Too often, women’s health has been viewed as a niche area – even though it involves around 50 percent of the world’s population.
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Kelly Burrowes, University of Auckland
International Women’s Day celebrates the achievements of women and raises awareness of the ongoing mission of gender equality. So it is a good time to remember that decades – even centuries – have yet to correct gender biases in medicine and medical research.
It’s no secret that men and women are different. So there is a whole genre of books and jokes about why “Men are from Mars and women are from Venus.”
Mentally, physically, and biologically, men and women are simply not built alike. It sounds obvious, but we’re only just beginning to understand why.
These differences have not been accurately reflected in medicine. Too often, women’s health has been viewed as a niche area – despite the involvement of around 50 percent of the world’s population.
Under-researched and underdiagnosed
What we do know is that as women we are at greater risk of suffering some of the most difficult conditions. Autoimmune diseases, for example, affect around 8 percent of the world’s population, and 78 percent of those affected are women.
Women are three times more likely than men to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis, an autoimmune disease that affects the central nervous system.
Women make up two thirds of people with Alzheimer’s disease and are three times more likely to have a heart attack than men. Women are at least twice as likely to suffer from chronic pain conditions as fibromyalgia, chronic fatigue syndrome and chronic borreliosis.
As the author Maya Dusenbery made clear in her book to do damage, These conditions have not been adequately researched and are often undiagnosed and untreated.
Different sex, different symptoms
Heart disease is another example where sex – or maybe sexism – still plays a big determinant. Women are less likely to experience the “classic” symptoms of a heart attack – symptoms discovered in male-led research in which most of the participants were men.
The most common symptom of a heart attack in women, as in men, is chest pain or discomfort. However, women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea, vomiting, and back or jaw pain.
However, because the diagnostic method still favors male biology, many women experience delayed diagnosis or misdiagnosis.
On average, women are diagnosed with heart disease seven to ten years later than men. This often results in other chronic conditions being prevalent at the time of diagnosis.
Male bias influences clinical trials
The reasons why women are so overrepresented under certain conditions are not clear. However, genetic and hormonal factors probably play a role. Historically, however, medical research has often excluded women.
In 1977 the US Food and Drug Administration (FDA) recommended that women of childbearing age be excluded from clinical trials. This should protect the “most vulnerable” population groups – unborn children – after the thalidomide scandal.
Another reason women are excluded from clinical trials is that depending on where a woman is in her menstrual cycle, the variation in her hormones “complicates” the results. This variability would mean that more subjects would be needed in clinical trials, which would increase costs.
Studies for men only were founded on the belief that what would work for men would work for women. This mistaken assumption had catastrophic results.
Every cell in a person’s body has a gender. This means that diseases and drugs used to treat women affect women differently – often at the expense of their health, as we have learned.
Eight out of ten drugs withdrawn from the US market between 1997 and 2000 were withdrawn from the market because of side effects that occurred primarily or exclusively in women. Between 2004 and 2013, American women suffered more than 2 million drug-related adverse events, compared with 1.3 million in men.
Time to end the gender segregation
The lack of recognition of gender differences in biology and medicine is a major problem that research has only recently begun to address.
In 1997, the FDA published a regulation requiring manufacturers to demonstrate how safe their drug is and how age, gender, and race affect it.
When the last in-depth measurement was taken in 2016, it was clear that there had been significant progress, with women making up about half of the participants in some of the clinical trials funded by the US National Institutes of Health (NIH).
Scientists now need to consider the possible role of gender as a biological variable in both animal and human studies.
But the lack of funds for women’s health remains a major problem. According to a previous analysis from the UK, less than 2.5 percent of publicly funded research was devoted to reproductive health. Yet every third woman suffers from a reproductive or gynecological health problem.
This means that around 16 percent of the population will experience a problem that only receives 2.5 percent of the annual research budget. While steps are being taken to bridge the large gender gap in medicine, there is still a long way to go.
Kelly Burrowes, Senior Researcher, University of Auckland
This article was republished by The Conversation under a Creative Commons license. Read the original article.