Gender disparity is nothing new. From wages, where women earn 77 cents to every dollar a man earns to housework, with women doing most of the cleaning and childcare, there has long been inequality in several different areas. There is one area of inequity that can prove to be fatal, however: healthcare. Across the board, women are treated differently when it comes to diagnosis and treatment. Here’s how.
One in five people in the U.S. are living with chronic pain conditions, and this is one area in which women are the larger percentage. Nearly 22% of women report living with a chronic pain condition as opposed to just over 16.2% of men. Women are much more likely to suffer from fibromyalgia at a rate somewhere between four and seven times that of men, depending on a variety of factors. Michael Moskowitz, MD, assistant clinical professor for the department of anesthesiology and pain medicine at the University of California, Davis and a board member of the American Pain Foundation had this to say about the difference:
“The statistics are startling in some conditions like fibromyalgia — women are so much more likely to have fibromyalgia than men are. When you look at that, it only makes sense that something biological is occurring here.”
Researchers have speculated about why women are diagnosed with pain conditions more than men, believing that a combination of hormones, brain chemistry, societal influence, and genetics may play a part. Proving this through medical research, though, is another part of the problem.
Researchers tend to favor men in their studies, leaving women out in all areas of treatment and diagnosis. This can result in medicines that are effective for men but less so for women. Even in animal studies, researchers tend to use male animals instead of female animals. A study published in Neuroscience & Behavioral Reviews found that in 2009, male animals were used in 80% of the almost 2,000 published animal studies. Researchers also chose fewer than 45% female animals in studies of depression, despite the fact that women are twice as likely to suffer from depression as men.
The same bias occurs in clinical trials. In 2006, women made up fewer than 25% of patients in 46 clinical trials conducted in that year. This may be the lingering aftereffects of a ban on using women of child-bearing age that was enacted by the U.S. Food & Drug Administration from 1977 to 1993, but instead of simply banning women who were likely to become pregnant, the ban included those women who were not sexually active or who were gay and thus unlikely to become accidentally pregnant. For 16 years, women disappeared from clinical trials, and in this time, 1,514 new drugs were approved, with the clinical groundwork laid for many more in the years to come.
So what does this mean for the treatment of women’s health issues?
Less effective (and more dangerous) drugs for women
In a study released by the U.S. Government Accountability Office in 2001, eight of every ten drugs pulled from the market due to safety concerns were pulled specifically due to health risks and safety concerns for women.
Women metabolize medications much differently than men, in part due to increased body fat and in part due to different biology altogether. Because of this, dosing requirements for each gender may vary wildly, but dose is usually based on age. For example, women may require less of a medication but still be given an amount calibrated to a man’s biology and general needs. Women require half the amount of flu vaccination needed for men for it to be effective but are routinely given a full dose.
Pain treatment for women
With regard to pain, women of every age, race, and income level are prescribed opioids at a higher rate than men and experience higher levels of addiction and overdose, including an alarming 127% increase in opioid dependence among pregnant women since 2000. This increase in the use of painkillers among women of child-bearing age doubles the risk of birth defects and increases the chances of maternal complications before, during, and after childbirth.
Women may report feeling pain more intensely than men, which could account for higher levels of opioid prescriptions for women, but they also appear to be able to cope with pain better than men. Women tend to seek healthcare sooner than men, and they also tend to cope by eliciting support from family and friends. The latter strategy can backfire in the case of chronic pain, where long-term emotional and physical support is needed, but many studies prove the efficacy of a strong support system in coping with chronic pain.
But even before treatment there needs to be a diagnosis, and women’s pain is often overlooked.
A review of research by the American Society of Anesthesiologists found that not only were women in pain often undiagnosed, but they were also improperly and harmfully treated. While male soldiers are often treated for phantom limb pain, a real neurological condition that occurs when the nerves continue to send painful stimuli from the missing limb, women who experience the same type of pain after mastectomy are often ignored.
Donna-Ann Thomas, M.D., a member of ASA’s Committee on Pain Medicine recognizes that this is a gender-specific issue:
“It’s fairly clear-cut when someone has phantom pain after a limb amputation, but it’s often overlooked when a woman has the same pain after a mastectomy or lumpectomy and she suffers unnecessarily.”
Increasing the focus on women’s healthcare is a crucial, basic human right for women. This includes increased research on issues such as reproductive rights, maternal health, mental health, and conditions that primarily affect women, such as fibromyalgia. This lack of attention to women in clinical research and trials combined with lack of diagnosis and improper medication is an international issue that affects every aspect of the world we live in.
In many ways, equal medical treatment can start with a simple conversation between you and your doctor. This issue affects men and women. How can you support the conversation on equity in medicine for men and women?
Image by Thomas Leuthard via Flickr