Women and Men in the History of Western Cardiology: Some Notes on Their Position as Patients, Role as Investigational Study Subjects, and Impact as Professionals

Women's health in The BMJ: a data science history

OBJECTIVE

To determine how the representation of women's health has changed in clinical studies over the course of 70 years.

DESIGN

Observational study of 71 866 research articles published between 1948 and 2018 in The BMJ.

MAIN OUTCOME MEASURES

The incidence of women-specific health topics over time. General linear, additive and segmented regression models were used to estimate trends.

RESULTS

Over 70 years, the overall odds that a word in a BMJ research article was 'woman' or 'women' increased by an annual factor of 1.023, but this rate of increase varied by clinical specialty with some showing little or no change. The odds that an article was about some aspect of women-specific health increased much more slowly, by an annual factor of 1.004. The incidence of articles about particular areas of women-specific medicine such as pregnancy did not show a general increase, but rather fluctuated over time. The incidence of articles making any mention of women, gender or sex declined between 1948 and 2005, after which it rose steeply so that by 2018 few papers made no mention of them at all.

CONCLUSIONS

Over time women have become ever more prominent in BMJ research articles. However, the importance of women-specific health topics has waxed and waned as researchers responded ephemerally to medical advances, public health programmes, and sociolegal changes. The appointment of a woman editor-inchief in 2005 may have had a dramatic effect on whether women were mentioned in research articles.

Ratiology and a Complementary Class of Metrics for Cardiovascular Investigations

Cardiovascular investigations often involve ratio-based metrics or differences: ejection fraction, arterial pressure augmentation index, coronary fractional flow reserve, pulse pressure. Focusing on a single number (ratio or difference) implies that information is lost. The lost companions constitute a well-defined but thus far unrecognized class, having additive value, a physical dimension, and often a physiological meaning. Physiologists should play a prominent role in exploring these complementary avenues and also define alternatives.