Male bias in medical research and how it is hopefully changing! explained by Peter Rogers @ConversationUK

Equal but not the same: a male bias reigns in medical research

By Peter Rogers, University of Melbourne

Despite significant gains in gender equity over the last few decades, a bias still reigns in one area of medicine. The lack of female representation in both preclinical studies and clinical trials has put women at greater risk of adverse events from medical interventions. But there’s now light at the end of the tunnel.

Treating women equally as subjects in scientific studies may seem obvious today, when we have evidence of varied disease susceptibility and severity among the sexes. And of differences in men’s and women’s response to drugs and treatment outcomes. But this has not always been so.

So much variation

Differences between the sexes, or sexual dimorphism, is a key evolutionary adaptation in most species. It has existed in human life expectancy in almost every country for as long as records have been kept: women still live longer, on average, than men. Perhaps that’s partly because suicide rates are three times higher in men than women.

It’s not really surprising that after millions of years of evolution, fundamental differences exist in many aspects of our biology. Differences between the sexes have been documented in cardiovascular disease and stroke, chronic fatigue syndrome, asthma and several types of cancer.

Biological differences between the sexes include variation in genetic and physiological factors such as telomere attrition, mitochondrial inheritance, hormonal and cellular responses to stress, and immune function, among other things. These factors may account for at least a part of the female advantage in human life expectancy.

Research has highlighted gender differences in autoimmune diseases, such as rheumatoid arthritis, lupus and multiple sclerosis, and psychological disorders such as bipolar disorder, schizophrenia, autism spectrum disorder (ASD), eating disorders and attention deficit hyperactivity disorder (ADHD).

Rheumatoid arthritis, for instance, is approximately twice as common in females as in males. And a study found that while the relative risk of schizophrenia was greater in men up to 39 years of age, it reversed to a greater risk in women over the age of 50.

But why?

The reasons for these gender differences are varied and complex. Behavioural and social issues, such as uptake of smoking and body image, are different between men and women. This may partially explain differences in diseases such as lung cancer and eating disorders.

Normal physiological differences, such as a lower red blood cell count, may lie behind the poorer stroke outcomes in women. Women also tend, though, to suffer from stroke at an older age, which may account for some of the observed differences.

Biological differences also exist within the dopaminergic neurons of the brain and may explain varied prevalence of a number of neurological conditions. Indeed, fundamental genetic differences between the sexes may contribute to males under 20 years of age experiencing higher mortality rates from a wide array of conditions in 17 of 19 major disease categories.

What’s more, men and women differ in their response to drug treatment. Women experience a higher incidence of adverse drug reactions than men, although the reasons for this are not well understood. But we do know female response to many commonly used pharmaceutical agents can be different to males.

And we know the differences in drug responses are partly due to differences in body weight, height, body surface area, body composition, total body water, drug metabolism and drug clearance. Adult males have greater arm muscle mass, larger and stronger bones and reduced limb fat, but a similar degree of central abdominal fat.

Sex differences in body composition are primarily attributable to the actions of sex steroid hormones, which drive gender differences during pubertal development. Oestrogen, for instance, is important not only in body fat distribution but also in the female pattern of bone development, which predisposes women to a greater risk of osteoporosis in old age.

Does it really matter?

For the last two decades, the largest US funder of grants for biomedical research, the National Institutes of Health (NIH), has required studies involving human subjects to test both men and women. But Australia’s NIH equivalent, the National Health and Medical Research Council (NHMRC) currently has no comparable policy.

Medical research in Australia is substantially funded by the taxpayer, with the unambiguous goal of improving health for all citizens. From this viewpoint, there may be a need for policy reflecting that of the NIH’s here.

But the picture changes substantially in light of recent advances in medical science. Current thinking revolves around concepts such as “precision medicine”, which recognises that variability exists not just between the sexes, but between individuals.

So, the goal now is to ensure that every patient receives the correct treatment and dose at the right time, with minimum adverse side effects. Women may have been neglected by medical research for a couple of decades but the march of technology is now bound to take them forward as individuals.

The Conversation

This article was originally published on The Conversation.
Read the original article.

#Science Quotable: Research!America’s Mary Woolley – Make Medical Progress a Priority! #SOTU2015

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Senator Rand Paul (R-KY) and Congressman Lamar Smith (R-TX-21) penned an op-ed inPOLITICO this week calling for more transparency and accountability in science agencies’ decision making. More transparency is a worthy goal and taxpayers are well served by it. What isn’t transparent in the op-ed piece is the grounds for which Paul and Smith make the assumption that more transparency will result in a pre-determined reordering of priorities for science. Calling for transparency in order to target specific grants or areas of research is not a way to assure either evidence-based policymaking nor scientific progress.

What will President Obama emphasize in his State of the Union address on Tuesday? Will medical progress make the list? I would like to think that remarks made by Department of Health and Human Services Secretary Burwell today are telegraphing the President’s message. She spoke about the importance of research and innovation at some length, emphasizing the promise of precision medicine, in particular. She said it’s in our children’s interest to make sure that medical innovations happen; it’s in our economy’s interest to make sure they happen here. Well said! You can share your priorities with the President for his speech via #SOTU2015. – From a weekly message from Research!America President Mary Woolley

Are we doing enough to accelerate medical progress?

Short answer: NO!!!

Long answer: this lovely blog post on The Hill by former reps John Porter (R-Ill.) and Kweisi Mfume (D-Md.)

Big points from the article: 

To accelerate innovation, protect health and save lives, policymakers must close the massive gap between the level of funding necessary to advance medical progress and the token funding levels allocated to research over the last several years.

“A majority of Americans agree that basic scientific research that advances the frontiers of knowledge is necessary and should be supported by the federal government, according to polling commissioned by Research!America. And Americans understand that research is important to job creation and economic recovery.  Why doesn’t the federal budget reflect those truths?”

In conclusion, scientists want more funding, Americans AGREE that science is important (my previous post), and that scientists should get more funding, but for some reason… we aren’t getting more funding and the budget doesn’t reflect what the scientists and the people want.  I think we can all see where the holdup is: congress.  

The solution?  From the blog post: It’s time for champions of science to engage the public and their elected representatives, and demand a stronger investment in the research that fuels discovery and innovation. 

Cutting budgets for medical research is dangerous… YA THINK?!

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Great op ed piece for CNN by Claire Pomeroy and Eric Kandel about why budget cuts to medical research are incredibly debilitating for scientists and dangerous for the public.  They hit on the point that even once (if) funding is restored, the effects of the slowdown (sequestration) will linger and further delay scientific progress.  They also point out the problem my generation faces… that too many of us are leaving the field because there is no money and too much uncertainty.  As a result, “This loss of human resources will take many years to replace” and thus, we will be even further behind in our progress. 

The article concludes with the biggest danger of budget cuts: The loss of hope.  “Many patients don’t have time to wait a few years for breakthroughs. Disease does not wait for an economic recovery.”

Too real.  What’s perhaps most upsetting to me is that these types of articles have to be written.  The smartest researchers, the dedicated scientists, the hardworking physicians instead of focusing on their work, are essentially forced to write oped pieces, bug their members of congress, speak out for their cause… which is really our cause.  

It’s a bit ironic isn’t it?  That we, medical researchers, are trying to convince people to give us funding, so we can conduct research, develop cures and therapies, and then go back and take care of those very same people?