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Pulling Back the Curtain: Ruemu Ejedafeta Birhiray, MD

March 26, 2024

April 2024

In this issue, Ruemu Ejedafeta Birhiray, MD, discusses growing up during the Nigerian Civil War, taking individual responsibility for diversity in clinical trials, and being a romantic at heart.

Mary Ellen Schneider

Mary Ellen Schneider is a medical journalist based in Setauket, New York.

Ruemu E. Birhiray, MDRuemu E. Birhiray, MD, is a hematologist/oncologist and clinical investigator at Hematology Oncology of Indiana in Indianapolis and president and CEO of Indy Hematology Education. He is also a clinical professor of medicine at Marian University College of Osteopathic Medicine in Indianapolis. Dr. Birhiray has published research on immunotherapy, lymphomas, and bone marrow transplantation, and recently authored a practical strategy for creating diversity, equity, inclusion, and access in clinical research, which appeared in Blood Advances.1

 

 

Tell us about growing up in Nigeria.

I was born in 1963 in the Niger Delta of Nigeria, and some of my earliest memories are of the Nigerian Civil War, which took place in the late 1960s and early 1970s. I remember times when we had to stay in the dark because of bombing. As a child, I hated darkness, so sleeping in the dark was not my idea of fun. My mom would have a tiny light on so I could have just enough light to see, but not enough to attract the bombers. It tells you what mothers will do for their kids.

Dr. Birhiray with his mother and younger sister in Nigeria. 
Dr. Birhiray with his mother and
younger sister in Nigeria.

I grew up in Nigeria during the apartheid era, and Nelson Mandela was a personal hero of mine. My boarding school hosted high school students from South Africa who were displaced because of the Soweto riots. It was an opportunity at a young age to be exposed to “man’s inhumanity to man” and learn about justice for all.

How did you become interested in hematology?

When I was in medical school in Nigeria, I wanted to be a psychiatrist. I graduated from medical school in 1986 when psychiatry was evolving from a psychoanalytical-based specialty to a biologic science in which you could study the biochemistry of the brain. I found that very intriguing. When I graduated from medical school, I decided to come to America for my residency and study psychiatry.

I came to the U.S. and did an internship in internal medicine with the intent that I would do one year of internship and apply for psychiatry residencies. I was at Columbus Hospital, which doesn’t exist anymore but was an affiliate of Northwestern. They had a large neuroscience program, which included oncology. A lot of neuro-oncology was going on around me, and on top of that, my internship was during the AIDS epidemic, so we admitted a lot of patients with brain lymphomas. I took an elective in oncology, and at the end of that month, I knew exactly what I wanted to be. I realized that part of psychiatry’s draw is the ability to interact with people and understand the human mind. In oncology, you do that, but also the biologic science was way more advanced than what was going on in psychiatry at the time.

Who are some of the mentors who have helped shape your career?

I ended up going to the National Cancer Institute (NCI) in Bethesda, Maryland, for my residency. There were really great people there to look up to who were wonderful mentors to me. Greg Curt, MD, who passed away several years ago, was one of my mentors there, as was Wyndham Wilson, MD, PhD.

At the NCI, we did autologous stem cell transplants, and I realized that I truly enjoyed bone marrow transplantation. However, I really wanted to do cellular therapy and was interested in natural killer cells and allogeneic transplant, so I took a leave of absence and went to Johns Hopkins. There I met Georgia Vogelsang, MD, one of my leading mentors. She was the clinical director of the bone marrow transplant program and a world-renowned expert on graft-versus-host disease. My second mentor at Hopkins was Robert Brodsky, MD.

John Paul Quinn, MD, who passed away in 2013, was my residency program director at Columbus Hospital. He was an infectious disease physician and a mentor who provided me with an interactive learning experience and guidance throughout my residency.

I met another mentor years later when I joined my current practice in Indianapolis. T. Howard Lee, MD, was one of the original hematologists in Indianapolis and the senior partner in the practice. When I came to Indianapolis, he gave me free rein to fulfill my dreams. He’s 80 years old now and retired, and at both major hospitals where he worked, there are plaques in the hallways honoring him. He was the oldest person in the practice but came to work at 4:00 a.m. and got done around 7:00 p.m., right up until the day he retired at age 65. He’s my guiding light. I always ask, “What would Dr. Lee do?”

When did you become interested in the issue of clinical trial diversity, and why has this been so important to you?

I have always had a desire to understand why things are the way they are. I decided about 20 years ago that I needed to understand the civil rights movement in the U.S. The more I delved into it, the more I recognized that civil rights struggles are ongoing. I was running the clinical trials program at St. Vincent Hospital, where I practice, and recognized that there was not a lot of diversity in the patients we were enrolling in our clinical trial program. And then I would go to the major meetings and see that the studies were just not representative of all people. I said to myself, if there is anything I can do that would be satisfying, it is being a voice for diversity in clinical research. I should be able to look at every patient in my clinic and say to them, these data that I’m speaking about are applicable to you, not that I think they’re applicable to you.

Dr. Birhiray and his daughter, Maya Birhiray, at the DRIVE Summit.
Dr. Birhiray and his daughter, Maya Birhiray, at the DRIVE Summit.

You and your daughter Maya published a strategy to diversify clinical trials called DRIVE. Tell us how you came up with it.

I was on vacation with my family, and we were talking about this issue and realized we needed a strategy that was simple but also meaningful and practical. To do that, we needed an acronym that people could remember. Once we came up with the elements, we started moving them around and changing the titles to fit something we thought would be memorable. That’s how we came up with DRIVE.

From left to right: Dr. Birhiray, Dr. Gilles Salles, Dr. T. Howard Lee, and Dr. Michael Wiemann at the 2023 Indy Hematology Review.
From left to right: Dr. Birhiray, Dr. Gilles Salles, Dr. T. Howard Lee,
and Dr. Michael Wiemann at the 2023 Indy Hematology Review.

What does DRIVE mean?

Every clinical trial should have a diversity officer. A diversity officer ought to monitor studies from the beginning to the end, just like a data and safety monitoring board does, to ensure the clinical trial is meeting the goals. That’s the “D” in drive.

The “R” is for ranking. We live in a society where people listen to rankings as an informational tool. If you go to the store to buy guacamole and there is a ranking system for guacamole, you’re going to buy the best-ranked one. If we come up with a system that ranks studies for their diversity, clinicians can use it to make decisions.

The “I” is that each of us has an individual responsibility for diversity. I need to have a diversity plan for every study I’m involved in, implement it, and be true to it.

The “V” is for verifying that studies are diverse, and then using that verification to give those studies more podium space at major meetings.

The “E” is for making sure that we are elevating minority voices. One of the reasons people don’t enroll in clinical trials is because the people trying to enroll them don’t look like them.

How do you apply the DRIVE strategy in your day-to-day work as a hematologist?

One of the things I’m doing in Indianapolis is creating relationships with community organizations that I continually communicate with so I’m not just going to them when a clinical study is needed. I am also ensuring I have diverse teams within my practice who can talk to patients interested in clinical trials. The other thing we’re trying to do is get funding to create a broad-based organization that can work across a variety of community organizations so we can educate them on why it is necessary for different people to participate in research.

Dr. Birhiray and his wife, Donna Marie Birhiray, at the Kentucky Derby in 2023. 
Dr. Birhiray and his wife, Donna
Marie Birhiray, at the Kentucky
Derby in 2023.

When you’re not working, what do you do for fun or to relax?

I enjoy good music, going to musicals, and watching equestrian sports, and I’m a romantic at heart. When I proposed to my wife, Donna Marie, The Phantom of the Opera was playing in Chicago, so I took her to see it for our engagement. It has become our thing, and we have seen The Phantom of the Opera probably a hundred times. Wherever it’s playing, we see it. It was getting ready to close on Broadway at the end of April (2023), and our anniversary was that month, so we went to see one of the last shows on Broadway. When we got there, we found out that a Black woman was playing Christine on Broadway for the first time, which was a wonderful moment. 

As you consider your career so far, what are you most proud of, and what are you most looking forward to?

Dr. Birhiray and his wife, Donna Marie Birhiray, enjoy one of the final performances of The Phantom of the Opera in New York.
Dr. Birhiray and his wife enjoy one
of the final performances of The
Phantom of the Opera
in New York.

When I first came to Indianapolis, we started a hematology education program called Indy Hematology Review where we bring the world’s leading hematologists to Indianapolis to present on the latest and best things that happened in the prior year. We’ve had 21 meetings so far with many of the country’s leading hematologists and oncologists in attendance. I’m really proud of this program because it’s sustaining, well regarded, and well attended, as we generally have about 500 attendees.

I am also really happy I found my voice in the diversity space. I was at a meeting last year, and at the beginning of the meeting, most of the people I was talking to were skeptical that it was even possible to achieve diversity in clinical research. But, at the end of the conversation, everybody was hugging each other. I can see myself dedicating the remainder of my career to this work.

Reference

Birhiray MN, Birhiray RE. Practical strategies for creating diversity, equity, inclusion, and access in cancer clinical research: DRIVE. Blood Adv. 2023;7(8):1507-1512.


This interview has been edited for length and clarity.

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