National Institutes of Health and Gender Bias

Did you know that many clinical trials of drugs and medical devices deliberately exclude female subjects? Scientists have traditionally preferred male subjects because they believe that female hormonal cycles might cause variability and skewed results. Of course, the deeply flawed logic of this thinking should be obvious – if hormonal fluctuations affect results, then results are not skewed but in fact may indicate a key gender difference. But nothing has been done about this bias until recently. The latest good news is that the NIH is now starting to require the use of female subjects in trials. See the details here.

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Death and Stories

If Ben Franklin is right that death and taxes are all that’s certain, our time in this world is pretty much defined by uncertainty. And if you’re seriously ill, like Paul Kalanithi, a neurosurgeon who wrote a lovely piece for Sunday’s NY Times about his fight against cancer, the uncertainty of knowing how much time you’ve got left takes on an entirely new level of intensity.

Skilled at offering hope to terminally ill people while being careful not to predict how long they might live, Kalanithi suddenly found himself in the same maddening position as his patients. At first, he persisted in trying to get his oncologist to tell him how much time he might have – of course to no avail.

But eventually he realized something important:

I began to realize that coming face to face with my own mortality, in a sense, had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one.

He began to understand that when patients become obsessed with how much time they have left, they are not really asking about how much time they have left:

What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.

Science has helped to keep Kalanithi alive for a bit longer, but it had no power to help him through what was arguably his real crisis: a heightened and crippling uncertainty. For that, he needed Samuel Beckett:

I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I’ve not even read that well, learned long ago as an undergraduate, began to repeat in my head, and the seemingly impassable sea of uncertainty parted.

What are the seven words? Read the full piece here to find out.

And then go read Samuel Beckett. Or whatever writer helps you grapple with the uncertainty that – unlike death and taxes – actually defines our lives.

Jeanette Winterson on Oscar Wilde’s Fairy Tales

Oh how I love Jeanette Winterson and most everything she writes. Along with her stunning novels and her ingenious 2011 memoir, Why Be Happy When You Could Be Normal, she writes great reviews that are both brilliant and warm. Read her latest in the Guardian on Oscar Wilde’s book of fairy tales, The Selfish Giant and Other Stories.

What I love about this review is how she explains – and understands the need to explain in our current age of science-worship – the value of fairy tales and fiction in general:

Reason and logic are tools for understanding the world. We need a means for understanding ourselves, too. That is what imagination allows. When a child reads of a Nightingale who bleeds her song into a rose for love’s sake, or of a Selfish Giant who puts a wall round life, or of a Fisherman who wants to be rid of his Soul, or of a statue who feels the suffering of the world more keenly than the Mathematics Master who scoffs at his pupils for dreaming about Angels, the child knows at once both the mystery and truth of such stories…As explanations of the world, fairy stories tell us what science and philosophy cannot and need not. There are different ways of knowing.

Read the full review. Read Winterson’s stories. Read Oscar Wilde.