Science's women's health issue means little unless trial rules change
Treating women as small men was a methodological failure, not an oversight. A special issue won't fix it; changes to trials, dosing and funding rules might.
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Can a science that spent generations treating half of humanity as a rounding error be fixed with a special issue? Probably not. But it is a start, and the way it is framed matters.
What Science actually did
As STAT reports, the journal Science devoted an issue to women's health, examining sex-dependent differences in many diseases and calling for more funding and more women in clinical trials. The journal's own social post says the issue explores a growing understanding of sex differences in health and disease, and how women's health extends far beyond reproduction.
In our view, that is welcome but limited. A journal issue can amplify a problem researchers have documented for years. It cannot, by itself, change how trials are run. And the substance is hard to dispute: as El Periódico reported in 2019, most studies of health and disease, and most trials of new drugs, have been run on male animals or male patients. The aim was a homogeneous sample whose results could be isolated and then applied to everyone.
It was a method, not an oversight
"Oversight" implies nobody was looking. Here someone chose. Using males to reduce variability was a design decision, defended in the name of objectivity. A historian of science quoted by El Periódico put it well: objective, yes; neutral, no. The article also notes that hormonal fluctuations were used to justify excluding females, even though both sexes go through such cycles. In our view, that is the crux: a convenience was dressed up as rigor.
And the cost is not abstract. A piece published by El País says a woman having a heart attack is twice as likely to die as a man, because male symptoms were treated as the generic ones. That is an advocacy-leaning op-ed from a scientific society, not a peer-reviewed estimate, so we would not quote the number as settled. The direction of the claim, however, fits what researchers cited by El Periódico say about drugs: psychiatric medications don't work identically in men and women, and side effects differ too.
There is also an irony for scientists who prize reproducibility. Cambridge researchers cited in that same article argue that gender bias is one of the factors contributing to preclinical replication problems. A bias that makes results less transferable isn't just unfair; it is bad science.
Words are cheap; rules are not
Here is where we get skeptical. A special issue is a statement of intent. A sentence in a journal can't change what a regulator requires, what a funder pays for, or how a trial is enrolled. Calling for more women in clinical trials is the easy part.
What would count as real change? We would look for three things: enrollment and sex-disaggregated reporting that are conditions of approval and funding rather than recommendations; dosing studies that examine sex as a variable rather than a footnote; and dedicated money for sex-difference research. Policy is clearly a lever, but not a simple one. A 2025 Science Advances paper describes policies meant to reduce sex- and gender-based health inequities, and a 2026 review argues that sex and gender remain inconsistently and inadequately integrated in health research. Even after years of policy, in other words, the integration looks patchy.
The bias also isn't confined to the lab. Studies summarized by Mujeres con Ciencia describe women being invited less often as peer reviewers and asked fewer questions at conferences. Fixing who is in the room is part of fixing who is in the trial.
Our verdict
Applaud the issue, then audit it. The test is not whether Science put the problem on its pages, but whether, in three or five years, the trials that support new drug approvals report results by sex as a matter of course, and whether funders have attached money to the demand. If you read health news, ask one question of every study: who was in it? If the answer is mostly men, treat the headline as a hypothesis for half the population, not a finding for all of it.
A special issue is worth exactly as much as the rules that follow it.
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