Medical Researches & Gender

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Aslı | Ben Bu Ay Ne İzledim?

5 min readApr 28, 2021

“Failing to include both sexes ‘right at the way beginning’ of the research is not only scientifically idiotic and a waste of money, but it is also an ethical issue as well.” — Jeffrey Mogil, McGill University

The medical system has been systematically discriminating against women and leaving women chronically misunderstood, mistreated, and misdiagnosed.

Why are women underrepresented in medical researches?

According to Caroline Criado Perez (Invisible Women) the women underrepresentation in medical researches have several reasons:

Like the failure to include women in anatomy textbooks, the failure to include women in medical trials is a historical problem that has its roots in seeing the male body as the default human body.
Female bodies (both the human and animal variety) are, it is argued, too complex, too variable, too costly to be tested on. Integrating sex and gender into research is seen as “burdensome”. Then when you don’t integrate all the genders into the researches, it is acceptable on the basis of “simplification”. (Check out this article for more: https://bit.ly/30nux1C)
Researchers also defend their failure to include women in trials by claiming that women are harder to recruit. Yes, women have less leisure time because of their caregiving activities but is it really a reason to exclude them?

How much are women underrepresented at the clinical trials and the studies?

In her “25 Years of Women Being Underrepresented in Medical Research” article, Katherine Ellen Foley explained a published work by researchers from the Allen Institute for Artificial Intelligence in Seattle in 2019. Researches identified medical researches from 1993 until 2018 and the participants of them. They analyzed over 43,000 research studies in PubMed, a searchable database of biomedical science, and 13,000 clinical trials registered on clinicaltrials.gov.

According to this research, overall, the rate of women participation is 49% of all participants.

Quantifying Sex Bias in Clinical Studies at Scale With Automated Data Extraction

I can hear you’re saying “It is almost equal, so what is the problem?”. I’ll answer it right away.

Let’s look at the participation of women in the trials of conditions one by one and the biological sexes of the patients of the regarding conditions:

Firstly, the conditions women are largely underrepresented:

Clinical research on diabetes, mental health, non-sex-specific cancers, and respiratory disease had roughly equal representation.

Secondly, the conditions women are evenly represented:

Thirdly, the conditions men are underrepresented:

The only two categories in which women were somewhat overrepresented were neurological conditions and musculoskeletal conditions.

If you are still not convinced that something is wrong with the rates. Let’s move to our next question.

Is participating in the clinical trials enough?

Unfortunately, NO! Because;

when women are included in trials at all, they tend to be tested in a period when their hormone levels are at their lowest (We may say when they are most like men). The idea behind it is, again, “simplification”.
even when studies do include women, they often fail to stratify data by sex or include information about hormone status or any other gender-specific factors. In other words, the collected data is not sex-specific data.

Let’s look at examples from Invisible Women by Caroline Criado Perez:

A 2011 review of ten cardiovascular journals found that when sex was specified 69% of cell studies reported using only male cells.
A 2007 analysis of 645 cardiovascular clinical trials (all published in prominent journals) found that only 24% provided sex-specific results.
A 2001 US Government Accounting Office (GAO) audit of FDA records found that about a third of documents didn’t sex-disaggregate their outcomes and 40% didn’t even specify the sex of the participants.

Why is sex-specific data important?

Basically, when we don’t take sex-specific data into account on a medicine trial, we cannot know if a medication has any different side effects for women then men.

According to “ Women Encounter ADRs More Often than Do Men” article; so far, the menstrual-cycle impacts have been found for antipsychotics, antihistamines, and antibiotic treatments as well as a heart medication.
Some antidepressants have been found to affect women differently at different times of their cycle, meaning that dosage may be too high at some points and too low at others (Check out this article for more: https://bit.ly/2MLwehb)

Women represent 55% of HIV positive adults in the developing world according to Women and HIV/AIDS in the United States (2014). In parts of Africa and the Caribbean women aged 5–24 are up to 6 times more likely to be HIV-positive than young men of the same age (https://bit.ly/2Uu7XAz). Also, it is known that women experience different clinical symptoms and complications due to HIV.

A 2016 review of the inclusion of women in US HIV research found that women made up only 19.2% of participants in antiretroviral studies, 38.1% in vaccination studies, and 11.1% in studies to find a cure (Check out this article for more: https://bit.ly/3cOZGxA).

There are many other clinical trials, medicines, and vaccines tests that can be given as examples. Although some quotas are argued and even put into practice in this regard, there is not much change in the results. Women should participate in medical researches equally and the results should be analyzed by sex to overcome this issue. If not, medical science won’t benefit everyone.