Hispanic Heritage Month: Improving Access to Health Information

Hispanic Heritage Month (September 15 to October 15) celebrates the many contributions to U.S. society of people originating from Spain, Mexico, the Caribbean, and South and Central America.

Today, there are almost 60 million Latinx-identifying or Spanish-speaking people in the United States (about 18% of the total U.S. population). Representing our nation’s largest ethnic or racial minority, the median age of the Hispanic population is 29.5 years, which is younger than the median age of about 38 years for the overall U.S. population. About 50% are female, almost half are married, and, unlike their non-Hispanic counterparts, they tend to live in households with children. The number of U.S.-born Hispanics is growing faster than the number of Hispanic immigrants.

The Centers for Disease Control and Prevention reports that people of all races who identify as Hispanic are more likely to develop chronic conditions such as cardiovascular disease, type 2 diabetes, and obesity. Each of these conditions can be managed, or even delayed or prevented, by engaging in healthy lifestyle behaviors that include physical activity, healthy eating, and regular check-ups.

So, the health and the health information needs of Hispanics in the United States, and the well-documented disparities that exist between the Hispanic population and other populations, is of critical importance to NLM.

Our powerful consumer health information resource, MedlinePlus, and our Spanish-language version, MedlinePlus en Español, are trusted sources of accurate health information, and we strive to make them culturally sensitive, relevant, and accessible. Our amazing PubMed literature citation database promotes access to research literature in both English and Spanish, and our molecular resources allow for exploring the intersection of genetics and nationalistic identity.

In addition to these online resources, NLM supports Hispanic individuals, families, and groups through our National Network of Libraries of Medicine (NNLM). Serving diverse communities, the NNLM provides another pathway for providing linguistically and culturally relevant health information.  

The NNLM is a powerful human network of over 7,000 academic health science libraries, hospital and public libraries, and community organizations that provide a point of presence in almost every county in the United States. Its eight Regional Medical Libraries (RMLs) make sure that up-to-date information about NLM’s resources are accessible to communities that are often underrepresented in biomedical research. Although all the RMLs provide access to information in English and Spanish, I’d like to highlight the efforts of two of our regions: the South Central Region, serving Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, and the Pacific Southwest Region, serving Arizona, California, Hawaii, Nevada, and the U.S. Territories in the Pacific. Together, these two regions serve 28 million Hispanics — reaching almost half of the Spanish-speaking population in the United States.

The South Central Region supports the Spanish-speaking community specifically through many programs, including outreach to Presbyterian Española Hospital in Española, New Mexico, a special award to the University of North Texas Health Science Center to support a Library School student from a minority community, and emergency funding for Mobile Programming/Pop-up Program Resources & Tools to support disaster relief and response. The Pacific Southwest Region offers programs that engage community health workers/promotores through activities that address social determinants of health as an approach to health education and promotion in the Hispanic community.

But service to the Spanish-speaking public is not limited to the South Central and Pacific Southwest regions. The Middle Atlantic Region offers Spanish language health information resources on topics ranging from AIDS to cancer to diabetes. An interesting program from the Pacific Northwest Region is a grant to bring health information and access to MedlinePlus en Español over the airways from local public libraries to the region.

Because NNLM members are embedded in their communities, they can utilize NLM resources to meet the particular needs of that community. The professional librarians in these communities provide a feedback loop that helps NLM appreciate both the professional terminology associated with critical health concerns and the need to map local colloquial language for Medical Subject Headings (MeSH) to index the literature.  

The NNLM not only helps us extend the amazing federal investment from Washington, DC, to local communities, but also helps ensure that federal staff in Washington understand, in the vernacular, the health concerns of this important population.

During Hispanic Heritage Month — and throughout the year — it’s important to think about how NLM can better engage with the populations we serve. I welcome your suggestions to ensure that our vast and trustable resources serve everyone, everywhere.

Taking NLM’s Story to Capitol Hill

Last month, I had the honor of joining National Institutes of Health (NIH) Director Francis Collins, MD, PhD, and four other NIH Institute Directors to provide testimony before the U.S. House Congressional Subcommittee on Appropriations for NIH Investments in Medical Research. This was the first time in 12 years that NLM provided testimony to Congress.

Each of us was given the opportunity to deliver a three-minute opening statement. As you can imagine, distilling our many successes and contributions down to a three-minute statement was incredibly challenging. I wish that there had been more time because we have so many wonderful stories to share. We were also able to submit a written statement, which is provided later in this post.

It is my hope that NLM will have more opportunities to share with Congress further insights and details about how NLM’s biomedical informatics and data science research play an integral role in supporting the mission of NIH and how we — true to the NIH tagline — turn discovery into health.

Below is the written testimony that was submitted:

PREPARED STATEMENT OF PATRICIA FLATLEY BRENNAN, RN, PhD, DIRECTOR, NATIONAL LIBRARY OF MEDICINE

Madam Chairwoman and Members of the Subcommittee: I am pleased to have this opportunity to speak to you about the exciting work taking place at the National Library of Medicine of the National Institutes of Health (NIH).

ACCELERATING BIOMEDICAL DISCOVERY & DATA-POWERED HEALTH

The National Library of Medicine (NLM) plays an essential role in catalyzing basic biomedical science through its cutting-edge data science and informatics research, comprehensive information systems, and extensive research training programs. As the world’s largest biomedical library, NLM acquires, organizes, and delivers up-to-date biomedical information across the United States and around the globe. NLM operates some of the most heavily used Federal websites.

Millions of data scientists, health professionals, and members of the public use NLM’s electronic information sources every day to translate research results into new treatments, products, and practices and provide the foundation for clinical decision making by health professionals and patients.

Leveraging its 180-year history of organizing and disseminating biomedical literature, NLM is committed to the application of emerging data science capabilities to challenges in biomedical research and public health.

It does this by enhancing its data and information resources and providing leadership in both the acquisition and analysis of data for discovery. It continues to expand its core biomedical literature and genomic collections to include a broad array of health, clinical, and biological data types. It makes these data findable, accessible, interoperable, and reusable (FAIR) for research.

NLM is investing in new research programs to systematically characterize and curate data describing complex health phenomena and to devise new methods to uncover the knowledge held in data. It has restructured its 16 biomedical informatics training programs to address data science as they continue to foster excellence and support a diverse workforce. NLM is in the process of developing an efficient organizational structure to accommodate emerging directions in research and services.

RESEARCH IN BIOMEDICAL INFORMATICS AND DATA SCIENCE

NLM’s research programs support pioneering research and development to advance knowledge in biomedical informatics and data science. Its research portfolio spans such areas as artificial intelligence, computational biology, clinical decision support, public health surveillance, visualization, and discovery mining in digital data sets. This research encompasses areas of high importance to NIH and society at large, and for audiences ranging from clinicians and scientists to consumers and patients.

Research in data science produces novel analytical approaches and visualization tools that help scientists accelerate discovery from data and translate these findings to clinical solutions. It also aims to solve problems consumers face in accessing, storing, using, and understanding their own health data and to produce tools that make precision medicine discoveries available and more understandable to patients.

Biomedical informatics research is yielding advanced analytical methods and tools for use against large scale data generated from clinical care, leading to fuller understanding of the effects of medications and procedures as well as individual factors important in the prevention and treatment of disease processes.

Recognized as a leader in clinical information analytics, NLM supports and conducts research in areas such as medical language processing, high-speed access to biomedical information, analysis and use of high-quality imaging data, health data standards; and analysis of large databases of clinical and administrative data to predict patient outcomes and validate findings from clinical research studies. Leveraging extensive machine learning experience and field-based projects, NLM is now advancing analytical tools and deep learning techniques for application in image analysis research.

NLM’s biomedical informatics research also addresses issues in computational biology. Research creates new ways to represent and link together genomic and biological data and biomedical literature and produces analytic software tools for gaining insights in areas such as genetic mutational patterns and factors in disease, molecular binding, and protein structure and function.

Last year, NLM established a new partnership with the National Science Foundation to support research on advanced analytical methods specifically applied to health.

BIOMEDICAL INFORMATION SYSTEMS FOR RESEARCH AND HEALTH

NLM develops and operates a set of richly linked databases that promote scientific breakthroughs and play an essential role in all phases of research and innovation.

Every day, NLM receives up to 15 terabytes of new data and information, enhances their quality and consistency, and integrates them with other NLM information. It responds to millions of inquiries per day from individuals and computer systems, serving up some 115 terabytes of information. This includes genomic data, such as that contained in the Sequence Read Archive, as well as citations to more than 30 million journal article records in PubMed.

On any given day, more than 2.5 million people use NLM’s PubMed Central (PMC) to retrieve more than 5 million full-text biomedical journal articles. PMC serves as the repository for NIH’s Public Access Policy and includes more than one million articles summarizing the results of NIH-funded research. Additionally, ten other federal agencies use PMC as the repository for publications collected under their public access policies.

Recently, NLM enhanced the ability to connect articles in PMC to openly available datasets that support reported research findings. Currently, more than 300,000 articles in PMC include datasets as supplemental materials. Others link to datasets hosted in other trusted repositories. The addition of this information has resulted in a 30 percent increase in daily downloads of supplementary material from PMC.

NLM also offers sophisticated retrieval methods and analysis tools to mine this wealth of data, many of which grow out NLM’s research and development programs.

For example, NLM tools are used to mine journal articles and electronic health records (EHRs) to discover adverse drug reactions, analyze high throughput genomic data to identify promising drug targets, and detect transplant rejection earlier so interventions to help clinical research participants can begin more quickly. Data analysis tools also support complex analyses of richly annotated genomics data resources, yielding important molecular biology discoveries and health advances for applications to clinical care. Such applications demonstrate how the benefits of big data critically depend upon the existence of algorithms that can transform such data into information.

As a major force in health data standards for more than 30 years, NLM’s investments have led to major advances in the ways high volume research and clinical data are collected, structured, standardized, mined, and delivered.

In close collaboration with other HHS agencies, NLM develops, funds, and disseminates clinical terminologies designated as essential for demonstrating meaningful use of EHRs and health information exchange. The goal is to ensure that clinical data created in one system can be transmitted, interpreted, and aggregated appropriately in other systems to support health care, public health, and research. NLM produces a range of tools to help EHR developers and users implement these standards and makes them available in multiple formats, including via application programming interfaces or APIs.

NLM is now providing support to develop tools to facilitate research use of the Fast Healthcare Interoperability Resource, or FHIR, standard that is being widely adopted for use in electronic health records.

ENGAGING THE PUBLIC WITH HEALTH INFORMATION

NLM uses multiple channels to reach the public with health information, including development of consumer-friendly websites, direct contact, and human networks that reach out to communities.

Direct-to-consumer information is made available in lay language through MedlinePlus, which covers more than 1,000 health topics. EHR systems can connect directly with MedlinePlus to deliver information to patients and health care providers at the point of need in healthcare systems. In collaboration with other NIH Institutes and Centers and other partners, NLM produces the print and online NIH MedlinePlus magazine, and its Spanish counterpart, NIH Salud.

The National Network of Libraries of Medicine (NNLM) engages more than 7,000 academic health sciences libraries, hospital libraries, public libraries, and community-based organizations as valued partners in conducting outreach to ensure the availability of health information and efficient access to NLM services. The NNLM provides a community-level resource for NIH’s All of Us program, ensuring a point of presence in almost every county in the U.S. The NNLM provides a robust network that reaches communities that are often underrepresented in biomedical research.

NNLM partners with local, state, and national disaster preparedness and response efforts to promote more effective use of libraries and librarians and ensure access to health information in disasters and emergencies. NNLM also plays an important role in increasing the capacity of research libraries and librarians to support data science and improve institutional capacity in management and analysis of biomedical data.

CONCLUSION

To conclude, through its research, information systems and public engagement, NLM supports discovery and the clinical application of knowledge to improve health. Its programs provide important foundations for the field of biomedical informatics and data science, bringing the methods and concepts of computational, informational, quantitative, social, behavioral, and engineering sciences to bear on problems related to basic biomedical and behavioral research, health care, public health, and consumer use of health-related information.

To watch the entire proceedings, click here: https://appropriations.house.gov/events/hearings/investments-in-medical-research-at-five-institutes-and-centers-of-the-national

Hear Ye, Hear Ye! NLM’s Summer Town Hall

Twice a year, leadership at NLM invites the 1,700 women and men who work for the Library to a Town Hall meeting. These meetings provide an opportunity for leadership to announce new initiatives and demonstrate accountability to our team, and for staff to ask questions and share ideas, concerns, and even words of appreciation.

I use a lot of channels to connect with my colleagues here, ranging from email updates to informal brown bag lunches with groups across the Library, casual conversations in the hallways, and Musings from the Mezzanine. But the NLM Town Hall structure is unique because it allows NLM leaders to receive valuable feedback from staff about how things are going and how changes are perceived, while we’re all in one place. I was happy to host one just last week.

First, we paused to remember Donald A. B. Lindberg, M.D., who served as the director of NLM for more than 30 years. As I noted in last week’s blog post, he was a visionary giant who lives on in the activities and legacy of NLM. We have lost a great treasure, but he would want us to keep investing in the future.

Our Town Hall meeting highlighted progress on many fronts. We reported on implementing NLM’s 2017-2027 Strategic Plan, discussed plans to stimulate innovation across NLM, and talked about employee engagement and the quality of work life.

As we put our strategic plan into effect, it’s important to me that every individual working at NLM knows that he or she plays an important role in the present and future of this great organization.

One of the pillars of our strategic plan is to accelerate data-driven discovery. I was pleased to announce that Xiaofang Jiang, PhD, will be joining NLM’s Intramural Research Program (IRP) as a tenure-track investigator who will be accelerating data-driven discovery. Her research plans involve developing methods for computational microbiome studies, including refining the resolution of metagenomic sequencing to the strain level. She also proposes to design a tool to track the transfer of antibiotic resistance genes using metagenomic data. In other staffing news, the search for a new scientific director for the IRP is underway.

A key component of implementing our strategic plan is communication. Our new director of the Office of Communications and Public Liaison, Jody Nurik, delivered a compelling vision for harmonizing NLM’s public presence to build a stronger, more consistent central identity that will create and enhance engagement with our stakeholders. This effort includes better showcasing the depth and breadth of our work and the resources we make available to the many audiences we serve.

Our discussion of innovation included an announcement of the launch of NLM Labs, a think tank to stimulate new ideas, prototypes, and research that support the goals of the strategic plan. Valerie Florance, PhD, director of NLM Extramural Programs, is heading a committee comprising staff from across NLM that will issue calls for proposals. Any NLM staff member can apply for an NLM Labs award.

The third theme of our Town Hall meeting was ensuring that NLM is a great place to work, and we addressed this in several ways.

The leadership team at NLM has reviewed the responses to the annual Federal Employee Viewpoint Survey, or FEVS, which measures federal employees’ perceptions of their agencies and job satisfaction. Overall, most NLM employees reported positive feelings about the work they do and the quality of their work life, so this year we’re focusing on employee engagement and our commitment to diversity, excellence, and safety.

Like other Institutes at the National Institutes of Health (NIH), NLM is developing a formal anti-harassment plan. Central to this plan is engagement with the NIH Civil Program, whose mission is to foster civility throughout the NIH workplace. The program provides a way for staff to report concerns about uncivil behavior, such as harassment, inappropriate conduct, bullying, and other disruptive actions.

We announced next steps for creating an NLM anti-harassment plan, as well as an upcoming presentation by the NIH Civil Program to Library staff planned for the fall.

After the Town Hall presentations, we opened the floor to comments and questions from staff, whether they were attending in person or online.

Several questions addressed challenges and opportunities facing NLM as a 21st century research institute, ranging from workforce planning, best practices for data center security management, and what it means to have perpetual access to the biomedical literature. Staff also discussed how NLM shares its story with stakeholders across the globe, which served as a reminder of NLM’s responsibility as a custodian of centuries-old historical treasures and our leadership role in the acquisition and analysis of biomedical data and information.

I welcome your questions, thoughts, and ideas about NLM and where we’re going. Whether you’re a Library employee, stakeholder, or member of the public, I want you to see yourself as a part of NLM—now and in the future!

Remembering Donald A. B. Lindberg, a visionary giant with a personal touch

Along with the 1,700 women and men of the National Library of Medicine (NLM), I am saddened at the death of Donald A. B. Lindberg, M.D. (September 21, 1933-August 17, 2019), director of the NLM for more than 30 years.  

A world-renowned leader in applying computers to health care and a giant in the field of biomedical research, he was hailed for his visionary and transformative leadership. When people talk about people with such great influence, they often say that those who come after them stand on their shoulders. With Don, it was different. He made sure that we stood beside him.  

Like many of you, I believe I had a relationship with Don that had nothing to do with me as a person, but everything to do with the personhood of “DABL.” Don had a way of making each of us feel chosen to be in his orbit and making you feel as if he singled you out as a winner—and he thought we all were winners!

Throughout the years, Don reinforced the feeling that I stood beside a giant, not on his shoulders.

Let me share a few memories that illustrate this point.

In the mid-1990s, Don recognized the importance of the patient as part of the health information ecosystem. He realized that changing the health care system couldn’t only be the job of health professionals, but that patient engagement was key and that it involved many disciplines, so he created committees to guide NLM’s long range planning efforts. He made sure that young people like me, who had strong research programs to address patient engagement, were part of the process.

In 2002, as I launched my sabbatical at NLM, Don and his wife, Mary, invited me and my son, Conor, to their home. I can still picture Don and my then-nine-year-old son splashing in their pool. The Lindbergs took the time to share their home with me, a kindness that my son and I will never forget.

When I became NLM director in August 2016, Don and Mary hosted a lovely party for me. They introduced me to so many people important to the Library with whom I wouldn’t have met so early in my tenure. Their warm welcome made me feel anointed as a person of importance to them and as a part of the next generation of NLM.

And as I prepared to attend my first Friends of the National Library of Medicine gala later that year, I told Don that I was looking forward to seeing him. His response was that he wouldn’t be attending; He said, “This is your time to shine. I will come back next year.” And so, he did—to the gala and to lectures, celebrations, and many professional events. He and his wife remained a strong presence in the life of the Library. Mary was not only Don’s wife, she was a hospice volunteer and a strong advocate in her own right.

Don left his legacy in so many ways, including the annual Donald A.B. Lindberg and Donald West King Lecture to be held September 11 at NLM. Edward Feigenbaum, a pioneer in the development of expert systems in artificial intelligence (AI) and in demonstrating its technological significance, will be speaking. I’d like to think Don would be pleased.  

As I sit in the same office where Don worked, I pledge to take forward the integrity and commitment that Don demonstrated in leading this great institution. It’s not only what he would want, it’s what he would expect.

Dr. Donald Lindberg with grandson, Martin, in his NLM office.
Dr. Donald Lindberg with grandson, Martin, in his NLM office, ca. 1999.

On the Importance of Mentors (and Mentors Who Become Friends)

The best mentors not only provide a sounding board to try out new ideas and thoughts, they also give you the confidence to ride new waves of opportunity. But sometimes mentors become something more: They become your lifelong friends.

That’s the way it’s been for me with Jon White, MD.

I’ve been blessed with many mentors and many friends, but this is a good time for me to reflect on my relationship with Jon because he just announced that he is leaving his post at the Office of the National Coordinator for Health Information Technology (ONC). Jon will become the associate chief of staff of research at the Department of Veterans Affairs Salt Lake City Health Care System.

I’ve known Jon for more than a decade, first in his role as the director of the Health Information Technology (IT) Portfolio at the Agency for Healthcare Research and Quality (AHRQ) and then in his role at ONC. We’ve served on committees together, pushed the national health IT agenda, and commiserated when the promise of automation fell short, once again, of what health care needed.

Jon was ONC’s lead for the Precision Medicine Initiative from 2014 to 2017, and he contributed significantly to the IT provisions of the 21st Century Cures Act. He solicited broad consultative input on the nation’s health IT agenda, engaging the JASON advisory group to inform the direction of artificial intelligence and patient participation, and served as co-chair of the Health IT Standards Committee, which was established in accordance with the Federal Advisory Committee Act.

It would take more space than this blog post to detail Jon’s accomplishments as a federal leader in the health IT space, which would detract from what I want you to know about Jon as a mentor who became my friend.

Like the best mentors, Jon challenged my thinking. During hallway conversations and AHRQ council meetings, Jon pushed me to consider how IT could better support patient participation in health care. He pointed me toward funding opportunities, and before the term “manel” was commonly used to describe all-male speaking panels, he invited me to participate on deliberation panels and key committees.

As I weighed the pros and cons of taking what turned out to be this outstanding opportunity to direct the National Library of Medicine, Jon provided me with sound advice, pointing out the opportunities and challenges I might find in a federal position.

My friendship with Jon is a special gift that reflects not so much the quality of his mentorship but an evolution of our relationship. And when you become friends, there is a mutuality that doesn’t really exist in a mentor-mentee relationship.

As Jon moves on, I hope he carries the gift of this mentorship that turned into a friendship into the next stage of his life, and I hope you’ll be inspired to reach out to the mentors and friends in your life.  

Click here for more Musings on mentors.

Accelerating Innovation in Science

Fast.

Healthcare.

Interoperability.

Resource.

Word about HL7 FHIR—pronounced “fire”—is spreading quickly across the National Institutes of Health (NIH) and scientific community, and for good reason.

The FHIR format is a global industry standard for exchanging health care data between institutions. Most electronic health records systems in hospitals and physicians’ offices already use FHIR to send and receive critical information for patient care and to support billing for patient services. With proper oversight and human subjects’ protection, clinical research and scientific advancement can benefit from FHIR. Data is becoming increasingly important for biomedical research, including predictive phenotyping and the conduct of clinical trials. 

NIH is taking steps to promote the use of FHIR in its funded clinical research to facilitate data access and promote interoperability of research data while protecting patient privacy and ensuring consistency with informed consent.

This afternoon, Clem McDonald, MD, Chief Health Data Standards Officer at the National Library of Medicine (NLM) at NIH, announced two notices issued today by NIH regarding FHIR at the Blue Button 2.0 Developer Conference held at the White House Eisenhower Executive Office Building in Washington, DC.

The Guide Notice on FHIR  encourages NIH-funded investigators to explore the use of FHIR to capture, integrate, and exchange clinical data for research purposes and to enhance capabilities to share research data. The Notice aims to make all NIH-funded researchers aware of the emerging ability to extract data from electronic health records using FHIR and encourage them to use FHIR-compatible formats when sharing data, consistent with privacy restrictions and informed consent. Following this notice, NIH will soon solicit input from the scientific community and other stakeholders about the tools that might be needed to support use of FHIR in biomedical research, as well as implementation challenges and opportunities they foresee in using FHIR. 

To complement the research component, NIH also posted a Notice of Special Interest to inform the small business innovation research and small business technology transfer communities of NIH’s interest in supporting applications that use FHIR in the development of health information technology products and services. NIH is interested in the implementation of the FHIR standard in health IT applications, such as the integration of patient- and population-level data from electronic health records systems, access to and management of electronic health information, the development of clinical decision support systems, the enhancement of recruitment into clinical trials, and improving privacy and security for electronic health information.

These efforts will help implement the NIH Strategic Plan for Data Science and build on activities already under way in individual Institutes and Centers within NIH. The NLM’s new strategic plan positions the NLM as a platform for data powered health, which will lead to the development of new analytics and novel visualization approaches to accelerate discovery-from-data.

As we promote the use of FHIR by our funded researchers and potential developers, institutes and centers across NIH—including the NLM, the National Human Genome Research Institute, and the National Center for Advancing Translational Sciences—are taking the lead in creating and using FHIR APIs in various research domains. Ongoing and emerging efforts aim to improve the retrieval of genomic and phenotypic data from the NIH database of genotypes and phenotypes, integrate data from genetic test results into electronic medical records, and prototype the infrastructure needed to query clinical data from partner organizations. Based on what we learn from our engagement with the scientific community, we anticipate supporting development of other tools and resources that can help scientists make better use of FHIR to enhance their research endeavors.

NIH is in a key position to contribute to the development of the research capabilities of FHIR—and we come ready to combine technology, scientific research, and data to make break-through discoveries to improve health.

We’re interested in your experiences and guidance. Come along with us, and let us know how NIH can help you and your researchers make the best use of FHIR.

The Power of 10: Women Leaders of NIH

For the first time in NIH’s history, we have 10 women leading institutes and centers.

Now, when the directors of NIH’s 27 institutes and centers meet, more than a third of our voices are female.

Individually, we bring to leadership our personalities, professional expertise, and personal power.

Together, we bring what I call the “Power of 10.”

We spoke with each leader to hear about her experiences and insights on being a female director of an NIH institute or center. We heard about advocating for more women and diversity, advice for work-life balance, what’s happening at the center- and institute-level in terms of women in leadership, plus a few telling anecdotes, and the three M’s. At the end of this post, I share some of my own thoughts on the “Power of 10.”


Ann Cashion, PhD from NINR

Ann Cashion, Ph.D., R.N., F.A.A.N.
Acting Director
National Institute of Nursing Research (NINR)

A seat at the table:
I think presence is important—just being there whether at the scientific directors’ table or the institute directors’ table. Even if you don’t say something, you make others accountable by your presence.

Nursing’s unique path:
By virtue of the demographics of the nursing field, our intramural and extramural leaders are primarily women. Yet, I’m always careful with that because I think diversity goes both ways.


Nora D. Volkow, M.D. from NIDA

Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse (NIDA)

Not taking anything for granted:
Being a woman in an academic environment dominated by males has made me incredibly perseverant. For example, to achieve tenure, I had to have almost double the number of publications that my male colleagues had and to get the highest ratings. That leads you not to take anything for granted.

A shift in perspective:
It’s not that in the past males set off their brain to say, “No, we don’t want women.” It was a system that generated conditions that were not welcoming to women and one that was not questioned for there were very few women that could raise their voices and be taken seriously. The increasing presence of women in academia, including those in leadership, is changing the dialogue as the value of their contributions continuously expands. Women also bring a diversity of perspectives that enriches and strengthens institutions.

Women in leadership positions beget more women leaders:  
Women in leadership serve as an example to other women that this is possible. When someone has demonstrated that something is feasible, it becomes a reality and you don’t question it anymore. I think that this is probably one of the most important ways by which having women as directors of institutes or centers has helped advance the leadership position of women in science.


Diana W. Bianchi, M.D. from NICHD

Diana W. Bianchi, M.D.
Director 
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Women leaders are on the rise everywhere:
Having had the privilege of testifying at a House Appropriations Subcommittee meeting in April, it was very noticeable to me that nine of the 13 representatives on the committee were women. And indeed, one of the members of Congress was eight months pregnant. This created a perceptible difference in both the tone and the types of questions asked. . . We at NIH are a reflection of diversity that’s occurring in Congress as well. It’s a very exciting time to be here.

NICHD as a leader in women’s health:
So many people think that we focus exclusively on the health of children. We have made a strategic decision to better articulate our focus on women’s reproductive health. About 30 percent of our research portfolio is in reproductive health, and that is primarily in gynecologic health, contraception, and pregnancy-related issues. From a leadership perspective, we have made a decision to increase the support of science not only on disease or atypical conditions but even on menstruation and endometrial biology—what needs to occur for normal health or typical health.

The significance of more women around the table:
By having more women around the table, there’s clearly an opportunity for women’s voices and women’s opinions, but I think it does connect to more of a focus on women’s health.


Andrea T. Norris from NIH CIT

Andrea T. Norris
Director
Center for Information Technology (CIT)

Progress through diversity:
There has been a concentrated push to increase the diversity at NIH—not just male/female, but other backgrounds and ethnic diversities. It makes for better leadership and better management decisions. I see this every day. I give tremendous credit to the NIH leadership for really valuing that diversity. It absolutely makes a difference. And you can’t make much progress without it.

An exciting time for women leaders at NIH:
I encourage women to look at the role of technology in the health sector and in biomedical research as an incredible career opportunity. This is such an exciting time for innovation at the intersection of biomedical, medical, and technology domains. It’s dynamic and fast moving. Whether you have scientific skills, business expertise or know technology, there’s a role—an important role—for you in this space, especially here at NIH.


Judith Cooper, Ph.D. from OD

Judith A. Cooper, Ph.D.
Acting Director
National Institute on Deafness and Other Communication Disorders (NIDCD)

Approaches that allow for healthy work-life balance:
I support a healthy work-life balance through encouraging flexible work schedules and ad hoc teleworking, allowing the voicing of concerns and grievances via an open-door policy, and creating a work environment and meeting style where all and diverse voices around the table are heard.

Advancing and supporting others:
As I advanced in my career at NIH, I tried to bring up deserving individuals with me by offering leadership training opportunities or activities with the potential for advancement, both within and outside NIDCD. As I step down from my year-long stint as acting director, I appreciate the insights and opportunities this role has provided, and I look forward to continuing as deputy director, sharing my experiences with and paving the way for Dr. Debara Tucci, who will be NIH’s newest female IC director when she arrives in September.


Noni Byrnes, PhD from CSR

Noni Byrnes, Ph.D.
Director
Center for Scientific Review (CSR)

An honor and a responsibility:
I was stunned at how many women came up to me when I was selected as the director and told me that they were just thrilled that I had been chosen. I’ve never thought of myself as a role model, so I consider it to be a real honor and responsibility.

On being a leader and a woman of color:
One of the issues that sometimes minorities, and especially women of color, face is the questioning of credentials. I appreciate that it can be pretty damaging to be qualified with significant accomplishments, but then be questioned as to whether or not you got the position because of the boxes that are checked. There’s always a little bit of that. You can spend your time internalizing those negative thoughts, or you can move ahead to advance science and advance the mission.


Martha J. Somerman, DDS, Phd from NIDCR

Martha J. Somerman, D.D.S., Ph.D.
Director
National Institute of Dental and Craniofacial Research (NIDCR)

Having a family:
I have talked more to women about having a child and a career. I’ve shared how I read my journal articles out loud to my newborn son. They need to hear your voice. One of the interesting things is that now when I talk about having children, I talk to men, too. The conversations are not necessarily based on gender.

 More women in leadership at NIDCR:
In terms of recruiting for our intramural research, I think we’ve done a great job increasing the number of women in leadership positions over the last five years, and we have diverse research teams. Our institute also offers intramural and extramural fellowships that enhance diversity. It’s an area I pay a lot of attention to. We’re being more proactive.


Helene Langevin, MD from NCCIH

Helene Langevin, M.D.
Director
National Center for Complementary and Integrative Health (NCCIH)

Re-entering the workforce:
I’m thrilled with what the NIH Office of Research on Women’s Health is doing to help women re-enter scientific professions and research careers after having taken time off for family reasons. I had personal experience with this. I chose to leave academia for six years when my children were babies and was fortunate that I was able to come back with tremendous support from mentors—some women and some men—who helped me re-enter my academic career. But I know how difficult it is and that not all women are as fortunate as I have been. We need to do more to help. I think this can apply to men as well, but women bear a special burden with pregnancy and the actual bearing of children can physically be very hard.

Managing stress and a scientific career:
One of the things that NCCIH is interested in is helping people manage stress. I think being able to manage stress and stay healthy throughout pregnancy, taking care of small children, and pursuing one’s career is difficult. You need help from all directions, but also help from the scientific and academic environment and the funding agencies. . . Advancing one’s scientific career is important, but staying healthy through that process is very important, too.


Linda S. Birnbaum, PhD from NIEHS

Linda S. Birnbaum, Ph.D., D.A.B.T., A.T.S.
Director
National Institute of Environmental Health Sciences (NIEHS)

On the three M’s:
I think about the three M’s: mentoring, modeling and—you’re going to laugh—mothering.

Mentoring:
In mentoring, it’s extremely important that you mentor more than your students and your postdocs, for example. You mentor people around you and even people above you.

Modeling:
Modeling is setting an example. I’m frustrated by people who think that it’s really great that all they do is work. I can remember years ago when I had three little kids at home and I didn’t take anything home with me because there was no way I could get anything done. I was very efficient when I was at work. I didn’t spend a lot of time chitchatting or going for coffee. The other thing with modeling is taking time off. It’s especially positive for the younger people to see their director out of the office.

Mothering:
And then there’s mothering. . . I really take an interest in the people in my institute. Part of good mothering is knowing when your children need help and letting them make their own mistakes and fly when they’re ready. At work, I let people explore new options.


Patricia Flatley Brennan, RN, PhD from NLM

Patricia Flatley Brennan, R.N., Ph.D.
Director
National Library of Medicine (NLM)

Driving research and discovery:
Engaging with women leaders in partnership with our male colleagues sends a powerful and strong message. It’s not that we stand apart, it’s that we stand among.

We subtly but persistently bring perspective into the conversation at the NIH leadership table. It’s one thing to say that we need to hear the voices of women. It’s another thing to hear them and keep hearing them.

It’s becoming clearer every day that health is a complex interplay of person, environment, biology, and action. Women bring a lateral understanding of how to engage across these four elements to drive research and discovery in a way that improves human health.

The magnificence of magnification:
The “Power of 10” means that each of our contributions to the leadership of NIH are magnified 10 times over.