Including Women's Bodies in History & Medical Science

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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. We don't usually play sound bites of guests who are appearing on the show. Why play them recorded when they're here talking to us live? The author, Cat Bohannon, has put out such a compelling three-minute video to help introduce people to her new book called Eve that I thought we might begin with 30 seconds of that video and then hear from her live. The full title of the book is Eve: How the Female Body Drove 200 Million Years of Evolution.

Cat Bohannon: Of Mice and Men, this much is certain. Being sexed permeates every major feature of our mammalian bodies and the lives we live inside them but for over a century, the female body has been radically left out of biological and medical research. That's finally starting to change and what we're learning about the biology of sex differences is rewriting the story of humanity.

Brian Lehrer: Cat Bohannon on video. Cat Bohannon is about to join us live. The book addresses such questions as why do women live longer than men? Why are they less hairy? Why do women menstruate? Does the female brain really exist? Why do girls do better at every academic subject until puberty, and then not? And much more. Cat Bohannon is a researcher and author with a Ph.D. from Columbia in the evolution of narrative and cognition.

Her essays and poems have appeared in Scientific American, Mind, Science Magazine, The Best American Nonrequired Reading, love that title, The Georgia Review, The Story Collider, and Poets Against the War. She lives with her family in Seattle. The book is out today, and she'll be doing a New York event tonight with Claudia Dreifus at Book Culture near Columbia at 112th Street and Broadway. Cat, thanks for joining us on your release day. Welcome to WNYC.

Cat Bohannon: Hi. Nice to be here.

Brian Lehrer: There are so many places we could start, but how about the line in the video clip about women being radically left out of medical and biological research for over a century. Can you give us some examples of what has been studied and what has not been that leaves everyone with an incomplete picture of evolution and of life today?

Cat Bohannon: Sure. It's an open secret in the biological and biomedical sciences, that when you're in the lab, where do you start? You usually start with rodents. Maybe you're a worm guy, but you're probably working with rodents. If you're working with rodents, what you're actually doing most of the time is working with males. You're working with males that have male gonads and male penises.

Obviously, rodents do not have a gender identity, but they do have gonads, and they're working with males primarily because estrous, what you and I might call a menstrual cycle, is thought of as a confound. When you're doing a scientific experiment, you want to keep things clean and neat, and tidy. You want to control for your confounds. Weirdly, everyone just decided without really talking to one another about it, but it was just became the norm, well, maybe we'll just use the males because they don't have these cycling hormones.

Now that goes all the way up to human clinical trials where women are also radically under-enrolled when we're testing out new drugs or testing out new treatment plans for one thing or another in our body. What you end up having is drugs coming onto market that haven't been properly tested for sex differences, so it has radical impacts in our day-to-day life.

For example, human women who have ovaries that are online, they process opioid drugs differently. They tend to need slightly different dosing regimens. They tend to clear it from their systems faster, and then feel like they need more to achieve the same level of pain relief as a typical male patient might do. That has radical impacts for who gets addicted to stuff, for who gets taken seriously in the clinic when they talk about their pain. It's everywhere.

Brian Lehrer: It's not just the last 100 years, as you address in the book, but what actually happened evolutionarily millions of years ago that gets left out, like from the start of human history and you use your viewing of the movie 2001, A Space Odyssey as a way into that.

Cat Bohannon: Absolutely. I'm a big Kubrick fan. Come on now. However, here I am, I'm a preteen, I have not yet entered my puberty, and I am because I'm the age I am, so that's when I was watching it and so I'm watching this group of hominins. Now it's actually American and British mimes in ape costumes, but fine, fine, fine. You're watching this group of hominins invent the first weapon. They find a bone, they start beating it on the ground. Some guy goes and beats the crap out of another guy with the bone, and then Kubrick's camera follows it up into the sky. It transforms into a spaceship and voila, humanity has tools.

The thing is, is even then I was thinking, why are there no females or babies in the scene? Maybe I missed them. I went back to look, couldn't find them but that is often how we tell the story of where we come from. This very male-dominant, male-typical story but the most challenging thing our species encountered wasn't necessarily whether or not we needed to beat the crap out of another guy. Actually, the most challenging thing we encountered was in our own bodies, we're actually not very good at making babies with our human reproductive system. The more important thing, and this is out in The Atlantic monthly today, was that we invented gynecology. Lucy had a midwife.

Brian Lehrer: Lucy, the [crosstalk]

Cat Bohannon: Australopithecus, yes. One of our ancient hominin ancestors. Exactly, and we're talking millions of years ago. The history of gynecology is millions of years old, and it's the reason our species still exists. We would never have made it to 8 billion without it.

Brian Lehrer: The press release says, Eve is everything Sapiens left out and that refers to the noted book Sapiens: A Brief History of Humankind by Yuval Noah Harari. Do you think that book deserves to be singled out for criticism because of its content or its place in the reading public's mind? Does it deserve to be singled out?

Cat Bohannon: I don't think of myself as a Harari's enemy. I see him, my beautiful fellow queer out there in Israel. He's doing good work. That's fine. It's just that, well, he starts at about 50,000 years ago, roughly. Our species is 300,000 years old and our mammalian evolution is 200 million, so there was a little more to do.

Brian Lehrer: I guess so. Listeners, your questions welcome for Cat Bohannon, an author of a new book, Eve: How the Female Body Drove 200 Million Years of Evolution. 212-433-WNYC, 212-433-9692, call or text that number with your question for Cat Bohannon. Also, in that video you say, "The book is the story of our mothers, our Eves, and they're the reason we're here at all. By all scientific accounts, we really shouldn't be." What do you mean by we by all scientific accounts we shouldn't even be here?

Cat Bohannon: The thing is, is that it seems like we're really good at making babies. 8 billion people, eh, maybe there's some birth complications, maybe, whatever. The thing is actually in our ancestral state before we had gynecology, we had all kinds of different birth complications. A lot of mothers and babies died from this process or became crippled. We know what other species that have reproductive problems look like. They look like the giant panda.

The giant panda is going extinct, mostly because of human encroachment and they only eat a lot of bamboo, and they're fussy. The other reason they're going extinct is that they've largely forgotten how to have sex. Actually, zoos are showing them videos of panda porn true, true, true, true and it only works. They're hoping to remind them, I don't know. In other words, we know what it looks like in other species when they have this most basic problem, which is that they're not particularly great at making more of themselves.

If you think back to your prior segment, the history of humanity is the history of migration often in response to climate change but just because we seem to be good at migrating doesn't mean it wasn't really hard and doesn't mean there was a lot of suffering along the way. True then, true now and one of the things we have to remember is that in order to not go extinct, what you really need to do in whatever new place you land is make a lot of healthy babies that survive to make more babies.

That's evolution right there. The way to do that in our species is by helping each other out. We actually aren't great at making our own babies, but we're great at helping each other survive the process.

Brian Lehrer: Let me go to some of the questions that the press release spotlights as, I guess things that listeners might be curious about regarding some of the biological sex differences or at least the way they come out. Is there an evolutionary reason that women tend to live longer than men?

Cat Bohannon: Yes, absolutely, there is and this is absolutely the future of the study of aging, of gerontology. This is how we're going to get to the point where we can extend the human lifespan. Female bodies across many different mammal species are better at not dying. That's the real story of menopause, actually. Congratulations, you're still alive. That's actually the big deal.

Our primates' ovaries, it turns out, are still running an older plan while the rest of our body, and we're still figuring out the mechanisms for this, manage to extend our lifespan. We've got our old monkey ovaries, if you like, aging at their normal rate, and then the rest of us keep on going. It turns out that the things that help us extend our lifespan in many, many mammal species tend to work a little bit better in biologically female bodies.

There are a number of different ways this might work. Actually, one of the very obvious reasons that we should enroll more trans bodies in studies because trans women, like all women, need to be better cared for and need to be better studied in scientific settings. There's a beautiful study a few years ago where trans women who had been on hormone therapy for decades at that point were studied for their various health measures, and one of the really interesting things is so long as they didn't smoke, which really is just bad for you, please don't smoke, people, is that their hearts were healthier.

Their cardiovascular system in general, by many measures, we're healthier than the average same-age male. That's one of those vulnerabilities that typically male bodies have. Your hearts are a little bit more crap, and we need to take better care of them, but if we don't know exactly why there's a male vulnerability there, then are we really getting to, I don't know, the heart of the problem? If we can actually better untangle why it is you get some of that female resilience and some of that male vulnerability for many markers of aging, well then we're going to let everybody live healthier lives. We have to dig down and figure out why it's working that way.

Brian Lehrer: Did you say the science suggests that menopause is one of the reasons it's working that way?

Cat Bohannon: Actually, what I said is that menopause, it turns out, is just one of those things that's an evolutionary accident, or at least that's the best I could suss from 10 years of digging into the research. It's like the primate ovaries are senescing, that means aging at the predictable, basically primate rate, but the rest of our bodies have this really extended lifespan. The rest of us manage to stave off death, whereas the ovaries are like, "We're still running the monkey plan."

That's actually what menopause is. It's not so much that we evolved in order to stop having babies necessarily, but rather, we evolved in ways that extended human lifespan, and it just so happens that female bodies are better at it.

Brian Lehrer: Is there an evolutionary reason why women tend to have less hair?

Cat Bohannon: [chuckles] Turns out we don't actually have less hair, technically. We have roughly the same number of follicles you do. We just have different hair types typically across our bodies. If you actually take a microscope and a centimeter of skin on any given body of any given sex or intersex even, you're still going to have roughly the same number of hairs.

It's just that we produce more of this sum, it's called villus. It's like the peach fuzz. We do more of that, and across your torsos, you do more of those longer guard hairs, those longer body hairs. Maybe if you were to actually shave it all off pound for pound, you're harrier if you exclude head hair because we tend to wear our head hair longer, just depends on the culture, but you're not actually harrier in the deepest sense.

Brian Lehrer: Let's take a phone call. Here is Desmond in Crown Heights.

Desmond: Wow.

Brian Lehrer: You're on WNYC with Cat Bohannon, author of a new book, Eve. Hi, Desmond.

Desmond: Good morning, Cat and Brian. I want to say thank you for your book. One of the things that I may have missed it in the pause when I had the silence, was that most people don't know that all zygotes start out as female.

Cat Bohannon: Yes. That's a very good point. I think what you're trying to say here is that in the womb, it actually takes quite a while to develop what we would call male-typical sex characteristics, especially around the development of the genitals. That is in my book, so don't be shocked. There's an illustration. It shows you where along the weeks of development you are when you start from having these little genital buds and then differentiate into either vulva or more male-typical bits.

Desmond: [unintelligible 00:14:37]

Cat Bohannon: Yes, absolutely. Some even think that the biologically female model for many parts of the body might be more of a default. I don't know if that's true or not, and I think the science isn't settled there. I will say that in the development of a body along a sex-typical path, all kinds of things get buggy. The size of things, the direction of things, whether or not you actually develop genitals of one type or another based on your sex chromosome profile, it actually goes wonky all the time.

Brian Lehrer: Desmond, thank you very much. Listener texts this question. "Could it be that the reason humans have difficulties having babies is to keep a limit over population, which is one of the most profound effects on our environment?" Asks that listener.

Cat Bohannon: The ways in which that question to me seems smart is that you're really asking about that relationship between how many babies we have and what our local environment can support. Now, when you're talking about ancient times, when you're talking about even prehuman in the millions of years of hominin evolution, the pressure on having too many humans around, it's going to be low. We're actually mostly getting eaten by a lot of local big cats and hyenas at this point.

The worry about overpopulation at that point, not so big. Now, definitely, we're concerned about population, but you're absolutely right. There's this relationship between body plans and how they tend to build out a reproductive system, and what pressures there are in that local environment that make one or another type of reproduction beneficial and then have more of those babies survive. That's absolutely true. As for right now, I think mostly we should be working to reduce human suffering. The population issue is an issue, but is maybe less of the concern than people who are migrating and suffering.

Brian Lehrer: Another question via text message, may be related though it's not about environmentalism.

Cat Bohannon: Bring it.

Brian Lehrer: It says, "Wouldn't the theory that we need help having children be the exact reason that women survive menopause to become older caretakers of the tribe?"

Cat Bohannon: As I say in the book, it's absolutely true that the most valuable thing historically, and I would argue now about our elders and women included, are the knowledge that they offer to our communities. It's not the free childcare, it's not the cookie jar, it's the knowledge and wisdom they have to share with our communities, which in times of crisis is really, really, really important and would've been even more important for our ancestors, so yes.

It's also true that humanity is a caretaking species. It's one of the really distinguishing things about us. We are often, as much as we can be jerks, driven to care for one another, particularly when those people are vulnerable, even if we're not necessarily directly related to those people. There is that drive to care for others, and that's certainly true in our elders too.

Brian Lehrer: My guest for another few minutes is Cat Bohannon, whose new book is called Eve: How the Female Body Drove 200 Million Years of Evolution. I noticed that you're not an evolutionary biologist- [crosstalk]

Cat Bohannon: That's true.

Brian Lehrer: -by training. Your master's degree at Columbia was in MFA, Master of Fine Arts in creative nonfiction, and your PhD there was in the evolution of narrative and cognition. I wonder how these humanities and social science groundings of yours influenced or informed how you approached 10 years of research for a book on evolution in a way that might be different from somebody who was narrowly or formally trained in the sciences.

Cat Bohannon: As someone whose father was the director of a psych department, the chair rather, and I grew up in the lab. I was a subject long before I was a researcher myself. By the time I arrived at my PhD, I was a super interdisciplinary person. I was doing a lot of experiments on using computational modeling over in the psych department. I was collaborating with [unintelligible 00:19:07].

What's true of me, in other words, isn't simply that I have some of that experience with humanistic study, but also that I'm used to being interdisciplinary, which means I get over being nervous. I get out of my silo and I go walk across the hall, and I talk to people. I'm able to do it in many of the bodies of scientific literature too. That's the thing that's maybe more unusual about me. It's that I know that this is a big enough project.

Telling the story of our evolution from early mammals forward is a big enough project that you have to be willing to go outside of your comfort zone and talk to experts in other fields because it involves many, many disciplines of research.

Brian Lehrer: In addition to Eve, which I guess is a biblical reference, you name an evolutionary Ancestor, Morgie. Who or what is Morgie?

Cat Bohannon: Morgie is a genus. She is an exemplar. She is Morganucodon. Actually, the Smithsonian named her Morgie on a little placard, so I felt free to do it. She is the ancestor of all human milk. She's the reason we have breasts because we actually had milk way before we had anything like breasts. We had milk before we had nipples, and which partially explains why some human babies are so bad at latching during lactation and effectively, the human chest wall, as all mammalian chest walls do, know how to milk better than the human mouth knows how to suckle.

Nipples came later. Morgie is a creature that lived about 200, 205 million years ago, and we know a lot about her life and her environment. She's a way into understanding how this weird trait evolved that we nurse our young. Where did it come from? What are the benefits, and what's crappy about it, and how does it still shape our lives today?

Brian Lehrer: Listener texts, "The reason why women live longer is because they hemoglobin flush every month for most of their life." Do you think that statement holds up the way it was written?

Cat Bohannon: I actually don't. There was a recent paper that came out. It was reported in The Times, about maybe the reason some blood tests are a little wonky on women, including diabetes tests, is that we women of reproductive age who do have a uterus that menstruates, not all of us do, we lose blood every month. Here's the thing, we're losing a couple tablespoons. This is not a massive amount of blood loss. Actually, the most profound blood loss most women will experience in their lives happen around childbirth and postpartum recovery. That's when we're really losing blood. Every clinician knows to be careful with blood tests around there because it changes your concentration profile.

That's already known in the medical world, thankfully, because OBs are great. It is absolutely true that our cardiovascular system is very, very sensitive to sex hormones. It affects the peripheral vasculature. It affects central functioning, which is to say it does matter what kind of hormones you've got on board for how your cardiovascular system is functioning. Maybe it's the case. It is true in the field that people are thinking this might be so, that estrogens are somehow protective in your cardiovascular system. That's part of how we live longer, because, of course, this is one of our weak points as we age.

Brian Lehrer: One more call. Michelin in Flora Park. You're on WNYC. Hi there, Michelin. Thanks for calling today.

Michelin: Hi, Brian. Good morning. I love your show, Brian. I get smarter every day by listening to your show, so thank you. I want to ask the author about the Klinefelter syndrome when you have the human who have both sex. They have the--

Cat Bohannon: Do you mean Klinefelter syndrome?

Michelin: Yes.

Cat Bohannon: Ah, XXY. Yes, yes, yes. A lot of people who are born with this syndrome, which is rare but known for sure, they will have a number of different features in their body. Because those who do have the Y chromosome, and importantly, it's not just everything in the Y chromosome, the SRY gene, which is a big regulatory thing on your Y chromosome. They'll develop a more what you'd call a male-typical trajectory of body development. They'll have some other stuff going on.

This is a rare syndrome. It's absolutely something that exists and we should care for these people with these bodies. It's interesting that even if you do have two X chromosomes, of course, if you then also have an extra Y chromosome, so you've got three now instead of your two, that SRY gene is going to drive a lot of sex-typical development.

Brian Lehrer: Is that intersex people and the question suggests is the gender binary necessarily absolute?

Cat Bohannon: Oh, well, I see a big difference between biological sex and human gender identity. I am queer. I'm not genderqueer. Many of my friends are. It's actually a pretty diverse thing, being genderqueer. It doesn't always mean you are a trans man or a trans woman. There are people who identify as non-binary. There are people who identify as flexy. They might say it one day, one another. It's actually a pretty diverse thing. That is something that we're doing as a human species, which isn't actually if you pull the lens back, all that unusual.

We're a hyper-social species. We're a hyper-intelligent species. The brain does a lot. It's no less real for driving your experience as anything else your body does. Your brain is an organ. I would say this falls pretty well under the curve of what humanity has done historically with the complexity of culture and identity. I do think there's probably some biological drive for gender identity. No one really knows what it is. I'm not sure that that's the part that matters. I think what matters is that when people talk about their experience in their bodies and they say this is what it's like, we listen. You're all the best authority on what it's been like to live in your body. No one can tell you what it's been like to be you.

Brian Lehrer: Last question, building on that and also that in the video clip, you said being sexed permeates every major feature of our mammalian bodies and the lives we live inside them. Does that contradict at all the feminist notion that so much of what we think of as gender differences is so socially constructed in a function of male power that focusing on biological differences risks undermining the fight for gender equality?

Cat Bohannon: I'm fine with it. I don't think so. I would say that what your liver is doing to-- sorry. Let me say that again. What your liver is doing to process opioid drugs differently than someone who is a typical male body is not going to shape your personality. It's not going to shape the choices you make in your life, except for whether or not you need to take different sorts of pain meds. Your liver doesn't have a pronoun, but it does have a biological sex more than likely.

Thousands of different genes are differently regulated in hepatocytes. Those are your liver cells, depending on your biological sex. That radically impacts how your body is processing drugs. That definitely to me seems to matter, whereas what you call yourself, this to a scientist, I think is less interesting.

Brian Lehrer: The book by Cat Bohannon is called Eve: How the Female Body Drove 200 Million Years of Human Evolution. Cat Bohannon will be doing a New York Book event tonight. Today is the release date of the book with Claudia Dreifus at Book Culture near Columbia at Broadway on 112th Street in Manhattan. Do you have time for that? I don't have the time right in front of me.

Cat Bohannon: I believe it is at 7:00 or 7:30, but the internet knows all.

Brian Lehrer: The internet knows all. Go to Book Culture's website because I imagine there'll be some people who heard this, who want to hear more from you in person.

Cat Bohannon: I'd love to hear more from them.

Brian Lehrer: Thank you so much for coming on today. Congratulations on the book. We just confirmed it's seven o'clock.

Cat Bohannon: There we go.

Brian Lehrer: Listeners, you don't all have to go running to the internet. Cat, thank you very, very much.

Cat Bohannon: Thank you for your time.

Brian Lehrer: Brian Lehrer on WNYC. More to come.

 

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