chapter one androcentric bias in clinical research

9
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±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²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

Upload: vutuyen

Post on 01-Jan-2017

218 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH��

&KDSWHU�2QH$QGURFHQWULF�%LDV�LQ�&OLQLFDO�5HVHDUFK

,Q�VFLHQWLILF�UHVHDUFK��ZKHWKHU�LW�EH�LQ�WKH�EHKDYLRUDO��ELRPHGLFDO��RU�SK\VLFDO�VFLHQFHV��UHVHDUFKHUV�UDUHO\�DGPLW�WKDW�GDWD�KDYH�EHHQ�JDWKHUHG�DQG�LQWHUSUHWHG�IURP�D�SDUWLFXODU�SHUVSHFWLYH��6LQFH�UHVHDUFK�LQ�ELRORJ\��FKHPLVWU\��DQG�SK\VLFV�FHQWHUV�RQ�WKH�SK\VLFDO�DQG�QDWXUDO�ZRUOG��LW�LV�SUHVXPHG�WR�EH�REMHFWLYH���WKHUHIRUH��WKH�WHUP��SHUVSHFWLYH��GRHV�QRW�DSSO\�WR�LW��7KH�UHOLDELOLW\�DQG�UHSHDWDELOLW\�RI�GDWD�JDWKHUHG�DQG�K\SRWKHVHV�WHVWHG�XVLQJ�WKH�VFLHQWLILF�PHWKRG�FRQYLQFH�UHVHDUFKHUV�WKDW�WKH\�DUH�REWDLQLQJ�XQELDVHG�LQIRUPDWLRQ�DERXW�WKH�SK\VLFDO��QDWXUDO�ZRUOG�

0RVW�UHVHDUFKHUV�LQ�WKH�EHKDYLRUDO��ELRPHGLFDO��DQG�SK\VLFDO�VFLHQFHV�DUH�WUDLQHG�LQ�WKH�VFLHQWLILF�PHWKRG�DQG�EHOLHYH�LQ�LWV�SRZHU��)HZ��KRZHYHU��DUH�DZDUH�RI�LWV�KLVWRULFDO�DQG�SKLORVRSKLFDO�URRWV�LQ�ORJLFDO�SRVLWLYLVP�DQG�REMHFWLYLW\��3RVLWLYLVP�LPSOLHV�WKDW��DOO�NQRZOHGJH�LV�FRQVWUXFWHG�E\�LQIHUHQFH�IURP�LPPHGLDWH�VHQVRU\�H[SHULHQFHV���-DJJDU��������SS�����±������,W�LV�SUHPLVHG�RQ�WKH�DVVXPSWLRQ�WKDW�KXPDQ�EHLQJV�DUH�KLJKO\�LQGLYLGXDOLVWLF�DQG�REWDLQ�NQRZOHGJH�LQ�D�UDWLRQDO�PDQQHU�WKDW�PD\�EH�VHSDUDWHG�IURP�WKHLU�VRFLDO�FRQGLWLRQV��7KLV�OHDGV�WR�WKH�EHOLHI�LQ�WKH�SRVVLELOLWLHV�RI�REWDLQLQJ�NQRZOHGJH�WKDW�LV�ERWK�REMHFWLYH�DQG�YDOXH�IUHH��WKH�FRUQHUVWRQH�RI�WKH�VFLHQWLILF�PHWKRG�

6FLHQWLVWV��OLNH�DOO�VFKRODUV��KROG��HLWKHU�H[SOLFLWO\�RU�LPSOLFLWO\��FHUWDLQ�EHOLHIV�DERXW�WKHLU�HQWHUSULVH��0RVW�EHOLHYH��IRU�H[DPSOH��WKDW�WKH�ODZV�DQG�IDFWV�JDWKHUHG�E\�VFLHQWLVWV�DUH�FRQVWDQW��SURYLGLQJ�WKDW�H[SHULPHQWV�KDYH�EHHQ�GRQH�FRUUHFWO\��+LVWRULDQV�RI�VFLHQFH�SRVLW�WKDW��TXLWH�WR�WKH�FRQWUDU\��WKH�LQGLYLGXDOV�ZKR�PDNH�REVHUYDWLRQV�DQG�FUHDWH�WKHRULHV�DUH�SHRSOH�ZKR�OLYH�LQ�D�SDUWLFXODU�FRXQWU\�GXULQJ�D�FHUWDLQ�WLPH�LQ�D�GHILQDEOH�VRFLRHFRQRPLF�FRQGLWLRQ��DQG�WKXV�WKHLU�VLWXDWLRQV�DQG�PHQWDOLWLHV�LQHYLWDEO\�LPSLQJH�RQ�WKHLU�GLVFRYHULHV��(YHQ�WKHLU��IDFWV��DUH�FRQWLQJHQW��$ULVWRWOH��FRXQWHG��IHZHU�WHHWK�LQ�WKH�PRXWKV�RI�ZRPHQ�WKDQ�LQ�WKRVH�RI�PHQ²DGGLQJ�WKLV�GHQWLWLRQDO�LQIHULRULW\�WR�DOO�WKH�RWKHUV��$UGLWWL���������*DOHQ��KDYLQJ�UHDG�WKH�ERRN�RI�*HQHVLV���GLVFRYHUHG��WKDW�PHQ�KDG�RQH�OHVV�ULE�RQ�RQH�VLGH�WKDQ�ZRPHQ�GLG��:HEVWHU�DQG�:HEVWHU���������&OHDUO\��REVHUYDWLRQ�RI�ZKDW�ZRXOG�DSSHDU�E\�WRGD\V�VWDQGDUGV�WR�EH�HDVLO\�YHULILDEOH�IDFWV�FDQ�YDU\�GHSHQGLQJ�XSRQ�WKH�WKHRU\�RI�SDUDGLJP�E\�ZKLFK�WKH�VFLHQWLVW�LV�LQIOXHQFHG�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

� �

�3DJH��

$OWKRXJK�HYHU\�VFLHQWLVW�VWULYHV�WR�UHPDLQ�DV�QHXWUDO�DQG�YDOXH�IUHH�DV�SRVVLEOH��PRVW�VFLHQWLVWV��IHPLQLVWV��DQG�SKLORVRSKHUV�RI�VFLHQFH�UHFRJQL]H�WKDW�QR�LQGLYLGXDO�FDQ�EH�FRPSOHWHO\�REMHFWLYH��,QVWHDG��REMHFWLYLW\�LV�GHILQHG�WR�PHDQ�LQGHSHQGHQFH�IURP�WKH�YDOXH�MXGJPHQWV�RI�DQ\�SDUWLFXODU�LQGLYLGXDO���-DJJDU��������S��������7KH�SDUDGLJPV�WKHPVHOYHV��KRZHYHU��DOVR�DUH�IDU�IURP�YDOXH�IUHH��7KH�SUHVHQW�YDOXHV�RI�WKH�FXOWXUH�DQG�LWV�KLVWRU\�KHDYLO\�LQIOXHQFH�WKH�RUGHULQJ�RI�REVHUYDEOH�SKHQRPHQD�LQWR�WKHRU\��7KH�ZRUOG�YLHZ�RI�D�SDUWLFXODU�VRFLHW\��WLPH��DQG�SHUVRQ�OLPLWV�WKH�TXHVWLRQV�WKDW�FDQ�EH�DVNHG�DQG�WKHUHE\�WKH�DQVZHUV�WKDW�FDQ�EH�JLYHQ��.XKQ��������KDV�GHPRQVWUDWHG�WKDW�WKH�YHU\�DFFHSWDQFH�RI�D�SDUWLFXODU�SDUDGLJP�WKDW�PD\�DSSHDU�WR�FDXVH�D��VFLHQWLILF�UHYROXWLRQ��ZLWKLQ�D�VRFLHW\�GHSHQGV�LQ�IDFW�XSRQ�WKH�FRQJUXHQFH�RI�WKDW�WKHRU\�ZLWK�WKH�LQVWLWXWLRQV�DQG�EHOLHIV�RI�WKH�VRFLHW\�

/RQJLQR��������KDV�H[SORUHG�WKH�H[WHQW�WR�ZKLFK�PHWKRGV�HPSOR\HG�E\�VFLHQWLVWV�FDQ�EH�REMHFWLYH�DQG�OHDG�WR�UHSHDWDEOH��YHULILDEOH�UHVXOWV�ZKLOH�FRQWULEXWLQJ�WR�K\SRWKHVHV�RU�WKHRULHV�WKDW�DUH�FRQJUXHQW�ZLWK�QRQREMHFWLYH�LQVWLWXWLRQV�DQG�LGHRORJLHV�RI�WKH�VRFLHW\���%DFNJURXQG�DVVXPSWLRQV�DUH�WKH�PHDQV�E\�ZKLFK�FRQWH[WXDO�YDOXHV�DQG�LGHRORJ\�DUH�LQFRUSRUDWHG�LQWR�VFLHQWLILF�LQTXLU\���������S��������7KH�LQVWLWXWLRQV�DQG�EHOLHIV�RI�RXU�VRFLHW\�UHIOHFW�WKH�IDFW�WKDW�WKH�VRFLHW\�LV�SDWULDUFKDO��(YHQ�IHPDOH�VFLHQWLVWV�KDYH�RQO\�UHFHQWO\�EHFRPH�DZDUH�RI�WKH�LQIOXHQFH�RI�SDWULDUFKDO�ELDV�LQ�WKH�SDUDGLJPV�RI�VFLHQFH�

,Q�WKH�SDVW�WZR�GHFDGHV��IHPLQLVW�KLVWRULDQV�DQG�SKLORVRSKHUV�RI�VFLHQFH��)HH��������������+DUGLQJ��������+DUDZD\��������������/RQJLQR��������DQG�IHPLQLVW�VFLHQWLVWV��%OHLHU��������������)DXVWR�6WHUOLQJ��������%LUNH��������.HOOHU��������������DQG�5RVVHU��������KDYH�SRLQWHG�RXW�WKH�ELDV�DQG�DEVHQFH�RI�YDOXH�QHXWUDOLW\�LQ�VFLHQFH��SDUWLFXODUO\�ELRORJ\��%\�H[FOXGLQJ�IHPDOHV�DV�H[SHULPHQWDO�VXEMHFWV��IRFXVLQJ�RQ�SUREOHPV�RI�SULPDU\�LQWHUHVW�WR�PDOHV��XWLOL]LQJ�IDXOW\�H[SHULPHQWDO�GHVLJQV��DQG�LQWHUSUHWLQJ�GDWD�EDVHG�LQ�ODQJXDJH�RU�LGHDV�FRQVWULFWHG�E\�SDWULDUFKDO�SDUDPHWHUV��VFLHQWLVWV�KDYH�LQWURGXFHG�ELDV�RU�IODZV�LQWR�WKHLU�H[SHULPHQWDO�UHVXOWV�LQ�VHYHUDO�DUHDV�RI�ELRORJ\��7KHVH�IODZV�DQG�ELDVHV�ZHUH�SHUPLWWHG�WR�EHFRPH�SDUW�RI�WKH�PDLQVWUHDP�RI�VFLHQWLILF�WKRXJKW�DQG�ZHUH�SHUSHWXDWHG�LQ�WKH�VFLHQWLILF�OLWHUDWXUH�IRU�GHFDGHV��%HFDXVH�PRVW�VFLHQWLVWV�ZHUH�PHQ��YDOXHV�KHOG�E\�WKHP�DV�PDOHV�ZHUH�QRW�GLVWLQJXLVKHG�DV�ELDVLQJ��UDWKHU�WKH\�ZHUH�FRQJUXHQW�ZLWK�WKH�YDOXHV�RI�DOO�VFLHQWLVWV�DQG�WKXV�EHFDPH�V\QRQ\PRXV�ZLWK�WKH��REMHFWLYH��YLHZ�RI�WKH�ZRUOG��.HOOHU��������������

$�ILUVW�VWHS�IRU�IHPLQLVW�VFLHQWLVWV�ZDV�UHFRJQL]LQJ�WKH�SRVVLELOLW\�WKDW�DQGURFHQWULF�ELDV�ZRXOG�UHVXOW�IURP�KDYLQJ�YLUWXDOO\�DOO�WKHRUHWLFDO�DQG�GHFLVLRQ�PDNLQJ�SRVLWLRQV�LQ�VFLHQFH�KHOG�E\�PHQ��.HOOHU���������1RW�XQWLO�D�VXEVWDQWLDO�QXPEHU�RI�ZRPHQ�KDG�HQWHUHG�WKH�SURIHVVLRQ��5RVVHU��������FRXOG�WKLV�DQGURFHQWULVP�EH�H[SRVHG��$V�ORQJ�DV�RQO\�D�IHZ�ZRPHQ�ZHUH�VFLHQWLVWV��WKH\�KDG�WR�GHPRQVWUDWH�RU�FRQIRUP�WR�WKH�PDOH�YLHZ�RI�WKH�ZRUOG�LQ�RUGHU�WR�EH�VXFFHVVIXO�DQG�KDYH�WKHLU�UHVHDUFK�PHHW�WKH�FULWHULD�IRU��REMHFWLYLW\��

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 2: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH��

2QFH�WKH�SRVVLELOLW\�RI�DQGURFHQWULF�ELDV�ZDV�GLVFRYHUHG��IHPLQLVW�VFLHQWLVWV�VHW�RXW�WR�H[SORUH�WKH�H[WHQW�WR�ZKLFK�LW�KDG�GLVWRUWHG�VFLHQFH��7KH\�UHFRJQL]HG�SRWHQWLDO�GLVWRUWLRQ�RQ�D�YDULHW\�RI�OHYHOV�RI�UHVHDUFK�DQG�WKHRU\��WKH�FKRLFH�DQG�GHILQLWLRQ�RI�SUREOHPV�WR�EH�VWXGLHG��WKH�H[FOXVLRQ�RI�IHPDOHV�DV�H[SHULPHQWDO�VXEMHFWV��ELDV�LQ�WKH�PHWKRGRORJ\�XVHG�WR�FROOHFW�DQG�LQWHUSUHW�GDWD��DQG�ELDV�LQ�WKHRULHV�DQG�FRQFOXVLRQV�GUDZQ�IURP�WKH�GDWD��7KH\�DOVR�EHJDQ�WR�UHDOL]H�WKDW�VLQFH�WKH�SUDFWLFH�RI�PRGHUQ�PHGLFLQH�GHSHQGV�KHDYLO\�RQ�FOLQLFDO�UHVHDUFK��DQ\�IODZV�DQG�HWKLFDO�SUREOHPV�LQ�WKLV�UHVHDUFK�DUH�OLNHO\�WR�UHVXOW�LQ�SRRUHU�KHDOWK�FDUH�DQG�LQHTXLW\�LQ�WKH�PHGLFDO�WUHDWPHQW�RI�GLVDGYDQWDJHG�JURXSV��5HFHQW�HYLGHQFH�VXJJHVWV�WKDW�JHQGHU�ELDV�PD\�KDYH�IODZHG�VRPH�PHGLFDO�UHVHDUFK�

&KRLFH�DQG�'HILQLWLRQ�RI�3UREOHPV�IRU�6WXG\

:LWK�WKH�H[SHQVH�RI�VRSKLVWLFDWHG�HTXLSPHQW��PDLQWHQDQFH�RI�ODERUDWRU\�DQLPDOV�DQG�IDFLOLWLHV��DQG�VDODULHV�IRU�TXDOLILHG�WHFKQLFLDQV�DQG�UHVHDUFKHUV��YLUWXDOO\�QR�PHGLFDO�UHVHDUFK�LV�XQGHUWDNHQ�WRGD\�ZLWKRXW�IHGHUDO�RU�IRXQGDWLRQ�VXSSRUW��*RQH�DUH�WKH�GD\V�ZKHQ�LQGLYLGXDOV�KDG�ODERUDWRULHV�LQ�WKHLU�KRPHV�RU�PDGH�VLJQLILFDQW�GLVFRYHULHV�ZRUNLQJ�LQ�LVRODWLRQ�XVLQJ�KRPHPDGH�HTXLSPHQW��,Q�ILVFDO�\HDU�������WKH�1DWLRQDO�,QVWLWXWHV�RI�+HDOWK��1,+��IXQGHG�DSSUR[LPDWHO\������ELOOLRQ�LQ�UHVHDUFK��6FLHQFH�DQG�*RYHUQPHQW�5HSRUW���������3ULYDWH�IRXQGDWLRQV�DQG�VWDWH�JRYHUQPHQWV�IXQGHG�D�VPDOOHU�SRUWLRQ��1DWLRQDO�6FLHQFH�)RXQGDWLRQ��������

7KH�FKRLFH�RI�SUREOHPV�IRU�VWXG\�LQ�PHGLFDO�UHVHDUFK�LV�VXEVWDQWLDOO\�GHWHUPLQHG�E\�D�QDWLRQDO�DJHQGD�WKDW�GHILQHV�ZKDW�LV�ZRUWK\�RI�VWXG\��L�H���IXQGLQJ��$V�0DU[LVW��=LPPHUPDQ�HW�DO����������$IULFDQ�$PHULFDQ��0F/HRG���������DQG�IHPLQLVW��+XEEDUG��������FULWLFV�RI�VFLHQWLILF�UHVHDUFK�KDYH�SRLQWHG�RXW��WKH�UHVHDUFK�WKDW�LV�XQGHUWDNHQ�UHIOHFWV�WKH�VRFLHWDO�ELDV�WRZDUG�WKH�SRZHUIXO��ZKR�DUH�RYHUZKHOPLQJO\�ZKLWH��PLGGOH�WR�XSSHU�FODVV��DQG�PDOH�LQ�WKH�8QLWHG�6WDWHV��2EYLRXVO\��WKH�PDMRULW\�RI�WKH�PHPEHUV�RI�&RQJUHVV��ZKR�DSSURSULDWH�WKH�IXQGV�IRU�1,+�DQG�RWKHU�IHGHUDO�DJHQFLHV��ILW�WKLV�GHVFULSWLRQ��WKH\�DUH�PRUH�OLNHO\�WR�YRWH�IXQGV�IRU�KHDOWK�UHVHDUFK�ZKLFK�WKH\�YLHZ�DV�EHQHILFLDO�DV�GHILQHG�IURP�WKHLU�SHUVSHFWLYH�

,W�PD\�EH�DUJXHG�WKDW�DFWXDO�SULRULWLHV�IRU�PHGLFDO�UHVHDUFK�DQG�DOORFDWLRQV�RI�IXQGV�DUH�VHW�QRW�E\�PHPEHUV�RI�&RQJUHVV�EXW�E\�WKH�OHDGHUV�LQ�PHGLFDO�UHVHDUFK�ZKR�DUH�HPSOR\HHV�RI�1,+�RU�RWKHU�IHGHUDO�DJHQFLHV�RU�ZKR�DUH�EURXJKW�LQ�DV�FRQVXOWDQWV��8QIRUWXQDWHO\�WKH�VDPH�GHVFULSWRUV²ZKLWH��PLGGOH��WR�XSSHU�FODVV��DQG�PDOH²WHQG�WR�FKDUDFWHUL]H�WKH�LQGLYLGXDOV�LQ�WKH�WKHRUHWLFDO�DQG�GHFLVLRQ�PDNLQJ�SRVLWLRQV�ZLWKLQ�WKH�PHGLFDO�KLHUDUFK\�DQG�VFLHQWLILF�HVWDEOLVKPHQW�

+DYLQJ�D�SUHSRQGHUDQFH�RI�PDOH�OHDGHUV�VHWWLQJ�WKH�SULRULWLHV�IRU�PHGLFDO�UHVHDUFK�UHVXOWV�LQ�GHILQLWH�HIIHFWV�RQ�WKH�FKRLFH�DQG�GHILQLWLRQ�RI�SUREOHPV�IRU�UHVHDUFK��+\SRWKHVHV�DUH�QRW�IRUPXODWHG�WR�IRFXV�RQ�JHQGHU�DV�D�FUXFLDO�SDUW�RI�WKH�TXHVWLRQ�EHLQJ�DVNHG��%HFDXVH�LW�LV�FOHDU�WKDW�PDQ\�GLVHDVHV�KDYH�GLIIHUHQW�IUHTXHQFLHV��KHDUW�GLVHDVH��OXSXV���V\PSWRPV��JRQRUUKHD���RU�FRPSOLFDWLRQV��PRVW�VH[XDOO\�WUDQVPLWWHG�GLVHDVHV��LQ�WKH�WZR�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

� �

�3DJH��

VH[HV��VFLHQWLVWV�VKRXOG�URXWLQHO\�FRQVLGHU�DQG�WHVW�IRU�GLIIHUHQFHV�RU�ODFN�WKHUHRI�EDVHG�RQ�JHQGHU�LQ�DQ\�K\SRWKHVLV�EHLQJ�WHVWHG��)RU�H[DPSOH��ZKHQ�H[SORULQJ�WKH�PHWDEROLVP�RI�D�SDUWLFXODU�GUXJ��WHVWV�VKRXOG�URXWLQHO\�EH�UXQ�LQ�ERWK�PDOHV�DQG�IHPDOHV�

)LYH�GUDPDWLF��ZLGHO\�SXEOLFL]HG�UHFHQW�H[DPSOHV�GHPRQVWUDWH�WKDW�VH[�GLIIHUHQFHV�DUH�QRW�URXWLQHO\�FRQVLGHUHG�DV�SDUW�RI�WKH�TXHVWLRQ�DVNHG��,Q�D�ORQJLWXGLQDO�VWXG\�RI�WKH�HIIHFWV�RI�D�FKROHVWHURO�ORZHULQJ�GUXJ��JHQGHU�GLIIHUHQFHV�ZHUH�QRW�WHVWHG��WKH�GUXJ�ZDV�WHVWHG�RQ�������PHQ�DQG�QR�ZRPHQ��+DPLOWRQ���������7KH�0XOWLSOH�5LVN�)DFWRU�,QWHUYHQWLRQ�7ULDO��������H[DPLQHG�PRUWDOLW\�IURP�FRURQDU\�KHDUW�GLVHDVH�LQ��������PHQ�RQO\��7KH�+HDOWK�3URIHVVLRQDOV�)ROORZ�8S�6WXG\��*UREEHH�HW�DO���������ORRNHG�DW�WKH�DVVRFLDWLRQ�EHWZHHQ�FRIIHH�FRQVXPSWLRQ�DQG�KHDUW�GLVHDVH�LQ��������PHQ��7KH�3K\VLFLDQV�+HDOWK�6WXG\��6WHHULQJ�&RPPLWWHH�RI�WKH�3K\VLFLDQV�+HDOWK�6WXG\�*URXS��������IRXQG�WKDW�ORZ�GRVH�DVSLULQ�WKHUDS\�UHGXFHG�WKH�ULVN�RI�P\RFDUGLDO�LQIDUFWLRQ�LQ��������PHQ��$�VWXG\�SXEOLVKHG�LQ�6HSWHPEHU������LQ�WKH�-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ�VXUYH\HG�WKH�OLWHUDWXUH�IURP������WR������RQ�VWXGLHV�RI�FOLQLFDO�WULDOV�RI�PHGLFDWLRQV�XVHG�WR�WUHDW�DFXWH�P\RFDUGLDO�LQIDUFWLRQ��:RPHQ�ZHUH�LQFOXGHG�LQ�RQO\�DERXW����SHUFHQW�RI�WKRVH�VWXGLHV��HOGHUO\�SHRSOH��RYHU�VHYHQW\�ILYH�\HDUV��ZHUH�LQFOXGHG�LQ�RQO\����SHUFHQW��*XUZLW]��1DQDQGD��DQG�$YRUQ��������

6RPH�GLVHDVHV�ZKLFK�DIIHFW�ERWK�VH[HV�DUH�GHILQHG�DV�PDOH�GLVHDVHV��+HDUW�GLVHDVH�KDV�EHHQ�VR�GHVLJQDWHG�EHFDXVH�DW�\RXQJHU�DJHV�LW�RFFXUV�PRUH�IUHTXHQWO\�LQ�PHQ�WKDQ�LQ�ZRPHQ��7KHUHIRUH��PRVW�RI�WKH�IXQGLQJ�IRU�KHDUW�GLVHDVH�KDV�EHHQ�DSSURSULDWHG�IRU�UHVHDUFK�RQ�SUHGLVSRVLQJ�IDFWRUV��VXFK�DV�FKROHVWHURO�OHYHO��ODFN�RI�H[HUFLVH��VWUHVV��VPRNLQJ��DQG�ZHLJKW��XVLQJ�ZKLWH��PLGGOH�DJHG��PLGGOH�FODVV�PDOHV�

7KLV��PDOH�GLVHDVH��GHVLJQDWLRQ�KDV�UHVXOWHG�LQ�YHU\�OLWWOH�UHVHDUFK�EHLQJ�GLUHFWHG�WRZDUG�KLJK�ULVN�JURXSV�RI�ZRPHQ��+HDUW�GLVHDVH�LV�D�OHDGLQJ�FDXVH�RI�GHDWK�LQ�ROGHU�ZRPHQ��.LUVFKVWHLQ��������+HDO\���������ZKR�OLYH�DQ�DYHUDJH�RI�HLJKW�\HDUV�ORQJHU�WKDQ�PHQ��%RVWRQ�:RPHQV�+HDOWK�%RRN�&ROOHFWLYH���������,W�LV�DOVR�IUHTXHQW�LQ�SRRU�$IULFDQ�$PHULFDQ�ZRPHQ�ZKR�KDYH�KDG�VHYHUDO�FKLOGUHQ��0DQOH\�HW�DO����������9LUWXDOO\�QR�UHVHDUFK�KDV�H[SORUHG�SUHGLVSRVLQJ�IDFWRUV�IRU�WKHVH�JURXSV�ZKR�IDOO�RXWVLGH�WKH�GLVHDVH�GHILQLWLRQ�HVWDEOLVKHG�IURP�DQ�DQGURFHQWULF�SHUVSHFWLYH�

5HFHQW�GDWD�LQGLFDWH�WKDW�WKH�GHVLJQDWLRQ�RI�$,'6�DV�D�GLVHDVH�RI�PDOH�KRPRVH[XDOV�DQG�,9�GUXJ�XVHUV�KDV�OHG�WR�D�IDLOXUH�DPRQJ�UHVHDUFKHUV�DQG�KHDOWK�FDUH�SUDFWLWLRQHUV�WR�XQGHUVWDQG�WKH�HWLRORJ\�DQG�GLDJQRVLV�RI�$,'6�LQ�ZRPHQ��1RUZRRG���������$,'6�LV�FXUUHQWO\�LQFUHDVLQJ�PRUH�UDSLGO\�DPRQJ�ZRPHQ�WKDQ�LQ�DQ\�RWKHU�JURXS��DQG�ZRPHQ�DSSHDU�WR�PDQLIHVW�GLIIHUHQW�V\PSWRPV�LQ�$,'6�WKDQ�PHQ��+RZHYHU��LW�ZDV�QRW�XQWLO�2FWREHU������WKDW�WKH�&HQWHUV�IRU�'LVHDVH�&RQWURO��&'&��DQQRXQFHG�D�FDVH�GHILQLWLRQ�WKDW�LQFOXGHV�J\QHFRORJLF�FRQGLWLRQV�DQG�RWKHU�V\PSWRPV�RI�$,'6�LQ�ZRPHQ��WKLV�FDVH�GHILQLWLRQ�ZDV�HQDFWHG�LQ�-DQXDU\�������%HOO��������

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 3: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH��

5HVHDUFK�RQ�FRQGLWLRQV�VSHFLILF�WR�IHPDOHV�LV�DFFRUGHG�ORZ�SULRULW\��IXQGLQJ��DQG�SUHVWLJH��GHVSLWH�WKH�IDFW�WKDW�ZRPHQ�PDNH�XS�KDOI�RI�WKH�SRSXODWLRQ�DQG�UHFHLYH�PRUH�WKDQ�KDOI�RI�WKH�KHDOWK�FDUH��,Q�������WKH�1,+�DOORFDWHG�RQO\������SHUFHQW�RI�LWV�WRWDO�EXGJHW�WR�UHVHDUFK�RQ�LOOQHVVHV�RI�PDMRU�FRQVHTXHQFH�WR�ZRPHQ��1DUULJDQ���������7KH�:RPHQV�+HDOWK�,QLWLDWLYH��ODXQFKHG�E\�1,+�LQ������WR�VWXG\�FDUGLRYDVFXODU�GLVHDVHV��FDQFHUV��DQG�RVWHRSRURVLV��LV�DWWHPSWLQJ�WR�UDLVH�WKH�SULRULW\�RI�ZRPHQV�KHDOWK�DQG�SURYLGH�EDVHOLQH�GDWD�RQ�SUHYLRXVO\�XQGHUVWXGLHG�FDXVHV�RI�GHDWK�LQ�ZRPHQ��3LQQ�DQG�/D5RVD���������$GGLWLRQDO�H[DPSOHV�WKDW�PLJKW�EH�WDUJHWHG�LQFOXGH�G\VPHQRUUKHD��LQFRQWLQHQFH�LQ�ROGHU�ZRPHQ��QXWULWLRQ�LQ�SRVWPHQRSDXVDO�ZRPHQ��DQG�HIIHFWV�RI�H[HUFLVH�OHYHO�DQG�GXUDWLRQ�XSRQ�DOOHYLDWLRQ�RI�PHQVWUXDO�GLVFRPIRUW��7KH�LVVXH�RI�H[SRVXUH�WR�9'7V��ZKLFK�KDV�UHVXOWHG�LQ��FOXVWHUV��RI�ZRPHQ�LQ�FHUWDLQ�LQGXVWULHV�JLYLQJ�ELUWK�WR�GHIRUPHG�EDELHV��KDV�DOVR�UHFHLYHG�ORZ�SULRULW\��,Q�FRQWUDVW��VLJQLILFDQW�DPRXQWV�RI�WLPH�DQG�PRQH\�DUH�H[SHQGHG�XSRQ�FOLQLFDO�UHVHDUFK�RQ�ZRPHQV�ERGLHV�LQ�FRQQHFWLRQ�ZLWK�RWKHU�DVSHFWV�RI�UHSURGXFWLRQ��,Q�WKLV�FHQWXU\�XS�XQWLO�WKH�����V��FRQVLGHUDEOH�DWWHQWLRQ�ZDV�GHYRWHG�WR�WKH�GHYHORSPHQW�RI�FRQWUDFHSWLYH�GHYLFHV�IRU�IHPDOHV�UDWKHU�WKDQ�IRU�PDOHV��&RZDQ��������'UHLIXV���������)XUWKHUPRUH��VXEVWDQWLDO�FOLQLFDO�UHVHDUFK�KDV�UHVXOWHG�LQ�LQFUHDVLQJ�PHGLFDOL]DWLRQ�DQG�FRQWURO�RI�SUHJQDQF\��ODERU��DQG�FKLOGELUWK��)HPLQLVWV�KDYH�FULWLTXHG��(KUHQUHLFK�DQG�(QJOLVK��������+ROPHV��������WKH�FRQYHUVLRQ�RI�D�QRUPDO��QDWXUDO�SURFHVV�FRQWUROOHG�E\�ZRPHQ�LQWR�D�FOLQLFDO��DQG�RIWHQ�VXUJLFDO��SURFHGXUH�FRQWUROOHG�E\�PHQ��0RUH�UHFHQWO\��WKH�QHZ�UHSURGXFWLYH�WHFKQRORJLHV�VXFK�DV�DPQLRFHQWHVLV��LQ�YLWUR�IHUWLOL]DWLRQ��DQG�DUWLILFLDO�LQVHPLQDWLRQ�KDYH�EHFRPH�D�PDMRU�IRFXV�DV�PHDQV�DUH�VRXJKW�WR�RYHUFRPH�LQIHUWLOLW\��)HPLQLVWV��$UGLWWL��'XHOOL�.OHLQ��DQG�0LQGHQ��������&RUHD�DQG�,QFH��������&RUHD�HW�DO���������.OHLQ��������KDYH�ZDUQHG�RI�WKH�H[WHQW�WR�ZKLFK�WKHVH�WHFKQRORJLHV�SODFH�SUHVVXUH�RQ�ZRPHQ�WR�SURGXFH�D��SHUIHFW��FKLOG�ZKLOH�SODFLQJ�FRQWURO�LQ�WKH�KDQGV�RI�WKH�PDOH�PHGLFDO�HVWDEOLVKPHQW�

7KHVH�H[DPSOHV�VXJJHVW�WKDW�FRQVLGHUDEOH�UHVRXUFHV�DQG�DWWHQWLRQ�DUH�GHYRWHG�WR�ZRPHQV�KHDOWK�LVVXHV�ZKHQ�WKRVH�LVVXHV�DUH�GLUHFWO\�UHODWHG�WR�PHQV�LQWHUHVW�LQ�FRQWUROOLQJ�WKH�SURGXFWLRQ�RI�FKLOGUHQ��&RQWUDFHSWLYH�UHVHDUFK�PD\�SHUPLW�PHQ�WR�KDYH�VH[XDO�SOHDVXUH�ZLWKRXW�WKH�ZRUU\�RI�SURGXFLQJ�FKLOGUHQ��5HVHDUFK�RQ�LQIHUWLOLW\��SUHJQDQF\��DQG�FKLOGELUWK�KDV�DOORZHG�PHQ�WR�DVVHUW�PRUH�FRQWURO�RYHU�WKH�SURGXFWLRQ�RI�PRUH��SHUIHFW��FKLOGUHQ�DQG�RYHU�DQ�DVSHFW�RI�ZRPHQV�OLYHV�RYHU�ZKLFK�WKH\�SUHYLRXVO\�KHOG�OHVV�SRZHU�

6XJJHVWLRQV�RI�IUXLWIXO�TXHVWLRQV�IRU�UHVHDUFK�EDVHG�RQ�WKH�SHUVRQDO�H[SHULHQFH�RI�ZRPHQ�KDYH�DOVR�EHHQ�LJQRUHG��,Q�WKH�KHDOWK�FDUH�DUHD��ZRPHQ�KDYH�RIWHQ�UHSRUWHG��DQG�DFFHSWHG�DPRQJ�WKHPVHOYHV��H[SHULHQFHV�WKDW�FRXOG�QRW�EH�GRFXPHQWHG�E\�VFLHQWLILF�H[SHULPHQWV�RU�ZHUH�QRW�DFFHSWHG�DV�YDOLG�E\�WKH�UHVHDUFKHUV�RI�WKH�GD\��)RU�GHFDGHV��G\VPHQRUUKHD�ZDV�DWWULEXWHG�E\�PRVW�KHDOWK�FDUH�UHVHDUFKHUV�DQG�SUDFWLWLRQHUV�WR�SV\FKRORJLFDO�RU�VRFLDO�IDFWRUV�GHVSLWH�UHSRUWV�IURP�DQ�RYHUZKHOPLQJ�QXPEHU�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

� �

�3DJH��

RI�ZRPHQ�WKDW�WKHVH�ZHUH�PRQWKO\�H[SHULHQFHV�LQ�WKHLU�OLYHV��2QO\�DIWHU�SURVWDJODQGLQV�ZHUH��GLVFRYHUHG��ZDV�WKHUH�ZLGHVSUHDG�DFFHSWDQFH�DPRQJ�WKH�PDOH�PHGLFDO�HVWDEOLVKPHQW�WKDW�WKLV�H[SHULHQFH�UHSRUWHG�E\�ZRPHQ�KDG�D�ELRORJLFDO�FRPSRQHQW��.LUVFKVWHLQ��������

7KHVH�IRXU�W\SHV�RI�ELDV�UDLVH�HWKLFDO�LVVXHV��+HDOWK�FDUH�SUDFWLWLRQHUV�PXVW�WUHDW�WKH�PDMRULW\�RI�WKH�SRSXODWLRQ��ZKLFK�LV�IHPDOH��EDVHG�RQ�LQIRUPDWLRQ�JDWKHUHG�IURP�FOLQLFDO�UHVHDUFK�LQ�ZKLFK�GUXJV�PD\�QRW�KDYH�EHHQ�WHVWHG�RQ�IHPDOHV��LQ�ZKLFK�WKH�HWLRORJ\�RI�WKH�GLVHDVH�LQ�ZRPHQ�KDV�QRW�EHHQ�VWXGLHV��DQG�LQ�ZKLFK�ZRPHQV�H[SHULHQFH�KDV�EHHQ�LJQRUHG�

$SSURDFKHV�DQG�0HWKRGV

7KH�VFLHQWLILF�FRPPXQLW\�KDV�RIWHQ�IDLOHG�WR�LQFOXGH�IHPDOHV�LQ�DQLPDO�VWXGLHV�LQ�ERWK�EDVLF�DQG�FOLQLFDO�UHVHDUFK�XQOHVV�WKH�UHVHDUFK�FHQWHUHG�RQ�FRQWUROOLQJ�WKH�SURGXFWLRQ�RI�FKLOGUHQ��:KLOH�WKH�UHDVRQV�IRU�WKLV�H[FOXVLRQ��FOHDQHU�GDWD�IURP�PDOHV�GXH�WR�ODFN�RI�LQWHUIHUHQFH�IURP�HVWURXV�RU�PHQVWUXDO�F\FOHV��IHDU�RI�LQGXFLQJ�IHWDO�GHIRUPLWLHV�LQ�SUHJQDQW�VXEMHFWV��DQG�KLJKHU�LQFLGHQFH�RI�VRPH�GLVHDVHV�LQ�PDOHV��PD\�EH�YLHZHG�DV�SUDFWLFDO�IURP�D�ILQDQFLDO�VWDQGSRLQW��LW�UHVXOWV�LQ�GUXJV�WKDW�KDYH�QRW�EHHQ�DGHTXDWHO\�WHVWHG�LQ�ZRPHQ�VXEMHFWV�EHIRUH�EHLQJ�PDUNHWHG�DQG�D�ODFN�RI�LQIRUPDWLRQ�DERXW�WKH�HWLRORJ\�RI�VRPH�GLVHDVHV�LQ�ZRPHQ�

8VLQJ�PDOHV�DV�H[SHULPHQWDO�VXEMHFWV�QRW�RQO\�LJQRUHV�WKH�IDFW�WKDW�IHPDOHV�PD\�UHVSRQG�GLIIHUHQWO\�WR�WKH�YDULDEOH�WHVWHG��LW�PD\�DOVR�OHDG�WR�OHVV�DFFXUDWH�PRGHOV�HYHQ�LQ�WKH�PDOH��0RGHOV�ZKLFK�PRUH�DFFXUDWHO\�VLPXODWH�IXQFWLRQLQJ�RI�FRPSOH[�ELRORJLFDO�V\VWHPV�PD\�EH�GHULYHG�E\�XVLQJ�IHPDOH�UDWV�RU�SULPDWHV�DV�VXEMHFWV�LQ�H[SHULPHQWV��:LWK�WKH�H[FHSWLRQ�RI�LQVXOLQ�DQG�WKH�KRUPRQHV�RI�WKH�IHPDOH�UHSURGXFWLYH�F\FOH��WUDGLWLRQDO�HQGRFULQRORJLFDO�WKHRU\�DVVXPHG�WKDW�PRVW�RI�WKH�WZHQW\�RGG�KXPDQ�KRUPRQHV�DUH�PDLQWDLQHG�DW�D�FRQVWDQW�OHYHO�LQ�ERWK�PDOHV�DQG�IHPDOHV��7KXV��WKH�PDOH�RI�WKH�VSHFLHV�ZDV�FKRVHQ�DV�WKH�H[SHULPHQWDO�VXEMHFW�EHFDXVH�RI�KLV�QRQF\FOLFLW\��+RZHYHU��QHZ�WHFKQLTXHV�RI�PHDVXULQJ�EORRG�KRUPRQH�OHYHOV�KDYH�GHPRQVWUDWHG�HSLVRGLF��UDWKHU�WKDQ�VWHDG\��SDWWHUQV�RI�VHFUHWLRQ�RI�YLUWXDOO\�DOO�KRUPRQHV�LQ�ERWK�PDOHV�DQG�IHPDOHV��$V�-RDQ�+RIIPDQ��������SRLQWV�RXW��WKH�UK\WKPLF�F\FOH�RI�KRUPRQH�VHFUHWLRQ�DV�DOVR�SRUWUD\HG�LQ�WKH�F\FOLQJ�IHPDOH�UDW�DSSHDUV�WR�EH�D�PRUH�DFFXUDWH�PRGHO�IRU�WKH�VHFUHWLRQ�RI�PRVW�KRUPRQHV�

:KHQ�IHPDOHV�KDYH�EHHQ�XVHG�DV�H[SHULPHQWDO�VXEMHFWV��RIWHQ�WKH\�KDYH�EHHQ�WUHDWHG�DV�QRW�IXOO\�KXPDQ��,Q�KLV�DWWHPSWV�WR�LQYHVWLJDWH�WKH�VLGH�HIIHFWV��*ROG]LHKHU�HW�DO�������D��RI�QHUYRXVQHVV�DQG�GHSUHVVLRQ��*ROG]LHKHU�HW�DO�������E��DWWULEXWDEOH�WR�RUDO�FRQWUDFHSWLYHV��*ROG]LHKHU�JDYH�GXPP\�SLOOV�WR�VHYHQW\�VL[�ZRPHQ�ZKR�VRXJKW�WUHDWPHQW�DW�D�6DQ�$QWRQLR�FOLQLF�WR�SUHYHQW�IXUWKHU�SUHJQDQFLHV��1RQH�RI�WKH�ZRPHQ�ZDV�WROG�WKDW�VKH�ZDV�SDUWLFLSDWLQJ�LQ�UHVHDUFK�RU�UHFHLYLQJ�SODFHERV��9HDWFK��������&RZDQ���������7KH�ZRPHQ�LQ�*ROG]LHKHUV�VWXG\�ZHUH�SULPDULO\�SRRU��PXOWLSDURXV�0H[LFDQ�$PHULFDQV��5HVHDUFK�WKDW�UDLVHV�VLPLODU�TXHVWLRQV�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 4: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH��

DERXW�WKH�HWKLFV�RI�LQIRUPHG�FRQVHQW�ZDV�FDUULHG�RXW�RQ�SRRU�3XHUWR�5LFDQ�ZRPHQ�GXULQJ�WKH�LQLWLDO�SKDVHV�RI�WHVWLQJ�WKH�HIIHFWLYHQHVV�RI�WKH�ELUWK�FRQWURO�SLOO�DV�D�FRQWUDFHSWLYH�>=LPPHUPDQ�HW�DO����������5HFHQW�GDWD�KDYH�UHYHDOHG�URXWLQH�WHVWLQJ�RI�SUHJQDQW�ZRPHQ�IRU�+,9�SRVLWLYLW\�ZLWKRXW�WKHLU�LQIRUPHG�FRQVHQW�DW�FHUWDLQ�FOLQLFV��0DUWH�DQG�$QDVWRV��������&KDYNLQ��'ULYHU��DQG�)RUPDQ��������DQG�VXEVHTXHQW�SUHVVXUH�SODFHG�RQ�ZRPHQ�ZKR�DUH�+,9�SRVLWLYH�WR�DERUW�WKHLU�IHWXVHV��6HOZ\Q�HW�DO���������

)UHTXHQWO\�LW�LV�GLIILFXOW�WR�GHWHUPLQH�ZKHWKHU�WKHVH�ZRPHQ�DUH�WUHDWHG�DV�OHVV�WKDQ�KXPDQ�EHFDXVH�RI�WKHLU�JHQGHU�RU�ZKHWKHU�UDFH�DQG�FODVV�DUH�PRUH�VLJQLILFDQW�YDULDEOHV��7KH�7XVNHJHH�6\SKLOLV�([SHULPHQW��LQ�ZKLFK�WKH�HIIHFWV�RI�XQWUHDWHG�V\SKLOLV�ZHUH�VWXGLHG�LQ�����PHQ�RYHU�D�SHULRG�RI�IRUW\�\HDUV��-RQHV���������PDGH�LW�FOHDU�WKDW�SRRU�$IULFDQ�$PHULFDQ�PHQ�PD\�QRW�UHFHLYH�DSSURSULDWH�WUHDWPHQW�RU�LQIRUPDWLRQ�DERXW�WKH�H[SHULPHQW�LQ�ZKLFK�WKH\�DUH�SDUWLFLSDWLQJ��)HPLQLVW�VFKRODUV��'LOO��������5X]HN��������KDYH�EHJXQ�WR�H[SORUH�WKH�H[WHQW�WR�ZKLFK�JHQGHU��UDFH��DQG�FODVV�PD\�EHFRPH�FRPSOH[��LQWHUORFNLQJ�SROLWLFDO�YDULDEOHV�DIIHFWLQJ�DFFHVV�WR�DQG�TXDOLW\�RI�KHDOWK�FDUH�

&XUUHQW�FOLQLFDO�UHVHDUFK�VHWV�XS�D�GLVWDQFH�EHWZHHQ�WKH�REVHUYHU�DQG�WKH�KXPDQ�VXEMHFW�EHLQJ�VWXGLHG��6HYHUDO�IHPLQLVW�SKLORVRSKHUV��.HOOHU��������+HLQ��������+DUDZD\��������+DUGLQJ��������KDYH�FKDUDFWHUL]HG�WKLV�DV�DQ�DQGURFHQWULF�DSSURDFK��'LVWDQFH�EHWZHHQ�WKH�REVHUYHU�DQG�H[SHULPHQWDO�VXEMHFW�PD\�EH�PRUH�FRPIRUWDEOH�IRU�PHQ��ZKR�DUH�UDLVHG�WR�IHHO�PRUH�DW�HDVH�ZLWK�DXWRQRP\�DQG�GLVWDQFH��.HOOHU���������WKDQ�IRU�ZRPHQ��ZKR�WHQG�WR�YDOXH�UHODWLRQVKLSV�DQG�LQWHUGHSHQGHQF\��*LOOLJDQ��������

8VLQJ�RQO\�WKH�PHWKRGV�WUDGLWLRQDO�WR�D�SDUWLFXODU�GLVFLSOLQH�PD\�UHVXOW�LQ�OLPLWHG�DSSURDFKHV�WKDW�IDLO�WR�UHYHDO�VXIILFLHQW�LQIRUPDWLRQ�DERXW�WKH�SUREOHP�EHLQJ�H[SORUHG��7KLV�PD\�EH�D�SDUWLFXODU�GLIILFXOW\�IRU�UHVHDUFK�VXUURXQGLQJ�PHGLFDO�SUREOHPV�RI�SUHJQDQF\��FKLOGELUWK��PHQVWUXDWLRQ��DQG�PHQRSDXVH��IRU�ZKLFK�WKH�PHWKRGV�RI�RQH�GLVFLSOLQH�DUH�FOHDUO\�LQDGHTXDWH�

0HWKRGV�ZKLFK�FURVV�GLVFLSOLQDU\�ERXQGDULHV�RU�LQFOXGH�FRPELQDWLRQV�RI�PHWKRGV�WUDGLWLRQDOO\�XVHG�LQ�VHSDUDWH�ILHOGV�PD\�EH�PRUH�DSSURSULDWH��)RU�H[DPSOH��LI�WKH�WRSLF�RI�UHVHDUFK�LV�RFFXSDWLRQDO�H[SRVXUHV�WKDW�SUHVHQW�D�ULVN�WR�WKH�SUHJQDQW�ZRPDQ�ZRUNLQJ�LQ�D�SODQW�ZKHUH�WR[LF�FKHPLFDOV�DUH�PDQXIDFWXUHG��D�FRPELQDWLRQ�RI�PHWKRGV�WUDGLWLRQDOO\�XVHG�LQ�VRFLDO�VFLHQFH�UHVHDUFK�ZLWK�PHWKRGV�IUHTXHQWO\�XVHG�LQ�ELRORJ\�DQG�FKHPLVWU\�PD\�EH�WKH�EHVW�DSSURDFK��&KHFNLQJ�WKH�FKURPRVRPHV�RI�DQ\�PLVFDUULHG�IHWXVHV��FKHPLFDO�DQDO\VLV�RI�SODFHQWDH�DIWHU�ELUWK��$SJDU�VFRUHV�RI�WKH�EDELHV�DW�ELUWK��DQG�EORRG�VDPSOHV�RI�WKH�QHZERUQV�WR�GHWHUPLQH�WUDFH�DPRXQWV�RI�WKH�WR[LF�FKHPLFDOV�ZRXOG�EH�DSSURSULDWH�ELRORJLFDO�DQG�FKHPLFDO�PHDQV�RI�JDWKHULQJ�GDWD�DERXW�WKH�SUREOHP��,Q�GHSWK�LQWHUYLHZV�ZLWK�ZRPHQ�WR�GLVFXVV�KRZ�WKH\�DUH�IHHOLQJ�DQG�DQ\�LUUHJXODULWLHV�WKH\�GHWHFW�GXULQJ�HDFK�PRQWK�RI�WKH�SUHJQDQF\��RU�ZHHNO\�HYDOXDWLRQ�XVLQJ�ZULWWHQ�TXHVWLRQQDLUHV�UHJDUGLQJ�WKH�SUHJQDQF\�SURJUHVV�DUH�PHWKRGV�PRUH�WUDGLWLRQDOO\�XVHG�LQ�WKH�VRFLDO�VFLHQFHV�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

� �

�3DJH���

IRU�SUREOHPV�RI�WKLV�VRUW��-HDQ�+DPLOWRQ�KDV�FDOOHG�IRU�LQWHUDFWLYH�PRGHOV�WKDW�GUDZ�RQ�ERWK�WKH�VRFLDO�DQG�QDWXUDO�VFLHQFHV�WR�H[SODLQ�FRPSOH[�SUREOHPV�3DUWLFXODUO\�IRU�XQGHUVWDQGLQJ�KXPDQ��JHQGHU�UHODWHG�KHDOWK��ZH�QHHG�PRUH�LQWHUDFWLYH�DQG�FRQWH[WXDO�PRGHOV�WKDW�DGGUHVV�WKH�DFWXDO�FRPSOH[LW\�RI�WKH�SKHQRPHQRQ�WKDW�LV�WKH�VXEMHFW�RI�H[SODQDWLRQ��2QH�H[DPSOH�LV�WKH�QHHG�IRU�PRUH�SKHQRPHQRORJLFDO�GHILQLWLRQV�RI�V\PSWRPV��DORQJ�ZLWK�LQFUHDVHG�UHFRJQLWLRQ�WKDW�SV\FKRORJ\��EHKDYLRUDO�VWXGLHV��DQG�VRFLRORJ\�DUH�DPRQJ�WKH��EDVLF�VFLHQFHV��IRU�KHDOWK�UHVHDUFK��5HVHDUFK�RQ�KHDUW�GLVHDVH�LV�RQH�H[DPSOH�RI�D�ILHOG�ZKHUH�LW�LV�UHFRJQL]HG�WKDW�ERWK�SV\FKRORJLFDO�VWUHVV�DQG�EHKDYLRUV�VXFK�DV�HDWLQJ�DQG�FLJDUHWWH�VPRNLQJ�LQIOXHQFH�WKH�RQVHW�DQG�QDWXUDO�FRXUVH�RI�D�GLVHDVH�SURFHVV���������9,����

3HUKDSV�DQ�LQFUHDVH�LQ�WKH�QXPEHU�RI�ZRPHQ�KROGLQJ�GHFLVLRQ�PDNLQJ�SRVLWLRQV�LQ�WKH�GHVLJQ�DQG�IXQGLQJ�RI�FOLQLFDO�UHVHDUFK�ZRXOG�UHVXOW�LQ�PRUH�LQWHUGLVFLSOLQDU\�UHVHDUFK�RQ�LVVXHV�RI�ZRPHQV�KHDOWK�FDUH�VXFK�DV�PHQVWUXDWLRQ��SUHJQDQF\��FKLOGELUWK��ODFWDWLRQ��DQG�PHQRSDXVH��7KRVH�FRPSOH[�SKHQRPHQD�IDOO�RXWVLGH�WKH�UDQJH�RI�PHWKRGV�RI�VWXG\�SURYLGHG�E\�D�VROH�GLVFLSOLQH��,QWHUGLVFLSOLQDU\�DSSURDFKHV�GHYHORSHG�WR�VROYH�WKHVH�SUREOHPV�PLJKW�WKHQ�EH�DSSOLHG�WR�RWKHU�FRPSOH[�SUREOHPV�WR�EHQHILW�DOO�KHDOWK�FDUH�FRQVXPHUV��ERWK�PDOH�DQG�IHPDOH�

7KHRULHV�DQG�&RQFOXVLRQV�'UDZQ�IURP�WKH�5HVHDUFK

7KH�UDWLRQDOH�ZKLFK�LV�WUDGLWLRQDOO\�SUHVHQWHG�LQ�VXSSRUW�RI��REMHFWLYH��PHWKRGV�LV�WKDW�WKH\�SUHYHQW�ELDV��(PSKDVLV�XSRQ�WUDGLWLRQDO�GLVFLSOLQDU\�DSSURDFKHV�WKDW�DUH�TXDQWLWDWLYH�DQG�PDLQWDLQ�WKH�GLVWDQFH�EHWZHHQ�REVHUYHU�DQG�H[SHULPHQWDO�VXEMHFW�VXSSRVHGO\�HOLPLQDWH�ELDV�RQ�WKH�SDUW�RI�WKH�UHVHDUFKHU��,URQLFDOO\��WR�WKH�H[WHQW�WKDW�WKHVH��REMHFWLYH��DSSURDFKHV�DUH�V\QRQ\PRXV�ZLWK�D�PDVFXOLQH�DSSURDFK�WR�WKH�ZRUOG��WKH\�PD\�DFWXDOO\�LQWURGXFH�ELDV��6SHFLILFDOO\��DQGURFHQWULF�ELDV�PD\�SHUPHDWH�WKH�WKHRULHV�DQG�FRQFOXVLRQV�GUDZQ�IURP�WKH�UHVHDUFK�LQ�VHYHUDO�ZD\V�

7KHRULHV�PD\�EH�SUHVHQWHG�LQ�DQGURFHQWULF�ODQJXDJH��0XFK�IHPLQLVW�VFKRODUVKLS�KDV�IRFXVHG�RQ�SUREOHPV�RI�VH[LVP�LQ�ODQJXDJH�DQG�WKH�H[WHQW�WR�ZKLFK�SDWULDUFKDO�ODQJXDJH�KDV�H[FOXGHG�DQG�OLPLWHG�ZRPHQ��7KRUQH��������/DNRII��������.UDPDUDH�DQG�7UHLFKOHU���������6H[LVW�ODQJXDJH�LV�D�V\PSWRP�RI�XQGHUO\LQJ�VH[LVP��EXW�ODQJXDJH�DOVR�VKDSHV�RXU�FRQFHSWV�DQG�SURYLGHV�WKH�IUDPHZRUN�WKURXJK�ZKLFK�ZH�H[SUHVV�RXU�LGHDV��%HLQJ�DZDUH�RI�VH[LVP�DQG�WKH�OLPLWDWLRQV�RI�SDWULDUFKDO�ODQJXDJH�PD\�DOORZ�IHPLQLVW�UHVHDUFKHUV�WR�GHVFULEH�WKHLU�REVHUYDWLRQV�LQ�OHVV�JHQGHU�ELDVHG�WHUPV�

7KH�OLPLWHG�UHVHDUFK�RQ�$,'6�LQ�ZRPHQ�KDV�IRFXVHG�RQ�ZRPHQ�DV�SURVWLWXWHV�RU�PRWKHUV��'HVFULELQJ�WKH�ZRPDQ�DV�D�YHFWRU�IRU�WUDQVPLVVLRQ�WR�PHQ��SURVWLWXWH��RU�WKH�IHWXV��PRWKHU��KDV�SURGXFHG�OLWWOH�LQIRUPDWLRQ�RQ�WKH�SURJUHVV�RI�$,'6�LQ�ZRPHQ�WKHPVHOYHV��5RVVHU���������2QFH�WKH�ELDV�LQ�WKH�WHUPLQRORJ\�LV�H[SRVHG��WKH�QH[W�VWHS�LV�WR�DVN�ZKHWKHU�WKDW�WHUPLQRORJ\�OHDGV�WR�D�FRQVWUDLQW�RU�ELDV�LQ�WKH�WKHRU\�LWVHOI�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 5: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH���

$Q�DQGURFHQWULF�SHUVSHFWLYH�PD\�OHDG�WR�WKH�IRUPXODWLRQ�RI�WKHRULHV�DQG�FRQFOXVLRQV�GUDZQ�IURP�PHGLFDO�UHVHDUFK�WR�VXSSRUW�WKH�VWDWXV�TXR�RI�LQHTXDOLW\�IRU�ZRPHQ�DQG�RWKHU�RSSUHVVHG�JURXSV��%XLOGLQJ�XSRQ�WKHLU�DZDUHQHVV�RI�WKHVH�ELDVHV��ZRPHQ�VFLHQWLVWV�KDYH�FULWLTXHG�VWXGLHV�RI�EUDLQ�KRUPRQH�LQWHUDFWLRQ��%OHLHU��������IRU�WKHLU�ELRORJLFDO�GHWHUPLQLVP�XVHG�WR�MXVWLI\�ZRPHQV�VRFLDOO\�LQIHULRU�SRVLWLRQ��%OHLHU�UHSHDWHGO\�ZDUQHG�DJDLQVW�H[WUDSRODWLQJ�IURP�RQH�VSHFLHV�WR�DQRWKHU�LQ�ELRFKHPLFDO�DV�ZHOO�DV�EHKDYLRUDO�WUDLWV��%OHLHU��������

1RW�VXUSULVLQJO\��WKH�DQGURFHQWULF�ELDV�LQ�UHVHDUFK�ZKLFK�KDV�OHG�WR�WKH�H[FOXVLRQ�RI�ZRPHQ�IURP�WKH�GHILQLWLRQV�RI�DQG�DSSURDFKHV�WR�UHVHDUFK�SUREOHPV�KDV�UHVXOWHG�LQ�GLIIHUHQFHV�LQ�WKH�PDQDJHPHQW�RI�GLVHDVH�DQG�DFFHVV�WR�KHDOWK�FDUH�SURFHGXUHV�EDVHG�RQ�JHQGHU��,Q�D������VWXG\�LQ�0DVVDFKXVHWWV�DQG�0DU\ODQG��$\DQLDQ�DQG�(SVWHLQ��������GHPRQVWUDWHG�WKDW�ZRPHQ�ZHUH�VLJQLILFDQWO\�OHVV�OLNHO\�WKDQ�PHQ�WR�XQGHUJR�FRURQDU\�DQJLRSODVW\��DQJLRJUDSK\��RU�VXUJHU\�ZKHQ�DGPLWWHG�WR�WKH�KRVSLWDO�ZLWK�WKH�GLDJQRVLV�RI�P\RFDUGLDO�LQIDUFWLRQ��XQVWDEOH�DQJLQD��FKURQLF�LVFKHPLF�KHDUW�GLVHDVH��RU�FKHVW�SDLQ��7KLV�VLJQLILFDQW�GLIIHUHQFH�UHPDLQHG�HYHQ�ZKHQ�YDULDEOHV�VXFK�DV�UDFH��DJH��HFRQRPLF�VWDWXV��DQG�RWKHU�FKURQLF�GLVHDVHV�VXFK�DV�GLDEHWHV�DQG�KHDUW�IDLOXUH�ZHUH�FRQWUROOHG�IRU��$�VLPLODU�VWXG\��6WHLQJDUW�HW�DO���������UHYHDOHG�WKDW�ZRPHQ�KDG�DQJLQD�EHIRUH�P\RFDUGLDO�LQIDUFWLRQ�DV�IUHTXHQWO\�DV�DQG�ZLWK�PRUH�GHELOLWDWLQJ�HIIHFWV�WKDQ�PHQ��\HW�ZRPHQ�DUH�UHIHUUHG�IRU�FDUGLDF�FDWKHWHUL]DWLRQ�RQO\�KDOI�DV�RIWHQ��7KH������-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ�VWXG\�FRQFOXGHG�WKDW�WKH�H[FOXVLRQ�RI�ZRPHQ�IURP����SHUFHQW�RI�WKH�WULDOV�DQG�RI�WKH�HOGHUO\�IURP����SHUFHQW�RI�WKH�WULDOV�IRU�PHGLFDWLRQ�IRU�P\RFDUGLDO�LQIDUFWLRQ�OLPLWV�WKH�DELOLW\�WR�JHQHUDOL]H�VWXG\�ILQGLQJV�WR�WKH�SDWLHQW�SRSXODWLRQ�WKDW�H[SHULHQFHV�WKH�PRVW�PRUELGLW\�DQG�PRUWDOLW\�IURP�DFXWH�P\RFDUGLDO�LQIDUFWLRQ��*XUZLW]��1DQDQGD��DQG�$YRUQ���������*HQGHU�ELDV�LQ�FDUGLDF�UHVHDUFK�KDV�WKHUHIRUH�EHHQ�WUDQVODWHG�LQWR�ELDV�LQ�WKH�PDQDJHPHQW�RI�GLVHDVH��OHDGLQJ�WR�LQHTXLWDEOH�WUHDWPHQW�IRU�OLIH�WKUHDWHQLQJ�FRQGLWLRQV�LQ�ZRPHQ�

$QGURFHQWULF�ELDV�LQ�$,'6�UHVHDUFK�PD\�DOVR�OHDG�WR�XQGHUGLDJQRVLV�DQG�KLJKHU�GHDWK�UDWHV�IRU�ZRPHQ��%HFDXVH�WKH�SURJUHVV�RI�$,'6�LQ�ZRPHQ�KDV�QRW�EHHQ�DGHTXDWHO\�VWXGLHG��DQG�VLQFH�WKH�&'&�FDVH�GHILQLWLRQ�IRU�$,'6�IDLOHG�XQWLO�YHU\�UHFHQWO\�WR�LQFOXGH�DQ\�J\QHFRORJLF�FRQGLWLRQV��PRVW�KHDOWK�FDUH�ZRUNHUV�DUH�XQDEOH�WR�GLDJQRVH�$,'6�LQ�ZRPHQ�XQWLO�WKH�GLVHDVH�KDV�DGYDQFHG�VLJQLILFDQWO\��2Q�DYHUDJH��PHQ�GLH�WKLUW\�PRQWKV�DIWHU�GLDJQRVLV��ZRPHQ�ILIWHHQ�ZHHNV��7KHRULHV�DQG�FRQFOXVLRQV�GUDZQ�IURP�$,'6�UHVHDUFK�VKRXOG�EH�H[DPLQHG�WR�GHWHUPLQH�WR�ZKDW�H[WHQW�WKH\�UHSUHVHQW�DQG�UHLQIRUFH�VH[LVP��UDFLVP��DQG�FODVVLVP�

5HFRJQL]LQJ�WKH�SRVVLELOLW\�RI�JHQGHU�ELDV�LV�WKH�ILUVW�VWHS�WRZDUG�XQGHUVWDQGLQJ�WKH�GLIIHUHQFH�LW�PDNHV��3HUKDSV�PDOH�UHVHDUFKHUV�DUH�OHVV�OLNHO\�WR�VHH�IODZV�LQ�DQG�TXHVWLRQ�ELRORJLFDOO\�GHWHUPLQLVWLF�WKHRULHV�WKDW�SURYLGH�VFLHQWLILF�MXVWLILFDWLRQ�IRU�PHQV�VXSHULRU�VWDWXV�LQ�VRFLHW\�EHFDXVH�WKH\�JDLQ�VRFLDO�SRZHU�DQG�VWDWXV�IURP�VXFK�WKHRULHV��5HVHDUFKHUV�IURP�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

� �

�3DJH���

RXWVLGH�WKH�PDLQVWUHDP��ZRPHQ��IRU�H[DPSOH��DUH�PXFK�PRUH�OLNHO\�WR�EH�FULWLFDO�RI�VXFK�WKHRULHV�EHFDXVH�WKH\�ORVH�SRZHU�IURP�WKHP��7R�HOLPLQDWH�ELDV��WKH�FRPPXQLW\�RI�VFLHQWLVWV�XQGHUWDNLQJ�FOLQLFDO�UHVHDUFK�QHHGV�WR�LQFOXGH�LQGLYLGXDOV�IURP�EDFNJURXQGV�DV�YDULHG�DQG�GLYHUVH�DV�SRVVLEOH�ZLWK�UHJDUG�WR�UDFH��FODVV��JHQGHU��DQG�VH[XDO�RULHQWDWLRQ��5RVVHU���������2QO\�WKHQ�LV�LW�OHVV�OLNHO\�WKDW�WKH�SHUVSHFWLYH�RI�RQH�JURXS�ZLOO�ELDV�UHVHDUFK�GHVLJQ��DSSURDFKHV��VXEMHFWV��DQG�LQWHUSUHWDWLRQV�

+RZHYHU��JLYHQ�WKDW�WKH�RYHUDOO�DJHQGD�IRU�UHVHDUFK�SROLFLHV�FRQFHUQLQJ�DFFHVV�WR�KHDOWK�FDUH�LV�VHW�LQ�WKH�SROLWLFDO�DUHQD��SROLWLFLDQV�PXVW�DOVR�UHIOHFW�WKH�GLYHUVLW\�DQG�QHHGV�RI�WKH�SRSXODWLRQ��7KHQ�ZH�FDQ�ZRUN�WRJHWKHU�WR�RYHUFRPH�JHQGHU�ELDV�LQ�KHDOWK�UHVHDUFK�

5HIHUHQFHV

$UGLWWL��5LWD��������)HPLQLVP�DQG�VFLHQFH��,Q�5LWD�$UGLWWL��3DW�%UHQQDQ��DQG�6WHYH�&DYUDN��HGV����6FLHQFH�DQG�OLEHUDWLRQ��%RVWRQ��6RXWK�(QG�3UHVV�

$UGLWWL��5LWD��'XHOOL�.OHLQ��5HQDWH��DQG�0LQGHQ��6KHOOH\��������7HVW�WXEH�ZRPHQ��:KDW�IXWXUH�IRU�PRWKHUKRRG"�/RQGRQ��3DQGRUD�3UHVV�

$\DQLDQ��-��=���DQG�(SVWHLQ��$��0��������'LIIHUHQFHV�LQ�WKH�XVH�RI�SURFHGXUHV�EHWZHHQ�ZRPHQ�DQG�PHQ�KRVSLWDOL]HG�IRU�FRURQDU\�KHDUW�GLVHDVH��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH��������±����

%HOO��1RUD��������%RDUG�RI�WKH�1DWLRQDO�/HDGHUVKLS�&RDOLWLRQ�RQ�$,'6��3HUVRQDO�FRPPXQLFDWLRQ�

%LUNH��/\QGD��������:RPHQ��IHPLQLVP��DQG�ELRORJ\��1HZ�<RUN��0HWKXHQ�

%OHLHU��5XWK��������6FLHQFH�DQG�JHQGHU��$�FULWLTXH�RI�ELRORJ\�DQG�LWV�WKHRULHV�RQ�ZRPHQ��1HZ�<RUN��3HUJDPRQ�3UHVV�

BBBBBB��������6H[�GLIIHUHQFHV�UHVHDUFK��6FLHQFH�RU�EHOLHI"�,Q�5XWK�%OHLHU��HG����)HPLQLVW�DSSURDFKHV�WR�VFLHQFH��1HZ�<RUN��3HUJDPRQ�3UHVV�

%RVWRQ�:RPHQV�+HDOWK�%RRN�&ROOHFWLYH��������7KH�QHZ�RXU�ERGLHV��RXUVHOYHV��1HZ�<RUN��6LPRQ�DQG�6FKXVWHU�

&KDYNLQ��:���'ULYHU��&���DQG�)RUPDQ��3��������7KH�FULVLV�LQ�1HZ�<RUN�&LW\V�SHULQDWDO�VHUYLFHV��1HZ�<RUN�6WDWH�-RXUQDO�RI�0HGLFLQH�����QR��������±����

&RUHD��*���HW�DO���HGV����������0DQ�PDGH�ZRPHQ��+RZ�QHZ�UHSURGXFWLYH�WHFKQRORJLHV�DIIHFW�ZRPHQ��%ORRPLQJWRQ��,QGLDQD�8QLYHUVLW\�3UHVV�

&RUHD��*HQD��DQG�,QFH��6��������5HSRUW�RI�D�VXUYH\�RI�,9)�FOLQLFV�LQ�WKH�8�6��,Q�3DWULFLD�6SDOORQH�DQG�'HERUDK�/��6WHLQEHUJ��HGV����0DGH�WR�RUGHU��7KH�P\WK�RI�UHSURGXFWLYH�DQG�JHQHWLF�SURJUHVV��2[IRUG��3HUJDPRQ�3UHVV�

&RZDQ��%HOLWD��������(WKLFDO�SUREOHPV�LQ�JRYHUQPHQW�IXQGHG�FRQWUDFHSWLYH�UHVHDUFK��,Q�+HOHQ�+ROPHV��%HWW\�+RVNLQV��DQG�0LFKDHO�*URVV��HGV����%LUWK�FRQWURO�DQG�FRQWUROOLQJ�ELUWK��:RPHQ�FHQWHUHG�SHUVSHFWLYHV��SS����±����&OLIWRQ��1�-���+XPDQD�3UHVV�

'LOO��%RQQLH�7��������5DFH��FODVV�DQG�JHQGHU��3URVSHFWV�IRU�DQ�DOO�LQFOXVLYH�VLVWHUKRRG��)HPLQLVW�6WXGLHV�����

'UHLIXV��&ODXGLD��������6HL]LQJ�RXU�ERGLHV��1HZ�<RUN��9LQWDJH�%RRNV�

(KUHQUHLFK��%DUEDUD��DQG�(QJOLVK��'HLUGUH��������)RU�KHU�RZQ�JRRG��1HZ�<RUN��$QFKRU�3UHVV�

)DXVWR�6WHUOLQJ��$QQH��������0\WKV�RI�JHQGHU��1HZ�<RUN��%DVLF�%RRNV�

)HH��(OL]DEHWK��������,V�IHPLQLVP�D�WKUHDW�WR�VFLHQWLILF�REMHFWLYLW\"�,QWHUQDWLRQDO�-RXUQDO�RI�:RPHQV�6WXGLHV������±����

BBBBBB��������$�IHPLQLVW�FULWLTXH�RI�VFLHQWLILF�REMHFWLYLW\��6FLHQFH�IRU�WKH�3HRSOH�����QR������

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 6: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH���

RXWVLGH�WKH�PDLQVWUHDP��ZRPHQ��IRU�H[DPSOH��DUH�PXFK�PRUH�OLNHO\�WR�EH�FULWLFDO�RI�VXFK�WKHRULHV�EHFDXVH�WKH\�ORVH�SRZHU�IURP�WKHP��7R�HOLPLQDWH�ELDV��WKH�FRPPXQLW\�RI�VFLHQWLVWV�XQGHUWDNLQJ�FOLQLFDO�UHVHDUFK�QHHGV�WR�LQFOXGH�LQGLYLGXDOV�IURP�EDFNJURXQGV�DV�YDULHG�DQG�GLYHUVH�DV�SRVVLEOH�ZLWK�UHJDUG�WR�UDFH��FODVV��JHQGHU��DQG�VH[XDO�RULHQWDWLRQ��5RVVHU���������2QO\�WKHQ�LV�LW�OHVV�OLNHO\�WKDW�WKH�SHUVSHFWLYH�RI�RQH�JURXS�ZLOO�ELDV�UHVHDUFK�GHVLJQ��DSSURDFKHV��VXEMHFWV��DQG�LQWHUSUHWDWLRQV�

+RZHYHU��JLYHQ�WKDW�WKH�RYHUDOO�DJHQGD�IRU�UHVHDUFK�SROLFLHV�FRQFHUQLQJ�DFFHVV�WR�KHDOWK�FDUH�LV�VHW�LQ�WKH�SROLWLFDO�DUHQD��SROLWLFLDQV�PXVW�DOVR�UHIOHFW�WKH�GLYHUVLW\�DQG�QHHGV�RI�WKH�SRSXODWLRQ��7KHQ�ZH�FDQ�ZRUN�WRJHWKHU�WR�RYHUFRPH�JHQGHU�ELDV�LQ�KHDOWK�UHVHDUFK�

5HIHUHQFHV

$UGLWWL��5LWD��������)HPLQLVP�DQG�VFLHQFH��,Q�5LWD�$UGLWWL��3DW�%UHQQDQ��DQG�6WHYH�&DYUDN��HGV����6FLHQFH�DQG�OLEHUDWLRQ��%RVWRQ��6RXWK�(QG�3UHVV�

$UGLWWL��5LWD��'XHOOL�.OHLQ��5HQDWH��DQG�0LQGHQ��6KHOOH\��������7HVW�WXEH�ZRPHQ��:KDW�IXWXUH�IRU�PRWKHUKRRG"�/RQGRQ��3DQGRUD�3UHVV�

$\DQLDQ��-��=���DQG�(SVWHLQ��$��0��������'LIIHUHQFHV�LQ�WKH�XVH�RI�SURFHGXUHV�EHWZHHQ�ZRPHQ�DQG�PHQ�KRVSLWDOL]HG�IRU�FRURQDU\�KHDUW�GLVHDVH��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH��������±����

%HOO��1RUD��������%RDUG�RI�WKH�1DWLRQDO�/HDGHUVKLS�&RDOLWLRQ�RQ�$,'6��3HUVRQDO�FRPPXQLFDWLRQ�

%LUNH��/\QGD��������:RPHQ��IHPLQLVP��DQG�ELRORJ\��1HZ�<RUN��0HWKXHQ�

%OHLHU��5XWK��������6FLHQFH�DQG�JHQGHU��$�FULWLTXH�RI�ELRORJ\�DQG�LWV�WKHRULHV�RQ�ZRPHQ��1HZ�<RUN��3HUJDPRQ�3UHVV�

BBBBBB��������6H[�GLIIHUHQFHV�UHVHDUFK��6FLHQFH�RU�EHOLHI"�,Q�5XWK�%OHLHU��HG����)HPLQLVW�DSSURDFKHV�WR�VFLHQFH��1HZ�<RUN��3HUJDPRQ�3UHVV�

%RVWRQ�:RPHQV�+HDOWK�%RRN�&ROOHFWLYH��������7KH�QHZ�RXU�ERGLHV��RXUVHOYHV��1HZ�<RUN��6LPRQ�DQG�6FKXVWHU�

&KDYNLQ��:���'ULYHU��&���DQG�)RUPDQ��3��������7KH�FULVLV�LQ�1HZ�<RUN�&LW\V�SHULQDWDO�VHUYLFHV��1HZ�<RUN�6WDWH�-RXUQDO�RI�0HGLFLQH�����QR��������±����

&RUHD��*���HW�DO���HGV����������0DQ�PDGH�ZRPHQ��+RZ�QHZ�UHSURGXFWLYH�WHFKQRORJLHV�DIIHFW�ZRPHQ��%ORRPLQJWRQ��,QGLDQD�8QLYHUVLW\�3UHVV�

&RUHD��*HQD��DQG�,QFH��6��������5HSRUW�RI�D�VXUYH\�RI�,9)�FOLQLFV�LQ�WKH�8�6��,Q�3DWULFLD�6SDOORQH�DQG�'HERUDK�/��6WHLQEHUJ��HGV����0DGH�WR�RUGHU��7KH�P\WK�RI�UHSURGXFWLYH�DQG�JHQHWLF�SURJUHVV��2[IRUG��3HUJDPRQ�3UHVV�

&RZDQ��%HOLWD��������(WKLFDO�SUREOHPV�LQ�JRYHUQPHQW�IXQGHG�FRQWUDFHSWLYH�UHVHDUFK��,Q�+HOHQ�+ROPHV��%HWW\�+RVNLQV��DQG�0LFKDHO�*URVV��HGV����%LUWK�FRQWURO�DQG�FRQWUROOLQJ�ELUWK��:RPHQ�FHQWHUHG�SHUVSHFWLYHV��SS����±����&OLIWRQ��1�-���+XPDQD�3UHVV�

'LOO��%RQQLH�7��������5DFH��FODVV�DQG�JHQGHU��3URVSHFWV�IRU�DQ�DOO�LQFOXVLYH�VLVWHUKRRG��)HPLQLVW�6WXGLHV�����

'UHLIXV��&ODXGLD��������6HL]LQJ�RXU�ERGLHV��1HZ�<RUN��9LQWDJH�%RRNV�

(KUHQUHLFK��%DUEDUD��DQG�(QJOLVK��'HLUGUH��������)RU�KHU�RZQ�JRRG��1HZ�<RUN��$QFKRU�3UHVV�

)DXVWR�6WHUOLQJ��$QQH��������0\WKV�RI�JHQGHU��1HZ�<RUN��%DVLF�%RRNV�

)HH��(OL]DEHWK��������,V�IHPLQLVP�D�WKUHDW�WR�VFLHQWLILF�REMHFWLYLW\"�,QWHUQDWLRQDO�-RXUQDO�RI�:RPHQV�6WXGLHV������±����

BBBBBB��������$�IHPLQLVW�FULWLTXH�RI�VFLHQWLILF�REMHFWLYLW\��6FLHQFH�IRU�WKH�3HRSOH�����QR������

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 7: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH���

*LOOLJDQ��&DURO��������,Q�D�GLIIHUHQW�YRLFH��3V\FKRORJLFDO�WKHRU\�DQG�ZRPHQV�GHYHORSPHQW��&DPEULGJH��0DVV���+DUYDUG�8QLYHUVLW\�3UHVV�

*ROG]LHKHU��-RVHSK�:���0RVHV��/RXLV��$YHUNLQ��(XJHQH��6FKHHO��&RUD��DQG�7DEHU��%HQ������D��$�SODFHER�FRQWUROOHG�GRXEOH�EOLQG�FURVVRYHU�LQYHVWLJDWLRQ�RI�WKH�VLGH�HIIHFWV�DWWULEXWHG�WR�RUDO�FRQWUDFHSWLYHV��)HUWLOLW\�DQG�6WHULOLW\�����QR�������±����

BBBBBB������E��1HUYRXVQHVV�DQG�GHSUHVVLRQ�DWWULEXWHG�WR�RUDO�FRQWUDFHSWLYHV��$�GRXEOH�EOLQG��SODFHER�FRQWUROOHG�VWXG\��$PHULFDQ�-RXUQDO�RI�2EVWHWULFV�DQG�*\QHFRORJ\��������±�����

*UREEHH��'��(���HW�DO��������&RIIHH��FDIIHLQH��DQG�FDUGLRYDVFXODU�GLVHDVH�LQ�PHQ��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH���������±�����

*XUZLW]��-HUU\�+���1DQDQGD��)��&RORQHO��DQG�$YRUQ��-HUU\��������7KH�H[FOXVLRQ�RI�WKH�HOGHUO\�DQG�ZRPHQ�IURP�FOLQLFDO�WULDOV�LQ�DFXWH�P\RFDUGLDO�LQIDUFWLRQ��-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ������QR��������±�����

+DPLOWRQ��-HDQ��������$YRLGLQJ�PHWKRGRORJLFDO�ELDVHV�LQ�JHQGHU�UHODWHG�UHVHDUFK��,Q�:RPHQV�KHDOWK�UHSRUW�RI�WKH�3XEOLF�+HDOWK�6HUYLFH�7DVN�)RUFH�RQ�:RPHQV�+HDOWK�,VVXHV��:DVKLQJWRQ��'�&���8�6��'HSDUWPHQW�RI�+HDOWK�DQG�+XPDQ�6HUYLFH�3XEOLF�6HUYLFH�

+DUDZD\��'RQQD��������$QLPDO�VRFLRORJ\�DQG�D�QDWXUDO�HFRQRP\�RI�WKH�ERG\�SROLWLF��3DUW�,��$�SROLWLFDO�SK\VLRORJ\�RI�GRPLQDQFH��DQG�$QLPDO�VRFLRORJ\�DQG�D�QDWXUDO�HFRQRP\�RI�WKH�ERG\�SROLWLF��3DUW�,,��7KH�SDVW�LV�WKH�FRQWHVWHG�]RQH��+XPDQ�QDWXUH�DQG�WKHRULHV�RI�SURGXFWLRQ�DQG�UHSURGXFWLRQ�LQ�SULPDWH�EHKDYLRU�VWXGLHV��6LJQV��-RXUQDO�RI�:RPHQ�LQ�&XOWXUH�DQG�6RFLHW\����QR�����±���

BBBBBB��������0RQNH\V��DOLHQV��DQG�ZRPHQ��/RYH��VFLHQFH��DQG�SROLWLFV�DW�WKH�LQWHUVHFWLRQ�RI�IHPLQLVW�WKHRU\�DQG�FRORQLDO�GLVFRXUVH��:RPHQV�6WXGLHV�,QWHUQDWLRQDO�)RUXP�����QR�������±����

+DUGLQJ��6DQGUD��������7KH�VFLHQFH�TXHVWLRQ�LQ�IHPLQLVP��,WKDFD��1�<���&RUQHOO�8QLYHUVLW\�3UHVV�

+HDO\��%HUQDGLQH��������:RPHQV�KHDOWK��SXEOLF�ZHOIDUH��-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ������QR�������±����

+HLQ��+LOGH��������:RPHQ�DQG�VFLHQFH��)LWWLQJ�PHQ�WR�WKLQN�DERXW�QDWXUH��,QWHUQDWLRQDO�-RXUQDO�RI�:RPHQV�6WXGLHV������±����

+RIIPDQ��-��&��������%LRUK\WKPV�LQ�KXPDQ�UHSURGXFWLRQ��7KH�QRW�VR�VWHDG\�VWDWHV��6LJQV��-RXUQDO�RI�:RPHQ�LQ�&XOWXUH�DQG�6RFLHW\����QR�������±����

+ROPHV��+HOHQ�%��������5HSURGXFWLYH�WHFKQRORJLHV��7KH�ELUWK�RI�D�ZRPHQ�FHQWHUHG�DQDO\VLV��,Q�+HOHQ�%��+ROPHV�HW�DO���HGV����7KH�FXVWRP�PDGH�FKLOG"�&OLIWRQ��1�-���+XPDQD�3UHVV�

+XEEDUG��5XWK��������7KH�SROLWLFV�RI�ZRPHQV�ELRORJ\��1HZ�%UXQVZLFN��1�-���5XWJHUV�8QLYHUVLW\�3UHVV�

-DJJDU��$OLVRQ�0��������)HPLQLVW�SROLWLFV�DQG�KXPDQ�QDWXUH��7RWRZD��1�<���5RZPDQ�DQG�$OODQKHDG�

-RQHV��-DPHV�+��������%DG�EORRG��7KH�7XVNHJHH�V\SKLOLV�H[SHULPHQW��1HZ�<RUN��7KH�)UHH�3UHVV�

.HOOHU��(YHO\Q�)R[��������)HPLQLVP�DQG�VFLHQFH��6LJQV��-RXUQDO�RI�:RPHQ�LQ�&XOWXUH�DQG�6RFLHW\����QR�������±����

BBBBBB��������$�IHHOLQJ�IRU�WKH�RUJDQLVP��7KH�OLIH�DQG�ZRUN�RI�%DUEDUD�0F&OLQWRFN��1HZ�<RUN��:��+��)UHHPDQ�

BBBBBB��������5HIOHFWLRQV�RQ�JHQGHU�DQG�VFLHQFH��1HZ�+DYHQ��&RQQ���<DOH�8QLYHUVLW\�3UHVV�

.LUVFKVWHLQ��5XWK�/��������:RPHQV�KHDOWK��5HSRUW�RI�WKH�3XEOLF�+HDOWK�6HUYLFH�7DVN�)RUFH�RQ�:RPHQV�+HDOWK�,VVXHV��9RO�����:DVKLQJWRQ��'�&���8�6��'HSDUWPHQW�RI�+HDOWK�DQG�+XPDQ�6HUYLFHV�3XEOLF�+HDOWK�6HUYLFH�

.OHLQ��5HQDWH�'��������,QIHUWLOLW\��/RQGRQ��3DQGRUD�3UHVV�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 8: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH���

.UDPDUDH��&KHULV��DQG�7UHLFKOHU��3DXOD��������$�IHPLQLVW�GLFWLRQDU\��/RQGRQ��3DQGRUD�3UHVV�

.XKQ��7KRPDV�6��������7KH�VWUXFWXUH�RI�VFLHQWLILF�UHYROXWLRQV���QG�HG��&KLFDJR��7KH�8QLYHUVLW\�RI�&KLFDJR�3UHVV�

/DNRII��5RELQ��������/DQJXDJH�DQG�ZRPDQV�SODFH��1HZ�<RUN��+DUSHU�DQG�5RZ�3XEOLVKHUV��,QF�

/RQJLQR��+HOHQ��������6FLHQFH�DV�VRFLDO�NQRZOHGJH��9DOXHV�DQG�REMHFWLYLW\�LQ�VFLHQWLILF�LQTXLU\��3ULQFHWRQ��1�-���3ULQFHWRQ�8QLYHUVLW\�3UHVV�

0DQOH\��$XGUH\��/LQ�)X��-DQH��0LUDQGD��0DJGDOHQD��1RRQDQ��$ODQ��DQG�3DUNHU��7DQ\D��������6SHFLDO�KHDOWK�FRQFHUQV�RI�HWKQLF�PLQRULW\�ZRPHQ�LQ�ZRPHQV�KHDOWK��5HSRUW�RI�WKH�3XEOLF�+HDOWK�6HUYLFH�7DVN�)RUFH�RQ�:RPHQV�+HDOWK�,VVXHV��:DVKLQJWRQ��'�&���8�6��'HSDUWPHQW�RI�+HDOWK�DQG�+XPDQ�6HUYLFHV�

0DUWH��&���DQG�$QDVWRV��.��������:RPHQ²WKH�PLVVLQJ�SHUVRQV�LQ�WKH�$,'6�HSLGHPLF��3DUW�,,��+HDOWK�3$&�%XOOHWLQ�����QR������±���

0F/HRG��6��������6FLHQWLILF�FRORQLDOLVP��$�FURVV�FXOWXUDO�FRPSDULVRQ��:DVKLQJWRQ��'�&���6PLWKVRQLDQ�,QVWLWXWLRQ�3UHVV�

0RQH\��-RKQ��DQG�(UKDUGW��$QNH��������0DQ�DQG�ZRPDQ��ER\�DQG�JLUO��%DOWLPRUH��-RKQV�+RSNLQV�8QLYHUVLW\�3UHVV�

0XOWLSOH�5LVN�)DFWRU�,QWHUYHQWLRQ�7ULDO�5HVHDUFK�*URXS��������0RUWDOLW\�UDWHV�DIWHU������\HDUV�IRU�SDUWLFLSDQWV�LQ�WKH�0XOWLSOH�5LVN�)DFWRU�,QWHUYHQWLRQ�7ULDO��)LQGLQJV�UHODWHG�WR�D�SULRU�K\SRWKHVLV�RI�WKH�WULDO��-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ���������±�����

1DUULJDQ��'HERUDK��������5HVHDUFK�WR�LPSURYH�ZRPHQV�KHDOWK��$Q�DJHQGD�IRU�HTXLW\��7KH�1HWZRUN�1HZV��1DWLRQDO�:RPHQV�+HDOWK�1HWZRUN��0DUFK�$SULO�0D\�������

1DWLRQDO�6FLHQFH�)RXQGDWLRQ��������6FLHQFH�DQG�(QJLQHHULQJ�,QGLFDWRUV��16%����$SSHQGL[�7DEOH��±����:DVKLQJWRQ��'�&���16)�

1RUZRRG��&KULV��������$ODUPLQJ�ULVH�LQ�GHDWKV��0V���-XO\����±���

3LQQ��9LYLDQ��DQG�/D5RVD��-XGLWK��������2YHUYLHZ��2IILFH�RI�UHVHDUFK�RQ�ZRPHQV�KHDOWK��1DWLRQDO�,QVWLWXWHV�RI�+HDOWK��SS���±���

5RVVHU��6XH�9��������7HDFKLQJ�VFLHQFH�DQG�KHDOWK�IURP�D�IHPLQLVW�SHUVSHFWLYH��$�SUDFWLFDO�JXLGH��(OPVIRUG��1�<���3HUJDPRQ�3UHVV�

BBBBBB��������:RPHQ�LQ�VFLHQFH�DQG�KHDOWK�FDUH��$�JHQGHU�DW�ULVN��,Q�6XH�9��5RVVHU��HG����)HPLQLVP�ZLWKLQ�WKH�VFLHQFH�RI�KHDOWK�FDUH�SURIHVVLRQV��2YHUFRPLQJ�UHVLVWDQFH��(OPVIRUG��1�<���3HUJDPRQ�3UHVV�

BBBBBB��������$,'6�DQG�ZRPHQ��$,'6�(GXFDWLRQ�DQG�3UHYHQWLRQ����QR�������±����

5X]HN��6KHU\O��������:RPHQV�KHDOWK��6LVWHUKRRG�LV�SRZHUIXO��EXW�VR�DUH�UDFH�DQG�FODVV��.H\QRWH�DGGUHVV�GHOLYHUHG�DW�6RXWKHDVW�:RPHQV�6WXGLHV�$VVRFLDWLRQ�$QQXDO�&RQIHUHQFH��)HEUXDU\�����8QLYHUVLW\�RI�1RUWK�&DUROLQD�&KDSHO�+LOO�

6FLHQFH�DQG�JRYHUQPHQW�UHSRUW��������:DVKLQJWRQ��'�&���0DUFK��������QR������

6HOZ\Q��3��$���HW�DO��������3URVSHFWLYH�VWXG\�RI�KXPDQ�LPPXQRGHILFLHQF\�YLUXV�LQIHFWLRQ�DQG�SUHJQDQF\�RXWFRPHV�LQ�LQWUDYHQRXV�GUXJ�XVHUV��-RXUQDO�RI�WKH�$PHULFDQ�0HGLFDO�$VVRFLDWLRQ���������±�����

6WHHULQJ�&RPPLWWHH�RI�WKH�3K\VLFLDQV�+HDOWK�6WXG\�5HVHDUFK�*URXS��������6SHFLDO�UHSRUW��3UHOLPLQDU\�UHSRUW�RI�ILQGLQJV�IURP�WKH�DVSLULQ�FRPSRQHQW�RI�WKH�RQJRLQJ�SK\VLFLDQV�KHDOWK�VWXG\��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH������QR�������±����

6WHHULQJ�&RPPLWWHH�RI�WKH�3K\VLFLDQV�+HDOWK�6WXG\�*URXS��������)LQDO�UHSRUW�RQ�WKH�DVSLULQ�FRPSRQHQW�RI�WKH�RQJRLQJ�SK\VLFLDQV�KHDOWK�VWXG\��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH��������±����

6WHLQJDUW��5��0���3DFNHV��0���+DPP��3���HW�DO��������6H[�GLIIHUHQFHV�LQ�WKH�PDQDJHPHQW�RI�FRURQDU\�DUWHU\�GLVHDVH��1HZ�(QJODQG�-RXUQDO�RI�0HGLFLQH��������±����

7KRUQH��%DUULH��������&ODLPLQJ�YHUEDO�VSDFH��:RPHQ��VSHHFK�DQG�ODQJXDJH�LQ�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚

Page 9: Chapter One Androcentric Bias in Clinical Research

� �

�3DJH���

FROOHJH�FODVVURRPV��3DSHU�SUHVHQWHG�DW�WKH�5HVHDUFK�&RQIHUHQFH�RQ�(GXFDWLRQDO�(QYLURQPHQWV�DQG�WKH�8QGHUJUDGXDWH�:RPHQ��6HSWHPEHU���±����:HOOHVOH\�&ROOHJH�

9HDWFK��5REHUW�0��������([SHULPHQWDO�SUHJQDQF\��+DVWLQJV�&HQWHU�5HSRUW����±��

:HEVWHU��'RXJODV��DQG�:HEVWHU��0ROO\��������&RPSDUDWLYH�YHUWHEUDWH�PRUSKRORJ\��1HZ�<RUN��$FDGHPLF�3UHVV�

=LPPHUPDQ��%���HW�DO��������3HRSOHV�VFLHQFH��,Q�5LWD�$UGLWWL��3DW�%UHQQDQ��DQG�6WHYH�&DYUDN��HGV����6FLHQFH�DQG�OLEHUDWLRQ��SS�����±�����%RVWRQ��6RXWK�(QG�3UHVV�

鐨鑔鑕鑞鑗鑎鑌鑍鑙鐅�鐅鐖鐞鐞鐙鐓鐅鐮鑓鑉鑎鑆鑓鑆鐅鐺鑓鑎鑛鑊鑗鑘鑎鑙鑞鐅鐵鑗鑊鑘鑘鐓鐅鐦鑑鑑鐅鑗鑎鑌鑍鑙鑘鐅鑗鑊鑘鑊鑗鑛鑊鑉鐓鐅鐲鑆鑞鐅鑓鑔鑙鐅鑇鑊鐅鑗鑊鑕鑗鑔鑉鑚鑈鑊鑉鐅鑎鑓鐅鑆鑓鑞鐅鑋鑔鑗鑒鐅鑜鑎鑙鑍鑔鑚鑙鐅鑕鑊鑗鑒鑎鑘鑘鑎鑔鑓鐅鑋鑗鑔鑒鐅鑙鑍鑊鐅鑕鑚鑇鑑鑎鑘鑍鑊鑗鐑鐅鑊鑝鑈鑊鑕鑙鐅鑋鑆鑎鑗鐅鑚鑘鑊鑘鐅鑕鑊鑗鑒鑎鑙鑙鑊鑉鐅鑚鑓鑉鑊鑗鐅鐺鐓鐸鐓鐅鑔鑗鐅鑆鑕鑕鑑鑎鑈鑆鑇鑑鑊

鑈鑔鑕鑞鑗鑎鑌鑍鑙鐅鑑鑆鑜鐓

鐪鐧鐸鐨鐴鐅鐵鑚鑇鑑鑎鑘鑍鑎鑓鑌鐅鐟鐅鑊鐧鑔鑔鑐鐅鐨鑔鑑鑑鑊鑈鑙鑎鑔鑓鐅鐍鐪鐧鐸鐨鐴鑍鑔鑘鑙鐎鐅鐒鐅鑕鑗鑎鑓鑙鑊鑉鐅鑔鑓鐅鐝鐔鐗鐚鐔鐗鐕鐖鐙鐅鐚鐟鐕鐜鐅鐵鐲鐅鑛鑎鑆鐅鐺鐳鐮鐻鐅鐴鐫鐅鐹鐪鐽鐦鐸鐅鐦鐹鐅鐩鐦鐱鐱鐦鐸鐦鐳鐟鐅鐚鐝鐘鐅鐠鐅鐷鑔鑘鑘鑊鑗鐑鐅鐸鑚鑊鐅鐻鑎鑑鑍鑆鑚鑊鑗鐓鐠鐅鐼鑔鑒鑊鑓鐌鑘鐅鐭鑊鑆鑑鑙鑍鐒鐒鐅鐲鑎鑘鑘鑎鑓鑌鐅鐫鑗鑔鑒鐅鐺鐓鐸鐓鐅鐲鑊鑉鑎鑈鑎鑓鑊鐦鑈鑈鑔鑚鑓鑙鐟鐅鑘鐖鐗鐗鐚鐚鐝鐚