In 2013 year The U.S. Food and Drug Administration issued an unprecedented recommendation, recommending that women take a lower dose of the insomnia drug zolpidem than men. The rationale was that the drug seemed to affect women for a longer period of time, which could become a safety issue.
However, in 2019, a study conducted at Tufts University showed that the drug had a varied effect nothing to do with sexInstead, the researchers found that what determines how quickly a person clears the drug from their body is their body weight. The report finds that the reduced dose prescribed to women may actually lead to underdosing and failure to effectively treat insomnia. “They used sex as a proxy for body weight because we tend to collect data on sex; we don’t collect data on body weight,” says Angela Saini, author of the study. Patriarchs: How Humans Came to Rule“That’s the perverse way medicine sometimes works: You base your diagnosis on the data you have, rather than the data you need.”
Indeed, Saini argues that many of the common gaps in health outcomes between men and women have nothing to do with biological sex. “It can be very tempting for scientists to look at a gap and want to find a simple biological explanation for it, but when it comes to sex and health, those simple explanations often don’t exist,” she said.
Sure, gender differences exist in aspects of health, such as reproductive health and physiology. But research suggests that in most cases, the health differences between men and women—from disease symptoms to the effectiveness of medications—are really quite marginal. “The differences that do exist are gender differences,” says Saini. “Differences in the way we treat and think about people and the assumptions we make about them.” Saini says that this explains much of the failure of women’s health.
Consider, for example, the common misconception that women have atypical heart attack symptoms that are different from men. This prevalent myth has been debunked by 2019 studyFunded by the British Heart Foundation, at the University of Edinburgh. The study, which involved almost 2,000 patients, found that in fact 93 per cent of both sexes reported chest pain – the most common symptom – while a similar proportion of men and women (almost 50 per cent) also had pain radiating down the left arm. “The problem of underdiagnosis in women is that healthcare professionals, and even women who have heart attacks themselves, believe that heart attacks mainly happen to men,” says Saini. Estimates suggest that differences in care for women have led to around 8,200 preventable deaths from heart attacks in England and Wales since 2014.
“It’s not that men discriminate against women; it’s often that women aren’t being listened to—sometimes by other women,” she says. Another example that clearly illustrates how gender can affect health outcomes comes from 2016 Canadian study about patients hospitalized with acute coronary syndrome. Studies have shown that patients who had higher rates of recurrence were those who engaged in gender roles stereotypically associated with women — such as doing more housework and not being the primary breadwinner — regardless of whether they were male or female. “That’s because people who are female in society are more likely to experience anxiety,” Saini says.
If these discrepancies are due to the way patients are perceived and treated, the solution is clear to Saini: “We need to be careful to diagnose the problem where it is, not where we imagine it to be.” She highlights the successful work Jennie JosephBritish midwife who founded the Commonsense Childbirth School of Midwifery in Orlando, Florida, in 2009 to support women without access to maternal health care. Studies have shown that black mothers, in both the US and the UK, are three times more likely to die than white women.
“Joseph has lowered maternal mortality rates among minority women simply by improving the quality of their care, listening to their concerns and responding when they say they are in pain,” Saini says. “We don’t need technology to solve this problem. We simply can’t let our prejudices and biases get in the way.”
This article was published in the July/August 2024 issue of the journal Czasopismo. WIRED UK Magazine.