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Invisible Women - doing a Freud

Invisible Women
Invisible Women - doing a Freud
By Caroline Criado Perez • Issue #59 • View online
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Well HELLOOO GFPs!! And welcome to this, your weekly default female oasis in a default male world.
Before we get going, a quick reminder to members about GFP LIVE Episode 2 which will be going out live on zoom tomorrow at 12:30pm BST which was the best balance I could find between the various timezones GFPs live in! I will probably vary this around to favour different timezones as we go on, but don’t worry if you can’t make the live event as I’ll be uploading this one onto YouTube afterwards.
This will be a GFP LIVE filled with firsts!
First the first (I like what I did there): it will be the first episode where live viewing is open only to members
First the second: it will be the first (and definitely not the last!) episode that doesn’t simply consist of me babbling away to myself
First the third! it will be the first episode where attendees can ask questions live on air! I’m hoping this will make it feel less virtual and less sterile and more like a fun chat – but it’s all an experiment so we’ll see how it goes :)
If you’re a member you should already have received a zoom invite, but please do get in touch if you haven’t and I’ll get another one out to you.
And if you’re not a member but would like to be able to join us and ask the co-founders of Make Space for Girls questions live on air: it’s not too late! I know I originally said you would have to have signed up before today, but I have GENEROUSLY decided to EXTEND this and let anyone who becomes a member BEFORE THE END OF TODAY to join us.
I’ll be sending around a final reminder with all the details tomorrow morning!
Gender data gap of the week
As faithful readers of Invisible Women may remember, heart disease is the number one killer of women worldwide.
A recent analysis of data from 22 million people from North America, Europe, Asia and Australasia found that women from lower socio-economic backgrounds are 25% more likely to suffer a heart attack than men in the same income bracket. (IW, p.217)
Despite this increased risk of death, research into cardiovascular disease remains highly male dominated. A 2021 review stated that
Although there is growing recognition of sex-specific determinants of outcomes, women remain under-represented in clinical trials, and sex-disaggregated diagnostic and management strategies are not currently recommended in clinical guidelines. Women remain more likely to experience delays in diagnosis, to be treated less aggressively and to have worse outcomes. As a consequence, cardiovascular disease in women remains understudied, underdiagnosed and undertreated.
This data gap is obviously a problem if you care about women not dying and luckily, there are GFPs working away in the medical field to close it. One such GFP is Dr. Jeske van Diemen of the Amsterdam University Medical Centre in the Netherlands.
Dr van Dieman had noticed that one of the drivers of this data gap was that women are harder to recruit and more likely to drop out. However – and this is what makes Dr van Dieman a GFP – she didn’t simply do what many non-GFPs do when they struggle to recruit women to either a job or a clinical trial, which is accurately rendered below:
Instead, Dr van Dieman decided to not do a Freud* and assume that there was something intractably wrong with women, but instead to look into why this might be. DOING RESEARCH: A NOVEL CONCEPT FOR A checks notes RESEARCHER.
Anyway, unfortunately, Dr van Dieman was slightly stymied in her good intentions by, drumroll please THE GENDER DATA GAP.
To better understand the factors that impact underrepresentation of women in clinical trials, we performed an extensive literature search (as detailed in the Appendix) on articles that addressed the challenges in enrolment—motivators, facilitators, and barriers to the enrolment and continuation of women in clinical trials. We had initially aimed at a systematic review but there was a paucity of data to conduct an extensive review. We found only six articles that report on motivators, facilitators, and barriers for women to participate in cardiovascular medical trials. [my emphasis]
These studies were all “relatively small survey-based cohorts,” which leaves “the rationale behind participating or declining participation in cardiovascular clinical research a black box.” Which means that, as with an estimated 87% of the papers I read for Invisible Women, one of the major recommendations of this paper is for MORE RESEARCH TO BE DONE.
That said, there were some noteworthy findings, including that women were more likely than men to decline to participate because a) they perceived a higher risk of trial participation than men, and b) because of transportation problems.
The paper does not state which out of risk perception or transportation issues is the greater problem, but readers of Invisible Women will not be at all surprised by b). As we know, women are far more reliant than men on public transport (IW p.29); when a household has a car, men dominate access to it (IW, p.30); and women are time-poor (IW, pp.70-72). All of this affects women’s lives in myriad ways, with access to clinical trials being just one of them.
The good news is that this paper is unusual in going beyond the usual cry of sex and gender researchers for MORE G*DD*MN DATA, and actually comes up with well-thought out and quite details proposals to fix these issues. I really do urge you to read them in full because they’re great and this is not just relevant to recruiting women to clinical trials. But in brief:
1) journals should be doing more to require researchers to recruit women and sex disaggregate their data
2) increase the diversity of research teams (readers of Invisible Women may remember a study I cited which found that the likelihood of a study involving gender and sex analysis ‘increases with the proportion of women among its authors’, with the effect being particularly pronounced if a woman serves as a leader of the author group.) 
3) get sex and gender into the standard medical curriculum
[At this stage as you can imagine I am whooping and cheering]
it me
it me
and 4 but most certainly not least) improve access to the centres participating in trials and other logistics such as onsite childcare or transportation
Ahem. Anyway all in all, this was an excellent paper, Dr van Dieman is an EXCELLENT GFP and I look forward to the data gap in cardiovascular research being closed STAT! hurrah!
Default male of the week
In other news….
Rhea Liang
Pics sent from a 5-foot 5.5 glove colleague. Lack of #DiversityandInclusion should be an #WorkplaceSafety issue shouldn't it? 😱😱😱
Ping @evonnephd
This seems…sub-optimal…for both the surgeon AND the patient 😬
Meanwhile, this study came out which further highlighted the damage the unrelenting default maleness of surgery as a specialism does to female practitioners:
Incidence of Infertility and Pregnancy Complications in US Female Surgeons | Health Care Workforce | JAMA Surgery | JAMA Network
Compared with male surgeons, female surgeons had fewer children (this is of course the case for the top of basically any profession, see for example Theresa May & Angela Merkel versus, say, Boris Johnson…), were more likely to delay having children because of surgical training, and were more likely to use assisted reproductive technology.
When female surgeons did get pregnant, they were more likely than the female non-surgeon partners of the male surgeons included in the study, to have major pregnancy complications, which was significant after controlling for age, work hours, in vitro fertilization use, and multiple gestation.
The causes highlighted by this paper are lack of paid leave, punishing work schedules – which are not modified during pregnancy, little support for childcare. So just your standard default male working environment then 🤪
Anyway, we are being SPOILT this week, because this paper ALSO has a thoughtful and detailed proposal for fixing this. I’m not going to repeat it here because it’s long and you should read it in full. So instead, here is the link again:
Incidence of Infertility and Pregnancy Complications in US Female Surgeons | Health Care Workforce | JAMA Surgery | JAMA Network
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GFPs fixing it
So as faithful GFPs will know, last week I wrote about the discrepancy in headgear rules for male and female boxers resulting from a lack of data on female boxers EVEN THOUGH WE KNOW CONCUSSION IS WORSE FOR WOMEN IN BASICALLY ALL WAYS.
Well someone at Nature is CLEARLY a fan of our work here, because look what came out THE VERY NEXT DAY!**
Why sports concussions are worse for women
And no, the piece does not make for jolly reading, but it does highlight the brilliant work of some of the very same GFPs I mentioned last week, including Dr Liz Williams, who are doing great work to close this particular data gap. No thanks to the IOC or the AIBA 😒
Product of the week
This one is for fans of my continuing descent into middle age, because, yes, that is the Boden website you can see in the screengrab below. And how can a website be designed for women, you ask? WHEN IT HAS A SPECIFIC “WITH POCKETS” FILTER, THAT’S WHEN.
Seriously though, it really can’t be that hard, why don’t all websites do this? Literally on the basis of this one feature Boden is about a million times more likely to get my money than any other site now. Although fair warning, as I was writing this section I *may* have got distracted and ACCIDENTALLY bought another dress 😬
In conclusion:
This week’s homework comes via GFP Carmit who wrote to me about these bike shelters:
Over to Carmit:
I’ve gotten into a Twitter–let’s call it debate, because I refrained from losing my shit about it. A male city planner wrote a thread about train/bike planning to promote cycling to/from stations (I’d link but it was in Hebrew). Specifically, a suggestion that people keep a second “station bike” at their destination station so they aren’t cycling to the station, bringing their bikes onto the train, and then continuing the journey from the destination station to the office, since many train systems don’t actually allow bikes on trains. To make people comfortable with leaving the station bike at the destination station overnight, they could store them in these locked storage sheds.
I replied to him that as a woman he’d not catch me dead in a shelter like that at night and he then proceeded to try to convince me that it’s safe (well lit, directly in front of station, with unobstructed walls). I’d love to know what you and the GFPs think.
I’ll add that the concept of a station bike absolutely works for me–my office is located about a mile away from the station of a Munich suburb and many of my colleagues keep a station bike. It’s these sheds specifically that gave me pause. I’d specifically be curious about why women would/wouldn’t use them. 
I am in two minds about these station bikes. I mean my first objection is that trains should just have room for bikes because bikes aren’t cheap and one is usually expensive enough. But looking at the storage shed, while I appreciate the well lit open walls in front of the station point, all of which are for sure best practice when it comes to designing for women, I have to admit I would think twice about going in there on my own at night. But maybe Carmet and I are outliers? Like Carmet, my curiosity has been PIQUED, so I’ve designed another GFP survey! Tell us what you think!
Poppy pic of the week
I agree Poppy, I agree
I agree Poppy, I agree
That’s it! Until next time my dear GFPs xoxoxo
*I thought I’d done a proper rant on Freud’s Femininity lecture in Invisible Women but checking the manuscript I can only see a couple of asides, so I guess it got cut from the final draft. EXPECT SOME THOUGHTS FROM ME ON THIS AT A LATER DATE.
**I jest, obviously I realise that it took more than a day to research and write this excellent detailed piece
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Caroline Criado Perez

Keeping up with the gender data gap (and whatever else takes my fancy). Like the Kardashians, but with more feminist rage. Plus, toilet queue of the week.

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