Not enough women are included in medical research. And while progress has been made, there are still challenges to fully recognizing both sex and gender factors that contribute to our knowledge of health and diseases. Two experts on the problem lay out how gender bias affects research and how to overcome it.
The two experts—Vivian Pinn, MD, senior scientist emerita of the Fogarty International Center, and Neelum Aggarwal, MD, chair of the AMA Women Physicians Section—participated in a webinar as part of Women in Medicine Month, which happens each September.
“We have made a lot of progress, but there are still challenges to fully recognizing the importance of sex and gender factors in contributing to our knowledge and our care of our patients and of ourselves,” said Dr. Pinn, founding director of the Office of Research on Women’s Health at the National Institutes of Health.
Here are three ways physicians and health professionals can improve the lack of women being studied as research subjects.
Women make up more than 51 percent of the population, yet fewer women than men participate in clinical research.
“And then if you start looking at clinical care, 80 percent of health care decisions are being made by women, yet how is this really being translated in a palpable way in the clinical offices?” said Dr. Aggarwal, chief diversity and inclusion officer for the American Medical Women’s Association.
Sponsorship, which is needed to accelerate where medical research needs to go, includes how to talk about the topic of sex and gender, which should be reflected in journals.
“If we don’t hold these journals accountable to how they are reviewing the papers and how they are demanding that sex considerations are being discussed in the paper, we will not be able to really learn through scholarship what is out in the literature,” she said.
Colleagues and medical students need mentorship from experienced physicians and health care professionals to overcome gender bias.
“We need inspiring roles in these careers with support to overcome these barriers,” said Dr. Aggarwal. “These barriers are large, so we need these role models to talk about how their careers were shaped, learning about what they have done and handling these issues of implicit and unconscious bias that exist.”
Mentorship is also important for work-life management, which can be achieved if there are role models and if awareness is raised on how these issues affect the care delivered to patients and the research that is conducted.
Sponsorship, mentorship and scholarship are all interrelated. But little progress will be made on the issue unless this translation and information is seen in scholarship. It should begin with medical education by having students ask about sex differences, the experts said. And if there are sex differences, students should learn what they are, why they exist and how care delivery can or should be changed to address the differences.
“Sex and gender is a large topic to get your head around and handle, especially when you’re trying to look at how it influences all different areas—whether it be a scientific field, the clinical care field or medical education,” said Dr. Aggarwal.
She noted that sex is male or female according to reproductive organs and functions assigned by chromosomal complement. Whereas gender is a person’s self-representation in response to, or by, social institutions that is rooted in biology and shaped by environment and experience.
Overcoming implicit and unconscious bias must include education, research and workforce development, the experts said. Demonstrate how integrating sex and gender into the basic science and clinical research platforms can occur.
“How is it going to change the way we carry out our research and how is that research going to be applied?” said Dr. Aggarwal. “That translatability is so important to consider when we talk about this topic because if you can’t translate it, people can’t see how it fits in.”
“Unless the effect of sex and gender are studied, we are at risk for misunderstanding human physiology and function,” she said.