Leveraging Diversity, Equity and Inclusion in Science
A Conversation with Hannah Valantine and Cori Bargmann
Biomedical science, just like our healthcare system, is rife with structural disparities, inequities, and injustices that are especially experienced by Black, Latinx, and Indigenous people, and other communities of color. These inequities and lack of representation impede innovative and trustworthy science — good science must be guided by principles of diversity, equity, and inclusion (DEI).
We recognize we will not achieve our mission of supporting the science and technology that will make it possible to cure, prevent, or manage all diseases by the end of the century unless we actively work to dismantle racism and systemic barriers in the scientific ecosystem.
As part of our work at CZI to reflect on these issues and to center these principles, in April we hosted a CZI-wide virtual Lunch & Learn featuring our Head of Science, Cori Bargmann, and our expert scientific advisor, Dr. Hannah Valantine, about the importance of addressing DEI in science and how CZI and other funders can accelerate progress.
Dr. Valantine is a respected cardiologist with extensive experience working at the intersection of science, medicine, and diversity. She comes to CZI most recently from the National Institutes of Health (NIH), where she was the Chief Officer for Scientific Workforce Diversity. She is also a professor of Medicine at Stanford University, where she previously served as a Senior Associate Dean of Diversity & Leadership.
As an advisor to CZI Science, Dr. Valantine is supporting our efforts to apply a racial equity lens to our work. She also brings a valuable clinician’s perspective to our science grant making.
The following is an edited excerpt of Dr. Bargmann and Dr. Valantine’s conversation.
Cori Bargmann: Hannah, could you tell us about your early years growing up in The Gambia and how those experiences brought you on the path to your life’s work?
Hannah Valantine: I’m really looking forward to what we can do together to actually change the culture of science, with big ideas and big dreams. A little about me — I was born in The Gambia in West Africa, where I grew up until the age of 13. Going through school, including medical school, I was highly competitive. I loved studying and science, but there was one particular area at which I was really poor: art. I was never first in my art class until one great moment when we were allowed to copy anything from a book that was artistic. I found this drawing of William Harvey’s depiction of the circulation of the blood, with blue blood on one side and red blood on the other. I copied that perfectly, and it was the only class in which I ever got an A in art. I think it foretold what was to come, because I’ve loved cardiovascular medicine ever since.
CB: Can you describe your experience as a cardiologist? How has your clinical expertise informed your thinking?
HV: I’ve always loved the idea of cardiology, that there’s this pump in your body that unfortunately, for some people, fails. No matter what medicines you give them, you cannot resuscitate their failing heart, and the patient ends up needing a heart transplant.
All through my career, I’ve had this burning desire to come up with something better than the heart biopsy. Some of you may not know that we do this gruesome procedure in order to monitor rejection after the person has had a heart transplant so that we can treat them and prevent the new heart from being damaged. We have to put a tube into the vein in the neck (called the internal jugular vein), pass a catheter into that vein, wiggle it through the heart, take a snippet of the heart muscle, and send it to pathology to look for rejection. One day a patient said to me, “Dr. Valantine, first you give me a heart, then you take it away bit by bit with your biopsies. Can’t you come up with something better?”
Many years later, I was sitting in my office reading an article that Stephen Quake (co-President of the Chan Zuckerberg Biohub), had just written about using technology to do prenatal diagnosis. When a woman of a certain age is pregnant and we want to make sure that there are no genetic abnormalities in the baby, we used to do something called amniocentesis, where doctors stuck a big needle in the abdomen to get a sample of the baby’s fluid so that they could make assessments.
In order to make this process less invasive, Steve Quake used new genomic technologies to simply take a sample of blood from the mother and analyze it using DNA sequencing methods to identify the fragments of the baby’s DNA that were circulating in the mother’s blood. When I read this article, I thought that if the baby’s DNA could get into mom’s blood, then perhaps the DNA from the transplanted heart could enter the patient’s circulation. I ran my idea by Steve and he thought it could work, saying “After all, a transplant is a genome transplant.” And the rest is history.
Now, we’ve moved away from doing these wretched biopsies to having a simple blood test, called the liquid biopsy, to manage heart transplant patients as well as other organ transplants. Thankfully, now doctors know much further in advance when a patient is going to reject a heart and can treat them more rapidly.
CB: That is really a beautiful example of how technology can be used to prevent disease or bad outcomes. Now, as I’ve learned over the past few years, there are many disparities in cardiovascular outcomes and diseases, particularly for African Americans — whether it’s age of death, heart attack rates, or rejecting organ transplants. What can you tell us about the way these disparities are affecting people, and what can be done about it?
HV: That’s a really important question. It feels like no matter what field you look at, we see these disparities in outcomes and to some extent, it is explicable by the social determinants of health and environments in which people live. Also, there is very good data to indicate that the chronic stress of systemic racism can translate to biological transducers that lead to damaging effects on the heart, lung and blood vessels.
In my own field, we’ve known for years that an organ transplanted into an African American has a higher risk of rejection — no matter if it’s a heart, lung, kidney, or liver transplant. All of those see greater levels of rejection, and we don’t know why. But now, we are going to be able to use new technologies to figure out: Is it because of a relative genetic difference between donor and recipient? To what extent do social determinants of health play a role? Once we answer those questions, we can have a full picture of the issue, and from that full picture, we can begin to answer your question. For now, we unfortunately cannot really answer because we don’t have that integrated approach to addressing complex human diseases.
CB: The questions you raise are exactly at the heart of how we’re trying to think about taking a racial equity lens to all of our work. And we’re very fortunate to have you here because you’ve not only been directly involved in an area of medicine where that’s important, but you’ve been thinking a lot about diversity from many angles. You were the leader of diversity efforts at Stanford for more than a decade. What have you learned from that experience?
HV: For every institution that is committed to this work, it’s important for them to develop an integrated strategy that involves a number of evidence-based approaches to diversity, equity, and inclusion. The organization must be ready to move away from the idea of doing just one thing and expecting a major change to occur. If you hope to have that tectonic shift in your culture of equity, you’ve got to be doing multiple things at the same time through a systemic approach.
First of all, a system must have a way of monitoring and tracking not only the demographic data of employees or representation, but also all of those equity inclusion metrics: salary, diversity of committees, best practices in outreach and hiring, education, and interventions on bias and racism. Finally, you have to tie outcomes and metrics to the institutional reward systems. So that integrated approach is critically important, as is moving away from just a “one size fits all” solution.
Another important shift needed is debunking the myth that we don’t have the people to do the science — that we are all fighting over a few excellent scientists from diverse backgrounds. Wrong. Every year over 3,000 scientists from underrepresented racial and ethnic groups receive their PhDs in biological sciences. So there is a pool of trained African American, Latinx, Native Hawaiian, Pacific islander, and Indigenous scientists who now make up about nearly 18 percent of the total PhD recipient pool each year.
What’s really happening and troubling is that the same representation is not showing in those that are hired into university faculty positions and ultimately getting tenure or applying for grants. This is a huge loss of talent from biomedical research. Additionally, once the few people of color are appointed into faculty positions, they have an extra burden of work, which we call the diversity tax. For example, you’re expected to serve on all the search committees, and mentor all of the students and trainees from underrepresented groups — and that just takes away time from your day job as a research scientist.
CB: What are some of the changes you made when you were the Chief Diversity Officer at the National Institutes of Health to tackle some of these problems?
HV: One of the first things I did was to set up and lead the Diversity Program Consortium. This program was built as part of the response to a very troubling finding that African American investigators and scientists applying for grants were so much less likely to get funded than their White counterparts. The program focuses on the early training period, building a robust pipeline of undergraduates advancing to PhD programs in science, and has been highly successful in achieving its goals. However, it is clearly going to take 15+ years before the undergraduate pipeline actually addresses the issue of faculty diversity and the racial gap in obtaining research grants.
In order to tackle the acute issue, as a cardiologist I had this burning feeling that we must go straight to the problem. The stenosis in the pathway to faculty positions is in the transition from postdoc to faculty level. So I used the NIH intramural research program to pilot the idea of cohort hiring for tenure track investigators, integrated with a structured mentoring program for the cohort. The mentors embedded as part of the senior leadership were well-versed in mentorship and uniformly recognized as the best within the institution for their ability to help tenure track investigators succeed. Within two rounds of that program, which recruited 15 people each year, we immediately saw a rise in the representation of Black and Latinx tenure track investigators. It showed absolutely terrific results — it went from about 4.5 percent to about 13 percent just after two years, and it’s now heading for 25 percent. But this increase is not enough to have a large national impact; the size of programs like this have to be amplified times 100. The program is also being evaluated for its impact on the overall climate within the departments of the participants and across the institution broadly.
CB: We are thrilled to have you working with us at CZI. After you stepped down from the NIH, people were clamoring for your time. So how are we so lucky? What makes you feel that this is worthwhile?
HV: I love the science at CZI. I love the fact that it’s a marriage between science and technology. I find Priscilla and Mark’s vision on this work compelling and inspiring. Ultimately, I believe CZI could be the place people look to for innovation in diversity and inclusion. We can start small and create some pilots that everyone will look to emulate. That’s my vision for this work.
It is a must to remember that diversity, equity, and inclusion isn’t something that you do on the side; it must be embedded in everything we do because it is essential for the best and most impactful science. If we are to treat and prevent all diseases by the turn of the century, we have to move rapidly, and that means we have to be inclusive about the people who are actually doing the science and the spectrum of biomedical research, spanning from discovery science to application. This will enable science teams to translate and advance their work rapidly into clinical and community settings. CZI can make a huge impact by supporting this work.
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