Lindy Rossow is frustrated.
The assistant professor at Lindenwood University Belleville is frustrated that even in her field of exercise science, even though the National Institutes of Health have demanded it since 1993, women are still used much less than men in scientific studies.
“It’s so ingrained that men are the default sex — why, why, why?” she said recently from her office at Lindenwood, where she teaches four classes a semester and is chair of the exercise science department.
She is among the authors of a peer-reviewed article in the Clinical Physiological Functional Imaging Journal, titled “Let’s talk about sex: where are the young females in blood flow restriction research?” published in September. Their review found that at most, only 29 percent of the 4,335 participants in Blood Flow Restriction studies were women; and only 17 percent were women in chronic exercise studies.
The lead author of the review was Jeremy Loenneke, an assistant professor at the University of Mississippi. He and Rossow attended grad school together; Loenneke was the best man in her wedding to Chris Fahs, who also works at Lindenwood.
“BFR (Blood Flow Restriction) is Jeremy’s thing, (his graduate student Brittany Counts) was the only woman in their lab, and women in research is my ranting,” Rossow said.
Counts did much of the legwork in the study, and is now at the University of South Carolina in a Integrative Muscle Biology Laboratory.
“We had a pretty good idea” before the review that women were under-represented in studies,” Loenneke said by phone from his office at Ole Miss. “You read paper after paper on it.”
Inferences made from men
From his perspective in exercise science, he said there was no reason to believe there is a difference between men and women’s reactions to blood flow restriction.
BFR is using a cuff — something like a blood pressure cuff — to help blood pool in an appendage while those muscles are worked with light weights. For instance, a cuff might be placed around the upper arm, and biceps are exercised with light weights.
“The point of the paper was that we are inferring a lot from men to women, and we need to do a better job” of testing both genders equally, Loenneke said.
Rossow and Loenneke say many studies shy away from using young women — a woman who has not yet hit menopause — because of menstruation.
“That is what they say,” Rossow says. “It’s a stupid reason.”
The question then becomes, Loenneke says: Does the menstrual cycle have an effect on the study’s outcomes?
“I don’t know that it does. Maybe you’re excluding people for no reason,” he said.
Rossow said studies need to have internal validity, or how well the study is done, and external validity, or “how applicable is it to the population.”
“We have to take women as they are,” she said.
It wasn’t something he thought a lot about until Rossow pushed him toward it, Loenneke says, and now he sees gender disparity everywhere.
“She’s always been in my ear about that, for the last decade. It’s one of those things I wouldn’t have thought about unless she brought it up. You look in the literature, and it’s just small things that she would pick up on,” he said.
An example is how studies are worded — if only men are studied, then the results are simply stated as “this happens,” Loenneke said.
“But if it only includes women, they say ‘This happens in women,’” he said. “I see that all the time now.”
Rossow has only to look at the textbooks she uses in her classes at Lindenwood. Perusing one to find graphics to explain a finer point of menstruation, she stumbles across unrelated line graphs.
“See? Even this, it says ‘Men and Women.’ Why not ‘Women and Men’?” she said of the titles.
“Men are always listed first because we are subspecies, I say with sarcasm.”
Rossow says only studies that are funded by the National Institutes of Health require women as subjects, and the great majority of medical studies are not funded by the institutes. That means the great majority of studies do not include women, or even female animals or female cell lines, which the NIH expanded to in 2014.
Women still rare in science
Rossow says the culture of scientific study tends to exclude women because men dominate the sciences. She is the department chair of exercise sciences at Lindenwood Belleville; the only other professor is her husband.
Loenneke’s office reflects the male-dominated field, and there’s no women currently in the graduate studies program at Ole Miss. Counts was the only woman when she was there.
Rossow thinks Loenneke’s male-dominated lab is simply because more men are interested in the areas he studies.
“He does not choose male graduate students over females,” she wrote in an email. He honestly just wants people who will work on and help him publish great studies and he chooses the people who will help him accomplish this.”
Graduate students at Ole Miss have two studies going on under his watch now, Loenneke said. One — with his push — has men and a slightly larger number of women.
“One study with BFR right now is only men,” he said. “The reason is we’re doing measurements on chest muscles. And we’re an all-male lab, so it’s an issue to do that measurement on a female.”
Rossow doesn’t agree with his exclusion reasoning.
“I understand why he reasoned that way (he has a lab of all young males and didn’t want them dealing with female chests), but I wouldn’t make the same judgment. As a graduate student in our field, you are required to act professionally,” she wrote in an email.
She also speculated that his decision may have been influenced because the measurement is “difficult to obtain accurately” and could be harder on people — men and women — who have more tissue in the chest.
He says “sometimes there are potentially good reasons to exclude women” from studies, but studies often don’t include the reasons. His study on BFR in chest measurements will “for sure” explain why women were not included in the study.
Before hearing about Loenneke’s current studies, Rossow had said “I’ve thoroughly convinced Jeremy,” of the need to study women as well as men, and if that were true then “I’ve done something in this world.”
She is hopeful for more change as well.
“I think awareness, publish more studies, what I do through my teaching ... I hope (students) carry this with them and will not be swayed by people saying ‘just do it as it’s always been done.’”