For years, women have been discriminated against in health care and health research. The Society for Women’s Health Research (SWHR) was founded in 1990 to “bring attention to the lack of inclusion of women and minorities in medical research and clinical trials.” (1) That is why, in 2001, the Institute of Medicine was commissioned to write Exploring the Biological Contributions to Human Health: Does Sex Matter? The document points out the difference between the terms “sex” and “gender,” and the study of these differences at the basic cellular and molecular levels. This article will discuss issues related to women’s wellness in today’s world.
According to the report, having two X chromosomes (XX) or one X and one Y chromosome (XY) has a much broader influence on whole body, one that is not just applicable to reproductive health. One example is how women and men differ in brain organization for language, which is important in the case of a stroke and rehabilitation. (2) The bottom line of the report is that sex matters, and every cell has a sex. The report also pointed out that barriers exist in the advancement of knowledge about sex differences in health and disease.
Unfortunately, the disparities continue today. The Society for Women's Health Research has been overwhelmed with evidence on women’s underrepresentation in the fields of science, technology, engineering, and mathematics (STEM). (3) As mentioned, medical research has a reputation of being unduly biased toward men, in spite of the fact that differences between the sexes affect everything from how diseases should be treated to how medications are developed. (1) According to the report, bias in medical research extends beyond the lab. Optimal health for all is predicated on equality in medical research.
There are many reasons for the past biases against studying women. The 155-pound white man was the norm, to the exclusion of women, children, and individuals of color. Studying women was difficult due to fluctuations in hormones. Testing on pregnant women may have endangered the fetus. However, pregnant women and children become ill and need drugs too, and therefore must be included in studies. In spite of some progress, disparities still exist, especially in disadvantaged groups. (4) A Nursing report lists a number of findings and recommendations, such as “the government and other funding agencies should ensure adequate participation of women, analysis of data by sex, and reporting of sexstratified analyses in health research.” Read the entire report for more information.
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“Sex-based biology,” the phrase of the day, is the study of the sex differences between men and women and how they apply to different aspects of medical research and health. (5) Dr. Haseltine challenged the status quo by listing different ways in which this inequality was manifested, including advocating for more women to be included in clinical trials. Despite the fact that the National Institutes of Health (NIH) have recognized that inclusion of women in clinical trials is essential, women still are not always included. (5)
A 2010 Institute of Medicine Report discussed a concept of women’s health that is expanded outside a narrow emphasis on disorders associated with the female reproductive system to include other diseases that create a substantial liability in women’s lives (e.g., autoimmune diseases). (6) Certain diseases are more common or more serious in women than in men, have separate causes or manifestations in women than in men, have different outcomes or treatments in women than in men, or cause high morbidity or mortality in women. This comprehensive approach to women’s health and related research presents a woman-centered view rather than a disease-centered view. It also emphasizes the significance of allowing for quality of life rather than simply survival or mortality in evaluating the success of treatments and interventions.
As recently as October 20, 2015, a study was published stating that the heart ages differently for women and men. (7) The study purports that the shape of the heart changes over time in both men and women, but the configurations of change are different. Men's hearts tend to get heavier and the amount of blood they hold is less, while women's hearts do not get heavier. This finding proposes a possible need for sex-specific treatments. Let’s be aware as these and other studies surface, when taking medical histories, that sex maters!
1. Society for Women's Health Research. Sexism in Science: Bias Beyond the Lab. Law Street. http://lawstreetmedia.com/issues/health-science/sexism-in-science-bias-beyond-the-lab/. Published October 12, 2015. Accessed October 26, 2015.
2. Exploring the Biological Contributions to Human Health: Does Sex Matter? National Academy of the Sciences. http://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Exploring-the-Biological-Contributions-to-Human-Health-Does-Sex-Matter/DoesSexMatter8pager.pdf. Published 2001. Accessed October 26, 2015.
3. Statistics: State of Women and Girls in STEM. National Girls Collaborative Project. http://ngcproject.org/statistics. Accessed October 26, 2015.
4. Nelson R. Women's Health: Progress, Not Perfection. AJN. 2011;111(2):19-21. doi: 10.1097/01.NAJ.0000394283.17459.8e.
5. History. Society for Women’s Health Research. http://swhr.org/about/history/. Accessed October 28, 2015.
6. Institute of Medicine (US) Committee on Women’s Health Research. Women’s Health Research: Progress, Pitfalls, and Promise. Washington, DC: The National Academies Press. 2010.http://www.ncbi.nlm.nih.gov/pubmed/24983027.
7. Eng J, McClelland RL, Gomes AS, et al. Adverse Left Ventricular Remodeling and Age Assessed with Cardiac MR Imaging: The Multi-Ethnic Study of Atherosclerosis [published online 20 October 2015]. Radiology. doi: http://dx.doi.org/10.1148/radiol.2015150982.