Book Lover

The shocking ways modern medicine lets women down

When it comes to medicine, women are still seen as both irrational and doomed to suffer. Our book columnist Ceri Radford investigates why, and what needs to change

Tuesday 19 May 2020 06:35 BST
People take part in the fourth 'Worldwide Endometriosis March' to help raise awareness of the condition in 2017
People take part in the fourth 'Worldwide Endometriosis March' to help raise awareness of the condition in 2017

If you ever find yourself engaging with the kind of tiresome troll who suggests that “feminism has gone far enough”, here’s some advice. Have a social media holiday, for starters. Then go read the US emergency care specialist Dr Alyson J McGregor’s new book Sex Matters: How male-centric medicine endangers women’s health and what we can do about it. Next, lie down in a darkened room until the feelings of impotent rage have died down, and come back at them armed with a few of the facts below.

For example, a 2012 US study found that paramedics were less likely to take severely injured women to an emergency or other trauma centre (49 per cent of women versus 62 per cent of men).

Men reporting irritable bowel syndrome (IBS) symptoms are more often referred for X-rays, women offered lifestyle advice or anxiety medication.

Perhaps even more worryingly, women are less likely to be referred for testing if they complain of cardiac symptoms, and more likely to die after a serious heart attack due to a lack of care.

Most doctors, male or female, who presumably don’t stroll around the wards jauntily indifferent to the fate of 50 per cent of their patients, would be horrified by these findings. So, what is going on? As McGregor unpicks in her accessible and urgently important book, there is a whole medical history and culture at work that assumes men are the default, with literally deadly consequences for the other half of humanity. It’s not as simple as blatantly sexist doctors (though one or two of those rear an oleaginous head in these pages), but a whole system that marginalises women and minimalises their suffering.

One of many anecdotes that liven up the grim litany of medical statistics is the author’s visit to a “sim lab” of lifelike mannequins used to train students at a top-tier medical school in the US. Every single model was white and male. The only “female” sim was a man with a blonde wig and a plastic foetus lying next to it. You don’t need a PhD in women’s studies to realise that a medical establishment which treats the female body as a faintly comical novelty with a baby attached is problematic. As McGregor writes: “Students are trained to look for male patterns of disease, trauma and pain on male bodies, and solve problems according to research and testing using mostly male models.”

We know that female health problems are prone to neglect. The author Hilary Mantel has written about the misery of endometriosis, an agonising condition that takes on average 7.5 years to be diagnosed in the UK and attracts only a fifth of the research as the distinctly less painful, more profitable erectile dysfunction. What is less understood is that the problem runs much deeper: women react differently to drugs and show different symptoms to some of the world’s biggest killers, including heart disease and stroke.

Hilary Mantel has written extensively about the subject of endometriosis 

The chapter on medication in particular made my jaw plummet. Women metabolise drugs differently 40 per cent of the time, McGregor writes. Yet 80 per cent of animals used in trials of potential new drugs are young males, and women’s participation in the first crucial phase of clinical trials is even now only 30 per cent. This leads to a situation where, for instance, it took nearly 20 years and thousands of complaints before the medical authorities realised that women only needed half the original recommended dose of the sleep aid Ambien.

More frighteningly, McGregor writes that when drug trials are designed without sex-based criteria, “the different effects of the drugs on men and women often simply cancel one another out”. For example, men may have no increase in QT interval (a gauge of heart activity) with a particular drug, whereas women may have a large, dangerous increase. When these results are lumped together by researchers, it results in a “statistically insignificant QT interval impact” – which is deemed as “acceptable risk” by US regulators and approved. Out of 10 prescription drugs withdrawn from the market in a four-year period, McGregor notes that eight were found to pose greater risks to women.

Medical research is a knotty, wicked problem: drugs are a public good, but the development of new ones is privately funded by pharmaceutical companies whose priority is to turn a profit. Men are easier, safer and cheaper test subjects because there’s no risk they’re pregnant and they don’t have monthly fluctuations of hormones, which can affect how drugs are metabolised. The incentives – and regulation – are apparently not yet in place to ensure the more fiddly and expensive clinical trials necessary to test how a drug performs at various points of a woman’s menstrual cycle. The problems with letting market forces rip right through the delicate task of developing drugs are so manifold they’ve spawned a canon of their own. Investigative journalist Gerald Posner’s Pharma: Greed, Lies and the Poisoning of America, published this March, is the latest in a long line of industry exposes.

For women, a different kind of problem, though one no less toxic, is the battered old cultural baggage that means women are still seen as both irrational and doomed to suffer. According to McGregor, they’re more likely to receive a psychiatric diagnosis than men and less likely to receive appropriate investigations or pain medication. She writes about how her husband, also a doctor, told her how a male neurologist had joked that he had an algorithm for treating paresthesia – the medical term for pins and needles that can precede serious diseases or stroke.

“When they come in, the first thing I ask is, ‘Are they male or female?’ If they’re male, I say, ‘Let’s do a CT scan’. And if they’re female, I say ‘Stop! It’s anxiety. It’s all in her head’.”

This is an educated man, in the second decade of the 21st century. Sure, rich men can no longer send off their troublesome daughters for lobotomies or consign their errant wives to the asylum, but we have a depressingly long way to go.

The author is optimistic that things are improving, and acknowledges that her research is no longer seen as fringe. Let’s hope this book is part of a major culture change, building on the momentum of the best-selling Invisible Women: Exposing Data Bias in a World Built for Men, by Caroline Criado Perez. Her research explored how the same male-centric thinking plays out in the world at large, with women for example 47 per cent more likely to be injured in a car crash because safety features are designed for men.

Feminism is basically the recognition that women are fully fledged humans, not men who went a bit wrong. The fact that medical science still doesn’t quite reflect this, from the way it develops drugs to who it refers for a life-saving scan, creates a queasy feeling that is not hard to diagnose.

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