Research based on the body of an ‘average man’ for the standard of science is endangering the lives of women every day. Treating women like they are men between the ages of 25 and 30 weighing 75 kilograms ignores the ways in which women’s bodies present symptoms, how they metabolize medications and the diseases that are more likely to affect them.
As my previous columns discussed, women are underrepresented in science as researchers — but they are also underrepresented as subjects. Two-thirds of studies do not analyze participants separately by sex and treat female bodies the same as male, despite the countless biological nuances that differentiate the male and female bodies. The scientific community must advocate women’s health by demanding medical schools teach their students about the differences between male and female physiology — and require studies to research the impact on male and female bodies alike. This more rigorous approach will improve the quality of science and prevent needless deaths of women.
The reason often given for women being studied less often than men is the ‘complicated’ nature of women’s cyclical hormones. Women’s bodies differ before, during, and after reproductive age, as well as throughout each menstrual cycle. Moreover, contraception use, which comes in various forms and brands, is also a factor which may affect results. Moreover, many women take contraception which comes in several forms and brands and is also a factor which may affect the results. This makes research on women more time consuming and expensive.
But these ‘complications’ are exactly why researchers need to separate the sexes. If women are too complicated to use as research subjects, surely they’re too complicated to assume the same results. The National Institutes of Health (NIH) acknowledges this, saying that unless there is a compelling reason not to, all biological sexes must be included in research studies. However, this guideline is not enforced.
This is a change that must be made at all levels. Researchers should plan their experimental designs to represent the populations which they aim to generalize their results to. The scientific journals which publish these articles and the peer review process should demand that women are appropriately represented in scientific studies.
Of course, some research is more generalizable. For example, no difference was found in the metabolism of drugs such as morphine, phenytoin oxazepam and lorazepam in male and female bodies. However, this is not something that should simply be assumed.
Many diseases appear to not have an obvious sex dependence — but do. For example, strokes are more common in women than in men. Furthermore, there is a clear difference in how the symptoms present themselves in men and women. While people are often taught to look out for ‘FAST’ (Face drooping, Arm weakness or Speech difficulty, it’s Time to call 911), these are the symptoms more prevalent in men. On the other hand, women are more likely to experience migraines, jaw pain and confusion.
Another example is cardiovascular disease, which is the leading cause of death for both men and women in the United States. However, women are significantly more likely to die of a heart attack than men because of the way their symptoms present. While both men and women may present with the typical symptom of chest pain, women are more likely to complain of back pain and indigestion, and some do not even experience chest pain. Without knowledge on these differences, women assume their symptoms are not indicators of a more serious condition.
Inequities are particularly prevalent in the research of female reproductive health. There are 4.5 times as many research articles published focusing on non-reproductive organs than reproductive organs, even though a British study estimated that almost a third of women have experienced ‘severe reproductive health symptoms.’
For example, endometriosis, a debilitating and chronic condition in which the womb lining grows outside of the uterus, is estimated to affect around 10% of the population — but it is painfully under researched due to the fact that it only affects women and the stigma around reproductive health. Debilitating pain, heavy periods and infertility are only a few of the symptoms that plague the lives of women with this condition. The focus of research on male bodies, and the lack of research on diseases that are more likely to affect women, endangers the lives of women every day. Everyone, regardless of gender, must advocate for funding to be equally allocated for research of diseases that have a sex bias. Medical schools have a responsibility to teach about the different presentation of diseases depending on sex to improve patient care for everyone.
Women’s lives depend on it.
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