Exploring how systemic gender bias affects research outcomes, drug safety, and healthcare for half the population
Imagine taking a medication that doctors declared safe, only to discover it was predominantly tested on male subjects and poses greater health risks to you because you're female.
prescription drugs withdrawn between 1997-2000 due to women's health risks 3
higher rate of adverse drug reactions in women compared to men 3
of population historically excluded from many clinical trials 3
This isn't a hypothetical scenario—between 1997 and 2000, ten prescription drugs were withdrawn from the U.S. market because they presented greater health risks for women, with some causing severe, life-threatening arrhythmias that predominantly affected female patients 3 . These tragedies represent just one manifestation of a deeper problem: systemic gender bias embedded within biomedical research.
For centuries, the default human subject in scientific studies has been male—from cells in petri dishes to animals in laboratories to participants in clinical trials. This bias persists despite profound biological differences between sexes that affect everything from disease progression to drug metabolism.
The consequences of this exclusion are far-reaching, compromising women's health, skewing scientific outcomes, and limiting the impact of medical breakthroughs. As we examine the evidence, we confront an uncomfortable question: is science itself sexist? The answer reveals not just problems in laboratories, but pathways toward more accurate, inclusive, and effective medicine for everyone.
The systematic exclusion of women from biomedical research has deep roots. American women first entered scientific work in significant numbers during the late 18th and early 19th centuries, but they were often segregated into low-wage roles with little opportunity for advancement 2 .
In the 19th century, women like Williamina Fleming and Annie Jump Cannon made groundbreaking contributions to astronomy at Harvard Observatory, yet were dismissed as merely 'human calculators' doing 'low-status women's work' 2 .
American women begin entering scientific work but are segregated into low-wage roles with the assumption they would return to domestic life 2 .
Women at Harvard Observatory make significant astronomical discoveries but receive little recognition, creating a scarcity of visible role models 2 .
Protectionist policies after drug tragedies lead to exclusion of women from clinical trials, cementing the male norm in research 3 6 .
Growing awareness of gender bias leads to policy changes, but male-focused research approaches remain entrenched 3 .
In 2015, an epidemiological study revealed a puzzling pattern: patients affected by chronic hypersensitive cough were predominantly postmenopausal women 3 . This finding presented an immediate problem—despite decades of cough research, scientists lacked understanding of what caused this particular condition in women.
The reason for this knowledge gap soon became clear: for decades, studies of cough neural pathways had been conducted exclusively on male guinea pigs 3 . When researchers scoured scientific literature, they found only three studies that had used female guinea pigs, and even these had failed to analyze results by sex 3 .
Distribution of chronic hypersensitive cough patients by gender 3
To address this gap, researchers developed a new model using both male and female guinea pigs for basic cough research. Contrary to long-held assumptions in the scientific community, they discovered that including both sexes did not increase internal variability or weaken statistical power 3 .
| Research Aspect | Traditional Approach | Improved Approach | Key Finding |
|---|---|---|---|
| Subjects | Male guinea pigs only | Both male and female guinea pigs | No increased variability with both sexes |
| Data Analysis | Sex not considered in analysis | Sex included as biological variable | Revealed female-specific patterns in cough sensitivity |
| Applicability | Limited understanding of female-predominant condition | Relevant insights for female patients | Explained why previous research failed to address chronic hypersensitive cough |
The research challenged the widespread belief that female subjects are more variable due to estrous cycles, showing comparable variability between male and female cohorts 3 .
Including both sexes didn't complicate research but provided more accurate, applicable findings for a condition affecting mostly women 3 .
The exclusion of female subjects from drug research has had dangerous consequences. Because medications are predominantly tested on males, women experience adverse drug reactions nearly twice as frequently as men 3 .
| Drug Name | Therapeutic Category | Primary Adverse Effect in Women | Year Withdrawn |
|---|---|---|---|
| Terfenadine | Antihistamine | Severe cardiac arrhythmia | 1998 |
| Cisapride | Gastrointestinal | Torsade de Pointes arrhythmia | 2000 |
| Mibefradil | Cardiovascular | Dangerous drug interactions | 1998 |
| Grepafloxacin | Antibiotic | Cardiac toxicity | 1999 |
10 drugs withdrawn due to disproportionate risks for women 3
Pregnant women represent one of the most excluded populations in biomedical research. Systematic under-representation has prevented them from benefiting fairly from biomedical advances, leading to medicine discontinuation, sub-optimal dosing, and reliance on repurposed therapies 6 .
This research gap has particularly severe consequences in low- and middle-income countries, where pregnant populations face a double disadvantage due to both gender and geographical location 6 .
Pregnant women experience substantial physiological changes affecting how medications are absorbed, distributed, and excreted, yet are systematically excluded from research 6 .
The gender bias in who participates in research mirrors broader patterns in scientific careers. While women now earn approximately half of STEM undergraduate degrees in many countries, they remain significantly underrepresented in senior positions and leadership roles 2 .
"I had to be on standby for nighttime emergencies, but safety concerns required a company vehicle to pick me up. My boss understood and exempted me. This challenge isn't unique to me, it affects many women in scientific fields" 2 .
Women in STEM often encounter "masculine cultures" that value traits associated with masculinity while reinforcing stereotypes that women don't belong in these fields 2 .
As artificial intelligence transforms science and medicine, gender bias risks being amplified at scale. Recent research reveals that AI models can inherit and exacerbate societal biases about gender and age 5 .
The AI then ranked these younger female applicants as less qualified than male applicants, demonstrating how "gendered ageism" can become embedded in automated systems 5 .
This bias originated from skewed information inputs—analysis of nearly 1.4 million online images and videos found women consistently portrayed as younger than men across various occupations 5 .
Fortunately, the scientific community is increasingly recognizing and addressing gender bias. Significant initiatives are emerging worldwide:
Agencies like NIH and Horizon 2020 now require inclusion of women and female animals in research 3 .
Programs like Marie Skłodowska-Curie Actions fund women scientists addressing gender gaps 1 .
Projects like UniswithHeart create zero-tolerance policies for sexual harassment in academia 1 .
Initiatives like Breaking Barriers Network work to dismantle systemic barriers worldwide 2 .
| Research Component | Traditional Approach | Inclusive Approach | Benefit |
|---|---|---|---|
| Subject Selection | Male-dominated cohorts | Balanced representation | Findings applicable to all genders |
| Data Analysis | Sex often not considered | Sex as biological variable | Reveals sex-specific effects |
| Research Teams | Gender-homogeneous teams | Diverse teams | Enhanced innovation and perspective |
| Policy Frameworks | Presumptive exclusion | Responsible inclusion | Ethical, comprehensive science |
The evidence clearly demonstrates that science has embedded gender biases that affect everything from laboratory designs to medical treatments. Yet the solution isn't to reject science, but to reform it.
Not replacing male-focused research with female-focused research, but creating truly inclusive science
Recognizing biological differences while rejecting outdated stereotypes
Questioning the assumption that male represents the human default
"Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less." — Marie Skłodowska-Curie 1
By better understanding and addressing gender bias in science, we move closer to a future where biomedical research serves everyone equally—a goal that benefits all of humanity, regardless of gender.