Dr. Pamela Kunz, associate professor of medicine/oncology at the Stanford University School of Medicine, spends her time in both patient care and research, specializing in the treatment of gastrointestinal cancers and neuroendocrine tumors. Recently, she has turned her research skills onto her own profession by examining the gender of principal investigators in phase 2 and 3 GI oncology clinical trials.
At a recent Faculty Research Fellows presentation, Kunz described her study. “My observation was that mostly men were presenting and publishing the large phase 3 clinical trials,” she said. Phase 3 trials evaulate prospective new treatments against existing therapies, following several successive smaller trials. If successful, these phase 3 trials can “change practice through new FDA drug approvals, lead to high-impact journal publications, and represent important currency in academic medicine.” Kunz knew from published research that disparities exist for women in medicine in other areas: leadership, academic rank, research funding, authorship and salary.
Knowing that serving as PI on a large trial is high impact, she set about to investigate gender trends using a large public dataset, clinicaltrials.gov. She hypothesized finding similar disparities in trial leadership, with hopes that the results could be used to educate trial sponsors, including the federal government, academic institutions and pharmaceutical companies. She is interested in expanding the project to look at not only gender but the race, institution size, faculty rank and geographic location of PIs. In a related published study looking at gender of corresponding authors, she noted that numbers were quite low for women, especially in industry-sponsored trials and in her field, GI oncology.
Kunz’ interest in researching gender was prompted by personal experiences. She recalled a lifelong interest in science and medicine – sharing a drawing from childhood of herself in a white lab coat – and said she was encouraged in her goals by her parents and others. “I never felt that my gender was a barrier until recently,” she said. “I started experiencing gender discrimination as a mid-career woman in academic medicine … and it’s inspired me to do research in this field.”
Kunz’ interest in researching gender was prompted by personal experiences. “I never felt that my gender was a barrier until recently,” she said. “I started experiencing gender discrimination as a mid-career woman in academic medicine … and it’s inspired me to do research in this field.”
She has been at Stanford since 2001, when she arrived as a resident in internal medicine. “I felt supported, mentored and valued” early in her career, Kunz said, and she became an assistant professor in 2010. “It was only when I started assuming leadership roles that I faced obstacles,” she said; she noticed others talking over her in meetings, and saw that “my leadership was being undermined.” Lack of support from a longtime mentor was particularly painful. Coming to terms with what happened was difficult and took time. “How is this happening?” she wondered. “I’ve never faced any barriers that I thought were attributed to my gender until now.” She decided to take a six-month sabbatical to heal, reflect, and refocus some of her research efforts.
Kunz received support through SPACE, a leadership program sponsored by the Department of Medicine in which she found support in small groups and executive coaching. She also sought out reading to help process her experience, sampling widely from books about gender discrimination in such fields as tech and academia. She particularly connected with the 1999 book by Frances K. Conley, Walking Out on the Boys. Conley, the first female tenured professor of neurosurgery in the country, made headline news when she resigned from Stanford in 1991 to protest the medical school's gender discrimination. Kunz also explored narrative writing as a form of reflection, and she read aloud from a piece she wrote in response to the Conley book: “I was drawn to her story of our shared experiences at the same institution. I slowly regained my sense of self and empowerment.” Other faculty fellows noted that some of the men mentioned in Conley’s book remain on faculty in Stanford School of Medicine.
Kunz also read a June 2018 report from the National Academies of Science, Engineering and Medicine (NASEM) on “Sexual Harrassment of Women: Climate, Culture and Consequences in Academic Sciences, Engineering and Medicine.” The report found that nearly half of medical students experience sexual harassment from faculty or staff (second only to the military at 69 percent). The report states: “Through our work it became clear that sexual harassment is a serious issue for women at all levels of academic science, engineering and medicine. The consequence of this is a significant and costly loss of talent.”
“Through our work it became clear that sexual harassment is a serious issue for women at all levels of academic science, engineering and medicine. The consequence of this is a significant and costly loss of talent.” -- 2018 report from the National Academies of Science, Engineering and Medicine (NASEM)
Kunz was struck by the findings. “This was really critical in my thinking about gender discrimination and harassment, taught me this was pervasive, and made me want to contribute to the objective data demonstrating gender disparities.” She determined to turn her research skills on the problem. “My way of coping with what was an incredibly painful personal experience was to think of ways I can contribute to research, be a social advocate, and move the needle.” Kunz is now involved in national organizations to address gender disparities in medicine, including the American Society of Clinical Oncology (ASCO) as a scientific track leader for a 2020 ASCO Annual Meeting Scientific Program Committee to evaluate scientific abstracts on diversity, a new undertaking for the group. In this role, she will be chairing a session entitled “Dismantling Gender Disparities in the Global Oncology Workforce Together.” She is also the newly appointed chair of the North American Neuroendocrine Tumor Society Membership and Diversity Committee. In addition, she said, “Applying to be a Clayman Faculty Fellow was an objective way for me to apply my passion for promoting gender equity and learn from Stanford faculty involved in gender research.”
Conversation among the Faculty Research Fellows group was lively following her presentation. Many books were recommended, including those by former fellows Jennifer Eberhardt, Debra Meyerson and Cecilia Ridgeway. Director Adrian Daub commented about the unrealistic depictions of highly diverse medical faculties on television, and Jennifer Freyd talked of the issue of institutional betrayal in cases of harassment.
Estelle Freedman, professor of history and a third-time faculty fellow, said to Kunz: “This is why Clayman is here. So that people at the University who need this group at that time in their career can find it.”
Kunz recently accepted a position as leader of the Gastrointestinal Cancers Program at Smilow Cancer Hospital at Yale New Haven and Yale Cancer Center, and director of GI Medical Oncology within the Section of Medical Oncology. She begins there in July.