‘This is a man’s world,’ first sang James Brown in 1966, but, apparently, ‘it would be nothing without a woman or a girl’. A soulful classic from Brown, but his sentiment falls flat on me; I think of myself not as an enriching adjunct to a more important man’s life, but a human being of equal value. I feel incredibly lucky to live in the UK, where, generally, we are moving closer to gender equality, and where healthcare systems are not prejudiced. Man or woman—both can walk into a health service and expect equivalent care. But I might be wrong.
It doesn’t always pay to be a woman. Women are more likely to be abused and mistreated in a way that makes them more vulnerable to illness and death1; to have difficulty obtaining education and work, which may affect their accessibility to healthcare2; and to have their symptoms misdiagnosed or their pain undertreated.3
Gender inequity is inherent in medicine too: the drugs you take and prescribe have often been tested largely on men, and the results of these trials have later been applied to women. Most recently, the US Food and Drug Administration (FDA) approved the safety of a drug for female sexual dysfunction based on a trial of 23 men and two women. It’s not just the obvious anatomical differences between the sexes that make these extrapolations erroneous; differences in physiology mean women may metabolise particular drugs differently, and at different rates. Prescribers will be aware of the phrase ‘children are not just small adults’, says Alyson McGregor, co-founder of the Sex and Gender Women’s Health Collaborative, but it may not always be in mind that ‘women are not just men with boobs and tubes’. But between 1997 and 2001, 80% of prescription drugs were pulled from the American market because of greater side effects in women—why are we discovering these adverse effects in women only after the drugs have been approved? Historically, there have been concerns about women of child-bearing age being involved in clinical research, so in 1977 the FDA banned these women from participating in early-stage trials. The ban was not revoked for another 16 years, when we realised we didn’t know how these drugs could affect women.
Things change slowly in medicine, but this bias is present even in the fast-moving, forward-thinking tech industry, whose apps and wearables we are increasingly relying on to monitor our health and fitness. In 2014, Apple launched its HealthKit for iPhone, which can track everything from heart rate to the nearest microgram of molybdenum intake, but there was no functionality to monitor menstruation or fertility—bad news for the large proportion of their consumers who bleed for four days every month. Apple has atoned for its oversight with the launch of its newest operating system, which allows users to track their reproductive health, and there are now hundreds of similar apps created by independent developers available to download.
Traditional healthcare ought to follow suit. There has been a lot of talk about personalised medicine and individualised care, but let’s not run before we can walk—we must guarantee safe and effective care for at least 50% of our population first.
1. World Health Organization (2009) Women and health: Today’s evidence, tomorrow’s agenda. http://tinyurl.com/zvqk383.
2.Namasivayam A et al (2012) The role of gender inequities in women’s access to reproductive health care: A population-level study of Namibia, Kenya, Nepal, and India. Int J Womens Health 4: 351–64.
2.Hoffman DE, Tarzian AJ (2001) The girl who cried pain: A bias against women in the treatment of pain. J Law Med Ethics 29(1): 13–27.
This article was first published in the March 2016 edition of Nurse Prescribing.