Politics and medical research

Myriam Marquez

April 16, 1993|By Myriam Marquez

THE incidence of breast and lung cancer is rising for women. Heart disease causes 28 percent of deaths among women.

And at least one of seven women has bouts of depression during her lifetime.

That much we know.

What we don't know -- except in the case of lung cancer -- is if women are somehow more predisposed to certain diseases. (Doctors are relatively certain that there is more lung cancer among women today because more women are smoking than were a generation ago.)

Fortunately, the big gap in our knowledge about what affects women's health may close soon. Congress has passed a measure that would require the director of the National Institutes of Health to ensure that clinical studies are not conducted solely on men. Instead, the proposal calls for having women and minorities included in federally financed NIH studies, unless researchers have a good reason to limit the study to one particular group of people.

The reasons that men are usually chosen for clinical studies of everything from heart disease to aging are varied, several researchers have told me. For one, men seem to be more willing to be guinea pigs in scientific research -- they answer the advertisements seeking study subjects in much larger proportions than women do.

Also, many studies of new medicines have tended to exclude women of child-bearing years for fear that the medication being tested might affect the reproductive health of those women in the testing group who may want to become pregnant later.

There are many scientifically sound and biologically rooted reasons to exempt women -- or men, for that matter -- from certain testing. Men don't get ovarian cancer; women don't get prostate cancer.

Requiring women and ethnic groups in all NIH studies to determine if there are genetic or ethnically based dietary reasons for diseases There's no excuse for ignoring the health of a majority of Americans by excluding them from medical research.

makes sense.

But it's senseless when politics -- instead of scientific evidence -- is used to decide which groups to study.

Benjamin and Janet Wittes, who work for Statistics Collaborative, a company that designs clinical trials, are concerned that politics is getting in the way of sound research. In the April 5 edition of the New Republic, the Witteses note, "People of different races and sexes have more biologic similarities than differences." Therefore, they maintain, there's no need to include women and minority groups in every study.

To do so in a way that accurately reflects any differences in each group, they add, would mean having study groups that are eight or more times larger than the male study groups most often used now. Larger study groups also would mean that research would take longer and would cost more. And because Congress would be unlikely to increase financing by the amount needed to expand research to all groups, the Witteses maintain, it would limit research.

"Conducting fewer trials that take longer and yield fewer new treatments serves no one's health," the Witteses wrote.

I agree -- political correctness ought not to be injected into scientific studies.

But the NIH testing bill, which is now undergoing some tinkering in a conference committee in Congress, would leave it up to researchers -- not politicians -- to determine when to exclude certain groups of people from certain types of research.

Those determinations would have to be based on scientific rationale, and that's as it should be.

It may well cost more to do such broad studies, but some of them may also garner results that end up saving health-care dollars on treatments that otherwise would not have been "discovered."

Absent scientific evidence, there's no excuse for ignoring the health of a majority of Americans by excluding them from medical research.

Myriam Marquez is an editorial page columnist for the Orlando Sentinel.

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