Medicine is Not Immune to Gender Bias

THE RECENT NEWS has been filled with stories of sexual harassment, and a light has been shined on a world which existed for years in the shadows. From Hollywood to Congress, powerful men who for years have been misusing that power in the worst ways are finally being brought to justice, and the sexism and gender bias that is all too prevalent in numerous industries has been brought to light. Medicine, despite what some might think, is not immune. In fact, from research to diagnosis and treatment, women have historically been neglected or even intentionally excluded. And as a result, women are insufficiently and inappropriately treated for the bulk of medical conditions.

Even when I was a medical student, I felt that my health concerns were glossed over or tossed aside outright. After two whole years without having a single menstrual cycle, I finally went to one of the prominent physicians at the faculty of the OB/GYN department for advice. I was nervous, and I assumed he would be interested in getting to the root of my medical malfunction. Instead, he told me flippantly, ‘You’re fine — just take birth control pills.’ This is all too common, and happens even today. My patients have shared stories of encounters with doctors in which they were treated as though they were malingerers or hypochondriacs! Their medical concerns were perceived to have been grossly exaggerated or even fabricated, and the end result of this was that they simply prescribed tranquillizers, sleeping pills or antidepressants!

The gender bias starts with research. Though it’s hard to believe, there remains a pervasive lack of understanding of the fundamental differences between the biological sexes. This failure to appreciate the differences between men and women stems from the mistaken concept that women are simply cute, small, child-bearing versions of men, decorated with breasts and a different set of genitalia. The reality of the situation is of course that women and men differ in many fundamental ways aside from the obvious structural differences. Women can respond to medications in sometimes dramatically different ways to their male counterparts, and they possess quite different immune, cardiovascular, neurological, and cognitive systems. Even at the cellular level, hormonal differences mean that gene expression itself is different between the sexes. And yet, in spite of this, the vast majority of medical studies relating to conditions shared by both genders have been performed predominantly on men. Brigham and Women’s Hospital in Boston found in a 2014 report that females are typically excluded from animal studies, and when they are included, the sex of the animals isn’t published. It was also noted by researchers that frequently studies do not enrol adequate numbers of women. And when they do, the studies fail to analyse or report data separately by gender.

Because of these foundational differences between the two sexes, women have more mood and sleep disorders than men do, and women feel pain more intensely. Women develop fibromyalgia more frequently and outpace males in the occurrence of autoimmune diseases. Treatments that are viable for men are applied to women for whom they serve no purpose. Stents placed in coronary arteries with the intention to reduce the incidence of heart attacks provide no long-term benefits in women; in women, coronary vascular atherosclerosis occurs predominantly in the smaller, branched arteries, and not just the major coronary arteries. Since stenting is only possible in larger arteries, women at risk of heart disease find their condition is unaddressed. Blocked smaller arteries continue to impede blood flow to the cardiac muscle, potentially leading to microvasculature disease.

In the realm of pharmaceuticals, there are many doctors who are still unaware that male and female bodies react differently to statins. In women they increase the development of diabetes at an incidence that is far greater than it is for men! The widespread prescription of anti-depressants to women also reveals a gross gender bias: 25% of all women in the U.S. are prescribed and are taking these antidepressants. Women are more prone to emotional triggers — internal and external — but rather than searching out and addressing the underlying causes of depression, doctors blindly prescribe drugs with marginal (if any) benefit, but very real and significant side effects. Contraceptives, meanwhile, though now understood to be endocrine disruptors rather than the hormones they claim to replicate, are freely given to young teenagers and young women without a pause to think of what they are and what their long-term usage might lead to. Ask yourself: would men accept the administration of endocrine disruptors, sometimes for decades, to themselves? No significant data has been collected on the real long-term effects of taking endocrine disruptors for decades, and yet they are prescribed in large amounts every day.

It’s time for all this to change. That starts with recognizing that women are distinct creatures with their own unique responses, needs and moods. We women must be studied separately from men and be treated as the complex organisms that we are. We must demand female data, female investment in research and female solutions! Women are not small, child-making men. And we are no longer willing to live in the shadow of our larger human companions.

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