Gender imbalance; a threat to humanity?

Madeleine Harris Smith

Inequality impacts many walks of life, but concern is growing that if we don’t tackle gender bias in healthcare, the threat goes far beyond pay and opportunity – but to the future of humanity itself.

There is an under-representation of women in the clinical trial data sets being used. That means that the solutions are not fit for women.  If medicines and healthcare technologies aren’t fit for women, they die. And if women die, ultimately humanity stops - Maxine Mackintosh

Speaking at a recent King’s Fund event, data scientist Maxine Mackintosh, posed the idea that gender bias could, quite literally kill us. The problem Mackintosh believes we urgently need to address is the under representation of women in clinical trials.

Despite efforts globally to address gender imbalance the gender gap in clinical trial data is having very real impact:

  • Globally, women are almost twice as likely to have an adverse reaction to a medicine than their male counterparts, with 80 per cent of medicines withdrawn from the market being due to adverse events experienced by women
  • In the US, cardiovascular disease is the number one killer of women, and it affects women differently at almost every level, including symptoms, risk factors and outcomes. But only one third of cardiovascular clinical trial participants are female, and a significant majority of those trials which do include women do not report results by sex
  • Evidence also shows that women are at a greater risk of developing Alzheimer’s disease than men. Prevailing thinking had been that this is simply because women live longer than men, but a study published earlier this year shows it’s the genetic makeup of women which puts them at a higher risk

What’s driving this under representation of women in clinical trials? 

The under representation of women in clinical trial data has been driven by three factors. Historically, medical trials were conducted solely in men, partially due to concerns of potentially damaging unborn foetuses, as well as the belief in women having ‘delicate constitutions’. This continues to haunt us, even now: where more recent clinical trials rely on old data sets, women are often not as well represented

It is more expensive to include both sexes into research study designs, particularly when taking proper account of physiological differences. This has been proven to hamper the involvement of women in a range of clinical trials

Where researchers do include women in clinical trials, they tend to make sure they are in the early follicular phase of their menstrual cycle, when levels of oestrogen and progesterone are at their lowest. However, this hampers a comprehensive understanding on the impact of those hormones of medicines

What’s the wider impact of gender biases in healthcare?

It’s not just in clinical trials where we see the impact of gender bias; it impacts across just about every aspect of healthcare, from women’s experience of the healthcare system (an article in The Guardian last week highlighted that women are more likely to be given sedatives for their pain, than men who are more likely to be prescribed pain medication) to the way we approach innovation in women’s health and wellbeing products (until recently, there had been little innovation around periods in the 80 years since the tampon was invented).

It’s also present in the way we communicate around women’s health issues, from using euphemisms and blue liquid to illustrate periods, to less media attention being given to ‘women’s health problems’.

This is a problem that has been hiding in plain sight for a number of years. But as progress in personalised medicines, technological developments and healthcare focused AI speeds up, the impetus to act on it grows. In order to ensure we develop a healthcare system fit for the future, we must ensure that the impact of gender inequality is tackled at every stage.

You can find Maxine Mackintosh on Twitter here. And stay tuned to the MHP website for more on addressing gender bias in healthcare…