By Dr. Jeannette Wolfe
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The podcast currently has 41 episodes available.
Host: Jeannette Wolfe Guest: Sara Haag
Dr Haag is a researcher in molecular epidemiology who studies human biological aging at the Karolinska Institute in Stockholm.
Background - Dr Haag has a PhD in functional genomics and Post Doc in genetic and molecular epidemiology. She studies telomeres and molecular association with telomere length, she also has experience in molecular biology and computer science.
Definitions and discussion points from podcast
Two major theories of aging:
As the field of Geroscience and epigenetics evolves, the “truth” around aging is likely to be a combo of both theories.
Sex Differences
Hormones
Estrogen
Dr Haag talked about research involving telomere length (telomeres are the cap of the chromosome and they help protect the chromosomes from damage.) Typically, telomeres shorten with repeated division in somatic cells and when they shrink to a certain length the cell is more vulnerable to error and damage. Females have longer telomere length at birth compared to males and there is evidence that women with longer exposure to estrogen have longer telomeres.
Testosterone
Here is the Korean Eunuch study mentioned in the podcast. The researchers examined a genealogical record of 385 eunuchs and compared their life span to several other groups of men who lived during the same time periods including a bunch of kings. They found that the average life span of a eunuch was 70 which was 15-19 years longer than the comparison groups. One theory behind this difference in longevity is “the disposable soma theory”. This postulates that in males there is competition between two different intrinsic systems - somatic aging and reproduction- and that as both systems require significant energy to maintain, when energy is diverted to one system the other suffers.
Sex Chromosomes
In females each cell has two X chromosomes. In female cells, one of the X chromosomes is typically inactivated so that some cells have genes expressed that are inherited by their father, while others express genes inherited from their mother. Complicating this further is that several genes do not fully inactivate that second X chromosomes so that females may have an “extra” expression of some genes. A concrete example of this is the gene Toll like receptor 7 which codes for proteins that helps the immune system recognize the early invasion of certain types of viruses. As this gene doesn’t undergo X inactivation, it may give females an extra boost in warding off certain types of viral infections.
With aging there can be “skewing” of the X chromosome in that females may have a disproportionate percentage of cells that express the X chromosomes of a single parent.
As male cells age, some may actually lose their Y chromosome. This news release suggests that his may happen relatively frequently as their work implied that 40% of all 70-year-olds had cellular evidence of it. The loss of Y chromosome can be associated with Alzheimer’s and heart disease in males.
Take home points:
1) The field of aging is absolutely exploding. Someday it may be possible to actively manipulate epigenetic signaling to slow or even reverse aging processes.
2) Different biological processes in our bodies age at different rates. Plus, if you follow a group of people over time, as they get older there will be greater and greater differences within that group in their markers of aging.
3) In aging research, there has historically been two different camps- the senescence camp, and the programmed theory one. In the senescence camp is the belief that as we age, things just start breaking down due to natural wear and tear. This contrasts with the programmed theory camp which believes that aging is a pre-designed active process that is triggered with age. The “truth” likely is a combination of both theories with epigenetics being the bridge.
4) Sex differences in aging include the mortality-morbidity paradox in that although females tend to have poorer health and greater fragility risk, males still tend to die sooner.
5) Sex differences with aging may include changes in the X chromosome with increased skewing and even the loss of the expression of the Y chromosome, both of which can be associated with an increase of health-related issues.
Thanks for listening. May you be well (and curious). Jeannette.Show Notes for Episode Twenty-Five of seX & whY, Part 2: Global Health and Pandemic Responsiveness Through a Sex and Gender Lens
Host: Jeannette Wolfe Guests: McKinzie Gales and Emelie Yonally Phillips
Phase 1 of the sex and gender equity in research (SAGER) for Integrated Outbreak Analytics (IOA) study involved A systematic literature review to better understand what is already known about the influence of sex and gender in outbreaks and to investigate if sex-disaggregated data and gendered data is being collected, analyzed, and used. Five different databases were searched and articles meeting the inclusion criteria were included. All included articles were published in English between 2012-2022, included the key terms “sex,” “gender,” or “pregnancy,” and discussed infectious disease outbreaks (e.g., cholera, dengue, Ebola, zika, hepatitis E, Malaria, influenza, yellow fever) in a low- and middle-income countries. Notably, they intentionally excluded articles focused on covid and tuberculous as sex and gender research is being extensively conducted on these diseases.
Of the 15,000+ articles in their original search, only 71 articles examined potential sex and/or gender related factors associated with outbreaks in low- and middle-income countries.
Although currently there is very limited data on the impact that sex and/or gender play in outbreaks and pandemics, what is known, underscores the complexity of these relationships. Studying specific outbreaks in specific contexts is important because who is most likely to get infected and how rapidly an infection is spread is influenced by several intersecting factors. These include the infectious agent, sex specific immunological factors and local socio-cultural practices and norms.
McKinzie highlighted that when there is a lack of gender and sex sensitive responses in outbreaks, evidence suggests that women, girls, and those with female anatomy are disproportionately negatively affected. For example, women are at greater risk for gender- based violence during a lock down and those with female anatomy are more directly impacted by the diversion of health care resources from clinics that offer reproductive health and pregnancy related services.
We went through an example as to how the SAGER IOA model might work in a theoretical outbreak. In establishing a functioning multi-disciplinary team, Emelie emphasized the importance of working within local systems to build long term relationships, community trust and capacity. She underscored how critical it was to understand the values and priorities of the individuals most impacted by the outbreak and to ensure they had a voice in decision-making. She also discussed the importance of effective and transparent community health messaging- particularly if new data suggests a change from current practice. A recent example of this was the confusion experienced by many pregnant women surrounding the safety of Ebola vaccination.
Emelie also spotlighted the opportunity to better understand how gender nonconforming and sexual minorities experience outbreaks as there is currently an absence of data on these groups. Finally, she emphasized that the failure of considering sex and gender specific needs in an outbreak can have tremendous downstream effects. Specifically, generational poverty, educational and professional inequities, gross domestic product, global trade, and security can all be impacted.
One of the other interesting areas we touched upon was how personal protective equipment (PPE) and other medical related equipment was initially designed for the anatomy and physiology of a male body and may not always work for a female one. Below are a few articles on this point.
Respiratory Personal Protective Equipment for Healthcare Workers. This study reported findings on adequate mask fitting in one hospital system’s fit test data for FF3 masks. Their data set suggested that 18% of women had an inadequate FF3 mask fit compared to 10% of men.
Unions say coronavirus crisis has brought ‘into sharp focus’ the problem of women being expected to wear PPE designed for men.
Here is a very interesting article that further explores whether medical equipment should be adjusted to better fit the anatomical variations of different users. The article - Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? makes a strong argument that most of the advances in laparoscopic surgical equipment have previously focused on accommodating different patient related factors and that their remains an opportunity to modify products to better align with anatomical characteristics of different users. In turn, this may help enhance performance, outcome, and injury prevention of the users - AKA in this case the surgeons.
Thanks for listening and be well.
Show Notes for Episode Twenty-Five of seX & whY: Global Health and Pandemic Responsiveness Through a Sex and Gender Lens
Host: Jeannette Wolfe Guests:
Definitions
IOA - Integrated Outbreak Analytics SAGER - Sex and Gender Equity in Research
The Integrated Outbreak Analytics (IOA) initiative is a collaborative partnership between UNICEF, WHO, US-CDC, ITM, Epicentre, IFRC, under the umbrella of GOARN.
The IOA concept started in earnest in 2018 during the Ebola outbreak in the Democratic Republic of Congo after it became clear that more real time, comprehensive on the ground data was needed to best manage outbreaks in an efficient and effective manner. The larger-picture concept is that the IOA model sets up a system for increased interagency data sharing and a process for data collection that produced more comprehensive information about:
The IOA - Creates a more holistic response to outbreaks along the entire pipeline from prevention to treatment. It creates a model that puts lots of partners at the table including major players like Unicef, WHO, CDC, Doctors Without Borders in addition to local governmental agencies and boots on the ground health care providers.
Examples of data that may be integrated to provide a clearer story of what is happening in an outbreak include:
Goal is to apply a multi-disciplinary approach to outbreak analyses to provide a more holistic and timely understanding of outbreak dynamics and provide local Ministries of Health and response actors with rapid evidence to make decisions during an outbreak.
A key component of IOA is understanding the dynamics of both sex and gender within outbreaks and outbreak response for more adapted and appropriate responses. Therefore, IOA systematically works to collect, analyse and use data disaggregated by sex and inclusive of gender criteria across all phases of response:
Four phase project
Phase 1:
Phase 2:
Phase 3:
Phase 4:
Great resources
Show Notes for Episode Twenty-Four of seX & whY: Sex and Gender Differences in Conflict, Part 2
Host: Jeannette Wolfe Guest: Joyce Benenson, lecturer of evolutionary biology at Harvard and author of the book Warriors and Worriers
In this podcast we continue our discussion about women interacting with each other at the workplace and how women often manage hierarchy differently than men. We got into a spirited discussion about a question posted on a female physician’s list serve querying whether women physicians want to be addressed as “Doctor” by other staff members. (My own preference was “yes” in front of patients, and “no” once we were outside of exam rooms.) Benenson believes that when women are interacting with women who are not family, they tend to act incredibly egalitarian. This can be challenging for women in hierarchical positions and lead to a downplay of their power. This intentional buffering may not only use up a lot of cognitive energy, but it can also be a potential disadvantage in professional situations that require a clear chain of command to optimize team performance. This can put women on a professional tightrope that can be hard to balance. Ways to address this include acknowledging that this challenge is real, committing to direct communication and focusing on shared outcome goals of the entire team. Personally, I have also found it extremely helpful to humanize the other person and remind myself that most people don’t go to work with malicious intent to try and screw up another person’s day.
Next, we talked about likeability, and Benenson shared a fascinating economics paper called: I (Don’t) Like You! But Who Cares? Gender Differences in Same Sex and Mixed Sex Teams. This paper included a series of studies in which pairs participated in games that involved economic transactions and “likeability”. In pairs where men worked with other men, “liking” their partner was not intricately related to maximizing their profits. This was not the case in teams that involved at least one woman. In these pairs, likeability increased the chance of profits and dis-likability decreased overall profits. This suggests that when interreacting with each other, men may have a greater ability to compartmentalize their professional interactions from their personal opinions.
Next, we talked about the “tend and befriend” theory developed by Dr Shelly Taylor. This theory suggests that when stressed, that females may benefit less from a fight or flight response and more from coming together to pool resources and share childcare. Benenson’s impression is that there is little scientific evidence that this theory holds true. She believes, contrary to the popular stereotype, that males are actually far more likely to be the communal sex and are much more likely to form intense group bonds.
At the end, I briefly reviewed some of the findings of a recent paper Dr Benenson published called: Self Protection as an Adaptive Female Strategy which supports the “Staying Alive Theory”. From an evolutionary perspective, behaviors that are more likely to be found in groups of males than females, such as direct competition, physical aggression, resource accumulation and risk taking, have evolved because they provide a benefit to males in optimizing their mating opportunities and reproductive fitness. The question becomes, is there a parallel evolutionary driver for females. The Staying Alive Theory is one proposal. This theory originally developed by Campbell in 1999, suggests that compared to males, females are more likely to be innately wired to avoid conflict and be more physiologically responsive to threats that can jeopardize their health. By doing so, this helps females optimize their chance of their own fitness and the survival of their own offspring. In their paper, Benenson and her group surveyed several different areas of science to look for support of the Staying Alive Theory and here are some of their findings.
This is a great paper and worth a full read if you are interested in this material.
Thanks for listening to Sex and Why!
Show Notes for Episode Twenty-Four of seX & whY: Sex and Gender Differences in Conflict, Part 1
Host: Jeannette Wolfe Guest: Joyce Benenson, lecturer of evolutionary biology at Harvard and author of the book Warriors and Worriers
Here is a link to Dr Benenson’s book Warriors and Worriers.
This book dives deep into the evolutionary roots of human behavior and Dr Benenson makes a very clear and well referenced case that human males and females have evolved from slightly different playbooks. The root of this difference is sexual selection in that adaptions and behaviors that optimize the chance that a male’s DNA gets into the next generation are slightly different than a female’s, specifically Benenson asserts that a female’s strategy relies more heavily on keeping herself and her children physically safe and healthy. Innate differences may then by amplified or attenuated by sociocultural norms and experiences that shape an individual’s “expected behavior."
Some bullet points from her work
This is Dr Benenson’s study that looked at how much time two players spent interacting with each other after the conclusion of a competitive sports match. It showed that men typically engaged longer with their opponent than did women. She theorizes this behavior suggests that men tend to be more agile in realigning these relationships because the relationship may be needed for a future allegiance (i.e. in war or hunting.)
Please tune in next month for Part 2 of this series.Show Notes for Episode Twenty-Three of seX & whY: Issues Surrounding Men’s Health, Part 2
Host: Jeannette Wolfe Guests: Peter Baker – Director of Global Action on Men’s Health Twitter: @pbmenshealth @globalmenhealth
Dominick Shattuck has a PhD in psychology and does Global Health Work at Johns Hopkins Bloomberg School of Public Health
https://www.linkedin.com/in/dshattuck/
Main topics discussed:
Challenges and barriers associated with optimizing men’s mental health and the role of men in reproductive health-related issues.
Men’s mental health is important not just for men but for the health of communities. Maladaptive coping mechanisms such as substance use disorder and aggression can impact gender-based violence, sexual and reproductive health, and the well-being of children. Part of tackling gender-based violence needs to include helping men better manage anger and stress.
Barriers to mental health for men
From a young age, many boys are taught to suck things up and not show signs of physical or emotional weakness. They also may struggle to find words to adequately articulate their emotional state or to appropriately label the challenges which they are experiencing. This may be further confounded by social media in which most posted photos portray men as carefree and perfect which can leave the viewer feeling inadequate and questioning their masculinity. Today many men may also have decreased contact with their extended families and thus may miss out on many of the informal connections and conversations that have historically helped men cope with common life challenges.
We then discussed some unanticipated and potentially detrimental consequences of “gender blind” policies. For example, due to concern of exclusivity, there has been a decrease in what historically were Men’s Only spaces. These closures can be costly for men who already have a fragile support system and who relied on these organizations to help them connect and bond with other men. Dominick then talked about the importance of code switching for men (using different communication styles with different audiences) and that in the ideal world we would create opportunities for men to become more proficient in the different roles they play (i.e. father, husband, employee etc) by exposing them to spaces with different audiences like men’s only, couples, and mixed gender gatherings.
Peter also brought up that mental health related depressive symptoms may just look differently in men. Consequently, many men and their health care professionals, may not be aware that some of the symptoms that men are describing (such as increased alcohol consumption) are often flags for depression.
Next, we discussed what roles men can play when it comes to areas surrounding reproductive health and reproductive justice. Dominick talked about some of the work he has done for a task force funded by the US Aid for use in low and middle-income countries to help better define these roles. He described a three-pronged framework- men as potential clients (i.e. work around condom use and vasectomies), as supportive partners to women, and as advocates for change. Messaging this framework so that men understand that these issues are not just relevant for women is critical. Peter also believes that this is an area in which Men’s Advocacy Groups can likely help so that women are not shouldering this load alone.
One of the take home moments for me was a story Dominick shared about the first time in his entire life that he had a talk with a medical doctor about family planning was when he was in the urologist’s office getting his vasectomy. I embarrassingly admitted that as an ER doctor when I am speaking to a male patient about condom use it is usually in the context of me treating them for an STD and my focus is primarily on preventing future infections not future babies. Made me realize that even in my speciality there are some opportunities.
Here are links to some of the information we discussed.
Mental Health Survey
Here is the article about Dominick’s work and his commentary related to the Covid Trends and Impact Survey. This is an online survey on Facebook that has surveyed millions of people across the world. Dominick’s study focused on over 12 million participants in 115 countries from May 2021 to Sept 2021 and found that 37% of men reported feelings or depression and 34% of anxiety with younger men reporting higher levels than older ones. These numbers were similar to the percentages of anxiety and depression reported by women. Men also reported that getting more resources on how to maintain their mental health was one of their top priorities surrounding the pandemic. Their findings were somewhat atypical because outside of Covid, women are typically much more likely to report symptoms of anxiety and depression and men are much more likely to under-report their symptoms, suggesting that COVID has caused significant suffering for men. Interestingly, it also hints that COVID may have helped some men to be more open to the concept of counseling and mental health related services.
Post-partum Depression in Men
Interestingly, when we think about post-natal depression, we tend to think it is something that only happens to newborn mothers, but Peter suggests that it is also relatively common in men. As this shocked me, I dug around a little.
Per this JAMA article about 10% of men suffer from postpartum depression but the rate can be as high as 1 in 4, 3-6 months after birth.
Factors that might contribute to postpartum depression in men
Again, interestingly, fathers are usually not asked questions about their own coping
Here is a summary of the paper we discussed that helped a hyper-masculine profession - offshore oil workers - change their culture surrounding safety.
Take home points
Thanks for listening to seX & whY, Jeannette
Show Notes for Episode Twenty-Three of seX & whY: Issues Surrounding Men’s Health, Part 1
Host: Jeannette Wolfe Guests: Peter Baker – Director of Global Action on Men’s Health Twitter: @pbmenshealth @globalmenhealth
Dominick Shattuck has a PhD in psychology and does Global Health Work at Johns Hopkins Bloomberg School of Public Health
https://www.linkedin.com/in/dshattuck/
Here is a list of Peter Baker’s publications including Men’s Health Policy: it is Time for Action.
Here is a list of Dominick Shattuck’s publications
Take home points
Please join us next month for a continuation of our conversation in which we will focus on issues surround men’s mental health and the roles that men may play in the shifting landscape of reproductive justice.
Show Notes for Episode Twenty-Two of seX & whY: Sex, Drugs, and Rats
Host: Jeannette Wolfe Guest: Dr Irv Zucker, Faculty at UC Berkley since 1966. Interests include behavioral endocrinology, chronobiology, and sex differences in pharmacology
General discussion
Many times, the worlds of basic science and human clinical trials do not overlap to the degree that they should. Greater coordination between the two silos, especially as it comes to the examination of sex differences, would likely produce more robust, higher quality science that would benefit a greater number of patients.
1993 NIH Revitalization Act. To get NIH funding for human clinical trials researchers needed to include or explain why they were not including, both men and women in clinical trials
2016 Sex as a Biological Variable. Applied above rules to basic science lab work. Irv and his team’s work were instrumental in triggering this policy change.
Sampling of Dr Zucker's Research
This paper surveyed prominent journals from 10 different areas of basic science research and highlighted that the consideration of the existence of sex differences was rarely considered by pre-clinical researchers. Most studies included only male animals with less than 25% including both sexes. Some concerning numbers in specific fields were totally lop-sided. For example, in neuroscience there was a 5:1 male to female animal ratio
Follow up research reexamined these numbers after the 2016 guideline change and showed:
Here is the paper we discussed that busted the myths surrounding female animal variability and numbers needed to study: Female mice liberated for inclusion in neuroscience and biomedical research.
Next, we talked about pharmacokinetics: Sex differences in pharmacokinetics predict adverse drug reactions in women. They evaluated 86 drugs in which they could find published information about pharmacokinetics broken down by biological sex (for example, if the drug was absorbed, distributed, metabolized and excreted similarly or differently in male and female bodies) and then compared these findings with a data base that evaluated for adverse side effects.
Bottom line - when giving a drug to a female start at the lowest dose possible and review other scripts they are taking to avoid potential drug/drug cross-reaction.
Also here is the amazing story of Dr Frances Kelsey who stood tall against the tremendous pressure by the manufacturers of thalidomide to approve the drug in the United States. Her request to not approve the drug without additional data ultimately saved the lives and physical disabilities of countless babies.
Take home points from podcast
Thanks for listening!
Show Notes for Episode Twenty-One of seX & whY: Opioid Use Disorder
Host: Jeannette Wolfe Guests: Dr Alyson McGregor, author of Sex Matters: How Male-Centric Medicine Endangers Women's Health and What We Can Do About It Dr Lauren Walter
Here is link to American Psychiatric Association DSM 5 diagnosis for opioid use disorder from the CDC. Essentially the disorder is defined by continued craving and use of opioids despite significant social and professional consequences caused by its use.
This podcast is on sex and gender differences in opioid use disorder. Although sex (s) and gender (g) are rooted in different etiologies - biological sex via innate chromosomal and hormonal characteristics while gender is heavily influenced by sociocultural factors, they are often heavily interconnected. Experiences influence gene expression through epigenetics and if a man is exposed to different experiences than a woman, they can have different epigentic responses. Further complicating things, however, is that if a male and a female have the same experience, they can have a different pattern of gene expression because the process of epigenetics itself is influenced by innate sex. Currently, if researchers are even looking for s/g differences in their data, they are usually doing so at a very basic level like patient reported demographics, this makes further exploration as to whether discovered differences are rooted in innate physiology or cultural influences difficult. Essentially, appreciating the current limitations of research, we will use the term “men” and “women” in this blog.
To highlight how recent the trend in research has been to even consider the potential influence of sex and gender as relevant factors in pain. A 2007 study that looked at over 10 years of research published in the journal Pain, found that almost 80% of their studies included only male animals and less than 4% looked at sex differences.
Stats
CDC- Opioid deaths accounted for > 70% of all deaths from drug overdoses (totally overdose deaths 70,630)
2019 Kaiser Family Foundation data
Opioid Overdose Deaths
2019 total deaths
Men
Women
49,860
34,635
15,225
2020 data https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm - total overdoses > 93,000 estimates that 69,710 from opioids.
For comparison 2020 mortality numbers for car crashes were 38,680
Sex and Gender Differences
Women
Men
Overall, in women compared to men, the prescription opioid abuse is decreasing more slowly while heroin use in increasing more quickly.
“From 1999 to 2010, overdose deaths increased 265% among men and 400% among women (CDC, 2018)”
Once in treatment have similar outcomes
Multidimensional approach - medical and psychosocial needs - these may be different for men and women
Sex and Gender gaps in the literature
Socioeconomic differences between typical methadone vs buprenorphine users
Increasing comprehensive services such as: housing, childcare and social support can help both men and women but what type of services they need and utilization of services may be sex/gender specific
May increase women’s participation by adding women support group and childcare services
Take Home Points
There are sex and gender physiological and sociocultural factors that come into play in substance use disorder
Finally, we talked about Alyson’s important work with the Sex and Gender Summit which is geared towards integrating sex and gender-based principles across health care curricula to better educate future providers.
Here are two great resources to learn more on how to do searches to include sex and gender:
www.sexandgenderhealth.org www.amwa-doc.org/sghc/
Show Notes for Episode Twenty of seX & whY: Interview With Dr Shirin Heidari Part 2: Gendro - Advancing Sex and Gender Equity in Science Research
Host: Jeannette Wolfe Guest: Shirin Heidari PhD, virologist and experimental oncologist, founding President of Gendro.
Part 2 of Interview with Dr Shirin Heidari
This podcast focuses on Dr Heidari’s work on systematically integrating the variables of sex and gender into different access points along the research pipeline. She helped start an organization called Gendro which is dedicated to this mission.
The three major gatekeeping posts that Gendro and other organizations are targeting are:
1) Funding
Require the inclusion of both male and female animals or justify an exclusion
2) Ethical Review Boards
These boards review research protocols prior to study enrollment to ensure that the researchers have designed their study to meet national and organization protocols designed to protect participants from being involved with unethical or dangerous practices. Traditionally these boards have been an overlooked area to target.
3) Journals
As many medical publishing house multiple journals, if they modify their standardized template to include query about sex and/or gender analyses, they have the power to rapidly change the expectations of authors and peer reviewers surrounding the inclusion of these factors.
In addition, we talked about the SAGER guidelines
SAGER guidelines a.k.a. Sex and Gender Equity in Research. These guidelines were put together by an international team of researchers in 2015 and geared towards giving researchers, journal editors, peer- reviewers and publishers better tools to include and evaluate the variables of sex and gender in scholarly work. Although the guidelines have increased the awareness and inclusion of these variables, and many journals have now adopted them, there continues to be a significant opportunity for more widespread use. A recent editorial highlights some of the barriers to utilization and possible concerns.
Here is a synopsis of some of the remaining barriers.
Perceived Barrier
Solution
Mandated inclusion will significantly increase overall research costs from enrollment to additional statistical analysis
Underscore that several countries have already been successful in tying initial funding with inclusion criteria which suggests that some of resistance is likely due to ingrained culture rather than significant financial barriers. Highlight that some countries have developed new supplemental funding to enhance adoption. *
Journal editors may have significant time and resource limitations that prohibit their ability to formally introduce or monitor SAGER guidelines.
Emphasize that optimizing science requires constant evolution and that as editors they are already well skilled in helping their journal comply with other required updates. Including SAGER guidelines can enhance the quality of research their journal publishes and in turn enhance its reputation.
In additional, engaging publishers to invest in better science by making system wide changes in both editorial expectations and technical support (see below) could rapidly accelerate adoption.
Peer reviewers may feel ill-equipped to evaluate for the proper inclusion of sex and gender in a review due to knowledge gaps in core principles surrounding sex and gender
Provide access to available online trainingmodules such as those offered by the Canadian Institutes of Health Research.
Enhance diversity training as who is at the table influences policy and priorities.
Technical challenges. Many publishers use the same templates across multiple journals which may limit an individual journal’s ability to change their own format.
Engage editors to encourage publishers to update digital templated formatting to reflect SAGER principles. The inclusion of a requested digital check off page in submission requirements confirming guideline compliance, could serve both as a reminder cue to the author and a screening tool to journal staff to ensure that it is completed prior to forwarding material to reviewer. This would help minimize any additional time the reviewer would need to spend to ensure SAGER compliance.
* As an aside, identifying important sex-based differences in pre-clinical studies may ultimately be quite cost effective as they may lead to the design of more successful and cost-effective clinical trials
We also discovered the opportunities to include the variables of sex and gender in COVID vaccine research and here are two important papers that Dr Heidari just published in this area.
A Systemic Review of the Sex and Gender Reporting in Covid-19 Clinical Trials.
75 initial published trials- 24% presented data broken down by sex and only 13% included in their discussion any discussion about potential sex differences.
Time for Action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind.
Take home points from article
This now becomes very relevant as we now know that there are significant sex differences in side effects in the vaccines including increased risk of myocarditis for males in Pfizer and Moderna (According to a recent Australian study done by their equivalent of the FDA, the Therapeutic Goods Administration (TGA) numbers may occur up to 1 in 10,000 in younger men. Of note, they suggest that chance of getting myocarditis from Covid is likely 8-10x this risk.)
Conversely women are more likely to get increased risk of clotting with the J and J vaccine.
Thanks for joining us!The podcast currently has 41 episodes available.