In the Eyes of the Beholders

This exploration of Valantine’s earliest encounters with DEI, cardiology, and medicine, and of the core concepts she hopes will have lasting impacts on the minds and hearts of researchers, begins with the ways the people who have worked closest with her characterize the special and unique gifts that make her wholly deserving of recognition, and that have enabled her to leave a lasting mark on science and medicine:

• Acting science advisor to President Biden in the White House and former NIH Director Francis Collins, MD, PhD, says, “Hannah Valantine represents the best aspects of being a change agent: she’s fearless, visionary, and driven by a sure knowledge of the rightness of the cause.”
• Cori Bargmann, PhD, head of science at the Chan Zuckerberg Initiative, thinks back to the time she worked closely with Valantine in the NIH, remembering, “Hannah used her star power in positions of influence to make science better and more inclusive, first at the intramural program at NIH, and then NIH-wide. Her impact on science, medicine, and the practice of science has been exceptional.”
• Robert A. Harrington, MD, Arthur L. Bloomfield Professor and Chair of Stanford Department of Medicine, states, “Hannah inspires us, in the Department of Medicine, to strive every day to make a difference in the lives of patients and the minds of researchers, to embrace necessary change, for the benefit of all, and to not be afraid to reach the limits and beyond of scientific discovery.”

The chance to reignite her commitment to DEI and assume a leadership role at Stanford arrived in 2004, when Philip Pizzo, MD, then dean of Stanford School of Medicine, approached Valantine with a request to set up the school’s first office for diversity and leadership. “And the rest,” she says, “is history.”

Diversity Leads to Better Research and Medical Care for All

Valantine’s work has led her, again and again, to bring the elements of diversity, inpatient care, and research innovation together, and to uncover the ways in which diversity drives innovations in research and health care that can benefit everyone.

She argues that discoveries based in a broader and more diverse patient population or research subject population (or cells from diverse ancestries) are more likely to provide a full picture of the disease or condition that scientists are trying to study. Those discoveries will, therefore, be more applicable to, and benefit, more people.

She has shown that more diverse representation in medical research also makes it more likely for scientists to produce more innovative ideas, discoveries that may not have necessarily been seen or thought of before, if only considering a homogeneous (i.e., less diverse) population.

When asked what are the key takeaways from her work and what is most important for people to understand, Valantine cites three things.

First, she lists “justice” and “equity,” in terms of “access to all the benefits of biomedical research that have come along very rapidly in the last 50 years or so.”

The second important thing for people to understand is that the “speed of discovery and the innovativeness of discoveries depends essentially on researchers studying a diverse spectrum of patients.”

Lastly, Valantine hopes readers of her work realize the critical importance, when pursuing scientific discovery, to have not just a diverse population of patients, but also a diverse population of scientists (including MDs, PhDs, MD-PhDs, and all of the scientists likely to be doing research with patient populations).

On this final point, Valantine shares, “There is a distinct link between the diversity of the scientist, the diversity of the clinical care provider, and better research and better clinical care.” She explains that it is now known that when patients receive advice from doctors, nurses, and other health care professionals who are of the same racial or ethnic background as theirs, they are more likely to adhere to that advice.

Valantine’s lifetime of work at the crossroads of clinical care and research discovery invites researchers, scientists, and care providers everywhere to embrace diversity as the key to better science and medicine for all.

Growing up in the inner city environment of East Palo Alto, around an extended family where Spanish was primary and English was a foreign tongue, a young Alfonso Molina was fortunate to be fluent in both languages. As a 9-year-old, he began accompanying relatives to medical appointments so he could interpret what the health professionals were saying. Those visits fanned a flame of curiosity about medicine that was sparked during gatherings with kin.

“Whenever I would go to family parties, I would hear people talking about medicines,” Molina recalls. “If you’re sick, you should try this remedy, or this remedy helps for anti-inflammation. I was always curious to know if that was true or not, if it had a scientific background. I think that’s the first step towards wanting to learn more about medicine.”

While serving as the family interpreter, Molina quickly learned how much knowledge his relatives lacked. He could see how frightening it was for a family member to be in the hospital and not understand much of the medical information. Those experiences inspired Molina to become a medical resource for his family, and for people like his family.

Today, Alfonso Molina, MD, MPH, is in his third year of residency at Stanford. “I grew up around here,” he says. “I know the areas, and it’s a lot of fun being a resident and taking care of people around the community. I’m familiar with all the different neighborhoods that they’re from.”

After high school, Molina moved 40 miles north to attend the University of San Francisco. Four years later, equipped with a bachelor’s degree in biology, empowered by the support of family and friends, and driven by his desire to care for others, Molina relocated 400 miles south to enter a dual degree program at the University of California, Los Angeles. The impetus for applying to UCLA was his participation in the SMDEP program (now known as the Summer Health Professions Education Program [SHPEP]). SMDEP was a free six-week summer academic enrichment program that offered freshman and sophomore undergraduate students the opportunity to focus on medical and dental school preparation.

Assisting Community

Familiarity with the areas around Stanford helps create knowledgeable discourse with the diverse patient population that Stanford Health Care serves. Molina recalls talking with one patient to determine how far that person would walk before experiencing shortness of breath. “He was describing how he would go from Fifth Avenue in Redwood City all the way down to the library. Making that connection, I knew exactly how far that is. That’s a good distance, so I could honestly say, ‘You’re doing great,’” Molina explains.

The third year resident also understands the challenges of communicating with patients whose primary language is not English, due to his experience growing up. “Whenever I see a Spanish-speaking patient, it’s nice to be able to help them because it’s my personal first language,” says Molina. “The patient can express themself in the first person without having to go through an interpreter.” Molina can be the doctor that explains things to the family, helping others just as he has done since he was a child.

organized a full-day preconference on women’s leadership for the Cambia Health Foundation’s Sojourns Scholar Leadership Summit. Facilitators from the global leadership development firm Cultivating Leadership led an interactive workshop enabling palliative care providers and experts to connect with a national community of women and explore methods for engaging with power differently and elevating their impact.

This palliative care event neatly presents Harman’s approach to women’s leadership. As Stefanac claims, “Steph’s dedication to promoting women’s leadership lives in her bones and is guided by a fierce and protective inner drive for women’s equity, for what will create a just and equal world at Stanford and beyond. She looks to empower women in their career and leadership choices. She does this by creating community among women, forums where women can connect and lift each other up.”

Executive coach Bonnie Wentworth believes that Harman — through her work “as a dedicated student and leader of gender equity at Stanford” and beyond — embodies writer Margaret J. Wheatley’s vision of a leader as “a host — one who convenes diversity; one who convenes the meaningful conversations.”

Sung emphasizes that the division leadership didn’t set out specifically to hire the same number of men and women, but instead they aimed to help equalize the privilege and support for women and other underprivileged groups as they rose to leadership roles on their own merit.

“We decided to try and grow our division organically. We have amazing fellows or physicians in training, who graduate and then may go into the community or get other academic centers to further their careers,” says Sung. “We felt the need to hire our own faculty.”

One of the challenges is that the academic hospital can’t always offer salaries that are higher than a physician might earn in a private practice, explains Nicolls. The team has worked to make up for that by offering leadership opportunities and mentorship that help develop portfolios and by providing flexibility for those who are building their families.

Sung says they told junior faculty members, “We want to cultivate your ideas. You have a great vision of a particular clinical program. So why don’t you take this leadership role, develop that program with the hospital and along with me and Mark, and we’ll promote you?”

Dedicating resources to growing the division’s subspecialties and supporting a gender-diverse faculty has paid off. “We’ve become an internationally recognized division in the past 10 years,” says Nicolls.

Several women have risen through the ranks in the division of pulmonary, critical care, and allergy medicine. The following stories highlight their achievements.

Kristina Kudelko, MD—Pulmonary Vascular Disease Fellowship Director and Director of Clinician Educator Faculty and Fellowship Career Development

Kudelko came to Stanford in 2008 for a pulmonary hypertension fellowship. “Being able to subspecialize in such a unique field, take care of patients with this fairly rare disease, and serve as a referral center for that disease was a privilege,” she says.

One of the reasons Kudelko stayed with Stanford after her fellowship ended was for the diversity. She doesn’t primarily focus on research, but she relished the opportunity to attend pulmonary critical care grand rounds where she’d hear research talks and continue learning.

A sense of curiosity has always driven her, and over her time in the department, she’s taken advantage of opportunities to expand her skill set. “I really liked that I’ve been able to pivot every five years or so and find a new passion,” she says, explaining that her interest in mentoring and supporting clinician educator–oriented junior faculty and trainees emerged recently.

Since her first few years here, “a lot has changed in a really positive way,” says Kudelko, describing an increase in the department’s diversity over the years that has helped her understand different experiences. And she personally feels “very heard and very engaged in the change.”

Edda Spiekerkoetter, MD—Principal Investigator and Associate Professor of Medicine

Spiekerkoetter came from Germany to do a postdoctoral research fellowship in pulmonary hypertension at Stanford in 2002. “We didn’t have good treatments for pulmonary hypertension [in 2002], and patients ended up needing lung transplants. It was very frustrating,” she says. “I wanted to do basic research to understand the disease pathobiology and find ways to treat it better.”

Since then, Spiekerkoetter says, she’s noticed many more women working as clinical professors and clinical researchers but would love to see more running basic science labs. “I think we can definitely improve on that,” she says.

Spiekerkoetter came to Stanford strictly as a researcher, but soon she got certified to treat patients in the United States. Over the course of her 20 years at Stanford, she’s particularly proud to say, several clinical trials have been initiated based on her research. She tells the story of one particular patient, a woman with end-stage pulmonary hypertension who wanted to go camping, but her treatment regimen required her to be hooked up to two separate infusion pumps. “It was so cumbersome,” says Spiekerkoetter. “It’s so difficult when you have to go to these extremes just to stay alive.” The care team decided to give the woman one of the medicines that Spiekerkoetter had studied in the lab. She wasn’t cured, Spiekerkoetter says, “but at least she didn’t have to come to the hospital so frequently afterwards. She could really enjoy her time and do things she enjoyed for the remainder of her life.”

Spiekerkoetter’s strongest motivation is this: to translate her research findings into improving clinical care.

Taking Up the Challenge

The Department of Medicine has long strived for more equity and diversity in its own healthcare system and within the Stanford School of Medicine curriculum, with dozens of programs on the medicine campus, as well as community outreach programs nationwide.

In 2004, the medical school created a new leadership position meant to attract more women and underrepresented minorities to postgraduate and faculty positions. Hannah Valantine, MD, professor of cardiovascular medicine, was the first to hold the post of senior associate dean of diversity and leadership. The school has since implemented dozens of programs for students, residents, postdoctoral scholars, and faculty members to promote diversity, equity, and inclusion.

Valantine notes that women now comprise 47% of all Stanford Medicine department chairs.

“Stanford Medicine has been working on faculty diversity and has made great progress with gender equity,” Valantine says in this Q&A. “My point is that if we can do this for gender inequality, we can do this for race and ethnicity, because the pool of qualified people exists.”

She is promoting additional training to combat unconscious bias and racism and gathering diverse groups to conduct team science and apply for NIH grants.

“The key to team science is bringing together a diverse group of people,” she says. “We want that collection of different ways of thinking to enhance our research and patient care.”

That focus on team science is one of the chief reasons why Alyce Adams, PhD, joined the Stanford Medicine faculty.

“I came to Stanford because of the opportunity to collaborate with scientists from across diverse disciplines to understand and address the drivers of health inequities,” says Adams, the inaugural Stanford Medicine Innovation Professor and professor of epidemiology and population health.

“Few places have the potential to conduct transdisciplinary health equity research on a single campus,” she says. “Plus, Stanford is known for 

COVID-19 as white people, and nearly three times as likely to die of it, according to the Centers for Disease Control and Prevention.”

Minor emphasized that all departments within Stanford Medicine must acknowledge and address institutionalized racism within the U.S. healthcare system. He noted that in 2002, the Institute of Medicine published the report Unequal Treatment, which revealed that racial and ethnic minorities receive poorer quality care even after controlling for factors such as insurance status and income.

“Nearly 20 years later, we continue to see reports of differential treatment for patients of color at hospitals around the country,” he said, pledging that Stanford Medicine would make social determinants of health a research priority as well as the recruitment and training of a more diverse workforce.

Furthermore, Minor said, the medical school intends to grow its care for the greater Bay Area community through its outpatient centers along the Peninsula and in the East Bay, like those in the often-underserved cities of Oakland and San Jose. Minor noted that clinics like the Stanford Medicine Cancer Center in South Bay and Stanford Medicine Cancer Center in Emeryville, both staffed by Stanford faculty, expand the network of clinical trials for rare diseases and cancer to a more demographically diverse population.

Department Chair Harrington echoed the need for this increased accessibility.

“The ability to reach our patients where they truly live … makes it easier for our patients to see us and for them to potentially participate in research,” Harrington told The Stanford Daily. “These ambulatory sites are a critical part of our future.”

The REACH Initiative, a series of programs dedicated to training a new generation of leaders in medicine and science who will actively promote health equity, racial equity, and social justice work to reduce our society’s devastating health disparities. With a $25 million gift from an anonymous donor, REACH will fund more than 700 students from historically underserved communities who will pursue health equity.

Stanford Medicine’s New Department of Health Policy

Stanford Health Policy (SHP) remains the umbrella organization across campus representing the medical school with the new department as well as the Center for Health Policy in the Freeman Spogli Institute for International Studies within the university. SHP faculty, fellows, students, and researchers investigate how social factors, economics, law, financial and insurance organizations, health technologies, and personal behaviors impact the accessibility, quality, and cost of health care.