Measurement and meaning: reporting sex in health research

Elsevier, The Lancet, Volume 393, Issue 10171, 9–15 February 2019, Pages 497-499.
Sarah Hawkes, Fariha Haseen and Hajer Aounallah-Skhiric

What is normal? In the study of medicine, from the laboratory to the bedside and to the art and craft of public health, we seek and apply standards and measures of normality that are designed to show that there is a baseline from which variation or deviation might be observed and possibly corrected for.

Over several centuries of medical and health research, normal has, generally, been male. From the earliest days of anatomical research, the bodies used for dissection and drawing were overwhelmingly male and textbook depictions of female bodies tended towards Aristotle's observation that “the female is, as it were, a mutilated male”, or Galen's description of women as “imperfect”, representing essentially a “turned in” version of men.

The norm of the male body persists in much of medical education. A study of 31 anatomy textbooks used between 1890 and 1989 found little difference in the proportions of anatomical drawings that were male (about 70%) compared with female (<10%, with the remainder classed as non-gendered),1 and a more recent survey of 15 general medical and surgical textbooks found that 78% of depicted faces were male.

This level of sex blindness in educational materials and medical research has consequences for individuals and groups who do not conform to the norm and who might receive erroneous diagnoses, missed opportunities for intervention, or simply the wrong dose of the wrong drug. The genetics, anatomy, physiology, biochemistry, and health-care experience of women and girls have historically been under-researched and under-addressed in the health sciences, but the question of whether it continues today has not been extensively and rigorously analysed until now.