Category Archives: June 2020

Racist Science: Books on How We Got Here

When I originally began writing this – my next article for the Insight – it was going to be about things to read during a pandemic. George Floyd hadn’t been murdered yet. Protests hadn’t begun. And originally, I was going to put an extra section at the beginning of my article on racism in science and medicine.

That’s not enough; this topic really needs its own article and more. Speaking here as a white person, I can’t stress enough how critical it is for people like me to self-educate and do some thorough self-examination, and this article meant to be a point from which people can start.

Racism is endemic in our society, and it’s endemic in our sciences. It’s something that the scientific community has passively accepted and ignored for years, and it’s high past time to end that. If you’re new to this, welcome! Reading about racism is a great way to open your mind and determine where your own biases lie. It’s also a great way to keep yourself moving and thinking if you feel you’ve hit a standstill in your progress on this important and evolving topic. Identifying and uprooting biases and racism is a continuous learning process, one that I’m committed to being better at.

The title of each book on this list is linked to The Frugal Bookstore, Boston’s only Black-owned independent bookstore, where possible. Please join me in picking one (or more!) to read, and let’s start educating ourselves and doing better!

The Immortal Life of Henrietta Lacks (Rebecca Skloot)

The scientist that obtained Henrietta’s cells did so without her consent. More than 20 years after her death in 1951, her family finally learned the truth: that scientists had been using her cells for years, that people had made a lot of money from discoveries using those cells, and that they themselves never saw any of the profits.

Most students in the biological sciences are familiar with HeLa cells. Here, Skloot presents the reader with the story of Henrietta Lacks herself, as well as the results of race exploitation in scientific discovery. If you have a few hours to spare, check out the 2017 movie adaptation, featuring Renée Elise Goldsberry (of Hamilton fame) as Henrietta Lacks and Oprah Winfrey as Deborah Lacks.

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (Harriet A. Washington)

The story of Henrietta Lacks is the tip of the iceberg when it comes to the history of exploiting African Americans for medical and scientific progress. It starts long before that, at least as far back as the 17th century. Medical Apartheid presents the first comprehensive history of medical experimentation on African Americans.

This is going to be an uncomfortable book to read. What we now think of as racism in the medical system – racial disparities in access to health care, morbidity, and mortality rates – began with horrific and nonconsensual experiments (a quick Google search on James Marion Sims, the so-called “father of modern gynecology” should do the trick, for anyone curious). And while we have made much progress in that regard, there is so much more left to be done.

Already read this one? Check out one of Washington’s other books on the intersection of race and medicine: A Terrible Thing to Waste details environmental racism and its contribution to racial disparities in disease.

Superior: The Return of Race Science (Angela Saini)

For many white people, the story of overt racism in science may end with the end of World War II and the Holocaust, when people realized the consequences (putting it quite lightly) of the mass implementation of eugenics. But science did not truly let go of racism. Society hadn’t (and still hasn’t) abandoned the idea. It just took on an even more insidious nature.

Superior covers racism throughout known history. It is a book exposing the way scientists cling to an idea of race as a biological truth, as something that is encoded in our genes. This is a book that reveals the propensity of science to look for genetic differences in races as a convenient way of explaining away a difference in disease risk, poverty, and other things, when so much more goes into an individual than genetics.

The Mismeasure of Man (Stephen Jay Gould)

And there is much more to an individual than genetics. Published in 1981, The Mismeasure of Man systematically dismantles the idea that differences between groups of people (such as races) comes from genetics, a malpractice often referred to as biological determinism.

While Gould received great reviews in the popular press, the scientific community gave him the cold shoulder with claims of historical inaccuracy and political bias.

We all have a lot of work ahead of us to successfully strip our communities of racism. The above works touch only on the highly visible aspects of racism in science; microaggressions and other vastly overlooked racist practices are yet another area in which the sciences need to get a whole lot smarter.  It’s not going to happen overnight, but it does need to happen. If you’re looking for more resources, please consult this #STEMforBLM Resource List. It contains more books on racism in science, as well as links to general resource lists (which contain titles like How to Be an Antiracist by Ibram X. Kendi, White Fragility by Robin J. Diangelo, and Between the World and Me by Ta-Nehisi Coates).

Books may not be everyone’s speed, but there are plenty of podcasts to check out if that’s more your style. There are two episodes of NPR’s Short Wave, a podcast on the science behind various news headlines, that might be particularly interesting. “Coronavirus and Racism are Dual Public Health Emergencies” details how systemic racism causes health disparities, such as during the Coronavirus pandemic. In “Science Is for Everyone – Until It’s Not” Brandon Taylor tells his heartbreaking story of why he had to leave science – because of how his fellow scientists treated him, as a Black person.

Which book will you be reading? Have you read any of these, and if so, what did you think?

Black Lives Matter: In STEM and Everywhere

Black lives matter. Derek Chauvin, the police officer who killed George Floyd, knelt on Floyd’s neck for 8 minutes 46 seconds; Eric Garner said “I can’t breathe” 11 times before he died in the chokehold put on him by a NY cop. It took 74 days to arrest Travis and Gregory McMichael, the shooters of Ahmaud Arbery. Amadou Diallo was shot 41 times by the NYPD, Michael Brown was shot 6 times by Ferguson police officer Darren Wilson, Philando Castile was shot 5 times by a cop from St. Anthony, Minnesota, Ezell Ford was shot 3 times in the back by LAPD even when he had his hands up in the air. It took Cleveland police officers less than 2 seconds to shoot Tamir Rice from the time of their arrival at the playground where 12-year-old Rice was playing. Rayshard Brooks, killed by an ex-Atlanta cop at a Wendy’s drive-through, left behind four children aged 1, 2, 8 and 13. Breonna Taylor would have been 27 years old last week. 

Between 2013-2019, police killed 7,666 Black people in the US. 

Black health matters. Black people are dying at ~2.4 times higher rate from COVID19 than white people in the US. Black Americans have the highest incidence AND mortality rates from lung, breast, prostate, colorectal and cervical cancers. Black women are 4-5 times more likely to experience treatment delays and less likely to receive proper treatment for cancer. Black women suffer more often from inadequate pain management. Black women of higher wealth and resource brackets suffer worse outcomes at childbirth compared to white women with fewer resources. According to the Centers for Disease Control and Prevention, 15.3% of Black children suffer from asthma compared to 7.1% of white children; Black people are ~3 times more likely to die from asthma. Racial bias in the form of “race correction” in diagnostic tools used for kidney transplants, kidney stones, urinary tract infections, childbirth, cancer, osteoporosis and bone health, and lung function risk Black patients’ lives through discriminatory clinical practices. 

In Boston, between 2008-2012, Black residents have consistently shown higher emergency department visits and hospitalization rates due to asthma, higher hospitalization rates and mortality due to diabetes, and higher hospitalization rates for chronic heart disease and hypertension compared to all other ethnicities. All of these indicators were observed at the highest quartiles in Roxbury and Dorchester, predominantly Black and poorer neighborhoods of the city.  

Approximately 50% of white medical students and residents in the US have misconceptions about the biology of Black people.

Black futures matter. In 2017, across more than a dozen STEM subfields, not a single doctoral degree was awarded to a Black person in the US; that same year, Black faculty made up 2% of full-time professors in the US. Between 2002-2017, the percentage of Black PhD earners rose from 5.1% to only 5.4%. In 2003-04, 40% of Black undergraduate students switched out of STEM majors compared to 29% of white students; 26% Black STEM majors dropped out of college compared to 13% of white students. In the 2015-16 academic year, Black faculty made up 0.7% and 1.4% of all faculty in Biology and Chemistry across top 40 US institutions, respectively, compared to 83.3% and 81.7% white faculty in those fields. A 2011 study reviewing NIH R01 applications submitted between 2000-06 found that applications from Black scientists constituted only 1.4% of all applications; only 16% of applications from Black scientists were funded compared to 29% of applications from whites. Between 2014-2016, applications from Black scientists constituted 2.2% of all R01 applications; overall award rate for Black applicants was 10.2% compared to 18.2% for white counterparts, resulting in a 45% funding gap. ln 2018, Black scientists received 1% of total R01 grants awarded. 

At Tufts, as of Fall 2019, Black students make up 3.8% of all graduate students and Black faculty constitute 2.7% of all faculty. In STEM fields, Black graduate students range from 0.7% (School of Dental Medicine) to 6.5% (School of Medicine, Public Health & Professional Degrees). At the Graduate School of Biomedical Sciences, there are 7 Black graduate students (3.4%); there are only 2 Black faculty members at Tufts School of Medicine and 3 Black faculty members at School of Engineering. 

It is often assumed that scientists care more about data than individuals. While that assumption is possibly wrong, the obsession with statistical significance as a proxy for significant biological phenomena cannot be understated. But when it comes to Black lives, both statistical and biological significance are tied together – the numbers show us the immense disparity in health outcomes, each death shows us the complexity of a life that is lost. Black people are dying at the hands of police and physicians at higher rates than other races/ethnicities in the US. The vicious cycle of misconceptions of Black bodies, that they have thick skins, or that they are “monsters” as Darren Wilson alleged, stem from the other-ization of Black people – the same racist ideology, so ingrained in every aspect of US culture including academia, that drives racial disparities in STEM education and careers of Black academics. From the Tuskegee Syphilis Experiment to HeLa cells to Black women vivisected to establish the field of gynecology, Black bodies have been used as disposable commodities throughout the history of biomedical research. Diversity and Inclusion efforts in academia are largely performative, as the #BlackInIvory stories on Twitter show; faculty hiring committees end up reproducing whiteness in their pursuit of diversity. 

Over 6,000 scientists across the world participated in #ShutDownSTEM and #Strike4BlackLives on June 10 in solidarity with the ongoing #BlackLivesMatter protests nation-wide. Yet, this outpouring of solidarity is not enough – one day of recognition is not going to undo centuries of racist ideology that permeates biomedical research and rest of academia. But this serves as a stepping stone to recognizing the racist history of the fields we work in, the subjects we study, the places we work at. Biomedical scientists need to grapple with the fact that health disparities ravaging Black populations are due to racism, rather than race. Faculty and universities need to recognize that “promoting diversity rather than substantive structural change will not create equal opportunity and equal outcomes.” The work to undo the racism within our own ranks require us to stand in solidarity with Black people, whether at our workplaces or neighborhoods, and to educate ourselves on the intersectionality between the diseases we study, the history of such research and the material conditions of Black lives.

Thoughts on the book “Bad Blood: Secrets and Lies in a Silicon Valley Startup”

I began to read more than usual because of social distancing, going through the list of books I had been planning to read for a while. One of the books that was recommended by a friend was “Bad Blood – Secrets and Lies of a Silicon Valley Startup” by John Carreyrou [1], based on the rise and fall of the blood-testing company, Theranos. I was especially interested in it given its relevance to the biotech industry and on recently finishing the book, I realized GSBS students might also find it interesting and thought of sharing a little bit about it. While there are plenty of resources out there that help you understand how to search for a job, determine if it is a good fit and notice red flags, this book paints a picture of life in the biotech industry, both as an entrepreneur and as an employee. I think students interested in careers in industry, entrepreneurship, venture capital, or science policy will gain some perspectives from reading this book. For instance, the book portrays the harsh reality of working in industry when a team of engineers were laid off because the research was headed in a new direction and they were not needed there anymore.

In January 2003, a 19-year-old Elizabeth Holmes founded Theranos with the vision of enabling multiple diagnostics tests to be run from a small volume of blood obtained from a finger-prick rather than the traditional venous blood draw, using the company’s small, portable, automated devices. In October 2015, a reporter from the Wall Street Journal, John Carreyrou, published an article [2] revealing that the company has been misleading investors and consumers, that the blood tests analyzed by Theranos devices were inaccurate and unreliable, and that a lot of the tests were actually performed by third-party commercial analyzers. Expanding the article into a book, Carreyrou walks us through how the company was formed, how it grew to become one worth over $9 billion, and finally, how it dissolved in September 2018 [1]. It is common knowledge that most, if not all, companies in Silicon Valley have skeletons in their closets that make headlines when they are revealed. However, fraud and irresponsibility by a health technology company like Theranos, and at such a massive scale at that, is even more dangerous considering the direct harm to patients’ lives. It is shocking that a company could get so far with technology that never performed as promised, and Carreyrou lays out the various scenarios and circumstances that contributed to it.

This book exemplifies the importance of validated and peer-reviewed data, the need for rigorous testing and quality-control checks, and the need for adhering to regulations – things we already know and are trained to practice. The book also highlights the need for communication within and between different departments in a company, so employees are aware of what stage of development the product is in, identify what exactly is holding up progress and work together to solve the problem. This lack of communication and the unusually high level of secrecy was frustrating to the employees at Theranos [1]. It is therefore important to find a balance between protecting proprietary information and facilitating communication to ensure highest productivity. Besides the need for effective communication between employees, the book also shows how there is a need for open, honest communication and understanding between the employees directly involved in developing the product and higher-level management. Without it, as a leader, you risk facing the dangers of being surrounded by yes-men – a false sense of security that you are doing things right, that the technology is working perfectly, experiments are returning expected and reliable results, and experiments that are not actually feasible can be done – hence wasting both time and money. You do not improve because you do not know where improvements are needed. However, at Theranos, the yes-men were not the only ones contributing to this culture. Holmes was not only a bad listener; she seemed to consider anyone who challenged her as disloyal [1]. She was surrounded by yes-men because she did not foster an environment that welcomed ideas, suggestions, and opinions opposite her own. Employees did not come forward with concerns because they did not want to get fired. This may be especially true of employees with H1-B or other work visas who have much more to lose, considering how their ability to stay in the country is tied to their employment. Abuse of H1-B visa workers is not unheard of; a recent example is Cloudwick Technologies Inc., based in Newark, California, paying their H1-B employees a much lower salary than what was agreed upon, and making illegal deductions from their salaries.

A negative (and savage!) review on the Glassdoor website (a website where employees can leave information about a company they work or worked in, such as CEO approval ratings, company reviews, salary reports) mentioned in the book prompted me to look at what else the ex-employees of the company had to say. Many of the reviews for Theranos are very detailed, with some ex-employees especially taking the time and effort to explain the “Pros” and “Cons” of working there. The most common “pro” mentioned was free food and snacks – something we, as grad students, can easily relate to. The “Cons” part of the negative reviews is where things got interesting. You could get an insight into how the employees felt and how they were treated. Most of them were overworked and underappreciated. It may be typical of employees to put in extra hours or feel like they have no work-life balance at a start-up firm, but at Theranos, they would not only track the number of hours the employees would spend at work, but would also monitor their social media activity [1]. The employees’ dedication was measured by how long they stayed at work and whether they would come in during the weekends. I imagine such a working environment would be suffocating and counterproductive, and it was no surprise that the employee turnover was high. What you can also glean from the reviews is the shattered hopes and dreams of the employees who were inspired by Holmes’s visions and dedicated their time to actualize it. As scientists, we all hope to contribute to making this world a better place. On top of not being able to do that at Theranos, they also feared that their time in the company will work against them in future applications. The book also mentioned how the HR department would post fake positive reviews on Glassdoor, and some of the reviews did spin the “cons” in a way to show Theranos in a positive light. For example, one of the reviews listed the cons as “truths” with statements like, “If you are unable to work in a highly self-directed environment where you are counted upon to create clarity from ambiguity, you will not be successful at Theranos.” This reminded me of reading about people answering the common interview question “What is your biggest weakness?” with “I work too hard.”

All things considered, Theranos did not really ruin the prospects of a biotech-startup in Silicon Valley. As a couple of articles in Wired mentioned, investors may be more skeptical now and that may actually be better. The increased scrutiny will hopefully mean rigorously tested data and more valid claims. Carreyrou points out how tech companies usually exaggerate about how their devices perform, but the same cannot be done with a medical device. No one ever died from a buggy Candy Crush app, but a misdiagnosis can be potentially fatal.

It is also interesting how Elizabeth Holmes and her downfall (from a net worth of $4.5 billion to zero) is discussed by the public. After she and her company were exposed for fraudulent practices, the focus skewed towards her appearance rather than her transgressions. They talked about how her unblinking stare (described as a “hypnotic” gaze in the book) is “sociopathic”, how she is not naturally blond, how her makeup is weird, and her deep, baritone voice is fake. Also, concerns about Theranos’ technology and the company’s practice were brought forward to some highly intelligent and experienced investors. Granted, they were not experts in the field of medical technology, but it would not be difficult to get an expert’s opinion and some of them were indeed alerted about Theranos by experts. If they genuinely did not have the power, even as a member of the company’s board of directors, to do anything about Holmes, why continue to be investors and not step down? Were they all simply manipulated and “bewitched” [1] by Holmes’s charm?

People have lots of ideas and opinions on where things went wrong, what Holmes could have and should have done, but the bottom line is, she blew the chance to be an inspirational leader and a role model. The struggle of female entrepreneurs, especially women of color, is no secret. Holmes did have a better chance than most women to become the “first female billionaire tech founder” [1] – she is smart, motivated, hard-working, charismatic and understands how Silicon Valley operates. She comes from a privileged family, had access to opportunities and was well-connected enough to benefit from the support of famous investors at a very early stage of the company. It is unfortunate that what was going to be a huge success story is now in the news for all the wrong reasons.

This book is a cautionary tale for biotech start-up founders and venture capitalists interested in biotech start-ups – providing insight into what makes an effective leader and the responsibilities that come with it, and what employees and venture capitalists should look for when looking to work or invest in a biotech firm. In my opinion, the story of Theranos could be an interesting case study for discussion in an ethics class or at the Tufts Biomedical Business Club. Regardless of whether you are interested in the biotech industry, I think anyone who is a fan of thrillers will enjoy this book. For those interested in something more visual and/or sensationalized, there is an HBO documentary covering this story called “Inventor: Out for Blood in Silicon Valley” and a movie based on Carreyrou’s book is set to release sometime this year.

References:
[1] Carreyrou, John. Bad Blood: Secrets and Lies in a Silicon Valley Startup. New York, Knopf Publishing Group, May 21st, 2018.

[2] John Carreyrou, “A Prized Startup’s Struggles,” Wall Street Journal, October 15, 2015.