No one wants to deal with a hormonal mouse. When I was a graduate research assistant, I studied the impact of enriching a human’s environment on cognition. My research was conducted on mice, but not every type of mouse. In fact, a large portion of the mouse population was purposefully left out of the study. The reason was simple: female hormones could potentially affect our data. We made the decision to eliminate the “noise” of these hormones. Every mouse that participated in our experiments was a male.
This “no females allowed” type of research is nothing new. Researchers have avoided the “interference” of female hormones by using male cell lines and male animal models in their basic and preclinical studies. Historically, the medical field has seen no problem with this approach. For centuries, females have been categorized as “little males.” Matters of sex and reproductive organs were thought to be the only physiological differences between these groups. So, it made sense then that any results obtained in male-only trials would apply to females. In 1977, the FDA went so far as to prohibit females with reproductive capacity from participating in clinical trials. They wanted to protect a “most vulnerable population” from potential medication toxicities and avoid a repeat of incidences such as the infamous thalidomide tragedy.1
Bikini Medicine Is Failing Women
This “bikini medicine,” the mistaken idea that female health diverges from male health only inside the anatomical confines of a bikini, has set back innovations in female healthcare. And these disparities in research and care aren’t just a thing of the past. Recently, a study examined where the National Institutes of Health (NIH) spend their research dollars among disorders. A disproportionate amount is allocated for diseases that affect mostly males. Diseases that primarily affect females are often ignored.1 An audit of titles and abstracts on ResearchGate supports this finding: five times more papers are on erectile dysfunction, which affects just 19% of males, than on premenstrual syndrome and the 90% of females who it impacts.2
This male bias isn’t isolated to the laboratory. The healthcare of females is impacted each and every day by these research choices. Female-focused landmark, studies such as the Nurses’ Health Study, find females are often diagnosed, treated, and prescribed drugs based on evidence from studies that excluded them. As we now know, male and female bodies differ in a variety of ways that go beyond the superficial confines of swimwear. Distinct characteristics exist at the cellular and molecular level of females and males. Research shows that males and females express 6,500 genes differently, including those that may cause disease or impact how an individual responds to treatment.3 According to a recent analysis, cardiovascular disease, osteoporosis, and autoimmune disorders all manifest differently in males and females.4
Unfortunately, plenty of evidence shows that a woman’s health is jeopardized simply because she is a woman. Women are more likely to have their heart attack misdiagnosed, less likely to receive preventative care, and more likely to die after a heart attack than men.3 And the hazards of underrepresentation in studies of disease mechanisms and therapy are evident in FDA data. Women in the United States suffered more than two million drug-related adverse events, vastly outnumbering the 1.3 million experienced by men.4
Closing the Healthcare Gender Gap
During my graduate research days, any potential shortcomings of our all-male mouse research was relegated to the discussion section of our paper. But dedicating a paragraph or two to limitations within the male-dominated biomedical research field does little good for the females whose lives are at risk every day. From the lab to the doctor’s office to the pharmacy, something as small as a mouse can have large implications for half our population.
We can’t and shouldn’t continue to make crucial decisions for people based on information that excludes them. Lasting change can only happen if we close the gender gap in health research funding. But funding is only the beginning. We can begin to reverse the tide of healthcare disparities by advocating for ourselves and our loved ones.
Next time you are in an exam room feeling that your symptoms are being overlooked, ask your doctor if they have factored your female physiology into the diagnostic equation. Before you walk out of your doctor’s office with a new prescription, question if your drug has been studied in females and if there is anything females should be aware of. This will result not only in better care for you, but ultimately better science, better guidelines, and better care for everybody.
References:
1. J Womens Health (Larchmt). 2021;30(7):956-963. doi: 10.1089/jwh.2020.8682. Epub 2020 Nov 27.
2. https://www.researchgate.net/blog/why-do-we-still-not-know-what-causes-pms.
3. Woodward M. “Cardiovascular Disease and the Female Disadvantage.” Int J Environ Res Public Health. 2019 Apr 1;16(7):1165. doi: 10.3390/ijerph16071165. PMID: 30939754; PMCID: PMC6479531.
4. Nowogrodzki, A. “Inequality in medicine.” Nature550, S18–S19 (2017). https://doi.org/10.1038/550S18a.
