Angela Huttner MD

27 January 2016

Most of us infectious diseases physicians and clinical microbiologists work in “pyramid” environments: there are many foot soldiers at the ground level and only a few generals at the top. Luckily most foot soldiers do not want or need to become generals later. But they all would appreciate an equal opportunity to try, should they ever change their minds.

Humans and other primates enter this world with a strong and apparently universal sense of fairness.1 Evolutionary biologists tell us that the purpose of this sense of fairness is not necessarily equality for its own sake. The aim is rather continued cooperation. So our ancestors already knew it, as we do innately: privilege hinders progress, and equality drives it. In science and medicine, whose advances depend often on unconventional ideas and always on cooperation, privilege is particularly noxious.

But privilege is powerful—literally. Privilege is the not-so-hidden channel through which power is passed from one generation to the next. Privilege is indifferent to merit. And the thrill of acquiring privilege is formidable. Though some apes are capable of giving up an immediate benefit to stabilize a long-term, cooperative relationship,2 it is the rare human who can resist privilege and the advantages it confers.

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) formed its Parity Commission in 2010. The Commission’s first major undertaking was a simple questionnaire on women and minorities in the infectious disease (ID) and clinical microbiology (CM) fields; it was posted on the Society’s website and sent to its members.

The first sign was the arrival—within hours—of angry emails. Some disgruntled members wanted to know why ESCMID would spend its resources on a “non-issue.” Yet over 1,500 professionals across Europe completed the survey, whose results were the second and final sign. According to respondents, there is obvious inequality between women and men in ID and CM, with the latter enjoying three times as many full professorships, higher paychecks, and more children.3 Discrimination—the dark obverse of privilege—was reported frequently on the basis not only of gender, but also of geographic provenance.

Some say that you can’t get there from here; you can never make it to a fully merit-based system from our privilege-oriented one. And it does look grim. Of course it is not only ID and CM. Many scientific fields are being examined systematically, and the results are disheartening. A recent meta-analysis of gender and science research conducted by the European Commission found that “there is no evidence of any spontaneous movement towards less gender segregation in European countries.” On the contrary, levels are unchanging, “if not rising.”4 The technology industry appears to be faring even worse than we, with the recent U.S. “Elephant in the Valley” survey finding that 60% of women experienced sexual harassment—and that nearly half of them did not report it for fear of harming their career prospects. (When women were not being outright harassed, a common refrain from male colleagues was that “once women get pregnant, they become irrelevant.”) And “case reports” of gender-based harassment from famous scientists, always comfortably established in those places we look to most for enlightenment, seem to be multiplying.

Between privilege and merit, there is admittedly a wide gulf. The purpose of this blog is to explore what is in that gulf, and why it persists in our fields though it is being successfully narrowed in other (non-science) sectors of society.

The approach will be multipronged. First, through testimony and other evidence, the burden and costs will be examined and defined. I am fortunate to have had many conversations with different players in our fields. I have spoken to many “victims.” But I have also had fascinating conversations with the ostensible drivers of this imbalance, among them the chairs of departments who must manage busy ID divisions and young female fellows who want to have a baby, or foreign doctors whose first months on service can be disastrous, with their language struggles and ignorance of the way things work “locally.”

As the Parity Commission’s current advocate for gender, I will write about some of these conversations in the coming months. My colleagues on the Commission will contribute; we hope to convey the voices of all of these players, anonymously whenever desired. We invite you, too, to contact us with your thoughts and experiences.

Second, we will probe exactly how and why we find ourselves still here and not there. We will enlist medical anthropologists, health economists and sociologists for their perspectives as to why discrimination and inflexibility persist so stubbornly in fields whose optimized advancement depends critically on cooperation, while other sectors of society are being transformed before our eyes.

Indeed, society is overtaking us, its pace of change still dizzying. All of us know the milestones. We know that just 100 years ago women could not vote, let alone become full professors. For millennia women had babies and nursed; no one else could. They played their well-defined parts while the men played theirs. Now both have been released from those roles and allowed new ones—which come with new expectations. And both are suffering. If, in our ID and CM fields, the gulf between privilege and merit is not narrowed in step with its narrowing in other spheres of life, professional privilege can become dangerous—for men and their families. Some actors in our fields have not yet recognized the new roles that much of society now expects men to play. For men, demands at home have increased enormously, yet at work they tend to face the same inflexibility, traditional gender-role expectations, and promotion pressures experienced by their grandfathers in the 1950s.

And finally, we will ask our specialists—and you—for strategies for the trip across that gulf. We believe that if we listen carefully enough, they—and you—can nudge us toward realistic solutions. If apes can do it, surely we can too. Some say you can’t get there from here. But we are wired to try anyway. So all I can say is this: I think the other side will be just beautiful. Don’t you?


  1. Brosnan SF, De Waal FB. Monkeys reject unequal pay. Nature 2003; 425(6955): 297-9.
  2. Brosnan SF, de Waal FB. Evolution of responses to (un)fairness. Science 2014; 346(6207): 1251776.
  3. Tacconelli E, Poljak M, Cacace M, et al. Science without meritocracy. Discrimination among European specialists in infectious diseases and clinical microbiology: a questionnaire survey. BMJ Open 2012; 2(6).
  4. EUR 25138 — Meta-analysis of gender and science research–Synthesis Report 2012. (accessed 19 January 2016).


Angela Csaki Huttner ( is an infectious disease physician & researcher in Geneva, Switzerland.

Categories: Gender Balance


  • […] promised in my first blog post that I would be presenting all sides of our uneven landscape here, particularly those of heads of […]

  • . says:

    I believe that ESCMID showed that it is not the same old scientific society but a different society exactly because of its interest in different aspects of the ID and CM fields.
    As Angela wrote, privilege hinders progress so privilege must no longer exist if we really want to make advances in science and medicine.
    I don’t understand disgruntled members, I don’t understand the reason for such acrimony in some comments on the Parity Commission……but perhaps they are more helpful than the messages supporting the Parity Commission initiative.
    I have never defined myself as “feminist”, this is probably due to the stereotype of what a feminist represents. When I was young I didn’t support feminism because in my mind this would have meant admitting that gender differences exist. Then I grew up and I realized that we need feminism because it is “the doctrine advocating social, political, and all other rights of women equal to those of men”. The problem is that the term is used with a negative sense. Perhaps we should coin a new term to eradicate the negative aura that has always accompanied feminism. Or maybe we should continue to use this term with pride. Why do both men and women frequently insult a woman calling her feminist when she says that females are discriminated against? In reality they are right, considering the true meaning of the word feminist, but why do they get angry? Why are they sarcastic? Because those who have privileges are frightened of losing them? And for women? Because it is easier to convince themselves that they are not discriminated against than it is to fight against discrimination? Because women need to convince themselves that they are living the life they choose freely?
    Despite enormous progress in the last 100 years, women remain imprisoned in their classic image of a woman. If a woman has a successful career, almost always people emphasize that she is a WOMAN, she is asked how she reconciles work and family life. Have you ever heard a man asked the same question? Discrimination is in our head, our neurons are soaked with gender differences.
    I quote Margaretha: “They have children and they don’t want to have their children grow up with au pairs, which is the case of many high position women at present”. Children and family are a women’s issue. If you give women the necessary support for the family, they still don’t get job promotions. Because discrimination is in our neurons. Because women still grow up with the idea that the family is a women issue and they feel guilty if they leave children in a kindergarten in order to work. Why men with high positions have 3, 4 or even 5 children? Why is the way of promoting women necessarily through the implementation of family services? Why doesn’t anyone think about improving possibilities for men in the same way? We cannot continue to think that family support policies are useful to women. The bias is right there. The parental leaving in the Netherlands is used by 25% of men and 75% women. Is this an enlightened country? Is this a country that offers the same opportunities to men and women?
    Let’s show our children that mother and father are equally engaged in work and in family, and perhaps our sons will stop discriminating against women and our daughters will stop discriminating against themselves.
    Forget the negative aura of the term feminism and start focusing on the true meaning of feminism. Because the irony, the acrimony put into the term feminist means exactly this: males must continue to be privileged, everyone who tries to fight against this statement must be humiliated.
    So please, clean out your neurons to free them from all stereotypes of female gender.
    And finally, even assuming that Marghareta is right saying that “people who filled in the questionnaires are mostly people who are not satisfied with something, while the majority doesn’t have problem with an issue”, should we accept discrimination against a minority group?

  • Eli P. says:

    Angela, I am greatly impressed with your thoughtful post and your efforts. As a non-European, I will refrain from commenting on the specific European issues you raised. However, as a male ID physician I can report that I have been in many promotion and tenure meetings (in the US) and search committee meetings where bias does arise against women – most of it unintentional yet it’s still very harmful. There have been numerous times when male colleagues will say things like “she can’t be a leader, she will just have kids” or “we shouldn’t promote her because she has other priorities” while ignoring the female colleagues record of productivity and desire for a leadership position or promotion. Thus, we are not at the stage where the lack of women in leadership positions is purely choice – there are many hidden biases. The key with the Commission and blog is that they are raising awareness of the issue. Now that I am aware, I can fight for female colleagues in closed-door meeting situations where they can’t (yet) flight for themselves. Time will surely fix this situation but not without a struggle.

  • Laura Kankkunen says:

    Interesting to read the comment of Dr. Taconelli (I assume to answer the critics on parity commission by Dr. Cauwenberghe) that the idea behind parity is indeed about discrimination in high position of academia!!! So, it is proven. Leadership is concerining 5% of so ESCMID members, while such an organization should be for all!

    Just to comment on Dr. Taconelli’s comment on discrepancy in the leadership positions in many of the North-EU countries. The system is good, the management is not hierachical (CEOs and Prof’s are not God), the salary is good. So why bother with the management issues? There are many parities commision here too, there are even incentives for companies and universities to increase the women part in leadership (day care, long maternity and fraternity leave, etc.), but the result is not significant, simply because the abovementioned reasons.

    Here, the women who become leaders are simply those who want it and follow all natural process to be one, for example the ex-president Mrs. Halonen and her ex-PM Mrs. Jäätteenmäki were politician who come from below the ladder. It will not be fun if you are a woman and when you become a leader the people tell you, aha, you are the leader because of positive discrimination…… Thats why I think such a parity organization can bring inverted effects.

  • Evelina Tacconelli says:

    Great piece Angela!
    To add some more bullets to the conversation in my experience and according to the second study we just completed with the PC of ESCMID, one important issue is the tendency of colleagues who are discriminated not to admit it. It is easier to work without fighting. It is easier to say there is no problem, if the solution is not easy to reach.
    I´m used in evidence based medicine and there is no doubt that EU data show that women and scientists coming from specific geographic areas have significantly less opportunities to be involved in leadership groups including board , committee, journals´ editorial board or conferences´ faculty and are paid less. Based on this result we can derive three conclusions: 1. the system performs well; if they are not in these positions means they do not merit it; 2. the system performs well; the colleagues do not want these positions; and 3. the system is strongly biased and not everybody with equal merits has the same possibilities to reach leadership positions. If the first statement is true there is an urgent need to change universities methods and teaching in order to define area of improvements to provide better education to all (unless there is a difference in QI and then there is obviously no way to correct the difference but then we need studies to prove it..). If the second statement is true we have to ask why more than 80% of these colleagues do not want to be part of the leadership. Because of family needs would be the most frequent answer. In this case should not we ask for more local family support? If this is true why this discrepancy in leadership positions exists also in many of the North-EU countries where these family supports are provided?
    As scientists we have to accept that the evidence of discrimination in medical universities is clear. As scientists we can contribute to decreasing it or we can say that it is not a major issue for science and there are more important issues to cover.
    I have been often angrily accused to be a feminist and I happily laugh about it. I do not understand why this should be an accusation. In my opinion is a compliment since the word means “equal conditions by gender” and I´m sure many of my male colleagues would be proud to be addressed with this adjective. In the reality I never thought about myself as a feminist. I cannot just accept inequality and close clubs in science where new ideas and difference brings always innovation and progress.
    I hope this blog would help us as a ESCMID committee in defining new strategies to reduce this problem. We do need participation and suggestions to design new projects and initiative as well to define specific guidance documents. I understand also that signing a comment of this type in this blog would not be always easy so please just provide your free opinion without feeling obliged to write your name. Your comment would go in any case online without any information about your identity and for us could be a very important contribution to future initiatives.
    Looking forward to reading your thoughts.
    Evelina Tacconelli

    • Sarah Logan says:

      Dear Parity commission!

      I was delighted to hear about this commission from Peter Chiodini, a colleague here at the Hospital for Tropical Diseases. As a second year consultant at HTD working 60% of full time with three children at home I rarely find the time to get exorcised about issues of gender equality until now. This year I was really thrilled to find that I could at the last minute make ECCMID, when I came to trying to pay I was so depressed.To discriminate whether one is an junior or senior physician on the basis of age ( before or after 1980) is discriminatory against anyone who has a.) chosen to work less than full time for any reason, B.) gone into medical training later in life. The majority of a.) will be women who have chosen to have children and work less than 100% . In the UK infectious diseases and microbiology training has a gender split of around 60:40 in favour of women and if we are to retain these women at a consultant level we have to empower them to attend conferences.
      Surely there is an urgent need to address these prohibitively high registration fees that are actively discriminating against the old mothers like myself! Do feel free to email me/ catch up in Amsterdam.

  • Margaretha van Cauwenberghe says:

    Many of the abovementioned issues are indeed the feeling of many women in academia. However, I believe from my own experience and in my own environment that many of the things mentioned are not absolutely (not) true. Firstly, the data showed were from questionnaires and they are full of bias. The author of this blog herself call the questionnaire ‘simple’. People who filled in the questionnaires are mostly people who are not satisfied with something, while the majority doesn’t have problem with an issue. In the politics, it is called silent majority. Secondly, about the paycheck, in several countries, the paycheck is relatively standardized so it doesn’t matter whether you are a man or a woman. Thirdly, a lot of the issues tackled by the parity commission is about higher position in the academia. Many women simply don’t want high position. A boss ever said ‘ we just want to be happy, no fight, no headache’. I know several colleagues with Harvard postdocs who come back to Europe and refuse the professorship. It is impossible to combine family live, friends, sports, arts and academia they say. They have children and they don’t want to have their children grow up with au pair’s, which is the case of many high position women at present. Fourthly, in many countries women are nowadays the majority among medical students (up to 80%) and it is simply the matter of time, that even many women don’t want to be professors, by evolution that the higher position will be filled in by women (even in classically specialisation for men such as surgery). In almost all departements where I have been working, 90% of the professors were women. Fifth, there is no concrete plan, even by the parity comission how to tackle this possible problem. By accepting only women in a departement? In my previous work, the head of the clinic need to close a part of outpatient clinic for a while because the half of his residents was pregnant. Or, by prefering to select abstract or paper from a female candidate? This is also a form of discrimination. In science as in many other fields, you should just simply choose the best. Otherwise we all slide to the regression of the mean.

    In summary, I think it is a pity that ECCMID, an organization that has a motto to treat patients and to improve science is putting a lot of effort in such a comission while it is really not the core business and definitely not making patients or science better. Such a politically sounds involvement is not a business of a scientific community. Moreover, there are a lot of other isssues where brain and money can be put on in the area of clinical microbiology and infectious disease. For example infectious disease in third world countries, improving quality of science among doctors. More projects that benefit many members of ECCMID and its surrouindings. After all, remember, the last Nobel Prize winner (interesting enough her research is in the CM field), Mrs. Tu Youyou, is a woman from China! A country not known for disparity project. She won something that for all of us only a dream, while she was never the highlight of ECCMID or any other conference (Nature, October 8th, 2015).

  • Dorothy McCurdy says:

    What a great article.

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