The gap in earnings between men in women is well-publicized. While any form of discrimination based on gender is unacceptable, a woman earning 77 cents to a man’s dollar is not going to kill her. There is, however, one area in which gender inequality may cause thousands of deaths annually: medical research and treatment.
Across the board, in all areas of health, women are largely ignored in all phases of medical research and treatment, from initial surveys to participation in control groups and clinical trials to seeking medical care.
The result? Medical breakthroughs that virtually exclude women in terms of safety and efficacy, and ignored symptoms that may lead to increased risk of side effects, poor results, and even death.
This is not exclusion based on gender in the Mad Men era of Don Draper; this is recent news. In a 2014 review of five major medical journals, researchers at Northwestern University found that in studies that stated the sex of animals used in cell research only 17% of animals were female. When studying just cells, results were just as biased, with only 21% of the studies using female cells. More troubling is the studies that reported sex-based results. For diseases that were predominantly present in females, 44% of studies did not report the sex, and when it was reported, only 14% of these studies of predominantly female diseases actually used female cells.
Another study published in Neuroscience & Behavioral Reviews found that in 2009, male animals were used in 80% of the almost 2,000 published animal studies. Researchers also chose fewer than 45% female animals in studies of depression, despite the fact that women are twice as likely to suffer from depression as men.
The same bias occurs in clinical trials.
In 2006, women made up fewer than 25% of patients in 46 clinical trials conducted in that year. This may be the lingering aftereffects of a ban on using women of child-bearing age that was enacted by the U.S. Food & Drug Administration from 1977 to 1993, but instead of simply banning women who were likely to become pregnant, the ban included those women who were not sexually active or who were gay and thus unlikely to become accidentally pregnant. For 16 years, women disappeared from clinical trials, and in this time, 1,514 new drugs were approved, with the clinical groundwork laid for many more in the years to come.
This absence of women in clinical trials and research spills over into the exam room, especially in areas that have been widely publicized as “men’s health.” Heart disease is the top killer of both men and women in the U.S., yet women are less likely to recognize and seek help for their symptoms. Heart attacks strike women at a younger age than men, and they result in death for women under 55 at twice the rate of men at a rate of 15,000 deaths per year.
There is some evidence that women don’t seek out care when they are having heart attack symptoms for two main reasons. First, they don’t recognize the symptoms as a heart attack. Since 1984, more women than men have died of cardiovascular illness, yet only 20% of doctors – even cardiologists – knew that. Two-thirds of doctors surveyed in a national poll had no idea that there were gender variations in the symptoms of heart attack. Textbooks and medical literature for both patients and doctors have been written with men in mind, so it’s no surprise that women and their doctors don’t recognize or treat seriously their symptoms.
The second reason why women don’t seek or receive treatment for heart attack is even more troubling: gender bias and stereotyping.
A 2014 study examined the records of 1,000 heart attack patients in the U.S., Canada, and Switzerland and found gender biases in both diagnosis and treatment. Doctors were far more likely to dismiss a woman’s heart attack symptoms as anxiety, even when chest pain was present. When chest pain was not present in both men and women, men were still more likely to receive care typically associated with a heart attack than women, and more quickly (15 minutes for a man to get a crucial electrocardiogram, 21 minutes for women). The same study found that patients of both genders with more stereotypically feminine traits had more delays in treatment than those patients with more “masculine” traits.
These types of delay are even more prominent when it comes to conditions that affect women in greater numbers than men. Women make up 75% of those who suffer from autoimmune diseases, but it takes an average of five and a half years to obtain a diagnosis. Women make up the majority of the 100 million people in the U.S. who suffer from chronic pain in the U.S, yet conditions such as fibromyalgia and chronic fatigue syndrome are only just recently being recognized as actual conditions and not just a bunch of women complaining about vague tiredness and sore muscles.
Many women, sick of being treated as hysterical or whiny, simple disengage from the healthcare system and ignore their annual preventative checkups. There are other factors that contribute to this pulling away, such as poverty, which affects women disproportionately, but many women are fed up with having their concerns dismissed and would rather cope with symptoms outside of the medical system.
While this may seem a tactic of last resort, there are other options for improving clinical research and treatment for women.
Cedars-Sinai Medical Center has created an online registry called Research for Her™, that helps to put women into research studies and clinical trials. This online registry was over four times faster at matching women with available trials than traditional paper registries.
Another major organization advocating and promoting inclusion of women in all aspects of medical research and treatment is the Society for Women’s Health Research (SWHR). This non-profit organization works hard to promote recognition of biological differences in disease, and their efforts are paying off. In June of 2015, the National Institutes of Health (NIH) formally included sex as a biological variable in designing, planning, and implementing all future medical research. This means that researchers will need to include considerations of sex in everything from writing research questions to gathering and analyzing data.
This major move by the U.S.’s largest public medical research agency is a huge leap forward in the push to narrow the gap between men and women. You can continue to help narrow that gap by supporting the SWHR’s efforts, signing up for a clinical trial near you, and continuing to educate those around you.
How will you get involved?