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  • Writer's pictureKaylah Holmes

Hey FemNeuro readers! My name is Kimberly Fiock. I’m 24 years old, and I’m a PhD student in the Experimental Pathology program at the University of Iowa. My work looks at factors that regulate the expression of tau during development. The tau protein is important for the stabilization of axons, which allow neurons to communicate with other neurons. When tau is hyperphosphorylated in adults, it aggregates and becomes toxic to the cell, ultimately leading to cognitive consequences like dementia. Studying this protein in development allows us to better understand the normal function and regulation of tau gene transcription and translation. We can then use this process to identify therapeutic targets for both neurodegenerative and neurodevelopmental diseases


I love what I do because I enjoy solving puzzles and discovering new things! Each experiment I do gives me a new piece of the puzzle, and I enjoy watching my project unfold. The brain is such a fascinating organ, and there is so much we don’t really understand. On top of that, a lot of degenerative diseases that were once thought to be exclusive to humans are now being studied in other species. If I can help provide therapeutic targets for disease in humans, I’m also going to help other animals.


Getting to this point in my career was pretty difficult. Impostor syndrome is a very real thing that many graduate students face but don’t ever talk about. There were many times where I felt I wasn’t qualified to being talking to other students about my work because I didn’t feel like I knew enough. As an undergraduate, I struggled a lot with other individuals telling me I wasn’t cut out for a career in science. I didn’t have a lot of guidance, so I didn’t take all the of important prerequisite classes for graduate school (not necessary classes that are required but are helpful in understanding advanced coursework). Because of this, I really struggled in my first year and fell behind my peers in my ability to understand basic biology concepts. I ended up dropping a class, which made me feel like a failure.


 

How does gender discrimination play a role in your career path thus far?


Gender discrimination is kind of a silent killer. We hear a lot of stories about explicit harassment of women in the workplace, but not everyone is going to experience discrimination in an obvious way. For me, discrimination manifested in my role models. All of my high school science teachers were men. As an undergraduate, I only had one female neuroscience professor in four years. The only labs I interned in were run by men. My thesis committee for my master’s degree was comprised of all men. There are only two female PIs in my department.


These are the kinds of examples that you don’t really think about when you think about discrimination. They’re not as obvious. Generations before us did not have a lot of women as role models in science, which discouraged women from breaking that mold. It’s a cycle that needs to be broken, though.


When was a specific moment you realized you were viewed differently in the scientific world because of your gender?


My first year of graduate school, I was told I couldn’t wear shorts to work (even in

the summer) because it’s a safety hazard. I’ve seen many men around work

wearing shorts, and no one says a thing. That’s when I realized that it’s not about

the concern for my well-being as much as the “lack” of professionalism if I show

more skin than a man.



 

How has Neuroscience helped shape your identity, how have you grown within this field?


I applied to college as a neuroscience major on a complete whim. I had no idea what it

entailed or what I was going to do with a neuroscience degree. Looking back, I can’t

imagine majoring in anything else. The brain is so complex and largely

misunderstood. The field of neuroscience is so broad that you can really study

whatever you want. If you’re interested in why we think the way we do, you can study

cognitive neuroscience. If you’re interested in why some people get sick and others

don’t, you can study neuropathology. There’s just so much to learn, you’ll never run

out of things to explore. I’ve grown immensely in the 6 years I’ve been studying

neuroscience. It’s embarrassing to admit, but there was a time when I thought that

neurons and cells were different things. Now, I’m able to write an 80-page thesis

about my work that people are actually impressed by. I’ve always wanted to be a

scientist, but I never really knew what that would mean for me. Once I found

neuropathology, I knew that’s where I’d make a difference.


What is the biggest lesson you have learned in your career thus far?


Know your own worth. Other people will try to tell you what you are and aren’t

capable of, but you have to know your own worth at the end of the day and make

the decisions that are best for you. It’s important to listen to advice, but you don’t

have to take every piece that’s given to you.


What advice do you have for girls who feel discouraged from pursuing a career in Neuroscience because of their gender? How do you think girls in stem should defend themselves against gender-bias in their school and college careers?


Just because you don’t see a woman in the spotlight of the career you want does not

mean it’s unobtainable for you! You don’t have to have someone showing you that it’s

possible for it to be possible. It’s okay to pave your own path. Remind yourself of your

value and follow your own passion, even if you’re the only person that thinks it’s worth

it! Don’t be swayed by the presentation of your gender in a specific field. It may feel

intimating to be the only woman at your job, but it doesn’t mean you don’t deserve to be

there.

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Hey FemNeuro Readers! My name is Lietsel Richardson, I am 27 years old, and I am a mechanical engineering PhD student at the University of Central Florida. I conduct research at the Biomechanics, Rehabilitation, and Interdisciplinary Neuroscience (BRaIN) Lab. We focus on neuromechanics, which combines biomechanics of movement and neuroscience to better understand human locomotion. We think that rehabilitation might involve more than just biomechanics, so we look at the brain dynamics during different walking, cycling, and stepping exercises using an EEG system.


Read about my experience as a black woman in STEM below :



Needle In A Haystack



How difficult was it for you to pursue this career?


It was very difficult, but only because I have been misguided by bad mentors and faced microaggressions that are typical in an engineering environment. Engineering is a male-dominated field that often lacks racial diversity in bigger programs like the one I graduated from. I have experienced racism, sexism, and was not taken seriously as a future engineer. After graduating with my Master’s degree in Biomedical Engineering, I found a female adviser to work with for my PhD in a positive lab environment, which has drastically improved my mental health. There will always be obstacles to overcome outside of the academics, but having good mentorship can make a world of a difference.



 

How has gender discrimination played a role in your career path thus far?


If I were to remain in academia after my PhD, I would be privy to engineering departments, which tend to lack diversity the most. Engineering in academia AND industry has a retention problem when it comes to women, but most critically when it comes to women of color. It should also be noted that the pipeline in engineering is very leaky in the early stages of education, so the output of women in the field is miniscule despite the increase in women engineers over the decades. There are several instances when women are hired in positions of power, they are not taken seriously by their male counterparts, they are not promoted as quickly, and experience harassment.


When was a specific moment you realized you were viewed differently in the scientific world because of your gender?


The first time I showed up in a classroom dressed in a floral dress, cute shoes, and red lipstick, I was constantly ridiculed by my male classmates. They said things like,

“who are you trying to impress?” and, “the professor might bump up your grade if you show up like that every day”.

The second notable moment was in my senior year of undergrad. I had experience harassment so often that I had had enough, so I cut off all of my hair and dressed in muted colors, so my classmates would focus more on my work and what I had to say and not what I looked like. A classmate came up to me and said:

“why would you cut off all your hair? Boys won’t like that.”


 

How has Neuroscience helped shape your identity, how have you grown within this field?


My first brush with neuroscience was when I started my PhD in the UCF BRaIN Lab with my new adviser. I had never felt passionate about engineering research until I started working in a lab that explored interdisciplinary approaches to rehabilitation. I have learned so much about how the brain works, about brain imaging and EEG, about coding, and about myself. It was the first time in a long while that I felt comfortable being myself in my environment, and I was able to get more involved in initiatives like Black In Neuro (www.blackinneuro.com). As a Black, biracial woman in STEM, and particularly in my field, I had not had the bandwidth to think about my identity in this space until now. I have learned that I actually do belong in STEM, and that I am passionate about making STEM, but specifically neuro-related fields, a more inclusive and safe space for everyone.


How many women do you see/are familiar with in your line of work? In other words, is the gender disparity between men and women in science visible to you?


This disparity is glaringly obvious and in my face. My adviser is one of maybe 3 or 4 other women in a large department of men. This is also true in the student demographics in engineering. Outside of that, I have used social media to connect with other women of color, and just women in general, in my line of work and I have been lucky enough to network with them. Nothing is more validating than seeing another woman who looks like you succeeding in your line of work.


What is the biggest lesson you have learned in your career thus far?


The biggest lesson I have learned is to not lose sight of who I am and my identity. STEM can be very competitive and it is so easy to forget who you are and to try to mold yourself to fit the narrative of what a scientist is or looks like. But you don’t have to do that. If you look in the mirror, what you see is a scientist. You don’t have to change who you are to become one.



 

What advice do you have for girls who feel discouraged from pursuing a career in stem/neuroscience because of their gender?


My advice is to not compare yourself to the boys/men in the room. They have the privilege of being in STEM and belonging immediately, and may have had access to opportunities to succeed that you may not have had access to. That does NOT mean you don’t belong in STEM. Find someone who can advocate for you, mentor you, and provide you with the tools you need to succeed. Mentorship is the biggest weapon you have against the burden of gender bias! And it is also okay to have more than one mentor. Next, don’t be afraid to stand up for yourself because although there may be “allies” among you, they won’t often speak up and defend you against gender-bias because doing so puts them out of their comfort zone. Look out for the signs of gas-light aka men telling you that you are overreacting or the ones who make excuses for the offensive things they say. Don’t be afraid to speak up and speak out. Lastly, stay optimistic. The women who are now scientists in-training or who are early-career scientists are all working so hard to make STEM a better place for girls.


What is your favorite thing to research and/or study about science!


I love learning about neurons and action potentials! I have a blog where I talk about neurons, as well as my research. It’s definitely the topic I love most about science. My favorite neuron fun fact: some neurons can conduct impulses as fast as 120 meters per second! This is accomplished in part because some neurons are insulated by myelin sheaths, kind of like how wires are insulated to conduct electricity (safely and quickly!)





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The Article series is designed to give female students a platform to share their own academic papers and research on Neuroscience and STEM concentrations that are relevant to today's society.

Hey FemNeuro readers! My name is Elizabeth Schwartz, I’m a 17 year old high school senior at Newark Academy in Livingston, New Jersey. This year I started exploring the field of neuroscience and I found my passion. I love to read, write, learn, and talk about all things neuroscience! Next year I am planning to pursue a major in neuroscience with a focus on the subject's intersection with Public Health. I’m very excited to enter this interesting field and see where my studies take me!"

Read my Neuroethics paper below:


Test or Treatment? A Neurological and Ethical Evaluation of the Placebo Response


Relief of pain and suffering are important aspects of patient care and cannot be overlooked by medical professionals, but many commonly prescribed pain medications can cause significant side effects. In the case of opioids, addiction frequently follows as a consequence of medical treatment of pain. The societal cost of the opioid addiction epidemic has been a matter of intense interest in recent years, costing the U.S. economy an estimated $78.3 billion dollars in direct and indirect costs, and leading to an estimated 33,000 deaths, annually. Although medical providers have an ethical responsibility to provide relief of suffering, pain is not life-threatening, which raises the question: does the benefit of these medications warrant the risk of compromising a patient’s health through addiction and other possible side effects? One option that may be safer, and yet effective for relief of pain, is deliberate use of placebo treatments. However, intentional administration of placebo treatment raises several ethical issues.

A placebo is a physiologically inert treatment provided to a patient with or without their knowledge for the purpose of treating symptoms, or for research purposes in clinical trials. The “placebo response” refers to objective or subjective relief of symptoms in persons receiving theoretically inactive placebo. The use of placebo-controlled trials in research has long been necessary to test and prove the effectiveness of new medications. Clinical trials of pain medications have demonstrated that placebo treatments often provide significant pain relief. Furthermore, proof of significant pain relief, beyond the placebo-treated group, is a requirement for FDA approval for treatments of pain. However, the placebo treatment itself is now being studied as a feasible primary therapy to manage pain.

There is no question about the necessity of a placebo arm in clinical trial. In contrast, several ethical concerns are raised in considering placebo as a stand-alone treatment. Is it ethical to provide a treatment that has no known mechanistic basis for providing relief? Can it ever be ethical to give a patient a placebo treatment without informing them? If the basis of the placebo effect involves withholding information from the patient, this violates the principles of patient autonomy and informed consent that are foundations of medical ethics. In addition, healthcare providers may feel uncomfortable prescribing a treatment that isn’t specifically formulated to treat the pain a patient is experiencing. However, findings from research performed over the past two decades may alleviate that ethical concern.

A large body of scientific evidence indicates that placebo treatments can cause significant changes in brain and neurological function. These effects can even be localized within the brain and attributed to specific neurotransmitter systems. For example, studies using brain imaging methods, such as functional magnetic resonance imaging and positron emission tomography scanning, have determined that relief of pain by the placebo response involves specific parts of the brain. The exact areas of the brain activated depend in part on the type of pain the individual is experiencing, and many of these areas overlap with known pain pathways, including the dorsolateral prefrontal cortex, nucleus accumbens, periaqueductal gray, left anterior cingulate cortex, right precentral and lateral prefrontal cortex, the amygdala, and the left periaqueductal gray, as well as other areas. In addition, different aspects of the placebo response appear to involve specific neurotransmitter systems. For example, expectation of pain relief requires signals from dopamine-secreting neurons, whereas the placebo effect itself largely involves endogenous opioid pathways. Other, non-opioid pathways such as the endocannabinoid system, are also sometimes involved. The fact that specific neurotransmitters in particular areas of the brain mediate the placebo response provides strong evidence that “inert” placebos can provide a real physiologic effect. Therefore, treating with placebo is very different from withholding treatment from the patient. Since there is a rational, scientific basis underlying the placebo response, this ethical concern can be lifted.

Another ethical consideration in using placebo treatments may be whether the placebo response provides adequate pain relief compared to pharmacologically active therapies. But, placebo research has revealed that in some cases, for instance in the treatment of migraine, placebo treatments administered along with strong verbal suggestions can provide relief comparable to treatment with medication. Studies show that placebo is most effective for pain relief when administered by a trusted caretaker, with strong positive statements about the expected effect, and with education about the potential benefits of the placebo response. Additionally, patients given placebo treatments often self-administer less actual opioids, suggesting that placebo treatments can be ethically used to either replace or reduce opioid use for pain relief.

Still, even if placebo is proven to be effective for relief of pain, there remains the ethical concern of deceiving the patient. A deceptive approach can undermine trust, damaging the therapeutic relationship between the patient and healthcare provider, and almost certainly undermining the placebo response itself. However, research suggests that deception is not a necessary component of successful placebo use. Studies conducted using open-labeled placebo (OLP) in both healthy volunteers, and in patients with low back pain and other types of pain, have consistently indicated that placebo treatments can be extremely effective, even with the patient’s full knowledge, if administered properly. In OLP studies, in which participants are explicitly given a placebo treatment along with education on the power of the placebo effect, OLPs have proven to be consistently effective in reducing pain compared to treatment as usual. These studies eliminate the need for the ethically questionable administration of deceptive placebo treatments, as they are not necessary to produce a positive placebo response.

Healthcare providers have an obligation to provide safe and effective relief of suffering to their patients. However, pain medications carry significant risks of side-effects. Additionally, our nation is experiencing the ravages of an opioid epidemic which is partly the result of well-intentioned medical prescriptions. Armed with objective neurobiological evidence that open-label placebos can safely provide relief from pain, and freed from the ethical barrier of applying deception, open-label placebo treatments should be explored further as an alternative method of pain management.













Works Cited (APA)

DeWeerdt, S. (2019). Tracing the US opioid Crisis to its Roots. Nature, 573, S10-S12. doi: 10.1038/d41586-019-02686-2

(2017). The High Price of the Opioid Crisis. The Pew Charitable Trusts. Retrieved July 8, 2020, from https://www.pewtrusts.org/~/media/assets/2017/07/highpriceofopioidcrisis_infographic_final.pdf?la=en

Wampold, B. (2018). The Therapeutic Value of the Relationship for Placebo Effects and Other Healing Practices. International Review of Neurobiology, Volume 139, Chapter 8, pp 191-210. doi: 10.1016/bs.irn.2018.07.019

Vase, L., & Wartolowska, K. (2019). Pain, placebo, and test of treatment efficacy: a narrative review. British Journal of Anaesthesia, doi: 10.1016/j.bja.2019.01.040

Klinger, R., Stuhlreyer,J., Schwartz, M., Schmitz, J., & Colloca, L. (2018).Clinical Use of Placebo Effects in Patients With Pain Disorders. International Review of Neurobiology, 139: pp 107–128. Doi: 10.1016/bs.irn.2018.07.015.

(1998). Guidance for Institutional Review Boards and Clinical Investigators. U.S. Food & Drug Administration. Retrieved July 8, 2020, from https://www.fda.gov/regulatory-information/search-fda-guidance-documents/drug-study-designs

(2016). Code of Medical Ethics Opinion 2.1.1. American Medical Association. Retrieved July 8, 2020, from https://www.ama-assn.org/delivering-care/ethics/informed-consent


Kaptchuk, T., & Miller, F. (2015). Placebo Effects in Medicine. New England Journal of Medicine, doi:10.1056/NEJMp1504023


Faria, V., Fredrikson, M., & Furmark, T. (2008). Imaging the Placebo Response: A Neurofunctional Review. European Neuropsychopharmacology, Volume 18, Issue 7, pp 473-485. doi: 10.1016/j.euroneuro.2008.03.002


Geuter, S., Koban,L., & Wager, T. (2017). The Cognitive Neuroscience of Placebo Effects: Concepts, Predictions, and Physiology. Annual Review of Neuroscience, doi: 10.1146/annurev-neuro-072116-031132

Amanzio, M., Benedetti, F,. Porro, C., Palermo, S., & Cauda, F. (2013). Activation Likelihood Estimation Meta-Analysis of Brain Correlates of Placebo Analgesia in Human Experimental Pain. Human Brain Mapping, 34:pp. 738–752. doi: 10.1002/hbm.21471


Benedetti,F., Mayberg, H., Wager, T., Stohler, C., & Zubieta, J. (2009). Neurobiological Mechanisms of Placebo Responses. The Journal of Neuroscience, 25(45):10390 –10402. Doi: 10.1111/j.1749-6632.2009.04424.x


Enck, P., Benedetti, F., & Schedlowski, M. (2008). New Insights into the Placebo and Nocebo Responses. Cell Press, 9(2):195-206. doi: 10.1016/j.neuron.2008.06.030

Benedetti, F. (2008). Mechanisms of Placebo and Placebo-Related Effects Across Diseases and Treatments. Annual Review of Pharmacological Toxicology, 48:33-60. doi: 10.1146/annurev.pharmtox.48.113006.094711

Benedetti, F., Amanzio, M., Rosato, R., & Blanchard, C. (2011). Nonopioid placebo analgesia is mediated by CB1 cannabinoid receptors. Nature Medicine, 17(10):1228-30. doi: 10.1038/nm.2435

Vase, L., & Wartolowska, K. (2019). Pain, placebo, and test of treatment efficacy: a narrative review. British Journal of Anaesthesia, 123 (2): pp 254-262. doi: 10.1016/j.bja.2019.01.040

Klinger, R., Stuhlreyer, J., Schwartz, M., Schmitz, J., & Colloca, L. (2018). Clinical Use of Placebo Effects in Patients With Pain Disorders. International Review of Neurobiology, 139:107-128. doi: 10.1016/bs.irn.2018.07.015.

Colloca, L. (2018). PREFACE Part II: The Fascinating Mechanisms and Implications of the Placebo Effect. International Review of Neurobiology, 139: xvii–xxiii. doi:10.1016/S0074-7742(18)30087-4.

Wampold, B. (2018). The Therapeutic Value of the Relationship for Placebo Effects and Other Healing Practices. International Review of Neurobiology, Volume 139, Chapter 8, pp 191-210. doi: 10.1016/bs.irn.2018.07.019

Stohler, C., & Zubieta, J. (2009). Neurobiological Mechanisms of Placebo Responses. Annals of the New York Academy of Sciences, 1156:198-210. doi: 10.1111/j.1749-6632.2009.04424.x.

Carvalho, C., Caetano, J., Cunhac, L., Rebouta, P., Kaptchukd, T., & Kirsch, I. (2016). Open-label placebo treatment in chronic low back pain: a randomized controlled trial. Pain, 157(12):2766-2772. doi: 10.1097/j.pain.0000000000000700

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