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Gender data gap: Women suffer needless pain in a world designed for men

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In the 1983 movie Yentl, the title character, played by Barbra Streisand, pretends to be a man to get the education she wants. She has to change the way she dresses, the timbre of her voice, and much more to get any respect.

In medical lore, the term “Yentl syndrome” has come to describe what happens when women present to their doctors with symptoms that differ from men’s — they often get misdiagnosed, mistreated, or told the pain is all in their heads. This phenomenon can have lethal consequences.

Many, many women have had this experience when they go to the doctor. I had it myself, years ago. As a spate of articles about the phenomenon has come out in the past couple of years, more people have begun talking about a “gender pain gap.”

In a new book, Invisible Women: Data Bias in a World Designed for Men, the British journalist and feminist activist Caroline Criado Perez argues that this is part of a larger problem: the “gender data gap.” Basically, the data our society collects is typically about men’s experience, not women’s. That data gets used to allocate research funding and make decisions about design. Because most things and spaces — from pain medications to cars, and from air-conditioned offices to city streets — have been designed by men with men as the default user, they often don’t work well for women.

Even when researchers do gather data from women as well as men in their studies, they often fail to sex-disaggregate it — to separate out the male and female data they’ve collected and analyze it for differences. That’s crucial, because a new pain medication that’s ineffective for men may work great for women, but you’d never know it if you mixed all their data together.

All this gives rise to a powerful possibility: What if we can reduce suffering for half the population, simply by ceasing to design everything as if it’ll only be used by men?

Criado Perez’s book discusses how biased design shows up pretty much everywhere, but the issues she identifies in the realm of health are the most striking because they’re the most dangerous.

I spoke to Criado Perez about why the medical system treats women’s pain differently, whether we need to design drugs specifically for women, and how she dealt with the gaslighting she experienced while working on the book. A transcript of our conversation, lightly edited for length and clarity, follows.

Sigal Samuel

You write that the medical system is “from root to tip, systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed.” Can you start by explaining how the system got this way?

Caroline Criado Perez

It’s always been this way. And it comes from the fact that the male body has always been taken as the standard human being. The female body is seen as the atypical body. You see that going all the way back to Aristotle — he refers to the female body as a mutilated male body — and you see it in textbooks today, where the male anatomy is presented as the anatomy.

I don’t think there’s some giant conspiracy and medical researchers all hate women and want us to die. It’s just that this way of thinking is so pervasive that we don’t even realize we’re doing it.

That’s partly because of the excuses we still get [from medical researchers], which are outrageous — like the excuse that women’s bodies are too hormonal and too complicated to measure. Male bodies can be very variable, too. And women are 50 percent of the global population!

Sigal Samuel

To me, one of the most striking findings in your book is that in the UK, women are 50 percent more likely to be misdiagnosed after a heart attack, according to Leeds University researchers. That stems from the fact that heart failure trials typically use male participants. And when we picture someone having a heart attack, we picture a middle-aged man clutching at his chest or arm, like in a Hollywood movie.

Caroline Criado Perez

Yeah, and it’s actually been heartbreaking because since publishing the book, I’ve had quite a few people get in touch with me about heart attacks, saying, ‘My mother died of a heart attack because she didn’t present with the ‘typical’ male systems.”

The fact that we are still misdiagnosing these women is shocking. We call female heart attack symptoms atypical, but they are actually very typical — for women. And we’ve known about the female symptoms [like stomach pain, breathlessness, nausea, and fatigue] for a long time now, because cardiovascular research is the field where the most work has been done on sex differences. [Misdiagnoses continue in part because some doctors practicing today were trained on medical textbooks and case studies that depict heart attack victims as men.]

I have no idea how I’m going to cope when my mum dies. But I know that if she dies because of something like that, I will just be so angry.

Sigal Samuel

A study published in Brain in March offered new evidence that men and women have different biological pathways for chronic pain, which means some pain medicines that work for men may not work for women. Do you think we should be designing drugs that are specifically made for women?

Caroline Criado Perez

I’m not a medical expert, but absolutely it’s something that needs to be looked at. The fact that women may experience pain differently is something I came across a lot in my research. And yet the vast majority of pain studies have been done exclusively on male mice.

Sigal Samuel

Can you give an example of a drug that’s been found to be less effective for women?

Caroline Criado Perez

The most shocking one was a heart medication that was meant to prevent heart attacks but at a certain point in a woman’s menstrual cycle is actually more likely to trigger a heart attack. That has to do with the problem of not testing the drug on women at different stages of their menstrual cycle, because you [the researcher] say, “Oh, that’s too complicated and too expensive.” You’re basically saying, “I would rather let women die than have to do a complicated test.”

What I actually find most interesting is this: Women have more adverse reactions to drugs than men, and while the number one adverse reaction in women is nausea, the second most common is that the drug just doesn’t work. That is partly because [in drug testing] we are — from the cell stage to the animal stage to the human stage — not testing in women. It’s particularly bad in the cell stage as that’s where a lot of drugs get ruled out.

Sigal Samuel

It’s really striking to me that some drugs out there are not just less effective for women, but are actually potentially harmful for us. Since encountering these studies in your research, have you been telling the women in your life, “Hey, you should maybe look at this study and talk to your doctor about it?”

Caroline Criado Perez

Absolutely, yeah. Women have to be aware of this, because the medical profession is not. At least, it’s insufficiently aware of it and not worrying about it enough. It’s really unpleasant actually, because ever since researching this book I wonder, can I trust my doctor to know what the best thing is for me? I don’t know if I can.

Sigal Samuel

You talk a lot in the book about how everything is designed around the body of a “Reference Man.” Tell me about him.


Caroline Criado Perez

Caroline Criado Perez
Rachel Louise Brown

Caroline Criado Perez

[laughs] Ah, my good friend, Reference Man. He is considered the standard human and he is a man. Usually a white man in his 30s, around 70 kg [155 pounds]. He’s the person we’ve used for decades in all sorts of research on the dose of the drugs.

When you get an over-the-counter medication, it doesn’t tell you male and female doses — it says “child” and “adult,” and that adult is a man. It’s Reference Man. To me, that shows the scale of the problem we have here. All these drugs need to be looked at to see whether male and female doses should be different.

In fact, they found that was the case for Ambien. Women were driving to work still under the influence of this sleeping pill and crashing their cars because the dose was too high. In 2013 the FDA had to tell women to cut their dose in half because it turned out they were metabolizing the active ingredient twice as slowly [as men]. The “gender-neutral” dose was anything but.

Sigal Samuel

Wow. And Reference Man also has implications for car crashes, right?

Caroline Criado Perez

Yes. Reference Man is who cars are designed for. For decades, the typical car crash test dummy has been based on the 50th percentile male. That means seatbelts are not designed for the female form, and women have to sit further forward because the pedals are too far away. So women are 17 percent more likely than men to die if they’re in a car crash. And they’re 47 percent more likely to be seriously injured.

Now there are female crash test dummies, but it’s just a scaled-down male dummy. In the EU, out of the five regulatory tests that must be done, the female dummy is only used in one of them, and it’s only used in the passenger seat. That is just completely mad.

A lot of examples are just down to people not having thought of something — like when Apple forgot to include a period tracker in its comprehensive health tracker app (even though it did include “copper intake”!) — that’s a case where they clearly just didn’t remember periods were a thing. But in a case like this, it has been brought to [car designers’] attention, and yet it’s still happening.

Sigal Samuel

There have been some attempts to force researchers to include women in their studies. Have they been effective?

Caroline Criado Perez

In the US, with the National Institutes of Health funding, there’s a regulation saying women must be included in human studies. In 2016, the same came into force for animal studies. But how rigorously is this being enforced? Not very.

In the EU, I’m not aware of any research that’s been done into how successful it’s been, but definitely the regulation is there that if you want funding you have to include women and sex-disaggregate your data.

The issue is that a lot of the research is being done by private companies, for which there is no regulation. And for generic drugs, again, there’s no regulation on including women.

Sigal Samuel

I’m curious about the emotional process you went through as you researched this book. Can you tell me what you felt?

Caroline Criado Perez

It was a building anger and frustration. And not feeling able to quite believe what I was discovering. It’s so explosive and outrageous, and you just feel like, how is it that this isn’t something everyone is talking about? You start to wonder: Am I going mad, am I making this up?

My way of getting through it was to speak to a lot of experts — doctors, anthropologists — because I wanted to be sure this wasn’t some sort of big misunderstanding.

And then after the book was published, some of the reactions from men have been, “You’re making this up, you’re crazy, this is not a real issue.”

Sigal Samuel

It strikes me that there’s a kind of meta-gaslighting here. On one level, women who present to their doctors with certain symptoms sometimes get told, “You’re crazy, it’s all in your head,” because their symptoms don’t conform to male symptoms. Then when you come along and try to study that as a phenomenon, you yourself have to wonder, “Wait, am I crazy for even thinking this is a phenomenon?”

Caroline Criado Perez

You’re really making me think now. I wonder… If I were not a woman and I weren’t so used to being told I’m crazy, would I have doubted and questioned myself so much while reading the research?

Sigal Samuel

I wonder that too. Looking to the future, what do you want people to do to fix this problem? Do we need legal change? A new field of gender-specific medicine? New textbooks?

Caroline Criado Perez

I don’t think I want a new specialization of gender-specific medicine. Because I want that to be the standard. Legislative change needs to happen — governments need to weigh in on this and enact legislation about how research gets done, specifying that it has to be sex-disaggregated. It’s also important to have women in positions of leadership, whether that’s the person doing the research or the person making the funding decisions. Women are more likely to be aware of female-specific needs and that will change the kind of research they think needs to get done.

Sigal Samuel

Overall, do you feel hopeful or hopeless that this problem will change in the near future?

Caroline Criado Perez

Ultimately I think it’s so outrageous and so ridiculous that actually what’s needed is for enough people to become aware of it, and then it will change. The evidence in the book — you can’t read that and think this is okay. It’s very clear: Women are dying. Unless you think it’s okay that women are dying, you must want to change it.


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Amazon 2-day shipping: Why packages sometimes arrive later

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In less than two decades, Amazon single-handedly transformed the way we think about online shopping. Before Prime launched in 2005, two-day shipping was virtually unheard of — now more than 100 million people use the service, and they expect the things they order online to arrive at their doorsteps in 48 hours or fewer.

There’s just one problem: Amazon, which has focused on obtaining customers at all costs for decades, seems to be looking for ways to cut down on shipping costs. In some cases, that means weaning Prime users off the near-instantaneous shipping they’ve come to expect.

From the beginning, free two-day shipping was Prime’s biggest draw. Memberships were cheap — $79 a year in 2005 and $119 today — and users had the option of paying a small fee to get their orders delivered in just one day. Today, Prime is about much more than package delivery: Users can order everything, from groceries to a house cleaner, through Amazon. But as Amazon has expanded, the promise of free two-day shipping — the main draw of Prime — has begun to come with a lot of caveats.

That’s not to say Amazon is totally changing course. In 2014, Amazon launched Prime Now, a service designed to deliver products in an hour or less, for some New York City-based users. (It expanded to other major cities in 2016.) Amazon often makes headlines for the grueling work expected of its in-house delivery fleet — or, more accurately, the network of contractors that deliver packages to Prime users across the country — a sign that it continues to take its shipping promise seriously, often at the expense of workers. But even as Amazon has doubled down on ensuring speedy delivery, it has begun looking for ways to rein in customers’ desire for instant gratification, a phenomenon it arguably helped create, in an attempt to cut costs and streamline its supply chain.

The result? Prime orders don’t necessarily arrive in two days anymore, nor are they always delivered to customers’ homes. All of this makes sense from a financial perspective, but that may not be enough to win customers over.

Prime customers pay for — and expect — quick, free shipping. They aren’t always happy about Amazon’s cost-cutting efforts.

Two-day Prime shipping isn’t necessarily a thing of the past, but it’s undeniable that Amazon delivery isn’t as seamless as it used to be.

Amazon will no longer deliver some small items, like razors or hair ties, individually. Instead, customers have to purchase $25 worth of these “add-on” items before Amazon will send the box out; the point, according to the company, is to give customers access to “low-cost items that would be cost-prohibitive to ship on their own.” Since 2011, Amazon has given users the option to have packages delivered to “lockers,” which are basically branded PO boxes, instead of to their homes or offices. Most recently, Amazon rolled out Amazon Day, a new delivery option that lets customers choose a specific day for all of their orders to arrive, is the company’s latest cost-cutting effort.

All of this makes sense from a financial perspective. Delivering packages to a single location instead of hundreds of individual homes cuts costs, and requiring customers to meet a delivery minimum for small orders helps Amazon consolidate deliveries, as does the Amazon Day program.

But the response to these new initiatives has been mixed at best.

Last December, Fast Company’s Mark Wilson wrote about how Amazon Prime is “getting worse,” claiming the company had all but abandoned its promise of two-day shipping for most products. “That little Prime logo used to mean something,” Wilson wrote. “Now it feels like a ruse that lulls shoppers into a false sense of security, until they go to checkout and see a shipping arrival date far later than anticipated.”

He continued:

“This cuts through the greatest promise of Prime. It’s not just the free, two-day shipping. It’s that it’s so reliable, you never have to think for more than a second about buying something. In this sense, Prime was constructed to be great for the consumer (so efficient) and great for businesses (mindless impulse shopping!). … It doesn’t help that we’ve seen a slow dilution of Prime itself over time, with the rise of Prime Pantry and Add-on Items. They force you to buy a minimum number of items to get the best deal, adding back the very psychic burden Prime had eliminated from the equation of online shopping in the first place.”

Wilson’s complaints about Prime suggest a bait-and-switch strategy. Amazon got 100 million people to become Prime users by guaranteeing frictionless service, but now that it’s gotten a sizable chunk of the market hooked on quick, free shipping, it’s trying to cut delivery costs by scaling back on the very thing that got customers interested in the first place. Put another way, Prime is built on the idea that shopping should be frictionless; Amazon has now introduced a degree of friction that wasn’t there before, and some customers aren’t happy about it.

https://twitter.com/esirof/status/1075426983104917504

“I can’t help but feel the frustration around how the false sense of shopping confidence is blown when Amazon simply uses the PRIME lockup as a gimmick,” one reader wrote in response to Wilson’s article. “The ‘prime’ benefit of getting your stuff when you expect it is gone, and it’s not just because of the holiday shipping crunch.

Amazon changed customer expectations regarding shipping. Now it’s changing them again.

One of Amazon’s core principles is “customer obsession,” a “vigorous” desire to “earn and keep customer trust.” (Amazon has, by the way, also been known to use customer obsession as an anti-union talking point.) Put simply, customer obsession means giving the customer what they want as cheaply and quickly as possible — e.g., within 48 hours or fewer — at the expense of profits.

Anne Goodchild, a professor of civil and environmental engineering at the University of Washington who focuses on supply chain transportation and logistics, told me that Amazon significantly altered customer expectations and shopping patterns.

“The status quo [has been] that we take ourselves to the store, pick up the goods, and go back to our homes. That’s actually a pretty inefficient way of doing the last mile: We all individually use our cars, and that kind of commuting creates a great travel burden,” she said. “Delivery services, to some extent, have the potential to be an improvement. [They consolidate] a lot of deliveries — hopefully — into one vehicle like a UPS truck. They have strong incentives, profit incentives, to do that in an efficient and cost-effective way.”

The problem, she said, occurs when delivery becomes too quick. “As we move toward faster delivery, it gets harder to consolidate.” The promise of instant delivery means that customers can buy virtually anything they want without thinking about it; they don’t always think to consolidate their purchases into a single order, because there’s no need to. (A 2018 survey by the optimization platform Feedvisor found that 46 percent of Prime members shop online more than twice a week.) “When we’re not paying some sort of personal cost for the trip, I think it’s easy to overlook how much travel we’re adding,” she said.

Other retailers have attempted to compete by offering similarly fast shipping. “After Amazon, we have things like ShopRunner and even Target [now] saying that if you order certain items, you can get two-day shipping,” Ambulkar said. “I don’t see two-day shipping going away. I think there’s definitely more and more businesses adopting it.”

Even as other retailers lower their shipping times to keep up, Amazon appears to be tweaking its two-day shipping promise. Prime may be cheap and easy for customers, but the cost of all those deliveries adds up quickly. Amazon spent $21.7 billion on shipping costs in 2017, according to its annual report. That’s nearly twice the amount it spent on shipping in 2015.

“Amazon has pursued a growth trajectory rather than a profit one,” Goodchild added. “I think everyone would agree that their strategy has been to please customers and, in doing so, grow their market share.”

But now that it has more than 100 million Prime customers, Amazon is looking for ways to make Prime more profitable — which could end up alienating some of the customers it has made an effort to court.

Justin Smith, the founder of TJI Research, an analytics firm that focuses on Amazon, told The Goods that Amazon is looking for ways to make Prime more efficient — and cost-effective. “Lockers or other pickup points, or encouraging customers to ship items in the fewest number of boxes possible, which might mean getting it a bit later than if you had shipped items separately,” are all part of that strategy.

“I also think that because of how big they are, they are able to become smarter about predicting what items people are going to order in different regions,” Smith added, “and I believe they’ve been able to put items in warehouses closer to where they expect people to order them from in order to reduce the distance that items have to be shipped when they’re ordered. If that can be done efficiently, I think you reduce the individual shipping volume as well as decrease the delivery time, which improves the customer experience.”

It’s also better for the environment. Transportation is one of the biggest contributors to carbon dioxide emissions in the US, and medium- and heavy-duty trucks — the kinds of freight vehicles that are often filled to the brim with Prime purchases and other online orders — are responsible for nearly one-quarter of the total transportation footprint. These trucks, which used to deliver the bulk of their loads to stores and other retail hubs, are now increasingly dropping packages off to individuals. All those one-off orders add up, both financially and environmentally — but, because this type of delivery is often more convenient for the consumer, this has become the new normal.

Not everyone agrees with the premise that more efficiency will result in greater customer satisfaction. Saurabh Ambulkar, a management professor at Northeastern University, said customers who have come to expect two-day — or even same-day — delivery might not readily accept more optimized, less customer-friendly options. “The whole [promise] was that Amazon can deliver the thing to my house, so why do I need to go to the central locker to get something? Why do I need to go to the store?” he said. “If I have to step out of my house to get something, they lose that competitive advantage that they have, but they have to do some of it [in order to] ease the pressure on the supply chain.”

“In bigger cities, maybe the central locker is closer to the place you work, but in other places, I think delivering to residents is what made Amazon more competitive than other players in the market,” Ambulkar added. “If I have to go to a central locker, I can just go to the store to get that product.”

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A Man From a Remote African Village Has Been Named Best Teacher and Will Get $1,000,000 for It

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When talking about the job of a teacher, many people refer to it as “a calling”. We all want our children to be educated by teachers who love their jobs and who make children feel inspired, interested, and motivated. There are 2 opinions when it comes to teachers: “A talented person will be successful, no matter what,” and “A talented person needs a good teacher.”

A charity foundation that was set up in 2015 by a businessman named Sunny Varkey (and Mohammed bin Rashid Al Maktoum, his patron) awards someone as “Best Teacher” every year with a Global Teacher Prize.

Bright Side was really interested in the winner of the 2019 competition because there were 10,000 applications from 179 countries, with a prize of $1,000,000.

Teachers from India, Australia, the US, Kenya, the Netherlands, Brazil, Japan, Argentina, Great Britain, and Georgia made it to the final stage of the competition.

A Kenyan science teacher and Franciscan friar named Peter Tabichi won the award. The award ceremony took place in Dubai and the name of the winner was announced by actor Hugh Jackman.

Peter Tabichi is a teacher in a small African village where the inhabitants often don’t have enough of the most necessary things. Despite this, his students are famous for their wins in international science competitions which is what ultimately attracted the foundation’s attention.

The school these students go to doesn’t look like a school that houses major victories. There is only 1 teacher for 58 students and 1 computer, and in order to make it to lessons, many kids have to cover huge distances on washed-out roads during the rainy season. Most of Tabichi’s students are kids from poor families or they’re orphans. The school is sorely lacking financial support, so Peter donates 80% of the money he makes on the development of the school — the school uniforms, textbooks, and other materials.

7 years ago, he used to teach at a private school but then decided to become a Franciscan friar and leave his job. The code he lives by requires him to have a somewhat ascetic lifestyle and help others. This is why teaching at a poor school is considered charity for Tabichi.

“This win does not belong to me: it demonstrates the achievements of young minds. I am here only thanks to my students’ achievements. A victory gives them a chance. It means that there are no borders for them.”

Tabichi explains how he uses different motivation methods with his students because the secret to success is believing in yourself. Every person can find something they like doing and feel confident. Peter teaches kids to look at things from different perspectives. This is why his projects where students can organize processes and analyze results by themselves are very popular.

The teacher doesn’t say that some of these projects are “cool” and others are “not cool”. The most important thing about them is that the students have to use their imaginations and have to look for new solutions. Tabichi says, “Creativity is extremely important, especially in difficult situations when the resources are limited.”

In this school, there are scientific and creative clubs where every student can showcase their achievements.

“Seeing my learners grow in knowledge, skills, and confidence is my greatest joy in teaching! When they become resilient, creative, and productive in the society, I get a lot of satisfaction for I act as their greatest destiny enabler and key that unlocks their potential in the most exciting manner.”

Tabichi also managed to talk about tolerance: “He created the ’Peace Club’ where there are people of 7 different nationalities and religious beliefs who all visit this school.

People are most interested in one big question: What is he going to spend his prize money on?

His answer? First and foremost, on computer science class, the development of the science lab, and new projects that can improve people’s lives. For example, Peter wants to teach his students to grow drought-tolerant crops. This project is absolutely necessary for life in Africa.

Interestingly, the agreement terms of the foundation say that the winner has certain responsibilities and the prize is not given to the winner right away.

For 10 years, the winner gets $100,000 every year and they have to stay in the profession for 5 years and be a global ambassador for The Varkey Foundation. It means that they have to visit certain events, talk to the media, and participate in training.

We’re deeply impressed by such people! Their stories are bright illustrations of what we call “the purpose of life”. What do you think about this award?

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Digital Trends Live – 4.15.19 – All Digital XBox + An App That Gives You Stock For Shopping

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On today’s episode: The discless Xbox may be the worst kept secret and it’s coming next month, Apple is spending big on its Arcade offering, A.I. invents a new sport, Gixo fitness app goes live in a world of VOD offerings, Bumped is a loyalty app that gives you stock for shopping with your favorite brands, Stratolaunch makes maiden voyage, Pepsi may become the most hated brand in the world with upcoming space billboard, Freelancer teems with Arrow Electronics to provide on-demand engineering services.

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