The signs are everywhere, and the closer you look, the clearer it becomes that medicine and healthcare are built for men.
From research to diagnosis and treatment, medicine is tailor-made for men's physiologies, and women simply have to make do with a healthcare system made by men for men.
It's much like fitting a circle into a square, it's possible, but it's not quite right. The ramifications of this, however, can be counterproductive and dangerous.
Let's look at what happens when a woman needs medical assistance in this man's world.
Emergency Aid & Man-nequins
A woman, let's call her Hema, is on her way to work.
She feels drowsy and nods off behind the wheel. It only happens for a second, but It's enough for her to crash into the divider.
The collision is so bad that Hema ends up losing consciousness.
Good samaritans pull her out of her vehicle. They call for an ambulance.
In such cases, the first thing to do is to try and revive her by administering CRP or Cardiopulmonary resuscitation. But the bystanders are reluctant to do so because Hema is a woman.
Surveys show that women are nearly 27 percent less likely to receive CPR from bystanders. These numbers are likely higher in India.
Bystanders are less likely to give CPR to women because of societal notions of propriety, and the sexualisation of women's bodies—even when it is a matter of life and death.
Unfortunately, this extends to paramedics as well. It isn't entirely their faults either, CPR dummies are typically of male anatomy, and hesitancy to touch women's breasts comes in the way of women like Hema getting life saving first aid.
To counter this gap, A New York Ad Agency came up with the 'Womanikin', a CPR practice dummy which comes with breast attachments.
Investigating: ‘It’s All in Your Head'
Hema is now in the hospital.
She's been resuscitated and patched up.
"On a scale of 1 to 10, how much pain are you in?" asks the doctor.
"8," says Hema.
But her X-rays, and blood works are clean, so after keeping her under observation overnight, she is sent home.
Days turn into months, and Hema is still in debilitating pain. Another trip to the hospital and she's given the same verdict—all is well. "It's probably stress or anxiety," they say, and she's prescribed some sedatives. It doesn't quite sit right with her.
Hema isn't the only one. Multiple studies and anecdotal evidences show that women reporting pain are less likely to be taken seriously, and less likely to be prescribed painkillers than men.
Women who have endometriosis, for instance, go years before their pain is recognised as a problem, much less diagnosed, because of how painful periods have been normalised.
"The historical hysteria discourse was most often endorsed when discussing “difficult” women, referring to those for whom treatment was not helpful or who held a perception of their disease alternative to their clinician," writes Public health researcher, DR Kate Young in a 2018 paper published in the journal, Feminism & Psychology.
Diagnosis: 404 Symptoms Not Found
Hema goes home and does some googling.
Turns out that the gender gap when it comes to recognising women's symptoms and getting a diagnosis is so stark that there's a name for it.
Women often present different symptoms of heart attack than men, and because heart attack studies have all been predominantly focused on men's physiological symptoms, they often go ignored.
This is called the Yentl syndrome.
This is one of the reasons why women are more likely to die from heart attacks even though the occurrence of heart attacks is rarer in women than in men.
And it extends to the diagnosis of other illnesses as well.
Medicine and Therapy
Finally, after some hospital hopping, Hema is diagnosed with Complex Regional Pain Syndrome, a chronic pain disorder caused by nerve damage.
She is prescribed some analgesic drugs.
But her woes don't end there.
Her periods become irregular, she feels nauseous, drowsy and gets hot flashes, and the pain isn't any better. She's confused.
She goes back to her doctor who asks her to discontinue these meds. "We can't be sure, but you may be having a reaction to them," he says.
Why does this happen?
According to a study conducted by the University of California, Berkley, women experience adverse drug reactions (ADRs) from medications nearly twice as often as men.
This is because clinical trials have historically focused on men.
The resulting gender gap in medical drugs is seen most commonly in painkillers, but also a string of other lifesaving medicines like antidepressants, anti-psychotics, cardiovascular, and even anti-seizure drugs.
It Starts with Clinical Research
This bias in clinical research begins, consciously or unconsciously, even before human trails are undertaken.
An article published in the Guardian brings to lights how male mice are preferred for animal trials of medical research, even when studying women's conditions.
While nearly 70 percent of those with chronic pain disorders are women, 80 percent of pain studies are conducted on male mice or human men.
Their reason? Hormonal fluctuations in female mice, they say, make the results interpretable.
This is counteractive to scientific evidence and the reason why so many medicines end up causing 'unforeseen' side effects (sometimes even fatality) in women after the medicines have been rolled out.
In a previous article, FIT looked at how this bias pervades vaccine research even today, wherein pregnant and lactating women are systematically shut out of trials.
There are also no answers to how the vaccines affect women's menstrual cycles, hormones, immune systems or why it is mostly women who are developing DVT (Deep Vein Thrombosis) after vaccination, simply because it was just never studied.
Rewind: Back To the Accident
Hema's doctor asks her for a history of the medicines she had been taking.
The only thing she'd taken was a prescribed sleeping pill the night before. Her doctor thinks that might have caused the accident. It wasn't uncommon.
The US FDA reccomends the dosage of insomnia drugs be cut to half for women citing the risk of next-day impairment, and as a result a higher instances of drug-induced car accidents in women.
This, more than 20 years after these drugs were green lit.
The dosage for most medicines, including painkillers and sleep medication are, once again, determined based on studies conducted on men. Which means women, especially ones with lower body mass end up over medicated, with most of these drugs staying in women's bloodstream way longer than in men.
But, things can be turned around with more cognisance to the physiological differences between males and females in clinical research, and with conscious steps to close the gap.
"If we don't take the necessary step to generate this data, —obviously with the utmost field care—we'll continue to be caught in the trap of not having enough evidence," says Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University to FIT.
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