The Underrepresentation of Women in Research and Clinical Trials
Emily Bergin
February 2024
Whether we are talking about the people conducting and authoring research or the individuals who serve as the participants in the studies, the same fact remains true; women are disproportionately underrepresented in medical research.
Background
This is not a new phenomenon. In fact, conditions today are much better than they used to be. Historically, researchers have held the misguided view that females’ biology is more “variable” than male’s due to their hormonal cycles, providing them a reason to exclude female subjects (both humans and rats) from clinical trials.[1]
True Differences
There are important differences to be noted between women and men on certain medications. Women tend to experience higher blood drug concentrations and often take longer to eliminate a drug from their body, making it incredibly necessary to test new drugs on both men and women.[1] In certain sectors such as cardiology, women are also found to be more likely than men to have side effects from medication at the same dose.[2]
The same remains true for women in the medical research workforce, with only 9% of graduates in 1970 identifying as women.3 Despite this growing to 48% in 2018, leadership positions in medicine have not reflected the same rising trend. Women remain underrepresented in full-time medical school staff, research investigators, department chairs, and deans.[3]
Despite progress in terms of the number of women authors of published research, the change is not reflected in positions of authority. Women are still underrepresented in senior authorship positions and significantly less likely to be named in the positions regarded as most prestigious, first and last, when the authors are listed.[4, 5]
Harmful Exclusion
Addressing this problem in clinical research involves first understanding the extent of harm caused by the unbalanced inclusion of participants in the scientific world. Once a study is complete, the findings are intended to be adopted into the target population to improve outcomes.[6] However, if the majority of male participants are included, the results will not be generalizable to the entire human population.
This can result in major consequences for women who are recommended a regimen of medication that has only been tested on men. For clinical trials in cardiovascular disease, the leading cause of death among women, rates of female participation sit around 29%.[2] This has huge consequences for drugs that affect the genders differently as a recent study found women obtained the optimal benefit from a heart failure drug at just 50% of the dose that men need.[2] This isn’t just true for medications either. When it comes to implantable devices like defibrillators, women are markedly underrepresented in trials.[2] Landmark research trials report rates as low as 14% for female participants, raising huge concerns over the efficacy of these devices in different bodies.[2]
Finding the Cause
There is a range of reasons as to why women disproportionately fail to participate in trials. Remaining beliefs surrounding the increased difficulty of studying women no doubt play a role. Women also face unique barriers to clinical trial participation such as the logistical barriers that come with often being responsible for children in a caregiving role.[2, 6] This holds true for those serving as research participants in clinical trials as well as those attempting to gain higher-ranking academic and industry positions.[3] Women also tend to be perceived as less committed or able due to their additional life responsibilities leading to less opportunities and income.[3] The issue of representation in research and medicine may seem benign, but in reality, it has far-reaching consequences for both women’s health and success in the workplace. Excluding women from these areas leads to medical consequences for inadequately studied pharmaceuticals as well as the perpetuation of harmful stereotypes surrounding the perception of women in medicine that only reinforces this dangerous cycle.[7]
References
[1] Zucker, I., Prendergast, B. J., & Beery, A. K. (2022). Pervasive Neglect of Sex Differences in Biomedical Research. Cold Spring Harbor perspectives in biology, 14(4), a039156. https://doi.org/10.1101/cshperspect.a039156
[2] Cho, L., Vest, A. R., O’Donoghue, M. L., Ogunniyi, M. O., Sarma, A. A., Denby, K. J., Lau, E. S., Poole, J. E., Lindley, K. J., Mehran, R., & Cardiovascular Disease in Women Committee Leadership Council (2021). Increasing Participation of Women in Cardiovascular Trials: JACC
Council Perspectives. Journal of the American College of Cardiology, 78(7), 737–751. https://doi.org/10.1016/j.jacc.2021.06.022
[3] Blumenthal, K. G., Bansal, P., Youssef, C. M., & Pappalardo, A. A. (2023). Women in Allergy and Immunology: The Future Is Female, Let Us Soar!. The journal of allergy and clinical immunology. In practice, 11(12), 3569–3577. https://doi.org/10.1016/j.jaip.2023.06.010
[4] Bagga, E., Stewart, S., Gamble, G. D., Hill, J., Grey, A., & Dalbeth, N. (2021). Representation of Women as Authors of Rheumatology Research Articles. Arthritis & rheumatology (Hoboken, N.J.), 73(1), 162–167. https://doi.org/10.1002/art.41490
[5] N. Pyatigorskaya & L. Di Marco. (2017). Women authorship in radiology research in France: An analysis of the last three decades, Diagnostic and Interventional Imaging, 98(11), 769-773. https://www.sciencedirect.com/science/article/pii/S2211568417301912
[6] Bierer, B. E., Meloney, L. G., Ahmed, H. R., & White, S. A. (2022). Advancing the inclusion of underrepresented women in clinical research. Cell reports. Medicine, 3(4), 100553. https://doi.org/10.1016/j.xcrm.2022.100553
[7] Wanted: women in research. (2010). Nature neuroscience, 13(3), 267. https://doi.org/10.1038/nn0310-267
