Among the failings of medical research, the under-representation of women and ethnic minorities in clinical studies is nothing short of a scandal. In 1994 the US National Institutes of Health made it mandatory for government funded research to include both these groups. The UK National Institute for Health and Care Research issued guidance on sex and gender in 2020. Yet, despite these and other requirements, increased awareness, and numerous pledges, progress is unacceptably slow.
Sidelining women reduces the wider applicability of research findings, because biological characteristics may influence disease presentation, pathophysiology, and responses to treatment (doi:10.1136/bmj.p845).1 By some estimates only 5-14% of studies across disciplines examine outcomes by sex (doi:10.1136/bmj.p1303).2 Gender …
Carolina Rau Steuernagel , Carolyn Lam , and Trish Greenhalgh argue for more attention to be given to social and economic factors to overcome implicit biases in research about women’s cardiovascular health
The US Multiple Risk Factor Intervention Trial in the 1970s screened 325 348 men and no women for risk of cardiovascular disease; 12 866 of these men were identified as high risk and offered prevention strategies.1 Dozens of publications resulted, producing a robust evidence base on cardiovascular risk and prevention in white men.1 Tellingly, the trial’s acronym was “Mr Fit.”
This flagrant sex and ethnic bias was part of a wider pattern. The Physicians Health Study, which established the efficacy of aspirin for prevention of myocardial infarction,2 and various cardiovascular prevention studies that ran till the mid-1990s were limited to white men.34 Indeed, in the second half of the 20th century, women in childbearing years were routinely excluded from medical research