Giving Younger Investigators Opportunities to Present Clinical Trials

A nice sentiment about giving younger investigators opportunities to present major, potentially practice-changing clinical trials. It can be a great opportunity to be on a big stage early in a career. But in reality, it often doesn’t happen that way. Why not? Some observations:/1 https://t.co/f0NGvp3vUm

— David Steensma, MD (@DavidSteensma) June 7, 2023

First, from the investigator perspective: if a mid or late career investigator enrolled the most patients, maybe even had the idea for the study and was heavily involved in development, it’s their prerogative to be first author and to make the initial “big splash” presentation./2

— David Steensma, MD (@DavidSteensma) June 7, 2023

Trials are so incredibly difficult and painful to execute – especially IITs. The person who did the heaviest lifting should be rewarded with presenting, whether junior or senior. It is complicated since usually effort for big studies is distributed, so may be multiple claimants/3

— David Steensma, MD (@DavidSteensma) June 7, 2023

Second, some investigators who look “senior” may still be struggling to make their way up the ladder. In some systems – Harvard, Hopkins, Penn come to mind – even later career academics might not yet be full Professors, when they would've been >10 years earlier at other places./4

— David Steensma, MD (@DavidSteensma) June 7, 2023

(The academic promotions ladder is mixed up for other reasons, and excessively rewards 1st authors for what is usually highly collaborative work - but we'll put that aside for now. Yet it definitely drives behaviors.)/5

— David Steensma, MD (@DavidSteensma) June 7, 2023

Of course ego is a big factor. Some people who already have reached the top academic rungs are thinking about their "legacy". Maybe they had a toxic mentor, or felt like, "my own senior colleagues never gave *me* a darn thing, so why should I?" We need to break that cycle!! /6

— David Steensma, MD (@DavidSteensma) June 7, 2023

Now from the sponsor side - assuming it's an industry sponsored study, which most of the big ones are. (Cooperative group negotiations are also complicated.) /7

— David Steensma, MD (@DavidSteensma) June 7, 2023

A lot of thought goes into who presents industry-funded studies and often there is negotiation and stakeholder alignment. Pharmaceutical sponsors really like it when someone who is a strong, compelling speaker & has a good reputation in the field presents pivotal data./8

— David Steensma, MD (@DavidSteensma) June 7, 2023

There’s a “selling it” component to big sponsored studies. A poor presenter (definitely seen this happen) who doesn't fully understand the trial/disease can undermine the credibility of results. So sponsors may object to transfer of talks away from someone they know & trust./9

— David Steensma, MD (@DavidSteensma) June 7, 2023

Sponsors worry that questions may come up that a senior person working in the field for a long time is best positioned to answer. A junior person no matter how well coached may not be able to draw on a relevant but esoteric example. (They might, but at least that's the worry.)/10

— David Steensma, MD (@DavidSteensma) June 7, 2023

All that said: it's critical for organizations & mentors to give opportunities for young investigators to present in big meetings. It might not be first presentation of a large multicenter trials at an ASCO, EHA or ASH plenary - but there are usually updates, encores etc. /11

— David Steensma, MD (@DavidSteensma) June 7, 2023