100 Best Spine Surgeons in America...What gives?!

This is cross-posted with my other blog.  Cheers!

The internal page for "my" college is boasting the inclusion of one of our faculty members on the recently released list of the "100 Best Spine Surgeons in America" by Becker's Orthopaedic and Spine Review. I was interested in which instiutions hosted the other 99 best spine surgeons, so I checked out the list myself. After getting about halfway down the page, scrolled back up, then began counting to confirm a feared conclusion: of the 100 "best" spine surgeons in this country, just 2 of them are female. I was dumbfounded--particularly as medical school classes are reporting higher and higher numbers of female entrants and applicants. And while I may have subconsciously expected a male-majority on the aforementioned list, the 98% figure was astonishing.

 

It's unclear where such a gender bias originates. I'd be willing to bet that of all the spine specialists in the united states, far more than 2% of them are women--which would rule out a representitive proportionality on the list. The site for the list reports:

"Physicians included in this list have been selected based on surveys, research and nominations. All physicians who are placed on the list undergo a substantial review with other peers and through our own research."

To me, this seems like odd selection criteria for surgeons. I suppose what really must be addressed first is the question: what makes a great spine surgeon? I would imagine it would depend on who you ask. Patients might value bedside manner and intrapersonal interactions. Other physicians and hospital administrators might value a colleague who is easy to work with and yields good patient outcomes, or a surgeon who takes on challenging cases. An insurance company might value surgeons with the most cost-effective outcomes, and those who report minimal "relapses." So the notion of an objective survey truely assessing the BEST spinal surgeons in the country is questionable, at best. Research and nominations also seem to depend on who is doing the nominating. It's also important to realize that the subtitle for Becker's Review is "Business and Legal Issues for Orthopaedic and Spine Practices."

Ultimately, I cannot answer whether the list is biased or not, only raise question with the striking minority of female surgeons.



Climate in Crisis

Here's a snippet of what I've been working on recently ("snippet" by grad student metrics). I presented a version of this at a History of Science conference last weekend (where I also included a section about the history of the Green Revolution), and got some positive feedback from professors and fellow graduate students.

"Look, my fear is that climate change is the crisis, the biggest crisis of all, and that if we aren’t careful, if we don’t come up with a positive vision of how climate change can make our economies and our world more just, more livable, cleaner, fairer, then this crisis will be exploited to militarize our societies, to create fortress continents. And we’re really facing a choice. And, you know, I think what we really need now is for the people fighting for economic justice and environmental justice to come together."

-Naomi Klein (author of Shock Doctrine) [1]

Two years ago I found myself wandering through rice paddies on the Southern coast of Bangladesh. One year earlier, this region had been devastated by a cyclone, and national and international aid organizations promptly swamped the region. I was there interning for a Bangladeshi non-governmental organization (or NGO), which was running an “agricultural rehabilitation program.” This program aimed to help farmers recover from the disaster and to avert a national food crisis. The NGO gave farmers free rice seed, fertilizer, machinery, and training in new intensive management practices. And they weren’t just giving out any rice seed- this was a new hybrid variety of rice that the NGO had commercialized and was selling in other regions of Bangladesh, but was new to this coastal region. This project was walking the line between disaster relief and exploitation of impoverished farmers, as once the crisis was averted, farmers would be locked into this new technology, paying higher prices for the new seeds and for more fertilizer.

A British journalist picked up the Bangladeshi story around the same time, writing that the NGO “is acting like a parallel state, but one that is accountable to no one.”[2] Similar criticisms are often made about agricultural research and exploitation of developing countries- for example, the Gates Foundation is currently calling for a Green Revolution in Africa, investing in controversial genetically modified crops. My experience in Bangladesh made me start to think about the role of organizations and governments in climate change adaptation.

Bangladesh is predicted to be hit very hard by climate change, due to its environmental vulnerability as a low-lying coastal country, as well as its social vulnerability of widespread poverty and an economic reliance on rice production. I started to wonder how the threat of future climate change will shape the agricultural research agendas in developing countries, and the relationships between power and technological development.

The concept of adaptation is defined by the IPCC as “adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects.”[3] In both climate change mitigation and adaptation, future-oriented conceptions of societal and technological solutions are used to justify present action. Climate adaptation is a deliberate restructuring of sociotechnical systems, supposedly to produce optimal social outcomes- such as alleviation of poverty, prevention of disease, preemption of cultural conflicts, and avoidance of food shortages. However, not only are there competing interests for this restructuring, as I saw with the Bangladeshi NGO, but also, people are faced with the risk and uncertainty of implementing these changes.

The construction of the climate crisis, and perceptions of risk and uncertainty are likely to drastically vary between scientists, policy-makers, and farmers. New agricultural technologies are implemented, or not, based on these perceptions. As the past Green Revolution has shown, it is not always the “best” technology that is adopted in agriculture, but rather the technologies that capture the imaginations of those in power, and that consequently shape the geopolitical landscape. In the face of climate change adaptation, the “best” technology becomes even more burdened by uncertainty, making agricultural development a channel for authority based on knowledge claims of the future.

Back to Bangladesh in the cyclone crisis aftermath, the NGO overlooked women’s significant role in agriculture. The NGO focused its resources and training on men. Although women do nearly all of the post-harvest processing and are often involved in other aspects of rice production, there was a lack of reflexivity in the NGO about its agriculture program, and especially in the disaster rehabilitation program. And this was from an NGO that pioneered women’s empowerment in rural Bangladesh for over 20 years. Even in central Bangladesh, the NGO was empowering women through microfinance and to sell hybrid seeds, breaking taboos on women’s participation in rice production and in public markets. What caused this drastic divergence of approaches to women's participation in agriculture?

If we fail to articulate a vision of the world in the face of a changing climate, then I fear that Naomi Klein's predictions will materialize (talk to me about the Green Revolution and the role of the feared "population bomb"). How will we imagine new sociotechnical systems in the face of this anticipated disaster? How will global environmental governance and conceptions of climate change adaptation be used to authorize profound interventions into peoples’ lives and livelihoods? What sorts of technological interventions will we accept? Or promote? How will we imagine new social arrangements in the face of climate-induced migration? How important is building socioecological adaptive capacity and resilience, vs. implementing technological fixes? Over the next few years I will be studying a tiny aspect of climate change adaptation and its relationship with agricultural research, but these broader questions are driving me.

[1] Goodman, 2011. http://www.guernicamag.com/blog/2482/naomi_klein_why_climate_change/

[2] Kelly, 2008. http://www.guardian.co.uk/society/2008/feb/20/internationalaidanddevelopment.bangladesh

[3] Intergovernmental Panel on Climate Change (IPCC) 2001. Third Assessment Report Glossary. P. 365.

Beauty and Brains

There is a really cool article on the New York Times about Natalie Portman's scientific success: finalist for the Intel Science Talent Search, straight-A student, Harvard degree in neuroscience (she studied the evolution of the brain). Now Ms. Portman boasts an Oscar for Best Actress as well--and I'll admit to being genuinely impressed. There's some mention of some other outrageously sucessful, gorgeous, and intelligent Hollywood women, too, who provide nice role models for young women who aspire to be actresses or scientists.

The articles ends with: "You can be a scientist, but if you want your name in lights, you’d better play one on TV." I hope that one day this changes, and little girls can look forward to the prestige of being a scientist in the same function that Hollywood actresses play today.