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Big data, machine learning & artificial intelligence — how BCVS19 showed me that basic cardiac researchers needs to take these more seriously.

I had one main goal this year when I attended BCVS19 in Boston: go to sessions I normally wouldn’t.

Basic cardiac researchers, myself included, can sometimes have a very narrow field view. We tend to focus on the workhorse of the heart, the cardiac myocytes. For a long time, other cell types were completely overlooked. Only recently have big conferences, like BCVS19, started to have more sessions focused on the unsung heart heroes like fibroblasts, inflammatory cells and even fat. These are now the norm now, which is definitely how it should be.

At BCVS19 this year, sessions such as “Beyond Myocytes and Fibroblasts: Forgotten Cells of the Heart” and “The Future of Cardiac Fibrosis” provided myocyte-free perspectives that are desperately needed. While I was excited to experience these talks, I noticed there’s another area that is critical to the future of cardiac research that I’ve been overlooking.

The last couple sessions touched on how to handle big data, machine learning and artificial intelligence (AI) both in basic research and clinical settings.

Based on session attendance, I wasn’t the only one who had been overlooking these topics.

Now, this low turnout could be because these sessions were towards the end of the conference, but I’m not sure that’s actually the case. Either way, I’m glad I decided to make it because I found myself wanting to know more about pretty much everything that was discussed, which is basically the whole point of going to conferences, right?

TheAdvances in Cardiovascular Research — New Techniques Workshop” was a panel of experts fielding questions from the audience. I was most struck by the information Dr. Megan Puckelwartz from Northwestern provided about her experience doing human whole genome sequencing experiments. Among many things, Dr. Puckelwartz mentioned that universities need to prepare themselves for the future of genomic research because most institutions don’t have the storage capacity needed for this analysis. The scale of data storage needed is massive, but few institutions are ready. Advances in genomic research are fast approaching personalized medicine becoming a reality, but we can’t harness the power of these experiments if we don’t have anywhere to store the data.

More people should be talking about this and discussing concrete solutions.

On the last day of the conference, on a whim I decided to attend the “Machine Learning, Big Data and AI in Heart Disease” session, which was worth it.

Simplified model of how machine learning works. Source: https://machinelearning-blog.com/2017/11/19/fsgdhfju/

Simplified model of how machine learning works. Source: https://machinelearning-blog.com/2017/11/19/fsgdhfju/

Kelly Myers, the chief technology officer from the Familial Hypertension (FH) Foundation talked about their work focused on creating an algorithm to better diagnose FH patients from their national registry/database called CASCADE. This was desperately needed because even though 1 in 250 people have FH, only ~15% of patients with FH have been identified, mostly because current biomarkers aren’t sensitive enough. With their machine learning algorithm and collaborating with several institutions and physicians, they’ve been able to identify 75 factors that fit into six distinct categories that are predictive of the disease. Looking at lab results alone isn’t enough — more information is needed but this wouldn’t have been understood without a machine learning approach.

Dr. Qing Zeng, the Director of the Biomedical Informatics Center at GW School of Medicine also talked about her AI/ deep learning approaches focused on improving the cardiac field. She mentioned that using deep learning approaches is advantageous due to their ability to model highly non-linear relationships. She also discussed that the main challenge in applying this approach to clinical data is that it’s not a magic pill — clinical data is highly complex. There are many missing values and researchers have to present the data in a way physicians will accept/understand. Because Dr. Zeng’s work was focused on creating a model that could predict if heart surgery was worth it for patients who were deemed “frail”, the cooperation from the cardiac surgeons is key.

When asked “Have you asked surgeons if your score aligns with their opinion about whether a patient should have surgery?” Dr. Zeng responded: “This is tough, we would like to compare what we recommend against what humans expect, but cardiac surgeons aren’t willing to give us a score, so we have a hard time pinning down it actually means to evaluate this against humans.” To make AI/deep learning studies relevant, the researchers and physicians need to figure out how to communicate.

Overall, I learned a lot from these sessions because they highlighted how far the field needs to grow in these areas. Looking forward to BCVS20 next year to see if we’ve figured out a way to work through these growing pains.

 

 

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BCVS 2019 Put Early Career Investigators at the Forefront

Attending conferences can feel overwhelming for young scientists because there’s a lot expected from us at these events — we’re supposed to learn the latest science, present our own work and make connections with potential collaborators or future employers.

It’s a lot.

Luckily, many meetings are building resources into the actual conference programming to help early career scientists with these daunting tasks. I was happy to see last week when I attended the American Heart Association’s Basic Cardiovascular Sciences (BCVS) conference, that the program was sprinkled with a multiple sessions specifically tailored for young scientists.

Attendees during the Early Career Investigator Social Event at AHA’s BCVS 2019 conference. Photo by © AHA/Todd Buchanan 2019

Attendees during the Early Career Investigator Social Event at AHA’s BCVS 2019 conference. Photo by © AHA/Todd Buchanan 2019.

Two sessions in particular called “Oh All the Places You Can Go … With a Degree” and “What I Wish My Mentor/Mentee Told Me” were a welcome change from the rest of the conference — and they were actually helpful.

Both events were career development panels, but they each had their own twist.

The “Oh All the Places You Can Go … With a Degree” panel had professors, a grant writer/instructor at a large cardiovascular institute and an industry scientist. The panelists’ diverse backgrounds and experiences allowed for an engaging discussion about the most effective way to start searching for a job, especially if you’re not looking to go the traditional academia route. This was particularly welcome since the chance of young scientists landing an academic position is insanely low. Young scientists need to be prepared for this environment.

During the “What I Wish My Mentor/Mentee Told Me” session, graduate students, postdocs and faculty talked about the academic side of mentoring — how to find a good mentor, how to be a good mentor and what to do if problems arise. Overall, I thought this session was interesting but most of the questions were geared towards the professor’s perspective. Also, it quickly became apparent that the participating professors were the actual mentors of the trainees on the panel, so it didn’t seem like an environment where the trainees could be completely honest about their work experiences because their bosses were sitting right next to them.

Both sessions were really well attended with almost every seat filled. I’m really excited to see events like these at future BCVS conferences and it seems like I’m not the only one.

 

 

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It’s conference season! Did you pack your inclusive resources?

Summer is in full swing, which means it’s conference season! At every stage of our careers, conferences are essential for our growth as professionals, but these meetings need to be inclusive of everyone attending for them to have the most meaningful impact. Maybe you’ve never had any issues attending a conference and don’t really see why something like this would need to be discussed, in which case, great for you, but I implore you to keep reading!

conference attendees

Photo by Product School on Unsplash

Diversity within our scientific communities is extremely powerful and strengthens the outcomes of our work, however, the structure of our community has traditionally only taken one kind of person into account, which prevents the rest of the members from flourishing. We need to ensure that these critical meetings are inclusive from the planning stages all the way to the actual presentations given on the day. Whether you are planning the meeting, presenting or attending, there are ways we can all work together to make these experiences successful for everyone.

Luckily, other organizations have put together helpful resources focused on this specific topic that we can all benefit from. These are obviously just a few select resources – I urge you to start with these but seek out more.

  • If you are planning a meeting or symposium, the 500 Women Scientists have created a comprehensive guide to organizing an inclusive meeting that is definitely worth using. It also explains what implicit bias is and why guides like this are necessary. There are also resources for mindful gender pronoun usage as well as ensuring gender neutral restrooms are available.
  • To make sure that your conference is accessible to disabled people as well, Gabi Serrato Marks published this guide via the Union of Concerned Scientists. What’s great about this How-To is that it’s helpful for organizers, presenters and attendees.
    • Google slides and PowerPoint now allows you to automatically add closed captions to your presentation, which automatically increases the accessibility!
  • Does the conference have reasonable accommodations for lactating scientists? Access to these spaces is critical for those caring for infants while attending the conference – this wonderful guide is a great place for organizers to start as well as for attendees to use to suggest improvements.
  • Academic conferences also need to be prepared to handle reports of harassment (sexual or otherwise) during the meeting. Does your professional society have a code of conduct for expected behavior and enforcement procedures to handle these issues? If not, the American Geophysical Union, has a great example to suggest for the future.

Conference season should be an exciting time for all scientists/physicians, let’s work together to make sure this becomes the reality.

 

 

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Getting To The Heart of Long-Term Space Travel

During my last years in graduate school, I learned that the coolest experiment to ever be conduct was about to take flight – literally. In the genetics world, twin studies have been a classical tool used to study the nature vs. nurture effect of any given trait or disorder in humans. With the ever-increasing interest in understanding how long-term space travel affects humans, exploring this idea would obviously benefit from controlled twin studies, but what are the chances that NASA could actually find identical twins that are both qualified enough to be astronauts?

Turns out not as low as you would think!

Mark and Scott Kelly are twin brothers who joined NASA in 1996 and already had many spaceflights under their belts before the idea of a twin study even popped in to anyone’s head. However, in 2015, NASA jumped at their opportunity to perform what I think, is the coolest science experiment to have ever been executed. To get a better understanding of how being in space for an extended period of time, the NASA Twin Study would monitor an outstanding number of biological variables in both brothers before, during and after Scott’s 1-year long stay at the International Space Station, while Mark stayed on Earth.

While that alone makes for a pretty outstanding story, the best part of this experiment was truly how collaborative and integrative the studies were. The study was coordinated by NASA’s Human Research program, and over 84 researchers across 12 different universities performed the insane amount of work to analyze 10 different biological areas, including:

  • Biochemistry
  • Cognition
  • Epigenomics
  • Gene Expression
  • Immune
  • Metabolomics
  • Microbiome
  • Proteomics
  • Physiology
  • Telomeres
NASA Twin Study experimental design via Garrett-Bakelman et al., Science 364, 144 (2019)

NASA Twin Study experimental design via Garrett-Bakelman et al., Science 364, 144 (2019)

They knew they probably wouldn’t have a shot like this again and took advantage it. I was ecstatic in April when I saw the published results of the study since I’ve been following this experiment for years. Obviously, I was most interested in how cardiovascular function was impacted by long-term space travel. It’s been well known that the gravity-free environment of space takes some pressure of the heart from working so hard, but since the heart is a muscle, this lack of use causes a decrease in muscle mass. To combat this loss of muscle mass, astronauts typically spend ~ 2.5 hours exercising on the International Space Station! The heart also changes shape in space becoming more circular rather than elongated. Luckily, these changes return to normal once the astronaut returns to space, but what does spending a year in space do to your heart and vasculature? Here are the main cardiovascular changes from this study:

  • Cardiac output increased by of 10% while moderate decreases in systolic and mean arterial pressure were observed (these findings are consistent with previous studies)
  • The carotid intima-media thickness increased while Scott was in space and remained thicker 4 days after landing.
  • Inflammatory cytokines and chemokines were increased during all spaceflight timepoints and returned to normal after landing.
  • Urine levels of Collagen alpha-1(III) chain (COL3A1) and collagen alpha-1(I) chain (COL1A1) proteins were increased compared with preflight values, and these returned to baseline levels postflight.
  • An increase in the ratio of plasma levels of apoliprotein B (APOB; a major constituent of LDL particles) to apolipoprotein A1 [APOA1; a major constituent of high-density lipoprotein (HDL) particles] during the last 6 months of the mission in space. This ratio came back to baseline once Scott returned to Earth.

One of the most important take-home messages is that many of the variables analyzed either stayed the same or returned back to baseline once Scott came back to Earth, suggesting the effects of being in space for a year, on the heart in particular, is temporary and reversible. Obviously, the results of this study are limited because only one set of twins was analyzed so it’s hard to definitively say that these results represent how a year in space affects all of us – but it gives great insight into the biological effects of long-term space travel.

While I only focused on the cardiovascular results here, this study has an insane amount of information that is definitely worth reading, particularly since there were some variables, such as telomere length and DNA damage that changed during Scott’s time in space, but never returned back to his normal levels. That SpaceX flight might not be the best idea *just* yet.

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Feeling Burnt Out? You’re Not Alone.

No matter your profession, burnout, which is caused by chronic stress, is something many of us have experienced. On top of our ever-changing work loads, the news cycle is non-stop, we’re constantly bombarded by social media and our bosses know we can be reached via email at any time – it’s a lot to handle plus trying to have a social life. Burnout is more than just being stressed or having a tough day on the job – it’s stress to the next level typically characterized by emotional exhaustion, feelings of ineffectiveness and cynicism. The way in which work-life balance is structured in American society has cultivated a rich breeding ground for burnout to flourish across fields, particularly in the sciences. If you’re worried about yourself or a colleague, this Nature article has a great list of signs of burnout for reference.

While burnout is not technically deemed a medical illness in America, it can definitely lead to issues such as depression that need to be taken seriously, especially since rates of depression in bioscience graduate students is six times higher than the general public. A recent report from a variety of Harvard and Massachusetts medical organizations concluded that burnout in physicians is a public health crisis. Obviously the main concern here is for the mental well being of physicians, but we also have to consider that patient care is also probably suffering.

physician burnout

Source: https://www.athenahealth.com/insight/technologys-role-fixing-physician-burnout

Ok, all of this sounds super important, but how can we actually tackle burnout?

Studies suggest that improving the amount of work-time devoted to activities that are most meaningful to you is particularly helping in combating burnout. Working to improve your work-life balance, taking more small breaks from work and doing more exercise will help. And while I definitely don’t disagree with any of these suggestions, part of the problem to begin with is that physicians and researchers don’t feel like they have time to make these adjustments in the first place. The Harvard report mentioned that while wellness approaches (yoga, mindfulness, self-care) are good in theory, they should be employed in complement to structural solutions, such as proactively treating mental health and hiring Chief Wellness Officers to continually monitor physician burnout. Hopefully academic institutions start taking this seriously, as well.

There are other alternatives to handling burnout that maybe aren’t as obvious. Earlier this year my blog focused on a great science outreach event (She Looks Like A Cardiologist), hosted by Dr. Kathryn Berlacher, where 28 female high school students interested in becoming cardiologists got to meet with local women in cardiology. When I asked Dr. Berlacher what motivates her and her colleagues to create events like this or volunteer at other science outreach initiatives she mentioned:

“Things like this (and all our other volunteering), keeps us grounded and really provides perspective. I honestly think it’s a great way to bond – AND to combat burnout in the field, which is another hot topic. If you feel valued and feel that what you’re doing is making a difference, then you’re much less likely to get burnt out at your job.”

Getting out of the lab or hospital to give back to the community is another anti-burnout tactic professionals can use to switch up their daily routine that has worked well for others. Personally, it’s great to hear that approaches such as this help combat feeling burnt out because I love participating in science outreach and I think that’s the key to handling this issue, enjoying how you spend your time. Because that’s why we all went in to research and medicine in the first place, we loved doing it! If enough people in our fields start to take this issue seriously, we can begin to make the structural changes needed to make the difference – let’s start now.

Looking for more resources or takes on this discussion? Luckily the 500 Women in Medicine and the Medical Professionalism Project had a great twitter chat under the #MedBurnout tag that is definitely worth checking out.

 

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The Future of Wearable Technology & Detecting Atrial Fibrillation – An Update!

Last November at AHA18, I was lucky enough to catch a talk from one of the investigators, Dr. Marco Perez, working on the Apple Heart Study, where he described the goals of the project. I even wrote about it for the blog I wrote at AHA18 in Chicago, which you can find here.

To quickly recap, this unprecedented collaboration between Apple and Stanford is a progressive clinical trial that uses data from Apple Watch devices from over 400,000 participants. The main purpose of this study was to examine if atrial fibrillation (AFib) can be reliably diagnosed from irregular pulse notification data from wearable devices. In November, Dr. Perez mentioned that they wouldn’t have data until early 2019, and this past March, they released some results that are really exciting.

Highlights from the findings include:

  • Around 0.5% of participants received irregular pulse notifications, which was particularly important since people were concerned that these devices would potentially over-notify people.
  • The pulse detection algorithm of the Apple Watch has a 71% positive predictive value – this was compared to simultaneous electrocardiography patch recordings.
  • The majority of the time (84%) when participants received irregular pulse notifications, they were found to be in AFib at the time of the notification.
  • 1/3 of the participants who received irregular pulse notifications and were then followed up by using an ECG patch over a week later were found to have AFib. This isn’t entirely surprising since AFib is an intermittent condition, so it’s not uncommon for it to go undetected in subsequent monitoring.
  • 57% of people who received irregular pulse notifications sought medical attention afterwards.
  • A clinical trial could be conducted in this large-scale virtual manner

The last point is particularly important because this is the first study of its kind. It was almost completely virtual, at least from the standpoint that the researchers analyzing the data never once had any contact with the participants. Additionally, the scope of the number of people who were analyzed is impressive – 400,000 participants is quite the sample size, especially for someone like me who studies heart disease in mice!

Because AFib is an extremely common condition, affecting between 2-6 million people in the United States, that often goes undiagnosed, understanding that wearable technology can aid patients in detecting their condition is huge. Also, with the increase in technology in our health care sphere (specifically in cardiology), something that was expertly discussed by Dr. John Chen earlier this year on his blog is that this is just the beginning in understanding how wearable technology can help us treat disease. We now have another tool in our kit, and this one looks promising.

In Stanford’s press release, Dr. Perez said, “The performance and accuracy we observed in this study provides important information as we seek to understand the potential impact of wearable technology on the health system. Further research will help people make more informed health decisions.”

Interestingly, Johnson & Johnson and Apple recently announced their plans to build off these preliminary results by partnering together in a new project called HEARTLINE. This study will focus on an older population (~ 65 years) of around 150,000 participants who, due to their age, are at a higher risk of AFib. It’s a really exciting time to be in the cardiology field since this is just the beginning of this type of research, which is full of therapeutic potential.

It’s also really thrilling to be able to follow-up with this study, especially since it all started with my father-in-law, who has AFib, being nervous about using wearable technology to detect his condition. I’m excited to share this data with him as well since maybe he’ll feel a little more comfortable using it now.

Examples of the notifications that participants in the Apple Heart Study receive. Courtesy of Apple

Examples of the notifications that participants in the Apple Heart Study receive. Courtesy of Apple

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Women’s History Month: Cardiology Edition

Somehow it’s already March, which means it’s Women’s History Month, so I wanted to take this opportunity to highlight some of the many amazing cardiologists and researchers (who also happen to be women) who have shaped our field.

Last month, I wrote about the importance of science outreach, especially with regard to promoting science and cardiology to young girls and women, because women still make up around only a third of scientific researchers and only around 13% of cardiologists are women. To learn more, Renee P. Bullock-Palmer’s most recent blog is a great resource.

This month I wanted to highlight some of the women who paved the way for the rest of us.


Now, unsurprisingly, simple Google searches for things like “scientists who shaped cardiology” or “most famous cardiologists” provide results that are pretty male and pale. There weren’t that many pieces that included women in their lists of cardiologists/researchers, and there were only a handful of sources I found that focused specifically on women. Lucky for you, I’ve collected what I found here! I’m also going to highlight several of the brilliant women who shaped our field – this is by no means an exhaustive list of amazing women in cardiology (or their accomplishments) because there are too many to fit on one list.

 

Maude Abbott, MD was a Canadian physician who invented an international classification system for congenital heart disease in the 1930’s. Her work the Atlas of Congenital Heart Disease became the definitive reference guide on the subject.

 

Helen B. Taussig, MD, FACC is widely regarded as the Founder of Pediatric Cardiology. In the 1940’s she developed the operation to correct the congenital heart defect that causes “blue baby” syndrome. She received the Medal of Freedom from President Lyndon B. Johnson and was the first female president of the American Heart Association.

 

Myra Adele Logan, MD was the first woman (and only the 9th person!) to operate on a human heart in 1943.

 

Marie Maynard Daly, PhD was first African American woman to obtain a PhD in chemistry in the United States, whose research in the 1950’s was invaluable in demonstrating the relationship between high cholesterol levels and heart attacks.

 

Celia Mary Oakley, MD was one of the first women cardiologists in the United Kingdom and was part of the team that coined the term hypertrophic cardiomyopathy in the late 1950’s.

 

Sharon A. Hunt, MD was just one of seven women in her 1967 medical school class and she went on to revolutionize the field of heart transplantation by working to improve survival rates by identifying and treating rejection and determining how to reduce the side effects of the drugs.

 

Nanette Kass Wenger, MD, was among the first cardiologists to focus on heart disease in women, and to evaluate the different risk factors and manifestations of the condition, specifically coronary artery disease, in women and men. I was lucky enough to talk with her about her work at AHA Sessions 2018, which I wrote about here. You can also follow her on twitter @NanetteWenger.

 

Christine Seidman, MD, is a researcher who transformed the field of cardiovascular genetics with her research that uncovered the genetic basis of many human cardiovascular disorders, including cardiomyopathy, heart failure and even congenital heart malformations.

 

Elizabeth O. Ofili, MD, MPH, FACC is a clinical scientist who led the effort to implement the landmark African American Heart Failure Trial (AHEFT), whose findings improved the practice guidelines for the treatment of heart failure in African Americans. She also became the first woman president of the Association of Black Cardiologists in 2000.

 

Ileana Piña, MD, MPH, FACC is a nationally renowned cardiologist known for her work in heart failure and improving patient rehabilitation outcomes. Her work has also upturned preconceived notions about women in the medical community and she works tirelessly to get more women into clinical trials.

 

Rong Tian, MD, PhD is a leader in the field of cardiac metabolism whose work has been translated to clinical trials. Among her many contributions, she was the first to demonstrate that AMP-activated protein kinase (AMPK) acted to remodel cardiac energy metabolism, which critically informed the heart failure field. You can also follow her on twitter @Rongtian2.

 

I want to note, that these cardiologists and researchers are not important just because they are women – they are talented scientists and cardiologists who happen to also be women. But pieces like this are important because representation matters. It’s important for everyone, especially young girls and women, to see that it’s possible not just to be successful in this field, but also to revolutionize it.

 

Helpful sources & suggested reading:

 

 

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Participating in Science Outreach is a Win-Win For Everyone

Last month I wrote about the January is for Advocacy AHA initiative and discussed the importance of physicians and scientists getting involved in science advocacy. Since I mentioned I wanted this New Year’s resolution to stick, I am continuing this theme for February because there are so many different ways to get involved with our communities and advocate for change.

One way I personally enjoy engaging with my community is by participating in science outreach activities. Now, the best part about this type of extra-curricular community engagement is that it comes in a variety of different forms, whether it be judging a local science fair, visiting an elementary classroom to talk about your science and do an experiment (my favorite is isolating DNA from strawberries with them), or even Skyping with a classroom of students through the fantastic Skype A Scientist program (you don’t even have to leave work!).

Before I highlight a fantastic cardiology outreach program that just recently happened, I want to take a moment to discuss why science outreach programs are so critical for our both our local and scientific communities. We are all busy, so finding time to fit something like this into our schedules feels like a scary game of Tetris. However, science and particularly the cardiology field, has diversity/inclusivity issues that need attention. Even though this is an issue that some may feel like has “been addressed,” women still make up around only a third of scientific researchers across the world. While this varies across disciplines, only around 13% of cardiologists are women – even though roughly 50% of medical students are women. All of these numbers are even lower for people of color.

While I understand that these issues are insanely complex and speak to the need of a re-vamp of how our scientific and medical institutions are structured, we need to continue to flame the excitement for science in students of every background, gender and race. The easiest way to do this is by getting involved and not just in your neighborhood, but also underserved communities. I highlighted a variety of ways to get involved in science outreach in last month’s post. The STEM ecosystem is a particularly good resource for getting in contact with underserved communities you may have not been aware of before.

I mentioned before that I completely understand that getting involved or organizing a science outreach event feels overwhelming. However, working with other colleagues within your network who are also passionate about this issue is the key to really making an impact. Just like with everything else in science, you don’t have to do this alone!

This is exactly the approach Dr. Kathryn Berlacher and Diana Rodgers took to organize their recent She Looks Like A Cardiologist event last month in Pittsburgh. Both women took their passion for increasing the diversity in cardiology into creating a fantastic event where 28 female high school students interested in becoming cardiologists got to meet with local women in cardiology. The day was filled with a mix of lectures, group discussions and some simulation, as well as one-on-one lunch with paired mentors. The best part of this event is that it’s not over – the organizers didn’t want this to be a “one and done” day, so every girl got paired with one of the mentors who will help answer college application questions, advise on jobs and summer experiences, and just be a resource for them in the future. You can find a great breakdown of the day on Dr. Berlacher’s twitter page (@KBerlacher). Seeing this event on Twitter is actually what inspired me to write this blog post and I emailed Dr. Berlacher right away to talk about it. I asked her if she thinks outreach activities are valued within our field and I loved her response:

Definitely – many of my colleagues do it and love it. Almost all of my fellows do it. The fellows who came on Saturday raved about the event afterwards, saying they thought it was going to be a great event for the high school girls, but at the end of the day they felt inspired and invigorated too.  Things like this (and all our other volunteering), keeps us grounded and really provides perspective. I honestly think it’s a great way to bond – AND to combat burnout in the field, which is another hot topic. If you feel valued and feel that what you’re doing is making a difference, then you’re much less likely to get burnt out at your job.”

I hope this event inspires you to get involved in science outreach within your community as much as it inspired me. Here’s to seeing many more events like this in the future.

 

 

 

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Why Advocacy is Critical for the Future of Cardiovascular Research & Medicine

As researchers and physicians, many of us got in to our professions to push the scientific enterprise further to ultimately help others. We’ve all trained for an insane amount of years and collectively we work as a unit to uncover the intricacies of the cardiovascular system, develop therapeutics and treat patients. We traditionally think of ourselves as researchers or physicians first, but obviously we are all so much more than our jobs. We are also citizens within a really complex system that has been continually struggling to serve all of its citizens equally. It’s no secret that access to affordable health care is currently not equitable within our society. Similarly, there are also large diversity & inclusivity issues within our training institutions for both researchers and physicians.

However, something we don’t think about enough is that our intensive training and experience within these systems has also prepared us to be effective advocates for these issues. We have the opportunity to promote tangible change and some might argue it’s even our responsibility.

One of the things I really appreciate about being apart of the American Heart Association (AHA) is that this is something the organization doesn’t shy away from. During his presidential address at AHA Scientific Sessions 2018, Dr. Ivor Benjamin gave a heartfelt and determined talk about what the future of the AHA’s advocacy mission looks like. He discussed how supporting local and federal advocacy, early careers and mentoring is key to supporting the future of the AHA – but only 3% of cardiac professionals are African American men and this is something the AHA wants to help change. To help solve the diversity and inclusivity issues within the cardiac field, the AHA is expanding major undergraduate initiatives to fix the leaky pipeline. My favorite part of Dr. Benjamin’s talk was when he urged everyone at AHA18 to get involved in advocacy, not just for our field, but also for our communities. Because this is the key point: in order for our work to have meaning and to be effective, we need to ensure our communities are healthy. We also need to put value to advocacy efforts in our field – this is an essential part of our profession.

Well, this is all great, but how can you get involved? We are all insanely busy; I know adding advocacy efforts can seem daunting. Luckily for all of us, one of the focuses of the AHA for January is Advocacy. Since over 7 million Americans with cardiovascular disease are currently uninsured, advocating for the protection of the Affordable Care Act is something we can all do from our computers right now.

How can you help? (Provided by the AHA newsroom)

https://www.heart.org/en/get-involved/advocate/state-issues

 

Looking for more ways to help on other issues?

  • The AHA has a great advocacy resource page for to get involved with efforts at the federal, state and community levels with issues regarding health care, tobacco prevention, and healthy lifestyles for kids.
  • Sign up here to become part of the AHA’s grassroots network, You’re the Cure, which is focused on advocating for heart-healthy and stroke-smart communities.
  • There are many great non-profits around the country focused on promoting science funding, literacy, inclusion, diversity & advocacy – finding the right one for you is key and many of them have already done the legwork by developing toolkits for you to get started in your community.
  • Interested in STEM outreach as a way to get involved in your community? The great Marian Wright Edelman said, “You can’t be what you can’t see.” Participating in local educational initiatives is one of the best ways to expose kids to what scientists and physicians actually look like (in addition to getting them excited about science). The STEM Ecosystem is a great way to get started; there are local chapters all over the country.

I recently watched the brilliant documentary (I highly recommend it!) about Mr. Rogers, “Won’t You Be My Neighbor”, where I was reminded of his advice many of us take comfort in during intense times.

“When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the helpers. You will always find people who are helping.” – Mr. Rogers

We are the helpers. Its time we use our power to advocate for equity within our field and communities.

 

 

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AHA18 Reminded Me We Need to Do More for Women

On the surface, it doesn’t really seem that surprising men and women develop heart disease differently or experience different symptoms for the same types of cardiac episodes. However, even though heart disease is the number one killer of both men and women, women have traditionally been omitted from clinical trials and female animals have either not been included in preclinical research studies or the two sexes have been combined1. We just simply weren’t taking half of the population into account at every level of cardiovascular disease (CVD) research for quite some time. I spent my graduate career focused on understanding the baseline differences in the heart between the sexes, and was extremely passionate about this work. Since I spent most of my scientific career working in this field, I wanted to switch it up as a postdoctoral fellow and am currently not researching sex differences. However, when I went to AHA sessions this year, I made it a point to go to any events focused on sex differences and women to get updated on what I’ve been missing this past year. Luckily the “State of the Heart For Women: Top Ten Advances in Gender-Specific Medicine” session provided the perfect summary. After ten great talks focused on a variety of gender specific concerns ranging from heart failure to pregnancy, the take home message was clear: women are still very much at risk, more likely to be misdiagnosed, and are still under-represented in clinical trials. These issues are also worse for women of color.

 

While this is a widespread issue across disciplines, the cardiovascular field has been particularly biased with regard to including women in clinical trials for drug development, leading to drugs being either not as effective in women or causing different side effects2. The good news is, things are changing. In the early 1990’s, reports from the Food and Drug Agency (FDA) demonstrated that less than 20% of participants in clinical trials were women and recent studies reveal that this number is steadily increasing – even in the cardiovascular field3. Fixing this imbalance is the result of the tireless work from many dedicated researchers over the past several decades. One of the main advocates this field has is Dr. Nanette Wenger, who was the first speaker of this session and actually let me ask her a some questions later during the conference while we were both in the Women in Science and Medicine Lounge. When I asked Dr. Wenger about her strategy for making this issue a priority in our field she explained the key steps to creating change:

  1. Investigate — people can’t ignore what the data is clearly telling them
  2. Educate — teach your peers & patients
  3. Advocate for the change
  4. Legislate — it took a long time, but we’re slowly transforming the strategic plan of the NIH

Dr. Wenger also stressed that since the emphasis in our field now is personalized care, many researchers and physicians are more supportive of including sex in their experiments and/or trials, but we need to move forward by not assuming that women are a homogeneous group. Other factors such as race are also important and must also be considered.

While progress has been made we still have a long way to go on many accounts. While there are more women in clinical trials than in the past, women still only make-up about 34% of the total participants in cardiac clinical trials3. Hopefully, with the passing of the 21st Centuries Cures act and the NIH policy mandating sex be included as an biological variable in basic research studies in 2016, these numbers will progressively increase. At the session before the talks even began, I immediately noticed that all but one of the ten panelists were women (which is awesome, but strange for the cardiac field) and the majority of people in the audience were also women. We will need to continue to advocate for this issue and we need men to join us and take it seriously for real change to be made. Additionally, while I really enjoyed this unique session, the speakers were only given ~10 minutes each to summarize their extraordinarily complex topics, which just wasn’t enough time. It would be great if gender-specific cardiovascular issues were given more time at AHA Scientific Sessions as well as other conferences in the future. This session reminded me just how pressing making CVD treatment equitable for all truly is and thankful for the researchers making it happen.

 

References

  1. Blenck CL, Harvey PA, Reckelhoff JF, Leinwand LA. The Importance of Biological Sex and Estrogen in Rodent Models of Cardiovascular Health and Disease. Circ Res. 2016;118(8):1294-312.
  2. Regitz-Zagrosek V. Therapeutic implications of the gender-specific aspects of cardiovascular disease. Nat Rev Drug Discov. 2006;5(5):425-38.
  3. Pilote L, Raparelli V. Participation of Women in Clinical Trials: Not Yet Time to Rest on Our Laurels. J Am Coll Cardiol. 2018;71(18):1970-2.