Blissful Ignorance or Malicious Exclusion?
An exploration into the horrendous impact of gender bias in medicine.
“And the rib that the Lord God had taken from the man, he made into a woman…” …who was subsequently ignored by medicine, with all the attention remaining on healing the man’s wounds, illnesses, and ailments. No matter how you believe that humanity came to existence, it is an undeniable fact that women’s healthcare (like many other things) comes in second place to men’s.
To understand the extent of the problem it’s important to look at some statistics. First and foremost, simply being female increases the risk of many health problems, including osteoporosis, depression and anxiety and autoimmune diseases. With this being said, it would seem to make sense to ensure time and funding is allocated to research how diseases affect women in particular, right? Sadly, this has historically not been the case, leading to a chronic lack of research into women’s health.
Initially, it was suggested that women of child-bearing age should be excluded from medical research studies, after the tragic Thalidomide scandal. Whilst pregnancy is of course an appropriate reason to exclude participants from trials, there seems to be a distinct lack of nuance here. Not every woman of child-bearing age will be physically able, or even want to have children. To exclude such a large group from life-saving research seems to be lazy at best, and ties in with the misogynistic view that a woman’s sole purpose is to reproduce.
Perhaps even more overtly misogynistic is the lack of representation of women in clinical research trials due to the variation of hormones throughout a woman’s menstrual cycle. Due to the cyclical changes in hormones, more participants would be required in each study, thus making the trials more expensive to complete. So instead of appropriate funding being allocated, it has simply been assumed that illnesses will affect women in the same way as they affect men, and that any data from clinical trials can be extrapolated to women’s treatment. This lack of representation is entrenched from the very start of the research process: within pre-clinical trials, which are usually based on cells, or rodents, it is still male samples being used.
These cost cutting measures seem to explain why issues related solely to women’s health remain under-researched, leading to difficulty in making diagnoses and even more problems with finding effective treatment. For example, in Australia, official clinical guidelines on the diagnosis and treatment of endometriosis were only published for the first time in 2020. The lack of evidence surrounding endometriosis has meant that women have waited for up to 12 years between first presenting to their doctor with symptoms and actually receiving a diagnosis. The impact of this can be enormous: the symptoms of endometriosis include heavy periods, chronic severe period pain which stops women being able to complete normal activities, and unsurprisingly, depression, as a result of these physical health problems.
As we have seen in the media recently, the panic and hysteria when side effects impact men is laughable when compared with the total non-response to dangerous side effects limited to women. The Oxford Astra-Zeneca vaccine against COVID-19 carries a risk of one in 250,000 for developing blood clots, compared to a risk of five-12 in 10,000 for women using combined oral contraceptives, and jumping even higher to approximately one in 1000 during the perinatal period (the period of pregnancy and shortly after giving birth). Whilst this should by no means be used as a scare tactic to stop women using highly effective contraception, healthcare professionals should most definitely be informing women of these risks, in just the same way as the general public has been made very aware of the risks associated with the vaccine.
It is important to also consider non-gender-specific diseases and illnesses, and how the lack of research into women’s health affects their diagnosis and treatment. In a 2018 Australian research paper it was found that women presenting with a major heart attack were half as likely to receive proper treatment in hospital, and twice as likely to die within six months of the episode, when compared to men. Furthermore, it was found in 2015 that for six different types of cancer, women had a longer wait time for diagnosis than men presenting with the same conditions. These longer waiting times and poor treatments are literally playing games with lives: in the US, it has been estimated that diagnostic errors cause between 40,000 and 80,000 deaths every single year.
So, what is being done about this? In short, not enough. Whilst the inclusion of women in research trials has improved over the last decade (from 28% in 2010, to 49% in 2020), there has been no change in the amount of studies available to actually analyse this new data. This means that the data is still reported as one group – so the inclusion of female test subjects makes little discernible difference, as the analysis and interpretation of the data does not include exploring whether what is being researched impacts differently on male and female test subjects.
Unsurprisingly, much of the literature surrounding this topic is written by women. Some notable titles to explore more around the subject include "Pain and Prejudice: A call to arms for women and their bodies” by Gabrielle Jackson, “Medical Bondage: Race, gender and the origins of American gynecology” by Deirdre Cooper Owens (an especially important read to explore the racist and misogynistic past of women’s healthcare) and “Invisible Women: Data bias in a world designed for men” by Caroline Criado-Perez. Ending on a quote from the latter author leaves us with much to consider, and much to feel angry about: “For millennia, medicine has functioned on the assumption that male bodies can represent humanity as a whole…women are dying, and the medical world is complicit.”
Words: Emily Parkman
Photography: Magda Ehlers