The gender bias in medicine is endangering the lives and well-being of Australian women, writes economist Katie McGregor.
For decades, women’s health has been systematically under-researched, under-funded and under-valued. As a result, women are more likely than men to receive delayed and ineffective treatment, experience harmful drug side effects and be denied necessary pain medication.
In the 2022-23 Budget, the Labor Government committed nearly $70 million in additional spending to women’s reproductive and maternal health. While this was an important pledge, it reflected a dangerously narrow view of women’s welfare.
The health of Australian women is determined by much more than their reproductive system, with women experiencing higher rates of chronic pain, poor mental health and autoimmune diseases. As such, addressing the gender bias in medicine will require systemic, large-scale changes to the way medicine is researched, funded and taught.
Next week, Labor will release its next Federal Budget. To date, the Government has made no commitments that explicitly target the gender bias in healthcare. This needs to change.
Where are the women?
Throughout history, women have been systematically excluded from medical research.
In fact, in 1977, the Food and Drug Administration (FDA) effectively banned women of child-bearing age from participating in any clinical trials. Foundational studies into ‘normal human aging,’ and cardiovascular disease – the leading cause of death for women – didn’t include a single woman. By the time the inclusion of women in American clinical trials was mandated in the early 1990s, this history of exclusion meant than less than half of publicly available drugs had been tested for sex-response differences.
Things have improved since then, however, most Australia studies still do not report sex-specific differences in their analysis and many preclinical studies continue to under-represent female cell-lines and animals. Further, drugs like Valium, which is prescribed for conditions like epilepsy and anxiety, were approved by the FDA prior to 1993 and have never been tested on a woman.
This exclusion has serious health consequences for women. Women have a 50-75% greater risk of suffering from an adverse drug reaction (ADR) compared to men and a majority of patients admitted to the hospital for an ADR are women. In 2012, a group of women received over $1.2 billion dollars in compensation after taking menopause hormone replacement drugs caused them to develop breast cancer.
What about women?
Women’s health continues to be massively underfunded.
One in three women will experience a reproductive or gynecological health problem in their lives – yet such conditions receive less than 2.5% of public medical funding in the UK. Endometriosis – a chronic, gynecological disease – is as common as diabetes but receives 39x less funding.
Even conditions that predominantly, rather than exclusively, affect women are short-changed. Women make up 80% of all people with an autoimmune disease. They are at least twice as likely to experience chronic pain or Alzheimer’s disease. Woman are also more vulnerable to developing mental health conditions like depression and anxiety. Thanks to gender bias, all of these conditions are severely underfunded.
Without adequate funding, diagnosis is delayed, health conditions are poorly managed and effective treatments aren’t found. In short – women suffer.
Why dismiss women?
Gendered stereotypes are undermining the health of Australian women.
Gendered stereotypes that women are “hysterical” and more “sensitive” than men can result in their health conditions being trivialised and mistreated. Despite the fact that women report more intense, frequent and lengthy episodes of pain, they are consistently treated for pain less aggressively than men. Instead, women are more likely to be prescribed unnecessary anti-depressants and denied treatment for the physical cause of their chronic pain.
The view that pain, even when chronic and severe, is natural for women, can delay diagnosis and undermine treatment. Women are diagnosed after men in more than 700 diseases, including diabetes and cancer. Women with endometriosis spend an average of 6.4 years and ten doctor visits, waiting for a diagnosis. During that time, their pain is typically perceived as “natural period pain.”
What now?
The Australian Government must seize the opportunity presented by the upcoming Federal Budget to eliminate gender bias in medicine.
It should:
- Invest in women’s health research and service delivery. Increasing research and service funding for under-resourced conditions that exclusively or predominantly affect women would correct for existing gender bias and produce large returns to women’s quality of life.
- Require publicly funded medical research to report sex differences and adequately represent women. Unlike its international competitors, including the United States and Canada, Australia doesn’t require the integration of sex and gender analysis in publicly funded research. Introducing this requirement, providing necessary funding supplements and legislating the inclusion of women in applicable clinical trials, would prevent male findings from been generalised to women. It would also help create the knowledge base needed to improve the health of Australian women.
- Educate medical professionals on sex differences and gender bias. Evidence-based training sessions on sex differences and gender bias in medicine should be used to increase understanding amongst medical professionals of how sex impacts patient outcomes and their own implicit bias.