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Invisible Women: our unreasonably woman-shaped faces

Invisible Women
Invisible Women: our unreasonably woman-shaped faces
By Caroline Criado Perez • Issue #101 • View online

HELLO GFPs!! First of all, thank you SO MUCH for all your lovely emails - your support has meant so much to me! It’s always scary putting something you’ve worked so long and hard on out into the world; having you on my side makes all the difference 😍
Got another LOVELY review which called VISIBLE WOMEN “a must-listen” and really made my day 🥰
guilty as charged
guilty as charged
And if you haven’t yet listened to episode one, or indeed Friday’s bonus episode – what are you waiting for??! You can listen at Apple Podcasts, Spotify, or wherever else you get your podcasts – and if you share using this link, it will *magically* take the listener to their preferred platform of choice. Woohoo!
Quick noticeboard time before I dive in to the newsletter proper, just a quick reminder that although the bonus episode on Friday (which I hope you enjoyed!) was free, as of next week it will be available exclusively to Tortoise members.
GFPs get a special discount on membership by using my code CAROLINE30: that gets you a 6 month membership for £30, PLUS a ticket to an exclusive event with me in the Tortoise newsroom about the podcast 😍. Visit tortoisemedia.com/caroline to join.
If you’re already a paying GFP (or if you become one!)you can get your first three months of a Tortoise membership for free and then pay just £50 for 12 months. I’ve already emailed paying GFPs with details on how to claim their free membership, and I’ve put up a notice in the members area.
Now, onto business…
Gender data gap of the week
So. If you read last week’s newsletter (the main Monday one not the OMG THE PODCAST IS LIVE!!1!1! one), you will remember that the default male of the week featured a default male study on the default male heart of default male endurance athletes, funded by the British [Default Male] Heart Foundation.
When I found this study, I tweeted the study author and the B[DM]HF to ask why they were only including men in the study, to which the answer can be summed up with the following gif:
A classic gif, that one.
Anyway, things changed when I featured the study in this newsletter, because, naturally, GFPs were not going to put up with that nonsense.
😍
😍
Anyway this shamed the B[DM]HF into deigning to answer the question. They said:
BHF
@CCriadoPerez @pswoboda81 @DSheridanYEP @leeSkettle @UoL_LICAMM @LTHTResearch Hi all, this research currently focuses on male athletes, because previous studies suggest they're at higher risk of having a cardiac arrest in sport. Studying those at highest risk first will help us understand the mechanisms of dangerous heart rhythms during sport. (1/4)👇
This, as GFPs will know, is nonsense. There are fundamental sex differences in the cardiovascular system: what you find in men cannot be blindly applied to women, so, sure, studying men will help you “understand the mechanisms of dangerous heart rhythms during sport”….in men.
As for their claim that men are more at risk, well, this argument would be more compelling if men didn’t also dominate in the research for diseases (including types of heart disease) where women are more at risk (or if we in fact ever did that research). And in any case, the vast majority of the research on endurance athletes has been done in men, so how on earth can they be so confident that this is the case? Spoiler: they really can’t. In fact, the initial study that prompted this larger study was done on….50 male athletes.
There is one (1) study that has been done in veteran endurance athletes which did include female athletes and that study was extremely interesting: it did indeed suggest that while endurance exercise might have a negative effect on men, it might actually have a protective effect on women. And wouldn’t it be nice to confirm that this is in fact the case with, you know, further study? And maybe even, and this is possibly going almost too far, but…to find out why?? Could we maybe look into what it might be about the female body that, at least according to this one study, responds so positively to endurance exercise? Lol, don’t be ridiculous, Caroline. Here’s me in Invisible Women explaining how things are actually done:
Even something as basic as advice on how to exercise to keep disease at bay is based on male-biased research. If you run a general search for whether resistance training is good for reducing heart disease, you’ll come across a series of papers warning against resistance training if you have high blood pressure. This is in large part because of the concerns that it doesn’t have as beneficial an effect on lowering blood pressure as aerobic exercise, and also because it causes an increase in artery stiffness. [FYI, this is the issue that has been identified in endurance athletes]
Which is all true. In men. Who, as ever, form the majority of research participants. The research that has been done on women suggests that this advice is not gender-neutral. A 2008 paper, for example, found that not only does resistance training lower blood pressure to a greater extent in women, women don’t suffer from the same increase in artery stiffness. And this matters, because as women get older, their blood pressure gets higher compared to men of the same age, and elevated blood pressure is more directly linked to cardiovascular mortality in women than in men. In fact, the risk of death from coronary artery disease for women is twice that for men for every 20 mm Hg increase in blood pressure above normal levels. It also matters because commonly used antihypertensive drugs have been shown to be less beneficial in lowering blood pressure in women than in men.
So to sum up: for women, the blood-pressure drugs (developed using male subjects) don’t work as effectively, but resistance training just might do the trick. Except we haven’t known that because all the studies have been done on men. And this is before we account for the benefits to women in doing resistance training to counteract osteopenia and osteoporosis, both of which they are at high risk for post-menopause.
Other male-biased advice includes the recommendation for diabetics to do high-intensity interval training; it doesn’t really help female diabetics (we don’t really know why, but this is possibly because women burn fat more than carbs during exercise). We know very little about how women respond to concussions, ‘even though women suffer from concussions at higher rates than men and take longer to recover in comparable sports’. Isometric exercises fatigue women less (which is relevant for post-injury rehabilitation) because men and women have different ratios of types of muscle fibre, but we have ‘a limited understanding of the differences’ because there are ‘an inadequate number of published studies’. (IW, pp.210-11)
Meanwhile a disease like Covid, that’s more deadly to men than women, left us scrambling around injecting oestrogen into male patients in the vague hope it might do something because we have literally no idea how the female body works 🤪
I don’t know, it’s almost like studying the female body might even matter for the important [default male] people or something???
But don’t worry little ladies, the B[DM]HA assures us they’ll get to us in good time. You know, after they’ve studied the default humans. I mean, maybe.
BHF
@CCriadoPerez @pswoboda81 @DSheridanYEP @leeSkettle @UoL_LICAMM @LTHTResearch These findings may then be applicable to female athletes, but this will need further research. Once this study is complete, the team plans to expand their research further to encompass women. Watch this space! (2/4)
Meanwhile, no explanation forthcoming for why the study was presented wholly in gender neutral terms. I mean, it doesn’t really fill me with confidence that they really understand the whole “women are not tiny men” point – although hilariously, the press release which, as I highlighted out last week, presented the study in entirely gender neutral terms has now been edited to reflect the fact that men are in fact not gender neutral and women exist so I guess that’s a small win.
Aaaaaaanyway, in brighter news, here’s a cool announcement from a group called MESSAGE (Medical Science Sex and Gender Equity):
Funding success for project to improve sex and gender inclusivity in medical research | The George Institute for Global Health
As readers of Invisible Women may remember, the UK lags quite significantly behind many other countries when it comes to incorporating sex and gender into medical research, basically because none of the major funders require it. (By the way, when I revisited the relevant section in the book just now, (pp.212-3 if you’re interested) I was…struck, shall we say by this line: “despite the at-risk population of women suffering more morbidity and mortality, UK research funding for coronary artery disease in men is far greater than for women.” cough B[DM]HF cough)
Anyway, last year, the co-lead of this project, Dr Kate Womersley, and her colleagues looked into the state of play in the UK and it’s safe to say nothing had changed:
Their work found that none of the 17 largest UK medical research funders (each with budgets larger than £5 million annually), or any of the UK’s major regulators (such as The Medicines and Healthcare products Regulatory Agency), has policies in place to ensure that sex and gender are appropriately addressed at the point at which projects are funded. This means researchers are not encouraged to disaggregate their data according to sex or gender, and results often have a male bias. The UK falls far behind other countries. In Canada, the US and Europe, sex and gender inclusion policies are standard.
Classic UK.
It goes without saying, this is brilliant news and huge round of applause to the excellent default female people behind it (it does seem to be almost exclusively driven by women, which is not really a surprise – in Invisible Women I reported on some research 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.” 🤔) 
Project outputs are expected late 2023 and regular updates can be found on the project Twitter @MESSAGE_TGI. I’m really excited to see what they come up with!
Default male of the week
Default male this week is continuing the PPE theme of last week’s podcast and it comes via a GFP who did not provide her name! Anyway, anonymous GFP says:
I am returning to a hobby of my youth- motorcycle riding. I am trying to buy a full face helmet (the industry standard for safety) and I can’t find one that does not impede my vision. The opening for the face is positioned in a way that means I have to look down to see the speedometer. I’m sure you’ve guessed that when I asked if there was any helmet designed for a women’s face the shop manager laughed and said no. So now my option is to ride with a ¾ helmet (less safe) or buy a helmet that I can’t see properly in (also less safe).
Sub-optimal. Can any GFPs help our anonymous correspondent out?!
STOP PRESS! Another entry in response to last week’s podcast episode, this one comes from GFP Hazel:
I am a retired nurse and I spent the last 18 years of my working life as a specialist nurse in paediatrics. As part of our winter pressure preparation every year we were mask fit tested and every year I failed. I was made to feel as though it was my fault, and basically bullied with language like “well if you want to run into a situation with no mask, crack on”. 
Because of course women are just being deliberately difficult with our unreasonably woman-shaped faces, HONESTLY, HAZEL 🙃
If you are enjoying this newsletter, consider becoming a member! Members get access to member-only events, a members-only area, plus the warm glow that comes from supporting the work that goes into producing this weekly blast 😍
Homework
ONCE AGAIN, your homework is to listen to my wonderful new podcast, Visible Women! And then to share it around with abandon!
GFPs sharing with abandon
GFPs sharing with abandon
In other news, I’m really sorry I sent you all on a wild goose chase last week with that IUD research which had closed by the time the newsletter went out! Thankfully, it’s not the only research on offer:
The Lowdown
[email protected]CCriadoPerez unfortunately the survey shared in your newsletter is closed but we're running our own survey on coil fitting experiences that's still open to responses! https://t.co/WY7cqrJ4ae
Go forth and share, GFPs!
Poppy pic of the week
That’s it! Until next time, my dear GFPs….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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