“It took 12 years for Michelle to receive a diagnosis.”
The first sentence of a chapter in Caroline Criado Perez’s Invisible Women immediately struck a chord with me. It wasn’t just because of the similarity in name, but because that sentence just about sums up my experience in dealing with the medical field. The chapter goes on to say, “It’s hard to read an account like this and not feel angry with the doctors who let Michelle down so badly.” In an article published in December’s AMP issue, I expressed a similar sentiment. Doctors really have let me down pretty badly. This article, however, is less about my sentiments on the matter and more about the systems which cause these issues in medical practice, particularly for women.
The first way to systematically ensure that women are receiving poorer treatment than men is training doctors to study that all bodies as though they operate like the cis male body. In Ancient Greece, the cis male body was been considered the default, while the different aspects of the cis female body were simply deviations from the norm. Essentially, the dominant mode of thinking approached the male body as the ideal while treating the cis female body as a depature from said ideal. While no self-respecting medical professional today would continue to endorse this view, the concept of the “neutral” human body being the male body is still pervasive within the medical profession. According to a 2008 ScienceDaily research report, most medical diagrams, even when demonstrating gender-neutral body parts and systems, depict cis men bodies as the norm. From sitting in various doctors’ offices throughout my life, I had a solid idea what the penis looked like from a young age, but had no clue where my own vagina was until I was 13. When listing symptoms of diseases and injuries, medical literature rarely acknowledges that cis women often experience dramatically different symptoms than men. For example, cis women typically don’t feel the excruciating chest pain that men do during a heart attack. Dr. Nieca Goldberg, medical director for the Joan H. Tisch Center for Women’s Health at NYU’s Langone Medical Center, states that cis women usually experience “shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue.” Because these symptoms are not typically associated with heart attacks, cis women are more likely to associate their symptoms with more harmless causes, such as acid reflux or the flu. This leads to more cis women suffering with heart attack symptoms for longer and failing to get the time-sensitive medical care that they need. Doctors are continually trained to treat all patients as if they were cis men, regardless of the nuances that sex and gender present. A Dutch study in 2005 as well as an Academic Medicine study in 2006 both agreed that the medical-school curriculum is very lacking in addressing the biological differences present between the male and female bodies. This issue definitely isn’t helped by the fact that a significant majority of medical professionals are cis men.
The second way that medicine reduces the quality of treatment for women is to not include them in important clinical trials and studies. A major reason that sex-specific information is lacking in medical textbooks is thatcis women themselves are frequently left out of medical research. The International Journal of Cardiology states that the reason textbooks tend to only address the male symptoms of a heart attack even though cis women often have very different reactions is because in all cardiac research since 1987, only 25% of the participants have been female. Additionally, the Journal of Acquired Immune Deficiency states that while women make of 55% of HIV positive adults, they have only made up 19.2% of participants in related retroviral studies. Therefore, whatever information arises from these trials becomes influenced by the skewed proportion of male to female participants and medical professionals are thus ill-equipped to address the unique issues faced by cis women. This becomes most apparent when addressing how pregnant women are treated within the medical field. Since most clinical trials exclude pregnant women from their studies, many doctors actually don’t know how to actually treat many illnesses in pregnant women. Although many pregnant women may opt out of certain trials due to the difficulties that may entail, that doesn’t mean they should be excluded from research altogether. In fact, it’s necessary to track how diseases affect pregnant women so that they can be treated properly. As a vulnerable section within the community, pregnant women should be considered all the more, which is something that the current set up of medical research fails to address.
Women researchers have tried to address this absence of cis women within medical research but have received so much pushback that makes progress often seems impossible. When applying for research grants, women like Johns Hopkins University professor Dr. Sabra Klein are often told to “stop focusing on sex and start focusing on science,” or that “biological difference doesn’t matter.” Claiming that studying biological differences is a waste of money because it’s too logistically difficult to include multiple sexes in research prevents research that finds information that’s equally useful to both cis men and women. Medicine should work to benefit the most people possible and this cannot be done with the information gained from studies mainly concerning cis men.
The third way cis women become entirely disregarded in the medical field is to completely ignore the evidence provided by science. Even within body systems commonly considered mutual between male and female bodies, differences have been found in every single tissue and organ in the body and in nearly every major disease between male and female bodies. For example, cis women and men react differently to vaccines, a fact that I had never once had a doctor inform me of before receiving my flu shot. This lack of nuance can have more dangerous effects rather than just failing to share information about a vaccine. For example, every doctor I have seen regarding my recent stroke has initially ignored the possibility that I was having a stroke because my symptoms “didn’t match the norm;” however, as previously addressed, symptoms between male and female bodies express themselves differently. By using the male body as the “norm” for addressing symptoms, cases such as mine may arise and prevent timely treatment from reaching those who may need it.
Doctors also continue to prescribe the same preventative medications to women and men. People at risk of a heart attack or stroke are most often placed on an aspirin regimen to prevent clots, yet recent studies such as one in the New England Journal of Medicine have shown that while this is an effective tactic for men, it is ineffective or even harmful to women. Even if a doctor is well-trained enough to recognize the difference in symptoms between male and female bodies, they still often treat the illness in the same manner in spite of the differences in how different sexes reacts to similar treatments for a particular disease.
And lastly, this discrimination continues by pretending that there is no problem to begin with. In spite of recent evidence proving otherwise, there’s an abundance of male medical professionals who still argue that there is no difference between male and female bodies or that these differences are adequately addressed in the latest research. However, this argument falls apart when looking at how multiple drug trials are generally conducted. While Phase Two and Phase Three may contain nearly equal parts women and men, Phase One almost always contains a significantly greater ratio of men to women. Although at face value, the end phases may look like they are the more important ones since they must be passed through in order to put a medication on the market. However, Phase One actually is important due to the fact that it’s when most medications are ruled out based on effectiveness. The most significant side effect that women experience from drugs is that they simply don’t work. In 2002, the FDA demonstrated that there are “statistically significant differences between men and women in bioqeuivalence for most generic drugs.” When Phase One is relying on mainly men, then there’s the potential for many medications to be ruled out because they simply don’t work on most cis men even if there’s the chance that they would have a significant positive impact on a woman’s quality of life.Rather than being lazy and appealing only to their own misogynistic interests, pretending that cis women and men are biologically equal when it suits their desires, or ignoring the problem whatsoever by stating there is no inequality in the research done for men and for women, medical professionals need to pay due heed to these differences and address them if they want to have any chance of doing their job properly. These nonchalant attitudes toward a significant problem are costing human lives and it needs to be addressed. We need more cis women doctors who understand that what they learn in medical school isn’t always accurate for them, and we need more cis men doctors who acknowledge that they aren’t superior, and that they have to consider a wider understanding of how sex influences health. We need medical schools to actually require courses on female biology so that all doctors are more knowledgeable about the differences. I am tired of my needs being neglected or mistreated just because people in charge choose to ignore science or manipulate it and because I happen to be on the “wrong” end of it. And pretty much every other woman with a chronic illness has likely felt the same.
Michelle Patten (sophomore | mathematics)
The end result of when the integers decided to climb rocks.