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Male-centric research and women’s health – a brief history

Male-centric research and women’s health – a brief history

To say that gender equality has come a long way in the last 100 years wouldn’t be false. Women now have the right to vote, the right to own property, and as of last year, we finally have the right not to have photos taken up our skirts – thanks to changemaker, Gina Martin. 

Progress is being made all the time, and yet, there are still many examples that prove we’re still living in a “man’s world.” From spacesuits to crash test dummies, the male body is too often seen as the default when it comes to design – a bias that limits opportunities for women and places their lives at risk. When it comes to medicine, you’d like to think things would be a little different, but unfortunately, that’s not the case. Male-centric medical research has been at play for centuries, and women across the world are still feeling its effects today in 2020. 

History and hysteria 

It’s easy to understand how (and why) women became sidelined in medical research. Aristotle himself, the guy heralded as the father of modern medicine once described the female body as “a mutilated male.” Nice. This belief that the male body was ‘typical’ and that the female body was ‘a-typical’ may have been something that originated in Ancient Greece, but it’s an idea that has continued for centuries. Still, now doctors will often refer to ‘typical’ symptoms or responses to medication – and more often than not, they mean male. 

For thousands of years, the female body remained a mystery that a male-dominated medical stratum had no interest in solving. Instead, wild theories about wombs wandering around bodies were given as solid diagnoses for any illness women experienced. While the “wandering womb” theory fell out of popular favor sometime in the 16th century, it was quickly replaced by the notion of ‘hysteria.’ Hysteria was a condition (notably only ever attributed to women) that included symptoms such as anxiety, sexual desire, and fatigue. Today, these are probably symptoms you would happily note down in your cycle tracking app, and 100 years ago they could land you in an asylum. It wasn’t until the discovery of the endocrine system in the early 20th century that the concept of the menstrual cycle and female hormones started to be understood – although the term ‘hysteria’ was still being used as late as the 1980s. 

History proves just how entrenched our lack of knowledge and understanding around the female body is, but it’s in modern medicine that we truly start to see the results of this millennia-old unconscious bias. 

Trials and tribulations 

While the discovery of the endocrine system may sound like a step in the right direction for women’s health, it introduced another blocker to progress. Researchers said that the hormones involved in the menstrual cycle introduced too many variables into medical studies, so females should be left out of medical trials. And that was that. It wasn’t until 1993 that the FDA and the NIH mandated the inclusion of women in clinical trials – by which point, almost a century of medical research had been conducted almost exclusively on men, by men. 

The general belief at the time was that men and women were alike in every way apart from their reproductive organs and sex hormones. Therefore, any evidence collected from medical research using men could be applied to women without issue… but that wasn’t and still isn’t the case. 

Dr. Alyson McGregor, author of  ‘Sex Matters: How Male-Centric Medicine Endangers Women’s Health—and What We Can Do About It’ brought the conversation of male-centric medical research to the world stage with her 2014 Ted Talk on the subject, which has now been watched over 1.5 million times. 

Alyson explains that women are not “just men with boobs and tubes,” but our XX and XY chromosomes impact every cell in our body – from our skin and hair to our heart and lungs. These genetic differences highlight the importance of including women in medical trials. So, while men and women may be equal, we are not built the same. 

Women paying the price  

One of the clearest examples of how this puts women at risk is the sleeping drug, Ambien. After over 20 years on the market, it was recommended that women should be taking half the dose of Ambien compared to men. Researchers finally realized that females metabolized the drug differently. Women were waking up the next day with more of the drug still active in their system and getting behind the wheel of a car – putting themselves and others in danger.  

But Ambien is just the tip of the iceberg. There are many other drugs and treatments prescribed to women when they have never been tested on them. 80% of drugs withdrawn from the market are done so due to side effects on women. 

But it’s not just drug tests that have been failing women. Studies on medical conditions have also historically been swayed in favor of men. Let’s consider heart disease: women are historically underrepresented in cardiovascular research because they often have different symptoms than men. For women, a heart attack could feel similar to indigestion – not pain in the chest. This bias is at least partly responsible for the fact that women are less likely to survive a heart attack, particularly when treated by a male doctor.

Girls just want to have funds 

So, it’s clear that when it comes to general medicine, there is a huge research gap that we’re only just starting to address. But surely when it comes to female-centric conditions, such as pregnancy or menstrual health, women must be getting a fair shot at conclusive evidence? Sadly not, and this largely comes down to funding. 

Less than 2.5% of publicly funded research is dedicated solely to reproductive health, even though one in three women in the UK will suffer from a gynecological or reproductive health problem in their lifetime. Similarly, data from the US shows that although 10% of women become pregnant each year, just 2% of research funding is spent on pregnancy research. If you want to see real bias come into play, go ahead and take this statistic in: there is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women. Oof. 

Even when women secure funding for female-centric research, they are often awarded less money than their male counterparts, thus proving that the gender pay gap doesn’t just exist in corporate boardrooms. 

A seat at the table 

If we want to see the true quality of medical research, we have thousands of years of gender bias to dismantle – and that’s one mammoth task that can’t happen overnight. But change will only take place when we see more women in the position of key decision-maker across STEM. Because ultimately, if men are always at the core of medical research, then medical research will continue to be male-centric. We may have come a long way from the days of “wandering womb”, but we’ve certainly got a long way to go.