The legacy of bias: Building the foundation for sex and gender-based medicine – Open Access Government

Report on Addressing Historical Gender Bias in Medical Research to Advance Sustainable Development Goals

Executive Summary

This report details the systemic issue of male-centric bias in medical research and its detrimental impact on health outcomes for women. It outlines strategic initiatives aimed at rectifying this imbalance, framing these efforts within the context of the United Nations Sustainable Development Goals (SDGs). The work chronicled, from foundational research to educational reform at the University of South Carolina School of Medicine Greenville (USC SOMG), directly contributes to achieving SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities) through multi-stakeholder partnerships (SDG 17).

Historical Research Deficiencies as a Barrier to SDG 3 (Good Health and Well-being)

The Male-Centric Research Model

For much of modern medical history, the male body was considered the universal standard in basic science and clinical trials. Women were systematically excluded, often citing hormonal complexity as a confounding variable. This practice created a profound knowledge gap, embedding a male-biased architecture into medical diagnostics, pharmaceutical development, and clinical standards. This foundational flaw directly undermines the objective of SDG 3 to ensure healthy lives and promote well-being for all at all ages.

Consequences for Health Equity

The exclusion of female biology from the evidence base has led to significant health disparities, representing a failure to provide equitable care. These consequences include:

• Misdiagnosis of critical conditions, such as heart attacks, which present differently in women.
• A higher incidence of adverse drug reactions in women due to dosing guidelines based on male physiology.
• Ineffective treatment protocols for numerous conditions that manifest differently across sexes.

Strategic Interventions to Promote SDG 5 (Gender Equality) in Healthcare

Establishing Sex and Gender as a Medical Discipline

To address these inequities, pioneering academic structures were established. The Division of Sex and Gender in Emergency Medicine (SGEM) at Brown University was the first of its kind, creating a hub for research on how sex and gender influence acute illness. This work is fundamental to achieving SDG 5 by ensuring women’s health is no longer marginalized in medical science.

Building Partnerships for the Goals (SDG 17)

Progress has been accelerated through collaborative efforts that exemplify SDG 17. Key partnerships include:

1. The Society for Academic Emergency Medicine (SAEM) Interest Group on Sex and Gender in Emergency Care, which built a professional network for scholarship.
2. The Sex and Gender Health Collaborative (SGHC), a multispecialty organization dedicated to integrating sex and gender into medical practice and training nationwide.

Public Advocacy for Systemic Change

Translating scientific findings for public awareness is crucial for driving reform. The publication of “Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It” and a widely viewed TED Talk served to educate the public on this critical issue of gender inequality in healthcare, empowering patients and advocating for policy change.

Advancing SDG 4 (Quality Education) Through Medical Curriculum Reform

Institutional Commitment at USC SOMG

At the University of South Carolina School of Medicine Greenville, the focus has shifted to institutionalizing this knowledge by reforming medical education. This approach aligns with SDG 4 by ensuring the next generation of physicians is equipped to provide inclusive and equitable care. An NIH-funded R25 grant is leading a national faculty development initiative to integrate sex and gender-based principles into teaching and research across disciplines.

A Pipeline for Future Leaders

USC SOMG has developed a comprehensive educational pipeline to cultivate expertise in sex- and gender-based medicine:

• A Sex and Gender Differences in Medicine Elective provides students with an immersive introduction to the science of individualized care.
• An Emergency Medicine Fellowship offers advanced training in the mechanisms of sex and gender differences in acute disease.

A Holistic Framework for Reducing Inequalities (SDG 10)

Integrating Lifestyle Medicine with a Sex and Gender Lens

USC SOMG’s leadership in Lifestyle Medicine offers a unique opportunity to address health disparities. Lifestyle factors such as diet, stress, and exercise intersect with biological sex and sociocultural gender. By applying a sex and gender lens, prevention strategies can be tailored to address these intersections, such as how hormonal cycles affect cardiovascular risk or how gender norms create barriers to mental healthcare. This integrated approach is essential for reducing health inequalities as targeted by SDG 10.

Inclusive Research as a Prerequisite for Precision Medicine

The goal of precision medicine cannot be realized without inclusive research. The NIH policy requiring the inclusion of Sex as a Biological Variable (SABV) is a critical step. However, true progress requires that data be consistently analyzed and reported by sex and gender. Research at USC SOMG in areas from pharmacology to emergency care embodies this principle, working to build an evidence base that reflects human diversity.

Conclusion: A Moral and Scientific Imperative for Sustainable Development

Achieving Universal Health Through Equity

The legacy of male-centric medicine is a direct challenge to the universal principles of the Sustainable Development Goals. Correcting this historical bias is not merely a political or social issue but a scientific and moral imperative. True health equity, as envisioned in SDG 3 and SDG 10, depends on medical science that recognizes and respects the biological and lived experiences of all individuals.

The Path Forward

The initiatives at the University of South Carolina School of Medicine Greenville provide a model for reforming medical education and research. By grounding these systems in the principles of sex and gender equity, the medical community can move closer to its promise of providing care that is not only life-saving but also truly understands the diverse populations it serves, thereby making a significant contribution to the global 2030 Agenda for Sustainable Development.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   The article’s central theme is the negative impact of historical bias in medical research on health outcomes. It directly addresses health and well-being by highlighting how male-centric medicine leads to misdiagnosis, adverse drug effects, and distorted care for women. The text states, “women’s heart attacks are misdiagnosed, medications cause more adverse effects,” which are clear issues of health and well-being. The overall mission described is to achieve “care that not only saves lives but truly understands them,” which is the essence of SDG 3.

2. SDG 5: Gender Equality

   The article identifies the root cause of the health disparities as a form of gender inequality. It explains that “Women were routinely excluded from basic science and clinical trials,” creating a “silent architecture of bias.” The entire effort to build the field of sex- and gender-based medicine is a direct response to this systemic inequality. The goal is to achieve “sex and gender equity” in medical research and education, which aligns perfectly with the aims of SDG 5.

3. SDG 4: Quality Education

   A significant portion of the article focuses on the solution to medical bias through education. It details specific initiatives at the University of South Carolina School of Medicine Greenville (USC SOMG) designed to “train future physicians to prevent” inequities. This includes an “NIH-funded R25 faculty development grant” to integrate sex and gender-based medicine into teaching, a “Sex and Gender Differences in Medicine Elective” for students, and an “Emergency Medicine Fellowship.” These actions directly address the need for quality education that is inclusive and promotes equality.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being
  • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s focus on misdiagnosed heart attacks in women directly relates to this target. By improving diagnosis and treatment based on sex and gender differences, the initiatives described aim to reduce premature mortality from cardiovascular disease, a major non-communicable disease.
  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The article argues that current healthcare is not “quality” for women because it is based on a male baseline. The work to integrate sex and gender into medicine is a direct effort to ensure that healthcare services and treatments are truly effective and high-quality for the entire population.
• SDG 5: Gender Equality
  • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article frames the historical exclusion of women from clinical trials as a fundamental form of discrimination that has created a “knowledge gap” and endangers women’s health. The efforts described are aimed at dismantling this systemic bias in medicine.
  • Target 5.c: Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels. The article explicitly mentions a key policy change that aligns with this target: “Recent NIH policies requiring the inclusion of sex as a biological variable (SABV) mark a crucial step forward.” This is a clear example of a policy designed to promote gender equity in scientific research.
• SDG 4: Quality Education
  • Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for… gender equality. The article details how USC SOMG is working to achieve this by equipping “faculty across disciplines with the knowledge and tools to incorporate these principles into their teaching and research.” The creation of specific electives and fellowships ensures that the “next generation of physicians understands how biological and sociocultural factors influence health,” directly contributing to education for gender equality within the medical field.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article implies several indicators that can be used to measure progress:

• For SDG 3, progress could be measured by tracking a reduction in the rates of misdiagnosis for conditions that manifest differently in women, such as heart attacks, and a decrease in the reported incidence of adverse drug effects in female patients.
• For SDG 5, a key indicator mentioned is the implementation and enforcement of policies like the NIH’s SABV policy. Progress can also be measured by the proportion of clinical trials and basic science studies that include female subjects and analyze data based on sex. The establishment of divisions and interest groups, such as the “Division of Sex and Gender in Emergency Medicine (SGEM),” serves as an institutional indicator of progress.
• For SDG 4, measurable indicators are explicitly described in the article. These include the number of medical schools that have integrated sex- and gender-based medicine into their curricula, the number of faculty trained through programs like the “NIH-funded R25 faculty development grant,” and the number of students enrolling in specialized courses like the “Sex and Gender Differences in Medicine Elective.”

4. SDGs, Targets, and Indicators Table

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