Keynote Address

Women in Science and Medicine

Karen Antman, M.D.

Columbia Presbyterian Medical Center

SPEAKER INTRODUCTION

SALLY SHAYWITZ, M.D., CHAIR, AXXS STEERING COMMITTEE

I’m also absolutely delighted to introduce our keynote speaker, Dr. Karen Antman. Dr. Antman, director of the comprehensive cancer center at Columbia Presbyterian Medical Center and the Wu Professor of Medicine and chief of medical oncology, has developed a number of now-standard regimens for the treatment of certain forms of cancer, has developed high-dosage chemotherapy regimens for high-risk breast cancer, and is testing various strategies of bone marrow or stem cell transplantation to replace immune stem cells lost during high-dosage chemotherapy. Dr. Antman is one of only four women currently serving as director of one of the National Cancer Institute’s 59 designated cancer research centers. So it is with great pleasure and enthusiasm that I introduce you to Dr. Antman.

DR. ANTMAN:

It’s a privilege to be asked to give this talk.

The data I will show you during this presentation are not from a Medline search of what’s been published; it is basically the same kind of literature review one would get as an academic from ripping pages out of journals over a period of about 20 years.

I received the following as an e-mail; it was kind of a joke. The hypothesis is that success in academia requires specific phenotypes. The abstract read:



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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 Keynote Address Women in Science and Medicine Karen Antman, M.D. Columbia Presbyterian Medical Center SPEAKER INTRODUCTION SALLY SHAYWITZ, M.D., CHAIR, AXXS STEERING COMMITTEE I’m also absolutely delighted to introduce our keynote speaker, Dr. Karen Antman. Dr. Antman, director of the comprehensive cancer center at Columbia Presbyterian Medical Center and the Wu Professor of Medicine and chief of medical oncology, has developed a number of now-standard regimens for the treatment of certain forms of cancer, has developed high-dosage chemotherapy regimens for high-risk breast cancer, and is testing various strategies of bone marrow or stem cell transplantation to replace immune stem cells lost during high-dosage chemotherapy. Dr. Antman is one of only four women currently serving as director of one of the National Cancer Institute’s 59 designated cancer research centers. So it is with great pleasure and enthusiasm that I introduce you to Dr. Antman. DR. ANTMAN: It’s a privilege to be asked to give this talk. The data I will show you during this presentation are not from a Medline search of what’s been published; it is basically the same kind of literature review one would get as an academic from ripping pages out of journals over a period of about 20 years. I received the following as an e-mail; it was kind of a joke. The hypothesis is that success in academia requires specific phenotypes. The abstract read:

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 We used human clones to identify the molecular events that occurred during the transition from a graduate student to a professor. A pool of graduate students was selected on minimal money media and they were dubbed post-docs. These were further screened for the ability to work long hours with vending machine snacks as their sole carbon source. Those selected by their ability to turn esoteric results into a fifty-minute seminar were labeled assistant professors. Clones which overproduced stress proteins, heat shock protein 70, were passed over “friends and family members” columns, and such selected full professors shared striking phenotypes: the inability to judge the time required to complete bench-work and the belief that all of their ideas constituted good thesis projects. Over-expression of these selected gene products may speed evolution of graduate students to full professor. The point of this is that making a contribution in science and medicine is not easy for either men or women. But there are differences. When women are depressed, they either eat or go shopping. Men invade another country. At many universities, as you’ll see in the next talk, the numbers of instructors and assistant professors are roughly equivalent to the pool since the 1970s. The percentage diverges with each promotion. Failure of the Trickle-up Theory Why hasn’t the trickle-up theory worked? I’ve heard lots of people commenting, both women and men. Is it commitment, frustration on the part of women, discrimination, or small differences in early resources? I think the latter reason is one that very subtly contributes to the differences and probably is part of the problem, although I believe the others are as well. A Columbia University commission on the status of women reported out in October 2001. It found that 40 percent of the Ph.D.’s in arts and sciences were given to women. However, when it came time to do academic appointments for tenure-track jobs, 23 percent were in the pool. They said there was a puzzling absence of qualified women. I thought the choice of words there was interesting. (It’s also interesting that, at Columbia at least, the hiring was actually done at 34 percent. So they actually hired a higher percentage of women than was in the applicant pool.) The commission considered the reasons for fewer women in the applicant pool, and one was New York City. Did women opt out of coming to New York City? If women are perfectly willing to get their Ph.D.’s in New York City, it doesn’t make sense to me that they would not be willing to take an academic appointment in New York City, but that was one of the reasons given: “Advising networks might steer women away from elite institutions or suggest a career at a research institute is incompatible with commitments to raising small children.” Which I thought was an interesting concern. The report also said, “Women may underestimate their qualifications.”

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 Let’s look at the latter two concerns in a little bit more detail. Family responsibility is an issue. The time commitments are impressive. We have two children (actually, they’re both now in medical school), and the amount of time required to care for and raise them was really an issue. I think women have to trade money for time, but when I’ve said that to graduate students and postdocs, they don’t have money at that point in their careers. So just about the time they’re having children and need adequate child care and a car and an apartment, they don’t have the money to get the basic necessities. This is particularly a problem in New York City. As for whether women may underestimate their qualifications, what might be the evidence for that? An interesting Project Access was partially reviewed in Science in 1996.1 The authors interviewed a variety of men and women in medicine and science in academic medical centers, and found that 70 percent of the men thought they had above-average ability compared with 50 percent of the women. So I believe it’s fairly clear that women are less likely to be confident about their ability in science. Twenty-five percent of the women, versus 5 percent of the men, said that, in retrospect, they should have dealt more actively with career obstacles. But it’s not always easy to do that when you’re a young assistant professor and don’t really know how to deal with these obstacles. So I think that senior women and men really have to provide ways for women to reduce the obstacles to the development of their careers. The authors also found that women were slightly more collaborative prior to their postdoc, but collaborated noticeably less thereafter, presumably because men were not treating them as equal partners. I think this is worrisome—that early on they collaborate and then they find that they have more difficulty collaborating on an equal basis as their careers advance. One of the issues that did come up in Project Access about promotions was that the men interviewed published slightly more papers per year (2.8) than the women (2.3). However, when the analysis was expanded, using a citation index, it was learned that the women had strikingly higher citation indexes than the men per paper. I believe this factor needs to be taken into consideration. The authors concluded that the women were more cautious and careful about adopting an extra-high measure of conformity to research formalities. Finally, it was discovered that women postdocs—and this is particularly worrisome to me—with female advisers left science more often than those with male advisers. The reason they gave was that the female adviser had given up any personal life and that they didn’t want to do the same. We can’t solve this problem by getting more female advisers who have given up everything. We have to have reasonably well-rounded female advisers who can serve as role models, 1   “Women and Minorities,” Science 271 (1996): 295.

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 because junior women coming up through the ranks don’t want unilateral kinds of role models. In fact, I remember, as an assistant professor, complaining to one of the administrators that there were no normal women role models. She said, “Look around—there aren’t a lot of normal men advisers either.” This is a problem for young men too—not having enough time to spend with their families. Different Cultures, Different Rules I believe that the cultures and the rules are different for men and women. Many of you may have read Carol Gilligan’s work from about 10 years ago, In a Different Voice.2 Basically, she was evaluating Radcliffe and Harvard undergraduates as part of her Ph.D. research. She found that the men were always ranked higher on ethical scores than the women. She finally concluded that the women weren’t ranked higher on ethical scores because they had different ethics—that is, they had been brought up somewhat differently and had a different set of rules. The men viewed law as important, and women did too, but, for them, the law was that relationships come before the law. Therefore, the women kept getting dinged on that particular basis and were not considered as well developed ethically. By publishing In a Different Voice, I believe Gilligan established that there are just differences in the rules that women and men follow. Promotion at academic medical centers is generally based on independence. Women tend to be collaborative. Many of the junior women whom I’ve mentored did not realize that if a full professor was listed as coauthor on their papers they would not be considered independent. Full professors know this and should take their names off papers when their colleague becomes a fairly senior assistant professor. Some do and some don’t. But young women don’t realize that that is the major value system in academic medicine. I’m not sure why collaboration shouldn’t be. Finally, critical mass is essential. I think the “old girls’ network” has been very helpful in getting women promoted and in making differences on committees. About 10 years ago I served on the board of the American Society of Clinical Oncology. There were three women and twenty men. We were very aware that often when a woman makes a good suggestion it is dropped and then a little while later is attributed to the men around her. So we three women met ahead of time, and for the whole year whenever one of the women in the group made a suggestion we thought was particularly smart, we would reinforce it. I don’t think the guys ever figured out what we were doing, but it was very effective for the year. I think that one or two women can’t do it. You really need a critical mass of women. 2   Carol Gilligan, In a Different Voice: Psychological Theory and Women’s Development (Cambridge, Mass.: Harvard University Press, 1993).

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 There are no real barriers, I believe, for a brilliant woman faculty member. Getting her a tenured position is not an issue. However, at least in my experience, plenty of B+ men also have gotten tenure, but trying to get a B+ woman tenure is often an issue. You’re caught in a position of supporting someone who isn’t perfect. It’s often difficult to get that person promoted. In 1997 a study came out in Nature (and I’d love to see something like this done at the National Institutes of Health—just a quick review to see if in fact this is correct).3 In 1995 the Swedish courts made public a group of grant applications to the Swedish Medical Research Council. The applications were made by 62 men and 52 women, so it was almost even. But 16 men and 4 women were awarded grants. After looking at these results, the investigators did a multiple regression analysis of the number of first author and total papers; journal impact factor—so they factored in where the applicants were publishing; citation index: education; rank of the applicant’s medical school; mentor, field; and postdoc, whether a postdoc had been done abroad. This study found that the women needed about two and a half times the scores of the men to receive the same evaluation. That’s worrisome. Many women say they have to be twice as good as men to be considered half as competent. These data support that evaluation. Women in the Classroom We all do teaching and we need to be aware of what’s happening in the classrooms when we teach. A 1985 paper by Krupnick4 looked at teaching styles in a Boston classroom and then the classroom discussion. Krupnick found that men dominated mixed-group discussion groups, that women were interrupted far more often than men, and usually by women, and that long periods of all-male talk were followed by short bursts of all-female talk. I’ve gone to lots of conferences, and in the question period this scenario almost always plays out exactly as described. Therefore, if you’re teaching a class and you’re a female and you’re aware of these data, you probably should be calling on women occasionally in the early male-dominated discussion, just to start mixing it up a little bit. Then when women start interrupting women, you probably need to interrupt that pattern and, say, let the last speaker finish. It’s almost as though there’s a rush to get it all in once it’s the women’s turn. We need to allow women to express themselves fully. And there are still leadership barriers. There’s discrimination, but it’s both for and against. Some people discriminate against women, but some others very clearly discriminate for women. One of the major problems is that leaders are comfortable with people like them. Since many leaders are men, they’re more 3   A. Wold and C. Wennerås, Nature 387 (1997): 341–43. 4   C. G. Krupnick, “Women and Men in the Classroom: Inequity and Its Reminders,” Journal of the Harvard-Danforth Center (1985): 18–25.

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 comfortable with men. That’s kind of a subtle effect. Assertiveness is often an asset in a man, but it may be problematic in a woman. I believe that when men work for a woman, they very quickly will try to go over her head to the next man. Whether they succeed depends on the sophistication of the woman’s boss. Professional Societies How can professional societies help? An example is the one I will be leading as its president next year. The American Association for Cancer Research [AACR] has a membership of about 12,000 men and about 5,000 women; 68 percent are Ph.D.’s and 24 percent are M.D.’s. Like in academic medical centers, women make up a higher share (41 percent) of associate members (those who do not yet have academic appointments), almost double that of active members (see Figure 1). So it certainly looks like the pipeline is full. The AACR has had a Women in Cancer Research Council for decades that is made up of 1,491 women, almost half of the women in the AACR, and 113 men (it’s kind of like the Marines, a few good men). Many more people come to the lectures and workshops than are actually in the group. There are breakfasts specifically for the trainees, mentoring programs for both trainees and mid-level FIGURE 1 Membership of American Association of Cancer Research, by gender. SOURCE: American Association of Cancer Research.

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Achieving XXCellence in Science: Role of Professional Societies in Advancing Women in Science - Proceedings of a Workshop AXXS 2002 faculty, and scholar awards for women. It is very important that professional societies undertake these kinds of programs to ensure that women have a place to go to get mentoring at both early and mid-career levels. Questions and Answers Participant: I was curious about evaluating the programs of the professional societies. Do you have measurable standards to determine how things have improved relative to having breakfasts and mentoring programs, or do you do a survey now and three years from now to really understand the impact of which programs are most effective? Dr. Antman: Surveys are done. Women are certainly increasing both in their percentages within the society and in their leadership within the society, which is fairly equitable. I’m referring to the number of women on the board, the number of women presidents, and the number of women editors of the five journals that AACR sponsors. There’s been a major shift over perhaps a decade and a half. Whether that has to do with this particular program, I don’t know how one would tell. But this certainly is a society in which women are well represented at all levels.