Exploring Different Methods and Approaches to Doing Feminist Biomedical Science

As Heather Shattuck-Heidorn explains in her recent post, scientific researchers, particularly in the health sciences, are being required by funding institutions to consider the concepts sex and/or gender in their research. Despite the introduction of these requirements, as Sari van Anders [Editor’s note: Hi! that’s ME!] summarizes in her review of Johnson et al., (2014), there is still inconsistent use of the concepts across disciplines as many researchers continue to use gender as a proxy for sex and sex and/or gender to simply mean including women in research studies.

This led us to search the feminist science literature for some direction. We limited feminist science scholarship to feminist scientists and feminist science studies scholars in the fields of biomedicine and public health. These scholars explicitly indicate that they use feminist approaches to science or use feminist conceptions of gender, sex, race and/or ethnicity in their work. What methods have feminist scientists developed to do biomedical science differently? How do these methods improve scientific knowledge and understanding of the world? Using these questions to guide our work, we sought to synthesize the theoretical and methodological approaches in the feminist biomedical science literature.

In our paper[1], we categorize feminist approaches to biomedical science into three main approaches: strong objectivity, partial perspective, and gendered innovations. By grouping the literature into these categories, we identify and describe different ways of doing feminist biomedical science and the particular aspects of the scientific method that each feminist approach seeks to change and improve.

The strong objectivity framework draws on the work of feminist science philosopher Sandra Harding and argues that science can be more objective if researchers include diverse perspectives and subjects/ experiences (for a deeper explanation, see Sari’s post Is Subjectivity Biased [Editor’s note: I am glad someone finally noticed how deep I am.]) into their research designs. Feminist empiricist and feminist standpoint approaches offer methodological direction for feminist scientists looking to apply the strong objectivity framework [Editor’s note: after all, it’s hard to take theory into practice, so this is really important]. Feminist empiricists offer a way for scientists to think critically about the theories and concepts they will employ by applying feminist and/or antiracist concepts and theories to critically analyze research in their fields of interest. This allows researchers to identify critical flaws in previous research designs and thereby open up new opportunities for research. Feminist standpoint approaches offer a way for scientists to locate their subjects and account for interacting social factors produced by gendered and racialized environments. The work of feminist biologist Anne Fausto-Sterling, The Bare Bones of Sex and The Bare Bones of Race [Editor’s note: I don’t mean to brag, but I totally know Anne Fausto-Sterling AND Sandra Harding so basically I am famous], provides an example of research that falls under the strong objectivity framework. Fausto-Sterling identifies critical discrepancies in how researchers define and measure bone health among and between women and men and suggests using a dynamics systems approach to account for social, geographical, and historical environmental factors that shape sex/gender and racial differences in bone health. In other words, the strong objectivity framework uses feminist concepts and theories to think critically about hypotheses, data collection methods, and interpretations of results, and promotes the design more complex and rigorous research studies

The partial perspectives framework draws on the work of feminist science philosopher Donna Haraway [Editor’s note: I don’t really know Donna Haraway but we emailed once so, basically, we are BFFs] and encourages feminist scientists to go beyond exposing gender and racial assumptions and “bad science” to examine the partial perspectives of scientific researchers. The partial perspectives framework does not seek to provide a more objective or truer knowledge of the world but rather strives to achieve what Haraway terms “feminist objectivity”. In contrast to strong objectivity, feminist objectivity requires researchers to think reflexively about their research interests and locate their objects of study and in doing so, deconstruct the web of power relations that allows certain sexed, gendered, and raced bodies to be produced and naturalized. Feminist science scholars El-Haj (2007), Gannett (2004), and M’charek (2005, 2013) provide examples of research that falls under the partial perspectives framework. These scholars use examples from population geneticists, DNA forensics and medical practices to trace how “biologi­cal races” [Editor’s note: I put irony quotes around biological races because I think they belong there and also because you can “never” have “enough” irony “quotes”] have been re-constituted in and through these scientific technologies and practices. And so, the partial perspectives framework seeks to deconstruct fields of research even before researchers consider the concepts, theories, and data collection methods they will use to design their research and thereby creates conceptual space for new research possibilities.

Finally, the gendered innovations framework draws on the work of feminist science historian Londa Schiebinger [Editor’s note: I don’t know Londa Schiebinger at all but I have read her work so, um, well, I’ve got nothing] and argues that integrating feminist concepts such as sex and gender into scientific research will advance our understanding and produce more scientific innovations. The methodology of this framework draws largely on the work of feminist scientists working in the fields of public health and biomedicine that have proposed ways to integrate and operationalize the concepts of sex, gender, race and/or ethnicity into the research process. Feminist scientists such as Johnson et al. ( 2009), Kaiser (2012), Krieger (2003), Springer et al. (2012), Ritz et al. (2014), Ford and Airhihenbuwa (2010), Gravlee (2009), and Hankivsky (2012) offer practical guidance to researchers seeking to use these concepts. The cross-disciplinary collaboration required to do this work has the potential to foster a shared language and the creation of new ways of operationalizing these concepts (both the social and biomedical sciences; see Hird 2009). Basically, the gendered innovations approach introduces additional steps in the scientific research process so that researchers account for sex, gender, and other intersecting factors related to their research that they might not have captured otherwise.

The various feminist methods we identify in our paper are illustrated in Figure 1. There are areas of research that I’m sure we missed in and outside the field of biomedicine. This paper is by no means an exhaustive review but rather simply seeks to provide a starting point to discuss, refine, and name some of the different feminist methods for doing science differently. [Editor’s note: what an awesome figure!!].

[1] See: Sarah Singh and Ineke Klinge (2015) ‘Mining for Methods: A Review of the Theoretical and Methodological Contributions of Feminist Science Studies’, Freiburger Zeitschrift für GeschlechterStudien (fzg). 12 (2). Pg. 15-31.

Sex, Gender, and the New NIH Policy

In May 2014, the NIH released a new policy mandate requiring equal representation of “sex” in all preclinical research (the research on animals and cellular materials that occurs before clinical trials in humans). I am part of a Harvard-based working group of scientists and science studies scholars that spent the last year reviewing the evidence for this new policy. In a recent opinion piece in the Proceedings of the National Academy of Sciences, we argue that while this policy is well intended, if the goal is to address women’s health inequities, it is ultimately unlikely to be effective. Here, at the invitation of Gap Junction Science, I delve into some of our criticisms in a more substantial way for a feminist science studies audience.

 

First, a bit of history. Once upon a time, white males were taken as the normative “species type” and clinical medical trials largely included only white men as participants. As a result, occasionally women using medications would have serious and unanticipated adverse reactions to drugs that had proved safe in men. In the 1980s feminists and/or medical scientists began agitating to improve the representation of women in medical research. This led the NIH to mandate the inclusion of women in clinical trials and to establish the Office of Women’s Health Research in the early 1990s. Yet today, despite adequate representation of women in clinical trials, women continue to disproportionately report adverse drug reactions. These drug reactions are a serious public health concern, as they are responsible for up to 5% of emergency room visits and roughly 100,000 deaths a year in the US.

Why, when women are approximately equally represented in clinical trials, do women continue to report a higher percentage of these reactions? According to proponents of the new NIH mandate, it is largely due to the unequal representation of females in preclinical research; i.e., with animal models and cellular material. Similar to human studies of yore, in some areas of preclinical research, research material is predominately male, and the donor sex of cellular material is often not reported. The new mandate suggests that unequal representation in preclinical materials is lurking behind the health disparity seen in men and women’s adverse drug reactions. NIH policies must serve human health and the explicit policy aim of the new mandate is to improve health outcomes between men and women in the realm of adverse drug reactions.

In our opinion piece, we argue that this policy is not likely to achieve that goal for two primary reasons. First, the non-hypothesis-driven study of sex differences in all preclinical research lacks conceptual clarity about just what sex is. Animal and cellular materials that poorly model human sex run the risk of generating non-replicable or irrelevant findings. For some preclinical materials, such as cell lineages, it is unknown whether XX and XY lineages are valid models of sex differences in humans (see this older post by Stacey Ritz!). For example, a non-negligible percent of XY cell line material has lost the Y chromosome during repeated replication. To what degree do these materials model human male biology? Animal models of sex difference are also challenging – in social animals housing condition produces significant variability in study outcomes, and male animals are often housed at lower densities than females. When modeling human sex differences in the lab, it is not enough to simply include XX and XY tissues or male and female animals and then attribute any differences found to intrinsic sex. Depending on the disease or condition under investigation, researchers analyzing sex-related factors may need to consider whether hormone exposures are relevant, the appropriate age or developmental stage to discern differences, and other variables. A broad mandate requiring study of sex in preclinical materials overlooks these considerations; instead preclinical sex difference models should be hypothesis-driven and validated with respect to the research question at hand.

Second, human sex-linked health disparities may be attributable to sex, gender, and the interaction of the two; focusing solely on sex variables, the mandate presents an impoverished approach to advancing scientific understanding of health disparities between men and women. Highlighting the need for research on gender alongside sex is a critical contribution of feminist science studies scholars. The case of health disparities in adverse reactions is an excellent example of the need for greater intellectual and institutional commitment to sex-gender research, and here I’ll develop this point in greater detail than our short PNAS piece allowed.

We know that gender influences how women and men interact with the medical system. For instance, women are more likely than men to regularly visit a doctor. The reporting of adverse drug reactions is voluntary, and fascinating recent data released by the FDA indicates that for women, nearly half of the adverse drug reactions on record are self-reported to a doctor, while for men, the majority of reactions are reported by a healthcare professional or other third parties. Similar to women’s greater likelihood to regularly visit a doctor, these data could indicate a greater propensity by women to report the experience of an adverse drug reaction.

Polypharmacy is another gender-related variable influencing higher rates of adverse drug reactions in women. Women are more likely than men to be on multiple medications, a major risk factor for adverse drug reactions. It is possible that the majority of serious drug reactions could be avoided simply by adhering to known information regarding contradicting prescriptions. Oral contraceptives are involved in significant numbers of adverse drug reaction cases. Recent research also indicates that SSRIs (a popular type of antidepressant) increase the risk of serious gastrointestinal adverse effects when combined with non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen). Nearly 1 in 4 US women take antidepressants, more than twice the rate of men, and we have long known that doctors are more likely to diagnose women than men with psychological diseases, even given the same clinical presentation.

Furthermore, there is evidence that some of the sex differences in adverse reactions are due to differences in outcomes such as allergic skin reactions. Allergic skin reactions are especially interesting to consider in light of known sex and gender differences. Outside of the context of adverse drug reactions, women generally report more allergic dermatitis reactions than men, a disparity linked to differences in exposure and contact factors, rather than intrinsic sex differences. Research on eczema has also shown that women experience greater distress from active eczema episodes, and that men are more likely to leave their eczema untreated. How these gender-inflicted differences in exposure factors, distress experience, and treatment probability in non-drug associated allergic dermatitis relate to the greater reported incidence of allergic dermal adverse drug reactions in women is unknown.

[Editor’s Note: IS THIS THE BEST MEME THINGIE EVER OR WHAT?!]

This is not to say there are no sex-intrinsic differences in adverse drug reactions, including those potentially related to drug metabolism. On average, there are known differences in enzymatic activity between men and women, though these are not consistent in all studies and may vary by age and ethnicity. We emphatically support basic and preclinical research on these types of sex differences. In our article we specifically argue for more validation research on how animal and cellular materials can model human sex differences. But we believe that the wholesale introduction of sex as a variable into all preclinical research will produce results of dubious meaning and introduce conceptual muddle into understanding sex and gender disparities in health outcomes. In an atmosphere of limited funding, this mandate will capture institutional resources and energy, which come at an opportunity cost to research on other types of questions. On the question of why women have greater rates of adverse drug reactions, we sorely need studies that examine how both sexed and gendered factors interact in the lives of men and women to create this health disparity.

Heather Shattuck-Heidorn is a Ph.D. candidate in Human Evolutionary Biology, with a secondary field in Women and Gender Studies, at Harvard University. Her research focuses on immune function in humans, and sex and gender in science. You can contact her at heather.shattuckfaegre@gmail.com, HEB Department, 11 Divinity Ave. Cambridge, MA 01239.

Here she comes to save the day: PIPETGIRL!

Editor’s Note: Here is a guest post by Stacey Ritz.

We put it in pink so that people with girl-eyes could read it.

Editor’s Note: I am SO GLAD she is pointing to the lab so that my girl brain can find the way there.

ATTENTION WOMEN SCIENTISTS: It’s not our propensity for falling-in-love/being-falled-in-love-with (#distractinglysexy), or all the weeping (I’ve been drinking PBS to rehydrate myself), or our inferior genes, or our lack of original thoughts, or our “belligerent moods”, that have been holding us back in the laboratory…it has been the lack of an appropriately feminine pipettor! And thank goodness those dark days of marginalization are over, because there is now the PIPETGIRL. <<heaves sigh of relief>>

According to Integra Biosciences, features of the PIPETGIRL that distinguish it from the PIPETBOY are:

  • “A significant weight reduction…”, which is something we all want, AMIRITE LAYDEEZ, I mean I have to fit into this size 2 lab coat before the lab photo next Friday.
  • “….Lighter, with only 195 grams and an optimized ergonomic balance”, because our dainty lady-hands can’t handle the bulky heft of the PIPETBOY acu2, which weighs in at a hefty 195 grams….oh hey wait, that’s the same. They must mean the PIPETBOY pro then, the one that weighs 190 grams. Um, what? SO WHAT IS IT LIGHTER THAN? LIGHTER THAN WHAT? THIS IS SOME BULLSHIT I TELL YOU, my hands are going to get all cramped.
  • “Faster, the new Turbo Mode provides the unit with 20% extra pipetting speed.” That way we can save 10 minutes aliquoting the media and get home in time to make dinner before hubby and the kids start whining.
  • “Longer operating time due to the latest lithium-ion battery technology.” Just like women live longer than men, so the PIPETGIRL outlasts the PIPETBOY.

PLUS BONUS PINKWASHING, Y’ALL! The nice lady scientist wearing a pink sweater under her lab coat, making a heart shape with her hands, has a caption that says “Let’s fight breast cancer together!”, and says “A $15 donation per PIPETGIRL goes to breast cancer research institutes.” To which I say HEY, what about ME and my non-breast cancer research, can you just give me a $15 discount on a PIPETBOY and make a donation to my lab instead?

Integra isn’t the only one selling the PIPETGIRL, you can also get it from other suppliers, and I plan to order mine from Vitaris, to reward them for their MOST AMAZING GRAPHIC of woman’s head making a kissy-face emerging horizontally from the side of a clipboard and her gloved hand clasping a purple pipettor (which is not actually the PIPETGIRL, which is pink, which is puzzling because why is the advertisement is for the PIPETGIRL, I AM SO CONFUSED) coming from above the clipboard.

The clipboard itself reads “ENDLICH ZIEHT DIE EMANZIPATION INS LABOUR EIN!”, which, if my memory of Grade 10 German is correct*, means “end draws the emancipation in the labour one!” But then underneath the picture it says “Emancipation has finally reached the lab – with full-on girl power!”, which is probably a better translation (though again my recollection of Grade 10 German suggests that “girl power” should be “Mädchen Macht” and I don’t see that on the clipboard anywhere). Which means that I guess we should be thanking PIPETGIRL for finally helping us reach gender equity in science! Who knew that a lighter** pink pipettor was all that we needed, eh?

*which it most certainly is not

**DISCLAIMER: NOT ACTUALLY LIGHTER

Medicine (yay!) vs. Medicalization (boo!)

Once, an undergraduate student told me she was experiencing depression, but that she had been concerned about telling me she was on anti-depressants. Why worry about telling me? I asked. She explained that she was worried I would think badly of her for using meds. I sat there, stunned, frantically running over the entirety of anything I had ever said to her or in front of her, wondering where this idea would have come from. Coming up blank, I asked her why she thought that. She explained to me that feminists were against anti-depressants. Again, I was stunned, did the frantic scrolling-through-the-entire-history-of-the-world thing, and came up blank. Of course, I congratulated her for getting treatment, for discussing mental health when it is more typically seen as taboo, and we had a long discussion. And it hit me, then or a bit later, where this all came from…

Feminists are very often against medicalization, but almost none are against MEDICINE. Do those words look too similar to mean different things? Kind of, eh? I mean, objectively they are different words, but they are so same-lookish! Maybe one is just a fancy way of saying the other? Nope. Medicine and medicalization are not the same. Even if they have the same first five letters!

Would you like some fancy definitions for the terms that I just made up? OF COURSE YOU DO! Medicine’s fancy definition: something you put in/on your body to reduce the negative effects of illness/sickness/bad health. And part of defining a term is thinking about who are the experts for that term. So, who is an expert on medicine?

Jon Bon, expert on bad medicine.

Bon Jovi, obviously. This is what Jon Bon says: Your love is like bad medicine | Bad medicine is what I need | Shake it up, just like bad medicine | So let’s play doctor, baby | Cure my disease. Wow. That’s a bit confusing because why does anyone need bad medicine? And, is it all medicine that needs to be shaken, or just the bad kinds? Who else is an expert on medicine? Doctors, pharmacists, some biomedical researchers, epidemiologists, all in addition to Bon Jovi, the reigning champion.

Ok, now for the fancy definition of medicalization: something that unnecessarily grabs a phenomenon from the ‘regular life’ box and puts it into the medical domain box. Who is an expert on medicalization? Here, Bon Jovi lets us down as does music in general (try to get on with life, though) – there are no songs, brilliant or otherwise, about medicalization. Who is left to be an expert on medicalization, then, without the frosted hair contingent? Sociologists of medicine, feminist scholars, medical anthropologists, people with the lived experience of whatever’s being medicalized, and other critical thinkers.

Well! Easy peasy lemon squeezy! Medicine means one thing and medicalization another! Phew.  Medicine = good; medicalization = not so good. Except that the line between the two isn’t so clear. In fact, that blurriness is kind of the point of the concept of medicalization: on one hand, medical folks think a phenomenon IS a legitimate medical target while, on the other hand, scholars and community folks do not. Who is right? This is a case of ‘competing knowledge claims.’ How do we decide which knowledge claim (medicine! or, medicalization!) is right? Helen Longino, a superfamous feminist philosopher of science, argues the only way we do this is with a “community of knowers,” which is a fancy way of saying ‘people.’ But she also argues that this community needs to be diverse. So, you can’t just have, say, MDs arguing over whether something is medicine or medicalization – in fact, the question of whether a thing that is already IN medicine might actually be not-medicine would probably not-occur to most or many mediciney people.

Tricky question: are pharmaceutical companies and their people experts on medicine? Some would argue that they can be experts on medicine but also that they are expert medicalizers. For example, they might have a medicine but no disease! What to do in that case?  The case of the missing disease? Make one up! Critical scholars have demonstrated how diseases sometimes get manufactured so that an existing no-use medicine can be sold. Or, how something that is regular (like balding in men, or small breasts in women) gets repackaged as a disease that can be solved by 10 easy installments of $$$ CALL NOW!

So the line between medicine and medicalization can be blurry because people with differing perspectives and goals will argue about whether the same phenomenon is one thing or another. But the line can be blurry in another way. For example, I’m super preggers, if by ‘super’ we all agree to mean having a really superior experience of the worst parts of pregnancy but don’t worry: if you get pregnant, it will be the best part of your life I PROMISE BECAUSE I HAVE THAT KNOWLEDGE AND POWER. So, why is my pregnancy the worst? Well, I’ve spent many months in bed or on the couch, super nauseous and vomity and uncomfortable and NO, GINGER WILL NOT HELP and YES, I AM ALREADY IN THE SECOND TRIMESTER AND I’M STILL CRAPTASTIC and PLEASE, SOMEONE BUILD A TIME MACHINE SO I CAN FAST FORWARD TO THE BIRTH NO WAY AFTER THE BIRTH NO WAY TIL THE KID IS FIVE YEARS OLD.  So, it’s pretty bad and I’ve been doing a lot of complaining (hey, do what you’re good at, eh?). My friends were all like: um, hey you friend of mine, do you know about this medicine for pregnancy nausea? And I was like yes, thank you, but things aren’t that bad yet. As things got worse, and my complaining ramped up, these friends were like: hey you friend of mine, seriously, there’s this medicine. For pregnancy nausea. Get it. Take it. And I was like, sure, when things get bad enough. Why? Because so much of pregnancy is medicalized, and I was trying to find the personal line between medicine and medicalization (and, no, I don’t need a ‘talking-to’ in the comments).

I mean, look, I’m a feminist scientist, a reproductive sciences person, a hormone researcher, and etc. I am generally pro-medicine and anti-medicalization. But knowing the difference in individual cases can be a nontrivial problem. Is taking anti-nausea pills self-medicating or self-medicalizing? Does it turn an incredibly common (horrifically so, given how debilitating it is) and regular part of the pregnancy “experience” into some sort of disease-like condition/state? I mean, my physical health wasn’t actually compromised since I was able to eat and, mostly, keep food down (sometimes women or other people gestating can’t, and very clearly need medical support to even just live). My psychological health was definitely another story: it’s a misery situation. Obviously, each person is going to have to figure this out for them. Once I finally decided the meds were medicine I took them and never looked back, feeling so much better, and happy with my choice.

So, the line between medicine and medicalization can be blurry, because what counts as a medical problem can be culturally situated (should there be a pill for lots/not much hair? are sticky-outy ears a medical issue? do periods have to be regular?). And, it’s not even always the case that we boo medicalization, because sometimes there might be benefits to putting something in the ‘medical’ box. Still, the presence of medicine (or a pill or a surgery) doesn’t magically transform whatever the medicine is for into a disease UNLESS YOU ARE HARRY HOUDINI AND THEN I RESPECTFULLY WITHDRAW. Feminism is, in part, about engaging with these distinctions (about medicalization vs. medicine, not Harry Houdini YET) even while supporting medical choices. Yes, there’s a tension there, but where isn’t there? (milkshakes.)

Even the cows are male: Impacts of gender/sex policy on grant apps

What happens when grant institutes ask applicants whether they are considering gender and sex? Joy Johnson, Zena Sharman, Bilkis Vissandjee, and Donna E. Stewart found out. But they’re not just your everyday run-of-the-mill finder-outers: Dr. Johnson is the Scientific Director of the Institute of Gender and Health (IGH, one of the Canadian Institutes of Health Research, CIHR), Dr. Sharman is its Assistant Director, Dr. Vissandjee is a Professor at the University of Montreal, and Donna E. Stewart is a Professor at the University of Toronto. You can see the article here. Long introduction short: in December 2010, CIHR instituted a requirement that all applicants had to indicate whether their grant accounted for sex or gender. These authors wanted to see what happened. I feel like it wouldn’t be inappropriate to insert those Law and Order doink-doink sounds here, from when they start off their show, in case you were wondering.

These are the questions: definitely not an onerous burden! And, they provided online links to applicants for help about gender and sex.

Why did CIHR use these questions? Basically, to solve this problem: that scientists generally study only men/males and aren’t really changing. The authors looked at all successfully funded applications (not just a sample). They couldn’t look at unfunded applications because of CIHR privacy laws, which is too bad because it would be interesting to see whether gender/sex attention differed according to funding status. Anyway, the policy made a difference: the purple line shows that relatively fewer applicants did not incorporate sex and gender over time, and the other lines show that relatively more applicants did incorporate especially sex but also gender over time.

Take-home: Over time, more applicants attended to sex and gender, and fewer applicants didn’t.

Also cool: the authors were able to look at fields: clinical research applicants were the most likely to take sex into account, and population health applicants the most likely to address gender. Biomedical applicants were, um, a bit behind: they were the least likely to take gender or sex into account – with over 80% initially saying no to both and ending up with 60% saying no to both (better, but I don’t need my swooning couch anytime soon).

You might be thinking: what about the applicants themselves? We know that ‘gender’ is often code for ‘women,’ which has the corollary that women are way more likely to think about gender than men are. That held true here: men applicants were less likely to involve sex or gender in their project than women applicants. Perusing the figures, it seems to me that the difference between disciplines is more marked than the difference between women and men applicants, though I didn’t run any stats on this.

Also very interesting: some panels were more likely to have applicants focusing on gender and/or sex. These high achievers included:

  • Aboriginal Peoples’ Health
  • Biochemistry and Molecular Biology -B (I don’t think this means it’s the B Team, though, just to be clear)
  • Social and Developmental Aspects of Children’s and Youth’s Health
  • Gender, Sex and Health (it would have been really embarrassing if this category wasn’t on this list.)
  • Psychosocial, Sociocultural and Behavioural Determinants of Health (1 and 2, whatever that means)
  • Public, Community and Population Health -1

I think we can all agree that the first thing anyone would notice on this list is the lack of the Oxford comma for a commonwealth country. AM I RIGHT?! The second thing is that this is actually a bit of a mixed bag but also kind of not. If you excluded the thematic outlier (biochemistry and molecular biology) (and don’t forget the “-B”!!!), all the other titles invoke culture somehow. So gender and sex = culture?

Of course, some panels were more likely to focus on sex, and some on gender. Some were also more likely to not focus on gender or sex, with gender especially absent (usually present ZERO times):

  • Biochemistry & Molecular Biology -A (in stark contrast to its sibling panel, B, above, which must make for some really tense family reunions)
  • Cell Biology & Mechanisms of Disease
  • Cell Physiology
  • Basically any panel that had an “-ology” in it (e.g. Cell Biology & Mechanisms of Disease, Immunology & Transplantation, Developmental Biology, etc.)
  • Basically any panel that has a new fancy way of not saying “-ology” but kind of really meaning it but saying neuroscience or behavioural sciences instead (e.g., Systems & Clinical Neuroscience, Cardiovascular System, Pharmaceutical Sciences, etc.)

Based on this and some other analyses, the authors note, and I like their language:

These results suggest that the integration of sex and gender is divided upon disciplinary lines, with the behavioural and public health communities having adopted the integration sex/gender and those panels based on cellular processes having apparently resisted voluntary incorporation of these considerations (bold mine, ALL MINE!).

I, personally, would have done a very loud tsk tsk and given cellular processes a very stern look, but these authors perhaps took a less volatile approach.

The authors did some qualitative analyses on the applicants’ text answers and found that applicants often conflated sex with gender, using “gender” in animal studies and studies of biological differences. The reverse wasn’t true: people didn’t use sex when they meant gender. And, as I wrote above, women = gender, so the authors note that applicants who were studying women OR who were studying women and men saw themselves as studying gender. Ha ha cry cry. Though some applicants talked about using gender and/or sex as a covariate, disconcertingly people would talk about recruiting equal numbers of women and men but:

… the descriptions of the methods did not specify a plan for analyzing these data by sex and/or gender.

Well, that sounds good. Willy nilly is definitely the best part of science, right? Right? What did people say when they did not integrate sex or gender? Get ready:

This is a basic science research project.

Because gender/sex = not science, as everyone knows. They also said:

No human subjects used in this study.

Because, as even our nations’ preschoolers know, animals come in only one flavor: male. Seriously, try to get someone to call any animal (especially a big, strong, scary, or ugly one) ‘she’ and watch their mouth stop working.

Even daycare-aged kids know that all animals are male. Even the cows are male.

There were other problematic responses, including that because the issue was “equally important” to men and women, gender/sex didn’t need to be accounted for. That is philosophy of logic right there, in action. Or, if applicants were studying only women or only men, then gender/sex was irrelevant. My undergraduate students sometimes struggle with this, to be fair: we live in a culture where gender = gender difference, and sex = sex difference. So if difference isn’t being studied, then a surprising number of people (including, apparently, PhDs and MDs who are studying gender/sex) will think that gender and sex aren’t being studied. Are you studying pregnancy? Well, as everyone knows, that has nothing to do with sex or gender because only women (and of course some trans men) do pregnancy. Are you studying semen? That has nothing to do with sex or gender, since only men (and of course some trans women) do semen. If you studied pregnancy in women and men, or if you studied semen in men and women, well, there you’d be all over gender/sex fer sher.

There was one excuse-I-mean-justification that was very striking and worrisome:

… lack of evidence – for example, no prior evidence of sex or gender-based differences.

Because science, obviously, only studies what’s already known. I mean, that’s what science does, right?! It’s not like we scientists are about producing new knowledge, asking unasked questions. That’s for amateurs!

Anyway, being snarky here is just like shooting fish in a barrel, which I have never done but sounds intriguing. So, moving on, the authors conclude (among other things):

…funding agencies have a key role to play in enabling this shift [38]. For example, the design and implementation of funding agency-level changes such as extending sex-based inclusion requirements to preclinical animal studies, providing applicants with clear instructions on sex and gender, educating applicants, peer reviewers and agency staff on the importance of sex and gender, and engaging in regular measurement and monitoring of progress [15], [39]. … knowledge gaps suggested by the results of the qualitative analysis presented here – for example, the persistent conflation of sex and gender by health researchers, the assumption that gender applies only to women, and the perception that sex is not relevant to research on animal or cell models.

I think the part of this paper that makes my heart glad is that the authors use science and scholarship to understand what is going on with grant applications. The part that makes my heart less glad is how much – I’m going to say it! – ignorance there is about the most basics around gender and sex even among a progressive nation’s most high-achieving scientists (um, full disclosure: I’m from Canada, but I think all those indices always put Canada pretty high on a progressive scale). But epistemology of ignorance or agnatology – the study of what we don’t know and why we don’t know it – is critical to moving forward and understanding where we are. The part that makes my heart sweat in a bad way is: can we do the work? That part that makes my heart sweat in a good way is: obviously, and this helps us know where to start. (My heart does a lot, sometimes.)

Men sent to Mars and women sent to Venus: A thought experiment in honor of the NIH’s upcoming policies on incorporating sex in basic research

Guest post by Stacey Ritz

Imagine if you will…

Editor’s note: this is my favorite drawing ever.

It’s the year 2075. After a worldwide search for the hardiest human beings, one man and one woman are selected to colonize other planets: Bob (a chemist from Finland) is sent to Mars, and Flo (a rice farmer from Thailand) is sent to Venus.

Editor’s note: These are skeptical clones (see the eyebrow??).

Each of them is placed in a large spacecraft provisioned with a laboratory for human cloning, 6 months’ worth of basic food and water rations along with oxygen, and space to house 5000 people; the World Space Organization will send additional rations for the populations every 6 months, and once the colonies are at maximum capacity, the WSO will conduct scientific tests of a variety of parameters on the colony.

After a lengthy journey, Bob and Flo arrive on their respective planets, set up their laboratories, and begin producing clones of themselves. They are very successful: by 2125 they are at maximum capacity, and the WSO sends scientists to study the populations.

In the first battery of tests, the scientists make the following measurements:

Editor’s note: WHO IS THIS GUY?! I definitely don’t trust his results.

  • Assay serum levels of LDL cholesterol
  • Administer the “Verbal Reasoning” section of the MCAT
  • Determine the ED50 (effective dose in 50% of the population) for the anaesthetic drug propofol
  • Evaluate leg strength by determining the maximum amount of weight the subjects can leg press
  • Measure height

Their findings are as follows:

Editor’s note: bar graphs!!

Excited by these data, the WSO scientists send the following report back to earth:

MAJOR GENDER* DIFFERENCES FOUND IN MOST EARLY MEASURES

Our initial testing of the inhabitants of Mars and Venus revealed stark differences between men and women for a variety of parameters. Men had significantly higher serum LDL cholesterol than women, which may explain the higher prevalence of cardiovascular disease in men. As expected, women had a much stronger aptitude for verbal reasoning than men, which is in line with the body of literature documenting that women have stronger communication skills than men. Women also required a 44% lower dose of propofol to achieve anaesthesia; anaesthesiologists should adjust their dosages of propofol accordingly for male and female patients. Just like on Earth, men were taller than women, but surprisingly there were no significant differences in lower body strength.

It is probably instantly obvious to most people that this experiment has a whole whack of problems that invalidate the scientists’ conclusions. Given the way this was set up, it is OBVIOUSLY completely unreasonable to ascribe the differences observed in these tests to the sex of the populations. The results could reflect any number of other differences between the two populations that have nothing to do with their sex, for example:

  • Genetically-inherited tendencies:
    • Turns out that Bob has a family history of genetic hypercholesterolemia and tall stature, and his allele for CYP2B6 is a variant that is very efficient in breaking down propofol. On the other hand, Flo comes from a somewhat short family with normal cholesterol, and her allele for CYP2B6 is a variant that has moderate efficiency in metabolizing propofol.
  • Socio-cultural factors:
    • The MCAT verbal reasoning test was administered in English. Flo speaks fluent English and Thai, and so the clones on Venus learned both languages from her and are fluently bilingual. Bob speaks Finnish and broken English, and so the clones on Mars are not very proficient in English.
  • Environmental influences:
    • The specific gravity is 0.376g on Mars, and 0.904g on Venus. Thus, gravity exerted less downward force on the bodies of the inhabitants of Mars, which would tend to allow them to grow taller than those living on Venus.
  • Interactions between genetics and environment:
    • The genetic tendency to tallness of the Bob clones that was magnified by the lower gravity on Mars; although their bodies were larger, the lower gravity on Mars meant that their leg muscles did not have to be as well developed in order to support their (higher) body weight. In contrast, the genetic tendency to shortness of the Flo clones was magnified by the higher gravity; although their bodies were smaller, the higher gravity on Venus meant that their leg muscles had to be relatively more developed to support their (lower) body weight. Thus the net effect of these genetic and environmental influences resulted in similar lower body strength between the groups.
    • Radiation exposure on the space journey to Venus caused a mutation in the CYP2B6 allele in the cell that Flo happened to use in her cloning; the mutation caused a 50% decrease in the activity of the enzyme, so propofol was metabolized more slowly in the clones than in Flo herself.
  • Researcher bias and over-extrapolation:
    • The findings on verbal reasoning fit with the researchers’ pre-existing perception that women are better communicators, so they didn’t consider whether there might be other factors that confounded their findings (ie. language).
    • The researchers are stretching their conclusions pretty far to argue that the difference seen in LDL cholesterol in a genetically homogeneous population under tightly controlled conditions explains a difference in the prevalence of a complex disease in a genetically heterogeneous population with little control over conditions.

You might be saying “well this is OBVIOUSLY a TOTALLY RIDICULOUS scenario and scientists would NEVER make these kinds of mistakes in interpretation.” Well, actually, what I’m suggesting is that people make these kinds of mistakes all the time when interpreting data from cell and animal studies (and also from human studies) that make crude comparisons of male vs. female.

Let me unpack my tortured analogy a bit to make the parallels more explicit:

THOUGHT EXPERIMENT CELLS EXPERIMENTAL ANIMALS
The hardiest humans are chosen to colonize another planet. Normal people aren’t chosen because they probably wouldn’t survive. Most cells grown in vitro for laboratory use are ‘cell lines’: cells of the type we’re interested in that have a nearly limitless ability to proliferate. These are usually cancer cells, or cells that have been genetically modified to permit ongoing proliferation. They are NOT normal. Most animals used in experiments are inbred, and have been adapted to laboratory conditions over many generations. They are NOT human and differ from humans in substantial ways.
The colonizers live in an atypical environment with the bare essentials they need to survive. This does not reflect the conditions in which humans live. Cells are grown in a plastic flask, fed by culture media. This does not reflect the conditions in which normal cells live. Experimental animals live in cages under highly controlled conditions. This does not reflect the conditions in which humans live.
Instead of living in a complex, dynamic human society made up of many different people, the colonizers live in a relatively static environment surrounded by others exactly like them. This does not reflect the conditions in which humans normally live. Instead of living in a complex, dynamic body made up of many kinds of cells, the cells live in a relatively static culture environment surrounded by other cells exactly like them. This does not reflect the conditions in which cells normally live. Instead of living in natural social groups and engaging in natural behaviour, animals are segregated into groups based on the convenience of the scientist, and live only with other animals of the same sex. This does not reflect the conditions in which mice or humans normally live.
The living conditions of the residents of Mars are different from those of the residents of Venus. The culture medium and conditions used for different cell lines are often different. In mice (the most commonly used experimental mammal), males are usually housed at lower density than females because of the males’ tendency to aggression against one another.
Differences observed between the inhabitants of Mars and Venus may be ascribable to a variety of factors, so making crude “male vs female” comparisons between the inhabitants of Mars and Venus is not very useful for understanding the influence of sex on the outcomes of interest. Differences observed between male and female cell lines may be ascribable to a variety of factors, so making crude “male vs female” comparisons between male cell lines and female cell lines is not very useful for understanding the influence of sex on the outcomes of interest. Differences observed between male and female animals may be ascribable to a variety of factors, so making crude “male vs female” comparisons between male cell lines and female cell lines is not very useful for understanding the influence of sex on the outcomes of interest.
More nuanced approaches are required to discern the influences of sex. More nuanced approaches are required to discern the influences of sex. More nuanced approaches are required to discern the influences of sex.

In the 14 May 2014 edition of Nature, the NIH announced that it intends to roll out policies beginning in October 2014 that will “require applicants to report their plans for the balance of male and female cells and animals in preclinical studies in all future applications, unless sex-specific inclusion is unwarranted, based on rigorously defined exceptions.” Although I applaud the motivation underlying these changes, I am far from convinced that simply requiring scientists to include male and female cells or animals in their work will be a significant advance in addressing sex and gender in medical research – in fact, I fear that a crude approach of this sort will not only fail to address concerns around equity, but it may in fact exacerbate them and serve to affirm our cultural bias that men are from Mars and women are from Venus.

So what do you think? Is my tortured analogy off-base? Will this policy and others like it help or hinder equity in biomedical research?

*Let’s ignore for the moment the ways that scientists tend to conflate sex and gender….that’s a whole other kettle of fish.

Gender and Sex in Cell Cultures and Animal Models

Though feminism is relevant across science disciplines, sometimes it’s easier to see how it might be relevant to the scientific questions of one area than another. For example, it might be less immediately obvious how sex comes into the bench biosciences vs. human research… though you’d have to have some serious post-feminist goggles on to think that human bioscience is in any way normatively feminist.

This is a really useful and interesting article by a member of the Gap Junction Science community; an environmental immunologist and medical science educator Stacey Ritz.

Here are the details below, and you can access the article here (Ritz et al – FASEBJ – in press). They do a great job of describing gender and sex, discussing how both may or may not be relevant to the sorts of research questions scientists are studying with cell cultures or animal models. Especially useful is, on page 6, a “Sex/Gender Toolbox for Experimental Scientists.” This might be perfect to spur discussion in a lab group discussion, a journal reading club, or something else.