Since the age of Aristotle, philosophical thought pertaining to science has attempted to evaluate the reliability of scientific theory. One issue that scientists continue to face is achieving complete objectivity. In science philosophy, this conundrum is expressed by the competing Positive and Normative theories. Positive theory involves no interpretation and is concerned only with what is; data is analyzed without value judgment. For example, the statement: government-provided healthcare increases public expenditures. Normative theory, on the other hand, is predicated on placing a value on the collected data; it describes what ought to be interpreted. Referencing the aforementioned example, a normative statement would sound like: government should provide basic healthcare to all citizens. These two theories form a tug-of-war in science that has real influence on the trajectory of conclusions and results that emerge from laboratories.
Although women have made advancements in many facets of society, discrimination still runs unchecked in health care. Women are at a steep disadvantage in terms of availability of drugs, and the access to medical devices. In framing the discussion on the gender gap in health care, it is important to acknowledge the influence that normative values have had in the research laboratory- where all of health care advancements originate. The challenges faced in the lab at the research level will also be expressed in the hospital at the level of primary healthcare. A vast amount of literature has been published that indicates that women are broadly discriminated against in STEM. One study determined that female postdoctoral fellowship applicants must be 2.5 times more productive than their male counterparts to be evaluated as equally competent. A more recent study revealed that men are more likely to be hired as science faculty at research universities than women with the exact same resume. Another report found that prospective male PhD students have more access to professors than female students, based on email response rates. This indicates that at the very foundation and heart of the healthcare establishment (research institutions) there is gender bias. It is important to identify that research scientists who champion objectivity and pure evaluation are subject to the same cultural norms, beliefs, and shortcomings as anyone else. The gender gap that exists within the laboratory will be reflected in the research that emerges from the lab and affect patients.
The evidence-based model of medical research shows signs that it too has been polluted by lack of equal consideration for non-male demographics. Perhaps most telling is that there are no major research tools that compensate for sex differences in study analysis. In the recent past this led to guidelines for one sex being generalized to the other (most often male to female). This oblique dynamic was first addressed in the 1970s, when legislators encouraged researchers to mix genders within study groups. In 1994, the National Institute of Health (NIH) took further steps by creating a guideline for the evaluation of gender differences in the safety and efficacy of drugs. These new guidelines finally allowed for women to participate in the first phases of drug development. In a shocking revelation, in 2005, it was revealed that 8 out of 10 prescription drugs that had been removed from the market were removed because they adversely affected women. This disastrous event made it clear to many Americans that accommodating gender and sex in research is critical.
Unfortunately, despite the efforts of the NIH there has not been a major increase in the number of women recruited for clinical trials. Many studies report specific barriers within their protocols that have led to the exclusion of women from clinical trials. Scientists from Sweden identified a lack of physiological data and the need to repeat studies that had been previously completed using only men as the primary deterrent to including women in their studies. A publication from the Society for Women’s Health Research also identified the higher economic costs (around quadruple the cost) of properly conducting research on women. This higher cost is attributed to the need to account for different hormonal states and control for hormonal contraception. And while higher costs could play a role in discouraging scientists from including women in their studies, the scientists also have an ethical mandate to accommodate for women. In an age where scientific funding is often a limiting factor, consideration for the greater good needs to be valued above publication.
The advent of gender medicine has certainly served to highlight the dire need for better representation of women in clinical studies. Also, although the population is not homogenous, research must be funded and conducted in a way that benefits all people equally, because the results in the laboratory have a direct link to outcomes in the hospital.
A responsible approach to generating more equitable research (and therefore healthcare) starts with identifying common themes that cause diseases to affect a particular sex more than the other. In examining diseases such as heart disease and stroke, it becomes apparent that men have generally been considered more at-risk populations, while women have suffered higher mortality rates due to a lack of research into gender-specific differences in the illnesses.
Heart disease proves to be a compelling example of how, historically, diagnosis and treatment became topics so heavily focused on men. Beginning in the 1800s, a common belief spread that those most prone to heart attacks were always men — ambitious, daring, and established men. Physicians proclaimed with confidence that it was excess emotion and a fiery demeanor that led to cardiac issues such as heart attacks. As the decades passed, researchers kept delving deeper into heart disease, producing dozens of groundbreaking studies — studies conducted exclusively in men. From these research endeavors, scientists and physicians were able to produce a “comprehensive” list of symptoms — symptoms primarily for men. In the late 20th century, countless studies, ranging from those linking cholesterol and heart disease to studies investigating aspirin’s utility in preventing heart disease, were conducted on thousands of men, and no women. Only in the past few decades have professionals finally grasped that much of the previously conducted “groundbreaking” research fails to adequately account for women. Concerning heart disease, women have smaller blood vessels, placing them at an increased risk of high blood pressure and heart attacks. Researchers were required only to conduct a few extra tests to see that plaques in a female’s arteries are more evenly spread out, rather than appearing as a discrete blockage — in other words, the female disease didn’t exactly look like the typical male disease, though females were at just as high of a risk as males. No innovative technology or massive funding was required to spot these basic structural differences between men and women. This was hardly elusive knowledge, yet it went ignored for so long.
Upon closer observation, a distinct and alarming pattern appears out of the onset, diagnosis, and treatment of diseases in women. The physiological and anatomical differences between men and women cause diseases to manifest themselves differently. This in turn leads to variation in symptoms, and when researchers and doctors inevitably fail to account for this incongruity, stark consequences begin to appear. Not only are women misdiagnosed by physicians more often, they are more likely to fail to self-diagnose and, on average, they arrive to emergency rooms over a day later than men do. These few extra hours can have disastrous effects in the long-term, as irreparable damage to the heart may have already occurred. Symptoms of an imminent heart attack in women, such as jaw, neck, or arm pain, as well as fatigue, nausea, vomiting, and sweating, are generally considered atypical. When unrecognized, they likely lead to delayed diagnosis and higher mortality in women.
This trend continues to be seen among other ailments as well. Stroke, which is often correlated with old age and a family history of the disease, is commonly misdiagnosed in women and young adults, especially when it is preceded by symptoms like headaches, dizziness, agitation and seizures. Depression, though often overlooked in males because of the way they choose to handle stress, is also frequently ignored or downplayed in women, due to the variety of hormonal and social stressors that they experience at different stages in their lives.
These recent investigations have revealed the underlying problem with health research in the past few decades — the failure to incorporate previous findings into modern-day medicine. Returning to the discriminatory nature of graduate school admissions and opportunities in research laboratories, it is evident that the divide between the sexes has infiltrated the actual investigative work and treatment that doctors and scientists do. This imbalance has put women at a disadvantage regarding diagnosis and treatment. Unfortunately, despite professionals’ increasing awareness toward this disparity, little has been done to actually implement safeguards and tools to evaluate the results of research in light of the participant’s sex.
Adjusting the inclusivity of research to ensure women are included isn’t enough. Moving forward, we need to identify and accept concrete differences between men and women, and act on these discoveries. As activist Malala Yousafzai asserts, “We cannot all succeed when half of us are held back.” It is our collective responsibility to encompass every demographic, and to understand that the health of humanity cannot improve until both halves are healthier.