202. Cat Bohannon

0:01This is a Global Player original podcast.

0:12Well behaved women rarely make history. Bloody difficult women do. This week's difficult woman is Cat Bohannon. She's a public intellectual, she's a writer and she's a researcher into the evolution of the female body. and she is basically science's Tina Fey. I should add that we do discuss the shooting that took place on the streets of Minneapolis when a 37-year-old woman called Renee Good was killed by ICE officials. We recorded this podcast the day after, so bear that in mind. But welcome to Difficult Women.

1:04Dr. Kat Berhannon, she has a PhD from Columbia University, is a public intellectual, author and researcher into the evolution of narrative and cognition. I'm sure we'll unpack that a bit. Who has written that Rara Arvis, a hit book about science that also foregrounds the female sex. It's called Eve, how the female body drove 200 million years of human evolution. The New York Times called it a page turning whistle stop tour of mammalian development that begins in the Jurassic era. Eve recasts the traditional story of evolutionary biology by placing women at its center. Kat, I think we should stop there because I could do a lot more biography and, you know, a lot more of your greatest hits when it comes to academe.

1:54But this is such an interesting... Terribly important. Just go on and on and on. Was that enough? No. That was fine. You can tell me all your illustrious achievements and we can also burnish your halo. This is a really important book. Another reviewer here in this country, because I'm speaking to you over Zoom in Seattle, where you live with your partner and two children, has called it a long overdue evolutionary account and a prehistory to Caroline Criado Perez's book called Invisible Women, which is all about how the world is configured for the male form and the male sex. I had dinner with her.

2:41Yeah, she's great. I was so relieved when her book came out, to be honest, because I got the book deal a couple of years before her book came out. And it was such a relief because it was like, oh, thank God, I'm not the only person saying it. Oh, thank God, I don't have to do the book about everything in data. I can focus on what I wanted to focus on, which was the story of these bodies, you know, because she can handle the car crash thing about how, you know, crash test dummies until very recently were only designed for male bodies. And so when we would get in car crashes, of course, we with the tits and all, you know, we would actually suffer more.

3:16And it's like, okay, cool, cool, cool, cool. So she did that. It's not the only voice I can actually get into the deep story of what these things are. I have room now. I don't have to just beat the drum. Well, you make a great team, both of you. You cover the waterfront and boy, did it need covering. And in your book, Eve, of how the female body drove 200 million years of human evolution. Why did you discover that science ignored the female form rather than dig in and find out the secrets of humanity and longevity that the female form, as you contend, contains? You know, the short answer for most of these questions is sexism.

4:01Like, hey, it exists. Sexism. Anyone? Sexism, right? But in this case, what was so interesting to me was that that wasn't the root of the problem. It was there, not there, but it wasn't the root of the problem. The root of the problem was that every female mammal has something called estrus. Well, the majority of us that do, you know, if our bodies are functioning normally, they develop according to a certain path. And OK, so estrus, we call it the menstrual cycle. You know, we have these hormones that go up and down a predictable pattern when we are doing that thing. And what you may not know is that nearly every tissue in our bodies has sex hormone receptors.

4:43We're only just starting to understand them because we're only just starting female studying females like now. But yeah, so if you're a good scientist, if you want to understand your data, if you unless you're asking something specifically about what ovaries are doing, you want to control for your confounds. And so it wasn't like there was some sexist, you know, cabal rubbing their hands together. Like I live in the U.S. right now, so it feels that way. But no, no, it was just, well, the easiest way to control for the messiness of the female body, that dynamism, was just to not study females at all, which means that a huge amount of biology was based on, well, the penis havers, the ball havers.

5:28To what extent was this sexism a kind of horror of the fleshly, liquid aspect of being female post until you hit menopause anyway, and then you get a whole other range of issues? Was it just men thinking we don't want to go there, even though oestrus is common to all females of the species because it's women? We don't like it. Why? Why wouldn't it be explored more? Well, here's the thing. You have to separate out the people who are dealing with human bodies. So that's your clinical trials. That's people studying stuff in the human body from basic biology, which goes back to rats. There really isn't a kind of fear of female rats among male biologists.

6:21I mean, maybe, but they haven't told me that, you know. It was more like, no, it is true that I can't count the number of people I've talked to who say in the ER, they will wait for an OB to remove a tampon before they begin procedures having to do with the pelvis. You know, like a male doctor could possibly take out a tampon, y 'all. It's okay. You don't have to be scared. Right. But in basic biology, it really was more controlling for the messiness and the numbers in your math and your data. It's like, I don't know how to interpret what's happening in the liver right now in this mouse. If half of my subjects are female and going through estrus and the liver might be behaving differently because of sex hormones.

7:09Right. So the easiest way to say I'm asking a liver question. I don't know how to deal with the complications of the female is to just not have any female livers. Right. But it has huge implications for when you're then trying to develop a pipeline for drugs that might affect the liver up in humans later. Right. If you're trying to understand basic liver physiology and you're studying it in rat and you're only studying it in male, When are you going to find out, oh, drugs that are metabolized in livers behave differently in average female bodies, which turns out to be true in humans, man. You're not going to find that out if you don't study the female rat.

7:47Are you basically saying that medicine has evolved separately from the female in terms of analysis because it hasn't incorporated the menstrual cycle in its findings? Well, as you may have noticed, you are not constantly menstruating. Like your entire life from birth to death was not just full of period. They happen, but they happen at certain times. But when they happen, things can happen to your immune system. Things happen to your digestive system. It turns out it affects how your liver is metabolizing things. Absolutely, it affects your brain. There's no part of your body that isn't affected by that if you're a person who's going through a menstrual cycle, right?

8:35Some of that feels real, maybe. Some of that feels, was it that big a deal? It depends on your body. But that's also true of basic mammalian biology. That's what I'm saying. And so if you're developing medicine, as you call it, evolving, well, it's not really evolution, but yeah, if you're developing medicine over time, then you need to understand basic biology. And if you're not studying that female sex, you're not really understanding it for how it's going to apply in any mammal. And we're mammals, man. We are very mammalian. I mean, we could move on to your views on whether you think that sex is non-binary or binary.

9:20Because speaking as a mammal, I think it is binary. given that what you've just said that the menstrual cycle of the female mammal affects so much of of how that body responds in various situations to various medicines how can you argue that sex is non-binary well first i want to separate out sex and gender Yeah, sure. So I'm talking about sex. Yeah. OK, so biological sex, that's something that is actually a little more complicated than a binary. But we're talking about math. OK, we're talking about averages under a curve. There are absolutely people with ovaries that have weird stuff going on that doesn't norm to what we'd say a female body usually does.

10:13There are absolutely people born with testicles that have all kinds of stuff going on that isn't under that norm. The majority of people with autoimmune conditions are biologically female. Not all. There are guys with lupus, right? So, okay, so we have to say, all right, sex isn't a binary, but it's still a powerful analytical tool when you're trying to make medicine better for most people, right? Right. So that's what I mean when I say, yeah, sex isn't a binary, but let's keep our eyes on the prize here. Right. Let's say what is the prize? Reducing suffering, making this suck less. That's the goal.

10:52Being a female suck less or being a woman of any sort. I think both is an OK goal. Sure. Maybe that's, you know, a little too pie in the sky, but I feel like we could actually reduce suffering for all bodies. That would be awesome. Right. Right. So, for example, one of the things that I usually talk about when I say eyes on the prize is it's like, OK, well, you may have noticed that menopause is not great for a lot of people who go through it. Not not like top of the list, not like what you hope for on any given Sunday. Right. There's a lot going on in the body that has to do with suffering. Okay.

11:26We don't really know to what degree hormone intervention is going to help with some of the many health effects of menopause. We're still studying that, right? We all want to slap a patch on our butts, those of us who do go through menopause, and hopefully that helps us. But it only helps with some things and not all people. Part of it is that it's understudied, right? Now, what's sort of fantastic from a scientific point of view, from a researcher's point of view, is that there are a lot of trans women who've been on hormone therapy for years. And what's so interesting there, for example, is that there was this beautiful study of trans women who'd been on hormone therapy.

12:09So they're suppressing testosterone. They're upping their estrogens. OK. And they'd been on it for at least 10 years. and they did a cardiovascular study for their basic heart health, right? And so long as they didn't smoke, to all of your listeners, don't smoke. Just don't do it. Just don't do it. It's just bad for you. Just don't do it. As long as those trans women didn't smoke, their hearts looked younger. Their cardiovascular systems look younger than same age cis men. Their peripheral vascular response was better. Their arteries were less stiffened, right? And that's one of the few ways as scientists that you can understand how much of why older men's hearts suck, you know, from a medical point of view, is about that androgen point thing and, you know, estrogen versus testosterone and how much of it is the Y chromosome and what's treatable.

13:01And then the fact that women's heart health presents differently in older ages. How much of that is X chromosome? How much of that is estrogen? Is there a way we can think about treating that with hormone therapy or not? We don't know yet. Studying trans women is one of the ways we're going to find that out. It's a brilliant control. It's a brilliant. I agree. It's a brilliant control group. I mean, in your book, you set out, you know, women die later, healthier than men do. I mean, this is a plane, you know, the elephant is in the room here. You know, let's look at the elephant. Why are women living longer and having healthier lives than men?

13:42And, you know, I think this is groundbreaking. Well, I'll just put a little pin in that. Sure. Live longer, but we spend more of our lives in poor health, which is interesting. It's a paradox. It's called the longevity-morbidity paradox. Define poor health, though. so once we pass menopause once we start to get into our late 50s and on into the 60s for those of us who do live that long more of us will have more health complaints more of us are suffering from frailty more of us are having a lot of morbidities and we and we don't know why exactly I mean mechanistically I mean we certainly know that our pain is under believed in the clinic We certainly know that we are diagnosed later with many conditions and some of those conditions are progressive.

14:31So if you're diagnosed later, then it wrecks more havoc in your body before you get treatment. So there is sexism at play for why women have poor health in later life, right? Because it can compound. But some of it is just deeply biological. Some of it is about sex differences. Some of it is the effect of menopause. We're trying to tease that out in the lab, right? But it is the obvious thing. The funny thing or depressing thing, let's go with funny, is that as we're finally starting to study female bodies in the lab, probably the first people who are really going to benefit are men. I knew that was going to come.

15:08But still, eyes on the prize. Eyes on the prize. Floats all boats. Let's get them all better, including the guys, even though they will be the first to benefit. Because if you have that baseline knowledge of how their bodies work and then you add in that sex differences knowledge, probably they're going to be the first ones to benefit. But I think all of us, all of us will benefit from this.

15:46is the menopause a kind of it's become a really big thing here there are books about you know, how to eat your way through menopause. Very, you know, very hot, cute broadcasters and presenters have all espoused the cause and banged the drum for rights for women post-menopause in the workplace and to make space for them. I mean, is it a thing? I don't think, is it such a thing in the US where you don't even get statutory maternity leave? Well, right now in the US, We're dealing with the very obvious rise of fascism. So there's a lot on our plates right now. Menopause is one of the things on our plates.

16:26It's a bit low down the list. Not that women should ever be low down the list again. Thank you very much. However, I will say there's just a lot in our media space right now, if that's what you mean. What are we talking about, right? We're talking about people getting shot in the face. However, also menopause. I think Halle Berry has been great, honestly, about because sometimes you're right. Sometimes it takes a really hot ass woman talking about menopause to get us. And she's famously one of the most beautiful women in the world. And she's like, hi, menopause, though. So, no, that's actually been great.

17:01That's been absolutely great. And in the UK, too. I think I'm all for increasing visibility for anybody suffering. and since literally half the planet who makes it to a certain age is gonna go through menopause absolutely we should it should be less taboo absolutely we should talk about it do you have coy terms for it in the u.s we call it the change like we call periods the curse here what do you call it in the states you know the uk is is really wonderful with language about that what happened in ireland is the troubles i'm like oh that's gentle you know menopause is the change i shouldn't compare the two so yeah I um I think would you call it have to ask my grandmother she would probably call it the change she would probably call it women of a certain age yes exactly and listen you don't name the age but it's a certain one you mentioned uh the shooting of a 37 year old mom in Minneapolis I mean we can't pass by without reflecting on that a bit yeah um yeah Yeah, it's awful.

18:08It's awful. It's awful. It's awful. You know, and I think, I really hope that we remember Renee Good. And I'm so broken by it. And I'm broken by it for a couple of reasons. One, she was a freaking poet, believe it or not. She won the Academy of American Poets Prize, the same one I won in 2002. So there's that. I'm broken by it because we've been seeing images of brown kids crying and brown people suffering in the U.S. under ice for a long time this year. But now we're noticing because it's a white woman shot in the face. So I'm I'm hurting for that, too. That is this is she good enough? Is she good enough now that we have a white woman who's a mother who who looks like people who have power?

19:06Like, is she good enough now that we can care about fascism in the US? I don't know. And I don't know. Maybe because she's a poet. It was too intellectual. Maybe we're too inured to everything this year. I can say that it's awful. It's awful and it's not remotely okay. And I hope that our Congress finally gets a goddamn spine and does something to make this better. Since Trump's second term, he's removed rights and he's taken away funding from healthcare programs, domestically, internationally, USAID. Does he remotely care about the things you care about? What's he done or not done for women's health?

19:54I will say that a lot of women can relate to this. When there's an abusive man in the room, we spend so much energy trying to figure out what he's thinking. Huge portions of our vitality is spent trying to unlock the black box of some abusive narcissist. And frankly, there's work to do. I don't care what he's thinking. I don't care what RFK Jr. is thinking. I see the damage that's done and I see the repairs that need to be done. And I'd like to talk to the adults in the room, you know. You don't care. We don't care what he's thinking. We can't second guess him because his superpower is his unpredictability.

20:41But we have to care about what he is doing. Yes. Look at the effects, look at the change and do not turn your eye away just because you're tired. Though I sympathize. We're so tired. Everywhere we look is horror in the U.S. right now. My God, you know. But it's absolutely the case that we were just getting going with research into the biology of sex differences. We were finally investing properly in research into women's health here in the U.S. and abroad. Right. We were really making strides. And so I think the wave has not stopped, but I think that we should mourn what's lost and refuse to let any more go.

21:28How's that? Absolutely. And in terms of women's of all, I mean, income levels and classes, access to health care, how would you explain it to an English audience that has benefit of public service health care from cradle to grave? Just to describe what is it like being a woman in Trump's America right now with a health condition?

22:01ah that thing my voice just did it's that it's that okay it's like don't go to that it no it's like it's it's like can i find the words for the every direction of suckage can i find language to describe what it is to know that your older relatives are not going to have a safety net for their health care. And that's true in a way that is not really comparable to the NHS, right? Because it's not just Social Security, it's not just Medicare in the US that actually, at every tier at every age, so much of health care access has to do with money in the US. It really, really, really does. Unless you're very, very poor, there is no safety net, right, in the way there is now.

22:52I sympathize. There are issues with the NHS. And I have friends who work for the NHS, you know, and it's not like the NHS shouldn't be made better. Okay. But in the US, okay, it is not the case that you will absolutely have access to this concept of a well woman's visit, where you unfortunately may have a speculum shoved up you. But you know, there are nonetheless, you're being screened for cancer, you're being heard, you're being talked to in ways that are useful that maintain your health. That is really much. That is really a thing that has to do with how much money you have. And in Trump's America, where basic hormone therapies, basic abortion services, basic treatments, if you're a person going through a miscarriage, depends on which state you live in.

23:43Our country's a lot bigger than yours. It's a big deal to get out of Texas if you can't get health care in Texas. Okay. Texas is bigger than you might imagine. And of course, yeah. No. And of course, you mentioned abortion rights and those have been removed from the Constitution in the sense that the Roe v. Wade was regarded as an extra constitutional matter for each state to determine whether women should access abortion services. How's that been? Oh, just awesome. Yeah. More suckage. No, I mean, you know, I comedy laughing is how I cope. OK, that's true for a lot of us. I think that's true in a lot of people in the UK, too.

24:30So if you hear me making light of it, it's because I'm coping. Sure. OK, you know, we do. And it's a friend of mine, Kate Mann. She's a feminist philosopher at Cornell and a badass. She's great. She often likes to remind me that giving them more information doesn't necessarily improve things. Here's what I mean. We know that since Texas changed its laws, that the rate of pregnant people dying of sepsis has gone up. We know that. Why is that the case? Because now you have to wait until the heartbeat has stopped in a miscarriage in order to evacuate the uterus. And that's true whether or not you are in a state of preeclampsia or other life-threatening conditions.

25:19And ectopic pregnancy, for example. Absolutely. That's a thing. Ectopic pregnancies are always a life threatening condition. The fact that one or two women have survived having a fetus grow outside the womb does not mean the vast majority of the time it won't kill you. But waiting to see if it has a heartbeat and if it stopped is not acceptable as a measure. So so it's absolutely we know, in other words, right, is more information enough. If they simply know more, the governor is in Texas. If they simply know more, will they change the law? And no, they know perfectly well that more women are dying since these laws have changed.

25:58But instead, they doubled down. They doubled down and made it more enforceable for doctors providing abortion care and miscarriage care. So it's not the case. No, you really, really, really just have to stop waiting for them to catch up. And you have to change the laws now. I'm so glad I live here.

26:33Let's move on to your new book. You've been commissioned by Knopf, which is a very distinguished house to write. Oh, I'm fancy. You are so high class. A book about women's health across the lifespan. I think you're calling it Being Alive. Is that still the working title? It is a very unambitious title. It's called Being Alive, The New Science of Women's Health and Why It Could Save Us All. Well, this is this is like, you know, the tea we want, because if women's health is the key to survival, you know, you are going to sell this book by the shed load. You know, the incredible damn privilege of writing books like these.

27:17It's nice that they give me money. I'm not going to make light of that. That's cool. I like making my mortgage. But it's really more like, oh, God, I actually get to work on things that matter. Not all of us do, you know, not all of us have the privilege of being able to spend our days working on things that feel like they could matter. And so that's an honor for me. But when I say it could save us all, I really do mean all of us. Yes, even the people with testicles, because it's going to improve their health care. The better we understand how being male is a thing that shapes their medicine and could be improved.

27:54It's also going to save us all because over 80 percent of the health care decisions that are made in our country are made by women. Because we make the decisions not simply for our bodies, but for our children, for our elderly relatives, for our sick cousins. And yes, also often for the men we live with. We're the ones who decide if they go to the doctor or not, which medicines they take. We buy most of the medicines that they then take. We're the deciders. And yet our health is the one being neglected. So, no, it really is the easiest way to make a country sick is to neglect the women. The easiest way to make a country healthier is to better improve their care and better empower them to make the decisions they need to make.

28:33Just that. And you're a mom. It's true in the UK, too. You're a mom, and I don't know whether your partner is male or female, but you've got two children. You presumably have to make sure they're fit and healthy. Oh, they're trying to kill themselves constant. They're five and seven years old. Keeping them alive is a nature bar to pass. And yes, I do. I do do my very best to keep them alive. But of course, that's part of the work, isn't it? Sure. For any caretaker, any caretaker. Now, there are men who are caretakers, to be clear. It's just that, well, the majority aren't. Now, look, everyone will be wondering how you wanted to get into this messy viscera of women's health.