Mar 26, 2020

Muddy Females & Unisex Stoves: Invisible Women Issue 11 (I think)

By Caroline Criado Perez • Issue #12 • View online

Hello and WELCOME to Invisible Women: The Newsletter! For those of you who have joined since the last newsletter, welcome to your new life as a G[eneric] F[emale] P[al]! Duties include calling men’s football men’s football and shouting at people when they don’t sex-disaggregate their data. IT’S FUN!

Everyone else, you may notice that I have moved to a new platform; please excuse me while I figure out how the hell to make it work. Theatre Wife will probably say she can’t tell the difference, as I never figured out how to make the *last* platform work to which *I* say…fair enough tbh. I guess now we’re in lockdown she should just be “Wife,” although I’m not sure how the A[merican]B[eefcake] will feel about that. Anyway, read her latest for The Atlantic: an excellent piece on the gendered impact of the pandemic.

Data in a Time of Corona -- a, let's face it, probably not very occasional series

Well, my GFPs, if there’s one silver lining to come out of this horror show it’s that governments and funding bodies might *finally* start to take the gender data gap seriously – at least in medicine, anyway. Let’s not go crazy.

As some of you may have seen in my *very slightly* intemperate tweet linking to an (actually very good) LA Times article about why the coronavirus seems to be so much more deadly for men than for women, I am a little annoyed that it’s taken a pandemic for us to start taking the lack of data on female bodies seriously.

Well, it was 🤷‍♀️

We now have absolutely no idea why women are more likely to survive this disease than men, (is it sex? gender? a combination of the two? who the hell knows?!?!?!?!111🤪).

I can’t help thinking about all the lost opportunities over the years that might have made us more prepared to deal with this outbreak – after all, every single disease outbreak has shown us that the outcomes are gendered. But we didn’t seem to take those warnings seriously.

I also keep thinking about this 2016 study I referenced in Invisible Women:

When researchers exposed male and female cells to [oestrogen] and then infected them with a virus, only the female cells responded to the oestrogen and fought off the virus. (IW, p.207)

And that virus? Was the influenza virus, ladies and gentlemen. Guess it might have been helpful to look into that a bit more in depth over that past four years, huh.

I referenced this study in Chapter 1o “The Drugs Don’t Work,” which was mainly focused on how women tend to have worse outcomes for a whole range of diseases, simply because the vast majority of medical research has historically been, and continues to be, done on the male body – male humans, male animals, and male cells. This is because the female body is just too complicated to study 🤪and we, you know, “muddy” the findings.

women are too complicated :(

Anyway, as a result my main focus at the time was on how bad it was for women that the majority of medical research excludes us on the clearly nonsensical basis that the bodies of , and I cannot stress this enough, *half the global population* are just too out there to bother with.

It’s a tantalising finding that inevitably leads to the following question: how many treatments have women missed out on because they had no effect on the male cells on which they were exclusively tested?

Now of course I’m wondering if, had we bothered to look more into how that muddy female immune system works, it would have benefitted men too. Maybe we can find out in time for the next pandemic.

Incidentally, I also read with interest this story from StatNews (well worth signing up to their newsletters if you’re interested in, well, stats 🤓😍) about how doctors in the US are turning to doctors in China for advice on how to treat this virus that we still know so little about. In particular, this line struck me:

Some immune system regulators — including alpha interferon, anti-IL-6 monoclonal antibodies such as tocilizumab, and immunoglobulin — showed hints of efficacy in some critical cases.

Has there been much (any) sex-disaggregated research done on these immune system regulators given the sex differences in immune system responses? Answers on the back of a pill packet please…

I also have questions about the steady flow of papers being published on the vaccine and drug research being done on Covid-19: is the research being done on women as well as men and is the data being sex-disaggregated? I would love to check every single paper but I have neither the time nor the access, so this is where it would be extremely useful if funders, regulators and publishers just laid down blanket rules that research must be sex-disaggregated *by default* and then we could be confident that research results are truly valid for both men and women.

And finally, the symptom checklists – are these based on sex-disaggregated data? Readers of Invisible Women will remember that there are several diseases where symptoms can vary by sex. Maybe Covid-19 isn’t one of them – but it sure would be nice to know, wouldn’t it?

Don’t hold your breath though (*pls* no covid puns we have suffered enough): only six out of the twenty most affected countries analysed by the BMJ and CNN are providing properly sex-disaggregated data, and neither the UK nor the US seem to have got the memo as yet.

Win of the Week

…but don’t despair, because some people have! Here is a survey by King’s College London that made my heart sing:

SEX-DISAGGREGATED DATA, BABY

They are not, however, collecting data on pregnant women which feels like a major oversight to me – although a fairly common one:

Because of their routine exclusion from clinical trials we lack solid data on how to treat pregnant women for pretty much anything. We may not know how a disease will take hold or what the likely out- come may be, although the WHO warns that many diseases can have ‘particularly serious consequences for pregnant women, or can harm the foetus’. Some strains of influenza virus (including the 2009 H1N1 swine flu virus) have ‘particularly severe symptoms during pregnancy’. There is also evidence that SARS can be more severe during pregnancy. It is of course understandable that a pregnant woman may be reluctant to take part in medical research, but this doesn’t mean that we have to just throw our hands up in the air and accept that we know nothing: we should be routinely and systematically tracking, recording and collating pregnant- women’s health outcomes. But we aren’t – not even during pandemics: during the 2002–4 SARS outbreak in China, pregnant-women’s health outcomes were not systemically tracked and ‘consequently’, the WHO points out, ‘it was not possible to fully characterize the course and outcome of SARS during pregnancy’. Another gender data gap that could have been so easily avoided, and information that will be lacking for when the next pandemic hits. (IW, pp.200-01)

And although data is (inevitably) limited, there are some causes for concern when it comes to COVID-19 and pregnancy:

pneumonia, which can occur in severe COVID-19 cases, is a concern for pregnant women because their lung capacity is already slightly diminished
a fever (one of the major symptoms of COVID-19) is associated with foetal developmental anomaly in the first trimester, and can cause preterm delivery in the third trimester – and preterm delivery is one of the trends that has been observed so far in this outbreak.

So let’s hope they address this gap quickly, but in the meantime you can and should nevertheless download the app here and report your symptoms daily – even if you don’t have any, because that will help them identify where and how it is spreading.

Default Male of the Week

It is of course worth remembering that women can and do still die from this disease. As I have been writing this newsletter I have seen two breaking stories about women who have died from Covid-19. The first, a 21 year-old woman who is apparently the youngest person with no pre-existing health conditions to die in the UK, and a 36 year-old who was not tested but whose symptoms certainly did match Covid-19 (her story is particularly awful: she was told she was not a priority and died the next day – and her husband is diabetic. Hopefully there will be an investigation into what went wrong here so this kind of mistake won’t be repeated.)

And as I wrote last week, because women make up the majority of frontline healthcare workers and carers, both paid and unpaid, women are more physically exposed to Covid-19, as indeed they are in all disease outbreaks.

[Women] also make up the majority of ‘traditional birth attendants, nurses and the cleaners and laundry workers in hospitals, where there is risk of exposure’, particularly given these kinds of workers ‘do not get the same support and protection as doctors, who are predominantly men’. (IW, p.299)

In Italy, the latest figures show that nearly 1 in 10 of those infected are healthcare workers – and of those healthcare workers 65% are women. This is almost a direct reversal of the infection rate in the general population where nearly 60% of those infected are men. Of course infection rates are not currently conclusive given not everyone who has Covid-19 is being tested, but the inverse proportions are nevertheless striking.

This is all of particular concern because as I explained in Invisible Women, the vast majority of women who work in jobs that require Personal Protective Equipment (PPE) wear PPE that has not been designed for female bodies. And as I touched on briefly last week, this seems no different when it comes to healthcare workers – even though the majority of healthcare workers are women. Numerous women have told me that they can’t get any of the PPE masks to fit their faces.

I’ve been tried with all three different PPE masks available and none fit with a good enough seal. Been told to use a surgical mask if I have to. So many other women in my department are having the same problems

My sister is an itu nurse, only 25% of them have masks that fit

I have been fitted before when we have had other virus outbreaks - swine flu, etc., and none of the 3 mask types fitted me but I was able to avoid exposure to infected patients as we weren’t overly busy or short staffed. I dread to think what is going on now.

Work in pharma - women often fail face fit tests , also most lab goggles leave gaps and lab coats don’t fit properly , PPE is designed for men

Gloves are also a problem…

I rarely got the glove size I needed (5) when a hospital doc, bc many hospitals only stock 6 & up. I have small hands, but not freakishly so. This is a patient safety issue, bc it’s much harder to do delicate procedures well in gloves that are too big.

Naturally, it is the women’s fault for having those atypical female-shaped bodies

The fit tester (a man) told me my face was the wrong shape

when I failed the fit test, my charming male boss said “Why don’t they fit you? It’s not like you’re weird looking!”

I feel like the worst mask-fit tester in the world because I can’t get my team through! I tell my colleagues it’s because we’re so female-dominated as a profession, but it’s immensely reassuring to hear that might not just be something I made up…

I was a scientist - I’m a woman. We use the same PPE as medics. I couldn’t get a mask that would fit my face despite testing loads with a mask fitter. ‘Your face is just too small’

There is nothing wrong with women’s bodies. They are the bodies that are providing about 75% of the care, both paid and unpaid, that are getting us through this crisis. They deserve better. If you agree, tell Matt Hancock, the Secretary of State for Health & Social Care. This is a public health crisis and we need to keep health workers safe, so they can carry on keeping the rest of us safe.

Gender Data Gap of the Week

👀

OK, OK, I know it’s difficult, but before we ladies get all over-emotional, we should look at the paper itself (which, by the way is called “Transforming [default male] brain signals related to value evaluation and self‐control into [default male] behavioral [default male] choices” and is published in the journal “[default male] Human [default male] Brain Mapping”) – and look! they’ve cited references for women’s troubling emotions so it’s all totally fine!

well…call me over-emotional, but I’d like to check those refs just in case…

Here is the Lempert & Phelps…

I read the paper. It does not mention sex, gender, or women at all, referring throughout to “people”. Now, to be fair, perhaps the authors of the brain mapping study are keen readers of Invisible Women and know that c.80% of men interpret the word “person” as male (IW, p.9). But on the other hand, perhaps not.

And here is the Al Omari et al

Wait........what?

famously a sample size of 7 tells you all you need to know about the billions of women around the world

yep, definitely seems safe to conclude from this that women are just biologically batshit crazy for no reason whatsoever

As Freud famously said: “women: wtf????! 🤪”

Entirely Predictable Bullshit of the Week

self-explanatory

Campaign of the Week

Ensure abortion access during COVID-19

The Health Secretary’s refusal to listen to scientific evidence on protecting women’s health during this pandemic is putting women at severe risk, and abortion services are already buckling under pressure.

bpas.eaction.org.uk • Share

Under current British law (, a woman in the early stages of pregnancy can take early medical abortion pills only if she

travels to a clinic
where she is prescribed the pill by the doctor
and takes the first pill at the clinic
she may take the second pill at home 24-48 hours later

The remote prescription of abortion medications and the taking of mifepristone at home are both expressly precluded.

According to the BMJ, there was already a strong case for changing this finger-wagging law even before the pandemic:

While there are many abortion clinics across England, Wales, and Scotland, access remains difficult for some women. Firstly, women need to live near clinics to be able to easily access them (and attend twice in a short space of time), which presents an issue for those who live in rural areas, or areas where there have been lots of clinic closures. Secondly, it is often difficult for women to get time off work, make childcare arrangements, or afford travel for two appointments.

Naturally, the pandemic has exacerbated these access issues. For those who are self-isolating, they may even miss the timeframe during which it is safe to have a pill-induced abortion. The BMJ also points to “a potential increase in demand (due to an increase in unwanted conception during periods of restrictions on socialising outside of the home).”

The BMJ is calling for women “to be consulted remotely about reproductive healthcare and potential treatment, be prescribed that treatment during that consultation, be sent the medication by post, and then women can self-administer both abortion medications at home.”

Inevitably, the situation is worse for women in Northern Ireland, for whom abortion has only just been decriminalised, and so a historic lack of abortion clinics means the need for telemedicine is even more urgent here.

For a few glorious hours this week it seemed like evidence might buck ideology when it comes to women’s health, as the UK government approved a change in the law.