When former First Lady Michelle Obama unveiled her new portrait at the National Gallery of Art in Washington DC on 12 February 2018, she made a speech. Standing before the striking image painted by Amy Sherald, she said just how important she thought it was for young black girls to visit the gallery and see the painting, to realise what was possible — to see a portrait of someone who looked like them. Perhaps she hoped the portrait of a black woman who had become First Lady, hanging side by side with the great and the good of America’s history, would inspire. Or perhaps not quite that; perhaps she hoped it would simply normalise the achievement.
In whatever field we work, we should not underestimate the power of examples, of role models, of trail blazers, of “people who look like me.” Women dominate the world of clinical research in terms of numbers, but not in terms of leadership. For example, what percentage of Chief investigators are women? In contrast, what percentage of Research Nurses and Administrators and Pharmacists are women? There are obviously a number of reasons for this imbalance, but might the lack of visible role models be one of the reasons why women are so underrepresented in leadership roles in this field.
When we write books and tell the tale of how Clinical Research has developed, it is inevitably a story of men and white men at that. I know this for a fact, because I have written several of those books. How many women innovators in clinical research can you name? Probably none. Is that because there weren’t any, or is it simply that their contributions have been overlooked and their stories untold?
Even a cursory glance through the pages of history, especially recent history, would suggest it is the latter. For example, there is Elizabeth Wortley Montagu who pioneered smallpox inoculation 75 years before Edward Jenner tested his vaccination procedure.
There are Dorothy Irene Height, an African-American Civil Rights Activist and Patricia King, an African-American Lawyer who both served on the National Commission that produced the Belmont Report in 1979 and defined the three key principles that would underpin Clinical Research Ethics in the US and in many other countries up to the present day.
And there are three women in Nuremberg — Herta Oberhausen, the German defendant, Wladyslawa Karolewska, the Polish victim and Vivien Spitz, the American Court Reporter who all sat in the same dismal courtroom in 1947. Their combined story helped shape the outcome of the Doctors’ Trial and the way we would remember it seven decades later.
Against this background of contemporary gender inequality, should we do more to raise awareness of these women and the countless others who have helped forge modern clinical research? I think we should, and I’m busy trying to do that right now, but in so doing I have come across a further, deeper complication in the work.
My approach has been one of excavation — to identify women who have played a significant part in the story of clinical research and to tell their stories, and thus to inspire and motivate or perhaps just to normalise their contributions. But, by specifically focussing on women I have been brought to task by some who feel that the problem is not solved by such positive discrimination.
“Why would you write a book about women in research?” they say. “You should be writing a book about people in research.” This objection seems to cut to the core of modern feminism — once an inequality is acknowledged, how do you redress it? Do you restore the balance by giving renewed emphasis to those who have been left out of the story, or is that just a patronising fix that only serves to paper over a much deeper crack? By focussing on women in this work, do I simply perpetuate, even amplify, a difference that should never have existed in the first place? I suppose my take, for what it’s worth, is that while it should never have been an issue, it is a real problem now with, I think, real consequences.
I know this is a controversial topic, and I know there is no single answer to it. I also know that it is not simply my male perspective at odds with a female one, after all not all women think alike, nor do all men. What it is, however, is an issue that divides rather than unites. If the ‘solution’ to a problem makes that problem worse, we should take a breath and start again. But if we only think it might make it worse, isn’t it worth a try?
We all need people who look like us whether we are young or old, black or white, male or female, and if they don’t paint pictures of them or write books about them, I think they should start.
© Allan Gaw 2018
Now available in paperback…
Testing the Waters: Lessons from the History of Drug Research
What can we learn from the past that may be relevant to modern drug research?
“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.” Madhu Davis review in Pharmaceutical Physician May 2016.
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