Paying Attention

I knew I was about to be schooled.

That’s what I thought when I first started to read the Twitter feed of Erin D. Michos, MD, MHS, an associate professor of medicine in the Division of Cardiology at Johns Hopkins University, Baltimore.

I have a Twitter account, but as a general rule, I use it just to stay informed. In Twitter parlance, I lurk. Lurking is the verb used to describe someone who has joined Twitter, but does not tweet. In the Twitterverse, I am a consumer, not a producer.

Twitter is better off without me. I am old enough that I use more than my thumbs to type, and most of my thoughts don’t fit into 280 characters. There is a certain paucity of language that makes tweeting its own dialect, and I am far from fluent. Besides, I think Twitter has enough people sharing their thoughts and not enough people just sitting and listening, so I try to restore balance to the cosmos by staying out of the fray.

This particular day, I was reading a thread started by Harriette Van Spall, MD, MPH, associate professor of medicine in the Division of Cardiology at McMaster University, Hamilton, Ont., Canada. She tweeted: “In [a] cross sectional analysis of 181 medical conferences in the US and Canada, the proportion of female speakers [from] 2013 to 2017 has increased from 25 to 34%.”¹

I think Dr. Van Spall meant that to be good news, but Dr. Michos replied: “Women speakers remain underrepresented at medical conferences. Pay attention, conference organizers! Think broadly, beyond the first names (usually men) that come to mind.” She continued, “At a minimum, representation should reflect the field. So even in cardiology, where women are only 25%, statistically there should be at least 1 in 4 on the panel who are women. … The larger the size of the all-male #manel, the more uncomfortable.”²

Manel?

New Word, Old Problem

The Oxford Dictionary’s blog on neologisms notes the following: “The term manel, used to refer to an all-male panel of speakers, has recently emerged to join the ranks of the ever growing lexicon of words that are formed by blending the word man with an existing word. … Conceptually, the reason why a panel would be organized in the first place, whether on a conference, on cable news or as part of a legislative session, is to ensure a diversity of opinions and perspectives [is] brought to the issue up for discussion. Obviously, there are many ways in which panels can fail to achieve this goal, not the least of which is the failure to actually assemble a diverse group of panelists. The term manel … has become a useful way to take note of a circumstance in which men may not realize that something they’re involved in has the effect of marginalizing women.”³

Manel is a new word, but the under-representation of women in the higher echelons of academia is not a new problem. For example, 27% of critical care physicians in the U.S. are women. From 2011–2017, 15% of articles on critical care published in high-impact journals (such as The New England Journal of Medicine, JAMA and the American Journal of Respiratory and Critical Care Medicine) had a woman as the first or last author. Despite this, when you look at the composition of critical care task forces convened during the same time period, women physicians accounted for only 7% of the panelists.⁴

Manels are an issue across disciplines, not just in internal medicine. In 2018, investigators from Rice University created a database of everyone asked to speak by the top 50 universities in the U.S. (as judged by U.S. News & World Report) in one of six disciplines: biology, bio­engineering, political science, history, psychology and sociology. The investigators found men were invited to give talks roughly twice as often as women. The observation that men give more talks than women held true across three academic ranks and six different specializations.

Why does this occur? The authors posit: “Seemingly innocuous schemas or stereo­types that people hold about men and women give rise to substantially different expectations …, which, in turn, produce lingering disparities. The biases may not be conscious, in that individuals may be unaware of their schemas and stereotypes. However, these same individuals often serve as gatekeepers or individuals who make decisions about who will enter and advance in the workplace. Gatekeepers may inadvertently restrict women from fulfilling their workplace potential.”⁵

A New Normal

How do we move toward a new normal? Not surprisingly, it starts with the committees that organize our conferences. Having women serve as colloquium chairs increases the selection of women as speakers by approximately 60%.⁵

Another way to have more women speak at our conferences is to ask more women to speak. Earlier this year, PLoS Biology featured an article on a database of women scientists created by Elizabeth McCullagh, PhD, who is a post-doctoral fellow in the Department of Physiology and Biophysics at the University of Colorado.⁶ The database comprises women scientists who have a priori agreed to get more involved—to speak to the press about something in their area of expertise, to consult on a project, to sit on a committee or to speak on a panel. The database now includes more than 7,500 women from 133 countries and has been accessed more than 100,000 times.⁷

The creators of the database note, “Our goal is to increase representation of women scientists in society and change [the] perception of what a scientist looks like. As our database grows, we plan to make it easier to use so women scientists are recognized for their significant contributions to science and our understanding of the world.”⁸

A satellite organization called 500 Women in Medicine was established by five medical students to expand the database to include women physicians. They note, “In order for women physicians to reach leadership roles, they must be visible, and they must be seen as experts in the public sphere.”⁹

The database was created specifically to address the most common explanation for why more women are not asked to speak at conferences—no one could think of a woman to ask.

Another way to prevent manels is for speakers to refuse to join them. In June 2019, National Institutes of Health Director Francis S. Collins, MD, PhD, announced he would no longer agree to participate in conferences that did not include women and members of other groups under-represented in science. In his announcement, he wrote, “It is not enough to give lip service to equality; leaders must demonstrate their commitment through their actions. Toward that end, I want to send a clear message of concern: it is time to end the tradition in science of all-male speaking panels.”¹⁰

Let me do my part. I am personally flattered every time I am asked to give a talk on systemic vasculitis. That said, if I am being honest, most of my talks could be delivered equally well by:

• Tanaz A. Kermani, MD, from the University of California, Los Angeles;
• Sharon Chung, MD, from the University of California, San Francisco;
• Alexandra Villa-Forte, MD, MPH, from the Cleveland Clinic;
• Anisha B. Dua, MD, MPH, from Northwestern University, Chicago; or
• Rebecca Manno, MD, MHS, from Johns Hopkins, Baltimore.

This list is not exhaustive; these are just some of the many women who may not come to mind, but should.

Such efforts may not go far enough. One criticism of efforts to improve gender distribution in committees, conferences and other public venues is that these efforts are often described in the same way physicians speak about the need to eat right and exercise. The efforts are aspirational, not actual requirements, with concrete expectations and goals.

The remedy may be for conference organizers to create a public policy that the gender balance of conference speakers should reflect the gender balance of the audience. The key word is public. Jennifer L. Martin, PhD, director of the Griffith Institute for Drug Discovery, Queensland, Australia, explains it thus: “It’s no use having a policy if no one knows about it. Make it visible. Put it online for everyone to see. Make a direct link to it on the conference or symposia website and put it on your Facebook page. Provide it to the organizing committee. … Send it to the chairs of the sessions, send it to the invited speakers. Make sure everyone knows right from the start that the conference committee is serious about getting gender balance right. Don’t make gender balance an afterthought.”¹¹

Dr. Martin suggests we take the extra step of committing to reporting the data: After each conference, calculate the proportion of female speakers, compare it with the composition of the audience, and see how well the speakers reflect those being spoken to.

I know it feels uncomfortable to use anything but the speaker’s expertise when selecting someone to speak. That said, this is important, because who we allow to stand at the podium affects the next generation. In her article in Wired, science writer Sarah Scoles noted the problem “reaches past the physical conferences and their chronology—to the postdoc watching the livestream on lunch break, to the student who searches YouTube five years from now. … Instead of inspiration, they can find a demonstration of just how steep the uphill battle is.”¹²

The goal isn’t—I hope!—to prevent men from speaking publicly ever again. We just want to bulldoze some of those hills. As Dr. Michos said, it’s just a question of paying attention.

Philip Seo, MD, MHS, is an associate professor of medicine at the Johns Hopkins University School of Medicine, Baltimore and director of its Rheumatology Fellowship Program. He also directs the Johns Hopkins Vasculitis Center.

References

1. Van Spall H. @hvanspall. In this cross sectional analysis of 181 #medical #conferences in the #US and #Canada, the proportion of #femalespeakers 2013 to 2017 has increased from 25 to 34%. #genderequity #inclusion. 12 Apr 2019 4:27 p.m.
2. Michos E. @ErinMichos. At a minimum, representation should reflect field. So even in cardiology where women are only 25%, statistically there should be at least 1 in 4 on panel who are women, and we can do better than that & aim for half. The larger the size of all-male #manel, the more uncomfortable. 15 Apr 2019, 6:00 a.m.
3. Sherwood J. On the radar: manel. OxfordWords. 2017 Jul 5.
4. Janssen KT, Urbach HM, Ham KR, et al. The gender gap in critical care task force participation. Lancet Respir Med. 2019 Apr 15; pii: S2213-2600(19)30120-1.
5. Nittrouer CL, Hebl MR, Ashburn-Nardo L, et al. Gender disparities in colloquium speakers at top universities. Proc Natl Acad Sci U S A. 2018 Jan 2;115(1):104–108.
6. McCullagh EA, Nowak K, Pogoriler A, et al. Request a woman scientist: A database for diversifying the public face of science. PLoS Biol. 2019 Apr 23;17(4):e3000212.
7. 500 Women Scientists.
8. CU Anschutz Medical Campus. Scientists create international database of women scientists. Phys.org. 2019 Apr 23.
9. 500 Women Scientists.
10. Collins FS. Time to end the manel tradition. National Institutes of Health. 2019 Jun 12.
11. Martin JL. Ten simple rules to achieve conference speaker gender balance. PLoS Comput Biol. 2014 Nov 20;10(11):e1003903.
12. Scoles S. The plan to end science’s sexist #manel problem. Wired. 2017 Aug 1.