If you are looking for an excellent, data-focussed present to buy for yourself and everyone you love, check out Invisible Women – Exposing Data Bias in a World Designed by Men by Caroline Criado Perez. Having lent my copy to most members of the SABS DPhil program already, I will quote stats from this book to anyone who will listen.

The book is a well-researched exploration of the systemic bias prevalent in a world designed for the mythical ‘average male’. Featuring 1267 pages of references, the book provides statistics on how a broad range of societal areas affect those who do not fit the average male body size, from snow-clearing routes in Sweden to body armour design. Criado Perez provides endless data on how unconscious and innate bias impacts our society and how this can (at best) inconvenience and (at worst) risk the lives of women in particular. For instance, Google’s speech recognition is 70% more likely to understand men (as it was predominantly trained using male voices), and women are 47% more likely than men to be injured in a car crash, due to car safety tests being carried out using a ‘standard male’ crash dummy. As Criado Perez was quoted in an interview for her book, “No one meant to deliberately exclude women. It’s just what may seem objective is actually highly male-biased.”

Those of us in the scientific world may be familiar with the sex-bias in healthcare, such as the historic disparity in numbers of female and male participants in clinical trials. Whilst there are many potential reasons for this imbalance, the result is a lack of data, particularly at the early stages of drug development, on how a potential drug candidate affects women. Not only does this risk adverse effects in women not being identified early, but it may also rule out drugs that are not efficacious in males but have an effect in females. Cases of drugs affecting males and females differently is documented; in 2000, phenylpropanolamine was removed from many available pharmaceuticals due to it causing increased risk of bleeding into the brain in women, but not in men. Interestingly, the bias of using predominantly male subjects extends to animal studies; 80% of surgical research publications included only male animals, vs 17% using only females. Females, with fluctuating hormones and non-male physiology are seemingly too complicated and variable to study – such a shame that they make up over half of the world’s population.

Whilst the number of women participating in clinical trials is improving – and for 2016 was reported as around 43% of worldwide clinical trial participants – progress is still to be made; a 2016 alcohol-interaction study for a drug designed to treat Hypoactive Sexual Desire Disorder exclusively in women was tested on 25 participants – 23 of which were male.

This lack of inclusion in the drug development process is not the only sex discrepancy in healthcare; the perception of male as the standard and female as ‘other’ pervades many aspects. A 2008 study of university-recommended textbooks found male bodies were used as ‘neutral’ body parts three times more frequently than women’s bodies. Women are more likely to die from a heart attack because their symptoms are more ‘atypical’, and standard thresholds of many diagnostic biomarkers may be more inaccurate for women due to size and physiological differences.

Whilst I should give a warning that reading Invisible Women may induce moderate feelings of outrage, the book is a fascinating example of collating and aggregating data to identify previously unknown trends, and to determine data gaps. The next step will be using the data to make impactful change.

Follow Caroline Criado Perez on Twitter at @CCriadoPerez.
I can also highly recommend the account “Congrats, you have an all male panel!” @allmalepanels

Further reading on women in clinical trials:
https://endpoints.elysiumhealth.com/why-women-are-underrepresented-in-clinical-trials-398c9e0735a