In 2013, the The U.S. Food and Drug Administration (FDA) has issued an unprecedented recommendation that women receive a lower dose of the insomnia drug zolpidem than men. The reason was that the drug appeared to affect women for longer periods of time, which could pose a safety concern.
However, in 2019, a study conducted at Tufts University concluded that the differential effect of the drug had nothing to do with gender. Instead, researchers found that what determined how quickly a person eliminated the drug from their system was their body size. The report concluded that the lower dose prescribed to women could actually lead to underdosing and failure to effectively treat insomnia. “They were using gender as a proxy for body size, because we tend to collect data on gender; we don’t collect data on body size,” says Angela Saini, author of The Patriarchs: How Men Came to Power“That’s how medicine sometimes works perversely: you base your diagnosis on the data you have rather than the data you need.”
Indeed, Saini says, most health gaps between men and women have nothing to do with biological sex. “Scientists may be tempted to look for a simple biological explanation for a gap, but when it comes to gender and health, those simple explanations often don’t exist,” she said.
Of course, gender differences exist in some areas of health, such as reproductive health and physiology. But research suggests that for the most part, health-related differences between men and women—from disease symptoms to the effectiveness of medications—are actually quite marginal. “The differences that exist are gender-related,” Saini says. “Differences in how people are treated and viewed and the assumptions we make about them.” That, Saini says, is what explains many of the failures in women’s health.
Take for example the common misconception that women have atypical heart attack symptoms, different from men. This common myth was debunked by a 2019 study funded by the British Heart Foundation at the University of Edinburgh. The study, which looked at nearly 2,000 patients, found that in fact, 93% of both sexes reported chest pain – the most common symptom – while a similar percentage of men and women (nearly 50%) also experienced pain radiating from their left arm. “The problem of underdiagnosis in women is that healthcare professionals and even women themselves who have a heart attack think that heart attacks are mainly men,” says Saini. Differences in care for women have led to an estimated 8,200 preventable deaths from heart attacks in England and Wales since 2014.
“It’s not about men discriminating against women, but rather about women being indifferent, sometimes by other women,” she says. Another example that clearly illustrates the impact of gender on health comes from a 2016 Canadian study of patients hospitalized with acute coronary syndrome. The study found that patients who had higher rates of recurrence were those who assumed stereotypical female roles, such as doing more housework and not being the primary breadwinner, regardless of whether they were male or female. “This is because people who assumed a feminine social role were more likely to be anxious,” Saini says.
If these disparities are due to how patients are perceived and treated, the solution, Saini says, is clear: “We need to make sure we diagnose the problem where it is, not where we imagine it.” She points to the successful work of Jennie Joseph, a British midwife who founded the Commonsense Childbirth School of Midwifery in Orlando, Florida, in 2009 to help women who lack access to maternal health care. Research has shown that black mothers in the United States and the United Kingdom are three times more likely to die than white women.
“Joseph has reduced the maternal mortality rate 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 can’t let our biases and prejudices stop us from doing so.”
This article appears in the July/August 2024 issue of British WIRED Magazine.
