How has gender bias in research skewed biomedical knowledge? originally appeared on Quora: the place to gain and share knowledge, empowering people to learn from others and better understand the world.
One big way that gender bias in research has skewed biomedical knowledge is that a lot of the knowledge we have about diseases that affect both genders and the effects of drugs and other treatments is based on research on men. For decades, a lot of clinical research was done solely or largely on men and the results were extrapolated to women. It’s really only since the early nineties that the research community has begun to recognize the importance of including women and paying attention to the possibility that there may be sex/gender differences. Back then, the National Institutes of Health wasn’t keeping track of whether women were enrolled in its federally funded research. The Food and Drug Administration was prohibiting all women of childbearing age from taking part in early-phase drug trials. And researchers were generally reluctant to include women for paternalistic reasons (a concern for the possible risks to women and/or their future fetuses) and also out of laziness (accounting for women’s varying hormonal states and cycles was thought to make it more complicated and costly to get statistically significant results).
Since 1993, its been federal law that women be included in NIH-funded research, but there’s still a long way to go. Women are still underrepresented in many research areas. When women are included, it’s still not routine for researchers to always actually analyze their results by sex or gender and include that information in the published study. When it comes to pre-clinical research on animals, tissue samples, and cell lines, it’s still firmly the norm to use male subjects—a problem that the NIH has only started to formally tackling in the last few years. Plus, although we’ve been amassing a large body of research over the past few decades about key differences between women and men—in everything from how certain drugs are metabolized to the symptoms and risk factors of various diseases—a lot of that knowledge has still not been fully integrated into medical education.
So women are still being judged against a “male model” when it comes to many conditions. As a result, they often tend to have more “atypical” symptoms. (Heart disease, which we studied almost exclusively in men for decades, is a good example: Once we started to study women in eighties and nineties, we realized that women are less likely to have the “textbook” heart attack symptoms of chest pain and radiating left arm pain and more likely to have other symptoms, like fatigue, nausea, jaw or neck pain.) Women tend to have more side effects from drugs, no doubt because many on the market weren’t studied in them. (Women are 50-75 percent more likely than men to have an adverse drug reaction.)
And that’s before we even get to the fact that many conditions that primarily affect women have been comparatively under-researched entirely. Many health problems that are extremely common among women and exact a huge burden in terms of suffering and economic costs—including autoimmune diseases, gynecological disorders, chronic pain conditions—just haven’t been a huge research priority. And, as I mentioned in other answers, many of these neglected conditions that disproportionately impact women haven’t attracted research funding and interest in large part because the biomedical community has assumed they are “all your head.”
This skewing of medical knowledge, while it obviously especially hurts women, hurts everyone. We’d know more about human health and disease period if we’d been thoroughly investigating sex/gender differences and investing more in understanding conditions that happen to largely affect women from the start.
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