The Receipts
You scanned the code. Here are the receipts.
PATISDEAD is loud on purpose.
But the statements aren’t pulled out of thin air.
This is where we keep the numbers, research and sources behind the designs.
ADHD RESEARCH & DIAGNOSIS
ADHD has historically been recognised and diagnosed more often in boys and men. Research suggests that girls and women are more likely to present with less overt hyperactivity and more inattentive or internalising symptoms, which can contribute to ADHD being overlooked, diagnosed later, or mistaken for other conditions. Researchers increasingly emphasise the need for better recognition of how ADHD can present differently in females.
Source: Understanding females with attention deficit and hyperactivity disorder – PubMed Central
OSTEOPOROSIS
Osteoporosis disproportionately affects women, particularly after menopause, and women's bone health has historically received more attention than men's. The important inequality here is therefore not simply that osteoporosis is “less researched in women.” A more accurate point is that sex differences in bone biology, diagnosis and treatment matter, and research and clinical practice need to account for them. We should revise the original claim behind this item before publishing it as a receipt.
AUTOIMMUNE DISEASES
Women carry a strikingly disproportionate share of autoimmune disease. According to the US National Institutes of Health, approximately four out of every five people diagnosed with an autoimmune disease are female. Scientists are investigating genetic, hormonal and immune mechanisms that may help explain this difference, but important questions remain unanswered.
Source: NIH – Understanding sex differences in autoimmune disease
BREAST CANCER RESEARCH
Research funding does not always correspond to disease burden. A large analysis of NIH funding found that diseases predominantly affecting women were more likely to be underfunded relative to their burden than diseases predominantly affecting men. More recent European research has also identified a funding disadvantage for female-dominated cancers after accounting for disease burden. This does not mean breast cancer itself has always received less total funding than male cancers; the broader evidence concerns how research funding is distributed relative to disease burden.
Source: Gender Disparity in the Funding of Diseases by the U.S. NIH
WOMEN'S HEALTH DIAGNOSIS
Diagnostic inequality extends beyond any single disease. A large-scale analysis across four healthcare datasets and 112 acute and chronic conditions found that women experienced longer intervals between symptom onset and diagnosis than men for most diseases examined. The researchers concluded that the results were consistent with systematic sex differences in patterns of diagnosis.
DRUG DOSAGES
The same dose does not necessarily produce the same exposure in male and female bodies. A major analysis identified substantial sex differences in the pharmacokinetics of dozens of drugs: at the same dose, women frequently had higher blood concentrations and slower elimination. Drugs showing higher exposure in women were also strongly associated with higher rates of adverse drug reactions in women. This does not mean every medication is “dosed for men”; it means sex can matter to drug metabolism and is not consistently reflected in dosing.
Source: Sex Differences in Pharmacokinetics – PubMed
CLINICAL TRIALS
Women were historically excluded or underrepresented in many areas of clinical research, leaving important gaps in knowledge about sex-specific safety and effectiveness. Representation has improved substantially, but it is not equal across all fields. A systematic review of 300 recent randomised controlled trials found a median female enrolment of 41%, with representation falling further in trials involving older populations. The FDA continues to issue guidance aimed specifically at improving female participation and sex-specific analysis.
Source: Systematic review of female representation in randomized controlled trials
BLOOD PRESSURE STANDARDS
Cardiovascular risk does not necessarily develop identically at the same blood-pressure values in women and men. Research increasingly supports examining sex-specific cardiovascular physiology and risk rather than assuming one reference model fits everyone. However, our earlier wording that blood-pressure standards are simply “based on men” is too broad, so I would not put that exact claim on the Receipts page without changing it.
TEMPERATURE STANDARDS
Body temperature varies with age, time of day, measurement site, hormonal state and other biological factors. Menstrual-cycle-related temperature changes are well established, but the statement that the conventional 37°C threshold is specifically a “male standard” is not strong enough for me to defend as written. I would remove or reformulate this item rather than trying to find a source that merely appears to support it.
MEDICAL DEVICES & IMPLANTS
Sex can affect the safety and effectiveness of medical devices, yet historically sex-specific enrolment, analysis and reporting have not always been adequate. The FDA now specifically recommends appropriate representation of both sexes in medical-device studies and analysis of device performance by sex so that clinically meaningful differences are not missed.
Source: FDA – Evaluation of Sex-Specific Data in Medical Device Clinical Studies
HEART DISEASE RESEARCH & TREATMENT
Cardiovascular disease has historically been perceived as a male disease despite being a major cause of illness and death in women. Modern reviews continue to document sex disparities in diagnosis, treatment and outcomes. The US National Heart, Lung, and Blood Institute notes that women may be less likely to be referred for diagnostic testing, may experience delays in assessment, and may be less likely to receive some medicines, procedures and specialist care.
Source: NHLBI – Women and Heart Disease
PAIN TREATMENT
Women experience many painful conditions more frequently than men, yet evidence also shows disparities in how their pain is recognised and treated. Reviews have found that women's pain is more likely to be underestimated, experience diagnostic delay and, in some settings, be undertreated. The causes are complex and include biological differences, clinical practices and gender-related bias; the evidence does not mean that every woman receives worse pain treatment in every setting.
Source: Pain in women: bridging the gender pain gap – PubMed Central
CRASH TEST DUMMIES
For decades, vehicle safety testing was centred on a crash-test dummy representing an average male body. Smaller dummies used to represent women did not fully reproduce female anatomy and biomechanics. In 2026, NHTSA highlighted research showing that women still have a statistically higher risk of several crash injuries and pointed to the need for an advanced female crash-test dummy.
Source: NHTSA – Female crash-test dummy and injury risk
SEAT BELTS
Vehicle restraint systems interact with body size, shape, seating position and anatomy, so occupant protection cannot be separated from who the safety system is tested on. The strongest documented inequality is not that “seat belts were invented only for men,” but that vehicle safety development and crash testing historically relied heavily on male-representative bodies. Female occupants continue to show different injury patterns in crashes, which is one reason regulators are developing more biofidelic female crash-test models.
Source: NHTSA – Research on female crash injury risk
FOOTWEAR
Women's feet are not simply smaller versions of men's feet. Three-dimensional studies have identified sex-related differences in foot and leg shape even after accounting for foot length. Researchers examining running-shoe lasts that were derived from men's designs concluded that simply scaling down male lasts for women's shoes should be questioned and recommended sex-specific reference measurements.
Source: Comparison of female foot morphology and athletic footwear design – PubMed
SPORTS EQUIPMENT
Much sports technology has historically been developed around male athletes. Research in sports engineering notes that products used in football and other sports remain predominantly designed around men and identifies areas including boots, clothing and wearable technology where female-specific design needs more attention. The issue is not that all sports equipment is unsafe for women, but that equipment developed around male bodies may not provide equivalent fit or performance for female athletes.
Source: Sports engineering and technology in elite women's football
WORKPLACE EQUIPMENT & TOOLS
Workplace equipment and personal protective equipment have often been designed around male anthropometric data. NIOSH specifically notes that women can face health and safety risks because respirators, gloves, boots, protective clothing and other PPE are often designed for average-sized men. Poor fit can reduce the protective function of the equipment.
Source: CDC/NIOSH – Women's Health at Work
FITNESS EQUIPMENT & PROGRAMS
Average differences in body size, body composition, strength distribution and biomechanics mean that a single male-derived reference body cannot automatically represent female users. However, the broad statement that fitness equipment and programmes are “typically designed around male averages” needs a stronger direct source than we currently have. I would either narrow this claim or leave it off the Receipts page until we have better evidence.
AI ALGORITHMS
Algorithms learn from the data they are given. When women are underrepresented in training datasets—or when disease presents differently by sex—models can perform differently for female patients. Studies of healthcare machine-learning systems have demonstrated higher false-negative rates for women in some disease-prediction models, meaning disease was more likely to be missed in female patients in those datasets. This is not true of every AI system, but it demonstrates why representative data and sex-specific validation matter.
Source: Sex disparities in healthcare machine-learning algorithms
SKINCARE PRODUCTS
Male and female skin can differ in measurable structural and physiological characteristics. Research has documented sex-related differences in skin structure and surface characteristics. However, the stronger claim that “most skincare testing is performed on male skin” is not supported well enough by the evidence I found. For PATISDEAD, I would change this receipt to focus on documented biological differences in skin rather than claiming systematic male-only product testing.
Source: Sex-related differences in skin topography and structure – PubMed
MOBILE PHONES
Hand dimensions affect reach, grip and one-handed smartphone usability, and ergonomic studies have found differences associated with sex and hand size. That supports designing interfaces and devices for a wider range of hands. It does not adequately prove our stronger original statement that phones are generally designed specifically for larger male hands, so I would soften this claim on the Receipts page.
Source: Smartphone ergonomics, hand use and sex – Ergonomics
VOICE RECOGNITION
Speech-recognition performance can vary across demographic groups because training data, accents, pitch, recording conditions and other characteristics affect model performance. However, I don't think we currently have a sufficiently strong source for the blanket statement on our graphic that voice-recognition systems have higher error rates specifically for female voices. I'd rather change this than manufacture a “receipt” for it.
EYEWEAR
Eyewear fit depends on facial anthropometry, and appropriate frame design requires measurements that represent the population using the product. Research has highlighted limitations in the anthropometric data historically available for spectacle-frame design. However, the specific claim that standard frames are often too large for women's faces needs better direct evidence before we publish it as a factual receipt.
Source: Facial measurements for spectacle-frame design – PubMed
CONTACT LENSES
Eye anatomy and ocular physiology can vary between individuals and between sexes, but I would remove our current claim that contact lenses are designed using male eye measurements unless we find much stronger historical design evidence. At the moment that wording goes further than the evidence I can confidently substantiate.
DIGITAL HEALTH APPS & SERVICES
Digital health systems can reproduce biases present in the datasets and assumptions used to build them. Healthcare machine-learning research has demonstrated sex disparities in predictive performance, including higher false-negative rates among women in some models. That does not mean every health app is biased against women, but it establishes why female representation in data and sex-specific validation are essential.
Source: Sex-based performance disparities in healthcare algorithms
TOILETS
Equal floor area does not necessarily create equal access to toilets. Women generally require cubicles rather than urinals and may need more time because of menstruation, pregnancy, clothing and caregiving. Research on public-toilet provision has documented fewer effective facilities for women and the resulting longer queues, making toilet design a well-established example of how apparently equal infrastructure can produce unequal outcomes.
Source: Join the Queue: Including women's toilet needs in public space
ARCHITECTURE & URBAN PLANNING
Cities are not experienced identically by everyone. Women's patterns of caregiving, public-transport use, walking and exposure to harassment can create different needs around lighting, transport, toilets and public-space design. UN Women specifically identifies mobility, sanitation, lighting and safety as areas where gender-responsive urban planning can change women's ability to use public spaces.
Source: UN Women – Gender-responsive public-space design
BODY WEIGHT & BMI
BMI is calculated only from weight and height and does not directly measure body-fat percentage or fat distribution. Men and women differ on average in lean mass, fat mass and where body fat is stored, meaning the same BMI does not necessarily represent identical body composition or metabolic risk. BMI can be useful at population level, but it should not be interpreted as a complete individual measure of health.