDOCRINE SYSTEMS. FOR EXAMPLE, LOW MOLECULAR WEIGHT THALLATES, LOW WP ON THIS TABLE, CAN LEAD TO EARLIER GROWTH SPURTS, HIGH MOW ELECTRIC ALREADY WEIGHT THALLATES SHOWN TO DELAY GROWTH, THIS COMPLEXITY AND MIXTURE OF EFFECTS ESPECIALLY COMBINED WITH THE MULTIPLE EXPOSURE WE'VE SHOWN MAKES IT DIFFICULT TO DETECT A SIGNAL TO DETECT POPULATION LEVEL CHANGES IN REPRODUCTIVE HEALTH OR OTHER KINDS OF HEALTH IMPACTS. UNDERSTANDING ON AN INDIVIDUAL BASIS, THESE CHEMICALS CAN HAVE POTENTIALLY SERIOUS CONSEQUENCES FOR REPRODUCTIVE HEALTH LEADING TO EFFORTS TO REDUCE EXPOSURES TO ENDOCRINE DISRUPTORS, THROUGH VARIETY OF REGULATORY MECHANISMS. I'D LIKE TO CONSIDER AIR POLLUTION. WE'VE NOPE FOR MANY YEARS AIR POLLUTION CAUSES EXACERBATION WITH YOUNG DISEASES LIKE ASTHMA AND COPD, CAN CAUSE HEART DISEASE, HEART ATTACKS, PREMATURE DEATH FOR BOTH SEXES, MORE RECENT RESEARCH HIGHLIGHTED IMPACTS OF PRENATAL EXPOSURE TO AIR POLLUTION ON THE DEVELOPING BRAIN AND ORGANS AS WELL AS DOCUMENTING ADVERSE NEUROLOGICAL IMPACTS ON WOMEN TOWARDS END OF LIFE. THIS ILLUSTRATION SHOWS SOME MECHANISMS BY WHICH AIR POLLUTION AFFECTS BRAIN AND SOME OTHER EFFECTS. THIS INCLUDES ON THE RIGHT YOU CAN SEE NUMBER ONE THAT SHOWS DIRECT TRANSPORT OF OXIDIZING AIR POLLUTANTS THAT MAY DEPOSIT IN NASAL PASSAGES AND GET TRANSPORTED TO THE BRAIN VIA OLFACTORY NERVES, SECOND IS STIMULATION OF INFLAMMATION CASCADES AND TRANSPORT OF INFLAMMATORY CYTOKINES THROUGH BLOOD CIRCULATION TO HARM THE BLOOD VESSELS BUT ALSO GET INTO THE BRAIN BY THAT MECHANISM. THIRD MECHANISM SHOWN HERE IS ALTERATIONS OF THE GUT MICROBIOME, RESEARCH SHOWING AIR POLLUTION CAN ALTER GUT MICROBIOME AND WE'RE LEARNING HOW THAT INTERACTS WITH THE BRAIN AND CAN CAUSE CHANGES IN BRAIN FUNCTION AND STRUCTURE. YOU CAN SEE FINE PARTICULATE MATTER, PM 2.5, HAS ALSO RECENTLY BEEN SHOWN TO DIRECTLY AFFECT WOMEN'S FECUNDITY. A WIDE RANGE OF HEALTH EFFECTS FOR MEN, WOMEN AND CHILDREN, SOME UNIQUE TO WOMEN'S SITUATION. THERE'S ANOTHER ASPECT UNIQUE TO WOMEN'S SITUATION, WHICH IS THE FACT WOMEN ARE PREDOMINANTLY EXPOSED TO HOUSEHOLD AIR POLLUTION, A PROBLEM OF GLOBAL SCALE, RELATED TO THE INDOOR COMBUSTION OF BIOFUELS AMONG THE POOREST POPULATIONS. WOMEN AND CHILDREN ARE THE MOST EXPOSED TO HOUSEHOLD AIR POLLUTION, LEADING TO ENORMOUS TOLL OF LUNG DISEASE AND INFECTION, HEART AND BRAIN DISEASE, PREMATURE DEATH, CAN YOU SEE THE QUOTE FROM DR. BUSTREO FROM THE W.H.O. CONFIRMING FOR WOMEN IN LOW AND MIDDLE INCOME COUNTRIES HOUSEHOLD AIR POLLUTION IS THE SINGLE LEADING ENVIRONMENTAL HEALTH RISK. AS WE CONSIDER BOTH ENDOCRINE DISRUPTING CHEMICALS AND EFFECTS THROUGHOUT LIFE STAGES, NEED TO CAPTURE AS WELL AS WE POSSIBLY CAN TOTALITY OF EXPOSURES, ALL EXPOSURES THROUGHOUT THE LIFE COURSE FOR RESEARCH PURPOSES STARTS TO BECOME CLEAR. CHRISTOPHER WILD COINED THE TERM EXPOSOME TO CONVEY THE SAME APPROACH TO UNDERSTAND ENVIRONMENTAL EXPOSURES RESEARCHERS WERE US ING WITH GENOME TO CONVEY STRUCTURE OF DNA. THIS SHOWS HOW MEASUREMENTS CAPTURE EXPOSOME OF DEVELOPING CHILD. THE EXPOSOME IS MORE THAN AIR POLLUTANTS.. ENVIRONMENTAL FACTORS LIKE WALKABILITY AND GREEN SPACE TO SOCIAL AND POLITICAL ENVIRONMENT THAT LEADS TO STRESS AND CONSTRAINED MOBILITY ALL OF THESE CAN HAVE ENORMOUS IMPACTS ON OUR HEALTH, PHYSICAL AND MENTAL HEALTH, AND THIS SLIDE SHOWS THAT OTHER ASPECTS OF OUR ENVIRONMENT INCLUDING EXTREME WEATHER EVENTS AND PROLONGED CLIMATE ABNORMALITIES ALSO HAVE PROFOUND EFFECTS ON HEALTH OF ALL OF US. THIS SLIDE ILLUSTRATES PATHWAYS AND CONSEQUENT HEALTH OUTCOMES BY WHICH CLIMATE CHANGE AFFECTS HEALTH AND WELL BEING, FOR EACH PATHWAYS, WOMEN MAY HAVE UNIQUE EXPOSURES, SUSCEPTIBILITY AND RISKS, I'LL GO INTO DETAIL ON TWO IN A MOMENT. WHEN WE UNDERSTAND FROM GENDER PERSPECTIVE MUST TAKE INTO ACCOUNT CONTEXTS OF THESE CLIMATE CHANGE EXPOSURES. THESE INCLUDE CO-EXPOSURES TO AIR POLLUTION AND OTHER CHEMICALS, INCLUDES CONSTRAINTS ON MEN AND WOMEN BY POVERTY, OFTEN PUTTING THEM POVERTY, LACK OF EDUCATION, DISCRIMINATION AND SOCIOECONOMIC FACTORS LEADING TO DISPROPORTIONATE EXPOSURES TO A WIDE VARIETY OF ENVIRONMENTAL RISKS. AND THEN ALL OTHER CONTEXT OF GOVERNANCE, LAND USE, AND URBAN AND RURAL INFRASTRUCTURE AMONG OTHER FACTORS. ALL CONTEXTS INFLUENCE WHETHER OR NOT AN INDIVIDUAL GETS EXPOSED, WHETHER OR NOT THEY HAVE A HARMFUL HEALTH EFFECT FROM BEING EXPOSED, AND WHETHER OR NOT THEY ARE ABLE TO BE ABLE TO BE RESILIENT TO THOSE RISKS. SO THIS TABLE WHICH IS ADAPTED FROM A PAPER WRITTEN WITH COLLEAGUES FROM UNIVERSITY OF COLORADO AND UNITED KINGDOM ILLUSTRATES SOME OF THESE FACTORS FROM WOMEN'S HEALTH PERSPECTIVE, EXPERIENCING UNIQUE HEALTH RISKS FROM EXTREME HEAT OR CLIMATE RELATED DISASTERS FOR SEVERAL REASONS. SOME HAVE TO DO WITH BIOLOGICAL FACTORS THAT HEIGHTEN RISK, LIKE HIGHER WORKING METABOLIC RATE OR REDUCED ABILITY TO SWEAT AND COOL, MAKES WOMEN IN SOME CASES MORE SUSCEPTIBLE TO ADVERSE CONSEQUENCES OF HEAT EXPOSURE BUT OTHER REASONS HAVE TO DO WITH POLITICAL OR CULTURAL FACTORS AND DISCRIMINATION. RECOGNITION OF THE IMPORTANCE OF THESE FACTORS FOR WOMEN'S HEALTH IS A PART OF THE DRIVE BY THE GLOBAL ORGANIZATIONS COMBATING CLIMATE CHANGE AND EFFECTS FORCE GENDER PERSPECTIVE TO ADDRESS WOMEN COMPREHENSIVELY. FOR EXAMPLE, HIV/AIDS IS NOT GENERALLY THOUGHT OF AS BEING A CLIMATE SENSITIVE DISEASE, AND YET THERE ARE CONNECTIONS BETWEEN CLIMATE CHANGE, DROUGHT, POPULATION DISPLACEMENT AND VULNERABILITY OF YOUNG WOMEN, THE STORY ABOUT THIS STUDY PUBLISHED IN PLOS MEDICINE DEMONSTRATES. SO HAVING FOCUSED MY TALK ABOUT THE UNIQUE RISKS WOMEN FACE TO THEIR HEALTH FROM ENVIRONMENTAL EXPOSURES, I'D LIKE TO RETURN TO THE STORY HONORING WOMEN'S CONTRIBUTIONS TO BRINGING HUMAN SOCIETY TO GREATER HARMONY WITH PLANET ENVIRONMENT AND START WITH THIS QUOTE FROM A LEADING THINKER IN THE ROLE OF WOMEN IN SUSTAINABILITY, AND YOU CAN SHE SAYS WE'RE GOING TO HAVE A FUTURE WHERE WOMEN LEAD THE WAY TO MAKE PEACE WITH THE EARTH OR WE'RE NOT GOING TO HAVE A HUMAN FUTURE AT ALL. I I WANT TO RECOGNIZE THE EFFORT OF WOMEN TO EFFECT CHANGE AFTER THE SHIRTWAIST FIRE, INCLUDING THE MOMS CLEAN AIR FORCE AND SILENT SPRING INSTITUTE WHICH IN CASE OF CLEAN AIR FORCE DEALS WITH AIR POLLUTION, SILENT SPRING FOCUSES ON ENDOCRINE-DISRUPTING CHEMICALS AS WELL AS GLOBAL GROUPS LIKE THE WOMEN'S EARTH ALLIANCE AND WOMEN'S ENVIRONMENT AND DEVELOPMENT ORGANIZATION. AND I WANT TO ALSO RECOGNIZE SOME OF THE GREAT INDIVIDUAL WOMEN LEADERS IN ENVIRONMENTAL HEALTH ISSUES, THAT'S RACHEL CARSON, NEXT THE LEAD OF THE U.N. FRAMEWORK CONVENTION ON CLIMATE CHANGE HELPING TO ADDRESS THE IMPACTS OF CLIMATE CHANGE AND REDUCE THEM, IN THE MIDDLE WROTE A SENTINEL REPORT ON SUSTAINALITY AND LATER BECAME HEAD OF WORLD HEALTH ORGANIZATION, NEXT TO HER IS GINA McCARTHY, LEADING ADVOCATE FOR HEALTH AS THE ADMINISTRATOR OF ENVIRONMENTAL PROTECTION AGENCY AND TO THE RIGHT IS THE NEXT GENERATION, GRETA THUNBERG. FINALLY PROJECT DRAWDOWN ANALYZE THE TOP 100 MEASURES TO REDUCE GREENHOUSE GAS EMISSIONS INCLUDING TWO ASPECTS FAMILY PLAN AND EDUCATING GIRLS, THE SINGLE GREATEST STEP THAT CAN BE TAKEN TO REDUCE GREENHOUSE GAS EMISSION IF YOU COMBINE THEM. WE COME FULL CIRCLE. UPLIFTING OF WOMEN AROUND THE WORLD IS ESSENTIAL TO SURVIVAL OF THE PLANET. I HOPE THIS TALK RAISED YOUR AWARENESS AND SPURRED THOUGHTS ON THE CONNECTION BETWEEN ENVIRONMENT AND WOMEN'S HEALTH, AND I THANK YOU FOR YOUR ATTENTION. >> I'M DR. SHANNON HUNTER, AND I AM ASSOCIATE DIRECTOR FOR BASIC AND TRANSLATIONAL RESEARCH AT THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. I'M PROUD TO INTRODUCE DR. SHAHEEN LAKHAN, EXECUTIVE DIRECTOR OF GLOBAL NEUROSCIENCE INITIATIVE FOUNDATION, PROFESSOR OF NEUROSCIENCE AND VIRGINIA TECH AND CONSULTANT WITH CAMBRIDGE ALLIANCE, A PHYSICIAN-SCIENTIST, OVER 15 YEARS OF EXPERIENCE FROM ACADEMIA AND INDUSTRY FOCUSING ON NEUROSCIENCE RESEARCH. HE IS BOARD CERTIFIED IN NEUROLOGY AND PAIN MEDICINE, CLINICAL TRAINING FROM CLEVELAND CLINIC AND MASS GENERAL HOSPITAL. HE'S EXPERT IN COMPREHENSIVE HOLISTIC PATIENT EMPOWERING PAIN MANAGEMENT AND PATIENT-CENTRIC CLINICAL DEVELOPMENT OF DRUGS, MEDICAL DEVICES, AND DIGITAL THERAPEUTICS. DR. LAKHAN'S RESEARCH FOCUSES ON USING ADVANCED TECHNOLOGIES, SUCH AS WEARABLES, ARTIFICIAL INTELLIGENCE, AND MACHINE LEARNING IN COORDINATED PLATFORMS FACILITATING BRAIN HEALTH AND WELLNESS AND SERVES PATIENTS AS PRACTICING NEUROLOGIST AND PAIN SPECIALIST IN DEVELOPMENT OF PAIN MANAGEMENT AND SERVICE LINE AT CAMBRIDGE HEALTH ALLIANCE. IN ADDITION TO CLINICAL SERVICE, DR. LAKHAN HAS RESEARCH, EDUCATION, ADVOCACY AND PHILANTHROPY PORTFOLIO WITH PEER-REVIEWED PUBLICATIONS, BOOKS AND BOOK CHAPTERS, RECEIVED SEVERAL PRESTIGIOUS AWARDS, INCLUDING AMERICAN ACADEMY OF NEUROLOGY A B BAKER AWARD, PRESIDENT'S VOLUNTEER SERVICE AWARD, AND PRESIDENT'S CALL TO SERVICE AWARD. PLEASE WELCOME DR. LAKHAN. >> I'M EXCITED TO SPEAK TO YOU TODAY ON PAIN AND ITS MANAGEMENT AND WOMEN. THIS IS A VERY JOYOUS DAY AS WE CELEBRATE THE 30th ANNIVERSARY OF THE OFFICE OF RESEARCH OF WOMEN'S HEALTH. I WISH TO EXTEND THANKS TO DR. DHOTAR FOR THE INVITATION TO SPEAK AT THIS CONFERENCE. THE TALK TODAY IS GOING TO BE ON PAIN AND ITS MANAGEMENT IN WOMEN. AND HERE I PROVIDE SIMPLE OUTLINE. TRULY WE'RE GOING TO FOCUS ON SEX DIFFERENCES IN PAIN, LOOKING INTO THE BIOLOGICAL AND PHYSIOLOGICAL MACHINERY INVOLVED IN THAT SEX BIAS, BEHAVIORS, COPING MECHANISMS, EXPRESSIONS, ALSO IN SEX DIFFERENCES, PROCESS OF CHRONICIFICATION OF PAIN, ACUTE TO SUBACUTE TO CHRONIFICATION AND OF COURSE MANAGEMENT IN CLINICAL PRACTICE. THIS IMAGE MIGHT CONJURE UP EMOTION, THAT'S INTENTIONAL. YOU MIGHT BE SAYING OUCH TO YOURSELF INTERNALLY. THIS IS OBVIOUSLY QUITE A PAINFUL STIMULI, AND YOU CAN HAVE THE PHYSIOLOGICAL STRESS RESPONSE, ACTIVATION OF SYMPATHETIC AUTONOMIC NERVOUS SYSTEM, BLOOD PRESSURE, HEART RATE, SWEAT RESPONSE, PUPILS DILATE. THIS IS A PERFECT INTRODUCTION INTO WHAT IS THE DEFINITION OF PAIN. THIS IS ON THE MINDS OF MANY FOLKS FOR A NUMBER OF DECADES, AND ACTUALLY THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN HAS FINALLY MADE AN ALTERCATION TO THEIR ORIGINAL DEFINITION FROM 1979, TO NOW INCLUDE THE BIOPSYCHOSOCIAL ASPECTS OF PAIN. IN FACT DEFINITION HAS BEEN BROADENED TO BE UNPLEASANT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH OR RESEMBLING THAT WITH ACTUAL OR POTENTIAL TISSUE DAMAGE. YOU CAN SEE THIS IMAGE CONJURES THOSE FEELINGS. IT'S ALSO EXPANDED BY SOME FURTHER NOTES WHERE PAIN IS A PERSONAL EXPERIENCE, IT'S INFLUENCED BY BIOLOGICAL, PSYCHOLOGICAL AND SOCIAL FACTORS, PAIN AND NOCICEPTION ARE DIFFERENT PHENOMENON. PAIN CAN BE INFERRED AND NOT SOLELY BY ACTIVITIES OF THE SENSORY NEURONS, BUT CASCADE OF DIFFERENT SYSTEMS AND INTERACTIONS IN PLACE, AND THROUGHOUT LIFE EXPERIENCES INDIVIDUALS LEARN THE CONCEPT OF PAIN. SO IT IS REALLY A MOVING TARGET. A PERSON'S REPORT OF PAIN SHOULD BE RESPECTED, AND THAT'S GOING TO BE THE TENOR OF OUR WHOLE DISCUSSION TODAY. AND PAIN BEHAVIORS CAN BE VERBAL, THESE ARE LIKE DESCRIPTION OF INTENSITY, VERBAL LIKE OUCH, MOANING, COMPLAINING, NON-VERBAL SUCH AS WITHDRAWING FROM ACTIVITIES, TAKING PAIN MEDICATION, BODY POSTURES RELATED TO PAIN, AND CERTAINLY FACIAL EXPRESSION THAT YOU MIGHT HAVE HAD IN THE COURSE OF OBSERVING THIS PICTURE LIKE GRIMACING ESSENTIALLY. THIS IS A GREAT SCENARIO THAT SHOWS THE TIMES OF 1944 WHEN STUDIES WERE DONE BY CHAPMAN AND JONES, APPLYING HEAT STIMULUS, 118.4 DEGREES FAHRENHEIT TO 321 HEALTHY YOUNG ADULTS, THE MEASURE WAS A PAIN RATING. ANYTHING FROM ZERO TO 100, 100 BEING THE WORST PAIN IMAGINABLE, MOST INTENSE PAIN IMAGINABLE. BY THAT SINGLE PERSON. AND AS YOU CAN SEE, THE MEAN RATING IS 71.8 BUT THERE IS A LARGE SPREAD, EVERYTHING FROM MINUSCULE, SINGLE DIGITS, UP TO THE MAXIMUM PAIN THRESHOLD, SAME STIMULUS, DIFFERENT TYPES OF PEOPLE, AND THIS DATA ILLUSTRATES A VERY DRAMATIC WAY OF INTRAINDIVIDUAL DIFFERENCE AND RESPONSE TO STANDARDIZED EXPERIMENTAL PAIN STIMULI. WE'RE GOING TO FOR THE TALK TODAY SEE HOW SEX PLAYS A ROLE AS A FACTOR. THIS SLIDE GOES THROUGH A MECHANISTIC MODEL. THERE ARE MULTIPLE INTERACTION FACTORS THAT ACTUALLY ALTER OUR NEUROCONNECTIVITY WHEN IT LEADS TO FORMATION AND SUSTENANCE OF PAIN CONDITION, AND BIOPSYCHOSOCIAL MODEL CONCEPTUALIZES INDIVIDUAL DIFFERENCES WITH THESE VERY DYNAMIC COMPLEX REACTIONS, AND EXPRESSIONS VARY ACROSS PEOPLE. IN FACT THIS MODEL DOES NOT DO JUSTICE, THIS EQUATES THAT THEY HAVE EQUAL INPUTS BUT YOU CAN SEE THERE'S DIFFERENT WEIGHTAGES AND DIFFERENT INTERACTIONS ACROSS DIFFERENT FACTORS AT DIFFERENT POINTS OF TIME. SO REALLY PAIN IS SCULPTED BY MOW MOSAIC OF FACTORS UNIQUE TO EACH INDIVIDUAL. THIS IS NOT MEANT TO BE EXHAUSTIVE SEARCH OF BIOLOGICAL, PHYSIOLOGIC AND PATHOPHYSIOLOGICAL DIFFERENCES ON THOSE FACTORS, HOWEVER SOME EXAMPLES, SOME ARE CELLULAR, SOME RECEPTOR LEVEL, SOME ARE THROUGH CLINICAL TRANSLATIONAL RESEARCH. GLIAL CELL FUNCTION, WE ALL KNOW THAT GLIA, MICROGLIA PARTICULARLY, IN THE BRAIN AND PERIPHERY, ARE INSTRUMENTAL IN PAIN PERCEPTION TRANSMISSION. BUT THERE ARE STUDIES DONE AFTER INDUCING MECHANICAL ALLODYNIA IN MICE, INTRATHECAL INJECTION OF GLIAL INHIBITORS REVERSED THAT ALLODYNIA IN MALES BUT NOT FEMALES SUGGESTING MICROGLIA ARE ESSENTIAL FOR MECHANICAL NOCICEPTION IN MALE MICE. THOSE TAKING TESTOSTERONE IN FEMALE TO MALE AFFIRMATION SURGERY ARE IMPROVEMENT IN PAIN. THIRD, THERE'S GROWING AMOUNT OF EVIDENCE THAT THERE'S SEX-SPECIFIC EFFECTS WITH GENES INVOKED IN PAIN PROCESS WITH VARIATION, SOMETIMES POLAR OPPOSITE, WHETHER YOU'RE MALE OR FEMALE. FOR EXAMPLE, COMT IS REFERENCING GENE, ENCODES FOR ENZYMES THAT METABOLIZE CATECHOLAMINE. ALLELES SENSITIZE PAIN IN WOMEN BUT NOT MEN. SAME SAID TO GTP, FUNCTIONAL ALLELES PROTECTIVE FOR NEUROPATHIC PAIN IN MEN BUT PREDISPOSE PAIN IN WOMEN, SAME FOR MU OPIOID RECEPTOR, VARIANTS WITH MINOR ALLELES YIELD GREATER PAIN THRESHOLDS AND EXPERIMENTAL PAIN IN MEN, HIGHER PAIN POST C-SECTION IN WOMEN. NOW, TAKING A BIG LEAP AND APPLYING TO PAIN BEHAVIORS, COPING MECHANISMS AND DEVELOPMENT OF DISEASE STATES, WELL, PREPONDERANCE OF EVIDENCE SUGGESTS WOMEN HAVE GREATER PSYCHOLOGICAL VULNERABILITY TO ACUTE PAIN, ACUTE PHYSIOLOGIC RESPONSES ARE IMPORTANT NOT BECAUSE THEY INFLUENCE SEVERITY BUT THEY CAN PREDICT CHRONIFICATION, THOSE THAT PROGRESS TO CHRONIC PAIN. WOMEN USE COPING MECHANISMS DIFFERENT THAN MEN. FOR EXAMPLE, THOSE THAT ARE MORE EMOTIONAL FOCUSED, SEEKING SOCIAL SUPPORT, RELAXATION, DISTRACTION, WHEREAS MEN TAKE DIRECT ACTION, PROBLEM FOCUSED, DENIAL. WOMEN MORE EXPRESSIVE ABOUT FEELINGS AND SEEKING OUT THAT SOCIAL SUPPORT, WHEREAS MEN ARE MORE ACCEPTING OF THE SITUATION AND ENGAGE FOR INSTANCE IN EXERCISE INSTEAD. WOMEN ARE MORE RESPONSEIVE TO AGGRESSIVELY RESPOND TO MEDICAL INTERVENTIONS THAN MEN AS WELL. NOW, DEPRESSION IS UNIQUELY TWICE AS COMMON IN WOMEN THAN IN MEN, FOR THOSE THAT EXPERIENCE DAILY PAIN SEVERITY. HOWEVER, MEN ON THE OTHER HAND REPORT LOWER PHYSICAL AND PSYCHOLOGICAL QUALITY OF LIFE, WHEN IT COMES TO BEHAVIORS. THIS IS SUCH AN ILLUSTRATIVE SLIDE BECAUSE I KNOW THE FONTS MIGHT BE SMALL BUT WHAT YOU SHOULD GET IS CHRONIFICATION OF PAIN, THERE ARE CLEAR SEX AND GENDER DIFFERENCES IN PAIN THAT ACTUALLY MIGHT BE MORE PRONOUNCED IN THE CLINICAL ENVIRONMENT THAN IN THE LABORATORY. THERE'S HIGH PREVALENCE OF A WIDE RANGE OF THESE PAINFUL CONDITIONS IN WOMEN THAN MEN, ACTUALLY SHOWN IN EVERYTHING OUTLINED IN THE RED BARS THERE. NOW, COUPLE THAT WITH THE VERY FEW CONDITIONS THAT HAVE MALE PREDOMINANCE AND THE REST HAVING MALE TO FEMALE PREDOMINANCE ESSENTIALLY. EQUITY I SHOULD SAY IN DISTRIBUTION. LET'S WHAT SAY YOU? THERE COULD BE DIFFERENT CLINICAL MECHANISMS THAT ARE OPERATING IN MEN VERSUS WOMEN. THERE COULD BE DIFFERENT OR EVEN ADDITIONAL RISK FACTORS RELEVANT TO ONE SEX VERSUS THE OTHER. AND THEN ACTUALLY THERE COULD BE ALL ABOUT THIS COMPOUNDING SMALL DIFFERENCES IN THE MECHANISM, BECOME LARGE ENOUGH DIFFERENCES IN ITS EXPRESSION, MORBIDITY AND MORTALITY, INTERACTION WITH INTERVENTIONS, PHARMACOTHERAPY, FOR INSTANCE. KEEP IN MIND THERE ARE AGE DEPENDENT SEX DIFFERENCES WHEN IT COMES TO THESE CONDITIONS. SUCH AS WOMEN, PARTICULAR AAFTER AGE 60 HAVE HIGHEST PREVALENCE FOR GOUT. BEFORE AGE 60 IT IS A MEN-PREDOMINANT CONDITION. OSTEOARTHRITIS AFTER AGE 45, PREVAILS IN WOMEN. PRIOR TO THAT IN MEN. VARIETY OF FACTORS GONADAL SEX HORMONES, OSTEOPOROSIS RISK, JOINT LAXITY AND VARIOUS OTHER FACTORS, LONGEVITY AND SO ON THAT COULD EXPLAIN IT. THIS IS THE CRUX OF THE MATTER. IN THE PRACTICE OF PAIN MANAGEMENT, THERE ARE DIFFERENCES. THERE ARE PATIENT-SPECIFIC DIFFERENCES THAT I'VE BEEN STRESSING ALL ALONG TO THIS POINT. AND THEN THERE ARE CLINICIAN OR HEALTH CARE SYSTEM-BASED DIFFERENCES THAT WE'LL GO THROUGH. FIRST AND FOREMOST I WANT TO DESCRIBE THE YENTL SYNDROME, APPLIES TO PAIN MANAGEMENT, IF YOU HAVEN'T HEARD OF THIS I URGE YOU TO WATCH THE 1983 FILM WITH BARBRA STREISAND, SHE'S A BILLANT PERFORMANCE, YOUNG JEWISH WOMAN IN POLAND, PRETENDS TO BE A MAN IN ORDER TO RECEIVE AN EDUCATION AND THE FILM'S NAME IS "YENTL." WOMEN ARE MORE LIKELY, THE PHENOMENON, TO BE TREATED LESS AGGRESSIVELY IN THEIR INITIAL ENCOUNTERS OF THE HEALTH CARE SYSTEM ONLY UNTIL THEY PROVE THAT THEY ARE SICK AS MEN. IN FACT, CARDIOVASCULAR DISEASE, M.I.s WERE SOME OF THE EARLIEST DISEASES WHICH THIS WAS TOLD. BECAUSE THE WHOLE BODY OF EVIDENCE CREATED AND RISK STRATIFICATION AND IN THE HISTORY AND EPIDEMIOLOGY WERE MALE DRIVEN, MALE SUBJECT AND PATIENT DRIVEN, THEREFORE THE MODELS WERE NOT APPROPRIATELY DEVELOPED AND VALIDATED TO APPLY TO THE OTHER HALF, ESSENTIALLY, FEMALE POPULATION. AND THAT RELATED TO A LOT OF UNDERDIAGNOSIS, UNDERTREATMENT, TREMENDOUS AMOUNT OF MORBIDITY AND MORTALITY, INDIRECT COST, YOU NAME IT, THE SAME APPLIED IN PAIN MANAGEMENT. IF WE THINK ABOUT ANIMAL MODELS, THE MAJORITY OF ANIMAL EXPERIMENTATIONS IN ANALGESIC RESEARCH IS DONE IN MALE MICE. AND MANY OF THE STUDIES I SHOWED BEFORE WERE INITIALLY DONE IN MALE MODELS THAT SHOWED THERE ARE CLEAR SEX-BASED DIFFERENCES IN GENETICS, IN THE CELLULAR PROCESSES, IN NEUROTRANSMISSION, IN THE CIRCUITRY, YOU NAME IT, YOU HAVE THESE DIFFERENCES IN THOSE MODEL SYSTEMS. ALBEIT BUT MAJORITY OF MALE MODELS WERE USED IN PRE-CLINICAL STATES, BUT WHEN YOU REACH CLINICAL STATES YOU HAVE OBVIOUSLY WOMEN SUBJECTS IN THOSE, THAT MIGHT EXPLAIN A GOOD AMOUNT OF SOME FAILURES IN A WERE LOST IN TRANSLATION, ESSENTIALLY. SO THERE'S BEEN CONCERTED EFFORT TO INCLUDE MORE FEMALE PRE-CLINICAL MODELS WHEN IT COMES TO LOOKING AT THIS, CERTAINLY WOMEN SUBJECTS WHEN IT COMES TO CREATING STANDARDIZATION, NORMATIVE VALUES, AND THINGS OF THIS NATURE, BUT I JUST WANT TO SAY WE CAN ESCAPE THE YENTL SYNDROME IN PRACTICE. LOOK AT THIS INTERESTING STUDY FROM 1992, SURVEY STUDY OF NURSES, ABOUT PATIENTS' EXPERIENCE OF PAIN. THEIR PERCEPTION OF PATIENTS' EXPERIENCES OF PAIN. IF YOU LOOK AT THE STARTLING FACTS, WE LOOK AT PAIN SENSITIVITY FIRST, NURSES THOUGHT THAT 27% OF MEN HAD GREATER PAIN SENSITIVITY THAN WOMEN, COMPARED TO 10% THAT THOUGHT WOMEN HAD GREATER THAN MEN, AND THE REST 63% THOUGHT IT WAS EQUAL. THAT'S FAR FROM THE LITERATURE. IN FACT, THERE'S CONTRADICTORY LITERATURE, PERHAPS IN TOTALITY GREATER PAIN SENSITIVITY IN MEN, 47% OF NURSES THOUGHT WOMEN HAVE GREATER PAIN TOLERANCE THAN MEN, VERSUS 38 EQUITABLE DISTRIBUTION, AND 15 MALE GREATER THAN WOMEN. THIS IS ANOTHER FALLACY DRIVEN BY A VARIETY OF FACTORS, MANY OF THEM GENDER ROLES, WOMEN'S ABILITY TO BEAR CHILDREN, AND SOME SOCIETAL EXPECTATION THAT THAT'S A CREDIBLY PAINFUL PROCESS, TOLERANCE MIGHT BE GREATER, DOES NOT BEAR OUT. THERE'S EVIDENCE OF CONTRARY THAT'S BEEN SUGGESTED. EVEN IN OTHER STUDIES, NURSES SURVEYED ALLOTTED MORE ANALGESIC ADMINISTRATION TIME TO MALE PATIENTS THAN FEMALE PATIENTS, WHEN PRESENTED WITH CLINICAL VIGNETTES AND REALLY ESSENTIAL DIFFERENCES WAS SEX. FASCINATING AMOUNT OF RESEARCH HAS BEEN DONE A COUPLE DECADES AGO ABOUT CONCEPT OF PHYSICAL INTRACTIVITY, SO WHEN CLINICIANS WERE ASSESSING PAIN LEVELS IN PATIENTS, PHYSICAL ATTRACTIVENESS WAS AN INDEPENDENT VARIABLE, PARTICULARLY IN FEMALES, AND FEMALE POPULATION, FEMALE SUBJECTS IN THOSE PARTICULAR RESEARCH. WHERE ADAGE BEAUTY AND HEALTH WAS APPLIED, SO THE THOUGHT THAT THE GREATER PHYSICAL ATTRACTIVITY, THE LESS PRONE TO PAIN ESSENTIALLY, THE LESS PERCEIVED PAIN FOR A VARIETY OF CLINICIANS. ALSO I'D LIKE TO GO ON TO FURTHER TYPES OF RESEARCH, AMONG ALL CHRONIC PAIN REFERRALS, MEN WERE MORE LIKELY TO BE REFERRED BY THEIR PRIMARY CARE DOCTORS VERSUS WOMEN BY SPECIALISTS. SO IF YOU READ BETWEEN THE LINES HERE, MEN GET TRIAGED EARLIER TO PAIN SPECIALISTS, AND WOMEN MIGHT HAVE TO GO THROUGH OTHER HOOPS TO, QUOTE/UNQUOTE VALIDATE THEIR PAIN BECAUSE JUST AS THE NEXT BULLET POINT SHOWS THEIR PAIN IS OFTEN DISCOUNTED AS PSYCHOGENIC, EMOTIONAL, NOT REAL, IN THE HEAD OFTENTIMES. FURTHER LINES OF RESEARCH SO THAT WOMEN PROGRESS FROM OPIOID USE TO DEPENDENCE MORE QUICKLY THAN MEN. AND IN FACT, THESE FINDINGS WERE ACTUALLY VALIDATED IN THE VARIETY OF STUDIES, WITH MULTI-MODAL PAIN REHABILITATION WOMEN IMPROVED IN DAILY LIFE THAN MEN, MIGHT BE MORE RESPONSIVE IN CERTAIN ELEMENTS WHEN IT COMES TO TRULY BIOPSYCHOSOCIAL, COUNSELING, PSYCHOLOGY, PSYCHIATRY, PHYSICAL THERAPY, PLUS MEDITATION, INTERVENTIONAL MANAGEMENT, THE MULTI-MODAL PAIN MANAGEMENT. INTERESTINGLY ENOUGH, ADULT MEN ARE TWO TO THREE TIMES MORE LIKELY TO HAVE DRUG DEPENDENCE OVERALL, BUT THE RATE OF ESCALATION OF DRUG USE IS HIGHER IN WOMEN. THEY SUFFER MORE SEVERE EMOTIONAL AND PHYSICAL CONSEQUENCES FROM OPIOID USE, AND WOMEN ALSO UNDERUTILIZE REHAB OPTIONS. AND THEY HAVE A HIGH LIKELIHOOD OF USING OPIOIDS TO COPE WITH PSYCHIATRIC, PSYCHOLOGICAL SYMPTOMS MUCH MORE THAN MALE COUNTERPARTS ESSENTIALLY. THIS BRINGS ME TO THIS GREAT ARTICLE HERE, APTLY NAMED THE GIRL WHO CRIED PAIN, A BIAS AGAINST WOMEN IN TREATMENT OF PAIN, FROM 2001. AND I THINK IT'S NOTABLE BECAUSE THIS TRULY SHOWED A CONCERTED EFFORT TO, ONE, RECOGNIZE THE PLIGHT OF WOMEN THROUGH WHAT WE'VE CALLED NOW THE YENTL SYNDROME, TO DECLARE PAIN, SHOUT IT THROUGH THE ROOF TOPS TO THE HEARD AND SEEN AND ACTED ON AND TREATED. IT SHOWED THE DIFFERENTIAL PAIN EXPERIENCE, AND JOURNEYS THROUGH HEALTH CARE SYSTEMS FOLKS GO THROUGH, NOT BEING REALLY TAKEN SERIOUSLY, AND NOT FEELING HEARD OR VALIDATED, NOT GIVEN APPROPRIATE RESOURCES, UNDERDIAGNOSED AND UNDERTREATED, DISPLACED, DISENFRANCHISED REALLY FROM THE WHOLE POPULATION. IN FACT THIS IS WHAT LED ME TO INCLUDE THIS NEXT ARTICLE, JUST IN SEPTEMBER, IN THE NEW ENGLAND JOURNAL, THIS POINT OF VIEW ARTICLE, TAKING BLACK PAIN SERIOUSLY, WHICH WAS A BEAUTIFUL NARRATIVE IN LIGHT OF BLACK LIVES MATTERS AND OTHER TYPES OF EFFORTS, TO, ONE, BRING FORTH LIGHT TO SYSTEMIC RACISM AND INJUSTICE IN EVERY INDUSTRY THAT WE COULD IMAGINE IN AMERICA AND EVERY SOCIETY, THAT EXISTS, SUBCULTURES THAT EXIST IN AMERICA. AND PARTICULARLY FROM A BLACK DOCTOR'S POINT OF VIEW. INCREDIBLY MOVING, INCREDIBLY TOUCHING, IF YOU HAVEN'T READ IT I HIGHLY SUGGEST IT. BLACK PATIENTS RECEIVE LESS ANALGESICS FOR FRACTURES IN THE EMERGENCY ROOM, 57% VERSUS 74%, IN THE FACE OF METASTATIC, 35% FOR PEOPLE OF COLOR VERSUS 50% OF PEOPLE NOT. BLACK WOMEN HAVE BEEN HISTORICALLY UNDERDIAGNOSED AND TREATED FOR ENDOMETRIOSIS, A PAINFUL CONDITION DUE TO PERSISTENT STEREOTYPES MORE COMMON IN THESE AFFLUENT WHITE WOMEN, ESSENTIALLY. AND MIND YOU, ALL THE THESE HAD TREMENDOUS NEGATIVE IMPACT ON QUALITY OF LIFE ESSENTIALLY. IN FACT, I ENCOURAGE EVERY INSTITUTION, LARGE AND SMALL, TO READ THE INSTITUTES FOR HEALTH CARE IMPROVEMENT ACHIEVING HEALTH EQUITY GUIDE FOR HEALTHCARE ORGANIZATIONS, IT'S A GREAT FRAMEWORK THAT REALLY FOLLOWS THE FIVE KEY ELEMENTS TO IMPROVE HEALTH EQUITIES. ONE CREATING STRATEGIC PRIORITY FOR HEALTH EQUITY, TWO BUILDING PROCESSES AND STRUCTURES NEEDED TO SUPPORT SUCH A PROGRAM, USE SPECIFIC STRATEGIES TO ADDRESS THE DETERMINANTS OF HEALTH AND REDUCE RACISM AND THEN THE ORGANIZATION EVENTUALLY DEVELOPS COMMUNITY PARTNERSHIPS TO INCREASE HEALTH EQUITY. I MYSELF HAVE SERVED FOR A NUMBER OF YEARS ON HEALTH PROFESSION EDUCATION FOUNDATION, IT IS A PUBLIC/PRIVATE CHARITABLE ORGANIZATION OUT OF CALIFORNIA, TO DATE AWARDED $200 MILLION FOR UNDERREPRESENTED INDIVIDUALS TO PRACTICE IN UNDERSERVED AREAS. AND HELP IN FORMATION OF SUITABLE PIPELINES AND LOAN REPAYMENT, AWARDS, ACROSS THE HEALTH PROFESSION, EVERYTHING FROM LPN, REGISTERED NURSING, PSYCHIATRIC NURSE PRACTITIONERS, TO PRIMARY CARE PHYSICIANS, COUNSELORS, YOU NAME IT WE'VE DONE IT. I SERIOUSLY ENCOURAGE ALL OF US TO BE INVOLVED IN THESE TYPES OF EFFORTS. I DRAW THE PARALLELS BETWEEN THE TWO, TO SHOW THERE'S DIASPORA, NOT TO SHOW THERE'S EQUITABLE JOURNEY BUT THERE ARE INTERACTION OF FACTORS. NO LONGER SHOULD WE BE THINKING THESE ELEMENTS ARE DISCRETE AND INDEPENDENT, I DON'T BELIEVE SEX IN AND OF ITSELF IS A MEDIATOR OF PAIN. IT'S HOW IT'S INFLUENCED OR IMMUNOGENICITY, OUR INHIBITION, EXTRAGLIAL PATHWAYS, HOW WE PRESENT WITH PAIN, HOW WE SEEK OUT HEALTH CARE, COPING MECHANISMS, BIASES THAT EXIST WITHIN OURSELVES AS PATIENTS, AS PROVIDERS, AS POLICYMAKERS, ESSENTIALLY, INCREDIBLE INFLUENCE. THESE ARE ALL MULTI-FACTORIAL INTERACTIONS. IN FACT, I'M OFTEN REMINDED FROM FOLKS, SOME COLLEAGUES, SOME NOT, THAT SAY BECAUSE OF MANY OF THESE PRACTICES TO DISCOUNT OUR UNDERVALUE PAIN IN PEOPLE OF COLOR, PARTICULARLY BLACKS, THEY WERE SOMEHOW PROTECTED, PERVASIVE TERM OF PROTECTION AGAINST OPIOID EPIDEMIC, FAR FROM THE TRUTH. YES, PRESCRIPTION OPIATES, YES, PRESCRIPTION OPIATES WERE UNDERUTILIZED RELATIVE, YOU KNOW, FROM BLACKS TO NON-BLACKS ESSENTIALLY. HOWEVER, THE OPIOID EPIDEMIC DEFINITELY EXISTS IN THIS PATIENT POPULATION. THERE IS DOWNSTREAM EFFECTS OF UNDERTREATING CHRONIC PAIN CONDITIONS, AND ONE OF THOSE OUT OF MANY, NEEDLESS SUFFERING, QUALITY OF LIFE, LACK OF RETURN TO WORK, SCHOOL, OR PRODUCTIVITY, ALL THOSE OTHER FACTORS, ALSO SOME DISPLACEMENTS, BLACK MARKET, USING OTHER ILLEGAL TYPES OF SUBSTANCES AND SO ON BECAUSE OF UNDERTREATMENT, UNDERUTILIZATION ESSENTIALLY IN THE SYSTEM. THERE'S A VARIETY OF PER VASION, MISTRUST FROM THE PAST. IF YOU LOOK AT TUSKEGEE TRIALS IN SYPHILIS, HENRIETTA IN OB/GYN, ALL OF THIS IS INDICATIVE OF SYSTEMIC RACISM ESSENTIALLY AND PARTICULARLY PILLARS OF THE CASTE SYSTEM TO UPHOLD. FIRST DEHUMANIZE MARGINALIZED POPULATIONS, THE OPPRESSED, THE SO-CALLED INFERIOR CASTE ESSENTIALLY, AND SECOND CLAIM MORAL DOMINANCE OVER THE SUBJECTED POPULATION. AND THAT COULD BE PRESCRIPTIVE AUTHORITY, FOR INSTANCE WHO TRIAGES WHO TO APPROPRIATE LEVELS OF CARE, THEY CERTAINLY EXIST. I WANT TO LEAVE TAKEAWAYS BEHIND THAT SEX IS A RELEVANT FACTOR IN PAIN AND ANALGESIA RESEARCH, I GAVE YOU EXAMPLES OF SHORTFALLS IN PRE-CLINICAL MODELS AND MECHANISMS THAT SHOULD IMMEDIATELY BE CHANGED. TWO HEALTHCARE AND CLINICAL PRACTICE THERE'S A VARIETY OF HEALTH DISPARITIES, ALL AS A RESULT OF SEX AND OTHER INTERACTIONS AS I'VE SHOWN YOU, RACE BEING ANOTHER. AND THEN PATIENT'S PAIN EXPERIENCE, AND I STARTED OFF WITH THAT CHART THAT SHOWED YOU 321 INDIVIDUALS THAT HAD THERMAL STIMULI, YOU SAW THEIR PAIN RATINGS THROUGHOUT FROM ZERO TO 100. YES, WHAT EXPLAINS EACH AND EVERY ONE OF THOSE POINTS DIFFERENCES IS UNIQUE CONSTRUCTS. THAT CONSTRUCT IS NOT JUST THE PHYSICAL GENETIC BIOLOGICAL CONSTRUCTS BUT IT'S THE ENVIRONMENT, IT'S YOUR DEVELOPMENT, YOU KNOW, IT IS YOUR PERCEPTION OF WHAT PAIN IS OR WHAT IS APPROPRIATE FOR YOU TO DISPLAY WITHIN YOURSELF, AND IN LARGER GROUPS AND SOCIETIES, AND THEREFORE WHO ACTS AS HEALTH CARE WHEN IT EXCEEDS TOLERANCE LEVEL ESSENTIALLY. IT'S A MOSAICISM, THAT'S WHAT I HAVE BEEN THROUGH DEVELOPMENT OF INTERDISCIPLINARY PAIN MANAGEMENT PROGRAMS, A STAUNCH ADVOCATE OF ATTACKING PAIN, PARTICULARLY CHRONIC PAIN THROUGH MULTIPLE AVENUES, UNDERSTANDING SOME POPULATIONS ARE MORE RECEPTIVE THAN OTHERS, I'VE EXPLAINED SOME OF THAT, THAT ARE SEX DIFFERENCES, BUT MAKING THOSE AVAILABLE ON WIDE SCALES IS QUITE IMPORTANT. ON THAT NOTE, HERE ARE SOME REFERENCES, WHEN YOU HAVE SOME LEISURE TIME TO REVIEW. I'LL CERTAINLY TAKE ANY QUESTIONS DURING OUR Q&A PERIOD AND OF COURSE FEEL FREE TO E-MAIL ME AT SLAKHAN@GNIF.ORG. THANK YOU SO MUCH FOR YOUR TIME. >> HI, EVERYBODY. THERE'S SOME TECHNICAL DIFFICULTIES BUT DR. BALBUS, WE COULD GET STARTED WITH THE ROUND OF QUESTIONS THAT'S IN THE QUEUE. >> SURE, FIRST, THANK YOU. GOOD AFTERNOON, EVERYBODY. THANK YOU FOR JOINING US TODAY. WE HAVE SOME QUESTIONS THE MODERATOR HAS POSED, WE WELCOME YOU ALSO TO PUT YOUR OWN QUESTIONS INTO THE Q&A BOX IN THIS LAB ROOTS PLATFORM. SO, ONE QUESTION THAT WAS COMING MY WAY, I DISCUSSED SOME TRANSGENERATIONAL EFFECTS OF EXPOSURES, THE QUESTION WAS WHAT STUDY DESIGN OR MEASUREMENT CHALLENGES EXIST. AND AS YOU CAN IMAGINE, THERE ARE MANY FOR BEING ABLE TO DO A STUDY OVER MULTIPLE GENERATIONS. ONE OF THE INTERESTING ASPECTS OF WHAT I SHOWED YOU IS THAT THE BIG EXAMPLES I TALKED ABOUT HAD EITHER VERY OBVIOUS EXPOSURES LIKE TAKING A SPECIFIC DRUG, OR A DISASTER, THE SEVESO DISASTER CLEARLY MARKED IN TIME BUT ALSO HAD EXTENSIVE EXPOSURE ASSESSMENT, AND TRYING TO MEASURE EVERYTHING, ALL OF THE ENDOCRINE DISRUPTING CHEMICALS, LEAD, MERCURY, AIR POLLUTION AND SO ON THAT PEOPLE ARE EXPOSED TO OVER THEIR LIVES. IT'S A WHOLE LOT HARDER TO BE ABLE TO TRY TO CAPTURE EXPOSURE TO THOSE KINDS OF THINGS, YOU KNOW, EVEN LAST YEAR LET ALONE IN YOUR CHILDHOOD, LET ALONE YOUR GRANDMOTHER'S EXPOSURES TO THOSE THINGS. SO, THAT'S ONE OF THE BIG CHALLENGES THAT WE'RE GRAPPLING WITH. SOME OF THAT IS COMING FROM THE USE OF UNUSUAL KINDS OF DATA SOURCES, BIG DATA SOURCES, HISTORICAL GEOSPATIAL, REMOTE DATA, SOME THROUGH INNOVATIVE THINGS LIKE THERE ARE PEOPLE WHO ARE TAKING BABY TEETH AND DOING LASER DISSECTION OF BABY TEETH IN ORDER TO CAPTURE THINGS LIKE METALS THAT GET DEPOSITED IN TEETH AS A BABY. SO THAT'S ONE OF THE INTERESTING CHALLENGES THAT'S GOING ON THAT I THOUGHT WOULD BE WORTH SHARING. >> THANK YOU. OUR NEXT QUESTION IS FOR DR. LAKHAN. HOW DOES THE NIH POLICY ON SEX AS A BIOLOGICAL VARIABLE ADVANCE PAIN RESEARCH? >> OH, GREAT. THANK YOU FOR THAT QUESTION. I HATE TO ADMIT BUT YES, POLICY DOES DRIVE RESEARCH, HAS TREMENDOUS INFLUENCE, ON MYSELF, FEDERALLY FUNDED PROJECTS BUT MORE RENTLY IN INDUSTRY, AND ALL THIS TRICKLES DOWN. ONE, RECOGNIZING THAT YES, THIS IS A BIOLOGICAL VARIANT THAT SHOULD BE INVOLVED IN CERTAINLY RESEARCH DESIGN, OUTPUT, INTERPRETATION, THERE NEEDS TO BE VALID RATIONALE FOR EXCLUDING ANY POPULATION, INCLUDING EFFECT AS BIOLOGIC OR POPULATION LEVEL PARAMETER, I THINK IT'S QUITE A GOOD MOVE, BEING IMPLEMENTED AND DOCUMENTED. GIVEN A LITTLE BIT OF EXPOSURES OF THE PAIN INDUSTRY, AND PAIN CLINICAL TRIALS, HEAVILY WEIGHTED BY MALE PREDOMINANT PRE-CLINICAL MODEL, THAT HAS BEEN SHIFTING OVER THE YEARS, OVER THE PAST COUPLE DECADES, CERTAINLY THIS POLICY WILL ACCELERATE THOSE EFFORTS. AND ACTUALLY ENCOURAGE MUCH RESEARCH INTO THE UNDERPINNINGS OF WHY DIFFERENTIAL EFFECTS EXIST AND RESPOND TO DIFFERENT STIMULI, DIFFERENT TREATMENT, HOW DOES IT FACTOR TOGETHER. CERTAINLY IT WILL BE AN ADVANCEMENT IN PAIN RESEARCH. >> THANK YOU. THE NEXT QUESTION IS FOR BOTH OF YOU. WE CAN PERHAPS GO ALPHABETICALLY. WHAT RECENT INNOVATION IN YOUR FIELD IS MOST EXCITING TO YOU AND WE COULD BEGIN WITH DR. BALBUS. >> GREAT. THANKS FOR THAT QUESTION. IN THE FIELD OF ENVIRONMENTAL HEALTH GENERALLY THERE HAVE BEEN INNOVATIONS OVER THE PAST COUPLE YEARS THAT I FIND REALLY EXCITING. ONE IS AT THE SOCIAL LEVEL, DEVELOPMENT AND NIEHS HAS BEEN A LEADER IN THIS IN THE UNITED STATES AND INCREASINGLY GLOBALLY. IN SOMETHING CALLED COMMUNITY-BASED PARTICIPATORY RESEARCH, IN OTHER WORDS ENVIRONMENTAL EXPOSURES ARE AFFECTING PEOPLE IN THE PLACES WHERE THEY LIVE, AND CHANGING THE RESEARCH PARADIGM FROM RESEARCHER KIND OF SWOOPING IN AND STUDYING A POPULATION TO A PARADIGM WHERE THERE IS CO-DEVELOPMENT OF THE RESEARCH QUESTIONS, CO-PRODUCTION OF KNOWLEDGE WITH THE PEOPLE WHO ARE AFFECTED, IS A REALLY EXCITING INNOVATION, NOT JUST FOR DISADVANTAGED COMMUNITIES OR EXPOSED COMMUNITIES IN THE U.S. BUT REALLY GLOBALLY. THE OTHER THING I'LL MENTION REAL QUICKLY IS KIND OF RELATED TO THE LAST QUESTION, WHICH IS SOME OF THE INNOVATION AND EXPOSURE ASSESSMENT, PART OF THIS HAS TO DO WITH THE EXPANSION OF SATELLITE DATA AND OTHER REMOTELY SENSE DATA THAT ARE ABLE IN COMBINATION WITH SOME OF THE COMPUTING CAPABILITIES EVOLVING TO BE ABLE TO CONVERT WHAT SATELLITES CAN SEE, ABSORPTION OF RADIATION, THOSE KINDS OF THINGS, INTO ESTIMATES OF THINGS LIKE AIR POLLUTION EXPOSURE, OR USING REALLY HIGH RESOLUTION IMAGERY TO SEE HAZARDOUS WASTE SITES OR NEARBY EXPOSURES IN THE ENVIRONMENT. SO THAT COMBINATION OF BRINGING IN THE EARTH SCIENCES WHICH IS SOMETHING WE'RE DOING A LOT AT NIEHS WITH THE HEALTH SCIENCES IS A REALLY EXCITING INNOVATION RELEVANT TO ALL KINDS OF EXPOSURES, BUT ESPECIALLY TO THE CLIMATE AND DISASTER-RELATED EXPOSURES. >> THANK YOU. DR. LAKHAN? >> OH, SURE, I'LL TAKE A STAB AT THIS. I THINK MANY COLLEAGUES WILL FIRST STATE THAT MEDICAL DEVICE INNOVATIONS IN PAIN MANAGEMENT, NEUROSTIMULATORS FOR PERIPHERAL NERVES, TRIGEMINAL NEURALGIA, INSERTING AN ELECTRODE STIMULATING IT TO BLOCK A SIGNAL, SAME CAN BE DONE WITH SPINAL CORD, DORSAL COLUMN STIMULATORS ARE MORE COMPACT, LESS INVASIVE, COVERING MORE VARIETY OF DISEASES. OTHERS OF MY COLLEAGUES WOULD SAY RECENTLY GAVE A TALK AT THE AMERICAN COLLEAGUE OF NEUROLOGY, CHOLINERGIC RECEPTORS, AND ACTUALLY I BELIEVE IT'S THIS DIGITAL HEALTH FRONT, SO WE'RE IN THIS INTERESTING TIME IN THE COVID-19 CRISIS WHEN THE SILVER LININGS, TELEMEDICINE, TELEHEALTH HAS BROKEN DOWN BARRIERS IN ACCESS, INCLUDING PATIENTS, PAYERS, POLICYMAKERS, REGULATORS, ALL OF THEM ALIGNING FROM ELIMINATING CO-PAYMENTS AND CO-INSURANCE, DEDUCTIBLES, AND SO ON, I THINK THE NEXT REVOLUTION THIS FRONT WILL BE SOMETHING I CALL SPATIAL THERAPEUTICS, DIGITAL HEALTH ECOSYSTEM, TRULY THE INCORPORATIONS OF ACTIVE AND PASSIVE DATA CONNECTION. WE CARRY A SMARTPHONE, NOT JUST TO TEXT AND BROWSE AND FACETIME AND FACEBOOK. THERE ARE A MULTITUDE OF SENSOR THAT COULD MEASURE HEALTH INCLUDING ACTIGRAPHY, OUR MOTION-SLEEP-WAKE CYCLE, GPS LOCATION, NOT TO BE CREEPY AND FIND OUT WHERE YOU BUT STEPS TAKEN, A VARIETY OF FACTORS COULD BE EARLY PREDICTORS BEFORE YOU REACH DISEASE STATES, BEFORE YOU REACH DSM CRITERIA FOR DEPRESSION AND ANXIETY, WHEN YOU HAVE POTENTIAL TRIGGERS OF SUBSTANCE ACCUSE, QUEUES YOU COULD INTERVENE, IMMEDIATE RESPONSIVE BIOMARKERS THAT COULD INTERVENE, A DIGITAL THERAPEUTICS PACKAGED TOGETHER, SOMETHING I THINK WILL BE ON THE FOREFRONT. UNFORTUNATELY ON THE BANKS OF COVID-19 BUT REALLY WILL DRIVE THIS EXPERIENCE. >> THANK YOU BOTH. NEXT QUESTION IS ALSO FOR BOTH OF YOU. DR. LAKHAN, YOUR PRESENTATION COVERED RACIAL AND GENDER DIFFERENCES HOW SERIOUSLY CLINICIANS TAKE AND TREAT PAIN. DR. BALBUS, YOU DISCUSSED WOMEN'S EMPOWERMENT OF TOP SOLUTION TO CLIMATE CHANGE AND NEGATIVE HEALTH IMPACT. TOPICS ARE DIFFERENT, BOTH PRESENTATIONS ADDRESSED CULTURE CHANGE. CAN YOU SAY A BIT MORE ABOUT EFFORTS TO BRING ABOUT CULTURE CHANGE IN YOUR RESPECTIVE FIELD? WE CAN PERHAPS GO IN REVERSING OR BEGINNING WITH DR. LAKHAN. >> I'LL TAKE THAT. ABSOLUTELY RECOGNITION THAT CULTURE CHANGE NEEDS TO EXIST, AND THERE'S A VARIETY OF CULTURES, SO THERE'S ONE WITHIN YOURSELF, WHERE YOU ENVISION YOURSELF AMONG FAMILY AND WORK AND DYNAMICS AND CULTURE, SOCIETAL CULTURES AND SO ON. I'LL GIVE A MORE GRANULAR EXAMPLE THAN PHILOSOPHY. I WAS AT VIRGINIA TECH CHIEF OF PAIN MANAGEMENT YEARS AGO, ONE RECOGNIZED THAT WE HAVE TO TAKE INITIATIVES ON DIVERSITY AND INCLUSION ON ORGANIZATION-WIDE LEVEL, BUT I WAS GOING TO START WITH OUR DEPARTMENT OF PAIN MANAGEMENT AND PERHAPS MANY OF YOU KNOW THERE IS IMPLICIT BIASES, TESTS, HARVARD AND SO ON HAVE THEM FREELY AVAILABLE. THAT WAS THE FIRST STEP. RECOGNITION THAT EACH AND EVERY ONE OF US HAVE SOME LEVEL OF CONSCIOUS AND UNCONSCIOUS BIAS, RECOGNIZING THAT, I CALL THAT THE FEEDBACK, BIOFEEDBACK TYPE OF STAGE. THEN STRUCTURED WAYS FOR YOU TO ADDRESS IT, MITIGATE IT, REFLECT ON IT AND THEN TAKE DIFFERENT ACTIONS OR BEHAVIORS, UNDERSTANDING THEY EXIST IN OUR COGNITIVE PROCESSES, SOME IS IS BEHAVIORAL CHANGES. THIRD, WHICH IS UNIQUE PUTTING IN A SIMULATION ENVIRONMENT, I'M A NEUROLOGIST SPECIALIST, DOING MEDICAL EDUCATION FOR YEARS WHERE WE PUT INDIVIDUALS IN CLINICAL STIMULATION LABS, ICU SETTING OR POST-STROKE OR HEART ATTACK. IT DESERVES THE SAME AMOUNT OF ATTENTION AND WE PUT FOLKS IN THIS ARTIFICIAL CLINICAL STIMULATION LAB, THE NURSE AND MEDICAL ASSISTANT, NURSE, EMT, FACTORS CHANGE LIKE GENDER, RACE, ETHNICITY, GUN OWNERSHIP, POLITICAL AFFILIATION, HAVE A DEBRIEFING IN SAFE HARBOR ZONE AND MEASURE AT VARIOUS POINTS FOR DURABILITY FOR EFFECT. WE TOOK BOTTOM-UP APPROACH, AT THE ENDS THE ENTIRE C-SUITE FOLLOW THROUGH, ONE EXAMPLE OF HOW CULTURE CHANGE CAN BE DONE, YEAH. >> THANK YOU. DR. BALBUS? >> LET ME START BY SAYING CULTURE CHANGE ARE WORDS EASY TO SAY BUT AS SOMETHING VERY HARD TO BRING ABOUT. AND MAYBE ANSWER THE QUESTION IN THREE WAYS. THE FIRST VERY TIMELY CULTURE CHANGE THAT I'M OBSERVING IN OUR FIELD OF ENVIRONMENTAL HEALTH IS WHILE WE HAVE ALWAYS RECOGNIZED HEALTH DISPARITIES, ALWAYS RECOGNIZED DISADVANTAGED COMMUNITIES ARE DISPROPORTIONATELY EXPOSED I'M SEEING CULTURE CHANGE IN LEVEL OF INTENSITY AND ENERGY BEING PUT INTO ENSURING DIVERSITY, INCLUSION, AND EQUITY IN THE CREATION OF THE WORKFORCE AND CREATION OF RESEARCH AGENDA. THIS IS REFLECTED AT THE NIH LEVEL WITH DR. COLLINS, VERY MUCH WITH OUR NEW DIRECTOR DR. RICK WOYCHIK, AND THAT WILL CHANGE THE RESEARCH AND THAT I BELIEVE, I HOPE OVER TIME, WILL CHANGE THE OUTCOMES AND CHANGE THE EXPOSURES. THE SECOND AREA OF CULTURE CHANGE IS SOME OF THE DIVISIONS BETWEEN THE EFFORT SCIENCES AND HEALTH SCIENCES. AND, YOU KNOW, THEY SPEAK VERY DIFFERENT LANGUAGES, AND YET BOTH, IN MY FIELD OF HAVE THE HEALTH SCIENCES, HAVE SIMILAR GOALS IN TERMS OF UNDERSTANDING EXPOSURES AND THE IMPACTS OF ENVIRONMENTAL FACTORS ON HUMAN LIVES. SO THERE'S A LITTLE BIT OF CULTURE CHANGE GOING ON THERE, ORGANIZATIONS LIKE THE AMERICAN GEO PHYSICAL UNION THAT HAS JUST STARTED UP A NEW GEOHEALTH SECTION AND GEOHEALTH JOURNAL WE'RE INVOLVED IN REALLY TAKING A LEAD IN IDENTIFYING AND CULTIVATING YOUNG EARTH SCIENCE RESEARCHERS AND BRINGING THEM TOGETHER WITH HEALTH SCIENCES AND SPEAKING OF LANGUAGE. LASTLY BRIEFLY, YOU KNOW, THE CHANGE THAT I WAS REFERRING TO WITH RESPECT TO CLIMATE CHANGE AND CRITICAL IMPORTANCE OF GENDER IS A MUCH MORE PERVASIVE CHANGE, NOT A CHANGE IN CULTURE OF NIH OR RESEARCH INSTITUTION, THAT'S REALLY FUNDAMENTAL SOCIETAL CULTURAL CHANGE, AND I AM NOT GOING TO EVEN TRY TO SAY THAT WE'RE BRINGING THAT ABOUT, BUT JUST TO SAY THAT IT IS A FUNDAMENTAL AND INCREASINGLY EMBEDDED PART OF GLOBAL DISCUSSIONS ABOUT GOVERNANCE AT GLOBAL CHANGE AT U.N. FRAMEWORK ON CLIMATE CHANGE, AND THAT IT WORKS ITSELF ALL THE WAIT BACK OUT TO THE HEALTH RISKS, TO THE DISPROPORTIONAL HEALTH RISKS OF WOMEN BUT SOLUTION SPACE IS CENTRAL TO JUST THE FUNDAMENTAL CULTURE AND SOCIETAL ROLES OF WOMEN IN DIFFERENT COUNTRIES AROUND THE WORLD. >> THANK YOU. AND WE HAVE TIME FOR ONE ADDITIONAL QUESTION. A QUESTION FOR DR. LAKHAN. WHAT ROLE DOES SEX AND GENDER OF HEALTH CARE CLINICIAN HAVE IN AFFECTING PAIN? DO FEMALE NURSES PERCEIVE MALE NURSES AS HAVING GREATER PAIN THAN FEMALE PATIENCE, DO FEMALE PHYSICIANS REFER MORE THAN MALE, WE -- I SUSPECT THE CLINICIAN PLAYS INTO THIS. >> YES, I LOVE THE QUESTION BECAUSE THERE'S OVEREMPHASIS ON PATIENT-SPECIFIC FACTORS THAT GO INTO THIS EXPERIENCE. ON THE OTHER HAND, THERE'S A CLINICIAN ROLE FOR SEEING PATIENTS, 100%. WITHOUT GOING INTO SPECIFICS AND CONSTRUCTING A TABLE, IF YOU IDENTIFY SUCH, THESE ARE YOUR BY BIASES, THEY ALL EXIST, A MULTITUDE OF LITERATURE, VALIDATING TO EACH OTHER, THAT SHOWS CLINICIANS HAVE DIFFERENT PERCEPTIONS BASED ON SOME CHARACTERISTICS THEMSELVES BEING THEIR OWN GENDER, RACE, EXPERIENCE, WITH PAIN. AND COMORBIDITIES. AND THAT TRANSFERS. THAT TRANSFERS INTO THE RELATIONSHIP, WHETHER IT IS THERAPEUTIC ALLIANCE, YOU KNOW, THE TRUST AND RAPPORT, WHETHER IT IS MANAGEMENT-BASED DECISIONS OR DIAGNOSTICS, HOW FOLKS ARE FACILITATED, SHEPHERDED THROUGH THE PAIN EXPERIENCE, REFERRALS TO FOR INSTANCE PAIN SPECIALIST, RATHER THAN A GENERALIST, INTERVENTIONAL PROCEDURES, PHARMACOTHERAPY RATHER THAN PSYCHOLOGICAL OR MORE BEHAVIORAL MANIFESTATIONS I THINK YOU'RE GETTING THE DRIFT OF THE UNDERTONES OF THIS CLINICIAN TAKE. ONE, RECOGNIZING THAT IT EXISTS, THOSE ARE EXACTLY HOW I LED TO IT IN THE EARLIER DISCUSSION, THESE ARE IMPLICIT BIASES THAT COULD AFFECT MANAGEMENT DECISIONS TO A GREAT DEGREE. IF NOT CALLED TO ORDER, AND THAT'S WHY I'D LOVE TO DO IT IN MORE OF A VIDEO DEBRIEFING SESSION BECAUSE IT'S HARDER TO DO BUT THAT'S YOUR ACTION, OTHERS COULD DO IT IF YOU GET A PANEL OF POPULATION, AND YOU STRATIFY BASED ON THESE FACTORS AND ACTUALLY FOLKS ARE BEING TRIAGED INTO THIS DIRECTION BUT DISEASE STATES IS NOT DIFFERENT. CALLING INTO ORDER THE NUDGE EFFECT, AND THEN HAVING THE TOOLS ACTUALLY TO SAY WHETHER THOSE ARE APPROPRIATE. MY WHOLE TALK WAS ABOUT SEX AND TO A LARGE DEGREE GENDER IS A FACTOR IN YOUR PAIN EXPERIENCE AND PAIN JOURNEY. WE CAN'T DISCOUNT THAT NOW. AND THROW A BLIND EYE. WE NEED TO TREAT EVERYONE WITH EQUITY. SO IT'S UNDERSTANDING THAT THOSE INTERACTIONAL FACTORS EXIST AND HOW DOES IT FIT INTO YOUR MODEL. IT'S HARD TO DO THAT AS SINGLE HUMAN BEINGS. THAT'S WHY I'M A FIRM BELIEVER WHEN YOU BUILD MODELS WITH MACHINE LEARNING, ARTIFICIAL INTELLIGENCE, YOU COULD TRAIN IT TO LEARN THAT THESE EXIST OR YOU COULD BE AGNOSTIC AND SAY THIS IS THE OUTCOME OF INTEREST, THESE ARE PATIENT-SPECIFIC DEMOGRAPHICS, LEAD THE WAY. THERE ARE PROS AND CONS TO BOTH. >> THANK YOU BOTH FOR A FANTASTIC PRESENTATION AND FASCINATING Q&A SESSION. I'D LIKE TO REMIND EVERYONE THAT OUR LUNCH BREAK IS NOW, AND NEXT SESSION WILL BEGIN AT 1:15 EASTERN, 10:15 FOR THOSE ON THE WEST COAST. THANK YOU. >> THANK YOU VERY MUCH, AGAIN, FOR THE INVITATION. IT'S A PLEASURE. WELCOME BACK TO THE ORWH SESSION, I'M LISA BEGG, PROGRAM OFFICIAL FOR THE BIRCWH PROGRAM WITH HAD ITS 20th ANNIVERSARY CELEBRATION YESTERDAY, I'VE BEEN ASKED TO COVER SLIDES AND INTRODUCE THE PANEL TODAY, BECAUSE OF THEM HAVE A BIRCWH AFFILIATION. IN ITEMS OF -- IN TERMS OF YESTERDAY, THERE WAS A LECTURE ON RUTH KIRSCHSTEIN BY DR. MOLINO, LEADING MENTOR AND RENOWNED RESEARCHER WITH CONTINUOUS NIH FUNDING, OVER 20 YEARS, AND SHE'S ALSO THE-- HAS ENDOWED CHEER AT LOUISIANA STATE UNIVERSITY IN NEW ORLEANS. HER TALK AS WELL AS OTHER TALKS ARE AVAILABLE ON THE PLATFORM FROM YESTERDAY AS WELL AS NIH VIDEOCAST ARCHIVE. THE SECOND MAJOR ADDRESS WAS GIVEN BY DR. CLAIRE STERK WHO GAVE INAUGURAL BIRCWH LEGACY LECTURE, THE PRESIDENT EMERITUS FROM EMORY UNIVERSITY, AND ALSO CREATED EMORY BIRCWH PROGRAM SIX YEARS AGO, AS SHE WAS ASSUMING HER PRESIDENCY AT EMORY, A BUSY LADY. SHE COVERED NEW TERRAIN AND VARIOUS CAREER ACHIEVEMENTS AND DIFFERENT PATHWAYS FOR YOUNG INVESTIGATORS TO CONSIDER. IN TERMS OF BIRCWH PROGRAM SOME MAY NOT BE FAMILIAR, I'VE BEEN ASKED TO GIVE YOU A FEW BRIEF SLIDES. THE BIRCWH PLATFORM, IT STANDS FOR BUILDING INTERDISCIPLINARY RESEARCH CAREERS IN WOMEN'S HEALTH, CREATED IN 2000, IT TRAINS MORE THAN ONE TRAINEE AT ANY ONE TIME, AND IT HAS -- IT FOCUSES ON HEALTH OF WOMEN AND SEX AND GENDER INFLUENCES. PROGRAM WAS ESTABLISHED IN 2000, PARTNERS ACROSS THE NIH AND THERE'S A SUBSEQUENT SLIDE WHICH LISTS I.C. PARTNERS, PARTNERING ON INTERDISCIPLINARY MENTORING, WE'VE HAD REPRESENTATION EITHER AS GRANTEE INSTITUTION OR SCHOOL WITHIN GRANTEE INSTITUTION IN TRAINING SCHOLARS IN THESE AREAS OF MEDICINE, NURSING, PUBLIC HEALTH, SOCIAL SCIENCES, BIOENGINEERING, BEHAVIORAL SCIENCES, ANTHROPOLLING -- ANTHROPOLOGY AS THEY RELATE TO HEALTH OF WOMEN. IN TERMS OF ACCOMPLISHMENTS, THIS SLIDE REPRESENTS A SUMMARY OF THE RESEARCH, EVALUATION DONE BETWEEN 2000 AND 2018, THERE WERE 88 GRANTS, 44 INSTITUTIONS, DURING THAT PERIOD OF TIME. AND AS YOU CAN SEE HERE ON THE LEFT THESE ARE THE INSTITUTES AND CENTERS AT NIH THAT HAVE PARTNERED WITH US OVER THE 20-YEAR PERIOD, INCLUDING OFFICE OF AIDS RESEARCH. AT PRESENT WE HAVE 22 ACTIVE BIRCWH PROGRAMS. IF I WAS ABLE TO SHOW YOU A MAP THEY WOULD REPRESENT ACROSS THE UNITED STATES, EASTERN, SOUTHERN, MIDWEST, AND THE WESTERN STATES AS WELL. SO WE'RE PROUD OF THAT. THE PROGRAM IS FUNDED AT APPROXIMATELY $10 MILLION A YEAR, AND THE INSTITUTES AND CENTERS ARE CONTRIBUTING FUNDING AS WELL AS ORWH BMA MAJORITY, ON THE RIGHT SIDE YOU'LL SEE THAT THE CURRENT RECIPIENTS ARE THE 22 INSTITUTIONS ON THE RIGHT SIDE. THE BIRCWH EVALUATION PROGRAM WAS UNDERTAKEN IN THE RUN TO THE 20th ANNIVERSARY AND I WOULD LIKE TO ACKNOWLEDGE MY TWO COLLEAGUES WHO WORKED ON THE EVALUATION REPORT. IN TERMS OF OUTCOMES, 84% OF SCHOLARS IN THE 18-YEAR PERIOD, STATE AND ACADEMIA, HEALTH RESEARCH, 15% IN INDUSTRY, AND VERY SMALL AMOUNT INTO GOVERNMENT. TERMINAL DEGREES, WE'RE INTERESTED AS IS NIH BECAUSE OF THE INTEREST IN TRAINING NOT ONLY Ph.D.-LEVEL SCIENTISTS BUT PHYSICIAN-SCIENTISTS. AS YOU CAN SEE HERE, ABOUT 42% OF THE BIRCWH SCHOLARS HAVE AN M.D. OR COMBINATION MD/PHD, AND 54% HAVE PhDs, SOME HAVE ADDITIONAL DEGREES. YOU'LL SEE ALSO THE MALE-TO-FEMALE RATIOS, 80% OF THE BIRCWH SCHOLARS ARE WOMEN, OVER THE 20-YEAR PERIOD, 20% ARE MEN. WE'RE VERY PLEASED ABOUT RECRUITING THEM AS WELL. IN TERMS OF PRODUCTIVITY, WE WERE GRATIFIED TO FIND HERE THAT OUR LEVEL GRANT, THESE WOULD BE R01 GRANTS, CLASSIC R01 GRANTS, R21 WHICH IS A SMALL GRANT, INNOVATION GRANT, AND RO3 ANOTHER SMALL GRANT MECHANISM, 70% OF HAD AT LEAST ONE R-LEVEL GRANT, RANGE GOES UP MORE THAN TEN, AND MANY WITH HIGHER NUMBERS OF GRANTS WERE PART OF VERY SUCCESSFUL INTERDISCIPLINARY TEAM SYNERGY INCREASED NUMBER OF GRANTS AS WELL. 30% OF SCHOLARS WENT ON TO ACHIEVE INDIVIDUAL PAY GRANTS, THESE ARE CAREER DEVELOPMENT GRANTS, AND THEN 77% OF THE SCHOLARS RECEIVED IN ADDITION TO R-LEVEL NIH GRANTS, THEY RECEIVED FOUNDATION GRANTS, INSTITUTIONAL SEED MONEY GRANTS, SO FORTH. AGAIN, THIS IS THE HIGHLY PRODUCTIVE GROUP OF SCHOLARS. AND NOW NUMBER OVER 700. WE WERE ALSO PLEASED, THIS IS A RELATIVELY NEW PHENOMENON HERE, WHEN THE PROGRAM WAS CREATED IN 2000, IT WAS NOT FOCUSED ON RECRUITING UNDERREPRESENTED MINORITIES. BUT IN THE MORE RECENT YEARS WE HAVE, AS YOU CAN SEE HERE, 21% OF THE SCHOLARS RECRUITED BETWEEN 2015 AND 2018 FALL UNDER UNDERREPRESENTED MINORITY CATEGORY, THAT'S NIH DEFINITION TO INCLUDE AFRICAN AMERICAN OR BLACKS, PACIFIC ISLANDERS, ALASKA NATIVES, AMERICAN INDIAN, HISPANIC OR LATINA. THERE WERE SOME SCHOLARS WHO DECLINED TO GIVE THEIR RACE AND ETHNICITY, AND THAT -- OF COURSE WE ACCEPT THAT IN TERMS OF THE RESEARCH. IN TERMS OF GENERAL PRELIMINARY CONCLUSIONS, THERE'S CAREER SUCCESS, THERE'S BENEFICIAL RELATIONSHIPS, AND THEN THE WOMEN'S HEALTH RESEARCH. IN ADDITION TO THE GRANT -- SECURING R-LEVEL GRANTS AND FOUNDATION GRANTS, THE SCHOLAR GROUP WAS ALSO HIGHLY PRODUCTIVE IN TERMS OF THEIR NUMBER OF PUBLICATIONS, AND WE'RE CONTINUING TO RESEARCH IN TERMS OF IMPACT. IN TERMS OF MUTUAL BENEFICIAL RELATIONSHIPS, IT WAS THE PRINCIPAL INVESTIGATORS, MENTORS, MENTEES, ALL WORKING TOGETHER, ALL WORKING TOGETHER TO BENEFIT ONE ANOTHER AND ONE OF THE INTERESTING FINDINGS WE FOUND AS WELL BECAUSE WE INTERVIEWED THE MENTORS, THE MENTORS FELT THEY BENEFITED FROM MENTEES IN TERMS OF LOOKING AT RESEARCH IN DIFFERENT WAY AND ANGLE, SO WE WERE VERY PLEASED ABOUT THAT. IN TERMS OF INSTITUTIONAL AND BROADER ASPECTS, THE PRINCIPAL INVESTIGATORS AND OTHERS DOCUMENTED THAT THE VISIBILITY OF THE BIRCWH PROGRAM IN HOME INSTITUTION HELPED ADVANCE WOMEN'S HEALTH RESEARCH AND SEX AND GENDER RESEARCH AS WELL, AND ALSO ALLOWED THEM TO LEVERAGE FOR NEW COURSES, OTHER GRANTS, AND SO FORTH, SO THERE WAS AN EFFECT. IT'S MY PLEASURE TO INTRODUCE THE SEX AS A BIOLOGICAL VARIABLE PANEL, JUDITH REGENSTEINER IS AN INNOVATOR IN WOMEN'S HEALTH RESEARCH AND SEX AS A BIOLOGICAL VARIABLE, SABV. AS YOU CAN SEE, SHE HOLDS A PROFESSORSHIP OF MEDICINE IN DIVISION OF GENERAL INTERNAL MEDICINE AND CARDIOLOGY UNIVERSITY OF COLORADO, SHE ALSO HAS ENDOWED CHAIR, JUDITH AND JOSEPH WAGNER ENDOWED CHAIR IN WOMEN'S HEALTH, DIRECTOR, CREATED CENTER FOR WOMEN'S HEALTH RESEARCH, LEADS AND INTERDISCIPLINARY TEAM -- THERE WE GO -- >> I'M SORRY FOR THE TECHNICAL DIFFICULTIES. I'M HONORED TO MODERATE THIS PANEL, SEX AS A BIOLOGICAL VARIABLE. WE HAVE THREE EXCELLENT PANELISTS, VIRGINIA MILLER, KAREN FREUND, AND KEDIR TURI, I WILL INTRODUCE THEM NOW, TALKS ABOUT FOLLOW. FIRST IS FROM DR. VIRGINIA MILLER, PROFESSOR EMERITUS OF SURGERY AND PHYSIOLOGY AT THE MAYO CLINIC. DR. MILLER'S RESEARCH INCLUDED WORK WITH EXPERIMENTAL ANIMALS AND CLINICAL STUDIES, FOCUSED ON SEX, STEROIDS AND CONDITIONS UNIQUE TO WOMEN, PREGNANCY AND MENOPAUSE AFFECT CARDIOVASCULAR HEALTH AND COGNITION. PLAYED A KEY ROLE IN CURRICULUM DEVELOPMENT ON THE TOPIC OF SEX AS A BIOLOGICAL VARIABLE, AND THIS HAS MADE A DIFFERENCE IN THE FIELD. SHE HAS SERVED AS PRINCIPAL INVESTIGATOR OF THE MAYO CLINIC BUILDING CAREERS IN WOMEN HEALTH, BIRCWH PROGRAM, AND SPECIALIZED RESEARCH OF EXCELLENCE ON SEX DIFFERENCES, AS WELL AS DIRECTOR OF MAYO CLINIC WOMEN'S HEALTH RESEARCH CENTER FROM 2010 TO 2020. SHE'S AUTHORED OVER 250 ORIGINAL PUBLICATIONS AND REVIEWS, HER AWARDS INCLUDE BERNADINE HEALEY AWARD, DISTINGUISHED LECTURESHIP, PHARMACOLOGY, WALTER CANNON AWARD FROM AMERICAN PHYSIOLOGICAL SOCIETY. SECOND PANELIST DR. KAREN FREUND, SARAH MURRAY JORDAN PROFESSOR OF MEDICINE AT TUFTS UNIVERSITY, VICE CHAIR DEPARTMENT OF MEDICINE TUFTS MEDICAL CENTER, HOLDS AMERICAN CANCER SOCIETY CLINICAL RESEARCH PROFESSORSHIP, SERVES AS CO-PRINCIPAL INVESTIGATOR OF THE TUFTS BIRCWH PROGRAM AND RECEIVED LOCAL AND NATIONAL AWARDS FOR WORK ON CAREER DEVELOPMENT, ESPECIALLY FOR WOMEN AND UNDERREPRESENTED WOMEN SCIENTISTS. RESEARCH CAREER FOCUSED ON WOMEN'S HEALTH WITH MUCH WORK SPECIFICALLY FOCUSED ON HEALTH DISPARITIES IN WOMEN. INTERNATIONALLY RECOGNIZED FOR WORK IN PATIENT NAVIGATION TO REDUCE DISPARITIES, ON THE IMPACT OF INSURANCE REFORM ON CARE. RESEARCH PORTFOLIO INCLUDES WORK FUNDED THROUGH OFFICE OF RESEARCH ON WOMEN'S HEALTH, TO EXAMINE FACTORS ASSOCIATED WITH LACK OF CAREER PROGRESSION OF WOMEN, ESPECIALLY FROM UNDERREPRESENTED POPULATIONS SPECIFICALLY IN BIOMEDICAL CAREERS. SHE AND HER COLLEAGUES CONDUCTED THE ONLY NATIONAL LONGITUDINAL STUDY OF MEDICAL SCHOOL FACULTY IN THIS REGARD, WORK DEMONSTRATED WOMEN CONTINUE TO LAG BEHIND MEN IN CAREER ADVANCEMENT AND LEADERSHIP EVEN ACCOUNTING FOR ACADEMIC ACHIEVEMENTS, OUTLINED INSTITUTIONAL INTERVENTIONS WHICH MAY REVERSE INEQUITIES. FINAL PANELIST IS DR. KEDIR TURI, WHO JOINED VANDERBILT UNIVERSITY AT T32 FELLOW, TRANSITIONED TO A BIRCWH SCHOLAR, AND WE'RE PROUD, IN 2018. HE WAS AMONG THREE SCHOLARS SELECTED FOR ALL ORAL PRESENTATION AT NATIONAL BIRCWH MEETING LAST YEAR AND DID AN ELOQUENT TALK ABOUT HIS WORK. RESEARCH FOCUS IS ON IDENTIFYING AND UNDERSTANDING PHENOTYPES AND ENDOTYPES OF CHILDHOOD ASTHMA USING MULTI-OMICS PLATFORM, INCLUDING ORIGIN OF SEX DIFFERENCE IN ALLERGIC DISEASES, RECENTLY AWARDED K01 GRANT, ACHIEVED HIS OWN INDIVIDUAL K AWARD, OFTEN THE NEXT STEP OF A SUCCESSFUL BIRCWH SCHOLAR, AND WILL PURSUE THE GOAL OF BECOMING INDEPENDENT INVESTIGATOR. WELCOME, DOCTORS. >> THANK YOU FOR THAT INTRODUCTION AND FOR INVITING ME TO WORK WITH YOU ON THIS IMPORTANT PANEL TODAY. ALSO THANKS TO THE OFFICE OF RESEARCH ON WOMEN'S HEALTH FOR PUTTING ON THIS CELEBRATION TO HIGHLIGHT ALL OF THEIR ACHIEVEMENTS OVER THE LAST 30 YEARS. HERE ARE MY DISCLOSURES. DURING THIS SHORT TIME I HAVE WITH YOU TODAY, I'D LIKE TO COVER THREE IMPORTANT TOPICS. FIRST LAY FOUNDATION FOR INCLUSION OF SEX AS A BIOLOGICAL VARIABLE, IN RESEARCH. DIFFERENTIATE SEX FROM GENDER IN TRANSLATIONAL RESEARCH. AND FINALLY I'D LIKE TO IDENTIFY BARRIERS IN STRATEGIES FOR CONTINUED SUCCESS. SO WHAT IS THE FOUNDATION? THE FOUNDATION IS SEX-BASED APPROACH TO RESEARCH IS REALLY THE DRIVER FOR DEVELOPING A HOLISTIC APPROACH TO PATIENT-CENTERED CARE. WHY IS THAT? JUST TO REMIND EVERYBODY THAT EVERY NUCLEATED MAMMALIAN CELL, INCLUDING US, HAS A SEX, IT CONTAINS A GROUP OF SEX CHROMOSOMES, XX FOR FEMALE, XY FOR MALE. ALTHOUGH THERE MAY BE SOME VARIATIONS IN THESE HORMONES, OR EXCUSE ME, IN CHROMOSOMES, WE KNOW THAT THE PRESENCE OF THEM IN THE NUCLEUS REALLY DIRECTS GENE TRANSCRIPTION AND TRANSLATION, WHICH AFFECTS CELL FUNCTION INDEPENDENT OF ANY HORMONES THAT MIGHT BE PRESENT. THIS IS A GENOMIC EFFECT, AND IT IS A SEX-SPECIFIC EFFECT. HOWEVER, THESE SEX CHROMOSOMES IN ADDITION TO INFLUENCING FUNCTIONS OF THE AUTOSOMES, ALSO DIRECT DEVELOPMENT OF THE SEX ORGANS, WHICH ARE IMPORTANT FOR THE PRODUCTION OF SEX-SPECIFIC HORMONES, PRIMARILY TESTOSTERONE FOR MALES, WHICH IS AROMA TIZED, AND HORMONES DIFFUSE INTO THE CELL TO BIND TO CELLULAR RECEPTORS WHICH AFFECT AGAIN NUCLEAR TRANSCRIPTION, BUT THEY ALSO COMBINE TO SURFACE RECEPTORS WHERE THEIR ACTIVITY AFFECTS ION CHANNELS, SURFACE RECEPTORS WHICH INITIATE CELL SIGNALING MECHANISMS, WHICH THEN MAY INDIRECTLY AFFECT GENETIC EFFECTS. THE ION CHANNELS AND SURFACE RECEPTORS WHICH DO NOT INITIATE DIRECT GENOMIC REACTION ARE CALLED THE GENOMIC REGULATION OF THE SEX HORMONES. BECAUSE ALL SEX HORMONES AND SEX GENES, THE CHROMOSOMES, IN EVERY CELL OF THE BODY, YOU CAN UNDERSTAND THAT SEX IS A BASIC BIOLOGICAL VARIABLE, AFFECTING ALL SYSTEMS OF THE BODY AND IT'S A BASIS FOR INDIVIDUALIZED MEDICINE. BECAUSE THERE ARE SEX-SPECIFIC CHROMOSOMES AND HORMONES THEN THERE ARE SEX DIFFERENCES AND INCIDENTS PRESENT IN ETIOLOGY, SYMPTOM SOMETHING, RESPONSE TO TREATMENT, MORBIDITY AND MORTALITY FROM DISEASE. BUT THESE AREN'T THE ONLY FACTORS WHICH INFLUENCE HEALTH AND DISEASE. THE BIOLOGICAL FACTORS BEING MALE OR FEMALE OF COURSE ARE DICTATED BY THE GENETICS, SEX CHROMES SEASONS -- CHROMOSOMES AND AGE, AFFECTING HEALTH AND DISEASE. WE MUST ALSO CONSIDER THE PSYCHOSOCIAL FACTORS WHICH CAN INDIRECTLY INFLUENCE THE BIOLOGICAL FACTORS. THESE ARE FACTORS WHICH ARE CONSIDERED AS COMPONENTS OF GENDER, INCLUDE THINGS LIKE WHERE YOU LIVE, GEOGRAPHICAL LOCATION, ENVIRONMENTAL EXPOSURES, FOR EXAMPLE IF YOU ARE EXPOSED TO CERTAIN LEVELS OF OXYGEN, DR. REGENSTEINER IS AT ALTITUDE, I'M AT SEA LEVEL IN MINNESOTA, WHAT WE MIGHT BE EXPOSED TO, FAMILY RELATIONSHIPS MIGHT INFLUENCE LEVEL OF STRESS, EDUCATION WHICH MIGHT INFLUENCE OUR INCOME, AVAILABILITY OF HEALTH CARE, AND OUR LIFESTYLE, WHETHER WE'RE ACTIVE, WHAT FOODS WE EAT, WHETHER WE USE RECREATIONAL DRUGS OR ALCOHOL, SMOKING AND SO ON, ALL CAN AFFECT DISEASE. THEREFORE WE HAVE TO CONSIDER THE INTERACTION BETWEEN THE PSYCHOSOCIAL FACTORS, AND BIOLOGICAL FACTORS, BY ACCOUNTING FOR THESE INDIVIDUAL OR EACH OF THESE PSYCHOSOCIAL FACTORS TO KNOW WHERE TO INTERVENE TO IMPROVE HEALTH. SO ONCE WE HAVE MADE THESE BASIC DISCOVERIES, WE MUST INCORPORATE THOSE CONCEPTS OF THE DISCOVERY INTO A CURRICULUM. BUT TO DO SO WE MUST CONSIDER THE COMPONENTS OF SUCH A CURRICULUM. FIRST WE MUST INCLUDE BASIC DEFINITIONS OF SEX AND GENDER. WE HAVE TO REVIEW CONTROL OF THE SEX CHROMOSOMES, HORMONAL EFFECTS ON CELLULAR ACTIVITIES, INTERACTIONS OF HORMONAL ACTIVITIES PHARMACEUTICAL OR METABOLIC COMPONENTS OF DRUGS, OR DRUG/HORMONE INTERACTION, NEED TO INCLUSION SEX DIFFERENCE IN STUDY DESIGN AND STATISTICAL ANALYSES, EXPRESSION IN HEALTH AND DISEASE, INTERSECTION OF ENVIRONMENTAL AND PSYCHOSOCIAL FACTORS WITH BIOLOGICAL FACTORS, AND HOW THESE INFLUENCE HEALTH DISPARITIES, AND ACTUALLY ETHICAL IMPLICATIONS OF HOW HEALTH CARE MIGHT BE DELIVERED AND NOW THERE'S DISCUSSION AROUND THESE ISSUES IN TERMS OF THE COVID VACCINE, HOW THAT MIGHT BE DISTRIBUTED, WE DON'T HEAR A LOT ABOUT SEX DIFFERENCES. WE HEAR ABOUT RACIAL DIFFERENCES AND SOCIOLOGICAL FACTORS WHERE INDIVIDUALS MIGHT BE LIVING OR THEIR AGE. SEX MUST BE INCLUDE INCLUDED IN THAT DISCUSSION. ONCE WE HAVE CONCEPTS EMBEDDED INTO CURRICULUM WE MUST DEVELOP GUIDELINES FOR HOW THEY ARE GOING TO BE IMPLEMENTED IN CLINICAL PRACTICE OR RESEARCH ACTIVITIES, AND THEN TO DISSEMINATE THIS INFORMATION INTO REAL WORLD SITUATIONS. FINALLY AS I MENTIONED BEFORE, PUBLIC HEALTH DECISIONS AND THE GLOBAL APPLICATION OF SEX AND GENDER THROUGH HEALTH, PUBLIC HEALTH INTEGRATION. ALTHOUGH WE HAVE ACHIEVED SOME SUCCESS IN THESE AREAS, WE STILL FACE THREE MAJOR BARRIERS. FIRST IS RESOURCES, SECOND IS TRAINING, AND THE THIRD IS SHIFTING AGENDAS AND POLITICAL PRESSURES. LET'S LOOK AT SOME OF THE STRATEGIES THAT HAVE BEEN IMPLEMENTED BY THE OFFICE OF RESEARCH ON WOMEN'S HEALTH TO OVERCOME BARRIERS. IN 1991, BERNADINE HEALEY WAS APPOINTED FIRST WOMAN DIRECTOR OF NATIONAL INSTITUTES OF HEALTH AND SHE DEVELOPED TARGETED FUNDING FOR INVESTIGATION INTO EFFECT OF ESTROGEN ON CORONARY ARTERY DISEASE. I WAS FORTUNATE TO RECEIVE ONE OF SIX APPLICATIONS THAT WERE SUCCESSFUL FOR THIS INITIATIVE, AND THAT'S LAUNCHED MY CAREER INTO STUDY OF HORMONES AND SEX-SPECIFIC EFFECTS OF HORMONES ON THE CARDIOVASCULAR SYSTEM AS A CONSEQUENCE OF SMALL REQUEST FOR APPLICATION THERE WAS A PLETHORA OF STUDIES THAT WEREN'T FUNDED THROUGH THAT INITIATIVE THAT CONTINUED TO MOVE THROUGH NIH STUDY SECTIONS AND REALLY BROUGHT ABOUT AN EXPLOSION OF INFORMATION ABOUT HOW HORMONES AFFECT CELLULAR FUNCTION DURING THE 1990s. THERE ARE SUPPLEMENTS TO APPLY FOR RESEARCHERS TO APPLY FOR TO INCLUDE MALE AND FEMALE ANIMALS OR ENRICH POPULATIONS OF POPULATION WITH MEN AND WOMEN TO ACHIEVE UNDERSTANDING, BE ABLE TO ASSESS HOW SEX INFLUENCES A PARTICULAR AREA OF STUDY. IN TERMS OF TRAINING, SPECIALIZED CENTER OF RESEARCH ON SEX DIFFERENCES, NOW THE SPECIALIZED CENTERS OF RESEARCH EXCELLENCE ON SEX DIFFERENCES, WHICH CONTAINS EDUCATIONAL OR CAREER ENHANCEMENT COMPONENT. TOGETHER WITH THAT, AND BUILDING INTERDISCIPLINARY CAREERS IN WOMEN'S HEALTH, COMPETITIVE PROGRAM INITIATED BY OFFICE OF RESEARCH ON WOMEN'S HEALTH, TO SUPPORT JUNIOR INVESTIGATORS IN THE AREAS OF WOMEN'S HEALTH, WILL ENSURE THAT THERE ARE INVESTIGATORS COMPETENT TO STUDY SEX DIFFERENCES GOING FORWARD AND ALSO THE FIELD WILL FLOURISH AND EXPAND THE OFFICE DEVELOPED SOME EDUCATIONAL MODULES FREE ON THE INTERNET, WHICH CAN BE USED IN A VARIETY OF EDUCATIONAL MODALITIES, TO REALLY ENHANCE WHAT WE KNOW IN A BROADER SENSE HOW SEX INFLUENCES DISEASE. IN TERMS OF SHIFTING AGENDAS AND POLITICAL PRESSURES WE KNOW FROM OUR EXPERIENCES EVEN AT OUR OWN INSTITUTIONS AGENDAS MAY CHANGE IN TERMS OF CURRICULUM, ACCESS TO MATERIALS, HOW THINGS ARE DELIVERED, WE MUST REMAIN VIGILANT IN TERMS OF PUSHING THE IDEA THAT SEX IS THE BASIC BIOLOGICAL COMPONENT AT THE FUNDAMENTAL LEVELS OF HEALTH AND DISEASE. THIS NOT ONLY HAS TO HAPPEN AT THE EDUCATIONAL LEVELS BUT ALSO IN RESEARCH INITIATIVES. HAVING THESE INITIATIVES THAT WE'VE ALREADY STARTED WE HAVE TO MAKE SURE THAT THEY ARE SUSTAINED, SOMETIMES THAT REQUIRES REPEAT VISITS TO DEANS, TO CURRICULUM MANAGERS, AND EDUCATIONAL PARTNERSHIPS WITH INDIVIDUALS DEVELOPING OR DELIVERING THE COURSE MATERIAL. WE MUST PARTNER WITH JOURNAL EDITORS TO ENSURE RESEARCH RESULTS ARE PUBLISHED FOR EACH INDIVIDUAL SEX, EVEN IF THE STUDY IS NOT POWERED TO DO A SECRETARY-SPECIFIC ANALYSIS HAVING RAW DATA AND DATA TO BE USED IN META-ANALYSIS, INCREASES TRANSPARENCY WHICH WOULD ALLOW FOR DEVELOPMENT OF NEW HYPOTHESES IN THE FUTURE. WE HAVE TO CONTINUE TO EDUCATE THE PUBLIC ON IMPORTANCE OF UNDERSTANDING SEX AS A BIOLOGICAL VARIABLE, AND REALLY DIFFERENCE IN TERMS AND INTERACTION ON HEALTH AND DISEASE. WE HAVE TO CONTINUE TO WORK WITH LAWMAKERS IN TERMS OF THEIR UNDERSTANDING OF THE GENERAL PUBLIC, OF COURSE, THAT THEY ARE IN HIGHER POSITION TO REALLY INFLUENCE WHAT WE DO IN TERMS OF FUNDING INITIATIVES, OR ACTUALLY APPLICATION OF DATA, TO INCLUDE THEM IN A HUGE EDUCATIONAL EFFORT SO THEY UNDERSTAND THAT SEX IS FUNDAMENTAL TO BIOLOGY AND RESEARCH IN THE FUTURE. SO OVER THE PAST 30 YEARS, THE OFFICE OF RESEARCH OF WOMEN'S HEALTH HAS BEEN SUCCESSFUL IN A VARIETY OF INITIATIVES, I CONGRATULATE THEM ON THESE EFFORTS, AND WISH THEM SUCCESS AS THEY MOVE FORWARD IN THE FUTURE THANK YOU FOR YOUR ATTENTION, AND WE'LL HAVE QUESTIONS DURING THE PANEL DISCUSSION. >> THANK YOU VERY MUCH, JUDY. IT'S A PLEASURE TO BE HERE AND I'M EXCITED TO BE TALKING ABOUT MENTORING AS A WAY TO ADDRESS SEX AS A BIOLOGICAL VARIABLE IN BIOMEDICAL RESEARCH. WHY DO I WANT TO FOCUS ON MENTORSHIP AS A WAY OF ENSURING JUNIOR FACULTY ARE INCLUDING SEX DIFFERENCE IN THEIR APPROACHES? IT'S CRITICAL AT THE STAGE OF OUR EARLY-STAGE INVESTIGATORS, IF THEY LEARN METHODS AND REASONING BEHIND INCLUDING SEX DIFFERENCE AT EARLY STAGES, IT'S NOT ONLY GOING TO IMPROVE RESEARCH BUT GIVE THEM THE SKILLS FOR THEIR FUTURE STUDIES. IT WILL SERVE AS THEY BECOME MENTORS OF THE FUTURE TO REINFORCE LOOKING AT SEX DIFFERENCES IN ALL RESEARCH. THERE ARE THREE ASPECTS OF MENTORSHIP I WANT TO CONSIDER IN OUR DISCUSSIONS TODAY AND HOPEFULLY IN OUR DISCUSSION PERIOD AFTER THESE PRESENTATIONS. ONE IS THE ROLE OF GROUP AND PEER MENTORSHIP, WHEN THINKING ABOUT SEX DIFFERENCES. THE SECOND IS ROLE OF THE INDIVIDUAL MENTORSHIP OR INDIVIDUAL MENTORS ON THE SCHOLARS MENTORING TEAM. AND THEN THE THIRD IS SPECIFICALLY THINKING ABOUT THE BIOSTATISTICAL MENTORSHIP. I'M GOING TO END WITH THOUGHTS ABOUT HOW WE CAN MOVE THIS FORWARD, ESPECIALLY HOW WE TRAIN OUR MENTORS IN ORDER TO HAVE THE SKILL SET TO DO THIS AS PART OF THEIR MENTORSHIP. SO STARTING WITH GROUP OR PEER MENTORSHIP, SO MOST OF OUR ORGANIZATIONS HAVE SOME TYPES OF CAREER DEVELOPMENT PROGRAMS FOR BIRCWH SCHOLARS. AND THESE ARE OFTEN JOINT PROGRAMS ALONG WITH OTHER K AWARDEES WITHIN OUR ORGANIZATIONS, OR OTHER JUNIOR FACULTY WHO ARE ASPIRING TO DEVELOP K APPLICATIONS. I THINK THIS IS REALLY A GREAT OPPORTUNITY TO INTRODUCE THE NOTION OF SEX AS A BIOLOGICAL VARIABLE TO A BROAD AUDIENCE OF INVESTIGATORS WHO MAY HAVE NEVER CONSIDERED IN THEIR RESEARCH. IT'S A CHANCE TO DESCRIBE AND DISCUSS WITH THAT AUDIENCE THE Y OF SEX AS A BIOLOGICAL VARIABLE, AND TO PROVIDE EXAMPLES OF WHERE THEIR OWN RESEARCH MAY TAKE A DIFFERENT TURN OR MAY PROVIDE THEM WITH MUCH BETTER CLARITY ON THEIR FINDINGS IF THEY LOOK SPECIFICALLY AT SEX DIFFERENCES. THIS IS AN OPPORTUNITY TO PROVIDE EXAMPLES THROUGH RESEARCH OF INDIVIDUALS IN THE GROUP TO SHOW WHAT POSSIBILITIES MIGHT BE IF THEY BEGIN TO DO THEIR ANALYSES, STRATIFY BY SEX AND START TO UNDERSTAND WHAT THE POSSIBILITIES ARE BY INCLUDING SEX DIFFERENCES IN THEIR RESEARCH AND IN THEIR ANALYSES. SECONDLY, I WANT TO FOCUS ON INDIVIDUAL MENTORSHIP. SO, ALL OF OUR SCHOLARS HAVE MENTORING TEAMS THAT EACH MENTOR WITHIN THE MENTORING TEAM CAN ASSIST IN INCLUDING SEX DIFFERENCES INTO THE RESEARCH. IT MAY START WITH LOOKING AT PREMISE OF THE RESEARCH AND BACKGROUND, LOOKING FOR POSSIBLE SEX DIFFERENCES THAT ARE KNOWN, THINKING ABOUT HOW TO INCLUDE BOTH SEXES IN THE METHODS, AND HOW TO DESIGN ANALYSIS TO ADDRESS SEX DIFFERENCES. I THINK THERE'S A PARTICULAR ROLE TO PLAY FOR THE BIOSTATISTICAL MENTORS, IN HELPING LOOK AT SEX DIFFERENCES. I OFTENTIMES BRING UP TOPIC OF SEX AS A BIOLOGICAL VARIABLE AND ASKING JUNIOR FACULTY HOW THEY ARE ACCOUNTING FOR SEX AS A BIOLOGICAL VARIABLE, THE ANSWER I FREQUENTLY GET IS, WELL, WE'VE ADJUSTED FOR SEX OF THE COVARIATE, SO IF THERE'S ONE THING WE CAN DO IT IS TRAIN EVERYONE TO KNOW THAT ADJUSTING FOR SEX AS A COVARIATE IS NOT ANALOGOUS TO LOOKING AT SEX AS A BIOLOGICAL VARIABLE AND UNDERSTANDING IF THERE'S SEX DIFFERENCES IN THE ANALYSIS. BIOSTATISTICAL MENTORS CAN BE HELPFUL IN UNDERSTANDING THE ROLE OF BOTH EXPLORATORY ANALYSES WHERE THERE MAY NOT BE POWER AND MAY BE LOOKING AT THE DATA WITHOUT STATISTICAL ANALYSIS FOR POSSIBLE SIGNALS THERE MAY BE A SEX DIFFERENCE AS OPPOSED TO HAVING A SEX-SPECIFIC HYPOTHESIS THAT REQUIRES CONFIRMATORY ANALYSIS AND ADEQUATE POWER CALCULATION TO ENSURE CONFIRMATORY ANALYSIS IS POWERED TO LOOK FOR RESULT. I THINK IT REQUIRES THAT OUR BIOSTATISTICAL MENTORS UNDERSTAND VARIOUS ANALYTIC METHODS USED TO ADDRESS SEX DIFFERENCES. SO HOW DO WE ADVANCE SEX DIFFERENCES IN RESEARCH THROUGH MENTORSHIP? I THINK THIS IS GOING TO INVOLVE MENTOR TRAINING. MANY OF OUR MENTORS, THEMSELVES, ARE UNCLEAR ON HOW TO INCLUDE SEX AS A BIOLOGICAL VARIABLE, INTO RESEARCH DESIGN, INTO ANALYSIS, SO I THINK IT REQUIRES THAT THOSE OF US THAT HAVE MENTOR TRAINING PROGRAMS CONSIDER ADDING THIS AS A COMPONENT IN FUTURE MENTOR TRAINING PROGRAMS. I THINK THERE'S ALSO A NEED TO CONSIDER TRAINING STUDY SECTIONS SO THERE'S UNIFORMITY IN HOW STUDY SECTIONS APPLY TO REGULATION AND RULES AROUND SEX DIFFERENCES IN BIOMEDICAL RESEARCH SO THAT OUR JUNIOR FACULTY CAN KNOW WHAT TO EXPECT WHEN THEIR GRANTS ARE REVIEWED AND CAN ADEQUATELY PREPARE STRONG SEX AS A BIOLOGICAL VARIABLE ANALYSIS PLANS TO ADDRESS THAT. I THINK THERE NEEDS TO BE A SPECIFIC FOCUS FROM OUR BIOSTATISTICAL CONSULTANT AND COLLEAGUES TO PUT THIS FOCUS INTO THE BIOSTATISTICAL SUPPORT THAT OUR JUNIOR FACULTY RECEIVE. I'M LOOKING FORWARD TO CONTINUING OUR DISCUSSION TODAY. I THANK THE OFFICE OF RESEARCH IN WOMEN'S HEALTH FOR 30 GREAT YEARS OF SUPPORT. THANK YOU VERY MUCH. >> HELLO, I'M KEDIR TURI FROM VANDERBILT UNIVERSITY. TODAY I'LL BE SHAKER MY PERSPECTIVE ON APRESIDENT DOING SEX AS A BIOLOGICAL VARIABLE IN RESEARCH. I'LL BRIEFLY DISCUSS MY EXPERIENCE AS BRIDGE SCHOLAR, THEN HIGHLIGHT MY APPROACH IN SEX AS A BIOLOGICAL VARIABLE IN MY RESEARCH. BEFORE JOINING BIRCWH SCHOLAR MY KNOWLEDGE ON WHY AND HOW TO INCORPORATE SEX AS A BIOLOGICAL VARIABLE WAS VERY LIMITED. I HAVE LEARNED A LOT DURING APPLICATION PROCESS AND ALSO DURING MY TENURE AS BIRCWH SCHOLAR. AS REQUIREMENT TO HAVE RESEARCH PROPOSAL, IN ADDRESS SEX DIFFERENCE IN THE PATHOGENESIS OF DISEASE, THE APPLICATION PROCESS HELPS ME A LOT. I WAS FORTUNATE ENOUGH TO JOIN THE COMMUNITY OF BIRCWH SCHOLARS WHO HELP IN LEARNING PROCESS. THEY INCLUDES PREVIOUS SCHOLARRING SERVING AS MENTORS. OUR GROUP MET EVERY WEEK TO PEER REVIEW DEVELOPMENT TOPICS, MANUSCRIPTS AND GRANT APPLICATION FOR SCHOLARS. THIS PROCESS ASSURED SEX AS A BIOLOGICAL VARIABLE IS DISCERN AND SEX DIFFERENCES WERE ADEQUATELY CONSIDERED. MY AREA OF INVESTIGATION IS ASTHMA. I WILL PROVIDE EXAMPLES ON HOW I APPROACHED SEX AS A BIOLOGICAL VARIABLE IN ASTHMA RESEARCH. ASTHMA IS A CHRONIC DISEASE THAT AFFECTS 339 MILLION PEOPLE AROUND THE WORLD. IN THE U.S. THAT NUMBER IS 25 MILLION, STILL INCREASING. THERE ARE RECOGNIZED SEX DIFFERENCES IN ASTHMA INCIDENCE AND MORBIDITY ACROSS THE LIFESPAN WHICH MAKES ASTHMA A NATURAL FIT. THIS FIGURE COMES FROM CDC. IT SHOWS PREVALENCE OF ASTHMA BY SEX AND AGE GROUPS, BLUE FOR MALE, YELLOW FOR FEMALE. AS YOU CAN SEE FROM THE FIGURE, DURING CHILDHOOD PREVALENCE HIGHER AMONG MALE CHILDREN. PREVALENCE SWITCHES AROUND PUBERTY, PREVALENCE OF ASTHMA WAS HIGHER AMONG WOMEN COMPARED TO MEN. SINCE THE SWITCH IS AROUND PUBERTY, THE USUAL SUSPECT FOR SEX DIFFERENCE IN ASTHMA ARE SEX HORMONES. THIS PROMPTS US AND OTHERS TO INVESTIGATE RELATIONSHIP BETWEEN SEX HORMONES AND RISK OF ASTHMA TO EXPLAIN THE SEX DIFFERENCES. USING PUBLICLY AVAILABLE NHANES DATA, AS YOU CAN SEE FROM THE FIGURE WHERE THE X-AXIS SHOWS, Y-AXIS SHOWS STRATIFICATION GROUPS, IN MALE AND FEMALE AGE GROUP IT IS NOT SIGNIFICANT BUT INCREASING FOR TESTOSTERONE SEEMS TO INCREASE ASTHMA. IN MALES AND FEMALES GROUP INCREASING TOTAL TESTOSTERONE SEEMS TO INCREASE ODDS OF ASTHMA, ALL ONLY SIGNIFICANT IN FEMALE ADULTS. EVEN THOUGH TESTOSTERONE IS ASSOCIATED WITH ODDS OF ASTHMA, IN FEEL WE'RE NOT SHOW IT'S RESPONSIBLE FOR SEX DIFFERENCE IN ASTHMA PREVALENCE. WHAT WE SEE FROM THIS IS DIFFERENTIAL ASSOCIATION BETWEEN CHILD GROUP IN ASSOCIATION. ASTHMA PATHOGENESIS LIKELY BEGAN IN UTERO AND EARLY LIFE EXPOSURE. IN PRESCHOOL GROUP ASTHMA IS INDISTINGUISHABLE FROM WHILE WHEEZE. YOU CAN SEE FROM THE FIGURE, IN PRESCHOOL GROUP WHEEZE PREVALENCE IS HIGHER AMONG MALE CHILDREN. CHILDHOOD EXPOSURE TO RESPIRATORY VIRUS CONSEQUENT RESPONSE OF IMMUNE SYSTEM STRONGLY ASSOCIATED WITH DEVELOPMENT OF ASTHMA. SEX AS A BIOLOGICAL VARIABLE AFFECTS IMMUNE SYSTEM AND WHEEZE. SO WE ASKED IF SEX DIFFERENCE IN IMMUNE RESPONSE TO RESPIRATORY VIRAL INFECTION COULD EXPLAIN SEX DIFFERENCES IN CHILDHOOD WHEEZE IN DEVELOPMENT OF ASTHMA. TO STUDY THIS, WE USED BIOLOGICAL ESTABLISHED (INDISCERNIBLE) SURVEILLANCE CONDUCTED FOR RESPIRATORY INFECTION DURING FIRST YEAR OF INFANTS, WE CONDUCTED SURVEILLANCE EVERY TWO WEEKS, WHEN THE CHILDRENS SIX WEEKS. WE FOLLOWED CHILDREN ONE YEAR TO FOUR YEAR EVERY YEAR, ASSESSING WITH FREQUENCY. WE TOOK THE DATA AND ANALYZED BY SEX. AS YOU CAN SEE, WE HAVE 167 MALES IN THE SAMPLE, 131 FEMALES IN THE SAMPLE. TO SUMMARIZE MY TALK, AT BIRCWH SCHOLAR I HAVE BEEN FORTUNED TO BE MENTORED BY INTERDISCIPLINARY COMMITTEE OF INVESTIGATORS AND BE ABLE TO ADOPT SEX AS A BIOLOGICAL VARIABLE IN MY RESEARCH. ASTHMA PREVALENCE HAS KNOWN SEXUAL DIMORPHISM, MAKES IT SUITABLE TO STUDY SEX DIFFERENCES. UNDERSTANDING THE UNDERLYING BIOLOGICAL AND ENVIRONMENTAL REASONS FOR THE SEX DIFFERENCES IN ASTHMA INCIDENCE AND MORBIDITY IS AN ONGOING EFFORT. MY APPROACH TO THIS PROBLEM INCLUDES USING SEX STRATIFIED HIGH DIMENSIONAL MOLECULAR DATA TO UNDERSTAND THE UPSTREAM PATHWAYS DRIVING DISEASE ORIGIN IN EXPLAINING HETEROGENEITY OF ASTHMA. WITH THIS, I WOULD LIKE TO ACKNOWLEDGE MY FUNDING SOURCES, MY MENTOR TINA HARTE ARE,T AT VANDER BUILD, VANDERBILT BIRCWH LEADERSHIP AND BIRCWH SCHOLARS AT VANDERBILT WHO REALLY PROVIDED GREAT FEEDBACK. THANK YOU VERY MUCH. AND I LOOK FORWARD TO THE QUESTIONS AND DISCUSSIONS. >> IT'S JUDY REGENSTEINER AGAIN FROM COLORADO. AND I'M HERE TO MODERATE THE QUESTION-AND-ANSWER SESSION. I WANT TO THANK MY COLLEAGUES FOR THEIR EXCELLENT TALKS. THANK YOU SO MUCH. I WANT TO START WITH A QUESTION, OTHERS CAN ANSWER AS WELL. I WANTED TO ASK YOU, VIRGINIA, WHAT IS THE ADOPTION OF SEX AS A BIOLOGICAL VARIABLE THINKING AT THE MAYO CLINIC, AND I KNOW YOU'RE AN INNOVATIVE LEADER IN CURRICULUM DEVELOPMENT AS YOU'RE ALSO IN RESEARCH, FORWARD THINKING. >> WELL, I HAVE LOST MY VISUAL, I HOPE YOU CAN HEAR ME. CAN YOU HEAR ME? >> I CAN HEAR YOU FINE. >> OKAY. THANK YOU. WELL, I THINK THIS IS PROBABLY TYPICAL OF MANY INSTITUTIONS, THAT WE'VE SEEN SOME SUCCESS WITH INCORPORATING SEX AS A BIOLOGICAL VARIABLE, INTO SOME ASPECTS OF THE CURRICULUM. HOWEVER, WE HAVE YET TO BE ABLE TO DEVELOP A STANDARD CURRICULUM INTO THE MEDICAL SCHOOL, WHICH WOULD INCORPORATE THESE CONCEPTS INTO EACH OF THE INDIVIDUAL BLOCKS. OUR BIGGEST SUCCESS HAS BEEN WITH THE CLINICAL SCIENCE TRANSLATIONAL PROGRAM, WHERE WE HAVE ACTUALLY A SERIES OF LECTURES AND WORKSHOPS ON THESE CONCEPTS. AND WE'VE ALSO DEVELOPED SOME COURSE MATERIAL WITHIN THE EPIDEMIOLOGY CLASSES, OR THE COURSE WORK THAT INCORPORATE THE STATISTICAL ANALYSIS INTO POPULATION STUDIES AS WELL AS IN THE DESIGN OF BASIC SCIENCE STUDIES. OUR MAJOR INITIATIVE HAS REALLY BEEN TO EDUCATE RESEARCHERS IN TERMS OF HOW TO ACCOUNT FOR SEX AS A BIOLOGICAL VARIABLE IN THEIR RESEARCH GRANT, WE STARTED WORKSHOPS THREE OR FOUR YEARS AGO, AND THOSE HAVE BEEN SUCCESSFUL IN TERMS OF INDIVIDUALS BRINGING GRANTS TO THE WORKSHOP WHERE WE HAMMER THESE CONCEPTS OUT IN PERSON, LOOK AT INDIVIDUAL GRANTS, TALK ABOUT HOW THEY CAN INCORPORATE CONCEPT, NOT ONLY TO FILL OUT SOME QUESTIONNAIRE OR BLOCK HOW SEX IS IMPORTANT BUT REALLY TO PUT IT THROUGH THE WHOLE THOUGHT PROCESS. THIS HAS BEEN MODELED IN OTHER PLACES, WE'VE HAD INQUIRIES FROM CEDARS-SINAI, ONE THE OTHER SCORE PROGRAM AND OTHER EMORY BIRCWH PROGRAM. SO INDIVIDUAL EFFORTS REMAIN. YOU HAVE TO KEEP AT IT. OTHERWISE PEOPLE LOSE ATTENTION TO THE NEXT BRIGHT SHINY THING DOWN THE ROAD. SEX AS A BIOLOGICAL VARIABLE ISN'T A BRIGHT SHINY THING THAT WILL GO AWAY. IT'S SO BASIC, IT IS THE BEDROCK OF WHAT WE MUST WORK FROM. >> I COMPLETELY AGREE. DR. FREUND OR DR. TURI, WOULD YOU LIKE TO RESPOND TO THAT QUESTION AS WELL OR SHOULD I MOVE ON? >> ONE ADDITIONAL COMMENT I MIGHT ADD IS THAT YOU -- YOU CAN HEAR ME OKAY? >> UH-HUH. >> GREAT. THE ONE ADDITIONAL COMMENT I MIGHT ADD, I THINK THERE STILL HAS BEEN SOME VARIABILITY IN HOW THE NIH STUDY SECTIONS ARE REVIEWING GRANTS AROUND THEIR USE OF SEX AS A BIOLOGICAL VARIABLE, AND I THINK THAT ONE OF THE POSSIBILITIES OF MOVING US FORWARD AT EACH INSTITUTION IS TO ASSURE THAT THERE IS STANDARDIZATION IN GRANT REVIEWS. THERE'S NOTHING LIKE KNOWING YOUR GRANTS WILL BE REVIEWED TO MOTIVATE INVESTIGATORS AND ORGANIZATIONS TO REALLY HAVE ROBUST CURRICULUM TO TRAIN AND ROBUST REVIEW OF GRANT SUBMISSIONS SO I THINK THERE ARE REAL NEEDS AND REAL OPPORTUNITIES AS INDIVIDUAL ORGANIZATIONS TO DEVELOP THIS CURRICULUM BUT I THINK IT ALSO CAN BE MOVED FURTHER, MAYBE FASTER, BY IMPLEMENTATION OF WHAT WE ALREADY HAVE AS GUIDELINES IN OUR NIH GRANTS TO DO -- TO INCLUDE SEX AS A BIOLOGICAL VARIABLE WHERE APPROPRIATE. >> IF I CAN ADD TOO THAT, JUDY, YOU MAY BE THINKING THIS TOO. YOU BROUGHT UP A GOOD POINT, ACCOUNTABILITY IN TERMS OF THE STUDY SECTIONS IS ONE THING BUT I THINK WE ALSO NEED TO HOLD ACCOUNTABLE INDIVIDUALS WHO GET THESE SUPPLEMENTS AND WHO ARE GETTING NIH GRANTS, THAT THEY ACTUALLY REPORT THEIR DATA ON SEX DIFFERENCES. SO THAT'S A PIECE THAT I THINK CAN BE STRENGTHENED MOVING FORWARD IS ACCOUNTABILITY. AND ONCE THAT ACCOUNTABILITY MOVES FORWARD IN TERMS OF GETTING THE DATA INTO THE LITERATURE, I THINK IT'S GOING TO BE EASIER TO SEE THE CURRICULUM DEVELOP AS A CONSEQUENCE OF THAT, BECAUSE THERE'S GOING TO BE A NATURAL SORT OF WATER FALL EFFECT, IF YOU HAVE THE INFORMATION IN THE LITERATURE AND IT GETS -- IT'S ALWAYS ASKED FOR AND IT GETS INTO CLINICAL GUIDELINES, IT'S GOING TO HAVE TO GO BACKWARDS INTO THE MEDICAL CURRICULUM FOR SURE. AND WITH QUESTIONS ON THE EXAMS IN TERMS OF LICENSING EXAMS, THAT WILL FACILITATE IT. IT'S A LITTLE TOUGHER ON THE BASIC SCIENCE END. AND THAT'S ONE OF THE ACCOUNTABILITY AND RESEARCH GRANTS AND PUBLICATIONS ARE SO IMPORTANT BECAUSE IT'S EASY FOR THAT MATERIAL TO SLIP THROUGH THE ROCKS, SLIP THROUGH THE CRACKS, BECAUSE THERE'S NO ULTIMATE OUTCOME IMMEDIATELY IN SOME OF THE BASIC SCIENCE STUDIES INTO PATIENT-DIRECTED CARE. >> I AGREE WITH BOTH OF YOU. WE'RE WORKING ON CURRICULUM, COLORADO MEDICINE, BIRCWH SCHOLARS WILL BE REQUIRED TO TAKE IT. AND IT INVOLVES -- THEY DO HAVE A REQUIRED CURRICULUM ALREADY, TAKING CURRICULUM INCLUDING ELEMENTS OF TRAINING IN ACADEMIC SKILLS, CAREER DEVELOPMENT SKILLS, AND NOW WE'RE GOING TO INCORPORATE THE NEW SABV PRIMER THAT NIH ANNOUNCED, I ENCOURAGE YOU TO LOOK, IT DESCRIBES HOW TO INCORPORATE SEX AS A BIOLOGICAL VARIABLE INTO TRAINING WHICH IS GOING TO BE CRITICAL TO CHANGE THE PARADIGM OF THINKING ABOUT ONE SEX AT A TIME OR MALE SEX ONLY. SO PLEASE LOOK AT THAT. >> I THINK THAT'S CRITICAL TOO IN TERMS OF EDUCATING THE EDUCATORS. MANY INDIVIDUALS ARE WRINGING THEIR HANDS SAYING WHERE ARE THE MATERIALS. IF WE CAN NOW GIVE THEM REALLY GOOD SOURCE MATERIALS, THAT THINGS DON'T HAVE TO BE CREATED DE NOVO EACH TIME A CURRICULUM IS DEVELOPED, IT WILL FACILITATE IDEAS, THAT GROUP OF MODULES FROM NIH IS WONDERFUL. WE HAVE TO BE DISSEMINATORS BECAUSE PEOPLE AREN'T NECESSARILY AWARE OF IT. >> DR. FREUND, I WANT TO DIRECT THIS QUESTION TO YOU FIRST. ONE OF THE THINGS THAT I THOUGHT ABOUT A LOT IS OUR JUNIOR SCHOLARS, JUNIOR FACULTY MAY BE EARLY ADOPTERS OF SEX AS A BIOLOGICAL VARIABLE, BUT HOW DO WE WORK WITH OLDER MENTORS, NOT SAYING SENIOR, THAT WORD IS NEVER POPULAR, BUT PEOPLE THAT ARE, YOU KNOW, MORE ESTABLISHED IN THE FIELD, HOW DO WE CHANGE THEIR THINKING AND HELP THEM HELP YOUNGER PEOPLE? >> I THINK, YEAH, JUDY, IT'S A GREAT QUESTION ABOUT HOW DO WE MOVE EXPERIENCED INVESTIGATORS WHO MAY HAVE NOT REALLY DEVELOPED THEIR RESEARCH TO INCLUDE SEX AS A BIOLOGICAL VARIABLE, ESPECIALLY IF THEY ARE SERVING AS MENTORS FOR THE NEXT GENERATION. I THINK THERE ARE A COUPLE THINGS THAT MIGHT BE HELPFUL. FIRST OF ALL, MENTORS ARE NOT BORN. THEY ARE REALLY TRAINED. I THINK THERE'S REALLY GOOD LITERATURE NOW TO SUGGEST THAT WE CAN TRAIN INDIVIDUALS TO BE GOOD MENTORS, THEY DON'T HAVE TO SOMEHOW BE BORN WITH THIS INNATE ABILITY TO HELP OTHER PEOPLE DO RESEARCH. THERE'S REALLY -- WE HAVE FOUND THAT IN ALMOST ALL THE TRAINING GRANTS THAT WE SUBMIT TO OUR ORGANIZATIONS, WHEN WE INCLUDE SPECIFIC MENTOR TRAINING AS PART OF THAT TRAINING GRANT, IT RECEIVES REALLY GOOD SCORES. REVIEWERS LIKE THE NOTION THAT WE ARE ACTIVELY TRAINING MENTORS. AND SO, YOU KNOW, I THINK THAT FOR ALL BIRCWH APPLICATIONS, FOR EXAMPLE, THERE SHOULD BE A COMPONENT ABOUT TRAINING MENTORS HOW TO MENTOR AROUND SEX AS A BIOLOGICAL VARIABLE AND HOPEFULLY THAT COULD THEN BE EXPANDED TO ALL TRAINING PROGRAMS BECAUSE THIS IS ONE OF THE KEY COMPONENTS OF AN NIH GRANT, AND JUST THE SAME WAY THAT WE'RE TRAINING ON RIGOR AND REPRODUCIBILITY, AND WE'RE TRAINING ON PREMISE, ONE OF THE KEY COMPONENTS. SO I THINK DEVELOPING THAT EXPECTATION, THE TRAINING GRANTS HAVE MENTORING PROGRAMS, MENTOR TRAINING BUILT INTO THEM AND THAT MENTOR TRAINING INCLUDES SEX AS A BIOLOGICAL VARIABLE WOULD BE ONE WAY TO VERY QUICKLY MOVE THE DIAL FORWARD FOR ALL OF OUR PROGRAMS. >> THAT'S GREAT. THIS IS SUCH AN EXCITING DISCUSSION. OF COURSE I LOVE THIS AREA. DR. MILLER, DO YOU WANT TO COMMENT ON THE IDEA OF GETTING THE MORE SENIOR, I'LL USE THAT WORD, WE'RE PASSIONATE ABOUT MENTORING AND CHANGING TO WORK AT SABV, HOW DO WE GET THAT OUT THERE? HOW DO YOU SEE THAT HAPPENING? >> THE MORE ESTABLISHED INVESTIGATORS WE HAVE STRUGGLED WITH. AND THE BEST WAY TO GET TO THEM, THEY ARE NOT GOING COME TO A TRAINING PROGRAM, OKAY? THEY ARE NOT GOING TO SIT DOWN FOR AN HOUR. WE'VE TRIED TO THINK ABOUT MORE CREATIVE WAYS, I KNOW AT UNIVERSITY OF KENTUCKY THEY START DOING THINGS AROUND LUNCH TIME WHERE THEY INVITE MENTORS TO LUNCH AND THAT MIGHT WORK BUT IN THE VIRTUAL ENVIRONMENT, GOOD LUCK WITH THAT. I THINK ONE OF THE THINGS WE CAN PUSH IS AN INDIRECT WAY. WE HAVE INTERACTION WITH THE SCHOLARS, AT MAYO WE'RE PRETTY SCHOLAR FOCUSED AND PRETTY HANDS ON WITH THESE SCHOLARS. AND IF WE REQUIRE THEM TO DO THIS MATERIAL AND REQUIRE THEM TO HAVE THEIR RESEARCH DIRECTED TOWARDS SEX DIFFERENCE THAT'S GOING TO TRICKLE UP MAYBE TO THEIR MENTOR. WE'VE REACHED SEVERAL MENTORS THAT WAY. INDIVIDUALS WHO WERE VERY RELUCTANT, NOW W. MAJOR SENIOR PEOPLE NOW WRITING MAJOR REVIEW ARTICLES LOOKING AT THEIR OWN LITERATURE FROM SEX-POINT OF VIEW. THERE'S NOT ONE APPROACH THAT'S GOING TO TAKE ALL. SOMEBODY CAME TO ME MY LAST YEAR OF WORKING AND TOLD ME I HAD TO GO TO A MENTORING CLASS, MY EYES WOULD ROLL. I'M SURE THERE ARE MANY INVESTIGATORS, DON'T MAKE ME DO ONE MORE THING, YOU KNOW? WE HAVE TO TAKE A MULTI-PRONGED APPROACH TO GET INVESTIGATORS AT ALL LEVELS ENGAGED AND THINK OF CAREER STAGE, AGE, OF COURSE GENDER IN TERMS OF WHAT MIGHT WORK BEST FOR THEM >> GREAT DISCUSSION. KAREN? >> I WAS GOING TO COMMENT ON YOUR COMMENT ABOUT WHERE YOU CAN GET MENTORS TO TRAINING. THE ONE APPROACH WE'VE USED HAS BEEN SUCCESSFUL IS MENTORS DON'T HAVE A CHANCE TO TALK ABOUT THEIR EXPERIENCES MENTORING, BOTH THE PITFALLS, WHAT'S WORKED WELL. WE'VE DONE A CLASSROOM APPROACH, GIVEN THEM MATERIALS BEFOREHAND, USED THE TIME FOR DISCUSSION. TO MY SURPRISE THE REVIEWS WHEN WE'VE DONE THAT SESSIONS WERE TOO SHORT. SO THAT MADE ME THINK THE SESSIONS WERE PROBABLY JUST THE RIGHT LENGTH BECAUSE OTHERWISE THEY WOULD BE TOO LONG. SO, I WOULD COMPLETELY -- I DO UNDERSTAND THE CHALLENGES OF ALL THE DIFFERENT COMPETING DEMANDS ON PEOPLE'S TIMES, I WENT GIVE UP ON GETTING MENTORS TOGETHER TO TALK ABOUT MENTORING. >> PERHAPS YOU COULD SHARE SOME OF THOSE MATERIALS. >> WE'VE USED MANY MATERIALS ON THE NATIONAL MENTORING -- I'M BLANKING ON THE NAME, USING THE ACRONYM, WE CAN PROVIDE THOSE MATERIALS LATER IN THE DISCUSSION. >> GREAT, GREAT. >> THAT POINTS OUT OF THE KEY THINGS AMONGST BIRCWH P.I.s AND PEOPLE INTERESTED IN WOMEN'S HEALTH, THE COLLABORATIVE NATURE OF THE INTERACTIONS, IT'S JUST WONDERFUL, WE ALL LEARNED VERY MUCH FROM EACH OTHER. DR. TURI, I WANT TO DIRECT A QUESTION IN YOUR DIRECTION. NIH INITIATIVES HAVE CONTRIBUTED TO BRINGING SEX AS A BIOLOGICAL VARIABLE THINKING TO THE FORE AND HAVE BROUGHT THAT THINKING TO RESEARCH. WHAT DO YOU SEE AS THE NEXT STEP OR A NEXT STEP? >> THAT'S A GREAT QUESTION. SO, ESPECIALLY FOR JUNIOR INVESTIGATORS LIKE ME WHO ARE JUST STARTING TO LOOK AT THE NIH SYSTEM ARE LEARNING HOW APPLY, SEX AS A BIOLOGICAL VARIABLE IS A GREAT WAY OF STUDYING IN THIS REGARD IT'S A LONG WAY TO GO IN THE SCIENTIFIC ARENA THAT THE APPROACH TO SEX AS A BIOLOGICAL VARIABLE IS STILL NOT -- PEOPLE LIKE ME CAN MAKE A CHAIR OUT OF IT AND DRIVE -- IN TERMS OF DEVELOPMENT, HOW TO INCORPORATE SEX AS A BIOLOGICAL VARIABLE INTO RESEARCH IN EXPANDING IN THAT AREA, BIOINFORMATICS, AND IN USING DATA TO CONVERT SEX AS A BIOLOGICAL VARIABLE ALSO DEVELOPING (INDISCERNIBLE) THAT INCORPORATES THIS INTO EVERY RESEARCH POSSIBLE, WE SEE SEX DIFFERENCES IN THE PATHOGENS OF DISEASE. >> THAT'S GREAT. WHAT ELSE WOULD YOU LIKE TO ADD, DOCTORS MILLER AND FREUND? >> WE'VE TALKED ALREADY ABOUT HOW TO INCREASE AND, YOU KNOW, MAKE SURE THAT MENTORING IS AVAILABLE AT ALL LEVELS. WE'VE TALKED ABOUT CURRICULUM. WHAT ELSE DO WE NEED TO DO? >> I THINK -- >> GO AHEAD. >> GO AHEAD, KAREN. >> I WAS GOING TO MENTION THERE WAS ONE COMMENT IN THE QUESTIONS ABOUT THE ROLE OF JOURNALS. AND MAKING SURE THAT HOLDING OUR JOURNAL EDITORS ACCOUNTABLE TO INCLUDING SEX DIFFERENCES IN MANUSCRIPTS, AND NOT JUST DELEGATING SEX DIFFERENCE TO SUPPLEMENTS BUT REQUIRING IF THE NIH IS REQUIRING THAT WE COLLECT THIS DATA AND REPORT, IT WILL REPORT ON THIS DATA, THERE'S A NEED TO REALLY PUSH AT JOURNAL EDITORS AS WELL. VIRGINIA, YOU WERE GOING TO SAY SOMETHING AS WELL? >> I WAS GOING TO SAY IN TERMS OF SORT OF THE CONCEPT OF MENTORING, YOU KNOW, OUR SCHOLARS HAVE A MENTORING TEAM. WHEN WE TALK TO OUR SCHOLARS, WE WANT TO ENCOURAGE THEM TO LOOK AT INDIVIDUALS BEYOND THEIR MENTORING TEAM IN TERMS OF WHAT THEY CAN LEARN FROM THEM. YOU DON'T HAVE TO HAVE A FORMALIZED MENTOR IN ORDER TO HAVE AN INFLUENCE ON YOUR CAREER. YOU CAN LOOK AT OTHER INVESTIGATORS WHOM YOU ADMIRE, OR WHO ARE LEADERS IN YOUR PARTICULAR SCIENTIFIC TOPIC. AND EMULATE WHAT THEY DO. WHAT IS IT ABOUT THEM THAT MAKES YOU ADMIRE THEM OR WANT TO BE LIKE THEM? AND THE KIND OF QUESTIONS THAT YOU ASK YOURSELF IN TERMS OF WHAT ARE MY STRENGTHS, WHAT ARE MY WEAKNESSES, AND WHERE DO I NEED TO DEVELOP THEM, SO WE HAVE DEVELOPED KIND OF A CHECKLIST FOR INDIVIDUALS WHEN THEY FIRST COME INTO THE PROGRAM IN TERMS OF CERTAIN CHARACTERISTICS OF WHERE THEY FEEL THEY ARE ON A SCALE, NO GRAY FOR THIS. THIS IS SOMETHING THEY CAN TRACK, WHAT THEY FEEL WEAKNESS ARE IN TERMS OF MANUSCRIPT WRITING, PRESENTATION, OR WHATEVER. AND EVERY TIME WE MEET WITH THEM DURING THE YEAR OF THE PROGRAM, WE BRING THAT CHECKLIST UP AND HOLD THEM ACCOUNTABLE TO WHAT THEY ARE DOING TO PROACTIVELY CORRECT WHAT DEFICITS THEY IDENTIFY WITHIN THEMSELVES. SO IT'S A DYNAMIC PROCESS. IT'S NOT JUST THE MENTOR DOING SOMETHING TO THE MENTEE. IT'S AN ACTIVE ENGAGEMENT THAT WE ONLY -- ONLY SUCCESSFUL IF THE MENTEE WANTS TO BE MENTORED, YOU KNOW? WE'VE HAD MANY -- YOU KNOW, WE CAN SPEND HOURS WITH THEM, THEY GO AWAY, IT'S LIKE REALLY? WHAT HAS HAPPENED, YOU KNOW? SO, THERE'S ACCOUNTABILITY ON BOTH SIDES, AND I THINK HAVING -- LOOKING AT OTHER INDIVIDUALS OTHER THAN YOUR MENTORING TEAM SOMETIMES CAN BE VERY BENEFICIAL IN TERMS OF ACTIVITY IN YOUR CAREER. EVEN REACHING OUT TO INDIVIDUALS AT OTHER INSTITUTIONS WE'VE HAD SEVERAL BIRCWH SCHOLARS DO THAT FROM WHEN WE USED TO GO TO MEETINGS, THEY END UP BEING A CO-MENTOR, OR WHATEVER, TO GO TO THEIR LABORATORY FOR ADDITIONAL TRAINING SO THERE'S A PRO-ACTIVE PIECE ON THIS IN TERMS OF THE MENTEE THAT IS I THINK ALSO CRITICAL. >> WHAT WE'RE TALKING ABOUT, THE ACCEPTANCE OF JOURNALS, IS NOT A FOREGONE CONCLUSION. IT'S STILL SOMEWHAT OF AN UPHILL BATTLE. A LOT OF JOURNALS DO NOT DISAGGREGATE REPORTS, MAKE AUTHORS DISAGGREGATE RESULTS, A LOT OF ARTICLES YOU STILL DON'T KNOW SEX OF ANIMALS BEING STUDY, MANY INSTANCES. THAT ISSUE IS STILL VERY MUCH AN ISSUE FACING US. THE OTHER ISSUES ARE STILL THERE. WHAT'S EXCITING IS NOW THAT THERE ARE BEGINNING TO BE MATERIALS ON WHICH WE CAN COMBAT THE LACK OF ATTENTION TO SEX DIFFERENCES, SO THINGS ARE CHANGING. >> I THINK IN TERMS OF THE JOURNALS, I LIKE TO CHALLENGE THE AUDIENCE, THAT THIS IS SOMETHING THEY CAN FIX BECAUSE WE ALL REVIEW PAPERS. I'LL TELL YOU WHAT. IF I GET A PAPER, AND I JUST GOT ONE TODAY, THAT, YOU KNOW, I STILL REVIEW PAPERS IF I THINK THEY ARE INTERESTING AND I CAN MAKE AN IMPACT. AND I CAN JUST READ THROUGH THE ABSTRACT, THEY TELL ME HOW MANY MEN AND WOMEN THEY HAVE, AND THEN GO OFF TO GIVE ME THE GROUPED RESULTS, DRUG-DRUG INTERACTION, NEVER SEGREGATING THEM BY SEX. THAT TO ME IS UNACCEPTABLE. THAT'S GOING BACK WITH MAJOR REVISIONS. AS A REVIEWER YOU HAVE QUITE A BIT OF INFLUENCE IN TERMS OF WHAT THE ULTIMATE PUBLICATION WILL BE. WE ALL CAN DO THAT. THAT'S NOT HARD. >> GRANT REVIEW ALLOWS YOU OPPORTUNITY TO MAKE SURE THAT PROPER ATTENTION IS PAID TO SUCH ISSUES. WE'RE RUNNING A LITTLE SHORT ON TIME, OR WE STILL HAVE A FEW MINUTES THOUGH. ANY THOUGHTS? HOW ABOUT EACH PERSON GIVE THEIR FINAL THOUGHTS TO THIS DISCUSSION. VIRGINIA? >> WELL, I JUST WANT TO SAY THIS HAS BEEN AN HONOR FOR ME TO PARTICIPATE IN THIS WORKSHOP. IF IT HADN'T BEEN FOR THE GRANT I INITIALLY GOT UNDER BERNADINE HEALEY'S LEADERSHIP I PROBABLY WOULDN'T BE ON THIS STAGE TODAY SO EMPHASIZE THE FACT HOW PROVIDING RESOURCES, ESPECIALLY FINANCIAL RESOURCES FOR THIS TOPIC GOES A LONG WAY. AND IT'S BEEN A PLEASURE OVER MY YEARS TO WORK WITH THIS AREA. I NEVER THOUGHT I WOULD BE IN IT. THIS IS A GOOD EXAMPLE OF, YOU KNOW, HOW YOU TAKE OPPORTUNITIES AND REALLY BUILD A CAREER. SO THANKS TO EVERYBODY. IT'S BEEN A PLEASURE WORKING WITH YOU OVER THE YEARS AND I DO WISH THE OFFICE OF RESEARCH AND WOMEN'S HEALTH CONTINUED SUCCESS. I'M SURE THEY WILL BE. >> THANK YOU TO ORWH FOR THIS GREAT -- PUTTING TOGETHER THIS GREAT SYMPOSIUM, YOU KNOW, DURING THESE CHALLENGING TIMES. I KNOW WE WOULD HAVE ALL LOVED TO HAVE BEEN TOGETHER BUT IT'S GRANTS SUPPORTING 700 -- BUT IT'S GREAT TO SEE COLLEAGUES ON THE SCREEN. DR. TURI'S PRESENTATION WAS A GREAT EXAMPLE AND COMPILATION OF EVERYTHING WE TALKED ABOUT, STARTING BY TALKING ABOUT WORKING WITH YOUR PEER MENTORS WHO GAVE YOU GUIDANCE STARTING WITH SUBMISSION PROCESS, TALKING ABOUT THE VARIOUS ROLES OF THE MENTORS WITHIN YOUR INTERDISCIPLINARY MENTORING TEAM, A PERFECT EXAMPLE. WITH ASTHMA BEING SO COMMON, IT'S INTERESTING WE'VE NOT HAD MORE WORK DONE TO UNDERSTAND THE SEX DIFFERENCES IN ASTHMA. I WANT TO CONGRATULATE YOU ON YOUR WORK AND WISH YOU LUCK WITH YOUR K01. >> THANK YOU VERY MUCH. >> THANK YOU, DR. TURI, BIRCWH SCHOLARS ARE THE WORK FORCE OF THE FUTURE. NONE OF OUR WORK ON WOMEN'S HEALTH OR HEALTH OF WOMEN OR SEX DIFFERENCES WILL HAPPEN WITHOUT EXCITING YOUNG INVESTIGATORS LIKE YOU. THANK YOU FOR THE WORK YOU'RE PURSUING. WHAT WOULD YOU LIKE TO SAY, DR. TURI? >> THANK YOU VERY MUCH FOR INVITING ME TO GIVE MY PERSPECTIVE AS BIRCWH SCHOLAR. THANK YOU VERY MUCH FOR NIH AND BIRCWH SETTING MY CAREER TRAJECTORY THIS WAY, K01, VERY HELPFUL SO I'M VERY THANKFUL TO ALL OF BIRCWH LEADERSHIP AND ALSO NIH TO REALLY PROVIDE GREAT ADVISORS ALL DURING THESE TIMES AND I APPRECIATE IT. I AM LOOKING FORWARD TO WORK ON THIS AREA AS MUCH AS POSSIBLE. THANK YOU. >> THANK YOU ALL. I REALLY APPRECIATE YOUR PARTICIPATION. I AGAIN THANK NIH FOR PUTTING ON THIS WONDERFUL PANEL. I FOUND IT SO EXCELLENT, LEARNED THROUGH THE PUTTING ON OF IT, AND I WANT TO THANK EVERYONE AND AGAIN THANKS TO DOCTORS CLAYTON, BEGG, AND DHUTARD FOR THEIR HARD WORK. THANKS, EVERYBODY, AND HAVE A GOOD DAY. >> IT'S MY PRIVILEGE TO INTRODUCE OUR NEXT PANEL, WE AT ORWH ARE HONORED BY PARTICIPATION AND LOOK FORWARD TO THEIR PERSPECTIVE AND THEIR WORK ON INTRODUCING THE HEALTH OF WOMEN. I'LL INTRODUCE THE PANELISTS. FIRST IS DR. HELEN LANGEVIN, DIRECTOR OF NCCIH ON MEDICAL AND HEALTH CARE SYSTEM, PRACTICE AND PRODUCTS THAT ARE NOT GENERALLY CONSIDERED PART OF CONVENTIONAL MEDICINE. THESE INCLUDE NATURAL PRODUCTS, MIND AND BODY PRACTICES, PAIN MANAGEMENT. SCIENTIFIC PRIORITIES INCLUDING NON-PHARMACOLOGIC MEASUREMENT OF PAIN, BIOLOGICAL SIGNATURES OF NATURAL PRODUCTS, DISEASE PREVENTION AND HEALTH PROMOTION ACROSS THE LIFESPAN. FOLLOWING IS DR. NED SHARPLESS, DIRECTOR OF NATIONAL CANCER INSTITUTE, THE FEDERAL GOVERNMENT PRINCIPAL AGENCY FOR CANCER RESEARCH AND TRAINING, LEADER OF THE NATIONAL CANCER PROGRAM NCI LEADS THE NATION'S RESEARCH EFFORTS TO IMPROVE CANCER PREVENTION, DETECTION, DIAGNOSIS, SURVIVORSHIP. IT SUPPORTS 71 NCI DESIGNATED CANCER CENTERS, 5,000 GRANTEES, COORDINATES AND SUPPORTS CLINICAL TRIALS ACROSS 2500 CLINICAL TRIAL SITES NATIONWIDE. NCI FUNDED SCIENTISTS PERFORM SCIENTIFIC RESEARCH, ON CAUSES OF CANCER. DR. DIANA BY BIANCHI OF DIRECTOR OF EUNICE KENNEDY SHRIVER NICHD, STUDYING HUMAN DEVELOPMENT THROUGH THE LIFE PROCESS UNDERSTANDING DISABILITIES AND LIFE EVENTS DURING PREGNANCY. ITS MISSION TO LEAD RESEARCH AND TRAINING TO UNDERSTAND HUMAN DEVELOPMENT, IMPROVE REPRODUCTIVE HEALTH, OPTIMIZE ABILITIES, LEADING TO VACCINES, CUTTING EDGE MOLECULAR IMAGING TECHNOLOGY, PROVIDING NEW INSIGHTS INTO RISKS OF CERTAIN ENVIRONMENTAL EXPOSURES AMONG POPULATIONS, AMONG OTHER ADVANCES. DR. NORA VOLKOW IS DIRECTOR OF NIDA, LEAD FEDERAL AGENCY SUPPORTING SCIENTIFIC RESEARCH ON DRUG USE, AND CONSEQUENCES. ITS RESEARCH ADDRESSES THE MOST FUNDAMENTAL WELL INCLUDING TRACKING EMERGING DRUG USE TRENDS, UNDERSTANDING HOW DRUG WORKS IN THE BRAIN AND BODY, DEVELOPING AND TESTING NEW DRUG TREATMENT AND PREVENTION APPROACHES, DISSEMINATING FINDINGS TO THE PUBLIC, RESEARCHERS, AND OTHERS. ITS RESEARCH REVOLUTIONIZING UNDERSTANDING OF DRUG USE, INCLUDING NEUROLOGY BIOLOGICAL, GENETICS, SOCIAL AND ENVIRONMENTAL FACTORS THAT CONTRIBUTE TO SUBSTANCE USE DISORDERS. FOLLOWING IS DR. GWEN COLLMAN, ACTING DEPUTY DIRECTOR OF NATIONAL INSTITUTE OF ENVIRONMENTAL AND HEALTH SCIENCES, HAS BEEN DIRECTOR OF THE NIEHS DIVISION OF EXTRAMURAL RESEARCH AND TRAINING, THE MISSION OF NIEHS IS TO DISCOVER HOW THE ENVIRONMENT AFFECTS PEOPLE IN ORDER TO PROMOTE HEALTHIER LIVES. ITS RESEARCH INVESTIGATES ENVIRONMENTALLY ASSOCIATED DISEASE, PREVENTION STUDIES OF EXPOSURE TO HAZARDOUS ENVIRONMENTS. DR. MONICA WEBB HOOPER, NIMHD, PRIMARY FOCUS ON INCREASING UNDERSTANDING OF THE EFFECTS OF NON-BIOLOGICAL FACTORS ON PROGRESSION OF DISEASE INCLUDING SOCIOECONOMICS, DISCRIMINATION CULTURE, ENVIRONMENT, THE NIMHD RESEARCHERS CONDUCT COLLABORATIVE TRANSDISCIPLINARY HIGH RISK AND HIGH IMPACT MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. THEY SEEK TO UNDERSTAND COMPLEX MECHANISMS THAT CONTRIBUTE TO HEALTH DISPARITIES, DEVELOP MULTI-LEVEL SOCIOBEHAVIORAL INTERVENTIONS TO REDUCE DISPARITIES AND PROMOTE HEALTH AND WELL BEING OF MINORITY HEALTH AND HEALTH DISPARITY POPULATION. >> HELLO, ON BEHALF OF THE EUNICE KENNEDY SHRIVER INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT WE'RE THRILLED TO BE JOINING THE OFFICE OF RESEARCH ON WOMEN'S HEALTH IN THEIR 30th ANNIVERSARY SCIENTIFIC SYMPOSIUM. IN MY TALK TODAY I'M GOING TO COVER THESE TOPICS, I'M GOING TO GIVE YOU SOME BRIEF INFORMATION ABOUT WHO WE ARE, AND HOW WE CONTRIBUTE TO WOMEN'S HEALTH, AND THEN I'LL FOCUS A LITTLE MORE ON MENSTRUAL HEALTH RESEARCH AND REPRODUCTIVE HEALTH RESEARCH AND THEN WHAT ARE WE DOING IN COVID-19 RESEARCH AS RELATES TO WOMEN LASTLY I'LL GIVE AN UPDATE ON RECOMMENDATIONS FOR THE TASK FORCE ON RESEARCH SPECIFIC TO PREGNANT WOMEN AND LACTATING WOMEN. YOU MIGHT BE ASKING WHY IS THE DIRECTOR OF A CHILD HEALTH INSTITUTE PRESENTING AT THIS ANNIVERSARY SYMPOSIUM. I THINK THAT OUR NAME IS SOMEWHAT MISLEADING. WE WERE NAMED FOR EUNICE KENNEDY SHRIVER, PRESIDENT KENNEDY'S SISTER, WHO RECOMMENDED TO HER BROTHER THAT THE NIH NEEDED AN INSTITUTE DEVOTED TO BOTH CHILD HEALTH AS WELL AS WOMEN AND PEOPLE WITH DISABILITIES. AND YOU CAN SEE THAT ACTUALLY 30% OF OR PORTFOLIO IS IN REPRODUCTIVE HEALTH WRIT LARGE. IN FACT, IF YOU LOOK AT THIS SLIDE WHICH LISTS THE MAJOR NIH INSTITUTES AND OFFICES THAT ARE FUNDING RESEARCH IN REPRODUCTION AND CONTRACEPTION, ON THE LEFT INDICATED BY THE ARROW NICHD IS THE LEAD FUNDER. WE FUND 51% OF RESEARCH RELATED TO WOMEN'S REPRODUCTIVE HEALTH. NOW, HOW DO WE SPEND THAT MONEY? WE HAVE A NUMBER OF REPRODUCTIVE HEALTH RESEARCH PROGRAMS AT THE NICHD. THEY ARE LARGELY GROUPED BY THE DIFFERENT COLORED BARS. FOR EXAMPLE, ON THE LEFT WE'RE LEGISLATIVELY MANDATED TO FUND RESEARCH IN CONTRACEPTION. YOU CAN SEE THOSE PROGRAMS INCLUDE CONTRACEPTIVE CENTERS PROGRAM, CONTRACEPTIVE CLINICAL TRIALS NETWORK, PRE-CLINICAL CONTRACEPTIVE DEVELOPMENT PROGRAM, ET CETERA. ON THE RIGHT WE FUND REPRODUCTION AND INFERTILITY RESEARCH PROGRAMS, INCLUDING THE NATIONAL CENTERS FOR TRANSLATIONAL RESEARCH IN REPRODUCTION AND INFERTILITY. THE REPRODUCTIVE MEDICINE NETWORK, INTRAMURAL GAMETE DEVELOPMENT PROGRAM, AND THE INTRAMURAL MOLECULAR ENDOCRINOLOGY PROGRAM. AND THEN IN PINK WE'VE GOT GYNECOLOGY RESEARCH PROGRAM, THESE INCLUDE THE PELVIC FLOOR DISORDERS NETWORK, A NEW CENTER TO ADVANCE RESEARCH ON ENDOMETRIOSIS, I'LL BE TALKING ABOUT THAT IN A FEW MINUTES, A NEW PROGRAM BASED AT THE NIH CLINICAL CENTER IN BETHESDA, MARYLAND, ON INTRAMURAL PEDIATRIC AND ADOLESCENT GYNECOLOGY. NICHD HAS RECENTLY UNDERGONE ITS FIRST STRATEGIC PLAN IN 20 YEARS. AND STARTING WITH APPROXIMATELY 270 SCIENTIFIC RESEARCH THEMES, THROUGH A LARGE AND LONG PROCESS THAT INVOLVED MANY PEOPLE FROM OUTSIDE AND INSIDE OF NIH, WE WHITTLED THEMES DOWN TO FIVE. AND BASICALLY ALL OF THEM HAVE A CONNECTION WITH WOMEN'S HEALTH. BUT MORE SO THE ONES THAT ARE LISTED IN BOLD. THESE THEMES INCLUDE UNDERSTANDING THE MOLECULAR, CELLULAR, AND STRUCTURAL BASIS OF DEVELOPMENT. AND THIS WOULD INCLUDE ACTUAL DEVELOPMENT OF THE REPRODUCTIVE SYSTEM. CLEARLY PROMOTING GYNECOLOGIC ANDROLOGIC AND REPRODUCE HEALTH IS RELATED TO WOMEN'S HEALTH AS WELL AS SETTING THE FOUNDATION FOR HEALTHY PREGNANCIES AND LIFELONG WELLNESS. AND IN ALIGNMENT WITH ORWH'S SCIENTIFIC AREAS OF FOCUS WE ALSO TAKE A LIFESPAN VIEW AND WE LOOK AT PREGNANCY AS A WAY OF PROVIDING INFORMATION ON RISKS FOR DISEASES IN LATER LIFE, SUCH AS HYPERTENSION AND DIABETES. WE'RE FOCUSED ON IMPROVING CHILD AND ADOLESCENT HEALTH WITH A FOCUS ON PUBERTY AND HOW TRANSITIONS ARE MADE TO ADULTHOOD. AND LASTLY, WE BELIEVE THAT IT IS IMPORTANT TO SINGLE OUT OUR POPULATIONS OF INTEREST TO ADVANCE SAFE AND EFFECTIVE THERAPEUTICS AND DEVICES FOR PREGNANT AND LACTATING WOMEN, CHILDREN, AND PEOPLE WITH DISABILITIES. SO NOW I'D LIKE TO INTRODUCE YOU TO SOME WORK WE'RE DOING IN REPRODUCTIVE HEALTH RESEARCH. IMPORTANTLY, MENSTRUATION IS AN AREA WHERE THERE HAS BEEN SIGNIFICANT GAP IN SCIENCE, AND IN UNDERSTANDING OF WHAT IS NORMAL MENSTRUATION AND HOW, FOR EXAMPLE, CAN MENSTRUAL BLOOD SERVE AS AN IMPORTANT BIOFLUID TO DETERMINE HEALTH OF THE WOMAN. WE RECENTLY HELD A TWO-DAY WORKSHOP, WHEN WE WERE IN PERSON, ON MENSTRUATION FROM THE SCIENTIFIC PERSPECTIVE AND ALSO FROM THE GLOBAL SOCIETAL PERSPECTIVE. AND WE LEARNED A LOT ABOUT PERIOD POVERTY IN THE DEVELOPING WORLD. THERE HAVE BEEN TWO PUBLICATIONS NOW, MAJOR REVIEW IN THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY THAT WROTE ABOUT THE TOPICS WE COVERED IN THE WORKSHOP, AND THERE'S ALSO BEEN AN EDITORIAL FROM THE NIH PERSPECTIVE WHERE WE NEED TO FUND MORE RESEARCH BUT EXISTING RESEARCH INCLUDED UNDERSTANDING GROWTH PROCESSES, UTERINE FIBROIDS, AS WELL AS CONTRIBUTING TO A FDA-APPROVED DRUG, ORION, FOR HEAVY MENSTRUAL BLEEDING DUE TO FIBROIDS. WE HAVE A MAJOR INTEREST IN ENDOMETRIOSIS, IT'S PART OF OUR STRATEGIC PLAN, AND WE'VE ALREADY SHOWN YOU CAN IMPROVE DIAGNOSIS OF END ENDOMETRIOSIS, AND MENSTRUATION, WHAT IS NORMAL, WHAT ARE MENSTRUAL PROBLEMS. I KNOW MUCH OF THE SYMPOSIUM IS FORWARD LOOKING, SO I DO WANT TO POINT OUT THAT IN OUR STRATEGIC PLAN ONE OF OUR TEN ASPIRATIONAL GOALS INCLUDES DIAGNOSING, PREVENTING, AND TREATING ENDOMETRIOSIS. RELATED TO THAT WE ARE DEVELOPING THIS EXTRAMURAL CARE PROGRAM TO IMPROVE UNDERSTANDING OF ENDOMETRIOSIS INITIATION, PROGRESSION, AND PATHOPHYSIOLOGY. THIS IS A CONDITION THAT AFFECTS 1 IN 10 WOMEN, AND IT IS ASSOCIATED WITH PAIN, INFERTILITY, INCREASED RISK OF CANCER. I ALREADY MENTIONED WE'VE DEVELOPED THIS NEW INTRAMURAL AND PEDIATRIC AND ADOLESCENT GYNECOLOGY PROGRAM. IN TERMS OF ADVANCES IN CONTRACEPTION RESEARCH, I THOUGHT IT WOULD BE INTERESTING TO PRESENT ANOTHER USE OF mRNA TECHNOLOGY, YOU'VE HEARD ABOUT THE VACCINE RECENTLY FOR SARS-COV-2, BUT OUR RESEARCHERS HAVE DEVELOPED ANTI-SPERM MONOCLONAL ANTIBODIES ENGINEERED FOR PHASE 1 CLINICAL TRIAL, WOMEN WHO DEVELOP THIS DEVELOP ANTIBODIES AGAINST SPERM ON A TEMPORARY BASIS. WE HAVE INTERNATIONAL STUDY OF 420 COUPLES TESTING DAILY SKIN APPLICATION OF A PROGESTIN-TESTOSTERONE SKIN GEL AND EFFECTS ON BLOCKING SPERM PRODUCTION AND A POPULATION DYNAMICS PROGRAM LOOKING AT HOW CHANGES IN LOCAL MEDICAID REIMBURSEMENT POLICIES ARE AFFECTING WOMEN'S ACCESS TO CONTRACEPTION AS WELL AS INCREASING INTERVALS BETWEEN BIRTH. NEXT I'D LIKE TO MENTION SOME OF THE RESEARCH THAT WE'RE DOING IN COVID-19. WE HAVE AN INTERNATIONAL PROGRAM AS WELL AS DOMESTIC PROGRAM. AND THIS IS IMPORTANT BECAUSE PREGNANT WOMEN ARE MORE LIKELY TO BE HOSPITALIZED AND REQUIRE MECHANICAL VENTILATION THAN NON-PREGNANT WOMEN. WE SUPPORT A MATERNAL-FETAL MEDICINE UNIT NETWORK GRAVID, GREASE TAIGSAL RESEARCH ASSESSMENT FOR COVID-19, ONGOING, ENROLLING MEDICAL REPORTS OF UP TO 24,500 PREGNANT WOMEN ACROSS 12 12 STATES. MARCH OF 2020 TO DECEMBER OF 2020, COMPARING IT TO THE PREVIOUS YEAR, WITH HYPOTHESIS THERE WILL BE INCREASED MATERNAL HEALTH COMPLICATIONS, AND INCREASE THE RATE OF CESAREAN SECTION, PERHAPS INCREASED RATE OF PRE-TERM DELIVERY AND INCREASE THE RATE OF MATERNAL MORTALITY IN THE CURRENT COVID-19 ERA, THERE COULD BE MANY REASONS FOR THIS BUT WHAT ARE THE THINGS WE'RE LOOKING AT, HOW TELEHEALTH CONSULTATIONS, FOR EXAMPLE, HAVE AFFECTED PRENATAL CARE. AND WITHIN THIS GROUP OF 24,000+ PREGNANT WOMEN WE'RE ALSO DOING A NATURAL HISTORY STUDY OF 3,000 WOMEN WHO HAVE CONFIRMED COVID-19 DISEASE. AND SIMILARLY, WE FUND A GLOBAL NETWORK FOR WOMEN AND CHILDREN'S RESEARCH, AND WE'RE TRACKING THE PREVALENCE AND IMPACT OF SARS-COV-2 INFECTION AMONGST 16,000 PREGNANT WOMEN IN SEVEN LOW AND MIDDLE INCOME COUNTRIES, AND WE'RE LOOKING AT THE MATERNAL FETAL AND NEONATAL OUTCOMES AS WELL AS FOLLOWING THESE WOMEN AND CHILDREN FOR A YEAR POSTPARTUM. LASTLY WE'RE INTERESTED IN BREAST MILK, BECAUSE THERE WAS A BIG QUESTION INITIALLY AS TO WHETHER THE VIRUS WAS TRANSMITTED TO AN UNINFECTED INFANT VIA BREAST MILK, APPARENTLY DOES NOT SEEM TO BE AS BIG A RISK AS WE THOUGHT INITIALLY. AND WITH GOOD HAND WASHING AND MASKING THE MOTHER IT'S SAFE TO BREASTFEED IF SHE HAS SARS-COV-2 INFECTION, BUT INTERESTINGLY RESEARCHERS HAVE FOUND THAT HUMAN MILK CONTAINS ANTIBODIES DIRECTED AGAINST SARS-COV-2, SO IT'S ANOTHER SOURCE OF POTENTIAL MONOCLONAL ANTIBODIES IN ADDITION TO BLOOD. SO THERE ARE RESEARCHERS WHO ARE EXPLORING THE POTENTIAL TO USE HUMAN MILK FOR THERAPEUTIC USE. SPEAKING OF BREASTMILK, I'LL CLOSE WITH THE TASK FORCE ON PRGLAC. THIS IS IMPORTANT BECAUSE 6.3 MILLION WOMEN PER YEAR IN THE U.S. BECOME PREGNANT, OVER 90% TAKE MEDICATION. 70% OF WHICH ARE PRESCRIBED MEDICATIONS. IN ADDITION, ABOUT HALF A MILLION WOMEN HAVE DIFFICULTY MAKING MILK. THERE ARE CONCERNS REGARDING LIABILITY OF MEDICATIONS TAKEN DURING PREGNANCY AND LACTATION. IT'S NOT EASY TO STUDY PREGNANCY BECAUSE IT'S A COMPLEX SYSTEM. THERE ARE TWO INDIVIDUALS INVOLVED. THERE ARE PHYSIOLOGIC CHANGES IN THE MOTHER DURING PREGNANCY. AND BOTH THE FETUS AND PLACENTA ARE CHANGING OVER GESTATION. THERE ARE EXTERNAL FACTORS SUCH AS OBESITY AND THE ENVIRONMENT, AND THERE ARE COEXISTING CHRONIC CONDITIONS. WE BELIEVE LACTATION HAS SIGNIFICANT BENEFITS FOR THE FETUS AND THE MOTHER, BUT WHAT IS RISK VERSUS BENEFIT RATIO IN TERMS OF TAKING MEDICATIONS FOR THE WOMAN VERSUS HAVING THE FETUS OR THE BABY EXPOSED TO THOSE MEDICATIONS, AND WHAT WE FOUND IN THE PRGLAC TASK FORCE IS THERE'S A HUGE GAP IN KNOWLEDGE, ALMOST NO INFORMATION ON MEDICATIONS TAKEN BY LACTATING WOMEN, LIMITED INFORMATION DURING PREGNANCY. AS PER THE 21ST CENTURY CURES ACT, NICHD WAS ASKED TO LEAD THIS TASK FORCE. WE COMPLETED OUR RECOMMENDATIONS IN 2018. AND ALL OF THE RECOMMENDATIONS ARE PUBLICLY AVAILABLE AT THE LINK BELOW. BUT THE HIGHLIGHTS WERE TO CHANGE CULTURE TO PROTECT PREGNANT WOMEN THROUGH RESEARCH INSTEAD OF FROM RESEARCH. TO REMOVE PREGNANT WOMEN AS A VULNERABLE POPULATION THROUGH THE U.S. COMMON RULE. AND TO EXPAND WORKFORCE OF PEOPLE WITH EXPERTISE IN OBSTETRIC AND LACTATION PHARMACOLOGY AND THERAPEUTICS, SPENT TWO YEARS HOW TO IMPLEMENT RECOMMENDATIONS AND THE IMPORTANT THING IS IT'S NOT JUST NIH RESPONSIBILITY. WE HAVE CROSS-SECTOR ENGAGEMENT. THE NIH AS WELL AS FDA AND OTHER HEALTH AND HUMAN SERVICES OPERATIONAL DIVISIONS. WE HAD PRIVATE NON-PROFIT FOUNDATIONS. WE HAD INDUSTRY ALL PARTICIPATING IN THIS TASK FORCE. AND THE IMPLEMENTATION RECOMMENDATIONS INCLUDED ESTABLISHING PRIORITIZATION PROCESS FOR STUDYING THERAPEUTICS, USED DURING PREGNANCY AND LACTATION, ADDRESSING ETHICAL AND LIABILITY CONCERNS, FOSTERING EDUCATION AND AWARENESS AMONG HEALTH CARE PROVIDERS AND PREGNANT AND LACTATING WOMEN, AND THEN CREATING PARTNERSHIPS TO ACCOMPLISH STEPS. PRESUMPTION IS THE WOMAN NOT TAKING MEDICATION IS MUCH SAFER BUT IN FACT IF A WOMAN HAS A MEDICAL CONDITION IN MANY CASES IT'S MUCH SAFER FOR HER AND HER BABY FOR HER TO BE HEALTHY AND FOR HER TO TAKE THE MEDICATION. IN SUMMARY IN MY SHORT TIME, I WOULD LIKE TO GIVE THE HIGHLIGHTS OF THIS TALK, WHICH INCLUDE THE FACT A THIRD OF NICHD'S PORTFOLIO IS IN REPRODUCTIVE HEALTH, MOSTLY, BUT NOT EXCLUSIVELY IN FEMALE REPRODUCTIVE HEALTH. EACH ONE OF NICHD'S FIVE STRATEGIC PLAN THEMES RELATES TO WOMEN'S HEALTH. THERE ARE MAJOR GAPS AS I SAID IN KNOWLEDGE IN MENSTRUAL BIOLOGY AND HEALTH, AFFECTING GIRLS AND WOMEN WORLDWIDE WITH ECONOMIC AND EDUCATIONAL IMPLICATIONS. THERE'S NEED TO STUDY AND TREAT PREGNANT WOMEN WITH COVID-19, YOU'LL NOTICE I DIDN'T HAVE TIME TO TALK ABOUT PREVENTION STRATEGIES, INCLUDING VACCINES IN PREGNANT WOMEN. THERE NEEDS TO BE A CULTURE CHANGE REGARDING INCLUSION OF WOMAN IN RESEARCH ON DRUGS AND VACCINES DURING PREGNANCY AND LACTATION. SO WITH THAT, I WILL END HERE AND I'D LIKE TO THANK YOU FOR THIS OPPORTUNITY TO SPEAK TO YOU AND I'M RAISING A GLASS, A VIRTUAL GLASS, TO THE NEXT 30 IMPACTFUL YEARS ON ISSUES IMPACTING WOMEN'S HEALTH. >> I'M GWEN COLLMAN, ACTING DIRECTOR OF NATIONAL INSTITUTE OF ENVIRONMENTAL AND HEALTH SCIENCES. AND ON BEHALF OF OUR NEW DIRECTOR, RICK WOYCHIK, AND MYSELF, AND STAFF OF NIEHS, I WANT TO THANK YOU SO MUCH FOR HAVING US BE PART OF YOUR 30th ANNIVERSARY CELEBRATION. CONGRATULATIONS TO THE OFFICE OF RESEARCH ON WOMEN'S HEALTH ON AN EXCITING 30 YEARS AND NIEHS HAS BEEN VERY PLEASED AND PRIVILEGED TO BE PART OF THAT 30-YEAR HISTORY. TODAY I'M GOING TO TALK ABOUT WOMEN'S HEALTH IN THE ENVIRONMENT. EARLIER TODAY YOU HEARD PLENARY TALK BY A COLLEAGUE OF MINE DR. BALBUS, AND HE SET THE STAGE BY GIVING YOU SOME EXAMPLES AND A LITTLE BIT OF HISTORY OF THE EVOLUTION OF THE FIELD AND WHY WE AT NIEHS THINK ENVIRONMENTAL HEALTH WORLD WOMEN'S HEALTH OUTCOMES ARE SO CRITICALLY IMPORTANT. SO, TO FIRST INTRODUCE YOU TO OUR INSTITUTE, LET ME TELL YOU ABOUT NIEHS. FOR STARTERS, WE'RE THE ONLY NIH INSTITUTE NOT ON THE BETHESDA CAMPUS AREA. WE'RE IN RESEARCH TRIANGLE PARK. LIKE ALL THE OTHER INSTITUTES, WE HAVE INTRAMURAL PROGRAMS, ACTUALLY TWO OF THEM, DIVISION OF INTRAMURAL RESEARCH AND DIVISION OF NATIONAL TOXICOLOGY PROGRAM. WE HAVE A ROBUST EXTRAMURAL FUNDING PROGRAM. AND WE ARE THE HOME OF THE NATIONAL TOXICOLOGY PROGRAM. WE ALSO HAVE AN ON-SITE CLINICAL RESEARCH UNIT AND WE CONDUCT CLINICAL STUDIES RIGHT HERE ON OUR NIEHS CAMPUS. THE MISSION OF NIEHS IS TO DISCOVER HOW THE ENVIRONMENT AFFECTS PEOPLE IN ORDER TO PROMOTE HEALTHIER LIVES. AND I'M GOING TO TELL YOU ABOUT HOW WE DO THAT AND HOW WE FRAME THE ENVIRONMENT. SO, SOME PEOPLE THINK ABOUT ANYTHING THAT'S NOT A GENETIC FACTOR TO BE INCLUDED IN THE ENVIRONMENT. IN FACT, THAT'S TRUE. YOU CAN THINK ABOUT THE ENVIRONMENT QUITE BROADLY. FOR THE PURPOSES OF THE MISSION OF NIEHS, AND TO FOCUS SPECIFICALLY ON CHEMICAL POLLUTANTS AND THINGS IN OUR ENVIRONMENT THAT ARE SOMEWHAT MAN MADE, WE THINK ABOUT THESE KINDS OF FACTORS AND AGENTS AS WHAT IMPACTS OUR HEALTH FROM THE ENVIRONMENT, LIKE PESTICIDES, SYNTHETIC CHEMICALS, POLLUTANTS IN WATER, AIR, SOIL, IN OUR FOOD, PERSONAL CARE PRODUCTS, WE ALSO THINK ABOUT FACTORS SUCH AS NUTRITION, STRESS, SOCIAL DETERMINANTS OF HEALTH AS PART OF OUR ENVIRONMENT. AND WE'RE VERY MUCH ALIGNED AND AWARE OF CLIMATE AND HEALTH AS AN IMPORTANT ENVIRONMENTAL FACTOR. SO WHEN WE THINK ABOUT ENVIRONMENT AND WE THINK ABOUT THE INTERSECTION WITH WOMEN'S HEALTH AND HOW WOMEN ARE EXPOSED TO THESE VARIOUS CHEMICALS, WE LIKE TO THINK ABOUT FOUR DIFFERENT DISEASE-BASED DOMAINS FOR CONSIDERATION OF WOMEN'S HEALTH OUTCOMES. THOSE WOULD BE METABOLIC, CARDIOVASCULAR, REPRODUCTIVE, AND CANCER. AND HERE YOU SEE I HAVE ON NUMBER OF HEALTH OUTCOMES, DISEASE STATES OR CONDITIONS THAT IMPACT WOMEN GREATLY, AND WE THINK THERE ARE ENVIRONMENTAL CONTRIBUTORS TO THESE DISEASE ENTITIES. SO JUST TO DIVE A LITTLE BIT DEEPER INTO WHAT KINDS OF ASSOCIATIONS ARE SEEN IN THE LITERATURE, MY TALK IS GOING TO FOCUS ON SEVERAL DIFFERENT AREAS OF EXPOSURE AND I'M GOING TO GIVE EXAMPLES OF IMPORTANT RESEARCH HIGHLIGHTS BOTH HISTORICAL AND CONTEMPORARY THAT GIVE US EVIDENCE TO CONSIDER HOW ENVIRONMENTAL CHEMICALS AND OTHER EXPOSURES IMPACT WOMEN'S HEALTH OUTCOMES. WE'RE GOING TO FOCUS ON ENDOCRINE DISRUPTING CHEMICALS, IN THAT CATEGORY I'LL INCLUDE THINGS LIKE THALLATES, PLASTICIZERS, FOREVER CHEMICALS LIKE PFAS, PER FLUORINATED COMPOUNDS, DIOXINS, FLAME RETARDANTS, SO STABLE THEY STAY IN OUR BODIES FOR DECADES AND DECADES. WE'RE ALSO GOING TO CONSIDER INDUSTRIAL CHEMICALS LIKE PCPs, PPBs, EXPOSURES TO PESTICIDES. HEAVY METALS SUCH AS ARSENIC, LEAD AND MERCURY ARE FOUND IN OUR ENVIRONMENT AND MAKE INTO WOMEN'S BODIES AND HAVE MULTI-SYSTEM OUTCOME IMPACTS. AIR POLLUTION, A MIXTURE OF A VARIETY OF CHEMICALS, METALS, AND PARTICULATES, ARE ALSO EXTREMELY IMPORTANT CAUSES OF SOME OF THE WOMEN'S HEALTH OUTCOMES. AND AS I MENTIONED BEFORE, SOCIAL DETERMINANTS OF HEALTH ARE SO CRITICAL, AT NIEHS WE LIKE TO CONSIDER BOTH CHEMICAL EXPOSURES THEMSELVES BUT ALSO INTERACTION BETWEEN CHEMICAL EXPOSURES AND SOCIAL DETERMINANTS OF HEALTH BECAUSE OFTENTIMES WHERE YOU LIVE OR WHAT KIND OF INDUSTRIAL SIGHTINGS ARE IN YOUR NEIGHBORHOOD AND WHERE YOU WORK AFFECT LEVEL OF EXPOSURE SUSCEPTIBILITY TO DISEASE OUTCOMES. ANOTHER VERY KEY FACTOR IN DETERMINING WHETHER CHEMICAL EXPOSURE WILL BE HARMFUL WHEN THAT EXPOSURE OCCURS. WOMEN ARE MORE SUSCEPTIBLE DURING DIFFERENT LIFE STAGES, THIS SHOWS CRITICAL LIFE STAGES OF A GIRL TO WOMAN'S DEVELOPMENT. WE LIKE TO THINK FIRST ABOUT EXPOSURES DURING PREGNANCY TO THE FETUS, BECAUSE THAT SETS UP A TRAJECTORY OF SUSCEPTIBILITY FOR THE BABY. THAT MAY BE A SUSCEPTIBLE TIME IF EXPOSURES OCCUR. I'LL GIVE SOME EXAMPLES OF SOME OF THE RELATIONSHIPS THAT WE SEE IN STUDIES ON THIS TOPIC. THE REPRODUCTIVE YEARS, WE KNOW WOMEN SOMETIMES HAVE REDUCED FERTILITY, INFERTILITY, DIFFERENT CONDITIONS LIKE POLYCYSTIC OVARY SYNDROME AND ENDOMETRIOSIS ALL HAVE ENVIRONMENTAL ETIOLOGY AND EXPOSURE EARLIER IN LIFE MAY CAUSE EFFECTS DURING THE REPRODUCTIVE YEARS BUT ALSO EXPOSURES DURING THE REPRODUCTIVE YEARS MAY BE IMPORTANT FOR MIDDLE AGE OR OLDER LIFE HEALTH OUTCOMES. PREGNANCY AND POSTPARTUM ARE ENORMOUSLY IMPORTANT WINDOW OF TIMING. WE KNOW THAT NOT ONLY IS THE FETUS EXPOSED DURING THE TIME OF PREGNANCY BUT THE WOMAN MAY, WE HAVE LAUNCHED A PROGRAM RECENTLY TO LOOK AT LONG TERM HEALTH EFFECT ON EXPOSURE DURING PREGNANCY. CHANGES OCCUR IN MIDDLE AGE, MENOPAUSE, VARIOUS CANCERS LIKE BREAST CANCER, UTERINE FIBROIDS, AND THERE'S GROWING EVIDENCE BODY TO SHOW EXPOSURES EARLIER IN LIFE MAY BE RELATED TO THOSE LATER LIFE ENDPOINTS. WE KNOW WOMEN IN OLDER AGE MAY HAVE HIGHER BODY BURDENS OF THINGS LIKE METALS WHICH WOULD BE LIBERATED FROM THEIR BONE STORES AS AGING PROCESS CONTINUES AND MAY MAKE WOMEN PARTICULARLY SUSCEPTIBLE TO NEUROLOGIC DISORDERS AND BONE FRACTURES. SO, NEXT SEVERAL SLIDES HIGHLIGHT THESE AREAS OF EXPOSURE. WE'RE TRYING TO ORGANIZE THEM THAT YOU CAN SEE THE WINDOW OF TIMING BOTH FOR EXPOSURE AND SUSCEPTIBILITY, I'VE TRIED TO SHOW A MIX OF RESEARCH OUTCOMES FROM THE VARIOUS SCIENTIFIC DIVISIONS OF OUR TWO INTRAMURAL PROGRAMS AS WELL AS EXTRAMURAL PORTFOLIO, EXAMPLES OVER DOMAINS OF SCIENCE ENCOMPASSED IN ENVIRONMENTAL HEALTH, FROM THE MOST MOLECULAR MECHANISTIC WORK ALL THE WAY THROUGH EPIDEMIOLOGIC AND COMMUNITY-BASED PARTICIPATORY RESEARCH STUDIES. SO ENDOCRINE-DISRUPTING CHEMICALS AMASS A LARGE CATEGORY THAT OCCUR IN OCCUPATIONAL AND HOME SETTINGS, AND HERE ARE A SERIES OF EXAMPLES OF RESEARCH PAPERS THAT HAVE COME OUT IN THE LAST TEN YEARS OR SO, WHICH REALLY HIGHLIGHT OUR INCREASED KNOWLEDGE AROUND THESE EFFECTS. SO PREGNANT WOMEN WITH HIGH LEVELS OF DDT IN BLOOD WERE LIKELY TO HAVE CHILDREN WHO DEVELOPED AUTISM, PRIOR PRENATAL COMPOSURE TO THALLATES LINKED TO EARLIER PUBERTY IN GIRLS BUT NOT BOYS. IN SOME RODENT EXPERIMENTS EXPOSURE TO GENISTEIN MICE EXPERIENCED PREGNANCY FAILURE. GENX FOUND IN WATER SUPPLIES EXPOSURE DURING PREGNANCY WAS LINKED TO GESTATIONAL WEIGHT GAIN AND ADVERSE EFFECTS ON PLACENTA IN RODENT MODELS. ALSO HIGHER PFAS EXPOSURE IN HUMAN STUDIES SHOWN TO BE LINKED WITH HIGHER POSTNATAL CARDIOMETABOLIC RISK. BECAUSE THIS IS SUCH AN IMPORTANT AND WIDE CLASS OF CHEMICALS THERE'S MORE RESEARCH TO TELL YOU ABOUT, THERE HAVE BEEN EXPOSURES STUDIES FOR THALLATES, IMPAIRED FERTILITY, WOMEN WHO USE DYE AND HAIR STRAIGHTERS IN HAVE RISK IN SISTER STUDIES. LONGTIME LANDMARK SCUDY OF WOMEN AFTER A LARGE CHEMICAL EXPLOSION IN ITALY LED TO HIGH LEVELS OF DIOXIN EXPOSURE THROUGH SEVESO COMMUNITY AND FOLLOW-UP STUDIES OVER 20-YEAR PERIOD HAVE SHOWN REDUCED FERTILITY TO CANCER RISK IN CARDIOVASCULAR OUTCOMES IN THE WOMEN WHO HAD HIGHEST LEVELS OF EXPOSURE IN SEVESO. ANOTHER ACCIDENT IN THE UNITED STATES LED TO RELEASE OF PBB CHEMICALS IN MICHIGAN, A FOLLOW-UP SHOW HIGHER RISK OF THYROID DISEASE AFTER DECADES OF EXPOSURE. HIGHER THALLATE EXPOSURE LINKED TO INCREASED UTERINE VOLUME, MEASURE OF FIBROID BURDEN IN ADULT WOMEN. AND HIGHER PFAS EXPOSURE IN MID-LIFE LINKED TO EARLIER MENOPAUSE AS WELL. TO THE NEXT SLIDE, NOW I'LL MOVE TO AIR POLLUTION, NATIONAL TOXICOLOGY PROGRAM CONDUCTED A SERIES OF SYSTEMATIC REVIEWS AND SCOPING STUDIES WHICH HAVE SHOWN EARLY LIFE EXPOSURE TO TRAFFIC-RELATED AIR POLLUTION HAS IMPAIRED DEVELOPMENT IN FEMALE RATS, INDICATED BY DECREASED BRAIN VOLUME IN ALTERED NEUROPRODUCTION, THAT WAS IN OUR EXTRAMURAL COMMUNITY. TRAFFIC EXPOSURE, TRAFFIC-RELATED AIR POLLUTION, INCREASED -- LED TO INCREASED RISK OF HYPERTENSION DURING PREGNANCY, THAT WAS DISCOVERED THROUGH A SYSTEMATIC REVIEW BY NATIONAL TOXICOLOGY PROGRAM. WE ALSO SHOWED THAT PM 2, A COMPONENT, ENVIRONMENTAL MARKER OF EXPOSURE LEVEL TO PARTICULATES IN AIR WHICH LEADS TO HIGH LEVELS OF AIR POLLUTION IS THOUGHT TO BE RISK FACTOR FOR DEVELOPING PREECLAMPSIA BY 50% OVER BASELINE. AREAS WITH HIGH PM10 EXPOSURE ASSOCIATED WITH BREAST TISSUE CHANGES LINKED TO INCREASED BREAST CANCER RISK ALSO IN OUR NIEHS SISTER STUDY. OLDER WOMEN EXPOSED TO HIGH LEVELS OF AIR POLLUTION SHOWN TO HAVE REDUCE THE WHITE MATTER IN BRAIN, EARLY MARKER OF ALZHEIMER'S DISEASE, AND THAT SUPPLEMENTATION WITH OMEGA-3 FATTY ACIDS LED TO PROTECTIVE EFFECT AGAINST BRAIN SHRINKAGE. METALS IN OUR ENVIRONMENT AND FOOD THROUGH AIR AND WATER, AND FOOD PRODUCTS. AND SERIES OF STUDIES LOOKED AT OVER THE YEARS LOOKED AT VARIETY OF METALS, IN UTERO COMPOSURE TO CADMIUM MAY INCREASE ER-ALPHA IN RATS WHICH ARE TWO IMPORTANT STEPS IN DEVELOPMENT OF ER+ BREAST CANCER. MATERNAL BONE LEAD INCREASED RISK OF MISCARRIAGE AND POOR BIRTH OUTCOME, CALCIUM SUPPLEMENTATION SEEMS TO COUNTERACT THOSE EFFECTS, A POSITIVE FINDING. ARSENIC EXPOSURE DURING PREGNANCY ALTERS LEVELS OF INFLAMMATORY MARKERS, LINKED TO CARDIOVASCULAR HEALTH IN MOTHERS AND INFANTS. HIGHER LEVELS OF AIRBORNE MERCURY, CADMIUM AND LEAD ASSOCIATED WITH HIGHER RISK OF POST-MENOPAUSAL BREAST CANCER. SOCIAL DETERMINANTS ARE VERY IMPORTANT SET OF EXPOSURES, NIEHS INTRAMURAL INVESTIGATORS AND GRANTEES ARE EXPLORING SOME OF THOSE ASSOCIATIONS. SO A GROUP OF OUR INVESTIGATORS LOOKED AT LIVING -- THE BUILT ENVIRONMENT AND WHETHER LIVING IN NEIGHBORHOODS THAT WERE GREENER DUE TO HIGH LEVELS OF TREES AND PARK AREAS COULD REDUCE RISK OF CARDIOVASCULAR DISEASE BY LOWERING STRESS HORMONES, BOOSTING ABILITY TO REPAIR BLOOD VESSELS, ASSOCIATIONS ESPECIALLY STRONG AMONG WOMEN. PREGNANT BLACK AND HISPANIC LATINA WOMEN HAD HIGHER PREVALENCE OF SLEEP DISTURBANCE COMPARED TO WHITE COUNTERPARTS, LINKED TO ADVERSE MATERNAL AND CHILD HEALTH OUTCOMES IN A VERY IMPORTANT DETERMINANT OF HEALTH ESPECIALLY IN HEALTH DISPARITY POPULATIONS. OUR INTRAMURAL PROGRAM CONDUCTS MECHANISTIC WORK IN THE AREA OF WOMEN'S REPRODUCTIVE DEVELOPMENT, AND HEALTH OUTCOMES, AND THEY HAVE PUBLISHED HIGH IMPACT PAPERS IN A NUMBER OF JOURNALS WHICH SHOW OVEREXPRESSION OF THE PROGESTERONE RECEPTOR PLAYING A ROLE IN GROWTH OF OF OVARIAN TUMORS IN MICE HELPING IN HUMANS, ANOTHER LABORATORY, WOMEN WHO DEVELOPED BREAST CANCER EXHIBIT DIFFERENCE IN DNA METHYLATION PROFILES YEAR BEFORE TUMORS ARE CLINICALLY DETECTED OFFERING ANOTHER POTENTIAL MARKER FOR IMPROVED EARLY BREAST CANCER DIAGNOSIS. NIEHS HAS BEEN A PIONEER IN INCLUDING AND INCORPORATING VIEWS AND ACTIVITIES OF COMMUNITIES THAT ARE AFFECTED BY ENVIRONMENTAL EXPOSURES INTO OUR RESEARCH PROCESS. WE ACTIVELY PROMOTE COMMUNITY ENGAGEMENT IN RESEARCH AND TRANSLATION, WE REALLY BELIEVE THAT OUR SCIENTISTS SHOULD BE ACTIVELY WORKING WITH COMMUNITY GROUPS, BOTH TEACHING THEM ABOUT THE RESEARCH PRACTICE, BUT ALSO TEACHING -- HAVING COMMUNITIES TEACH THEM ABOUT REAL LIFE EXPERIENCES WITH ENVIRONMENTAL EXPOSURES IN THEIR COMMUNITIES AND TO LISTEN TO THE COMMUNITIES ABOUT THE THINGS, HEALTH IMPACTS THEY ARE PARTICULARLY WORRIED ABOUT. IN OUR BREAST CANCER AND ENVIRONMENT RESEARCH PROGRAM WHICH WAS CONDUCTED OVER 15 YEARS WITH THE NCI, WE WERE ONE OF THE FIRST GROUPS TO INCORPORATE ADVOCACY GROUPS AS KEY PARTNERS IN THESE RESEARCH CENTERS AND AMOUNT OF RESEARCH TRANSLATION FROM THE RESEARCH STUDIES HAS BEEN AMAZING, WHEN THAT KIND OF PARTNERSHIP OCCURS AND INFORMATION CAN FLOW FROM MULTI-DISCIPLINARY RESEARCH TEAMS INTO COMMUNITIES. WOMEN IN THE ADVOCACY GROUPS WERE MAJOR PLAYERS MAKING THAT HAPPEN. SO WE BELIEVE WOMEN ARE OFTEN ON THE FORE FRONT, FAMILY CARETAKERS, TRUSTED SOURCES OF INFORMATION IN THEIR COMMUNITY, SO BY EDUCATING THE WOMEN ABOUT ENVIRONMENTAL HEALTH AND ENVIRONMENTAL HEALTH OUTCOMES WE BELIEVE THE COMMUNITY LEADERS CAN SPREAD THAT INFORMATION TO BOTH COMMUNITY MEMBERS WHO NEED TO KNOW AS WELL AS POLICYMAKERS. THEY HAVE BEEN VERY ACTIVE IN DOING THAT AROUND THE COUNTRY LEADING TO REGULATORY AND PUBLIC HEALTH CHANGE. PROMONTORSA ARE MOSTLY WOMEN, THESE WORKERS CAN HELP TEACH COMMUNITY MEMBERS WILL ENVIRONMENTAL HEALTH ISSUES. WE'VE MADE A MAJOR INVESTMENT IN PORTFOLIO IN WOMEN'S HEALTH RESEARCH, COULDN'T DO THIS ALONE. WE'RE PRIVILEGED TO HAVE CO-FUNDING FROM SISTER INSTITUTES AND A LOT OF CO-FUNDING OVER THE YEARS FROM OFFICE OF RESEARCH ON WOMEN'S HEALTH AND WE'RE VERY GRATEFUL FOR THOSE PARTNERSHIPS. AND I THINK THE INVESTIGATORS ARE ALSO QUITE GRATEFUL AND ABLE TO SEE PERSPECTIVES OF MULTIPLE INSTITUTES INTERESTED IN THESE WOMEN'S HEALTH RESEARCH TOPICS. SO TO CLOSE, I WANT TO SAY THANK YOU TO THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. WE'VE WORKED AND PARTNERED WITH THEM OVER YEARS TO ADVANCE WOMEN'S HEALTH IN THE ENVIRONMENTAL HEALTH RESEARCH THROUGH A NUMBER OF INITIATIVES, ORWH HAS BEEN AN ACTIVE PARTNER. SEVERAL ARE LISTED AT THE TOP, PREGNANCY IS A VULNERABLE TIME PERIOD, INTERSECTION OF SEX AND GENDER INFLUENCES ON HEALTH AND DISEASE, WE PARTICIPATED IN THE ORWH TRANS-NIH HIGH PRIORITY SHORT TERM AWARD, GRATEFUL FOR THEIR SUPPORT FOR ADMINISTRATIVE SUPPLEMENTS TO RESEARCH COMMUNITY AND WE'VE BEEN RECIPIENTS OF A NUMBER OF SUPPLEMENTS FOR THE U 3 UNDERSTUDIED UNDERREPRESENTED AND UNDERREPORTED POPULATIONS PROGRAM. AND WE FUNDED ONE OR TWO BIRCWH AWARDS OVER THE LAST 30 YEARS AS WELL. THESE LOGOS THREE THREE INTRAMURAL PROGRAMS, IN A MULTICULTURAL STUDY OF ENVIRONMENTAL LIFESTYLE AND FIBROIDS, WOMENS HEALTH AWARENESS INITIATIVE STARTEDS AWARENESS DAY IN THE BLACK COMMUNITY IN DURHAM, NORTH CAROLINA, NOW WITH ORWH SUPPORT TURNING INTO A RESEARCH COHORT. THE ORWH LONG-TERM SUPPORT FOR OUR SISTER STUDY, WE'RE GRATEFUL FOR THOSE KINDS OF CONTRIBUTIONS AND PARTNERSHIPS AND COLLABORATIONS. SO THANK YOU SO MUCH, AND I WANT TO -- TO ORWH, AND I WANT TO CONGRATULATE DR. CLAYTON FOR HER LEADERSHIP AND LOOK FORWARD TO WORKING TOGETHER OVER THE NEXT 30 YEARS. THANK YOU VERY MUCH FOR YOUR ATTENTION. >> GOOD MORNING. IT'S MY PLEASURE TO PARTICIPATE IN THIS CELEBRATION OF THE 30th ANNIVERSARY OF THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. I'M GOING TO BE TALKING ABOUT NCCIH'S FOCUS. COMPLEMENTARY AND INTEGRATIVE HEALTH APPROACHES ARE USED BY WOMEN, 37% OF WOMEN COMPARED WITH 29% OF MENUS SOME FORM OF COMPLEMENTARY HEALTH. AND SO WHAT ARE THESE TYPES OF APPROACHES? WE DESCRIBE THEM AS BEING IN THREE BROAD CATEGORIES, DIETARY, PSYCHOLOGICAL, PHYSICAL THERAPIES AND PRACTICES, THAT INCLUDE THINGS LIKE, FOR EXAMPLE, NUTRITIONAL SUPPLEMENTS, PROBIOTICS, OR MEDICATION, MINDFULNESS BASED STRESS REDUCTION, OR PHYSICAL THERAPIES SUCH AS MANUAL THERAPIES. THERE'S OVERLAP BETWEEN CATEGORIES, FOR EXAMPLE YOGA IS A COMBINATION OF PSYCHOLOGICAL AND PHYSICAL COMPONENT. WE KNOW THAT IF WE ASK WHAT IS THE REASON PEOPLE USE THESE TYPES OF APPROACHES, A LOT OF PEOPLE USE IT FOR GENERAL HEALTH, WELLNESS, WELL BEING, BUT A CERTAIN PERCENTAGE OF THE POPULATION USE THEM FOR SPECIFIC HEALTH CONDITIONS. WHAT ARE THESE HEALTH CONDITIONS? WHEN WE ASK SPECIFICALLY, YOU CAN SEE OVERWHELMINGLY PAIN IS A -- BACK PAIN, NECK PAIN, JOINT PAIN AND MUSCULOSKELETAL ARE MORE FREQUENTLY CITED BY INDIVIDUALS FOR USE OF COMPLEMENTARY INTERVENTIONS. AND WE KNOW THAT WOMEN TEND TO HAVE DISPROPORTIONATELY GREATER AMOUNTS OF BOTH PAIN AND HIGH IMPACT CHRONIC PAIN. SO THIS IS IMPORTANT FOR THE HEALTH OF WOMEN THAT WE UNDERSTAND HOW BEST TO ENCOURAGE THE RATIONAL USE OF THESE THERAPIES THAT WE DO PROPER RESEARCH TO UNDERSTAND, ARE THESE THERAPIES ACTUALLY USEFUL? ARE THEY EFFECTIVE AND SAFE? WHEN WE LOOK AT PORTFOLIO PAIN IS WELL REPRESENTED, AS WELL AS OTHER TOPICS SUCH AS GENERAL HEALTH, WELL BEING, STRESS, ET CETERA. SO, TALKING ABOUT PAIN FIRST, WE ARE VERY FORTUNATE THAT WE HAVE BEEN ABLE TO CONTRIBUTE, PARTICIPATE IN A VERY IMPORTANT HEAL INITIATIVE, STANDS FOR HELP TO END ADDICTION LONG TERM. THIS IS A TRANS-NIH EFFORT THAT IS AIMED AT ADDRESSING BOTH THE OPIOID EPIDEMIC AND ALSO PAIN EPIDEMIC BECAUSE WE KNOW THERE'S A LOT OF VERY EXTENSIVE PROBLEM WITH PAIN IN THIS COUNTRY THAT ALL TOO OFTEN RESULTS IN PRESCRIPTION OF OPIOIDS. AND SO NCCIH HAS BEEN LEADING A PROGRAM CALLED PRISM, WHICH IS PRAGMATIC AND IMPLEMENTATION STUDIES FOR THE MANAGEMENT OF PAIN TO REDUCE OPIOID PRESCRIBING, NON-PHARMACOLOGIC APPROACHES, FOR EXAMPLE USING TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION, MINDFULNESS, ACUPUNCTURE, AND TELEHEALTH FOR EXAMPLE IN RURAL COMMUNITIES, AS WELL AS GUIDED RELAXATION. SO THESE ARE EXAMPLES OF STUDIES THAT WE'VE BEEN ABLE TO FUND THROUGH THE HEAL INITIATIVE. ANOTHER IMPORTANT AREA IS NATURAL PRODUCTS. A LOT OF PEOPLE USE NATURAL PRODUCTS, MANY OF THEM, PEOPLE IN THE HOPE OF HELPING WITH PAIN. IT'S VERY IMPORTANT THAT WE UNDERSTAND BOTH POTENTIAL USE OF THESE PRODUCTS BUT ALSO THEIR SAFETY AND POTENTIAL INTERACTIONS WITH MEDICATIONS, FOR EXAMPLE OTHER NATURAL PRODUCTS THAT PEOPLE MIGHT BE TAKING. SO WE HELD A WORKSHOP BACK IN 2019, THAT WAS IN COLLABORATION WITH NINDS AND NCATS, AND THIS IS A VERY GOOD WORKSHOP IN THAT IT LED TO A PROGRAM THAT IS AGAIN IN COLLABORATION ALSO WITH NCI TO MINE ELECTRONIC DATABASES AND ALSO NATURAL PRODUCT LIBRARIES THAT ALREADY EXIST THAT HAVE EXTENSIVE COLLECTIONS OF NATURAL PRODUCTS THAT CAN BE SCREENED FOR PHENOTYPIC ASSAYS, IN HIGH-THROUGHPUT SCREENING FOR EFFECTIVENESS IN TARGETS THAT COULD BE FOR ANALGESIA. THIS HAS LED TO A COLLABORATIVE PROGRAM TO EXPLORE AND DISCOVER NEW POTENTIAL ANALGESICS THAT ARE DERIVED FROM NATURAL PRODUCTS. CANNABINOIDS ARE ALSO VERY MUCH AT THE FRONT OF PEOPLE'S MINDS BECAUSE THEY ARE USED A LOT. PEOPLE USE CANNABINOIDS ESPECIALLY PRODUCTS THAT ARE AVAILABLE, MAYBE OVER THE COUNTER, AND WE WANTED TO MAKE SURE WE UNDERSTAND HOW EFFECTIVE THESE ARE AND HOW SAFE THESE ARE. IN 2019 WE MADE 11 AWARDS OF THE COMPOUNDS IN CANNABIS INCLUDING CANNABINOID, TERPENE, GIVING YOU AN IDEA OF THE PORTFOLIO AND OUR BREADTH OF RESEARCH IN PAIN. PAIN IS NOT THE ONLY REASON WHY PEOPLE USE COMPLEMENTARY AND INTEGRATIVE HEALTH APPROACHES. GENERAL HEALTH AND WELL BEING IS EXTREMELY IMPORTANT, IN SOME CASES REALLY -- FOR EXAMPLE FOR YOGA, IT WAS OVERWHELMINGLY THE REASON PEOPLE USED THESE PRACTICES, FOR PROMOTING HEALTH AND WELL-BEING. SO WE NEED TO UNDERSTAND FIRST OF ALL HOW DO YOU DO RESEARCH ON WELL-BEING? WE ARE GEARED TOWARDS UNDERSTANDING DISEASE, RIGHT? AND WE HAVE A LOT OF SOPHISTICATED MEASUREMENTS OF SYMPTOMS AND DISEASE BIOMARKERS. WHAT ARE BIOMARKERS OF WELL BEING AND HEALTH? WE NEED TO UNDERSTAND THAT, RIGHT? WE HAD A ROUNDTABLE IN 2018 ON EMOTIONAL WELL-BEING, AND THIS RESULTED AGAIN IN A COLLABORATION, WE FUNDED FIVE RESEARCH NETWORKS THAT WILL BE LAUNCHED IN DECEMBER 2020, LOOKING AT ONTOLOGY OF EMOTIONAL WELL-BEING, HOW DO YOU CHARACTERIZE AND MEASURE, MECHANISMS, BIOMARKERS, PREVENTION, AND ALSO TECHNOLOGY AND OUTCOMES MEASUREMENT. THIS IS AN EFFORT VERY CROSS-DISCIPLINARY THAT WILL HELP IN FURTHERING RESEARCH ON THIS VERY IMPORTANT TOPIC. ANOTHER EXCITING INITIATIVE THAT WE HAVE AGAIN ANOTHER COLLABORATION THIS TIME BETWEEN NIH, KENNEDY CENTER, AND NATIONAL ENDOWMENT FOR THE ARTS, ARTS IS THE SOUND HEALTH INITIATIVE, THE GOAL WHICH WAS SPEARHEADED BY DR. FRANCIS COLLINS, TO REALLY INCREASE OUR UNDERSTANDING OF HOW MUSIC AFFECTS HEALTH WITH EMPHASIS ON BASIC NEUROSCIENCE AND ALSO POTENTIAL CLINICAL APPLICATIONS, AND JUST LIKE AS MANY OF THESE OTHER INITIATIVES WE STARTED WITH A WORKSHOP THAT REALLY BROUGHT TOGETHER AMAZING COLLABORATIONS, BACK IN 2017, BETWEEN KENNEDY CENTER, NEA, AND MANY MUSIC THERAPY PROFESSIONALS. THERE WAS DR. COLLINS THAT PARTICIPATED HERE WITH RENƒE FLEMING, A WELL-KNOWN SOPRANO WHO IS VERY ACTIVE IN THIS AREA PROMOTING UNDERSTANDING OF MUSIC. AND ITS USE IN PROMOTING HEALTH. AND THIS PANEL RESULTED IN AN INITIATIVE THAT WE'RE NOW -- WE HAVE FUNDED THREE GRANTS NOW IN THIS AREA, EVALUATING, FOR EXAMPLE, THE IMPACT OF SINGING INTERVENTION ON MARKERS OF CARDIOVASCULAR HEALTH, EFFECT OF MUSIC-BASED INTERVENTION ON NEURODEVELOPMENT IN PAIN RESPONSE AND PRE-TERM INFANTS AND SELF-GENERATED RHYTHMIC CUES IN PARKINSON'S DISEASE, HOW WE BETTER UNDERSTAND HOW MUSIC AND OTHER ARTS, FOR EXAMPLE, VISUAL ARTS, CAN BE USED FOR PROMOTING HEALTH. ANOTHER AREA THAT WE'RE VERY MUCH INTERESTED IN IS CONNECTION BETWEEN THE MIND AND THE BODY. ONE OF THE AREAS WHERE WE DEVELOPED THIS IS IN CONCEPT OF INTEROCEPTION, A VERY IMPORTANT AREA OF SCIENCE IN NEED OF FURTHER DEVELOPMENT SO WE STARTED IT WITH A WORKSHOP IN COLLABORATION WHERE YOU SEE ALL THESE INSTITUTES SPONSORED BY THE NEUROSCIENCE BLUEPRINT INITIATIVE. AND WHAT IT DID, SO WHAT IS INTEROCEPTION IN IT'S REALLY THE PROCESSES BY WHICH OUR BODY SENSES, INTERPRETS, INTEGRATES AND REGULATES SIGNALS FROM WITHIN ITSELF. SO HOW DOES YOUR BRAIN, FOR EXAMPLE, PERCEIVE WHEN YOU'RE HUNGRY OR THIRSTY OR TIRED? WHAT ARE THE SIGNALS THAT COME FROM OUR BODY THAT THE BRAIN THEN AND NERVOUS SYSTEM HAS TO INTEGRATE? THIS IS THE BARE ASSESSMENT AREA THAT HAD A LOT OF BEARING OR UNDERSTANDING THIS HAS A LOT OF BEARING IN OUR UNDERSTANDING OF, FOR EXAMPLE, MEDITATION OR YOGA, REALLY FOCUSING ON YOUR BREATHING, HOW IS IT YOU SENSE THAT AND WHAT INFORMATION DOES IT GIVE YOU? WHAT CAN YOU DO ABOUT IT? SO, THIS WORKSHOP IN 2019 EXPLORED ASPECTS OF THE NEURAL CIRCUITRY UNDERLYING THIS, MODULATING THESE PROCESSES, POTENTIALLY WITH DIFFERENT INTERVENTION AND THERAPIES, ALSO DEVELOPING METHODOLOGY AND TECHNOLOGY TO BETTER DO THIS RESEARCH. AND SO WE HAVE AN RFA THAT'S OUT, APPLICATIONS ARE DUE SOON, DECEMBER 18. AND GOAL IS TO ENHANCE OUR FUNDAMENTAL UNDERSTANDING OF INTEROCEPTION WITH SPECIFIC FOCUS ON DETERMINING THE FUNCTION OF THESE NEURAL CIRCUITS. SO, I'VE TALKED JUST -- THIS IS A SNAPSHOT SUMMARY THAT I GAVE YOU OF SOME OF THE EXCITING INITIATIVES WE'VE BEEN INVOLVED IN BUT I WANT TO FINISH WITH THIS SLIDE THAT SHOWS HOW THIS FITS IN THE BIGGER PICTURE. NCCIH, WE'RE DEVELOPING A NEW STRATEGIC PLAN, WHAT WE'RE FOCUSING ON IS WHOLE PERSON HEALTH RESEARCH. HOW DOES ALL THIS FIT? WELL, WE KNOW THAT THE WHOLE PERSON HEALTH IS TWO AXIS, VERTICAL AXIS WE HAVE INTEGRATION OF THE SORT OF BIOPSYCHOSOCIAL ELEMENTS AS WELL AS ENVIRONMENT, THAT'S VERY IMPORTANT. WE KNOW OUR PHYSICAL ENVIRONMENT AS WELL AS SOCIAL ENVIRONMENT IS VERY IMPORTANT IN DETERMINING OUR HEALTH. AND WITHIN THE PHYSIOLOGICAL DOMAIN YOU HAVE ALL OF THESE DIFFERENT SYSTEMS, NEURAL, RESPIRATORY, CARDIOVASCULAR, DIGESTIVE, ET CETERA, THAT NEED TO INTERACT. THE INTEROCEPTION EXAMPLE IS AN EXAMPLE OF THAT. ON THE HORIZONTAL AXIS YOU HAVE WHAT WE CALL THE BIODIRECTIONAL CONTINUE CONTINUUM, YOU CAN GO BACK TOWARDS HEALTH, NON-PHARMACOLOGICAL INTERVENTIONS CAN HELP PEOPLE TO GO BACK AND RESTORE THEIR HEALTH AFTER THEY HAVE BEEN SICK OR IF THEY HAVE A CHRONIC ILLNESS TO HELP THEM GAIN -- REGAIN HELP. THIS HAPPENS ON A DIFFERENT PLANE, PHYSIOLOGIC AS WELL AS SOCIAL AND PSYCHOLOGICAL PLANE. AND SYMPTOM MANAGEMENT IS PART OF THIS, AT EVERY STEP. MANAGING PAIN IS PART OF THIS CONTINUUM. I LOPE THIS GIVES AN IDEA OF EXCITING TISSUE I WAS INITIATIVES, ALL RELEVANT TO THE HEALTH OF WOMEN. WE LOOK FORWARD TO FURTHER DISCUSSIONS WITH ORWH ON HOW WE CAN FURTHER COLLABORATE ON MANY OF THESE INITIATIVES. THANK YOU. >> THANK YOU VERY MUCH. THANKS TO DR. CLAYTON AND THE ORGANIZERS OF THIS ANNIVERSARY CELEBRATION FOR INVITING ME TO PARTICIPATE. I'D LIKE TO ADD MY CONGRATULATIONS TO OFFICE OF RESEARCH ON WOMEN'S HEALTH ON BEHALF OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES AND OUR DIRECTOR DR. ELISEO PEREZ-STABLE. I AM DELIGHTED TO BE HERE. I'LL START WITH A LITTLE ABOUT NIMHD. OUR MISSION IS TO LEAD SCIENTIFIC RESEARCH TO IMPROVE MINORITY HEALTH AND REDUCE HEALTH DISPARITIES. NIMHD ENVISIONS AN AMERICA WHICH ALL POPULATIONS WILL HAVE AN EQUAL OPPORTUNITY TO LIVE LONG HEALTHY AND PRODUCTIVE LIVES. TO ACCOMPLISH THIS, OUR INSTITUTE RAISES NATIONAL AWARENESS ABOUT THE PREVALENCE AND IMPACT OF HEALTH DISPARITIES AND DISSEMINATES EFFECTIVE INDIVIDUAL COMMUNITY AND POPULATION LEVEL INTERVENTIONS TO LEAD US CLOSER TO HEALTH EQUITIES. NEXT SLIDE. WHY IS IT IMPORTANT TO UNDERSTAND THE HEALTH OF UNDERSERVED WOMEN IN PARTICULAR? WELL, WHILE THERE HAS BEEN SEVERAL SCIENTIFIC AND MEDICAL ADVANCES THAT HAVE PREVENTED AND CURED DISEASE, HELPED CHANGE BEHAVIOR, EXTENDED LONGEVITY, NOT ALL POPULATIONS HAVE BENEFITED FROM THESE ADVANCEMENTS. THE INITIAL STEP IS UNDERSTANDING WHAT HEALTH DISPARITIES ARE, THEN THE CONTRIBUTING FACTORS, AND THEN INTERVENTIONS THAT REDUCE AND ULTIMATELY ELIMINATE THEM. THAT'S HOW WE REACH HEALTH EQUITY AND THAT'S WHY IT'S IMPORTANT TO STUDY HEALTH DISPARITIES IN THE CONTEXT OF UNDERSERVED WOMEN. DISPARITIES, LAWS AND YOU ARE RELATED TO IN SPECIFIC CASES ATTRIBUTABLE TO SOCIAL DETERMINANTS OF HEALTH, CONDITIONS IN THE ENVIRONMENT IN WHICH PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP AND AGE THAT AFFECT A WIDE RANGE OF HEALTH FUNCTIONING AND QUALITY OF LIFE OUTCOME AND RISKS. THIS INCLUDES EXAMPLES OF SOCIAL DETERMINANTS AND THEY INCLUDE AVAILABILITY OF HEALTHY FOODS, OPPORTUNITIES FOR HIGH QUALITY, EDUCATION, EMPLOYMENT, ACCESS TO QUALITY HEALTH CARE, PUBLIC SAFETY, SAFE AND AFFORDABLE HOUSING, SOCIAL NORMS AND ATTITUDES SUCH AS RACISM, THE BUILT ENVIRONMENT SUCH AS BUILDINGS, SIDEWALKS, BIKE LANES, AND OF COURSE ENVIRONMENTS FREE OF LIFE-THREATENING TOXINS. THESE AND OTHER SOCIAL DETERMINANTS COMBINE TO INFLUENCE HEALTH OUTCOMES. NEXT SLIDE. ONE KEY OUTCOME IS LIFE EXPECTANCY. THESE ARE FROM 2017, THIS IS A GOOD EXAMPLE WHY IT'S IMPORTANT TO FOR SEX AS A BIOLOGICAL VARIABLE AND GENDER AS SOCIAL VARIABLE. AFRICAN AMERICANS HAVE LOWER LIFE EXPECTANCY COMPARED TO WHITE AND LATINO POPULATIONS. LATINOS HAVE LONGER LIFE EXPECTANCY COMPARED WITH WHITES. BUT IF WE FOCUS ON FEMALES ONLY, DATA SHOW AFRICAN AMERICAN FEMALES LIVE FEWER YEARS ON AVERAGE COMPARED TO WHITE AND LATINA COUNTERPARTS. NEXT SLIDE. AND WHEN WE THINK ABOUT SPECIFIC MEDICAL CONDITIONS, DATA INDICATE THAT AFRICAN AMERICAN WOMEN HAVE POORER HEALTH COMPARED TO WHITE WOMEN. SPECIFIC EXAMPLES ARE BREAST CANCER, HEART DISEASE, DIABETES, HIV/AIDS, MATERNITY MORBIDITY. LITERATURE TREATED WOMEN AS A MONOLITHTIC GROUP. PRESUMING FACTORS THAT INFLUENCE HEALTH ARE EQUALLY APPLICABLE AND EFFECTIVE FOR ALL WOMEN. THIS APPROACH PLACES EMPHASIS ON GENDER AND MAY MASK RISKS AND EXPERIENCE BASED ON OTHER SOCIAL CATEGORIES, IF WE APPLY HEALTH EQUITY LENS, THE SCIENCE WILL FOCUS ON IMPROVING BLACK WOMEN'S HEALTH AND ALSO STUDY PROTECTIVE FACTORS HERE TO PREVENT OTHER RACIAL/ETHNIC MINORITY WOMEN FROM THESE AND OTHER DISPARITIES. NEXT SLIDE. NIMHD, WE'RE A SMALL BUT MIGHTY INSTITUTE, AND WE COLLABORATE ACROSS NIH AND SISTER AGENCIES TO FUND BEST SCIENCE THAT FITS OUR PRIORITIES. AND WE'VE ONLY RECENTLY ESTABLISHED INTRAMURAL PROGRAM, FIVE YEARS SINCE DR. PEREZ-STABLE HAS BEEN DIRECTOR, THE EXTRAMURAL HAS GROWN TO FUND MORE CATEGORIES OF AWARDS. THIS TABLE IS A SUMMARY OF OUR FUNDING PORTFOLIO IN RESEARCH RELATED TO WOMEN'S HEALTH AND WE NARROWED IN ON THE PATH THREE FISCAL YEARS. THE PRIMARY POINTS ARE THE FUNDING FOR MINORITY HEALTH AND HEALTH DISPARITIES AS THEY RELATE TO WOMEN'S HEALTH IS INCREASING YEAR OVER YEAR, SECONDS THIS IS TRUE OF ALL CATEGORIES. WE THINK THIS IS AN IMPORTANT ACCOMPLISHMENT. NEXT SLIDE. I'D LIKE TO HIGHLIGHT A FEW AREAS OF WOMEN'S HEALTH INITIATIVES THAT ARE WITHIN THE MISSION OF NIMHD, AND IN THE INTEREST OF TIME WE'LL FOCUS ON LUNG CANCER, BREAST CANCER, HIV/AIDS, AND MATERNAL MORBIDITY AND MORTALITY. FIRST IS LUNG CANCER. THERE IS A DOCUMENTED HIGH BURDEN OF LUNG CANCER AMONG ASIAN AMERICAN FEMALES WHO NEVER SMOKED, IF SMOKING IS THE KNOWN FACTOR, UNDERSTANDING THE ROLE OF OTHER RISK FACTORS IS IMPORTANT. IN A STUDY FUNDED, FOCUSED ON GENETIC AND NON-GENETIC RISK FACTORS IN THIS POPULATION, THIS IS A POPULATION-BASED CASE CONTROLLED STUDY FROM AN ESTIMATED 600 ASIAN AMERICAN FEMALES WHO NEVER SMOKED, LUNG CANCER CASES, 600 MATCHED CONTROLS. MULTI-LEVEL ANALYSES EXAMINE CLINICAL FACTORS, GENOMIC DATA, TO CHARACTERIZE MUTATIONAL LANDSCAPE OF LUNG CANCER CASES AND CONTROLS, AS WELL AS ENVIRONMENTAL, BEHAVIORAL, SOCIOECONOMIC, NEIGHBORHOOD, AND BUILT ENVIRONMENT EFFECTS. LUNG CANCER AMONG NEVER SMOKERS IS A DISEASE HYPOTHESIZED. STUDIES THAT INCLUDE A BIOBEHAVIORAL CONTEXTUAL FOCUS HAVE POTENTIAL TO ADVANCE SCIENCE IN THE AREA. NEXT SLIDE. IN THE AREA OF BREAST CANCER THIS IS AN EXAMPLE FROM A K 99 GRANT FROM EVALUATION OF BREAST CANCER AMONG AFRICAN AMERICAN OR BLACK WOMEN WHO ARE ABOUT TWICE AS LIKELY COMPARED TO WHITE WOMEN TO DEVELOP THESE BREAST CANCERS THAT HAVE A MORE AGGRESSIVE PHENOTYPE. VITAMIN D DEFICIENCY IS MORE COMMON, THIS STUDY AIMED TO EVALUATE ASSOCIATION OF VITAMIN D EXPOSURE THROUGH DIET, SUPPLEMENTS, SUNLIGHT, AND CALCIUM INTAKE WITH THE RISK OF BREAST CANCER BY ER- AND TRIPLE-NEGATIVE BREAST CANCER STATUS AMONG AFRICAN AMERICAN WOMEN. USING A CASE CONTROLLED DESIGN THEY DID NOT FIND ASSOCIATION BETWEEN DIETARY VITAMIN D AND CALCIUM INTAKE AND RISK OF BREAST CANCER IN POOLED ANALYSIS, RESULTS DID SHOW MODERATE SUPPLEMENTAL VITAMIN D INTAKE WAS ASSOCIATED WITH DECREASED RISK OF TRIPLE-NEGATIVE BREAST CANCER, AND THAT INCREASED SUN EXPOSURE WAS ASSOCIATED WITH REDUCED RISK OF ER+, ER, AND TRIPLE-NEGATIVE BREAST CANCER IN THIS SAMPLE OF WOMEN. THESE FINDINGS BEGIN TO MOVE US FORWARD AND HIGHLIGHT AREAS THAT WE REALLY NEED TO CONSIDER IN ADDITION TO LOOKING AT, FOR EXAMPLE, IN THIS CASE VITAMINS. NEXT SLIDE. EXAMPLE OF NIHMD RATES OF NEW INFECTION DECREASED OVER THE LAST DECADE. AFRICAN AMERICAN WOMEN AND LATINAS ACCOUNT FOR OVER 3/4 OF WOMEN LIVING WITH HIV. AND RATE OF NEW HIV INFECTION IS 16 TIMES HIGHER FOR AFRICAN AMERICAN WOMEN AND OVER THREE TIMES HIGHER FOR LATINAS THAN WHITE WOMEN. NEXT SLIDE. ER-NEGATIVE THIS SUPPORTS INTERVENTION TO ADDRESS RACIAL, ETHNIC, GEOGRAPHIC AND SOCIOECONOMIC DISPARITIES, FOCUSED ON HIV PREVENTION, SCREENING, DIAGNOSIS AND/OR TREATMENT. WE'RE LOOKING AT HIV PREVENTION PROGRAMS THAT ADDRESS SPECIFIC RISK FACTORS AMONG WOMEN, INCLUDING ACCESS TO CARE, FINANCIAL STRAIN, TRAUMA EXPOSURE, INTERPERSONAL VIOLENCE, SUBSTANCE USE, CULTURAL BELIEF, GENDER ROLES, STIGMA. WE'RE ALSO ADVANCING SCIENCE ON STRATEGIES TO ENCOURAGE ROUTINE HIV TESTING AMONG WOMEN IN STUDIES OF PRIMARY CARE AND OB/GYN, AS WELL AS STUDYING HIGH RISK WOMEN SUCH AS WOMEN'S SHELTERS, MENTAL HEALTH, AND SUBSTANCE TREATMENT SETTINGS, ALSO CRIMINAL JUSTICE SETTINGS. ALSO IMPORTANT TO STUDY SYSTEMS LEVEL CHANGE SO THAT IS BEYOND AND ABOVE THE INDIVIDUAL LEVEL. AND TO STUDY IMPLEMENTATION SCIENCE APPROACHES TO INFORM THE ADOPTION AND SUSTAINABILITY OF EVIDENCE-BASED INTERVENTIONS AND PRACTICES TO PREVENT HIV OR TO ENGAGE WOMEN IN HIV CARE. NEXT SLIDE. THE FINAL SCIENTIFIC AREAS I WILL COVER TODAY, RACIAL DISPARITIES IN MATERNAL MORBIDITY AND MORTALITY. NEXT SLIDE. DATA SHOWING RACIAL/ETHNIC DISPARITIES AND MA TERRIBLE MORBIDITY ARE A PRIMARY REASON FOR INCREASED FOCUS NATIONALLY. THESE DATA SHOW TIME PERIOD BETWEEN 2007 AND 16, AND YEAR OVER YEAR A CONSISTENT PATTERN IS OBSERVED. WITH BLACK OR AFRICAN AMERICAN WOMEN IN THE DARK PURPLE BARS AND AMERICAN INDIAN/ALASKA NATIVE WOMEN IN MAUVE BARS, TWO TO THREE TIMES MORE LIKELY TO DIE FROM PREGNANCY-RELATED COMPLICATIONS. NEXT SLIDE. A COMMON QUESTION PARTICULARLY FIVE TO TEN YEARS AGO WAS WHETHER THIS RACIAL DIFFERENCE WAS DUE TO SOCIOECONOMIC STATUS. WE KNOW DISPARITIES ARE INDEPENDENT. DATA SHOW SPECIFICALLY THE PREGNANCY RELATED DEATH AMONG AFRICAN AMERICAN WOMEN AGAIN IN DARK PURPLE BARS WITH AT LEAST A COLLEGE DEGREE IS FIVE TIMES AS HIGH AS WHITE WOMEN WITH SIMILAR EDUCATION LEVEL. TAKEN A STEP FURTHER YOU CAN SEE AFRICAN AMERICAN WOMEN WITH COLLEGE DEGREE HAVE A 60% INCREASED RISK OF PREGNANCY RELATED MORTALITY COMPARED TO WHITE WOMEN WITH LESS THAN HIGH SCHOOL EDUCATION. NEXT SLIDE. THESE ISSUES ARE OF CONCERN TO NIMHD. WE SUPPORT SCIENCE THAT TESTS CLINICAL, SOCIAL, BEHAVIORAL AND HEALTH CARE SYSTEM INTERVENTION TO ADDRESS RACIAL DISPARITIES IN MATERNAL MORBIDITY AND MORTALITY IN THE UNITED STATES. NEXT SLIDE. AND THERE'S BEEN A ROBUST RESPONSE TO THIS INITIATIVE, AND WE RECENTLY FUNDED PROJECTS FOCUSED ON TOPICS YOU SEE HERE, INCLUDING MULTI-LEVEL INTERVENTION AND STUDIES FOCUSED ON UPSTREAM FACTORS OF HEALTH CARE QUALITY, ALSO EFFECT OF WORKING WITH COMMUNITY-BASED DOULAS, AND ROLE OF MEDICAID EXPANSION IN REDUCING RACIAL AND ETHNIC DISPARITIES IN MATERNAL MORBIDITY AND MORTALITY. ROLE OF POLICIES ARE UNDERSTUDY, FINDINGS FROM NIHMD FUNDED R01 EXAMINING FAMILY ECONOMIC SECURITY BETWEEN 1980 AND 2011 ACROSS 50 STATES. THIS WORK ADVANCED SCIENCE BY DEMONSTRATING A $1 INCREASE IN STATE LEVEL MINIMUM WAGE ABOVE FEDERAL LEVEL WAS ASSOCIATED WITH 1 TO 2% DECREASE IN LOW BIRTH RATE BIRTH, 4% DECREASE IN INFANT MORTALITY. IN ADDITION, A STATE LEVEL EARNED INCOME TAX CREDIT WAS ASSOCIATED WITH MODEST INCREASES IN BIRTHWEIGHT AND GESTATION IN TERMS OF WEEKS. THE STRONGEST EFFECTS WERE FOUND AMONG AFRICAN AMERICAN MOTHERS AND MOTHERS WITH HIGH SCHOOL EDUCATION OR LESS. NEXT SLIDE. FINALLY, NIMHD IS VERY MUCH SUPPORTIVE OF WOMEN SCIENTISTS, AS WE RECOGNIZE MANY CONTRIBUTIONS TO MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH. THIS TABLE IS A SUMMARY OF SUPPORT BY GENDER OVER THE PAST THREE FISCAL YEARS. AS YOU CAN SEE, WITH RARE EXCEPTIONS WHEN GENDER IS KNOWN WOMEN ARE VERY WELL REPRESENTED ACROSS COMPETING AWARD TIMES FOR MAJOR MECHANISMS SUPPORTED BY NIMHD AND THIS IMPROVED FELLOWSHIPS, RESEARCH PROJECTS, TRAINING GRANTS. I NOTED HERE THAT THE FUNDING OF SBIR/STTR GRANTS ARE LOWER AMONG WOMEN VERSUS MEN, EVEN THESE AWARDS ARE STILL QUITE STRONG AMONG WOMEN. AND OVERALL OVER THE PAST THREE FISCAL YEARS GRANTS AWARDED TO WOMEN EXCEEDED 50%. NEXT SLIDE. WE'RE VERY PROUD OF THESE ACCOMPLISHMENTS. WE'RE DELIGHTED TO CONTINUE OUR GROWING COLLABORATION WITH OFFICE OF RESEARCH AND WOMEN'S HEALTH. I INVITE ALL OF YOU TO CONNECT WITH NIMHD THROUGH OUR WEBSITE AND ON SOCIAL MEDIA. THANK YOU. >> GOOD AFTERNOON, IT'S MY PLEASURE TO JOIN YOU IN THIS CELEBRATION OF A 30th ANNIVERSARY OF THE OFFICE OF RESEARCH ON WOMEN'S HEALTH. THERE ARE MANY MORE SCIENTIFIC OPPORTUNITIES IN THE YEARS AHEAD. NCI IS ON THE CUSP OF MOMENTOUS ANNIVERSARY, 2021 WILL MARK 50 YEARS SINCE THE PASSAGE OF THE NATIONAL CANCER ACT OF 1971. MILESTONES LIKE THESE CAN SEEM CONTRIVED BUT I THINK THEY ARE REALLY IMPORTANT PROCESS OF REVISITING THE PAST TO RECALL CIRCUMSTANCES AND GOALS SALIENT ON OUR BEGINNINGS AND MEANINGFUL CATALYST TO PROGRESS. I COMMEND MY COLLEAGUES IN THE ORWH AND ACROSS THE NIH FOR CAREFUL CONSIDERATION OF PLANNING FOR THESE EVENTS AND CONVENING THESE EVENTS EVEN IN 2020 WITH ALL THE UNCERTAINTY AND UPHEAVAL NOW, IN MY BRIEF PRESENTATION I'LL REVIEW KEY INDICATORS OF WHERE WE STAND WITH REGARD TO CANCER AND WOMEN AND POPULATION LEVEL. I'M DESCRIBE INSTANCES OF CANCERS THAT HAVE IMPACT ON WOMEN AND PROVIDE OVERVIEW OF NCI RESEARCH PORTFOLIO IN SOME CANCERS THAT OCCUR ONLY OR PRIMARILY IN WOMEN. FIRST NATIONAL CANCER STATISTICS, A SNAPSHOT. YOU CAN ASCERTAIN BREAST CANCER IS THE MOST COMMON TYPE FOR WOMEN FOLLOWED BY LUNG AND COLORECTAL, THEN MELANOMA. GENERALLY THE SAME PATTERNS HOLD FOR MEN EXCEPT PROSTATE CANCER IS MOST COMMON FOR MEN. WHEN YOU LOOK AT MORTALITY SHOWN HERE, YOU CAN SEE LUNG CANCER IS RESPONSIBLE FAR MORE DEATHS THAN ANY OTHER TYPE OF CANCER, CAUSING GREATER LETHALITY AND BREAST, COLON AND PROSTATE, THAT'S AN ISSUE I'LL COME BACK. TO I'D LIKE TO SHOW WHEN YOU LOOK AT STATISTICS FOR CHANGES IN INCIDENTS OF MORTALITY FOR WOMEN, MORTALITY ON THE RIGHT, YOU CAN SEE DECREASES IN MANY CANCERS IN INCIDENCE AND MORTALITY OVER FIVE-YEAR PERIOD WITH A FEW OUTLIER EXCEPTION CANCERS INCREASING IN INCIDENCE, EVEN MORTALITY. WHAT'S ENCOURAGING IS THAT FOR MOST CANCER TYPES WE'RE SEEING DECLINE IN CANCER MORTALITY AND THIS IS A TREND GOING ON FOR DECADES BUT HAS ACCELERATED IN MORE RECENT YEARS FOR A NUMBER OF REASONS. ONE THING YOU'LL NOTICE IS DECLINES IN MORTALITY FOR LUNG CANCER, MELANOMA, HODGKIN'S DISEASE, NON-HODGKIN'S DISEASE, MUCH GREATER THAN THEY ARE FOR DECLINES IN INCIDENCE, MELANOMA INCREASING IN INCIDENCE, DECLINING IN MORTALITY. WE BELIEVE THAT MOST OF THESE SUBSTANTIAL DECLINES IN MORTALITY FOR SOME CANCERS SEEN IN THE LAST FEW YEARS REFLECT IMPROVED TREATMENT OF THESE CANCERS, THAT IS NEW THERAPIES THAT HAVE BEEN DEVELOPED PARTICULARLY IN THE AREA OF IMMUNO-ONCOLOGY AND KINASE INHIBITORS HAVE STARTED TO MAKE A DIFFERENCE AT SURVIVAL DATA AT THE POPULATION LEVEL. WE SEE SIMILAR PATTERN FOR COLON CANCER, DECLINE IN INCIDENCE AND MORTALITY, GOOD NEWS REFLECTS IMPROVED SCREENING FOR COLON CANCER THAT IS NOW HAVING EFFECT ON POPULATION LEVEL STATISTICS. OVARIAN DECLINING FOR A VARIETY OF COMPLICATED REASONS THAT WE DON'T FULLY UNDERSTAND. THERE'S DISCOURAGING NEWS. UTERINE CANCER, ENDOMETRIAL IS THE LEADING CANCER IN TERMS OF INCREASING MORTALITY. PANCREATIC AND LIVER, THERE HASN'T BEEN MUCH PROGRESS TO SPEAK, HIGHLY LETHAL CANCERS WITH VERY LITTLE IMPROVEMENT. THIS SLIDE SENDS THIS MESSAGE OF PROGRESS ACROSS THE WATERFRONT OF CANCER, IN SOME CASE DUE TO TREATMENT AND ENHANCED SCREENING BUT MAKES THE POINT THERE ARE FEW CANCERS PARTICULARLY CANCERS ASSOCIATED WITH OBESITY WHERE DATA ARE NOT SO GOOD, THERE'S STILL A LOT OF PROGRESS THAT NEEDS TO BE MADE. OVERALL THIS IS A TIME OF REMARKABLE PROGRESS IN CANCER. DECADES OF PAINSTAKING BASIC SCIENCE HAVE YIELDED INSIGHTS INTO HETEROGENEITY OF CANCER THAT HAVE IMPORTANT IMPLICATIONS FOR RESEARCHING, PREVENTING, TREATING, DIAGNOSING CANCER. TALKING ABOUT SEX DIFFERENCE, NORMAL GROWTH IN AGING IN MALES AND FEMALES, CANCER IS REALLY AMONG THOSE DISEASES WITH SIGNIFICANT SEX DIFFERENCES AND RISK TREATMENT RESPONSE AND OUTCOME. THIS PAPER LISTS 31 CANCER TYPES WITH CLEAR SEX DISPARITY IN AGE ADJUSTED RATES PER 100,000 POPULATION IN SEER INCIDENCE DATA. RESEARCHERS UNCOVERED SEX DIFFERENCES IN CANCERS THAT OCCUR IN THREE GENERAL WAYS. THERE WILL BE SEX DIFFERENCES IN GENETIC AND MOLECULAR BASIS OF CANCER, THAT IS GENETIC AND MOLECULAR DISPARITIES, CONTRIBUTE TO DIFFERENCE IN INCIDENCE OF A VARIETY OF CANCERS. SEX HORMONES NEGATIVELY OR POSITIVITY AFFECT, FOR EXAMPLE ESTROGEN LINKED TO HIGHER RATE OF THYROID CANCER IN WOMEN, AND SEX DIFFERENCES IN P53 SIGNALING, SENESCENCE, ANGIOGENESIS, BIOLOGICAL PROCESSES THAT POINT TO INTRIGUING OPPORTUNITIES FOR FUTURE RESEARCH. WITH REGARD TO LUNG CANCER IN WOMEN, IT'S AN AREA WHERE THERE'S BEEN SIGNIFICANT PROGRESS FOR DECADES IN TERMS OF INCIDENCE IN THE UNITED STATES BECAUSE OF TOBACCO CONTROL. NOW SUPERIMPOSED AGAINST LONGER HISTORY OF DECLINING INCIDENCE RELATES TO DECREASED SMOKING WE SEE MORE COMPLICATED STRUCTURE CONSIDERING FOUR SUBTYPES OF LUNG CANCER SHOWING CANCER INCIDENCE BY SUBTYPES SINCE 2000. IN RECENT YEARS A LONGSTANDING PATTERN OF HIGHER LUNG CANCER INCIDENCE IN MALES COMPARED TO FEMALES HAD REVERSED AMONG NON-HISPANIC WHITES AND HISPANIC SINCE THE 1960s, NOT FULLY EXPLAINED BY SEX DIFFERENCE IN SMOKING BEHAVIOR, IDENTIFIED IN ANALYSIS BY RESEARCHERS FROM AMERICAN CANCER SOCIETY AND NCI USING DATA FROM SEER AND NATIONAL HEALTH INTERVIEW SURVEY. EARLIER THIS YEAR DATA FROM 40 COUNTRIES SHOWED SIMILAR PATTERN WITH HIGHER INCIDENCE OF LUNG CANCER AMONG YOUNG WOMEN THAN YOUNG MEN NOT EXPLAINED BY SMOKING BEHAVIORS. HIGHER RATES IN WOMEN SEEN BY INCREASE IN ADENOCARCINOMA, TYPICALLY LUNG CANCER SEEN IN SMOKERS BUT NOT EXCLUSIVELY, AND THIS COMMON IN YOUNG WOMAN LARGELY ASSOCIATED WE BELIEVE IN NONSMOKERS, HIGHER RATES OF A SPECIFIC TYPE OF LUNG CANCER IN YOUNG WOMEN COMPARED TO YOUNG MEN AND WIDESPREAD AND NOT FULLY EXPLAINED BY SEX DIFFERENCES IN SMOKING PATTERNS. ALTHOUGH TOBACCO SMOKING ACCOUNTS FOR MAJORITY OF LUNG CANCER, APPROXIMATELY 10% OF PATIENTS WITH LUNG CANCER IN THE UNITED STATES ARE LIFELONG NEVER SMOKERS, AFFECTING WOMEN MORE OFTEN THAN MEN. A STUDY LOOKS AT GENOMIC CAUSES OF LUNG CANCER, USING VERY COMPREHENSIVE MOLECULAR ANALYSIS IN NONSMOKERS, AS I MENTIONED THIS IS A PARTICULAR PROBLEM IN WOMEN WITH LUNG CANCER, AND THIS IS TRYING TO IDENTIFY OTHER ENVIRONMENTAL CAUSES OF LUNG CANCER, ALSO MOLECULAR GENETIC EVENTS THAT CONTRIBUTE TO LUNG CANCERS, TO REALLY UNDERSTAND THIS DISEASE WHICH HAS BEEN LESS WELL STUDIED IN SMOKING ASSOCIATED LUNG CANCER. NOW I'LL TURN TO GYNECOLOGIC CANCERS. TO GIVE A SENSE OF WHERE OUR CLINICAL RESEARCH IS FOCUSED WITH REGARD TO CANCERS, LET ME POINT OUT THESE PRIORITIES ARE DEVELOPED AND UPDATED EACH YEAR. IT'S REALLY A VERY ROBUST INTRAMURAL AND EXTRAMURAL PROCESS TO DEVELOP PRIORITIES. GYNECOLOGIC COMMITTEE ADDRESSES DESIGN, PRIORITIZATION AND EVALUATION OF CONCEPTS FOR PHASE 2, PHASE II-III AND PHASE 3 CLINICAL TRIALS IN ADULT GYN CANCERS, NOT ALL PRIORITIES ARE LISTED HERE BUT THIS SHOWS A FEEL OF THE PROMISING RESEARCH DIRECTIONS WE'VE ARTICULATED IN AREAS OF PARTICULAR INTEREST INCLUDING STUDIES TARGETING PATHWAYS WITH KNOWN ASSOCIATIONS, COMBINATION THERAPIES. WE'VE HAD DISCUSSION TO REALLY FURTHER IDENTIFY FUTURE OPPORTUNITIES. LET ME TALK ABOUT CERVICAL CANCER. THIS IS AN AREA WHERE THERE'S TREMENDOUS INTERNATIONAL INTEREST AND OPPORTUNITY FOR REAL PROGRESS. CERVICAL CANCER IS A MAJOR SUCCESS STORY WHEN IT COMES TO CANCER PREVENTION, ONE OF THE MOST COMMON CANCERS OF WOMEN IN THE WORLD BUT INCIDENCE AND MORTALITY HAVE DRAMATICALLY DECLINED SINCE MID-1970s THANKS TO SCREENING WITH PAP SMEARS. THIS DECLINE HAS NOT BEEN SEEN IN COUNTRIES WHERE PAP SMEARS HAVE NOT BEEN BROADLY ADOPTED. THIS IS A REALLY IMPORTANT SCREENING MODALITY THAT HAS A TREMENDOUS IMPACT ON INCIDENCE ON MORTALITY, SUPERIMPOSED ON ADVANCES FROM SCREENING IS WORK FROM DOUG LOWY AND JOHN SCHILLER TO PREVENTS HPV INFECTION THROUGH VACCINE APPROACH, JOHN AND DOUG LED TO APPROVAL OF THREE VACCINES BY THE FDA, FIRST IN 2006. AND NOW WITH BROAD UPTAKE OF VACCINES WE CAN FURTHER LEAD TO DECLINE IN CERVICAL CANCER SINCE THE VAST MAJORITY, ALMOST ALL CERVICAL CANCER, IS CAUSED BY HUMAN PAPILLOMAVIRUS INFECTION, THERE BY BY GREATER USE OF VACCINES WE CAN HAVE A REAL IMPACT ON THIS DISEASE NATIONALLY AND INTERNATIONALLY. MORE THAN HALF A MILLION WOMEN AROUND THE WORLD ARE DIAGNOSED WITH CERVICAL CANCER EACH YEAR, OVER HALF WILL DIE, MOST CASES OCCUR IN LOW AND MIDDLE INCOME COUNTRIES AND THEREFORE IT'S BEEN ESTIMATED WIDESPREAD VACCINATION USING CURRENTLY AVAILABLE HPV VACCINES TO PREVENT MORE THAN 2/3 OF CERVICAL CANCER, SEVERAL COUNTRIES DECLARED AN INTEREST IN TRYING TO ELIMINATE CERVICAL CANCER BY FUTURE DATE USING SCREENING AND VACCINATION APPROACHES. FINALLY I'LL PROVIDE UPDATES ON BREAST CANCER. AN IMPORTANT STUDY TOOK A LONG TIME TO CONCLUDE, LAUNCHED IN 2006, AND LARGEST PRECISION MEDICINE TRIAL COMPLETED TO DATE, IF A SPECIFIC TEST THAT MEASURES EXPRESSION OF 21 GENES, ONCOTYPE DX TEST, WAS GOOD AT PREDICTING RISK OF BREAST CANCER OCCURRENCE, AND COULD DETERMINE -- AND COULD RESULTS BE USED TO DETERMINE WHICH PATIENTS WOULD BENEFIT FROM THERAPY, PARTICULARLY WITH CHEMOTHERAPY, WITH SIDE EFFECTS BUT ALSO OF BENEFIT IN TERMS OF ADJUVANT THERAPY FOR BREAST CANCER. IN 2018 AFTER A LONG PERIOD OF OBSERVATION, THE STUDY CONCLUDED MOST WOMEN WITH MOST COMMON TYPE OF BREAST CANCER, ER+ DON'T BEN EFID FROM THERAPY BUT COULD BE STRATIFIED TO SAVE WOMEN UNNECESSARY TREATMENT. THERE'S A COURSE GOING ON, UNDERSTANDING HOW ENVIRONMENTAL EXPOSURES MIGHT CONTRIBUTE TO BREAST CANCER RISK. THIS EFFORT HAS BEEN UNDERWAY FOR 15 YEARS, WHERE THE NATIONAL CANCER INSTITUTE PARTNERED WITH NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES, NIEHS, TO SUPPORT BREAST CANCER ENVIRONMENT RESEARCH PROGRAM. I EXPECT MY COLLEAGUE DR. COLLMAN WILL ALSO HIGHLIGHT THIS WORK IN HER REMARKS AS WELL. BCERP IS A MULTI-DISCIPLINARY NETWORK ENGAGED IN RESEARCH TO EXAMINE EFFECTS OF ENVIRONMENTAL EXPOSURES THAT MAY PREDISPOSE A COME, OF PARTICULAR HAVE IS NATURALLY OCCURRING ENDOCRINE DISRUPTORS IN WINDOWS OF SUSCEPTIBILITY WHERE COMPOUNDS CAN MIMIC OR INTERFERE WITH HORMONES. BCRP DISCOVERED GIRLS ENTERING PUBERTY AT EARLIER AGES THAN PREVIOUSLY BELIEVED AND CERTAIN CHEMICALS MAY BE CONTRIBUTORS TO THAT OBSERVATION. BCERP GENERATED A RODENT MODEL WITH BREAST LESIONS, AND OPTICAL SPECTROSCOPY. AND BREAST CANCER GENETIC STUDY IN AFRICAN AMERICAN ANCESTRY POPULATIONS, BEING COMPARED TO EACH OTHER, AS WELL AS TO THOSE OF WHITE WOMEN WITH BREAST CANCER. WE KNOW THERE'S A DISPARITY IN INCIDENCE OF BREAST CANCER SUBTYPES WHEN BLACK AND WHITE WOMEN, NOW TRYING TO UNDERSTAND GERMLINE GENETICS. THE OTHER STUDY IS DETROIT ROCS STUDY, THIS IS LOOKING AT MAJOR FACTORS AFFECTING CANCER PROGRESSION, RECURRENCE, MORTALITY, QUALITY OF LIFE AMONG AFRICAN AMERICAN SURVIVORS, COLLECTING COMPREHENSIVE DATA THROUGH INTERVIEWS OF MORE THAN 5,000 PARTICIPANTS WITH INFORMATION FOR MEDICAL RECORDS AND FIVE SPECIMENS FROM PARTICIPANTS, A UNIQUE STUDY IS INCLUDE OF 2700 FAMILY MEMBERS TO HELP RESEARCHERS UNDERSTAND HOW CANCER DIAGNOSIS AFFECTS MENTAL, PHYSICAL, FINANCIAL HEALTH OF THOSE PROVIDING CARE. WE REFLECT ON PROGRESS, SEE WE MADE CONSIDERABLE PROGRESS BUT MUCH MORE WORK REMAINS. THIS IS WITH REGARD TO CANCER EFFECTS WITH REGARD TO WOMEN. WE HAVE WAYS TO PREVENT, DIAGNOSE, DETECT AND TREAT MANY CANCERS IN WOMEN AND ENCOURAGING TRENDS FOR MANY CANCER TYPES AND MANY POPULATIONS. OF COURSE WE ALSO HAVE TREMENDOUS CHALLENGES BEFORE US AS WELL. SOME WE'VE TALKED ABOUT ALREADY, INCREASING MORTALITY OF ENDOMETRIAL CANCER. AT NCI WE'RE PROUD OF OUR TRACK RECORD AND PRAGMATIC ABOUT NEED TO FOCUS ON MOST VEXING PROBLEMS THAT WE MAIN, DO NOT REST ON PAST SUCCESSES. WE'RE GRATEFUL FOR THE OPPORTUNITIES TO COLLABORATE PRODUCTIVELY WITH PARTNERS ACROSS THE NIH, LED BY OFFICE OF RESEARCH ON WOMEN'S HEALTH, SUCH POWERFUL CHAMPIONS OF COLLABORATION AND INCLUSION. THANK YOU FOR THE OPPORTUNITY TO SPEAK AT THIS AUSPICIOUS OCCASION ONCE AGAIN. >> I'M NORA VOLKOW, THE DIRECT THE NATIONAL INSTITUTE ON DRUG ABUSE. IT'S A PLEASURE TO BE WITH YOU TO CELEBRATE THE 30-YEAR ANNIVERSARY . I WANT TO CONGRATULATE DR. JANINE CLAYTON AND YOUR FANTASTIC TEAM FOR ALL OF THE WONDERFUL WORK THAT THEY HAVE DONE IN ORDER TO UNDERSTAND BETTER WHAT IS UNIQUE ABOUT WOMEN'S HEALTH AND HOW CAN WE USE THAT KNOWLEDGE TO IMPROVE THE OUTCOMES AND WELL-BEING OF MEME OF PEOPLE OF BOTH GENDERS. IN THE CASE OF SUBSTANCE USE DISORDERS, WHICH ACTUALLY IS THE ASPECT OUR INSTITUTES WORKS VERY MUCH, WE'VE COME TO REALIZE THERE ARE STRIKING DIFFERENCES BETWEEN MEN AND WOMEN, AND EVEN THOUGH WE IGNORED IMPORTANCE OF THOSE DIFFERENCES FOR YEARS, WE CAN NO LONGER DO THAT. I MEAN, IN THE PROCESS OF UNDERSTANDING BETTER WE'VE COME TO REALIZE MUCH BETTER WAYS OF PREVENTING AND TREATING SUBSTANCE USE DISORDERS. WE'RE CURRENTLY LIVING WHAT IS THE MOST CHALLENGING EPIDEMIC WE'VE HAD REGARDING DRUGS, AND THAT RELATES VERY MUCH TO THE OPIOID CRISIS. THE OPIOID CRISIS WHICH HAS BEEN ACCOUNTING FOR VERY HIGH NUMBER OF PEOPLE DYING FROM OPIOID OVERDOSES STARTED MORE THAN TWO DECADES AGO, AND IT'S STILL CONTINUING TO RISE. IT'S ESTIMATED THAT IN 2019 MORE THAN 70,000 PEOPLE DIED FROM OVERDOSES. IN 2020, AMIDST THE COVID-19 PANDEMIC, IT'S ESTIMATED NUMBERS FURTHER INCREASED. UNDERSTANDING THE IMPORTANCE OF SEX IN HOW OPIOID CRISIS ACTUALLY AFFECTS OUR COUNTRY, IT'S FUNDAMENTAL, DETERMINING HOW TO CONTROL IT. YOU SEE HOW THE CRISIS HAS BEEN CHANGING FROM INCEPTION TO WHERE WE ARE RIGHT NOW IN 2020. THIS IS DATA UP TO 2016. IT SHOWS HOW DIFFERENTLY HAS AFFECTED MALES FROM FEMALES. 1999 TO 2016 YOU SEE COLOR SCALE THAT IDENTIFIES HOW THE FIRST OPIOID CRISIS STARTED. IT STARTED BY THE OVERPRESCRIPTION OF PRESCRIPTION OPIOIDS, YOU SEE X-AXIS, 20 TO 80 YEARS OF MAJOR, IN MALES USE OF PRESCRIPTION OPIOIDS, ADDICTION HAS BEEN VERY IMPORTANT CONTRIBUTOR FROM THE INCEPTION OF THE EPIDEMIC, SIMILARLY THAT IS THE CASE FOR FEMALES, 20 TO 80 YEARS OF AGE. BY COMPARING UPPER TO LOWER PANEL THAT ACTUALLY THE PRESCRIPTION OPIOID CRISIS INITIATED SOMEWHAT LATER IN FEMALES THAN MALES. BY COMPARING THEM IT IS VERY SIMILAR. WE SEE ENTRANCE OF HEROIN, AND THAT CONTRIBUTES SIGNIFICANTLY TO MORTALITY. HEROIN EFFECT MORE MARKED AMONG MALES THAN FEMALES. THIS HEROIN CRISIS AFFECTS YOUNGER MALES AS OPPOSED TO OLDER ONES, WHICH ARE AFFECTED BY PRESCRIPTION OPIOIDS. YOU SEE A VERY SMALL IMPRINT HERE OF YOUNG FEMALES THAT ARE AFFECTED BY HEROIN. THESE ARE USING THESE EXAMPLES TO ILLUSTRATE STRIKING DIFFERENCES ON THE USE OF DRUGS AMONG MALES AND FEMALES. FEMALES ARE EXPOSED TO DRUGS, ESCALATING TO DRUG USE, BECOME ADDICTED FASTER THAN MALES. ACTUALLY, THEY ARE MUCH MORE VULNERABLE TO RELATE TO USE OF DRUGS IN ORDER TO ESCAPE DEPRESSION OR STRESSFUL SITUATIONS. AS OPPOSED TO MALES, MORE IMPULSIVE IN USE OF DRUGS. THE REASON WE OBSERVE THE SITUATION WHERE FEMALES HAVE ACTUALLY MANY INCREASINGLY HIGHER AND HIGHER LEVELS OF USE OF PRESCRIPTION OPIOIDS, REACHING LEVELINGS SOMEWHAT SIMILAR TO THOSE OF MALES, , RELATES TO CIRCUMSTANCES, PRESCRIPTION OPIOIDS IN FEMALES INITIATED BY PRESCRIPTION OF PAIN MEDICATION, WITH OPIOIDS, TO TRY TO FURTHER ANALGESIC PROPERTIES. IF WE SUNS THE OPIOID CRISIS WAS TRIGGERED BY OVERPRESCRIPTION OF OPIOID MEDICATIONS WE COME TO REALIZE WHY WOMEN BECAME VULNERABLE, WOMEN ARE MORE LIKELY TO HAVE CHRONIC PAIN FOR SEVERE HEADACHE OR MIGRAINE, THEY ALSO HAVE HIGHER RATES OF LOW BACK PAIN, ALSO HIGHER RATES OF NECK PAIN. THESE CHRONIC CONDITIONS ARE FREQUENTLY TREATED WITH OPIOID MEDICATION AND ARE MORE LIKELY TO SUFFER DEPRESSION THAN MALES, INCREASING THE LIKELIHOOD THEY WILL BE PRESCRIBED OPIOID MEDICATIONS, THIS IS ACTUALLY THE MAIN REASON WHY WOMEN HAVE BECOME SO VULNERABLE IN OPIOID CRISIS TO ADDICTION TO OPIOID MEDICATIONS BUT ALSO TO OVERDOSES. FROM THE PERSPECTIVE OF, AGAIN, IMPORTANCE OF RESEARCH FROM RESEARCH WE KNOW ACTUALLY THE BRAIN OF THE MALE AND THE FEMALE DIFFER IN TERMS OF THE WAY THEY RESPOND TO PAIN, AND, FOR EXAMPLE, THIS IS ILLUSTRATED ON ACTUALLY TWO STUDIES THAT ARE LOOKING AT ONE OF THE CENTRAL BRAIN REGIONS INVOLVED WITH NETWORK OF PAIN THAT ALLOWS YOU TO PROCESS PAIN, NOW UNDERSTOOD THAT INFLAMMATORY RESPONSES SUCH AS GLIAL CELLS IN THE BRAIN INCLUDING ASTROCYTES IMPORTANT INVOLVE IN PAIN SYNDROMES. HERE WE'RE SEEING ACTIVATED MICROGLIA, INFLAMMATORY RESPONSES MORE PRONOUNCED IN THE FEMALE THAN IN THE MALES, THESE ARE STUDIES DONE IN RODENTS. THIS COULD PROVIDE MECHANISMS FEMALES MAY BE MORE VULNERABLE TO CHRONIC PAIN CONDITIONS. A STUDY IS LOOKING AT THE PERIAQUADUCTAL RAIN, IN THE MALE AND FEMALE BRAIN. YOU SEE MU OPIOID RECEPTORS, YOU CAN SEE BY VISUALIZING THE CONCENTRATION OF THE MU OPIOID RECEPTORS IS HIGHER IN THE MALE BRAIN THAN FEMALE BRAIN. THIS IS ALSO RELEVANT BECAUSE WE HAVE ENDOGENOUS OPIOIDS IMPLICATED IN MULTIPLE FUNCTIONS IN THE BRAIN. TO THE EXTENT YOU HAVE HIGHER LEVELS OF MU OPIOID RECEPTORS IN THIS REGION OF THE BRAIN, THE MALES ARE BETTER ABLE TO ACTUALLY MODULATE AND INHIBIT THOSE PAIN SENSATIONS THROUGH THE MU OPIOID RECEPTORS, YOU CAN SEE CLEARLY DIFFERENCES IN THE CONCENTRATION OF RECEPTOR LEVELS. THIS STUDY IS MEASURING SENSITIVITY TO THE ANALGESIC EFFECTS OF MORPHINE AS FUNCTION OF THOSE AND IT IS MEASURED BY THE TIME IT TAKES AN ANIMAL TO WITHDRAW ITS PAW FROM A PLATE THAT IS HEATED. THE LONGER IT TAKES TO REMOVE THE PAW, HIGHER ANALGESIC EFFECTS. YOU CAN SEE THE STRIKING DIFFERENCES IN THE SENSITIVITY TO PAIN BETWEEN THE MALES AND THE FEMALES, THE FEMALE WITHDRAWS THE PAW FASTER, EVEN WITH HIGHER DOSES, RELATED TO THE FACT THEY HAVE LOWER CONCENTRATIONS OF MU OPIOID RECEPTORS. THIS NEEDS TO BE FURTHER INVESTIGATED WHERE WE DO KNOW FROM STUDIES USING BRAIN IMAGING INDEED THERE ARE DIFFERENCES IN THE LEVELS AND CONCENTRATIONS OF OPIOID RECEPTORS BETWEEN MEN AND WOMEN. OTHER ASPECTS VERY UNIQUE RELATED TO OPIOID CRISIS WHICH I'M USING TO ILLUSTRATE THE IMPORTANCE OF SEX AS A VARIABLE TO UNDERSTAND ADDICTION IS THE FACT THAT WOMEN BECOME PREGNANT AND UNFORTUNATELY WE'RE STILL HAVING A LOT OF WOMEN WHO BECOME PREGNANT EXPOSED TO OPIOIDS. AND THIS IS A SITUATION BECAUSE AT LEAST 17% OF PREGNANT WOMEN IN THE UNITED STATES ARE PRESCRIBED AN OPIOID DURING PREGNANCY. NOW, OPIOID MEDICATIONS ACTUALLY PRODUCE ADDICTION AND CAN RESULT IN ADDICTION, AND INDEED ADDICTION OPIOID USE DISORDER IN PREGNANT WOMEN IS ONE OF THE BIG CHALLENGES IN ITEMS OF DEVELOPING TREATMENTS OPTIMAL TO ENSURE THE WELL-BEING OF WOMAN AS WELL AS WELL-BEING OF THE INFANT. WE KNOW THE USE OF OPIOIDS DURING PREGNANCY OF COURSE ALONG WITH INCREASED UTILIZATION IN THE UNITED STATES OVER THE PAST TWO DECADES HAS ALSO BEEN SEEN IN SIGNIFICANT INCREASE IN RATES OF NEONATAL ABSTINENCE SYNDROME IN THE UNITED STATES. MORE THAN A FOUR-FOLD INCREASE IN NUMBER OF NEONATES BORN WITH ABSTINENCE SYNDROME THAT REQUIRES TREATMENT. THAT'S AN AREA OF RESEARCH TO MINIMIZE ADVERSE EFFECTS INTO THE NEONATE DURING THIS PERIOD. SIMILARLY, AS WE ARE GATHERING INFORMATION USING BRAIN IMAGING TECHNOLOGIES THAT ALLOW US TO LOOK AT OUTCOMES OF USE OF DRUGS DURING PREGNANCY BECAUSE AS WE'RE UNDERSTANDING THE WOMEN BECOMING PREGNANT AND HER WELL-BEING, WE NEED TO RECOGNIZE USE OF DRUGS NOT JUST NEGATIVELY AFFECTS CARE BUT ALSO AFFECTS THE NEWBORN, AND THIS IS RECENT DATA THAT SHOWS ON WOMEN THAT WERE PREGNANT OR MEASURING VOLUMES OF AN AREA IN THE FRONTAL PARTS OF THE BRAIN SHOWING THOSE CHILDREN EXPOSED TO OPIOIDS HAVE MUCH SMALLER VOLUMES THAN THOSE THAT DID NOT. AGAIN, HIGHLIGHTING HOW CRUCIAL THIS AREA OF RESEARCH IS IN ORDER TO UNDERSTAND WHAT ARE THE BEST INTERVENTIONS TO PROVIDE A WOMAN WITH AN OPIOID USE DISORDER WHEN PREGNANT AS WELL AS THE BEST INTERVENTIONS TO ADDRESS SEVERE PAIN CONDITION DURING PREGNANCY AND IMPORTANTLY WHAT ARE THE TREATMENT INTERVENTIONS, WHEN THE NEWBORN IS BORN, TO TREAT BOTH THE NEWBORN TO MINIMIZE ADVERSE EFFECTS FROM NEONATAL ABSTINENCE SYNDROME AND MAXIMIZE WELL-BEING OF THE MOTHER. I WANT TO SHOW THE LAST SLIDE IN TERMS OF OPENING UP OPPORTUNITIES. THE STUDY OF THE DIFFERENCES BETWEEN THE MALE AND FEMALE BRAIN IS NEEDED JUST IF WE WANT TO ADDRESS DISPARITIES THAT HAVE EXISTED, CONTINUE TO EXIST, OUTCOMES AND IN ALTERNATIVES FOR TREATMENT BETWEEN MEN AND WOMEN. IMPORTANTLY SCIENTIFICALLY, MUCH BETTER UNDERSTANDING HOW BIOLOGY WORKS, THAT IS ALSO TRUE FOR THE BRAIN. IN THE CASE OF THE BRAIN ONE OF THE AREAS THAT IS CRUCIAL IN TERMS OF UNDERSTANDING VULNERABILITY TO DRUG TAKING AND VULNERABILITY FOR MENTAL ILLNESS AND CONDITIONS IS A DEVELOPMENT OF HUMAN BRAIN, A MAJOR FRONTIER. ONE OF THE MOST IMPORTANT STUDIES WE'VE LAUNCHED WITH OTHER INSTITUTES, INCLUDING OFFICE OF RESEARCH ON HEALTH, ABCD STUDY THAT FOLLOWS CLOSE TO 12,000 CHILDREN AS THEY TRANSITION FROM AGE 9 TO 10, LONGITUDINALLY, INTO ADULTHOOD, PERIODIC IMAGING AND DOES PERIODIC BEHAVIORAL MEASUREMENTS WITH THE IDEA OF BASICALLY PROVIDING KNOWLEDGE THAT WILL HELP US UNDERSTAND WHAT MAKES EACH ONE OF US DIFFERENT AND HOW DOES OUR ENVIRONMENT NEGATIVELY AFFECT US INTO MAKING US VULNERABLE TO MENTAL ILLNESS, SUBSTANCE USE DISORDER, HOW DOES THE ENVIRONMENT PROVIDE RESILIENCE. FROM RESULTS STARTING TO EMERGE, WE KNOW FIRST OF ALL EVEN BRAIN IMAGES FROM A 9 TO 10-YEAR-OLD BOY AND GIRL, STUDY ON THE RIGHT, CAN DIFFERENTIATE ON THE BASIS OF THE DIFFERENCE THAT IN VOLUME OF CORTICAL STRUCTURES THERE'S DIFFERENCE, SOME AREAS MORE PROMINENT IN GIRLS THAN BOYS. IMPORTANTLY, WE'RE ALSO LEARNING ALSO LEARNING RESPONSE RESPONSE IS DIFFERENT FROM GIRLS AS BOYS. STRESSORS TO DIFFERENT RESPONSES MAY LEAD TO GREATER WITHDRAWAL IN GIRLS AND MORE GREAT VULNERABILITY FOR DEPRESSION AND USE OF SUBSTANCES IN ORDER TO ESCAPE DEPRESSION AND BOYS TO BECOME MORE IMPULSIVE THAT CAN LEAD THEM TO DRUG TAKING AS PART OF THAT IMPULSIVITY. SO WE HAVE BETTER TOOLS AND LARGER DATABASES, COMING TO REALIZE KNOWLEDGE THAT LIES BEHIND AND GREAT OPPORTUNITIES AS WE UNDERSTAND KNOWLEDGE TO ASSURE THERE ARE BETTER TREATMENTS AND BETTER ACCOUNTS FOR GIRLS AND BOYS, FOR MEN AND WOMEN. THANKS FOR YOUR ATTENTION. I'LL BE HAPPY TO ANSWER ANY QUESTIONS THAT THERE MAY BE. >> AMAZING PRESENTATIONS FROM ALL OF YOU. THANK YOU VERY MUCH. EVERY ONE OF YOU PROVIDED A WINDOW INTO THE IMPORTANCE OF THE WORK THAT YOUR INSTITUTES AND CENTERS ARE DOING RELATED TO THE HEALTH OF WOMEN. I PARTICULARLY ENJOYED THIS WHIRLWIND TOUR. IT'S JUST THE TIP OF THE ICEBERG. WE HAVE A QUESTION THAT IS FOR DR. SHARPLESS, FOR NCI. THERE ARE WELL ESTABLISHED DISPARITIES IN CANCER OUTCOMES THAT RESULT FROM INTERPLAY BETWEEN STRUCTURAL, SOCIOSOCIOECONOMIC, ENVIRONMENTAL BEHAVIOR AND BIOLOGIC FACTORS. WOMEN IN CERTAIN RACIAL AND ETHNIC GROUPS ARE UNDERREPRESENTED IN SOME CANCER TRIALS. CAN YOU TALK ABOUT ACTIVITIES TO INCREASE AWARENESS TO TRIALS FOR THESE POPULATIONS? NED? >> SURE. THANK YOU FOR THE QUESTION. IT'S A REALLY IMPORTANT TOPIC. THIS IS AN AREA WHERE THE NCI HAS A VERY LARGE PORTFOLIO. MORE THAN A DECADE AGO IT CHANGED HOW IT WANTED CANCER CENTERS TO EVALUATE THEMSELVES, CANCER PROGRAM IS HIGHLY IMPORTANT TO THE NCI AND ASKS THE CANCER CENTERS TO WORK ON CATCHMENT AREA, POPULATION THEY SERVE, THIS REALLY FORCED CENTERS TO TAKE AN INTEREST, TO HAVE A POSITIVE EFFECT ON RESEARCH PORTFOLIO THAT'S LED TO A REAL INCREASE IN ACTIVITIES RELATED TO DIAGNOSIS AND DETECTION OF CANCER IN UNDERREPRESENTED POPULATIONS. THIS IS A BIG ISSUE IN WOMEN'S CANCER, IN PARTICULAR IN BREAST CANCER, ENDOMETRIAL, TIED TO LOW ACCESS OF CARE, AND OFTEN HARD POPULATIONS TO STUDY, THAT MAY BE DIFFICULT TO GET ON CLINICAL TRIALS. SO WORKING THROUGH CANCER CENTERS PROGRAMS AND OTHER NOVEL TRIAL NETWORKS WE MOVED TO ADDRESS THESE IMPORTANT QUESTIONS AND WE STILL CONTINUE TO THINK, YOU KNOW, CONTINUOUSLY HOW TO IMPROVE THAT PORTFOLIO AND PROVIDE CARE TO THESE POPULATIONS THAT HAVE BEEN CHALLENGED. IT'S AN AREA WHERE THERE HAS BEEN POSITIVE CHANGE AND WE CONTINUE TO SEE MORE GOOD THINGS HAPPENING. >> THANK YOU. NEXT A QUESTION FOR DR. WEBB HOOPER. CAN YOU ELABORATE HOW YOU SEE MULTI-LEVEL INTERVENTIONS CONTRIBUTING TO SOLUTIONS INCLUDING THOSE ALONG THE CARE CONTINUUM TO IMPROVE CARE ACCESS AND QUALITY? MONICA? WE'RE NOT HEARING YOU, MONICA. UH-OH. GO ONE MORE TIME. WE'RE HEARING YOU IN AND OUT. NO. YOU HAVE TO MAKE THE MICROPHONE GREEN. SEE THAT AT THE BOTTOM? OKAY. I'M GOING TO THE NEXT QUESTION. WE'LL DOUBLE CHECK MONICA'S IN A SECOND. LET'S SEE. WE'RE GOING TO GO TO DR. BIANCHI. DIANA, CAN YOU TELL US A LITTLE BIT ABOUT WHAT YOU SEE AS THE NEXT STEPS IN THE IMPLEMENTATION OF THE PRGLAC AND THERE'S BEEN INCREDIBLE WORK NICHD HAS BEEN AT THE FOREFRONT, AND IMPRESSIVE NUMBER OF PARTNERS INVOLVED AS YOU OUTLINED. WHAT DO YOU SEE AS THE NEXT STEPS? >> SO, THANK YOU, JANINE. WE DID HAVE A PUBLICLY AVAILABLE DOCUMENT THAT OUTLINES AND IS QUITE EXTENSIVE, BRIEFLY WE NEED TO MAKE USE OF EXISTING NETWORKS. THERE'S TREMENDOUS AMOUNT OF INFORMATION THAT'S ALREADY AVAILABLE WHERE PREGNANT WOMEN ARE TAKING MEDICATIONS. WE DON'T CURRENTLY HAVE A MECHANISM TO COLLECT THAT INFORMATION. SO ONE OF THE THINGS THEY RECOMMENDED WAS TO USE EXISTING NETWORKS TO BEGIN TO COLLECT THAT INFORMATION. WE ALSO RECOMMENDED THE USE OF A CENTRAL IRB TO MAKE THINGS EASIER TO HAVE SPECIFIC QUESTIONS AND A SPECIFIC APPROACH THAT COULD BE APPROVED BY A CENTRAL IRB. WE CAN'T STUDY ALL DRUGS, WE NEED TO PRIORITIZE WHICH ARE THE MOST IMPORTANT DRUGS, THAT MANY PREGNANT WOMEN ARE TAKING. AND IMPORTANTLY WE NEED PROBABLY TO REFERENCE TO MY OTHER REMARKS, WE NEED TO REMOVE PREGNANT WOMEN AS AN EXAMPLE OF A VULNERABLE POPULATION. THAT'S JUST VERY BRIEFLY A HIGHLIGHT. >> THANK YOU, DIANA. DR. WEBB HOOPER, LET'S TRY YOU AGAIN. >> CAN YOU HEAR ME? YOU WERE ASKING ABOUT MULTI-LEVEL INTERVENTIONS, WE THINK ARE IMPORTANT AND WANT TO ENCOURAGE MORE INVESTIGATORS TO CONSIDER AS AN APPROACH. I THINK PRIMARILY MOST INTERVENTIONS HAVE BEEN FOCUSED AT THE INDIVIDUAL LEVEL, RANDOMIZING INDIVIDUALS, FOR EXAMPLE, IN A CLINICAL TRIAL TO AN INTERVENTION AND EXAMINING OUTCOMES AT THAT LEVEL. WE DO KNOW THAT THERE ARE UPSTREAM DETERMINANTS OF HEALTH THAT ARE IMPORTANT TO CONSIDER, AND THAT WE CAN INTEGRATE OR FOCUS ON IN OUR INTERVENTION APPROACHES, THAT MIGHT BE LOOKING AT INDIVIDUAL LEVEL BUT ALSO INTERPERSONAL LEVEL, COMMUNITY, AND SOCIETAL LEVEL FACTORS. THOSE WOULD BE CONSIDERED LEVELS OF INFLUENCE. YOU ALSO HAVE DOMAINS OF INFLUENCE WE CAN ALSO CONSIDER, SUCH AS FROM BIOLOGICAL LENS, BEHAVIORAL LENS, LOOKING AT THE PHYSICAL BUILT ENVIRONMENT, SOCIOCULTURAL ENVIRONMENT, HEALTH CARE SYSTEM LENS. SO THE NIMHD HAS A RESEARCH FRAMEWORK WHICH DESCRIBES LEVEL OF INFLUENCE AND DOMAIN OF INFLUENCE, TAKE A LOOK AT THE MODEL, A VEHICLE FOR ENCOURAGING NIMHD AND NIH-SUPPORTED RESEARCH THAT ADDRESSES COMPLEXITY AND MULTI-FACETED NATURE HOW WE CAN ADDRESS RESEARCH, LOOKING AT MINORITY HEALTH AND HEALTH DISPARITIES BUT CERTAINLY ANY AREAS OF RESEARCH CAN APPLY THE VARIOUS DOMAINS. I THINK IF YOU LOOK AT THAT AS EXAMPLE FRAMEWORK WHICH CAN BE CUSTOMIZE YOU CAN IDENTIFY WAYS TO IMPACT AT EVERY LEVEL OF CARE ACROSS THE HEALTH CARE CONTINUUM. SO I WOULD ENCOURAGE YOU TO TAKE A LOOK AT THAT. >> THANK YOU. SO GLAD WE GOT YOU BACK. FANTASTIC. DR. LANGEVIN, WHAT ASPECTS OF WHOLE PERSON HEALTH ARE RELEVANT TO WOMEN, HELENE? >> WHOLE PERSON HEALTH FRAMEWORK WE THINK IS USEFUL TO THINK ABOUT WOMEN'S HEALTH AS ORWH TALKS ABOUT HEALTH OF WOMEN, WHOLE WOMEN, RIGHT? WE'RE VERY INTERESTED IN HOW ALL THE VARIOUS DIFFERENT ORGAN SYSTEMS, FOR EXAMPLE THE BODY INTERACTS WITH EACH OTHER, PARTICULARLY INTERESTED IN IMPACT OF STRESS, FOR EXAMPLE, HAS ON THESE VARIOUS SYSTEMS AS WELL AS FOR EXAMPLE THINGS LIKE POOR DIET, SEDENTARY LIFESTYLE, HOW THESE CAN BE MITIGATED BY NON-PHARMACOLOGIC OR BEHAVIORAL INTERVENTIONS, HOW THESE VARIOUS ASPECTS OF OUR PHYSIOLOGY ARE INTEGRATED, PART OF INTEGRATIVE HEALTH. >> CERTAINLY COVID-19 AND WHAT'S HAPPENING NOW PLAYS INTO THAT, DOESN'T IT? >> CERTAINLY. THAT'S RIGHT. WE KNOW PEOPLE ARE ALL CONNECTED. SO WE HAVE TO LOOK AT THAT AS A WHOLE. >> ABSOLUTELY. DR. COLLMAN, HOW CAN WE EXPAND COMMON KNOWLEDGE IN THE COMMUNITY ABOUT HOW IMPORTANT THE ENVIRONMENT IS IN OUR HEALTH AND HOW EXPOSURES CAN HAVE PROFOUND EFFECTS? >> THANKS FOR THE IMPORTANT QUESTION. THROUGH OUR EXPERIENCE AT NIEHS, WE'VE BEEN REALLY IMPRESSED TO SEE THAT MANY COMMUNITIES WHERE THEY ARE IMPACTED BY ENVIRONMENTAL HEALTH, SELF-LITERACY AROUND THESE EXPOSURES, AND THE EFFECTS IS QUITE HIGH. SCIENTISTS THINK THE CONCEPT OF ENVIRONMENTAL HEALTH ARE COMPLICATED AND SCIENCE BASED, AND A LITTLE BIT SCARY, BUT IF YOU'RE LIVING NEXT TO AN INDUSTRIAL SITE OR AT A FRONT LINE COMMUNITY, OR YOUR NEIGHBORHOOD IS POLLUTED WITH HEAVY LEVELS OF AIR POLLUTION WE'VE BEEN AMAZEDs TO SEE HOW EAGER THE COMMUNITY IS TO LEARN AND SHARE THEIR KNOWLEDGE WITH OTHERS. USING SOCIAL MEDIA THESE DAYS, THERE'S A GREAT OPPORTUNITY TO SPREAD THAT INFORMATION TO A BROADER RANGE OF PEOPLE, BEYOND PEOPLE WHO LIVE IN THE IMPACTED COMMUNITIES. I THINK COMMUNICATING WITH HEALTHCARE PROFESSIONALS IS ALSO ENORMOUSLY IMPORTANT BECAUSE OFTENTIMES PEOPLE WHO HAVE PERCEIVED HEALTH EFFECTS, OR LIVING IN POLLUTED ENVIRONMENT WILL GO TO THEIR DOCTORS OR NURSE PRACTITIONERS OR OTHER HEALTH CARE PROVIDERS ASKING FOR HELP WITH WHAT THEY CAN DO TO PROTECT THEMSELVES AND RIGHT NOW I THINK THE LEVEL OF LITERACY AMONG OUR HEALTH PROFESSIONALS ISN'T QUITE AT THE LEVEL WE WOULD LIKE TO ACHIEVE. THANKS FOR THAT QUESTION. >> THANKS, GWEN. THERE'S A QUESTION ABOUT NHANES BUT WE'LL COME BACK TO THAT. I DO THINK THERE'S A QUESTION AS WELL, NED, FOR YOU. IT'S ABOUT A FAMILY THAT HAS MULTIPLE MEMBERS WITH ENDOMETRIAL CANCER. YOU MENTIONED IN YOUR PRESENTATION THAT IS ONE OF THE VERY CONCERNING FEMALE-SPECIFIC CANCERS, CAN YOU SPEAK A LITTLE BIT MORE TO INTERGENERATIONAL POTENTIAL EFFECTS? >> SURE. THIS IS A CANCER THAT IS INCREASING IN MORTALITY IN THE UNITED STATES. IT'S ONE OF THE FEW THAT IS IN GENERAL CANCER MORTALITY IS DECLINING BUT ENDOMETRIAL CANCER NOT SO, DISPROPORTIONATELY AFFECTS CERTAIN POPULATIONS, WE BELIEVE ALSO ASSOCIATED WITH OBESITY AND THEREFORE SOME RISE IN MORTALITY MAY BE ASSOCIATED WITH OBESITY EPIDEMIC. THERE ARE IMPORTANT GERMLINE SYNDROMES ASSOCIATED WITH END MEDIAL CANCER, LYNCH SYNDROME, FOR EXAMPLE, BUT THERE ARE OTHERS THAT ARE ASSOCIATED WITH HIGH RISK OF THAT PARTICULAR TUMOR. SO IN PATIENTS THAT HAVE MANY FIRST-FAMILY RELATIVITIES WITH THAT CANCER WE WOULD RECOMMEND EVALUATION BY MEDICAL GENETICIST WHO SPECIALIZES IN INTERPRETATION OF HIGH RISK CANCER SYNDROMES. IN THIS MALIGNANCY WE'VE HAVE CONVERSATIONS WITH THE GYNECOLOGIC ONCOLOGY COMMUNITY HOW PORTFOLIO NEEDS TO CHANGE, AN AREA WITH RESEARCH OPPORTUNITIES FOR THE NCI AND WHERE THERE WILL BE EVER INCREASING INTEREST BECAUSE OF THE REASONS MENTIONED. INCREASING MORTALITY AND OTHER PROBLEMS. >> THANK YOU, NED. I'M GOING BACK TO DIANA. CAN YOU TALK A LITTLE BIT MORE ABOUT COVID-19 VACCINE USE IN PREGNANT WOMEN? THE VACCINES ARE ON THE STREET. PEOPLE ARE VERY INTERESTED IN THIS PARTICULAR TOPIC. DIANA? >> THANK YOU, JANINE. THAT'S A GREAT AND TIMELY QUESTION. AS YOU KNOW, THE TRIALS HAVE BEEN DONE IN ADULTS WITH EMPHASIS ON UNDERREPRESENTED POPULATIONS. THE PREGNANT WOMEN WERE SPECIFICALLY EXCLUDED FROM THE VACCINE RESEARCH TRIALS. CHILDREN HAVE JUST STARTED TO BE TESTED, BE INCLUDED IN THESE TRIALS. FORMERLY PREGNANT WOMEN ARE NOT YET THERE. HOWEVER-- FORMALLY, PREGNANT WOMEN ARE NOT THERE. HOWEVER WITH APPROACHING ADVENT OF THE VACCINE, BOTH AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS AND SOCIETY FOR MATERNAL MEDICINE ENDORSED A CONVERSATION BETWEEN PREGNANT WOMEN AND THEIR HEALTHCARE PROVIDERS SO THAT PREGNANT WOMEN CAN DETERMINE FOR THEMSELVES WHETHER OR NOT THEY FEEL THE BENEFITS OUTWEIGH THE RISKS. THIS IS CRUCIAL INFORMATION BECAUSE THE FRONTLINE HEALTH CARE WORKERS ARE DISPROPORTIONATELY WOMEN, AND MANY OF THE WOMEN ARE IN REPRODUCTIVE AGE GROUP. SO NOT ONLY ARE THEY TAKING THE RISK OF GETTING EXPOSED TO PATIENTS WITH COVID BUT THEY MIGHT UNKNOWINGLY BE PREGNANT. IN FACT, THERE WERE A SMALL NUMBERS OF WOMEN IN THE PFIZER TRIAL WHO WERE PREGNANT, BUT THIS IS WHERE THE RUBBER MEETS THE ROAD FOR PRGLAC. HERE WE SPEND FOUR YEARS TRYING TO COME UP WITH RECOMMENDATIONS, IMPLEMENT RECOMMENDATIONS, AND YET HERE'S THE PERFECT EXAMPLE, WE SAY WOMEN NEED TO BE PROTECTED THROUGH RESEARCH, THEY CAN'T BE INCLUDED IN THESE TRIALS. WE'RE VERY HAPPY THAT THE PROFESSIONAL SOCIETIES HAVE REALLY PUT THE DECISION ON THE WOMAN HERSELF IN CONSULTATION WITH HER HEALTHCARE PROVIDERS. THANKS FOR THE QUESTION. >> THANKS, DIANA. DR. WEBB HOOPER, THERE'S A QUESTION ABOUT THE HISPANIC PARADOX. YOU DELINEATED DIFFERENCES IN DEATH RATES IN WOMEN BY RACE/ETHNICITY, CAN YOU TALK ABOUT THE VALUE OF STUDYING BOTH RISK AND RESILIENCE FACTORS? >> SURE. I THINK THIS QUESTION IS RELATED TO WHAT IS KNOWN AS SORT OF THE HISPANIC PARADOX, HISPANIC MORTALITY PARADOX. AND THAT IS A PHENOMENON DESCRIBED ABOUT 30 YEARS AGO, ATTRIBUTED MOSTLY TO SORT OF A HEALTHY MIGRANT EFFECT, ONE EXAMPLE OF THAT WOULD ALSO BE IF YOU THINK ABOUT SOCIOSOCIOECONOMIC SOCIO-- SOCIOECONOMIC STATUS, ALL CAUSE MORTALITY BY HOUSEHOLD INCOME LEVEL SO IF YOU LOOK AT THE DATA IT WOULD SHOW YOU THAT THE RISK OF DEATH FROM ANY CAUSE IS THREE TIMES GREATER AMONG INDIVIDUALS WHOSE INCOME IS LESS THAN $25,000 PER YEAR, DEMONSTRATING THAT INCOME ALONE IS INDEPENDENTLY RELATED TO LIFE AND DEATH. AND YOU SEE THAT HOLDS WHEN YOU LOOK, FOR EXAMPLE, AT AFRICAN AMERICAN WOMEN WHO ALSO HAVE LOWER MEDIAN INCOME COMPARED TO WHITE AND ASIAN WOMEN, WHEN YOU LOOK AT THE MEAN INCOME FOR LATINO WOMEN, FOR EXAMPLE, IN 2019 WAS THE LOWEST, YET DESPITE SOCIOECONOMIC DISADVANTAGES AND HIGHER BURDEN OF SOME DISEASES YOU SEE ALL-CAUSE MORTALITY THAT IS LOWER IN THIS POPULATION, THE HISPANIC MORTALITY PARADOX. THERE IS EVIDENCE THERE ARE CERTAIN RESILIENCE FACTORS THAT NOT ONLY WITH LATINO WOMEN OR LATINAS BUT WITH OTHER RECENT IMMIGRANTS IN THE UNITED STATES, THAT MAY CHANGE OVER TIME BUT CERTAINLY MAY PROVIDE PROTECTIVE BENEFIT SO IT'S IMPORTANT TO UNDERSTAND WHAT THESE VARIOUS FACTORS ARE BECAUSE THEY MAY PROVIDE IMPORTANT INSIGHTS ABOUT HOW WE CAN ADDRESS HEALTH DISPARITIES WITH WOMEN IN OTHER POPULATION SUBGROUPS. >> THANK YOU SO MUCH, DR. WEBB HOOPER. DR. LANGEVIN, THE LAST QUESTION. WE'VE GOT JUST A MINUTE OR SO. CAN YOU TALK ABOUT NCCIH AND WHAT WORK YOU'RE DOING TO ADDRESS HEALTH OF WOMEN IN THE CONTEXT OF THE COVID-19 PANDEMIC? >> WELL, THANK YOU FOR THIS QUESTION. VERY IMPORTANT, VERY INTERESTED IN EFFECT OF STRESS, NOT ONLY HAS PEOPLE EXPERIENCED STRESS DURING THE COVID PANDEMIC DUE TO ANXIETY ABOUT THE VIRUS BUT ALSO SOCIAL ISOLATION HAS BEEN CRIPPLING TO A LOT OF PEOPLE. AND A LOT OF THIS IS SOMETIMES ACCOMPANIED BYPRODUCTS SLEEPING, FOR EXAMPLE, THAT CAN HAVE EFFECTS WE KNOW ON THE IMMUNE SYSTEM. WE KNOW CHRONIC STRESS AFFECTS THE IMMUNE SYSTEMS IN WAYS THAT HAS BEEN SHOWN TO AFFECT AFFECT TO OTHER VIRUSES BUT SO FAR WE DON'T REALLY KNOW IN THE CONTEXT OF COVID-19 SO WE HAVE FUNDED SOME APPLICATIONS TO LOOK AT THAT AND WE'RE VERY INTERESTED TO SEE WHAT WE FIND OUT. >> I'M LOOKING FORWARD TO TOO. THANK YOU VERY MUCH TO MY ESTEEMED COLLEAGUES FOR THIS AMAZING PANEL OF PRESENTATIONS. >> THANK YOU, JANINE, FOR INCLUDING US. >> THANK YOU FOR THE OPPORTUNITY TO SPEAK TODAY. >> THANK YOU. >> THANK YOU. . >> GOOD AFTERNOON, I'M THE ASSOCIATE DIRECTOR FOR SCIENCE POLICY, PLANNING, ANALYSIS AT THE NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH. I'M PLEASED TO INTRODUCE OUR NEXT SPEAKER, MISS MARY WOOLLEY, THE PRESIDENT OF THE RESEARCH/AMERICA ADVOCATING FOR SCIENCE, DISCOVERY AND INNOVATION THROUGH BETTER HEALTH FOR ALL. SHE HAS A CONNECTION TO NIH, AS HER FIRST AND LONGTIME CAREER POSITION WAS ON AN NIH-FUNDED CLINICAL TRIAL. SHE'S AN ELECTED MEMBER OF THE NATIONAL ACADEMY OF MEDICINE, AND SERVED TWO TERMS ON A GOVERN COUNCIL. SHE WAS A FELLOW OF AMERICAN ASSOCIATION FOR ADVANCEMENT OF SCIENCE AND SERVES ON THE NATIONAL ACADEMY BOARD OF HIGHER EDUCATION AND WORKFORCE, HAVING PREVIOUSLY SERVED ON THE BOARD ON LIFE SCIENCES. SHE'S A FOUNDING MEMBER OF THE NATIONAL BOARD OF ASSOCIATES OF THE WHITEHEAD INSTITUTE FOR BIOMEDICAL RESEARCH AND MEMBER OF THE UNIVERSITY OF CHICAGO DIVISION OF BIOLOGICAL SCIENCES AND PRITZKER SCHOOL OF MEDICINE COUNCIL. SHE HOLDS HONORARY DOCTORAL DEGREES FROM WAYNE STATE UNIVERSITY AND HAS ALSO SERVED AS PRESIDENT OF ASSOCIATION OF INDEPENDENT RESEARCH INSTITUTES AS REVIEWER FOR THE NIH AND NATIONAL SCIENCE FOUNDATION AND CONSULTANT FOR SEVERAL ORGANIZATIONS. WELCOME, MS. WOOLLEY. >> GOOD AFTERNOON. WONDERFUL TO BE WITH YOU TODAY. THANK YOU, DR. CLAYTON, AND YOUR COLLEAGUES AT THE OFFICE OF RESEARCH ON WOMEN'S HEALTH FOR THE INVITATION TO JOIN THIS EXTREMELY IMPORTANT SESSION. IT'S A REAL HONOR FOR ME. IN FACT, IT'S PERSONAL. NIH HAS BEEN PART OF MY CAREER FROM THE GET-GO. MY FIRST PAYCHECK AFTER GRADUATE SCHOOL CAME THROUGH AN NIH-SPONSORED CLINICAL TRIAL, THE LARGEST ONE EVER AT THE TIME, MULTIPLE RISK FACTOR INTERVENTION TRIAL, KNOWN AS LISTER FIT. I AS MRFIT. I WAS RESPONSIBLE FOR RECRUITED. RECRUITED MEN, ONLY MEN, TO PARTICIPATE IN THIS PRIMARY PREVENTION TRIAL ON CARDIOVASCULAR DISEASE. WE TRAINED RECRUITERS TO EXPLAIN TO MEN AND WOMEN THAT EVERYTHING THAT WOULD BE DISCOVERED ABOUT PREVENTING HEART DISEASE IN MEN WOULD OF COURSE APPLY TO WOMEN TOO. NOW, THAT STRIKES EVERYONE I TALK TO TODAY AND ACTUALLY PEOPLE AT THE TIME AS JUST NUTS. DOESN'T MAKE ANY SENSE AT ALL. IT DIDN'T MAKE SENSE. AND YET IT WAS THE SCIENTIFIC CONSENSUS OF THE DAY. SCIENCE CHANGES ALL THE TIME. IT'S ONE OF THE CHALLENGES WE HAVE RIGHT NOW IN TALKING ABOUT WHAT WE KNOW AND WHAT WE DON'T KNOW YET ABOUT THE PANDEMIC, AND ABOUT VACCINES, ABOUT SO MUCH THAT AILS PEOPLE. SCIENCE IS NOW AND SCIENCE WILL BE TOMORROW, I'M PRETTY EXCITED, TO HAVE BEEN PART OF THE NIH JOURNEY, IF YOU WILL, FOR A VERY LONG TIME NOW. I'M PROUD OF THE FACT THAT I'VE BEEN PART OF IT AS NIH HAS REPEATEDLY MET THE MOMENT. RIGHT NOW MEETING THE MOMENT MEANS OVERCOMING THE PANDEMIC, AND AVOIDING, PREVENTING, THE NEXT ONE. BUT IT ALSO MEANS IMPROVING THE RECOGNITION AND SUPPORT AND TRUST AND SCIENCE THAT WE HEAR SO MUCH ABOUT TODAY. AND I WILL BE TALKING ABOUT THAT IN MY REMARKS. BUT FIRST A LITTLE MORE ABOUT THE MOMENT 30 YEARS AGO WHEN NIH STEPPED UP. THIRTY YEARS AGO WE WERE AT A PROJECTS -- PIVOT POINT TO RECOGNIZE WOMEN'S HEALTH AND WOMEN'S HEALTH RESEARCH, URGENT FOCUS AND ULTIMATE CHANGE WASN'T BROUGHT BY A PANDEMIC OF COURSE BUT BY WOMEN'S HEALTH ADVOCATES WHO URGED WOMEN LEADERS IN PARTICULAR IN CONGRESS TO DEMAND CHANGE AND THEY DID. THEY BROUGHT ABOUT ENORMOUS PROGRESS WHICH HAS BEEN CARRIED ON OVER THE YEARS THROUGH LEADERS LIKE DR. CLAYTON AND STARTING WITH THE FIRST DIRECTOR OF THE OFFICE OF WHAT IS NOW CALLED OFFICE OF RESEARCH ON WOMEN'S HEALTH, MY FRIEND VIVIAN PINN. IN THE CONGRESS, A BIPARTISAN GROUP OF WOMEN WHO INCLUDED CONGRESSWOMAN MORELLA, SENATOR SNOW, SHE WAS CONGRESSWOMAN AT THE TIME, CONGRESSWOMAN SCHROEDER AND THE RINGLEADER SENATOR BARBARA MIKULSKI, HERE AS SHE'S RECEIVED MAKING REMARKS ON RECEIVING AN AWARD FROM RESEARCH AMERICA A FEW YEARS AGO. SHE RECALLED THE DAYS WHEN IT WAS 10,000 MALE MEDICAL STUDENTS TESTING THE FAMOUS TAKE AN ASPIRIN A DAY KEEP A HEART ATTACK A WAY. SHE WAS KNOWN FOR BEING RILED UP AND GETTING RESULTS. SHE ALONG WITH HER COLLEAGUES MARCHED UP TO THE NIH AND HAD A MEETING WITH THEN-DIRECTOR BERNADINE HEALEY AND CHANGE STARTED HAPPENING. OTHERS, LOTS OF OTHERS, WERE INVOLVED IN MEETING THAT MOMENT. I'M REALLY PROUD OF THE FACT THAT I WAS THERE, URGING FOLKS AT THE TIME AS WELL. THERE WERE GROUPS LIKE THE SOCIETY FOR WOMEN'S HEALTH RESEARCH WITH ITS RENOWNED FOUNDER, FLORANCE HAZELTINE, ONE OF THE GREAT OF NIH'S ROBUST HISTORY OF LEADERSHIP. AND I ALREADY MENTIONED DR. VIVIAN PINN. THIS OFFICE, AND NIH OVERALL, HAS ACCOMPLISHED SO MUCH TO BE PROUD OF, OVER THE LAST 30 YEARS BUT WE ALL KNOW THERE'S MUCH MORE CHALLENGE OUT THERE. WHEN YOU THINK ABOUT THE APPALLING LEVEL OF MATERNAL MORTALITY IN THIS COUNTRY, ESPECIALLY AMONG WOMEN OF COLOR, THERE'S SO MUCH MORE THAT WE NEED TO UNDERSTAND AND THEN PUT INTO ACTION. SADLY THERE'S STILL A VERY HIGH LEVEL OF HARASSMENT, SEXUAL HARASSMENT, ACROSS THE RESEARCH COMMUNITY. AND THAT NEEDS TO END. PROGRESS IS GREAT. IT NEEDS TO STOP. AND LAST BUT NOT LEAST, IN MY BOOK, THE INCREDIBLE IMPORTANCE OF OVERCOMING CHALLENGES TO DIVERSITY AND INCLUSION IN THE SCIENTIFIC COMMUNITY AND HEALTH CARE. THERE WERE THOSE AND MANY MORE CHALLENGES, SO THANK GOD WE HAVE THE OFFICE FOR RESEARCH OF WOMEN'S HEALTH. I WANT TO TALK ABOUT RESEARCH AMERICA FOR JUST A MOMENT. WE WERE FORMED IN 1989 TO MEET THE MOMENT, IT WAS A TIME THAT THE CONGRESS WAS NOT AS STRONG AS IT HAD BEEN PREVIOUSLY IN FUNDING NIH AND IN DOING EVERYTHING WITHIN ITS POWER TO ASSURE THAT NIH AND INDUSTRY WORKING HAND IN HAND WOULD MEET THE MOMENT AND FIND THE SOLUTIONS TO WHAT AILS US. SO A GROUP OF INDIVIDUALS THAT INCLUDED JACK WHITEHEAD, WHO HAD ALSO FOUNDED THE WHITEHEAD INSTITUTE, AT M.I.T., AND TED COOPER WHO HAD FOR SO LONG BEEN THE LEADER OF THE NATIONAL HEART INSTITUTE, THEY AND OTHERS CAME TOGETHER TO FORM RESEARCH AMERICA, IT REMAINS TO THIS DAY A ROBUST ALLIANCE. STAKEHOLDERS ACROSS THE COMMUNITY FROM ACADEMIA, SCIENTIFIC SOCIETIES, FOUNDATIONS AND VARIOUS STATE AND LOCAL ORGANIZATIONS. WE ACT TOGETHER. SPEAK WITH ONE VOICE. ADVOCACY IS ABOUT MANY VOICES, WITH A SHARED MESSAGE DRIVING FOR CHANGE. I THINK THE WAYS WE WORKED WERE FAMILIAR TO MANY AND NOT UNIQUE TO RESEARCH AMERICA. AGAIN, BEST ADVOCACY IS IN ALLIANCE WITH MANY, MANY OTHERS. MANY VOICES MAKING THE CASE. ONE OF THE THINGS WE DO AND HAVE FOR A LONG TIME IS COMMISSIONED PUBLIC OPINION SURVEYS. I'LL TALK ABOUT THAT IN A MINUTE. BUT I WANT TO UNDERSCORE THE POINT ABOUT PARTNERSHIPS AND ALLIANCES, WHETHER WITH THE PUBLIC AND PRIVATE SECTORS WORKING TOGETHER, WITH EXAMPLES RIGHT NOW LIKE OPERATION WARP SPEED, OR WHETHER IT'S ABOUT PUBLIC AND PRIVATE WITH PATIENT COMMUNITIES VERY MUCH ENGAGED. THAT DIDN'T USED TO BE THE CASE. IT CERTAINLY WASN'T 30 YEARS AGO. BUT IT'S THE STATE OF THE ART NOW. AND THANK GOODNESS BECAUSE THAT WILL HELP POWER RESEARCH GOING FORWARD TO HAVE THE PATIENT'S VOICE AT THE TABLE FROM THE GET-GO. MY FRIEND DON BERWICK WITHOUT AN ESSAY IN JUNE ABOUT MEETING THE MOMENT. HE TALKED ABOUT THE NEW NORMAL. AND ABOUT TAKING A ROLE PERSONALLY AND AS A LEADER IN ASSURING THAT WHAT COMES NEXT IS ABOUT CHOICES WE MAKE NOW, THE RIGHT CHOICES. IT REALLY RESONATED FOR ME AND I HOPE FOR YOU AS YOU THINK ABOUT YOUR ROLE AS LEADERS AND YOU ALL ARE. WHAT KIND OF CHOICES AM I TALKING ABOUT? CERTAINLY CHOICES TO MAKE SURE THAT WOMEN'S VOICES ARE AT THE TABLE, AND THAT WOMEN'S HEALTH RESEARCH IS A ROBUST, VITAL COMPONENT OF THE NIH AGENDA. BUT THERE'S MANY OTHER CHOICES, THOSE WE MAKE EVERY DAY AND THOSE THAT WE MAKE TO ASSURE VOICES THAT HAVEN'T BEEN HEARD WILL BE HEARD NOW. WE'RE AT A TIPPING POINT IN SO MANY RESPECTS IN OUR NATION RIGHT NOW, AND ALL OF US, ALL OF YOU, HAVE CHOICES TO MAKE NOW THAT ARE GOING TO MAKE A BIG DIFFERENCE FOR HUNDREDS, THOUSANDS, HUNDREDS OF THOUSANDS OF PEOPLE GOING FORWARD. I MENTIONED PUBLIC OPINION SURVEY DATA. WE KNOW FROM A VERY RECENT SURVEY WE'VE COMMISSIONED IN AUGUST OF THIS YEAR WE'RE NOW IN THE LEVEL OF URGENCY, NOT JUST IMPORTANT, WE'RE NOW AT A LEVEL OF URGENCY IN TERMS OF PUBLIC DEMAND THAT WE PLACE A HIGHER PRIORITY ON SCIENCE IN THIS NATION. I CAN SEE HERE THAT'S A BIPARTISAN DEMAND, ACROSS PARTIES, AND INDEPENDENCE, BASED ON WHAT WE'VE BEEN EXPERIENCING LIVING THROUGH WITH HORROR THE PANDEMIC THAT HAS TAKEN SO MANY LIVES AND CAUSED DISRUPTION AND HAS IMPLICATIONS THAT WE'RE GOING TO SEE LASTING FOR YEARS AND YEARS TO COME. IT'S TIME TO PUT SCIENCE TO WORK AT THE LEVEL IT CAN DELIVER. PUBLIC SENTIMENT WHICH I JUST REFERRED TO THERE IS WHAT WE'RE TALKING ABOUT. AND THAT'S WHAT DECISION MAKERS ULTIMATELY ARE RESPONSIBLE TO. PUBLIC SENTIMENT, TO THE VOTER. TO ADVOCATES WHO SPEAK UP, EXERCISING THEIR CONSTITUTIONAL RIGHT TO BE HEARD. TO PETITION THE GOVERNMENT. ABRAHAM LINCOLN SAID THIS BEST I THINK. THE PUBLIC SENTIMENT IS, FRANKLY, EVERYTHING. WITHOUT IT, NOTHING CAN SUCCEED, AND THAT'S THE REASON THAT WE HAVE, FOR MANY YEARS NOW, BEEN COMMISSIONING PUBLIC OPINION SURVEYS TO HELP MEMBERS HELP US TO HELP EVERY ADVOCATE, TO KNOW WHAT'S ON THE MINDS OF THE AMERICAN PUBLIC. GOOD NEWS, BAD NEWS, MESSAGING THAT WORKS, AND THAT THAT THAT'S CONFUSING OR UNDERCUTS TRUST, WHAT IS INTENDED TO SUSTAIN IT. SO, OUR METHODOLOGY THAT OF OUR VENDORS I SHOULD SAY BECAUSE WE DON'T ACTUALLY CONDUCT SURVEYS, WE COMMISSION THEM, BUT OUR METHODOLOGY IS THE SAME AS THOSE OTHERS USED, WHETHER PEW, KAISER, GALLUP OR ANY NUMBER OF OTHERS. NOT ALL THE NEWS IS GOOD IN THESE SURVEYS. WE SEE AND YOU'VE SEEN ELSEWHERE AND HEARD COVERAGE AND PROBABLY HAD A LOT OF CONCERN ABOUT DECLINING BELIEF IN THE BENEFIT OF VACCINE. AND HESITANCY IN SAYING WHETHER ONE WOULD TAKE, FOR EXAMPLE, A COVID VACCINE. PERSONALLY, I BELIEVE THAT WE'RE GOING TO SEE A SURGE IN DEMAND FROM PEOPLE WHO WANT THIS VACCINE, THEY'VE HAD ENOUGH OF DEATH AND ILLNESS IN THEIR OWN FAMILIES AND THEIR COMMUNITIES. WE SHALL SEE, TIME WILL TELL. THERE'S BEEN A TREND OF DECLINING BELIEF IN THE VALUE OF VACCINES IN THE LAST SEVERAL YEARS. THAT'S A VERY SERIOUS CHALLENGE FOR THE SCIENCE COMMUNITY BECAUSE VACCINES WITHOUT VACCINATIONS AREN'T GOING TO HELP. IT'S TIME FOR ALL OF US TO TAKE TIME TO BE A LEADER, TO BE A CLEAR VOICE ON THE VALUE OF VACCINES. I TALKED ABOUT URGENCY EARLIER. WE ASKED IN THIS SURVEY BACK IN AUGUST ABOUT 20 OR SO ISSUES, ASKED PEOPLE TO RANK IN TERMS OF PRIORITY LEVEL IN THE NATION. I'M JUST SHOWING TOP SIX RESPONSES. OBVIOUSLY, EXPECTEDLY, AS WE EXPECTED, ENDING THE PANDEMIC CAME IN NUMBER ONE BUT IT WAS ESSENTIALLY THE SAME IN THE SAME RANK ORDER AS FINDING NEW WAYS OF PREVENTING, TREATING, CURING OTHER ILLNESSES. AND ALTHOUGH WE'VE COMBINED URGENT AND HIGH PRIORITY HERE, I'M HERE TO TELL YOU URGENT IS OVER 50%. URGENT. THAT'S MANDATE LANGUAGE. THAT'S PAY ATTENTION DECISION MAKERS, DO MORE TO HELP US IN THE RESEARCH COMMUNITY, IN THE INNOVATION COMMUNITY, ACHIEVE MEDICAL PROGRESS. WE ALSO ASKED, YOU SEE THAT IN THE RED BAR, WHETHER PEOPLE FELT SCIENCE COULD HELP IN ACHIEVING THE ANSWERS, FINDING THE SOLUTIONS IN EACH OF THESE AREAS. AND THE PERCENT THAT SAID SCIENCE CAN HELP A LOT IS ALSO SHOWN HERE. THERE ISN'T ANY QUESTION, DESPITE WHAT YOU MAY SUSPECT OR HAVE HEARD ELSEWHERE, THE AMERICAN PUBLIC CONTINUES TO SUPPORT SCIENCE. LET ME TALK ABOUT THAT A LITTLE MORE. THIS IS PEW DATA. AND IT SHOWS EARLY IN THE PANDEMIC, THIS IS APRIL, MOST RECENT DATA HERE IS APRIL 2020, THAT U.S. ADULTS SAY THEY HAVE A GREAT DEAL, YOU CAN SEE THAT RISING, GREAT DEAL OF CONFIDENCE IN SCIENTIST, MEDICAL SCIENTISTS IN PARTICULAR TO ACT IN THE BEST INTEREST OF THE PUBLIC. THIS FAR ECLIPSES OTHER GROUPS, TRUE FOR MANY YEARS, PEW RECORDED A SURGE JUST SINCE THE PANDEMIC BEGAN. WE SAW THIS TOO IN THAT AUGUST SURVEY, YOU CAN SEE NURSES, DOCTORS AND SCIENTISTS COMING IN AT THE TOP IN TERMS OF SAME KIND OF QUESTION, CONFIDENCE TO ACT IN YOUR BEST INTEREST. THAT'S WHAT IT'S ALL ABOUT, ACTING IN THE BEST INTEREST OF THE PUBLIC. SERVING THE PUBLIC'S INTEREST. THAT'S WHAT YOU DO, THAT'S WHAT WE DO. THAT'S WHAT ALL OF OUR PARTNERS DO TOGETHER. ARTICULATING THAT, LIVING IT, BREATHING IT IS WHAT MEETING THE MOMENT RIGHT NOW IS ALL ABOUT. NOW, MY HYPOTHESIS WHICH THERE'S SOME DATA ON IT, AT LEAST, EVEN AS TRUST IN INSTITUTIONS IS STEADILY DECLINING, THAT'S TRUE IN DATA FROM MANY ORGANIZATIONS, STILL TRUST IN INDIVIDUALS IS INCREASING. I THINK BECAUSE OF THIS, IT'S THE INDIVIDUALS WHO ARE GOING TO LEND CREDIBILITY AND INCREASE TRUST TO INSTITUTIONS. IT MEANS PUTTING A HUMAN FACE ON THE INSTITUTION. LITERALLY, MAKING SURE THAT WHEN WE SHOW AND TALK ABOUT INSTITUTIONS WE'RE NOT LOOKING AT BUILDINGS, BUT WE'RE LOOKING AT PEOPLE. BECAUSE IT'S THE PEOPLE WHO ARE THE CONVEYORS, THE PURVEYORS OF TRUST AND CONFIDENCE. NOW, WE'VE LEARNED OVER THE YEARS THAT A SHOCKINGLY LOW PERCENTAGE OF THE PUBLIC CAN'T NAME A LIVING SCIENTIST. BY THIS I MEAN SCIENCE IS ESSENTIALLY INVISIBLE TO THE PUBLIC. WE'VE GOT TO CHANGE THIS. THERE'S BEEN SOME GOOD NEWS. AND THANK YOU, TONY FAUCI, FOR DRIVING THAT. WE'VE SEEN AN INCREASE. WE CAN SEE WHO PEOPLE NAME WHEN THEY SAY THEY CAN NAME A LIVING SCIENTIST. THIS IS, LET'S UNDERSCORE IT, AUGUST OF THIS PAST YEAR. THIS SAME YEAR. THE SHOCKING AND MAINTHING IS 72% OF AMERICANS DON'T GUESS OR NAME SOMEONE WHO IS DEAD, ALBERT EINSTEIN, STEPHEN HAWKING. SOMEONE MIGHT BE A SCIENTIST BUT NEVER SELF IDENTIFIED, COULD BE LIVING IN THEIR NEIGHBORHOOD, HAVE A CHILD IN THE SAME SCHOOL, PLAY GROUP, THERE'S A LOT OF WAYS SCIENTISTS END UP HIDING OUT. WE SHOULD BE MORE PROMINENT. THE NEWS IS ALSO NOT GREAT WHEN PEOPLE ARE ASKED TO NAME A PLACE, ANY PLACE, WHERE MEDICAL OR HEALTH RESEARCH IS CONDUCTED. THIS IS NOT OUR QUESTION. THIS IS PRE-PANDEMIC QUESTION. WE WILL BE ASKING AGAIN NEXT MONTH. JANUARY 2021. I HOPE WE'LL SEE ANOTHER SURGE. THERE WAS PREVIOUSLY QUITE AN INCREASE ON 35% TO 53% OVER A COUPLE-YEAR PERIOD, I DON'T KNOW EXACTLY WHY THAT WAS, BUT WE'RE GOING TO SEE WHETHER IT HOLDS UP AND EVEN STRENGTHENS GOING FORWARD. BUT STILL, IT'S SHOCKING THAT ONLY ABOUT HALF OF AMERICANS CAN NAME ANYWHERE THAT RESEARCH IS CONDUCTED. AGAIN, I UNDERSCORE THE POINT, IT'S INVISIBLE, TOO INVISIBLE. FINALLY, IN THIS SERIES OF INVISIBILITY, THE UNFORTUNATE REALITY IS THAT 2/3 OF AMERICANS DON'T KNOW THAT MEDICAL RESEARCHERS IN THE U.S. IS CONDUCTED IN ALL 50 STATES. THEY DON'T KNOW THAT IT'S RIGHT THERE AT THEIR STATE UNIVERSITY. THEY DON'T KNOW THAT IT'S RIGHT THERE AT THE MEDICAL CENTER, IN THE CLOSEST CITY. THAT'S A PROBLEM. ONE THAT WE NEED TO OVERCOME AND CAN OVERCOME. IF WE SET OUR MINDS TO IT, WE CAN CHANGE METRICS AND WITH IT WE CAN PUT A MORE HUMAN FACE ON THE CONDUCT OF SCIENCE. IT'S THE PEOPLE WHO ARE GOING TO DERIVE THIS AND ASSURE THAT WE MAINTAIN THE PUBLIC'S TRUST. SO, I WANT TO CHARGE YOU TO THINK ABOUT WHAT YOU'RE GOING TO DO TO MEET THE MOMENT IN THE MONTHS AND YEARS AHEAD TO INCREASE THE VISIBILITY OF SCIENCE, DO IT BY TELLING YOUR STORY, DO THAT BY LISTENING, YOU CAN DO THAT BY INVITING CONVERSATIONS, INCLUDING THOSE ABOUT SKEPTICISM. AFTER ALL, SCIENTISTS ARE TRAINED TO BE SKEPTICAL, WHY SHOULD WE BE CRITICAL OF MEMBERS OF THE NON-SCIENCE PUBLIC WHO EXPRESS SKEPTICISM? IT'S A GOOD THING TO ASK WHY, OR CAN I REALLY TRUST WHAT YOU JUST SAID? OR TELL ME MORE. ENCOURAGE SKEPTICISM. MEET PEOPLE WHERE THEY ARE, SAY WE HAVE THAT IN COMMON, BEING SKEPTICS. YOU'RE THINKING LIKE A SCIENTIST. I DO THINK WE NEED TO MODERNIZE THE RELATIONSHIP BETWEEN SCIENTISTS AND THE PUBLIC. I THINK IT WOULD BE A HEALTHY THING IF EVERY GRADUATE SCIENCE STUDENT LEARNED IN A SYSTEMATIC WAY, NOT JUST OPTIONAL WORKSHOP, THAT AS PART OF THE CURRICULUM HOW TO PARTICIPATE IN PUBLIC ENGAGEMENT, BE AN EFFECTIVE COMMUNICATOR, HOW TO CONVEY TRUST, HOW TO TALK ABOUT CERTAINTY, AND WHAT ISN'T CERTAIN YET, HOW TO TALK ABOUT WHAT WE KNOW NOW AND WHAT WE'RE GOING TO KNOW WITH YOUR SUPPORT, WITH PUBLIC SUPPORT IN THE DAYS AHEAD. WE'VE MADE SO MUCH PROGRESS. WOMEN'S HEALTH, WOMEN'S HEALTH RESEARCH, HAS MADE SO MUCH PROGRESS. PEOPLE TAKE IT FOR GRANTED NOW THAT WOMEN ARE FULL PARTICIPANTS IN STUDIES. THERE'S MUCH MORE TO DO. NOT ONLY FOR WOMEN'S HEALTH, FOR SCIENCE BROADLY, SCIENCE FOR THE FUTURE OF OUR NATION. IT'S TIME FOR A SCIENCE-STRONG FUTURE, IN THE U.S. AND GLOBALLY. WE CAN GET THERE. I THINK A BIG PART OF IT IS PUTTING YOUR FACE ON RESEARCH. MEETING THE MOMENT PERSONALLY. WE LIKE TO SAY THAT THE MOST IMPORTANT FOUR WORDS A SCIENTIST CAN SAY AND CONVEY, CONVEY WITH YOUR ATTITUDE, WITH YOUR WILLINGNESS, TO LISTEN, WITH YOUR WILLINGNESS TO WORK TOGETHER WITH PEOPLE. THE MOST IMPORTANT FOUR WORDS WITH "I WORK FOR YOU." I WORK FOR YOU. NOT SAYING I'M A GENETICIST, VIROLOGIST, BUT RATHER SAYING, I WORK FOR YOU. LET THE CONVERSATION GO WHERE THE OTHER PERSON WANTS MOST TO TAKE IT. IT'S A PRIVILEGE TO WORK FOR OTHERS, TO SERVE THE PUBLIC'S INTEREST. I FEEL THAT PRIVILEGE EVERY DAY. I'M NOT A SCIENTIST MYSELF, BUT I WORK FOR YOU. SO DOES RESEARCH AMERICA. THANK YOU SO MUCH FOR THE OPPORTUNITY TO BE HERE TODAY, TO BE PART OF THIS CELEBRATION AND TO BE PART OF WHAT COMES NEXT UNDER THE LEADERSHIP OF ALL OF YOU AND I SAY, AGAIN, THANK YOU. >> THANK YOU FOR AN INTERESTING AND INFORMATIVE PRESENTATION. THE WORK RESEARCH AMERICA DOES TO ADVOCATE FOR WOMEN'S HEALTH, RESEARCH AND DEVELOPMENT IS CRITICAL AND MUCH APPRECIATED. LET'S BEGIN WITH THE DIALOGUE. YOU TALKED ABOUT MEETING THE MOMENT. HOW DO WE TURN THIS MOMENT INTO A MOVEMENT TO GET THE VOICES OF WOMEN HEARD AND INTEGRATE ITS CONSIDERATIONS AND CONSIDERATIONS SEX AND GENDER INTO THE BIOMEDICAL RESEARCH ENTERPRISE? >> THANK YOU FOR A GREAT QUESTION AND A THOUGHT STARTER, IF YOU WILL. I'M GOING TO TURN ON MY VIDEO SO I CAN SEE YOU, MAYBE YOU CAN SEE ME. THERE I AM. DEVELOPING A MOVEMENT IS SOMETHING THAT IS NOT -- SHOULD NOT BE LEFT TO OTHER PEOPLE. THIS IS SOMETHING THAT EACH OF US WHO CARE NEEDS TO STEP UP ON. AND SURE, SOME PEOPLE CAN STIMULATE IT BUT I THINK WE'RE AT A TIME NOW OF PROFOUND CHANGE IN OUR NATION, AND IF WE WANT TO INCLUDE A BETTER FUTURE FOR WOMEN, FOR WOMEN'S HEALTH RESEARCH, WE NEED TO ASK FOR IT NOW. DEMAND IS A STRONG WORD. BUT ASKING FOR IT, SAYING THIS IS OUR TIME, THIS IS A TIME TO MAKE SURE WE CAN MAKE BIG LEAPS FORWARD. SO ASK YOURSELF, ASK EVERYONE WHO MIGHT BE LISTENING, WHAT CAN YOU DO? WHAT CAN YOU DO? AND I'LL BET YOU CAN DO MORE THAN YOU THINK YOU CAN. THAT MIGHT BE BY REACHING OUT TO THE POLICYMAKER, MIGHT BE BY TALKING TO YOUR BOOK CLUB, MIGHT BE TALKING TO YOUR RELATIVES OVER THE HOLIDAYS. TELL THEM WHAT YOU BELIEVE IN, HOW THEY MIGHT GET INVOLVED. THANKS FOR THE QUESTION. >> THANK YOU. THAT WAS A GREAT ANSWER. SO LET'S TALK FARTHER. EARLIER YOU DESCRIBED AS A MANDATE FOR THE PUBLIC, ABOUT RAISING PRIORITY OF SCIENCE. CAN YOU TALK A LITTLE BIT ABOUT HOW PRIORITIZING SCIENCE MIGHT, FOR EXAMPLE, INFLUENCE RESPONSIVENESS TO THE CHALLENGES THAT WOMEN FACE WHEN TRYING TO ACCESS CARE OR ACTUALLY SITTING IN THEIR PROVIDER'S OFFICE? >> RIGHT. SO I THINK I'M A VERY OPTIMISTIC PERSON ABOUT SCIENCE RIGHT NOW, BEING IN THE FOREFRONT. THAT INCLUDES QUESTIONS BEING ASKED OF SCIENCE. AS I SAID IN MY REMARKS, THAT'S OKAY. THAT'S GOOD. THAT'S ENGAGING. WITH SCIENCE IN THE FOREFRONT, WE CAN PUSH -- I'M OPTIMISTIC, PUSH FORTUNE PUTTING WITH FORWARD WHAT WE KNOW TO WORK TO AVOID BIAS IN DELIVERY OF HEALTH CARE, THAT MEANS WE'RE NOT PUTTING WHAT WE ALREADY KNOW PERFECTLY WELL TO WORK. BUT WE ALSO NEED TO KNOW MORE. AGAIN, IT'S ABOUT SPEAKING UP, MAKING SURE YOUR VOICE IS HEARD, ALSO ABOUT LISTENING BECAUSE CHANGE AND PROGRESS COME BY LOTS OF PEOPLE SPEAKING WITH THE SAME MESSAGE, SAME VOICE, AND BANDING TOGETHER IN AN ALLIANCE. WE'D LOVE TO HELP. WE BELIEVE IN FORWARDING RESEARCH, THAT'S OUR JOB. WE'RE ADVOCATES. AND EVERYBODY ELSE CAN JOIN IN ADVOCACY TOO, AND I HOPE DO YOU. >> GREAT. THANK YOU. I TOTALLY AGREE. IT TAKES A RISK IN VULNERABILITY SAYING WHERE WE ARE AND WHAT WE NEED, THAT MIGHT CREATE A MORE RICH DIALOGUE. SCIENTIFIC TEAMS PROVIDED A PATH TO ENDING THE PANDEMIC AND OF THROUGH COVID VACCINES, DATA SUGGESTS THERE IS HESITANCY ABOUT ACCEPTING COVID INOCULATION. WHAT CAN WE AS STAKEHOLDERS ADVOCATES AND INDIVIDUALS DO TO IMPROVE PUBLIC TRUST AND PUBLIC HEALTH MESSAGING THAT'S BEING DISSEMINATED, VACCINE SAFETY AND EFFICACY, SCIENCE IN GENERAL? >> IMPORTANT CHALLENGE FOR ALL OF US. AND THE ANSWER IS, DON'T CONTRACT THAT OUT TO OTHER PEOPLE. EVERY SINGLE ONE OF US HAS A ROLE TO PLAY. BY LISTENING TO QUESTIONS, FIRST OF ALL, ALL OF US HAVE RUN ACROSS, I KNOW I HAVE, IN CASUAL CONVERSATION WITH FRIENDS, RELATIVES, FOR EXAMPLE, PEOPLE WHO DO EXPRESS SOME HESITANCY. IT'S THE RIGHT THING RIGHT NOW, YOU KNOW, HERE'S WHAT I'VE BEEN HEARING, WHATEVER. INSTEAD OF SAYING, I DON'T KNOW, OR, YOU KNOW, CONSULT SOMEBODY ELSE, IN OTHER WORDS, HIDE OUT, GET IN THE CONVERSATION. ASK PEOPLE WHAT'S ON THEIR MINDS. DO YOU WORRY THAT YOU MIGHT BE PUTTING YOUR FAMILY'S HEALTH AT RISK? WOMEN ARE OFTEN CONSIDERED THE CHIEF MEDICAL OFFICER OF THEIR FAMILY. THEY ARE LOOKED TO FOR ADVICE, AND IF YOU'RE ONE OF THOSE PEOPLE WHO IS LOOKED TO, TAKE THAT SERIOUSLY. SPEAK UP. SPEAK OUT. IF YOU DON'T KNOW THE ANSWER, LOTS OF TIMES PEOPLE IN THE SCIENCE COMMUNITY FEEL THAT THEY DON'T WANT TO GET INVOLVED IN THE QUESTION BECAUSE THEY MIGHT NOT BE ABLE TO ANSWER AN INQUIRY. IF YOU DON'T KNOW THE ANSWER, SAY SO. BUT SAY THAT YOU'D LIKE TO HELP FIND OUT. FIND SOMEBODY WHO CAN RESPOND TO A QUESTION. THAT QUESTION MIGHT BE, THESE DAYS, ABOUT VACCINES. >> GREAT. THANK YOU. THE NEXT QUESTION WE HAVE IS FROM THE AUDIENCE. THE COMMENT, THEY APPRECIATE YOUR COMMENT ABOUT BEING A PUBLIC COMMUNICATOR. HOW CAN WOMEN SCIENTISTS GET MORE VISIBILITY? >> YEAH, SO FIRST OF ALL, I WOULD ADVICE EVERYBODY TO STOP USING THE TERM "LAY." QUOTE/UNQUOTE, LAYPERSON, THAT COMES FROM A RELIGIOUS CONTEXT WHICH APPROPRIATELY BELONGS IN A RELIGIOUS CONTEXT, BUT WHEN YOU'RE TALKING ABOUT PEOPLE IN MEDICAL RESEARCH, SCIENCE AND HEALTH, IT DOESN'T FIT. THERE ARE PLENTY OF PEOPLE I CAN ASSURE YOU IN THE PATIENT COMMUNITY WHO DON'T LIKE THE TERM. THAT'S ONE THING ANY OF US WHO ARE SCIENTISTS THEMSELVES, I'M ACTUALLY A POLITICAL SCIENTIST, NOT A SCIENTIST THE WAY YOU ARE, OR OTHERS, BUT IF WE AROUND THE SCIENCE COMMUNITY WE SHOULD LOSE THAT TERM. MOVING ON FROM, I ALMOST FORGOT YOUR QUESTION. YOUR QUESTION WAS WHAT CAN WE DO, OH, TO GET PRACTICE, TO BECOME PROFICIENT AT SPEAKING TO PEOPLE WHO AREN'T TRAINED THE SAME WAY WE ARE. SO, YOU CAN DO THAT VERY EASILY BY THINKING ABOUT THREE CONCEPTS, THREE WORDS. THEN. NOW. IMAGINE. ANYTHING YOU CAN NAME THAT HAS TO DO WITH HEALTH, YOU CAN TALK ABOUT THEN. THE THEN POINT, REMEMBER BACK IN THE OLD DAYS WHEN WE DIDN'T HAVE A MEDICATION TO STOP AIDS IN ITS TRACKS? WELL, NOW WE DO. A LOT OF PEOPLE DIED THEN. NOW, WE HAVE THE ABILITY TO TREAT HIV/AIDS LIKE A CHRONIC DISEASE. WELL, IMAGINE IF WE CONTINUED TO PUT RESEARCH TO WORK, WHAT WE CAN DO. WE CAN REMOVE AIDS FOREVER, WE CAN ERASE IT AND CONSIGN IT TO THE HISTORY BOOKS. YOU CAN TALK ABOUT COVID THAT WAY. AND LITERALLY EVERYTHING ELSE. YOU CAN DO IT YOURSELF, AND THEN, NOW, IMAGINE TERMS. PRACTICE WITH SOMEBODY. DON'T SPEAK FOR A PARAGRAPH. GET IT DOWN TO A SOUND BITE. IN ADDITION, I MENTIONED THIS IN MY REMARKS, WE NEED TO MODERNIZE THE EDUCATION OF SCIENTISTS SO THAT IT INCLUDES LEARNING HOW TO COMMUNICATE TO NON-SCIENTISTS. IT'S GOING TO SERVE YOUNG SCIENTISTS WELL FOR THEIR ENTIRE CAREER, INDEED FOR THEIR LIVES, AND ENFORCE IT BY -- IN OUR TRAINING GRANTS FROM NIH AND OTHERWISE, SO THAT EVERYBODY CONSIDERS IT ROUTINE TO LEARN HOW TO BE A STRONGER COMMUNICATOR. >> I TOTALLY AGREE. IT REMINDS ME OF SOME PUBLICATIONS OF LATE THAT TALKED ABOUT CITIZEN SCIENTISTS. HOW WE AS A LAYPERSON, CORRECTION CITIZEN SCIENTIST, CAN SPEAK INTELLIGENTLY ABOUT THE CORE ISSUES IN THE WORLD AND HOW WE CAN IMPACT CHANGE. REALLY GREAT ANSWER. SO THE NEXT QUESTION IS, WHICH I TOTALLY AGREE WITH THE AUDIENCE MEMBER, YOUR PRESENTATION WAS ABSOLUTELY FANTASTIC. DO YOU HAVE EXAMPLES THAT COME TO MIND ABOUT SCIENCE COMMUNICATION THAT YOU FEEL STANDS OUT TO YOU? >> RIGHT NOW, I CAN'T HELP BUT SAY THAT I ADMIRE WHAT WE'RE HEARING FROM LEADERS IN THE INCOMING ADMINISTRATION WHO TALK ABOUT SCIENCE AS SOMETHING THAT WE SHOULD TREAT WITH RESPECT, AND SUPPORT, ACCORDINGLY. THERE ARE OTHERS IN POLICY MAKING RULES WHO ARE TALKING ABOUT SCIENCE WHO NEVER HAVE BEFORE, OR ARE FOR THE FIRST TIME PUTTING FORTH LEGISLATION WHICH THEY NEVER CONSIDERED DOING BEFORE. THIS IS AN EXTRAORDINARY MOMENT FOR SCIENCE. IT'S TIME TO MAKE IT EVEN BIGGER, TO GO BOLD. AND ASK FOR A COORDINATED, LEADING EFFORT BY THE NEW LEADERS IN OUR GOVERNMENT, BOTH IN THE CONGRESS AND IN THE ADMINISTRATION, SO THAT THERE'S MORE AND MORE PEOPLE WHO BECOME KNOWN FOR THEIR COMMITMENT TO MEDICAL RESEARCH, PEOPLE LIKE THOSE WHO HAVE THEIR NAMES ON BUILDINGS, ON THE NIH CAMPUS. EVER NOTICED IN THOSE BUILDINGS WERE NUMBERS THAT 12 HAVE THE NAMES OF FORMER MEMBERS OF CONGRESS? WELL, YOU KNOW, IT'S TIME FOR A FEW MORE NAMED BUILDINGS, CERTAINLY THERE ARE PEOPLE DESERVING OF THAT KIND OF HONOR. AND SOME OF THOSE PEOPLE ARE WOMEN. WOULDN'T THAT BE GREAT? >> ABSOLUTELY, INDEED. SO THE AUDIENCE MEMBER HAD A SECOND PART OF THAT QUESTION THAT TALKS ABOUT MODERNIZING RELATIONSHIP BETWEEN THE PUBLIC AND THE SCIENTIFIC COMMUNITY. DO YOU HAVE ANY IDEAS ABOUT THAT? WHAT THAT MIGHT LOOK LIKE? >> IT STARTS WITH EDUCATIONING EVERY MEMBER OF THE SCIENCE GRADUATE COMMUNITY HOW TO DO THAT, RIGHT? THAT'S THE LONG-TERM SOLUTION, BUT THERE'S OTHER WAYS IN ACADEMIA THAT INVOLVE CHANGING TENURE AND PROMOTION SYSTEM TO ACKNOWLEDGE AND RECOGNIZE AND REWARD PUBLIC OUTREACH, PUBLIC ENGAGEMENT, NOT PUBLIC LECTURES, ENGAGEMENT. THAT'S THE BIG DIFFERENCE HERE. YOU CAN LEARN HOW TO BE A GREAT LECTURER, BUT MOST PEOPLE LEARN BETTER WHEN THEY ARE ENGAGED. THE EDUCATION RESEARCH SHOWS US THAT AND HAS FOR YEARS AND YEARS AND YEARS, BUT WE TEND TO STAY WITH THE SAME OLD MODELS. TIME FOR CHANGE. >> TOTALLY AGREE. THANK YOU SO MUCH. ARE THERE ADDITIONAL TAKEAWAYS TO SHARE HOW TO BE EFFECTIVE COMMUNICATOR IN TERMS OF ADVOCATING FOR WOMEN'S HEALTH BUT IN GENERAL FOR RESEARCH PARTICIPATION OR OTHERS? >> I'D SAY JUST DO IT. PRACTICE. PRACTICE. SAY TO PEOPLE WHEN -- I HAD IT IN MY REMARKS, SO IT'S NOT A NEW PIECE OF INFORMATION BUT I'LL UNDERSCORE IT. WHEN SOMEONE ASKS YOU, SO WHAT DO DO YOU? REMIND ME WHAT YOU DO OR WHAT YOU'RE WORKING ON OR WHATEVER. JUST SAY, I WORK FOR YOU. THE CONVERSATION GOES. IT WON'T BE CHALLENGING. WE HEAR THE MOST WONDERFUL STORIES, INCLUDING WHO PEOPLE WENT TO THEIR OWN WORKPLACE, A REALTOR ONCE WENT TO HER WORKPLACE AND GOT UP A PETITION TO SEND TO THEIR LOCAL MEMBER OF CONGRESS SAYING THAT THEY -- ACTUALLY BEFOREHAND THEY REALIZED HOW IMPORTANT THE NATIONAL INSTITUTES OF HEALTH WAS, AND THEY WANTED THAT MEMBER OF CONGRESS TO BE TALKING ABOUT IT MORE OFTEN. AND TO GO -- A LOT OF STORIES LIKE THIS. I HAVEN'T HEARD TO BE HONEST, I HAVEN'T HEARD ANY STORIES, THEY HAVE HAPPENED BUT HAVEN'T HEARD STORIES ABOUT HOW THAT ADVICE, ENDED UP HAVING A SPONTANEOUS MOVEMENT FOR WOMEN'S HEALTH RESEARCH, BUT WHY NOT? ALL YOU HAVE TO DO IS LISTEN FIRST, AND THEN SEIZE THAT MOMENT. GET INVOLVED. >> YES, DEFINITELY. WE DEFINITELY NEED MORE PEOPLE TO SEIZE THE DAY. THANK YOU SO MUCH FOR CREATING THE OPPORTUNITY FOR US TO SPEAK TOGETHER TODAY. AND JUST TO ALL OF THE PRESENTERS FOR PARTICIPATING IN TODAY'S EVENT, VERY MUCH INTERESTING, INFORMATIVE, WE SO APPRECIATE YOUR CONTRIBUTION TO WOMEN'S HEALTH, TO RESEARCH, AND TO DEVELOPMENT. WE KNOW WE WILL BE MOVING THE NEEDLE ON WOMEN'S HEALTH AND PUBLIC HEALTH RESEARCH IN THE FUTURE WITH KEY PLAYERS LIKE YOU. THANK YOU SO MUCH! >> THANKS, MIA AND EVERYBODY. >> THANK YOU. >> THANK YOU, EVERYBODY. WE'VE COME TO THE END OF THE 30th ANNIVERSARY SCIENTIFIC SYMPOSIUM. I WANT TO THANK YOU ALL FOR JOINING US TODAY. I HOPE YOU FOUND TODAY'S PRESENTATIONS OF GREAT INTEREST. AS WELL AS DIRECTLY RELEVANT AND HOPEFULLY APPLICABLE TO YOUR WORK. FROM OUR PERSPECTIVE AT ORWH WE COULD NOT BE MORE PLEASED WITH THE PARTICIPATION OF OUR SPEAKERS, OUR PANELISTS, OUR MODERATORS, AND YOU. THEY TOOK US ON A JOURNEY TO NEARLY EVERY CORNER OF WOMEN'S HEALTH AND WOMEN'S HEALTH RESEARCH. THE DISCOVERIES DESCRIBED IN THE WORK CURRENTLY UNDERWAY REFLECT COMBINED BRILLIANCE, INSPIRATION AND JUST OUTSTANDING WORK OF THOUSANDS OF RESEARCHERS HERE AT NIH AND AT INSTITUTIONS ACROSS THE NATION. THIS AMALGAM REFLECTS THE DEEP COMMITMENT OF OUR FELLOW BIOMEDICAL RESEARCHERS TO IMPROVING THE HEALTH OF WOMEN, A MISSION NEAR AND DEAR TO ALL OF OUR HEARTS. FIRST, THERE THERE WAS DR. COLLINS WHO SPOKE OF ORWH LEGACY AND CONTINUING ROLE AS FOCAL POINT AT NIH FOR RESEARCH ON WOMEN'S HEALTH, AND WOMEN IN BIOMEDICAL CAREERS. HIS PARTNERSHIP HAS BEEN CRITICAL TO ADVANCING SEX AS A BIOLOGICAL VARIABLE, AS A POLICY INNOVATION, AND AS APPLICATION TO SCIENCE. HE ALSO SHINED A SPOTLIGHT ON HEROES BEHIND THE FOUNDING OF ORWH, ONE OF WHOM HAS JOINED US ONLINE TODAY. DR. VIVIAN PINN. LET ME TAKE A MOMENT TO RECOGNIZE MY MENTOR AND FRIEND AS MOST OF YOU KNOW, DR. PINN HAS BEEN A TRAILBLAZER FROM HER EARLIER CAREER IN MEDICINE TO LATER A CAREER IN WOMEN'S HEALTH RESEARCH. SHE WAS THE FIRST FULL-TIME DIRECTOR OF ORWH FROM 1991 TO 2011, THE FIRST PERMANENT NIH ASSOCIATE DIRECTOR FOR RESEARCH ON WOMEN'S HEALTH, THROUGHOUT HER 20-YEAR DIRECTORSHIP SHE WAS DEDICATED, CREATING CENTERS OF RESERVE ON SEX DIFFERENCES PROGRAM, FIRST SEX DIFFERENCE FUNDING OPPORTUNITY, AND LAUNCHED THE THE BUILDING INTERDISCIPLINARY RESEARCH CAREERS IN WOMEN'S HEALTH PROGRAM, OVERSAW THE LANDMARK RESEARCH ON CAUSAL FACTORS AND INTERVENTIONS RFA. THE RESEARCH HAS PRODUCEDDED EVIDENCE ON OBSTACLES FACING WOMEN AT ALL STAGES IN THE CAREER PIPELINE AND IDENTIFIED EVIDENCE-BASED INTERVENTIONS NETWORK. ALL OF US WHO WORK IN OR CARE ABOUT WOMEN'S HEALTH OWE A DEBT OF GRATITUDE TO DR. PINN. THANK YOU, MY FRIEND. WOULD YOU LIKE TO SAY A FEW WORDS, DR. PINN? I'M GOING TO SEE IF SHE'S ABLE TO JOIN US. OKAY. I THINK SHE IS WORKING TO JOIN US BUT I WILL KEEP GOING. OH, DR. PINN? >> YES, AM I IN? >> YOU ARE. GO RIGHT AHEAD. >> I WASN'T SURE I COULD MAKE IT. THANK YOU SO MUCH, DR. CLAYTON. YES, I'M HEARING NOISE. I DON'T KNOW IF THAT'S COMING FROM ME OR NOT. WHAT AN EXCITING TWO DAYS THESE HAVE BEEN. I'LL TRY AGAIN AND SEE IF THIS WORKS. I WANT TO CONGRATULATE YOU. ARE YOU GETTING THE ECHO? IF SO I WILL NOT TRY TO SPEAK. >> WE DON'T HAVE THE ECHO. I THINK YOU'RE ADDRESS BARRIERS -- MAYBE YOU HAVE A TAB OPEN ON YOUR COMPUTER BUT YOU'RE GOOD. >> OKAY. YES. I THINK WE LOST DR. PINN. >> I WILL BE EVEN BRIEFER. THANK YOU SO MUCH, DR. CLAYTON. I WANT TO CONGRATULATE YOU, THE STAFF OF THE ORWH, INVESTIGATORS, SUPPORTERS AND FRIENDS OF THE ORWH, IN NIH AND THOSE WHO ARE COLLABORATORS OR JUST FRIENDS AND SUPPORTERS OF THE EFFORT YOU'RE DOING FOR CARRYING THIS OFFICE FORWARD IN WAYS I'M NOT SURE WE WOULD HAVE IMAGINED WHEN I LEFT ALMOST TEN YEARS AGO. WHAT I WAS THINKING WAS I WAS REMEMBERING DURING THE FIRST FEW YEARS OF THE OFFICE BACK IN THE '90s, WHEN PEOPLE WERE STILL TRYING TO DECIDE IF THIS WAS A LEGITIMATE SCIENTIFIC ENTERPRISE, SO MANY TOLD US IF WE DID OUR JOB WELL, THE OFFICE WOULD NOT NEED TO EXIST AFTER TEN YEARS. BUT WE MADE IT TO TEN YEARS AND WE MADE IT TO TWENTY YEARS. AND ANYONE WHO HAS THOSE QUESTIONS BACK IN THE '90s, SHOULD JUST HEAR THE EXCITING OPPORTUNITIES AND THE EXCITING SCIENTIFIC INITIATIVES THAT NEED TO GO FORWARD AND NEED MORE EXPLORATION, BOTH IN TERMS OF RESEARCH AS WELL AS CAREER OPPORTUNITIES. YOU'VE DONE A GREAT JOB. YOU AND YOUR COLLEAGUES AND YOUR FRIENDS AND SUPPORTERS. IT'S SO WONDERFUL TO SEE THE MAGNIFICENT REPORT YOU'RE RECEIVING FROM THE OTHER INSTITUTE DIRECTORS AND THOSE ACROSS NIH AND ESPECIALLY FROM DR. COLLINS. WITH THAT, I SAY IT'S BEEN A WONDERFUL TWO DAYS. I'M LOOKING FORWARD TO TOMORROW. THANK YOU FOR GIVING ME A CHANCE TO JUST CONGRATULATE YOU. WE'RE VERY PROUD OF WHERE THE ORWH IS GOING AND HAS GONE. THANKS, JANINE. >> THANK YOU, VIVIAN. I'M SO GLAD WE COULD GET YOU ON. I REALLY APPRECIATE THOSE KIND, KIND WORDS. YOU ARE RIGHT. IT'S BEEN AN INCREDIBLE JOURNEY. OF COURSE, MANY OF YOUR EFFORTS ARE COMING TO FRUITION SO IT'S MY PLEASURE TO SHARE THAT, THE JOY ABOUT THESE ACCOMPLISHMENTS WITH YOU. EARLY THIS MORNING WE STARTED OUT WITH AN AMAZING KEYNOTE FROM DR. PAULINE MAKI, WHO EXPLORED WOMEN'S MENTAL HEALTH ACROSS THE LIFE COURSE. HOW MANY OF US WERE ASTOUNDED TO LEARN ABOUT THE CONNECTIONS BETWEEN CERTAIN MENTAL AND PHYSICAL CONDITIONS AND THE LIFE. NUANCES BETWEEN LIFE STAGE, SEX HORMONES, MENTAL HEALTH BRIDGING INTERNAL AND EXTERNAL FACTORS, INCLUDED IN THE CURRENT TRANS-NIH PLAN FOR WOMEN'S RESEARCH. TWO MORNING PANELS AND THIS AFTERNOON'S PANEL FEATURED RENOWNED ACADEMICS AND RESEARCHERS, WE LEARNED ABOUT ROLE OF CUMULATIVE ENVIRONMENTAL STRESSORS ON WOMEN'S HEALTH, AND IMPORTANCE OF MEASURING TOTALITY OF EXPOSURES THROUGHOUT THE LIFESPAN. THE COMPLEXITIES OF THE ENVIRONMENT WHICH WE INHABIT WERE DELINEATED. WE LEARNED SEX IS A RELEVANT FACTOR, NOT ONLY IN PAIN AND ANALGESIA RESEARCH AND CLINICAL PRACTICE BUT ALSO THE PATIENT'S PAIN EXPERIENCE. WE'VE LEARNED A LOT ABOUT THIS TOPIC YET EACH INSIGHT EMPHASIZED HOW MUCH WE DON'T KNOW ABOUT THIS CRITICAL ISSUE. PAIN CERTAINLY IS SOMETHING WE ALL HAVE IN COMMON AND WITH THE OPIOID CRISIS RUNNING RAMPANT WE MUST REMAIN COMMITTED TO UNDERSTANDING THE FUNDAMENTAL UNDERPINNINGS OF PAIN PROCESSING. OUR AFTERNOON PANEL PRESENTERS ON SABV LAID OUT FOUNDATIONAL CASE FOR STUDYING SEX AT ALL LEVELS OF RESEARCH, A MAIN ARGUMENT BEING THAT SABV IS A DRIVER FOR DEVELOPING A HOLISTIC APPROACH TO PATIENT-CENTERED HEALTH CARE. WE LEARNED PROGRESS AND INTEGRATING SABV DEPENDS ON MENTORING FELLOW RESEARCHERS ESPECIALLY EARLY-STAGE INVESTIGATORS AND REMAINING PERSISTENT IN INTEGRATING THIS PARADIGM SHIFT THROUGHOUT THE BIOMEDICAL RESEARCH CONTINUUM. FINALLY WE HEARD FROM A BIRCWH SCHOLAR WHO SHARED HOW FORTUNATE HE WAS TO BE MENTORED BY AN INTERDISCIPLINARY COMMUNITY OF INVESTIGATORS, BENEFITS OF WHICH INFORMED HIS WORK IN INVESTIGATING THE UNDERLYING BIOLOGICAL AND ENVIRONMENTAL REASONS FOR SEX DIFFERENCES IN ASTHMA INCIDENCE AND MORBIDITY. SPEAKING OF BIRCWH, WE HEARD FROM DR. LISA BEGG, WHO LEADS THE PROGRAM ABOUT ACCOMPLISHMENTS OF THE PROGRAM CELEBRATING ITS 20th ANNIVERSARY YESTERDAY, BOASTING 70% RATE OF NIH RPG FUNDING. NOTICE OF INTENT TO PUBLIC REISSUANCE OF BIRCWH PROJECT, THE FUNDING OPPORTUNITY ANNOUNCEMENT WILL SUPPORT MENTORED RESEARCH CAREER DEVELOPMENT OF JUNIOR FACULTY MEMBERS ENGAGING IN INTERDISCIPLINARY BASIC TRANSLATIONAL BEHAVIOR, CLINICAL AND/OR HEALTH SERVICE RESEARCH RELEVANT TO WOMEN'S HEALTH AND JUST HEARD FROM A RESEARCH AMERICA PRESIDENT MARY WOOLLEY WHO OFFERED A PRO-ACTIVE ASSESSMENT OF PUBLIC STANCE ON SCIENCE. IN PARTICULAR RESEARCH AMERICA'S POLLING SHOWED RENEWED BELIEF IN SCIENCE BEING A MEANS TO SOLVE THE NATION'S PROBLEMS. AS WE FACE THE WORST PUBLIC HEALTH EMERGENCY IN A CENTURY, WITH SCIENCE ITSELF FACING CRITICISM, WE CAN BE HOPEFUL IN THIS RENEWAL. LET ME ALSO EXPRESS MY PROFOUND GRATITUDE TO THE INSTITUTE AND CENTER DIRECTORS AND DEPUTY DIRECTORS WHO PARTICIPATED IN TODAY'S EVENTS. IT'S A RARE AND SPECIAL INDEED TO HAVE SO MANY TAKE TIME OUT OF THEIR EXTRAORDINARILY BUSY SCHEDULES TO JOIN US. IT REFLECTS THE IMPORTANCE OF RESEARCH ON WOMEN'S HEALTH AND ITS CONTRIBUTION TO NIH BIOMEDICAL RESEARCH ENTERPRISE. AS YOU HEARD THERE ARE DEEP ROOTS OF WOMEN'S HEALTH RESEARCH ACROSS THE MISSION AREAS OF THE INSTITUTES AND CENTERS WHO TOO ARE COMMITTED TO ADVANCING SCIENCE FOR THE HEALTH OF WOMEN. IN ITS 30 YEARS OF EXISTENCE, ORWH HAS BENEFITED TREMENDOUSLY FROM THE SUPPORT OF VARIOUS ORGANIZATIONS WITH WHOM WE'VE SHARED GOALS AND VISIONS. AT ORWH'S FOUNDING FEW ORGANIZATIONS WERE STRONGER ADVOCATE FOR WOMEN'S HEALTH RESEARCH THAN THE CONGRESSIONAL CAUCUS FOR WOMEN'S ISSUES. SUBSEQUENTLY THE WOMEN'S CONGRESSIONAL POLICY INSTITUTE REMAINS STEADFAST IN SUPPORT OF OUR MISSION. JUST A FEW SHORT MONTHS AGO I HAD THE PRIVILEGE OF ADDRESSING WCPI ON THE HISTORY AND LEGACY OF ORWH. RESEARCH AMERICA TOO HAS BEEN AN IMPORTANT VOICE IN WASHINGTON, IN SUPPORT OF ENHANCING RESEARCH OF THE CONDITIONS OF DISEASES AFFECTING WOMEN. THERE WERE SO MANY OTHER GROUPS THAT HAVE MADE A DIFFERENCE AND SUPPORTED IT. I WOULD LIKE TO RECOGNIZE IMPORTANT SUPPORT FROM PROFESSIONAL ORGANIZATIONS AND SOCIETIES SUCH AS SOCIETY FOR WOMEN'S HEALTH RESEARCH, ORGANIZATION FOR STUDY OF SEX DIFFERENCES AND ENDOCRINE SOCIETY AMONG MANY OTHERS. FINALLY I STEPPED A WARM THANK YOU TO EVERYONE WHO WORKED ON THIS ORWH 30th ANNIVERSARY EVENT SERIES. YOU CANNOT IMAGINE WHAT GOES INTO PLANNING A THREE-DAY VIRTUAL EVENT WITH DOZENS OF SPEAKERS, POSTER GALLERIES AND NETWORKING LOUNGES, A HUGE THANK YOU GOES OUT TO TEAM ORWH. LITERALLY EVERY PLAYER ON THE TEAM HAS BEEN AT THE TOP OF THEIR GAME GOING ABOVE AND BEYOND FOR THIS TOUR DE FORCE. FOR THAT I'M GRATEFUL. THIS SYMPOSIUM CAPPED A YEAR-LONG OBSERVANCE OF ORWH'S 30th ANNIVERSARY YEAR. THROUGHOUT THE YEAR WE'VE CELEBRATED OUR ACCOMPLISHMENTS, AS WELL AS NIH'S MANY CONTRIBUTIONS TO IMPROVING THE HEALTH OF WOMEN, THE PAST THREE DECADES HAVE SEEN DRAMATIC GAIN IN WOMEN'S HEALTH CARE AND OUTCOMES, IN WOMEN'S ENTRY AND ADVANCEMENT INTO BIOMEDICAL CAREERS, IN WOMEN'S PARTICIPATION IN NIH-FUNDED CLINICAL STUDIES. OUR WORK, HOWEVER, IS FAR FROM DONE. PERSISTENT AND EMERGING CHALLENGES CONTINUE TO PLAGUE THE HEALTH OF WOMEN FROM THE WORSENING RATES OF MATERNAL MORBIDITY AND MORTALITY, TO INCREASING CASES OF CERTAIN CANCERS, TO STUBBORN RATES OF CARDIOVASCULAR. THEN THE CORONAVIRUS PANDEMIC ARRIVED POSING TREMENDOUS RISK TO WOMEN WHO ARE THE MAJORITY OF FRONT LINE HEALTH WORKERS AND OTHER ESSENTIAL WORKERS, EXACERBATING HEALTH DISPARITIES AMONG WOMEN OF COLOR AND UNDERSERVED POPULATIONS, ITS IMPACT ON WOMEN'S ACADEMIC AND WOMEN SCIENTIST CAREERS HAS BEEN SIGNIFICANT. NEVERTHELESS, I AM AN OPTIMIST. FOR ORWH THE PATH FORWARD HOLDS PROMISE, THE CONSENSUS WILL LEAD TO BETTER SCIENCE, A MORE COMPLETE KNOWLEDGE BASE, AND ULTIMATELY IMPROVED CARE FOR WOMEN AND FOR MEN. THE ADVANCEMENT OF MORE WOMEN IN S.T.E.M. LEADERSHIP ROLES WILL BRING THE DIVERSITY OF THOUGHT, EXPERIENCE, AND TALENT NEEDED FOR MORE PRODUCTIVE AND MORE INNOVATIVE RESEARCH, AND CHANGES IN MEDICAL EDUCATION OFFER THE PROMISE OF UNDERSTANDING AND PRODUCING BETTER INFORMED CLINICIANS, ACADEMIC LEADERS, HEALTHCARE VISIONARIES. JOIN US IN OUR NEXT 30-YEAR JOURNEY. HELP US IN OUR MISSION TO IMPROVE THE HEALTH OF WOMEN. WE DO WORK FOR YOU. HELP US ACHIEVE NIH'S VISION IN WHICH EVERY WOMAN AND EVERY GIRL RECEIVES EVIDENCE-BASED DISEASE PREVENTION, TREATMENT AND CARE, TAILORED TO HER OWN NEEDS, CIRCUMSTANCES, AND GOALS. THANK YOU AGAIN TO EVERYONE, ATTENDEES, SPEAKERS, MODERATORS, STAFF, AND SUPPORTERS. MAY ALL OF YOU HAVE PEACEFUL AND SAFE HOLIDAYS.