Three medical researchers from Sydney have been published in a renowned peer-reviewed science journal for their work researching the impact of sex and gender in scientific research.
Sue Haupt, Robyn Norton and Cheryl Carcel – researchers from the George Institute for Global Health at the University of New South Wales (UNSW) – collaborated on a comment piece after the international journal Nature invited the Sydney women to develop an article for the journal earlier this month.
Backed up by dozens of international studies and data, the article argued the neglect of sex and gender as variables in medical and scientific research poses a “public health risk”, particularly as technological advances such as artificial intelligence (AI) show no signs of slowing down in the industry.
“The consideration of sex and, where appropriate, gender in biological research must become routine – especially as molecular genetics, biomedical engineering and AI open up possibilities for treatments that are better tailored to the needs of individuals,” the article reads.
There are three things that Haupt, Norton and Carcel said stakeholders in medicine, including pharmaceutical companies and intergovernmental organisations, should take into consideration: first, how sex and gender can significantly impact health outcomes for men and women*; second, how sex and gender are “disregarded in basic research and clinical trials”; and third, that change in the field can only occur through “increasing awareness among all stakeholders”.
The researchers noted that men and women experience non-communicable diseases in different ways, and these variations stem not only from biological factors (i.e. sex assigned at birth), but also from “people’s exposure to the environmental factors that trigger the disease, how they manage their condition, how they are treated by caregivers and so on, all of which can be influenced by a person’s gender”.
“Often, a combination of factors will be at work,” the article reads.
How does sex and gender impact health outcomes?
On sex as a variable, there is limited but nonetheless valid research that identifies biological factors to be the cause of conditions experienced by men and women respectively.
“Although mechanisms are yet to be fully understood, it is plausible that differences in people’s biology help to explain why women are more likely to experience pain between their shoulder blades, nausea or vomiting and shortness of breath during a heart attack; why men are more likely to experience chest pain and increased sweating; and why women are nearly twice as likely as are men to die after a severe heart attack,” the article reads.
For example, research led by Sue Haupt found a cancer-defence gene found in women helped them survive lung adenocarcinoma (the most common type of lung cancer) longer than men who suffered from the disease.
On the other hand, the researchers highlight is the impact of tobacco consumption as an example of how gender can affect one’s health: worldwide, around 37 per cent of men smoke, compared to 8 per cent women – which could be why men are more likely to experience heart conditions than women, for example.
“Also, in part because health-care professionals and others are more familiar with the heart attack symptoms commonly seen in men, when women have a heart attack, they are more likely to delay seeking help, and caregivers are often slower to intervene,” the article reads.
A study of 500,000 people who had a heart attack in the UK between 2004 and 2013 found women were 37 per cent more likely to receive an incorrect diagnosis than men, and were two to three times less likely to be referred to a cardiologist when they experienced chest pain.
The public health risk – and the solution
These are “compelling indications that sex and gender matter” in medicine, the researchers argue, yet they continue to be neglected by many researchers and health practitioners around the world.
“Women represent nearly half of the population, but they are still underrepresented in many clinical trials for numerous diseases, even in cases in which disease prevalence for women has been measured,” the article reads.
Inclusion is even lower for transgender, gender-diverse and intersex people, which poses serious health risks for these underrepresented groups.
To ensure better health outcomes for the full population, the researchers say having a diverse group for human clinical trials is the first step.
“Inclusivity in human trials will ensure the best possible outcomes for all participants, including cis and trans women and men, gender-diverse and intersex people,” the article says.
While policy changes to ensure this happens are “crucial”, the article suggests many researchers may see such calls for inclusivity as “burdensome” – which is why greater awareness must be developed.
“Especially because studying more than one sex can increase costs – sample sizes might need to be increased to achieve sufficient statistical power when comparing groups,” the article reads.
“Awareness must be built… of the ramifications of failing to consider sex and gender.”
The researchers highlighted the work of the Canadian Institute of Health Research (CIHR) in building focus on sex and gender in their research; between 2011 and 2019, the percentage of all research grant applications that submitted to the CIHR that took sex into consideration increased from 22 per cent to 83 per cent. The CIHR also provided training and workshops on the importance of sex and gender for scientists, researchers and specialists.
“Greater awareness, the wealth of data now emerging and the possibilities presented by new tools, from AI to gene editing, could mean a new era for research and medicine,” the article reads.
*For the purpose of the article published in Nature, the researchers use “men” to refer to people who identify with that gender and were assigned male at birth, and use “women” to refer to people who identify with that gender and were assigned female at birth.