Sex and Gender Equality Policy in

Research Funding

Canadian Critical Care Forum

November 2018

Objectives

2

Share what other networks are doing in Canada to raise the

bar on sex and gender science in their field.

Highlight policies that target gender equity, diversity and inclusion

at CIHR; and

Raise awareness of steps that CIHR is taking to promote scientific

excellence through the integration of sex and gender in research

content;

SEX & GENDER IN SCIENCE VS. GENDER EQUITY

Who receives funding.

DATA COLLECTED BY

Applicant checkbox Male/Female

***New Tri-agency questionnaire asks for age, gender, Indigenous identity, visible minority, person with

disability

Gender EquitySex and Gender in

Science

Who is being studied.

DATA COLLECTED BY

Sex and gender checkbox in administrative section of

applications

(Integration of sex as a biological variable and/or gender as a socio-cultural determinant of health in

the proposal)

SCIENTIFIC EXCELLENCE

How rigorous the

research is

Who will benefit from its

innovation and impact

Are governments and taxpayers funding research that benefits

diverse populations of boys, girls, men and women equally?

If not, what should we do?

TRUE OR FALSEThe terms SEX and GENDER

mean the same thing and can

be used interchangeably in

science.

FALSESEX refers to biological

differences between males and

females like genes, sex

hormones, physiology and

immune response

GENDER refers to psycho-social

differences between women,

men, boys, girls and gender-

diverse people; factors like

behaviour, roles, identities,

cultural and societal influences

and expectations

BOTTOM LINE:

EVERY CELL

HAS A SEX.

EVERY PERSON

IS GENDERED.

MICE DO NOT

HAVE GENDERS.

TRUE OR FALSEIt’s safe to assume that

conducting single-sex

pre-clinical studies will have

no effect down the line on

humans.

FALSE• Cell-based: 80% male/not reported

(i.e. male)

• Animal-Based: 75% male

• Human Trials: 67% men

• Post-Market: Females 2x risk to

develop adverse drug reactions

Prescription drugs withdrawn

from the US Market 1997-2000

Source: United States General Accounting Office (GAO) analysis

of these drugs posed more of a threat for women.

www.drugwatch.com

GENDER AND SEX

SEX

Biological variables

Seldane®, Propulsid®

cause fatal arrythmias in women only because of a

longer normal QT interval

GENDER

Social variables

Redux ®, Fen-Fen appetite

suppressants

cause valvularheart disease

equally

but more women take them

WHY DOES

SEX

MATTER IN CRITICAL

CARE MEDICINE?

Alyson McGregor et al. (2017) West J Emerg Med 18:1079

1. Identify patient sex and gender

2. Understand sex differences in

clinical manifestation of disease

3. Recognize potential limitations in

diagnostic testing

4. Use sex-specific thresholds for

biomarkers or laboratory value

references

5. When available, dose medications

based upon sex-specific evidence

6. Mitigate bias

6

COGNITIVE

STEPS to identify and

manage sex and

gender

considerations in

critical care

practice

© McGregor AJ, WJEM 2017

© McGregor AJ, WJEM 2017

Who gets crushing ischemic chest?Who has higher stroke risk from this:

CHADS VASC

© McGregor AJ, WJEM 2017

©McGregor AJ

© McGregor AJ, WJEM 2017

Source: http://globalnews.ca/news/3029934/drugs-arent-tested-on-women-like-they-are-on-men-and-it-could-have-deadly-consequences/

Pharmacokinetic differences accentuated with increasing age

Female patients may require:• higher doses of lipophilic medications like propofol• lower doses of water-soluble drugs like rocuronium• higher doses of morphine – effect attenuated by estrogen –

leading to higher risk of respiratory depression

Male patients with dementia have:• higher mortality rates from antipsychotics

Sources:McGregor et al. WJEM 2017; Rochon PA et al. JAGS 2013; Doyle et al. JNR 2017

© McGregor AJ, WJEM 2017

HISTORIC CONTROL GROUP

490 men 233 women

Men vs Women

77% vs 69% guideline therapy

104 vs 112 min door to balloon time

30-day mortality 6.1% higher in

women

MITIGATE BIAS: A SYSTEMATIC APPROACH TO

STEMI REDUCES GENDER BIAS

INTERVENTION GROUP

378 men 171 women

Usual care forST-Elevation MI

New 4-step protocol1. ER Criteria do not require cardiology consult 2. Guideline based drug therapy3. Immediate transfer to the cath lab4. Initial radial approach for vascular access

Men vs Women

84% vs 80% guideline therapy

89 vs 91 min door to balloon time

30-day mortality only 3.2% higher in

women

Huded et al. (2018) JACC

Do gender issues matter in

the ICU?

Women only CPR teams delay onset of chest compressions, even though communication improves

Published November 6, 2017

Published November 6, 2017

Published February, 2017

Who receives CIHR funding?

2000-2017

Can you guess?

Who receives CIHR funding?

2000-2017

28%

72%

30

Back to CIHR: Gender in CIHR’s funding system

Small but consistent differences in success rates between male and female

applicants to some programs (e.g. males more successful in Foundation and

Vanier/Banting scholarships)

Assessment of the applicant’s leadership experience, in addition to assessment of

the science, favours male applicants in the latter competitions

Female applicants request a lower amount of grant funding and a shorter duration

for the grant for clinical, health systems and policy research proposals

Over time, applicants to open investigator-initiated programs have gotten older,

with a higher proportion of female applicants being in early career stages

31

Gender in CIHR’s funding system

Referee letters to scholarship competitions more often described

communal skills (e.g. collaboration, team work) for female applicants,

and use more standout adjectives (outstanding, cutting-edge) for

males

When asked to describe their leadership, applicants and reviewers

were more likely to discuss teaching and mentoring experience for

female applicants, over other leadership activities

Text analysis of applications, referee letters and peer reviews highlight

differences in the assessment of the applicant:

Unconscious Bias Learning Module

32

Unconscious bias is an

implicit, unintentional attitude

or assumption

Module provides strategies

to detect and mitigate

unconscious bias in

research and peer-review

Mandatory for peer

reviewers in some CIHR

programs

Paid Parental Leave (PPL)

Supportive policies for parental leave and caregiving

• All CIHR, SSHRC and NSERC training award holders are eligible

for PPL

• Extension allowance within Common CV to account for leaves

taken

• Currently updating Tri Agency PPL policy (e.g., extension of leave)

• Definition of early career researcher includes accounting for leaves

taken

• Consultations to be held to determine best ways to ensure

continuity in research during period of leave for grant holders

3311

WANT MORE

INFORMATION ABOUT

SEX AND GENDER

MEDICINE?

ONLINE TRAINING MODULES

www.discoversexandgender.ca

WANT TO HEAR WHAT

HAPPENED WITH THE

WOMEN IN

TRANSPLANTATION

GROUP?

BE AN EARLY ADOPTER!

OUR PATIENTS DESERVE IT