Why sex matters in health research

Starting our health careers in the 1970s, we remember a time when little attention was paid to differences in health needs between women and men.

Katherine, who was a cardiac care nurse at the time, often suspected that the women in her care might need a different approach to treatment, but there was scant scientific evidence available to make the case. And Delia, a health educator working on cancer prevention among poor populations, saw how inadequate resources for basic women’s health services often resulted in early death from potentially preventable conditions such as breast and cervical cancer.

Both of us came away from these experiences with “a women’s health perspective.” That is, we understood that shining a light on sex-based differences could result in better health and health care for everybody. It’s a point of view that makes scientists continually ask: How do fundamental biological and social differences between men and women cause them to experience health states differently? What are the implications of these differences when it comes to screening, prevention, and treatment of various conditions? And how do health care and policy need to be designed to meet men and women’s unique differences?

Without this awareness, scientists and health care providers may not recognize, for example, that genetic or hormonal differences between men and women can affect how drugs are absorbed, metabolized, and excreted; or that risks for heart disease, depression, and intimate-partner violence are different for women than for men and may affect them differently at various stages of life.

Fortunately, Group Health Research Institute is a great place to study such issues. We have access to data on a large, stable population of women and men getting their care in real-world clinical settings over time. Group Health providers partner with us, offering their perspectives on ways to design and improve care. We also have the opportunity to collaborate with similar organizations through the HMO Research Network, the Patient Centered Outcomes Research Network’s PCORnet, and the Food and Drug Administration’s Mini-Sentinel Initiative—affiliations that provide statistical power for further discovery.

Our clinical trials and observational research have led to many important discoveries—including a better understanding of how menopausal hormone therapy, contraceptives, and other drug treatments affect women’s well being. We’ve shown that population-based Chlamydia screening can reduce the incidence of pelvic inflammatory disease and its associated infertility. We’ve discovered ways to improve the quality and effectiveness of screening for breast cancer and other cancers. And we’re continuing to ask and answer gender-related questions to improve health across the life span—questions like:

• How do certain drugs taken in pregnancy affect the health of the mother and her baby?
• How effective is early-adolescent human papillomavirus (HPV) vaccine in preventing cervical cancer later in life?
• How do oral contraceptives affect a woman’s bone density and risk for fractures?
• What are the benefits and risks of various contraceptives?
• How effective are non-hormonal approaches to menopause symptoms—e.g., herbal supplements, soy diets, or yoga?
• How can we find more effective ways to treat urinary tract infections and incontinence, problems more commonly seen in women and largely neglected by medical research?
• What are the most effective treatments for heart disease, diabetes, and other chronic illnesses—and how should these treatments differ between men and women?
• What are the health effects of caring for a relative with dementia, a role more often taken by wives and daughters?

Not only do we explore these questions in our own research, but we extend our work through a postdoctoral-fellowship training grant funded by the National Institute on Aging. Over the past eight years, the fellowship has supported 11 outstanding trainees to work with our faculty on projects aimed at improving health care for aging women. All 11 have gone on to research careers at places such as Case Western University, Albert Einstein College of Medicine, Cornell University, the University of Vermont, and the University of Washington.

Through our lens of a “women’s health perspective” we’ll keep helping researchers, providers, and others address sex bias in research and care—and we’ll work to eliminate it. Doing so, we’ll continue finding practical ways to improve health and health care for everyone.

Katherine Newton, PhD
Director of Research & External Affairs
Senior Investigator
Group Health Research Institute

Delia Scholes, PhD
Senior Investigator
Group Health Research Institute