Medical Researchers, Heal Thyselves of Gender Bias : Health: Women are often left out of drug tests and research on diseases, but their allies in Congress are moving to correct this harmful neglect.

PALO ALTO —  Women visit doctors more often than men, take more medications and spend more time in hospitals, but they are routinely shortchanged by our health-care system. For instance, women--more than half the population in the country--are regularly excluded from medical research and drug tests. Physicians may not know whether new findings can be applied to female patients.

Furthermore, research on conditions unique to women--breast cancer, menopause, osteoporosis, ovarian cancer and postpartum depression--often receive too little attention and too little money. One woman in nine now may contract breast cancer during her lifetime, and surely these women deserve more attention.

When women talk about being left out of research, what do we mean? Consider these examples:

--Although heart disease is the leading cause of death in this country for men and women, most clinical studies do not include women. The Physician’s Health Study, conducted by the Harvard Medical School and Brigham and Women’s Hospital in Boston, observed 22,071 men and no women; it concluded that taking an aspirin every other day may reduce the risk of heart disease. Many women began the suggested treatment despite the lack of evidence that aspirin reduces the risk of cardiovascular disease in women.

--A famous long-term study of lifestyle factors related to cholesterol levels and the development of heart disease included 15,000 men and no women. Twenty-two major health research centers participated in this study, the Multiple Risk Factor Intervention Trials (called, appropriately, MR. FIT).

--A study released last year by the Harvard School of Public Health concluded that coffee did not encourage the development of heart disease. The research excluded women from the study population of 45,589.

--A major aging study financed by the National Institute on Aging, begun in 1958, did not include women until 1978. Thus, long-term data on women and the aging process are still unavailable. Just this month, UCLA and Harvard University researchers reported on two studies on the effects of aging on mental faculties, reports that excluded women though women routinely live longer than men.

AIDS researchers also note that many of the early drug trials were conducted on men, leaving the rapidly growing population of women and children with AIDS at a disadvantage. Since 1980, about 54,000 persons have died of AIDS, while eight times as many women have died from breast cancer. Yet 44 times as much money was spent by the National Institutes of Health on basic AIDS research in 1989 as was spent on breast-cancer research.

These comparisons do not diminish the need for funding AIDS research, but emphasize the lack of funding for breast cancer. Many examples of promising research into the causes of breast cancer and links with diet, alcohol and family history have not been explored because of insufficient funding.

Why, you may ask, do researchers show such a gender bias? The most frequent response is that including women, with their hormonal changes, would unduly complicate studies. But the same scientists who say that are willing to turn around and extrapolate their findings to women. In too many circumstances, this is bad science, and it leaves physicians guessing whether a treatment will be effective for women patients. The problem is exacerbated because of the dearth of women scientists at senior levels of government and research universities.

It is hardly surprising that the one sector in which there is consistent research on women is nursing. That profession is dominated by women, its leaders are women and many of its studies--for example, at the Center for Women’s Health Research at the University of Washington--concern treatment of women’s health conditions. It is unfortunate, but not surprising, that research in the field of nursing receives less money than other specialties.

Last year was a watershed in the efforts to bring women into researchers’ field of vision. In June, the General Accounting Office reported that the NIH was not ensuring women’s inclusion in research on causes of disease and possible treatments. Then in July, the Congressional Caucus on Women’s Issues drafted the Women’s Health Equity Act creating an Office for Women’s Health Research at NIH. That legislation would require that women and minorities be included in drug trials and expanding funding for research in breast cancer, osteoporosis, contraception and infertility.

Last year was also spent laying legislative groundwork, and this week the legislation will be reintroduced; passage seems likely.

As interest in this issue grew, NIH did indeed create an Office of Research on Women’s Health. It will identify the gaps in scientific knowledge created by the exclusion of women from trials. Dr. Ruth Kirschstein, the interim director, is also the director of the Institute of General Medical Science, a top post in the NIH hierarchy. That such a high-level person was appointed to head the office is an encouraging sign that the NIH is committed to change. What is needed now is assurance that the new office will get the money it needs to function effectively.

Reps. Patricia Schroeder (D-Co.) and Olympia Snowe (R-Me.), co-chairs of the women’s caucus, have cooperated on these issues with the Society for the Advancement of Women’s Health Research, established in February, 1990, specifically to bring attention to needs going unmet. But although women legislators are particularly responsive to issues related to women’s health care, this is not an exclusively female effort. Rep. Henry A. Waxman (D-Calif.), who heads the Health and Environment Committee, has also helped to create a better climate for legislation.

The government report, the new NIH office and the congressional support represent a promising beginning. But it is only that. How much better it would be if front-page headlines could focus not on increased odds of getting breast cancer but on increased funding for breast-cancer research and, finally, on breakthroughs in its prevention or treatment.