If you have spent much time in universities you may have seen various stickers or leaflets raising awareness of campaigns that support women in STEM fields (science, technology, engineering and mathematics). There has been a push in recent years to get more girls and women into STEM subjects. Fifty-two percent of those who graduated in STEM disciplines in 2014 were female. This varies widely between disciplines though, with females making up around 80% of graduates in subjects allied to medicine or veterinary sciences, but only around 15% in computer science or engineering and technology. While the gender balance of all STEM graduates are roughly equal, this is not reflected in employment however, with figures suggesting around 23% of employees in UK STEM industries are female, while data from the UNESCO Institute for Statistics less than 30% of scientific researchers worldwide are female.
Does the future hold more promise? A meta-analysis by Miller and colleagues looked at fifty years worth of studies where school children were asked to draw a scientist and examined the genders depicted. They found that over time the percentage showing female scientists has increased – from 0.6% in data collected in 1966-77 to around 40% in 2015. However, when looking at the age of children (in studies since the 1980s) they found that while there was roughly equal representation of male and female scientists among 5 and 6 year olds, by the age of 7-8 years significantly more men were drawn. In the drawings made by girls only, the switch from predominantly female to male depictions happened around 10-11 years. Perhaps with an increase in female representation in STEM roles, especially in public, then young girls might be more likely to see themselves in such a field and thus increase the proportion in the workplace. Equally more needs to be done to emphasise gender equality at these key developmental milestones.
— Peter Chilton, Research Fellow
- WISE Campaign for Gender Balance in Science, Technology & Engineering. Women in STEM workforce 2017. 24 October 2017.
- UNESCO Institute for Statistics. Women in Science. Fact Sheet No. 43. March 2017.
- Miller DI, Nolla KM, Eagly AH, Uttal DH. The Development of Children’s Gender-Science Stereotypes: A Meta-analysis of 5 Decades of U.S. Draw-A-Scientist Studies. Child Development. 2018.
In a previous News Blog  I reorganised Henry Higgins’s famous line from ‘My Fair Lady’ in response to a paper in JAMA based on MediCare records showing that SMRs (standardised mortality rates) following acute medical admissions were slightly lower when the admitting physician was a woman rather than a man. So what about surgery then? Same pattern I am afraid blokes! Slightly lower adjusted odds ratio (0.96) for harm. True? Probably, since women outperform men on many tasks requiring a combination of care and cognition, as per the above News Blog. But results of this sort may be ephemeral – gender based predilections are notoriously labile as different selection and cultural effects play out in society. For example, the proportion of women studying and excelling in STEM (Science, Technology, Engineering and Mathematics) subjects has been rising steadily. The proportion of women who become boxers or get incarcerated is also rising. It seems that women and men are becoming more like each other! But will they ever become the same as each other? The effect of gender on surgical outcomes has been heavily debated and was the topic of the Editor in Chief’s editorial, yet this point about change in the attributes of men vs. women over time was not discussed.
— Richard Lilford, CLAHRC WM Director
- Lilford RJ. Are Female Doctors Better Than Male Doctors? NIHR CLAHRC West Midlands News Blog. 13 January 2017.
- Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017; 177(2): 206-13.
- Wallis CJD, Ravi B, Coburn N, et al. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017; 359: j4366.
- WISE. Women in Science, Technology, Engineering and Mathematics: The Talent Pipeline from Classroom to Boardroom. UK Statistics 2014. Bradford: WISE; July 2015.
- Sport England. Record Number of Women Get Active. 8 December 2016.
- Swavola E, Riley K, Subramanian R. Overlooked: Women and Jails in an Era of Reform. New York, NY: Vera: Injustice of Justice. August 2016.
- Marx C. Improving patient outcomes after surgery. BMJ. 2017; 359: j4580.
About two decades ago I went head-to-head in an argument with the great Michael Marmot at the Medical Research Council. The topic of conversation was information that should be routinely collected in randomised trials. Marmot was arguing that social class and economic information should be collected. He made a valid point that these things are correlated with outcomes. I pointed out that although they may be correlated with outcomes, they were not necessarily correlated with treatment effects. Then came Marmot’s killer argument. Marmot asked whether I thought that sex and ethnic group should be collected. When I admitted that they should be, he rounded on me, saying that this proves his point. We met only recently and he remembered the argument and stood by his point. However, it turns out that it is not really important to collect information on the sex after all. Wallach and colleagues, writing in the BMJ, cite evidence from meta-analyses of RCTs to show that sex makes no difference to treatment effects when averaged across all studies. So there we have it, a parsimonious data set is optimal for trial purposes, since it increases the likelihood of collecting essential information to measure the parameter of interest.
— Richard Lilford, CLAHRC WM Director
- Wallach JD, Sullivan PG, Trepanowski JF, Steyerberg EW, Ioannidis JPA. Sex based subgroup differences in randomized controlled trials: empirical evidence from Cochrane meta-analyses. BMJ. 2016; 355: i5826.
There seems to be two models of feminism:
- Women and men are constitutionally identical (in everything but size and appearance), and any observed differences are entirely patterned by social influences.
- Differences between men and women are more than just anatomy and physiology, and women bring useful and unique attributes to society.
I am inclined to the second opinion. It is already known that female doctors are more likely to adhere to clinical guidelines, provide more preventative advice, and are better listeners than male doctors. Well they also seem to save more lives, according to a brilliant study from Yasuke Tsugawa and colleagues. They compared outcomes from Medicare beneficiaries treated by general internists in hospital. These were really sick patients with a death rate of over 11%. The patients treated by female doctors had a risk-adjusted difference in mortality of nearly 0.5% and also lower risk of readmission. Findings were similar if the analysis was restricted to patients treated by ‘hospitalists’ – a general physician on call for emergencies. Patients hospitalised for an emergency medical condition are less likely to select their physician than patients who are admitted electively, and severity and condition profiles were well balanced between male and female physicians. The authors claim that this means their study was ‘quasi-randomised’. The results are congruent with other studies; across many industries it has been shown that men, compared to women, are “less deliberate in their approach to solving complex problems.”
In ‘My Fair Lady’ Henry Higgins sings “Why can’t a women by more like a man?” In the context of clinical care it seems that the song should go “Why can’t a man be more like a woman?”
— Richard Lilford, CLAHRC WM Director
- Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2016.
A large amount of international research is done sitting at the desk and analysing large datasets. Arguably the largest and most widely used dataset concerning low- and middle-income countries is the Demographic and Health Services (DHS) dataset. This dataset is based on repeated cross-sectional questionnaires in many low- and medium-income countries. The emphasis is on reproductive and infant health. Large databases often disappoint, but DHS is producing some gems.
The authors of a recent World Bank report were interested in a possible preference for sons in sub-Saharan Africa. However, the difference in birth ratio of boys and girls seen in China and India was not found in Africa. So they examined reproductive choices in families where the existing children were all girls or boys. They found that people continue to have children to a greater extent when their existing children are girls rather than boys. There still appears to be a strong cultural preference for boys over much of the world, although manifested in a more subtle way in Africa than in Asia; perhaps because people do not have access to ultrasound to determine the sex of the early foetus, or perhaps because they are less reluctant to have large families. The findings show that many people can control their fertility, suggesting, perhaps, that behavioural factors rather than poor access to contraception is the main cause of the slower decline in family size seen in Africa compared to Asia and South America.
— Richard Lilford, Director CLAHRC WM
- Milazzo A. Son Preference, Fertility and Family Structure. Evidence from Reproductive Behavior among Nigerian Women. Policy Research Working Paper 6869. Washington, D.C.: World Bank Development Research Group. 2014.