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May 2020 Lead

Friday, May 22, 2020   (0 Comments)
Posted by: Jane Sharer Maier
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May 2020
GWIS LEAD is a GWIS periodical profiling women leaders in science.  Subscribe
Dr. Emma Benn: On Encouragement, Belonging and Inferential Approach to Health Disparities Research
 
Dr. Emma Benn is an Associate Professor in the Center for Biostatistics and Department of Population Health Science and Policy and Director of Academic Programs for the Center for Biostatistics at the Icahn School of Medicine at Mount Sinai. She has contributed her biostatistical expertise to a variety of research areas including but not limited to: epilepsy, traumatic brain injury, COPD, prostate cancer, bladder cancer, HPV, vagal dysfunction, opioid adherence, skin bleaching in African and Afro-Caribbean populations, stroke, and cognitive disability. More recently, Dr. Benn has been focused on applying her statistical expertise to health disparities research. She is also involved in a number of initiatives for increasing diversity in the field of biostatistics. We caught up with Dr. Benn and discussed her work in biostatistics and the efforts she has made in improving diversity in her field.
 
Could you please tell me a little bit about yourself and your journey to the research you are doing right now?

Well, I am originally from Bryn Mawr, Pennsylvania, and I always enjoyed science and math in school. I can’t say that I would have thought I would be a biostatistician when I was younger because I did not really know that this path existed. Also, while I thrived in science classes, I also thrived in Spanish. I majored in Spanish and was interested in languages and cultures, and my intention at the time was to become an interpreter for the United Nations. Fortunately, at Swarthmore I had an opportunity to explore, be exposed to science and take chemistry and math classes while pursuing Spanish. Unfortunately, many of my friends, most of whom were people of color, became discouraged along the way and dropped out of their science majors, while here I was, a Spanish major, still taking all of these science classes.

Why do you think they got discouraged?

I feel that STEM programs aren’t always as encouraging. There is this idea that if you are not doing well, it means you are not cut out for this. Whereas I think there were things that should have been done to see where the students were struggling. STEM is not always as inclusive and welcoming as it could be. Somehow, I kept going, while my friends dropped out of their science majors to pursue something else. 

Once I started thinking that I should focus more on science, I switched my major to Chemistry, but kept taking more math classes. And I think this has to do with the fact that there was one professor of color in the Math Department who was engaged in mentoring and was very encouraging. Once I switched to Chemistry, I decided that I would eventually pursue pharmacology. I got some exposure to public health in my senior year when I took a bioethics course, and that’s when I started learning more about health disparities. This left something in the back of my mind about how certain populations are more vulnerable or how certain populations may be more likely to be exploited or have been exploited over time in biomedical research. 

I was offered a job after graduation as a quality control chemist at a Johnson & Johnson company, and although I enjoyed the job, I kept thinking back to my public health experience. So I went to Columbia University to get a Master’s in Public Health that focused on sociomedical sciences. I was interested in this area because I was looking around in my suburban community and realized that although many people in my community had access to care, my parents’ friends were still dying prematurely from preventable conditions. I was seeing racial and ethnic disparities in my local community even when people had access to healthcare, education and nutrition. So I went into sociomedical sciences to understand the social determinants of health, and I found that biostatistics is a great tool to answer some of the questions that were being posed in areas of sociomedical sciences and epidemiology. Interestingly, when I approached my epidemiology professor to talk about pursuing a doctoral degree in the field, she discouraged me, but my biostatistics professor was very supportive. So I applied to a doctoral program in Biostatistics at Columbia and pursued my degree there.


So one of the things I am hearing you say is that support and encouragement are important. Encouragement from just one person that you meet along the way might help you find the right path. Is that so and what are some of the other lessons you learned on the journey to your research career?

Yes, you need one. Or you need to find something deep inside yourself to push forward. My father never graduated college, my mother graduated, wanted to pursue a Master’s degree, but never got to finish, so I did not have an immediate family member that could tell me what a doctoral program is. When I got to the Biostatistics program, I was looking around and realizing that, “wow, I am the only one”. It was really hard for me to find study groups, I felt like an outsider and while most students had a Master’s in Mathematics or Statistics, I didn’t. There was a lot of feeling that I was not good enough to be in this field. And I think it was probably very easy to give up, but some of the relationships that helped me a lot were, surprisingly, not with the faculty, but with the staff, who were often people of color and who would just ask how I was doing. It was tough, but it also made me reflect on why I am not seeing others like me here. What is it that I can do about this? Because this is feeling really lonely. And in my loneliness and feelings of discouragement at times, I thought it might have been different if I got an earlier exposure to the field. So, I ended up starting a program at Columbia, The Biostatistics Epidemiology Summer Training (BEST) Diversity Program, that is aimed at exposing underrepresented and economically disadvantaged undergraduates to biostatistics and its applications to cardiovascular research and public health more broadly. At the time I started this not thinking that it will continue for over 10 years, but it is still going.
Dr. Benn with her mentee, Steven Lawrence, when he graduated from Medgar Evers College. Steven is a Biostatistics M.S. candidate at Columbia University's Mailman School of Public Health and also an alum of the NHLBI-funded BEST Diversity Program, which Dr. Benn co-founded.

 

Given these personal experiences and lessons learned from running this program, what do you think are some of the reasons why people of color are underrepresented in STEM programs?

 

Well, first of all you have to know that this career path even exists. It helps if someone tells you “you should go and pursue engineering, you’re really good”. Also trying to make these fields relevant to communities and showing that having this particular tool will help you fix the problems that you see every day. It’s not enough to just accept these students into the programs; having the numbers is not the only thing that matters. Nurturing and supporting the students throughout the programs is important, especially if they are a minority.  So, I mentor a lot of students from CUNY colleges, and I always try to find a project for them if I can. I see a lot of students that are first generation scholars and are really strong, but just don’t know the path to get to graduate school. There are so many things that make one competitive for graduate school, and sometimes the students just don’t know how to get there. 

 

And when it comes to graduate school, I think there is an assumption that you will figure it out, you are on your own, you are not an undergraduate anymore. Sometimes it is not only about mastering the scientific topics - there are so many other things that one needs to be a successful scientist. I feel that there has to be an investment and understanding that people come into science with a whole array of barriers. And it doesn’t always depend on what you look like. When I was in my doctoral program, I came out to my family, and that did not work out so well at first. So, then you are dealing with all of this, and when you are struggling, it is harder to call home. I failed my qualifiers the first time around, and in that I thought I was the biggest failure ever. Now it turned out that seven other students also failed, but in my mind, I messed it up for every other black person trying to get into Biostatistics at Columbia. You carry this burden that you should not carry. You put pressure on yourself and feel that you are representing the entire community. Not all of us come into science with parents who are scientists, or a lot of folk ahead of us that can give us advice on how we should do it. So, some try and succeed, some try and fail, and don’t get up because there is no one pushing them to get up. So you do need encouragement, and sometimes it comes from places outside of the sciences. This encouragement, the feeling that you belong, the feeling that you have a scientific identity and can make a valuable contribution to the field is extremely important. Somebody has to let you know you belong.

 

What do you think makes a successful diversity program in undergraduate or graduate school that can help address some of these issues?

 

Based on my experience, there has to be strong mentorship and good exposure to research, and these things have to be combined. There are many things that have to be added to ensure success of the underrepresented scientists that go beyond just the science. For example, for a mentor, understanding where the student is coming from is very important. Working on an initiative to reduce the racial and ethnic gap in promotion of faculty made me realize that it is not enough for a mentor to make sure a trainee is competent in their field. A mentor has to help position folks for success by making sure, for example, they are engaged in a productive research network.

Dr. Benn and her statistics friends at the 2019 Joint Statistical Meetings (JSM)- working towards a common goal to increase diversity in their field.
Given your experiences in leading the programs focused on enhancing diversity among faculty and faculty retention, what were some of the roadblocks you encountered and what are the main things you learned from them?

One of the initiatives I work on is the Eastern North American Region (ENAR) of the International Biometrics Society Fostering Diversity in Biostatistics workshop which happens once a year and revolves around exposing folks to biostatistics, career paths and graduate school. In the beginning of my career I focused more on studying racial and ethnic minorities most likely because it is the most prominent barrier that I could voice and whose mechanisms I understood. As I progressed further in the field, I started asking questions about women in Statistics and Mathematical Sciences. Recently a great group of LGBTQ statisticians and data scientists reached out to get me involved as well. So, at this stage of my career I can fully acknowledge my intersectionality. I also learned to acknowledge my own privileges. Yes, I am a black woman, but I also come from the suburbs, I received a very good education, so how these things operate for me might be very different from some of the mentees I have that come from places that may have less quality education, for example. With the initiatives I work on I am trying to learn from my own struggles while also acknowledging that others come to the table with other types of struggles that I may not always be able to address.

In terms of roadblocks, these initiatives need to be sustainable, so you need to prove that you are effective. But the metrics that we use might be very different from the metrics the funders use. We are trying to address that so we can keep these programs going. Dissemination is very important, so that’s what we are trying to do as well as building a stronger mentorship component and formalize these relationships, because we need mentors that will be able to support their mentees throughout their path. And, of course, you want to do all you can while still having time to get your research done, publish and try to get promoted. So unless you are strategic about it, these initiatives might not be ranked as highly. Even though you might be making an incredible impact and creating a culture that allows for equitable advancement in the field, you have to find a way strategically to make that mean something too for those who evaluate you. 


Do you think the fact that one has to compromise between scientific accomplishments and investing in these programs impedes these efforts?

I think that some institutions start to recognize this additional task that women, people of color and other underrepresented groups in these fields have, and they are trying to find ways to acknowledge this. If you are a successful researcher, students see you and relate to you, so you will have more mentees. The institutions have to do better at quantifying what it is that we do. So, I don’t think it impedes the efforts, but it is tough to do these things in a way that does not burn us out. So, it helps to get a grant to work on diversity issues in your field. It helps to have a leadership role or to have national visibility. I have been trying to effectively align my research interests in [health] disparities with my service interests in reducing disparities in promotion and increasing engagement of minorities in these fields. 

Do you feel that other women of color that are trying to do this work face similar choices?

Yes, I do. You definitely have to be strategic about this. For example, if I work with a lot of CUNY students and first-generation scholars, I take them on board, but we have a goal of getting a paper out, which is an important accomplishment for them and beneficial to the lab. Another example would be thinking carefully about who you are bringing on board for leadership on your grant. I know that some of my colleagues that are women of color, are struggling. So, I want to make sure that I involve them because otherwise they may not be able to stay at a given institution. This is, of course, not true for everyone. Everyone gets into science for a variety of reasons and the fact that you are a person of color doesn’t mean you can only deal with problems affecting people of color.

Yes, you are just more likely to be interested in these problems and they are more likely to drive you. 

Yes, the problems one decides to focus on have to be the problems you see. Even the clinical problems. For example, my wife is Jamaican, and I am generally around communities of color. And skin bleaching is a big problem in these communities. I remember asking a dermatologist about long term implications of skin bleaching and the work that is done in this area, but the person did not know what I was talking about. So, this is not something she sees and this is not the type of patients she is treating. Interestingly though, she connected me to a dermatologist at the Skin of Color Center at Mount Sinai. So, when I was talking to him, he was so happy that someone was interested in this because he sees these patients and deals with this problem all the time. You have to bring more people to the field who are diverse because it allows us to tackle the problems that went under the radar for those who are in the majority population, and to bring a level of ingenuity to tackle complex problems in a different way. I feel that I am working on diversity problems not simply because I want to see lots of different people. I believe that having diverse biostatisticians will advance the field. But we have to make sure that those people feel welcome when they get in.

Given that you work on issues of racial and ethnic disparities, do you feel that your science is misunderstood or misinterpreted at times in your field?

Yes. For example, here I am a statistician. Here I am an African-American woman who is interested in health disparities. However, as a statistician I am very much interested in how we can conduct disparities research in a way that is more inferential rather than descriptive. For example, when some of my colleagues might want to look at racial disparities in an outcome or disease, I think that some of these questions will not get us closer to intervening. What do you think are the real predictors of this disease? In inferential statistics, we tend to think of causes as something that individuals undergo rather than the attributes that they possess. This sometimes puts me at odds with the approach that my colleagues want to take. So, if we want to look at disparities as they pertain to deaths from COVID, we don’t want to just say “yes, there is a difference”. We want to look at what actually impacts your trajectory with COVID, such as diabetes or hypertension, so we can then effectively intervene.

Tackling the problem with the goal of intervening and potentially helping the community seems like a more reasonable idea.  Why do you think these differences in approaches exist?

Because we are trained to see things as black versus white. If you are looking at disparities between education and a health outcome, we are not trained to ask how low and high education plays out with respect to this outcome solely among blacks. Society tells us that we are different, and that our  differences are due to our differences. And we use this cyclical logic in our research. We say we want to look at a racial difference, we power our study, we look at the difference and we see the difference. Did we get any closer to fixing it? So that is where I am at now: I am trying to ask what is the insight that I can add to the project that might get us closer to fixing the problem and away from further stigmatizing the group we initially wanted to help. So sometimes I am misunderstood, and people think I don’t care about race. 

I also think there are times when I am at the table when people want to involve me in something because of my race: someone wants me to be on a diversity committee, for example. But when I get to the table, I am still a statistician, and I still think in a certain way. So, people are taken aback sometimes because I still have my expertise. I may have gotten to that table because you needed to fill a quota, but when I get there, I bring my expertise. That never leaves. So, I think sometimes that causes problems. 

I actually feel similarly sometimes. Even when I get to the table, it sometimes feels like people think that the reason why you’re there is because you are a person of color. And this, of course, brings the spiral of “Should I be here” and “Is there a better person that could do this job”. 

Yes, I think at this point, I feel that however I got there, now that I’m here, y’all are going to have to deal with me. I am here, and you’re going to have to acknowledge my intelligence, you’re going to have to acknowledge my expertise and if you can’t, it’s your problem.


Do you still feel that those preconceived notions about you are still there even at the level of your achievement and career?

Yes, I think so. I don't think that ever goes away, and I don’t think my self-doubt ever goes away. It’s always in the back of my mind, and I am always pushing through. If someone invites me for a lecture, my self-doubt makes me want to say “no” really quickly - “it’s too much pressure”, “I won’t be good enough”. And I have to push through and make sure that I don’t allow myself to respond right away, for example. I feel that it’s always there, but I do the best I can. I try to find mentors and cheerleaders that can help me push through the self-doubt. But I think it’s the nature of the beast. In science we are always supposed to critique each other, there is nothing that we can do that is enough. It makes us feel that we have to keep being perfect, and that’s really stressful. 

This brings me to my last question. For graduate students and postdocs that are thinking about life as a professor, what are some of the things we need to think about and choices we need to consider to organize our lives in a way that is somewhat healthy and balanced? Do you think that this is attainable and what is the advice you can give to live a healthy and balanced life while being a professor and being engaged in many things at the same time?

Look, I don’t think any of us have the answer, and whoever says they do is lying. This is probably the toughest question that you've asked me. I don’t think I have it all figured out. Probably within the last couple of years I’ve gotten a better balance, but I’ve been in the game as faculty for about 7.5 years, so it took me that long to start trying to find a better balance. I had a health condition, where I completely lost control and had to submit to being treated for that condition. That really made me rethink some things. You think you have to keep doing everything, but when you are out of the game for a while, you realize that things keep getting done whether you’re there or not.

I had to really think about what brings me joy. For me it is about finding joy. And I find joy baking, but I always make the same things: oatmeal, banana cookies, pecan pie, or banana pecan pie. But things like that clear my head. Or being around people I love. You have to find some way to remove yourself. Understand who you are as a human being. Not just as a scientist, but who you really are. That's very important to me.  Making sure I find time to spend with my wife, spend time with my family, wanting to build a family. Being in that space where there are so many other things that bring me joy beyond my job.
Left   Dr. Benn with her wife on vacation in Dubai in 2019.















Below   Dr. Benn and her NYC family for New Year’s Day 2020.
Yes, the idea that there’s so much more to me than being a scientist. 

Right. There are many things that bring me joy as a biostatistician, but there are also headaches, like constant pressure to get grants, supporting yourself and your team. Those things can be challenging. But I do get joy from students who I work with, who bring me a new perspective. Ultimately, I am constantly trying to find joy. I do not always have balance and I think I mess up a lot, but I do find that I need to re-center and be with family and friends. I am constantly trying to re-center, to recalibrate and then keep pushing through.
Contributed by Gloriia Novikova
GWIS Lead Coordinator - Vidya Narayanaswamy

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