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cover of episode How to deal with backsliding democracies, and balancing life as a scientist and athlete

How to deal with backsliding democracies, and balancing life as a scientist and athlete

2024/10/17
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Erika Berg
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Jon Chu
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Kevin McLean
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Sarah Crespi
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Sarah Crespi:民主的定义不仅仅是选举,还包括其他重要因素,例如公民自由等。 Jon Chu:这项研究的动机是由于全球范围内民主面临的挑战以及对民主定义的争论。反民主领导人经常利用对民主的另类定义来为其统治辩护。研究旨在调查普通民众对民主的理解是否与学者的传统定义一致,以及不同社会和人群之间是否存在差异。研究采用了一种新颖的 conjoint design 方法,通过比较不同情景来了解人们对民主的偏好。研究发现,在六个不同国家,选举和公民自由始终被认为是最重要的民主特征,而权力制衡的重要性相对较低。性别平等和经济平等也被认为是重要的民主因素。研究结果表明,削弱权力制衡可能比破坏选举或言论自由更容易被公众接受。同时,领导人可以利用经济和社会平等来为其统治辩护,即使他们削弱了其他民主要素。未来的研究将扩展到更多国家,并探究人们在民主与其他价值观(如公共安全和医疗保健)之间的权衡。 Jon Chu: 这项研究调查了六个不同国家(埃及、印度、意大利、日本、泰国和美国)的民众对民主的定义。这些国家在民主程度和社会经济发展方面存在差异。研究采用了一种新颖的方法,即 conjoint design,让参与者比较不同属性的假设国家,以确定他们认为哪些属性更能体现民主。结果显示,在所有六个国家,选举和公民自由始终被认为是最重要的民主特征,即使在不同人口统计群体(按性别、年龄和政治意识形态划分)中也是如此。性别平等和经济平等也相对重要,但权力制衡的重要性相对较低。这一发现出乎意料,因为它与一些文献中关于不同社会对民主定义存在差异的观点相矛盾。研究结果对民主的未来发展具有重要意义。一方面,它表明人们对民主的基本要素具有一致的理解,这有助于抵抗反民主行为。另一方面,它也揭示了民主的脆弱性,即对权力制衡的重视不足,以及对经济和社会平等的重视可能被反民主力量利用。

Deep Dive

Key Insights

What are the key findings from Jon Chu's study on how people define democracy across six countries?

The study found that elections and civil liberties were the top two dimensions of democracy consistently across six countries, including established democracies and non-democratic contexts. Checks and balances were less valued, and gender equality ranked third in importance.

Why did Jon Chu's team use a conjoint design methodology in their study on democracy?

The conjoint design allowed participants to compare hypothetical countries with varying attributes of democracy, helping to evaluate multiple dimensions simultaneously and avoid biases like availability bias, where participants might default to easily remembered terms like 'elections' or 'freedom' without considering comparative contexts.

What are the implications of the study's findings for leaders attempting to redefine democracy?

The study suggests that leaders who try to redefine democracy to their own ends by subverting elections or free speech may face public backlash, as people across different societies consistently value elections and civil liberties as core components of democracy.

How does Lena Svanholm balance her dual careers in science and professional sports?

Lena Svanholm, a PhD student in chemistry, is currently on academic leave from UC Davis to play professional basketball in Germany. She manages her time by prioritizing her passions and finding ways to integrate her academic and athletic commitments, despite the challenges of balancing both careers.

What challenges did Lena Svanholm face when pursuing both chemistry and basketball in the U.S.?

Lena faced challenges such as missing classes due to travel and the lack of explicit support for combining science and athletics. She also had to navigate the NCAA eligibility rules, which required her to adjust her academic path to maintain her athletic status.

What are the historical reasons for the disparity in research focused on women's health?

Historically, research prioritized men over women due to a combination of benevolent assumptions about women's vulnerability and misogyny. Women were excluded from clinical trials, and decision-makers, mostly men, focused on men's health, leading to a significant gap in understanding female-specific conditions.

What are the most promising areas of research for addressing conditions like endometriosis and preeclampsia?

The most promising research involves applying advanced sequencing and technology to understand the biology driving these conditions. For example, studying the tissue microenvironment and systemic changes months before clinical manifestations could lead to earlier diagnosis and more effective treatments.

How does understanding sex-specific biology impact personalized medicine?

Understanding the biological differences between men and women is crucial for personalized medicine. It allows for more precise treatments tailored to sex-specific responses, potentially revolutionizing care for conditions that affect both sexes differently.

What is the current state of investment in women's health research?

In 2021, only 10% of the NIH budget was allocated to women's health, despite women making up a significant portion of the population. While there are signs of improvement, more drastic structural changes are needed to significantly advance women's health research.

Shownotes Transcript

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This podcast is supported by the Icahn School of Medicine at Mount Sinai, the academic arm of the Mount Sinai Health System in New York City, and one of America's leading research medical schools. What are scientists and clinicians working on to improve medical care and health for women? Find out in a special supplement to Science Magazine prepared by the Icahn School of Medicine at Mount Sinai in partnership with Science. Visit

Visit our website at www.science.org and search for Frontiers of Medical Research-Women's Health, the Icahn School of Medicine at Mount Sinai. We find a way.

This is the Science Podcast for October 18th, 2024. I'm Kevin MacLean filling in for Sarah Crespi. First up this week, host Sarah Crespi talks to John Chu, a presidential young professor in international affairs at the Lee Kuan Yew School of Public Policy at the National University of Singapore, to talk about how people around the world define democracy. Does democracy mean elections, freedom of the press, social mobility, or something else?

Chu's team found that there was common ground across six countries. Next, when staying at home meant choosing between chemistry and basketball, Linus von Holm sought an opportunity in the U.S. to pursue both. She joins me to discuss the next phase in her life: balancing dual careers in science and professional sports.

And in a sponsored segment from our custom publishing office, director of custom publishing, Erica Berg talks with Dr. Michael Elevitz about addressing the gaps in women's health research.

Okay, maybe you're tired of hearing about elections right now. I might personally be exhausted as we slide towards the November elections here in the United States. But elections are one of the key components of democracy, right? It's how we form the government and to some extent, as citizens, how our voices are heard.

But is this the end-all, be-all of democracy, something that we can all agree on? Or are there other things that we should consider when defining democracy? This week in science, John Chu and colleagues measured what people in six different countries consider key attributes of democracy. Hi, John. Thanks for coming on the show. Hi, Sarah. Thanks for having me.

Oh, sure. Can we just start off with the motivation for this work? I mean, I know we're publishing it, a number of articles in the issue this week addressing elections, democracy, perception, politics. But what made your group decide to chase down this definition across countries?

So we noticed, of course, as many people have, that democracy has been facing serious challenges in different societies worldwide. And we wanted to look at the role, hone in on the role of public perceptions. And as democracy has been facing challenges, and as people see democracy, especially political scientists, try to define democracy in terms of

the traditional aspects, elections, civil liberties, checks and balances that prevent a single leader from having unlimited power, we notice that

alternative definitions have also been promoted by anti-democratic leaders, by other governments who see these definitions as Western or not fitting their style of rule. So we wanted to see if these alternative definitions that sometimes involve things that are maybe good policies like economic equality, social goods,

But other things that sometimes we don't associate with democracy at all, usually like obedience of the mass public. So we wanted to ask, do ordinary people, have they absorbed these alternative definitions or do they see things the same way scholars do in different societies and across different populations within societies? Right. So what countries did you look at? I think there are six.

And you kind of slotted them into different categories. Can you tell us the six and where they fit? We ran a large-scale survey of about 6,000 plus people across these six countries: Egypt, India, Italy, Japan, Thailand, and the United States. And they range on a lot of different dimensions: geography, region of the world,

Some are established democracies facing challenges like the United States and India. Some are non-democratic contexts like Thailand and Egypt.

and some maintain their democratic quality quite resiliently, Italy and Japan. So we wanted to look at a very diverse sample to answer this question: is it just the people in the US and Italy, like North America and Western Europe, thinking about democracy one way and other people in other societies thinking about democracy another way, or do we find more consistency?

Very interesting. The method also in this study is really interesting. It's something I haven't seen before. Participants were given scenarios with different elements that might come into play when they go to define democracy. They were asked to say which of these scenarios was more democratic. And statistically, you found a few ringers, a few that really seemed to be the same across the groups.

But why did you use this approach instead of asking people, give us your definition of democracy or here's a pick list, rank them or give us your top choices? What made this approach appeal to you? That's a very exciting part of our research. So I'll start with a little bit of some of these existing approaches that you mentioned and then how that motivated us to try a new methodology. Probably the most straightforward way is just ask people, what do you think democracy is? And one thing that is limited is that

people will tend to just grab terms that are easy to remember. So this is availability bias in psychology. I might just say, oh, freedom or elections, because those are like key terms, but it doesn't really represent what I would evaluate as more democratic in a meaningful way. If you ask people, on the other hand,

Instead of just an open-ended way, you tell people, "Oh, do you think democracy means elections?" I could easily just say yes, but it's not really in any comparative context. And people are arguing that democracy is a multi-dimensional concept. So if you use these straightforward questions, they might just say yes, yes, yes. But we don't know a comparative sense how these different dimensions stack up against each other.

So we sort of intervene with this methodology called the conjoint design, where we show people two hypothetical countries and we randomize different attributes of the country on these different dimensions of democracy.

And we asked them, which country do you think is more democratic? Some people might be familiar with this methodology actually from business marketing, where you choose which product would you rather buy? We sort of borrowed that approach and applied it to our social science question. And it worked quite well as a way to evaluate all these different dimensions at once. Let's hear an example of a scenario that one of the subjects in the study might have encountered.

Sure. So subjects are presented to hypothetical countries, country A and B. We don't use real names to just sort of neutralize the context and home in on these dimensions. And one example might be country A is one that has free and fair elections, but civil liberties are only weakly protected. The leader is highly constrained by the courts and the legislature.

And economic equality is low, gender equality is high, and so on and so forth. So for each of these nine dimensions that we are interested in, the quality of each dimension can vary.

When you looked across all of these descriptors and all these subjects in all these countries, what were the most important characteristics, the ones that kind of came out on top the most often? We were surprised about this striking consistent pattern, which is that elections and civil liberties were the top two dimensions in pretty much all the societies, all six countries.

And even comparing different types of individuals within countries and demographics. Yeah, that's right. By gender, by age group. We even had a question about your left-right ideology. Do you identify as a minority in your society? Are you more pro-China or pro-US in the international competition that's going on? And really,

really a consistency that was very striking. Why did you find this result surprising? Does it not match up with like previous literature or some of your expectations about the divides that would be out there? So there have been documentation of alternative definitions of democracy taking root in different societies. And many authors and pollsters have found that people in especially non-U.S. contexts

have defined democracy in different ways. So we were very surprised that that didn't seem to be the case. And especially surprising was not just across societies, but across these different demographic groups as well.

Yeah, so some of the non-winners, some of the also-rans in this list are things like checks and balances in the government, but also equality between men and women or across genders. Was that something that you would expect to vary more by country or by region? The equality by gender actually came a close third in

in the sort of rank order of which attributes matter most. So that was a sort of important point we wanted to make in the article, that even though these traditional ideas about elections and civil liberties really popped consistently, it's not that the other factors didn't matter at all. What we found, contrary to the traditional definition, was that checks and balances had a weaker role across most of the societies.

This has a really important implication, which is that leaders who start to dismantle checks on their power may face less public backlash than trying to subvert elections or free speech, for example. That's really interesting. Yeah, because you do see kind of these examples of subversion of elections, things like we don't need to have more elections because I listen to what people say and I already know the will of the people and I will just follow those and stay the leader for a very long time.

People aren't going to buy that. This is what it seems to me this research is suggesting. People aren't going to believe that. That's right. Does this fit in with the motivation that we talked about, you know, that there is this democratic backsliding and there are places that are trying to redefine democracy to suit their own needs? Do you feel like this is an argument against that or that it won't work? There are some optimism and some cautions coming out of our research.

The bright side, at least from the standpoint of traditional democracy, is that people aren't defining democracy in all sorts of different ways to the point where you can't even defend democracy because we can't agree on what it is. So we do find consistency that supports this type of collective pushback against undemocratic behavior. At the same time, we do see two areas where there

There's weaknesses to and potential democratic erosion. The checks and balances, which I just mentioned about removing checks on the leader's power, people don't seem to appreciate that as much. Maybe it's too abstract for people like I vote. I vote.

I like free speech. I like to say what I want. But this idea of checks and balances may be a little more abstract, so they don't appreciate it. The second area that is potentially a weakness for democracy is that people do see the gender and economic equality as important.

also contributing to the democratic quality of a country, maybe not as much as elections and civil liberties, but to some moderate degree. So a leader who can say, oh, well, I brought you these economic goods and I've improved social outcomes, can maybe still have seemingly legitimate claims to democracy, even as they're weakening other aspects like elections and democracy.

Down the line in the future, would you want to expand the study to maybe include countries from other parts of the world like Australia or parts of Africa to get more of a sense, even more broadly, of how people are defining democracy? We'd love to expand the study beyond the six countries we began with, which was already a big starting point. Absolutely, yeah. But of course, we don't want to dismiss the fact that there are a lot of other variations across countries

other regions of the world. We don't have South America and Africa in our sample. Another area which, depending on feasibility of doing this type of survey work, countries like China would be very interesting to see since the information environment is quite different there.

That would be really interesting. I guess one aspect in terms of our next steps and our bigger project, my research team and I, we are interested in sort of mass perceptions of democracy. And we're also interested in how people value other things besides democracy, like public safety and health care. And would they be willing to give up democracy?

if they had other stuff. So now that we know how people define democracy, we want to look at how people weigh democracy compared to other things. And I hope people will look forward to our future research on that question. That's super interesting. I feel like that really gets at this, like, do I want protection or do I want freedom to do what I want? And that dichotomy plays out in the U.S. a ton in all different kinds of political arena. So that's very interesting. All right. Well, John, thank you so much for coming on the show. It's

Thank you for having me. John Chu is a Presidential Young Professor in International Affairs at the Lee Kuan Yew School of Public Policy at the National University of Singapore. You can find a link to the study we discussed at science.org/podcast. Don't go anywhere. Next up is my conversation with chemist and basketball star, Linus von Holm.

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Science was always in the cards for me when I was looking at colleges. I was interested in biology, maybe studying wildlife. I felt all in on studying science, but it wasn't the primary lens through which I made decisions before or during undergrad because I was also a collegiate athlete, a diver. Now, I had the great fortune of not being talented enough to pursue any post-college training for the Olympics or anything like that and use the years following to...

redirect my passion towards wildlife research. And this all feels like it happened a lifetime ago. But when I saw this week's Working Life essay, so much of that period came back to me. Linus von Holm wrote about her experience balancing dual passions for basketball and chemistry as a student athlete. And I was interested in hearing more from her.

Unlike me, her athletic career has continued beyond undergrad, which we'll get into. But first, hi, Lena. Welcome to the Science Podcast. Hi, thank you so much for having me. Oh, sure. So first, tell me, you're working on your PhD in chemistry at UC Davis right now, but you're not in Davis. You're done with your NCAA eligibility, but you're not done with basketball. So where are you? Where are you playing and what's going on? Yeah.

Yes, that is correct. I just finished my NCAA eligibility and I am now in Germany where I am playing professional basketball. I am currently on an academic leave from my program at UC Davis, but I had a unique opportunity to go play professionally. So I took it while I had the chance and I

plan to resume my studies whenever I can. So you mentioned in your essay that growing up in Europe, you felt like you're going to have to choose between pursuing chemistry or basketball after high school. I'm a little less familiar with trajectories for sports and academics there, but what would that decision have looked like if you had stayed in Denmark?

If I stayed in Denmark, I think I wrote in my essay too, we don't really have this concept of university athletics that the U.S. has. So I would either have to choose to go to university and study there, or I would find a club already and play professionally at the age of 18 after high school. Because combining those, I mean, you can do it

to some extent, but I wanted to pursue a high level of both. And that is not really possible because we don't have the system that

kind of intertwines those two things. Right. Yeah. And the other thing you wrote about was you found that there were some almost boundaries or challenges. I remember myself when I was visiting schools, there were some places that like explicitly said that like you can't study science and be an athlete. But I guess what was that experience like for you once you got here, knowing that you had wanted to pursue these two things?

It's not like they said you're not allowed to do it at all. They just said you need to be aware of this and this and that and it'll be very difficult and you'll be traveling. You'll be missing a bunch of classes. You won't be able to attend review sessions and all these things. So it's kind of all the difficulties were outlined. And then it was at the end of the day, it was still my choice. But just the fact that I didn't have anybody tell me, yes, you can definitely do it. We're here to help you. That made it a little difficult.

But I found a way. I mean, I still ended up finishing in four years, but on paper, I didn't have a chemistry major. I ended up with a different major. It was German, which becomes in very handy right now as I'm living in Germany. Yeah. And it's, I mean, I've always been interested in languages as

as well. So it's not something I'm mad about or sad about at all, but it was something that allowed me to stay eligible while also then just focusing on the specific requirements I needed for consideration for graduate admission. You had this sort of unique situation that affected your timeline. You transferred from Colorado State to UC Davis and COVID hit and gave you a year of eligibility and you had an injury. That

Extra eligibility offered you the opportunity to take extra courses for graduate admission on top of your major and get a master's and even start your PhD all while still playing.

What was different about balancing graduate level work with basketball? Was that a bit of a shift in itself? It was indeed a bit of a shift. I think what really helped me out was that there was a lot of independent work there as well. Sure, I had a couple of classes, but it was a lot of research. It was a lot of being in a lab, you being responsible for keeping up with your own degree and meeting your own milestones. What was different compared to my undergrad experience was mostly that

It was very uncommon for an athlete to be a graduate student. So there were a lot of people that weren't as familiar with the processes, professors that just had not dealt with it before. So I really had to communicate well and just peers that also didn't really know what that was like. They were used to just school being school.

And to that being like the main priority. But I had to, I wanted to still prioritize two different things. What made you decide to write the Working Life essay? This was actually happening on the plane as I was moving from the U.S. to Europe. And I was kind of reflecting on the past seven years of my life on everything that I had experienced in the U.S. And I wanted to

write down a couple of thoughts or notes of what I had gained from this whole experience. A lot of people have had questions to me about how did it all work out? Like, how were you able to do this? What did you gain from all of this? And I thought that maybe there would be other people who were interested in hearing about it as well. I wanted to

Yeah.

Science and athletics can both definitely be kind of all in types of endeavors. Like, what would you say to folks that might say that it's a you can't really be fully committed to two things?

I think as long as you have the passion for both, then you will be willing to do a lot of things and you'll be willing to make a lot of things work. And at the end of the day, then it may feel stressful and like you're very busy and doing a lot, but it won't necessarily feel like a burden because you're happy about what you're doing. And as I said, as long as the passion and the commitment are there, then you'll find yourself honestly achieving a lot of really cool things.

How did your sort of more specific research interests develop? I know it's still early, but do you have a sense of like what you want to be focusing on now that you're in your PhD? So my master's was officially in pharmaceutical chemistry. So it is more, I mean, there are so many different areas of chemistry, but it's a little bit more directed towards medicines. And that is also what I've been focusing on during the first year of my PhD.

So, I mean, I think there are some really cool things out there that we can do and that we hopefully can help with by studying different interactions. I have always been more into the biology and the chemistry world of science rather than the math and physics. So I feel like this is what really combines it. Also just from being an athlete, learning a lot about the body. And that's also really useful when you want to

study medicinal chemistry. Do you have any advice for people who are sort of juggling multiple passions or do you have anything that you might have told your former self back when you were really figuring things out? It's easy to get caught up in small details, but for me, I always just took it day by day. You pretty much never can be perfect in all the areas that you want to, but you can at least try your best and not be overwhelmed by all the things you have to do. Just

be super meticulous about it and figure out what you want to do, what you want to achieve and how to get there. That has really helped me a lot. That's great. What do you think your future is going to look like in terms of balancing athletics and sciences? I mean, I know that there are two areas that have different time frames and opportunity windows, as you mentioned. I know that things aren't always in your control or totally in your control, but what are you hoping for your dual careers to sort of look like? The

Yeah, as you said, it's much about opportunities. And right now there is a window for me to play professionally. I think at some point that side is going to ramp down a little bit because eventually I do want to get back to academics. So I think I will. It's weird to say right now because that's not where I'm at right now, but I will have to find a way where I'm deprioritizing that a little bit and kind of just as life goes, priorities shift and

figure it out. Have there been any instances of success that sort of have made all of the extra work and everything feel worthwhile? I think we hear a lot about how hard it is to balance lots of things at once and everything. But have there been any moments that come to mind that have felt like, oh, it's it's been really worth it to do all this work that I've been doing? I mean, I wouldn't change a thing. I would do it all over again.

This doesn't mean that it was easy at all. There were definitely a lot of hard times in early morning practices, late nights at the library, whatever it is. I don't know if it's related, but I remember my senior night this year, our last home game in Davis. So the seniors being celebrated, the ones that are moving on from the program. And pretty much my entire research lab showed up to support me. The ones that I was doing my PhD with and that I also did my master's with.

And I think that was just a very sweet culmination of all these years and showing that I had been able to still be invested in my friendships with the PhD program and with my research group. Even my PI showed up and they wanted to see this side of me as well. They wanted to come support me and see what I spend all of, not all of my time, what I spend half of my time doing, I guess. That was a great experience.

example of a great journey. Yeah, that's great. I mean, it is such a perfect representation of that too. I think as much as like being in sports is very different from being in science. One thing that I feel like scientists really understand is passion for something and can really recognize that. It's very true. That's great. Thank you so much, Lina. Thank you. Appreciate it.

Lena Svanholm is a PhD student in chemistry at UC Davis, currently on leave, playing for Syntanix MBC in Germany. You can find a link to the essay we discussed at science.org slash podcasts. Up next, we have a custom segment sponsored by the Icahn School of Medicine at Mount Sinai. Custom Publishing Director Erica Berg chats with Dr. Michael Elewitz about the critical need to invest in women's health research. ♪

Hello to our listeners and welcome to this sponsored interview from the Science AAAS Custom Publishing Office and brought to you by the Icahn School of Medicine at Mount Sinai. I'm Erika Berg, Director and Senior Editor of Custom Publishing at Science. Many of the medical conditions that have affected women since the dawn of humanity, from pregnancy to menopause, remain a mystery to science.

That is beginning to change as researchers become newly energized to tackle female-specific diseases, as well as those that affect women differently than men, with hopes that more effective treatments will soon become available.

Today, I am very excited to welcome Dr. Michal Elovitz, Dean of Women's Health Research at the Icahn School of Medicine at Mount Sinai in New York City, and the Director of the Women's Biomedical Research Institute. We'll be talking about an introductory essay that Michal co-authored for an upcoming supplement to Science Magazine entitled Frontiers of Medical Research, Women's Health.

The supplement will be jointly published by Science and ICON Mount Sinai with our November 15th issue. Michal, thank you so much for being here. I am so delighted to be here and always welcome the opportunity to talk about women's health, so thank you for having me. Well, I'm delighted to talk about women's health, so let's just dive right into it. In your article in the supplement, you mention that science has long prioritized the study of men over women,

What are the key historical factors that led to this disparity? And how are current research initiatives working to bridge this gender gap?

I get asked this question so many times and there's this reflex to want to say that it's just misogyny, right? That it's always been there and it continues to be there. And I'm going to take a pause and change my answer for once and say, I do think in the beginning it was about benevolence, right? And that we didn't want to cause harm. We, the global we, not we, the women we.

to women and the idea that women were more vulnerable, that we didn't understand pregnancy, that we didn't understand why women died in childbirth, that we didn't understand so many things about women that we were afraid to focus on them. Unfortunately, this is where misogyny does end up coming in. - Okay. - Right? Is that as we began to learn more, instead of saying, "Let's figure this out," it became, "Well, let's just kind of push it to the side and not think about it." And so historically,

Women have not been included in clinical trials. And then we have to understand the decision makers, the people from Congress to the National Institutes of Health making decisions about what research was done on was mostly by men. And so it was men making decisions about men's health. And here we are. So let's talk a little bit about some female specific conditions.

Endometriosis and preeclampsia affect millions of women, and yet there are no reliable diagnostic tools or cures. Can you talk a little bit about the most promising research or breakthroughs that are currently addressing these conditions?

These are two areas that we are actually actively doing research on. But before I can talk about the breakthroughs, I think it's important to talk about why there's such a problem, right? And this is, it goes from endometriosis to preeclampsia to menopause to all the things that you mentioned in the beginning. There is a fundamental gap in knowledge about the biology that drives disease. And because we don't have that biology, we take these symptoms women experience, these very significant conditions, and we

We lump them together. The more we lump it together, the less we understand it, the less we advance care. And so that's for preeclampsia. I would say the biggest breakthrough for preeclampsia in a lot of these disorders is applying some of the innovative sequencing and technology that we have that we applied in COVID and in other conditions

to more deeply understand what's happening at the tissue microenvironment, so for in this case, the uterus, or systemically and how those things are being altered months prior to the disease to understand really the biology that's happening prior to clinical manifestations as opposed to treating it once it's already happened. Endometriosis falls on the same path.

It's based on uterine biology. Well, we don't understand menses or people having their periods. We don't understand the uterus and the biology. So how is the lining of the uterus ending up in the peritoneum in the abdomen and leading to this condition that affects one in eight to one in 10 women and a diagnosis that's delayed for eight to 10 years? So again, I think we need to apply some of these very amazing techniques that have worked in other areas of science.

to women's health and we will start seeing transformative findings in all of these diseases because we've applied this kind of focused energy and investment into these conditions and diseases.

So in the introduction to the upcoming supplement, you mentioned the need for sex-specific treatments. Could you explain how understanding biological differences between women and men might revolutionize personalized medicine, especially in diseases that affect both sexes?

So I do want to, it's interesting because, you know, for years in my own jargon, right, I talk about personalized medicine. How have we as a medical society, as a scientific society, talked about personalized medicine before talking about sex-specific biology? If we really want to achieve personalized medicine,

How does that come before understanding differences in female and male sex biology? It's kind of a little bit mind blowing when you frame it that way, right? Precision based medicine can only reach its full potential if we understand how female and male biology is different. It does seem a bit like low hanging fruit in the personalized medicine space. Like, let's just start with...

men and women. So you asked for an example. There was an article published in Nature that talked about the change in the immune system in individuals getting gender affirming care with testosterone. It is an impressive, wildly thought provoking paper because what it talks about is individuals getting testosterone, that their immune system shifts.

This shouldn't be news to us. We know that the rate of autoimmune disease is four to one more women than men. So now we have scientific evidence that sex specific steroids are influencing how our immune system functions. So this is huge. And so if we invested in this, we would have an impact across so many different conditions for both men and women. Switching gears a bit, there is a growing interest in the role of the microbiome in women's health.

close are we to developing microbial therapeutics and what conditions show the most promise for this approach? So this is a special research interest of mine. I've been working on the microbiome for about 15 to 20 years with some amazing collaborators. So there's a lesson that we learned from the gut microbiome. There's an infection, usually a hospital-acquired infection called C. difficile that causes

really bad symptoms and bad disease for people who are infected by this bacteria. And so we treat with antibiotics. What they actually found out is that a fecal microbial transplant was highly effective.

in treating the disease. What can we learn from within that microbial transplant that we could create a therapeutic? And today, when we try to isolate that and treat it, we have not been as successful, right? So there's something about the microbial communities that we don't understand yet. Following the playbook has been done with vaginal microbial transplant, trying to treat women who have bacterial vaginosis or other conditions that are

are predicated on the vaginal microbiome. For women across their lifespan, the vaginal microbiome, if it really impacts, which I believe it does, infertility, preterm birth, and symptoms in menopause, then it's a therapeutic that would have a profound effect for women across their lifespan. And I think that's really hopeful. What is the state of investment in women's health research? How are we doing? So in the year 2021, 10% of the NIH budget went to women's health. So not great.

I would say 10% for a population that's 50 to 60%, depending on which age group you're looking at, it's probably not great. So is it getting better? Are there positive changes? There have been a couple of task force, one by the National Academy of Medicine that has been looking at NIH funding. There was a White House executive order on women's health and funding. I am hopeful. I am reserved. I think there needs to be

pretty drastic structural changes to how NIH funds women's health research if we're going to want to be transformative in our approach. Assuming that we could get some funding, what would you want that funding to go toward? What areas do you think have the most potential to improve health outcomes for women in, say, the next decade?

Oh, that's difficult for me because, you know, I could start from both as a scientist, as a doctor, as a mom, as someone in midlife. I think the more we reveal biology, the more we elevate across the spectrum. We talked about kind of sex steroids and hormonal milieus and how it shifts.

If we understood even that, if we just started right, how does our hormone shift across time? I think you would elevate understanding why children and women have such dysmenorrhea or bad periods, if you will. And I will take a moment to say, right, we think at 16, staying home for two to three days because you have bad cramps is normal. It's not normal. Our society has normalized these kind of women's health conditions.

If we understood these hormonal shifts, we might understand endometriosis better and how it interacts with uterine biology. If we understood this kind of very specific female biology about hormones, we might understand all the dramatic changes that happen in midlife during menopause. I'm really concerned with the health impact it has for my daughters,

their friends, my friends who are women, and the next generation. We have to start making a change or the care that my daughters and other daughters are going to receive is going to be no different than mine 30 years from now. I'm also a girl mom, so I feel all this. Well, Michal, thank you so much for joining today. This was so informative. I really appreciate you being here and sharing all of this with us. Thank you so much for having me, Erica. I really appreciate your time and interest.

And I'd also like to thank the Icahn School of Medicine at Mount Sinai for sponsoring this interview. I'm Erica Berg. Thank you for listening. And that concludes this edition of the Science Podcast. If you have any comments or suggestions, write us at sciencepodcast at AAAS.org. To find us on podcast apps, search for Science Magazine. Or you can listen on our website, science.org slash podcasts.

This show was edited by Sarah Crespi, Megan Cantwell, and me, Kevin McLean. We had production help from Megan Tuck and Greg Soares at Podigy. Our music is by Jeffrey Cook and Nguyen Khoi Nguyen. On behalf of Science and its publisher, AAAS, thanks for joining us.