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Meg is joined by Dr. Sabine Linn, professor of translational oncology focusing on breast cancer at Utrecht University and a practicing medical oncologist at the Netherlands Cancer Institute.
Show Notes
On Episode 9 of The Game-Changing Women of Healthcare, Meg is joined by Dr. Sabine Linn, professor of translational oncology focusing on breast cancer at Utrecht University and a practicing medical oncologist at the Netherlands Cancer Institute.
The two discuss Dr. Linn's work in biomarker research, the immunological aspects of breast cancer, advancements in cancer diagnostics and how they can help personalize cancer treatment, the patience and perseverance necessary to complete cancer research studies, Dr. Linn's love of sports as meditation, her vision for achieving equality in her field and beyond, and much more.
About Dr. Sabine Linn
Dr. Sabine Linn is a professor of translational oncology focusing on breast cancer at Utrecht University and a practicing medical oncologist at the Netherlands Cancer Institute. She received her Ph.D. on multidrug resistance in solid tumors from the Free University of Amsterdam. Dr. Linn was awarded a Dutch Cancer Society Research Fellowship in 2000 and developed two conditional knock-out mouse models, for both non-small cell lung cancer and small cell lung cancer, in close collaboration with Dr. Ralph Meuwissen in the laboratory of Dr. A.J. Berns at the Netherlands Cancer Institute in Amsterdam.
She has also been a group leader at the Division of Molecular Pathology at the Netherlands Cancer Institute since 2005, where she and her research group focus on the molecular dissection of breast cancer by differential drug sensitivity.
Further Reading:
Episode Credits:
The Game-Changing Women of Healthcare is a production of The Krinsky Company.
Hosted by Meg Escobosa.
Produced, edited, engineered, and mixed by Calvin Marty.
Theme music composed and performed by Calvin Marty.
Intro and outro voiced by John Parsons.
©2022 The Krinsky Company
Creators & Guests
Host
Meg Escobosa
Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.
Producer
Calvin Marty
A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.
What is The Game-Changing Women of Healthcare?
The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.
ANNCR: You're listening to The Game-Changing Women of Healthcare, a podcast, celebrating courage, perseverance, creativity, and vision in the pursuit of healthcare innovation. Join host Meg Escobosa in conversation with some of the most inspiring and forward-thinking women working in healthcare today. Meg goes behind the scenes to uncover previously untold stories of struggle and success in a notoriously complex and highly-regulated industry. As the worlds of healthcare and technology continue to converge, and as women take on increasingly more important roles in both, these are timely tales that deserve to be told. And now, here's your host, Meg Escobosa.
Meg Escobosa: Welcome back to The Game-Changing Women of Healthcare. I’m your host, Meg Escobosa. Today’s episode is the fourth and final in our International Women’s Day series. We’ve had wonderful conversations this month with European healthcare leaders including Dr. Luna Gargani, Lisa Emery, and Elena Sini.
Today, we’re speaking with Dr. Sabine Linn. She is a professor of translational oncology focusing on breast cancer at Utrecht University and she’s a practicing medical oncologist at the Netherlands Cancer Institute.
Sabine Linn: 50% of my time I evote to patient care, mainly breast cancer patients, and the other 50% of my time, I have my own lab. And we are focusing in my lab on the development of diagnostics to improve breast cancer treatment and to really personalize breast cancer treatment.
Meg Escobosa: Dr. Linn was awarded a Dutch Cancer Society Research Fellowship in 2000 and developed two conditional knock-out mouse models, for small-cell lung cancer and non small-cell lung cancer, in close collaboration with Dr. Ralph Meuwissen in the laboratory of Dr A.J. Berns.
Since 2005, Dr. Linn has also been a group leader at the Division of Molecular Pathology at the Netherlands Cancer Institute, where she and her research group focus on the molecular dissection of breast cancer by differential drug sensitivity.
Welcome, Sabine! Thank you so much for joining us today.
Sabine Linn: Thank you, Meg. It's a great pleasure for me to be in this podcast and thank you so much for the invitation.
Meg Escobosa: Wonderful. Important work that you're up to. You wrote your PhD thesis on multi-drug resistance in solid tumors. You've gone on to lead this research lab. You are a recognized expert in biomarker research, studying what's happening directly inside cells. Can you give us a little bit of some sort of foundational explanation of what you know, for, especially for those of us outside of the field, what is biomarker research and how important is it to the advancement of cancer treatment?
Sabine Linn: Yeah, that's a great question. Well, biomarkers in general, what it means is that it is a marker that can be in blood and tissue, that we can measure. And this marker then tells us something about the course of the disease. And this is crucially important when we are treating cancer patients because cancer treatment consists mainly of surgery, radiotherapy, and or chemotherapy or other anticancer agents. And all of these treatments come with a cost. So what we would like to do is to only apply that treatment that is most likely to result in a cure without too many side effects and costs. So, and that's why we need these biomarkers because these biomarkers can tell us whether the treatment can be simple and light or not very aggressive, or whether we need a very aggressive treatment in order to achieve a cure. So this is why we need biomarkers in cancer treatment.
Meg Escobosa: That's a really nice explanation and I appreciate it. It shows your professor skills, you are regularly being able to make it plain to people who don't have that scientific background is lovely. What are you working on right now in your lab?
Sabine Linn: Well at the moment, I think it's all in the cancer research field, we are all focusing on the immune system. So formerly, we were mainly interested in the cancer cells themselves, and we thought that the key to success is to understand what has gone wrong in the DNA. DNA in cells tells the cells what to do, and cancer cells typically have problems with the DNA, and that's why they have deregulated growth and can disseminate, and they don't listen to the normal signals that are not operational anymore in cells. But recently, we understand better that it's not only the cancer cells, but it's also the immune system that can help us combat these cancer cells. But if the immune system is hijacked by the cancer cells, well, then it goes wrong.
What we are really interested in now is to study what is ongoing with the immune system and how can we help the immune system to, again, recognize the cancer cells as being the bad guys that need to be eradicated. So in my lab, we are currently focusing on the immunological aspects of breast cancer. Not only, but yeah, it seems to be a very important aspect of how we can treat cancer.
Meg Escobosa: How has the field changed since your days as a PhD student? And what are you most excited about? It seems like this insight about the immune system is huge and that it is also this personalization of medicine. And maybe you can share a little bit about that evolution as well.
Sabine Linn: Yeah. I think so many things changed since I was a PhD student. Well, I think one of the greatest breakthroughs was gene expression analysis. So genome-wide techniques that can give us an overview of what's wrong in cancer. And of course we could only develop these tools because we had computers. So I think the advent of the computer is the first step.
And then the next step was a technique called polymerase chain reaction (PCR). It was developed by a guy in California, who I think spent most of his time on the beach, but then suddenly thought, wow, this is a great idea. And so he developed this technique and that enabled us to decode the DNA. So the human genome, and I think that was the next big step that we now know the human genome.
And these techniques really enabled us to better understand that cancer is a very complex disease. And then the field that immunologists have been studying the immune system in relation to cancer for over 30 years, but only recently they discovered so-called checkpoints and these checkpoints are kind of switches in immune cells. And so you can switch off the immune system and you can switch it on. And because they have pinpointed the right switches, we can now use these switches to enable the immune system to combat the cancer cells. So these are things I think are the most important achievements for the last 30 years.
Meg Escobosa: I’ll say, wow. The idea that we have insight into how to switch on the immune system is incredible. It's very heartening to think about that. And just using our own system, our own bodies to help ourselves is obviously the holy grail, if you will.
How much does your lab research actually come into play in your actual clinical practice as a sort of day-to-day? The insights you learn in the lab you can use immediately or what is the process?
Sabine Linn: It's taking years really, really. For instance, one of my first large projects started in 2004. So that's 17 years ago. And the question we had at the time, I think it was a really simple question. At that time breast cancer patients, in a curative setting, 95% of breast cancer patients can come at a time that the disease is still curable.
Many of these patients receive chemotherapy to eradicate what we call micro metastasis. So typically patients at that time, first received surgery so the cancer was removed, but we knew that before the cancer was removed from any patients already single cancer cells traveled through the lymph vessels or blood vessels to other parts of the body. And you can’t see these single cancer cells on imaging, but you need to eradicate them. So we then give patients after surgery, we give them chemotherapy or hormonal therapy, or more recently anti-HER2 therapy to eradicate those cancer cells. And at the time we only used two types of chemo, well, anti-cancer agents, anthracycline and cyclophosphamide.
And at the time there was a third agent that became standard. It's called a Taxane. And what we knew was that if we would treat 100 breast cancer patients, with the Taxane, that 3% of those patients would really benefit from that treatment and their lives would be saved because of the additional, the Taxane.
The other 97% in fact received that additional anticancer agent in vain. So we thought, well, this is not cost-effective and also not in the sense of it will cause a lot of side-effects to patients while they do not benefit from it. So can we develop a test that only teases out those patients of 3%? Well that would be ideal, but maybe select only, let's say 50% or 30%, off of the right base. So not all of our patients, but the only to reach for the patients that really benefit from it.
So we started this in 2004 and we recently published the paper that may help to better select patients. So that's 17 years of research. It really takes a long time. And even now I think this, so what we found, I can tell you because it's published, is that in fact, if there is, especially in a certain subtype of breast cancer - it is called triple negative breast cancer. About 10% of all patients with breast cancer have that subtype. In that subtype, it appears that if there are a lot of immune cells around cancer cells, then ataxin is very effective. And if there are no immune cells around the cancer cells, then ataxin is probably not effective.
Meg Escobosa: That's very, very helpful to hear. Yeah. The journey from 2004 to today, the time that it takes to really show the value of this approach and that it works.
You have to really have the long game, the persistence to keep with these kinds of efforts.
Sabine Linn: Yeah, yeah. I was just thinking about another example that's maybe more well known to the audience. So it's called a Mammaprint Test. It's a test based on characteristics of the breast cancer cells. It's now standard of care and it's being used all over the world. It's only meant for a hormone receptor positive HER2 negative breast cancer. That's about 70% of all breast cancer patients have that subtype. And it can only be used when women are over 50 years of age. 75% of patients are over 50 years of age at diagnosis. And only if there are at most three extra lymph nodes involved, but that's a large proportion of all breast cancer patients. And you can use this test to decide whether the addition of chemotherapy is needed next to hormonal therapy. And it's very useful because by using this test, we can reduce the amount women that have to take chemotherapy substantially. The original tests were developed in the 2000s and it became standard of care in 2016. So that’s again 16 years. So all of these tests take usually 10 to 20 years before they become standard practice.
*music*
Meg Escobosa: What got you interested in this field to begin with, you know, medicine, molecular biology, molecular pathology, breast cancer research. How did you know, can you tell us a story about how you knew what you wanted to do?
Sabine Linn: Honestly, when I was a high school student, I was interested in almost everything. So it was really difficult for me to choose a certain study. So in fact, I just did a kind of test and the result was that I should become a physician. So that's what I did. I studied medicine. So it was not that it was really from a young age. I played, I liked to have doctors. I have to say this kind of, when you're a child, you can have this suitcase, like a suitcase for doctors. So that's what I always wanted to have. So in that sense, it was really, probably already encrypted.
Meg Escobosa: Is anyone in medicine in your family?
Sabine Linn: Yeah. From my father's side, all were physicians. So, yeah.
Meg Escobosa: You’re just carrying on the family tradition.
Sabine Linn: Yeah. Well, I tried to resist it, but yeah, I failed. (Laughter.) And then, and then why oncology? Well, in fact, originally, I was interested in psychoneuroimmunology. So in fact, the interplay between how your senses experience the world, how it’s processed in your central nervous system and how that affects your immune system?
So your hormonal system. So it was in fact what I was really interested in, but there is no specialty for this. So the next closest to this idea was, what I thought, treating cancer patients because it's really like an existential crisis.
It has a lot of psychology. Well, apparently the immune system is very important. At the time, we didn’t know that, but apparently there is a link there. And when I was a junior house officer, I listened to my supervisor when he was telling a cancer patient that he was advising chemotherapy is the state-of-the-art treatment. And then this patient asked “what are my chances to be cured and what are the side effects?” And then the supervisor explained that the chances of a cure with the chemo were around 40%, but the chances of the side effects, nausea, hair-loss, were close to 100%. And when I listened to that, I was really amazed and I thought “Wow, this is so suboptimal.” And I thought, well, I should really try to contribute to better diagnostics so that in the future, as a physician, I do not have to tell that the chances of a cure are only 40% while the chances of side effects are almost 100%. I think that really triggered me to go into this biomarker research.
Meg Escobosa: To your earlier point, just about how long it takes to find results and to see the progress and to use the work. From what you said earlier, it just seems like there's a quality of persistence you really need to have…the ability to kind of stick with something through thick and thin to overcome some challenges. I mean, is that sort of your character, is that what you have demonstrated in other parts of your life? Or do you just kind of find it now that you're doing something that you really care about? I mean, not to be simplistic, but I'm just curious if that's a character of who you are.
Sabine Linn: Well, it's an interesting question that I think you're right. Yeah. That I like complex things. I like to solve puzzles and the more complex they are and the bigger the challenge, the more I'm motivated to go for it. So, yeah, I think it's part of my character.
Meg Escobosa: Well, it also made me wonder about, you know, when you're looking for people to hire in your lab, you know, what are you looking for in your team and how do you know when it's a good fit?
Sabine Linn: Well I really like people who are curious. I look [for] whether they ask questions. The more questions they ask and the type of questions they ask tells me whether I think this is a good fit. The second aspect is I think the team player aspect. I am looking for people who–in a joint effort– like to produce a result so that they are committed to establishing something. And they’re ego is not the most important part of that. So I think that's also something that I think is important, at least for my lab. Also, what I have organized in my lab is that, in fact, all members that are already there have a veto right. So if a new person is coming to the lab, They will have talks with each member and well, if there is something that there's no match. Some people really do not match at all. Then you can have a veto as a member, as a Linn Lab member. I think that also is useful. And then of course, I always look at what they have accomplished so far.
So I really like people who have done things that are a little bit, how you say, “out of the box.”
Meg Escobosa: That's great. And you know, it makes me think about the challenge is so great. You described there was even all this effort to understand the cancer cell itself, and then suddenly an opportunity presented itself where you can now study the immune system. You know, sometimes you have to try some unusual ways to look at a problem that will hopefully unlock or reveal another area to dig in and do research. To explore, I imagine.
Sabine Linn: Yeah. That's, that's so true.
Meg Escobosa: There’s an innovative mindset that you're looking for.
Sabine Linn: Yeah. So if you find something that's totally unexpected, you can do two things: You can say, “Oh, well, it doesn't belong to my research,” or you can say, “Wow, that's funny. Let’s look into this.” And I think, well, one of the things that we found in our lab really happened like this. So we were looking for something different and then suddenly this PhD student said, “Well, I just ran this analysis. It’s just not what we are working on, but…” And I found this highly significant. And I said, “Wow, that's interesting. Well, let's, let's move on to the same thing.” And then, and then two weeks later I thought, “Wow, this was really interesting. So we have to go back to that!” Then we sat together and we decided we have to completely redirect this research because what you found is so amazing, we have to follow this lead. Yeah.
Meg Escobosa: Yeah. The fact that you were able to reflect and remember to go back and you know “let's revisit that.” That makes me curious about…Are there risks or things that you've tried in, in your career? Whether it's work or in your personal life, have you taken a risk that didn't work out? It’s always interesting to hear what you learned from that. And does that actually impact the way you work today or the way you think today? So can you share a story about a risk you took and how did it work out?
Sabine Linn: Well, I could tell you it was pretty long ago. So at that time I was a master student and I had to do a research project. And at the time I was really interested in alternative medicine. So what you call now, “complementary medicine.” So I was interested in acupuncture, so I decided to do a project in China, in Shanghai, and to do a randomized clinical trial. Randomizing patients with epilepsy to either acupuncture treatment or Western medicine treatment. So I traveled to Shanghai and I arrived there and I had my supervisors there and we sat down drinking tea.
And then the supervisor said, “Well, this research is really difficult.” And I thought, “Yes, it may be difficult, but let's start,” and nothing happened. And I was there for two weeks drinking tea and nothing happened. And at some point in time, I realized if they say it's “really difficult,” they mean it's impossible.
So it was really this cultural thing that, and then I asked, “Oh, is it impossible?” And then, well, they don't like to really say that in China, but yeah, it was impossible. And then I realized that I should have first have checked whether the whole idea was feasible or not. And apparently it was not feasible at all because in China, Western medicine is considered superior. And so people would never like to be randomized to either acupuncture or Western medicine. They would all like to have Western medicine. So I should have investigated the feasibility of my projects. So that's what I learned from that.
Meg Escobosa: I had a similar experience where I was working on a project in South Korea and I worked with a local person because they were obviously speaking Korean and it's not obvious to you all, but I don't speak Korean. And we really needed somebody locally to help us with contacts and help create meetings and interviews with local people. And every time we had a check-in call to see how things were going, everything was going “well.”
And so we arrive with our client in Korea and we go to check on the project. How are the lined-up interviews? Well, nobody is available for the interviews and it was just so, I was young, I was in my twenties and I just was so mortified. I could not understand how this could have happened. It was such a wake up call. I think of myself as a globally-minded person and, you know, sensitive to cultural differences. And it really was a shock to me. And I just it's amazing to really, so that was thankfully it happened in my twenties and it is a good lesson. It's a hard lesson to learn. It was very embarrassing. Yeah, we got through it, you know.
Sabine Linn: It's very similar. Yeah. So that's the other lesson, indeed. So the cultural differences, you don't really have to understand these before you start writing internationally. Yeah. So that's the other thing, but indeed. Yeah. So yeah, it's the same. It was very similar.
Meg Escobosa: It's very funny actually, to think that we had similar experiences like that.
Can you share with us? Who are some of your biggest mentors? How have they influenced you?
Sabine Linn: Yeah. I think my biggest mentors were when I was a PhD student. Bob Pinedo…what he taught me is that each cancer patient is unique and it's really important to listen to each patient and to be dedicated, so really give good care. He knew all his patients by heart, he knew all their more personal circumstances. And he really tried also in that sense to give personalized medicine. So to also take into account personal circumstances. Patient. And I think that's really something he taught me. And he also taught me to think out of the box and not to be afraid if you propose a treatment that is not according to the guidelines, but is much better for this particular patient in this particular situation. That was really helpful.
And my other great mentor was, Giuseppe Giaccone, originally from Italy, but he went to the NCI and he had an amazing career in the United States and he told me a few things. And one of them is that in fact, the first strike, so the first therapy that you will offer to a cancer patient is the most important. So this is the most important moment where you can cure a cancer patient. So show diagnostics and really understanding the disease. This unique disease in this particular patient is of paramount importance.
In fact, he thought, in fact, you have only one chance.
Meg Escobosa: That is fascinating. You know, I have heard that, I have friends who have had cancer and the treatment that they, you know, I know that there is a lot of emphasis on that first treatment is so important. Can you explain just quickly why that is? Is it because you're changing the patient in a significant way? Can you explain that?
Sabine Linn: Yeah. So one of the characteristics of cancer cells is that they can adapt very quickly to a changing environment. And so it is crucial that, you know, the Achilles heel of these cancer cells, that if you give chemotherapy or another medicine that, in fact, you really hit that Achilles heel. Because if you don't strike right first time, the cancer cell will adapt to the not so toxic agent for this particular cancer cell and will become resistant. So that's why it's so important.
Meg Escobosa: It’s like bacteria.
Sabine Linn: Yeah.
Meg Escobosa: Yeah. I did not appreciate that. Yeah. Okay. Wow. That's a whole new framing for me. I didn't realize that.
Sabine Linn: That's why, for instance, scientists are still, I think they still try to model cancer cells, like bacteria, in a Petri dish. See what drugs work against this tumor. But unfortunately, I think the host is also really important. Like what we talked about before the immune system and that's lacking in the Petri dish. So that's why this model is not working so well for cancer cells while it's working pretty okay for bacteria.
Meg Escobosa: Right, exactly. What innovation in breast cancer research holds the greatest promise for cancer treatment or early detection of disease in your view?
Sabine Linn: Ah! That's a huge question. There are so many things. So for screening, I think that, well, there's a very exciting study now, ongoing in the United States where they try to better personalize screening. So for instance, properly, some women have very protective genes against cancer, the development of cancer or maybe more precisely, breast cancer. So these women do not need screening every year, or maybe they don't don't need screening at all. And so also lifestyle can usually influence breast cancer risk. For instance, alcohol can increase your breast cancer risk. Smoking can increase breast cancer risk. Having your first child at an age above 30 can already increase it. And if you combine all this information in an algorithm, well, you can personalize the screening program.
And so this is, this is ongoing in the United States. I think this is very valuable because it's also stressful and to be in a screening program. And if it's not needed then, well, maybe we shouldn't do it. On the other hand, if you have a high risk that maybe we should screen more often or even use MRI instead of mammogram. So I think that's very important.
I think also environmental exposure to certain compounds. It's still in its infancy, but now with everyone using Google maps, etc., we can trace back where everyone has been all the time. And then we can combine breast cancer incidents with locations and maybe also find, then, compounds that might increase breast cancer risk.
Then I think regarding imaging, I think we now have computer-guided surgery and computer image-guided radiotherapy.
Also, I think artificial intelligence will help us, for instance, tests like Mamma Print or IBX, that are used in breast cancer to tell who needs chemo and who can forgo chemo.
And then we have, of course, so in the development of new drugs, I think what's really promising are these antibody drug conjugates. What it means is in fact that you're using an antibody (an antibody is, in fact, something that can recognize a cancer cell). You can use a characteristic on the cancer cell–that’s only on the cancer cell and not the normal cells–and then you can use an antibody to recognize that specific characteristic early on the cells. And you can load an anticancer drug on that antibody. So that, in fact, you have a magic bullet that only targets the cancer cells and not the normal cells.
*music*
Meg Escobosa: How do you get unstuck when you feel like you're hitting a wall in a research study? What are some things that you guys do in your lab to bring a fresh take?
Sabine Linn: Well, of course we discuss this. Every Friday we have a meeting and if there's something like hitting a wall, we openly discuss that among ourselves.
And sometimes we also ask other people to join. And to think along with us.
Of course, if we see that something is, well, it will just not happen, then we also can decide to really redirect our research and to stop a trial prematurely. It's always really difficult to do that, but I think it's also important to acknowledge if something doesn't work and then to stop it because otherwise it's draining too much energy.
And failures are always difficult, but I think failures are also very useful because they teach us a lot. So I think you should never be afraid of having failures and making mistakes because that's the way that we can learn. So don't be afraid of mistakes.
Meg Escobosa: No, that's a good thing. I mean, you'd like to avoid them, but unfortunately in life, we have them.
Sabine Linn: And of course, if there's damage, you have to apologize. You have to talk it through with all the people who are involved. And of course I have to take this seriously, but I think if you want to avoid mistakes in life, well, I think then that's not the purpose of life.
Meg Escobosa: Yeah, you’re not living, really. I was thinking about what are some of the biggest challenges in running a lab like yours? You've been running it for a number of years. What have you learned about leading a team? It sounds like, you know, obviously some clarity about creating a culture where saying, “we're hitting a wall” or “this may not be working” is accepted. That's actually, it sounds like a great culture. Are there other things that you may have learned from that experience?
Sabine Linn: So that's, I think what is really important in all organizations, it's so important that people feel safe. So I think it's really important that you encourage people that you also can get feedback; always mention all the positive. It's well known that we are always focusing on the negative, that costs a lot of energy. And so from, I think from research it is now known that you have to say four positive things to neutralize one negative item. So I think we should keep that in mind.
And also because all of us, maybe most of us at least, really want to do well in society and want to establish something and would like to be seen. And I think if we can use that energy in every person, then I think you can establish a lot of things together.
Meg Escobosa: I agree with that. And I have noticed in myself, certainly, four good things for one bad to neutralize. It's sad, but true.
For women in your field, have you seen in the Netherlands any disparity in terms of opportunity and are there things that we can do about it? And if there are, are there disparities in opportunity for women in your field in the Netherlands?
Sabine Linn: Yeah, I think so. I think it's all very subtle. So I think the whole discussion about inequality is due to how we have been raised. So I think it is not on purpose. I think it's all encrypted through all the advertisements, movies, stories, fairy tales. So I think the issue is that we have learned that some characteristics should be called “female” and some other characteristics in a human being should be called “male”. And that's an issue because I think there are males who would really like to care, but it's not allowed because then he’s a “sissy” and our females would really like to lead, but if they do so, they are a “bitch.” So I think this is something we have to rescript and it's not trivial because if something is encrypted, it's very difficult to rescript it.
So the issue, I think that women, they believe because of this whole story that I just told, they believe that they are inferior to men and it's unconscious, but it really, it doesn't help if you would like to accomplish something as a woman. And I'd like to mention a few people I really admire when we're talking about this topic. And one is Chimamanda Ngozi Adichie. She's from Nigeria and she has a great TedTalk is already from 2012 and it's called, “We should all be feminists”. And the story is really funny. It starts really funny because if you talk about feminism, nobody listens anymore. Which makes sense because yeah, this word is just, we can't use it anymore. But her story tells us why we should all be aware that we are all equal, no matter male, female, no matter skin color, no matter social economic status, etc.
And then the other person that I really like is Dr. Javid Abdelmoneim. He has made a documentary in the UK and it's called No More Boys and Girls. And he has done an experiment on a primary school. I think children are seven years old or so, and together with the parents, they try to rescript. So they have to wear different clothes. Their room at home needs to be redecorated. So it’s this kind of gender free teaching in primary school. And it's so fascinating. I would recommend to see this document to everybody because it really shows that in the first place we're all human and we all have different talents and we should develop those talents. And no matter whether we are male or female, it's just not interesting.
Meg Escobosa: Wow. Thank you for sharing that. I have teenage girls, daughters, children, and it's amazing to see how their generation is thinking about these issues and how aware they are and sensitive to them and mindful and much more thoughtful about it and fluid, frankly.
Sabine Linn: Exactly. Yes. So I'm so happy with this, all these gender fluid, we call in Dutch nonbinary, maybe? I think that's in fact, the reaction to this old-fashioned script about male and female.
Meg Escobosa: Wonderful. I agree that we make assumptions, we've been taught. We don't know. It's broken. It's baked in.
Sabine Linn: Yeah. It's baked in. I think it's really unconscious, but yeah, there is inequality in our Institute. Only 10% of females run their own lab. It's 90% male and in the audience, if females ask something, they don't get the word. It's mainly male. So two times more often a male can ask something compared to a female that has been counted. PhD students - 2x more often, males get a cum laude than females. So if your supervisor is male, then it's two times more males than females. If your supervisor is female, then it's equal. It's everywhere.
Meg Escobosa: Wow. Yeah. And what do you think there are ways we can make a difference? How can we change that?
Sabine Linn: Yes, because I'm encrypted in the same way as my male counterpart of the same age. So if he asked me who should be the next medical director of our institute, I immediately start thinking about males and then I have to become conscious about this and think I have to make a same list, a similar list of females. And same for, if you are thinking about a symposium, uh, who I'm going to invite as a speaker, we have to think about females. So we have to really be conscious about it and try to balance it. So the faculty should be 50% male, 50% female, and we should pay attention to this all the time.
Meg Escobosa: Yeah. You know, we developed this podcast with an eye toward celebrating great women who've made an impact in healthcare and also making it easier for people to see themselves in a career, understand what it takes, recognize that maybe their inherent fears or anxieties are normal and everybody experiences them and you can still achieve great things and you can overcome it.
Sabine Linn: Yeah. Wonderful. Yeah. I think it's really important.
Meg Escobosa: You sharing your experience and your journey is so helpful to people who are thinking about a science, a career in science and medicine, and it's possible.
Sabine Linn: Yeah, it is!
Meg Escobosa: So, the work is both exhilarating and exhausting. What do you do to recharge and renew outside of the lab or the hospital, in the classroom?
Sabine Linn: What I do to relax is: I really love sports. Formerly I played field hockey and tennis. Nowadays, I do speed cycling and skating. Formerly I did a lot of running. I once ran the New York marathon. So running is really like meditation, but now I'm too old to run so now I cycle. The other thing I really like is just to be in nature. So just to enjoy the seaside, the beach, just to go into the woods or, well, we don't have mountains here in the Netherlands, but I really enjoy the mountains. So I do a lot of hiking in my holidays. Just in daily life, I don't know whether you know, but many people cycle to work. So I also cycle to work, a 30 minutes cycle. And it really helps me. I cycle through a park. During that travel, it really helps me to empty my head, to get a clear mind.
Meg Escobosa: That’s great. I also enjoy cycling and have never done a marathon. So one day, maybe. I don’t know…(laughter) I don’t want to have to replace the hip down the road.
Sabine Linn: (Laughter) Well, I finished with a guy who I think was 75 years old or so, next to me, so I know I'm 33 at the time.
Meg Escobosa: (Laughter) At 75, maybe I'll do it then.
Sabine Linn: Should be no problem. (Laughter)
Meg Escobosa: Knowing what you know now, what advice might you give your 28 year old self? I kind of think of 28 as you know, you kind of have a sense of who you are, you have a little more confidence and you're on your feet. So thinking back to that version of yourself, do you have any advice that you might want to give “her” as she goes forward?
Sabine Linn: Yeah, I really like that question. In fact, I've two advices. The first one I think is very important, And that's be gentle with yourself. And it's because I recently read the books of Edith Eger. I don't know whether you know her cause she was a Holocaust survivor and she moved to the United States after she had survived Auschwitz and became a psychologist and she has written two books. One is called The Choice, and the other one is called The Gift. And in fact, she gives you all the advice you need in life.
But the one I really liked about her or what maybe resonated most is “Love yourself.” You the only person that will accompany you during your entire life. So you better have a pleasant time. And I think that that would have helped me because I was often really severe to myself when I was younger. And I think that it's important to love yourself. Be gentle with yourself.
And the other advice that's more related to my work is that if you are convinced that you have a groundbreaking idea, stick to it. And show perseverance and be patient because the greatest ideas often receive a lot of criticism and this belief in the beginning, but also sometimes turn out to be the most important research findings. If you're convinced, just stick to it.
Meg Escobosa: Great, great advice. When you think of innovation. What comes to mind?
Sabine Linn: Yeah, I think innovation begins with a question or something that intrigues you and you don't understand it and you think it's not optimal and you would like to provide a solution.
And then you start to think how you can solve this problem or this topic that is unclear. In the current era, I think innovation should move towards how can we live in a good relationship with the planet? The environmental–climate change–environment is really an urgent issue. So I think innovation should really move towards how can we be in balance with nature and with the planet?
And one book that I really like also is Doughnut Economics from Kate Raworth. Oh, it's really, it's awesome. Kate Raworth is a professor of economics at Oxford University in the UK, and she comes up with a completely new theory about economics and she's considered, in fact, the new Keynes. And in fact, she comes up with a completely new model. And so it takes into account many more aspects of society and she gives that a role within the idea of economics. I would recommend everyone to read that book. I think it’s the solution for our current issues.
Meg Escobosa: Great suggestion. I'm so happy you brought up climate change. It’s such a crucial issue. I care a lot about it. What innovation in healthcare most excites you today?
Sabine Linn: Yeah, there are so many so it is really difficult question for me, what I already mentioned. I think it's the combination of computer science together with the revolution in molecular science. And maybe called “omics:” genomics, proteomics, etc. And then also I think the insight in, but maybe that's more cancer related, but I think what's important is that the computer has helped a lot to collect all the data regarding health and disease. And it also has facilitated us to find patterns that before the computer, we could not see. And so it really helps us to analyze a huge amount of data and those data we are generating with all these exciting new molecular technologies. It's the combination of genetics, imaging, computer science. And what is missing here–and maybe it's also exciting innovation, but it's always less well-acknowledged–is the soft skills, the more…”care” about health.…
Meg Escobosa: The “human” side of medicine?
Sabine Linn: Yes, I think also, it’s getting more attention, but it's, we're not there yet. So I think in these communication skills, shared decision-making, (in the case of cancer) advanced care planning, really listening to patients, giving dedicated care. I think that’s also really, really important in health care. So I was first mentioning all the technical innovations, but I think also to the social innovation for healthcare and care innovation, maybe even more.
Meg Escobosa: What are the most essential ingredients to healthcare innovation?
Sabine Linn: I think the most essential ingredients are–so any innovation–are curiosity, and almost needs to, I don't know, in English, but that you really want to solve something. So you are dedicated when you have a problem, and you want to solve it. So it's a kind of commitment. And I think what you need is a team of people that are all really excited about thinking in all different ways, how to solve this problem.
And I think for this you need a setting where people really trust each other. So trust, I think, is also an undervalued aspect of society. So trust, safety, and then of course, fantasy and then of course, you need money and all those other things. But I think it starts with curiosity, identifying a problem and a team of people that trusts each other and feel safe and enjoys to think about these kinds of things.
I think that those are the essential ingredients and of course, a lot of perseverance to solve it because, well, we talked about 17 years or whatever.
Meg Escobosa: Exactly. Thank you so much for taking the time, Sabine, for talking with us and we really appreciate you sharing your story.
Sabine Linn: Well, it was a great pleasure for me and thank you so much.
Meg Escobosa: And thank you to our listeners for joining us today. If you enjoy our show, please consider leaving a rating and review wherever you listen. It helps us reach new listeners. And if you know other folks who might enjoy it, please spread the word. To find out more about The Krinsky Company. Check out our website. See you next time.
ANNCR: Thank you for listening to The Game-Changing Women of Healthcare. This podcast was produced, engineered, edited, and scored by Calvin Marty. Please take a moment to subscribe via your favorite streaming service. The Game-Changing Women of Healthcare is a production of The Krinsky Company, a growth strategy and healthcare innovation consultancy. Visit us on the web at www.thekrinskyco.com.