Excellent BMJ editorial on sex and gender

[2Rebecca]

twitter.com/bmj_latest/status/1372890963278958594
Makes a change from the Stonewall influenced stuff on gender that usually graces the BMJ. Not sure how to attach the pdf

www.bmj.com/content/372/bmj.n735?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage a different link that doesn't go on to twitter

It's a pity it's paywalled but the opening section which is shown looks admirably clear.

This link should allow access: www.bmj.com/content/372/bmj.n735.full?ijkey=xn35xYzLXf2qhe6&keytype=ref

Full text tweeted here
twitter.com/lascapigliata8/status/1372929345858252800?s=21

However, contemporary medical research and clinical practice often erroneously use sex and gender interchangeably.…

The right question must be asked to obtain the information desired; recent debate around the 2021 census in England has drawn public attention to classification problems.4 The Office of National Statistics, in discussion with stakeholders, recognised that the previous census question that asked, “Are you male or female” without accompanying guidance was insufficient to provide quality information for planning services and monitoring equality. The 2021 England and Wales census5 will collect data on sex (a mandatory question with two answers) and gender identity (a voluntary categorical question plus a free text answer). However, the original accompanying guidance did not clearly explain whether the sex data being sought was legal sex as recorded on a birth or gender recognition certificate, sex as recorded on other administrative documents such as passport or NHS records, or biological sex.
…
Ambiguous data collection methods that conflate sex and gender risk erroneous research findings, poor service planning, and lower quality medical practice. Gender and sex should not be used interchangeably. We risk harming patients if we do not understand the difference.

They make express reference to the Census case by FPFW clarifying what is meant by sex for statistical purposes.

Umm, maybe we need to find a way to pay their open access fee, then it would be available for all. Might suggest this to FPFW

Susan Bewley is great, she's spoken about this a lot. Suprised to see it being promoted on the bmj twitter account though.

@Belleende

Umm, maybe we need to find a way to pay their open access fee, then it would be available for all. Might suggest this to FPFW

Does the link I gave above not work? It usually does - apologies if it doesn't.

[quote EmbarrassingAdmissions]This link should allow access: www.bmj.com/content/372/bmj.n735.full?ijkey=xn35xYzLXf2qhe6&keytype=ref[/quote]
This worked!
Thanks for highlighting, op

Really interesting, thanks for sharing.

Bravo BMJ and bravo Susan Bewley. There are no new points or perspectives there, but an elegant simplicity that sums up the issue very well. It eases the constant cognitive dissonance that has been my constant companion of late, to hear respected journals beginning to emerge from the doublethink. This is a milestone. That the BMJ were vulnerable illustrates how far down this road we have travelled already. We are not home and dry yet so respect to the BMJ for sticking out their neck.

Brilliant!

Just goes to show how the FPFW 'just changing a couple of words in the guidance that no-one reads anyway' (every TRA on twitter) is already starting to shake the foundations....

I wonder if this could have international ramifications for research as now the 'gold standard' would be to have a clear definition of what information is being collected. Without being clear whether it is data on sex or gender, the findings of any research would be less convincing surely?

@Xanthangum

Just goes to show how the FPFW 'just changing a couple of words in the guidance that no-one reads anyway' (every TRA on twitter) is already starting to shake the foundations....

Yes! This!

I sincerely hope the tide is turning.

thanks for the link EmbarrassingAdmissions - I will read it fully in a bit but this sentence stood out for me

In Scotland, the national statistician is currently consulting on the 2022 census wording of sex and gender questions, proposing the converse of England and Wales: a compulsory gender identity question but a voluntary question disclosing sex

Compulsory gender identities for all. Not really interested in sex.

Which planet are these people living on??? And what is the point of doing what they are doing at all?

That is good news, though surprising. The BMA and BMJ are separate organisations, but deeply emmeshed, and the BMA is full Kool-Aid.

Margaret McCartney wrote a column expressing concerns about cross-sex hormones a couple of years ago and, shortly afterwards, lost her regular BMJ column. I've always assumed it was as a result though - given this development - perhaps not.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: CM is a member of the government’s LGBT Advisory Panel. This editorial was written in her academic capacity and not as part of the panel. MMc, SB & AR declare no relevant interests (full declarations for all can be found at www.whopaysthisdoctor.org).

Encouraging that one of the authors is on the government's LGBT Advisory Panel - I'm not sure what that is in relation to things like the WESC etc but presumably a positive.

The authors shouldn't need to be courageous as well as good scholars but they are.

“However, contemporary medical research and clinical practice often erroneously use sex and gender interchangeably”

Indeed. The consent form DS brought home for his HPV jab asked me for his gender with the option of male/female/prefer not to say. I’d have thought a vaccine to prevent a sexually transmitted disease that largely affects biological females was one where the sex of the recipients for data and monitoring purposes was important.

I've quoted these before so please ignore if you've seen them.

SAGER - Sex and Gender Equity in Research guidelines are a good read:

researchintegrityjournal.biomedcentral.com/articles/10.1186/s41073-016-0007-6

Heidari S, Babor T, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Research Integrity and Peer Review. 2016;1:2.

SAGER guidelines are useful to persuade authors:
*to acknowledge the number of male/female trial participants;
*to provide sex disaggregated data analysis of the results.

At an early enough stage, they should promote a better sex and gender balance of the research team and can improve the design of trial protocols. However, as in the thread below, they've existed for some time and there is still disappointingly little implementation.

www.mumsnet.com/Talk/womens_rights/a4104564-Sex-and-gender-analyses-in-the-design-of-research-studies?msgid=102566915#102566915

I used to work as a biomedical editor and now I'm a medical writer. I've been on a one-woman crusade to ensure that 'sex' and 'gender' are used correctly in every academic article I have edited and written over the years. The number of academics, and even medics, who really don't get it just baffles me. I'm very pleased to see the BMJ offering solid advice.

Fantastic article and one which definitely needed to be written- well done the authors. They make a good point too about medications, laboratory tests and covid too.

In fact, I've just emailed this article to myself at work so that I can quote it at any healthcare professionals who push back when I correct them!