Journalwatch: Ethics chairs unaware of research sexism; breast cancer and HRT use fall in concert

In today’s Hoyden Journalwatch: Adelaide bioethics researchers found that human research ethics committee chairs in Australia were unaware of issues of sexism in scientific research.

The research, published in today’s Medical Journal of Australia[1], consisted of interviews with 25 chairs of Australian Human Research Ethics Committees (HRECs) in the last twelve months.

The researchers aimed to investigate the views of these chairs about “the role of HRECs in identifying sex discrimination, monitoring the inclusion of men and women in clinical research, and interpreting and applying National Health and Medical Research Council (NHMRC) guidelines relating to fair inclusion in research.”

The chairs, on the whole, took a laissez-faire attitude, not so much as asking for information about the sex of participants in proposed research. Not even one HREC had so much as an application-form question about the sex of participants, and none require reporting of participants’ sex.

Worse, they were ignorant of issues of institutionalised sexism in medical research: most didn’t even believe that sexism in research was a significant problem, and they were unfamiliar with debates around scientific sexism. None had been involved in consultation regarding fair inclusion. Only four of the 25 raised the possible applicability of anti-discrimination regulations to research when asked about legal requirements regarding sex equity.

A few comments from the ethics committee chairs:

I’m sure if there was a [bias] in some way, someone would have picked it up in our committee. — Frank

I don’t think it’s ever come up, but I certainly think the committee would deal with it if it did. A researcher that was aiming at studying males or females only, for no good reason, would probably be rejected. — Victor

I’m not sure that, you know, being a human guinea pig is just such an honour that, you know, women are queuing up to not be discriminated against or males are queuing up to not be discriminated against. — Wendy

It is more unethical to have no research than to have gender [in]equality research. — Sam

Because, you know, at the end of the day, it’s probably better someone was studied rather than no [one]. — Jason

Bear in mind that exclusion from research does not only mean that women may be arbitrarily excluded from trials of substances or protocols that could do them harm. It also means that women with severe, possibly terminal diseases may be systematically excluded with from trials of experimental treatments that may be their only hope, with impunity and without oversight. It also means that studies of basic physiology may exclude women, instead only focussing on “default”, “homogeneous” male bodies.

I find it particularly alarming that HREC chairs are profoundly ignorant of basic issues and debates relating to social justice in scientific research.

[1] “Fair inclusion of men and women in Australian clinical research: views from ethics committee chairs”
Angela J Ballantyne, Wendy A Rogers on behalf of the Australian Gender Equity in Health Research Group
MJA 2008; 188 (11): 653-656 [free registration required.]

Hormone Replacement Therapy and Breast Cancer

In other news, and in a damn good argument for clinical trials with female subjects, age-standardised invasive breast cancer incidence in post-menopausal women in Australia dropped 6.7% from 2001-2003 [2]. This occurred at a time when hormone replacement therapy (HRT) prescriptions dropped by 40% after the results of the Women’s Health Initiative research revealed the correlation between HRT and breast cancer diagnosis. There was no significant change in breast cancer incidence in younger women. The authors conclude that the available evidence is consistent with a causal relationship between HRT and breast cancer.

A close look at the charts shows that breast cancer incidence appears to have been on the increase just prior to 2001. I recall heavy blanket marketing of HRT to general practitioners in the late 1990s, which is consistent with the rapidly rising prescriptions in the prescriptions graph. I’d really like to see more recent data.

hrtscripts

breastcancerhrt

[2] “Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia”
Karen Canfell, Emily Banks, Aye M Moa and Valerie
MJA 2008; 188 (11): 641-644



Categories: ethics & philosophy, gender & feminism, health, medicine, Science

Tags: , ,

8 replies

  1. Wow. I was learning about the historical problems with gender biased pharmaceutical and physiological studies back in the late 80s. These people must not have been paying attention for at least two decades.
    While it’s great that the cancer rate had decreased for post-menopausal women, it’s sobering to say the least that HRT appears to have provoked so many cases before the link was investigated and established.

  2. The link between HRT and breast cancer has been discussed for a long time, but the biggest problem was that observational studies kept showing not only no correlation, but an inverse correlation in some aspects – some studies showed more cancer diagnoses, but better prognoses and overall fewer cancer deaths. (More screening/early diagnosis of non-invasive carcinomas was one hypothesis at the time). Those observations combined with correlations with lower incidence of heart disease and osteporosis, as well as the symptomatic relief that some women experienced, HRT prescriptions went through the roof.
    The Women’s Health Initiative included a set of randomised blinded placebo-controlled prospective interventional trials including both oestrogen-only and oestrogen + progesterone HRT.
    The WHI didn’t show HRT to be unequivocally dangerous across the board; there were increases in breast cancer and cardiovascular illnesses, but significant decreases in colorectal cancer and major fractures.
    It is postulated that the previous correlations were real, but were due to confounding by “healthy user bias”: women who were healthier and lower risk in the first place were more likely to be prescribed/to take HRT. Classic correlation does not equal causation stuff. There was plenty of talk about this possibility before the WHI came along, and debate was eager. The possibility wasn’t ignored by any means – but the evidence was equivocal.

  3. The study that seems to persist in the media in almost mythical proportions is the “French paradox” aka ‘a couple of glasses of red a day is good for you’. The initial research was on men only (and a lot more complex than being about wine, which incidentally was rough, young local red table variety). Replicating the study on women showed no benefit. What is more is that all evidence points to there being no safe intake of alcohol for women if we want to avoid breast cancer.
    Yet women are still being told a glass or 2 of red a day is good for us (hey I know we want it to be!) and from ignorant GP’s too is verging on negligence.
    another outspoken females last blog post..the game (things to do while the beans cook)

  4. Just on the wine thing – I have heard that eating a handfuld of red grapes gives you exactly the same effect, without the alcohol, and you get a serve of fruit too.
    For me the sexism in research is one of those things that is blindingly obvious, once someone has pointed it out. Hopefully now these people will be more aware.

  5. In other research that came through my feed reader today, a paper in Science shows that the “maths gap” between girls and boys is highly correlated to gender inequality as measured by the Gender Gap Index (not very surprising. On the other hand, it found that the “reading gap” (which favors girls over boys) was consistently present and uncorrelated to the GGI.
    Anyone here care to comment?

  6. I’d need to read more about the study before commenting in detail, Fmark. However, Echidne had a very good post recently on the bias in reporting on gender and education/science which may have some worthwhile concepts to examine before that discussion anyway.
    She notes that many studies of the under-representation of women in SET (Science Engineering Technology) speak of women and girls “self-selecting” to avoid these study areas (i.e. it’s all about “preference” and “choices” that women have/make), whereas studies of men and boys being under-represented on the honor roll never speak of boys “self-selecting” away from education, but present this as an obvious failure of the schools in question.
    So, who’s “self-selecting” and who is being failed by their schools? I suggest that both boys and girls experience some of both.
    IMO it’s not so much the schools but broader societal messages about how men who compete with women (and maybe come in lower ranked) are somehow weakened and unmanly, so perhaps it’s better to find other areas to express/display male strengths. That turns boys away from education, while the same societal message for girls is more along the lines of needing a solid body of excellent achievement to have a hope of being considered a man’s intellectual equal, therefore girls strive harder.
    None of that explains that cross-cultural reading difference though. That may possibly end up being in the same genetic basket of uneven distribution as men’s bulkier musculature.

  7. About the HRT studies, did they say which hormones they thought were dangerous? From memory, the studies showing a problem involved Premarin and Provera, not oestrogens such as Progynova and progestins such as Duphaston, or real progesterone.

  8. The study is outlined in more detail at this page, linked from my previous WHI link.
    The particular hormones use were conjugated equine estrogens (CEE, Premarin), either alone or in combination with medroxyprogesterone (Provera).
    The study doesn’t say anything about what “hormones they thought were dangerous”; these are the particular hormones that were given in this particular trial.
    At the moment I am aware of little evidence suggesting that other common HRT substances have a substantially different risk profile, except perhaps tibolone. The 2005 Cochrane take is here: ”Long-term use of hormone therapy in women around the time of and after menopause.”. Full text is available via the WHO. Different hormones used in the Cochrane review studies included oestradiol (oral and transdermal), oestradiol valerate (Progynova), CEE, MPA, dydrogesterone (Duphaston), norethisterone, micronised plant progesterones. If you have some more evidence (from peer reviewed journals), you are more than welcome to post links and brief summaries.

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