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Invisible Women - Morally Indefensible PPE

Invisible Women
Invisible Women - Morally Indefensible PPE
By Caroline Criado Perez • Issue #14 • View online
Hello GFPs, well, it’s been…a week.
First of all, the AB came up to me and called me gorgeous for the first time since lockdown began. I was extremely pleased…until I realised I had just finished doing the Fawcett Society’s inaugural #CoronaConversations panel and that it was therefore the first time I had put on make-up for weeks. So that was great for my self-esteem.
Anyway if you’d like to see how gorgeous I look while wearing make-up (and hear what I, Pragna Patel of Southall Black Sisters, and Mary-Ann Stephenson of the Women’s Budget Group have to say about the gendered effects of Covid-19), you can catch up with the panel here.

Caroline Criado Perez
Thanks to everyone who joined us for the first @fawcettsociety #CoronaConversation! Bloody loving this WFH thing of only having to get half dressed :D
I think we can all agree with the AB that I definitely look gorgeous.
Shut up.
Other highlights of my week included recording the New Scientist podcast – not out yet, but I’ll let you know when it is – and doing an Instagram Live with my publisher, Vintage Books, which I’m afraid is no longer available, but which I thoroughly enjoyed so maybe I’ll do another one if there is demand…
Then last night I went on the Christiane Amanpour show on CNN to, again, talk about the need to collect sex-disaggregated data during the Covid-19 pandemic, and to give a bit of background on why this data has been historically lacking. I’m starting feel a bit like that lady from the “I can’t believe I still have to protest this shit” meme. I imagine this feeling will only progress as I get older. Maybe I’ll buy a hat.
Anyway, originally they had just asked me to appear, but then they added Dr Sharon Moalem, the author of a new book called “The Better Half: On the Genetic Superiority of Women”, to give the perspective from a scientist. Made sense to me; I expected it to be an interesting segment and I was keen to hear what Dr Moalem had to say – I had been sent his book back in December, in the hope that I would provide a blurb for it, and I felt truly guilty* that I hadn’t had time to read it before publication, especially since I had actually been genuinely interested to read the book. I even tweeted about it.,
Caroline Criado Perez
Post today! I've had a proof copy of this by @sharonmoalem balefully glaring at me for months as I've guiltily failed to read it. OTOH, during a global pandemic which is highlighting exactly the point this book makes feels like not a bad time to finally get round to reading it...
The segment was beset by difficulties from the start. Having sat online for about fifteen minutes listening to the show (they like to set you up early so that any technical difficulties can be ironed out before going live), suddenly when we went live, the sound my end dropped. The text I got from the AB to tell me I was on the telly and that Christiane Amanpour was holding up a copy of Invisible Women was the only way I knew I had, in fact, gone live. Eek!
The producer called me on my mobile, I restarted skype, couldn’t get through. Tried again, got through, but I still couldn’t hear anything. Third time we struck lucky, but who knew for how long. Meanwhile, I had heard nothing that had been said by Dr Moalem, and it’s fair to say I was a bit flustered by this point.
The truth is I get extremely nervous every time I do any broadcast appearance about Invisible Women. It’s one of the least favourite parts of my job.
It’s the usual imposter syndrome, magnified by the fact that of course I’m not a scientist. Worse than that, I’m a lady not-scientist, challenging the work of not-lady scientists (admittedly using the work of many other scientists, both of the lady and not-lady variety).
But nevertheless, what I say will put people’s backs up (who is SHE to question US/THEM?), and so they will not be reading me with a charitable, open mind, but with a view to finding errors and “debunking” me. The fact that I don’t come from a position of traditional authority means that if I make any mistake, no matter how tiny, I risk undermining the entire thesis.
And the stakes are huge: nothing less than preventing the unnecessary suffering of the hundreds, thousands, millions of women who are injured and sometimes die, simply because we know less about their bodies. Simply because of our unthinking positioning of the male body as somehow unisex. Neutral. Default. Universal.
The thought of making a mistake terrified me the entire time I was writing the book, and while that fear has gradually started to lessen now that it’s won awards, and it’s been read and endorsed by so many people far cleverer than I and whose research I actually cite (thankfully correctly!) in the book, I still have that fear every time I go live. You never have much time to really lay out your thesis and one fumble can be fatal. So the technical difficulties didn’t set me off to a good start.
But on the other hand, deep down I know that I know my stuff. I know that what I’m saying is important and right. And in this case I knew there was one thing in particular I really wanted to highlight. Something that readers of Invisible Women, readers of this newsletter, and the benighted readers of my twitter account, will know I have raised many times before: the lack of adequate Personal Protective Equipment (PPE) for female workers.
This is a huge issue outside of Covid-19, but it is of particular concern right now, as so many of the workers on the frontlines of this pandemic are female. Recent analysis found that 77% of workers who are in the most high-risk jobs in terms of exposure to Covid-19 are female. And of those high risk workers being paid poverty wages, women make up 98%. You want more stats? Try these: 77% of NHS staff are female, 89% of nurses are female, 84% of care workers are female.
And, yes, men do seem to be more likely to die (although we still don’t have good enough data to tell us exactly to what extent it is sex versus gender that is causing this *COUGH MATT HANCOCK COUGH*), but women do still die. And one of the risk factors in this disease, that seems to be driving a fair number of the “surprising” deaths, is the viral load to which the patient has been exposed.
Healthcare workers are the ones most likely to be exposed to a high viral load. Obviously. And so they are most likely to be the ones who, despite not having underlying health conditions, catch a bad case of Covid-19. And so, you would think it would follow, it really matters that these workers have access to good quality PPE.
And yet they don’t. Because like PPE everywhere, much of the PPE that frontline workers have access to has been designed around the “unisex” male body. Small, as one worker memorably explained, is small for men.
Even where women are being able to get a “good enough” fit on a mask, it has to be pulled so tight that they are developing pressure sores. Obviously #notallwomen and #notallmen, but these are average gendered trends, because bodies are not unisex. On average.
This was the case I made on CNN, noting that there was a problem with PPE designed for a default male body being used by a predominantly female workforce. It seems clear to me that we want to avoid as many unnecessary deaths as possible. This includes measures like lockdown, but it also includes measures like having PPE that actually fits the bodies of those providing the care. Not only so they themselves don’t die, but also so that we keep our healthcare workforce healthy so they can treat those who are not. Or, crazy idea, so they don’t spread the disease. It’s a matter of both justice and practicality. Of fairness and saving lives.
Some people are going to get this virus and some people are going to die from it, no matter what we do. And those deaths are a tragedy, but they are no-one’s fault. But some people will get it and die from it because our response is inadequate. And those deaths are someone’s fault. Those deaths are, arguably, criminally negligent. So, obviously carry on making PPE that fits men. But add to it PPE that fits women. It seems to me to be a no-brainer.
So it was a fairly unpleasant surprise when Dr Moalem took great and aggressive issue with my comments, calling me “morally indefensible,” for raising this. Men are the ones who are most likely to die, his thinking seemed to go, so it was shockingly wrong of me to raise the issue of safe working conditions for the, predominantly, women caring for those with coronavirus.
I was taken aback and confused by his reaction – but also immediately felt terrible. I had done the thing I had always worried so much about: I hadn’t stated my case clearly enough and, in so doing, I had let women down. I had made it possible to characterise my comments as a war of the sexes, which is the last thing I have ever wanted to do, since I know how damaging that can be to an argument like mine. I had wasted this opportunity to make things better during this horrendous pandemic, where so many unnecessary deaths have already taken place.
Going on twitter afterwards, my worst fears seemed realised. I had already noted a growing attitude where since men are dying in higher numbers, talking about the need for sex-disaggregated data, talking about the gendered effects of this pandemic, is seen – and angrily dismissed – as nothing more than feminist grifting. “Morally indefensible.” And the CNN segment brought it all out.
We don’t need data on women because MEN ARE DYING. Ignore the fact that if we had historically been studying the female immune system rather than excluding women from medical research because our bodies are “too complicated”, maybe we would understand better why women have a higher chance of survival and, who knows, we might even be able to save more male lives. Ignore too the fact that for many common diseases such as heart disease, the sex outcomes are exactly the inverse because we simply know less about how heart disease progresses in women, leaving them under-diagnosed, under-treated, and over-dead.
Ignore all this. I was a liar. There is no evidence that women suffer from poorly fitting PPE (well yeah at the moment we don’t have official data, because sex-disaggregated data hasn’t been collected – please let’s collect some! – but I choose to believe that the healthcare workers who are busting their guts on this are not lying. But no, I should shut my craven mouth, because it is men who are delivering me my chablis in my castle.**
To which I could easily riposte with the stats about women being the majority of frontline workers, but I didn’t *want* to because I don’t *want* to make this a war of the sexes. It *isn’t* a war of the sexes. It’s about avoiding avoidable injury, disease, and death. Every death, whether of a man or a woman, is a tragedy. Why not use all the possible tools at our disposal to avoid as many as possible?
*I no longer feel at all guilty. Bite me.
**just to note that I actually prefer champagne.
Click on the pic to watch a clip of me being "morally indefensible"
Click on the pic to watch a clip of me being "morally indefensible"
PS, there are some other famously morally indefensible people doing some research on the issue of PPE, including the The Royal College of “Morally Indefensible” Nursing, and a Professor of “Morally Indefensible” Healthcare Ergonomics at Loughborough “Morally Indefensible” University. I urge you to share with any healthcare workers you know so they can reach as wide a sample as possible.
Sue Hignett
@CCriadoPerez HI Caroline. I am a Professor of Healthcare Ergonomics at Lboro University. We are interested in usability (fit and comfort) of PPE. Can you please retweet to encourage your followers/clinician staff to complete this 5 minute survey
Gender Data Gap of the Week
So here’s a fun postscript to my Amanpour appearance. In response to a tweet-out of a clip from the show, some guy in clinical research tried to use some big words to explain that I needed to “learn why drugs are disproportionately tested on males not females,” because apparently it’s “nothing to do with sexism,” but instead that women can’t be included in early stage trials basically because we can get pregnant. So we must exclude all fertile women. OBVIOUSLY, DUH.
And no we can’t just give women the relevant information and let them decide for themselves. We must protect our precious vessels from themselves, even if that means letting them die in huge numbers from Ebola. From a few newsletters ago:
But it wasn’t just the childbirth that killed them. It was also the intransigence of governments, pharmaceutical companies, and, ultimately, insurers, who repeatedly refused pregnant and lactating women access to effective vaccines and antiviral drugs because….they had not been tested in pregnant or lactating women. Because pregnant and lactating women had not been allowed to take part in trials. This despite Ebola being a disease that resulted in a c.93% death rate for pregnant women. Those women who did survive Ebola had a miscarriage rate of essentially 100%, and not a single mother-baby pair infected with Ebola survived the outbreak. Only one baby of an Ebola-infected mother survived the 2014 outbreak, as a result of being given experimental drugs immediately after birth outside of a clinical trial; the mother was denied such access, and died shortly after giving birth to her baby. By the way, some pregnant women were accidentally given vaccines during the outbreak. They and their babies all survived, seemingly without complications. And yet in the next outbreak, pregnant women were once again routinely excluded from trials and from receiving treatment.
Of course, since he is a Science Dude and I am a mere Lady Writer, his words carry far more weight than mine. But, if she may, this Lady Writer would like to voice just a couple of minor issues with Science Dude’s explanation.
1) amazingly, having written a book about this, I do actually know about the pregnancy excuse. And to state the obvious, women are not pregnant for their entire fertile years, and actually the lack of information about pregnant women is a huge issue. We don’t know what is safe to treat them with for pretty much anything. And it is for this reason that the National Institute of Health and the Wellcome Trust have both funded major research projects, including one on the exclusion of pregnant women from vaccine development, that have been set up specifically to address the huge gaps in our knowledge when it comes to treating pregnant women. It is a question, they say, of ethics. Because apparently pregnant women deserve evidence-based medicine too. Rather than what Science Dude seems to be proposing, which can be summed up as follows
But to return to my central point: women are not always pregnant. Some women SHOCK! don’t even want to get pregnant! Ever!!! And ALL women suffer from a failure to do research in female bodies. So your excuse is just that: an excuse. And it’s, dare I say it, a MORALLY INDEFENSIBLE ONE.
2) Cells can’t get pregnant and yet we conduct most cell trials on male cells, even though we know there are sex-specific cell responses that make this omission…yeah that’s right I went there again. To quote this passage from Invisible Women for what feels like the millionth time:
As in animal and human studies, when sex has been analysed in cell studies, dramatic differences have been found. For years researchers were puzzled by the unpredictability of transplanted muscle-derived stem cells (sometimes they regenerated diseased muscle, sometimes they didn’t do anything) until they realised that the cells weren’t unpredictable at all – it’s just that female cells promote regeneration and male cells don’t. Perhaps of more urgent concern for women’s health is the 2016 discovery of a sex difference in how male and female cells respond to oestrogen. When researchers72 exposed male and female cells to this hormone and then infected them with a virus, only the female cells responded to the oestrogen and fought off the virus. 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? 
But, you know, definitely nothing to see here.
And finally, because I am not going to regurgitate the entire of Invisible Women in a free newsletter, 3)
I rest my case.
Default Male of the Week
The New York Times came under fire last week for publishing an article about Europe’s top scientists, calling them “The Rising Heroes of the Coronavirus Era”. Sounds like a pretty nice article, right? What was the problem?
GFP’s, I regret to inform you that this was the problem:
Every single “science hero” described here is male. This does not reflect the reality of the scientific teams fighting #Covid19, just those who end up on TV most often.

More invisible women ⁦@CCriadoPerez

The Rising Heroes of the Coronavirus Era?
Oh dear. Here a non-exhaustive list of female European science heroes that the NYT can include in their next round-up:
delia chiaro
@CCriadoPerez The three researchers who first isolated the DNA sequence of the virus in February were women. I thought the news didn't make international news because they were Italian, not because they were female.
Dr Heather Mackenzie
@CCriadoPerez Professor of Primary Care @trishgreenhalgh is doing incredible work on Covid-19 at the moment!
Tamsin Dewé
@CCriadoPerez At Imperial: Professors @azraghani, Christl Donnelly, Helen Ward, as well as @IlariaDorigatti, @lucy_okell, Natsuko Imai, and a whole lot of others.
@CCriadoPerez @azraghani @rozeggo @petrakle @SunetraGupta @profhelenward @ProfKateJones @mathModInf Julia Gog @lisawhite1000 @n3113n in the UK alone are great epidemiologists, and that’s just off the top of my head...
Gordon Struth 🐑
@CCriadoPerez Dr Kate Broderick, originally from Dunfermline and a Glasgow Uni graduate, now SVP of R&D at Inovio Pharmaceuticals in San Diego, working on a Covid-19 vaccine:
Oli Franklin-Wallis
@CCriadoPerez Helen Lee of Diagnostics For The Real World, creators of the Samba Two COVID testing machines
🕷️The wife scientific🕷️
@CCriadoPerez Prof Sarah Gilbert @JennerInstitute is head of the #COVID19 #vaccine development program here. Prof @TeresabLambe of @jenneratingVacc leading on the work to design the vaccine and measure immunity. Unbelievable that they should have been left off the hero list
Dr Claartje Vinkenburg
@CCriadoPerez Marjolein Kikkert @LUMC_Leiden
Marion Koopmans @ErasmusMC and there are more in the Netherlands
Polly Peach 🏡
@CCriadoPerez Dr. Marylyn Addo 🇩🇪 should definitely get more airtime
Chris Lilley
@CCriadoPerez @caitlinmoran In Sweden, @AgnesWold has become a very well known figure with her expertise on the virus
Stephen Low #TPFIDR
@CCriadoPerez Edinburgh University's professor of Global public Health Devi Sridhar @devisridhar
Rikke Siersbæk
@CCriadoPerez [email protected]ClionaNi has been featured on the radio here in Dublin several times in the last few weeks to share her expertise in infectious diseases!
Clair Titley
@CCriadoPerez Don’t forget @isaperena - Director of infectious diseases
Live footage of the world rn. Although as many have pointed out, while the applause is nice (and definitely deserved), fair wages, decent sick pay, and PROPERLY FITTING PPE would be even better
Live footage of the world rn. Although as many have pointed out, while the applause is nice (and definitely deserved), fair wages, decent sick pay, and PROPERLY FITTING PPE would be even better
Quick Links
TONIGHT at 9pm BST / 4pm ET, join me, Alisha Haridasani Gupta and Francesca Donner as we chat Covid-19 and gender. MORALLY INDEFENSIBLY.
Sign up here:
Gender And Covid-19
And some nice news for me – Invisible Women has been long-listed for the Orwell Prize! So that’s nice :) Hopefully being morally indefensible won’t count against me.
The Orwell Foundation
First up, here is your #orwellprize for Political Writing longlist 2020. As we move into an uncertain future, these books warn us to tread carefully. Congratulations to all the longlisted authors!
Civic Duty of the Week
This newsletter has not turned out how I planned at all. I had a whole thing about female leadership all researched and ready to go…let’s just blame the good doctor. I’ll try to do it for next week’s newsletter. In the meantime, GFPs, stay morally indefensible xoxoxo
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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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