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Culture War Roundup for the week of March 18, 2024

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I am kindly asking this knowledgable community to check my data and my argument.

Fact 1

In the 2024 state of the union address Biden said:

Women are more than half of our population but research on women’s health has always been underfunded.

Biden used this argument to call for more funding for women's health research:

That’s why we’re launching the first-ever White House Initiative on Women’s Health Research, led by Jill who is doing an incredible job as First Lady. Pass my plan for $12 Billion to transform women’s health research and benefit millions of lives across America!

https://www.whitehouse.gov/state-of-the-union-2024/

Fact 2

The NIH 2017, 2018 and 2019 research budget breakdown is:

  • Gender neutral research: 80% of funding.

  • Women's health research: 14% of funding.

  • Men's health research: 6% of funding.

Source: Report of the Advisory Committee on Research on Women’s Health: 2017–2019, table 8, page 117. https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_BiennialReport2019_20_508.pdf

In other words, Biden was not saying the truth because at least in 2017, 2018 and 2019 women's health research received more than double the funding compared to man's health research.

Note 2.1

83% of all medical research in the US is funded via NIH. The other 17% may be funded via private foundations and organizations, pharmaceutical companies and other for-profit entities, or via state and local governments.

Source: https://www.nih.gov/about-nih/what-we-do/budget

Note 2.2

Funding of the reproductive & maternal care is certainly justified and will be always reported as women's specific research funding - but only about 7%-10% of the women's health research was in the "Reproductive & Maternal/Child/Adolescent Health" category.

Source: Report of the Advisory Committee on Research on Women’s Health: 2017–2019, table 9, page 117. https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_BiennialReport2019_20_508.pdf

Note 2.3

NIH defines “Women’s health conditions,” as...

...defined in section 141 of the NIH Revitalization Act of 1993 (PublicLaw 103–43), include all diseases, disorders, and conditions:

  • That are unique to, more serious in, or more prevalent in women
  • For which the factors of medical risk or types of medical intervention are different for women or for which it is unknown whether such factors or types are different for women
  • With respect to which there has been insufficient clinical research involving women as subjects or insufficient clinical data on women

Source: Report of the Advisory Committee on Research on Women’s Health: 2021–2022 https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_Biennial%20Report_121823_1516_F_508c_Optimized.pdf

Note 2.4

After 2019, the NIH has decided to stop calculating data on men's health research funding. This means that it will no longer be possible to show that men's health research is grossly underfunded compared to women's health research. I wonder what the motivation was for this decision.

NIH does not currently calculate or report annual funding associated with projects dedicated solely to men’s health or projects benefiting men and women.

Source: Report of the Advisory Committee on Research on Women’s Health: 2021–2022 https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_Biennial%20Report_121823_1516_F_508c_Optimized.pdf

Fact 3

Globally men suffer 53.4% of all Burden of Disease.

Global Burden of Disease: https://ghdx.healthdata.org/gbd-2019

Note 3.1

In the US specifically:

Men over the past decade have shown poorer health outcomes than women across all racial and ethnic groups as well as socioeconomic status.

https://www.congress.gov/bill/117th-congress/house-bill/5986/text?r=16

PS: I do not consider the argument "research on women’s health is underfunded because all health research is underfunded" a good faith argument.

What you are parsing as a statement about the world (simulacrum level 1) is in Fact 1 is in fact no such thing. It is meant on simulacrum level 3, purely as a membership signal to a certain group. An applause light.

See Zvi's Level 3 and The War Against Knowledge.

Very interesting link, thanks

I think that Biden may have been imprecisely referencing the idea that many 'gender neutral' medical studies are done only on men (classically because you get less variance if the subjects are more similar to each other so picking one gender for subjects is good, and it should be men because women might be pregnant or their cycle might introduce variance).

The classic example, which for all I know may be apocryphal, is that women having heart attacks present with slightly different symptoms than men having heart attacks. But most studies done on heart attack symptoms used men as subjects, leading doctors to not recognize women having heart attacks when reporting their symptoms some larger percent of the time.

Autism is another example, women with autism/aspergers didn't match the DSM criteria which were designed around mostly male subjects, and took a while to be recognized and receive treatment at the same rates.

And I stress, all of that is basically folk wisdom I've received from mostly cultural sources, it might be an old wive's tale for all I know. But it's a commonly-cited concept on the left, and makes sense as something he could be referencing.


Also, I don't think it follows that men having higher disease burden means men's health should receive more of the gendered medical research funding. It may mean that men should get more healtchare funding.

But it's quite possible that

  1. the conditions men get are well-understood and just need more money on treatment rather than research, and/or
  2. Men's disease burden is mostly made up of gender neutral conditions that are being covered under the 'gender neutral research' category.

In fact, it's even possible that the 'gender neutral funding' covers gender neutral conditions that affect more men than women, in a way that makes the overall research funding more beneficial towards men overall (not saying we have evidence of that, just that the data you've presented doesn't rule it out)

I think that Biden may have been imprecisely referencing the idea that many 'gender neutral' medical studies are done only on men

This is not the case for a long time now. From 2010 to 2020 the ratio of women in clinical trials oscillated between 52% and 62%.

Source https://orwh.od.nih.gov/sites/orwh/files/docs/ORWH_BiennialReport2019_20_508.pdf, Apendix E, Table 1A.

Also, I don't think it follows that men having higher disease burden means men's health should receive more of the gendered medical research funding. It may mean that men should get more healtchare funding.

I think this is a very good point.

In fact, it's even possible that the 'gender neutral funding' covers gender neutral conditions that affect more men

This goes against the definition. See Note 2.3. If I am not mistaken, a condition is considered gendered as soon as it crosses the 45%-55% ration.

Autism is another example, women with autism/aspergers didn't match the DSM criteria which were designed around mostly male subjects, and took a while to be recognized and receive treatment at the same rates.

Tangential, but I find this strange. It's a condition that we don't know the cause of, nor is there anything like a lab test or imaging to confirm it. It's all based on observed behavior.

For males there's one set of behaviors that are used to confirm diagnosis, and for females another.

How can you make the determination that this is actually the same condition?

Science has moved past your statements. We now know many genetic variations which lead to testably differing neurologies and predictable personality traits. The baseline differences between male and female result in different behaviors stemming from the shared differences from neurotypical neurology.

You can look for correlated clusters of symptoms. It’s not that women and men with autism present with entirely qualitatively different features, it’s just that men and women present them to different degrees (men usually more so). If the scale is calibrated to men it will be relatively insensitive for women (though more specific).

Toy example: playing Warhammer and MtG is not especially diagnostic of autism in men. Lots of non-autistic men play Warhammer and MtG [citation needed]. I would expect a far higher proportion of cis women who play Warhammer/MtG to be autistic. So if our toy autism scale only puts a small amount of weight on this variable it will miss autism in women.

There are more risks involved in giving new drugs to women of childbearing age because of unexpected pregnancies.

Possibly yes, but Fact 3 tells me these risks are not too high and/or already managed.

2 things can be true at the same time.

  1. Women's health needs to be studied more because their hormones show large fluctuations every month and over a lifetime. More women take a daily dose of drugs (birth control) than men, and the higher potential for damage requires higher funding for women's health.

  2. In an equal world, women and men are assumed to have the same expected lifespan. The worse outcomes for men suggests that theyre the ones being discriminated against.

For the longest time, our understanding of medicine came from the outcomes on American college students. They tended to be young, male and white. So it is reasonable to expect every other cohort to be less understood. Women are the largest of that cohort that felt left behind, and raising funding for them makes sense. Ofc, the make up of colleges since the 2000s means that this is more so an act of 'correcting the past', than fixing the present.

Women's health needs to be studied more because

men suffer 53% of burden of disease.

In an equal world, women and men are assumed to have the same expected lifespan.

In a slightly less equal world men will still be victim of majority of accidents and suicides. That is why the Burden of Disease is calculated with the expected lifespan 82 for women and 80 for men.

the make up of colleges since the 2000s

Women outnumbered men in college since the early 80s. I bet most people posting here never lived in an era in which men outnumbered women in college.

Women outnumbered men in enrollment in the late 80s, but didn't outnumber men in degrees until around 2010, as far as I can tell.

Also, a lot of medical knowledge was established before most of us were born, the timeframe doesn't matter if it's treated as established knowledge and hasn't been updated since.

  • -15

Women outnumbered men in degrees around 2010 if you count everyone over age 25 rather than just recently awarded degrees.

https://www.theatlantic.com/ideas/archive/2021/09/young-men-college-decline-gender-gap-higher-education/620066/

The statistics are stunning. But education experts and historians aren’t remotely surprised. Women in the United States have earned more bachelor’s degrees than men every year since the mid-1980s

Women outnumbered men in degrees awarded per year since the 80s and as older people die off women had most degrees for all adults including elderly retirees in 2010 or so.

So regarding the "makeup of colleges": that's mostly women since the 80s.

research on women’s health has always been underfunded.

I think your argument that women's health was not underfunded in recent years is accurate. People sometimes use the word "always" in a colloquial sense to mean "for ages" or "for a really long time". It's possible that Biden's scriptwriter may have meant something like "research into women's health was underfunded for a really long time, and this is a regrettable oversight which we're only just starting to correct for".

I have no idea whether that claim is accurate: to check, you'd pretty much have to do a deep dive on all the funding allocated by the NIH since its foundation. But if that's what Biden/Biden's scriptwriter meant, I imagine that it could be true.

I have no idea whether that claim is accurate

I think it is accurate to an extent - yes, women's health research WAS underfunded for a long time but apparently the impact wasn't big enough to be reflected in the burden of disease, 53% of which is carried by men.

We know why the burden of disease is disproportionately carried by men, it’s not a medical mystery. Men have much higher risk tolerance and lower inhibition, so are more likely to take physical risks and are more likely to try and become addicted to harmful substances like drugs and alcohol which cause many diseases that shorten life expectancy.

This is a good point, but do we know WHY do men have much higher risk tolerance and lower inhibition?

Moreover, in today's political climate, don't we want to achieve equal outcome? If the factors are biological, then we need health research funding to achieve equal outcomes. If the factors are social, then we need health research funding and social programs to achieve equal outcomes.

Mind you, almost all dangerous jobs are done by men. Chemical exposure, mental stress, transportation - you name it.

do we know WHY do men have much higher risk tolerance and lower inhibition

The greater male variability hypothesis and the related cluster of explanations is still the best theory I've seen bandied around for this.

The Y chromosome has a much higher mutation rate and its presence determines sex, which makes men the volatile and unstable genetic testing ground, and women the selectors and carriers of the successful experiments.

Of course it's a lot more complicated and nuanced than that at the margins. But I think the broad idea is sound. And it coheres with the behavioral traits you name because this specialization ties us into opposite behavioral strategies as to how much we desire to conform to social norms.

in today's political climate, don't we want to achieve equal outcome

It remains to be seen whether this climate is sustainable. Nature does tend to win over moral fads in the long run. It doesn't always do so, but unless technology makes sexual dimorphism truly irrelevant, I think this equalizing is a fool's errand.

The greater male variability hypothesis and the related cluster of explanations is still the best theory I've seen bandied around for this.

The Y chromosome has a much higher mutation rate and its presence determines sex, which makes men the volatile and unstable genetic testing ground, and women the selectors and carriers of the successful experiments.

What?

No, the reason males are more risk taking is because a male can impregnate multiple females, where as, a female can only be impregnated by one male. So a male has a higher expected return to risk taking mating strategies.

Chickens are the opposite of humans where females have ZW chromosomes and males have ZZ chromosomes; however, roosters are famously aggressive and risk taking. You can't stop them from fighting if enclosed together.

In contrast to the XY sex-determination system and the X0 sex-determination system, where the sperm determines the sex, in the ZW system, the ovum determines the sex of the offspring. Males are the homogametic sex (ZZ), while females are the heterogametic sex (ZW). The Z chromosome is larger and has more genes, similarly to the X chromosome in the XY system.

Chickens are the opposite of humans where females have ZW chromosomes and males have ZZ chromosomes; however, roosters are famously aggressive and risk taking. You can't stop them from fighting if enclosed together.

Males are indeed the homogametic sex in the ZW system, but the argument still stands if Z-linked genes evolve faster than W-linked ones, making females more genetically stable, which is actually something we have observed in birds and in snakes.

If we could find a species with a neutral or female biased mutation rate where males still exhibit more risk taking behavior, that would be an issue for this theory, but I don't know of any.

the reason males are more risk taking is because a male can impregnate multiple females, where as, a female can only be impregnated by one male. So a male has a higher expected return to risk taking mating strategies.

The argument from the economics of reproduction is also sound in my opinion, but it isn't mutually exclusive with the genetic one.

The claim is that much of the "neutral" research has been male-centric. Whether that's accurate or not, it won't be easy to address with a look at the headline data.

a) that is incorrect, see Note 2.3

b) if men suffer 53% of burden of disease then whatever the current level of male centric is not enough.

I'd be curious to know how much of the new funding would go to neutral research, and how much would go to particularly female-centric research. It doesn't seem unreasonable to me for funding to go to making sure studies on hypertension also include women, but if it just goes to yet more breast cancer or birth control research (when men don't even have access to a birth control pill yet!), that would be biased.

Looking at how the order defines things...

The term “women’s health research” means research aimed at expanding knowledge of women’s health across their lifespans, which includes the study and analysis of conditions specific to women, conditions that disproportionately impact women, and conditions that affect women differently.

That doesn't make me optimistic, but we'll see.

I'd be curious to know how much...

See Fact 2.

Gender neutral research: 80% of funding.

Women's health research: 14% of funding.

Men's health research: 6% of funding.

conditions that affect women differently.

This makes me hopeful that it will go into hypertension/heart disease/etc stuff. As a woman, I really don't want women's health care to be Birth Control and nothing else.

See note 2.2

only about 7%-10% of the women's health research was in the "Reproductive & Maternal/Child/Adolescent Health" category.

I think that, in current year, "birth control issues" don't affect women per se differently; the people they affect are Humans with Wombs. So, with consistency, they wouldn't come under that category, though women would still be more likely to be Humans with Wombs (womb-men?).

I think that, in current year, "birth control issues" don't affect women per se differently; the people they affect are Humans with Wombs.

Right. In other words, women.

It's not a good faith claim, and if you go digging into it the goalposts will move until you get tired of chasing them.

Can you please knock it off with these drive by low effort culture war snipes.

Women are more than half of our population but research on women’s health has always been underfunded.

He didn't say (or at least you didn't quote) "underfunded relative to men", he just said "underfunded". Is it not that he could have been speaking in an absolute rather than a relative sense?

*DISCLAIMER: I actually believe that his words should be seen as tribal applause lights and so fact-checking them is missing the point, but there you go.

See my PS. I consider that type of argument to be in bad fait.

He didn't say (or at least you didn't quote) "underfunded relative to men", he just said "underfunded". Is it not that he could have been speaking in an absolute rather than a relative sense?

No, this is no more likely to be his meaning (in the sense of the factual content he wanted his listeners to impart from his words) than Bill Clinton wanted people to believe that he hadn't had vaginal sex with Monica Lewinsky.

DISCLAIMER: I actually believe that his words should be seen as tribal applause lights and so fact-checking them is missing the point, but there you go.

This seems likely correct, but I'd say that not fact-checking tribal applause lights is missing the point. If the tribe I belong to uses applause lights that don't stand up to fact-checking, then that makes me question the tribe's epistemic/honesty standards and thus makes me question if the reason I elected to join to the tribe is due to incorrect/dishonest information. I don't think of myself as some high-minded elite idealist, but I do consider it preferable that I choose my tribes based on true information rather than deception.

I do not see flaws in your in reasoning. But arguing against "women are the primary victims of war", "11% of killed journalists are women" type statements which value utils experienced by women higher than those of men, is a dead end. Women Are Wonderful is a universal and powerful bias. It makes sense in patriarchies, because if women have as much rights as children, then they also deserve greater protection. But in egalitarian state, in which women are considered to be able to make their own choices and are allowed to do so, granting them extra consideration is a textbook example of privilege.

On the other hand, perhaps thinking women are just as capable as men is a paradigm which doesn't explain present gender relations. But thinking women as being akin to people with disability does. A person in a wheelchair or a person with blindness are given the same rights as a person with working legs and eyes, but also some on top. Like the ADA which demands resources be expended for the sole benefit of the disabled.

Going back to healthcare funding, just because women's health gets twice as much money as men's, and American women live on average 5.8 years longer than American men, it doesn't mean US women are experiencing peak possible health, just as all lectures being subtitled doesn't mean all natural handicaps which nature imposed on those unlucky by birth or accident, have been overcome.

if women have as much rights as children

In western democracies, Women have more legal rights than men. There are almost no laws or regulations that discriminate against women but more than few that discriminate against men.

On the other hand, perhaps thinking women are just as capable as men is a paradigm which doesn't explain present gender relations. But thinking women as being akin to people with disability does. A person in a wheelchair or a person with blindness are given the same rights as a person with working legs and eyes, but also some on top. Like the ADA which demands resources be expended for the sole benefit of the disabled.

I've seen a few times in the crime-think-sphere a partially joking suggestion in various forms, to mount a campaign to call out misogyny or "misogyny" as a form of ableism under social justice discourse.

But yeah, a lot of this is the usual "women most affected" kind of thing. For example, women have always been the primary victims of male expendability as @RenOS described below.

Mary Harrington, feminist reactionary extraordinaire, claims the current gender paradigm views women as defective men, which is similar to your comparison to the disabled.

The male ideal is universal, and as women have biological impediments towards that ideal (periods, pregnancy, lower physical strength), women should be given accommodations to achieve that ideal (lower expectations at certain times of the month; pregnancy should not hinder career prospects; systems in place to guarantee women’s safety in potentially dangerous situations).

What I find an odd cultural quirk however is that men are in many ways seen as defective women. The desire to subordinate aggressive, domineering, or high energy men a la toxic masculinity being one such example. The emphasis on a female model of learning within school that requires being still and listening for long periods of time and the subsequent reprimands or potential medication for boys that can’t live up to that standard.

The current paradigm is "women's bodies are defective male bodies, men's brains are defective women's brains." That's not an explicit viewpoint or something that anyone intends directly, it's the outcome of the slow process of commoditizing human beings and molding them into good little workers and subjects who are obedient, pliant, and don't rock the boat. Anything that stops them from doing this is a flaw which the powers that be seek to destroy -- signal-boosting any ideology that seems likely to accomplish it. Once again, this isn't a conspiracy; it's a prospiracy, a side effect of powerful institutions doing what powerful institutions do, and of humans in powerful positions doing what humans do: endorsing ideologies that subconsciously go along with their pre-existing goals. This is the origin of "woke capital."

Women are more likely to uphold institutions and, as girls, to sit still for long periods of time (like you say), and are less likely to shout loudly about the emperor having no clothes. Men are less likely to do things that remove them from the workplace for a period of time (especially bear children), and more likely to slave away at work for hours on end while abandoning their families at home.

Institutions, especially corporations, want their employees to be male in the ways that benefit them and female in the ways that benefit them. They don't want people, they want androgynous commoditized worker bees. They want cattle and not pets, human docker containers cloned and scaled at will from the amorphous "cloud" of the "workforce." The end desire of the system is Kubernetes for human beings. You will own nothing and you will be happy, and your storage will be separated from your compute and kept in trust by Amazon.

My girlfriend has gotten explicit advice that she should never get pregnant, it will "hurt her career." She detests these people who have established a system that expects her to sacrifice her biological and spiritual drive to bear and raise beloved children in the name of economic productivity and ruthless inhuman competition. This system sees bearing and raising the next generation of human beings, the most fundamental purpose of society, as a distraction from the more worthy goal of creating wealth for Wall Street. It asks this of men too, but because of the unchangable realities of being a sexually-dimorphic mammalian species, this requirement hurts women more than men. The entrance of women into the workforce on the same terms as men is the true systemic oppression of women. The left used to know this, like when Elizabeth Warren wrote The Two Income Trap. But it has forgotten it as its funding has shifted to corporations "woke" to their own interests, who are more likely to fund the striking of a child in the womb than to pay for the care of that which is born. And the abortionist feminists celebrate them for their avarice like good little girls.

The goal isn't to turn men into women or women into men. That's an ideological side effect, like "Communism" in Stalinist Russia. The goal of Stalin was to empower himself. And so it is with woke capitalism. (Perhaps real woke has never been tried?)

She detests these people who have established a system that expects her to sacrifice her biological and spiritual drive to bear and raise beloved children in the name of economic productivity and ruthless inhuman competition.

Is that actually correct? Unrestrained capitalism, as far as it's political, is associated with the right. Women having equality in the workforce with men is associated with the left, and continues to be.

You could equally well have argued, in the years before women's rights, that companies wanted women to stay at home so as to support the men working long hours in the name of economic productivity and ruthless inhuman competition.

As Ayn Rand points out, collectivism will always seek to override the individual choices of a person to fulfill their own happiness. Whether that be building a skyscraper or turning a child into a civilized adult, a woman’s agency is just as valuable when deliberately chosen, not coerced or bullied. In any collectivist system, right or left, the able bodies and capable minds of those able to work are coerced into working for the collective instead of working for their own happiness.

But the soul is still oracular; amid the market's din,

List the ominous stern whisper from the Delphic cave within,

—"They enslave their children's children who make compromise with sin."

I'm having trouble parsing the last verse.

Who is "who"? Is it "They" or the "children's children"? The logic of the phrase points to "They" but there is no comma.

A more understandable rephrasing is probably "They who make compromise with sin, enslave their children's children".

I love this poem. Any more you'd like to share?

Not at this time; I usually am reminded of them by relevant context.

That particular verse appeared as Arc Words in Scott Alexander's novel UNSONG.

Is the claim not, and I have no knowledge of whether the claim is true, that a lot of historic medical research upon which eg. current diagnoses and treatment plans are based was conducted primarily upon men?

Is the claim not...

No. The claim is:

research on women’s health has always been underfunded.

In any case, men suffer more than half of burden of disease, apparently we do not address male health enough.

Yes, this is the claim that I also encounter most often in medical science, i.e. that the majority of the so-called gender neutral research is actually biased towards men because the majority of consenting subjects is male. And this makes me furious. Yes, medical researchers generally prefer male subjects because having to consider the period, which unfortunately can have a major influence on many medications, is an absolute pain in the ass. But if there was a huge number of female subjects desperately wishing to be included in early phase trials, they'd take them; But women are by and large very risk averse, and in particular when it comes to untested substances that give them no expected benefit. This is well reflected in the data for different phases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867082/

Phase I is for testing the safety and distribution of medication. There is no benefit for the subject, and hence the percentage of women in these trials is small, only around 22% in this particular review (but this is pretty consistent).

Phase II and later is for testing whether a drug works for humans, and hence most subject actually have a specific disease that they hope the medication will help with. Hence, the percentage of women suddenly reflects the population very well, usually around 45+%.

So somehow if women refuse to sign up for medical research that doesn't benefit them personally so men take up the slack, who is the primary victim? Obviously, the poor women.

And, just to be clear here, kudos to the minority of women who do sign up for early research. I agree this is an issue, but critically it is an issue that can only be solved by women willingly signing up more. And it also is a somewhat minor issue, since a lack of efficacy or the presence of female-specific side effects will still be caught in the later phases when women are well represented.

How does one actually sign up for these types of trials? I've long admired the conscientious objectors who got injected with infectious disease to help medical research instead of fighting in the army, but I have no idea what I should do to do something similar. Something like donating a kidney is more obvious how to do, but also seems like there's a lot more hurdles since it seems to happen so much less.

Depends a lot on the country you're in, I'd honestly have to look it up myself for most of them. I'm not really directly involved with patients nor drug development, pretty much strictly lab experiments on one side and data analysis for existing data sets on the other.

Leaving aside the truth of that claim, I would skip right to saying that it usually doesn't matter.

Drugs that work for the goose work for the gander, and vice versa. I mean, you'd presume that in the domains that are specific to a given sex, all the studies were done on them.

I can't imagine trials for vasectomies needing women, even as the controls, or a new form of IUD needing male volunteers really into sounding.

Most of physiology is conserved between men and women. Barring gross and obvious anatomic differences, there are minor things like pain tolerances and so on, but if unisex therapies that were tested on a predominantly male population were that suboptimal for women, doctors would have noticed.

Absence of evidence is weak evidence of absence. Add up enough and you get to where I'm standing.

Would dosage not vary significantly between genders based on their relative average sizes?

For most drugs that's not particularly relevant, and where it is we already adjust for body weight in a gender neutral manner.