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November 23, 1994

Discrimination in research affects health care of women, minorities

The scientists who conduct medical research in this country are overwhelmingly white, male, heterosexual and middle-to-upper class. So are the politicians who set America's health care agenda.

And as long as that's the case, women and minorities will continue to suffer discrimination in health care services and research — as well as in science classrooms and laboratories, according to a leading women's health advocate.

Sue V. Rosser, director of women's studies and professor of family and preventive medicine at the University of South Carolina, spoke at Pitt Nov. 17 and 18. She argued that androcentric (male-centered) bias, much of it unintentional, is epidemic in the U.S. health care system and the scientific community in general. "There's nothing wrong with being white, middle-class and male," Rosser emphasized. "What's wrong is if that's all that is represented in the pool of scientists." Traditionally, women have been excluded from clinical trials and female animals from experiments, often for what seemed like good reasons, Rosser noted. For example, it is widely believed that male subjects yield "cleaner" data untainted by estrogen and menstrual cycles, she said. Also, there is the fear of inducing fetal deformities in pregnant subjects, and some diseases are specific to males.

"However, the result (of excluding females) has been that health care practitioners must treat the majority of the population, which is female or so-called minority male, based on information gathered from research in which drugs may not have been tested on females or on men of color," Rosser said at a Nov. 17 lecture at the Graduate School of Public Health.

The idea that female reproductive hormones throw off research data may be outmoded, she said: Recent research indicates that humans produce nearly all hormones, not just female reproductive hormones, in a cyclical rather than a steady fashion. "The female body, because of its cyclicity, may in fact be a better model" for clinical trials, said Rosser.

Rosser cited four recent, influential studies of cholesterol-lowering drugs, coronary heart disease mortality, the suspected link between coffee consumption and heart disease, and the effect of low-dose aspirin therapy on the heart. The four studies involved more than 84,000 men research subjects — but no women.

When white, male bodies are used to set the norms for such factors as blood pressure and immunological responses, the results can be deadly for women and minority men, Rosser said.

Heart disease, hypertension and AIDS have all been misdiagnosed at one time or another as "men's" conditions, she noted, pointing out that it wasn't until January 1993 that the U.S. Centers for Disease Control developed a definition of AIDS that included gynecological conditions and other symptoms related to HIV and AIDS in women.

In response to the argument that men made up 92.6 percent of AIDS patients in the United States by 1992 and so it was understandable that AIDS research here focused on men, Rosser said that AIDS in Africa has been predominantly a disease of heterosexuals since the early 1980s; American AIDS researchers knew the disease would strike women here eventually, she said.

According to Rosser, the fact that most physicians still are unable to diagnose AIDS in women until the disease is well advanced probably helps to explain these statistics: A man's average life expectancy after being diagnosed with AIDS is 30 months; for women, it is 15 weeks.

The language used in much of the research on AIDS in women has emphasized patients' status as either mothers or prostitutes, according to Rosser — reminiscent of the madonna/whore dichotomy. Sexist language and behavioral assumptions can influence scientists' observations, Rosser said. She recalled a primatologist who noticed new aspects of ape behavior once she stopped thinking of a social group consisting of a male ape and several females as a "harem" and began thinking of the male as a "stud" for the females.

* * * "Attracting and Retaining Women Science Students" was the subject of a Nov. 18 panel discussion, sponsored by the women's studies program, that featured Rosser, Provost James Maher and two women Pitt faculty members.

Panelist Martha Pollock, a computer science professor, cited a recent article in the journal Science that described the U.S. scientific culture as "a workplace organized on the assumption of a social and emotional support structure provided to the male scientist by an unpaid, full-time housewife, or done without." Pollock said: "So many women have told me, 'I don't know if it's possible to have a rich outside life and be a scientist.'" Pollock said she intentionally refers in class to her two young children in the hope of showing that women can be both scientists and mothers.

One factor that makes that life style difficult, Pollock said, is what she called "the macho science work ethic" that says scientists must put in 60-70 hour weeks, 52 weeks a year. "Some scientific careers do require those hours, but there are plenty that don't," Pollock said. She called for a more uniform faculty maternity leave policy at Pitt, adding: "There is a conflict between the tenure clock and the child-bearing clock that needs to be resolved in academic science." Philosophy professor Tamara Horowitz suggested that Pitt grant tuition rebates to women and minority students who must take extra math and science classes to complete science degrees. A cheaper alternative, she said, would be to allow such students to choose between a letter grade or a pass/fail option for math and science courses — after the students have seen the letter grades they would be getting. This flexibility in grading might encourage more women and minorities to pursue advanced degrees and careers in the sciences, Horowitz said.

The relatively few women who do become academic scientists tend to get asked to do a great deal of advising and mentoring, to serve on numerous committees — and panel discussions, Horowitz said. She recommended that such women be relieved of some teaching duties in compensation.

Provost Maher said he did not disagree with any of his fellow panelists' comments or recommendations. But he suggested that "self-confidence and the standards that we set for ourselves" may be as important as sexism in explaining why some women do not pursue scientific careers. "There are women dropping out (of science courses) with solid B-pluses because they don't have A-pluses. And there are men hanging on by their fingernails with D-minuses because someone told them to be an engineer," Maher said.

— Bruce Steele

Filed under: Feature,Volume 27 Issue 7

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