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Sexism: The Greatest Silent Killer

By: Yeeun Lee

Sexism in the medical field has been present throughout history. From the 18th century notion of female hysteria, to the numerous obstacles of becoming a female physician, discrimination against women in healthcare has taken many forms. And while we have overcome many of these barriers, women still suffer from the consequences of differential treatment. The discrimination is still present; it is simply manifested in different, subtler ways. And as a society, we are unaware that these exist or that they have tremendous social and health consequences. The lack of conversation regarding these discrepancies make these hidden actions all the more dangerous.

Today, the clearest example of this phenomenon is seen through gender differences in diagnosis. A newly published study conducted in Denmark showed that “women are diagnosed an average of four years later than men for the same diseases.” The study, published in Nature, took hospital data from over 6 million people for two decades. The authors were able to reveal that for over 700 diseases, including cancer and diabetes, women are diagnosed at a later age than men. While the study wasn’t designed to explain what the causes are, the researchers do state that investigating why these differences exist is crucial.

However, even within these differences, separating sex and gender is important. The study mentions early on that both sex and gender are essential in medicine. Sex refers to the biological components while gender, a social construct as defined by the WHO, refers to social differences. Both sex and gender stratified medicine are understudied research areas but this specific study presents sex-specific data. And even in sex-stratified medical research, “sex-specific analyses focus on one sex” – males.[1]

“Today, research dictates how medical knowledge and discourse is created and disseminated.”

Hence, another form of gender bias in our health system lies in the contemporary medical framework. Because it is built around male physiology, our understanding of disease completely disregards that men and women can have different symptoms for certain conditions – such as heart attacks. Common symptoms such as chest pains apply across the board; however, women can have less common symptoms including “indigestion, shortness of breath, and back pain. . . even in the absence of obvious chest discomfort.” Heart attacks today are known as a “man’s disease” because more men experience them compared to women. But in fact, heart disease is the leading cause of death for women. According to the CDC, heart disease accounts for 25% of female deaths. If doctors aren’t looking for these different symptoms, this decreases the chance of survival for women at risk.

Additionally, if public knowledge regarding heart attack prevention is built on male symptoms; even women may be unaware of these symptoms. Amongst the many other sex and gender problems in our health system, later diagnosis in women and research on men being applied to women are two issues that must be addressed. Both of these affect early intervention, which can affect or delay treatment, and thus, lead to complications or even death.

When reflecting on the complex question of why this still occurs, it is necessary to consider the countless narratives of women being brushed off by their doctors. From stories found in personal blogs to those told in more private settings, women are still ignored and assumed to make up or exaggerate their pain when expressing legitimate health concerns. The stereotype that women are overly sensitive still exists. And, correspondingly, the idea that everything they say regarding their health must be taken with skepticism.

The differential treatment that men and women receive when entering these medical spaces has immense social and health consequences. It propagates false ideas that characterize women as dramatic and as liars, and it puts them at risk by delaying potential intervention. Whether the differential treatment stems from preconceived notions, knowledge gaps about the female body and symptoms, or a combination of both remains unclear.

Nonetheless, acknowledging that sex and gender bias exists in research is a growing trend. Which is important because research dictates how medical knowledge and discourse is created and disseminated. One way this knowledge gap has been approached in research has been through The Sex and Gender Equity in Research (SAGER) guidelines, which urges researchers to “pay more attention to sex and gender dimensions in research.”[2] The guidelines also seek to make sex and gender findings part of standard protocol in scientific publishing. Hopefully the adoption and enforcement of these guidelines will result in more robust sex and gender analysis within the research community, thereby hampering any gender biases that lead to health inequities.

While the problem is complex, multilayered, and will probably take decades to completely address, accepting that there is a problem with how research is currently conducted is a step forward. Researchers, peer reviewers, editors, and publishers should all help strengthen these changes as the norm in research, which will contribute to rigorous science and more importantly, health equity.

[1] Westergaard, David, et al. “Population-Wide Analysis of Differences in Disease Progression Patterns in Men and Women.” Nature Communications 10.1 (2019): 666.

[2] Heidari, Shirin, and Vivienne C Bachelet. “Sex and Gender Analysis for Better Science and Health Equity.” The Lancet, vol. 392, no. 10157, 2018, pp. 1500–1502., doi:10.1016/s0140-6736(18)32619-9.