Examines the systemic obstacles limiting women's advancement in science and health care careers. Sexism in science and health care rarely announces itself as a single, dramatic event. More often, it appears as a steady accumulation of slights, exclusions, and unequal expectations that shape careers over time. In Harsh Medicine, Jennifer Rubin Grandis, MD, describes this reality and examines its consequences for women working in academic medicine and biomedical research. Grandis brings the perspective of an insider to a profession that prides itself on objectivity while tolerating persistent inequities. Through firsthand accounts from women and men in her field, she documents how bias operates in hiring, evaluation, authorship, and leadership—and how the decision to speak openly about discrimination can carry lasting professional and personal risks. The book also addresses how race intensifies these dynamics, revealing layered barriers that remain largely unacknowledged in the field. Productivity metrics, prestige economies, and informal networks often reward silence while penalizing those who challenge the status quo. The result is a system that appears meritocratic while quietly reproducing inequality. Harsh Medicine insists that visibility and transparency are prerequisites for accountability. It speaks to scientists, physicians, administrators, and trainees, as well as readers concerned with equity in professional life. By refusing euphemism and abstraction, the book shows why progress has been slower than promised—and why confronting discrimination remains both necessary and costly to everyone in these fields.