10/11/02

Separate, Unequal 

Sydney Smith 

Tech Central Station

You may have noticed that there's a gender bias in medicine. How could anyone not notice? We are constantly reminded of the neglect that women's health issues have suffered at the hands of a male-dominated medical establishment. Medical research ignores women. We don't have a cure for breast cancer or ovarian cancer. For years, we gave women untested hormone replacement therapy with the misbegotten promise that it would save them from heart disease and dementia. We misdiagnose heart attacks and strokes in women because we fail to recognize their symptoms. We perform too few cardiac catheterizations in women, but too many hysterectomies. Evidently, it's a double misfortune to be an unhealthy woman in our society.

Or is it? In 1999, the last year for which information is available, women made up 62% of the subjects in research sponsored by the NIH. The studies that purport to show discrepancies in the diagnosis of heart disease and strokes in women base their claims on small percentage differences - differences so small that they aren¹t truly of any significance beyond the statistical type. Walk into just about any doctor's office or hospital and you'll find posters aimed at women - posters urging them to get mammograms, to get pap smears, to get prenatal care, to stop smoking, to guard against osteoporosis. Let your fingers do the walking through the yellow pages of your local phone book and you'll find medical practices completely devoted to women's health. Go to the website of the National Institute of Health and peruse their patient information publications. Under the heading of "Women's Health", You'll find not only information about the usual issues such as breast cancer and pap smears, but information about heart disease, HIV, and mental health, too. Go to the "Men's Health" section and you'll find information about .... male breast cancer. That's it. Nothing about prostate cancer. Nothing about testicular cancer. Nothing about heart disease, or HIV, or mental health. Yet men die at higher rates from these maladies than women. There certainly does seem to be a gender bias in medicine, but it isn't against women.

Women are enjoying the fruits of success of "the personal is political" philosophy of the women's rights movement. Not only did that philosophy succeed in giving us equal employment, educational, and legal opportunities, but it succeeded in putting our medical issues at front and center. It succeeded so well that Congress created the Office on Women's Health to champion women's healthcare. It was closely followed by the creation of the Women's Healthcare Initiative, an ambitious research project designed to evaluate the effectiveness of preventive healthcare - in women only.

Men presumably would benefit just as much from public service announcements, patient education, and research into preventive healthcare. Yet, there is no Men's Health Initiative, nor is there a Department on Men's Health, although efforts have been made to establish one. Both the House and Senate bills that call for a Department on Men's Health are languishing in committees. In the case of the Senate bill, no one is interested in co-sponsoring it. Evidently, our mostly male legislators are in a state of denial about the state of men's healthcare funding. Perhaps they've bought into the myth that men are the masters of their bodies whereas women are the slaves of theirs. Perhaps they believe that the medical profession already provides superior care to men and men alone. More likely they just aren't cowed by the few and meagerly funded men's health advocacy groups. As a group, men elicit little sympathy, even from other men.

In the long run, this dichotomy of spending harms all of us. Limited federal funds are spent on research investigating subtle, small differences between the sexes in the diagnosis of disease and the delivery of healthcare, while basic research in the causes and treatment of those diseases goes begging. The long-term consequences of preventive health measures used in both men and women, such as cholesterol lowering drugs, go unexamined. Diseases such as strokes and angina become defined along artificially drawn gender lines, making their misdiagnosis more likely in both sexes. It's time to end the separate and unequal treatment of the sexes, and give scientific truth a chance to triumph over gender politics. Women may once have been treated as second-class citizens, but that is clearly no longer the case, at least not in the world of federally funded medicine.

The author is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.