Female scientists allege discrimination, neglect of research on women at NIH’s child health institute

In November 2014, nine senior female scientists at the National Institute of Child Health and Human Development (NICHD) requested a meeting with their director. Their concern: that the careers of women at the institute’s Division of Intramural Research (DIR) were being stymied by its powerful scientific director, Constantine Stratakis. They complained that the number of tenured and tenure-track female scientists in the then–$177 million division was at a historic low, and they said women were starkly lacking among its leaders. They wanted more women recruited and better retention of female talent.

After the meeting, then-NICHD Director Alan Guttmacher wrote in an email forwarded to the women: “There is wide agreement that we have a serious problem.” He added that he looked forward to “action … which actually makes a difference.”

But today, fewer female scientists run labs in DIR than in 2014, when one in four lab leaders was a woman. In 2011, the year Stratakis became permanent scientific director, 27% of DIR labs were run by women, compared with 23% today. At leading children’s research hospitals canvassed by Science, comparable percentages range from 30% to 47% (see table).

Stratakis’s critics charge that the numbers form one piece of a picture of sex discrimination at the division he led; that picture, they say, includes a slew of equal employment opportunity (EEO) complaints and the dismantling of research on reproductive disease in adult women. Between 2013 and 2019, at least eight female professionals at NICHD filed EEO complaints naming Stratakis. Other women who did not file complaints also felt ill-treated by Stratakis, and some of them left the institute.

“Constantine Stratakis does not value the diversity, perspective, and contributions that women bring to the table as physicians and as scientists,” says Lynnette Nieman, an endocrinologist who filed a complaint charging him with sex bias in 2014. “That has shown in his actions, in how he has treated women here, and his poor record in enhancing the diversity of the institute.”

Stratakis, 54, a pediatrician and expert in the genetics of pituitary and adrenal gland tumors, vehemently counters those arguments. “The NICHD intramural program is highly supportive of women scientists,” he said in a statement. He notes that he recently hired three female gynaecologists to staff a new program on gynaecological disease in children and teens. He adds that women comprise nine of 10 DIR clinical investigators, who treat patients, staff trials, and train physicians. (In contrast to lab-running scientists, clinical investigators typically lack independent research budgets and labs and have time-limited, renewable appointments.) “I have made demonstrative strides to diversify not only my leadership team but also the Board of Scientific Counselors,” an external advisory board, Stratakis adds. In 2008, one of 12 board members was a woman; today, eight of 14 are women. And, he notes, in 2015, after the senior women complained, he eliminated a heavily male layer of middle managers, replacing them with eight associate scientific directors—four men and four women.

NIH’s child health institute trails peers Science canvassed research-intensive children’s hospitals about the gender of scientists who head experiment-running labs. NICHD appears unusually male-dominated. (These numbers exclude clinical researchers without lab space and scientists who run dry labs studying topics like epidemiology or population science.) version="1.0" encoding="utf-8"? NANE OF INSTITUTION LOCATION NUMBER OF LABS NUMBER OF LABS RUN BY WOMEN PERCENTAGE OF LABS RUN BY WOMEN Los Angeles Bethesda, Maryland Boston Cincinnati Philadelphia London Houston National Institute of Child Health and Human Development Boston Children’s Hospital Cincinnati Children’s Hospital Medical Center St. Jude Children’s Research Hospital Children’s Hospital Los Angeles Children’s Hospital of Philadelphia UCL Great Ormond Street Institute of Child Health Memphis 33% 47% 43% 37% 34% 34% 31% 30% 23% 19 121 32 52 34 60 60 13 56 Toronto Hospital for Sick Children Research Institute 256 74 142 155 101 195 200 57 NIH’s child health institute trails peers Science canvassed research-intensive children’s hospitals about the gender of scientists who head experiment-running labs. NICHD appears unusually male-dominated. (These numbers exclude clinical researchers without lab space and scientists who run dry labs studying topics like epidemiology or population science.) 51 Texas Children’s Hospital

Some women at NICHD staunchly support Stratakis, saying he faced structural obstacles to boosting the numbers of women running DIR labs. Other women say he advanced their careers and had reason to curtail those of others, including some who filed EEO complaints. “He tried to seriously elevate this institute by eliminating people who he saw as nonproductive, whether male or female,” says Kristina Rother, a National Institutes of Health (NIH) pediatric endocrinologist who has worked with Stratakis for decades and whom he hired in July 2019 to direct a physician training program. “NICHD is by far not the worst—instead, it is one of the better NIH institutes for women’s careers.”

Stratakis plans to leave NICHD at the end of May to become executive director and chief scientific officer at the Research Institute of the McGill University Health Centre. He stepped down as NICHD scientific director in February, but remains an NICHD scientist. He leaves behind an institute that is, by some accounts, scientifically stronger but, according to others, has earned a reputation that keeps female scientists away. Stratakis “makes you small,” says one female scientist at NICHD who feels Stratakis treated her unfairly. She did not file an EEO complaint, she says, because “I just didn’t feel like fighting.”

The $1.56 billion NICHD is the seat of U.S. government research on infant and child health. Because NIH has no dedicated institute for women’s health, NICHD is also the home of much U.S.-funded obstetrics and gynecology research, including an intramural OB-GYN research program mandated by Congress in 1993. As scientific director, Stratakis had the final word on staff, space, equipment, lab supply budgets, and salaries for DIR’s scores of lab-running scientists; he also controlled hiring and firing, shaping the direction of the division’s research.

That research explores topics as diverse as protein synthesis in yeast and synapse formation in embryonic fruit flies. Some DIR scientists conduct additional clinical research, enrolling patients in trials at NIH’s Clinical Center, where NICHD physicians also oversee gynecological patient care throughout the hospital.

In 2012, the year after Stratakis became permanent director, a blue-ribbon panel convened to address financial and other problems in DIR that predated him. The panel’s 2013 report proclaimed that “the poor representation of women and minorities in the DIR has a broad negative impact on training, morale, and quality of science and leadership. Addressing this problem should be a priority.”

That task fell to Stratakis, a leading Greek-born geneticist who discovered the genetic basis of several rare tumors. A charismatic figure who spouts Greek aphorisms and drives a midnight blue Porsche, Stratakis has been spotted stooping to tie a patient’s shoelaces. He earned his M.D. and a doctorate from the University of Athens and then completed a pediatrics residency and subspecialty training at Georgetown University. Hired to launch a lab in DIR in 1996, he has been there since, becoming acting scientific director in 2009 and taking over the permanent job in 2011.

In response to financial pressures and later to Trump administration hiring controls, Stratakis shrank the ranks of lab-running scientists in DIR in Bethesda, Maryland, from 84 to 57 between 2011 and March 2020. To do so, he forced or eased out aging scientists; he also did not retain four female physicians in a temporary program grooming them to become tenure-track scientists. The number of women running labs fell from 23 to 13 (a 43% drop); the number of men fell from 61 to 44 (28%), according to annual DIR reports and recent public announcements.

Despite the overall reduction, between 2013 and this January Stratakis oversaw the hiring of eight tenure-track scientists in DIR; two—just 25%—were women. More than half of U.S. Ph.D. graduates in biological sciences have been women since 2008; nearly half of postdocs in health research are women. According to the most current public data, today 29% of DIR’s tenure-track scientists are women, compared with 45% across NIH. (NIH notes that a separate, smaller intramural division at NICHD, focusing on the health of populations, has two female tenure-track investigators. Stratakis became acting director of this division in late 2017; both women were hired in 2012.)

Agency observers acknowledge that administrators across NIH face a challenge in quickly boosting the proportion of women running intramural labs. Many intramural scientists remain in their positions for decades, resulting in a workforce heavy with aging male scientists and relatively few chances to make new tenure-track hires. According to NIH data, as of September 2019, 76% of tenured scientists across NIH are men. “To actually affect the percentage per se takes a lot,” says Hannah Valantine, NIH’s chief diversity officer.

But Stratakis’s critics say that doesn’t excuse his failure to recruit and retain young female scientists or explain why proportionally more women than men left DIR. And some current and former female scientists at NICHD, both young and older, say Stratakis badly damaged their careers.

In 2015, Diana Blithe, a Ph.D. biochemist who is chief of NICHD’s Contraceptive Development Program, met with Nieman and Stratakis. Nieman, Blithe, and others had co-patented a drug, ulipristal acetate, that was marketed in different dosages as an emergency contraceptive and as a treatment for uterine fibroids. (Fibroids are noncancerous growths that lead to more than 150,000 hysterectomies in the United States each year.) At the meeting, Blithe recalls, Stratakis prohibited further clinical studies of the fibroid drug that Nieman had proposed. Blithe says Stratakis “was speaking to Lynnette in a very disrespectful, demeaning way. He was just saying that her work wasn’t good enough.”

Blithe, who filed her own EEO complaint against Stratakis and another senior NICHD administrator last year, was infuriated on Nieman’s behalf. “I said words to the effect of ‘How dare you treat her in this way? NICHD is getting hundreds of thousands of dollars in royalties from work that she did, developing a drug that’s helping hundreds of thousands of women avoid hysterectomies. And she was just elected president of the Endocrine Society.’ I got very upset.”

One year earlier, Nieman, 66, had filed an EEO complaint claiming that Stratakis had crippled her clinical research by shrinking her staff and budget because she was female. Reviews written by external experts in 2011, given to Science by Nieman, were lukewarm about some of her lab studies. But the reviewers were enthusiastic about her clinical studies of a serious disease on which she is a world authority: Cushing syndrome, in which the body makes too much of the stress hormone cortisol. “Her work is recognized as invaluable by peers,” one reviewer wrote. The reviewers also worried about her “modest” budget. Stratakis nonetheless downsized Nieman’s research team, which fell from seven in 2011 to five in 2012, three in 2013, and one in 2014, according to DIR annual reports. By 2014, Nieman says, Stratakis had also reduced her $118,000 budget for items including supplies and travel to $20,000.

NICHD’s director, Diana Bianchi, declined to allow Stratakis to comment on specific cases and added that she would not address Nieman’s or other women’s cases, saying the agency does not comment on personnel matters.

Nieman and NIH agreed on a settlement of her EEO complaint in 2015. But she says she despairs at how Stratakis harmed her career. “I know that I won’t ever be able to do things I could have done.”

Stratakis’s defenders note that Nieman and Stratakis, who also studies Cushing syndrome, have clashed for years. In 1999, when she was NICHD’s clinical director, Nieman reprimanded Stratakis, writing that he had failed to follow the rules for protecting human subjects.

Employment lawyers say the collection of eight complaints against Stratakis is extraordinary. The number suggests “an environment that is not welcoming or fair towards women because statistically speaking, there are going to be many other women who haven’t come forward and haven’t complained,” says Deborah Dixon, a lawyer with Gomez Trial Attorneys who has represented female scientists in sex discrimination cases.

From 2015 to 2019, an average of 36 EEO complaints alleging sex discrimination were filed annually across NIH—about 1.3 sex discrimination complaints per NIH institute per year. That figure suggests that from 2013 to 2019, the period during which the eight complaints were filed, Stratakis received roughly as many complaints as would be expected in the entire NICHD, which had between 550 and 600 full-time employees during those years, about half of whom were in DIR.

For comparison, NIH’s National Institute of Neurological Disorders and Stroke (NINDS) is about the same size as NICHD. But Story Landis, NINDS’s scientific director from 1995 to 2003 and its director from 2003 to 2014, says she was not named in a single EEO complaint.

Of the eight EEO complaints filed by women against Stratakis, six alleged sex discrimination, sometimes combined with age discrimination, and two alleged age discrimination alone. Three complaints have been settled. A fourth complainant lost a lawsuit on appeal, a fifth dropped her complaint after quitting the agency, and a sixth complaint was dismissed. Two others are ongoing.

One of those in process is Blithe’s, which alleges sex bias by Stratakis and by pharmacologist Karim Calis, NICHD’s director of clinical research and compliance and a member of Stratakis’s leadership team. Blithe, a world-leading contraceptive expert, alleged that Calis made disparaging, false public statements that she was doing science without appropriate supervision and endangering safety, for which she says he offered no evidence or examples. She added that Stratakis refused to curb Calis, who has no expertise in contraception, and that Stratakis instituted unnecessary and discriminatory surveillance of her work.

“[Stratakis] gave deferential treatment to Dr. Calis and, without reason, gave more weight to Dr. Calis’s comments about my program than to mine,” Blithe alleges.

Calis referred questions to NICHD, which declined to comment.

“No leader of long standing, in my experience, can please everyone,” says Brenda Hanning, Stratakis’s chief of staff from 2011 until her 2016 retirement. (Hanning was not referring to Blithe, who came to the intramural program after Hanning retired.) “I was involved in cases where some women with problems in their careers looked for someone to blame for their own failings. It was shameful when they targeted him.”

Critics of Stratakis also blame him for gutting gynecological research on adults, a field that tends to attract female investigators. “The in-house gynecology research program has been subjected to drastic cuts,” says James Segars, a veteran OB-GYN who left his fibroids-focused NICHD lab in 2015 after Stratakis refused, against the recommendation of external reviewers, to put Segars on tenure track. He is now director of reproductive science and women’s health research at Johns Hopkins Medicine.

Segars was part of NICHD’s answer to the 1993 law that requires an intramural research program with lab and clinical studies in both obstetrics and gynecology. The obstetrics research is carried out at a $15.5 million satellite intramural research program at Wayne State University. Stratakis oversees the tenured NICHD investigator Roberto Romero, who runs the program and supervises its 21 contract physicians and scientists, four of whom are women.

Gynecology research is headquartered in Bethesda where under Stratakis five veteran OB-GYNs left DIR. Three were women. All four labs conducting adult gynecology or infertility research have closed as well, including those of Nieman and Segars. “I am concerned that there is no meaningful basic science research going on in gynecologic disease at the moment,” Serdar Bulun, chair of OB-GYN at Northwestern University’s Feinberg School of Medicine, told Stratakis at a December 2019 meeting of his Board of Scientific Counselors. “There are major missed opportunities” for research on topics such as abnormal uterine bleeding, Bulun said.

In the meeting, Stratakis acknowledged the “thin” gynecology lab program but said relevant basic research also occurs in nonobvious places. Today, NICHD in Bethesda has one tenured OB-GYN, Alan DeCherney, 78, whose lab Stratakis closed in 2015 and who now helps train infertility physicians. Stratakis also recently hired three female non–tenure-track gynecologists who focus on pediatric and adolescent gynecology.

One gynecologist who left DIR is Alicia Christy, who in 2013, after a mission trip to Uganda, applied for a Bill & Melinda Gates Foundation grant to assess how reducing barriers to the use of intrauterine devices would affect rates of unintended pregnancy in female farmers in sub-Saharan Africa. Stratakis signed her application. But Christy recalls him standing in her office returning the application to her, looking down at her and saying: “That’s not our mission. Even if you get the money, I would never support you.” She did not win the grant.

Beyond her own experience, Christy says, “I saw what he did to other women.” She recalls a promising female DIR physician who won a highly competitive $360,000 research award from the American Association of Obstetricians and Gynecologists Foundation. NICHD said it could not spend the money on the young woman’s research and returned it. She soon left the institute for private practice.

After her experience with the Gates Foundation grant, Christy moved out of DIR to the institute’s extramural branch. “I took a lower position to not be under [Stratakis’s] authority,” she says.

NICHD declined to allow Stratakis to comment on Christy’s account and declined to explain why the young physician’s award was returned.

I took a lower position to not be under [Stratakis’s] authority. Alicia Christy, formerly of NICHD

Another OB-GYN who left was Erin Wolff, 44, now an infertility consultant in McLean, Virginia. From 2011 to 2016, she was an assistant clinical investigator, part of an NICHD program grooming her to become a tenure-track scientist. She studied the uterine lining in monkeys and human patients, with the goal of designing therapies for abnormal uterine bleeding and infertility.

In 2015, Wolff accused Stratakis of sex discrimination in an EEO complaint, alleging that he set her up for failure, failed to find effective mentors for her, stared at her chest, and spoke to her condescendingly. She claims Stratakis pushed her to take over NICHD’s infertility physician training program, a job she feared would compromise her chances to win a tenure-track research job. When she resisted and asked for a raise, presenting data showing that the next highest paid NIH physician in her job category was making $40,000 more than she was, Stratakis went on a “tirade,” she alleges. He told her he had a plan for her future as a physician, not a scientist, she says. He “tried to belittle me, telling me that I had little potential.”

Several months later, Wolff alleges, Stratakis and other NICHD officials targeted her, investigating all of her clinical studies for what Wolff contends were minor paperwork mistakes and protocol deviations in two of them—lapses of a sort that NICHD tolerated in male colleagues, she alleges. Her male mentor, who was associate investigator on one trial, was not investigated, she says. She adds that NICHD insisted that a program she launched to freeze eggs from young women faced with losing their fertility be structured as a research trial. Wolff contends it should have been offered as a patient service.

In December 2015, Calis, vice chair of the institute’s ethics committee, sent Wolff a memo saying it had suspended all her clinical studies.

NIH declined to comment. But in a 2018 affidavit responding to another woman’s EEO complaint, pediatrician Forbes Porter, whom Stratakis had promoted to NICHD clinical director, wrote: “The decision to audit and suspend [Wolff ’s] protocols was a decision by the NICHD Institutional Review Board (IRB). The Wolff case has undergone multiple levels of review. None have found in favor of Dr. Wolff.”

Wolff left the institute in June 2016 for a job with a company. In fall 2019, she and the agency agreed on a settlement.

“Constantine Stratakis effectively gutted our research division for women’s health, and then my career, everything that I personally had invested in making this my life’s mission,” Wolff says. “It’s tremendously heart-wrenching.”

NICHD declined to comment and would not allow Stratakis to respond.

On 1 June, Stratakis is scheduled to assume his new position at the Research Institute of McGill University, overseeing 445 researchers, nearly 1200 trainees, and more than 1100 staff.

His departure will open a new chapter at NICHD, where his boss, Bianchi, said in a statement in response to questions from Science, “We absolutely support women.” Bianchi became the institute’s first permanent female director in 2016; she retained Stratakis after a performance review in 2018. Her statement noted that several other senior administrators at the institute are women.

Dixon says the individual women’s stories, combined with the paucity of women running DIR labs and the loss of DIR gynecological research on adult women, “reveal that change is unfortunately slow.” She says NICHD should be concerned. “They want to ensure the best and the brightest and the most capable researchers and doctors are addressing child health. Which means you can’t exclude women.”

This story was supported by the Science Fund for Investigative Reporting.