The Nuzzo Letter

In June, the International Journal of Sports Physiology and Performance published a survey study on the history of exercise science. The survey, titled “Standing on the Shoulders of Giants: Essential Papers in Sports and Exercise Physiology,” was conducted by two accomplished exercise scientists – Jos de Koning and Carl Foster.

de Koning and Foster asked 52 male and female exercise science academics, who varied in subdiscipline expertise and who had been journal editors at some point in their careers, to each nominate 25 papers that they thought were “essential readings” for exercise science students.

de Koning and Foster conducted the survey because they observed that “many students [are] generally ill-prepared in terms of their understanding of the ‘deep history’ in exercise physiology.” The authors also stated that exercise science students seem to “do well with contemporary literature related to current research projects” but that student understanding of older literature is “deficient.”

de Koning and Foster’s study was much needed. Little information is available on the history of exercise science research, and this might partly explain why exercise science degree programs generally do not include courses or lectures on the history of the field. Moreover, exercise science has been one of the fastest growing academic majors in the United States over the past 20 years. Thus, thousands of exercise science students are graduating from universities each year without understanding where the knowledge in their field came from – who produced and how it evolved over time.

The 52 academics who were surveyed by de Koning and Foster nominated a total of 396 papers as “essential reading.” This list of 396 papers was then sent back to the survey respondents. The respondents were then asked to vote on the papers, and the 100 papers out of the list of 396 that received the highest number of votes were then considered the “100 essential papers in sports and exercise physiology.”

The top 100 papers, which ranged in publication date from 1923 to 2018, covered many topics within exercise and sports science. Consequently, de Koning and Foster organized the 100 papers by general theme – for example, “altitude,” “thermophysiology,” and “resistance training.” The themes with the greatest representations on the list were “muscle energetics/metabolism,” “aerobic work/VO2max,” and “performance.” Importantly, de Koning and Foster admitted that the list is somewhat biased toward sports physiology and performance, given the editors who were surveyed.

Nevertheless, the list of 100 essential papers will be a useful resource for exercise science educators moving forward, and de Koning and Foster deserve recognition for their contribution to the field. However, there was one aspect of the survey’s results that de Koning and Foster either overlooked, found too uninteresting to mention, or purposely ignored. That aspect was the sex of the authors of the top 100 papers.

The surnames of many of the “giants” on the reference list, and their sex, were already known to me. “Komi, P” is Pavo Komi, the Finnish biomechanist who was known for his research on the stretch-shortening cycle, and who passed away in 2018. “Hakkinen, K” is Keijo Häkkinen, another Finn, known for decades of research on resistance exercise for improved health and performance. And then there is “Costill, D.” – David Costill, emeritus professor at Ball State University, known for his research on muscle fiber types in athletes and the impact of microgravity on muscle physiology and function.

However, as the reference list for the top 100 papers included only the first initial of the author’s name, and because the survey covered subdisciplines whose researchers are less familiar to me, I was not certain exactly how many of the top 100 papers were written by men. To find out, I downloaded the reference list and conducted the relevant searches online to determine the sex of the authors of the top 100 papers in exercise and sports science history.

As shown in the graph below, only three of the top 100 papers in exercise and sports science history were written by women. Ninety-five papers were written by men, with author sex not applicable or indeterminable for two of the 100 papers. Thus, men authored 97% of the top 100 papers in exercise and sports science history. Nice work, boys!

Pointing out the supplemental fact that the giants of exercise science have been overwhelmingly male is not something I particularly enjoy. I do not to wish to emphasize sex or gender in places where one’s ideas and intellectual contributions are what is most important. de Koning and Foster might have omitted information on author sex for similar reasons.

That said, gynocentrism and misandry are running amok (see the archives of The Nuzzo Letter for examples). Consequently, in such an antagonistic environment toward men, men have a right, and a responsibility to their families, their communities, and most importantly, to their own self-esteem, to defend their purpose and existence in life. If gynocentrists in academia, politics, and the media are going to use sex as a sword directed toward the torso of men, then men have the right to counter by using sex as a shield.

In contemporary exercise science, there exist pockets of female researchers who fill journal pages with lists of grievances about how bad women have it in the field, portraying themselves as perpetual victims. Examples include papers published on “manels” at academic conferences and female underrepresentation in professorships and research study participation.

Reading between the lines written in these papers, one gets the sense that men are being blamed for the supposedly problematic current state of things. Reading the actual lines written in these papers, one also notices the inabilities of the authors to grasp the realities of sex differences in male and female psychology. Moreover, these types of papers – in both their content and tone – signify a lack of appreciation for what men – in their ambitious drives for knowledge, status, and the betterment of humanity – have done for everyone. This includes the female academics who now leverage off the knowledge founded by these male giants. Thus, men have every right to throw up their shields and highlight their role in leading the way in discovering of how the human body responds to physical exercise.

Women have also contributed to this exercise science knowledge base, and their work, just like anyone else’s work, deserves a level of recognition commensurate with the work’s impact on the field. Frances Hellebrandt, who I have discussed previously at The Nuzzo Letter, is an example of a female researcher who deserves such accolades, given the originality of her ideas and the substantial number of research outputs that she generated over her career. Interestingly, though Hellebrandt was conducting her research in the 1940s, 1950s, and 1960s – a time that should, according to contemporary authors, be associated with higher levels of misogyny, patriarchy, discrimination against women, and female underrepresentation, I have not found a single comment by Hellebrandt in her dozens of papers about such topics. I suspect she was too busy collecting data in the laboratory and writing papers to give a damn!

So, the first reason for men to bring sex into this discussion is because their sex is under attack. A second reason to highlight de Koning and Foster’s omission of author sex in the top 100 papers is that it might represent gamma bias. Gamma bias occurs when sex or gender is omitted from discussions about achievements, when those achievements are made by men, but includes sex or gender when those achievements are made by women. Gamma bias theory also posits that sex or gender is included in discussions about negative acts, when those acts are committed by men, but sex or gender is omitted from discussions of negative acts when those acts are …

Previously, at The Nuzzo Letter, I explained that the White House’s Initiative on Women’s Health Research would be allocating 100 million dollars to work being done by women’s health researchers and startup companies. Now, we know more details of where that money will go.

The Office for Research on Women’s Health, in coordination with the National Institutes of Health (NIH), issued a Notice of Special Interest to inform researchers of the organization’s interest in receiving applications for research studies that are focused on diseases and health conditions that predominantly impact women, including, but not limited to, autoimmune diseases, depressive disorders, Alzheimer’s disease, and “gender-based violence.” The organization also announced its interest in receiving applications for diseases and conditions that are specific to women, such as endometriosis and menopause, as well as diseases and conditions that present or progress differently in women, including, but not limited to, cardiovascular disease, human immunodeficiency virus (HIV), and reproductive aging.

Addressing women’s health is important. However, as explained previously at The Nuzzo Letter, the NIH already shells out more money for research trials that enrol only female participants compared to research trials that enrol only male participants. In financial year 2020, the NIH invested 4.47 billion dollars into women’s health research (see Table 1 below). Interestingly, unlike reports from the Office for Research on Women’s Health in previous years, this latest report does not include a comparison of how much the NIH invested into men’s health in 2020, 2021, or 2022. However, a previous report from the Office of Research on Women’s Health reveals that the NIH invests about 2 billion dollars per year in men’s health – less than half of what it invests into women’s health (see Table 8 below).

With approximately 4.5 billion dollars per year already dedicated to women’s health, you might be thinking that it seems strange that the health conditions to be targeted by the White Houses’ Women’s Health Research Initiative were not already within the purview of the 4.5 billion dollars already being spent. I wondered the same thing and consequently did some digging around. What I found will probably not surprise you.

The NIH has been investing hundreds of millions of dollars into these areas of women’s health for many years. The table below shows the NIH’s research budget for women’s health for the 2020, 2021, and 2022 financial years. In 2022, the NIH spent 55 million dollars on research into violence against women, 27 million dollars on research into endometriosis, 189 million dollars on research into sexually transmitted infections, which will include HIV, 298 million dollars on research into autoimmune conditions, 954 million dollars on research into mental health conditions, which will include depressive disorders, and 586 million dollars into research on cardiovascular disease.

As I have discussed before, the greater funding into women’s health research than men’s health research then helps to explain why women make up a greater proportion of participants NIH-funded research trials. Between 1995 and 2022, women made up 58% of participants in NIH-funded trials (figure below). All other things held constant, the new lot of 100 million dollars can only cause an increase in women’s representation as research participants and a decrease in men’s representation as participants – odd outcomes to have considering that male life expectancy is 5.4 years shorter than female life expectancy in the United States.

Given that the extra 100 million dollars into women’s health research will inevitably increase female participant representation beyond its current levels, here, I pose the question as to how the NIH and the Office for Research on Women’s Health will present and discuss these data in future reports. I see two possibilities.

The first possibility is that these national health offices report the data in a way that makes it hard to know the exact percentages of male and female participants. This could involve reporting the data in an ambiguous way or simply not including it, similar to how the overall budget for men’s health research was oddly absent from the latest report from the Office for Research on Women’s Health.

A second possibility – the one that I think is more likely – is that the NIH and the Office for Research on Women’s Health simply will not give a damn. They will not care that male participant representation decreases to 35-40%, while female representation increases to 60-65%. In this scenario, the data would be publicly available, and the agencies would celebrate their achievements in women’s health research. They would justify their celebration by rehashing the same old talking points such as the supposed historical exclusion of women from research trials, suggesting that current disproportions in representations are merely recompense for years of lost knowledge about women’s health. And, of course, any celebration would be coupled with imprecise phrases that would rationalize the continued existence of the Office for Research on Women’s Health, such as, “more research is necessary on women’s unique health needs” and that there is “still a long way to go until gender equality is achieved.”

Sceptics might question whether the NIH and the Office for Research on Women’s Health would be so brazened as to increase the number of female participants as high as possible, particularly with the sex difference in life expectancy looming in the background. The answer is: probably.

In other domains, we see the goal is never 50/50 representation. In the academic world, when outcomes, such as numbers of degrees earned or numbers of staff positions filled in certain fields, surpass 50% female representation, there are no subsequent initiatives to try to increase male representation, such that the ratio stabilizes at 50/50. I have personally been on the receiving end of university emails that brag about the fact that over 70% of winners of internal research grants are women. The goal, therefore, does not seem to be parity. It seems to be something akin to matriarchy.

So, if government research funding does indeed improve health outcomes, and the NIH already invests more money into women’s health than men’s health, and the health conditions to be targeted by the 100 million dollars from Jill Biden and the White House are conditions already being funded under the NIH’s 4.5 billion dollar budget for women’s health, then perhaps Jill should have considered directing the money toward men’s health.

One might think that Jill Biden would have a personal interest in seeing more funds directed toward certain areas of boys’ and men’s health. Topics such as cocaine-use disorder, dementia, and falls risk prevention should hit close to home for the First Lady. Or, if Biden were to have a moment of deep and solemn reflection, she might encourage investment into research that explores mental health outcomes in boys who lose their mothers and husbands who lose their wives and daughters via tragic circumstances.

But in my opinion, the best place for the 100 million dollars is back in the hands of American taxpayers. With it, each individual man and woman, in consultation with friends, family, and health professionals, can determine how they might best spend the few extra bucks in their pockets to optimize their health. Perhaps they could use the money to help pay for a health screening, more nutritious food, or a gym membership. The decision should be up to them not to the gynocentrists in government.

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On November 13th of 2023, the Biden White House and its Gender Policy Council announced the creation of the White House Initiative on Women’s Health Research. On February 23rd of 2024, the White House revealed the initiative would start with an investment of $100 million dollars into work being done by women’s health researchers and startup companies.

The $100 million dollars adds to the oodles of money already poured into women’s health research through government bureaus such as the Office for Research on Women’s Health (ORWH) within the National Institutes of Health (NIH). Nevertheless, this did not stop First Lady Jill Biden from saying that the reason taxpayers need to fund the White House’s new initiative is because we do not know enough about women’s health as a result of women’s health research supposedly being historically underfunded, or altogether lacking. Jill Biden also suggested that women’s health has not been a primary concern of society. The Associated Press quoted Biden as saying, “We will build a health care system that puts women and their lived experiences at its center…Where no woman or girl has to hear that ‘it’s all in your head,’ or, ‘it’s just stress… Where women aren’t just an after-thought, but a first-thought.”

In Australia, similar narratives about women’s health have recently emerged as part of the political and biomedical milieu. In announcing the Queensland state government’s $46 million dollar plan to build four free walk-in health clinics for girls and women, Health Minister, Shannon Fentiman said, “We know that historically, there has been a lack of investment in health services tailored to the unique needs of Queensland women and girls.” Moreover, in announcing a state inquiry into women’s experience with pain and the healthcare system, Victoria’s Premier, Jacinta Allan, stated, “For too long, women’s health has been seen as a niche issue and it has not had the attention or the support that it deserves.”

The claim that women’s health has been an “after-thought,” residing underfunded and understudied in the periphery of health research, has been made for many years. However, this claim has been untrue for much of its history. Gynoncentrism – the preoccupation with the needs, desires, and wellbeing of women – is rampant in biomedical and public health research. And here is some of the evidence to prove it.

Underfunded and underrepresented?

The NIH’s own data refute the claim that women’s health is underfunded. The table below was published in a report by the NIH’s Office for Research on Women’s Health in 2021. It shows that 11-14% of the NIH’s research budget funds studies that include only female participants, whereas 6% of the budget funds projects that include only male participants. The remaining 80% of the budget funds studies that include both male and female participants.

This funding of women’s health research then helps to explain why women are, in fact, not underrepresented as participants in medical research trials. This claim of female participant underrepresentation was first questioned by researchers in the 1990s, around the time the Office for Research on Women’s Health was created. The claim was then again debunked in 2001 in a three-page ripper of a paper by Ed Bartlett. What’s more, annual reports show that girls and women are not underrepresented as participants in federally funded research projects. And the publisher of these reports is the NIH and the Office for Research on Women’s Health!

The figure below, which is an update of a previous graph published at The Nuzzo Letter, shows that for all but one year between 1995 and 2022, women made up a greater proportion of participants in NIH-funded research than did men. Averaged across all years, women made up 58% of participants in NIH-funded research between 1995 and 2022.

Just like the data from the NIH show major investments into women’s health research in the United States, data from Australia’s federal health bureau, the National Health and Medical Research Council (NHMRC), show the same. The table below, published on the NHMRC’s website, shows that for every year between 2013 and 2002, the NHMRC invested approximately five times more money into women’s health than men’s health research – all the while, the average Aussie bloke has a life expectancy four years shorter than his female counterpart.

PubMed search: “men’s health” and “women’s health”

Another way to get a sense of how much attention men’s health and women’s health receive in research is to conduct keyword searches in PubMed. PubMed is a digital database of biomedical research articles. It is maintained by the NIH and the U.S. National Library of Medicine. PubMed indexes millions of research articles from around the world. PubMed does not index papers from every academic journal, particularly journals from the humanities, but it indexes most biomedical and public health journals. Thus, PubMed is an appropriate place to examine the amount of attention given to specific research topics.

Based on the claim that women are understudied, one would expect to find substantially fewer articles on “women’s health” than “men’s health,” when searching PubMed. But this is not the case. In fact, the opposite is true.

The bar graph below shows how many articles indexed in PubMed contain the phrases “women’s health” and “men’s health” in their titles or abstracts. Between 1973 and 2023, the phrase “women’s health” appeared in the titles or abstracts of 24,148 articles. Over that same 50-year period, the phrase “men’s health” appeared in the titles or abstracts of 2,804 articles. Thus, in contemporary biomedical and public health research, for every one article on “men’s health” that is published, there are 8-10 articles on “women’s health” that are published. This ratio is shown in the line graph below.

The results from the search of PubMed suggest that the phrase used to refer to the physical and mental wellbeing of men, “men’s health,” is not communicated as a broad abstract concept in the same way that “women’s health” is communicated as an abstract concept. Thus, to the extent that researchers, clinicians, and health officials want to move forward with men’s health as a broad area of interest, the term “men’s health” should be used more frequently. Lack of use of the phrase perpetuates the problem of relative lack of attention to men’s health because it signals that there are few health problems that are patterned among boys and men. On the other hand, frequent use of the phrase “women’s health” continues the ongoing (and often appropriate) attention to health problems that are patterned among girls and women.

Importantly, more frequent use of the phrase “women’s health” than “men’s health” is not the result of a reaction to decades of a supposed lack of interest in women’s issues or from the supposed exclusion of women from research trials. As I have explained, there is a lack of evidence of a disinterest in women’s health issues or of women’s exclusion from research trials.

Less frequent use of the phrase “men’s health” than “women’s health” is also not due to a lack of research on men. Males make up about 42% of participants in NIH-funded research trials, and searches for the words “male” and “female” and “boy” and “girl” in the titles and abstracts of articles indexed in PubMed reveal roughly equal numbers of articles for both sexes. Thus, researchers who study boys and men do not appear to be labelling their research as “men’s health” as often as researchers who label their research on girls and women as “women’s health.”

This then begs the question - why have scientists not framed their work on boys and men as “men’s health” research? Or conversely, why have so many researchers who study girls and women framed their studies as being about “women’s health”?

One explanation is gamma bias or a similar cognitive process that results in greater empathy for women …

In March of this year, I shared a story about one of my research papers that was found to be so disagreeable to a women on the journal’s editorial team, that she decided to resign from her position in protest to the editor’s decision to accept my paper for publication. The paper was finally published online earlier this month, and what follows is a description of the content that one woman found so provocative. Consider this your official “trigger warning.”

“Woke” is a colloquial term used to describe a raised consciousness or awareness of suggested social injustices that are thought to be caused by unfair power dynamics in society. To “dismantle” these proposed power dynamics, teachers of “critical theory,” or Woke philosophy, encourage students to engage in political activism aimed at achieving “social justice.” Diversity, equity, and inclusion (DEI) committees at universities and at other institutions are the cells that imbed and then metastasize Woke ideas into society.

Critical theory and Woke ideas originated in university humanities departments. But acute observers have probably noticed the emergence of these ideas in the sciences, including medical science and health science. Deborah Cohan, a medical doctor in San Francisco, declared “I am a racist,” in an article she wrote for the New England Journal of Medicine in 2019. After telling the world how racist she was, Cohan proceeded to tell other white doctors how racists they were, too. Cohan’s two-page commentary was a treasure trove of Woke nomenclature, which she used in repeated displays of virtual signalling and self-flagellation. Cohan littered the pages of one of the medical profession’s most historically important journals, not with words such “organ,” “brain,” “tumor,” and “infection”, but with words like “privilege,” “white supremacy,” “implicit bias,” “implicit racism,” “racial inequities,” “dismantle,” “revolution,” and, of course, “social justice.”

Readers of the Rubbish Bin at The Nuzzo Letter will know that Cohan’s article is not a stand-alone in terms of Woke papers published in biomedical and public health journals. Readers may recall the qualitative study out of the University of Saskatchewan in 2022, in which the study’s thesis was all about “confronting the problem of whiteness” in nursing education. Readers may also recall the editorial in Lancet Public Health titled, “Addressing weight stigma,” in which the anonymous author lamented about the pervasive and “stereotypical perception that people with overweight and obesity are somehow responsible for their weight.” The author professed that the “obesogenic environment” is largely responsible for obesity and that individual responsibility and personal health choices are dogmas of the past.

Nevertheless, sceptics might wonder if Woke critics are overexaggerating the impact of Woke on biomedical research and overemphasizing the musings of only a small number of unhinged medical practitioners and health researchers.

New Research on The Rise of Woke Medicine

My recent study, published in the Psychreg Journal of Psychology, sought to bring clarity to such questions. I quantified the extent to which Woke ideas are prevalent in biomedical and public health research. To do this, I searched for Woke (or Woke-related) words and phrases in the titles and abstracts of papers indexed in PubMed. PubMed is a digital database that archives millions of studies and commentaries in fields such as medicine, public health, nursing, psychology, exercise science, and more. Thus, if Woke is impacting health science, a search of PubMed will reveal this.

I searched for 156 Woke words and phrases. These words and phrases were selected based on my acquaintance with Woke concepts and James Lindsay’s online dictionary of Woke terminology.

Importantly, only the titles and abstract of articles were searched. The text making up the bodies of the articles were not examined. Consequently, the results inevitably underestimate the extent to which Woke concepts are referred to by health researchers. The results also do not reflect the impact of Woke on academia as a whole, because PubMed does not index all academic journals. For example, it does not index many education and sociology journals, which is where Woke ideas originated and are most prevalent.

The analysis revealed that use of Woke nomenclature has increased markedly in health and medical research over the past 15 years. Below is a graph that demonstrates the total use of all 156 Woke words and phrases from 1960 to 2022. The accelerated use of these words, which be seen in the sharp upward trend of the line on the graph, corresponds roughly with the time of Donald Trump’s presidential election win in 2016.

Some Woke words and phrases were used more frequently than others. Here, I highlight only a selection of the results.

Woke nomenclature can be broken down into various broad themes. Regarding the theme of group differences – something that Marxism and critical theory focus on heavily – the phrases "equity" and “inequity” were used in the titles or abstracts of 47,705 articles indexed in PubMed. The more specific phrases “health equity” and “health inequity” were used in 8,730 articles. “Racial equity” and “racial inequity” were used in 501 articles. “Gender equity” and “gender inequity” were used 1,841 articles, and “gender equality” and “gender inequality” were used in 3,724 articles.

Regarding the theme of justice, the phrases “social justice” and “social injustice” were used in the titles or abstracts of 3,933 articles indexed in PubMed. “Environmental justice” and “environmental injustice” were used in 1,186 articles, and “climate justice” and “climate injustice” were used in 77 articles.

Regarding the theme of race, the phrase "critical race theory" was used in the titles or abstracts of 180 articles indexed in PubMed. "Structural racism" was used in 714 articles, "institutional racism" in 251articles, "internalised racism" in 77 articles, "environmental racism" in 38 articles, “racial bias” in 786 articles, and "Black Lives Matter" in 198 articles. Regarding how supposedly evil and privileged white people are, the phrase "white supremacy" was used in the titles or abstracts of 129 articles, and "white privilege" was used in 114 articles.

Regarding the theme of feminism and how supposedly evil and privileged men are, the words “feminism” and “feminist” were used in the titles or abstracts of 5,349 articles indexed in PubMed. “Misogyny” and “misogynist” were used in 182 articles, "gender-based violence" in 1,862 articles, “rape crisis” in 117 articles, “male gaze” in 18 articles, "male privilege" in 30 articles, "MANELS" in 21 articles, and “benevolent sexism” in 181 articles. “Toxic masculinity” was used in 12 articles, "hegemonic masculinity" in 280 articles, and the controversial pluralization of masculinity, “masculinities,” was used in 630 articles. And then there is old canard, “patriarchy," which was used in 494 articles.

Regarding the theme of sexual orientation, the word “transgender” was used in the titles or abstracts of 10,192 articles indexed in PubMed. “Gender affirming” was used in 1,270 articles, “LGBTQ” in 1,704 articles, “non-binary” in 584 articles, “heteronormative” in 496 articles, “homophobia” in 1,864 articles, "transphobia" in 323 articles, "queering" in 101 articles, "queer theory" in 175 articles, and "birthing person" and “birthing people” in 49 articles.

Regarding the theme of violence, the word "microaggression" was used in the titles or abstracts of 555 articles indexed in PubMed. “Microassault” was used in 11 articles, “microinsult” in 18 articles, “microinvalidation” in 17 articles, "safe space" in 706 articles, and "trigger warning" in 23 articles.

Regarding the theme of individual people who have influenced Woke causes, the name "Foucault" appeared in the titles or abstracts of 1,347 articles indexed in PubMed, "Paulo Freire" in 166 articles, "Derrida" in 101 articles, a…

Let us pretend that you are asked to perform five consecutive sets of resistance exercise with a one-minute rest between each set. You can choose whatever exercise you like, and you can lift whatever weight you like, but the weight must be the same for all five exercise sets, and you must try to perform as many repetitions as possible during each set. For example, you might choose the biceps curl exercise and a dumbbell weight that allows you to complete 30 repetitions in your first set before failing on your 31st attempt.

My question for you is: after a one-minute rest, how many repetitions do you think you will be able to perform in Set 2? Do you think you will perform more repetitions, fewer repetitions, or do you think your performance will remain the same at 30 repetitions?

If you think your performance will worsen, how many fewer repetitions do you think you will be able complete in Set 2? Do you think your performance will decline by only a repetition or two to 28 or 29 repetitions? Do you think your performance will plummet dramatically in Set 2, and you will complete only four or five repetitions? Or do you think your performance in Set 2 will be somewhere in the middle of those two extremes, perhaps a 50% drop to 15 repetitions?

Then, what do you think will happen to your performances in Sets 3, 4, and 5? If you predicted that your performance in Set 2 will be worse than in Set 1, do you think your performance will continue to drop by the same number of repetitions in successive sets? In other words, what will the trendline of your performance across sets look like?

Scientific insight from personal workouts

Not all scientific insights are inspired by discussions in the presentation halls of academic conferences or on the pages of peer-reviewed academic journals. Some insights come from the events of everyday, non-academic life. Take for example, professor of anatomy, Alf Brodal, who in 1972 had a stroke, and then subsequently detailed his own clinical experiences in a paper published in Brain in 1973. Brodal’s paper has been cited a few hundred times.

In 2021, I also published a paper that was largely based on my personal health experience. In the paper, I argued that the textbook guideline for placing one’s feet on the floor during the bench press exercise is misguided, because it is a historical byproduct of old bench designs and because it causes the spine to assume an unnecessarily biomechanically unsound position. My insight stemmed, in part, from my history with low back discomfort and the relief of that discomfort that I would feel by simply placing my feet on the bench rather than on the floor.

The following story is a second story of scientific insight based on my personal experience.

For a period of about two months in 2023, I was finding it easier and more enjoyable to exercise my chest and arms by doing push-ups at home rather than going to the gym to do the bench press or chest press exercises. My push-up routine was brief and straightforward. It involved completing five sets of push-ups until failure, with a one-minute rest between each set. The total time was about seven minutes, including rest intervals and the time necessary to complete the push-ups. This is an example of resistance exercise “snacking,” which is a type of minimal dose resistance exercise.

To keep myself motivated and accountable, I tracked my performance. I recorded my results in a paper diary.

My results are provided in the table below. They show how many push-ups I performed in each of five sets on 11 separate days.

After the first couple of days of performing this minimal dose program, I noticed a fascinating trend in my data. The number of push-ups that I could perform in Sets 3, 4, and 5 remained stable within each session. For example, on the first day, you will see that I performed 8 push-ups in Set 3, 8 push-ups in Set 4, and 7 push-ups in Set 5.

I was surprised when I first saw this trend in my data. I would have predicted that my performance would have progressively worsened as my fatigue accumulated across sets, perhaps to the point of not being able to perform a single push-up by Set 5. However, this was clearly not the case.

And then it hit me. I had seen this trend before.

Muscle fatigue curve

Earlier in 2023, we had published an original research paper and a review paper in the Scandinavian Journal of Medicine and Science in Sports about how muscles fatigue during a type of resistance exercise in which each repetition is performed with momentary maximal force. This can be accomplished using an isokinetic dynamometer in the laboratory or the Vitruvian exercise machine at home. Our original research and our review of 30 other studies revealed that during the first few repetitions of a set of resistance exercise in which every repetition is performed with a momentary maximal resistance, there is a marked decrease in force production in the first few repetitions. This is then followed by a levelling off in force at about 40% of the person’s initial peak strength.

This curvilinear pattern of muscle fatigue, which is depicted in the figure below, is often referred to as the “muscle fatigue curve.” The horizontal tail of the curve has been referred to by various names over the years, including the “fatigue plateau,” “fatigue level,” “endurance level,” and “steady state.” In our review, I used the phrase “muscle strength preservation” because the results suggested that physiological mechanisms within the body allow the body to preserve strength to keep going with exercise and movement.

New research on muscle strength preservation

In previous research, muscle fatigue curves have been documented using either maximal isokinetic or isometric exercise protocols. These tests are common in laboratories but neither of them is the type of resistance exercise that most people do at home or at the gym. Instead, most people select a weight that is a percentage of the maximal weight that they can lift, and they proceed to repeatedly lift that submaximal weight until a high level of fatigue sets in, or in the case of my push-up program, until collapsing to the floor after failing to lift the weight of my own body mass another time.

Thus, in my recent secondary analysis published in the Journal of Strength and Conditioning Research, my aim was to examine the possibility of muscle strength preservation during this more common form of resistance exercise. For the paper, I analysed data from 29 studies in which individuals lifted a given weight as many times as they could across four, five, or six exercise sets – similar to my push-up workout. Most studies required individuals to lift a load that was equal to about 70-80% of their maximum.

The results revealed muscle strength preservation, with the tail of the muscle fatigue curve levelling off at about 50% of Set 1 performance. Specifically, the results illustrated that during Set 2, an individual can be expected to complete about 70% of the repetitions that they completed in Set 1. In Set 3-6, an individual can be expected to complete about 45-55% of the repetitions that they completed in Set 1.

However, as expected, the findings also revealed that the magnitude of fatigue that is experienced is impacted by the amount of rest between sets. The shorter the inter-set rest period, the more pronounced the dip in performance. For example, my push-up program included short inter-set rests of one minute, and that is why my performance dipped to 25% of Set 1 before levelling off. Nevertheless, the curvilinear pattern of the muscle fatigue curve occurs irrespective of the amount of rest taken between sets.

Finally, the paper includes a chart where an individual can estimate how many repetitions they can be expected to complete in subsequent sets based on how many repetitions they are able to achieve in Set 1. The chart is intended to be a general guide and educational tool, and it should be used cautio…

[Skip to the end to see all the photographs!]

In 1972, President Richard Nixon signed Title IX of the Education Amendments Act into United States law. The broad aim of Title IX was to ensure, within federally funded educational institutions, that individuals were not discriminated against based on their sex. Men and women were to receive equal opportunities to participate in educational programs, including school sports.

“No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.” (Title IX)

The Problem

Over the years, Title IX has been used by some exercise scientists as a convenient reference for suggesting that women were almost entirely absent from the exercise and research conversation prior to the 1970s. As I have discussed in a previous essay and podcast, researchers Barabara Ainsworth and Catrine Tudor-Locke used Title IX as a rhetorical launching point for claiming that prior to Janet Wallace’s paper in 1975, there were no exercise intervention studies published in the journal Research Quarterly that included only female participants. In their review of that journal’s history, the authors suggested that increased research focus on women’s health and exercise experiences in the 1990s began in the 1970s with the passage of Title IX. Thus, their claim about women’s research participation was linked with their belief about the impact of Title IX. However, as I showed in 2020, there were at least 33 female-only exercise intervention studies published in Research Quarterly between 1930 and 1975. The 33 studies included approximately 5,000 female participants. Ainsworth and Tudor-Locke portrayed history inaccurately.

One issue with use of Title IX as a convenient bookmark for the start of female participation in exercise studies, is the implication that exercise researchers had little or no research interest in girls or women prior to that time. This bookmark is then further glued into place by the public health narrative that says women were historically excluded from participating in medical research trials. This latter narrative, which started in the early 1990s, and led to the creation of the Office of Research on Women’s Health, persists today, though it has been refuted multiple times.

Thus, within academia, there are continued issues regarding the accuracy of information surrounding female participants in early scientific research. My aim here is to provide further evidence – photographic evidence – challenging the belief that women were rarely included in early exercise and fitness research. However, before I do that, I will first explain how female participation can be expected based on surrounding historical events, and then secondly, I will briefly discuss how false narratives about female participants betray student learning.

Reasons to Expect Female Participation

The idea that women rarely served as participants in exercise or exercise-related research prior to the early 1970s is tempting to believe because female participation in school sports increased markedly in the years after Title IX. Naturally, the increased sports participation led to more research interest in female sports performance. However, just because Title IX caused increased sports participation among girls and women, and subsequently, increased research participation among girls and women, does not mean that women were absent from early research related to exercise. In fact, male exercise research participation also increased substantially after Title IX simply due to the overall expansion of university programs and professional opportunities in the field of exercise science.

Importantly, early research related to exercise often focused on characteristics of muscle fitness, such as muscle strength, muscle power, and muscle endurance. There are a few reasons why participation of girls and women would be expected in this type of research prior to Title IX.

For one, the science of exercise grew from fields like biology, medicine, physical education, and physical therapy. Knowledge of muscle fitness did not emerge directly from a field called sports science. That field did not yet exist, and its precursor, exercise physiology, was still coming on to the scene. Instead, knowledge of muscle fitness, which would have been some of the most relevant information on the capacities and limits of human physical performance at that time, emerged from various intellectual directions.

Second, school and university physical education classes would have still been split by sex prior to Title IX. Thus, female physical education professors and educators would have used “samples of convenience” in their research. These samples would have been the girls and women in their classes.

Third, much early research on muscle fitness originated in the field of physical therapy. Physical therapy, which developed in response to polio epidemics and the need to rehabilitate male soldiers injured in World Wars I and II, has always been a field dominated by female researchers and practitioners. In fact, the main professional organization of physical therapists in the United States, the American Physical Therapy Association, was, at the time of its founding in 1921, called the American Women’s Physical Therapeutic Association. Thus, as physical therapy often deals with the restoration of muscle function, and women would have made up most of the physical therapy researchers and students prior to Title IX, it would have been unusual if girls and women were not participants in this early research, particularly as many studies on muscle fitness are often first tested on healthy control participants who are samples of convenience – that is, the staff and students in the university’s physical therapy program.

We know that female samples of convenience were used in such research because scientists of that era told us so. For example, in her study on the effects of heavy resistance exercise on muscle strength, pioneering neuromuscular physiologist Frances Hellebrendt and her female colleagues tell us that the study participants were “[f]ifteen normal, healthy, women,” and that “[a]ll but 2 were connected with the Baruch Center’s physical medicine program, either as students or staff members.”

Student Learning

Given these reasons to expect female participation in early research, and given evidence that such participation does exist, claims to the contrary are unfair to students who are eager to learn about the nuanced history of women’s research participation. Based on the current narratives, a scholarly undergraduate student, let us call her Jane, might conclude, “Well, if females did not partake in many research studies prior to Title IX or the creation of the Office of Research on Women’s Health, then what is the point at looking through the archives of exercise, medicine, physical education, and physical therapy journals for information on women’s health and fitness?”

Yet, I know Jane is being told an incomplete story. I know this because I have gone through the inductive processes of identifying, downloading, and reading the archives of journals in the fields of physical education, physical therapy, and exercise science. I know, for example, that participants in strength training intervention studies before 1980 were more likely to be men than women. I know this because I was the guy who discovered, aggregated, and read all 339 relevant papers, and then tallied up the numbers of male and female participants and then published them. However, just because women were less frequent participants in specific types of exercise research, does not mean, prior to Title IX, that researchers did not care about women or study them.

When I look the archives of relevant journals, I see female participation scattered around in fascinating ways. I see researcher…

There are many reasons why one should want to maintain adequate muscle strength throughout life. Greater muscle strength correlates with reduced risk of all-cause mortality, reduced risk of falls, better ability to perform activities of daily living, and better recoveries after hospital admissions.

The most effective way to maintain or improve one’s muscle strength is by participating in resistance exercise with free weights or weight machines or by completing other muscle-strengthening activities such push-ups, pull-ups, or other body weight exercises.

Though decades of research has shown that resistance exercise is medicine, with regular participation causing an array of health and fitness benefits, a significant number of individuals do not meet the recommended guidelines for participation in muscle-strengthening activities established by the American College of Sports Medicine (ACSM) and U.S. Department of Health and Human Services. According to these organisations, for optimal health and fitness benefits, individuals should try to complete at least two days per week of muscle-strengthening activities for all major muscle groups, using body weight resistance, elastic bands, free weights, weight machines, or other strength training machines.

According to my review of the epidemiological literature, published in 2023, about 80% of people do not meet the recommended guidelines for participation in muscle-strengthening activities. Moreover, not only do many individuals not meet the guidelines, but a substantial proportion, about 58%, do not participate in any muscle-strengthening activities. With regard to resistance exercise with free weights and weight machines, arguably the most effective method for increasing muscle strength, approximately 80% of individuals do participate in any of this type of activity.

Many factors serve as “barriers” to participation in physical exercise. The most commonly cited barrier is perceived lack of time. Most people say they are too busy to exercise. They have families, they work full-time, and they have various social obligations that consume their schedules. For many people, exercise gets pushed down the priority list. It sits low on the value hierarchy.

With a substantial number of individuals not participating any resistance exercise, and with perceived lack of time as one of the most cited reasons for lack of participation, some researchers have started to consider whether small amounts of strength training, which take less time to complete than traditional approaches, might also warrant consideration in public health messaging about participating in muscle-strengthening activities. This relatively new concept is called minimal dose resistance exercise, and our research team defines it as “resistance exercise that does not meet guidelines recommended by professional exercise organizations but that still has the potential to improve muscle strength.”

To the extent that minimal dose resistance exercise might improve health and fitness, this should be understood given the large number of people not exercising and the possibility that initial engagement in small volumes of exercise might serve as a “gateway” to more frequent participation. Nevertheless, few researchers have attempted to describe minimal dose strategies and their impact on health and fitness. Thus, my colleagues and I recently published a paper in the journal Sports Medicine, titled, “Resistance Exercise Minimal Dose Strategies for Increasing Muscle Strength in the General Population: An Overview.”

In our overview paper, we identified and defined five different minimal dose resistance exercise approaches. We then summarised the evidence regarding the extent to which these types of training programs, when performed over multiple weeks, increase muscle strength compared to no resistance exercise at all. The five minimal dose strategies that we summarised were “Weekend Warrior,” single-set resistance exercise, resistance exercise “snacks,” practicing the strength test, and minimal dose eccentrics.

Weekend Warrior

The Weekend Warrior approach minimizes training frequency. It involves performing all of one’s weekly exercise volume in a single training session, which for many people, is likely to occur on a Saturday or Sunday, when they are not working.

We found fairly clear evidence that performing one resistance exercise session per week increases muscle strength and some other outcomes of health and fitness compared to no resistance exercise at all, though greater improvements would be seen with more frequent exercise that causes higher training volumes. Nevertheless, if individuals are not currently engaging in any muscle-strengthening activities, but they do have time to engage in one longer exercise session during the week, then they should be encouraged to do so.

Single-set resistance exercise

Single-set resistance exercise was the second minimal dose approach that we overviewed. Single-set resistance exercise is one set of multiple exercises performed multiple times per week. The single-set approach minimizes the number of sets per exercise and thus minimizes session duration. Typically, single-set programs are characterised by a training frequency of three days per week and involve exercise for all major muscle groups in each session. We considered single-set resistance exercise a minimal dose approach because some professional organisations recommend that the minimum number of sets per session be no less than two.

We found fairly clear evidence that single-set resistance exercise programs that include four or more exercises per session, and are performed two or more times per week, significantly improve muscle strength and some other outcomes of health and fitness, though programs that involve multiple exercise sets, and thus greater volume of work, will lead to further improvements. Thus, we concluded that single-set resistance exercise can be recommended to people not currently participating in any muscle-strengthening activities.

Snacking

The third minimal dose strategy that we overviewed was resistance exercise “snacking.” Exercise snacks are brief bouts of exercise performed once or more daily. Snacks usually last between one and 10 minutes. This reduced session duration occurs because the number of exercises and exercise sets are reduced.

Snacking is a novel approach to resistance exercise because guidelines for exercise have historically suggested that to do the act of muscle strengthening one needs to go the gym multiple times per week for extended periods, usually between 30 and 90 minutes. Exercise snacks break this historical trend. They represent a more spontaneous and convenient way to participate in muscle-strengthening activities. Snacking is most aligned with home- or office-based exercise programs where someone has continued and convenient access to resistance exercise equipment. With these programs, a person might take a five-minute break from their work at home to perform two or three sets of bicep curls, followed by another hour or two of work, and then another five-minute snack involving two or three sets of lateral raises, and so on.

We found evidence that resistance exercise snacks increase muscle strength and some other outcomes of health and fitness. This evidence included a series of studies that found that daily exercise snacks that targeted the muscles of the neck and shoulder improved strength and reduced neck pain in individuals who had neck and shoulder pain.

Practicing the strength test

We also overviewed two other minimal dose approaches: practicing the strength test and eccentric minimal doses. Practicing the strength tests involves performing one repetition per set using a maximal resistance and doing this for one or more sets in a session. This strategy minimizes the number of exercise repetitions. Many studies have found …

In Story 5 of my personal experiences with ideological drama in academic peer review, we learned how an editor can hold a paper under review unnecessarily, culminating in a total review time of almost two years. Such delays hinder important data from being shared quickly with the public and with other researchers.

Story 6 – the last story in this series – is similar to all the preceding stories in that it reflects the impact of reviewer bias and editorial cowardice. However, it is also different than all other stories in that it did not have a happy ending of paper acceptance.

On July 28, 2021, I submitted a paper about the probable misuse of causal language in biomedical research articles to an open access, South Korean journal called Science Editing. In the paper, I quantified the use of the word “determinant” in biomedical research articles. I did this because I wanted to compare how often this strong causal word is used by researchers in attributing health outcomes to biological, social/environmental, and individual/behavioural causes. I had noticed frequent use of the term “social determinant of health” in the public health literature, and this appeared to me to be driven by political motives, with scientific precision in nomenclature considered secondary to ideological aims. Misuse of causal of casual language (e.g., “effects,” “impacts”) is already a known issue in biomedical research; my analysis was simply testing for this with a different term and underlying rationale.

The reason that I decided to submit my paper to Science Editing is because the topic of my paper fit within the journal’s scope, and I thought that South Korean reviewers and editors might not be so greatly triggered by a researcher who questions the motives of the social determinant of health movement, which originated with the World Health Organization in the 2000s and its desire to create “health equity.”

Two days after submitting the paper, on July 30th, I received feedback from one peer reviewer, and I was asked by the journal to respond to the reviewer’s comments. I addressed the reviewer’s comments and then on August 1st, I resubmitted the paper. A day later, on August 2nd, I was informed that my paper had been accepted for publication. I was then informed that my paper would be checked by “English and/or bibliographic experts,” and that I would be informed if any other revisions were necessary.

Great news, right?

Unbeknownst to me, the review process was not over. On August 6th, I received an email from the journal containing the proofs of the paper. When I opened the proofs, I noticed that the copyeditor had corrected some of the grammar in the text, which was expected, but the copyeditor also inserted comment boxes in which they questioned my interpretation of the results.

One of the comments involved the copyeditor identifying themselves and why they felt compelled to provide their opinion on my paper:

“As a linguistics PhD (and native speaker of English), I may have a tendency to be a bit picky in this regard, but since the need for linguistic precision lies at the heart of the point being made in this article, this point would seem worth clarifying or rephrasing.”

The copyeditor then went on to question one of my statements in which I said that many researchers were likely not using the term “social determinant” appropriately, and that they were likely often not reflecting on whether what they were measuring or discussing was actually a “determinant” (noun) or whether it was a “correlate” (noun). And I was putting forward the idea that the marked increase in the use of the phrase “social determinant” in recent years, which I had quantified in my paper, likely stems more from the political motives behind the social determinants of health movement. Any confusion in what I was saying could have been easily clarified with a minor change in wording to the sentence.

Interestingly, the editor of the journal also appeared to mistakenly send me the copyeditor’s overall comments on my paper, which revealed their view of my paper more openly.

The copyeditor wrote:

“This paper is obviously opinionated. To a reader familiar with the politics of Anglophone countries, this paper is clearly aligned with one side of the political spectrum, but that is not necessarily a problem. For the most part, the points being raised are within the scope of reasonable scholarly disagreement.”

The copyeditor then went on to say:

“The author gives no citations for the claim that researchers have failed to consider the difference between correlation and causation. If I was an epidemiologist, I would find this claim almost offensive. It is certainly possible that researchers have not done so effectively, or adequately, or consistently, but the extremely strong claim that researchers in this field have not considered this possibility at all warrants support – and there is not even a single citation at the end of this sentence.”

Of course, I did provide citations throughout my paper referencing studies that have shown misuse use of causal language in biomedical research articles, and when I submitted the edits to the proof, I did address the copyeditor’s concern by revising the sentence in question. But, to no avail.

On August 9, 2021, I received the following note from the editor:

“The editorial team discussed this manuscript again. We found that there was an incomplete peer review. I apologize for the carelessness during the editorial process. Unfortunately, we decided not to consider this manuscript for publication due to the following reasons. There should be more concrete evidence to support the author's opinion, as the author mentioned in the manuscript as following: "at this point, it is only a hypothesis and requires formal examination in future research... Such hypotheses require formal examination in future research.”

From the editor’s decision, I gathered that the English copyeditor’s feedback influenced the editor and caused the editor to withdraw my paper. Unfortunately, the results from my descriptive analysis have never been published. There are many individuals in the public health space that have a vested interest in the concept of social determinants of health. And the reason for this is because the social factors in questions are ones which public health officials believe they can control, giving them a sense of importance and a sort of misguided high ground for empathy and morality.

The take home message from Story 6 is that, not only can an academic paper be rejected by biased reviewers and incompetent and cowardly editors, it can also be rejected by an ideological copyeditor, even after it has already been accepted for publication.

Conclusion

In conclusion, I have presented six stories of my own unique politicized experiences in the peer review process. One important thing to remember is that these are only my experiences. There are many other researchers who have experienced similar issues. The root of the problem is ideological bias in peer review coupled with the dysfunctional nature of the current peer review system (e.g., editors and reviewers not being paid by for-profit publishers for their review services).

On a positive note, five of the six stories ultimately resulted in success. Five of the six submitted research articles were ultimately accepted. Thus, even in the current academic climate that is increasingly irrational, small wins for reason can be made. They just require a submission strategy, a well-written paper, undeniable data, willpower, and extremely high levels of patience and tolerance for b******t.

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In Story 4 of my personal experiences with ideological drama in academic peer review, we learned how incompetent and biased editors and reviewers slow the review process. This then delays findings, which go against their beliefs, from being published. We also learned of the increased tendency for such delays to occur when the research in question deals with sex or gender. In the case of Story 4, the total review time for our simple survey study was 1.5 years – an unacceptable length of time for peer review. Yet, this is not the longest amount of time that one of my papers on a sex or gender issue has been under review. That honour goes to the International Journal of Human Rights.

On June 29, 2021, I submitted, to the International Journal of Human Rights, a paper that reviewed use of the phrases “male circumcision” and “female genital mutilation” in biomedical research articles. I also summarized the existing data on why parents choose to have these procedures performed on their children. I argued that because (a) parents choose these two procedures for mostly cultural or social reasons rather than medical reasons, (b) both procedures involve significant alteration of a child’s genitalia, and (c) “circumcision” is a benign medical term, whereas “mutilation” is a term loaded with value judgment, that the frequent use of the phrase “male circumcision” rather than “male genital mutilation” reflects a gender bias against males.

My paper sat under review for several months without an update. On August 6 and then again on October 22 of 2021, I emailed the editorial office asking for an update on the paper. I was provided copy and pasted responses about how the peer review process can sometimes take a while.

By the end of March 2022, I still had not heard back about my paper. So, again I emailed the editorial office. I was then informed that the journal was trying to identify reviewers for my paper, as some reviewers had declined to appraise the manuscript. The editorial office asked me if I knew of any persons who might be willing to the review paper. On April 1, I sent the assistant the names of six individuals who I thought might be willing to reviewer the paper.

On May 15, I still had not received the reviews, so I again emailed the editorial office. In emailing, I provided the names of eight other individuals who I thought might be interested to appraise my work.

On May 26, an associate editor reached out to me, confirming that the researchers I had listed originally had all turned down the opportunity to review the paper. The associate editor then said he would have a look at my most recent list of suggested reviewers, which I had sent to the office two weeks earlier.

Then, in one of the strangest coincidences in my scientific career, on June 29, 2022 – exactly one year from the day I originally submitted my paper – I received the first round of reviewer comments.

Two reviewers had appraised the manuscript. Both reviewers supported publication of the paper. They requested only relatively minor revisions. So, I addressed their minor concerns, and on September 1, 2022, I submitted a revised version of the paper to the journal.

You might think that because I had to wait one year to receive the reviewers’ comments, and because their concerns were relatively minor, that the remainder of the peer review process would be expedited. That is, within a matter of days, the editor would look at the minor edits that I made to my paper and simply accept the paper for publication there on the spot. Unfortunately, this was not the case. The editor sent the paper back out for a second round of reviews.

Six months later, on February 9, 2023, I received the second round of comments from the reviewers. Remarkably, the editor appeared to have sent the paper out to two different reviewers. I cannot be certain of this because the reviews were anonymous, but the type of feedback provided makes me think that this was the first time that the reviewers had seen the paper. For an editor in this situation to send a paper back out to review to two new reviewers is ridiculous; it is something typically not done for a paper that requires only minor revisions and for a paper in which identifying the initial reviewers was a struggle. Finding two new reviewers would help to explain why it took six months to hear back. Nevertheless, I now needed to address the minor concerns of one of the new reviewers.

On February 24, 2023, I submitted a revised of the paper to the journal. At this point, you might think for certain that they would expedite the acceptance of the paper. I had undergone two rounds of reviews with four different reviewers, all of whom agreed that the paper should be published. Up to this point, the process had taken one year and seven months. Yet, it still took the editor another month to officially accept the paper. Thus, the paper’s official acceptance date was March 23, 2023, and for anyone who might be interested to confirm this history, they can look on the title page of the published paper. Next to the abstract, they will see a note labelled “article history.” In that note, the “received” date is listed as June 20, 2021, and the “accepted” date is listed as March 28, 2023. However, though the paper was accepted on March 28, it did not appear online until April 20, 2023, which is two months shy of being two years from when I originally submitted the paper.

Over this approximate two-year period, I probably sent the journal’s editor and editorial office 20-30 emails asking for clarifications and status updates about my paper. The handling of the paper was unfair to me, and it reflected incompetence at the editorial level. It was an excruciating experience. To add to the frustrations was the fact that during the long review process, I could see the editor regularly commenting about science and politics on Twitter. This was occurring at the same time that I could see, via the publisher’s submission portal, that my paper was sitting in the editor’s inbox. Thus, he had the time to get to my paper but chose not to.

I suspect, but cannot prove, that the topic of the paper was a key reason why the editor handled the paper so poorly, why he and his associates sent it out to two different sets of reviewers, and why it took the paper so long to get the final editorial nod of approval. Throughout the review process, I wanted to call the editor out for his incompetence and inconsiderate behaviour. But I held my tongue. I knew that I had four positive reviews on my side. I also knew that given the “controversial” nature of the paper, I might struggle to find another journal that was willing to review it.

Ultimately, my patience paid off. The paper was eventually published under the title, “‘Male circumcision’ and ‘female genital mutilation’: why parents choose the procedures and the case for gender bias in medical nomenclature.” According to the journal’s website, the paper was their most read paper in 2023, with over 8,000 views, nearly three times as many views as the second most viewed paper. The editor has yet to tweet it out.

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In Story 3 of my personal experiences with ideological drama in academic peer review, we learned how editorial safetyism, caused by a worry to publish something that might be deemed “controversial,” delays important and corrective information from being published. We also learned that this occurs when the topic being discussed has to deal with sex or gender. Story 4 is another example of the issues that exist within peer review when one attempts to say that sex differences exist, and one is unlucky enough to have a social constructionist or determinist review their paper

On April 16, 2022, we submitted a paper titled, “Sex differences in interest and willingness to participate in exercise and sports science research,” to the high-ranking exercise journal, Scandinavian Journal of Medicine and Science in Sports. Our paper summarized the results of our survey in which we asked men and women about their interest and willingness to participate in exercise and sports science research and the factors that impact this interest and willingness to participate.

After 6.5 months, on November 1, 2022, we received comments from two peer reviewers on our paper. Reviewer #1 was supportive of our paper and recommended only minor revisions. Reviewer #2 was a much different case.

Among many other critiques of paper, one of Reviewer #2’s primary concerns was our use of the word “sex” rather “gender” throughout the paper. The reviewer’s opinion was that by using the word “sex” rather than “gender,” we were not accounting for any social factors that might account for the psychological differences that we observed between the male and female survey takers. However, by using the word “sex,” we were not necessarily discounting any social influences. Instead, we had asked participants about their birth sex, and also, for most people, there is no difference between their birth sex and their gender.

Nevertheless, as there were only two reviewers, we needed to address Reviewer #2’s comments carefully. Reviewer #2 seemed to be in favour of rejecting our paper. At minimum, Reviewer #2 was using their position of power in this instance to try to bully us into using their preferred nomenclature.

However, for the sake of our work, our self-esteem, and for all other academics who conduct research in this space, we did not feel that giving into the reviewer’s demands, just for the sake getting the paper through peer review, was the right thing to do. Just as in war, appeasement does not work in the long run. Give them an inch, and they will take a mile, particularly as it pertains to language and nomenclature.

We needed to find a way to address Reviewer #2’s concern without causing them to feel unheard or causing them to overreact and reject our paper. Also, at this point, our paper had been under review for 6.5 months. We wanted to get our paper through peer review as quickly as possible, and we did not want to have to submit the paper to another journal.

One day, a solution to our problem with Reviewer #2 occurred to me: I asked myself, “Do we even need to use the words ‘sex’ or ‘gender’ in our paper? Would it be possible to remove mention of these words and not lose any scientific legitimacy?”

Sure enough, this was possible, and that is exactly what we did. We carefully reworded and restructured sentences such that instead of calling results “sex differences,” we simply referred to them as “differences between men and women.” For example, the original title of our paper was, “Sex differences in interest and willingness to participate in exercise and sports science research.” We simply changed the title to, “Men and women differ in their interest and willingness to participate in exercise and sports science research.”

I actually prefer the latter title. I think it stronger and clearer. And by not referring to “sex” or “gender,” no reader will be confused about what we believe to be the causes of the differences we observed. Identifying the causes of such differences in interest and willingness to participate in exercise research was not the point of the study. The point was simply to examine whether such differences exist.

So, two weeks after receiving the reviewers’ comments, on November 15, we submitted the revised version of our paper. Given that Reviewer #1’s feedback was minimal, and given that we found a trick to not let Reviewer #2 serve as the gender word police, we thought, given that the paper had already been under review for 6.5 months, that our resubmission would be quickly processed. This was not the case.

We did not receive the second round of reviews on our paper until April 3, 2023, nearly five months after our resubmission and nearly one year after our original submission. Moreover, during the five-month period, we repeatedly emailed the editorial office asking for status updates about our paper. In return, we received unhelpful responses from an editorial assistant who had no administrative power. We also attempted to contact the associate editor directly via his university email, but we did not receive a response. Then, we attempted to contact the chief editor of the journal. Again, no response. We even offered the editorial office a solution to the associate editor’s incompetence and unprofessional behaviour; we suggested that they simply hand our paper off to a different associate editor. That potential solution never came to fruition. 

In this second round of reviewer comments that we finally received in April, Reviewer #2 was still not happy. The reviewer made comments about the “underrepresentation” of females as participants in exercise research, and how we were not doing enough to discuss this in our paper. The reviewer also suggested that because we were not discussing such things that our results did not have much to offer. This was a ridiculous statement considering that we have been the only researchers to actually ask women (and men) about their interest in participating in such research and the factors that influence their participation, which, can be used in efforts to try to increase both male and female participation. In effect, Reviewer #2 was disappointed that we were not serving as feminist activists or as wimps who bow to the gender langue police. Moreover, the editor was on Reviewer #2’s side, which made the process even more annoying. Thus, on April 11, we once again submitted a revised version of our paper, this time including responses to both concerns of Reviewer #2 and the editor.

Then, finally, a month later, on May 15, 2023 our paper was finally accepted for publication. It appeared online later that month.

In total, the paper took 1.5 years to get through peer review. The abnormally long review time was due a combination of an incompetent editor and a social constructionist peer reviewer. For a simple survey study to take this long to get through peer review is unacceptable.

Nevertheless, the good news is that we were able to get the results published in a major journal. Moreover, in December of 2023, we published a follow-up piece in another journal. Also, we have written about our results at Reality’s Last Stand on Substack.

The review process associated with this paper was long and excruciating. Yet, remarkably, it was not the longest review that I have gone through. The longest review I have experienced is the topic of Story 5.

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