From Lab Coats to Leadership—My Candid Conversations with Dr. Lucile Adams-Campbell, Dr. Caryn Lerman, and Dr. Deborah Schrag

Interview 1 with Dr. Adams-Campbell

[00:00:05]

John Marshall, MD: We have been talking about how disrupted the world is. And in particular, we've been focusing on women in science and how not only is the world disrupted, but women in science have all had a long history of disruption, of steeper climbs, of more difficult challenges ahead and I am so pleased to introduce and welcome, another incredible voice, another incredible person who has had dramatic impact on cancer and cancer outcomes for us here in the D.C. area, but frankly, on a global scale. Dr. Lucille Adams-Campbell and I have been working together for a long time now, and neither she or I will say exactly how long. We first met when she joined us here at Georgetown having come from Howard University where she directed the Cancer Center here in Washington D.C. We had some partnerships even before she joined Georgetown, but since coming to Georgetown she has continued her work and dedication to serving those who are not equally served, if I could just put it that way. But she's also, as you can see, a woman. She's also a woman. I don't know, what does one say as a white man of color? She's a Black woman, and she has had a strong, mature, consistent voice. about what it is to be a woman in science, what it is to be a black woman in science, and we're just honored that she's joining us today for some of her thoughts. So Lucille, with all of that preamble, welcome, but give us a sense of your take on all of this. Is this real? Women have a steeper climb? Is it worse for Black women? What are your initial thoughts out there about this topic?

Lucile Adams-Campbell, PhD: Thank you for having me, John. And I will say that women in science, and women of color in science have an incredibly steep climb in this world. And the reason being is they often are looking for mentors and role models. You don't find many role models of color. And the role models that I have sought out even in my latter days in my job recently, have died. So, we have a dearth of mentors, role models that we can look up to. So, we have to really do a lot our own. We also have to do a lot with society, which means I have had white male mentors throughout my career. I started in engineering, which was a male dominated field. I spent four years in chemical engineering.

John Marshall, MD: This mean you actually know how to use a slide rule? Do you know how to use a slide rule?

Lucile Adams-Campbell, PhD: Yes, but those days have changed. But I did use a slide rule for many years. But at the same time, I've had phenomenal male mentors. Including someone named Baruch Blumberg who won the Nobel Prize in 1976. That spurred me on to become an epidemiologist. I've also had people during my training predominantly male and White institutions at University of Pittsburgh, for example. The only Black female in the program at a point in time for a PhD. So, for me the curve is very steep, but at the same time, you have to ground yourself. You have to really study. I felt like I worked ten times harder than all of my classmates. I feel that even today, I work harder than many people are working.

John Marshall, MD: Can you tell me a little bit about what that is, why that is? Is that because white men aren't listening? Is it because there's additional barriers? Give me a little sense of why you are working harder.

Lucile Adams-Campbell, PhD: Well, I'll tell you, coming through my training, one of the faculty members said I should be dismissed. I should not be allowed to get a PhD. Only because of the color of my skin.

John Marshall, MD: Seriously?

Lucile Adams-Campbell, PhD: Seriously.

John Marshall, MD: Did they say that out loud to you?

Lucile Adams-Campbell, PhD: They said that out loud, and my chairman, who was my staunch supporter, said, ignore this person. You don't work for this person. You don't take classes with this person. You will get your PhD. You are staying in the program. But I always had to make certain I worked much harder than everybody else. I'm an epidemiologist. We did a lot of biostatistics. We did a lot of computer programming. People would run computer programs. What was I doing? I was writing the programs that people were running. I always had to go to another level, just to fit in, just to fit in.

John Marshall, MD: Let me, let me drill down on that a little bit more because, you know, I think about today. And diversity, equity, inclusion, and all of the vulnerability that that's there. Because you went from a world where someone could say out loud to you, a mentor or a boss could say, you can't do this because you're a Black woman.

To now, to for a while there, that was no way anyone would be able to say that. To now, I think it's okay to say again.

Lucile Adams-Campbell, PhD: Now it's okay to say, and I can tell you that I have witnessed white medical students, I'm not calling any places, that say Black people are just taking up space. We can do better without them. So, these things are now made very easy to say. There's no punishment, nothing. You just said it. And so that's a, that's a really big change. And right now, Black and Brown people are almost invisible. And we watch the administration just wipe it out. Wipe it out. Anything that even is remotely linked to minorities. It's taken away, and that's very demoralizing feeling. They know that. So all you can do is stay pigeonholed, do your work, don't go out of your little square domain because of what's going on.

People don't understand what DEI is. It's supposed to be enhancing diversity, equity, and inclusion in the workforce. Did you see the Super Bowl? Did you hear the comments after the Super Bowl? The halftime show performed by All Blacks what did the white women complain about? There were no whites in it.

But you don't want diversity, equity, or inclusion. So, an all-Black performance should be applauded because that's what you are asking for. Blacks and Browns are really being removed at an alarming pace. Without any rationale.

John Marshall, MD: Let's talk a little bit more about mentorship. Is it different today? Are there specific, mentors that are bringing forward women? And women of color and people of color. You know, I was thinking about my own medical school class, my own faculty here. It's about half and half men and women, many more people of color than certainly we had 10 years ago.

Do you see that trajectory of mentorship changing?

Lucile Adams-Campbell, PhD: I think we will strive to continue in the same vein that we're going now. I think we have external forces that might try to slow us down, but at least mentally, I think we are there to see. Increases in women, increase in minorities, in the whole arena for oncology, for medicine, I think that would be the norm.

John Marshall, MD: Let me ask a very biting question. If you put training grant money out for specific subgroups, let's say women, or let's say people of color, one argument is that that's making the hill less steep and that you're identifying the right person and overcoming them. The discrimination, if you will. The counter argument is that you're setting aside money for maybe people who are less qualified and my argument has always been the former and that you're allowing people through that would not have gotten through otherwise.

But do you think there's any legitimacy to the qualification issue?

Lucile Adams-Campbell, PhD: You know, I've heard this discussion about qualifications, saying, can't remember who said it, but on national TV, if I get a Black surgeon, I know that they're less qualified. Standards have not changed. So my, my take on that is, We have a training grant. We do want to make certain that we bring on minorities. But guess what? If they do not come up to the bar, we do not bring them on. So we believe that people of color, they excel just as their white counterparts. There are people that aren't of color that don't do well. But we put all the pressure and emphasis on minorities are always at the bottom of the, of the, of the poll. So I believe in targeted recruitments. But not just as a handout. People that deserve to be in. Now, do we ever make exceptions? Not really when it comes in terms of what they can do. If there's no way this person can do this job, not hiring. Not hiring them. So, I think I've been true to that. People that come on and they can't do the work, they have to be let go. I think it has to be fair system across the board.

John Marshall, MD: I was just in a country, New Zealand, believe it or not, where it was the first Western country where women were given the vote, quote unquote Western country. And then I was thinking about that women in this country have only frankly recently been given the vote. Black women, you know, the last of the group.

And then, but then now this swing back the other way, that basically, as you say, to make them invisible again.

What's your advice to our folks out there who are listening in to me as a white man? What's your advice to us to how do we push back against this?

Lucile Adams-Campbell, PhD: Well, I think there will be a revolution one day. I think it will be televised. We always say a revolution will not be televised, but it will be televised.

John Marshall, MD: Or it'll all be, you know, filmed with this, right? Yeah.

Lucile Adams-Campbell, PhD: Filmed with your phones.

I think it's really important that we stay the course. We cannot back up. We cannot back up and back away. We have to stay the course, and we have to start fighting more for what is right. We know what's happening is wrong. Now, my mother, as you know, who died, was 101 years old. She said to me one week before she died, ‘I am sorry that you're getting ready to live the life I lived when I was growing up.’

I think we have to fight, but we're in a very awkward position right now. We have the oligarchs, we have the, the, the authoritarian approach, and in that type of system, it's very dangerous as well. So, we have to stay the course with our science. We have to keep doing as much as we can to promote ourselves, but we still have to collaborate and work, and we have to be inclusive. This not work in silos, it's not just about Blacks or Brown people, it's everybody. And the difference now, and I'll say this out loud, the difference nowadays is the fact that oppression has been felt by Blacks. I have felt oppression, racism, discrimination all my life. I have had different people over time, even here, say comments that they don't realize are really offensive and racist. But you understand all of this racism going on, you still have to function. You still have to keep working. You still have to do what you do. But you hope that the people in power will not just sit back and let it happen to our institutions, to our universities. Don't take away our academic freedom. We have to be certain that we're fighting for the right things. And what's right is not what's happening in this world.

John Marshall, MD: I see you as one of my mentors. I know we're peers as well, but I also see you as an important mentor to me. And you've taught me many things over the years, and you continue to even with our discussion right now. Still keeping the job going. I get that. You know, try to keep your head up, keep looking forward, but it feels to me, I feel like, as, as a voice, you're a voice in this world, that it needs to, in fact, at our level, be even a little higher at the leadership level of a tone setting or, not just show up and do the job, but to somehow not accept what's going on at the same time, and that's a fine balance, right? Because we work for institutions that need to keep existing. Is there any advice that you would give me or share with others about pushing that envelope further than just showing up and being inclusive and being accepting? Is there something more that we should be doing in your opinion?

Lucile Adams-Campbell, PhD: We need to stop labeling. We need to just do the work. We label DEI, and it gets struck down. But we need to get rid of the labels and do the work. If you're going to build your community, build your scientific world, build your labs, whatever you're going to build, it being inclusive of people. And that's really not what's happening. People say it, they say those words, but it's not happening. I think we need to be involved and engaged at every level. So, you're in leadership roles, I'm in leadership roles, but who's really in leadership in academia? It's the lawyers, not us! We want to fight for it. I just had a grant that was taken from me, but it wasn't because of DEI.

John Marshall, MD: Well, it had the word woman in it, didn't it?

Lucile Adams-Campbell, PhD: Women, Women's Health Initiative.

John Marshall, MD: That's out!

Lucile Adams-Campbell, PhD: It's out. But also it was with Columbia University. And they are a hot target right now. So, I really don't have a solution. Because we have to keep fighting.

But you know, I look at the farmers as an example, and it's really intriguing and very sad. We have been oppressed for so long as people of color. Now, what's different? The difference is, now, everybody is feeling it. Before, you've never felt this before. And I think that's the difference that's happening right now. That White people are feeling that they are being oppressed. Even those that voted for this administration never thought it would come back and hurt them. So, for me, I do sit back at some point and say this what we've always gone through. Now, there's a change in mentality across the board, across all races and genders. You know, it is a change. So, that's, that's different. That's different. Have you ever felt like this before?

John Marshall, MD: No, I keep saying that too. I've never lived at a time. I mean, we keep equating ourselves with the Jewish people in 1937, right? And the Black people in, you know, slavery and post slavery. and, and now white guy, Presbyterian White guy from, you frigging Mayflower is now feeling it, right?

Lucile Adams-Campbell, PhD: That’s the difference.

John Marshall, MD: Yeah.

Lucile Adams-Campbell, PhD: And that, and that different feeling, I think, is going to help us regain what we need, because it is now oppressing everybody. And when I go back to the farmers, the white farmers are outraged because they are not getting the money that was promised to them. But they never cared. The Black farmers never got a penny of the money. So now, the Blacks have always struggled in farming. But they made it. Now the Whites are struggling, and they don't know what to do.

John Marshall, MD: Will we ever stop scoring people based on their skin color? And do you think this is an opportunity for us to get there? Do you think that's ever going to happen?

Lucile Adams-Campbell, PhD: In this administration?

John Marshall, MD: No. In our lifetime, how about that?

Lucile Adams-Campbell, PhD: A lifetime. Well, I think there's beauty in skin color.

John Marshall, MD: Me too.

Lucile Adams-Campbell, PhD: I think that there are so many hues that we have to look at. I don't think it would be really a nice fit for everybody to look the same. So, I think the diversity in color tones and hues is so important. So, for me, we win. with the score with all the different shades of gray, literally. I think we really win.

John Marshall, MD: I'll tell our audience, I'm hoping you watched all of this. Dr. Lucille Adams Campbell, an amazing voice, an amazing mentor to me, and I hope now to you, Lucille, thank you very much for joining us today on Oncology Unscripted.

Lucile Adams-Campbell, PhD: Thank you.

[00:18:39]

(Transition - Interview with Dr. Caryn Lerman and Dr. Deborah Schrag)

[00:18:45]

John Marshall, MD: Hello, everybody. I promise you famous people to interview. And I'm lucky enough to know, they won't admit that they know me, these two people, but they are incredibly famous, successful people in the world of cancer. Dr. Caryn Lerman on the other coast out there, where it's probably warm and sunny out in Southern California. Dr. Deb Schrag, who is just up 95, somewhere up there, who is up curing cancer, GI cancer person from up there. These are leaders in the cancer world and they have agreed to join us for Oncology Unscripted today to talk about something we've been dancing around in the last few episodes, and that is women in science, women in professions, and the fact that over time, since sort of modern science, I guess we'd say, the DNA and things like that discovery is that women have not consistently been credited with their contribution with their success with their leadership in this world.

And so, they were nice enough as successful leaders in this world to join me today to share a little bit about their perspectives. Caryn let me Let me pick on you first, if you will. I mean, you've made it to leadership role in an NCI designated comprehensive cancer center in the biggest city in America, right? That's still the biggest city in America. So, tell us a little bit about your perspectives and your thinking about women in science.

Caryn Lerman, PhD: Well, first of all, thanks for having me, John. I totally admit that I've known you for decades and I'm really excited to be here.

I started, In the mid-80s. So just to give some context, and I was fortunate to have an absolutely exceptional female mentor Barbara Rimer, who ultimately became Dean at UNC, Dean in the school public health. And so, I was fortunate to have a wonderful female leader, role model who took me under her wing and helped me. And I will say that as my career advanced and I had the opportunity to work at other institutions, it became very obvious to me that there are very few women in leadership roles as role models as mentors, and I've had great male mentors as well, but I think it's very important because there are unique perspectives and it is more challenging as a woman.

 If you look in the cancer center leadership space, you know, and in the research space, this is where I live. Even now, there's just a small minority of cancer center directors who are women. Okay. And, and then you look at the next level down, you know, associate directors and deputy directors, and it's still like 80, 85 percent are men still at that level. So, 10, 15 percent are women.

John Marshall, MD: Can I, can I drill down on this mentorship thing?

So, when you have a good mentor, I, I, this is white man looking from the outside in. Okay. So, I want you to mansplain back to me what the reality is. Are there some women mentors that just say, tough it out. You're not. You're not strong enough or so or are you all actually is the mentorship of recognizing that this is an unfair world and here's some strategies for getting there or is it both?

Caryn Lerman, PhD: Well, like anything, there's a lot of variability, right? And I think there is some folklore and there's probably a kernel of truth in the fact that the farther you go back. The harder it was so there's a little bit of I had a battle my way through with all my male colleagues, who treated me differently, didn't let me into the old boys’ network,  who felt that I had to always be charming and not push back and had different expectations. So, you do have sometimes women coming, you know, moving up the ranks, feeling like you do just tough it out, tough it out, tough it out. And I think as I mentor people for me, it's really about how do you be authentic to who you are? It's not about trying to be one of the, the, the guys, it's about, you know, being authentic, being authentic to your personality, showing compassion, being nurturing and being tough when you need to be tough. So, I think there's some great female mentors out there, but there are also some who are pick yourself up by your bootstraps because it's tough out there, and I had a tough. So just deal with it.

John Marshall, MD: Yeah, Deb, let me get to you, because I think about, you know, I'm a member of the GI old boys club, right, and I think part of the reason why I'm still giving the same adjuvant therapy for the last 20 years, and no other cancer is that true, but colon cancer, is because of it some old boys that didn't want to move things. But you have in fact changed standards of care and in the backdrop of an old boy’s club through innovative clinical research and taking a stance that, you know, was impressive and you stuck to it and succeeded. So maybe reflect a little bit at that research level and, you know, disease orientation and clinical leadership roles. You know, some of the struggles or feedback you would have in this space.

Deborah Schrag, MD, MPH: Yeah. So let me start by saying that, you know, Caryn and I have different roles, and we have different jobs and have had somewhat different trajectories, but I agree with everything she said. I think it applies to people who are focused on wet lab research, dry lab research, you know, basic biology, behavioral, clinical trials. It spans the gamut because these are fundamental human sort of issues about how we work together and what people's expectations and biases are. I think as women leaders, we have to get comfortable with ourselves.

I completely agree with what Caryn said about authenticity. Women lead differently. We just have different styles. There are certainly women who lead like men and men who lead like women, but as a generalization, and this is a generalization, you can find many exceptions. Many women have a more male style, and men have a more female style. It is really hard for us when everyone is angry with us when we feel like everyone is hating us for making difficult decisions, not to staff, not to grant, not to fund to say no, that is really hard. And those are hard skills to learn. And women struggle with that. Some of it's very cultural.

For us to learn how to be comfortable with power, to navigate conflict, to communicate clearly, to sit with the discomfort, and again, that is with people who are above us in positions of power, people who are our peers with similar levels of, as well as with trainees and mentees and team members because science is so these days to do anything really impactful and involves a team. And you have to inspire and lead a team, and you have to make tough calls. You know, we were going to do this project, the budget was cut by X, and we got to chop off an aim or we submitted this grant. And it had four components, and this part scored really badly. And so now we are cutting your project loose. That is something that women leaders, I think, that's something that women really struggle with. I think men have the same struggles, but I think they sometimes experience them differently or feel the pain, a little bit less.

Would Caryn agree? I'm curious if she agrees with me or not.

Caryn Lerman, PhD: I agree 100 percent and I'll just add that I think that still in this day and age. And there's research to back this up. Women are more likely to experience the imposter syndrome, more likely to downplay what they have to offer. And I would just tell you, I've run a lot of searches, and you have women, you know, reaching out to people say, are you interested in being chair of department X? I don't know if I'm qualified for that. Yes, you are, come on. I don't know. And then. It's just a very, it's very different for people to even consider their candidacy or whether they are worthy of roles like that. The system has created some of that and I 100 percent that.

John Marshall, MD: Let me lean in on that, because on the other end of Pennsylvania Avenue, just down that way, this is only going to get worse, right?

I mean, right now the public tone is very male driven, women minimizing, almost dehumanizing tone. So do you feel like that the gains that have been made in science and medicine are even more vulnerable now than ever before?

Deborah Schrag, MD, MPH: So, so John, I want to just quickly respond to that question, Caryn I don't mean to interrupt. Women should not interrupt each other, but you know, are we all terrified and worried and distraught about the immediate future? Yes, sure we are. We are. Noone in biomedicine is happy, whether, no matter male, female, junior, senior, east coast, west coast, blue state, red state, we're all concerned, alarmed even. But when you look at the long game and look at the arc of history and how much progress has been made, women are too central. We are too critical to the biomedical research enterprise. It cannot function or run without us. If you look at PhD graduates, medical schools, yes, at the top echelons, I completely agree with Caryn about it still hasn't penetrated up to the top-level C suite. But I believe that in the long run, that is going to happen because the talent is there, the training is there, the motivation is there, the skills are there, and we are in it for the long game.

So yes, we're in a bad patch, but long game? We're going to prevail. I know. I believe nothing can prevent that from happening because it's so powerful.

Caryn Lerman, PhD: I have to agree. And I love your optimism. I agree. But I do at the same time, these the efforts to dismantle programs, you know, in the name of efficiency, reducing staff at NIH, reducing indirect costs. This is going to affect all of us. And that means that this is the time where we have to band together as scientists of all of all genders and all backgrounds, because we're going to lose the tremendous breakthroughs and scientific gains that we've made over the decades. And, and that to me is the biggest threat that's out there right now.

John Marshall, MD: But let me lean in on that just a minute for the last few comments from you guys. And that is, when we went back and looked at literature around women in science, one of the very strong themes that came forward was the lack of credit. Those people who had done the work were not on the papers or were tucked in the middle or, and the like. And I, there was part of me that didn't understand that there, is this right, even today that if you that as a woman, you might not get the proper credit because of your gender.

Caryn Lerman, PhD: I don't feel that I've experienced that personally. Obviously, I feel it's wrong. I feel people should get credit and there should be transparency about individuals’ contributions and agreements up front about authorship and who's going to be PI, and so forth. I guess I've been fortunate to not experience that.

Deborah Schrag, MD, MPH: I wish I could say the same as Caryn. I have experienced that, and I think it continues to be an issue, but it relates to the comment I made earlier, which is that women are more likely to be conciliatory. We have that hardwired in us from pre-kindergarten. So, when there's a discussion about authorship, sure. Let's have two first authors and two last authors and you can be, I'll be second. In other words, I'll be the one, I'll be the co first author, but you can go first, I'll go second.

But women are also wily and strategic. We're in it for the long game. We're not going away. I think we have to support and coach each other.

 but I think that we are really making great strides. I've seen it, and I think that when there are more women who are directing cancer centers, and who were sitting on panels, whether study sections or other things. That is a really important corrective because they help ensure that awards. Resources grant funding is allocated according to merit, which is what we all want, right?

That's what we all want. We want merit-based systems. We really do.

John Marshall, MD: You guys have been awesome. I know you both have lots to do, and I've interrupted your busy day and the world's gone to hell. We all know that we're trying to hold on to what we can. So let me, on behalf of everyone, thank you guys for sharing your thoughts and your feedback on this.

And I know that your comments and your success, personal success and collaborative success will have an impact on women in the future to where this will not be a subject in the years ahead. That's the goal.

Caryn Lerman, PhD: Thank you very much.

Deborah Schrag, MD, MPH: Thank you, John.

John Marshall, MD: It's just amazing to talk to such smart people who have made so much progress, not only for cancer and cancer medicine, but for women in science. And so, I'm very grateful to Deb and Karen for joining us. And to all of you out there for sharing and thinking about these issues in front of us, not only the, the parity in individuals, women versus men, diversity, equity, inclusion, accessibility, but also in the increasing threat day in day out threat that is to science from our current administration and how we will keep innovation going forward. We all have to work together to ensure that success.

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