A Conversation with Dean Nancy J. Brown

Dean Nancy J. Brown, a 212-year-old physician-researcher and first woman to become dean of Yale School of Medicine, arrived in February 2020. Since returning to Yale, a Yale College graduate, Dean Brown has championed efforts to improve the research, clinical service and education of the medical school.

His dedication to a diverse, equitable, and inclusive environment where all feel welcome is woven throughout these efforts. This goes hand in hand with the Dean’s commitment to health equity, through which everyone’s health is optimized.

These goals guide the vision of Dean Brown and Women’s Health Research at Yale. With the support of the school, WHRY advances equity by ensuring that women’s health is studied and that differences in health outcomes between and among women and men are investigated. . In keeping with the school’s commitment to improving health, WHRY also integrates research findings into our teaching, shares new health information with the community, and uses emerging data to inform clinical interventions.

In a recent conversation, Dean Brown and WHRY Director Carolyn M. Mazure, PhD, talked about the importance of research, the value of focusing on the study of women, the influence of biology and social factors that affect women’s and men’s health differently, community awareness, diversity, equity, etc.

Dr. Mazure: You have spent your professional life in academic medicine and have had the chance to see how academic health centers contribute to the common good. What role do you think academic health centers like the Yale School of Medicine play in advancing research to improve the health of our nation?

Dean Brown: Academic health centers and medical schools are the engines of discovery that drive better health. Our scientists strive to discover new ways of thinking about pressing health issues and competing for innovation-based funding of proposed research to shed light on a critical health issue and the potential impact of the findings. In a medical school, clinical observations can inform research and enhance its impact. Additionally, academic health centers provide the community with early access to the application of discoveries in new therapies and diagnostics. Scientists from different fields can cross disciplines and work together to solve problems that cannot be solved by expertise in one field alone. Additionally, faculty collaborate through laboratory, clinical, and community research to provide multiple platforms for understanding the biological and social mechanisms that promote health and underlie disease.

Dr. Mazure: As you know firsthand, for a long time women have been largely excluded from study participants, and women’s health has not been studied enough. Do you think that has changed?

Dean Brown: We have made great strides in including women in research. Women’s Health Research at Yale has played a national role over the past two decades and has been rightly recognized for pioneering new research in women’s health, educating students and faculty about women’s health and advocated for change. Yet many other areas of women’s health require our attention, and we have made less progress in digging into differences in disease mechanisms and responses to therapies in men and women. Here, WHRY leads the way by emphasizing the importance of understanding how sex and gender influence biology and behavior.

Dr. Mazure: For those who may be less familiar with the current scientific landscape, what do you think are the most pressing women’s health issues that research needs to address?

Dean Brown: We need to understand the impact of sex and gender on diseases and conditions that cause significant morbidity and mortality. These include cancer, cardiovascular disease, diabetes and obesity, as well as behavioral health disorders. We also need to look at reproductive health in a broader sense, for example, understanding that a mother’s health influences the health of the next generation. Moreover, there is still much to be done to study epigenetic effects – how environment and behaviors affect how our genes work. In a place like the Yale School of Medicine, where there is so much scientific depth, it is possible to bring together scientists from various fields to tackle these problems.

Dr. Mazure: As WHRY approaches its 25th anniversary, why do you think it is important to have a center within Yale School of Medicine that focuses on how sex and gender influence health?

Dean Brown: Centers such as WHRY serve as a model, a catalyst and an academic home for the search for knowledge covering a broad area of ​​interest. By gather the investigators, provide financing and adviceand involve the community in its vision, WHRY inspired research questions that might not have been considered. WHRY also provides essential functions as a health information channel for the medical and public communities and like a source of mentorship for students and junior faculty members so that they are prepared for their careers and embrace lifelong learning.

Dr. Mazure: We know that biological and social factors, such as gender and race, influence health. Is the future of research to study both?

Dean Brown: We need to study both, and we need to rigorously test the hypotheses. This requires following the questions where they lead us. Too often, investigators seek to to prove a hypothesis rather than test a hypothesis. We need to probe the interactions between biological, environmental and social factors with open minds and eyes to detect possible differences with significant impacts on health. For example, we know that women of color more often give birth to low birth weight babies and suffer higher rates of maternal mortality and that biological and environmental factors interact to affect these outcomes. In my own area of ​​research, hypertension, we understand that there are important interactions between genetic factors, dietary salt intake, and hormone production that increases under stress.

Dr. Mazure: Yes, this is a key point. At WHRY, we often say that difference does not mean better or worse, but that we must – without judgment – ​​explain how the disease can affect people differently. I feel that more people need to hear this message when it comes to studying the influence of biological sex on health. From what you have seen, has the study of sex as a biological variable kept pace with the study of women in clinical investigations and has it become an integral part of institutional research portfolios ?

Dean Brown: Since the National Institutes of Health policy took effect in 2016 requiring grant recipients to include female vertebrates and study sex as a biological variable, we have seen accelerated progress. Research has already shown how differences between and among women and men affect the risk of various diseases, the prevalence and course of these disorders, and the response to treatment. This is true for a wide variety of diseases and conditions, including cancers, cardiovascular disease, Alzheimer’s disease, and more. Again, more work is needed to encourage researchers to study the mechanisms of sex differences in the laboratory. We now know that sex chromosomes affect signaling inside cells, and cellular pathways are often regulated differently in male and female cells. These data contribute to promising avenues of research that would help us understand disease mechanisms and develop better prevention and treatment strategies for women and men.

Dr. Mazure: We talked about translating the search for the common good in a broad sense. Can you comment on the importance of how research can help local communities move forward? For example, how important is it for centers like WHRY to work with communities who want to take action to improve health?

Dean Brown: As Yale School of Medicine faculty, students, and staff, we are part of our larger New Haven and Connecticut communities. It’s not enough to advance discovery if we don’t also benefit our community as well as society as a whole. We need to listen to community members when thinking about the health research questions we need to answer. We must engage local, state, national and global partners in clinical trials and research and advance efforts to improve public health by implementing evidence-based outcomes. I am encouraged by how WHRY is advancing community efforts in partnership with the Yale Elevate Policy Lab. It is exciting to see our school enable public-private relationships that fund data-driven interventions and formulate cost-effective health policies to improve the lives of those living in difficult circumstances, especially pregnant women and mothers.

Dr. Mazure: The medical school has incorporated the language into its mission statement to promote “an inclusive environment enriched by diversity.” You called YSM to be a place “where women and underrepresented medical (URiM) faculty, staff and students thrive, and where diversity and excellence are inextricably linked.” What are some of the next steps to strengthen diversity, equity, inclusion and belonging (DEIB)?

Dean Brown: Under the leadership of Dr. Darin Latimore, our Assistant Dean for Diversity and Inclusion, the YSM community has engaged in self-examination and strategic planning. We understand that we must not only focus on recruiting a diverse student body, faculty and staff, but also mentoring, sponsoring and promoting those here as we continue to build an inclusive community. An important part of our strategic plan is measuring our progress.

Dr. Mazure: How do you see WHRY advancing this work?

Dean Brown: From the beginning, WHRY has aligned itself with individuals and groups advancing the principles of DEIB at Yale School of Medicine. More recently, WHRY has collaborated with the Office for Health Equity Research under the direction of Dr. Marcella Nunez-Smith.

Dr. Mazure: Thank you Dean Brown for this opportunity to speak with you.

Dean Brown: You’re welcome. We still have a lot of work to do and I look forward to progressing together.

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