MIT Lincoln Laboratory 70th Anniversary Lecture
August 12, 2021
I am so honored to be part of this lecture series celebrating the 70th anniversary of Lincoln Laboratory.
We’re very proud at Wellesley of our alumnae who work at Lincoln Lab—about a dozen of you today. The Lincoln-Wellesley connection dates back to programmer Mary Allen Wilkes of the Wellesley Class of 1959, who wrote the code for one of the world’s first personal computers at Lincoln in the early 1960s, while, she said, working “crazy hours,” eating “all kinds of terrible food,” and feeling “completely accepted.”
I wish I could say that in the six decades years since, women’s struggles for complete acceptance in the workplace have diminished to the point of vanishing—especially for those women expanding horizons and saving lives in science, engineering, and medicine.
But the pandemic has woken the world up to the struggles that remain. As Emmanuel Macron put it, SARS-CoV-2 is “an anti-feminist virus.”
It certainly revealed the degree to which women are on their own in trying to balance family responsibilities and work—particularly in the United States, where public spending on early childhood education and care is paltry. The balancing act has been particularly difficult for women of color, who lost jobs in greater numbers, and who are more likely to be both the primary breadwinners in their households and responsible for all of the child care and housework. They also generally have fewer resources to help them maneuver during an emergency: The median Hispanic family has one-fifth the wealth of the median White family and the median Black family, one-eight of the wealth.
Without question, the pandemic has been cruel to working mothers, whether they are frontline workers, or have the luxury of working from home—and between February of 2020 and March of 2021, 1.5 million women with school-aged children left the workforce. Even those women who slogged on had difficulty advancing in their careers: One study found that four times as many fathers got a promotion while working remotely, as mothers.
With the budget blueprint passed by the Senate yesterday morning, the United States has an opportunity to define child care and early childhood education as what they actually are: the armature that allows women to live up to their potential and to contribute fully to our economy—as essential a public good as roads and bridges.
The virus also highlighted the degree to which health outcomes can diverge by sex and by race. In the U.S., for every 10 deaths from COVID-19 among women, there have been 13 deaths among men. At the same time, the preliminary evidence suggests that women may be more prone to “long COVID.” None of this is surprising. Sex is biological, and women and men often experience diseases differently.
Race, on the other hand, is a social construct, so the disparities during this pandemic underscore just how much social factors determine health outcomes: Black, Hispanic, and American Indian and Alaska Native people have been three times as likely to be hospitalized for COVID-19 as White people and at least twice as likely to die, and at younger ages. Between 2019 and 2020, life expectancy in the United States fell by a year for White Americans, but three years for Hispanic and Black Americans.
There are many likely contributors to poorer outcomes during this pandemic for people of color: comorbidities such as diabetes and obesity, poverty, lack of health insurance, a greater exposure to the virus in service and production jobs that cannot be done at home—and while commuting to those jobs. However, an early study by researchers at the MIT Sloan School of Management found that, at the county level, the higher the percentage of Black residents, the higher the death rate—even after those variables were adjusted for. Clearly, other factors are involved, including possibly chronic stress and/or discrimination in the health care system itself.
I tend to look at the fault lines of sex and race in our society as a physician-scientist and an educator. But at Lincoln Lab, where the mission is national security, I will say that there is an element of national security here, too. When you have women leaving the workplace in droves and minorities dying in large numbers, it is obvious that our failure to treat a large portion of our population equitably weakens the United States economically and geopolitically. It limits our ability to innovate and lowers our standing in world. It certainly worsened the humanitarian disaster that is COVID-19, and it impinges on our credibility in terms of health diplomacy, which is critically important right now.
The question is, what have we learned from COVID-19? And how do we apply those lessons?
On the road to some answers, please allow me to tell you a bit about my own career, since I have studied the fault lines of sex and race since I was an undergraduate—and been aware of them since I was a child, because of what happened to my grandmother.
Some of my most wonderful childhood memories are of spending time with her in the house that we shared in Brooklyn. She was warm and exuberant, a force of nature. She might have worked in a factory, but that did not stop her from saving her pennies and traveling to Europe. My grandmother loved life, and she loved me.
Then, when I was eight and she was 60, something changed. She became listless and withdrawn and stopped eating. Her care became all-consuming for my family. It took forever for us to receive a diagnosis. Even today, women of color often find that their symptoms are ignored by the medical system. In my grandmother’s case, she’d been hit by a deep depression, and by the time she was finally diagnosed, she was in a downward spiral from which she never recovered.
Her experience sparked an aspiration in me to keep similar things from happening to other women, even if I didn’t know exactly how that would happen.
As a college freshman at Harvard, I had the good fortune to enroll in a class with Ruth Hubbard, the first woman biologist to be tenured there. The class was called “Biology and Women’s Issues,” and Ruth made explicit something that women had often sensed, but rarely articulated: that scientific practice had made men the norm—both their bodies and their ideas—and that what was deemed scientific truth was socially constructed and deserving of reexamination.
This idea that scientific orthodoxies might reflect a limited perspective was underscored for me during an independent study I did with Ruth and evolutionary biologist Stephen Jay Gould during my junior year. A new field known as human sociobiology had come into vogue, which offered evolutionary—hence genetic—explanations for particular human behaviors—including coyness in women—ignoring the influence of culture. Ruth and Stephen challenged the concept and pushed me to challenge it. I learned that I not only had the right to question scientific paradigms—but a responsibility to question them.
One of my first clinical rotations during my residency in cardiology at Brigham and Women’s Hospital helped me find my path. My attending was Dr. Lee Goldman, a cardiologist who was one of the early founders of the field of clinical epidemiology, taking large clinical datasets and finding patterns to steer better outcomes. He helped clinicians predict the cardiac risk of non-cardiac surgery, established criteria to determine which patients with chest pain require hospital admission, and modeled policy priorities for the prevention and treatment of coronary heart disease.
I was so interested in his work that I did three months of research with him later in my residency training and decided that I would combine clinical epidemiology with cardiology, in order to research disparities based on sex and race.
By 2001, I was able to make great use of the inspiration provided by my grandmother and Ruth Hubbard and founded the Connors Center for Women’s Health and Gender Biology at the Brigham and Harvard Medical School, as well as relaunched the Division of Women’s Health. In that role, I worked for 15 years to advance the science and change a medical and scientific culture that views men’s biology and experiences as normal, and women’s as a mere deviation from the norm.
The truth is that men and women are different in every cell in their bodies. And these genetic differences are compounded by hormonal and reproductive changes across a woman’s lifetime—as well as women’s unique experiences and stresses.
Women’s hearts are different, their lungs are different, their lives are different. Pharmaceuticals act differently in men and women. Diseases manifest themselves differently. If we fail to take such realities into account, we are leaving women’s health entirely to chance.
Yet, until the 1990s, women were routinely excluded from National Institutes of Health Phase III clinical trials. The cost of leaving them out was high. Of the 10 prescription drugs withdrawn from the market by the FDA between 1997 and 2001, eight had more severe adverse health effects in women.
But in 1991, there was a watershed event: the Senate Judiciary Committee hearings at which Anita Hill accused Supreme Court nominee Clarence Thomas of workplace sexual harassment and was not treated particularly well by the White male Senators questioning her. A lot of American women woke up then to the injustices they were experiencing. It was not unlike the moment in 2017 when women began coming forward with allegations against Harvey Weinstein, and #MeToo became a rallying cry.
Among those injustices was biased medical research. Congresswoman Pat Schroeder said it was the Physician’s Health Study—which led in 1989 to the finding that aspirin taken daily would prevent heart attacks—that tipped her off. Every single one of the 22,000 physicians included in the clinical trial was a man. In fact, in 2005, aspirin was shown by the Women’s Health Study to reduce the incidence of strokes in women, but not heart attacks. Both of these trials had their homes at the Brigham, but it’s telling that women had to wait 16 years longer for their results.
By 1993, Pat Schroeder led a group of women in Congress who ensured that the NIH Revitalization Act included a mandate that women and minorities be included in Phase III clinical trials.
That was a step forward, but it was definitely too early to declare victory. In 2015, 22 full years later, the Government Accountability Office concluded that the NIH was not living up to the intent of the law, by failing to ensure that clinical trials analyzed their outcomes by sex. Clearly, when you include both men and women in a drug trial, the average response may hide what is most relevant. Here is how Pat Schroeder described the lagging NIH: “It reminds me of when you ask your children to move the clothes from the washer to the dryer. Then you go back, and the clothes are still wet, and they say, ‘Well, you didn’t tell me to turn the dryer on.’ ”
It took another act of Congress in late 2016, the 21st Century Cures Act, before the NIH began insisting that clinical trial results be reported by sex and race.
In terms of basic and preclinical biomedical research, the vast majority of studies have focused on male animals and male cells. It was not until 2016 that the NIH began expecting that sex be a biological variable factored into the design, analyses, and reporting of the studies it supports. Without that variable—what you have is poor science.
Without that variable in public health surveillance data—what you have is poor public health. Yet, health data is still not routinely stratified by sex and race—and COVID-19 pointed out the costs.
By June of last year, only 13 of the 26 states that had more than 2000 cases of COVID-19 were publishing sex-disaggregated data about COVID deaths. The New York Times had to file a Freedom of Information Act lawsuit in the spring of 2020 to get the CDC to release data about race and ethnicity in COVID cases, which revealed grossly disproportionate infection rates for Black and Hispanic people.
The failure to consider the differences that affect health outcomes really held us back in understanding and fighting the virus in the first months of the pandemic, and we should take a lesson from it.
Nonetheless, slowly, the science is improving and assembling a growing body of evidence that heart disease, lung cancer, depression, and Alzheimer’s all take different courses in women as in men. I recently ran into a male colleague who is developing a sex-specific drug for a type of heart failure highly prevalent in women, Heart Failure with Preserved Ejection Fraction. That is progress!
Slowly, we also are paying more attention to what is happening at the intersection of sex and race—in part because of the extreme crisis that is maternal and infant mortality in the United States among Black women. Black women die of pregnancy-related complications at a rate more than three times that of White women. Maternal mortality has more than doubled in the United States since 1987, because Black women fare so badly—and this includes wealthy and highly educated Black women. More than half of these deaths are from preventable causes, led by cardiovascular disease. Infant mortality among Black babies is also more than twice that of White babies.
It may be counterintuitive, but the only way to achieve greater equity in health outcomes is to take these differences into account.
Of course, who you are often determines what you see. It’s no surprise that an analysis of 11.5 million health sciences publications between 1980 and 2016 found that studies with a female first or last author were more likely to report research findings by sex.
Who you are influences what you see. But all of us need to see with a greater sensitivity to differences and with more empathy. I am emphasizing the importance of this in medicine because that is my field. But a sensitivity to differences clearly is just as important in the other sciences and engineering.
If you resort, always, to what Invisible Women author Caroline Criado Perez calls “the default male,” you wind up with women’s lives being put at risk because they are outfitted with combat gear, Personal Protective Equipment, or spacesuits sized for men. You have vehicle safety tests for drivers being done on dummies whose size reflects the 50th percentile male in the 1970s—and women 73% more likely to be injured in a frontal car crashes because of it. You have facial recognition software that has an error rate under 1% for when asked to identify the gender of light-skinned men, but that gets it wrong 35% of the time for dark-skinned women.
Women are 51% percent of the population, yet we frequently are treated like outliers whose lives should not influence the design of the world around us.
So, what can we do to change the culture of science, engineering, and medicine in the United States so they can better serve the full breadth of our population?
Clearly, institutions like Lincoln and Wellesley have important roles to play, because the United States needs to bring more women and minorities into science, engineering, and medicine.
It matters, who is at the table, asking the questions. All of us have blind spots. In every field of study, we need the perspectives of different races, genders, degrees of wealth, life histories, etc.—in order to truly understand our world and make progress.
It’s no accident that the two authors on the groundbreaking study of bias in facial recognition software were Black women, Joy Buolamwini at the MIT Media Lab and Timnit Gebru, then a graduate student at Stanford.
And when women can innovate, it’s important for women. I think of the MIT spinout Bloomer Tech, co-founded by three women, which addresses the fact that medical devices such as heart monitors designed for men are bulky and uncomfortable for women. Bloomer Tech, on the other hand, has developed washable, flexible sensors to measure heart and lung function that can be embedded into a bra.
That’s why it is so disheartening that last year, just 2.3% of venture capital went to start-ups led by women. Again, women are not a niche market, but a slight majority of the population, so we need more women at the tables where the investment decisions are made, too.
Clearly, a crisis like COVID demonstrates the value of getting the full talent pool involved. Countries led by women on the whole fared better during 2020, with more rigorous testing strategies, lower death rates, and better economic performance. On the research side, women and women of color were absolutely key to the development to Covid vaccines, including Dr. Kizzmekia Corbett of the National Institute of Health’s Vaccine Research Center, who helped to forward the speedy development of the Moderna vaccine; Dr. Özlem Türeci, who led the development of the Pfizer vaccine as Chief Medical Officer of BioNTech; and Dr. Katalin Karikó, who conducted the foundational research for the modified messenger RNA on which both these vaccines are based.
At the same time, COVID-19 shone a harsh light on the challenges faced by women in STEM.
A recent National Academies report on the impact of Covid-19 on the careers of women in academic sciences, engineering, and medicine catalogs the struggles: They range from the sudden expansion of women faculty members’ unequal “second shift” responsibilities as schools and child care centers closed, to the extreme burnout being experienced by those on the frontlines of health care—women who are generally younger, less well paid, asked to work harder, and given less support than their male counterparts.
Research by Wellesley economist Dr. Olga Shurchkov found that even before the pandemic, women in academia spent about 50 minutes more each day caring for children and doing other household tasks than the men in academia. The pandemic increased women’s child-care and housework burden by more than two hours a day, and decreased the research work these women were able to do by about an hour every day. Men showed smaller effects.
So, it’s no surprise that women have submitted proportionally fewer papers to journals than their male peers during the pandemic—especially younger women—putting them behind in the quest for tenure and promotions.
But COVID-19 has only worsened gender inequities in the academic sciences and engineering, not changed their character or fundamental unfairness.
I recently co-authored a paper that demonstrated that article peer reviewers in the health sciences are biased against studies focused on women. Of course, as I mentioned earlier, such studies are much more likely to be conducted by women scientists. Even though the reviewers found the studies focused on women more likely to contribute to medical science, they were nonetheless twice as likely to recommend for publication the same research conducted in men.
Unfortunately, publication bias is far from the worst insult experienced by women in STEM fields. There is the gender gap in pay and promotions, and there is the hostility and harassment. In 2018, I was co-chair of a National Academies committee that reported on the sexual harassment of women in academic science, engineering, and medicine. We found that academic workplaces are second only to the military in rates of sexual harassment.
This is shocking only if you consider it hastily: These are both environments where men outnumber women and where the leadership is dominated by men, and such environments tend to foster sexual harassment.
This harassment includes the unwanted sexual attention and coercion that leap immediately to mind—as well as the more common problem of gender harassment—the put-downs and confidence-destroyers that tend to float beneath public consciousness. We also found that women of color, who have to battle both sexism and racism, were subject to the most harassment.
Frankly, as all of us in higher ed work so hard to bring young women into science and engineering, it is beyond discouraging to think they are being bullied out of those fields. Academic institutions need leaders willing to take on the issue forcefully.
Ultimately, one of the great lessons of the pandemic is that as a society, we cannot leave gender equity to chance. We were thoughtlessly shrinking women’s prospects even before the pandemic. The difference is, COVID-19 has made the unfairness so blatant, we cannot ignore it.
So, this moment of recovery is truly an opportunity to rethink: What can we do to allow women to live up to their full potential, both in service to themselves and to the world at large?
Clearly, both MIT and Wellesley have succeeded in offering opportunities to women in science and engineering, and I know that Lincoln has been wonderful about outreach, even at the K through 12 level, working to widen the pipeline of talent—again, a national security issue.
At Wellesley, five of our seven most popular majors are in STEM, and we have fantastic faculty in STEM fields: They top the list of faculty at liberal arts colleges without graduate programs, in terms of federal support for their research. Among our liberal arts peers, we produce the largest number of women who go on to earn science doctorates, and the second largest number of women who earn doctorates in math.
We are also a force for racial and ethnic diversity in the sciences: Over the past 10 years, we have doubled the percentage of STEM degrees we award to underrepresented minority women, to 22%.
But I want to emphasize, if those of us in academic leadership want to be more diverse and inclusive, it is not a numbers game. It requires a complete transformation of the institution.
At Wellesley, our strategic plan—the first for the College—puts inclusive excellence at the very center of the Wellesley experience. And we have made our whole curriculum more inclusive, to help young women from all backgrounds progress in their courses of study.
We also understand that it is so important that we introduce our students from less privileged backgrounds to the full range of possibilities, because they may very well not know what is out there to dream about.
I am an example of that. I started medical school without understanding what academic medicine is. When I first arrived at Wellesley as president and learned that the college was stratifying pre-med students—coaching them on where to apply to medical school, based on what they thought as undergraduates that they wanted to do with their lives—I put a stop to it. That kind of stratification clearly discriminates against first-generation, low-income, and underrepresented minority students, who do not have the same exposure to potential career pathways as their more privileged peers.
If I had been subject to that kind of thinking, I would have been discouraged from applying to Harvard Medical School, and many options could have been closed to me.
It is the job of colleges like mine to give students a sense of the possibilities. And getting them to participate in research is so important, in that it allows them to understand the culture and practice of science, and to explore different fields hands-on.
As institutions, and society-wide, we also need to rethink the structural supports we offer our women graduate and medical students, post-docs, research staff members, junior faculty, and research scientists—to allow them to do their best work. At Wellesley, we provided our junior faculty with a grant this year specifically geared to childcare and housing—both, as you know, very expensive in the Boston metro area. And we are thinking hard about ways we can further support their career progression.
Possibly most important, we need to take the painful lessons of COVID-19 and help the next generation to ask better questions of themselves. When they consider the grand challenges in science, engineering, medicine, and national security, do they also consider how social inequalities influence them? Are they including justice and fairness as design criteria, whether for a scientific study or a new technology? Do they see talent in people who are different from them, and do they value it as something not to be squandered?
These lenses are utterly essential, for anyone hoping to find a way to real solutions.
Ultimately, COVID-19 offered an extreme test of many of our society’s structures and systems—and gave us the gift of a new perspective on the ways that they disadvantage women and minorities.
I have been talking a lot about sight today. The first step in fighting injustice anywhere is transparency: You need to see what is happening before you can fix it.
As scientists and engineers, all of us are in the business of revealing truths. We should be impatient with average responses, with one-size-fits-all designs, with unstratified data, and with objective sorting mechanisms that nonetheless always seem to disfavor women and minorities.
When we consider and uncover the distinctions that matter, we are giving injustice no place to hide. We are facing up to the problems that count. And we are putting the United States on the road to a healthier, more equitable, and more resilient society.
Thank you.