“Science is not a boy’s game, it’s not a girl’s game. It’s everyone’s game. It’s about where we are and where we’re going.” These are the words of Nichelle Nichols. Known as Lieutenant Uhura to many, Nichols’ role in Star Trek was one of the first televised examples of a woman fulfilling a role habitually occupied by a man: a commanding Lieutenant receiving and analysing data at lightning speed and saving USS Enterprise from destruction episode after episode. Her presence on-screen was part of a larger shift in perception at a time that women were perfectly capable of fulfilling the same intellectually challenging, data-orientated, scientific roles as men. She became a role model off-screen too, advocating for the inclusion of women and ethnic minorities in Astronaut Programs as a NASA Ambassador. Nichols inspired women to “boldly go where no man has ever gone before”.
Countless women, through their bravery and defiance of social norms, have paved the way for female scientists all over the world today. This could be by inspiring generations of future scientists through acting roles, such as Nichelle Nichols, or by suggesting to their husbands and lab colleagues to use agar instead of gelatine to culture bacteria, as Fanny Hesse did. Today, on the International Day of Women and Girls in Science, we want to focus on the extraordinary contributions of women through antibiotic research history: to name just a few, Dorothy Hodgkin, Elizabeth Bugie and Mildred Rebstock. Furthermore, we will take a look at antibiotic use today, so as to analyse the gender dimension behind the prescription of antibiotics by healthcare professionals.
The discovery of the first antibiotic, penicillin, by Alexander Fleming, Ernst Chain and Howard Florey, marked the beginning of a new era in medicine. Penicillin was produced by culturing moulds in the laboratory and then extracting the active substance from them; however, only minute amounts of penicillin could be obtained from vast quantities of mould. Indeed, even in 1942, all the penicillin that was being produced in the world only sufficed to treat a handful of patients. In order to scale up this production process, deep-tank fermentation was developed by the American chemical engineer Margaret Hutchinson Rousseau, and used by Pfizer. Margaret Hutchinson Rousseau was the first woman to be admitted to the American Institute of Chemical Engineers. Her work helped on saving the lives of thousands of soldiers during World War II, and made penicillin available for civilian use too. Today, the deep-tank fermentation is still the main manufacturing process of penicillin.
It was the isolation of penicillin’s structure that led to the discovery of more ß-lactam antibiotics, such as ampicillin and methicillin, and allowed the production of semi-synthetic penicillin with improved stability and bioavailability. Dorothy Crowfoot Hodgkin was the Oxford scientist who pioneered X-ray crystallography with her team and confirmed the structure of penicillin. For this, and her work on the structure of insulin and vitamin B12, she received the Nobel Prize in Chemistry in 1964.
Streptomycin was discovered in 1943, and the credit of its discovery was first claimed by Professor Waksman, although later contested by his PhD student Albert Schatz, who managed to negotiate 3% of the royalties following a lawsuit. The Nobel Prize for this discovery was solely awarded to Waksman. But the paper published in Proceedings of the Society for Experimental Biology reporting it had a third name sandwiched between Waksman’s and Schatz’s: that of Elizabeth Bugie. She was a master’s student at the university where Waksman, a key member of the research team. Following her research on streptomycin, she also worked on antimicrobials for plant health and antibiotic use for treating tuberculosis. Her name is more or less omitted from most accounts of the discovery of streptomycin, and her name was present neither on the patent nor on the Nobel Prize associated to the antibiotic. Bugie later told her daughters that she wasn’t included on the patent application for streptomycin under the assumption that she would later become a housewife and a mother instead of continuing to pursue research.
Chloromycetin, also known as chloramphenicol, was the first antibiotic to be fully synthesised, and one of the few antibiotics which is cheaper and easier to synthesise than to grow. Dr Mildred Rebstock was the 28 year old chemist leading the team who achieved this feat. After starting to work on streptomycin, in 1949 they were tasked with synthesising a new antibiotic: chloramphenicol. Rebstock also advocated for women in science: at the peak of her career, just 3% of research scientists were women, which was something she wanted to help change.
Women in Research Today
The generations that have come before have forged the way forward and continue to inspire girls today as their stories are remembered and recounted. Now, we are closer than ever to a true gender balance among PhD students in Europe, with 48% of them being women – a huge step forward from the 3% in Mildred Rebstock’s day. Movements like the International Day of Women and Girls in Science, with the Science Assembly accompanying it organised by the UN, continue to support the way towards equality in research. The scientific community continues now – not as men and women, but as scientists – to seek answers to questions, solutions to problems and cures to disease, and to boldly go where no scientist has ever gone before.
The Antibiotic Gender Gap
Today, bacteria have evolved in response to the surge of antibiotics: this antimicrobial resistance is “one of the top ten global public health threats facing humanity”, and will become the first cause of mortality by 2050, according to WHO. The race is back on, this time to identify alternative antimicrobial treatments to which resistant bacteria would still be susceptible. Over-prescription of antibiotics remains an important factor contributing to antimicrobial resistance. So, where do women sit in this issue?
Numerous studies have been conducted looking into the gender gap in antibiotic prescription. That is because, from a purely statistical outlook, women are prescribed more antibiotics than men. Taking a 2017 study carried out in England by David Smith for Public Health England as an example, adult women received almost twice as many (99% more) antibiotic prescriptions than men. This is a shocking figure, but it’s important to unpack the factors underlying this gender gap in order to fully understand it. For example, women are more likely to suffer urinary tract infections (UTIs) than men, making them more likely to receive the needed antibiotic treatment for UTIs than men. This accounts for some, but not all, of the discrepancy between female and male antibiotic prescription rates – lowering the figure to a 70% increase between genders instead of 99%.
…antimicrobial resistance is “one of the top ten global public health threats facing humanity”, and will become the first cause of mortality by 2050, according to WHO.
In the same study, David Smith and his team found that the antibiotic gender gap could be explained by significant differences in consultation rates between men and women. In their study, they estimated that women were approximately 80% more likely to seek out healthcare than men for the conditions they studied. The study concluded that when consulting a doctor for the same health condition. women were no more likely to be prescribed antibiotics than men. But women were more likely to seek out healthcare in the first place, explaining why they are prescribed antibiotics more often than men. Smith and his team did note that in general there was an overly precautious prescription of antibiotics by doctors to their patients regardless of gender, resulting in a widespread over-prescription of antibiotics. This is an issue not just in England, but throughout Europe and around the world. Greece, France, Italy, and Portugal have some of the highest rates of antibiotic prescription worldwide, and Spain isn’t far behind.
The International Day of Women and Girls in Science marks a day for us to dig through history and recognize inspirational women’s perseverance and intellect in research. It’s an opportunity to encourage girls to pursue science in their futures, and to stay involved in the science over the course of their lifetimes. But it’s also a day to encourage women to participate in science across the globe, whether as patients, as researchers or as doctors, and to foster equal implementation, dissemination, teaching and understanding of science across genders. It’s a chance to highlight science which has been performed by women, and to discuss how science impacts women in their everyday lives, so we can ensure that science and research work for both genders equally.