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The evidence basis of medicine may be fundamentally flawed because there is an ongoing failure of research tools to include sex differences in study design and analysis. The reporting bias which this methodology maintains creates a situation where guidelines based on the study of one sex may be generalized and applied to both. In fact, study design in the 1970s in response to sex discrimination legislation made efforts to mix gender within study groups since this was considered the best approach to equality.
Although significant social progress has been made since then, the application of the principles behind the legislation to women's health and gender-based research have not been so positive. Those who research gender issues in clinical and laboratory medicine are aware of significant barriers both for researchers and for subjects entering studies. This is one illustration of continuing deep-seated patterns of disadvantage that triggered an equalities review by the UK Cabinet Office in November 2005. For example, research funding for coronary artery disease in men is far greater than for women, yet the at risk population of women, which is an older age group, suffers more morbidity and mortality. The lack of funding for women's disease in effect maintains women's lower economic status. It can also hinder research into gender medicine where significant advances in the diagnosis and management of coronary artery disease have built up from small differences into major gender medicine issues.1 Clinical research also exhibits gender bias in other areas. One of these is in recruitment into clinical trials;2 another is the reporting of gender-related data.3 However, there is a dearth of gender-based clinical research from within the UK. Thus it is pertinent to use studies from North America and Europe where these issues have been investigated.