It’s time to break the glass ceiling in health-care research

Sleeping pills were on the market for decades before a research study revealed that women metabolize their active ingredient much differently than men. The study showed women still had substantial amounts of the drug in their systems the day after taking the medication, leading to negative side-effects that ranged from drowsiness to impaired driving.

In 1993, the U.S. Federal Drug Administration (FDA), followed shortly after by Health Canada, recommended a reduction in the dosage for women – by half.

Welcome to the glass ceiling of sex and gender in health care.

“That drug had been prescribed literally for decades,” says Dr. Paula Rochon, vice-president of research at Women’s College Hospital in Toronto and a senior scientist at Women’s College Research Institute.

“Still today, we really don’t have the kind of information that we should have about women’s health and how important health-related conditions are impacted by sex and gender.”

The sleeping pill problem is just one example of a sex and gender gap that continues to plague the health care system — one that Women’s College Hospital is working hard to close.

Women are underrepresented in research

Every cell in the human body has a sex, according to the Canadian Institutes for Health Research’s (CIHR) Institute for Gender and Health. Sex is biological, according to scientists, while gender is a social construct.

Two years ago, the Heart and Stroke Foundation of Canada issued a warning that women were dying unnecessarily because the health care system is ill-equipped to diagnose and treat them. Cardiac symptoms present differently in women, the organization warned, and early signs were missed in a staggering 78 per cent of cases.

“A lot of the original studies had been done primarily in men and most of the guidelines for diagnosis and treatment were based on men. So, there was a particular way that people thought a heart attack might present, but actually we know now that many times it’s different in women and men,” says Dr. Rochon, whose hospital runs a cardiac rehabilitation program designed specifically for women.

The health gap, like the gender gap overall, is partly due to the under-representation of women in research, Dr. Rochon says.

This fact was exacerbated by a well-known medical tragedy: the sedative Thalidomide was prescribed to pregnant women to relieve pregnancy nausea from the mid-1950s until the early 1960s, when it was found to cause congenital birth defects. The findings led researchers to believe that it was dangerous to include women of reproductive age in research.

“What happened for a long time after the scandal was that any research we had was focused on men,” says Dr. Simone Vigod, chief of the department of psychiatry at Women’s College Hospital and a scientist at Women’s College Research Institute.

“Over time, issues really specific to women — around the reproductive cycle, pregnancy, and so on — remained under-researched and not properly understood.”

The gap grew until 1993, when the FDA, again followed shortly by Health Canada, mandated that women be included in clinical trials.

“People are starting to understand that, yes, sometimes you should be studying a woman who could become pregnant or a pregnant woman in a clinical trial and it’s not unethical to do so. In fact, it’s unethical not to do so,” Dr. Vigod says.

Women’s College Hospital is a leader in female-focused research

Evolved from Woman’s Medical College, founded in 1883 by Canada’s first female doctor, Dr. Emily Stowe, Women’s College Hospital is home to one of the only hospital-based research institutes in the world focused on the health of women. It’s also considered a global leader in efforts to improve the well-being of women.

Dr. Vigod’s research explores mental health generally but also specifically examines mental health around the time of pregnancy and the postpartum period.

For example, one recent study at Women’s College Research Institute found women who had immigrated to Canada had double the rates of postpartum depression symptoms but were half as likely to seek help. In another study, the Women’s College Hospital team found more than 50 per cent of reproductive-age women on antidepressants were struggling to decide whether to continue medication during pregnancy.

Dr. Vigod and her colleagues developed an interactive online tool to help women and their health care providers weigh the continued use of antidepressants. A small study of 100 women found that the tool helped and the team is now recruiting for a more extensive study of its efficacy. Women’s College Research Institute is also about to launch research into the use of at-home transcranial direct current stimulation for the treatment of more severe depression in pregnancy.

Yet another area of research at the institute focuses on loneliness and the impact it has on older women. It’s an emerging issue worldwide that prompted the United Kingdom to recently appoint a “Minister of Loneliness.” Like all research at Women’s College Hospital, the loneliness study will have a particular focus on sex and gender.

“We require that our investigators include a sex and gender lens in all of the proposals that they put forward for funding submissions,” Dr. Rochon says. “That sets the stage for making sure that the research is going to produce information that’s important for women and men and other diverse groups.”

Women-led research requires more funding

A study published in the journal Nature Human Behaviour in 2017 found a “robust” correlation between female researchers’ participation in medical research and the inclusion of gender and sex analysis.

Yet an analysis by the CIHR published last year found that women-led projects have less success receiving funding. A review of 24,000 grant applications from 2011 to 2016 found that when assessments looked primarily at the calibre of the lead researcher, the gender gap jumped from one to four per cent.

At Women’s College Hospital, almost all of their post-doctoral fellows and half of their scientists are women. But Women’s College Hospital is an exception to the rule: Canada-wide, just 28 per cent of all scientists and 30 per cent of research chairs are women. To help address this gap, Women’s College Research Institute is now launching a new initiative that aims to engage young women in health science careers and provide support and mentorship that will help keep them in the field and advance into leadership roles.

“Who is doing the work is a really important piece,” Dr. Rochon says. “By building equity among Canada’s community of health researchers, we’ll start to see enormous gains in terms of the amount of research being conducted for women, by women – leading to a more equitable health landscape for everyone.”

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