Edith Mitchell came a long way from growing up on a Tennessee farm, to becoming a brigadier general and serving on the President’s Cancer Panel.
“It was making a plan, having a plan, and all of us had similar type plans that we needed to leave the farm—yes I grew up on a farm—and get out of town,” Mitchell, member of the President’s Cancer Panel, clinical professor of medicine and medical oncology, director of the Center to Eliminate Cancer Disparities, and associate director of diversity affairs at Sidney Kimmel Cancer Center at Jefferson, Thomas Jefferson University. “Yes, you have success, but look back and pull somebody behind you, pull them up.”
Mitchell spoke with Robert Winn, director of VCU Massey Cancer Center and John Stewart, founding director of LSU Health/LCMC Health Cancer Center.
When Mitchell was growing up, and well into her training, there weren’t many Black doctors. She noted that even now the percentage of Black practicing clinicians hovers around 5%.
“We’ve got to get more people out there like you Dr. Stewart, like you Dr. Winn, like me, so that we can say that we are affecting change,” she said. “And it’s up to us to either accept the 5% or do something to affect change.”
The role of Historically Black Colleges and Universities and working to change the pipeline are crucial to increasing that number, she said.
“One of the things that I’m doing now with the Accreditation Council for Graduate Medical Education is—how do we work with the pipeline? How do we get residents through their training so that they are successful? It probably is not recognized that more Black residents and fellows leave their training programs before completion,” Mitchell said. “HBCUs now are receiving more funds and resources for research, for graduate studies as well. And therefore, it’s very important that we support the HBCUs in making sure that they are thriving and doing well.”
When Mitchell attended medical school at Virginia Commonwealth University, then called Medical College of Virginia, she was given a military scholarship and was supposed to give the Air Force two years of service.
She became interested in health policy and military medicine and remained in the Air Force. When thinking about retirement after 20 years of service, Mitchell, a colonel at the time, learned she was up for a promotion.
The only problem? Her competition, mainly white men, had all been to flight school.
“Most people go to flight school in their 20s, right? I was in my 40s with two teenage kids. So what did I do? I signed up for flight school. I finished. I got my flight wings and my certification in aerospace medicine,” Mitchell said. “Very few people know that I am certified in aerospace medicine, but what happened was, I was selected. I am the first woman doctor ever to be promoted to brigadier general in the history of the Air Force.”
Edith Mitchell: So, Dr. Winn, let me just tell you that I decided when I was three years old, that I would become a doctor and I would focus on disparities.
My great-grandfather—who I was very close to, and he was very close to me—he and my great-grandmother had been my babysitters from the time I was about a month old. So, I was very close to them. And my great grandfather became ill. He was 89 years old.I overheard family members talking, that they couldn’t take him to the hospital because they didn’t take care of Black people really well. And they were making a list of who was going to be with him and what time and so forth.
A very elegant gentleman who was an African American physician came by the house for a house call. And I thought his black bag—and that he was so elegant. And when he left, I told my great grandfather, “Pa, when I grow up, I’m going to be a doctor. I’ll make sure you get good care.” And he patted me on my head and said, “Baby, you can do whatever you want. You just have to plan.”
So, I went to first grade. We didn’t have kindergarten for Black kids. I went to first grade telling my teacher that I was coming to school so I could be a doctor. Move forward a few years. St. Jude was built in Memphis. And after my sophomore year in high school, there was a National Science Foundation program for Black kids. And I was selected for that program. And I decided then that I would become a cancer doctor.
I was so impressed with St. Jude. And at that time, St. Jude was only one building, but the research ongoing really sparked my interest in oncology and I’ve never looked back. I love oncology research. I love taking care of cancer patients, the teaching for medical students and residents and fellows. I enjoy it all. And of course, working with the National Cancer Institute. And last week I was at the White House with President Biden outlining his reimagined Cancer Moonshot and the report from the President’s Cancer Panel, which I’m a part of, was released.
I wake up every morning thinking about what I can do in cancer research, cancer healthcare delivery, and what I can do for my patients.
EM: Well, yes, there were not many Black physicians, but I was mentored, Rob, by lots of people. There was a woman doctor in my hometown, which is near Memphis, [who] encouraged me to go into medicine. She was my doctor and was white. But she and I talked and she recognized that I was OK, and that I would accomplish my goals. Later—I had not had contact with her for a few years. I was referred a patient from Tennessee, and it was [from] my doctor.
I reminded her of our visits when I was a kid, and she says, “You know, I knew you would do well.” The patient she was sending was a patient with colorectal cancer who was looking for a clinical trial, and obviously my name had come up as a researcher for colorectal cancer.
EM: I did not have a Black woman doctor at that time, but later in my career, I had mentorship from many women, many Blacks, including Dr. LaSalle Leffall. I never attended Howard, however, I met Dr. Leffall at a National Medical Association meeting. He was a great mentor for me. Dr. Louis Sullivan. I never trained with Dr. Sullivan formally, but I gave an abstract presentation at the National Medical Association after completion of my internship, so the summer that I started residency. I was giving my presentation orally and Dr. Sullivan walked in the back of the room.
Dr. Cobb, who was the panel director for the residents. My topic was multiple myeloma without a protein spike. And I was halfway through my presentation and Dr. Cobb said, “And just look who has come in the room? Dr. Louis Sullivan.” And he asked Dr. Sullivan after I finished to comment. And Dr. Sullivan gave some really nice comments. And afterwards I said to him, “Gee whiz, when they said Dr. Louis Sullivan was in the room, I was expecting a chewing out.”
Dr. Sullivan and I have kept in touch over the years. He was my grand round speaker at Jefferson for Black History Month a couple of years ago. When I was president of the National Medical Association, I called him to ask for a special presentation. He said, “Edith, you know I’m up in age now and I’ve quit doing these programs.” I said, “Oh.” He says, “But for you, I will always come.”
I’ve been mentored by many people, Blacks, whites. In fact, at MCV, and when MCV comes to mind—sometimes I say VCU now, but it was MCV back then. Dr. Nancy McWilliams was a pediatric hematologist. She is deceased now, but Dr. McWilliams really took me under her arms, taught me clinical hematology and oncology, as well as general medicine. And just being a person, a doctor.
Dr. Nancy McWilliams, you may look her up in the records, but she is one of my sheros and she helped me a lot. I was very interested in meeting people, and therefore I had mentors who were white, who were Black, who were women, who were men. I just appreciate all of them and how they helped me.
EM: Dr. Stewart, I talk with people from Brownsville. I am back there several times per year, even despite COVID. And I tell them to set your goals, know what you’re looking for, and be specific about designing that pathway, so that you’ve got options, you’re meeting people, and therefore, affecting your plan. Everybody, if you’re going to be successful—some people are lucky, but most people have to plan. And I tell them to do that all the time.
I work with students from Tennessee State University, the Levi Watkins Institute. I am pleased to say I was selected to be the chair of the board of that institute. I’m working with Tennessee kids frequently and on different levels, some in Brownsville, which is a small town, but a small town that really has contributed to the growth and success of many people.
I was actually, John, giving a lecture at Vanderbilt once and was going to be in town for just one day. I asked the supporter of the program if I could invite just a couple of people in the city who were successful and who I knew. I think I had about five people from Brownsville, all physicians. I know one was a PhD. And my colleague at Vanderbilt asked, “How can a little town like that have so many successful people?” And we all gave the same reply, that we just needed to get out of town.
Therefore it was making a plan, having a plan, and all of us had similar type plans that we needed to leave the farm—yes I grew up on a farm—and get out of town. But all of us come back there frequently. It’s a part of the skin that yes, you have success, but look back, the students—the college students, the medical students, look back and pull somebody behind you, pull them up.
It’s always a pleasure for me to look at our pipeline. And one of the things that I’m doing now with the Accreditation Council for Graduate Medical Education is—how do we work with the pipeline? How do we get residents through their training so that they are successful? It probably is not recognized that more Black residents and fellows leave their training programs before completion.
We’ve got to get more people out there like you Dr. Stewart, like you Dr. Winn, like me, so that we can say that we are affecting change. Do you know that the number of practicing clinicians over the last three decades has not changed significantly, the Black ones? It’s been about the same, 4.9% one year, 5.0% the next year. Right about 5% of practicing clinicians in this country are Black. And it’s up to us to either accept the 5% or do something to affect change.
EM: Oh, absolutely. The Historically Black Colleges have contributed to approximately 60% of all practicing Black doctors in this country in some way. And that’s really important. Understand that for a long time there was only Howard and Meharry for medical school training. Now we have two more colleges, Drew and Morehouse, for medicine. But the undergraduate campuses are contributing to individuals going to medical school at many places. Just like I am a graduate of Tennessee State, and went to MCV for medical school, there are lots of medical schools now opening their doors and increasing opportunities for African American students.
But 60% of all practicing clinicians who are Black had some connection with an HBCU. HBCUs now are receiving more funds and resources for research, for graduate studies as well. And therefore, it’s very important that we support the HBCUs in making sure that they are thriving and doing well. And I had the pleasure and the privilege of being the HBCU Alumni of the Year, that was from all of the schools. I think it was 2012 maybe, somewhere about there. So yes, we need to support all of the avenues that allow our pipeline to grow and to increase so that we’ve got more Black doctors in the country.
EM: Just seeing Dr. Wright and Dr. Pinn was just amazing. And you know Rob, I have continued with the National Medical Association since that year when I had completed my internship and submitted that abstract. And that’s how I get to meet a lot of people. For example, Dr. Yvonnecris Veal. Do you know her?
EM: She is an MCV graduate as well, and Dr. Veal always talked to me about things and people. For Dr. Jane Cooke Wright, Dr. Karen Antman, who is [a] dean at Boston University, called me one day when she was president of ASCO and asked if I knew about this woman founder. I said, “No, but remember there was a lecture about the founding fathers of ASCO?” She says, “Yes, I know. But Edith, there was a woman in that founding group.” She says, “How about if we invite her to ASCO, would you be willing to speak with…” Absolutely.
Dr. Jane Cooke Wright attended the ASCO meeting and all the women just loved her and so forth. I got to know her really well. I continue a relationship with her daughters. Dr. Wright, we invited her to the NMA, where we presented her with a lifetime achievement at the NMA with a group of ASCO doctors who attended the NMA meetings.
I kept in touch with the family and the family invited me to speak at her homegoing service. They were just tremendous individuals, Dr. Pinn, Dr. Wright, Dr. Yvonnecris Veal—I keep in touch with her now. These people were really experts in their work, obviously in the years that they were active in practice. It was just tremendous, and I had an email from Dr. Pinn just a few weeks ago in 2022.
It’s so important to keep up with people. And you know Rob, I was just very privileged to have been mentored by so many great people, not only women, but men, not only Blacks, but whites. And in fact, I have to tell you this story.
I had a military scholarship at MCV, and when I finished, I was supposed to give the Air Force two years of service, which I was glad to do. But I became interested in health policy and military medicine.
I had great opportunities with people. I stayed in the Air Force longer than the two years. But as I was getting ready to think about retirement after more than 20 years, one of my mentors called me in and said, “Everybody is talking about you being in the group to be evaluated for promotion to general.” At that time I was a colonel. And he said to me, “Your competition is going to be mainly white men.” I said, “Yes, sir. I know that.” But I hadn’t decided.
So he says, “There is one dot you don’t have. You’ve done research, you’ve done this and you’ve done that. And you have led people on deployments.” He says, “But all of the white men are going to have been to flight school.” Most people go to flight school in their 20s, right? I was in my 40s with two teenage kids. So what did I do? I signed up for flight school. I finished. I got my flight wings and my certification in aerospace medicine.
Very few people know that I am certified in aerospace medicine, but what happened was, I was selected. I am the first woman doctor ever to be promoted to brigadier general in the history of the Air Force. And it was interesting. I was giving a lecture someplace and was introduced. And the person in charge of the program introduced me as the first Black woman to become a general in the Air Force, a Black woman doctor. So I go up and I start talking.
I said, “Thank you for that great introduction. Yes, I was the first Black woman doctor to be promoted to brigadier general. But my genomic test says that I have a percentage of white genes. So, I’m the first white woman doctor to be promoted to the rank of brigadier general in the history of the Air Force, too. So, I’m the first Black woman and I’m the first white woman.” After that I really didn’t have to make a talk.
EM: Dr. Stewart, tremendously. The Air Force is not only a good place to work, but it is a great place to learn. I am a graduate of Air War College, which is the strategic planning force in the Air Force. It’s where you learn. And with that, I was with pilots, boomers, admin, all of the people in training for strategic planning at Air War College.
I learned a lot about planning, a lot about bringing people together, influencing people, how do you learn, how do you reach people, and how do you command large groups of people to keep them in the direction that you need them to work. I learned a lot there. I met people. One was a lecture from General Colin Powell about being a leader. I learned a lot in the Air Force regarding planning, regarding evaluation and how to encourage and how to move and motivate people to reach your goals.
It was just a tremendous learning environment that allowed me to plan to conduct my research. I had grants to do cancer research, grants for other research as well. I’ve learned to, with the Air Force training, meet people, how to engage people, how to listen, which is one of the important facets of the training. I love the Air Force. I still love the Air Force and being a part of the Cancer Moonshot, working with then Vice President Biden and now with President Biden on his initiatives for cancer in the country for the next 25 years.
He indicates he wants to decrease cancer mortality by 50% in 25 years and that’s a heroic goal. And he and his wife, Dr. Jill Biden, indicated that if we all work together, we can do it. But how do you bring people together to follow his plan for cancer in this country? We released the President’s Cancer Panel’s report on closing the gaps in cancer screening and getting people to understand that with screening, we can find cancers at an earlier stage where interventions will be more successful and outcomes greater for the patient.
That’s one of the first plans that he outlined, and then there will be others like increasing access to care, so I can prove to my great grandpa, who hopefully is looking down on me and saying, “You go get it girl.”
EM: No, it’s 50 years. We celebrated that December 23, 2021.
EM: The major advancement was expanding the national programs in cancer. So, for example, the National Cancer Institute director was given additional responsibilities and efforts and privileges. There was the establishment of the National Cancer Program with the cancer designated centers, as your center in Richmond and mine in Philadelphia, and 71 cancer institutes around the country, the designated cancer centers, so that there’s education research and training, availability of cancer treatment, new treatment endeavors, development of therapeutic interventions, screening and diagnostic interventions, the SEER database, so that we’ve got a recording and we can use that information collected over the years for cancer research.
And, of course, the poet James Baldwin said, “Know from whence you came. And if you know from whence you came, there is no limit to where you can go.”
It’s pulling all of those things together. I don’t think there was one individual entity that allowed for the great development in studies for patients and the decline in cancer mortality over the years. I think all of those things, including the collection of data. We started collecting data, the first report in 1974, showing that there were differences and disparities between whites and Blacks.
A few years later, we collected and reported data on many other races and ethnicities so that we know where our people are located, what kind of disease processes are developing in communities, and therefore we can specifically target programs for individuals.
That leads me to the next area. Yes, we’re going to continue therapeutic interventions, but our interventions now are targeted toward genomics so we can therefore evaluate a patient’s tumor and select therapies that give the highest risk of effectiveness.
I think more of that will continue. And then our preventive strategies so that we can predict cancers occurring in various populations in relationship to either their work, or their living environment for lung cancer, for example.
I think over the next few years, we’re going to do more targeted therapy. We’re going to do more risk assessment for diseases. And then we are going to work toward ending disparities, where there are differences related to who you are, either your genes, or genes plus the effect from the environment.
I think we are going to find that we really have to broaden our umbrella. We can’t just say Black folks end up with more lung cancer or more colon cancer. We’re going to expand our umbrella so that we can predict disease processes in people that might be influenced by the environment, and therefore be more specific in our diagnostic plans, our prevention plans. We’re going to see the individual, I won’t say the patient, the individual, from prevention, early diagnosis and treatment, survivorship, and living a life after treatment for cancer.
EM: Oh, Dr. Stewart, I don’t know. I will continue to do the things that I’m doing. I’m working a lot now with students and I will decide at some point that I’ll maybe go golfing every day, and retire or write my cookbook. I’m a foodie. And I was taught to cook by my great grandparents first and then others. One of these days I will write my cookbook and so forth. I haven’t planned when, but those are things that are on the horizon for me.
EM: Thank you. And thanks for this opportunity today to speak with you. We always have such fun at meetings in the past where we can go to restaurants and talk together. But I think that someday, hopefully in the near future, we will be able to adapt, have fewer people dying as a result of COVID, and where we can perhaps have this conversation in person.