Arghavan Salles, MD, PhD Profile picture
Aug 26, 2021 7 tweets 4 min read Read on X
It's not every day your piece is front and center on the @TheLancet homepage!!

I was delighted to work with @reshmajagsi on this commentary covering what institutions should do to reverse the damage the pandemic has done to women's careers. 🧵

thelancet.com/action/showPdf…

1/ Screenshot of The Lancet ho...
We have four major recommendations. "First, institutions must intentionally implement best practices to recruit, select, retain, and promote women..."

This would include criterion-based evaluations and transparency regarding roles and compensation.

2/ Screenshot of first page of...Screenshot of second page o...
"Second, institutions should ensure they provide paid parental leave and resources to support caregiving. Flexible options...can be helpful if they are part of a broader approach that recognizes the existence of family responsibilities for all employees."

3/ Screenshot of second page o...
"Third, academic institutions should ensure that women researchers receive adequate funding to mitigate any longer-term impacts of the COVID-19 pandemic on their contributions to medical science."

4/ Screenshot of second page o...
"Finally, institutions should more proactively address workplace gender bias and harassment, which have worsened and taken on new forms with virtual work, particularly for non-white women."

Indeed, none of this will work without attention to intersectionality.

5/ Screenshot of second page o...
"The leading institutions of the future will be the ones who make the choice now, in this moment of uncertainty, to reverse the pandemic-induced backsliding of women's careers."

Pls share what your institutions are doing below!

6/6 Screenshot of second page o...
PS Huge thank you to @jocalynclark for inviting us to write this and for giving critical feedback. Please also check out the other articles in the "Advancing women in science and health" collection!

thelancet.com

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More from @arghavan_salles

May 28
I signed up for the "n0n-w0ke" impl!cit b!as training. Follow along if interested!

It looks like Part 1 is about 42 mins or so and starts with an overview. Notice there are no references for the bold assertions on the right. Screenshot of a slide that says "Key points: Part 1 -Requirements for Michigan implicit bias training -"Implicit bias" defined -The Implicit Association Test 9IAT): what does the evidence say? -"Health equity" and "equitable access to care" -How Critical Race Theory (CRT) relates to implicit bias in healthcare  a box on the right says, "Did you know? Politicized healthcare means more discrimination, less personalized care, and less innovation that saves lives."
Lol off to a great start as they say "Do No Harm" was established to "restore merit to healthcare," a phrase that is problematic for many reasons, including the implication that healthcare was ever meritocratic (it was not).
Their stated goal is to keep "identity politics" out of healthcare, which is 1 way of saying they want to pretend everyone is treated the same and has the same opportunities even though that's not true.

I know this is petty, but there's an extra space before "renewals" Screenshot of a slide that says "Michigan Implicit Bias Training Requirements": New applicants: 2 hours of implicit bias training in the 5 years preceding your application; Renewals: one hour of training for each year of your license cycle
Read 18 tweets
Apr 9
The problem isn’t false accusations. It’s that men refuse to acknowledge rape. “They [rapists] had absolutely no sense of themselves as rapists and were only too happy to talk about their sexual behaviors.”

Based on a study of rapists, as described in Missoula by Jon Krakauer.🧵 The participants in the study had no qualms about being research subjects, Lisak told me, "because they share this common idea that a rapist is a guy in a ski mask, wielding a knife, who drags women into the bushes. But these undetected rapists don't wear masks or wield knives or drag women into the bushes. So they had absolutely no sense of themselves as rapists and were only too happy to talk about their sexual behaviors." Most of the student rapists interviewed by Lisak were regarded by their peers as nice guys who would never rape anyone, and regarded themselves the same way.
They are too entitled and self-centered to see the harm they cause. The serial rapist hidden in plain sight among us, isak explained, "harbor all the usual myths and misconceptions about rape. Adi. tionally, we now have data showing they are more narcissistic than average. So they are caught up in their own worldview. They lack the ability to see what they do from the perspective of their vic-tims. It's not like they've spent any time thinking about what it would be like to be passed out and wake up to someone raping you. It's not like they've ever asked themselves, 'How would I feel if I fell asleep, someone climbed on top of me, and penetrated me wit...
“It pissed me off that she played along the whole way and then decided to squirm out of it…I mean, she was so plastered that she probably didn’t know what was going on, anyway.”

It’s sad this has to be said, but if she doesn’t know what’s going on, she can’t consent.
She was really woozy by this time. So I brought up another drink, you know, and sat her down on one of the beds, sat down next to her, and pretty soon I just made my move. I don't remember exactly what I did first. I probably, you know, leaned her down on the bed, started working on her clothes, feeling her up. ... I started working her blouse off. ... At some point she started saying things like ... I don't want to do this right away, or something like that. I just kept working on her clothes, ... and she started squirming. But that actually helped, because her blouse came off easier. And ...
Lisak's interview with Frank was typical of the interviews he did wich other rapists. In a part of the interview not included above, Lisak told me, Frank "actually described two other rapes he did, under almost exactly the same circumstances, except the two other victims were unconscious from alcohol at the time. And Frank had no idea that what he was describing to me were acts of rape." Predators like Frank get away with it over and over, Lisak explained, because most of us are in denial. We're disinclined to believe that someone who's an attentive student or a congenial athlete ...
Read 4 tweets
Dec 16, 2023
The pandemic has been so badly bungled that people don’t know if they have Covid, don’t care if they have Covid, don’t know when to test for Covid…what are we doing here??

My mom just tested positive for Covid and wouldn’t have known if I hadn’t told her to test again… Photo of a positive Covid test and a text message that says “positive”
…She had tested the first day of symptoms and was negative. I told her to test again, and bam, positive.

A family friend got Covid around Thanksgiving. I told her she should keep testing even after she feels better bc of rebound and how long some people stay positive…
…She had taken paxlovid and started to feel better. Then, symptoms came back and bam, she was positive again.

These are smart people who follow the news. My mom didn’t know to test again, family friend didn’t know about paxlovid rebound…
Read 5 tweets
Aug 25, 2023
We don’t talk enough about coercion in healthcare. I just had a procedure I did not want to have because I was forced to do so in order to move forward with IVF. I stated multiple times I would accept the risk of foregoing the procedure. (The risk, as far as I can tell, is…
…perhaps slightly lower success rate for implantation.) I invoked shared-decision making and bodily autonomy to no avail. I was reassured, in the classic paternalistic medicine way, that this was in my best interests.

I am a 43-year-old physician. If my doctor doesn’t think…
…I am competent and capable of making decisions about what’s in my best interest, do they think anyone is?

So today when the PA wanted to confirm that I wanted to move forward with the procedure, I told her the truth: No, I did not want to have the procedure, but…
Read 11 tweets
Jul 19, 2023
Did you know up to 200 women at Yale’s fertility center were forced to undergo egg retrievals without narcotics? These procedures are typically done under heavy sedation, but these women were awake enough to talk; one even told them she was alert enough to drive. These women…
…were in pain, and they were brushed off. A nurse in the clinic had swapped out fentanyl for saline in hundreds of syringes. So for FIVE MONTHS women had these horrific experiences. They told their doctors, but nothing was done. One of the women recalls her doctor saying…
…only that he was “perplexed” and “surprised.” Without another explanation, some of the women were convinced it was their own fault; they must not be sensitive to fentanyl.

The patients weren’t aware of the fentanyl swap, but they knew something was wrong. One of them said…
Read 10 tweets
Jul 18, 2023
We all know women make less money than men. Did you know people are compensated less for performing procedures on female patients than if performing similar procedures on male pts? We’ve know this in the US, where compensation is based on RVUs which are determined by a group of…
…almost exclusively men.

A recent study found the same thing in Canada, where compensation is totally different!

Urologists and ob/gyn surgeons created a list of procedures performed for female patients and identified analogous procedures performed on male patients…
…70% of these procedures were compensated more highly when performed on male patients. What really blew my mind is that treating ovarian torsion (remember, the ovaries are inside the pelvic cavity) is compensated less than treating testicular torsion. We all know… Screenshot of a figure showing compensation for procedures performed for female patients to similar procedures performed for male patients. Bars extending to the left are ones where compensation is lower for caring for female patients. The majority of the bars extend to the left.
Read 7 tweets

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