Gender Equity in Medical Research article and picture‏

For years we have complained that there aren’t enough women in medical research, in
medical academia. Does it really matter? Does this make a difference in what happens
to patients? Is there still gender bias in medical research? In 2017, don’t men and women
get the optimal treatments based on evidence-based practice?
Unfortunately, even in 2018, we just don’t know. Much of the time, medical research
starts out in the animal lab, but animal studies use five times as many male animals as
female animals, even when studying diseases that are more common in women. This is
despite the known fact that data from male animals may not accurately predict what will
happen in human females. Some treatments that might benefit women more than men
may be getting lost right at the beginning.
Women are underrepresented as participants in almost every type of medical
research, other than research on cancers that occur primarily in women.
Only 25% of the participants in research in heart failure are women, even though more
than 50% of the people suffering from heart failure are women. Ironically, this can even
happen in drugs that are primarily used in women. The medication fibanserin was
recently studied in combination with alcohol, to see if it led to a drop in blood pressure.
23 men and two women participated in the study. The results don’t really help us, since
fibanserin has been approved for use only in women! This is not an unusual story.
Research that does not account for gender differences can result in inaccurate conclusions
about how women respond to disease and this, in turn, will influence the effectiveness of
treatment choices.
Cardiovascular disease is a prime example of the manner in which disregarding gender
differences can influence treatment effectiveness. It is now known that women may have
different signs and symptoms of a heart attack compared to men. For many years women
were not diagnosed and/or diagnosed late in the event, leading to excess morbidity and
mortality in women due to heart disease. Benefits of gender equity in medical research
do not apply just to women. Improved understanding of gender issues in medicine
improves medical care for men as well. The more we learn about “female” patterns of
disease, the more we realize that men may have similar disease states, although in lower
percentages. Sometimes we know more about the female version of a disease than the
male version, for example regarding depression. Research has traditionally been done on
the female pattern of depression; this frequently leaves men under-diagnosed and under-
treated.

Some differences are biologically related, and some to the socio-cultural differences that
relate to what it means to be male or female in our society. Women may fail to seek care
for chest pain, because of concerns about being perceived as hysterical or because
caretaking responsibilities overtake other concerns. Young men are at increased risk of
smoking and violence because of cultural norms that are more salient than concerns about
the distant future. These same cultural issues lead to biases in medical caretakers, both
men and women. Following an acute medical incident, women are prescribed less
medication then recommended by evidence-based practice. Interestingly, research has
shown that checklists remove these differences. Medical professionals are not
purposefully treating women insufficiently. There are underlying biases that interfere
with appropriate care.
Will getting more women into academia make a difference?
We know that research trials in which the first author and last author are both men have a
significantly lower rate of female study participants. At this point in time, funding and
staffing decisions by research funders and research institutions are made by committees
that are almost exclusively staffed by men.
To ensure that men and women get the medical care that they deserve:
 Research funders need to adopt formal policies that encourage researchers to
include considerations of sex and gender in their research designs and analyses.
 All medications should be tested in both women and men, and drug companies
should be required to report gender analyses of pharmacokinetics and
pharmacodynamics.
HW-ZOA in the United States, and the Linda Joy Pollin Cardiovascular Wellness Center
in Israel are working to promote gender equity in medical research. We are working with
Knesset members, with women’s organizations, and within the Israel Heart Society to
promote gender equity. Let’s hope that our efforts translate into improved cardiovascular
health for women and for men!!!