Why do we know so little about women’s health?

There is a big problem persisting in the world of medicine. Though a problem in itself, it’s not coronavirus. This problem has existed a long time before the pandemic and will continue long after social distancing becomes a thing of the past.

The problem, in the eyes of some doctors, is women. Aristotle saw that as such, characterising women in ‘On The Generation of Animals‘ as a mutilated male, their biological differences from the male body deviations at best and faults at worst. Although this was written over two thousand years ago, this attitude and the sexism behind it has become embedded in the medical community in more ways than one. It has contributed to a dearth of knowledge about women’s health and female illness that continues to the present day.

Aristotle’s description creates the impression that not only are men the ‘default’ and women the ‘other’ in terms of biology, but that women are simply men with different reproductive organs. This is how women have continued to be treated throughout the history of medicine, to the point where women’s health was sometimes known as ‘bikini medicine’. This term came about because medical professionals acted as though the only thing that made women different from men was the parts of the body that would be covered by a bikini. Every other biological difference between the sexes was historically disregarded because women were only viewed as reproductive beings, and thus only the health of her reproductive organs mattered.

women are seven times more likely to have their heart attacks misdiagnosed by a doctor and thus more likely to be discharged from hospital while the heart attack is still happening.

Consequently, because of this belief, medicine overlooked the fact that symptoms of certain health conditions presented differently in men and women. An example of this is heart attacks: the classic symptom of a heart attack is chest pain, which only one in eight women who have heart attacks experience. Men are more likely to experience chest pain whilst having a heart attack, while women are more likely to develop flu-like symptoms. Because of this, women are seven times more likely to have their heart attacks misdiagnosed by a doctor and thus more likely to be discharged from hospital while the heart attack is still happening as a study published in ‘The New England Journal of Medicine’ in 2000 found. This also means women are more likely to die since the mortality rate of a heart attack doubles when the patient does not experience any chest pain and women under the age of 50 are twice as likely to die as men of the same age.

Similarly, a lack of consideration of the non-reproductive biological differences between men and women has created issues within treatment of illness. Between 1997 and 2000, the American Food and Drug Administration (FDA) removed ten different prescription drugs off the market on the grounds that they caused ‘severe health effects’. Eight out of ten of these drugs caused greater health effects for women. A 2018 study found that this was the result of ‘serious male biases in basic, preclinical and clinical research’.

essentially we’ve ended up with a healthcare system, among other things in society, that has been made by men for men.

– Dr. Kate Young, Monash University

Speaking to The Guardian last year, public health researcher Dr. Kate Young, who works at Monash University in Australia, said that the cause of this bias is the constant exclusion of women from science and medical research, to the extent that “essentially we’ve ended up with a healthcare system, among other things in society, that has been made by men for men.” Most cells, animals and humans studied in medical research are male and most of our breakthroughs in medical science have come from the study of male biology. As a result, according to Dr. Janine Austin Clayton, a women’s health researcher at the US National Institute of Health (NIH), “we literally know less about every aspect of female biology compared to men.”

How has this happened? The long-held opinion of women as solely reproductive beings has been used against them by senior scientists throughout history as grounds to exclude them from medical research. This exclusion began early in the twentieth century after the discovery of the endocrine system, which produces hormones. This discovery became another sexist weapon to wield against women because the fluctuations in hormones that take place throughout the menstrual cycle were grounds to exclude them from medical research, as it was said to introduce too many variables into scientific studies. This was somewhat ironic considering that the discovery had revealed another biological difference between men and women (and hormones replaced the uterus as the biological reason for women’s inferiority), yet women were still treated in the eyes of medical researchers as no different from Aristotle’s description of ‘mutilated males’.

Between the 1970s and the 1990s, many national and international regulators made the exclusion of women from medical research more concrete with a policy that ruled out women of childbearing age from participating in early stage drug trials. This was because of apparent concerns of early-stage drugs damaging women’s fertility, especially since women are born with all the eggs they will ever produce. Whether participants actually planned on having children was never considered.

The FDA and NIH both made it compulsory for women to be included in medical research in 1993, but this only happened in response to years of campaigning by the Society for Women’s Health Research. Regardless, the damage had already been done. A 1985 report conducted by the US Public Health Service Taskforce on Women’s Health concluded that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive.”

If a female patient’s condition didn’t respond to treatment, or if she contested the doctor’s diagnosis or perception of the seriousness of her illness, she would be dismissed as crazy.

The gaps in medical knowledge about women’s health were plugged with more sexism. Young’s research has revealed how doctors have, rather than facing up to their lack of knowledge of women’s health caused by their own personal biases, instead perpetrated hysteria narratives. If a female patient’s condition didn’t respond to treatment, or if she contested the doctor’s diagnosis or perception of the seriousness of her illness, she would be dismissed as crazy. Even in 2020, countless women have recounted having this experience, potentially with devastating consequences, when doctors have dismissed something that has later revealed itself to be gravely serious or even life-threatening. It has led to the coining of the term ‘Yentl syndrome’ to describe the notion of women having to prove they are as sick as a man or mirror typically male symptoms to be taken seriously (the premise of the film Yentl is a Jewish girl disguising herself as a boy in order to receive an education).

What must the medical community do, then, to counter centuries of male bias? The first and most immediate answer to this question is to acknowledge the field’s deeply entrenched institutional sexism. After all, a problem cannot be solved unless people are made aware of it. Medical students aren’t taught about the disparity in knowledge of the male and female bodies and how that came about, and teaching them this is vital.

Gender parity in medical trials must also be rigorously maintained.

Gender parity in medical trials must also be rigorously maintained, with potential consideration of how both diseases and treatments can affect men and women differently. It would also be worthwhile for the medical community to research this as well as devoting more time and resources to exploring historically underresearched conditions that only affect women. Endometriosis is a prime example – though a tenth of women suffer from it, there is still no cure and though theories exist, its cause is still not known, and none of the theories fully explain how endometriosis happens.

Finally, the hysteria narrative perpetrated by doctors must be challenged and unconscious biases recognised. A recommendation made in guidelines by the National Institute for Clinical Excellence (NICE) to speed up the diagnosis of endometriosis (which takes on average seven to eight years to diagnose) is all too telling: NHS doctors were advised, in the report, to ‘listen to women’. No progress will ever be achieved if women are not taken seriously when they go to the doctor. They know their bodies better than a third party ever will.