Healing medicine from its gender bias

THURSDAY, 4 MARCH 2021

A few weeks ago, I was speaking to a friend, and whilst I cannot remember what exactly we were discussing, I can still vividly hear a statement that he casually let out during our conversation:

“But, Sofia, is sexism really a problem that women face in 21st century Europe?”

A third friend who was present, a self-identifying woman, turned to me. An almost telepathic exchange took place between us in the few seconds that followed:

S: do you have the emotional bandwidth to explain?

A: no, but we should.

S: let’s.

And so, we began to repeat what is by now our own mantra, which we are well-versed in sharing when confronted with statements like this one. That yes, we are extremely privileged, and that gender equality has much improved in European countries, but also that in fact, we are still paid less ^[1], cannot always access the same jobs^[2], are almost always scared to walk home at night, and that absolutely, the patriarchy still creates standards for men and women that harm both.

“OK, give me an example!” came the reply.

Here’s five:

“How many times have you, as a man, had to take contraceptives that negatively impact your mood, give you headaches or make you nauseous^[3]? Or that may increase your risk of serious conditions, such as blood clots?^[3]”

“Do you ever worry that the medications you’re prescribed might have been under-tested in bodies of your gender^[4]? Or that there is a dearth of knowledge about conditions that affect your gender, because biomedical research’s fundamental approach is that research on the opposite gender only is ‘good enough’?^[4]^[5]”

“Have you ever been told by a healthcare professional that you likely don’t have a mental health issue, but are rather just a little ‘hysterical’^[6]^[7]^[8]? Probably not, in part because the gender you identify with is not supposed to express pain or emotion.^[9]^[10]^[11]”

“Do you realise that a large majority of medical conditions, from coronary artery disease to irritable bowel syndrome and tuberculosis are investigated and treated more extensively than women – even when the severity of symptoms is the same?^[4]”

“What about the fact that it is thought that 10% of women suffer from endometriosis^[12], yet the average time period between onset of symptoms and diagnosis is between four and eight years^[13]? Can you think of any equivalent disease in men for which this is also the case?

Do not misconstrue me: I love my friend dearly, and do not believe him to be at personal fault for asking his question – in fact, I am glad he did, so that we could discuss it. Nonetheless, I worry that the society we live in wishes to forget – or worse, ignore – that it is not ‘game over’, just because the position of women may have levelled up. Sexism and gender bias still exist, not only against self-identifying women, but also against non-binary and transgender people – who in fact often face more stigma, discrimination and abuse than their cis-women counterparts. But this violence is often implicit and shielded from direct view: it is so systemic, that if we do not pay conscious attention, we forget that it is there.

As the examples above suggest, medicine – the profession in which I am training – is not immune. As medical students, we learn complex physiological calculations based on the body of the ‘standard’ human – namely, the 70kg able-bodied, white and cis male^[5]^[14]. Women, at least fifty percent of our patient demographic^[15], are seven times more likely than men to be misdiagnosed in the middle of having a heart attack^[4]^[5]^[16], simply because trainees are taught only to recognise the signs and symptoms that men characteristically experience^[4]^[5]^[16]. Furthermore, seventy percent of chronic pain patients are women^[16], but over eighty percent of pre-clinical and clinical studies on the condition are carried out on – you guessed it – men^[16]. As a final example, over 30% of transgender people have reported delaying seeking healthcare for fear of discrimination^[17], with those who reported having to educate their own healthcare provider on trans healthcare being four times more likely to delay^[17]. We have a clear-cut diagnosis:

For a profession that is often perceived as noble and humanistic, we are actually in fact all too often depriving those who seek out our help of appropriate diagnoses and treatments, as well as of a dignified experience of healthcare.

Now, what do we do about it? This is where I share my own disclaimer: I am an idealist. I hold onto the belief that the world can be made a more tolerant, kind and safe place than it currently is. And I trust that each of us can make it so, one medical encounter at a time. This is the vision that I share with a not-for-profit, social innovation project that I have been working with for more than one year: Medical Herstory. Our mandate is to “eliminate sexism, shame and stigma from health experiences^[18],” advancing gender health equity. We were born to rewrite the outdated and sterile narratives of medical history, intentionally crafting instead a version of medicine where all will receive the care that they deserve, – and which is actually their human right – no matter the gender or sexuality with which they identify.

Whilst there are no silver bullets to achieve this aim, our medical cabinet is full. The first intervention of our work is to provide a platform where women, trans and non-binary people can reclaim their healthcare story through writing, and we publish their articles on our website. My engagement with Medical Herstory began with taking ownership of my own story of eating disorder recovery; I chose this organisation intentionally as the right one to share my story. Our second remedy is to educate: we run workshops on gender bias for current and future medical professionals, encouraging them to critically reflect on their biases, and act upon them to improve the care they deliver. We couple these with teaching sessions on self-advocacy in the healthcare setting, and in line with our tradition of storytelling, on patient empowerment through writing. Finally, we run an outreach programme: we have partnered with over fifteen organisations to run – to name but a few – an annual Feminist Health research conference; sexual health trivia nights; storytelling sessions; and academic panels on chronic illness, endometriosis, and gender-based violence.

Almost two years into our project, we count over seventy volunteers at twenty universities in seven countries amongst us. Yet, we are just getting started. Medical Herstory will work creatively and innovatively until all have equal access to healthcare and bodily autonomy, in conditions that are free of sexism, shame and stigma. This is the impact we hope to have, such that one day no self-identifying woman will ever again be told that she is hysterical for being in pain; no trans person will have to be afraid of mistreatment from their healthcare professional; and people of all genders will benefit from higher quality, more just care. And maybe, in that day and age, sexism and gender bias will finally be relegated to the history books. Then, and only then, would my answer to my friend’s original question become “why no, thankfully it is not.”

Sofia Weiss Goitiandia is a medical student at Emmanuel College, currently taking one year out of her studies to complete a Master in Global Health at Karolinska Institutet.

Want to get involved with Medical Herstory? You can:

Check us out on social media (Facebook, Instagram, Twitter & TikTok): @medicalherstory
Take a look at our website: medicalherstory.com
Or email us at founder@medicalherstory.com (or sofia.weiss@stud.ki.se if you’d like to contact Sofia, the author of this article, directly)

References:

^[BACK] The gender pay gap situation in the EU [Internet]. European Commission - European Commission. [cited 2021 Mar 3].
^[BACK] The gender gap in employment: What’s holding women back? [Internet]. [cited 2021 Mar 3].
^[BACK] Combined pill [Internet]. nhs.uk. 2017 [cited 2021 Mar 3].
^[BACK] Hamberg K. Gender Bias in Medicine. Women’s Health (Lond Engl). 2008 May 1;4(3):237–43.
^[BACK] Holdcroft A. Gender bias in research: how does it affect evidence based medicine? J R Soc Med. 2007 Jan;100(1):2–3.
^[BACK] Samulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag [Internet]. 2018 Feb 25 [cited 2021 Mar 3];2018.
^[BACK] The female problem: how male bias in medical trials ruined women’s health [Internet]. the Guardian. 2019 [cited 2021 Mar 3].
^[BACK] The feminisation of madness is crazy | Mind your language [Internet]. the Guardian. 2012 [cited 2021 Mar 3].
^[BACK] Patriarchy’s unlikely victims [Internet]. New Internationalist. 2014 [cited 2021 Mar 3].
^[BACK] de Boise S. Boys Don’t Cry? Men, Masculinity and Emotions. In: de Boise S, editor. Men, Masculinity, Music and Emotions [Internet]. London: Palgrave Macmillan UK; 2015 [cited 2021 Mar 3]. p. 45–69.
^[BACK] Why We Should Help Boys Embrace All Their Feelings [Internet]. Greater Good. [cited 2021 Mar 3].
^[BACK] Filby C, Gargett C, Cousins F. 1 in 10 women are affected by endometriosis. So why does it take so long to diagnose? [Internet]. The Conversation. [cited 2021 Mar 3].
^[BACK] Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod. 2003 Apr;18(4):756–9.
^[BACK] Gender Bias in Medicine [Internet]. Harvey MedSoc. 2018 [cited 2021 Mar 3].
^[BACK] Male and female populations [Internet]. [cited 2021 Mar 3].
^[BACK] Kiesel L. Women and pain: Disparities in experience and treatment [Internet]. Harvard Health Blog. 2017 [cited 2021 Mar 3].
^[BACK] Jaffee K, Shires D, Stroumsa D. Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery [Internet]. [cited 2021 Mar 3].
^[BACK] Medical Herstory – Medical Herstory [Internet]. [cited 2021 Mar 3].