The trouble with girls: obstacles to women’s success in medicine and research—an essay by Laurie Garrett
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5232 (Published 13 December 2018) Cite this as: BMJ 2018;363:k5232
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Obstacles for doing any discipline and research are always there which are not obstacles but challenges that are overcome by many lady doctors and scientists all over the world.
The more you suppress talent more it gets exhibited. Some of the great lady doctors of India who are my inspiration and role models are shown below: Each great doctor has done something miraculous to change the face of Medicine in India and stand tall amidst men.
New Delhi: Anandi Gopal Joshi, considered by some as India's first female doctor, was one of the earliest female physicians in India. Anandi Gopal Joshi, who also goes by the names 'Anandibai Gopalrao Joshi' and 'Anandibai Joshi', celebrates her 153rd birthday today
In 1907, she joined the Madras Medical College, where she achieved a brilliant academic record. With several gold medals and prizes to her credit,Muthulakshmi graduated in 1912 to become one of the first woman doctors in India. Soon thereafter, she came under the influence of Annie Besant, and then of Mahatma Gandhi.
Dr. V. Shanta, who was awarded the Padma Vibhushan this year, has won many awards for her work as an oncologist — Padma Shri in 1986, Padma Bhushan in 2006, and the Magsaysay Award in 2005 to name but a few — for public service and many more for academic distinction. Her name is synonymous with the Cancer Institute at Adyar, Chennai, a pioneering centre of oncology which, starting in 1954 from a thatched shed with 12 beds, has two campuses, 423 beds, and patients from all over the country. It is like a brand, earning instant recognition and smooth entry for its alumni in professional placements nationally and globally.
Asima Chatterjee received a master's degree (1938) and a doctoral degree (1944) in organic chemistry from the University of Calcutta. She was the first Indian woman to earn a doctorate in science.
Dr Sivaramakrishna Iyer Padmavati is the first female Cardiologist of India. At 96, she is still active and treating her patients, much like when she started 60 years ago. Born in Burma, Padmavati studied her MBBS at Rangoon Medical College, following which she moved to London in 1949, where she received an FRCP from the Royal College of Physicians, London, followed by an FRCPE from the Royal College of Physicians, Edinburgh. She started practising medicine in a number of famous hospitals in London before her interest in cardiology grew. Studying further into the subject, she realized that cardiology in India did not receive the importance it was due. Returning to her homeland, she not only set up the country’s first cardiology clinic, she also created the first cardiology department in an Indian medical college and founded India's first heart foundation.
Dr Indira Hinduja will always be remembered for delivering the country’s first test-tube baby, all the way back in 1986. A gynaecologist, obstetrician, and infertility specialist, she received her medical degree from Mumbai University and has been practising in her hometown since. Hinduja is also credited with inventing the Gamete intrafallopian transfer (GIFT) technique, which resulted in the birth of the country’s first GIFT baby in 1988.
Considering the state of health-care in South India even a few years ago, Dr Kamini Rao’s contributions to fertility and reproductive endocrinology is no small feat. Having spent her early life in Bengaluru, earning her medical degree from St John’s Medical College, Rao has been trained by some of the world’s best names in medicine, including Prof. Ray Garry and Prof. Kypros Nicolaides. After spending several years in professional training and practice in the UK, Rao returned to South India with advanced knowledge in gynaecology and is credited with the birth of India’s First SIFT Baby. Along with this, she also set up South India’s first Semen Bank and also engineered its first babies born through ICSI (Intra Cytoplasmic Sperm Injection) and Laser Assisted Hatching.
Suniti Solomon (1938 or 1939 – 28 July 2015) was an Indian physician and microbiologist who pioneered AIDS research and prevention in India after having diagnosed the first Indian AIDS cases in Chennai in 1985 along with her student Sellappan Nirmala.
Competing interests: No competing interests
It may be worth checking and referencing the historical aspects. Is there evidence Eunice Foote's work was done in 1848 when it was presented to the AAAS in 1856 and published the same year? At the time of the presentation women could in principle be members of the AAAS and speak at meetings (though very rare) but Eunice was not a member. This might explain why Joseph Henry read the paper.
I have a substantial paper coming out on this soon in the Royal Society's Notes and Records.
Competing interests: No competing interests
Laurie Garrett’s article, ‘The trouble with girls: obstacles to women’s success in medicine and research’, raises a number of important issues about gender equality in science. Wellcome is dedicated to addressing inequalities in science and broadening the diversity of people we fund, engage with, and employ. As part of this we recently established Diversity and Inclusion as one of our priority areas, supported by £12.5m funding over five years.
Wellcome has taken a number of steps to broaden the diversity of who we fund and the figures used in this article are not the latest available and do not accurately demonstrate where we are today.
Our figures show that at all career stages women and men have equal success in applying for Wellcome funding, https://wellcome.ac.uk/funding/grant-funding-data-2016-2017. And for each type of scheme, the overall average value of awards made to women and men are similar. Women do receive fewer of our more senior personal awards in science, and in humanities and social science, because fewer women than men apply for them.
We have greatly increased the representation of women on our grant committees, and this now stands at 46% rather than the 23% stated in the article. Wellcome is also piloting unconscious bias for staff involved in our committees.
We’re pleased to see Laurie Garrett’s response clarifies that Wellcome did not make the following statement that funding decisions are “'attributable to less favorable assessments of women as principal investigators, not differences in assessments of the quality of science led by women”. This was instead from a separate paper by Witteman et al that made no mention of Wellcome and received no Wellcome funding.
We’re taking further steps to improve the research environment for all. Wellcome provides supplementary funding to cover the costs of maternity, shared parental or sick leave taken by Wellcome-funded researchers, and we also provide a supplement to grant-holders to cover research costs incurred during their leave. Researchers can also claim for caring responsibility costs related to conference travel, as conferences are key for researchers to build their networks and profiles.
There is still more to be done to improve diversity and inclusion in research, but these steps are laying the foundations for a research culture in which everyone feels able to contribute their ideas to improving health.
Competing interests: No competing interests
Laurie Garrett clarifies that misattribution of my and my colleagues’ work occurred in error and was not present in the original version of the essay. The original statement written by Ms. Garrett was, "When the names of the principle [sic] investigators were blinded, so that gender was unknown, review committees awarded far more grants to women, which, researchers said, 'suggests gender gaps in grant funding are attributable to less favorable assessments of women as principal investigators, not differences in assessments of the quality of science led by women.'[1]"
While it didn't misattribute our work to the Wellcome Trust, the original statement is still incorrect. Our work involved no blinding of principal investigators' names nor concealment of gender. Our quoted words therefore do not support the claim for which they are quoted and referenced.
To the best of my knowledge, the only study that has examined gender-blinded funding applications was when n=891 applications to the European Molecular Biology Organization Long-Term Fellowship programme had elements that might reveal the gender of the applicant removed prior to review.[2] In the four years immediately prior to this new, gender-blind approach, application success had been 14.8% among female applicants and 18.1% among male applicants. When applications had gender information removed, application success was 14.7% among female applicants and 20.7% among male applicants.[3]
I note here that Ms. Garrett makes the same mistake about blinding at another point in the essay. The essay claims: "The German Cancer Research Center has taken perhaps the biggest step: this year it hid the identities of all authors who applied to speak at its conference, leaving only one basis for judging entries: the merit of the work. The result? A whopping 82% of invited speakers at the October gathering were women.[4]" The supporting citation is a hyperlink to the conference website, at which I could find no evidence in support of the claim of a gender-blind process for selection of invited speakers. Furthermore, the conference organizers gave an interview, published in Science, in which they indicated that they knowingly selected a high proportion of women as invited speakers.[5]
Claiming that a process was blinded when, in fact, no blinding occurred is a major error in science. Making such a major error twice raises doubts about the author’s grasp of the literature and the accuracy of other assertions in the essay.
Allowing such errors to stand in the scientific literature is unacceptable, especially as they may potentially influence policies in ways that could harm rather than help gender equity. I repeat my original concern about this essay: This is an important topic. It deserves high-quality scholarship. At present, the quality is lacking.
1 Witteman HO, Hendricks M, Straus S, et al. Female grant applicants are equally successful when peer reviewers assess the science, but not when they assess the scientist. bioRxiv. 2017;:232868. doi:10.1101/232868
2 Ledin A, Bornmann L, Gannon F, et al. A persistent problem. Traditional gender roles hold back female scientists. EMBO Rep 2007;8:982–7.
3 Tricco AC, Thomas SM, Antony J, et al. Strategies to Prevent or Reduce Gender Bias in Peer Review of Research Grants: A Rapid Scoping Review. PLoS One 2017;12:e0169718.
4 Frontiers in Cancer Research (FCR). https://www.dkfz.de/en/frontiers-in-cancer-research/index.html (accessed 20 Dec 2018).
5 Vogel G. Tired of male-dominated meetings, leading cancer conference makes nearly all of its speakers women. Science. 2018. doi:10.1126/science.aav5694
Competing interests: I am the lead author of one of the references cited.
Holly Witteman and her colleagues are correct: I made an error in attribution in “The trouble with girls.” I apologize to the Canadian research team and Wellcome Trust for any difficulty this may have caused. In its original for the relevant section read as follows:
When the names of the principle investigators were blinded, so that gender was unknown, review committees awarded far more grants to women, which, researchers said, “suggests gender gaps in grant funding are attributable to less favorable assessments of women as principal investigators, not differences in assessments of the quality of science led by women.” (1)
Sarah Casemore, Acting Head of Diversity & Inclusion at Wellcome, tells me the institution is committed to achieving equity by 2023, but it has a long way to go. Currently 9 out of 12 top management positions at the Trust are filled by men, and women represent only 23 percent of members on grants’ peer review panels. The NIH is also committed to attaining equity, (2) and similarly has a long way to go. In nearly every grants category the percentage awarded (3) to women hasn’t budged since 1998, according to the institution’s own assessments .(4) The only exception (5) is in the highly competitive 89 young investigator grants, which in 2017 were overwhelmingly given to men, and in 2018 showed a sharp increase in female awardees. For example, 100 percent of 2017 Pioneer Awards and 90 percent of Early Independence Awards went to men in 2017; this year half the Pioneers and 45 percent of the IAs were awarded to females.
1. Witteman et al, “Female grant applicants are equally successful when peer reviews asses the science, but not when they assess the scientist,” http://dx.doi.org/10.1101/232868 .
2. Hechtman LA et al, “NIH funding longevity by gender,” https://doi.org/10.1073/pnas.1800615115 .
3. NIH Databook, https://report.nih.gov/NIHDatabook/Charts/Default.aspx?showm=Y&chartId=1... .
4. NIH Databook, https://report.nih.gov/NIHDatabook/Charts/Default.aspx?showm=Y&chartId=1... .
5. NIH, “2018 NIH Director’s awards for High-Risk, High-Reward Research program announced,” https://www.nih.gov/news-events/news-releases/2018-nih-directors-awards-... .
The above was compressed for space in final BMJ edit, resulting in an inadvertent, but highly regrettable, set of errors in attribution.
Competing interests: No competing interests
As lead author of a preprint cited in this essay, I read this essay with some confusion. A portion of the essay reads, "The gap is also wide at the Wellcome Trust, where female principal investigators received an average £44 735 less than men in 2000-08. [22] However, when review committees were blinded to the names (and sex) of principal investigators, they awarded far more, and larger, grants to women. Wellcome explained that this was 'attributable to less favorable assessments of women as principal investigators, not differences in assessments of the quality of science led by women.' [23]"
Reference 23, our work, directly quotes a line from our preprint. Yet our work was not about Wellcome Trust funding, includes no explanations by Wellcome Trust, and does not describe a blinded experiment.
A later citation to our preprint is placed next to the statement, "The male domination of the process reflects who is invited, not a higher refusal rate by women. [23]" I believe this is indirectly referencing a primary source by Lerback & Hanson (https://www.nature.com/news/journals-invite-too-few-women-to-referee-1.2...) cited in our preprint. It would be better to cite the primary source here.
I reached out on Twitter directly to the author but received no response. I observed that others have raised concerns about problems in other references (e.g., https://twitter.com/abracarioca/status/1074094146930008064) and have similarly received no response from the author. I am therefore posting this rapid response. I encourage the BMJ and the author to review the essay's citations and carefully consider the extent to which they support the statements made in this essay. This is a critically important topic. It deserves high-quality scholarship.
Competing interests: I am the lead author of one of the articles cited.
Most women value family life despite often being penalized for it in their careers. Comparably, career men must also value family life regardless of whether or not they're rewarded (economically) for it in their careers. Men must learn to place as high a value upon family life as women do.
Competing interests: No competing interests
This is a very powerful piece. (1).
As a father of a teenage daughter, I desire a society which is fair, free of obstacles and helps her to achieve her full potential. I hope this article encourages the society to make the necessary changes as quickly as possible.
But the paragraph about Tim Hunt does make me uncomfortable .
Could the author read the investigative piece by Louise Mensch and either offer rebuttals or clarifications, or apologies.(2).
Wikipedia page on Tim Hunt says : “ Trish Greenhalgh said that only "those who went on hearsay" would call him sexist.” It would be great to hear from Trish_Greenhalgh whether the Wikipedia article is an accurate reflection of her views. (3).
References:
1. The trouble with girls: obstacles to women’s success in medicine and research—an essay by Laurie Garrett. BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5232 (Published 13 December 2018).
2. Louise Mensch: The Tim Hunt Debacle. https://medium.com/@LouiseMensch/the-tim-hunt-debacle-c914395d5e01 (accessed 16 Dec 2018).
3. Wikipedia. Tim Hunt: https://en.m.wikipedia.org/wiki/Tim_Hunt (accessed 16 Dec 2018).
Competing interests: No competing interests
Dear Editor,
This article hits an extremely critical issue. In Science and in Medicine the challenges require "all hands on deck" and basically half of our intellectual capital is sidelined. However, I would point out four additional points:
1) The other side of women in this field is that they do not always enjoy the social support of a dedicated assisting spouse, partner, family or community. That is to say all of the social "infrastructure" to support a high stakes career is not in place for women.
2) There is a systematic alienation of women's intellectual product as is pointed out. Basically a "me too" of the mind where women often discover and develop innovation only to see men commandeer the effort. So we build the house, but we are not given ownership---when it is important men are brought in or move themselves in to run it.
3) Discrimination of this level is extremely difficult. Women scientists and doctors are often left to wonder if it was their basic competence and science which was faulty when, in fact, it was simple discrimination.
4) When women retire they are often awarded gardening gloves and a nice watering can. The future of our field relies on expert opinions of senior scientists and physicians brokered through boards and advisory councils. There the ratio of women to men remains abysmal.
Thank you for this piece. In particular thank you for highlighting some of the solutions offered which need to be more widely adopted. If we take these models and work with them we will achieve equity so our daughters will have a robust space to contribute.
Competing interests: No competing interests
Holly O. Witteman's rapid response is exemplary scholarship.
As people from the left-wing and right-wing spectrum of beliefs retreat to their respective echo chambers comforted by opinions reinforcing their respective beliefs, the people in the centre and the honest dissenters are increasingly forced to adopt the cloak of self-censorship rather than face the wrath of social media mob.
Only a rare brave soul nowadays persists in defence of truth. So I applaud Holly O. Witteman for using facts to fight discrimination. (1. 2).
References
1. Holly O. Witteman. https://www.bmj.com/content/363/bmj.k5232/rr-4
2. Holly O. Witteman. https://www.bmj.com/content/363/bmj.k5232/rr-2
Competing interests: No competing interests