Research provides us with a greater understanding of our world. One of the most obvious ways that research is used is in the medical field. Medicines, medical technology, patient databases, and training models are just a few of the many areas where research is applied in order to improve the lives of others. Research can also show flaws of a system and show where change is needed most.
All medical professionals strive to provide the utmost care, and legally, all patients must be treated with the same level of care. A medical professional’s knowledge is based on credible scientific research. While this research is reputable, it can be unintentionally biased against different demographics , such as race, sex, and sexuality due to a lack of representation in clinical studies. This can lead to less effective treatment in the diagnosis, prescription, and recovery of a patient. It is important to acknowledge where representation is lacking in studies and to take the steps to overcome this issue.
While female doctors are becoming much more largely represented, with 50.5% of medical students in 2020 being female (Heiser 2019), current and past medical research has a lack of women represented in clinical studies. This has led to women receiving medical care that is often not the best suited to their needs. In 1977, the FDA issued a statement that women with childbearing potential be excluded from early phases of drug trials because of the teratogenic effects, also known as the possible risks of birth defects. As a result of limited representation, women more commonly have problematic side effects to medication. Within the span of 1997 to 2000, 8 out of 10 drugs withdrawn by the FDA were withdrawn because of harmful side effects in women. These side effects often happen in women because while women may receive the same dosage of medicine as a male, drugs metabolize slower in women than men, leading to women receiving more exposure to the drug and more intense drug side effects (Parek 2011).
Despite heart disease being the top killer of women, only one-third of cardiovascular clinical subjects are women. Not having a representative proportion of women is very problematic for research because this disease presents differently depending on gender. For instance, instead of feeling pressure on the chest, women may experience burning pain, nausea, or extreme fatigue. This issue is also apparent when studying neurological conditions since these conditions can also present differently between genders (Foley 2019).
In addition to bias in sex, clinical studies can be biased in racial identity. Certain medical conditions can present differently according to the level of pigmentation in the skin. For instance, many physicians' knowledge of dermatological conditions are limited to how they present on less pigmented skin. Even extremely common conditions, such as pityriasis rosea, go underdiagnosed among those with darker complexions because of inadequate training in diagnosing skin conditions on darker skin (Perlman 2020).
On a more positive note, there are strides being made towards equity, even on the Bloomington campus. Ten undergraduate students from Indiana University Bloomington’s club “Hoosier Health Advocates '' (previously named Timmy Global Health) spent a weekend in November volunteering with the nonprofit Remote Area Medical (RAM) at a clinic in Elgin, Illinois. RAM’s mission is to provide under-served and uninsured populations with free medical care. While these students are currently in their undergraduate studies and unable to provide medical services, they provided their skills in support areas such as patient registration, guiding, and checkout. On the first day of the RAM clinic, November 13th 2021, the clinic was able to provide 96,317 dollars worth of medical expenses for free to 273 patients. This is just one of the countless examples of the works being done across the nation to improve healthcare for its citizens.
Medicine should not follow a one-treatment-fits-all approach. Every human has unique treatment needs, and recognizing the differences in our bodies can allow a better standard of treatment for all. It is imperative that we acknowledge how we can improve research samples to more accurately represent the population being studied.
Parek, Ameeta, et al.“Adverse effects in women: implications for drug development and regulatory policies”. Expert Rev. Clin. Pharmacol. (2011). https://www.fda.gov/files/science%20%26%20research/published/Adverse-effects-in-women--Implications-for-drug-development-and-regulatory-policies.pdf.
Perlman, Katherine, et al. “Racial disparities in dermatology training: The impact on Black Patients”. MDedge Dermatology. (2020, December 14). https://www.mdedge.com/dermatology/article/233023/diversity-medicine/racial-disparities-dermatology-training-impact-black?sso=true.
Foley, Katherine Ellen. “25 Years of Women Being Underrepresented in Medical Research, in Charts.” Quartz (2019, July 3rd), https://qz.com/1657408/why-are-women-still-underrepresented-in-clinical-research/
Heiser, Stuart. “The majority of U.S. medical students are women”. New Data Show. AAMC. (2019, December 9). https://www.aamc.org/news-insights/press-releases/majority-us-medical-students-are-women-new-data-show