Pinn, Vivian and Janine Clayton (2026)

Valera: Good afternoon, my name is Devon Valera. I'm the curator and collections manager at the Office of NIH History and Stetten Museum. Today, I have the honor and privilege of talking to Drs. Vivian Pinn and Janine Clayton. Dr. Pinn is the founding director of the Office for Research on Women's Health, and she served in the role from 1991 to 2011. Dr. Clayton is the current director of the office and has been since 2012. Thank you both for joining me today.

Both of you have participated in oral histories with our office that outlined your early careers and later experiences as directors of the Office of Research on Women's Health, which I will be referring to now as ORWH. To connect both of your stories, let's first talk about how you got to know each other at Howard University. Can you tell me a little bit about how you two met?

Pinn: Well, Janine, I'll turn that over to you.

Clayton: Perfect, perfect. I met Dr. Pinn, first, when I was a medical student at Howard University College of Medicine. Dr. Pinn was the chair of the Department of Pathology and taught me pathology. So, it was fantastic to see a woman, leader, chair, and if you know anything about Dr. Pinn, which you can still see, she has a very lovely, elegant presence about herself. So, it was impressive to see woman with such credentials, mastery of an incredible field — pathology — and then just as a leader, as a chair. And there were very few chairs…

Pinn: I was the only woman chair.

Clayton: Only [black] woman chair of a Department of Pathology in the United States at the time. Do you remember me from medical school?

Pinn: Oh, of course I do. Janine was very quiet but obviously was a good student. And I remember [her] from the classes, and I knew her because her father was actually a rheumatologist. So, I knew it was Dr. Austin's daughter, but she stood on her own. I just remember she was very quiet, and [a] very lovely medical student… I think [she] just stood out as a good student, that's all I can remember. But knowing that she was going on into ophthalmology was great. And, of course, we then met up later.

Valera: Absolutely. So, you both came to NIH, but previous to that, while you knew each other at Howard, did you speak about women's health at that time, or did those conversations come in later?

Clayton: Those really came later because, you know, the conversations would have been about pathology.

Pinn: Just surviving as a student and being a woman in medicine — [there] still weren't many women in medicine — but not specific [conversations] because there really wasn't any focus on women's health research as such or women's careers in biomedical fields. That really wasn't an area that was being discussed back then. So, if we did discuss it, it would have just been peripheral in terms of our interactions of what we were seeing at the college. Remember, the field of women's health research did not exist until the office started up.

Valera: Absolutely. So, turning to NIH, both of your paths would bring you here. Dr. Pinn as the director of ORWH in 1991 and Dr. Clayton as a postdoctoral fellow in 1994 at the National Eye Institute, as you said, specializing in ophthalmology, and there you later became deputy clinical director. Now on the same campus again, did you get back in contact when you arrived in ‘94?

Clayton: Dr. Pinn was somebody that I then saw as a real role model. Again, the office was just getting started and programs were being formed. I would see that she was hosting a seminar, or leading a conference, or speaking in a meeting. But at that point, I was really focused on ophthalmology and so our connections were really at events.

Valera: Absolutely.

Pinn: I can add that then, because I tried to reach out, there were so few women scientists moving up at NIH and even fewer women of color who were moving up. Having known who Janine was and seeing that she was here, you know, I was always reaching out to those [people coming along] to [let them] know that my office was open and available, and to see how they were doing, and learn from their experiences. I liked to use my position to really fight for the needs of others coming along.

I've never been one to really hold my voice, which I probably should have, but then I would learn what experiences others were going through to see what input I could have with others in the administration to make things better. So, I did get to talk to Janine, and it was great to know she was here. We did have some discussions. I'd invite her to come by my office and that was great. So that's how we kind of reestablished our connection.

Valera: Absolutely.

Clayton: Definitely in periods of times where I had to make a decision or there were leadership challenges — I remember sitting on your couch in your office in Building 1 with a challenging situation. It was so wonderful to have somebody to talk to who understood the circumstances, who understood the complexity, and who was a safe space. You know, there are not that many of those, all three of those together. So, you know, Vivian was really important to me, both as a role model, but also just as somebody that I could talk to about the challenges of ascending in a scientific career.

Valera: Yeah, absolutely.

Pinn: I could understand that, having been through it myself, and having very few [people] that I could talk to, and knowing how important it was just to sometimes be able to reflect that off of someone. Also being in my position, I would want to — if I could — speak up or do something to help out others. But Janine handled her situation. Having that safe space, I know for so many years that I didn't have a safe space. So, I really wanted my office and my presence to offer that to those who were coming along, because that could make such a difference.

Valera: Absolutely. So, it does sound like you had a relationship before you joined ORWH, where it was definitely one of —

Clayton: Oh, absolutely.

Valera: We have questions about mentorship —

Pinn: I saw that she was really good. I suggested and asked her institute director if I could then take her on part time in my office for her to get more exposure to leadership roles, administrative roles, and dealing with the kinds of issues I had to deal with. I thought it would both be helpful to me and would also give her more administrative experience for her bio and for her CV to say she'd had this experience.

That worked out very well because we worked so well together, maybe because of our past history and getting along. Then when my deputy director left and I had to search for a new deputy director, it just seemed to me that she was a natural: she knew the office, she knew how I worked, she knew what the issues were, she knew what our staff was, she knew about women's health, she was a physician, she could speak to the issues, she could represent me, and represent the office beautifully.

I just felt that she was perfect to be the deputy director. So that's the next step up—from just seeing her, having her come through to spend some time for some administrative experience, to becoming my deputy director. She was the deputy when I left and became acting director at the time I retired.

Valera: Absolutely. A little bit of backtracking back to before you did join ORWH, Dr. Clayton. While you were at NEI and you were looking at sex-linked disparities in eye health. You were on the NIH campus during the early days of ORWH, you mentioned seeing the events [and] seeing the presence of women's health now on campus. Can you share a little about what that was like? Maybe your memories from your peers while you were still at NEI about ORWH?

Pinn: Well, that's a good question, because I never asked her what people thought of the office outside. I want to hear that too.

Clayton: I was working on autoimmune eye disease, which is much more common in women than men, and recognizing that sex difference is something that got me even more interested in women's health, which was a growing field at the time. So, there were conferences: there was the BIRWCH meeting, there was the SCOR meeting, there was the symposium. There was National Women's Health Week. That was one of the biggest presences of ORWH on the NIH campus, because you always had a booth for the whole week, usually on that second floor of the bridge in the Clinical Center, so that people who were going to lunch and walking around — employees, anyone in the Clinical Center — could come up and get information about women's health.

That really stood out because it was incredible outreach that I didn't see for every other topic. It also made such an impression that the topics being talked about, the materials, and Vivian and the office, always had incredibly beautiful and impactful informational resources that were very much on topics that, you know, everyone wasn't talking about.

She brought a lot of attention in her approach to issues of importance, and she was very clear on wanting to push that out and disseminate that to the public. The office made themselves available for five days during National Women's Health Week, which is the week after Mother's Day.

Valera: Wow. That's fantastic to hear. I am very interested in the way that ORWH would be seen on campus. Was there outreach among your peers at other institutions, perhaps? Or when you'd go to conferences and talk about women's health? Was that —

Clayton: Because I was going to eye conferences, you know, I was the one saying: “Sex difference exist” and “Are you paying attention to this?” There was not attention to that issue. And the fact that at that time a meta-analysis published said two-thirds of the world's blind were women, people were surprised. No, they didn't know about it.

I think in those early days, you know, the specialties, the various specialties were fragmented in a way and hadn't really heard about the importance of women's health.

Valera: Now we're going to go back to the process of bringing Dr. Clayton on as your special assistant. I know we talked about this previously, but do you remember the process of bringing her on? You mentioned she first joined —

Pinn: Well, I spoke to her institute director. I'm not sure I ever told her all the discussion I had, but I went to him, and I told him I thought she was very valuable, and I really wanted to have her have a chance to develop administrative skills. Even though she had administrative titles at NEI, I thought being exposed to an office like ours would bring a whole other set of experiences.

I also pointed out to him that I wasn't trying to take her away from ophthalmology. It was very important that he keep her on at the eye institute and reinforce and support her research, just because she was actually the only person of color in a position at the eye institute. I pointed out to him that in the field of ophthalmology — which he should know, perhaps he knew, but I wanted to make the point, that in a field of ophthalmology at that time there were very few women and even fewer women of color. I did not want to take her away from her main specialty because it was important that she continue in that field. So, we had this kind of honest discussion about why I want her to be able to develop other areas in her ability to be a leader, but that it was very important to me that she maintain her ties to the eye institute and that she continued to have support for her research and for her role there. And he accepted that. I mean, thank goodness he did, but looking back, that took some nerve, but it worked.

So, she was able to come work [as] the special assistant, but she maintained her liaison to the eye institute, spent time there, and that was fine with me. And I really felt that way. I really sometimes feel that some of us jump into administrative roles and take time away or forget what our primary specialty was, either as a PhD scientist or a medical scientist, we get caught up in things like personnel and hiring, and we forget the science that brought us in. I just think it's very important when you have invested so much time in developing a skill or developing an area of expertise that you don't give that up.

Valera: Yeah, certainly not an easy decision to make, but how was that from your perspective, Dr. Clayton? Did Dr. Pinn reach out to you about being a special assistant? Did you inquire? What was that process in your perspective?

Clayton: This was a follow-up from discussions that we were having about options and pathways. So, I was excited to really be able to be a special assistant — I wasn't sure what a special assistant was — but that is an NIH thing, it's very much an NIH thing. Each special assistant is actually unique, because you are doing what your principal needs you to do. But it also means you learn a lot, and I learned so much with Dr. Pinn just in the rooms that I was in, in the meetings that she exposed me to, in the conversations, the strategic way of thinking. I was able to see that and her leadership. I was really grateful for that opportunity.

Pinn: I sort of remember that at that time the White House was very interested in women's health and had a lot of things to do. So, I started taking Janine and after a while saying, “You can go to the White House.” Just to think — you know, now it doesn’t work that way, the invitations. But I'm thinking to go from being a fellow to all of a sudden, she's going to the White House, knows how to get in, [is] attending meetings, [and] representing the office there. I thought, well, this is a step up, this is a benefit for coming to work with me. I love the fact that I can say “Janine's going to the White House, I don't need to go.” [laughter]

Valera: What was that like for you? That sounds like —

Clayton: That was amazing. A little heady, because, you know, again, just little things like you need to go to this guard room, you need to make sure you have this information in advance. Because I was doing that with Vivian, it made it so much easier for me to do it once I had the chance to do it myself. So, I'm so grateful for that opportunity, and many, many, many people who are very capable do not have those opportunities. I wanted to make the most of that and really appreciated Vivian's generosity, because she didn't have to do that. You know, at any point she could have said, “I'm going. You can stay here.”

Valera: Wow, so that's one aspect, it sounds like, of the many things you did as a special assistant. Is there any particular project or memories that you have from that time at ORWH that you're proud of? That stick out in your memory?

Clayton: I'll share something. I don't know if it's something I'm proud of or not, but I will tell you, when I came to ORWH I had written about 100 papers at that point. So, I thought I was a good writer. Okay, let me tell you, Dr. Pinn is an outstanding writer. I do remember some documents going back with various colored ink on them that took me aback the first time. [laughter] I thought it was a good writer.

But I had to admit, when I incorporated her changes, it was even better. And when I saw what she was writing, I understood it's a different kind of writing. It's writing for impact. You know, I'm still using "galvanizing," I am still using these words: “capitalizing upon,” “maximizing impact,” “amplifying impact,” “magnifying the efforts of others.” I wasn't writing like that before. So, I learned even more about the importance of being able to demonstrate your value, demonstrat[ing] the value of the office from Dr. Pinn. So, that was an incredible lesson for me.

Pinn: She also stepped into, I mean, as an administrative assistant — she really experienced more in the role of leading in areas of women's health research reflecting on her medical career, as well as her research, and emphasizing why sex and gender made a difference. But also, just why women's health research was important. So we can’t overlook the basic role of the office, which was pursuing research to define more about what we know about women's health. And she was excellent at that. So, she picked up many areas of that and helped with our completing the strategic plan that we had that was done just before I left.

She had all of that experience, knowing how to arrange meetings, look for advisors for the office to chair those meetings, and to really dwell on the science and the medical aspects of women's health in addition to the leadership and all the other things. She was great at that. I mean, that helped me so much, and it helped the office to move forward.

Valera: Absolutely. It does seem like ORWH has so many different responsibilities and so many different topics that it touches. We were talking about [the role of] special assistant and now, moving into 2008, you became the Deputy Director of ORWH, Dr. Clayton. And in this new role, did anything change? Was there a difference from what you're doing as a special assistant?

Clayton: Well, the leadership responsibilities were substantial at that point. So, that was a shift for me. That was also kind of the point where the ophthalmology piece was a little less, because the women's health piece was little more. But always, I decided to just bring it with me everywhere I went. So, I would say, “women's eye health” and “sex differences in ophthalmology,” I would use those as examples.

But as Vivian said, you know, as a physician, it's so much a part of how you're trained to think about what the clinical impact of something is, or what the public health need is. So, outlining those issues, that's what drove me, but it was the leadership responsibility and the leadership opportunities. I did get to do some leadership courses and other things like that. Vivian was very supportive of that. And then sometimes, I was representing the office as a leader.

Valera: Did you learn anything about each other as you stepped up as a leader and as you saw her [do it], Dr. Pinn?

Pinn: I don't know how much I learned. I think it was more that, what I expected of her — that she met all my expectations. I was very comfortable. I do like to, what's the word, when I give responsibilities to others?

Clayton: Delegate?

Pinn: Delegate. But I don't like to delegate when I see I've delegated to somebody who can't meet the standards I want for that. I had no problem delegating to Janine. I hope not with too much to do. Feeling that she could represent the office, or she could go to this particular meeting, or she could meet with this group of scientists because I knew that she was able to.

So, I'm not sure I discovered so much, as really just saw what my expectations were—all were real, and that she was meeting those. So, it was a great experience for me to have a deputy that I could trust and lean on. Of course, we always had some issues that I could discuss with her, because it's not all just roses. I mean, there are things to deal with, both political and personnel and other issues that are not the most pleasant things to deal with, but having someone to work with…

In fact, I remember one particular personnel problem she's never forgiven me for, but someone that she supervised who was a real problem for the office. Janine had that under her list of people to deal with. I think we both got great experiences out of that, but she handled that with authority and with respect and so, I could only appreciate that.

So, I know I didn't take her on thinking I'm going to learn that she's a good leader. I knew she was a good leader, and sure enough, she was good leader. You can see that has manifested itself in the office continuing and doing all it's doing and surviving at this point.

Valera: Yeah. It does sound like you built such a layer of trust with each other, so that a lot of this went relatively seamlessly. I think we touched upon it a bit before, but your relationship as sort of mentor-mentee really seems to exemplify one of ORWH's larger projects, which is to foster opportunities for women in positions like this. So, is that true to you? Do you see each other as mentor-mentee?

Clayton: I am not Dr. Pinn's mentor. [laughter]

Valera: [laughter] Well, I guess — I beg your pardon.

Clayton: I am definitely her forever mentee. She can be my forever favorite mentor. She is very well known for her generosity.

Pinn: I just say she's my former student, and that's it.

Clayton: [laughter] Yeah, well, you have a lot of former students.

Pinn: I have a lot of former students, and I like to identify former students. But then we became colleagues. So, I didn't really think of it as mentor/mentoring, but maybe that's what it was, but really to provide an opportunity for someone to grow in her career. And I tried to do that for others at NIH, because there were issues — people don't like to own up to them — but there were issues of survival, and promotion, and progress, or lack of it, for so many young women and so many people of color that I wanted my office to be, as she said, a safe space.

I couldn't always solve their problems, but I could do what I could. Sometimes it was just being able to give advice or sometimes saying I don't have the answer. But seeing that women in biomedical careers was part of our mission statement, I wanted my office to reinforce that. That's why we had one person that we recruited to come back to our office who had a child with some learning disabilities, and she needed time with her child. So, we worked out a flexible schedule so that she would have time with her child at the school and still meet her responsibilities in the office. I thought if we don't do something like that, how can we be reaching out to demand of other institutions that they need to be paying attention to the role of women, the dual role of woman as both mothers and professionals. I was very proud of that kind of thing. And so, we did try to do that kind of thing to set an example.

I just heard a lecture last night and they were talking about how even in airports now, they've got lactation rooms. And I was thinking back to the office when we really stood up because, we were hearing from young women scientists who were physicians on faculty, that they had no place to go to pump their milk. I remember one young woman who was a physician in New York, told me she was going out to her car, parked on the street, to pump her breasts. So, we started this whole thing about reaching out. We didn't have anybody in our office who was lactating, but we also worked to try to get that done at NIH, and at the same time, get that established at schools. And that's just one small thing, and then to hear them talking about the fact — I had noticed that they've got lactation rooms at airports. It's taken maybe 20 years to get there, but it's finally gotten there. That's another aspect of women's health that probably people don't think of right away, but our office, we were able to. Janine, to the best of her ability, in this current political situation [has] to deal with these kinds of issues of the wider world, the community, in which women work, in which they do their research, and in which they live as women.

Valera: That's fantastic. Because your office does [have] that whole multifaceted quality. It's the health, it's the leadership and jobs, and then in the world, existing in the world. So that's a fantastic example, I really appreciate that.

I am going to go back to mentorship real quick because as you're talking, it sounds like you sort of wanted to have that, you know, on the couch in Building 1 experience for as many people as possible, to extend it. How did your relationship inform the way you went about mentorship elsewhere? I think, Dr. Clayton, that may be particularly relevant?

Clayton: Vivian was so generous with her time. It really made me want to be that way with other people that needed my time. I'm actually a really quiet person and an introvert, as you heard her mention that before. So, it's harder for me to talk to a lot of people in a short period of time, but people also gave me the same reinforcement that I probably said to Vivian, which is: “This means so much to me for you to spend even 10 or 15 minutes with me or let me share my perspective.” So, it did inspire me to be even more generous with my time and realize that you don't have to have all the answers for somebody. They really just need to talk to you, because there's so few of us in these positions. As a result, I pretty much say yes to everybody who asks to talk me. We might have to wait a little while to get on the calendar [laughter], but, you know — countless days I would see people reaching out to Vivian for letters of recommendation, or “do you know somebody at this place,” or even referrals for care, medical care.

That's the other thing. I mean, you know, with physicians, people are asking us all kinds of questions. That's important because we want people to get the best care possible and many people just don't know, or they don't know what they don't know. So, you can play a real role in people's lives in these positions. They go beyond the leadership, the programs that we're creating. This is real impact on people's lives.

Valera: Wow. Fantastic, thank you.

Pinn: That's true, I've forgotten about that. The many phone calls from people who needed a doctor, or needed a specialist, or they just got a diagnosis of breast cancer. What do we think about this or that? Or could they get in a clinical trial at NIH? There were people we could go to. I don't know that that many people in leadership positions still are as supportive now as they were when Dr. [Alan] Rabson was here, for example, and others, who we would go to and they would just say, “Tell them to call me.” Then we'd later hear: “Thank you, you saved my daughter's life,” or “You saved my child.” So, people did look to the office for that, and I'm sure they continue to do that.

It does take time to do that. So, you're torn between, you've got a meeting in Building 1, or you've got a report that's due to Congress, and you've somebody on the phone who's crying because they need to find care, or can they get in a clinical trial at NIH. You've got to learn how to juggle all those things, and it's something you have to learn yourself. So, I can't say Janine learned all that from me. She learned that from experience and learning how to handle things on her own. There are some things individuals are able to do and others [they] might not, but she was able to learn how to juggle all these things. That's why she's been successful, that's why she's still the director of ORWH.

Valera: I hadn't considered the fact that, probably being one of the most publicly facing women's health organization offices, you'd be serving as that sort of resource. You'd be the place where people would see the name and say: “Well, hopefully they have the answers.” So, I'm surprised by that, actually.

Pinn: We got calls from men about their wives. We got calls from children about their mothers, or their aunts, or their grandmothers. From women who wanted some help — “What do you think of my doctor here?” So, we'd go to — let's say if it was about a cancer — we'd go to someone in the [National] Cancer Institute and they’d say: “Oh, I know them, they spent time here. They're excellent, go with what they say,” or “I would recommend you see somebody someplace else.” But that was a real part of the office function. I don't know if it's spelled out anywhere, but it's what happens. I mean, that's the reality of the responsibility of the office.

Valera: Absolutely. That's great to know, because I can read the reports that your office publishes, but that sort of day-to-day...

Pinn: But that doesn't even make it into the reports. That's just something that happens.

Valera: Exactly. But it does make, as you say, a real impact on people's lives. So, it's fantastic to hear. We've talked a bit about what happened while you two were working together, but what was that transition like from Dr. Pinn's tenure to, Dr. Clayton, you stepping into the role.

Pinn: I'm going to comment on that, because I had so many papers and books. Look, I had been at NIH over 20 years and so I stepped down, but I was still sorting stuff. And a friend outside of NIH called me up — I thought it took nerve to do this, but perhaps — and said: “You are keeping Dr. Clayton from running that office and doing her job by you being there. You need to get out of there, so she is really in charge and give her your office.” And I hadn't thought about it. So, I don't know that Janine had anything to do with that, but it was suspicious.

Clayton: [laughter] Oh, no, no, no.

Pinn: So, I came into the office, and I said: “I apologize if I'm keeping you from doing this.” And I was out of there by the end of that week, because I did not want to be seen as interfering with the person who's taking over. I had had that experience when I became a department chair and the department chair who'd been there for 40 some years was there. Boy, he really gave me a hard time. I had that experience; I did not want to seem that way to Janine. So, the beginning may have been rough for her because I stayed a little bit longer sorting stuff, but then you can take it from there, Janine, once I left. [laughter]

Clayton: I had nothing to do with that, let me make the record — let the record show. [laughter] You know, it was a big transition, because Vivian's legacy in building that office is so huge. So, I felt it as an awesome responsibility and an opportunity at the same time. A little daunting, you know, because you're coming behind somebody who's done so much. If there is so much that's [already] been accomplished, what else can be accomplished? But there were so many needs. There are so many gaps. There's still so much work to be done. So over time, I just grew into my own leadership role and my own style. People definitely would compare me to Vivian, so that's a little tough. [laughter]

Pinn: They shouldn’t have done that.

Clayton: Like, I'm not standing in her shoes. She's still in her shoes, by the way. I don't need to stand in her shoes. These are my shoes. And hopefully, over time, you'll see that I'm bringing some value. So over time, I was able to find my voice there and share that with people and lead programs, really building upon the programs that Vivian started.

I do think it's always important to recognize those trailblazers and the people that came first, because that's not easy. So, I would incorporate that into my messaging. I felt good about that as a way to not say, “I'm here as a replacement,” because that's not the case. But, to recognize the legacy, and then say, “Going forward, here's what I'm looking at,” and ask for input. Because Vivian has so many relationships with the institute directors, as well as outside groups, advocacy groups, professional organizations, and so I needed to build my own, but she had made that a little easier for me because of the way that I came through.

Pinn: And I liked that, because she was building on what we had, but doing her own thing and putting in her own programs. It was good for me, because somebody could have come in behind me and wiped out all the things that we'd done before. But instead, she built and she put — she was innovative. She brought in new programs, she revised some of the old ones, but also introduced new programs and new priorities, all to further the role of the office and the recognition of the importance of the office. To me, that was good. I could be very proud of what the office was doing. I'd often say, you know, “I can't speak for the office today, except this is what they're doing, and this is Dr. Clayton's information.”

But it did make me feel good that she was building. And to me, that's what a good leader does, you build on — I had to build on what Dr. Kirschstein had started. So, I had the build on what had come before me. I remember thinking at times; all this work I'm doing, nobody's going to remember [what] I did. All the credit's going to go to the previous person. I didn't want Janine to feel that way and to [not] get credit. I think the best thing was that really got it out there that she was the new director, was your sex and gender thing you did with Dr. [Francis] Collins [the director of NIH from 2009-2021]. Maybe just mention that, because I think that really established her in the public mind as the director of the office and being in charge.

Clayton: Yeah. One of the things that was really important to me was making sure we had an NIH inclusion policy. Vivian was instrumental in getting that integrated and launched at NIH, and so we did have 50 percent of our participants in NIH-supported studies were women. But when you looked at the preclinical studies, those laboratory-based studies, animal models, that was not the case. So, I brought that issue to Dr. Collins' attention. The first meeting, he said, “hmm.” The second meeting — but I got a second meeting on this topic! The second meeting, I shared some data with him from his field of genetics. After that he was very supportive, and we were able to put together a plan for NIH to release a policy requiring investigators to study males and females. Or if they had a single-sex study, which is fine if it's scientifically based, to justify that. Because so much of the work was done in male animals, so much of the clinical research was done predominantly in men, or only in men. There just wasn't this recognition and understanding that it wasn't okay to apply those findings to females or women.

Pinn: You often heard, if we were out in public or doing a conference, somebody would stand up and say: “Tell me, why is breast cancer studied in male rats rather than female rats?” I mean, that was the kind of thing that would bring attention to this. So, Janine was — they published — where was your article published?

Clayton: In Nature.

Pinn: In Nature, which is a fine scientific magazine, and she became the owner of this policy. I think that was the major point of transition that people could recognize there's a new leader in the house and look at what she's doing. It really sort of transformed how people were looking at research on women's health, because it really focused on the basic science studies, in addition to continuing the clinical studies.

Valera: Absolutely. Is that “Sex as a Biological Variable?”

Pinn: That's it, yes.

Valera: Fantastic. I mean, yeah, that is something I certainly heard about from your office.

Pinn: That came from Janine putting it in place, yes.

Valera: So, when you did take the position as director, did you come in with these ideas? It sounds like you had identified some gaps and tried to make it your own. What was that process like looking at the organization?

Clayton: I can't say that I had identified specific gaps coming into that role. I can say that it was an incredible opportunity to see where the science was at that time. So, this was in response to the science and what we didn't know. The fact that there were gaps in knowledge about, you know…We knew medications work differently in males and females, but we weren't really studying that in the preclinical space. So, it evolved over time.

Valera: Fantastic. Thank you. Back to talking about that transition, Dr. Pinn, what advice, if any, did you give to Dr. Clayton when you handed off the role of director?

Pinn: I don't know that I really gave advice. [laughter]

Clayton: I don’t remember. [laughter]

Pinn: She had been working with me as a deputy, so she knew the role, she knew the office — This is yours now, call on me if you need me. I don't think I really sat down to — if it had been somebody new who had not been there, then I would have had a whole list of things to talk about. But she'd had a couple of years, what, three or four years working with me? She knew what my priorities were. She knew how I thought the office should run. Now it's her turn to either run it that way or a different way, seeing how she could best do it. I don't think I sat down and gave her any directives. I thought: She's going to be able to handle this.

Remember, she was interim director for a while, before she was named as a director. When Dr. Collins who was — for those who don't remember, Dr. Collins was then the director of NIH. When he called me at home one day to say that they were ready to name the new director, and it was going to be Dr. Clayton. What did I think about that? I said, “I think that's wonderful.” So, she was named and there it was, and there she was. If she'd been from outside, I would have had to tell her where the ladies’ room was and all those kinds of things, but I didn't need to do that. She knew the staff, she knew where we had issues, she knew where we needed development. That was hers.

Valera: Fantastic. So, I guess, again, the context does matter, but what advice would you give to the future or ORWH directors when it comes to how this role works?

Pinn: Well, I'm going to let Janine answer that. But I will say that it's important that a director of the Office of Research on Women's Health understands why that office needed to be established, and the importance of having a unique office in the Office of the Director to be able to interact with all of the institutes and centers at NIH, rather than being shuttled off as a side institute or a side center, and the importance of that. And to understand that when we're looking at women's health research, we've made some progress, but there's still a lot to do. Coming into that office, you've got to recognize that while the push was to look at conditions that affected both men and women, which had not been studied, but also women's reproductive issues had been neglected.

So, somebody coming in as a new director needs to know the importance of the office, be dedicated to that office — I mean, really take that office as their child and work with it — and then remember the reason it was there and to make progress on where we are. Janine, I turn it over to you, but I think you've had some experience with that, with some people who still don't understand the arguments that we went through 35 years ago, explaining why we need an Office of Research on Women's Health.

Clayton: The gaps in knowledge remain. There are so many spaces and places where people still don't understand the importance of women's health and don't understand how you need to address the health of women from a life course perspective, which is something that Vivian advocated from the beginning. That doesn't mean that we're looking at discrete life stages, that means we understand that your health in your childhood can affect your health in your adulthood. Pregnancy pre-eclampsia affects your risk for hypertension.

We haven't, as a biomedical research enterprise, yet fully actualized that understanding. That is not yet integrated into how we deliver care to men and women. We have a lot of work to do in terms of making sure we have sex-based evidence to make treatment decisions, or to counsel a patient [by saying]: “Somebody with your background and your perspective, this is the best way to start antihypertensive therapy.” There are so many gaps in knowledge in terms really integrating accounting for sex as a biological variable. That includes accounting for female-specific health concerns, midlife [and] menopause as a health inflection point for chronic disease development.

So, if somebody were to come today because I won the lottery, I would say: “There's so much work to be done; it's an awesome and really honorable responsibility; and the women of the world are counting on you to do it, because there are not a lot of people saying these things.” There are people. I don't want to minimize the women's health research community that's out there. That's not what I mean by that. I mean, in biomedical research enterprise leadership positions where policies are being made, where decisions are being made that affect many people, there needs to be somebody there with the voice and the strategic understanding of how things change to be able to advocate for all women from all backgrounds, all locations, and to change science. And there's still a lot of work to do there. We've made progress but [there’s] still work to do.

Valera: Absolutely. This probably dovetails a bit, but what advice would you give to people looking to work in the still-growing field of women's health right now? Someone who's starting out, looking around at all the places where research does need to be done?

Clayton: Yeah, incredible methodologies exist. The tools: AI, machine learning, new approach methodologies. You have so many tools now. I want people who are considering women's health to understand that they can take advantage of tools that didn't exist before, and they should, because women's health needs to be integrated into those new fields. There are many opportunities. Just because somebody tells you “no” once, twice, three, four, five times doesn't mean that you shouldn't keep going.

Pinn: Also, a lot of folks who are entering just see the field of women's health research and say, “I want to do it.” They don't understand, there aren't that many positions like our office, which is just women’s health research. If you think of almost any field in medicine or science, you can really take an approach for sex and gender issues, looking at women's health aspects. A number of our senior scientists who were funded when I was there initially said, “You know, I'm not a women's health research person. I'm doing research on this or that.” And I said, “Yes, but have you thought about, when you're looking at that, the differences between men and women?” If you simply remember that you need to look and identify where there are differences, you really are doing research on women's health. And they go, “Oh. Yes, maybe so.”

Some of our most important senior researchers were folks like that, who, once they realized that, if they just took a different look, a different approach to the research they were doing, what they were doing would fit into what our agenda was. Whether they wanted to do health policy, or public health, or be in a medical school, or be at a high school, or be in a government position — to realize that by getting a strong academic scientific background in whatever your field is, you can always work and focus on the issues related to women's health. There aren't a lot of positions that advertise for someone who's interested in women's health or women's health research. You either do the research, or you help to review for funding.

Valera: Yeah. Women's health touches all topics, so it's broadly applicable. So, how has being ORWH director changed or shaped your perception of women's health and the field of health research more broadly? I think both of your responses previously have touched upon this, but do you identify any particular change that you entered with? Maybe, a misconception that this role has changed for you?

Pinn: Well, I think as the science has come about, and as Dr. Clayton said, the whole field evolves. You learn something from one bit of research, and it directs you to other areas. I just think that in this position, she's right, it's an honor to be there and it's a privilege, because you get to see what's happening across the research spectrum, as well as across the medical spectrum. You hear about people with new diseases or things that are still around to be dealt with.

I just saw something on cable where they were practicing something — pounding somebody with temporal mandibular joint disorder. That was one of the first things we focused on, that advocacy group just really directed our office, like “You‘ve got to do something about TMJ [temporal mandibular joint] disorder.” It just makes you, then, more aware of the needs of the women's health community, the needs of the medical community, and the needs of the scientific community in order to get some of the answers. It all comes back to a scientific base and gaps in knowledge that we need to fill in, and it just has evolved over the years.

And with that, my own mind has just evolved as I've learned more and tend to think of things in a different way, perhaps more so than most. Janine is probably there, because it's on your mind 24 hours a day. But it broadens your perspective. We like to say with that passing of the bill in 1993, requiring inclusion of women and minorities in clinical research [National Institutes of Health (NIH) Revitalization Act of 1993 (Public Law 103-43)], research designed for NIH changed, and it's never been the same since. And it's just grown in perception.

Clayton: It definitely opens your eyes to so much, because in this role, as Dr. Pinn mentioned, you see so many scientific opportunities. You're exposed and you're privy to knowledge about developments in science and medicine. You also see the public health need, because it's part of the job to know those things. So, the needs of women, and the importance of women, and the health of the country, in any society, are definitely on my mind all the time. The fact that health touches so many aspects of your life, whether the seatbelt design is appropriate for you as a woman, is a health issue. It's not just a transportation issue.

So, I do see health everywhere, it does change how you think, but I see that as opportunities everywhere. I, again, feel very privileged to have the opportunity to be in this space and to have followed Dr. Pinn, and for the visionary leadership of NIH leadership that created the office, and especially the women and men in Congress who made sure that there was an Office of Research on Women's Health here at NIH.

Valera: So how do you guys perceive ORWH's role in NIH history? You're talking about the 1993 [NIH Revitalization] Act, I believe. How do you perceive where you guys sit within the larger NIH history, and what do you want historians to know and appreciate about what your office has done?

Pinn: Well, I think just look at the mission of the office and that it has survived and has tackled the mission. It was actually the vision of the office, and the major challenge for the office was to establish inclusion. That was really the reason the office was set up, to ensure the inclusion of women in clinical trials. Then minorities were added into that, but it really was established to look at women. That was the push in 1989 and 1990, with the GAO [Government Accountability Office] report when the office was set up, it was to show Congress that they were responding to the need to be able to ensure women in clinical trials. But with that, and then of course, with the law that finished, the NIH Revitalization Act of 1993, it became a matter of public policy. I have still not learned that there's any other country in the world that has a public policy or a law that requires the inclusion of women and diversity in clinical trials. And I hope they don't find out about it and reverse it, but it still exists. But that's unique and it's tied into the office.

Of course, realizing you want inclusion, you need to know what to include, what to do research on. So, I think that the entire NIH spectrum — especially since the ORWH was established within the Office of the Director, which then gave us a direct outreach to all of the institutes and centers — that all of the institutes and centers have since had to focus on and think about what they were doing for women's health, not just in terms of inclusion, but being able to report what advances they've made in terms of women's health and to think about it more broadly.

I think ORWH has had a major impact on NIH, as well as the outside community, because the outside of community sees it as a source of information about women's health. But remember, we're seeing it in terms of not just implications for medical care, but we're seeing it in terms of implications about research, and research funding, and what priorities are, what deserves to be funded, and giving investigators cues about maybe where to direct their research.

I can't tell you how many people I have run into who'll say, “Oh, Dr. Pinn, you don't know, my whole career changed because of a grant that your office funded for me.” “I got into this area of research, because I got a supplement from you when your office first started.” So that really is reassuring, but it also points out the value that the office has had in influencing careers. And if nothing else, just making scientists, individuals, and people — women and men — think “women's health” and “are there differences between men and women when I'm looking at this?”

The last thing is, I think, we are known to not be anti-men’s health. There were many who thought when the office was set up, women's health, that we were going to be anti-men’s health, taking research away from men. I point out that if you're doing sex and gender research, you're studying men too. So, in fact, men have benefited from the majority of the ORWH funded research because it's looking at sex differences, which means it's studying both men and women. We've made it clear that we are not anti-men’s health, we have worked with the men's health organizations, and we have tried to be collaborative there, so that it is important for the entire research community, not just a small pocket of people who say they're women's health researchers.\

That to me is, I think, a major impact, a major thing. It's interesting to me, people that I didn't even know paid attention to what was happening in back in the ‘90s — I may go somewhere to give a speech and some man will stand up to introduce me and he'll say: “All of NIH research funding has changed since she was the director because of this and that.” So, people have recognized that difference. I think that is the historical importance of this office.

Clayton: The historical impact — it's interesting you use the [phrase] “how people think about this,” because that's what I always say about SABV [Sex as a Biological Variable]. I wasn't actually trying to set out to make a policy, I was talking about the data to change the way people think about approaching the research question — to acknowledge the data shows sex has such profound effects at a subcellular level, at a genetic level, at a clinical level, and at organ level, that you cannot ignore this variable without missing a big part of the picture, that it's incomplete information. And by definition, that means that you are not delivering the best care to men or women, because you're not accounting for a variable that has profound effects on our health.

Historically I would hope that people looking back would say, there are these movements that have been led through policies, programs, and a variety of other efforts that have integrated the NIH biomedical research enterprise; that have integrated clinical medicine; [and] that have led to increasing recognition of how important it is to consider the health of women across the life course, female specific health, health of conditions that affects women differently or disproportionately as part of human health.

Valera: Absolutely. I will say in my research, there does seem to be a definitive before and after. Just having a central office that's saying: “Have you considered this?” Again, just opening the way we conceive of health. So that's been fantastic to see, and it's been fantastic to talk to both of you and learn about your story and your relationship to the office and making it what it is today. Thank you both for joining me today for this important conversation. And thank you to the audience for tuning in. If you want to see Dr. Pinn's and Dr. Clayton's individual oral histories, please visit the Office of NIH History and Stetten Museum's website, history.nih.gov.