Kanecia Zimmerman, MD, MPH, is an associate professor in the Department of Pediatrics, Division of Critical Care Medicine, at Duke University Medical Center, as well as the co-principal investigator of the STAR program. Dr. Zimmerman is the recipient of a Duke CTSA Career Development Award, and she focuses her research on improving the safety of drugs administered to critically ill children. Dr. Zimmerman earned her MD from Duke University and her MPH from the University of North Carolina at Chapel Hill. Dr. Zimmerman is a graduate of the Duke Clinical Research Institute Fellowship program and currently serves as one of its associate directors. She is passionate about teaching and mentoring young scientists. She is also the co-chair of the ABC Science Collaborative, founded in 2020.
In this edited and condensed interview, Dr. Zimmerman discussed her long ties to Duke, the importance of centering the needs of children in medical research, and her growing interests in educational equity and its importance in the COVID era with Black Think Tank’s Allayne Thomas.
What drew you to Duke?
I actually went to medical school here. I’ve done most of my training at Duke and I would say the primary thing that drew me in medical school was the community. Actually, I’m from North Carolina and I had no intentions of applying to Duke for medical school. None at all. (laughs) I was a Carolina fan, so I was very married to not applying to Duke. But my parents made me. So, I ended up doing that and coming. It was at a time when Brenda Armstrong was here and she had done a really great job of creating a community of Black scholars in my medical school class and it was great. It was just a great place to be. I’ve stayed now because my family is around. I have a family and lots of community around here which has made me comfortable with staying here at Duke.
What is a proud moment over the course of your career and research?
I’m fairly junior in my career considering. I’ve had a lot of really great opportunities in pediatric drug development working at the Duke Clinical Research Institute and took over the day-to-day management of the Pediatric Trials Network a couple of years ago. I think it is certainly a very different place and a place that I had never really been before as far as the type of work that we do in that network. We’d present to the FDA all the time because our job is to try to negotiate with them to do the studies that are necessary in order to make sure that there’s appropriate labeling for children. So, I’d watched a number of my mentors and colleagues do this (all men by the way (laughs)). They were all doing this and I never really had an opportunity or you know, really even knew how to do it myself. Then we designed a study that was specific to critical care, which is what I do, and we wanted to present it to the FDA. So, I decided that I was going to do it and I was going to do it without any help and it ended up being a pretty controversial interaction but one that I like walked away from being like ‘Yeah, I did that, and it was good. I did a good job and now the FDA understands that we have to do this for children.’ So that was probably my first proud moment of being in this space
Can you tell me more about the kind of research you typically do in pediatrics therapeutics? What do you enjoy about the research and the work that you do?
I do a number of different types of research. The first is with the Pediatric Trials Network as I mentioned and our goal really is to do clinical trials and to try to fill the gaps. There's not a lot of information about drugs that we give kids and that’s kind of scary and pretty sad. Our organization develops these studies, executes them, and goes to the FDA to talk about what should really happen with regard to these drugs. Oxycodone is one example. Tons of kids get oxycodone for their pain control after their surgery but there’s no data to actually guide how much oxycodone these people should get. If you look on the product labeling it says something like ‘not studied in children.’ So common drugs that we use all the time, there really aren’t any dedicated studies. That is the majority of the time that I spend right now, or have spent over the last couple of years, figuring out what the studies should be, executing the studies and then negotiating with the FDA. Other parts of my research involve doing creative work– trying to figure out what's the best way to study things or get the best answers for drugs, particularly in kids in the ICU, which is where I work. I do that with a combination of existing databases and clinical trials, and put that information together and see if we might be able to get the appropriate information. I do some epidemiology work as well and it might be about critical illness or asthma or whatever, but that’s the other part of my research. More recently I’m also in schools doing school-based type of work.
How did you get involved in the ABC Science Collaborative? What motivated you to start it and like get involved in that work?
Through the Pediatric Trials Network, we always have an eye for public health. Our goal is to try to do things to fill the gaps for kids in particular and when COVID hit, it became pretty obvious that kids were going to get forgotten. Because kids didn’t really die that often and they didn’t get hospitalized that often, there wasn’t a lot of conversation about it. But it also became pretty obvious when schools closed that the one issue that needed to be addressed was schools. The public health issue for children was going to be about schools, particularly for black and brown communities. We know a lot of us go to public schools––my own kids go to public school. There are fewer resources, sometimes less motivation to do the things that need to get done, and I saw that as a problem and as a problem in particular for kids that looked like mine. That was the primary motivation for trying to get it started. Also, there was a lot of misinformation out there about COVID-19. All kinds of rumors, all kinds of craziness, all kinds of stuff, so we wanted to make sure that schools, when they were making these decisions, weren’t making those decisions based on fear but were making decisions based on data and information and actual science. In order to do that, schools had to have access to science right? They're not scientists––they are educators. A number of them actually came to us and said ‘hey can you help us? can you help us get some information about what we should do and what we should actually believe because there’s someone over here saying this, someone over here saying that ––I don’t know which one I’m supposed to actually follow.’ That was the primary motivation and kind of how it all got started––by people coming to us and saying please help us and we’d go ‘okay’.
As schools transition into re-opening, what more can be done in your opinion? Where do you see the collaborative going forward?
I think it’ll be interesting to see where the collaborative goes. I mean it was developed for this kind of finite moment in time––or at least that was the original idea. We’ve collaborated now with people across the entire country and even across the world to try to gather data and get information and get the information out there, which has been a really cool experience. We’ve presented before congress and we’ve talked to staffers and presented before NICHD council to tell them ‘Hey this is the problem.’ Unfortunately, schools have gone back at varying rates and it doesn’t always have to do with how much COVID is in their community. It has to do with a lot of different things and I think we’re all understanding what the politics are––or we understand that there are politics involved in these decisions. There are places in North Carolina that have had the highest rates of COVID and they go right back and there are places in North Carolina that have not had very much COVID and they’re still at home. So, [we need to] understand the things that are at play, understand that there will be differences in how kids are affected by not going to school because some of them are in school and some aren’t. And then even when schools are open, some kids are still not going back. I think the other thing is that we’ve uncovered there’s a lot of things in schools that are unequal. There’s a lot of things in schools that I think COVID has uncovered (shrugs)––that thing’s aren’t as rosy, maybe, as some people had pictured them. I think that part of what I’ve hoped to do is show people ‘hey these are problems that need to be fixed and they were before COVID.’ COVID just happened to show us all of this stuff (laughs) but just because COVID is getting better doesn’t mean we ignore all of these problems. We have to fix those things.
[I don’t know] what the role of the Collaborative will be in moving forward, but I hope that we’ve done a good job of showing people that (pause) we have to do something. (laughs) We must do something about it. Children are suffering. I think that’s been the primary thing: kids are suffering and it’s not fair. It's not fair that they suffer for adult mishaps. We have messed up things for kids and they don’t deserve that.
What plans do you have upcoming in the next year? What research are you interested in at the moment?
I think as far as pediatric therapeutics goes, it’ll probably be more of the same. We are starting some new studies, as I’ve mentioned, in the pain area of oxycodone and drugs that we use in the ICU. We’re trying to investigate some of those, so I think that that will be really cool. The other thing is that there's so much we don’t know about kids––like how do we even measure pain in kids? Those are some of the things that we’re starting to work on right now, especially for younger kids. How do you know they’re in pain versus how do you know that they’re hungry? We use those things to give them medication, so how do we know? I think those are areas that I’m interested in. I think I also still have a lot of interest in general educational outcomes and inequities. I don’t have formal training in that area, so it’s kind of weird for me to be interested in it, but clearly our work has been very impactful. There are all of these things coming out of the CDC and out of the federal government; we want to make sure that there’s data to support them right. They’re doing all of this, they’re giving people all of this money to do X Y or Z, but do we know that X Y or Z actually is helpful? That’s my special soap box (laughs)––that we’re doing all of this stuff, but do we even know that it’s helpful? I think there will be more work to do generating evidence for schools as vaccines and variants [increase] and communities try to figure out how to navigate this space. I would love to be involved in some of that
As a Black woman in your field, what are challenges you’ve faced? What are some of the biggest challenges as a black scholar in your opinion and how have you or how would you recommend overcoming them?
It’s a great question and I don’t know if I have a great answer. There aren’t that many of us in this area––in any area of scholarship, there just aren’t that many of us. I think my hope is that we, as scholars, are able to train and encourage the next generation of people and bring them under our wings in order to make sure that they have [access to] opportunities or give them opportunities and help them be better than ourselves. Those are some of the things that I’m really interested in. I run a summer program: it's Summer Training and Academic Research (STAR) at the DCRI and we bring in people from high school and college to spend a summer basically at DCRI learning about research, meeting myself and others, talking to us, interacting with us, and understanding what it’s like day to day. I think that those things are critical for success of future people. There are a lot of barriers, the first one being that there just aren’t that many people that look like me. I have to believe first of all that I can actually get there. Having the next generation and things for them is really important to make people believe that we can actually get there. We’re understanding more and more about systemic racism and how it impacts a number of things: medicine is no different. All the challenges that come with systemic racism are here for me.
What do you suggest for people trying to find community within their field or at Duke overall? Are there resources that they could benefit from? Is there anything you would like to see at Duke?
I think I personally probably haven’t taken advantage of all of the community that is currently here. In medical school I had this ready-made community. We still talk, hangout, travel together with our families. There's like 12 or 13 of us and we run deep and still do. It’s much more difficult as you get up, and climb the ranks. As you become faculty, you're very concentrated on moving your career forward and because there aren’t that many of us in general, there aren’t that many entities in my field where I can say ‘hey let’s do this together, let’s climb together.’ That just doesn’t really exist so we have to really reach across specialties for sure and I think it can be hard to do that because we have erratic work schedules, families, and all of those types of things. I think ways that can promote togetherness would be great. This summer a group of us got together across the institution to think about what we wanted from the School of Medicine. We developed the COST letter and did all of that stuff together to try to put in place and allow people to realize what we’re going through and what we think are the solutions. That’s really the first time that I’d really gotten together with that group of scholars or people across the university to think about those types of things. I think it would be helpful. In peds I’ve been very fortunate to have like a couple of girlfriends who have come over the years. We get together outside of work and they’ve been great. Now I don’t know what I would do without them, although I was here without them before. It’s important to find community. I think that if there were more organized things that would be great. I think you also have to do it organically in some ways and I’m so grateful there are just more of us––when there are more of us it’s easier (laughs). Otherwise, I’m just searching for a needle in the haystack.
What can be done to make the medical school more inclusive? Are there any ways you see Black Think Tank supporting in this endeavor as well?
Absolutely, I think Black Think Tank could definitely do some wonders here (laughs). I think the primary thing is really having more of us to have a community and reaching across not only the School of Medicine, but even outside of the School of Medicine is great. I think we need to do more of that. I’m as guilty as anyone to not take advantage of all the opportunities that are present. I think now that we have Zoom and things like that, maybe it’ll be easier. If there’s spaces like that, then you don’t have to travel or do any of those types of things at least.
Is there advice you have for junior Black faculty as they advance their career and look for mentors?
I think––I guess it’s probably not fair for me to call myself junior––maybe I’m mid-career now but it just feels like I’m six years in ‘oh I’m mid-career okay’ (laughs). I think being really confident in yourself, and in your abilities: you got here, you're here for a reason, and someone saw some amazing talent in you and you deserve to be here. I guess that’s the main thing that I didn’t learn for a while. I don’t owe anyone anything for me being here; I deserve to be here. I have done a lot of things and I deserve to be here. We think often as females about imposter syndrome and that might be even more prevalent in Black females because not only am I having to deal with like the male thing, but also, I’m Black. But I’m good enough. I am good enough. I think believing and understanding that is the first step to being successful in this space. Find people who have your best interests at heart. I think in medicine in particular there’s not always people who want you to advance. Even mentors might not want you to be more successful than them. You need to grasp onto people who have your best interests at heart. That means even if you’re more successful than them, they are behind you, cheering you on. I think you should look for the right mentors and follow what you love, what you want, and where you want to make an impact. I think for such a long time, even in this space of pediatric drug development, I didn’t really understand why I was there or how I could actually do the things I wanted to do. I couldn’t stand pharmacology when I went to medical school. Pharmacology was the last thing I wanted to do, so the thought of doing pharmacology was horrible. Then I saw that doing it in this manner allowed me to have an impact on, maybe, thousands and millions of children. It was finding that kind of opportunity within this weird space. I think keeping your eyes open, being creative, and understanding how maybe [something] doesn’t seem that way on face value, but it could be something that you actually want to be, that you want to follow, and you want to fulfill. It’s really important.
How do you build strong mentor relationships? What makes a good mentor and mentee in your opinion?
I think there’s mentorship and there’s sponsorship and I think you need both. The sponsor is the person who’s going to put you up and say ‘Hey, Kanecia, [you’re] great. You need to do X Y or Z.’ The mentor might be a mentor for life, research, or career. They might be a mentor for your clinical career. It’s okay to have multiple. I think the characteristics of the mentor are: what do you want from me? What is it that you want from me? What is your vision? Is your vision for me bigger than my vision is for myself? That’s hard to find. But there are people out there who want something more for you than you can even imagine for yourself, which I think is just an amazingly important takeaway point.
Are there any favorite quotes or poems you would like to share?
I think probably in the last year I’ve increasingly gone back to the book of Esther in the Bible. There’s this section in there––I mean everyone always quotes “for such a time as this” ––I think that that is so very important, but in the beginning of that is, paraphrasing: Mordecai is saying ‘don’t think that just because you’re married to the king that you’re going to escape all of this.’ I think that maybe you were put into this position ‘for such a time as this.’ I think as a physician, as a Black female physician, I remember the march that we did this summer and feeling like I couldn’t put my jacket on (this is kind of an aside). I carried my white coat, walking with it, because I know that when I leave the building or like when I leave that place, I am just another Black woman. My husband is a Black male. He is subject to all the things that Black men are subject to. My son is a Black male. I can’t just come into the building and put on my coat and hide underneath that. God gave me an ability and I need to do something with it. Esther 4:13 and 14. The meaning behind that is you were put here for a reason and don’t forget that you were put here for a reason.
Kanecia Zimmerman, MD, MPH
https://medschool.duke.edu/about-us/our-faculty/kanecia-obie-zimmerman&…;
https://dcri.org/education/dukes-star-program/dukes-star-program-facult…;
Further Reading
“Vasoactive medications in extremely low gestational age neonates during the first postnatal week.” J Perinatol https://doi.org/10.1038/s41372-021-01031-8.
“Pharmacokinetics of Hydrochlorothiazide in Children: A Potential Surrogate for Renal Secretion Maturation.” J Clin Pharmacol https://doi.org/10.1002/jcph.1739.
“Wide range of perioperative drugs and doses used in inguinal hernia repairs for premature infants.” J Perinatol https://doi.org/10.1038/s41372-020-00864-z.
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