Gender Bias in Medical Research

A gender bias is the unfair favouring of one gender above the other. In terms of medical research and evidence based medicine, it is the bias in which males are the primary focus and any treatments or discoveries are generalized to apply to females. Different symptoms may arise between men and women for the same disease or condition as well as treatment methods which work for one gender that may not work for the other. Additionally, there may be a high level of diagnosis for an illness or condition in women than men; however, the research being undertaken would be primarily comprised of a sample size containing an exponentially larger amount of men than women or the treatment method was found to be effective in males and then assumed that it would work for females as well. Additionally, the "gender order" is the implication that women are less valued and influential than men.

Background

There are, without a doubt, more women than men in the world. Statistics have also shown that women live longer than men, on average, and undergo more health tests than men. Not only that, but women also tend to have more health related exams, spend longer times at the hospital, and require more complex procedures and treatment methods.

Artistic rendering of a woman diagnosed with hysteria. Public domain via Wikimedia Commons.

Since the 1970s, medical research has been conducted on primarily young to middle aged white men and the results of these studies would be generalized to apply to the whole population. Physicians are more likely to take men's symptoms as being "organic" and women's symptoms of the same nature and severity to be "psychosocial". It was not until recently that the National Institutes of Health (NIH) created rules and regulations which reinforce the need for women participants and inclusiveness in the protocols of proposals.

Evidence

Further understanding diseases and conditions

In order to garner a better understanding of our bodies and the diseases or conditions which may befall us, we must advance in research directed towards progressing our knowledge of the underlying physiological and genetic mechanisms. A lack of comparison between sexes for a specific disease can prove fatal for women. For example, nonsmoking women are more likely to get lung cancer than nonsmoking men. However, the majority of lung cancer research findings do not take into account gender-specific variables. Another prominent example would be that of cardiovascular disease in which far more women are affected by heart attacks than men yet the results of most of the research findings are reported irrespective of gender as well as having only one third of the participants being women in these studies.

Drug development and treatment methods

The conception of a study starts with an idea and this idea must travel through various checkpoints and overcome numerous amounts of hurdles along the way of seeing it to fruition. Before a study is brought to the clinical stage, it must have been proven to be at a heightened level of safety to humans as well as efficacy and statistical significance which indicates it is promising and worthwhile to further undertake it under human trials. In order to conduct clinical trials with human participants, the drug or method of treatment must be administered according to the protocol of the study and guidelines set in place by regulating bodies. However, a gender bias arises at the core of the protocol of the studies which lead the research to the point it is at when it reaches the clinical phase. Although regulations mandate the inclusion of women in studies at the clinical stage, the drug may have underlying side effects or harms that have not been identified due to the exclusion of female mammals in the laboratory stages of the study. A review was conducted by Beery and Zucker which analyzed ten different biological fields for gender bias in animal models used in the protocols of the study. They found that eight out of ten disciplines were biased in favour of males with the field of neuroscience having a male to female ratio of 5.5 to 1. Relating to this review's findings, depression is found to be more prevalent in women than men; however, brain studies in male animals outweigh those in female animals at a ratio of 5 to 1.

Significance

These disproportionate analyses and the disregard to the magnitude of the biological differences between genders greatly skews our understanding of diseases and female biology. The studies at their core fail to compare sexes in terms of symptoms arising from illnesses, physiological mechanisms involved, and subsequent morphological differences which calls for concern about our current state of medicine and the foundation it is built upon. If we had more female participants in clinical trials and subjects in studies within the early stages of research, it is highly likely that many women's lives could have been saved. For example, the chest pain associated with heart attacks may not present itself in women as they may feel pain in the arm rather than in the chest. Knowing what to look for, identifying specific signs and symptoms, and understanding differences between sexes is crucial for possessing the ability to provide the best and most effective care possible for patients.

Controversy

There has been controversy surrounding this topic ranging from people choosing not to believe the reviews or statistics to scientists claiming female participants or subjects are "too troublesome for inclusion". The decision by funding bodies as well as key research centers to have guidelines on inclusive research proposals sparked further division in the scientific community and public alike.

It is disappointing in and of itself to have even included a "Controversy" section on this page as how can equality and better healthcare for all be a controversial topic.

Regulations

National Institutes of Health (NIH)

A research proposal must contain an indication of whether women and minorities are included in the study and to what degree; if they are not included, an explanation is needed.

USA Food and Drug Administration (FDA)

The inclusion of women and minorities is necessary for clinical trials and if they are not included then an explanation must be given.

Centers for Disease Control and Prevention (CDC)

Women must not be excluded from studies except for reasons which may harm the participant. Additionally, pregnant women must not be excluded for no strong reason implying harm to the participant and the child she is bearing.