Government Medical Research Spending Favors Women

It is commonly believed that medical research spending is biased against women. Here are some representative headlines: Why Medical Research Often Ignores Women (Boston University Today), Gender Equality in Medical Research Long Overdue, Study Finds (Fortune), A Male Bias Reigns in Medical Research (IFL Science). Largely on the basis of claims like this the NIH set up a committee to collect data on medical research funding and gender and they discovered there was a disparity. Government funded medical research favors women.

The Report on the Advisory Committee on Research on Women’s Health used the following criteria to allocate funding by gender:

All funding for projects that focus primarily on women, such as the Nurses’ Health Study, the Mammography Quality Standards Act, and the Women’s Health Initiative, should be attributed to women. For research, studies, services, or projects that include both men and women, recommended methods to calculate the proportion of funds spent on women’s health are as follow:

a. If target or accrual enrollment data are available, multiply the expenditure by the proportion of female subjects included in the program. For example, if 50 percent of the subjects enrolled in a trial, study, service, or treatment program are women, then 50 percent of the funds spent for that program should be counted as for women’s health. On the other hand, for diseases, disorders, or conditions without enrollment data, expenditures can be calculated based on the relative prevalence of that condition in women.

b. Where both males and females are included, as may be the case for many basic science research projects, multiply the expenditure by 50 percent.

On the basis of these criteria the report finds that in almost every category there is more female-focused NIH funding than male-focused NIH spending with the totals more than two to one in favor of females ($4.5 billion to $1.5 billion). Now personally I don’t regard this as a terrible “bias” as most spending ($25.7 billion) is for human beings and I don’t see any special reason why spending on women and men should be equal. It does show, however, that the common wisdom is incorrect. The Boston University Today piece I linked to earlier, for example, motivated its claim of bias in funding with the story of a female doctor who died of lung cancer. The NIH data, however, show a large difference in favor of women–$180 million of NIH lung cancer funding was focused on women while just $318 thousand was focused on men ($135 million wasn’t gender focused).

What about clinical trials? Well for NIH-funded clinical trials the results favor women:

Enrollment of women in all NIH-funded clinical  research in FY 15 and FY 16 was 50 percent or greater. Enrollment of women in clinical  research was highest in the intramural research program at 68 percent for both FY 15 and FY 16.

In the most clinically-relevant phase III trials:

NIH-defined Phase III Clinical Trials are a subset of NIH Clinical Research studies. The proportion of female participants enrolled in NIH-defined Phase III Clinical Trial was 67 percent in in FY 15 and 66 percent in FY 2016.

Historically, one of the reasons that men have often been more prevalent in early stage clinical trials (trials which are not always meant to treat a disease) is that after the thalidomide disaster the FDA issued a guidance document which stated that women of child-bearing age should be excluded from Phase 1 and early Phase 2 research, unless the studies were testing a drug for a life-threatening illness. That guidance is no longer in effect but the point is that interpreting these results requires some subtlety.

The NIH funds more clinical trials than any other entity but overall more clinical trials are conducted by industry. FDA data indicate that in the United States overall (the country where by far the most people are enrolled in clinical trials) the ratios are close to equal, 49% female to 51% male, although across the world there are fewer women than men in clinical trials, 43% women to 57% men for the world as whole with bigger biases outside the United States.

It would be surprising if industry research was biased against women because women are bigger consumers of health care than men. The Centers for Medicare and Medicaid Services, find, for example, that:

Per capita health spending for females was $8,315 in 2012, approximately 23 percent more than for males, $6,788

Also:

Research indicates that women visit the doctor more frequently, especially as they have children, and tend to seek out more preventive care. The National Center for Health Statistics found that women made 30% more visits to physicians’ offices than men between 1995 and 2011.

Nor is it the case that physicians ignore women. In one study of time use of family physicians and thousands of patients:

After controlling for visit and patients characteristics, visits by women had a higher percent of time spent on physical examination, structuring the intervention, patient questions, screening, and emotional counseling.

Of course, you can always find some differences by gender. The study I just cited, for example, found that “More eligible men than women received exercise, diet, and substance abuse counseling.” One often quoted 2008 study found that women in an ER waited 65 minutes to men’s average of 49 minutes to receive a pain killer. Citing that study in 2013 the New York Times decried that:

women were still 13 to 25 percent less likely than men to receive high-strength “opioid” pain medication.

Today, of course, that same study might be cited as a bias against men as twice as many men as women are dying of opioid abuse. I don’t know what the “correct” numbers are which is why I am reluctant to describe differences in the treatment of something as complex as pain to bias.

Overall, spending on medical research and medical care looks to be favorable to women especially so given that men die younger than women.

Hat tip: Discussants on twitter.

Addendum: I expect lots of pushback and motte and baileying on this post. Andrew Kadar wrote an excellent piece on The Sex-Bias Myth in Medicine in The Atlantic in 1994 but great memes resist data. Also, school summer vacation is not a remnant from when America was rural and children were needed on the farm.

Comments

Research indicates that women visit the doctor more frequently,

That's because all women are hypochondriacs.

Or do men visit the doctor less frequently because of toxic masculinity?

Actually, more likely because they do visit a gynecologist regularly, nor do men become pregnant.

Sometimes, one really has to wonder how many commenters here have even the slightest contact with women, or whether they just resolutely ignore commonplace aspects of femininity that women cannot.

You're an idiot.

I pay a visit everyday a few websiktes and information sites to read posts, however this webpage
offers quality based writing.

How much of that is driven by the mandatory annual physical in order to be allowed to use birth control pills?

What does that have to do with medical *research*?!

Can any of you people actually read more than a sentence?

i can't even write a complete

Actually, more likely because they do visit a gynecologist regularly, nor do men become pregnant.

You haven't lived with any women in some time, have you?

You haven't had your head examined, have you?

There's a bias on the NIH research as shown by the numbers above, but what's the whole picture? What about private and military medical research?

Industry funded clinical trials of drugs to treat indications afflicting both sexes have to include representative sample sizes of each so that both efficacy and safety can be adequately evaluated. There are FDA guidance documents on this subject.

Alex included on entire paragraph on industry spending: "The NIH funds more clinical trials than any other entity but overall more clinical trials are conducted by industry. FDA data indicate that in the United States overall (the country where by far the most people are enrolled in clinical trials) the ratios are close to equal, 49% female to 51% male, although across the world there are fewer women than men in clinical trials, 43% women to 57% men for the world as whole with bigger biases outside the United States."

It was a rhetorical question to bring attention to this paragraph, sorry for the misunderstanding.

So, 49% female 51%. The post title should be "government medical research funding helps to balance overall funding on men and women"

Your main link is wrong. It links to the report on opioid abuse you mention towards the end.

Since I can't find the report from a quick google (I can find the FY15-16 which I assume is not the most recent), perhaps you could answer some questions:

Do they have break-outs of research on sex-specific conditions? What about targets vs. actual enrollments?

If they're targeting a 50/50 split but getting differing levels of participation (particularly likely if you need old people, since more old people are women), it's hard to call that "bias".

Now, I get that the Straussian reading here is something along the lines of, "Of course that shouldn't be called 'bias'! But people make that type of stupid argument, taking a top line summary statistic and over-interpreting it to mean something it probably doesn't, and so I've gone and done the same thing but in a way that will piss them off so hopefully they'll stop making dumb arguments like this." But I worry your headline will just instead encourage different people to make bad arguments and perpetuate more folks arguing over poorly-interpreted summary statistics.

Beat to the punch on the main link being wrong. There is no way that Alex can write this post without cross-checking the relevant diseases being studied. the major male-only cancer is that of the prostate which usually strikes late in life. Women have several more gender-specific cancers and depending on genetics these can strike much earlier (notably breast and ovarian). Certain thyroid disorders disproportionately strike women (though NIH is funding much research in this area and my old branch at NIH dealing with thyroid disorders was closed some years ago).

I'm loathe to call this post 'junk science' as there is some bias in funding but it's probably explained with a thorough examination of the data which this post unfortunately does not do.

Alex is refuting the claim that funding is more directed at men, which he does conclusively. He also addresses the argument on whether there should be a 50/50 split. RTFA

Well he is refuting a claim found in some headlines (and which many people may believe, of course). Further, as noted here - 'most spending ($25.7 billion) is for human beings' - the bias is very much in the eye of the person making the categories. Basically, 6 billion dollars can be categorized into 'male' or 'female,' though this distinction seems hard to reconcile with the 'human' category - 'a. If target or accrual enrollment data are available, multiply the expenditure by the proportion of female subjects included in the program. For example, if 50 percent of the subjects enrolled in a trial, study, service, or treatment program are women, then 50 percent of the funds spent for that program should be counted as for women’s health.'

Basically, this makes no sense, at least when one has a 'human' category - essentially, the above described example would seem to be 'human,' and not actually split into male/female.

Since the link is still broken, there may be an answer to that objection. And the point about lung cancer is not possible to look into, but if there had been a recent increase in lung cancer among women, for example, I would reasonably expect more research being directed to that area.

'It would be surprising if industry research was biased against women because women are bigger consumers of health care than men.'

Here is a possible explanation that comes entirely from so far out in left field that a GMU economist cannot be reasonably expected to see it - men don't get pregnant, nor do they visit the gynecologist regularly, nor do they need a prescription to buy hormonal birth control.

You seem to fighting Alex and something he's not claiming. I saw nowhere where he said funding should be equal. Your examples are good though. Women do need more medical care, and I'm willing to invest more to cure breast cancer that affects young moms over prostate cancer that kills old guys.

'I saw nowhere where he said funding should be equal. '

There are several places where he explicitly said he had no problem with unequal funding.

My major problem is with the methodology (you take a study that seems to be about humans, and then you assign a value for male/female based on participation numbers?), and how Prof. Tabarrok seems to accept it fairly uncritically.

The real take way would seem to be that roughly 15% of total NIH funding can be considered directed to women, roughly 5% directed to men, and the other 80% to both men and women. Sounds a bit less dramatic that way, particularly when one thinks about how women play the major role in human reproduction, and have problems directly related to that reality - such as ovarian cancer or pregnancy related diabetes.

Linked fixed. Thanks.

See how much discussion one can have without anyone being able to read the link?

Uhh...breast cancer is not gender-specific. Men can get it, but do so at much lower rates than women.

Very true, but I think his point was that breast cancer affects more women of child bearing age, and is thus more relevant than something like prostate cancer - or to stay more within a similar reproductive range, testicular cancer, which is also comparatively rare compared to ovarian cancer.

Dude... breast cancer is a female disease. Less than one percent of breast cancer cases are in men and about 1 in 1000 men will be diagnosed with breast cancer (http://lmgtfy.com/?q=male+incidence+of+breast+cancer).

Why is it that so many of us obsessed with the belief that some other group is getting more favorable treatment than the group to which we belong. It seems that everyone is discriminated against! By gender, race, ethnicity, region, nationality, even ideology. We are a jealous species.

This obsession with one's group is often reflected in dislike or hatred of the other. Men hating women, whites hating blacks, Christians hating Jews, and so on. In extreme cases, groups seek isolation from the other, whether in the neighborhoods in which they reside or the country to which they belong. The secessionist movement is a manifestation of this, whether the secessionists in California or the secessionists across Europe. The Benedict Option is appealing to a large number of Christians, Rod Dreher being a well-known advocate of it. The thought of spending all of my time with like-minded people gives me a feeling of dread. What would one learn? Not much.

No extreme cases required. Even a mild bias will, given time, result in a great deal of segregation across the relevant dimension.

But this doesn't seem too shocking to me. We're social primates. Developing a clique or in-group seems like the correct strategy in most settings. Loners and neutrals would appear to be ill-equipped for the usual struggle.

"Why is it that so many of us [are] obsessed with the belief that some other group is getting more favorable treatment than the group to which we belong?"

Because it's very hard to make sound arguments for government intervention and infringing on other people's liberties. Countering some alleged privilege and combatting climate change are two general purpose rationales for justifying infringement when all other arguments fail.

Think in terms of natural selection. In trying to justify infringing other people's rights, one tries many random arguments. Most fail to pass muster so that the only arguments remaining are those claiming some alleged privilege needs to be countered or those claiming the infringement is needed to combat climate change.

So what?

I don't understand the point of the research nor the point of the post.

Has anyone thought that women due to their biology might be subject to a greater variety of disease?

Another hypothesis: It is possible that since women care a lot more about health than men*, pharma companies chose to focus more on women specific diseases, right?

*which might be one of the causes why women's life expectancy is higher than men's. Guys simply care less!

There are other things in the world besides discrimination and bias, you know.

Has anyone thought that women due to their biology might be subject to a greater variety of disease?

This is a well known fact and one major reason for increased morbidity in the female population. Obviously, complications from pregnancy also contribute to increased health utilization.

"increased morbidity in the female population"
*slaps forehead*

Alex is refuting the claim that funding is more directed at men

Exactly, TMC. Most comments here miss the point of Alex’s article.

No pushback here. It was a nice break from Tyler's casual sexism. Thank you.

>It is commonly believed that medical research spending is biased against women.

I've literally never heard this, ever, even amongst the crowd that insists daily that everything on Earth is biased against women. (Except of course Middle-Eastern culture; heavens no, not that.)

Really? It's been a very popular framing - googling "gender bias in medical research returns dozens of links. Intuitively, of course, it never made much sense, breast cancer research - well, fundraising anyway - vanquishing all comers.

Well, considering the post is from Prof. Tabarrok, your praise might be a bit misdirected.

And it just occurred to me right after posting that you may be attempting to praise Prof. Tabarrok without actually naming him as worthy of praise - both interpretations are possible from your second sentence.

I have heard it taken as accepted fact many times that men are favored in medical research.

Glad to see the 1994 Kadar piece cited. It should have demolished that myth.....but it didn't.

"Government Medical Research Spending Favors Women"

It favors mice much more. All the time, I read about how this or that product or procedure scientists test make mice healthier, stronger, more beautiful (as mice go) or grows an ear on their backs. How those miracle solutions slash cancer rates or prevents strokes ... on mice. Just a though, Einsteins,: maybe we should spend that money and effort helping human beings instead! I am sick and tired of mice being favored and free-riding on everyone's taxes.

We have a new mouse volunteer.

lol. You've earned your keep for the day.

+1. Bravo

My point is that it is better to spend research money on women than on creatures whose best laid plans often go awry.

If I read it right, the "rules" used in their compute seems to be strongly biased. (a) "On the other hand, for diseases [etc] without enrollment data, expenditures can be calculated based on the relative prevalence of that condition in women." So, as long as a study doesn't specify male:female stats, we should assume that there are a proportionate number of women?? Have you heard the phrase "Begs the question"?
and then there's (b) "Where both males and females are included, as may be the case for many basic science research projects, multiply the expenditure by 50 percent." WTF! Also add the value of automotive imports and attribute half that to women as well, since adding even more noise to the data is the objective here, right? In what CLINICAL study is sex of the subjects NOT available???? or perhaps I should add the word "valid" to it: In what valid clinical study is sex stats unavailable?? risible. Also, does this include mental health studies? What a morass. This seems to confound several questions: is the health care research funding roughly speaking evenly distributed? (women live longer, but also have more interactions with health care system. If they live longer, should they get more dollars allocated or less, I could make a case either way...) & For a specific disease/condition which impacts men and women ~equally (in terms of severity of outcome), do the studies recruit ~equal #'s of each sex?

"(a) "On the other hand, for diseases [etc] without enrollment data, expenditures can be calculated based on the relative prevalence of that condition in women." So, as long as a study doesn't specify male:female stats, we should assume that there are a proportionate number of women?? Have you heard the phrase "Begs the question"?"

This seems quite straightforward. If you are researching a disease that only women have, it (directly) benefits only women.

"women care more about their health" or "women are hypochondriacs"
"men are stoical about pain" or "men have toxic masculinity"
"floor wax" or "dessert topping"

I never go to the doctor, ever. Even with broken limbs, even when very heavy things fall on me. This may sound like a joke but I'm dead serious. I just don't bother going. It's a waste of time and money and my so-called 'insurance' never covered anything back when I used to go. I tough it out. Not because I'm a tough guy--I'd much rather have medical care. But medics don't care.

And is there no number for african american lesbian women? The framing of the whole article is the epitome of sexism

Gotta get that intersectionality into the scientific research.

"found that women made 30% more visits to physicians’ offices "

My only objection to this paper is that the 30% should be more in the 200-300% range.

Unrelated - what's going on with the website? All of a sudden all the text is wrapping by inserting line breaks mid-word.

Resize your browser. It's hyphenating words. Here is some ipsum to play with.

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Also, collapsible threads are wonderful. Thank you, hosts!

that's cool
but isn't what the people need right now is for malcom I just wanna explain things to people gladwell to explain to the people more about how we
get our social media score because you don't get to just give people social media scores do you ? like in that creepy movie conspiracy.

you mean the movie ;"theconspiracy" with stanley tucci as eichman

where the sociology dept
gets together to figure how to calculate
other peoples social media scores;
that was a creepy movie 1
that makes the whole idea of social media scores pretty creepy

1heydrich; especially creepy

"Per capita health spending for females was in 2012, approximately 23 percent more than for males, "

Women medical practitioners were paid $8,315 compared to men paid $6,788 per capita, or were mostly men paid more for treating women than mostly men were paid to treat men?

The thousands paid to health care workers are the primary economic benefit of health care spending in the US.

Other nations focus on health care outcomes and then pay workers to obtain the labor required to strive to meet those outcomes. Women willing to work for less income tend to do more of the care delivery.

The link to Timothy Taylor's post on the origins of summer vacation was enlightening. I remember in elementary school learning that children in Japan had many more schools days than American children, basically year-round schooling with a couple of long breaks IIRC. I don't know the history of public education in Japan but it looks like they adopted the American "urban" schedule of schooling rather than the rural one or the hybrid one that the USA eventually adopted.

Back in the 1980s, my wife worked in medical research once on a study of uterine cancer. Medical research was a fairly female dominated profession at the time and I imagine it's only become more so.

Looking at Nobel Prizes in hard sciences, it looks like a huge amount of female scientific talent over the last two generations has gone into the Life Sciences, rather than into the Death Sciences, like Physics and Chemistry.

No bright little girl ever thought the most awesome thing anybody ever said was, "I am become Death, destroyer of worlds." But more than a few bright little boys felt that way.

As somebody who had his life saved 20 years ago by a breakthrough in cancer research, I am grateful to all the very bright women who played a role in that.

"No bright little girl ever thought the most awesome thing anybody ever said was, "I am become Death, destroyer of worlds." But more than a few bright little boys felt that way."

Great insight, worth enjoying and remembering.

So, these statistics confirm that women bear a disproportionate burden of serving as test subjects in clinical trials? Drug companies, mostly run by men, earn profits by testing their drugs disproportionately on women. :)

So let me get this straight? When there's FEWER women than men as test subjects, women are the victims since they're ''under-represented'' but when there's MORE women than men, they're still victims as they ''bear a disproportionate burden''?

Wow, it's almost as if feminism is unfalsifiable :)

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