Clayton, Janine (2025)

Higingbotham: Hello, my name is Haley Higingbotham. I am an archivist at the Office of NIH History and Stetten Museum. Today is August 12, 2025, and I am joined by Dr. Janine Clayton. Dr. Clayton is the Associate Director for Research on Women's Health and the Director of the Office of Research on Women's Health [ORWH] at NIH. Dr. Clayton has strengthened NIH support for research on diseases, disorders, and conditions that affect women. Previously, Dr. Clayton, a board-certified ophthalmologist, worked as the Deputy Clinical Director at the National Eye Institute [NEI]. Thank you so much for joining me today, Dr. Clayton.

Clayton: Thank you for having me.

Higingbotham: To get started, could you discuss your background including your early education and family life?

Clayton: Sure. I am very fortunate to have had an incredible education. As a young child, I went to an all-girls Catholic grade school and actually went to all-girls Catholic high school, so for 12 years my early education was in a really supported and rich educational environment. I think that that helped me to have a firm foundation for the work that I've been able to do today.

Higingbotham: Did your high school also help promote STEM and help you get into science?

Clayton: I was exposed to medicine early as a child because both of my parents are in a medical field. I am very fortunate to have that early exposure, but also in high school, I was able to expand that early interest and take courses that resulted in me learning more about biology, about physiology. Actually, in high school I was fortunate to be able to take a class at Georgetown University, a college level course, in immunology, which is my first love in science. My high school is right next to Georgetown University, so I was able to walk over, take this class, and come back. I do think that having those early opportunities to address somebody's interest and get them excited about any aspect of science and show what the possibilities are is very important to anyone's education.

[Interview was paused and then resumed.]

Higingbotham: It's good to hear about your early interest and being able to take classes at Georgetown, but did you have any scientific role models during this time that also kind of inspired you?

Clayton: Growing up, one of my friends had a mother who was the dean of the dental school at Howard University College of Dentistry. In carpool, we’d get to see her, and so the fact that I was able to have both parents that were in medicine and see women leaders – my friend's mom being the dean, so in a leadership position – that definitely influenced me early on so that it didn't seem like it was unattainable to be able to have those types of positions and so those opportunities felt open to me. Not to say that I haven't had experiences that have been challenging, that there haven't been people that didn't believe in me who could have influenced me, but I think that that was balanced out by early exposures by parents who were very supportive, by an education, and then in the end, somehow I think everyone has to find their own why – why you're here, why you want to do whatever you're doing and your passion and then go after it.

And so, for me, I've kind of learned that I have 5 things that are important to me. The first is faith, and I'm a woman of faith, but also that could be faith in yourself. The second is fortitude. There are going to be obstacles. They are going to be things that you don't get that you want. They are going to be people that don't believe in you, and you need to be able to be strong enough to move forward. The third is flexibility. Life is not going to be the way you want it, and you need to be flexible and adapt. The fourth is focus. You need to be able to focus on different things at different points in your life. You may be able to have it all, but you probably can't have it all at the same time. [The fifth is family.] Those are important to me.

Higingbotham: That is some really good advice. Moving to your undergraduate [years], you received your undergraduate degree from Johns Hopkins in 1984. What made you pick Johns Hopkins? Did you have any mentors while at Johns Hopkins to help shape your interest and future plans?

Clayton: Johns Hopkins was a $9 train ride from Washington, DC at the time that I went to undergrad. I applied early decision to Hopkins because I had already started getting interested in medicine and research, and Johns Hopkins is the first research university in the United States, so it's very known for both. Having that nearby and at that point in my life, I wanted to be near to home and fortunately was accepted early decision and that also meant that I didn't have to fill out more applications which was nice. It was really the knowledge that it was one of the leading universities in research that made me apply there.

Higingbotham: That makes a lot of sense. Once you were there, can you discuss some of your time at Johns Hopkins like classes or what really stood out?

Clayton: Yeah. I was a natural science major at Johns Hopkins – a major that doesn't even exist anymore. It's a very broad science major, so that allowed me to learn a lot about different things. I also had my first research real research experience at Johns Hopkins and was influenced by a genetics professor named Robert Dottin, who gave me that opportunity. I was the lowest person on the totem pole. I was the one feeding the cells at night, but I was able to be part of that experience where in a lab meeting people are talking about their lab results and people are talking about papers and the fact that you could have a research question, or a hypothesis, and then design an experiment and follow some rules – the research method – you know, very rigorous. If you follow these rules, you get an answer. Either it worked, it didn't work, or something's the same or it's different. The fact that you could ask a question and answer a question were things that got me hooked on research as a way to move my career forward, because the appeal of that was that you would always be learning something either way. Whatever happened with the experiment, you're going to learn something. It's information, it's data. What you do with it, how you interpret it is different, but being at Hopkins, I was exposed to incredible opportunities. I took a class in public health delivery. I volunteered at the hospital, so I got exposed to a lot of things in medicine and that just solidified my interest in medicine and in research.

Higingbotham: After you graduated from Johns Hopkins, you received your medical degree from Howard University College of Medicine in 1989. How did you choose Howard to get your medical degree from, and was there a particular program or researcher you wanted to work with there?

Clayton: I actually started medical school at Harvard Medical School in Boston, and I got pregnant with my daughter. I had some complications from that and ended up taking a year off and transferred to Howard. I knew about Howard – my father is a professor there, and so I had previously applied. I really knew that I needed the support of family. Luckily, my daughter was fine, but having a baby early in your career, first year of medical school, really puts you in the position to understand that you really have to take advantage of every minute of every day. I was really blessed to have family that was able to support me through that. I had an incredibly nurturing environment at Howard University College of Medicine. I worked for the Dean – I read papers for the Dean as one of my jobs. I was a microbiology tutor. I created this microbiology jeopardy game to try to make it fun. Again, I had immunology and fell even more in love with the amazing intricacy of the immune system. I was just fascinated about the many networks and all the different ways that our immune system can respond appropriately when we have an infection, but also how it can go awry in autoimmunity.

Great teachers, many of whom were women, women chairs of departments. One of my mentors was Dr. LaSalle Leffall, who was the chair of the Department of Surgery at Howard, and one of the things that he taught me that has continued to influence me even today is his favorite motto was, “Equanimity under duress.” First, I had to look up equanimity, but after I look that up and he said that he felt that he had to steel himself with equanimity under duress as a surgeon, and the fact that somebody I looked up to shared that and shared that vulnerability that even him as a surgeon and a leader in the field, the first to do many things, that really stuck with me and has become kind of a motto for myself as well.

I also got introduced to ophthalmology at Howard. The chief of the division was Dr. Claude Cowan, and I had a Commonwealth Fund funded research associateship with Dr. Cowan, so was able to do my first ophthalmology research study. I got exposed to the incredible field of ophthalmology with a clinical rotation and that research and had an incredibly rich nurturing and supportive environment in a context where you have a lot to learn in a short period of time. And I, you know, had my daughter, so I had to be efficient and really move forward. I think that there is no way that I would have moved forward in my medical career without that type of environment early on. I'm very grateful.

Higingbotham: Yeah, sounds like a great support network, both professionally and personally. We're getting into your interest in ophthalmology. After you graduated from Howard, you had a residency at the Medical College of Virginia. You touched a bit on what made you interested in ophthalmology, but you also mentioned a few other disciplines that were interesting to you. What really made you choose ophthalmology over like immunology or surgery?

Clayton: My first choice was going to be pediatric surgery, because in surgery, you can fix a problem quickly. I very much realized that at some point, though, that was not going to be the kind of surgery that I wanted to do. Ophthalmology is a surgical subspecialty. It has medicine, so you have lots of medications you can deliver, and it has surgery too, and you can use lasers. It has cool toys – we have so many microscopes we can look at every part of the eye with and, you know, measure everything. And you can see an outcome pretty quickly – the surgeries are not ten hours long.

That's the case for most, you know, ophthalmology surgery. It was that combination of the medical, surgical getting an impact quickly, and the immunology of it – because I was interested in ocular immunology. I was able to put those two things together, and that's how I got interested in autoimmunity in the eye and immune mediated diseases, where the immune system instead of just fighting off an infection it has an over response and results in scarring of the cornea (the front part of the eye) or the conjunctiva or the inside the eye there's actual inflammation. There are many, many diseases that cause that.

Higingbotham: It seems you were able to find a specialty that really had all your interests. After your residency, you had additional training at the Wilmer Eye Institute at Johns Hopkins Hospital in cornea and external diseases and then also at the National Eye Institute in uveitis and ocular immunology, as you kind of just said. How did you find and choose these opportunities and what made you pick these types of training?

Clayton: Ophthalmology and then fellowships are governed and selected by a match system. You apply, you are interviewed, and then you get ranked by another institution, and so it's a match. I was matched at Wilmer for cornea and uveitis. It was great to go back to Johns Hopkins, where I started my undergraduate career. Incredible place, incredible mentors – men and women who supported me and sponsored me, put me on committees and gave me opportunities to write papers and we'll talk more about that. From MCV [Medical College of Virginia], I was able to solidify again that I really wanted to do this research career, which means you need to do a fellowship. I did a clinical fellowship for cornea and uveitis, and then I did a research fellowship in ocular immunology at the National Eye Institute and had the opportunity to work with Dr. Robert Nussenblatt and many others at NEI and really spent 15 years of my career growing that in ocular immunology. The reason I picked it is because, again, there were not great treatments for all these conditions. There are so many of these conditions; they are vision threatening; they affect people of all ages, including children. We did have some surgical interventions, but those were not enough and there was a lot happening in the field of immunology at that time where monoclonal antibodies and other modalities were being developed as new treatments. It was an exciting time to be able to bring those treatments to the eye.

Higingbotham: After you finished your training at NEI, as you have discussed, you stayed working there as a staff clinician. What made you want to stay part of NIH?

Clayton: NIH is really one-of-a-kind. There is really no other place where you could have such a rich intellectual environment, so many different potential collaborators, people at the cutting edge of technology and science, all trying to move things together forward and that opportunity to be a principal investigator [PI] on protocols and studies that I was initiating and being supported to do so was just an incredible opportunity. I was really pleased when the leadership offered me a position to stay, and then I was teaching fellows, so I became the attending and I was teaching fellows how to do complicated cataract surgery – uveitis creates very complicated situations – and so you know having that challenge – doing corneal transplants on patients with Sjogren's disease and other really difficult circumstances - I rose to the challenge. Those were exciting to me. That was an important way to advance science and have an impact. There was really no better place to do that. For example, I was able to be the PI of a protocol looking at one of the early TNF-alpha [Tumor Necrosis Factor] medications for juvenile idiopathic arthritis related uveitis. These are kids with arthritis and uveitis and an early phase treatment that NIH is the place to do that kind of thing and then get to support and training that I needed to grow as an investigator.

Higingbotham: The fellowship program seems very supportive. You eventually, from 2001 to 2008, became the deputy clinical director at NEI. What was that experience like and what was your normal day-to-day like in that role along with some challenges? How did it feel to be in this leadership position?

Clayton: Transitioning to leadership from being a clinician adds a whole additional set of skills that you need to cultivate and grow. Just on a day-to-day basis, in addition to taking care of your patients, writing protocols, responding to emails completing reviews, serving on committees and task forces like the IRB [Institutional Review Board], you now have additional committees and task forces like the running of the Clinical Center or how the operating room can be more efficient or how can you make the clinic move more quickly. You have additional challenges, but to me, those were all ways to try to again make things better and have an impact. I’m data-driven person, so instead of just looking at how many patients I saw, we were able to look across the whole clinic and say, “Okay, well how many patients did we see on Monday and Wednesday? Do we need to move these resources around so that we can be more efficient across the week?” It just took that attention to those details and making data-driven decisions in a different sphere, which really then made the clinical experience even more meaningful to the doctors and patients who were there, so II was able to impact from a different perspective. Then, you're also dealing with your peers as a leader, which is different, right? Because sometimes I had to make decisions that were not necessarily the popular decisions but were the right decision for the organization or the clinic or a protocol. I mean, there are limited resources. You can't necessarily do everything. It stretched me even further as a leader and again was a way for me to have a different impact on the field.

Higingbotham: Yeah, definitely. While at NEI, both as part of your post-doctoral training and as a researcher, you conducted quite a bit of research, some that you've mentioned, from ocular sarcoidosis to keratoconjunctivitis sicca (or dry eye) and ocular autoimmune diseases such as Sjogren’s syndrome. In addition, you were already looking into the role of sex in health and disease. Could you discuss some of your research during your time at NEI and some of the significant findings?

Clayton: So, one of the areas that I worked on was keratoconjunctivitis sicca, which is a complicated long name for dry eye disease. Dry eye disease is a lot more complex than it sounds by the name. It actually causes debilitating pain, discomfort, blurred vision and can be vision threatening in certain circumstances. It's a condition, a set of conditions, in fact, that were poorly understood as to the etiology. Sometimes there's not enough tears in terms of volume, but sometimes there are enough tears being made, but the tears have inflammatory mediators in the tear film that cause ocular surface inflammation. By the time I was doing this research, we were just learning that that inflammation is a key part of dry eye disease and that inflammation of the lacrimal gland, the gland that makes tears under the surface of the eye, that that was a key pathogenic factor. You can't just treat dry eye with drops that are artificial tears, because if the etiology is inflammation, you're just treating a symptom, and you're not treating the cause of the condition. I was able to do that initial work where we actually did biopsies of the conjunctiva, the surface of the eye, to be able to look at what cells were infiltrating, what cells were abundant in the conjunctiva, and we showed inflammatory white blood cells that express certain markers that showed that there was active inflammation. The reason that was so important – other people working in that space as well and talked about inflammation but we were able to use that information to serve as a outcome measure for the early phase clinical trials that resulted in the use of topical cyclosporine, an anti-inflammatory medication, to treat dry eye, and that was the first time that an immunosuppressive drug was being used to treat dry eye so that way of looking at those cells, we were able to treat and then see those cells go away or the markers decrease that supported the pathway for FDA [Federal Drug Administration] approval of that particular medication. Now, 30 years later, there are a lot of different anti-inflammatory treatment modalities available for dry eye and there are ways to also affect the quality and consistency and constituents of the tear film. The field has moved forward in many ways, but there's still lots of work to do there.

That's one of the big areas that I worked on, and the second one is premature ovarian insufficiency or premature ovarian failure. This was really fortuitous. I was standing in front of a NEI education booth in the lobby of the Clinical Center giving out educational materials and talking to people in the lobby, and a patient came up to me in her pajamas, a young woman, and said, “I'm here for a study, but my eyes are really bothering me. I see it's the National Eye Institute – is there any way I can get my eyes examined?” So, I’m like, “Sure, just tell your docs to put in an ophthalmology consult, and we can certainly see you.” I saw this patient; she was very young, 18-19, and she had dry eye and her ocular surface, the surface of the eye, looked more like somebody who was 50 or 60. And she had premature ovarian failure in that her ovaries had stopped producing the correct amount of estrogen and other hormones; she had premature menopause, essentially. The fact that this person had premature ovarian failure and eyes that looked older made me interested and maybe whether there was a relationship between the lower estrogen and dry eye in a young person. I wrote a protocol to look at this and was actually able to discover that there are ocular manifestations of this disease and wrote a paper describing that and was the first to do so. This is fortuitous – I mean, a patient just came up to me and asked me something but being able to think of a research question and the ways to ask and answer it, really require a research environment to be able to do that.

Higingbotham: Yeah, it's so nice the NIH has so many different fields that you can really be collaborative on cases like this. In addition, while you're at NEI, you filed a patent for ocular therapeutic agent delivery devices and methods for making and using such devices. Can you discuss the research related to this patent?

Clayton: I mentioned inflammation being a key and cyclosporine is a medication. We wanted to find a way to be able to deliver cyclosporine on a sustained basis without having to apply drops. Our goal was to develop biomaterials that would hold the drug and release it over time. We worked in the lab – this is certainly many people working in the lab, and I was one member of the team doing this work. Multiple people are here on this patent, but it just showed me what you need to do if you're trying to take a finding and move it to a therapeutic, in this case a novel therapeutic strategy like an implant. These were cyclosporine implants that we put under the conjunctiva to release the drug over time. That did not end up getting marketed or manufactured at a larger scale, but it taught me a lot about innovation, and it continued to spark my interest in doing things in new ways and more efficient ways. I think today there are even more modalities and ways to deliver medications – therapeutics, pharmacologic agents – than there were then and there are implants that are being put inside of the eye now and just that stay there and deliver medication like steroids or others. That was the very beginning of that kind of technology and those types of interventions.

Higingbotham: That's very interesting. We're moving to your time at ORWH now. In 2008, you became the Deputy Director of the Office of Research on Women's Health, becoming the Acting Director and then the Director in 2012 when you were also made the NIH Associate Director for Research on Women's Health. What led to your increased interest in focusing on women's health and also accepting these roles?

Clayton: In ophthalmology, there are sex differences in many diseases. For example, Sjogren's disease effects 9 times as many women as men. We know that some of that is related to the female immune system being a little bit more exuberant in its response to perturbation and that if that response is an exaggerated response, it can lead to autoimmune conditions, where the immune system is reacting against a person's own tissues and materials. That's how we were understanding sex differences. When a paper came out that looked at across the world – it was a global meta-analysis, so it took all these studies from different countries, put all the data together, and they found that two-thirds of the world's blind or visually impaired were women. Two-thirds. Including in the US at the time. We know that age is a risk factor for most eye disease, and women do live longer than men, but they couldn't explain this difference by just looking at the fact that women live longer than men. That idea that we did not know why two-thirds of the world blind were women, and I didn't really see a lot of attention to that topic, made me very interested in understanding how biology, being male or female, and the social factors around that affect eye health and then affect health and disease in general. As part of a group out of Boston that supported the development of a new group called Women's Eye Health Task Force, we were bringing attention to those issues, highlighting the fact that, for example, most people with dry eye are women (it affects men as well) but those differences, and that's when I had an opportunity to do a detail or a temporary placement in the Office of Research on Women's Health under Doctor Vivian Pinn, the first full time director.

Dr. Pinn had been my professor in medical school at Howard. She was the Chair of the Department of Pathology when I was a medical student – one of the very first female chairs in pathology – so I already knew her, and I already knew she was an amazing mentor and had consulted her periodically for advice and things. So the chance to work with her – I was actually her special assistant on detail, so I got to go where she went and got to see how decisions are made at high levels, how data is considered when you map out where resources are going to go, how you lead a meeting, and how you need to make sure you include voices from different sectors and different perspectives as you move forward. She’s a very charismatic, amazing, inspirational person who did so many things. The chance to be her special assistant got me exposure to that, and then when there was an opportunity to apply for the position of deputy, I became her deputy. Then when she retired, again, I applied for the director position. At this point, I was doing very little ophthalmology and had really moved into women's health, which was a big transition for me. I went from a very, very, very, very sub specialized area to a huge area because women's health is everything that affects a woman from head to toe across her whole life course. That was a big shift in my perspective, but I found it really exciting and the opportunity to have a larger impact was there. It was hard to give up doing ophthalmology every day. I love ophthalmology. I still see patients a little bit occasionally, and I'm grateful that NEI allows me to do that, but I had a chance to really lead new efforts as the director of the Office of Research at Women's Health, and that was an incredible opportunity for me.

Higingbotham: That sounds like one. So, your current research focuses are sex influences in health and disease, pathogenesis and treatment of immune mediated ocular surface diseases, and the development and standardization of outcome measures for anterior segment diseases. Could you discuss these varied research areas along with some of your clinical activities and how you really balance having this leadership role while also trying to still do what you love in research?

Clayton: At this point, I have the opportunity to see a few patients along with actually an individual, Dr. Theresa Magone, who I trained. She is now an investigator in the National Eye Institute, a cornea uveitis specialist as well, and I was able to continue my interest by supporting and mentoring her and providing guidance and advice and counsel to her. At this point in my career, I'm excited to be able to support many others doing their careers, and so when I told you about inflammation and subconjunctival inflammation in dry eye in early days, she's now working on a machine that can examine the tear film and pretty quickly, within minutes, give you a profile of many different mediators that are present in the tear film which is amazing compared to what we had to do, which was to do a biopsy, look at cells under the microscope, stain them and then count them, and then a few weeks later give an answer of what was present there. The technology has advanced so much that instead of just putting a piece of paper in the corner of your eye to measure how much tears you're making, (it's called a schirmer tear test), you can actually take a little bit, a microliter or just two microliters, a very small amount of tear fluid, and put them in this machine and through this technology look at the mediators. That allows us to have much more exquisite understanding of what's going on in that particular patient's eye at that moment, which lays the groundwork for us to have personalized individualized therapy for that person. Also, it means that we're going to get a treatment that's really focused on what's going on for that person instead of a trial-and-error approach or a shotgun approach where we say, “OK, we're just going to put you on this because we're not sure exactly what’s going on, but it'll work. It'll decrease all the inflammation, but it might have more complications, but we don't have enough information to titrate or really tailor your treatment.” I know you've all heard about personalized medicine, and everything is about every individual deserves to have an understanding what their particular condition is. Provided that information, we can research, can design therapeutics that are individualized and personalized to that person. I'm able to do that because I sit on boards or I sit on task forces and I'm able to co-author papers and see the next generation of investigators move forward. It’s really a privilege to do that and feel like I still am contributing in the space.

Higingbotham: That definitely makes sense. As the director of ORWH, you were instrumental in establishing the NIH policy regarding sex as a biological variable [SABV]. Could you discuss the efforts to establish this policy along with your role in the process?

Clayton: You've heard this recurring theme throughout my career is understanding why women might be affected differently, and the other side of that coin is why men might be affected differently. I became very interested in the biology of sex differences and why having an XX chromosomal complement or an XY complement might have such profound different effects on our health, and we kept learning more and more that there are differences in gene expression between men and women; there are differences in the way physiology, normal physiology, hepatic Physiology, how you metabolize a medication; we know that women tend to have more adverse effects from nearly every medication, and that results in some cases in those medications being withdrawn from the market. I actually used to take an antihistamine that is now no longer available.

I took this every day for years. Antihistamines sound like they're pretty innocuous, right? You have allergies, you take antihistamines. Well, normally the QRS interval which is part of the EKG in females is slightly longer in women than men. It doesn't mean anything; It's just slightly longer. Unfortunately, some medications can prolong that QRS interval and trigger arrhythmias, abnormal heart rhythms, which can be fatal. This is part of my why – the fact we didn't understand that, we didn't know why, we’re not always looking at it, we aren't always reporting on it, and people are taking these medications without us understanding that that may be a risk. It made me very interested in making sure that there was some kind of way to raise visibility about these issues, get work done on sex differences, and one of the ways to do that is through policy. I worked with Dr. Francis Collins, then NIH Director, presented this information to him that I really think we need to do something different to make sure that we are accounting for sex as a biological variable, looking at male and female influences in health and disease in our research – in the lab and in the clinic. We were already including women in clinical studies as a result of the NIH Revitalization Act, but in the lab, in those preclinical studies, we weren't always looking at that in the animal models that we were studying or in the data that we were generating from computational approaches or otherwise.

He was convinced that it was an important effort, and we wrote a paper together in Nature that came out in 2014, and he worked with me to develop a new policy, so I would say played a key role as the architect of this SABV policy that now requires investigators who are doing animal or human studies for animal and human studies to account for sex as a biological variable and to include male and female animals unless there's a scientific reason not to do so. It's fine to do single sex studies as long as there are scientific reasons to do it that way, but it made investigators have to think about it and explain it in their applications. Now we see many, many, many more studies looking at sex differences, looking at sex influences. Sometimes they're clinically meaningful and sometimes they're not. Any of the findings that are generated provide that data for other scientists to pick it up and look more deeply, to understand the biological underpinnings of that, so that we might understand, you know, why women don't always have chest pain when they're having heart attack. And cardiovascular disease (heart disease) is the leading cause of death for women in the United States, but we don't understand everything about why a woman might just have jaw pain or shoulder pain or be fatigued and not realize she's having a heart attack. That is a problem because women go under diagnosed, because if they come to the emergency room with the heartburn, but not chest pain, they may not be fully evaluated, so by doing this type of work where a policy says you need to do this, you need to publish it, you need to put it out there, we affect the knowledge base that's out there that is being used by clinicians to inform how they deliver care and by organizations and how they develop guidelines for treatment. Those affect the health of women and men. When we can get more individualized, we get better treatment for everybody.

Higingbotham: Oh yes, definitely. You kind of mentioned earlier about being on different boards and task forces. You've been on a part of numerous NIH committees and task forces. Could you speak about some of the unique opportunities and vantage points that come from being on such a wide range of projects?

Clayton: You have an opportunity to learn a lot when you're on a board or a task force. For example, I was on the Institutional Review Board for neurosciences here and that showed me a lot about how investigators are putting together protocols and also was a chance for me to give back and provide service to the institution. Being on search committees or governing boards, again, you have an opportunity to influence and have your voice heard and share your perspective, which may be different from others. Being on international groups where we were developing standards for diagnosing and treating dry eye, again, you're affecting the field and what goes forward. Every time you say yes to an opportunity, you are saying no to something else, so it is important to pick those opportunities thoughtfully because you can't do everything at the same time, but those opportunities do give you a chance to see a different perspective as well as an opportunity for you to share your perspective, which is unique and provides value and expands the scope of thoughts and ideas and notions that are being considered in decision making. Every single one of us has an opportunity, has our own voice, has our own unique perspective on things, and we know that we make even better decisions when we have even more information and more perspectives. I feel it is a privilege to be one of those groups, and now when somebody asked me to be on those and I'm not able to, I just think about another person that I can provide a couple of other names to them who might need the opportunity and I can pay it forward in that way.

Higingbotham: Earlier you also mentioned in terms of being on boards, having an opportunity to mentor future researchers. Can you discuss the importance of mentoring to you?

Clayton: I have been so blessed and fortunate that people took a moment to tell me and give me a mentoring word or in a room where I wasn't and, you know, sponsored me, spoke up for me. I have learned some of those things later in life – how that made a big difference – so I tried to do the same. I think it's part of our responsibility as members of the biomedical research workforce and in the space to be able to support the entire workforce, meaning those that are coming after, to share our perspectives, but also respect when they make different decisions that we might have made, but just to share it as an opportunity and to bring them along. When you have a chance to take somebody to a meeting, just take them to the meeting with you. They get exposure. They get to see things, and you never know where that next major discovery is coming from. We need as many people as possible, as much expertise and talent as possible, coming to bear on biomedical research to affect human health. We have so many challenges and chronic diseases. For example, you know ocular diseases, blindness, that we need to bring biomedical engineers in the space, people who have expertise in social sciences and humanities in the space, those folks that love to do surgery and care for complicated patients and then write research protocols and papers and textbooks. We need all of that, and so I just feel like I'm playing my little part of that of a system that has been a beneficial to me and I think that in the end we're all doing this to make people's lives better. The impact is on somebody's life. We're not doing this just because it's interesting. It's because by that finding you might discover a way to treat a patient, improve their quality of life, have them seeing or not seeing (having them seeing is a big benefit) or improve their health, prevent that heart attack, treat that autoimmune disease early or prevent the complications. Hopefully in the future we'll be at the point where we can prevent poor outcomes from so many diseases because we learn how to detect them and we learn how to prevent them, or we learn how to treat them better. I feel like it's all of our responsibility in this, in the field, in this space to share that opportunity. It's a responsibility to share that opportunity with others.

Higingbotham: Kind of winding down the interview a bit. What are some areas that ORWH is currently working on, along with areas you're hoping ORWH can explore or contribute to in the future?

Clayton: I mentioned that women's health is everything that affects a woman from head to toe, inside and out, so internal factors, external factors, environmental influences, genetic predisposition, all of that, and that happens across the life course and there are key transition periods in the life of a woman. Menarche, so puberty, pregnancy, and menopause, where that's the cessation of reproductive capacity. That is the time when chronic disease risk increases. The average age is 51 1/2 in this country and it's an opportunity to intervene again to prevent the development of hypertension, to treat chronic diseases, to address concerns like cardio metabolic diseases, obesity, Alzheimer's, early onset Alzheimer's, depression. We know there are linkages between these different conditions. For example, we know there's a linkage between depression and cardiovascular disease, but we don't exactly understand why those are linked, especially in women. One of the efforts that we have at ORWH is Specialized Centers of Research Excellence on sex differences. Those are called SCOREs – S-C-O-R-E. We're looking at sex differences in diseases like heart disease and linkages to depression, so interdisciplinary approaches where you bring together multiple perspectives and really probe how sex is working and why there might be differences. Specialized Centers of Research Excellence are one of our premier programs. It's NIH’s only center level program on sex differences. We continue to see an impact, and we're trying to spread that across the country.

Then our IDeA [Institutional Development Award] states program where we've worked with other institutes and centers on this congressionally mandated program, where the funding for capacity building and research goes to the states that received the least amount of NIH funding. We've worked with them to create a women's health research component there. In the last five years, we have given over 83 supplements to 21 of the 23 IDeA states, and we created a new program called Centers of Biomedical Research Excellence [COBRE] on Women's Health. The COBREs are an existing IDeA states program, and now we added women's health to that. Now we've now funded 4 women's health centers in states that never had a women's health center in that way, bringing capacity to address the health needs of those women in those states. The first three were Idaho, Louisiana, and Kansas. Looking at really interesting topics like nutrition, big data, and precision medicine. We are thrilled that we're able to bring together forces, other sectors, other collaborators, to focus on the health of women and to understand that by designing research in the most rigorous way, meaning you account for SABV in the lab, in the clinic, in translation, in publications, you are making every dollar work harder for the health of women, you are doing the most rigorous science that's the highest quality science, and you're benefiting as many people because you're generating findings that may be more generalizable or applicable. And, you know, with taxpayer funded research, it's critical that we do that and that benefits everyone.

Higingbotham: I can't wait to check out some of the findings from these centers. Well, the final question I have for you is a bit more of a personal question. You're a native Washingtonian and were able to spend most of your educational and professional career in the DMV [DC, Maryland, Virginia]. You kind of have said that this has been something that was on purpose, but what does it mean to you to have been able to stay primarily in the DMV and have that support system?

Clayton: I am really incredibly fortunate to be able to say in this amazing area. It has so many rich opportunities. I'm an art lover – there are like a million museums here. My family is here. NIH is here. I mean, there's millions of universities around and other resources, so I really feel blessed and fortunate to have been able to be in a location where I could pursue a passion, I can be near my family, I can explore museums on the weekend, I can go to Rock Creek Park. I went to grade schools here and was supported in doing that, but most importantly it gives me a chance to give back to a community that has given so much to me. It is a little hot; it is a little humid, but it includes so many rich opportunities, great food everywhere, you can get whatever you want here. Just that mixture of so many opportunities, chances, different kinds of people, different perspectives is such a rich community to me, so I feel very fortunate to have been able to do this here and look forward to continuing those efforts.

Higingbotham: Well, thank you so much for joining me today. I really enjoyed this conversation, and I wish you the best in the future.