8 Shocking Facts About Women in Medical Research That Will Make You Say, ‘Seriously?’
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32 replies
I knew this and it's still infuriating.
They glossed past it, but the idea that men are the default human and women are extra has been around for centuries(at least.) It doesn't make it any easier to know that medical funding still largely excludes the female experience with all we know today.
Another common bias was disproved when early psychological studies, at least a hundred years ago, sought to understand if women truly were more emotional and less rational than men. Even that old research found no disparity between genders. This is important because it remains a common bias in medical research that women are more emotional and likely to misrepresent their symptoms, no matter how many studies have come out since then that show the opposite is true. It remains part of the subtle drive to keep women out of medical trials and impacts the kind of care and attention we recieve.
At the risk of infuriating people, it's complicated. Most of the article focuses on cardiovascular disease. It is the number one killer of women, as it for men. But men have an elevated risk over women, and develop CVD 10 years earlier.
Lumping CVD research into a single bucket isn't super helpful. A lot of it will be done in vitro and focused on molecular mechanisms. These studies are essentially sexless and it's not clear to me if the funding calculations were limited to human, whole organism, or anything at all. Were they comparing funding targeted specifically to women against a denominator that included test tube research? I can't tell, but maybe I missed it on a quick read.
Research also covers different areas: mechanisms, treatment options and outcomes, cost, patient factors such as access to treatment, acceptability of treatment, impact of disease on life factors and a million other things. Some of these require a sex or gender segmentation. Some don't. Some studies will use a convenience sample i.e. everyone who showed up to a hospital, some will have screening criteria. This not a case of comparing apples to oranges, but rather comparing apples to poodles and a growing sense of doom for an upcoming exam. They are just not relatable in the aggregate.
No discussion of this sort can take place without a reference to Simpson's Paradox .
So I completely agree that women need to be included in CVD research. I think the article is being deliberately inflammatory and ignoring critical details on how it is already being done, and where improvement is most needed.
Just 2 of the 8 facts they listed tackled cardiovascular disease. I wouldn't call that most.
The second of the two specifically talks about the research gap for black women:
So while it is talking about studying women's health in regard to cardiovascular health, the point was that black women face a greater risk but are not included at rates they should be in clinical studies.
These are valid points, and I must stress that CVD is nowhere close to being in my wheelhouse - I can overstep here easily. From the bit that I know about prospective trials of those sorts, participation is often driven by a single factor; physician links to the study which biases towards university affiliated clinics. I have no doubt that impacts patient recruitment.
As the article states there has been a directive since the 1990s for clinical trials to reflect the racial and ethnic proportions of the real-world populations impacted by the condition. That has met with some (limited?) success. The guidance has strengthened in the last few years.
These issues are well worth discussing. My point was that the article seems to be focused on awareness raising with a confrontational edge. The research field is well aware of these biases and has been taking steps to correct them. I didn't see that sort of nuance in the article.
Is it getting better?
I don't know what's captured in the category. I'm not in the USA anymore so I've been out of touch with NIH for more than a decade.
I was simply pointing out that this article that we’re discussing specifically mentions that funding has been going down, not increasing.
Funding for everything at NIH has been going down. It is not a great time to be in medical research, particularly in public health.
If you read the article, you'll know that the NIH's overall grant funding grew while women's health research funding shrank.
It's in the quoted section in my comment above.
I wonder about some of the facts. Whilst I do not dispute that there are differences, there are some points here that seem dishonest. For example there is a number cited that roughly 9% of resources or whatever is directed at women, despite them making up half the population. This number is women-only, right? But there is a point earlier that specifies that, at least in the US, research should in general include both men and women.
Does anyone have any numbers percentages that relate to shared research as well as mamen-only? I asked chatgpt and all it could find was some UK study between 2000 and 2013 on cancer research:
On the one hand there seems to arguments about a more equal distribution of resources, which I agree with, but on the other hand the numbers seem to compare women-only investments to everything else. That such numbers are small does not mean that the men-only percentages are large. It would be more interesting to compare these numbers. Showing only one of them, feels a little disingenuous.
It feels I little unclear whether the author thinks the distribution should be equal or whether or not it should reflect problem groups. What's more we do not see any numbers showing whether or not one of them is being favoured over the other.
Women's health has been neglected for a long time and it is well documented. Thoroughly documented.
Yes that was the claim, but the number 8.8% did not mean that the remaining gap was funding that excluded women. But reading this article made it seem that way.
Did you click through to read the National Academies analysis that's linked in the article?
Yes I did but I had trouble understanding what the number meant. The article in question made it seem like the remaining funding ignored women when it didn't. That number corresponds to funding specific to women. It does not mean ober 90% is male focused. That's why I was interested in how much was male-only funding as this number would be better at revealing the inequality.
Oh my god, dude. That is what it means if you read further. Most research is based on male bodies and is then applied to women's bodies as if they are the same.
Where does it say that? It says
A bigger portion of the finding needs to go towards finding out if there really are sex differences. But this is not the same as 92.2% of spending ignores women.
According to the article the NIH has been required to include women in medical research since the 90s and have been required to determine whether there are any expected sex differences since 2016.
Also, if they determine that there are no sex differences, does it matter if the research has been conducted on female animals or not?
Go forth and read more.
Excuse me?
I asked it for references. I do not see what the problem is.
You are very capable of pulling references yourself, y'know.
The article is littered with references, you just need to click and read them.
You're right, and I did. To me the 8.8% cited in the reference used in this article seems pretty vague. This number relates to women's health defined as "[...] includ[ing] diseases and conditions that are sex specific or affect women and men differently or disproportionately, [...]". So this particular work does not really say that men are particularly favoured here. However, they do cite another article by Arthur Mirin (DOI: 10.1089/jwh.1029.8682) which stated as of 2021:
To me, these numbers give ordinary people a much better view of the problem, I would say. The 8.8% likely makes much more sense to experts within the field and I never meant to oppose that. It was simply difficult to make sense of within the scope of the article.
Also, whether or not there are references in the article is completely irrelevant to my criticism about the author being unclear as of what point they were trying to make with their piece. They simultaneously claim that healthcare should be allocated more equally and depending on the gender specific needs. It reads like rage-bait.
Just because you're enraged doesn't make it bait. As a number of the references and the article makes clear, it's about allocating resources equitably. Equitable!=Equal.
How is it unclear? Women's health should be studied more than it is currently.
Those aren't mutually exclusive claims.
No they aren't mutually exclusive, that's true. But if women-only research funding is below 10%, this says nothing about male-only funding. From what I could find that majority of funding goes to research that is gender agnostic. The problem seems to be that when gender specific funding is warranted, male-specific conditions seemed to get more attention than made sense. If the goal is to have equality in healthcare, is this not promising?
Our bodies are not gender agnostic though. That research is predicated on male bodies.
No not really. Whilst it may not be gender agnostic, including both men and women does not make research for male bodies. Sure, historically this has been a problem and this is why it became a requirement to include women in the 90's, who h is mentioned in the article.
I can't hold your hand through this anymore. You're being willfully obtuse about this.