Biology matters, but it’s not destiny

During my Brooklyn childhood, one of my favorite playthings was a toy doctor’s kit. In imitation of our fabulous neighborhood pediatrician  — whose tongue depressors were coated with orange candy and who told the mothers that each child should consume about a quarter pound of dirt weekly — my friends and I whacked each other’s knees and elbows with the little rubber mallet, gave each other pretend vaccinations, and performed assorted medical miracles. 

So when I reference the childhood pastime of “playing doctor,” I really do mean impersonating a physician. Along with one of my best buddies, I even entertained thoughts of going to medical school, an uncommon career goal for girls in the 1960s.

Not any more. According to the Association of American Medical Colleges, women were slightly over half the first year students in the nation’s medical schools in 2017. In 1974, only 22 percent of seats in medical schools were occupied by women. While the increasing number of women in medicine is a sign of real progress, there is another area of medicine in which gender bias has a profound impact on women: medical research.

For too long, research into health and medicine has assumed the normative male. As noted by the Laura W. Bush Institute for Women’s Health: “National clinical guidelines for hypertension, diabetes, heart failure, asthma and many other conditions are based on a majority of research performed in men and applied to women.”

So what’s the problem? Haven’t women’s rights activists urged the undoing of arbitrary distinctions between the sexes? Aren’t women and men more alike than different, with most of our organs the same? Don’t women’s health concerns go beyond reproductive biology? If we seek equality, why should we be troubled that medical research has been overwhelmingly geared towards men and male physiology?

As I tell my students: the sign of a well-functioning mind is the capacity to hold seemingly contradictory ideas at the same time and know that they can all be true. Seeking the undoing of arbitrary, socially-constructed distinctions between the sexes — the kind that used to keep women out of the medical profession — does not mean ignoring the fact that biological differences can have a significant impact on the diagnosis, treatment, and prevention of disease.

Paying attention to such differences requires rooting out gender bias in basic research, as well as ensuring that women are adequately represented in clinical trials. As noted on the website Medical Daily, “Because women have only been included equally in drug studies since 2001, there are still many pharmaceuticals circulating on and off the shelves at the local drug store, many of which still haven’t been tested on women.”

And, according to Women’s Health Research at Yale: It took until 1994 for the National Institutes of Health “to begin requiring government-funded research on conditions affecting both sexes to actually include both sexes.” And not until 2016 did NIH require researchers “to include female animals and female cells in their studies as well as male animals and male cells.”

The need for gender-informed medical research is illustrated by a few examples:

  • As reported by Stanford University’s Gendered Innovations initiative, between 1997 and 2000, ten drugs were withdrawn from the U.S. market because of life-threatening health effects. Eight of them posed greater risks for women than men.
  • A study by Duke University researchers indicates that, while aspirin helps to reduce men’s heart attack risk, it does not reduce their risk of stroke while, for women, aspirin reduces the risk of stroke, but not of heart attacks.
  • Women metabolize the active ingredient in the sleeping pill Ambien more slowly than men, meaning that they are more susceptible to the drug’s after-effects, and resulting in a warning by the Food and Drug Administration for women to cut their dosages in half.  ““This is not just about Ambien…” Dr. Janine Clayton, director for the  Office of Research on Women’s Health  at the National Institutes of Health, told The New York Times. “There are a lot of sex differences for a lot of drugs, some of which are well known and some that are not well recognized.”
  • According to Harvard Medical School, “Women don’t seem to fare as well as men do after taking clot-busting drugs or undergoing certain heart-related medical procedures.”
  • The Texas Heart Institute reports that heart attacks are usually more severe in women than in men. In the first year after a heart attack, women are 50 percent more likely than men to die. In the first six years after a heart attack, women are almost twice as likely to have a second attack. Women are often misdiagnosed because their heart attack symptoms may be more general — e.g. nausea, vomiting, dizziness and indigestion.
  • A report from Boston’s Brigham and Women’s Hospital notes that women who don’t smoke are three times more likely than nonsmoking men to get lung cancer.
  • Nearly 80 percent of those with autoimmune diseases (e.g. lupus, rheumatoid arthritis, multiple sclerosis) are women. (National Jewish Health).
  • The Society for Women’s Health Research (SWHR) reports that common drugs like antihistamines and antibiotics can cause different reactions and side effects in women and men, and some pain medications are more effective in women while others are more effective in men.
  • Women tend to produce less gastric acid than men, resulting in slower digestion. Therefore, medications that need an acidic environment to be absorbed, like the antifungal ketoconazole, for example, may not be as effective in women. Also, drugs that require an empty stomach for absorption, like the antibiotic tetracycline, may not work as well if women don’t wait long enough before taking them after meals. (Everyday Health).

The list goes on.

The women now practicing medicine in record numbers are heirs of the foremothers who fought to claim their place in the medical professions, as well as of those in all fields who devoted their lives to disengaging biology from lifelong destiny. In our century, acknowledging how our biology affects us, while simultaneously insisting on women’s full legal, social, and economic equality, may be the most radical notion of all.

© Rhea Hirshman 2019

11 thoughts on “Biology matters, but it’s not destiny

  1. Carol Lowe

    I absolutely agree Rhea. We continue to see more women professionals,like Samantha, who have so much to offer. Great article
    Miss you,
    Carol

    Reply
  2. Marcia Falk

    Very well written and researched article. Thanks for sharing. By the way, what was the name of your Brooklyn pediatrician? I too had a wonderful pediatrician in Brooklyn and his name was Bernie Greenberg,
    See you son.
    Marcia Falk

    Reply
  3. Karla

    Professor,
    I truly enjoyed reading this column! Working in the healthcare field for 10 plus years, this is so eye opening!
    Karla

    Reply
  4. Ginny Bales

    Another excellent meaty column Rhea! Thanks for articulating these issues so clearly. I read a lot of medical literature, but learned some new things from this article! Well-done!

    Reply

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