On the day U.S. President Donald Trump was sworn into office, he mandated an end to all government Diversity, Equity and Inclusion (DEI) programs and other forms of “wokeness” in government. But that attack on wokeness also will hinder research on how certain diseases, drugs and medicines affect men and women differently.
Following Trump’s executive order, the National Science Foundation began reviewing any active research grants it perceived as including elements of DEI for termination. Including words like “women,” or “female,” in a grant proposal would get it flagged for possible rejection, but the words “man” or “male” would not.
The vast majority of diseases affect men and women differently. For example, in 2019 the top five death-causing diseases in Canada were heart disease, diabetes, cancer, lung infections and strokes. Other than strokes, all of these kill more men than women. The sex differences seen in these diseases are also all seen in mice, suggesting that these differences are rooted in biology rather than behaviour (e.g., men smoking more and seeing the doctor less than women).
Biological sex is known to affect every organ system. Female hearts beat more but push less blood out to the rest of the body, resulting in a lower blood pressure; female pancreatic cells produce more insulin.
Even the immune system, responsible for everything from defending the body against infection-causing pathogens, patrolling for cancer and healing damage is different in men and women. Auto-immune diseases, in which your immune system attacks your own body, exhibit stark sex differences, impacting four women for every man. On the extreme end, lupus affects nine women for every man.
On the other hand, men are more likely to die from infections like pneumonia or sepsis due to improper immune responses. During the COVID-19 pandemic, men were 1.4 times more likely to die than women. During peak COVID, the average Intensive Care Unit contained almost three men for every one woman.
Research into sex differences has only recently begun improving.
Research into sex differences has only recently begun improving. In 1977, the U.S. Food and Drug Administration discouraged the inclusion of reproductive-aged women into clinical trials. The rationale was a well-intentioned desire to avoid the risk of possibly giving harmful experimental drugs to pregnant women. Excluding women led to a shortage of data on how drugs affect women; in 1986, the National Institutes of Health (NIH) established a policy to encourage researchers to include women in studies, though that did not become law until 1993.
As a result, we have only begun to understand how men and women respond differently to disease within the past 20-30 years. It was only in 2016 that the NIH in the United States and the Canadian Institute for Health Research mandated the consideration of biological sex in research.
But this research is not only of benefit to women. Take the field of drug development for example.
Tirilazad mesylate was a promising drug candidate for the treatment of stroke. An early clinical trial found that the drug improved stroke outcomes in male patients dramatically. Despite several subsequent trials finding similar results, tirilazad has been shelved ever since on the basis that it failed to improve overall outcomes for all stroke patients – irrespective of biological sex.
The total number of promising drug candidates set aside due to overlooked sex-specific effects is unknown. Within the field of stroke research alone, the historic neglect of biological sex has contributed to the failure of every new treatment within the past 25 years. Current stroke research guidelines require studying both biological sexes to improve the chances of successful drug development.
As the U.S. disengages with sex differences research, Canada must double down on its own research program. After all, science takes years to bear fruit – the research we invest in today are the therapies we have tomorrow.
Thanks Kevin for your article!
I couldn’t agree more about the importance (and sheer fascination) of medical research in sex/gender. It is regretful that in the US there has been an overreaction in the culture wars arena.
There is a nuanced discussion that can be had about maintaining apolitical and non-ideological stewardship of Canadian research dollars, and I worry that Trump’s eye-rolling tantrum will dismiss fair criticism of our federal research granting agencies. Dave Snow (University of Guelph) recently published a paper detailing pragmatic concerns about Canada’s federal research granting agencies elevating and preferentially funding critical social justice activism (which he argues should instead be funded based on its merits in the marketplace of competing ideas and research).
That’s not to say that DEI relevant research isn’t important (it is!), but biased funding may harm the reputation and quality of the institution and its research, and we should thoughtfully examine such criticism (rather than ban all research or blanket dismiss the criticism).
Link to Dave Snow’s publication: https://macdonaldlaurier.ca/promoting-excellence-or-activism-equity-diversity-and-inclusion-at-canadas-federal-granting-agencies/