In 2013, the The U.S. Food and Drug Administration has made an unprecedented recommendation: Women should be given a lower dose of the insomnia drug zolpidem than men. The rationale for this recommendation was that the drug appeared to affect women for longer periods, which could become a safety issue.
However, in 2019, research conducted at Tufts University concluded that the differential effect of the drug had Nothing to do with sexInstead, the researchers found that it was their body size that determined how quickly a person eliminated the drug from their system. The report concluded that the reduced dose prescribed for women could, in fact, lead to an underdose and a failure to effectively treat insomnia. “They were using sex as a proxy for body size because we tend to collect data on sex; we don’t collect data on body size,” says Angela Saini, author of The Patriarchs: How Men Came to Rule“This is the perverse way medicine sometimes works: you base your diagnoses on the data you have rather than the data you need.”
In fact, Saini argues that many of the prevailing 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 gender and health, those simple explanations often don’t exist,” she said.
Of course, there are gender differences in aspects of health, such as reproductive health and physiology. What research indicates, however, is that in most cases, health-related differences between men and women – from disease symptoms to the effectiveness of medications – are fairly marginal. “The differences that do exist are due to gender,” says Saini. “Differences in the way people are treated and how people are thought about and the assumptions we make about them.” That, according to Saini, is what explains many of the failures when it comes to women’s health.
Consider, for example, the common misconception that women have atypical heart attack symptoms, different from men. This prevailing myth was debunked by a 2019 StudyThe study, which involved nearly 2,000 patients, was funded by the British Heart Foundation at the University of Edinburgh. The research, which involved nearly 2,000 patients, showed that 93 per cent of both sexes did in fact report chest pain – the most common symptom – while a similar percentage of men and women (nearly 50 per cent) also felt pain radiating down the left arm. “The problem of underdiagnosis of women is because healthcare professionals and even women who are having a heart attack themselves believe that heart attacks are something that mainly happen to men,” says Saini. Estimates suggest that differences in care for women have led to around 8,200 preventable deaths due to heart attacks in England and Wales since 2014.
“It’s not about men discriminating against women, but often it’s about women not being heard, sometimes by other women,” she says. Another example that clearly illustrates how gender can affect health outcomes came from a study 2016 Canadian Study The study found that patients who had been hospitalised for acute coronary syndrome had higher recurrence rates because they played gender roles stereotypically associated with women (such as doing more housework and not being the main breadwinner), regardless of whether they were men or women. “This was because people who played a feminine social role were more likely to be anxious,” says Saini.
If these disparities are caused by the way patients are perceived and treated, the solution, for Saini, is clear: “We have to be careful to diagnose the problem where it is, not where we imagine it to be.” He highlights the successful work of Jennie Josea British midwife who, in 2009, founded the Commonsense Childbirth School of Midwifery in Orlando, Florida, to support women without access to maternal health care. Research has shown that black mothers, in both the US and the UK, are three times more likely to die than white women.
“Joseph reduced 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 cannot allow our biases and prejudices to get in our way.”
This article appears in the July/August 2024 issue of WIRED Magazine from the UK.