Gendered medicine: A matter of life and death

International Women’s Day on March 8 was a significant milestone for gender equality. It followed hot on the heels of the #MeToo movement and the conviction of its flagship offender; as well as a general groundswell of change stirring around the globe.

But in the world of medicine, it seems we’re still operating in a gendered time warp.

According to ​​Dr Alyson McGregor, associate professor of emergency medicine at Brown University in the US, medical science over the past century has been based on only half the population. The male half…

Health Issues CEO Danny Vadasz says this gender imbalance can be deadly, leading to a raft of problems for female patients. This includes misdiagnosis or delayed diagnosis, inappropriate prescribing and treatment, and poor patient education about risk factors, symptoms and management.

Systemic sexism

The medical profession self-reports a gender imbalance at every stage of medicine, from research, to diagnosis, to treatment – even determining the correct dosage of medication.

“Drug companies have historically excluded women from research, partly on the basis that endocrine fluctuations throughout different stages of their lives – including puberty, pregnancy and menopause – make it difficult to produce consistent results,” he said.

“In a 2014 report, researchers at the Brigham and Women’s Hospital in Boston noted that women were excluded from the earliest stages of research, hampering ability to identify differences that could benefit the health of everyone.

“Despite this, we know women’s bodies are very different to men’s in ways that go far beyond merely sex organs. For example, they metabolise drugs very differently and this can have serious consequences if what we refer to as ‘adult’ doses are actually standard male doses.”

Mr Vadasz said the sleeping pill Ambien was a case in point. The US Federal Drug Administration cut the recommended dose for women in half in 2016 in response to research showing that women metabolise the drug differently.

“Women reach maximum blood levels of Ambien 45 percent higher than those of men, so they were more likely to wake up the next day with levels of the drug in their bodies that could impair driving a vehicle,” he said.

“Women also experience a range of unexpected side effects as a result of taking doses that are designed for a man potentially twice their size and with higher muscle mass.”

 Frontline inequity

Mr Vadasz said change was happening slowly but differences the treatment of women continue and are also present in emergency care and hospital treatment – including the way we define symptoms, which can have deadly consequences.

For example, women are more likely to present with “non-typical” heart attack symptoms than men, causing delays in recognising they need help and presenting to the emergency room.

“We talk about ‘typical heart attack symptoms and we’re referring to tightness in the chest, pain radiating to the upper body and arms and sweating,” Mr Vadasz said.

“Women are more likely to have ‘non-typical symptoms like shortness of breath, weakness, nausea or vomiting, dizziness, back pain and unexplained fatigue.

“The question then becomes, how much should we be characterising these as ‘typical’ symptoms versus ‘typical men’s symptoms’? And are we over-emphasising the promotion of these symptoms as heart attack indicators in educational literature and putting women’s lives at risk?”

Troublingly, the Australian Heart Foundation says that on arrival in hospital, women are also less likely to receive life-saving treatment like angiograms, bypasses and stents.

“A woman in 2020 has a right to expect that she can walk into a GP’s surgery or hospital and receive treatment that is appropriate to her – or at the very least, not harmful,” Mr Vadasz said.

“But unfortunately, systemic inequities in the way we manage women’s health still exist and they are putting women at risk.

“These clearly track back to historical rather than contemporary causes but perhaps its time for a #MeToo revolution in healthcare. Women have their own unique physiology – they’re not simply small men – and for safety’s sake, we need to stop treating them that way.”