Serpil Erzurum, M.D., was named Chief Research and Academic Officer of Cleveland Clinic in 2020, representing an expansion of her role as Chair of the Lerner Research Institute, which she has held since 2016. She has published more than 200 peer-reviewed articles, and her work has led to significant advances in diagnosis and treatment of lung diseases. We spoke to her about the importance of inclusivity in medical research and the future of WAM’s exciting new partnership with Cleveland Clinic.
Read the Q&A with Dr. Serpil Erzurum below.
WAM: As you know, WAM has recently joined forces with Cleveland Clinic to raise awareness around the need for research to be more inclusive of sex and gender in research around women’s neurological health, especially when it comes to women of color. Why do you consider this an important endeavor—and what’s the most effective argument for inclusivity in medical research?
Dr. Erzurum: Black Americans age 65 and older are approximately twice as likely as Caucasians in that same age group to develop Alzheimer’s disease or another dementia. For Latinx people, the ratio is about 1.5 to 1, according to the Alzheimer’s Association. Yet the lack of diversity in clinical research is a broad-based and regrettable shortcoming: minorities are underrepresented in Alzheimer’s clinical research, with college-educated Caucasians comprising 95% of all participants. The downstream effects are a lack of understanding of the manifestations of Alzheimer’s disease in diverse populations, ignorance about factors that promote or prevent it, and limited ability to predict the positive or negative effects of current and future treatments in the breadth of patients for whom they might ultimately be prescribed. We simply don’t know what we don’t know.
WAM: You are both a scientific researcher and a practicing doctor. Where do you see the consequences today of medicine having been researched primarily on men—and how do we fix this issue?
Dr. Erzurum: Historically, women have been excluded from clinical trials, despite comprising one of the most frequently considered “subgroups” of patients for many medical conditions. For decades, drugs were approved without being tested on women or factoring in whether women would have different reactions or require different dosages.
We now know, in large part due to advancements in genomics and the advent of precision medicine, that there are significant sex-based differences in disease pathology and treatment response. We have made remarkable progress in recent years. The inclusion of women in research, both as subjects and scientists, has increased tremendously over the years, as has our understanding of how many diseases—including Alzheimer’s disease, heart disease and cancer—affect women differently than men.
WAM: In several conversations we’ve had, you’ve spoken highly of Dr. Bernadette Healy, who made medical history by becoming became the first woman to head the NIH—and medical research by launching the ground-breaking Women’s Health initiative. Why were those moves so critical for women’s health today?
Dr. Erzurum: Dr. Healy was a trailblazing physician, scientist and public health advocate who championed research on women’s health. She had a tremendous impact on shifting our thinking about gender and research. From early in her medical career, her research focused on how heart attacks manifest differently in women.
As NIH Director, she changed policy to require that equal research be done on both men and women for all diseases and conditions that affected both. The NIH Revitalization Act of 1993 contributed significantly to our understanding of disease in women, mandating that NIH-funded trials have sample sizes adequate to support a valid analysis of gender and racial subgroups. She launched the NIH Women’s Health Initiative, a $500 million effort to study the causes, prevention, and cures of diseases that affect women. This long-term study of 150,000 women produced significant new insights into the prevention of heart disease, cancer and osteoporosis in women.
These efforts were so critical—the more we learn about how diseases affect women differently than men, the better informed we are about how to treat disease in women, as well as things women can do to take charge of their health.
WAM: You say that in addition to women’s bodies differentiating them from men, there are also lifestyle and socio-economic issues that may impact women’s health differently and put them at greater risk for neurological disease, including Alzheimer’s. How so?
There are numerous factors that contribute to the differences in women’s health – from the role of stress on women’s lives throughout their life span to large fluctuations in hormones from the onset of puberty, during pregnancy and menopause. We also know that lower education attainment in women than in men born in the first half of the century could account for elevated risk in women, as limited formal education is a dementia risk factor.
Longevity – women living longer has been an explanation for their increased risk for Alzheimer’s – but researchers are pursuing additional reasons including structural and functional connections in the brain as well as societal, cultural and biologic factors, such as the role of menopause.
WAM: What’s your greatest hope for how this new partnership between WAM and the Cleveland Clinic can change the trajectory for women’s health?
We are really looking forward to building on our important work with Maria Shriver and WAM to expand our efforts to better understand the link between women’s unique biology and health experiences over the course of a lifetime and their risk for Alzheimer’s and other diseases.
We all know the statistics – that one in two women will be diagnosed with a neurological disorder in her lifetime – and we hope this new partnership will foster an environment of collaboration and innovation to advance women’s brain health. By bringing together Maria and WAM’s experience in advocating for awareness around women and Alzheimer’s with our academic medical center’s robust research infrastructure, we are poised to make strides towards altering the narrative that brain disease is a woman’s disease.