It’s Women’s Month, and we want to continue the conversation about gender bias in the medical field. The lack of inclusion and understanding of women in medicine has important, and sometimes fatal, effects on women’s health.
Gender bias permeates the healthcare system, from research, to diagnosis, to treatment. A major problem is the lack of representation in research, which causes serious problems in diagnosis and treatment for women.
In this blog, we’ll talk about this issue and look at some solutions proposed by experts to reduce gender bias in medicine and provide better care for women.
Lack of representation in research
An important consequence of gender bias is that most medical research is carried out on men.
Why is this? Historically, scientists believed that men, lacking menstrual cycles and the possibility of pregnancy, were better test subjects. As a result, medical trials have systematically excluded women for a long time, with medical science studying mostly male cells, animals, and humans. Researchers justified excluding female animals because they caused too much variability in results, but a 2010 study of sex bias in mammal research found this explanation to be “without foundation”.
To give an example, Rockefeller University conducted a pilot study backed by National Institutes of Health on obesity’s impact on breast and uterine cancer without including a single woman, according to Maya Dusenbery’s 2018 novel Doing Harm.
In the last 50 years we have seen more women in human studies, but increasing male bias in non-human studies. Still today, more men participate in medical trials than women. Even in studies of both sexes, not all drug researchers consider sex or gender when analyzing results.
Why it matters
Why does this matter?
It’s not just a question of equal representation. There are notable differences between the male and female body which change the way diseases, drugs, and therapies affect people.
Some medical research results can be extrapolated between sexes, but many pathways, such as cardiovascular disease and some cancers, are affected by hormones, which differ significantly between sexes.
Because of this, many pre-90s studies are flawed, and doctors have a poorer understanding of female and intersex people’s health. This also means the drugs that come out of these studies are less safe and effective for women, who were not included in the development process. To illustrate, the US FDA withdrew eight drugs with unacceptable risks for women between 1997 and 2001.
The lack of female representation in the research also complicates diagnosis. Doctors often miss or misdiagnose diseases that look different in women. Diseases that affect mostly women are understudied, undertreated, and commonly misdiagnosed or undiagnosed. For example, it’s said that waiting to have children causes endometriosis, or that it can be cured by getting pregnant, which was also said about breast cancer before it was proven otherwise.
Progress
The mystery around women’s illnesses has a great impact on women’s health. Luckily, there are advocates in the field taking steps to improve women’s health research and treatment.
In the 80s, a number of female scientists in the US created what is now known as the Society for Women’s Health Research, to advocate for better health research in women.
Ongoing advocacy from groups like this one has incited important regulatory changes. For example, in 1993 the FDA and the National Institutes of Health (NIH) made it obligatory to include women in clinical trials. 20 years ago, the NIH mandated that every study they fund must disclose the proportions of women and minorities included, and to explain why, if none were included.
Despite this progress, many grants with few or no women are still funded.
Solutions
What can be done?
An important step is education and awareness. Healthcare professionals and those they serve need to understand gender bias, how we all hold these biases, and how they impact healthcare.
An American Medical Association (AMA) article suggests nourishing education with research and workforce development, with the goal of showing how it’s possible to integrate sex and gender into basic science and clinical research platforms. They also advocate for sponsorship, including how to discuss sex and gender in medical research, and consequently, journals.
Concretely, there must be more sex and gender diversity in research. While women currently reflect about 50% of participants in NIH-supported clinical research, the same does not apply for all studies, nor does it erase decades of male-only research.
We’re calling on health organizations and researchers to prioritize sex and gender diversity in any relevant studies, as well as fund research to fill in the missing knowledge.
If we want to ensure women’s health, we must not only include them in research, but design research specifically for their bodies.
