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female in surgical researchMore than two decades after the 1993 Revitalization Act was signed (stating women and minorities must be included in NIH funded research), females are still under-represented in both “basic science and translational surgical research”.

The authors acknowledge that medical research on human subjects is only a small subset of all medical research. However, even those studies using animals and cells have females under-represented. Why? Females, whether cell, animal or human (due to hormonal fluctuations) are harder and more expensive to study and including them may make the research much more complex to analyze. They are simply not as predictable as male cells, animals or humans.

Yet, there is a growing body of research showing “men and women may manifest diseases differently, experience illnesses differently, and benefit from treatments differently”. The authors list disease processes where male and female patients respond differently, including “but not limited to cardiovascular disease, lung cancer, depression, obesity, osteoporosis, thyroid disorders, multiple sclerosis, and Alzheimer’s Disease”. Yet, the authors tell us, in 2014, “all medications except for zolpidem (Ambien) are dosed the same for men and women, including anesthetics and chemotherapeutics, drugs that can be lifesaving”.

This is a fascinating (and disturbing) article to read and we will simply hit the high points (or should that be low points?). The authors looked at the top 5 surgery journals (i.e., Annals of Surgery, American Journal of Surgery, JAMA Surgery, Journal of Surgical Research, and Surgery) from January 2011 through December 2012. Here is some of what they found on medical research:

One-third of all publications using animals or cells did not specify the sex studied, and when they did specify, 80% studied only males.

For research on cells, 76% did not specify the sex of the subject from whom the  cell studied was drawn. When they did specify, 71% studied only males.

Although a larger percentage of publications now state sex of the animal or cell studied than they did one and two decades ago, more male-only studies are being published. The authors say this reflects the sex disparity in basic research is growing rather than decreasing over time.

Thyroid and cardiovascular disease are female-prevalent disorders and so we might expect more female subjects in those articles. Only 12% of those publications studied females or both sexes.

The authors offer several memorable quotes:

“With robust and surmounting evidence that women are clearly different from men with respect to cardiovascular mortality, it is unacceptable that less than 25% of current cardiovascular trials are designed without apparent regard to sex in terms of trial design, patient selection, and analytic processes.”

“Furthermore, recent population-based outcome studies show that even as mortality has decreased in most counties in the United States from 1992 to 2006, female mortality increased in 42.8% of these counties.”

This, say the authors, is not simply a problem of surgical research, but rather, based on recent review articles, “sex disparity is pervasive across all disciplines for biomedical and clinical research, with most studies showing no improvements over time”.

The good news is that several of the surgical journals revised their requirements after receiving this information from the authors. Now all authors are required to state the sex of the animal or cell used and if they did not use both sexes, they need to give a rationale. It’s a good first step, but certainly not a solution to such a significant problem in medical research. This article does not address whether minorities also remain under-represented, but we’d take a wild guess they may be as well.

From a litigation advocacy perspective, it is worth considering whether this work applies to a personal injury Plaintiff. If there are known differences between how male and female patients respond to a particular disease or surgical procedure or medication–check to see if their treatment was appropriate for their gender or if a female patient was treated “like a man”. These authors (some of them surgeons) cite a 2005 study showing “only one in five physicians across multiple specialties was aware that more women than men die from cardiovascular disease each year, and most of these physicians did not rate themselves as effective in treating sex-tailored cardiovascular disease”. Similarly, product liability cases involving medical products or medicines could be informed by this research as well.

What should they have known?

What should they have considered?

What would it have cost them to use both male and female research participants?

Yoon DY, Mansukhani NA, Stubbs VC, Helenowski IB, Woodruff TK, & Kibbe MR (2014). Sex bias exists in basic science and translational surgical research. Surgery, 156 (3), 508-516 PMID: 25175501

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lying to womenBack in 2012, we wrote about which gender was the more moral in negotiations. (Spoiler alert: it was women.) Now we have a new article on why women get lied to in negotiations. Not when or if–but why. Basically, people believe women are more easily misled than men and people believe women to be less competent than men. Therefore, “negotiators deceived women more so than men, thus leading women into more deals under false pretenses than men”. The researchers completed three separate studies and (to add insult to injury) these were not experiments using the ubiquitous undergraduate. These research participants were adults in the working world.

In Study 1, 131 employees (75 male and 56 female) at an online marketing research website participated in the research. (Gender was the only demographic information collected so we don’t know their educational backgrounds, average age or racial identity.) Participants were asked to imagine they were selling a used car and posted an ad on a community website. They were then approached by a male (or female) buyer. The participants were told that the buyer appeared to be a typical (male or female) negotiator. They were then asked to rate the imagined buyer on eight different traits: warmth, kindness, business sense, ambition, gullible, naïve, arrogance or stubborn. The researchers added four additional traits: easily misled, impulsive, confident and knowledgeable.

Women were perceived as both less competent and more easily misled in negotiations than were men. (These variables were derived using multiple traits rated by participants: Ease of being misled = Easily misled + Gullible + Naïve + Impulsive; and Competence = Good business sense + Confident + Knowledgeable + Ambitious.)

In Study 2, 394 employees (116 female, average age 32 years, 74% White, 7% Black, 5% Hispanic, 11% Asian, 1% Native American and 2% ‘other’) at Amazon Mechanical Turk participated in the research. These participants were asked to imagine someone (the Seller) was selling an antique chair said to be worth $1,250 according to a popular buying guide. However, one of the legs was broken and would cost $250 to repair correctly. Instead, the Seller fixed it temporarily knowing it would become wobbly again with use. The only way the Buyer would know the chair was defective is if the information was disclosed by the Seller. Again, a male and female buyer approached the Seller.

Again, women were perceived as more easily misled and as less competent. Women were believed to be less able to detect deception on the part of the Seller.

Undaunted, the researchers continued on to Study 3. This time the participants were 298 full-time MBA students (221 of whom were male) enrolled in a negotiations course. They were paired into 149 dyads (65 male-male, 23 female buyer-male seller, 48 male buyer-female seller, and 13 female-female). Research participants completed the “Bullard Houses” role-playing exercise which basically simulates a real estate transaction. They were randomly assigned to negotiate as the buyer’s agent or the seller’s agent. The buyers’ agents could either tell the truth, misrepresent, or tell an outright lie about their intentions in order to lure the sellers’ agents into a deal. And you will never see this finding coming.

Female negotiators were deceived more than male negotiators.

The researchers say that women at the negotiating table are going to be offered less favorable deal terms (based on past research) and they are going to be lied to more often than men. As the researchers looked more closely at the ways in which women were deceived, they found that women were told more blatant lies than were men and men tended to be told the truth. The researchers summarize their findings this way:

“The gender bias in deception appears driven by a greater propensity to tell women blatant lies in a situation in which men tend to be told the truth.”

This study is disheartening for any number of reasons, and it raises questions about how universal this general pattern is. From a litigation advocacy perspective, this series of studies tends to indicate women may simply be lied to rather than being allowed to engage in actual negotiations about case issues. Are they more subject to men failing to properly disclose in discovery? More often victims of spoliation of evidence? Dirty tricks at trial?

The researchers wonder if their findings could help explain the gender gap at high levels in business organizations. Women, say the researchers, may shy away from negotiations since they will be lied to and thus be at increased risk of entering into deals on the basis of false pretenses. While okay as a hypothesis worthy of testing, it is not at all supported by evidence. Let’s see an experimental design that looks at “what do women do when they know that they are being lied to by men?”. And, let’s be clear– it is more than ironic (“sexist” comes to mind) to think of this in terms of women somehow being less effective because of their weariness over men lying to them. Aren’t we talking here about being lied to? By men? We would say that until the social stereotype that women are easy to mislead is changed, and men stop lying in ways that are less likely when dealing with other men, awareness will do little to change the outcomes of their negotiations, mediations, and settlement talks.

Kray, LJ, Kennedy, JA, & Van Zant, AB (2014). Not competent enough to know the difference? Gender stereotypes about women’s ease of being misled predict negotiator deception. Organizational Behavior and Human Decision Processes.

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win-argument-cat-paperThis is something we’ve told our clients about for a number of years because it simply made sense. Now we have a current research citation for it rather than using research that is more than a decade old! We see this “new” strategy as a variation on the “you may want to disagree” strategy–or, perhaps, as an update.

What we especially like about this one is that it tells us how to make something totally implausible seem more acceptable to the listener. Say, something implausible like….Bigfoot! Actually, it goes beyond that. This research shows us how to increase the likelihood you can convince others of supernatural events having occurred. It’s all, as you may have surmised, about the narrative frame. You do not, say the authors, want to begin your narrative by starting off with an admission of long-standing beliefs in the frankly bizarre. That would totally undermine your credibility. Instead, begin by presenting yourself as a skeptic of such events. The authors explain it in this, uniquely academic, fashion:

“The presentation of the evidence that converted the narrator within the account itself offers the audience an invitation to go on the same journey from scepticism to belief along with the narrator.”

We don’t really say it like that (frankly, there should be a rule against anyone saying it like that), but we do essentially recommend that our clients embed their initial skepticism in questions for expert witnesses who explain how something works or in direct examination questions for the witness who is explaining why something was done the way it was done. The off-hand, seemingly casual, inclusion of initial skepticism bypasses juror resistance to persuasion and takes them on our client’s journey of discovery. Just like the author said above.

Here is what the researcher did. She had research participants in two different experiments (a total of 215 participants) read a description of either a “precognitive dream” in which the narrator predicted and ultimately prevented a car accident, or of a telepathic experience in which the narrator thought of “an old friend, Sally” and then half an hour later, learned Sally had been hospitalized. The research participants were placed into three different conditions as they read the descriptions:

The narrator claimed to be skeptical of the paranormal prior to describing the event.

The narrator said s/he really had no interest at all in the paranormal prior to describing the event.

Or, the narrator admitted to being a fervent prior believer.

After reading the descriptions of the events from the skeptical narrator, the disinterested narrator, or the avid believer narrator, the research participants were asked whether they saw the event described as being truly paranormal, just a coincidence, or the product of a gullible narrator.

In both experiments, having a skeptical narrator increased the likelihood participants would see the event as possibly being paranormal. The researcher clarifies that the disinterested narrator did not result in an increase in those seeing the events as paranormal.

“The narrator must establish a prior position contrary to the one they are now assumed to hold in order to influence the audience.”

However, when participants were warned about the “avowal of prior skepticism” technique in Experiment 2, the pattern was reversed–that is, a skeptical narrator was less likely to result in participants seeing an event as paranormal.

When the narrator held a position of prior belief, s/he was seen as more gullible and easily convinced only when female and not male! The researcher thinks it likely is due to men being seen as relatively rational and skeptical when it comes to the paranormal and telepathy while women are not seen that way. We have at least 33 thoughts on this finding.

The author concludes the paper with this straightforward paragraph:

“In conclusion, the present research supports the proposition that an avowal of prior scepticism serves to increase the plausibility of a paranormal causal explanation for an anomalous event as long as the audience are not pre-warned. An avowal of prior belief serves to increase the perceived gullibility of a female, but not a male, narrator, suggesting a bias towards more readily perceiving a woman than a man as gullible.”

From a litigation advocacy perspective, when you have a pretty unbelievable story to tell, embedding skepticism into your narrative can be a powerfully persuasive tool. And if your opponent employs this strategy, you may want to educate jurors on the “avowal of prior skepticism” strategy to “undo” their efforts at persuasion.

Stone, A. (2013). An Avowal of Prior Scepticism Enhances the Credibility of an Account of a Paranormal Event Journal of Language and Social Psychology, 33 (3), 260-281 DOI: 10.1177/0261927X13512115

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pink and blue chalk figuresRecently we blogged about a new study on women and leadership saying women are no longer punished for “acting like a leader” as long as they are not seen as aggressive in their leadership behavior. Here are four different, easy-to-read articles on the leadership gender gap that will give you a good sense of both the ‘what’ and the ‘why’ of the issues.

Many of us have read about Sheryl Sandberg’s stories of being called “bossy” in her book Leaning In and recent stories characterize Jill Abramson (former NYT Executive Editor) as “pushy”. So, a linguistics doctoral student at Georgia State looked at a “random sample of 200 to 300 occurrences” of the following words: brusque, condescending, pushy, and stubborn, in the Corpus of Contemporary American English. Women were only mentioned 37% of the time, so he checked to see if the adjective was used significantly more than 37% of the time to test for gender differences. He found “brusque” and “stubborn” were words equally applied to men and women but men were more often labeled “condescending” and women were more often labeled “pushy”. We may not like either trait, but we are quicker to attribute it one gender or the other. Read the entire article to see more about this language issue.

linguistic pulse pushy condescending

Another interesting article “The self-assurance imbalance in the workplace” was recently featured in the Washington Post. This brief article speaks to the self-doubt rampant among working women and mentions several recent books discussing how to minimize self-doubt. She ends with the following memorable quote:

“Rather than advocating that an entire class of people start faking it ‘til they make it, maybe we should be coaching voters, students, bosses, and viewers at home how to be a bit more skeptical of the loudest guy (or gal) in the room.”

The longest article was featured over at the Atlantic: The Confidence Gap. Written by the authors of the book, The Confidence Code, this article is an easy, albeit long, read. If you are interested in the challenges women face as leaders, this is an interesting spin on the questions we have all asked over and over again. The short version is that men have self-doubt just like women do, but perhaps due to socialization, they have the confidence to step up and ask to do tasks in which they might fail. Confidence matters as much as competence when it comes to success. The bottom line to the message in this book may be the famous Nike advertising slogan: “Just Do It”. Women need to stop thinking so much and just take action (like men do). With practice, acting will become more natural than obsessing over the possible pitfalls. These authors also end with a lovely closing paragraph:

“Almost daily, new evidence emerges of just how much our brains can change over the course of our lives, in response to shifting thought patterns and behavior. If we keep at it, if we channel our talent for hard work, we can make our brains more confidence-prone. What the neuroscientists call plasticity, we call hope.”

And finally, Amy Cuddy is a social psychologist who does research on confidence and judgment. We’ve written about her work on power poses here before. You might find them useful for job interviews, in the courtroom, and for persuasion in general, although sometimes posing has to vary by gender. Perhaps though, today you feel more like watching a 20 minute video than reading additional blog posts. Cuddy’s talk is for people in general–both men and women. It just seemed to fit well with the other three articles in this post.

Amy Cuddy’s TED Talk message is that “tiny tweaks can make big life changes”. She also says “don’t just fake it until you make it”, but instead, “fake it until you become it”.

Changing small behaviors can, according to Cuddy, change your life. Her twenty-minute TED Talk is well worth your time (and truly deserves a blog post of its own).

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how women leadWe’ve written about women and leadership before. While some new research shows female leaders handle stress more effectively than male leaders, we’re not going to write about that one today. Instead, here is a report on a study showing some other good news: women are no longer punished for behaving assertively in a leadership role!

It’s a positive change. The past research showed us that women who were assertive were seen negatively due to perceived violations of their gender role expectations. That is, men are assertive and women are sweet. And when women are not sweet, we call them witches (or something like that). So. The news that what these researchers call “agentic behavior” (i.e., acting like a leader) is now acceptable for women (as long as they are not aggressive and ruthless as they exhibit leadership behavior) is good news indeed.

Alas, though. Every silver lining seems to have a cloud and the battle is not yet won. As it happens, while women are now evaluated just as positively as men leaders for behaving assertively in their leadership role–women leaders who are tentative or submissive are rated much more negatively than are tentative or submissive men who lead. Leaders frequently fake their confidence and strength, but if a woman is seen as doing that, reactions they get are worse than those accorded to men.

The researchers used 185 participants (47% female, average age 28.3 years, either undergraduate students or graduates from an Australian university) who were told they were participating in a study on effective communication. The participants read a transcript of a speech (on climate change) which was identified as being given by an Independent (non-party-affiliated) candidate for national office. They were told the speech was given by a female (Annette Hayes or Susan Hayes) or a male (David Hayes or Andrew Hayes).

The speech itself was written in either an assertive voice (indicating dominance, confidence and strength) or a tentative voice (indicating deference, hesitancy, and a lack of confidence). After reading the transcripts, the participants rated the candidate’s likability and influence (i.e., how persuasive they were and therefore how likely to convince others of their position). They also rated the leaders on agency (i.e., how dominant, forceful and confident they were) and communality (i.e., how friendly, sensitive and warm they were).

Assertive female leaders were rated more likable than tentative female leaders but there was no difference in likability between the assertive and tentative male leaders. Further, while there was no difference in likability between assertive male and assertive female leaders, tentative males were more likable than tentative females.

Assertive female leaders were significantly more influential with participants than were the tentative female leaders. There was no difference in influence exerted on participants between the assertive and tentative male leaders. Further, while participants saw no difference in influence by the assertive women and assertive men leaders, they saw the tentative man as more influential than the tentative woman.

In other words, say the authors, women in political leadership will only be as effective as men if they are always confident, strong and decisive. When their behavior deviates from these male-stereotypic leadership ideals, they will be punished far more than their male counterparts. A follow-up study found the same pattern. The authors summarize their findings as follows:

“Based on men’s continued dominance in positions of power, expectations of women to show unwavering signs of confidence and strength will provide a considerable challenge. While a few women will be able to meet this expectation, the majority who cannot remain disadvantaged, with men avoiding similar penalties for equivalent non-agentic behaviors. Therefore, this subtle form of prejudice towards women demands our attention and effort if gender equality is to be achieved.”

It’s a societal double standard recently highlighted by Jon Stewart on the Daily Show. When male leaders display emotion– even inappropriate emotion– it is often celebrated. When women display even a little emotion, it is interpreted very negatively. It’s a good thing to keep in mind as you consider the behavior and leadership potential of male and female attorneys. We are all subject to bias– until we pay attention to it. Merely by being conscious of its potential, it can become a much smaller problem.

Bongiorno, R., Bain, P., & David, B. (2013). If you’re going to be a leader, at least act like it! Prejudice towards women who are tentative in leader roles. British Journal of Social Psychology DOI: 10.1111/bjso.12032

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