A play in 3 acts’; Weighing the Risks vs. Benefits of Research

Act I. Can women intubate?

Two South Korean authors asked whether physician gender has a significant impact on intubation success, and found that “Female physicians are not inferior to male physicians in performing emergency endotracheal intubation.”

Act II. It’s not about American women – South Korea is really sexist.

The article had a swift and bitter reaction on Twitter with some calming voices noting that “noninferiority” in this context is a defined statistical term, and that this study was likely undertaken in the name of combating sexism in South Korea.

The aftermath has led to the removal of the article and apologies from the authors.

Act III: Consider: “Injustice anywhere is a threat to justice everywhere.” MLK, Jr.

The twitter outrage over this study was much greater than the outrage of American women over other more blatant sexism and discrimination in the world.  When revelations about the policies rigged to keep women out of medical school in Japan were made public, there was no twitter storm in its wake.  Similarly, while women in Saudi Arabia only recently got the right to drive, and it’s still “complicated,” no twitter mob is tagging representatives of that country.

No. And that is because while women are not equal in any place in the world, and while exposing the degree of injustice is a beginning to address the discrimination, most women are generally aware of some of the inequality they face.  What outraged women, and the twittersphere, is not the sexism in South Korean medicine, or the lack of understanding of context and culture by two native South Korean authors.  Rather, the outrage was directed toward the sexism of an American academic journal for physicians.  For if the editors at the American  Journal of Emergency Medicine, functioning within their native culture and language, failed to see how the phrasing of this paper would be received broadly, then this episode simply exposes the sexism women face in this country.

In medicine, when we make a treatment recommendation, we weigh the risks against the benefits of treatment.  Life is not perfect, and there are few things we do that have no risk.  Instead, we weigh the value of what we hope to gain vs. the risk of what we might lose if a certain course of action is recommended.  Similarly, one can consider a process where the possible benefit to South Korean female physicians in having these data published is weighed against the possible risk of harm to others who view research of this sexist question as legitimizing it, and the attitudes it tries to counter, in the world.

Perhaps these data could have been framed with more appropriate context and expectations about strategies on combating structural sexism and racism. For example, is every sexist and racist question worthy of a clinical trial to be disproved? And if so, by statistical methods we would expect at least some of those studies to find a difference by random chance even if none exists. Can these studies then be justified in perpetuating the racism and sexism they purport to alleviate?

Biological differences between people and groups of people are common, and have been used since time immemorial to justify all kinds of discriminatory behavior. Women are outraged because while we remain optimistic at the progress made, we are continually reminded of how close we are to slipping back.  “Injustice anywhere is a threat to justice everywhere,” MLK said, and the American Journal of Emergency Medicine has reminded us that the injustice in South Korea is a lot closer to home than we would have liked to believe.

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