Participants at the Wellcome Trust and New Statesman round table.
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Antibiotic resistance: the greatest public health threat of our time?

A world without antimicrobials would be a world without modern medicine, so why is there not more urgency in addressing the global rise of drug resistance? The New Statesman brought leading health experts together to discuss the problem.

Imagine a world without antibiotics: hipreplacements, cancer therapies, C-sections and most routine surgery would no longer be possible without greatly increased risks. A visit to hospital would become rife with danger. Hundreds of thousands of people would die of diseases such as tuberculosis, pneumonia and gonorrhoea that we once, perhaps arrogantly, thought we had beaten. 

This nightmare is not as far off as you might think. Already, bacteria and parasites are developing resistance to front-line antimicrobials that are overprescribed and under-regulated. Each year about 25,000 people in Europe die of infections that doctors were unable to treat with the drugs available to them. That’s about the same number as die in road-traffic accidents. In south-east Asia the situation is even worse: every five minutes a child dies as a result of a drug-resistant bug. 

The threat of antimicrobial resistance is on a major scale, opening us up to the possibility of global pandemics and undermining the foundations of modern medicine. We are running out of antimicrobial drugs, and we are not developing enough new ones. This is the greatest public health threat of our time, but as things stand there is a limited sense of urgency.

Dame Sally Davies, the chief medical officer for England, has shown commendable leadership in highlighting the issue, but antimicrobial resistance can’t be addressed by any single country. The problem is global. In an increasingly interconnected world, an infection that emerges in Delhi today will have an impact in London tomorrow.

We can do more on a scientific level to develop new antibiotics and improve diagnostics, but science alone will not solve the problem. We need a greater political will to affect policy, we need to incentivise the pharmaceutical industry to develop new antimicrobials, and we need to look at social and behavioural issues to tackle the misuse of those drugs we do have. A commitment by the agricultural industry, which uses the majority of all antibiotics in many countries
worldwide, is also key. 

We need global leadership to tackle antimicrobial resistance; current institutions, which were set up in the 1940s, are not fit for purpose. Waiting until children and young people in the western world are dying of the same diseases as the Victorians is a mistake we can’t afford to make. 

Dr Jeremy Farrar is the director of the Wellcome Trust

The discovery during the course of the 20th century of antimicrobial drugs, a class of medicines that includes antivirals, antimalarials and antibiotics such as penicillin, is among the greatest medical breakthroughs of our time.

Yet according to the World Health Organisation the reality of a “post-antibiotic era”, in which even the most minor infections caused by bacteria could spell death, is fast becoming a possibility. Experts agree that misuse, overprescription and poor diagnostics have driven an environment that favours the proliferation of resistant strains of bacteria, rendering oncevital medicines obsolete.

The “honeymoon period” in recent decades, of cheaply available, widely effective antimicrobial compounds, has driven a rise in resistance levels across the globe. For example, deaths in England and Wales related to MRSA, a bacterial infection resistant to a number of popular antibiotics, rose steadily from 1993 onwards to a 2007 peak of more than 2,000. Hot spots of antimalarial-resistant parasites are springing up in south-east Asia, and cases of extreme drug-resistant tuberculosis (TB) in South Africa and other parts of the African continent are among the many examples that illustrate the urgent nature of this health problem.

In order to assess the causes of and possible solutions to antimicrobial resistance, the New Statesman, in partnership with the Wellcome Trust, gathered leading figures from science, pharmacology, politics and agriculture for a round-table discussion. 

Delegates were tasked with assessing the UK’s position in antimicrobial strategy domestically and internationally; how to improve development pathways for drugs; how to incentivise political and public engagement; and the role of the agricultural industry and wider governance structures in curtailing antibiotic misuse. The issues at hand are ones that span human beings, animals and the environment, said Dame Sally Davies, chief medical officer for England, in her opening remarks. She made note of the British government’s Five-Year Antimicrobial Resistance Strategy, led by the Department of Health under the One Health Agenda. 

However, there is still far to go. “This is the start of a journey,” she said. “We have a beefed-up government strategy and the National Health Service is starting to take things seriously. But in the UK thousands die annually of drug-resistant septicaemia. One child every five minutes dies in south-east Asia as a result of an antibiotic-resistant infection. Worldwide, this is having a massive impact on health, mobility and happiness for people and their families.”

Picking up on Davies’s comments, Jeremy Farrar, director of the Wellcome Trust, emphasised that the scale of the problem was “global in every way”. “This is geographically global in that it harms all of us,” he said. “It is also global in the sense that there is a pressing need to talk about regulation and the way we mitigate drug resistance worldwide. It is global in its scope of impact; the long-term consequences will stretch across medicine. Surgery would be impossible, as would oncology [cancer treatments]. Even childbirth would become a risk.” 

While Farrar said that there was a “pressing need” to discuss regulation and surveillance of antimicrobial usage, he stressed that the spectrum for solutions must be more wide-ranging. “We cannot pretend surveillance alone will solve the problem,” he said. “Unless we take in all the social drivers of drug resistance – including human and animal health, and the economic incentives for governments and industry to invest in doing something – then we won’t address this properly.”

For Professor Christopher Whitty, chief scientific adviser and director of research with the Department for International Development (DfID), it was important to bear in mind that this “global scale” mustn’t overlook critical country differences. 

“In the developed world, infections in the elderly are repeatedly treated with antibiotics, while in the developing world they are used for a different set of people, such as children and pregnant women. Restricting antibiotic use in poor countries, where access to health care is extremely limited, is a very difficult tension. There is a danger of turning a global issue into ‘one problem’ when in fact it’s a series of problems in varying populations. That means different drivers and different drugs.”

Another of these “drivers” is poor diagnostic techniques, many around the table agreed. An inability to identify a patient’s infection quickly and cost-effectively, or indeed whether antimicrobials are needed at all, is a root cause of “blanket” drug usage around the world.

To Sir John Savill, chief executive of the Medical Research Council (MRC), the issue of poor diagnostics was as prevalent in the UK as anywhere in the developing world. “Even in the very best hospitals here we rely on techniques for the diagnosis of bacterial infections that [Robert] Koch and [Louis] Pasteur would recognise,” he said, referring to the two giants of early germ theory. “We are a high-resource country with 19th-century diagnostics; elsewhere in the world the capacity to diagnose is even more limited.” 

Nicholas White, professor of tropical medicine at Mahidol and Oxford Universities, was more optimistic, saying progress had been made in the past few years and that soon there could be “an hour’s turnaround” in the identification of microbialresistant genes: “Ninety per cent of the variants in TB treatment can now be explained by known resistant genes. If we can make these techniques quick, affordable and applicable in other areas then I think there is a real possibility for hope.” 

As Dr Paul Cosford, medical director for Public Health England, summarised it, the conversation on diagnostics was all about getting “the right antibiotics to the right people at the right time”. While improved diagnostics increase the effectiveness of antimicrobials already in use, the need to develop more sophisticated drugs that can keep pace with the dynamic evolution of resistance is critical. A new, distinct class of antibiotics has not been discovered since 1987. For Davies, the lack of investment in health-care research is connected to the dwindling of industry, and results in a “bare pipeline” for new drugs. “I think we’re pussyfooting around the issue,” she asserted. “We’ve lost microbiology in hospitals, we’ve lost clinical microbiologists, and funding from the NIHR [National Institute for Health Research] isn’t much. The lack of pull from the health services has signalled that this issue doesn’t matter, and industry has deinvested. [Yet] we know that if you put more money in, then the better brains come.” 

The consensus around the table was that if new drugs are to be brought through the pipeline, pharmaceutical companies must be part of the equation. Yet the number of companies engaged in significant antimicrobial research has declined. Moreover, the structure of antibiotic usage needs to shift from blanket distribution to more bespoke, patient-specific drugs with a limited range. Taking all of this into account, where is the economic incentive for pharmas to foot the bill?

With senior research and development figures from AstraZeneca and GlaxoSmithKline (GSK) present at the table, discussion on this topic was lengthy. Patrick Vallance, president of pharmaceutical R&D at GSK, stated plainly that from a business perspective, pharmaceuticals are wary of funding a “billion-pound pill” ith limited scope for use afterwards. “The number of companies engaged in this kind of research has fallen since the 1980s to just a handful,” he said. “Today, the right thing for society is to use new drugs in an extremely restricted way, but that’s a horrible economic model. Nor can we introduce a targeted antimicrobial and sell it for the price of a cancer drug, because you’re entering a market where people are used to getting antibiotics for peanuts. It’s simply impossible.”

Manos Perros, who serves as the global head of infection and site head of Astra-Zeneca’s R&D facility in Boston, agreed wholeheartedly with Vallance. “Pharmas and biotechs are all businesses,” he said, “and the way to engage with business is to provide incentives.”

Many of the incentive hold-ups, he said, lay in the fact that the old drugs still worked. “Much of the plan across pharma is traditional antibiotics,” he said. “This year there will probably be three new MRSA project groups, but we are going to reserve them because well-known drugs still work, and if one of them doesn’t there is always a back-up that will.” 

Vallance backed Perros on this, noting that the incentive is twofold. First, there is a need to reduce the cost of making drugs and holding clinical trials. Second, we need to delink R&D payoff from bulk sales. On the first point, reducing the cost of clinical trials requires mixing “investment in the basic antimicrobial science” with introducing novel, more flexible clinical trial projects of the sort being advanced by the Innovative Medicines Initiative (IMI) across Europe.

Referring to the R&D question, Vallance said that refocusing attention away from large-scale distribution could be achieved using a model similar to the one applied to vaccines, in which the pre-purchasing of new antimicrobial drugs for a set number of years is agreed at late clinical stage. “Pre-purchase agreements would mean that the health-care system becomes responsible for things like proper usage and surveillance, and would put a stop to the perverse commercial incentives,” he said. “It worked for vaccines, and it could work for antimicrobials.”

While rousing support from the pharmaceutical industry will no doubt form an elemental part of long-term strategy, it was also time to start talking about how to create incentives for engagement with an even wider stakeholder group – the public. Delegates agreed that, generally, public apathy toward the risk of a post-antibiotic era remained high, and that this bled into other areas of society, including the media and government, where rallying around the issue was perceived to be lacklustre.

Tom Feilden, a science correspondent for the BBC’s Today programme, revealed that newsroom editors were “a bit bored by the story” and said that the scientific community needed to give them something new to report. “I think it’s beholden on people like me to win the argument within newsroom discussions and say that we should be talking about this more,” he said. “But it also reflects a sentiment from the public; that they’ve heard all this before. There is a willingness to report, but we need something new to say.”

The picture isn’t all bleak. The very week this report went to press, the public voted to focus the new £10m Longitude Prize on antibiotics. The money will go to whoever can develop a rapid bacterial infection diagnosis test within five years. Many at the round table had mentioned the prize as a promising opportunity, but agreed that a continued lack of solutions lay at the root of apathy. As Professor Ian Boyd, the UK government’s chief scientific adviser on food and environment, put it: “I think there’s a commonality with a lot of environmental issues I have to deal with. The public don’t want to be continually bombarded with bad news if we aren’t going to give answers. That means getting more sophisticated in our messaging – we need to show the public how we are marching towards a larger objective.”

At this point, the conversation turned to a natural comparison with the HIV/Aids crisis of the 1980s and the “convergence of forces”, as Farrar put it, which eventually put Aids at the top of the health agenda. “Why haven’t we got that same level of attention in relation to antimicrobial resistance?” Cosford asked. “One factor that influenced the Aids crisis was the absolute sense of public urgency on the issue.” 

Vallance offered further insight, reiterating the importance of strong diagnostics and the availability of clinical trials. “It was possible to tackle HIV in a relatively short period of time because the virus was relatively well understood. “Patients could be diagnosed with accuracy, and there was a great willingness in the coalition of clinical investigators to do clinical trials. Plus [when it came to drug development], there was an economic return at the end of it.”

For Professor Jackie Hunter, chief executive of the Biotechnology and Biological Sciences Research Council (BBSRC), it was important to remember that the science base alone didn’t solve everything. “We cannot forget the vociferous public lobbying that took place in the US and made the issue political. That’s where we’ve got to go. We’re deluding ourselves if we think investing in basic research is going to solve this quickly. It isn’t.” 

Hunter also stressed that making firm, clear data on the issue more widely available is essential to prompting both public and political action. “We need to get much better at having the basic facts,” she said. “There’s plenty of data out there, but there has got to be a better way of articulating it.”

White wholly agreed, and added that this data must disseminate the quality, quantity and the global pathways of antimicrobial drugs in use: “You cannot go on to Google right now and find out exactly how much doxycycline or erythromycin is being manufactured in China, or what the pathways are for that drug. Nor can you find the pathways for the vast quantities of veterinary antimicrobials. These are incredibly vulnerable situations – we don’t treat these drugs like radioactive material, but they are that dangerous. So why can’t we find out about them? If there’s one simple thing that would help politicians it would be high-quality, real-time, easily digestible information.”

Despite the consensus on the need to survey and regulate antimicrobial usage, adhering to such measures is easier said than done. As Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh reminded the group, an EU-wide ban on the use of antibiotics as growth promoters in animal feed, an effort to curtail the spread of resistance, has been in effect since 2006. “It was probably the single biggest effort to reduce antimicrobial usage,” he said, “and it’s failed. Completely. There is no net reduction in antimicrobial controls across Europe – just a few pockets where drug use is going down matched by other pockets where it’s going up.” 

Woolhouse concluded that if blanket bans made no impact, it was time to look at “alternatives”. “We need to find other ways to produce animals that are healthy, that have high standards of welfare and are productive.” 

Zac Goldsmith MP, the sole politician at the table, said that the UK’s Department for Food, Environment and Rural Affairs (Defra), and its worldwide equivalents, were held back by the interests of agricultural lobbyists, whose voices were often heard by government above those of clinicians and scientists. “If there was a debate in parliament on this issue next week I wouldn’t hear from the scientific base, but I would hear from business,” he said. “Unfortunately, I think that’s led to a perversion of policy.”

Boyd, who advises Defra, countered that it “takes this issue very seriously”, but warned that antimicrobials could not be eradicated quickly. “You cannot expect to ban them overnight without dangerous outcomes. We have to make sure we put in proportionate measures.” 

Representing the lobby perspective, Catherine McLaughlin – adviser on animal health and welfare policy to the National Farmers’ Union – offered to correct some of the “outdated” misperceptions of the agricultural industry. She said that the sector is actively seeking fact-based solutions and is happy to work with governments on the issue. “A good lobbyist doesn’t spin facts,” she continued. “While the Danish ‘yellow card’ system [which alerts the government when producers purchase over their set limits of antibiotics] restricts usage, we are also starting to see more post-slaughter evidence of disease. So the debate is complicated, and one of the most unfortunate things is that it has also become polarised. We spend too much time blaming one sector for the problems.”

In an effort to pursue the discussiondown the route of solutions, Mike Barrett, the chair of the round table, who is also a professor of parasitology at the University of Glasgow, raised a recent proposal put forward jointly by Farrar and Woolhouse in Nature magazine: it called for the creation of an organisation similar to the Intergovernmental Panel on Climate Change to “marshal evidence” and “catalyse policy” on antimicrobials. Did others think a cross-governmental action group was needed? 

“Leadership isn’t strong enough within our current structures,” said Farrar, clarifying his argument. “Such bodies, I believe, are timid in the way that they approach this issue. Is the WHO fit for purpose to deliver change at the scale and in the multidimensional way that is required? As we’ve seen, this issue is not only about human health but animal health, regulation and ensuring that industry links up in a positive way.” 

Davies welcomed the proposal, but stated that the form was “not quite right yet”. She advocated, first, a dedicated day at the UN General Assembly in 2016. “At the end of such a day we would indeed need to reach some form of international treaty,” she said. “The question isn’t should we have something, but rather what would it look like?"

“We must remember that it will be subject to international negotiations and that we cannot impose anything. We must also be very careful not to become the north doing it to the south.” 

A concluding current of the conversation was that of “consortiums” and the desire to link academia, pharma and science to maximise what each could offer. The UK has ready expertise in the science base, many participants agreed; now is the time to bring the moving pieces together. “We have world-class chemists, fantastic biologists and synthetic biologists, environmental researchers and economists,” Savill said. “But are enough of them engaged in this issue? No. We need to move on from centres of excellence towards networks of excellence.”

Charlotte Simmonds is a supplement and reports editor for the New Statesman

Charlotte Simmonds is a writer and blogger living in London. She was formerly an editorial assistant at the New Statesman. You can follow her on Twitter @thesmallgalleon.

Photo: Getty
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We're asking the wrong questions about the Google “anti-diversity memo”

Which sex is better at what skills is less important than which skills we value in the first place. 

Yes, I feel sorry for the Google employee who has been fired for writing an "anti diversity manifesto" and circulating it within the company. (Guess what? It leaked.) Losing your job is painful, and doing it in public is even more so. But the conversation around this is heading in such an unproductive direction (do women suck at maths?) that I can't resist wading in.

I agree with the writer that these issues are hard to talk about, but that pushback comes from both directions. Look at the crap Mary Beard is wading through for trying to inject some facts into a discussion about the racial composition of Roman Britain. Nicholas Nassim Taleb keeps honking about "diversity genes" and refusing to listen to evidence that contradicts him. But in his mind, he's Mr Science - sorry, Professor Science - and she's Madam Arts-Subject.

This matters, because when it comes to diversity, there are fact-based positions on both sides. Yet there is a certain strand of Rational Internet Thinker (let's be honest, mostly men) who solemnly tells everyone that we Must Stick To The Facts while advancing deeply ideological stances, which only happen to look "natural" because they are so embedded in our culture. 

But back to the subject at hand. Here's the recap: the memo was headlined  "Google’s Ideological Echo Chamber" and its writer's firing will be taken as confirmation that his thesis was true. Ironically, this will be done by the same section of the right which usually has no problem with firing at will and normally thinks that HR should be a brutally Darwinian process. (Looked at from that perspective, of course Google would fire someone who brought such criticism on the company.) But now there are Principles involved. Probably Free Speech is under attack. Political Correctness may even have Gone Mad. Social Justice Warriors are on the march. Before it's all placards as far as the eye can see, instead I would like to look at what was actually said, and whether it's an argument with any merit. 

In essence, the memo argued that the gender imbalance of staff in tech companies like Google is primarily the result of biological, not cultural differences. ("They’re universal across human cultures," it argued. "They often have clear biological causes and links to prenatal testosterone".) There are differences in ability between the sexes, the writer said, and that's why most top programmers are men. Men like numbers, and the numbers like them right back.

The memo added:

Differences in distributions of traits between men and women may in part explain why we don’t have 50% representation of women in tech and leadership. Discrimination to reach equal representation is unfair, divisive, and bad for business.

The section about typically female traits is also interesting, because of a couple of points the writer picks out.

"Women, on average, have more...

- Openness directed towards feelings and aesthetics rather than ideas. Women generally also have a stronger interest in people rather than things, relative to men (also interpreted as empathizing vs. systemizing).

- These two differences in part explain why women relatively prefer jobs in social or artistic areas. More men may like coding because it requires systemizing and even within SWEs, comparatively more women work on front end, which deals with both people and aesthetics.

- Extraversion expressed as gregariousness rather than assertiveness. Also, higher agreeableness. This leads to women generally having a harder time negotiating salary, asking for raises, speaking up, and leading. Note that these are just average differences and there’s overlap between men and women, but this is seen solely as a women’s issue. This leads to exclusory programs like Stretch and swaths of men without support.

- Neuroticism (higher anxiety, lower stress tolerance).This may contribute to the higher levels of anxiety women report on Googlegeist and to the lower number of women in high stress jobs.  

Well, SOMEONE has been reading their Simon Baron Cohen. The first point is a distillation of Baron Cohen's argument about "male brains" being better at understanding systems, and "female brains" being better at feelings - which he extends to say that autistic traits might be an "extreme male brain". Unsurprisingly, there are other scientists in the field, such as Cordelia Fine and Rebecca Jordan-Young, who find a lot of the neuroscience of sex difference quite flaky.

I'm not a neuroscientist, but from a lay perspective, my take is that yes, there are some biological differences between the average male and female brain, but that these pale beside a) the way our brain architecture is shaped by stimuli (like years of being told you're rubbish at maths) and b) the overall effect of culture (eg companies which value presenteeism, or make it hard for women to return after having children, or cover up for senior men who are repeated sexual harassers etc etc). 

The "higher agreeableness" point was dealt with by Sheryl Sandberg in Lean In. Women aren't stupidly not asking for raises or being assertive in the office because they are delicate little flowers. One of the reasons they are more agreeable at work is because they face heavier penalties if they are not. As Sandberg formulates it: "Success and likeability are positively correlated for men and negatively for women. When a man is successful, he is liked by both men and women. When a woman is successful, people of both genders like her less.” Women are nicer because there are more negative consequences for them if they are not nice.

The last point about neuroticism is bleakly funny, because while women might report more anxiety, men commit suicide in far greater numbers. Which gender is really more susceptible to stress and anxiety? Women talking more about their mental health on "Googlegeist" is being held against them here, when possibly one of the reasons that more men kill themselves is because of the stigma of talking about their feelings.

Overall, the memo makes some compelling points, but it also chucks in a lot of stuff that "everyone knows" about sex differences, which isn't scientifically supported, and also some evolutionary psychology about "protecting females" which strays into the kind of rhetoric found on MRA sites. Its understanding of male and female work patterns can also be naive, for example:

"Yes, in a national aggregate, women have lower salaries than men for a variety of reasons. For the same work though, women get paid just as much as men. Considering women spend more money than men and that salary represents how much the employees sacrifices (e.g. more hours, stress, and danger), we really need to rethink our stereotypes around power."  

I mean, doesn't this just raise a huge number of questions?

How often do men and women do the same work, and for what reasons might they not? (Clue: women do far more unpaid care work and housework.) Are women spending that money on themselves, or are they running household budgets, which is an unpaid project-management task they are doing alongside any paid work? What an individual finds stressful is also entirely subjective.

The author chucks in a reference to "Marxist intellectuals" but doesn't seem to have read any of the vast and fascinating literature on unpaid care and its interaction with paid work. I'd recommend starting with The Second Shift or Wife Work. Angela Saini's Inferior is a good recent choice, too, on women's overlooked contributions to science.

When I talk about feminism with self-styled rationalist men, this dynamic comes up again and again. They will present my arguments as mere anecdote and emotion, which - sad shake of the head - is contradicted by the available evidence. When you point to peer-reviewed studies, or great ethnographies, supporting your point, which they haven't bothered to read, they steam on regardless. It makes the contest deeply unequal. Internet skeptic types talk about the need to engage with writers they don't agree with, and the importance of free and open debate, but often actually don't want to read the contrary view. 

 

***

If you want to read more about the discussion of the science of sex differences which has arisen as a result of this memo, then this piece by Slate Star Codex is interesting - it argues that interest in STEM subjects, not ability, might be the key difference between the sexes. It also completely misses the point. 

Here's a thought experiment. Say you were recruiting for a spoon-juggler. Your advert would probably mention "needs to juggle spoons". But, almost certainly, there would be other skills involved. Turning up to performances on time. Keeping your spoon inventory in check. Not turning up drunk. Not stealing forks from the fork-juggler. 

This is what the argument that women can't succeed in tech because they are innately bad at the skills needed to succeed in tech sounds like to me. We know that many of the early programmers were women, back when the job was considered to be largely secretarial. (Go watch Hidden Figures for more on this, and also because it's just a lovely film and I am so happy for Mahershala Ali and Taraji P. Henson.) We know that the fastest way to depress wages in a job is to feminise its workforce. It's not unreasonable to wonder if we've constructed the whole idea of "success in tech" in such a way that it makes men's success look natural and pre-ordained. Yes, you need to be able to code to be a coder. But there are other skills you need too. 

Yonatan Zunger, who recently left Google, makes this argument better than I could. And he seems to own a pair of testicles, so you know he's more rational and objective than me:

"Essentially, engineering is all about cooperation, collaboration, and empathy for both your colleagues and your customers. If someone told you that engineering was a field where you could get away with not dealing with people or feelings, then I’m very sorry to tell you that you have been lied to. Solitary work is something that only happens at the most junior levels, and even then it’s only possible because someone senior to you — most likely your manager — has been putting in long hours to build up the social structures in your group that let you focus on code.

All of these traits which the manifesto described as “female” are the core traits which make someone successful at engineering. Anyone can learn how to write code; hell, by the time someone reaches L7 or so, it’s expected that they have an essentially complete mastery of technique. The truly hard parts about this job are knowing which code to write, building the clear plan of what has to be done in order to achieve which goal, and building the consensus required to make that happen.

All of which is why the conclusions of this manifesto are precisely backwards. It’s true that women are socialised to be better at paying attention to people’s emotional needs and so on — this is something that makes them better engineers, not worse ones."

As I said on Twitter, this is a pattern we see again and again - a high status job is coded as "male", requiring "male" traits, to justify men's dominance of it. The same thing happens in politics: we are assured that politicians need to be "strong" and "decisive", when many of the most successful male politicians today have incredible people skills. Jeremy Corbyn makes time for everyone he meets, hugging them and posing for endless selfies. Sadiq Khan has that Queen Mum ability to remember your name and a key fact about you. What's the real difference between the Clintons? Bill demonstrated huge empathy and made people he was talking to feel special; Hillary didn't. But still, maybe men dominate politics because they are just more aggressive and ambitious. Yeah, OK. 

Tech suffers from a similar silent rewriting of core competencies to flatter its mostly male leaders.

We have all these conversations about how hard it is for Mark Zuckerberg to make the leap to being a frontman CEO because he's a maths guy, not a people guy. We treat this like he's doing an amazing project of personal growth. We don't go, "wow, they really lowered the bar for CEOs to let someone without some of the key skills have a go at it". Or, "his poor colleagues, having to make up for the stuff he's not naturally gifted at". 

There was a similar reaction when Sergey Brin and Larry Page brought in Eric Schmidt when it was time for Google to "grow up". We didn't say, "How embarrassing, they have to find someone to counteract their deficiencies." We said: "Smart move. Not every human can possess all skills, it's wise to have a range of experience and aptitudes at the top of your company."

So this, for me, is the most interesting takeaway from the Google memo. "Do women suck at maths" is a complicated question, and I'm not sure how far answering it will move the conversation forwards. "Have we structured society so that those competitions between the sexes that men can win are deemed to be the most important competitions?" is a better one.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.