Dr. Juanita Merchant is an academic gastroenterologist specializing in gastric and colon cancer. She’s also a professor at the University of Arizona College of Medicine – Tucson and is their chief of gastroenterology and hepatology.

While Dr. Merchant wears numerous other professional hats, her focus boils down to that of a physician scientist: part patient care, part targeted research.

“Working in gastroenterology, we’re not only thinking about diagnostics, but also about nutrition for patients, too. So when I see patients in my clinic, we’re talking about the microbiome, probiotics, nutrition,” she said.

Although her work bridges the gap between research and practice, Dr. Merchant knows that these two areas can often be kept frustratingly separate.

“I would like to get more training programs set up where we have clinicians work with basic scientists to understand how a patient presents and what the real clinical need is,” she said. “I keep emphasizing that we need things that will help us make decisions on a day to day, patient by patient basis.”

Dr. Merchant’s career began at Stanford University. She entered as an undergraduate student, planning to model her career after her mother’s by becoming a math teacher. But after her first few math classes, she knew she needed to pursue a different path.

An adjunct professor helped guide the future Dr. Merchant to biological research and medical school – and ultimately served as her introduction to inequality in academia.

“That mentor was under pressure and was not being admitted to the tenure track. This was the era with very strong bias against women and against minorities going into biomedical research, especially at top tier institutions,” she said. “It’s certainly changing, but it’s not changing fast enough or significantly enough. I think we can do a lot more.”

Dr. Merchant sees a continuation of this bias elsewhere in her work, noting a significant underrepresentation of diverse ethnic and genetic backgrounds, especially when it comes to research.

“Too often, there’s a standard treatment reliant on identifying a specific gene target, but most of the time those drugs don’t work for everybody. We need clinical trials, with diverse participation, to improve those drugs,” she said. “As an underrepresented minority myself, I’m trying to put my money where my mouth is. As much as we can, we need to get underrepresented groups to participate in clinical trials because these targets, these biomarkers, are going to be different depending on your population.”

In many ways, this can contribute to a vicious cycle, one that Dr. Merchant has seen play out in various ways during her 30+ year medical career.

“If you’ve got a rare disorder that’s more prevalent in certain populations – and those populations don’t participate in research – then we don’t really have an understanding of how well a treatment is going to work,” Dr. Merchant said. “This leads to issues with decision making: whether we should put a patient on a certain drug, how they’re responding to it, if we should change the drug due to their ethnic or genetic background, or try another approach.”

Dr. Merchant is taking some of these problems into her own hands. For example, at a recent family reunion, she did a workshop with her family members to answer questions and assuage concerns about enrolling in studies. Existing relationships made this much easier for her, but she understands that this isn’t always the case – and she knows how researchers can do better for the sake of future generations.

“From my interactions with community outreach programs, one of the community complaints is that researchers come and take, but they don’t ever come and give back. Majority researchers should work to relay information instead of just seeking participation – this can go a long way in garnering trust from underrepresented minority groups,” she said. “Researchers need to help train people who can be ambassadors for these communities. This means that majority researchers should, hopefully, bend over backwards to train researchers that are from underrepresented groups to garner that trust and ultimately improve patient care.”