An article by our Culture Editor, Chloe Lawson, examining the inherent misogyny in medical research and exploring the very real and dangerous impact of ignoring half the population.
Image description: Depicting two figures, one male and one female, this work articulates the presence of power hierarchy and discrimination. The graphic and abstract application of the paint echoes ideas of anatomy and inner emotion, whilst the dark setting amplifies the sharp lines and colour. Although Capucine’s original concept for this work was not informed by a medical background, she believes in a flexible interpretation for art work for anyone who comes across it. Broken pieces’ (as part of a self-portrait series), Capucine Leclere, 2018. Acrylic and oil on canvas / red vinyl stickers cut-outs. 33cm x 46cm.
Since the time of the ancient Greeks, women were believed to simply be “mutilated males” with an added dose of hysteria. In previous centuries, women who were found to be making too much of a fuss were thrown into asylums, given clitoridectomies or lobotomies and that was that (Criado Perez, 196). This is perhaps not a surprising view for thousands, or hundreds, of years ago and one would hope that doctors and medical researchers today find this laughable. However, far too often this is still the case, if not demonstrated to such extremes. Inequalities persist in the medical world which can have life-altering and sometimes fatal consequences for women around the world. In her book Invisible Women, Caroline Criado Perez illustrates, “a medical system which, from root to tip is systematically discriminating against women” for both mental and physical health (Criado Perez, 196).
One remnant of Greek medical theory is that women are essentially treated as variations of men, with a sprinkling of additional hormones thrown in the mix. The male body is viewed as the standard, meaning that medical testing and the understanding of diseases is based around this assumption. This obscures how drugs and symptoms of disease (for example, heart conditions) may affect men and women differently (The Economist, 2021). Although researchers have found sex differences at a cellular level, and in the fundamental workings of organs like the heart, medical trials do not reflect these findings (The Economist, 2021). Women are more likely to have severe reactions to vaccinations, to the extent that some researchers have suggested female-specific vaccines (Criado Perez, 199). Yet, there is a distinct reluctance to include women in many studies, with some weak claims that women are harder to source for medical research due to caregiving responsibilities. Additionally, a few researchers refuse to include women due to the ‘complications’ that the hormones at different stages of the menstrual cycle can cause (Criado Perez, 222).
The resulting lack of knowledge about how women's bodies react and respond to different diseases and their treatments is dangerous. It can lead to misdiagnosis or lack of diagnosis altogether. Many young women will not suffer chest pain during a heart attack but experience other symptoms such as nausea, stomach pain or fatigue (Criado Perez). This is problematic not only because these are common symptoms of PMS and may be dismissed by the woman herself but could also lead to dismissal by medical professionals as the patient does not exhibit the stereotypical behaviours of a heart attack. This could be fatal.
Aside from physical health, there is significant evidence showing that symptoms of mental illnesses are divergent in women and therefore missed by medical professionals. The common belief is that autism is 4x more common in boys than girls but recent research has found that female socialisation patterns may mean that young girls simply mask their symptoms more effectively (Criado Perez, 222). Similarly, it is believed that three-quarters of girls with ADHD remain undiagnosed because they rarely display stereotypical hyperactive behaviours, and the condition manifests itself in other ways such as being more introverted and scattered (Criado Perez, 223).
In terms of pregnant women, there is next to no data about the increased risk of disease for mothers and their unborn children. For obvious reasons, pregnant women are often reluctant to take part in medical trials. However, that seems a trivial reason for medical researchers to just stop researching this group. During pandemics and epidemics such as SARS or Swine Flu, where pregnant women were significantly at risk, there was an opportunity for the effects on pregnant women to be studied without clinical trials and yet this was missed. I would hazard a guess and say that the same goes for the current pandemic. Pregnant women have long been misunderstood by medical research. The infamous thalidomide scandal in the 1960s is one example. The drug was used because the researchers had found that they could not “find a high enough dose to kill a rat” and it was therefore deemed safe (Criado Perez, 201). It is reported to have resulted in 10 000 miscarriages, stillbirths and infant deaths in Britain (The Guardian, 2016). The scandal resulted in increased regulations for drug and vaccine approval, but it is an example of a misunderstanding about drug use on pregnant women (Kingsland, 2020). In the present day, drugs with dramatic side effects are still used to treat pregnant women. Relaxin is a hormone used during labour to loosen women's hips and makes the birthing process easier. However, it lingers in women's bodies for up to a year and makes them more prone to injury (The Economist, 2021).
Obtaining the funds for studies or technologies that specifically aim to improve the lives of women (as opposed to all humans) is a considerable challenge when faced with boards of balding white men who dismiss the existence of a market for such things. According to the Royal College of Obstetricians and Gynaecologists, less than 3% of overall medical funding in the UK is focused on women-specific afflictions (Endometriosis UK, Instagram).
A frustrating example cited by Criado Perez is a 2013 study into the alternative effects of sildenafil citrate (otherwise known as Viagra). The drug was found to allow for over 4 hours of pain relief with little to no side effects, therefore being a godsend to the 90% of women who suffer from dysmenorrhea (period pain). However, funding ran out on the project, and multiple attempts to raise money have been rejected due to its reviewers failing to see the priority. Additionally, pharmaceutical companies are reluctant to do tests which may result in a potential loss of male customers if the drug was marketed for women (Criado Perez, 230). Yet, erectile dysfunction affects only 5-15% of men, compared to the 90% of women who have to endure pain “almost as bad as a heart attack” every month (Criado Perez, 230).It seems illogical.
There have been some recent slithers of hope, with the rise of ‘Femtech’ businesses- projects such as period tracking apps, created to help women tackle sex-specific health concerns. The market value of this area is forecasted to rise from $22.5 billion in 2020 to $65 billion by 2027 (The Economist, 2021). However, it seems strange that it has taken this long for the world to realise the size of this potential market. According to the Economist, women are 75% more likely than men to use technology for health purposes, and yet there are still powerful voices claiming that there isn’t a market (The Economist, 2021).
Another example to highlight is the few effective treatments offered for Endometriosis - a disease resulting in womb tissue growing elsewhere in the body (Criado Perez). This condition is considered one of the 20 most painful diseases in the world and affects 10% of women according to the charity Endometriosis UK (Endometriosis UK, Instagram). Currently, it takes on average 8 years to receive a diagnosis in the UK and 10 years in the US (Criado Perez, 224). Several MPs have expressed the opinion that if this condition affected 10% of men, then there would be no question of more research and looking at the amount of research into erectile dysfunction, this is not hard to believe.
There is a long way to go. While it would be natural to assume that if women make up half the population, then they should be able to trust what their doctor is telling them, it is clear that there is a significant misunderstanding of the female experience, and no obvious movement to change that fact. Women often have to fight against first, second and third opinions to find out what is wrong with them, while being told they're not ‘actually ill’ and that ‘it’s all in their head’. Their pain is dismissed as emotional or a result of anxiety, which may go some way to explain why so many more women are prescribed antidepressants than men. The idea that women are ‘too emotional’ is something that should have been left behind in the last century. Yet, this assumption still floats around in the minds of some researchers and medical professionals. The very people we rely on to deliver we depend on to deliver objective and reliable diagnoses.
References:
Criado Perez, Caroline. Invisible Women: Exposing Data Bias in a World Designed for Men. London: Vintage. 2020.
Endometriosis UK. 2nd November 2021. ‘The UK parliament debate on endometriosis’. Endometriosis UK.
‘Girls Uninterupted’. The Economist. 16th October 2021. https://www.economist.com/business/2021/10/16/femtech-firms-are-at-last-enjoying-an-investment-boom
The Guardian. March 2016. https://www.theguardian.com/society/2016/mar/06/thalidomide-caused-up-to-10000-miscarriages-infant-deaths-uk [accessed 09/11/2021].
Kingsland, James. ‘How the Thalidomide scandal led to safer drugs’. Medical News Today, 15th December 2020. https://www.medicalnewstoday.com/articles/how-the-thalidomide-scandal-led-to-safer-drugs
About the artist:
Capucine Leclere from Marseille, France. Currently studying BA intermedia Art at the Edinburgh College of Art. Her practice aims to explore human relationships to memory and intimacy. She like to experiment with various media and processes, such as printmaking, painting, sculpture, and video.