Profiles of Cancer Researchers

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Dr. Crawley is an Assistant Professor (Research) of Pediatrics at the Stanford Center for Biomedical Ethics. Dr. Crawley is a past recipient of NCI's Howard Temin Award and a grantee of CRCHD's Continuing Umbrella of Research Experiences (CURE) program, which supported her training and research in prevention and population-based cancer research.

Dr. Crawley received her M.D. from Meharry Medical College and completed her residency in Family Practice at the University of California, San Francisco. Dr. Crawley holds an M.P.H. from the University of California, Berkeley focusing on Interdisciplinary Studies.

LaVera M. Crawley, M.D.

Did you know going into medical school that you wanted to pursue a career in research?
When I finished medical school and did my residency in family practice, I really was on a track to be a clinician. But I wasn't completely happy with that track because I found that the needs of underserved patients I cared for were greater than what I could offer merely as a technically competent clinician. So that, coupled with curiosity about research, ultimately showed me that research was a much more fulfilling path for me and, I hope, for the population of patients that my work serves.

Ironically, it was my National Health Service Corps obligation that played a big part in this because, through it, I was assigned to the Indian Health Service, and, while there, I became truly fascinated with the intersections of two cultural worlds. For example, practicing Western medicine, I was trained to see infectious diseases through a framework based in germ theory, and yet there I was with Navajo patients, who explained things in a completely different way based on their traditional world views. So, they were explaining that something like an ear infection was caused by transgressing some taboo that was related to something, say, like snakes or lightening. I was absolutely fascinated that these two completely different world views could coexist. The question I asked myself was: How do you practice truly cross-cultural medicine when not everyone sees the world the same way? I was ultimately pointed in the direction of ethics as being a great place to ask those kinds of questions, so I pursued a fellowship in ethics, and it happened to be one that was at the Stanford Center for Biomedical Ethics, which is a very strong research center. I also went to the Kennedy Institute of Ethics, which offers an annual summer intensive in ethics, which I highly recommend. I now consider myself an empirical bioethicist. The only difference between me and any other researcher is that I focus on the ethical sides of medical and health care issues—things like health disparities, social justice, and equity issues.

Did you have mentors along the way?
My first important mentor in medical school was Dr. Richard Carter at Meharry Medical College, who, at the time, ran the preventive medicine program. He was the first person who taught me to start asking questions and start looking for the evidence basis for health outcomes.

The next mentor I had was a medical anthropologist here at Stanford who also taught me how to further fine-tune the way I think about and ask questions about medical phenomena.

My third, and probably my key mentor right now, is an epidemiologist, Dr. Marilyn Winkleby, also here at Stanford. She looks at population-level differences, and her insights really help me think about inequities at a population level. She's also a great mentor in relation to what it means to be a woman in academia.

What prompted you to get your M.P.H.?
My training at Stanford initially was under a medical anthropologist, so I had a very strong qualitative and ethnographic foundation. But I really felt that qualitative research is only one side of understanding phenomena, and I wanted to be able to do research in the quantitative realms. In my M.P.H., I focused on biostatistics and epidemiology; it was clearly calculated just for those skills.

What then got you interested in cancer research specifically?
Cancer is big in my family—my mother died from cancer and my father and other relatives have been diagnosed with cancer—so there were personal reasons as well as professional reasons for my interest in looking at cancer.

The research on which we recently published a paper looked at patterns of cancer prevention screening—breast cancer and colon cancer, specifically—wondering whether the perception of being discriminated against inside a medical setting had any relationship to whether patients were up-to-date with these different screenings. The literature on perceived discrimination often talks about whether one experiences discrimination globally in their life, but there haven't been that many studies that have looked at discrimination inside a medical encounter, and it seemed to me to be logical that, if someone felt they were treated unfairly in a medical setting, it would have ramifications with respect to medical procedures or medical outcomes.

What we found is that, if you are discriminated against, you are less likely to be up-to-date with cancer screening. What was really fascinating, however, is that we adjusted it for several factors, and we found that there are gender differences regarding discrimination and outcomes that we didn't expect; men and women respond differently to racial discrimination.

How important has NCI's support been to your career and what you've been able to accomplish?
I'm trying to figure out what superlative I can use that really expresses just how phenomenal the support that NCI has given me is; it's been just amazing. I received initial K01 grant support through the NCI Continuing Umbrella of Research Experiences (CURE) Program. CURE's yearly career development meetings were wonderful for me because they gave me an implicit feeling that NCI cares about me, and they care about my contribution to reducing health disparities. Obviously, I'm a big NCI fan.

Do you see yourself staying on the track of disparities research?
Yes, my focus now as an empirical bioethicist is on issues of social justice and health care. Right now, that means health disparities and health inequities.

What advice would you give to minority medical students who might be interested in research?
One important thing is that, if you aren't at an institution that stresses research, seek it out on your own; there is always research being done somewhere in an institution. Most faculty members would love to have interested, curious, and critically thinking students to help with their work. Also, I would say that you should find out as much as you can about other opportunities to get research exposure such as summer programs, particularly if there are ones that are available NIH.

What do you see in your future?
I love what I do. I was talking to my husband just a couple of weeks ago, and I said that, if I was starting from scratch and had to design the best job for all of my sensibilities, interests, and skills, it would be the job I have now. My job is to think about how to improve life for people, what specifically needs to happen to make those kinds of improvements, and then convince an institution like NCI to fund it so we might ultimately improve the human condition. To me, that's the perfect job, and so I see myself doing this until I retire—and then some.

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