Gendered Innovations in Orthopaedic Science: Sex, Lies, and Stereotype: In Praise of the Systematic Review.

S ir William Osler is credited with the phrase, ‘‘The greater the ignorance, the greater the dogmatism’’ [1]. The role of clinician scientists in orthopaedics is to fill in the gaps—decrease the ignorance—in order to replace dogmatism with evidence-driven practices. Researchers dedicated to the study of medical ignorance emphasize that scientific facts, like dogma, are neither solid nor immutable, but should be vigorously challenged and revised by successive generations [14]. The systematic review represents a tool that can help us answer clear, important questions premised on currently available evidence. Research about sex and gender—the purview of this column—will only improve with thoughtfully performed systematic reviews. At a basic level, differentiation between studies examining sex (biology), gender (society’s lens of sex), or both is critical, but often confused in the literature [15, 17]. Recent attention to examining sex as a variable in scientific research will help clarify and guide analysis from retrospective reviews to prospective analyses. A January 2014 editorial in Nature [9] indicated that a failure to account for sex differences and poor experimental design may contribute to poor reproducibility and generalizability in biomedical research. In June 2015, the National Institutes of Health (NIH) announced the inclusion of sex as a biological variable in grant applications, citing the Nature article in addition to other pivotal publications [19]. The NIH provided supplemental resources to identify accurate terms and variables for both sex and gender in submitting grant applications [20]. The important NIH 2015 language includes: ‘‘Accounting for sex as a biological variable begins with the development of research questions and study design. It also includes data collection and analysis of results, as well as reporting of findings. Consideration of sex may be critical to the interpretation, validation, and generalizability of research findings. Adequate consideration of both sexes in experiments and disaggregation of data by sex allows for sexbased comparisons and may inform clinical interventions. Appropriate analysis and transparent reporting of data by sex may therefore enhance the Note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research the latest installment of ‘‘Gendered Innovations in Orthopaedic Science’’ by Amy L. Ladd MD. Dr. Ladd is a Professor in the Department of Orthopaedics at Stanford University, and is the PastPresident of the Ruth Jackson Orthopaedics Society. She provides commentary on sex and gender similarities and differences in orthopaedics. The author certifies that she, or any members of her immediate family, have no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of Clinical Orthopaedics and Related Research or the Association of Bone and Joint Surgeons. A. L. Ladd MD (&) Chase Hand and Upper Limb Center, Stanford University, 770 Welch Rd. Suite 400, Palo Alto, CA 94304-1801, USA e-mail: alad@stanford.edu Gendered Innovations in Orthopaedic Science Published online: 19 October 2015 The Association of Bone and Joint Surgeons1 2015