Gender specific medicine – The small difference and its consequences

It is well known that men and women are fundamentally different. In medicine, too, gender-specific diseases are treated accordingly: breast cancer and pregnancy at the gynaecologist’s, prostate diseases at the urologist’s. In the meantime, however, the realization has prevailed that women get sick differently than men with many diseases and that new treatment approaches are necessary in medicine.

Call for differentiated treatment methods.

Even if the term “equality” is already well established in the working world, it has not found its way into medicine for a long time. It was not until the 4th World Women’s Conference in Beijing in 1995 that a new political focus on the advancement of women was coined under the term “gender mainstreaming”. Since then, women are no longer viewed as a homogeneous group but in their social, ethnic and age differences.

In medicine, the call for differentiated treatment methods arose with AIDS research in the USA. Women between the ages of 20 and 40 complained twice as often as men about side effects during treatment. On closer inspection, it turned out that the drugs had been tested mainly on men and that women hardly played a role in the drug studies.

The reasons for this were as understandable as they were ultimately wrong: women of childbearing age in a drug study may be exposing themselves to a high long-term health risk if they become pregnant during the study. In the early phase of drug development, it is often not yet possible to say whether the active ingredient harms an embryo. Experiences with the Contergan scandal, for example, have led to women being primarily kept out of drug studies, both out of concern and fear of recourse claims.

 

Women are often mistreated.

How problematic this attitude is can be seen in treating high blood pressure. In many studies to prove the effectiveness of drugs, no or only a few women were included. However, women process active ingredients differently than men: On the one hand, they are usually smaller and lighter, and on the other hand, there are proven gender-specific differences in how active ingredients are metabolized.

Finally, targeted examinations of the studies showed that although men benefit from hypertension treatment, mortality among women increases. Only since older women have been increasingly used in drug testing has it been possible to treat high blood pressure with reliable therapy recommendations.

As a consequence, these results meant that women were often mistreated until then. Very few package inserts contain, for example, dosing instructions based on body weight or particular information for women that go beyond the information on taking during pregnancy. For example, the higher percentage of body fat in women makes it easier to absorb fat-soluble medicines.

sensitivity grows

However, sensitivity to this question has increased significantly in recent years. Both drug approval authorities worldwide and pharmaceutical manufacturers take this challenge very seriously.

However, drug research is not the only area in which “gender mainstreaming” is practised. Since the end of the 1990s, there have been increased efforts in the Federal Republic of Germany to include gender-specific considerations in all areas of medicine. In addition, the Health Ministers’ Conference in 2001 determined that insufficient attention to gender-related needs contributes to over-, under- and incorrect care in the health care system.

Beyond the individual’s well-being, this approach is also relevant to overall health policy. In 2001, the Federal Government published the first “Women’s Health Report”, which showed innovative approaches in practice and research but also many prejudices, gaps and deficits.

 

Not just for men

As discussed above, one of the best examples of the need to distinguish between diseases in men and women is heart attack. Gender differences are also noticeable here, for example, in the symptoms: While men complain about “typical” symptoms such as shortness of breath, chest pain and numbness in the left arm, a heart attack in women often causes nausea, a feeling of pressure in the upper abdomen or back pain. Accordingly, it often takes more time to diagnose a heart attack in women than in men because the symptoms are not apparent, and the possibility of a heart attack is not considered.

It is also interesting that women often describe their symptoms more holistically, while men show apparent physical symptoms. Conversely, men receive far too little support for mental illnesses such as depression because they tend to look for physical signs. Both sexes benefit from “gender mainstreaming” in medicine with a biological-psychosocial approach.

behaviour optimistic

Doctors and politicians have recognized the gender-specific approach in medicine as an opportunity. In times of tight budgets, those involved see gender mainstreaming as an opportunity to improve the German healthcare system. The Bundestag has now decided to consider gender-related aspects in all healthcare sector funding projects. Lectures on gender mainstreaming in medicine are now being held at universities, and a lot is also happening in the medical profession.

The Medical Association of Westphalia-Lippe was the first to set up a “Gender Mainstreaming” committee. The Association of Women Doctors continues vehemently campaigning for more women in universities and research. Because if more women do research for women, the interests of the patients will also be taken into account more.

However, it will be quite a while before new dosage recommendations or fundamentally different treatment approaches become available to patients. Until then, the only thing left for them to do is promote the topic through their interest, obtain comprehensive information and thus ensure that equal opportunities in medicine become a matter of course.