Biology matters, but it’s not destiny

During my Brooklyn childhood, one of my favorite playthings was a toy doctor’s kit. In imitation of our fabulous neighborhood pediatrician  — whose tongue depressors were coated with orange candy and who told the mothers that each child should consume about a quarter pound of dirt weekly — my friends and I whacked each other’s knees and elbows with the little rubber mallet, gave each other pretend vaccinations, and performed assorted medical miracles. 

So when I reference the childhood pastime of “playing doctor,” I really do mean impersonating a physician. Along with one of my best buddies, I even entertained thoughts of going to medical school, an uncommon career goal for girls in the 1960s.

Not any more. According to the Association of American Medical Colleges, women were slightly over half the first year students in the nation’s medical schools in 2017. In 1974, only 22 percent of seats in medical schools were occupied by women. While the increasing number of women in medicine is a sign of real progress, there is another area of medicine in which gender bias has a profound impact on women: medical research.

For too long, research into health and medicine has assumed the normative male. As noted by the Laura W. Bush Institute for Women’s Health: “National clinical guidelines for hypertension, diabetes, heart failure, asthma and many other conditions are based on a majority of research performed in men and applied to women.”

So what’s the problem? Haven’t women’s rights activists urged the undoing of arbitrary distinctions between the sexes? Aren’t women and men more alike than different, with most of our organs the same? Don’t women’s health concerns go beyond reproductive biology? If we seek equality, why should we be troubled that medical research has been overwhelmingly geared towards men and male physiology?

As I tell my students: the sign of a well-functioning mind is the capacity to hold seemingly contradictory ideas at the same time and know that they can all be true. Seeking the undoing of arbitrary, socially-constructed distinctions between the sexes — the kind that used to keep women out of the medical profession — does not mean ignoring the fact that biological differences can have a significant impact on the diagnosis, treatment, and prevention of disease.

Paying attention to such differences requires rooting out gender bias in basic research, as well as ensuring that women are adequately represented in clinical trials. As noted on the website Medical Daily, “Because women have only been included equally in drug studies since 2001, there are still many pharmaceuticals circulating on and off the shelves at the local drug store, many of which still haven’t been tested on women.”

And, according to Women’s Health Research at Yale: It took until 1994 for the National Institutes of Health “to begin requiring government-funded research on conditions affecting both sexes to actually include both sexes.” And not until 2016 did NIH require researchers “to include female animals and female cells in their studies as well as male animals and male cells.”

The need for gender-informed medical research is illustrated by a few examples:

  • As reported by Stanford University’s Gendered Innovations initiative, between 1997 and 2000, ten drugs were withdrawn from the U.S. market because of life-threatening health effects. Eight of them posed greater risks for women than men.
  • A study by Duke University researchers indicates that, while aspirin helps to reduce men’s heart attack risk, it does not reduce their risk of stroke while, for women, aspirin reduces the risk of stroke, but not of heart attacks.
  • Women metabolize the active ingredient in the sleeping pill Ambien more slowly than men, meaning that they are more susceptible to the drug’s after-effects, and resulting in a warning by the Food and Drug Administration for women to cut their dosages in half.  ““This is not just about Ambien…” Dr. Janine Clayton, director for the  Office of Research on Women’s Health  at the National Institutes of Health, told The New York Times. “There are a lot of sex differences for a lot of drugs, some of which are well known and some that are not well recognized.”
  • According to Harvard Medical School, “Women don’t seem to fare as well as men do after taking clot-busting drugs or undergoing certain heart-related medical procedures.”
  • The Texas Heart Institute reports that heart attacks are usually more severe in women than in men. In the first year after a heart attack, women are 50 percent more likely than men to die. In the first six years after a heart attack, women are almost twice as likely to have a second attack. Women are often misdiagnosed because their heart attack symptoms may be more general — e.g. nausea, vomiting, dizziness and indigestion.
  • A report from Boston’s Brigham and Women’s Hospital notes that women who don’t smoke are three times more likely than nonsmoking men to get lung cancer.
  • Nearly 80 percent of those with autoimmune diseases (e.g. lupus, rheumatoid arthritis, multiple sclerosis) are women. (National Jewish Health).
  • The Society for Women’s Health Research (SWHR) reports that common drugs like antihistamines and antibiotics can cause different reactions and side effects in women and men, and some pain medications are more effective in women while others are more effective in men.
  • Women tend to produce less gastric acid than men, resulting in slower digestion. Therefore, medications that need an acidic environment to be absorbed, like the antifungal ketoconazole, for example, may not be as effective in women. Also, drugs that require an empty stomach for absorption, like the antibiotic tetracycline, may not work as well if women don’t wait long enough before taking them after meals. (Everyday Health).

The list goes on.

The women now practicing medicine in record numbers are heirs of the foremothers who fought to claim their place in the medical professions, as well as of those in all fields who devoted their lives to disengaging biology from lifelong destiny. In our century, acknowledging how our biology affects us, while simultaneously insisting on women’s full legal, social, and economic equality, may be the most radical notion of all.

© Rhea Hirshman 2019

Blending reality….

Blending reality: putting virtual technologies into practice

Over the past two years, my friends (you know who you are!) have listened to me as I tangled with, obsessed over, and written about the phenomenon of “blended reality” for two reports on innovative work in that area being done at Yale. I thought that some of my readers might be interested in learning about everything from the potential for using virtual reality to teach anatomy to medical students, to how acoustics can be used to test materials for 3D printing. So here is a slightly tweaked version of my introductory essay for this past year’s report; the link to the full document is in the final paragraph.

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The introduction of the telephone in the 1870s was not greeted with universal enthusiasm; responses ranged from awe and excitement to confusion and terror. A disembodied voice emerging from a wire was spooky, and who knew whether actual ghosts might be lurking in the lines? There was concern that telephones might be dangerous, drawing lightning in thunderstorms, and zapping everyday users and innocent bystanders with electrical shocks. As late as 1933, a New Yorker article noted that people were intrigued by the ingeniousness of the devices but “no more thought of getting one of their own than the average man now thinks of getting on an airplane.”

And besides, what was the point of the contraption? A high-ranking official at Western Union, the telegraph company, declared the device “practically worthless,” and a 1907 New York Times essay warned that: “The general use of the telephone, instead of promoting civility and courtesy, is the means of the fast dying out of what little we have left.”

Nearly a century and a half later, we wrangle with similar concerns about our latest technological innovations. What is this thing? What can it do? What can it not do? What should we do with it? How might it change the ways we live, work, learn, and play? Will it enhance or detract from our lives?

During 2017–18, teams of students and faculty at Yale University applied these questions to mixed, or “blended” reality — applications and experience that explore the intersections of the physical and the virtual environments. The teams worked on projects that included integrating virtual reality technologies into the study of anatomy — both botanical and human; exploring the possible applications of immersive technologies to music-making; and rethinking the ways that bodies can function in virtual spaces.

As you will read in the following pages, most of the projects are, by design, in process. Blended reality is not simply a medium, but a field of ongoing and rapid transformation. What is learned from all the projects will offer valuable insights as we continue to embrace, refine, and challenge these technologies.

© Rhea Hirshman 2019

 

Public spaces need real women

Alice in Wonderland and I go back a long way. In my childhood I read and reread the books in which she starred. My entire 9th-grade class, unbidden by any teacher, memorized Jabberwocky. To this day, I can still recite it, as well as convulse my cousins with a dramatic recitation of The Lobster Quadrille.

I tell you all this to assure you that I am perfectly happy to have a statue in New York City’s Central Park of Alice and her buddies.

But, although she has delighted generations, Alice is, after all, a figment of the imagination — as are Mother Goose, Juliet (of Romeo and), and the assorted nymphs, angels and allegorical figures who are the only females represented among the statuary in the nation’s most-visited urban park.

Assorted men, and a dog

While not one breathing female person has been deemed worthy in the park’s 160-year history of having a statue erected to her, nearly two dozen assorted men have been so honored. The 14th– century Polish king, Wlasyslaw II Jagiello, greets the parks’ 40 million annual visitors, as does the 19th-century Danish sculptor Albert Thorvaldsen. Italian politician Giuseppe Mazzini and Prussian naturalist Alexander von Humboldt are there. So are Hans Christian Andersen, Ludwig van Beethoven, Simón Bolívar, Alexander Hamilton, William Shakespeare, Daniel Webster, and a dozen other undoubtedly commendable gentlemen. There is even a statue of Balto, the lead sled dog on the final leg of a 1925 journey to deliver diphtheria antitoxin from Anchorage, Alaska to Nome.

Give the historical restrictions on women’s participation in public life, one might expect somewhat fewer public representations of women’s accomplishments than of men’s. But there are scarcely any such images. According to the Smithsonian, over 90 percent of U.S. outdoor sculptures of historical individuals depict men. None of our national holidays celebrate women or milestones in the struggle for women’s equality. Congress took 75 years to bring up the “Portrait Monument” of Lucretia Mott, Susan B. Anthony and Elizabeth Cady Stanton from the depths of the U.S. Capitol basement into the Rotunda, where visitors could actually see it.

Even as more women have entered public life, the balance has scarcely shifted. Establishing the Vietnam Women’s Memorial in Washington, dedicated in 1993 to the eleven thousand nurses and other women who served in that war, required a decade-long struggle. Smithsonian records show that, since 1960, women have been portrayed on just 12 percent of new public statues of individuals.

Sculpture by Adelaide Johnson.

The right sort of pedestals

However, communities around the country are beginning to rethink the public representation of their own and the nation’s past.

As we approach the centennial in 2020 of the passage of the 19th amendment, a New York City organization called the Elizabeth Cady Stanton and Susan B. Anthony Statue Fund (www.centralparkwherearethewomen.org) has obtained permission to move forward with plans to honor a group of women who had an indelible impact on American history. After complex negotiations with various agencies, they received approval from the city’s Department of Parks to erect a statue that will portray Stanton and Anthony, and include representations of others whose work was crucial to the eventual success of the 80-year struggle for women’s right to vote. The statue will be erected near Central Park’s West 77th Street entrance — not far from statues of Abraham Lincoln and Frederick Douglass.

Stanton (1815-1902) spearheaded the 1848 Seneca Falls women’s rights convention that marked the beginning of a recognizable U.S. women’s rights movement, wrote the groundbreaking Declaration of Sentiments detailing the wrongs and indignities suffered by women, and later presided over the National Women’s Suffrage Association. Describing herself in an 1852 letter to Anthony as on the verge of “a woman’s rights convulsion,” she published throughout her long life essays and speeches that read as starkly contemporary over a century after her death.

Anthony (1820-1906), the resolute and indefatigable organizer, traveled in all kinds of weather to bring the message of women’s rights to the largest cities and the most isolated farms. She counted among her accomplishments getting herself arrested in 1872 for voting in Rochester, New York, in a case that made national headlines. Not allowed to testify on her own behalf, and convicted for “the crime of voting” by the all-male jury, she declared, “Resistance to tyranny is obedience to God.”

The women who committed their lives to obtaining voting rights for half the U.S. population have to be as important as a beloved Danish author or a Polish warrior king. When I visit the new statue, I’ll certainly stop to say hello to my old friend Alice — and I’ll be glad to see that tomorrow’s girls visiting the park will have some real women to look up to.

© Rhea Hirshman 2017

Subversion by sweater set

In the wake of the recent kerfluffle (August 2017) over Melania Trump’s footwear choice when she and The Donald traveled to the area devastated by Hurricane Harvey, I’ve been thinking again about the role of the U.S. First Lady (whoever she may be). With those thoughts in mind, I’ve revisited and slightly revised an article I wrote a few years ago about Michelle Obama. In another post (coming shortly), I’ll say more about why First Ladyhood is such a peculiarly American institution.

Having written and spoken often of my annoyance at the enormous amount of attention paid to the hair styles and dress of female candidates and other women prominent in public life, I can’t believe that I am admitting this in print: I have been known, on many an occasion and of my own free will, to read about Michelle Obama’s clothing choices.

There. I feel better now.

Lest you’re wondering whether this fascination with fashion means that I’ve gone over to the Dark Side, leaving behind my decades-long principled stand against the trivialization of women’s accomplishments, I can assure you: Not hardly.

Rather, I was so relieved to have a White House whose denizens relished complexity and nuance and whose moral compasses contained direction points that I recognize, that I found myself eagerly reading about everything from the momentous to the quotidian.

In other words: I became a Fan. Negotiations with Mexico? Organic gardening? Monetary policy? Sweater sets? If it was happening at or emanating from 1600 Pennsylvania Avenue, I wanted to read about it, so thrilled was I to have adults running the country.

That said: I have no intention of discarding my critical faculties. The First Lady role is a most peculiar one, about which the U.S. public has been ambivalent since the Republic’s founding. The position has no Constitutional basis, no legal definition, and no direct public accountability. While the candidate’s wife has been allowed in the limelight during the campaign, she’s also been expected to occupy that back seat — except for certain michelle-obama-leaves-china-public rituals — should her man achieve office. First Ladies Eleanor Roosevelt and Hillary Rodham Clinton paid the price of being the exceptions that proved the rule, including excoriation in the press for their refusal to follow the script.

Enter Michelle Robinson Obama, with a degree in sociology from Princeton, a law degree from Harvard, and her American story. Like many wives of nationally prominent politicians — even before taking up residence in the White House — she had already become part of popular culture: Listed in 2006 by Essence as among “the world’s 25 most inspiring women” and in 2007 by Vanity Fair among “the ten world’s best-dressed people,” she was also an honorary guest at Oprah Winfrey’s 2005 “Legends Ball” which invited a younger generation of African American women to join Oprah in honoring an older generation of trailblazers such as Maya Angelou, Ruby Dee, Katherine Dunham, Nikki Giovanni, Dorothy Height, Lena Horne, Coretta Scott King, Toni Morrison, Cicely Tyson and Alice Walker.

And still, we wanted to know what she was wearing. “The Obamas are in town this week and all eyes are on the fashion choices of First Lady Michelle,” noted the British web site uk.msn of the First Couple’s first visit to the United Kingdom. Max Mutchnick, co-creator of the television series Will and Grace, opined that at least one of Michelle’s outfits might have signified that the Obamas might have needed a few more gay people around them. “If more homosexuals were in the Obamas’ lives,” he said, “there is no way that Michelle would have worn a twin set when she met the Queen.”

Of course, I still find myself irritated by the degree to which this kind of sartorial scrutiny is so heavily gendered, and by the extent to which we focus on hair, clothing and grooming as a way of managing our anxieties about powerful women in public life.

But the freedom for women to use clothing as a means of self-expression is also not to be taken lightly, given centuries of restrictions on women’s bodies — particularly the bodies of women of color. A First Lady whose entire bearing says “Here I am!” and who by all appearances is living comfortably in her own body (and who is not afraid to laugh, dance, and rock a sweater set) is a compelling symbol of female agency. Even as she was being made into a fashion icon, Michelle Obama was subverting the status quo, thus pulling off the neatest trick of all. Fan club, anyone?

© Rhea Hirshman 2017

Sounds of silence?

In the wake of the horrific happenings in Charlottesville, Virginia this weekend:

I often think that the more powerful counter protest — at least at certain moments — would be to deny an audience to white supremacists and their ilk.  Go inside. Close doors. Draw the curtains. Leave only one light on in the window as a sign of resistance. Let them march through totally empty streets, screaming only at each other. The confrontation and attention and violence are what they want. Don’t give it to them.

And then come together to build and nurture community after they are gone.

© Rhea Hirshman 2017

Misery does not bring the revolution

This was written in response to comments I’ve heard from some progressives who have said that they could conceive of voting for Trump because the chaos and misery caused by a Trump presidency might inspire more radical action for change.

The theory that making the most vulnerable people suffer is a good way to bring about progress is one that conflicts with both historical reality and human decency. Expanding the right to vote and abolishing slavery (to reference examples of major social/political shifts accomplished by political activism) both took decades. Electing an egomaniacal real estate developer is not going to bring about “the revolution” — and, in the meantime, much progress will be lost, particularly by those who can least afford those losses.

To cite one example: Obamacare is not perfect, and not the solution that many progressives hoped and worked for (I include myself here), but a lot more people now have health insurance. Do we want to build on that, or see it destroyed in the naive hope that the destruction will cause the “rising of the masses”? But meanwhile — the most vulnerable will suffer.

Or can you imagine what will happen if Roe v. Wade is overturned by a Supreme Court packed with right-wing ideologues? As always, women with means will be able to access abortion care. But, while we wait for the masses to rise, poor women and young women will die. Or what will happen to voting rights, already gutted by this current Supreme Court, if we were saddled with a court even further to the right?

It is a luxury of those with some degree of privilege and/or security to wish for misery that will fall hardest on those least able to bear it.

© Rhea Hirshman 2016

Keep the guns, ditch the ammo

Once again, the National Rifle Association can be heard chanting its cynical mantra as it demands the right to unfettered firearms access for even the sketchiest of our fellow residents: “Guns don’t kill people. People kill people.”

I have pointed out, patiently, that people with spatulas do not kill people. People with tennis racquets do not kill people. People with garden hoses do not kill people. While most who own guns in this country never shoot anyone, guns are, in fact, used to kill people. Between 2000 and 2015, nearly 302,000 Americans died by gun violence. On average, in 2015, a toddler shot someone once a week. In that same year, nearly 800 children in the U.S. were killed by gunfire.

But today I had a revelation. The NRA has a point. Sort of. Guns do not kill people.

AMMUNITION kills people.

So I offer this compromise. Let those who feel the need or urge purchase as many firearms as they want. Let them stockpile and fondle arsenals; about 25 percent of gun owners possess five or more guns, with over five million Americans owning ten or more guns.

And then let’s regulate ammunition to the moon and back: background checks, purchase limitations, constraints on transfers, and so on.

After all, the Second Amendment, to which the NRA and its minions pledge absolute fealty, presents the right to “keep and bear arms.” It makes no mention of loading them.

I’m sure I’ll hear from the NRA any day now.

© Rhea Hirshman 2016