Profiles of women in science: Nora Volkow, Director of the National Institute of Drug Abuse, Bethesda MD.

Abstract

As a research psychiatrist and scientist, Dr. Volkow pioneered the use of brain imaging to investigate the toxic effects and addictive properties of abusable drugs, and her work has been instrumental in demonstrating that drug addiction is a disease of the human brain. Dr. Volkow was born in Mexico, attended the Modern American School, and earned her medical degree from the National University of Mexico in Mexico City, where she received the Robins award for best medical student of her generation. Her psychiatric residency was at New York University, where she earned the Laughlin Fellowship Award as one of the 10 Outstanding Psychiatric Residents in the USA. Dr. Volkow spent most of her professional career at the Department of Energy's Brookhaven National Laboratory (BNL) in Upton, New York, where she held several leadership positions including Director of Nuclear Medicine, Chairman of the Medical Department, and Associate Director for Life Sciences. In addition, Dr. Volkow was a Professor in the Department of Psychiatry and Associate Dean of the Medical School at the State University of New York (SUNY)-Stony Brook https://www.drugabuse.gov/about-nida/directors-page/biography-dr-nora-volkow. Dr. Volkow has published more than 730 peer-reviewed articles, and her laboratory's latest work published in EJN is titled: “Methylation of the dopamine transporter gene in blood is associated with striatal dopamine transporter availability in ADHD: a preliminary study” https://onlinelibrary.wiley.com/doi/10.1111/ejn.14067. I had the pleasure of speaking with Dr. Volkow in July 2018. N. Volkow: I've always been interested in understanding how our brain works. What is it that makes us human? Why we respond, each one of us differently, to the same situation? How do we figure things out? I'm very curious and always had that need to understand how processes work, and the most challenging one is, of course, our brain. I always knew I wanted to do research. What wasn't clear to me was what type of research. I like life sciences very much, I like mathematics, and I didn't know where I would end up going. But then I fell in love with medicine, and that's when my interest for the physiology of the brain fully developed. As a medical student I volunteered in a laboratory, whose purpose was to discover a medication for pain based on opioids that would not be addictive. Immediately, because I was working with opioids, I became fascinated with the concept of an animal working compulsively in order to get a very small amount of drug injected into them – how the animal (at the time I was working with both rats and monkeys) would forgo everything else. I observed how one chemical can so profoundly disrupt someone's behavior. I was struck by how we as humans are so vulnerable to the effects of drugs, how they change us in such profound ways, and how that leads people to actually isolate themselves and others to reject them. In my own family, my uncle was an alcoholic, and as a medical student you would see patients coming into the hospital with cirrhosis or varicose veins, or with cancer because they've been smoking all of their lives. But it was also very frustrating to see as a physician, and as a student, how stigmatized addicts were – doctors didn't want to treat them, they dismissed them. That was very bothersome to me because it was antithetical to what they're supposed to do as a physician. I mean physicians are supposed to have empathy and care for those that are vulnerable, and yet the way we dealt with addicted individuals was exactly the opposite. I think you cannot not have issues as a woman in science if you are a woman. I think that the system, while it has evolved in ways that are more receptive and supportive of women, it still has tremendous disparity in the way that women are treated at the different levels of their careers. My advice to women that want to go into science is not to let others undermine their own confidence in themselves. I think actually many women, as well as men, are not conscious that there is discrimination. Now, being in a leadership position I can observe from the outside the dynamics on how women and men interact in a meeting and notice how many times the women's comments are ignored and brushed over. I guess when I was inside as part of the group, I wouldn't notice it. But now, I see these dynamics all too often and they can undermine the self-confidence of an individual. Again, in my view, that's one of the first recommendations I would say to a woman scientist – to not let anyone undermine your own position as a scientist because each individual has a unique perspective that is valuable. And in science the value of the most creative ideas, of breakthrough discoveries, is not always evident and many times is hard to recognize. The second thing is to persevere. As a woman you need to – well actually I say the same thing to my male post-docs – part of success is determination to achieve your goal. Don't get yourself distracted or demoralized. I have seen it many times with my colleagues, perhaps more with women than with men, that after many failures they just give up and say well, “It's not worth it; I'll never be able to convince others to recognize its value.” My message is, no! You have to persevere and whether your goal is to understand something or to bring a new treatment, or whatever your goal might be, you're going to have failures along the way, that's part of the journey you are on. Just don't give up. Yes, it is harder and particularly if you don't have funding. In looking at my experience as a young scientist when I wrote my first grant the director of the laboratory, who was a very prominent scientist, basically said, “Nora, if you submit that grant I will remove any support for your studies.” He said this to me the day before the grant was due for submission to the NIH. So, I didn't submit. What could I do? Even though I had someone who was supporting my research, at the same time that person did not support me becoming an independent investigator. So the ability of a scientist to move forward, to have the support to allow them to grow, is indispensable. Part of that growing is to secure funding. If the funding is harder and harder to get, that of course makes it more difficult. At this point, it pertains to both women and men. In looking at the data (these data have been analyzed in many different ways) if you are a female or male, more or less your chances of getting the first grant are similar, but there are much fewer women that apply than men. So the question is why, why is that so? Why are women applying less than men? And it's not that we have fewer women being trained as neuroscientists, there's something in the process of making that jump that is not encouraging them to do so. Something is interfering with women neuroscientists moving toward independence. I feel, at one level, it has to do with the lack of confidence that women develop as a function of the environment that they are working in. That is why one of the things we need to do is to help build the self-confidence of women scientists. So they will feel embolden to go and apply for a grant, and if the grant does not get a score or if it gets a score that is not fundable, then be embolden to try again and try again until they get it. Correct. I also think that another element that plays a role is the university setup itself. We obviously learn by seeing others, so an extraordinarily important aspect of our development as scientists, or whatever we're going to be doing, is observing how others do things. So, if as a woman your only experiences are other woman that cannot achieve any leadership positions or that leave the university after a certain amount of time, those are perhaps your expectations. As opposed to being in an environment where you see other women being very successful, which would help you gain confidence in yourself, knowing how you can get there. If you haven't seen it before, it's much harder to imagine. So we should promote environments in universities where women have an opportunity to see successful women in leadership positions. I think that neuroscience in 15, 20 years will be in areas that we, at this point, are barely scratching the surface of. You think about 20 years ago when we did do some imaging but nothing at the level where we are right now. I think that there are two areas that are going to enable that extraordinary, continuing fast pace, at even greater speed. One of them is the advances in tools and technologies to measure function and neurochemistry in the brain non-invasively. We do have MRI, which is a great imaging tool but it has limitations in terms of its temporal and spatial resolution and its chemical sensitivity. I predict those limitations will be broken and also predict advances in wearables imaging devices with capabilities to image the human brain in real life. A second transformative component for neuroscience is, like for other disciplines, our expanding ability to mine complex databases that will allow us to analyze multifaceted signals and to monitor activity in real time in large data sets. And ultimately, as we think of the big challenge, ‘understanding the human brain’, the ability to dynamically process information about neuronal interactions is key. The brain works in a very precise sequencing of events, signals are transmitted in an extraordinarily complex and orchestrated way. So if we don't have the capacity to look in a dynamic and comprehensive fashion, then we are only going to be looking at processes in isolation, just pieces. I think those two things – the development of tools and technologies and the capacity to generate large databases that can be accessible for very complex analysis – are going to play a fundamental role in the neuroscience of the future and have already started to do so. We are generating and analyzing intricate data sets more and more, but still the level of complexity that we can tackle in the brain is mostly confined to one or two levels, so we look at circuits between neurons or we look at the macro circuits but we rarely integrate one with the other. I think it's probably one of the most extraordinary areas of science. It is the most complex but one with incredible richness. It's incredibly varied and offers a diverse set of opportunities in research. You can be a bench or a clinical neuroscientist, work with flies or with humans, focus on perception or on emotions, study neurons or vascular systems, concentrate on sleep or development, among a multiplicity of possibilities. It also provides diversity with respect to the places where you can do research: a career in academia or a career in the pharmaceutical industry or other types of industry, such as the device industry. In the future devices may give us the opportunity of using a stimulation device to help us achieve certain states of mind or to help in the treatment of brain diseases. An example is the research that is ongoing to treat addiction, to decrease craving, to improve mood. So if you get trained as a neuroscientist you could end up working to help develop and translate that knowledge into products that can be clinically useful, or you can work as a neuroscientist teaching neuroscience. You can also choose to do research. Of course I am biased, but in my brain the most exciting area of science is research. I didn't have many mentors but I had a very influential one. He was my mentor when I was a medical student and had a major influence on my way of thinking as a scientist – his name was Julian Villarreal. He was the director of the Pharmacology Laboratory I was volunteering in when I was a medical student. What was unique about Julian Villarreal was that he constantly encouraged me in every single way to think differently. To me that is a fundamental aspect of what a mentor has to do. To help the individual find their own voice and their own perspective. If I, as a mentor, am looking at data with my postdoc, and the post-doc comes up with an interpretation and I basically override that interpretation, which is easy to do as a mentor because they respect you, but if in the process I silence them, then I think I have failed. You do need to give them different perspectives and mentoring has to be tailored to the person. For example, for a very timid post-doc who gives the most typical and safest answer, I might encourage them to, “Give me the most outrageous interpretation.” In other instances when their interpretation is not taking something else into account, I bring alternative interpretations and encourage them to take them into account, “these are other aspects you have to think about.” But at the end of the day, they're going to have to decide what they think makes the most sense. So I help them ponder alternative options that they may have not thought about. Each trainee is different and each has a perspective and capacity that I may not have, yet at the same time I have a capacity from my experience that I can use to guide them. Ultimately they have to learn to trust their own instincts, and I have always been very respectful of this with my students and postdocs. What I like the best is the opportunity to come up with scientific strategies to address complex problems that are meaningful. This is incredible; I think it is a privilege and, right now as we're living with the opioid crisis, this becomes so much more important. It's an amazing opportunity to be able to use science to solve problems. I am also surrounded by extraordinary colleagues who are also driven by scientific discovery and the conviction of helping others, which makes the job so much more enjoyable. What do I like least? I think that what I like least is that in a position of leadership like this one, there are components of yourself that get lost. Because you are representing a government organization you lose part of yourself. There are also big, big demands on time. I love my job but sometimes I miss the time. The time that I have outside work-related obligations is very limited. It is wonderful that you're doing this series; for many women neuroscientists may not have successful women in their institutions that they can learn from. By reading these pieces about women who have succeeded, it provides them a way to learn from these stories and that's why I wanted to do it. My main message is do not let others undermine your self-confidence and do not give up. I love Bach, Schubert. Beethoven, Rachmaninoff, Stravinsky. I like the Russians. Last book I read for pleasure is 4 3 2 1 by Paul Auster. 4 3 2 1 is basically the notion of what determines who we are. He takes four characters that are exactly the same in terms of their reactivity to their world, their emotions, their comedic capacity, but he tweaks what happens in their lives, which is outside of their control. These events basically modify the course of how you grow up and who you are. It's a fascinating book about the notion of identity. Alaska. I love Alaska. I love isolated places, I love nature, and I love the beauty of the earth.