‘Relinquishing the podium’: Women remain underrepresented in CV clinical trial leadership
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Women continue to be underrepresented in clinical trial leadership, corresponding with a lack of gender diversity among presenters at scientific meetings, according to a review published in the Journal of the American College of Cardiology.
An analysis of CV trials published during the last 4 years showed women comprised only 10.1% of clinical trial leadership committees; more than half of the trials had no women as part of the trial leadership team. Historically, clinical trials have largely enrolled white men and participation has been low among women, older adults and racial and ethnic minorities, according to Mary Norine Walsh, MD, MACC, medical director of heart failure and cardiac transplantation at Ascension St. Vincent Heart Center in Indianapolis and past president of the American College of Cardiology, who wrote the review.
Walsh, who attended all the virtual late-breaking clinical trial and featured research sessions for the 2021 ACC Scientific Sessions, said she was struck by a lack of diversity among presenters — 93% were men — despite a diverse slate of panelists and chairs throughout the meeting and efforts by the ACC to elevate and support women in leadership roles.
“We cannot simply say we do not have enough women in cardiology,” Walsh, a member of the Cardiology Today Editorial Board, told Healio. “Yes, we can say there remains a minority of women cardiologists, but 26% of fellows in training now are women. That is not the only reason.”
As Healio previously reported, data from the Association of American Medical Colleges from 2007-2008 and 2017-2018 show that among all adult cardiology trainees in 2017-2018, 21.4% were women, which was a modest increase from 15.9% in 2007-2008. The most skewed sex distribution was present in interventional cardiology (10.2% women) and electrophysiology (11.6% women) compared with advanced HF/transplantation (31.2% women) and adult congenital heart disease (46.7% women).
Expanding mentorship
The root cause for the underrepresentation of women presenters at scientific meetings is the disproportionately low numbers of women who lead clinical trials, Walsh said. Underscoring those low numbers is a lack of mentorship, she said.
“Mentorship does tend to flow more along gender lines,” Walsh said in an interview. “Those already in clinical trial research leadership may be tending to mentor their own a little bit more.”
Industry-funded studies also tend to “feed a nondiverse investigator pipeline,” whereas other research collaborations often encompass established networks, Walsh wrote.
“The clinical trialist leadership, especially on the steering committees, is often a case of who you know and who knows you,” Walsh said. “A lot of this has been informal. There is no call for applications to be on a steering committee. As more women cardiologists and investigators are coming along, we hope to see this change.”
The ACC via its Diversity and Inclusion Initiative has expanded an effort to support more women and those from underrepresented groups in the clinical trial space. The Clinical Trials Research: Upping Your Game program is intended to increase the number of individuals historically underrepresented in cardiology who serve as leaders in CV clinical trials research. The program includes three 2-day sessions, webinars, professional development exercises and crafting an original research proposal to be considered for a research award.
“What we do with this cohort is help people come up from early in their career, being a site principal investigator to ascend to these leadership roles in trials,” Walsh said. “That is an important effort on the part of the ACC.”
Offer ‘experience and visibility’
Walsh laid out steps to increase representation in clinical trial leadership, including:
- Federal and industry sponsors of clinical trials must insist on diversity of the trial steering committee.
- Investigators asked to lead clinical trials must consider geographic, institutional and trial site diversity, along with a diverse slate of experienced investigators in leadership positions.
- Institutions, department chairs and division chiefs must encourage women to serve as site principal investigators.
- The informal or formal “pecking order” of CV trial leadership needs to be reworked.
- Women should not be tapped for clinical trial leadership and late-breaking results reporting solely if the trial is pertinent only to a female patient population.
Senior investigators should also offer opportunities to women on a steering committee to present the data at a conference, Walsh said.
“It is not necessary for the most senior person on the steering committee to always present the data,” Walsh told Healio. “It is a very high-profile situation. We all love the podium. But is there someone on the steering committee who has had less experience who maybe could have a career-changing event by presenting this data? I call on my fellow senior colleagues to rethink who will stand up at the meeting. I fully understand that the principal investigator of a trial put the most work in, but just as we mentor our fellows to be a first author on a paper, we also should think about relinquishing the podium to them to provide that experience and visibility.”
Sponsors of trials, too, should consider the diversity of any group leading a clinical trial, which can also have a direct impact on the diversity of participants recruited.
“[Sponsors] certainly cannot dictate to a steering committee who is going to do what,” Walsh said. “But they can ask, do we have a diverse group leading this trial? The more diverse the committee is, the more likely the presentation of trial results will become more diverse.”
For more information:
Mary Norine Walsh, MD, MACC, can be reached at macwalsh@iquest.net.
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