IT’S A LITTLE thing, I know. After all, my insurance will pay for an annual physical, which includes the test. But why am I not being hounded like my wife? Experts estimate that there will be 182,000 new cases of breast cancer this year and about 180,000 new cases of prostate cancer.

Is it because insurers figure that, as a man, I’m endowed with a sense of invincibility and have no interest in seeing a doctor unless I’m really sick?

Whatever the reason, the question underscores a political debate that has infused the health-care profession. Are men treated unfairly by the health-care system? Or, as popular belief has long had it, are women?

For years, it was widely assumed and, by some professionals’ standards, documented that women have been excluded from clinical research trials, leading to health-care protocols for both sexes that were based upon research on men. In the late ’80s, a flurry of interest in how heart disease affects women pinpointed profound differences between the sexes.

Because women are largely protected against the disease until menopause, most research was indeed conducted on men. As life expectancy rose, however, epidemiologic evidence emerged that women caught up to men very quickly in both risk and incidence — by 65, their chances of having a heart attack were about the same as men. Yet their treatment was based upon what had proved most effective for male heart patients, despite the fact that women were more likely to die of an initial heart attack than men.

FOCUS ON WOMEN’S HEALTH

That research and some cancer studies highlighted what many felt was a powerful gender bias in research. In response, the Society for Women’s Health Research was founded in 1990, followed by the U.S. Department of Health and Human Services Office on Women’s Health and the National Institutes of Health Office of Research on Women’s Health.

There is no such comparable research office for men. Of course, women’s health advocates counter that men don’t need one, since most research is done on them anyway. This thinking persists. For instance, an article in the February issue of the American Journal of Psychiatry reported that alcoholic women show much more severe brain shrinkage and other brain deficits than alcoholic men. Yet because of the stigma attached to the disease and because they fear having their children taken from them if they seek help, many female alcoholics avoid treatment. That presents a problem for researchers, who have difficulty recruiting subjects to study.

Yet somehow this problem, which is really not researchers’ fault, filtered through an academic perspective, leads to charges of bias.

Astonishingly, an editorial in the journal accompanying the article about alcoholism decried the “exclusion” of women from such clinical trials that has created gaps in medical knowledge about the effects of the disease and treatment of women.

According to a comprehensive new study, though, the long-standing public perception that women have been underrepresented or understudied in clinical trials is not supported by the evidence. Curtis L. Meinert, director of the Center for Clinical Trials at the Johns Hopkins University Bloomberg School of Public Health, and his colleagues recently analyzed more than 100,000 clinical trials appearing in peer-reviewed scientific journals between 1965 and 1995. Even after accounting for specific studies on prostate cancer and breast cancer, the team found no pervasive bias against women in scientific research.

The only consistent bias against women was in heart-related trials. Less than 1 percent of all heart trials were exclusively female. But the investigators also found a bias against men, who were often underrepresented in cancer research.

“The findings are important because the perception that females are underrepresented and their diseases are understudied erodes the public trust, which is essential to continued clinical research,” says Meinert.

NO MEN’S HEALTH SPECIALTY

If there is bias in the health-care system, some experts argue, it is against men. How so? Women go to doctors who deal exclusively with female health issues, while there is no comparable field of “andrology” not only to treat men but to pick up early signs of disease the way obstetrician/gynecologists do in women.

And many doctors feel there should be. The most important benefits of a male specialty would be preventive, according to Dr. David Gremillion, a specialist in infectious diseases at the University of North Carolina School of Medicine. “The current system of health care is not well-suited to making men feel comfortable enough to step forward and do health maintenance,” he says. “It’s well-suited to handling men who have a workplace injury or caring for them once they’ve had a big heart attack. But it’s not focused on preventive care.”

Regardless of what side you’re on, the debate about gender bias in research has indisputably advanced medical science. In attempting to prove or disprove bias, researchers have learned that some diseases do affect men and women differently and need to be studied accordingly. The Institute of Medicine of the National Academy of Sciences recently confirmed differences between the sexes in the prevalence and severity of a broad range of diseases, disorders and conditions. Its report, conducted over 16 months, concluded that gender differences that affect well-being occur throughout the life span, affecting behavior, perception and health.

“Sex does matter,” says Mary Lou Pardu, chair of the IOM Committee on Understanding the Biology of Sex and Gender Differences. “It matters in ways that we did not expect. Undoubtedly, it also matters in ways that we have not begun to imagine.”

Enough said. It’s time to end the debate and let such research begin.

JUST IN the past few months, surprising new research has highlighted the heart risks to both teenagers and young adult men.

A study reported in the American Heart Association journal Circulation is particularly alarming. Researchers from Louisiana State University examined the arteries of 760 teens and young adults who died as a result of an accident, suicide or murder and found that many were clogged badly enough to cause a heart attack.

They found that 2 percent of males aged 15 to 19 and 20 percent of men between 30 and 34 had advanced fat-laden plaques, the obstructions that can become dislodged and cause a heart attack or stroke. They found no advanced plaques in girls 15 to 19, but did find them in 8 percent of women in the 30 to 34 range.

The investigators admit that their research cohort may not be representative of the public at large — perhaps people at risk of an early death eat poorly or have other factors associated with heart disease, such as depression. “But if our results hold true for larger populations, one in five men between the ages of 30 and 34 has some significant damage to his heart arteries,” says Dr. Henry McGill of the Southwest Foundation for Biomedical Research in San Antonio, Texas, who led the study.

“That would indicate the need to tailor prevention messages to younger people.”

Not surprisingly, the researchers found that those who were obese or had high levels of low-density lipoproteins (often called the “bad” cholesterol) were 2.5 times more likely to have advanced plaque blockages. The results, says McGill, give strong support to the idea that nutritional guidelines for the prevention of heart disease should be recommended for children as well as adults.

Another study that followed about 82,000 men over 34 years uncovered some equally startling data. While men in their 20s and 30s may think it unnecessary to worry about their cholesterol levels, the study, reported in the Journal of the American Medical Association, indicates otherwise.

Younger men with high cholesterol face a greater long-term heart risk than men diagnosed with the condition in middle age for a simple reason: The longer high levels exist, the more damage they cause.

The JAMA report found that those with high levels of cholesterol were 3.5 times more likely to die of a heart disease-related death than men with healthful levels.

So what’s a strapping, invincible young man to do with this information? He should get a cholesterol test every five years beginning at age 20. If his level is above 240, he should try to bring it down through exercise, nutrition or, perhaps, medications.

And thus avoid the fate of many of the men in these two studies, as well as that of my father.