In 2013, the US Food and Drug Administration made an unprecedented recommendation, advising that women should receive a lower dosage of the insomnia drug zolpidem than men. The rationale behind it was that medication seemed to affect women for longer periods, which could become a safety issue.
However, in 2019, research conducted at Tufts University concluded that the differential effect of the medication had nothing to do with sex. Rather, researchers found that what determined the rate at which the person cleared the drug from their system was their body size. The report concluded that the reduced prescribed dosage for women could in fact lead to underdosing and a failure to effectively treat insomnia. “They were using sex as a proxy for body size because we tend to collect data about sex; we don’t collect data about body size,” says Angela Saini, author of The Patriarchs: How Men Came to Rule. “This is the perverse way that sometimes medicine works: You base your diagnostics on the data you have rather than the data you need.”
Indeed, Saini argues that many of the prevailing gaps in health outcomes between men and women have nothing to do with biological sex. “It can be so tempting for scientists to look at a gap and want to find a simple biological explanation for it, but when it comes to gender and health those simple explanations often don’t exist,” she said.
Of course, sex differences do exist in aspects of health, such as reproductive health and physiology. However, what research suggests is that, in most cases, the health-related difference between men and women—from disease symptoms to drug efficacy—is really quite marginal. “The differences that do exist are down to gender,” Saini says. “Differences in the way people are treated and thought about and the assumptions we make about them.” That, according to Saini, is what explains many of the failures when it comes to women’s health.
Consider, for instance, the common misconception that women present atypical heart-attack symptoms, different from men’s. This prevailing myth was quashed by a 2019 study, funded by the British Heart Foundation, at the University of Edinburgh. The research, which involved nearly 2,000 patients, showed that, in fact, 93 percent of both sexes reported chest pain—the most common symptom—while a similar percentage of men and women (nearly 50 percent) also felt pain radiating from their left arm. “The problem of underdiagnosis of women is because health professionals and even the women themselves who are having a heart attack believe heart attacks are something that mostly happens to men,” Saini says. Estimates indicate that differences in care for women have led to approximately 8,200 avoidable deaths due to heart attacks in England and Wales since 2014.
“It’s not about men discriminating against women; this is often about women not being listened to—sometimes by other women,” she says. Another example that starkly illustrates how gender can affect health outcomes came from a 2016 Canadian study about patients who had been hospitalized with acute coronary syndrome. The research showed that the patients who experienced higher rates of recurrence were the ones who performed gender roles stereotypically associated with women—like doing more housework and not being the primary earner at home—independently of whether they were a man or a woman. “This was because people who carried out a female social role were more likely to be anxious.” Saini says.
If these disparities are caused by the way patients are perceived and treated, the solution, to Saini, is clear: “We need to be careful to diagnose the problem where it is, not where we imagine it to be.” She highlights the successful work of Jennie Joseph, a British midwife who, in 2009, founded the Commonsense Childbirth School of Midwifery in Orlando, Florida, to support women without access to maternal health care. Research has shown that Black mothers, both in the US and in the UK, are three times more likely to die than white women.
“Joseph lowered maternal mortality rates among minority women simply by improving the quality of their care, listening to their concerns, and responding when they say they’re in pain,” Saini says. “We don’t need technology to solve this issue. We just very simply can’t allow our biases and prejudices to get in the way.”
This article appears in the July/August 2024 issue of WIRED UK magazine.