Invisible Women

Data Bias in a World Designed for Men

By: Caroline Criado Perez

Narrated by: Caroline Criado Perez

Length: 9 hrs and 25 mins

Publisher's summary

Data is fundamental to the modern world. From economic development, to healthcare, to education and public policy, we rely on numbers to allocate resources and make crucial decisions. But because so much data fails to take into account gender, because it treats men as the default and women as atypical, bias and discrimination are baked into our systems. And women pay tremendous costs for this bias in time, money, and often with their lives. 

Celebrated feminist advocate Caroline Criado Perez investigates the shocking root cause of gender inequality and research in Invisible Women, diving into women's lives at home, the workplace, the public square, the doctor's office, and more. Built on hundreds of studies in the US, the UK, and around the world, and written with energy, wit, and sparkling intelligence, this is a groundbreaking, unforgettable expose that will change the way you look at the world.

©2019 Caroline Criado Perez (P)2019 Blackstone Audio, Inc.

A statistical fire hose

This won't be a popular review, but here goes. Some fraction of the statistics and studies presented in this book are either misrepresented, misinterpreted, or flat out wrong, and the fraction is significant. If you read/listen to this book with genuine curiosity, you’ll want to check into some of the data that are presented. If you do this, you'll find the narrative summary is sometimes right on, sometimes misleading, and sometimes just plain wrong. Unfortunately, it’s impossible to know prima fascia which is which. The result, for this curious reader anyway, is that I don't have faith that what Perez presents is factually or summarily true. I'm sure there is a lot of good information in this book, but it's impossible to know which are real issues and which are misrepresented to exaggerate the narrative.

Here's one example (and curious readers can and should find others; this review is long enough already): the discussion of the use of Viagra for period pain (PMS/dysmenorrhea). To quote the book directly:
"The primary outcome of a double-blind, randomized, controlled trial of sildenafil citrate, was, ladies, you may want to sit down for this: total pain relief over 4 consecutive hours, with no observed adverse effects. Imagine."
Except that's not what the study showed. The study (in the journal Human Reproduction, 2013, volume 28, pages 2958-2965) showed that a fraction of the women experienced some pain relief (statistically significant) over the 4-hour studied time period. "Total pain relief over 4 hours" – TOPAR4 – is the scale that is used to assess the level of pain relief; it is not a result in and of itself. In fact, the scale goes from 0-20, and the average score for the 13 women in the study was 11.9. There are additional issues: they had a hard time getting women to enroll in the study. Of the 69 women they deemed eligible to participate in the study, only 29 women agreed to do so. This is a smaller number than even the study authors expected and does not support the conclusion that women are just dying to get into these studies, but men prevent them from doing so. Further: the study compared Viagra treatment with placebo. But the standard of care is ibuprofen. We have no way of knowing how that score of 11.9 would compare to treatment with ibuprofen. But the prospects are not encouraging: the authors stated that they wanted to see an improvement in TOPAR4 score of 6.5 units (speculating: perhaps this is a score one would expect with ibuprofen treatment?), but in fact they only saw improvement of 5.3 units. So, the study did not meet its primary endpoint. Perez claims that follow up studies were not funded because 1) Men don't care about menstrual pain; and 2) pharma companies wouldn't fund a study for a generic drug that is off patent. These claims are shaky at best. In fact, it was a man who ran the initial study (Dr Richard Legro) and applied for additional funding. And there are myriad ways for a pharma company to patent new uses of a generic drug (new formulations, for example - which is highly relevant in this case). The real story is 1) There's little if any benefit compared to the existing standard of care (ibuprofen); 2) The demand for this particular treatment, as measured by the number of women who were willing to participate in such a clinical trial, is low; 3) Women may not be terribly inclined to administer Viagra directly into their vaginas (this is how it was administered in the study for reasons of safety and to avoid potential adverse effects) every 4 hours for several days each month while menstruating when they can swallow a pill instead; and 4) The long term safety of chronically administering Viagra into the vagina is not established; these are women of child-bearing age, and any adverse effects – which are much more likely to be observed with a larger patient cohort observed over a longer time period – could be devastating. This, of course, is not as flashy a conclusion as “Men don’t care and control all of the money.”

This is NOT to say dysmenorrhea is no big deal and women have plenty of perfect treatment options. But the conclusion that Viagra for PMS pain is a "gold plated opportunity," and the men who control all the funding just don't care is just plain wrong.

If you’re the type of reader who is convinced by mountains of statistics without caring what those statistics were derived from, and you’re an active believer in the narrative, then you’ll enjoy this book. And by “enjoy” I mean you’ll be outraged (which seems to be Perez’s intention) and I’ll make the same recommendation as others, which is to avoid the presence of sharp objects while reading. If you read with a keen and critical eye and want an accurate representation of the issues, then you’ll be sorely disappointed, as was I. With all that said, I award one star above baseline for making me think about some issues in ways I hadn’t previously, and for presenting a comprehensive laundry list of issues I can follow up on as I see fit.

Rich and Deep Analysis of Hidden Bias in Data

I'm not sure if the other reviewer actually read this book. South Asian women using stoves is only a couple minutes of this audiobook. Instead it is about hundreds and hundreds of small and nefarious ways in which the male bias in data makes it harder to live as a woman in our modern world. The woman who wrote this book is a data expert and she shines a light on how this death by a thousand cuts harms women at all levels of society. She also points out how easy it is to dismiss women's issues as no big deal (like this other reviewer did). The other reviewer refers to the hundreds of specific problems women face as minutiae, but this reflexive belittling is precisely why this book is so important. I have listened to hundreds of audiobooks on Amazon and this is one of my top 10 favorites. Please don't be discouraged by the other anonymous (vaguely racist) and totally misleading review. Unfortunately, in recent months there has been a trend where alt-right trolls give negative fake reviews to feminist and progressive books in order to trick people into avoiding facts. But don't be fooled. This isn't a liberal book or a conservative book. It is a data science and sociology book. With apologies to the young man who wrote the other review (and the data would suggest you are in fact a young man), please understand that science is not a liberal conspiracy. And if even 10% of the facts the author reports in her book are true, then we face a very real problem when it comes to equality of the sexes. I had no idea how bad things were. I thought women waiting in line for bathrooms was no big deal. Now I see the thousands of connections between the way the building blocks of society are organized, and the myriad obstacles women face that men can blithely ignore. This man's eyes are opened. Thank you for your stunning work Ms. Perez!

Yes, we know.

While this book contains important information, it restates the obvious relentlessly. The author reads quickly and insistently. I found it hard to pay attention to lists of statistics. I understand how vital the data gap is for women and how horrible the ramifications are of this problem. But it should’ve been a long article, podcast or series, not a book.

Painful listening experience, good info

Horrible, nervous, jumpy and too fast narration of the book with a difficult English accent. Too bad as the info is good, but God, she should have hired a professional calm narrator!

Not great science but interesting

As a scientist, I think the author makes some pretty big leaps between cause and effect at points. That said, she did a tremendous amount of research and the facts alone are compelling. I wouldn’t accept a students paper that relied on this book as evidence but it will easily point them in the right direction for solid source data.

Listen to the whole book as a student.

Listen to the whole book as a student of sociology. Be objective in your thinking until you finish the book. I am not a feminist. I am a conservative middle class grandmother who has worked her entire life, served in the military, married, college educated and raised two children. I have seen a lot in my lifetime and I encourage books that are well written and touch on society’s reality.

Self-perception and the gender data gap

I was intrigued by the premise of this book, so had to check it out. So glad I did. I had to take the occasional break from it to brood over some of the things she reveals in terms of the Gender Data Gap. However, gotta say I'm overall inspired . I didn't realize just how much of my self-perception was tied to being a female. In a world where we are literally not meant to reach the top shelf.

Need to do sex disaggregated data collect analysis

The biggest point that was made poignantly clear with copious examples is that we need to be collecting dad data for females in all the data collection we do. In other words sex disaggregated data analysis.
we need to ask women what is it that they feel they need not what men feel is needed because men don't think about women's needs.

Eye opening to say the least

As a middle aged American woman I'm ashamed, well not really, that I chalked up the ill fitting everything from seatbelts to actual furniture to being short (5' 2"). As this books shows its not my height its my gender and the lack of consideration of it that make causes the world to not fit me.
I will be joining the UPMC All of Us initiative which is geared toward building a massive data set to help the medical community create better health care. However, before I join they will have to show me hiw their study will include women as a focus not a peripheral side note.
I think I'll gift the book to a few of the top dogs at the University fir Christmas. the Chancellor is a man but the Provost is a woman. Lets see what she does to change our institution and the world she lives in.

Terrible book

This is a very important subject and she makes some great points but comes off as bitter, biased, and angry. It is easy to find corroborating statistics and complain about how the world is against you; it is harder to actually come up with workable solutions. I kept waiting for some advice on what could be done to improve but all the way to the end it was just complaining about how unfair the world is. Life is unfair to everyone. I think there is a lot of work to be done to improve the lives and voices of women, but this does not suggest any.