The Importance of Accurately Defining Gender and Sex in Pathology.
The Importance of Accurately Defining Gender and Sex in Pathology.
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准确定义性别和生理性别在病理学中的重要性。
DOI：
10.1093/ajcp/aqac008
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发表时间：
2022
影响因子：
3.5
通讯作者：
Park,JasonY
中科院分区：
文献类型：
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作者：
Jacobs,JeremyW;PeabodyLever,JacelynE;Lee,YeonsooS;Bryan,KatherineM;Booth,GarrettS;Njoku,IhuomaO;Arvisais-Anhalt,Simone;Araj,Ellen;Park,JasonY
Arvisais-Anhalt等人最近发表的文章有效地强调了病理学领域男女之间持续存在的薪酬不平等。鉴于这一关键发现，我们感到失望的是，在整个调查中使用的术语，以确定病理学家的基础上，他们的“性别”或“性别”没有解决或定义。我们还认为，由于作者提出了这个重要的话题，讨论性别错误描述的数据来源的固有局限性是谨慎的。“提供者性别”进行了方法学评估;然而，医疗保险和医疗补助服务中心和国家提供者识别数据集指定“性别”作为识别类别，尽管报告“M”和“F”作为每个提供者的性别。性别是指出生时被赋予的标签通常是女性或男性。然而，性别也可以包括非二元特征，包括生殖解剖学不适合任何一种选择时的雌雄同体。相比之下，性别是自我定义的，与识别某人的情感，社会和心理特征有关，从女性/男性到非二元。2不幸的是，数据库本身存在根本性缺陷，因为个人被不恰当地按“性别"、“M”（男性）或“F”（女性）而不是性别分类。虽然“sex”和“gender”经常被错误地互换使用，3但在报告数据时必须了解两者之间的差异，因为每一个词的影响可能因所用术语的不同而有所不同。3，4由于这些问题，许多研究同样缺乏监督。作者纳入了数据库中使用的特定术语（M和F）;然而，关于源数据中这些重大限制的讨论将有利于观众和更广泛的科学界，以证明故意精确语言使用和准确识别的重要性。人。美国医学会2021年关于推进健康公平的指南强调了影响我们对世界的看法的叙述或“意义系统”的重要性。这些叙述改变了我们的思维过程，决定了我们如何解释、研究和解决不平等问题。作者勇敢地尝试假设男女病理学家之间薪酬不平等的病因;然而，缺乏对术语/描述符和叙述本身的关注似乎来自过时的社会观点，即女性经验较少，工作在“更容易”的角色中，与男性相比，生产力较低。我们要求研究界在解决性别不平等问题时超越这些叙述。基于补偿的分析进一步讨论了医疗领域的不平等问题，因为发现的任何一个不平等都可能为其他不平等问题设定优先顺序。我们赞扬调查人员证明，联邦薪酬数据集突出了长期存在的女性病理学家和男性病理学家之间的不平衡。这些不平衡预计将在整个医疗生涯中持续存在，导致男女医生之间的差异超过200万美元。我们认为，病理学中的性别不平等值得调查，应该像其他研究论文一样受到学术严谨的尊重，并且应该在医学期刊中占据类似的空间。因此，我们希望作者和本杂志继续支持病理学中的多样性，公平性和包容性研究。
The recent publication by Arvisais-Anhalt et al 1 effectively highlights the persistent remuneration inequities between women and men in pathology. Given this key finding, we were disappointed that the terminology used throughout the investigation to identify pathologists based on their “gender” or “sex” was not addressed or defined. We also believe that since the authors broached this important topic, it would have been prudent to discuss the inherent limitations of the data sources regarding gender mischaracterization.“Provider sex” was methodologically assessed; however, the Centers for Medicare and Medicaid Services and National Provider Identification data sets specify “gender” as the identification category, despite reporting “M” and “F” as each provider’s gender. Sex refers to a label assigned at birth—usually female or male. However, sex can also encompass nonbinary characterizations, including intersex when reproductive anatomy does not fit either option. In contrast, gender is self-defined and associated with the emotional, social, and psychological traits that identify someone, ranging from woman/man to nonbinary. 2 Unfortunately, the databases themselves are fundamentally flawed, as individuals are inappropriately classified by “gender,”“M”(male) or “F”(female), rather than sex. While “sex” and “gender” are often incorrectly used interchangeably, 3 it is imperative to understand the differences when reporting data, as each has effects that may differ depending on the intended term. 3, 4 Many studies suffer from the same lack of oversight because of these issues. The authors incorporated the specific terms (M and F) used in the databases; however, discussion regarding these significant limitations in the source data would have been beneficial for the audience and the broader scientific community to demonstrate the importance of being intentional with precise language use and accurate identification of people. The American Medical Association 2021 guide on Advancing Health Equity highlights the importance of narratives or “systems of meaning” that influence our perception of the world. 2 These narratives modify our thought processes, dictating how we interpret, study, and address inequities. The authors made a valiant attempt to hypothesize etiologies for payment inequities between women and men pathologists; however, both the lack of attention to the terminology/descriptors and the narratives themselves seem to derive from the antiquated societal perspective of women being less experienced, working in “easier” roles, and achieving lower productivity compared with men. We challenge the research community to look beyond these narratives when addressing gender inequities. Compensation-based analyses further the conversation related to inequities within medicine, as any single inequity identified may set precedence for other disparities. We commend the investigators for demonstrating that federal compensation data sets highlight long-standing imbalances between women pathologists and men pathologists. These imbalances are projected to persist throughout a medical career, resulting in a more than $2 million discrepancy between physicians who identify as women and men. 5 We believe that gender inequities within pathology are deserving of investigation, should be respected with the same academic rigor as any other research manuscript, and should occupy similar space in medical journals. Thus, we hope that the authors and this journal continue to support diversity, equity, and inclusion studies within pathology.