Ninety-five years ago today, U.S. Secretary of State Bainbridge Colby certified ratification of the 19th Amendment to the Constitution, granting women the right to vote 42 years after the measure’s introduction in Congress. And every year since 1972, the president has issued a proclamation commemorating Aug. 26 as Women’s Equality Day.
The near-century since this pinnacle of the women’s suffrage movement has seen great progress beyond the ballot box. American women hold elected office, run corporations and universities, star in Hollywood blockbusters, and orbit the Earth. But not as often as men. Almost never in the highest offices. And, on average, for less pay.
True equality still evades us. Though not just in ways that are easy to see.
Only since 1994 has the federal government begun to take steps toward fully accounting for sex and gender in biomedical research. For every year before then, women were rarely if ever included as participants in clinical trials. And even when researchers included women, they rarely if ever analyzed their data to account for sex and gender differences.
A law passed in 1993 forced the National Institutes of Health – the world’s largest single funder of biomedical research – to require health investigators to factor women into their federally funded research. We now know that men and women differ in the prevalence, symptoms, and response to treatments for many health problems. In June, the NIH announced it would soon require preclinical research on animals and cells to also account for sex differences.
In 2001, the U.S. General Accounting Office looked at the 10 prescription drugs approved and then withdrawn by the U.S. Food and Drug Administration over the prior four years. Of the 10 drugs, the GAO determined that eight comprised a more serious risk to women than men.
In 1992, the FDA approved Ambien for sale as a sleep aid, but it wasn’t until 22 years later that the agency cut the dosage recommendation in half for women. Even before the drug hit the market, researchers had discovered differences in the way men and women process Ambien that left more of the drug in women’s systems the following day, reducing their ability to function and placing them at greater risk for accidents.
Women tend to live longer than men, though life expectancy for women has begun to drop in the United States, largely because of health problems created by smoking, a habit that women have a harder time quitting than men. Women experience pain more acutely than men. Women experience greater complications from anesthesia. Women experience different heart attack symptoms, and more American women than men die from cardiovascular disease. All of these findings and more arrived from a deliberate focus on women’s health research as distinct from research focused only on men.
But progress has been slow, and there is much more work to do.
Women remain underrepresented in clinical trials addressing cardiovascular disease and cancer, the first and second leading killers of both men and women in the United States. Even today, when women are included as subjects in clinical research, the effect of gender is not widely analyzed and reported. And most laboratory studies continue to use only male animals.
There is no more time to waste. We must now fully include women as a factor in all biomedical research.
There is no more time to waste. We must now fully include women as a factor in all biomedical research, from study designs and subject enrollment to analysis of results.
The NIH and FDA must enforce their current guidelines with more vigor and strengthen them to better guarantee that women are included in research. Grant applications that address sex and gender differences should receive preferential treatment, particularly those studies that include women of diverse ages, races and ethnicities; that account for hormonal variations; that investigate drug interactions; and that include analysis of the impact of sex on cell lines and laboratory animals.
Medical journals should publish only studies that address results by sex and gender unless those studies involve conditions, like uterine cancer, that only affect one sex or gender.
Medical schools must train biomedical researchers to always consider sex and gender. Health care professionals should receive continuing education that stresses the importance of reporting sex and gender differences.
Everyone must take responsibility for ensuring these changes happen, including members of the health care community, elected officials, and consumers. If we don’t demand that research and care account for the effects of sex and gender, we will all suffer from a lack of knowledge and potentially misguided medical decisions.
We are celebrating women’s equality today even if we are not all equal in terms of our physical makeup. But that doesn’t mean we don’t all deserve equal treatment. Nor that we should remain ignorant of the biological and behavioral differences that, if studied and reported vigorously, can help everyone lead happier, healthier and more productive lives.
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For questions, please contact Rick Harrison, Communications Officer, at 203-764-6610 or rick.harrison@yale.edu.