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, research at Tufts University concluded that the drug’s differential effect had nothing to do with sexInstead, the researchers found that body size determined how quickly a person eliminated the drug from their system. The report concluded that the lower dose prescribed to women could actually lead to underdosing and failure to effectively treat insomnia. “They were using sex as a proxy for body size because we tend to collect data on sex; 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 misconception that women have atypical heart attack symptoms, different from those of men. This common myth has been debunked by a study Study 2019funded by the British Heart Foundation, at the University of Edinburgh. The study, which involved almost 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 mainly affect 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; it’s often about women not being listened to, sometimes by other women,” she says. Another example that clearly illustrates how gender can affect health outcomes is a woman who needs help with her health. 2016 Canadian Study The researchers studied patients hospitalized with acute coronary syndrome. The study found that patients who had higher recurrence rates were those who assumed stereotypical female gender 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 caused by how patients are perceived and treated, the solution, for Saini, is clear: “We need to be careful to diagnose the problem where it is, not where we imagine it.” She points to the successful work of Jennie Josepha 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 both the US and the UK 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.
