“Ask and Ye Shall Receive” – Women, Stand Up and Be Counted!

At the ASH annual meeting last December in New Orleans, attendees were inspired by the accomplishments of Nancy Andrews, MD, PhD, (winner of the Henry Stratton Medal for basic research), Elaine Jaffe, MD, (winner of the Henry Stratton Medal for clinical/translational research), Katherine High, MD, (E. Donnall Thomas Lecturer and Prize winner), and Clara Camaschella, MD, (Ham-Wasserman Lecturer) that led to their being chosen by the Awards Committee or invited by the President of ASH to receive prestigious awards or deliver named lectures. Their selection meant that half of the eight recipients of ASH honorific awards or named lectureships in 2013 were women. We were proud of them, and pleased that a concerted grassroots effort to nominate women for ASH awards had succeeded, led by us and several other female hematologists, including Barbara Alving and Linda Burns. At the same time, we were troubled that it had taken so long for us to figure out that we (i.e., women hematologists) had to nominate these exemplary individuals in order for their achievements to be recognized.

Our 2013 award nomination effort was spurred by the observation that since 1970 only 11 percent of ASH honorific awards had gone to women (including several instances of women receiving an award together with their spouse, also a hematologist). Perhaps more troubling, no significant improvement in this paltry rate of representation has been observed since 2000. Even the ASH Mentor Awards, initiated in 2006 and chosen by a process led by the Trainee Council and distinct from the achievement awards, went to women only 18 percent of the time, progress perhaps in comparison with the other awards, but reflecting recognition of a different type of achievement. Gender parity in U.S. medical schools and biomedical doctoral programs was reached in the past decade, and graduating classes have been more than 40 percent female for at least an additional decade.^1,2  Based on American Council for Graduate Medical Education data, in 2010, almost 50 percent of hematology-oncology fellows were women, and currently, approximately one-third of ASH members are women. With so many women involved in the field, surely more than 5 to 10 percent of major contributions to hematology have come from women.

Have the ASH Awards and Executive Committees really demonstrated a long history of gender bias? The answer to this question is a resounding “no” as representation of women in leadership positions at ASH over at least the past two decades has been laudable. When we asked colleagues who had served on the Awards Committee about the situation, we were informed that the problem was that few women had been nominated. And they acknowledged that, given the pool of deserving woman hematologists worldwide who had never received an ASH award, the lack of female nominees was a major source of frustration for the committee.

So what accounted for the dearth of award nominations for female Society members? The “aha” moment came when several committee members pointed out that plenty of men either nominated themselves or orchestrated nomination campaigns. We then realized that each of us had been asked to write award nomination letters as part of an organized process spearheaded by friends or institutional colleagues of male nominees. Senior women often feel more isolated within their institutions and may not have developed a professional or personal network as strong as that of their male colleagues.³  To remedy this situation, we initiated an effort to nominate deserving women for the 2013 awards, with the successful results being evident at the annual meeting in New Orleans.

Gender imbalance in ASH awards reflects a much larger issue that plagues academic medicine. The percentage of female full professors at U.S. biomedical institutions remains stubbornly below the 20 percent level.²  A 2008 analysis by Tim Ley and Barton Hamilton of NIH grant submissions and awards reported no percentage difference in the success rate for men versus women, but a marked drop in the fraction of submissions from women at the RO1 stage compared with the fraction of submissions from women at earlier stages of career development.¹  RO1s are the currency that supports career advancement to tenure and to more senior status in U.S. institutions, so the drop-off at the RO1 stage of the grant process mirrors and, in part, explains the paucity of women in the upper levels of academia.

What accounts for this reduction in funding of women investigators at the RO1 stage? Are women disproportionately more likely to become discouraged by the lack of initial funding success and, as a result, fail to resubmit revised applications? This is an important question, the answer to which is being sought by the NIH. Recent research supports the hypothesis that the continuing underrepresentation of women in the upper echelons of business and academia may be explained, at least in part, by a lack of persistence in response to perceived failure. Claudia Goldin, a Harvard Business School economist, discovered that female undergraduates with a declared interest in economics were more likely to change their plans upon receiving Bs and Cs in introductory economics classes as compared with male classmates.⁴  Many studies, including those focusing on medical students and residents, demonstrate differences in self-assessment of competency or achievement, with men being more likely to overestimate their abilities.⁵  During Cynthia Dunbar’s tenure as Editor-in-Chief of Blood, only a single instance of a female senior author rebutting a rejection decision occurred, in contrast to almost 100 direct rebuttals from male authors. Although the denominator of articles submitted by male versus female authors is unknown, since Blood does not require authors to disclose their gender at the time of submission, the differences were quite striking in terms of the willingness of male versus female authors to challenge peer-review opinions about their work.

Being aware of these tendencies should motivate women to avoid self-deprecation and advocate for themselves, and encourage both men and women to be more informed and effective mentors and sponsors of women at all stages of career development. The current abysmal funding rate for NIH grants may disproportionately drive women out of research if their response to initial failure is more likely to result in a decision to not resubmit a revised application. Loss of female physician/scientists would further exacerbate the underrepresentation of women in top academic positions, making retention of female investigators an urgent issue that must be addressed by stakeholders, including academic institutions and professional societies such as ASH.

Although it was a banner year for recognition of the contributions that women make to hematology, we don’t want subsequent analysis to show that 2013 was an outlier. We will continue to advocate for recognition of the accomplishments of our female colleagues, and we urge all ASH members to support the efforts of women so they can provide inspiration for the next generation of hematologists, both male and female. The deadline to submit award nominations for 2015 is July 15, 2014. Visit the Honorific Awards Nominations page for more details.