The problem: Why do some polyps become colon cancer while others do not? What is the role of inflammation in the development of colon and stomach cancers? Juanita L. Merchant, MD, PhD, has spent her career in medicine trying to answer these questions, focusing on the genetic and chemical triggers that can eventually lead to cancer.
Background: Merchant grew up in an African American neighborhood in Los Angeles. Her mother was an elementary school teacher who instilled in Merchant a respect for education without imposing a lot of pressure as to where, exactly, that education should lead. Her father, who did not finish high school, left the family when Merchant was eight; she has not seen him since.
Merchant was always interested in math and science, but she did not consider medical school until she was in college. “I didn’t have any role models,” she says.
Straight A’s in high school opened doors to many top-flight universities. Merchant chose Stanford, where she majored in biology, set her sights on medical school, and discovered how much she loved working in the laboratory.
One of her early mentors, a research investigator named Renu Heller, PhD, offered life-changing advice. Heller recommended that Merchant go the extra mile and get an MD and a PhD. “I didn’t understand it at the time, but now I do,” Merchant says. “She was saying that to get the leverage you need to be credible in that academic environment, you need to go loaded for bear—basically, you need to get every degree you can get.”
Merchant did just that, completing a joint MD/PhD program, with her doctorate in cell biology, at Yale University in 1984. That is where she first heard about the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program (back then called the Minority Medical Faculty Development Program).
Next, Merchant went to Massachusetts General Hospital for her internship and residency in internal medicine. There, too, she benefitted from the guidance of a mentor, Harold Amos himself.
The project: Increasing understanding of gastrointestinal genes. Wanting to get back into the laboratory, Merchant found a nonclinical fellowship at Massachusetts General Hospital in 1987, where she began to research how expression of the gastric gene is regulated. (This means studying how a gene's coded information is translated into structures in cells and how the gene is turned on and off). This was the same year she became an Amos fellow.
Doing laboratory research in mice, Merchant began to learn more about how gastrointestinal genes worked, with the ultimate goal of identifying better, non-invasive ways to diagnose gastrointestinal cancers and monitor treatment progress. While she does only laboratory research, she partners with clinical colleagues nationwide who conduct clinical research to determine whether the findings in mice are also true for humans.
Merchant took a year’s hiatus for a clinical fellowship in gastroenterology at the University of California, Los Angeles, in 1990. Then the University of Michigan recruited her as an assistant professor and to develop a molecular biology laboratory. Merchant completed her Amos fellowship there in 1993. She published results of her fellowship research in journals such as Molecular & Cellular Biology (1991;11: 2686–2696,) and Molecular Endocrinology (1992; 6:1175–1184,).
“The Robert Wood Johnson Foundation award consistently supported me during my training and evolution into an independent investigator,” says Merchant, who received a five-year grant from the National Institutes of Health to continue her research in 1993. She credits the Amos fellowship with enabling her to collect enough preliminary results to submit the grant application.
Ongoing laboratory research and a leading role in academic medicine. Merchant remains at the University of Michigan today, still chasing the causes of gastrointestinal cancers, with the help of major funding from the National Institutes of Health. She has authored or co-authored nearly 100 research articles in the process.
Merchant has served on the editorial boards of half a dozen professional journals and as an officer or adviser for a long list of professional societies, universities, and foundations. Among the latter is the Harold Amos Medical Faculty Development Program, where she now helps choose the minority fellows who hope to follow in her footsteps.
Helping other gifted minority students. The Harold Amos Medical Faculty Development Program operates on what might be called a pay it forward philosophy. It seeks to establish gifted minority students in successful careers as medical and dental school faculty. The hope is that those physicians and academics will then return the favor by helping other gifted minority students establish their careers. For more information read the Program Results Report.
Merchant, who is under no illusion that the pathway for minorities in academic medicine is substantially easier today than when she entered the field, could serve as the poster child for that approach. That is why she runs a 10-week summer Pre-Medical Scientist Training Program at the University of Michigan for undergraduates interested in applying for MD/PhD programs, and gives frequent talks to groups of minority students. The summer program is geared toward underrepresented minority students, as well as people with substantial physical or mental disabilities and people with financial hardships.
Merchant teaches all these students what they need to know in order to play the “academic game,” such as being assertive, mastering the art of applying for grants, and finding good mentors. Perseverance and passion are also necessary.
“I’m trying to give students coming along today a sense of structure, to codify for them some of the things I didn’t know when I was starting out,” she says.
In 2010, Merchant co-authored an article on the problem of the underrepresentation of minorities in academic medicine for the journal Gastroenterology. After describing the problem, the authors made suggestions for increasing the pipeline of underrepresented minorities in pre-doctoral programs, increasing the number of mentors from similar backgrounds for medical students and junior faculty, and promoting the retention of junior faculty from underrepresented minorities.
RWJF perspective: The Harold Amos Medical Faculty Development Program is a four-year postdoctoral fellowship launched by RWJF in 1983. Its purpose is to increase the number of faculty from minority and other historically disadvantaged backgrounds who achieve senior rank in academic medicine and dentistry. A commitment to eliminating health disparities is among the selection criteria.
The program supports one of RWJF’s major objectives: To increase diversification of the medical and dental professions and, as a consequence, improve the health care received by the nation’s underserved populations.
Of Amos program scholars, RWJF senior program officer David M. Krol, MD, MPH, says:
Ultimately, we would like to see these individuals from disadvantaged backgrounds becoming full professors at prestigious institutions, putting out important, valuable work, looking at a variety of different issues—including how to decrease the disparities between rich and poor, majority and minority—while climbing the academic ladder.
Juanita L. Merchant is one of more than 185 Amos program alumni in academic medicine today. Her career and research exemplify the academic achievement and professional contributions that the program was designed to stimulate.
“The measure of the success of the program is the success of the individuals” who participate in it, says Krol.
Paying it forward: A researcher passes along lessons on how to build a career in academic medicine