He and She

Researchers in medicine and science continue to focus on male animals in their trials and experiments. Men are left out of osteoporosis studies. And government auto safety testing doesn’t use crash test dummies that are designed to resemble pregnant women.

Efforts to include sex and gender analysis, such as guidelines by the National Institutes of Health instructing grantees to include women and minorities in clinical research, have been around for more than a decade.

But researchers are not doing a good enough job of incorporating such analysis in their work, say experts involved in a Stanford University project called Gendered Innovations in Science, Health & Medicine, and Engineering. They say that doing so would lead to better science.

The project, initially started with funding from the Clayman Institute of Gender Research at Stanford, has now grown into a $2 million endeavor supported by the European Union and the U.S. National Science Foundation. Since 2009, the project has produced 14 case studies, including the ones cited above on osteoporosis and the crash-test dummies. Based on these studies, the project suggests 11 different ways to include sex and gender analysis during the different stages of research.

Next month, scientists associated with the project will meet at a workshop in Brussels to discuss and conduct peer review on case studies on climate change and urban design, among other topics. 

“Our research fills a gap when it comes to the importance placed on sex and gender analysis,” said Londa Schiebinger, project director of Gendered Innovations and a professor of the history of science at Stanford. “It needs to be systemically implemented in university curricula. You can create knowledge and better technology. And it saves money and enhances safety”

Schiebinger said that she has been interested in “bias in science” issues for a while, and Gendered Innovations was a next step, with scientists working together for positive change. “This allows us to do something innovative. That’s what is exciting.”

She pointed to three of the case studies, to explain why such analysis is important:

• Female animals are underrepresented in clinical trials because researchers "perform single-sex animal studies to reduce the cost of experiments," or because changes in their hormone levels can affect the result of experiments, according to journal articles cited in the study. According to one article in Neuroscience and Biobehavioral Reviews, female animals tend to be underrepresented in most health and biomedical research fields except immunology and reproduction. "Results of studies in males are often generalized to females without justification, and even some conditions that occur more often in women are studied in mostly male animals,” the case study states. The study found that using female animals in research led to new knowledge about traumatic brain injury. The study suggests that government-backed research require “two-sex studies and sex analysis.”
• Crash test dummies come in diverse sizes and weights, but more inclusive standards are needed. “Making pregnancy a research priority in automobile research and testing can lead to greater vehicle safety overall,” according to the study, which says that the government should mandate safety testing using crash test dummies modeled on pregnant women.
• One-third of all hip fractures from osteoporosis happen to men. Yet osteoporosis continues to be treated as a disease that happens to women. Although research is improving, gender-based analysis can lead to better osteoporosis prevention, according to Gendered Innovations. “A prevention campaign might focus on increasing physical activity and on smoking cessation, recognizing that women are more likely to be physically inactive and men are more likely to smoke tobacco,” the study states.

Another case study looks at the role of textbooks that train future scientists, and suggests removal of “unintended gender assumptions.” One example: “In the case of developmental biology, omitting information about the role of the female reproductive tract in sperm transport and capacitation may reinforce cultural stereotypes that portray females as passive,” the study states.

The project also lists the ways sex and gender analysis can be introduced at the different stages of research, such as when deciding on research questions or when interpreting data.

“The project is making clear that we sometimes have blinders on. Our scientific endeavors need to make sure to factor in the differences between male and females,” said Marcia Stefanick, a professor of medicine at Stanford who is an adviser to the project.

Stefanick said not enough journals require that male and female data be reported separately. “Our goal is to raise awareness on everyone who teaches science and get this into the curriculum.”

More case studies are on the way.

Margaret McCarthy, chair of the pharmacology department at the University of Maryland School of Medicine in Baltimore, who is part of the project and is helping with a forthcoming case study on gender and the brain, said that males tend to suffer more from “developmentally based disorders” like autism or dyslexia while females “suffer more from depression, anxiety, compulsion, eating disorders and late onset schizophrenia.”

“Many of these have a cultural bias (e.g., males are more likely to self-medicate with alcohol or drugs than seek help for depression), but only by understanding the biological basis of sex differences in vulnerability can we hope to understand the cultural influences as well,” McCarthy said in an e-mail.

But an advocate for men’s health questioned whether the project itself was free of any gender biases.

Ron Henry, co-founder of the Men’s Health Network, a nonprofit that aims to better the health of men and boys, said that he could not imagine that many researchers would object to bigger budgets that allowed more findings. Henry said there was little in the Gendered Innovations case studies to indicate that scientists were doing anything but working to get the most research they could do with limited budgets and the sample sizes they could afford.

Henry said that it was obvious that pregnant women would occupy a car seat differently than other passengers. But he suggested that the research staff should also step back and examine their own gender biases. “The Stanford Project gives one nod to the problem of under-recognition of male osteoporosis but everything else appears to be female-oriented,” Henry said.

He suggested that the researchers should also look at the “elephants in the room” such as the differences in lifespan between men and women or the disproportionate rate at which boys drop out of school.