Male cardiologists urged to ‘relinquish the podium’ on clinical trial leadership

Women will continue to be underrepresented at cardiology meetings because there are still very few who are leading cardiovascular clinical trials, a new report has concluded.

A review of gender diversity at the recent 2021 American College of Cardiology (ACC) Scientific Sessions found that organisers had gone a long way to ensure women were equally represented on panels and as chairs of sessions, but they had little influence on the predominance of males as presenters of clinical trial results.

In the sessions covering the Late Breaking Clinical Trials and Featured Clinical Research Sessions at ACC.21, six of the 16 session chairs were women almost half the panellists were women, with no all-male ‘manels’.

“What the planning committee had no control over, however, was the diversity among the presenters of the clinical trial results,” said review author Dr Mary Norine Walsh, writing in the Journal of the American College of Cardiology.

Of the 42 sessions for clinical trials 93% of them were presented by men and only three by women that were related to ‘women’s issues’ in cardiology, she noted.

“The root cause for the under-representation of women presenters at these sessions is the disproportionately low numbers of women who lead clinical trials,” said Dr Walsh, medical director of the heart failure and cardiac transplantation programs and the Cardiovascular Research Institute at Ascension St. Vincent Heart Center in Indianapolis.

“A lack of women in leadership positions on clinical trials [also] results in fewer women participating in the trials,” she added.

Dr Walsh said that increasing the number of women in clinical trial leadership roles on steering committees needed to start at a deeper level. Mentorship in early career was crucial as was knowledge of clinical trial committee structure, she noted.

“Mentorship tends to occur along gender lines with recent landmark clinical trial publications, led by men, including very few women as authors. Industry-funded trials tend to feed a non-diverse investigator pipeline and other research collaborations often encompass established networks that rely on “whom you know” and are rarely refreshed with new, diverse members,” she wrote.

To address this, some medical societies have started to release recommendations and roadmaps to foster change and to help develop and train the next generation of women and underrepresented minorities as clinical triallists.

“We’re starting to see work being done to close the gap in representation, but more needs to be done,” said Dr Walsh.

The review included several suggestions for systemic change including:

  • Government and industry sponsors of clinical trials insisting 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 need to encourage women to serve as site principal investigators.
  • The informal, or formal, pecking order of cardiovascular 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.

“Scientific sessions and meeting planners only have so much influence over who is presenting at conferences. Ultimately … it is the most senior clinical triallists, some in the twilight of their research careers, who need to foster and lead the greatest change,” said Dr Walsh.

“They need to relinquish the podium and give a leg up to others. There will be no room at the top for new and innovative investigators to shine if those who have already achieved success do not make room,” she concluded.

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