Does Sex Really Matter?

[music playing] NARRATOR: The simple fact is that, on average, across the world, women live longer than men.

I felt that I was being attacked.

My body was reacting to it, but couldn't fight it.

NARRATOR: The latest research reveals the higher death rates in men, in everything from cancer to viral infections, are not just down to lifestyle, but because of sex.

SARAH HAWKES: Men have about a 40% higher chance of dying.

NARRATOR: It turns out women fight disease better than men.

But this film also reveals that despite this, women and girls are being dramatically let down.

Not understanding how the sexes differ is costing female lives.

Many of the drugs that we give, we have actually no idea how they function in women's bodies.

Didn't realize how close I was to dying.

NARRATOR: And this data gap isn't just in health and medicine.

It's across society.

CAROLINE CRIADO PEREZ: We just don't notice when we're excluding women, because we're always talking gender neutrally, when most of the time, we're actually talking about men.

NARRATOR: If this data gap is filled, it could save thousands of lives.

We will discover more differences that have the potential to be important for improving treatments for men and women.

[music playing] NARRATOR: When it comes to risky behavior, men are the worst offenders.

[cheering] Men are more likely to drink, smoke, drive faster, and get into car crashes.

It's no surprise, then, that in the US, women outlive men by an average of five years.

But there are a growing number of scientists who believe biology might actually be playing a more important role than behavior.

[music playing] Hi, my name is Josh Lim.

I am 43 years old.

I work here at Shady Grove Fertility Center as a reproductive biologist, or also known as embryologist.

I have a wife and two kids, a son and a daughter.

Happy life, happy family.

We're just doing great.

NARRATOR: Josh is a patient of Dr. Andy Lane from the Dana-Farber Cancer Institute in Boston.

He's been looking at sex differences in his cancer research.

I'm a physician and a scientist, and I take care of patients with leukemia for most of my time in the clinic.

Many of the diseases that I take care of, those patients have a slight bias toward there being more men than women.

And it's something you can notice seeing your clinic waiting room.

NARRATOR: In fact, across all cancer types, men are 16% more likely to get cancer and 40% more likely to die from it.

For years, it was thought men were hit harder by the disease because of their lifestyle.

It was assumed that it was because men did more risky behaviors than women, like they smoked more cigarettes.

They drank more alcohol.

And indeed, those things are cancer risk factors, and they do change, perhaps, the skew of cancer.

But there are a few things that say it's not simply that.

NARRATOR: And it wasn't simply that for Josh.

For him, the risk factors hypothesis made little sense.

I never thought this cancer, any type of cancer, for that matter, could happen in my life.

I exercise regularly, and nobody in my family had a cancer.

And my lifestyle was-- I wouldn't say super, but it was close to great.

And you know, my eating habit was OK. Everything was great until this happened, so it took me by surprise.

NARRATOR: Josh began to feel unwell in 2019 and was diagnosed with a combination of lymphoma, skin cancer, and leukemia.

Leukemia is a relatively rare form of cancer, but one of the most common in children.

And Andy's research has revealed a surprising fact about the disease.

The two most common cancers in children are brain tumors and leukemias.

Both of those have a male bias.

Now, it is not 2 or 3 to 1, but it's still 20% or 30% higher in males than in females, that means boys than in girls.

And of course, infants are not working in the factory being exposed to chemicals, smoking, et cetera.

NARRATOR: Andy's research suggests simply being male makes you more likely to get leukemia and brain tumors.

Andy set about trying to find out why.

That got us thinking that there might be something intrinsic to being a male or a female at the level of the cell, the DNA, or the organism that might be contributing.

Obviously, females have two X chromosomes.

Males have one X and one Y.

So of course, there are going to be differences there.

NARRATOR: Chromosomes are where our DNA is stored, the genetic code that builds our bodies.

DNA is divided up into genes, sections of code that decide whether a cell becomes anything from part of a kidney to muscle tissue.

Most human cells contain 23 pairs of chromosomes.

The 23rd pair, the sex chromosomes, differ between males and females.

The females have two X chromosomes, and males have one X and one Y.

Each X chromosome contains around 1,000 genes.

The Y chromosome is considerably smaller, with less than 100.

What we were working on was trying to understand why men and women have difference in incidence of cancer.

We found that at least an explanation for a part of that difference is related to the biology of the X and the Y chromosomes themselves.

[music playing] NARRATOR: Having two X chromosomes means women have some doubled up genetic information.

We've known for some years that the body switches off one X chromosome in each cell.

It's called X inactivation.

But scientists now know that up to a quarter of the genes on the X chromosome escape inactivation, remaining turned on, providing a set of backup genes.

Some of these genes could give females added protection to diseases like cancer.

In our study, we called them escape from X-inactivation tumor-suppressor genes.

They have a normal function, and one of those functions is to prevent the cell from behaving like a cancer.

And that's where the overall hypothesis of our work came.

Female cells, by virtue of having the escape, essentially have extra protection.

And that simply was kind of a new idea that hadn't been looked at across all cancer types.

[music playing] NARRATOR: It appears female cells are better at protecting against cancer than male cells.

It might explain that when all his risk factors were so low, Josh still contracted cancer.

I ended up getting a new bone marrow transplant from my son, who was 15 years old.

But because we have this relationship, you know, father and son, it has better chance of getting blood from my son than other people unrelated.

NARRATOR: Thankfully, after this stem cell transplant, Josh is making good progress.

Nobody says cancer-free within five years.

But for now, I don't really have any cancer cells in my blood or my body.

If there is a way to fix or help curing cancer that happens more in men or more in women, I think it's definitely worth looking at it.

NARRATOR: If the mechanism that gives women and girls added protection against cancer can be found, it could pave the way for even better forms of treatment for people like Josh.

Even as a trained oncologist, I don't think I was really aware of these sex differences.

I think there are likely to be many differences between men and women in diseases that have not been discovered because we haven't taken forethought to look at differences between men and women as we do our research.

And I think it could have the potential to be important for improving treatments for men and women.

NARRATOR: It's not just cancer.

Women do appear to have a biological advantage when it comes to health.

Before the menopause, women are less likely to contract diabetes or heart attacks than men.

They are also less likely to get neurodegenerative diseases like Parkinson's.

And anecdotally, at least, women seem to have been less affected by the COVID pandemic.

[music playing, sirens] ANNA SCHUCHMAN (VOICEOVER): Me and Dani have been together for, well, about 21 years.

We've got four kids together.

We definitely are healthy, fit.

We care about what we eat.

When we first heard about COVID, we weren't particularly concerned.

It started on a Friday.

We'd both lost our taste buds and sense of smell.

I had a general headache.

Dani, at that point, had his fever and was coughing away.

And whilst my symptoms plateaued and then sort of disappeared within a week, his got very serious very, very quickly.

He seemed to just be getting worse and worse and worse.

At that point I said, I'm getting him to hospital.

[music playing, sirens] I felt that I was being attacked.

My body was reacting to it but couldn't fight it.

I just couldn't catch my breath.

It was as if I had been scuba diving and somebody was, little by little, turning off my oxygen tank.

And you're gasping to get that last bit of fresh air coming in.

You know, we're both fit, healthy, young.

Just could not believe it.

I think it was a few days in where it became really, really serious, that I was thinking, like, why is this happening to me?

How come Anna had it very mild and was able to function?

And for me, it just spiraled out of control.

And I'm now in a hospital where they're trying to figure out what to do with me.

There had to be something in the physiology, something within the body that's different between men and women.

[music playing] NARRATOR: Although science has been aware of differences between the sexes for years, it's only relatively recently that researchers have begun to thoroughly investigate them.

Even today, it's surprisingly hard to get data on the subject.

SARAH HAWKES (VOICEOVER): From the very beginning, I was interested in whether the virus was affecting men and women differently.

You'd imagine that it would be one of the simplest things that you could collect on a medical record.

But even so, we're finding that still, a majority of countries are not telling us anything about whether it's men or women that have got COVID.

NARRATOR: Sarah's organization has been collecting data to understand the global patterns of this disease.

SARAH HAWKES (VOICEOVER): We want to know, is it men getting infected, or is it women?

If we look at data from the USA, what we see is slightly more cases confirmed amongst women, but still higher death toll amongst men.

If you look at the rates, it's a rate of 739 per 100,000 men and 637 per 100,000 women in the over 85s.

And that pattern is repeated again and again across multiple countries.

So for every 10 women, globally, we get 12 cases, in men, 13 hospitalizations in men, 18 ICU admissions, changed slightly in the past couple of weeks, and 14 deaths.

It's a 40% higher death rate.

[music playing] NARRATOR: Across the world, more men are dying of COVID than women.

In the US, at the end of 2020, it was almost 29% more.

So with clear evidence that men and women are affected by disease and illness so differently, why has there not been more research into the area?

Professor Philip Goulder, an expert in immunology, uncovered sex differences during his work in HIV.

He has his own theories as to why the subject has been so avoided.

PHILIP GOULDER: It's a taboo subject, in a way.

It might be that there's a feeling to want to make out that people are equal, that there aren't any differences.

And therefore, to identify differences or suggest that there might be differences could be an unpopular thing to do.

On the other hand, I think now that these differences are becoming very clear-cut with something like COVID, people are very interested.

NARRATOR: Philip is carrying out a study that looks at how men and women's immune response to COVID differs.

Our immune system is divided into two parts, the innate and the adaptive.

The innate response is our first line of defense against a virus.

It's fast and untargeted.

A fever is a sign it's working, raising the temperature to kill any potential enemies.

If that fails, the slower adaptive response takes over and attacks the virus with specialized antibodies and blood cells known as T cells.

So how and why do males and females respond differently?

We invited Anna and Dani on the study because they were a special couple, a special family, in the sense that they were all exposed at the same time.

[music playing] NARRATOR: They have been taking blood samples from men and women to try and understand how their innate and adaptive responses differ.

One of the reasons we're really interested in studying you guys, you both, is that your disease outcome has been very different.

And that's reflected across the whole kind of spectrum of people who've been infected by this virus.

[music playing] NARRATOR: The study will examine differences in Dani and Anna's T-cell and antibody responses.

If Dani's are higher, it could mean that his adaptive immune response had to work much harder to compensate for a weaker first line of defense.

PHILIP GOULDER: Why haven't we been looking at the sex differences more before?

I think-- and for example, in my field of work in HIV, it took something like 36 years since the epidemic started to realize that women have five times more chance of completely suppressing the virus through their immune response than men.

[music playing] NARRATOR: If men's and women's immune responses are different, what's the cause?

It might go back to those X and Y chromosomes.

Professor Sabra Klein has been studying how fighting viruses like HIV, influenza, and COVID is affected by our genes and other differences between the sexes, like hormones.

[music playing] Over 60 genes that are very important for the functioning of our immune system are located on the X chromosome.

High levels of estrogens have been associated with greater immunity in females.

This has been shown for the activity of those T cells as a part of the adaptive immune system.

In contrast, the functioning of those adaptive immune cells is often downregulated or reduced in the presence of high circulating testosterone concentrations.

[music playing] NARRATOR: So estrogen, the female sex hormone, seems to improve immunity.

Testosterone, the male sex hormone, weakens it.

All too often, these differences have gone under-reported and under-noticed because there has been a lack of reporting.

And we have interpreted a lack of reporting to equal a lack of a sex difference, which is not true.

NARRATOR: Perhaps it's no surprise there are differences.

Just looking at the way our bodies respond to drugs and alcohol reveals that.

Women break down alcohol more slowly than men, and paracetamol takes 20% longer to clear women's bodies.

[music playing] But some differences can lead to real problems.

When Ambien, a sleeping pill prescribed to millions in the US, first started being prescribed, the recommended dose for both men and women was the same.

A big wake-up call tonight for the millions of Americans who take certain kinds of sleeping pills, including popular brands like Ambien.

We've reported on some of the potential dangers before, but a major new study out today is revealing just how much they increase your risk of getting into a car accident.

NARRATOR: There have been cases around the US of women taking Ambien having road traffic accidents.

And when taken with alcohol, it can be even more dangerous.

Some users have even found themselves having car crashes and not even being aware they were driving.

[music playing] I saw hundreds and hundreds of people with the same complaints of taking Ambien, and not remembering what they did the next day, and waking up on jailhouse floors, and not remembering how they got there.

[music playing, sirens] It also ruined a lot of women's lives.

They lost jobs.

They have jail records.

This is a classic example of developing a drug for both sexes and improving it for both sexes.

And so both sexes were taking it, except women started reporting to their physicians, I'm actually groggy the next day.

NARRATOR: When enough physicians reported this data back to government agencies, it was realized women were getting a greater than required dose, and the recommended dosage for women was reduced.

This only came about because enough women came and complained to their physicians, thankfully, that we actually got to review it.

How many other drugs that are we prescribing have sex differential effects that we're not aware of?

[music playing] NARRATOR: It isn't simply due to difference in size, US men being, on average, 30 pounds heavier and six inches taller than US women.

It's because men's and women's bodies are fundamentally different.

Women tend to have more body fat than men, where medication can accumulate and linger.

Their kidneys also function differently, which means it takes longer for drugs to leave their system.

Female hormones also mean that drugs can be processed differently over a menstrual cycle.

But for years, these sex differences either haven't been widely known about or have simply been ignored.

One reason is because, over the years, there's been a history of excluding women from drug trials, in part to protect women's fertility, but also because fluctuating hormones meant women's results were often inconsistent and considered too complicated.

I don't think that there was some type of patriarchal conspiracy.

In fact, I think it's the opposite, because when you look back into the recent history of medicine, it was mostly men that were actually volunteering themselves up for some pretty dangerous, horrific medical experiments.

And the reason was, it was altruistic.

It was seen that men are a bit stronger, and they didn't want to harm women.

NARRATOR: So drug trials have historically used male cells, male mice, and male humans.

This means most drugs on the market have been predominantly tested on men.

Many of the drugs that we give, we have actually no idea how they function in women's bodies.

The reason for that is modern medicine was developed using males.

NARRATOR: So what's the situation today?

Incredibly, even now, in some countries, including females in clinical trials isn't a legal requirement.

And shockingly, women are twice as likely to experience side effects to drugs than men, and they have more adverse reactions to vaccines.

It seems that although women are biologically better protected than men, medicine and healthcare are letting them down.

Including more women in clinical trials is vital.

But unless that data is used correctly, it can do more harm than good.

I call this current drug approval process the ros effect.

So what does that mean?

So if we start out using male cells, male mice, and then at the end of the trial, we include both men and women, but not enough of them to get a meaningful result, it's like mixing red and white wine into a bowl together.

You will get ros.

And that's the way in which we have drugs approved.

So in fact, by including women in clinical trials today, we have less information about the sex differential effects of the drug.

[music playing] NARRATOR: Even when we do know about adverse effects of drugs, the information doesn't always get through.

The drug sodium valproate has been on the market since 1973.

It's used to treat epilepsy and bipolar disorders.

But very few patients were told it could damage unborn babies, even though the potential risk to pregnant women was known about for over 40 years.

[music playing] Emma has epilepsy and has been taking sodium valproate since the age of 12.

Her friend Janet had also taken the drug since her teens.

When they decided to have children, they spoke to their doctors.

The consultants always advised that it would be OK to take during pregnancy.

There would be no risk to the baby.

And that's what I did.

[somber music] I've got five children, and they've all been diagnosed with fetal valproate spectrum disorder.

There are many symptoms-- autism, epilepsy, cerebral palsy, deafness, incontinence, neurodevelopmental delays, speech and language delay, a huge array.

NARRATOR: Emma and Janet know now that these issues are related to the sodium valproate they took in pregnancy.

EMMA MURPHY (VOICEOVER): They were poorly.

They weren't developing.

It couldn't just be my bad luck that this was happening.

My sister phoned me one day, and she was crying on the phone, saying that she'd seen a lady appealing for women to come forward who had been on sodium valproate.

That was a light bulb moment.

It was that moment where everything I'd been saying to everyone, to health care professionals, doctors, nurses, family, that there was something wrong.

And no one believed what I was saying.

Very hard.

And just to speak to Janet, just to hear somebody that-- that knew what I was going through, it was-- never forget that moment.

It saved my life.

Saved my children's life, because we've now got answers.

Since we met, we decided to start up this campaign, and try and help and support other families, and try and make a difference to ensure that these families are looked after the way that they should be, knowing full well that they weren't at the time.

[somber music] NARRATOR: One of the families that have joined their campaign are Lisa, Robbie, and their nine-year-old son, Kieran.

He's one of an estimated 20,000 children that have been affected by sodium valproate since it came to market in 1973.

I thought it was me.

Have I been a bad mom, or am I fated to be like this?

[meldodic music] I think there'll always be an essence of guilt there.

NARRATOR: Today, thanks to the campaigning of Janet and Emma, women taking sodium valproate are aware of the dangers.

LISA HURTON: So that's a big warning for women and girls that this medicine can seriously harm your unborn baby.

NARRATOR: This symbol has finally given women some power to make informed choices.

[music playing] It's obvious that females are biologically different to males.

But those differences go way beyond how drugs act on them.

Women can show different symptoms to men for the same diseases or conditions.

But again, because aspects of medicine and health care are biased towards men, these differences can be overlooked.

An example of this form of bias is in the diagnosis of autism.

Some believe hundreds of thousands of women and girls are going undiagnosed.

Professor of cognitive neuroscience Francesca Happ believes part of the reason is that it is a condition typically linked to boys.

FRANCESCA HAP: We all carry in our heads a stereotype of autism that is around a male sort of presentation.

So we have this stereotype, and it's perpetuated in research.

A lot of studies didn't even recruit females because they didn't expect to get enough.

And that's a real problem, because then that trickles down into what we know about autism, how we design the diagnostic systems, and so on.

So this male stereotype is a real problem.

[music playing] NARRATOR: It means that places like Limpsfield Grange, a school in Britain that focuses on autistic girls, are a rarity.

I'm Amina, and I'm 13.

I'm Scarlett, and I'm 15.

My name is Layla, and I'm 15.

I'm Sophie, and I'm 12.

I was diagnosed formally when I was three.

I think I was about seven or eight.

I was in year five at my old mainstream primary school, and it was more of a relief to my parents because they were fighting so much to get my diagnosis.

I was nine when I was diagnosed.

And I remember, like-- because my parents, literally, like Scarlett, they'd been fighting for like two years, like, so hard.

[music playing] NARRATOR: Part of the problem is that autistic women and girls behave quite differently to men and boys.

And if the diagnostic process is geared towards males, females slip under the radar.

We know that some autistic women develop quite complex masking behavior.

So they've learned how to behave, and they maybe watch a lot of films to try and learn, how do I dress?

How do I walk?

What do I talk about?

How do I start a conversation?

Learning quite consciously and deliberately how to fit in.

I guess I was just really good at masking, which I don't know if that's a good thing or a bad thing.

But nowhere would believe that I was autistic.

NARRATOR: It makes identifying autistic girls much harder.

And yet this identification is vital if they are to access support.

The parents of autistic girls and women often say that it's really difficult to get a diagnosis, to be identified as autistic.

And I think parents, mums in particular, report that they are quite often told that it's about their parenting, or they're told that they're being overanxious, or they're worrying too much.

And it's almost like autism isn't even on the list because you're female.

NARRATOR: Each one of these girls has a different experience of being diagnosed, but without this diagnosis, no help would be available to them.

How much it has benefited them is clear.

I guess I know who my self is, and I know I'm not like the angry person I was when I was-- like, before I was diagnosed.

Now that I'm here, I found girls who were just like me.

This school has honestly changed my life.

I think it's created a person out of what I was at a mainstream school that I could never have done by myself.

[music playing] NARRATOR: This gender bias in diagnosing autism is a clear indicator of the gender data gap, the gap in knowledge about women's health.

In some instances, this data gap can mean the difference between life and death.

We tend to think of heart attacks as a male problem, but it is the single biggest killer in women worldwide.

VIJAY KUNADIAN: The gender bias in heart disease is something that we have known about for a number of years now.

So when a woman presents, or even if she's experiencing, she doesn't think that she could be having a heart problem herself.

NARRATOR: One of Dr. Kunadian's patients, 35-year-old Jenna, experienced this bias firsthand.

[music playing] Jenna wasn't having a chest infection.

She wasn't having indigestion.

But she was actually having a full-blown heart attack.

The important thing is that these atypical characteristics of the heart pain has been described more prevalent in women when compared to men.

And that could be one of the reasons why women's symptoms are ignored.

NARRATOR: Some research suggests that ambulance responders have been shown to take 30 minutes longer to arrive if it's a woman reporting chest pain rather than a man.

Women are also less likely than men to receive CPR outside hospitals from members of the public.

Traditionally, CPR is being shown to be performed on a man.

So obviously, for women, when somebody wants to do CPR, then we have the breast.

And people may not be comfortable to do that.

NARRATOR: CPR dummies are designed to look like human beings, but they represent only half of society.

Not having women's bodies to train on in CPR classes means bystanders are less likely to respond to a woman having a heart attack in public.

But this gender bias goes beyond emergency responses.

[music playing] We know that women are 50% more likely than men to receive the wrong initial diagnosis for a heart attack, and this can often be fatal.

The diagnosis procedure is called a coronary angiogram.

It uses X-ray imaging and contrast dye to see if your heart's blood vessels are allowing blood through as they should.

Most male heart attack patients show very clear blockages, like this one.

But this angiogram of a woman's heart reveals women often present differently.

What we see is that her arteries further down, they are very narrowed, and some unusual appearances, particularly in that area.

And that is a condition which happens more frequently in women than in men.

NARRATOR: Women are more than twice as likely as men to have only partially blocked arteries.

This means problems are harder to spot on an angiogram.

VIJAY KUNADIAN (VOICEOVER): So women particularly, they tend to have problems in the smaller vasculature.

So if you are paying attention to the big arteries, it is very likely that we will miss the blockages that are there in the small arteries.

So there is bias at all stages in the pathway in the care of a woman with heart disease.

[music playing] NARRATOR: So much of the treatment for heart disease seems geared towards how men present with an attack.

It's no wonder one in five women slip through the net and die of heart disease.

The data gap is clear.

It's something journalist and campaigner, Caroline Criado Perez, investigated for her best-selling book, Invisible Women.

I was so horrified to discover that we were basing medical treatment and the development of drugs just using male bodies, and that women were basically dying as a result.

NARRATOR: And within the health system, women aren't being listened to.

When women go to A&E or go and present with pain, they're more likely to be diagnosed with depression and given antidepressants than men, who are more likely to receive pain medication.

We just don't notice when we're excluding women, because we're always talking gender neutrally, when most of the time, we're actually talking about men.

And then when women don't conform to that, they're screwed.

NARRATOR: Caroline examined data not just from medicine and healthcare, but across all areas of life.

Time and again, data about women was absent.

How can this be going on in the 21st century and it not be a front-page news story every day?

And that is because of the data gap.

So in the allocation of government resources, in how we plan our economy, in public transport, in private transport, and you just see it crop up in all sorts of areas.

NARRATOR: Her conclusion?

The world is designed by men for men.

The formula used to determine the ideal office temperature was made using data gathered from a 40-year-old male.

And basically, his metabolic resting rate is higher than your average woman.

As a result, office temperatures are around five degrees too cold for most women doing office work.

And that is why the women are freezing and the men are fine, because the women are freezing, and the men are fine.

NARRATOR: But it goes from tiny details like office heating to much more life-threatening ones, like car safety.

How did we end up in a situation where someone thought, if we just had an average male car crash test dummy, that that would somehow represent all of humanity and would provide enough data to make everyone safe in cars?

[music playing] MAN: Reduce the risk of serious injury by more than half.

Wear a seat belt, always.

NARRATOR: Even though men are faster drivers and more likely to get in a crash, women are 71% more likely to be injured in one and 17% more likely to die.

Why?

One reason might be crash tests collect data using an average male dummy.

An anatomically accurate average female dummy does not yet exist.

There's a danger car safety is designed around men, not women.

Cellbond is a manufacturing company based in the UK.

They produce Thor.

He doesn't look much, but he's a hugely complex crash test dummy built to the spec of the average male.

WILLIAM MARSHALL: Thor's actually quite similar to me.

He's about 77 kilos.

He's 1.75 meter, 1.77 meter, area, so that average human male.

Though, things have changed, of course, over the past few years.

So it's based on a single source of anthropomorphic data.

The last set was in America in the 1980s.

NARRATOR: Thor is used by car manufacturers around the world to improve car safety.

DEREK WINTER: All crash test dummies interact with those restraint systems in a car crash and see what the effect of that crash would be on a human occupant.

NARRATOR: But instead of using a female equivalent of Thor, manufacturers use a smaller version of their male dummy, the equivalent of a 12-year-old child.

[music playing] But a 12-year-old child's body is quite unlike that of an adult woman.

Weight distribution, bone density, head weight to neck strength ratio are all different.

Women's bodies react in quite distinct ways in a crash.

It means car safety features could be geared towards men, not women.

If you think about the range of people that sit in cars, you've got a 50th percentile adult male covers a larger, heavier occupant.

And you've got a 5th percentile female is the extreme small.

We can't do everything.

So how do we most effectively cover the largest sweep of the population?

And that's the approach that's made in selecting these sizes.

NARRATOR: When the male body is the norm in car design, it is a gender bias that could kill.

It also means the data about why women get injured in car crashes is hard to find.

Some companies are aware of the data gap and are doing their utmost to close it.

[music playing] In Gothenburg, Volvo have been collecting sex-disaggregated data on car crashes since the 1970s.

The technical safety specialist here is Lotta Jakobsson.

It is a fact that, given a certain force, women are generally more likely to be injured.

So that has been well known all over the years.

NARRATOR: Whilst Volvo aren't able to use a female equivalent of Thor, they are able to see how crashes affect women's bodies virtually.

Also, vitally, they've been collecting data about gender, stature, weight, and injuries sustained from road traffic accidents for years.

Real-world data is the key for development of protection for everybody.

You have data on gender, stature, weight, then we know how to design the product based on that.

NARRATOR: What this data reveals is how subtle differences in anatomy between the sexes can have big consequences in road traffic accidents.

Generally, women are smaller.

They have smaller bones.

And smaller bones, like, long bones, they simply will break at a lower force, making them the more vulnerable.

And then women also have more slender neck.

NARRATOR: That slender neck with a proportionally heavier head on top means women are more prone to whiplash injuries than men.

Our task is to help to reduce those forces so that even the most fragile can sustain those forces without an injury.

NARRATOR: It's an example of how closing the gender data gap can help improve women's lives.

And closing that data gap is just what the Oxford team are trying to do with their COVID immunity study, the one Anna and Dani took part in.

And now they've got the results.

ANNA SCHUCHMAN: Hello.

Hey.

ANNA SCHUCHMAN: Hi, good evening.

So should we cut to the chase and tell you what the results are?

Basically, you both have antibody responses, which-- however, the-- the size of the responses was very different.

And Dani's antibody levels are about 15-- a bit more than 15 times higher than yours, Anna.

And then the T cell response is really, again, the same sort of pattern.

And we know that females make stronger responses, innate immune responses, to viruses and vaccines.

If that innate immune response can block or deal with most of the virus, then the adaptive immune response has much less work to do to-- to clear out the rest of it.

Her first line of defense is much stronger than, let's say, my first line of defense.

So it broke down my first line of defense, got into me, which is then why I had a lot more of the effect and a lot more, I guess, now of the antibodies, where Anna was able to deflect it and still get some of it through and, I guess, built up her immunity as well.

I think that's a good summary of it.

NARRATOR: If we could understand why Anna's first line of defense is so strong, it could be used to help someone like Dani and perhaps prevent him ending up in hospital or worse.

This could have massive implications for prevention through vaccines and treatments that, together, could save many lives.

I think it was really interesting just hearing the results and what it means, and that even, like, six months down the line, it's still there.

Like, our body remembers it.

But really breaking it down between the XX and XY and how my body had to fight double the amount of what you did in order to really fight it off.

And-- What it means for the bigger picture for diseases along the-- you know, what's to come.

Yeah, it's just interesting how they can then take this and now maybe adopt it into all these other things and put it to good use, right?

Yeah, there is a difference in the sexes, but let's do something with it and try to help out.

Yeah.

[somber music] NARRATOR: Many in the science community have been pushing this message for decades.

Only now are they starting to be heard, as are Emma and Janet and the thousands of families affected by the drug sodium valproate.

A long-awaited review is aired on UK TV.

If this government and the health care system ignores our review, and another medication, a medical device, damages people to the extent that we have witnessed, they will and should not be forgiven.

Women told us that when they were pregnant, and controlling their epilepsy with sodium valproate, they were never told that the unborn baby could be seriously damaged.

They didn't know that the chances were one in two.

One in two damaged babies-- what a tragedy.

[sombre music] It's a vindication that we were right, you know.

It's been worth every fight, every tear, every late night.

And to hear that, to see that, it's been worth every moment.

We've got to continue the campaign, because children's lives depend on this now.

NARRATOR: It's a start.

But the tragedy of sodium valproate reveals the need for health care professionals to acknowledge women are different to men and to listen to their concerns.

If you can be difficult, be difficult.

You know, go back to your doctor, and don't just accept that the doctor has told you there's nothing wrong and that you're crazy, because you know your own body.

NARRATOR: Whilst cutting-edge research is revealing extraordinary things about women's genetic makeup and their ability to fight disease, research that could help both women and men, the data gap between the sexes is costing lives.

[music playing] And yet there's a very simple solution.

All you have to do is collect data on men and data on women, and then label it, and then analyze it separately.

NARRATOR: It feels that, finally, sex-disaggregated data is being collected and acted upon, and the differences between men and women explored.

It seems the key to protecting us all equally might be to treat us all differently.

[empowering music] # # # #