Introduction
Healthcare is the most advanced it’s ever been, yet the healthcare gap remains a fundamental flaw in the system – something particularly experienced by the female population. Studies have shown that people who identify as women are more likely to have their symptoms dismissed, pain disregarded, and are less likely to receive the guideline treatments.1,2
The Data Gap
Historically, the male form has been the standardised anatomical figure, however it is increasingly more evident that research carried out in male participants cannot simply be extrapolated to women.3 Until regulations were introduced in the late 90s, the male sex formed the majority, if not entirety, of clinical trial populations. Even in pre-clinical trials, the male species dominated,4 and the impact of this has led to a data gap in the healthcare sector.
Including sex-diversity is vital when researching new pharmaceuticals, as investigating only 50% of the population can lead to serious and unexpected adverse effects – dosing, safety and efficacy profiles have been proven to differ between the sexes, and women experience higher rates of adverse effects than men.5
Female representation has come a long way in the past few decades: today, approximately half of the participants in clinical research funded by the National Institute of Health (NIH) in the US are women.6 However, the number of female participants is not always proportional to the disease prevalence7 examples include heart failure, acute coronary syndrome and myocardial infarction. Inclusion of women in trials does not always equate to accurate testing either, particularly if the data is not sex-disaggregated, whereby the differences between women and men are.8,9
The Impact of The Menstrual Cycle in Clinical Research
In clinical trials, drug effects are commonly studied in women at the point in their cycle when hormones are lowest to ‘simplify’ trial outcomes by minimising Anti-depressants, anti-histamines, antibiotics, anti-psychotics and heart medication are all examples of drugs influenced by the menstrual cycle.10 Resulting adverse effects can prove fatal: drug-induced heart arrhythmia is more likely to occur in the female sex, and the highest point of risk is within the first half of the menstrual cycle.11
Yentl Syndrome
Beyond testing and trials, an apparent bias seems to exist in the diagnosis and treatment of women’s health conditions. Yentl Syndrome, a term coined by Bernadine Healy in 1991, is the phenomenon where treating physicians follow a different course of action for women than for men, most notably, in cardiology.12 UK research found that the probability of being misdiagnosed following a heart attack (or myocardial infarction, MI) is 50% greater for women than for men.13
A 2017 study found that women with acute MI had a higher excess mortality than their male counterparts when adjusted for use of guideline-indicated treatments, suggesting that improving adherence to guidelines would see a reduction in premature deaths in women.14 Deviation from the guideline treatments can, in part, be explained by the tendency of guidelines to derive from the clinical outcomes for men – even though pathophysiological differences are observed between the sexes.15 For example, ‘male-pattern’ ischaemic heart disease (IHD) is readily recognised and diagnosed by physicians, whereas ‘female-pattern’ IHD, is less so, due to the recognition strategies having been devised from the historical standard ‘male-pattern’ IHD.16 Interestingly, women who presented with ‘male-pattern’ IHD were more likely to receive the recommended treatment.15 This is one example of many where women are not receiving adequate healthcare simply because the guidelines have been tailored to the male perspective, leading to harmful implications in clinical outcomes.
Reproductive Health
There is little data in the field relating to women’s reproductive health, which strongly links to the lack of public funding dedicated to the research. A 2018 study found that only 2.1% of research was dedicated to the fields of reproductive health and childbirth,17 despite a government survey finding that 1 in 3 women suffer from severe reproductive health problems.18 90% of women are affected by premenstrual syndrome,19 yet there is 5 times more research into erectile dysfunction, which affects 19% of men.20 Insufficient research into women’s reproductive health means doctors do not have access to information to educate themselves about the treatment of these conditions.
In these circumstances, it is impossible for women to make informed decisions. Medical communications is extremely valuable in this case, as there is a distinct need for greater awareness of the conditions and available treatments among health care professionals.
Conclusion
A vast amount of progress has been made in the past few decades in addressing the sex/gender healthcare gap. The booming FemTech (female technology) industry is a great example over the past few years, which is promising to shape the future of women’s health.21 (Find out more on our blog about the Natural Cycles app) There are still many opportunities for research and trials to improve education in this area, and in order to achieve its full potential, sectors such as FemTech are relying on creative marketing strategies to establish themselves in. To learn more about our experience in promotional healthcare launches, please get in touch.
By Liv O'Hern
