guidelines. Although there are exceptions, such as the women-specific guidelines for CVD issued by the American Heart Association (AHA) (Mosca et al., 2004a), most practice guidelines are not sex specific.

Government agencies and professional organizations play an important role in the translation of research findings into policy and practice. For example, in light of findings from the Breast Cancer Prevention Trial showing that tamoxifen reduced the incidence of invasive breast cancer in women at high risk for the disease (Cuzick et al., 2003; Fisher et al., 1998; Lewis, 2007; Mamounas et al., 2005; Powles et al., 1998; Veronesi et al., 1998, 2007), the Food and Drug Administration (FDA) required modification of the language on the label for tamoxifen (FDA, 1998). Government agencies and professional organizations have also developed campaigns to disseminate research findings to both health-care providers and women. For example, the National Heart Lung and Blood Institute, the Department of Health and Human Services (HHS) Office on Women’s Health (OWH), and AHA collaborated to develop the Heart Truth campaign to increase women’s awareness of their risks of heart disease (HHS, 2010). The campaign has contributed to an increase in awareness compared with that in 1997 (Christian et al., 2007; Mosca et al., 2010).

Barriers Associated with the Nature of Science

Clinically useful findings are almost never generated by a single study but require a multitude of studies of types—basic, clinical, and applied—and require the overall evidence to lay the foundation for a given clinical action. Along the way, different studies may produce dissimilar results. Beyond the uncertainty due to inconsistent findings, uncertainties about the applicability of findings and about inadequate data on the effects of treatments in women can occur when data are not analyzed and reported by sex. Failure to report sex-specific findings has resulted in delays in standard-of-care treatment for women, such as the use of stents, beta blockers, and aspirin for myocardial infarction (Berger et al., 2009; Chauhan et al., 2005; Lansky et al., 2005; Rich-Edwards et al., 1995).

Paradoxically, there are also examples of rapid adoption of unproven interventions, such as transplantation of autologous bone marrow for advanced breast cancer, which was later shown by research not to provide benefit but to increase risk (Farquhar et al., 2003; Rettig et al., 2007). An objective research base with sex-specific information is critical both for the adoption of new approaches and to stop practices that are not beneficial and may actually be harmful.

Barriers Associated with Economic, Social, and Cultural Factors

Economic forces and other nonscientific factors may complicate the interpretation of scientific data and their translation into practice. Conflicts of interest can occur in the conduct of science and the publication of scientific information



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