Wednesday, 10 January 2018

Medical research often ignores differing health outcomes for men and women

Female lead and last authors more likely to consider disparities related to sex and gender. PDF version Female co-authorship increases the likelihood that a medical-research paper will address gender-related differences in disease or treatment outcomes, a study in Nature Human Behaviour finds (M. W. Nielsen et al. Nature Hum. Behav. 1, 791–796; 2017). Neglecting these disparities — which affect health outcomes in conditions such as cardiovascular disease and osteoporosis — can have life-threatening consequences, the study adds. The authors analysed more than 1.5 million medical-research papers published between 2008 and 2015. They found that the research was most likely to address gender differences when female scientists were first and last authors. However, female researchers comprised only 40% of first authors and 27% of last authors in the papers analysed. This is troubling, the study authors say, because last authors usually lead on identifying, planning and developing research pursuits in health disciplines. Increasing numbers of medical researchers, journal editors and science agencies already acknowledge the importance of including gender analysis in research, the authors note. doi: 10.1038/d41586-017-08993-w Letter One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis Mathias Wullum Nielsen, Jens Peter Andersen, Londa Schiebinger & Jesper W. Schneider Nature Human Behaviour 1, 791–796 (2017) doi:10.1038/s41562-017-0235-x Download Citation Health occupationsInterdisciplinary studiesSociology Received: 05 May 2017 Accepted: 27 September 2017 Published online: 06 November 2017 Abstract Gender and sex analysis is increasingly recognized as a key factor in creating better medical research and health care1,2,3,4,5,6,7. Using a sample of more than 1.5 million medical research papers, our study examined the potential link between women’s participation in medical science and attention to gender-related and sex-related factors in disease-specific research. Adjusting for variations across countries, disease topics and medical research areas, we compared the participation of women authors in studies that do and do not involve gender and sex analysis. Overall, our results show a robust positive correlation between women’s authorship and the likelihood of a study including gender and sex analysis. These findings corroborate discussions of how women’s participation in medical science links to research outcomes, and show the mutual benefits of promoting both the scientific advancement of women and the integration of gender and sex analysis into medical research. References 1. Arnold, A. P. Promoting the understanding of sex differences to enhance equity and excellence in biomedical science. Biol. Sex Differ. 1, 1 (2010). Show context ArticlePubMedPubMed Central 2. Schiebinger, L., Leopold, S. S. & Miller, V. M. Editorial policies for sex and gender analysis. Lancet 388, 2841–2842 (2016). Show context ArticlePubMed 3. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals (International Committee of Medical Journal Editor, 2016); Show context 4. Heidari, S., Babor, T. F., De Castro, P., Tort, S. & Curno, M. Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Res. Integr. Peer Rev. 1, 2 (2016). Show context Article 5. Miller, V. M. In pursuit of scientific excellence: sex matters. Physiol. Genomics 44, 485–486 (2012). Show context ArticlePubMed 6. Nieuwenhoven, L. & Klinge, I. Scientific excellence in applying sex- and gender-sensitive methods in biomedical and health research. J. Womens Health 19, 313–321 (2010). Show context Article 7. Johnson, J. L., Greaves, L. & Repta, R. Better science with sex and gender: facilitating the use of a sex and gender-based analysis in health research. Int. J. Equity Health 8, 14 (2009). Show context ArticlePubMedPubMed Central 8. Oertelt-Prigione, S. & Regitz-Zagrosek, V. (eds) Sex and Gender Aspects in Clinical Medicine (Springer, London, 2012). Show context 9. Kim, E. S. H. & Menon, V. Status of women in cardiovascular clinical trials. Arterioscler. Thromb. Vasc. Biol. 29, 279–283 (2009). Show context CASArticlePubMed 10. Mosca, L., Hammond, G., Mochari-Greenberger, H., Towfighi, A. & Albert, M. A. Fifteen-year trends in awareness of heart disease in women results of a 2012 American Heart Association national survey. Circulation 127, 1254–1263 (2013). Show context ArticlePubMedPubMed Central 11. Kwiatkowski, K., Coe, K., Bailar, J. C. & Swanson, G. M. Inclusion of minorities and women in cancer clinical trials, a decade later: have we improved? Cancer 119, 2956–2963 (2013). Show context ArticlePubMed 12. Beery, A. K. & Zucker, I. Sex bias in neuroscience and biomedical research. Neurosci. Biobehav. Rev. 35, 565–572 (2011). Show context ArticlePubMed 13. Shah, K., McCormack, C. E. & Bradbury, N. A. Do you know the sex of your cells? Am. J. Physiol. Cell Physiol. 306, C3–C18 (2014). Show context CASArticlePubMed 14. Klein, S. L. et al. Sex differences in the incidence and case fatality rates from hemorrhagic fever with renal syndrome in China, 2004–2008. Clin. Infect. Dis. 52, 1414–1421 (2011). Show context ArticlePubMedPubMed Central 15. Adler, R. A. Osteoporosis in men: a review. Bone Res. 2, 14001 (2014). Show context ArticlePubMedPubMed Central 16. Smith, P. M. & Koehoorn, M. Measuring gender when you don’t have a gender measure: constructing a gender index using survey data. Int. J. Equity Health 15, 82 (2016). Show context ArticlePubMedPubMed Central 17. Courtenay, W. H. Behavioral factors associated with disease, injury, and death among men: evidence and implications for prevention. J. Mens Stud. 9, 81–142 (2000). Show context Article 18. Alabas, O. A., Tashani, O. A., Tabasam, G. & Johnson, M. I. Gender role affects experimental pain responses: a systematic review with meta‐analysis. Eur. J. Pain 16, 1211–1223 (2012). Show context CASArticlePubMed 19. Pelletier, R. et al. Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young? J. Am. Coll. Cardiol. 67, 127–135 (2016). Show context ArticlePubMed 20. Schiebinger, L. & Stefanick, M. L. Gender matters in biological research and medical practice. J. Am. Coll. Cardiol. 67, 136–138 (2016). Show context ArticlePubMed 21. US General Accounting Office Drug Safety: Most Drugs Withdrawn in Recent Years had Greater Health Risks for Women (Government Publishing Office, Washington DC, 2001). Show context 22. Schiebinger, L. et al. Sex and Gender Analysis Policies of Major Granting Agencies (Gendered Innovations in Science, Health & Medicine, Engineering, and Environment, 2017); Show context 23. Gender Equality in Horizon 2020 Version 2 (European Commission, 2016); Show context 24. Consideration of Sex as a Biological Variable in NIH-Funded Research (National Institutes of Health, 2015); Show context 25. Ely, R. J. & Thomas, D. A. Cultural diversity at work: the effects of diversity perspectives on work group processes and outcomes. Adm. Sci. Q. 46, 229–273 (2001). Show context Article 26. Page, S. E. The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies (Princeton Univ. Press, Princeton, NJ, 2008). Show context 27. Nielsen, M. W. et al. Opinion: gender diversity leads to better science. Proc. Natl Acad. Sci. USA 114, 1740–1742 (2017). Show context CASArticlePubMedPubMed Central 28. Charles, M. & Bradley, K. Indulging our gendered selves? Sex segregation by field of study in 44 countries. Am. J. Sociol. 114, 924–976 (2009). Show context ArticlePubMed 29. Alers, M., van Leerdam, L., Dielissen, P. & Lagro-Janssen, A. Gendered specialities during medical education: a literature review. Perspect. Med. Educ. 3, 163–178 (2014). Show context ArticlePubMedPubMed Central 30. West, J. D., Jacquet, J., King, M. M., Correll, S. J. & Bergstrom, C. T. The role of gender in scholarly authorship. PLoS ONE 8, e66212 (2013). Show context CASArticlePubMedPubMed Central 31. Light, R. in Networks, Work, and Inequality (ed. Mcdonald, S.) 239–268 (Research in the Sociology of Work Vol. 24, Emerald Group Publishing, Bingley, 2013). Show context 32. Dolado, J. J., Felgueroso, F. & Almunia, M. Are men and women-economists evenly distributed across research fields? Some new empirical evidence. SERIEs 3, 367–393 (2012). Show context Article 33. Kretschmer, H., Kundra, R., Beaver, D. D. & Kretschmer, T. Gender bias in journals of gender studies. Scientometrics 93, 135–150 (2012). Show context Article 34. Söderlund, T. & Madison, G. Characteristics of gender studies publications: a bibliometric analysis based on a Swedish population database. Scientometrics 105, 1347–1387 (2015). Show context Article 35. Johnson, J., Sharman, Z., Vissandjee, B. & Stewart, D. E. Does a change in health research funding policy related to the integration of sex and gender have an impact? PLoS ONE 9, e99900 (2014). Show context ArticlePubMedPubMed Central 36. Oertelt-Prigione, S., Parol, R., Krohn, S., Preissner, R. & Regitz-Zagrosek, V. Analysis of sex and gender-specific research reveals a common increase in publications and marked differences between disciplines. BMC Med. 8, 70 (2010). Show context ArticlePubMedPubMed Central 37. Oertelt-Prigione, S., Gohlke, B. O., Dunkel, M., Preissner, R. & Regitz-Zagrosek, V. GenderMedDB: an interactive database of sex and gender-specific medical literature. Biol. Sex Differ. 5, 7 (2014). Show context ArticlePubMedPubMed Central 38. Gelman, A., Jakulin, A., Piitau, M. G. & Su, Y.-S. A weakly informative default prior distribution for logistic and other regression models. Ann. Appl. Stat. 2, 1360–1383 (2008). Show context Article 39. Valantine, H. A. & Collins, F. S. National Institutes of Health addresses the science of diversity. Proc. Natl Acad. Sci. USA. 112, 12240–12242 (2015). Show context CASArticlePubMedPubMed Central 40. Gneezy, U., Niederle, M. & Rustichini, A. Performance in competitive environments: gender differences. Q. J. Econ. 118, 1049–1074 (2003). Show context Article 41. Reskin, B. F. & Roos, P. A. (eds) Job Queues, Gender Queues: Explaining Women’s Inroads into Male Occupations (Temple Univ. Press, Philadelphia, PA, 1990). Show context 42. Patel, V. M. et al. How has healthcare research performance been assessed? A systematic review. J. R. Soc. Med. 104, 251–261 (2011). Show context ArticlePubMedPubMed Central 43. Young, N. S., Ioannidis, J. P. A. & Al-Ubaydli, O. Why current publication practices may distort science. PLoS Med. 5, e201 (2008). Show context ArticlePubMedPubMed Central 44. Darmoni, S. J. et al. A MEDLINE categorization algorithm. BMC Med. Inform. Decis. Mak. 6, 7 (2006). Show context ArticlePubMedPubMed Central 45. Martin, A. D., Quinn, K. M. & Park, J. H. MCMCpack: Markov Chain Monte Carlo in R. J. Stat. Softw. 42, 1–21 (2011). Show context Article 46. Martin, A. D., Quinn, K. M. & Park, J. H. Package ‘MCMC-pack’ v.1.3-9 (R Foundation for Statistical Computing, 2017); Show context 47. Lenth, R. Package ‘lsmeans’ Version 2.2 (The Comprehensive R Archive Network, 2016); Show context Download references Acknowledgements We thank S. Oertelt-Prigione and the Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Germany, for data acquisition from the GenderMed database. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Competing interests The authors declare no competing interests. Author information Affiliations History of Science, Stanford University, Stanford, CA, USA Mathias Wullum Nielsen & Londa Schiebinger Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Aarhus, Denmark Jens Peter Andersen & Jesper W. Schneider Contributions The research was designed by M.W.N. The database was constructed by J.P.A. and M.W.N. The data were analysed by M.W.N., J.W.S. and J.P.A. All authors contributed to writing the paper. Corresponding author Correspondence to Mathias Wullum Nielsen. Electronic supplementary material Supplementary Information Supplementary Methods, Supplementary Figures 1–5, Supplementary Tables 1–14, Supplementary References