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Exclusion, Women & Medical Research / Perception vs. Reality
Here's another article that refutes the myth of the "routine exclusion" of women from medical research.
It's going to take a while until this feminist myth goes away.
THE EXCLUSION OF WOMEN FROM MEDICAL RESEARCH: PERCEPTION VS. REALITY
American Public Health Association http://www.apha.org/ Epidemiology Section Newsletter Spring 2001 www.apha.org/sections/newsletters/epispring2001/htm
It has often been asserted, but not proven, that women were routinely excluded from research studies conducted by the National Institutes of Health. As early as 1993, Marcia Angell, MD, associate editor of the New England Journal of Medicine, alleged, "There is little doubt that women have been systematically excluded as subjects for study . . . it is not surprising that most clinical trials have been heavily, if not exclusively, weighted toward men". (New England Journal of Medicine 1993 329: 271-272). At a public health conference on January 28, 2000, NIH acting director Ruth Kirschstein informed a startled audience that the Framingham Heart Study was "all-male."
The statements by Angell and others were based on the fact that certain studies such as the Coronary Primary Prevention Trial, the Multiple Risk Factor Intervention Trial (MRFIT), and the Physicians' Health Study were all-male. But the NIH sponsors thousands of studies every year, and one must question the logic of generalizing from the sex composition of a handful of studies to the universe of all NIH research.
But to this point in time, the claim of the routine exclusion of women could never be definitively refuted because no one had actually done a count of sex-specific enrollments in medical research, especially prior to 1990. Recently Curtis Meinert, PhD of Johns Hopkins University and colleagues undertook an exhaustive review of all 342 clinical trials published in 1985 and 1990 in five leading medical journals (Controlled Clinical Trials 2000; 21: 462-475). They tallied the number of enrollees in these trials: 126,234 males and 343,675 females. Hardly an example of the routine exclusion of women.
In my research, I have undertaken Medline database searches of the epidemiological literature. I used the search delimiters "Epidemiology," "United States," "Human," "1966-1990," and "Male" or "Female." These are the results for the five leading causes of death in the United States:
Male Female Heart disease 2,226 1,741 Stroke 346 294 Cancer 4,650 5,059 Injuries 1,814 1,659 COPD 345 294 TOTALS 9,381 9,047
Overall, it is seen that there were 334 more epidemiological studies that included men than included women, representing a 3.7% difference. I have analyzed a broader range of conditions, and found very similar findings. Again, it is hard to find evidence that women were shortchanged by epidemiological research.
As far as the claim that the Framingham Heart Study was "all-male," women represented 51% of the research cohort at the inception of the study in 1948. Due to sex-specific differentials in mortality rates, the percentage of women eventually rose to 60%. (Journal of the American Medical Women's Association 1993; Vol. 48, No. 5).
Unfortunately, the widespread perception that women were neglected by medical research has overshadowed the reality. As a result, laws have been passed, regulations have been promulgated, and new reporting requirements instituted. More significantly, women's health research has enjoyed a rapid expansion.
Now, attention to men's health research has begun to lag significantly. According to the NIH, male participation in all extramural research studies in 1994 was 44.9%. By 1998, that percentage had dropped to just 32.2%. According to the recent GAO report on Women's Health, NIH now devotes 15.5% of its budget to women's health, vs. 6.4% on men's health.
For the sake of good science and for the sake of fairness, it would seem that we need to reconsider the belief that women were routinely excluded or generally underrepresented in medical research studies sponsored by the NIH.
Edward E. Bartlett, PhD Senior Policy Advisor Men's Health America Rockville, MD
Back to Epidemiology Main Newsletter Page http://www.apha.org/sections/newsletters/epidemiology.htm ©2000 American Public Health Association. All rights reserved.
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