The Risks of Gender Bias in Health Care

  • The reference model in medicine is and continues to be the male, although there is no certainty that this is the valid model for both sexes

  • The gender perspective aims to provide medical evidence in favor of women, but also men

  • Eliminating health gender bias requires rethinking and change in clinical practice and research, experts say

In 1991, JZ Ayanian and AM Epstein published in the journal The New England of Medicinethe article “Differences in Procedure Use Between Women and Men Hospitalized for Coronary Artery Disease,” which introduced the concept of “gender bias in health care”. This is an inclusive study 49,623 patients admitted to Harvard Hospital and 33,159 to New Haven Hospital with coronary heart diseasein 1987. The conclusion drawn from this investigation is the existence of differences significantly in performing more angiographic and revascularization tests men than women, including controlling for age, comorbidity, and severity. More recently, and following on from this article, the Lancet Commission on Women and Cardiovascular Disease: Time for Change in Women’s Health conducted bibliographic review of 600 articles what evidence is this women are still less studied with less diagnostic and therapeutic effort.

The consequences of having this type of bias are translated “c errors and delays in the diagnostic process and in the therapeutic strategy and uncertain predictions in terms of morbidity and mortality,” says María Teresa Ruiz Cantero, Professor of Preventive Medicine and Public Health at the University of Alicante and researcher at the Social Determinants of Health Group of the Center for Biomedical Research in Epidemiology and Health Network Public , responsible for coordinating the monograph “Gender Perspective in Medicine” published by the Dr. Antoni Esteve Foundation in 2019.

María Rosario López Jimenez, professor at the Faculty of Medicine, member of the University Institute for Women’s Studies at the Autonomous University of Madrid (UAM) and expert on health and gender, maintains that “the development of medical science is made by men and also reference models are male based on the unproven belief that they were models applies to both sexes. This flawed approach to equality has given rise to discriminatory actions regarding women’s health; It is gender bias, making it invisible and allowing this bias to encompass all aspects related to health; diagnosis, treatment, research”.

When dealing with health problems, be aware of the differences between biological sex and sexAs the European Commission points out in its A guide to gender equality in Horizon 2020. Regarding the former, this document states that “the biological characteristics of women and men, boys and girls, in terms of reproductive organs and functions based on physiology and chromosomes, would be. The second refers to the sociocultural and political construct that determines the interpersonal relations of women and men. that provide benefits and access to resources, such as health care, to those higher up in the gender hierarchy’. The health and gender expert explains that both aspects can have a greater weight in one or the other pathology, leading to a more pronounced deviation. Thus, “these pathologies, which are supposed to be mainly male, are usually not diagnosed in women and, on the other hand, those pathologies that are predominantly female (such as some immunological diseases) tend to be more unknown and have fewer available treatments and less research attention.

Lack of adequate diagnosis also leads to an important therapeutic gender bias. When this happens, continues María Rosario López Jiménez, “as it happened until recently with a myocardial infarction in women, for example, which has symptoms that are very different from those in men, therapeutic efforts are affected because the problem is not considered important enough and fewer tests are done. In other cases, such as chronic pain or general malaise in older women, antidepressants or anxiolytics are used instead of seeking an accurate diagnosis.

Which today, androcentric medicinewhich it considers to be a person like gold standard in medicinecontinues to prevail in both diagnostic and therapeutic work, contributes according to experts to perpetuate inequalities to the detriment of women, as the disease does not always manifest itself in the same way in men as in women. “We are talking about biological differences. For example in spondyloarthrosis -a pathology in which only 11% of diagnoses in women are correct-, in men it manifests itself with inflammation, problems in the spine, but in women it often starts with problems in the arms and legs. It also happened with Covid-19, says María Teresa Ruiz Cantero: “pneumonias have led to the admission of more men than women, while women more often have digestive problems. It is important to take these differences into account so that women are not misdiagnosed when their symptoms are different from theirs.”

sometimes, gender bias can also occur in men, commented the professor of preventive medicine and public health at the University of Alicante. For this reason, this specialist explains, “the gender perspective aims to provide medical evidence in favor of women, but also men. For example, osteoporosis is diagnosed less often in men than in women, and the diagnostic delay is longer in men than in women. Yes why Osteoporosis is considered especially in women during menopausewhen really one third of osteoporosis is in men”.

Added to the gender bias in diagnosis and treatment the gender perspective in scientific research through the development of clinical trials. María Teresa Ruiz Cantero says that “there are many clinical trials that use first of all, samples from men and then extrapolate their results to women without considering that they have different hormonal variability typical of the menstrual cycle. Hormones interact differently with medication and can have different side effects. It’s not so much the efficacy of the product that is different as it is various side effects. Therefore, this expert believes, it would be advisable “to include it in this type of research, since in order to prescribe a drug, it is necessary to know the presence of variations in response to treatment depending on the stage of the menstrual cycle and if it is before or after menopause, whether hormonal therapies influence the response, whether the study drugs can affect their fertility, and whether the two sexes respond differently to the same treatment”.

Eliminating gender bias in health care in each of its fields goes directly through universities, although “it is not easy,” as María Rosario López Jiménez states. according to you, this paradigm shift involves rethinking and changing clinical practice and research. A transformation that requires “introducing the differential aspects of sex and gender in health care in future health education and in those who already play sports, in order to change the approach to health care. And in the investigation it is necessary to consider the need to do this from a different perspective, requiring, among other things, the implementation of Organic Law of Equality or the new Science and Technology Act which reveals the inclusion of a gender perspective in health research’. A criterion with which María Teresa Ruiz Cantero agrees, who affirms that “the point of view of gender differences and gender inequalities must enter university medicine programs. To end sex/gender health bias, it is necessary to provide scientific evidence through scientific journals. The credibility and authority to be able to make changes is derived from scientific evidence and the existence of bibliographic references. Sensitivity to these issues is achieved with knowledge”.

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