Notes on Engineering Health, June 2021

XX Versus XY

Does having two X chromosomes set one back when it comes to being understood and treated by the medical profession? 

The answer seems to be yes in many instances. Here are five striking examples where there are clear differences between diseases men and women get, as well as the way they are treated:

Autoimmune Diseases
They affect 8% of the global population, but 78% of those affected are women. Females are three times more likely than males to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis. 

Long Covid-19
While acute cases of Covid-19 have tended to be mostly male and over 50, long Covid sufferers were, by contrast, both relatively young and women outnumbered men four to one.

Heart Disease
A classic example in how men and women differentially experience a similar condition is heart disease. Women’s most common heart attack symptom, as with men, is chest pain or discomfort. But women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea, vomiting and back or jaw pain. Because MDs are still overwhelmingly trained to consider symptoms from male patients, women can sometimes be diagnosed wrongly. 

Risk & Side Effects
The risk of blood clotting while taking the J&J vaccine against SARS-CoV-2 is roughly of one in every 250,000 people —prompting the FDA to halt its use in the USA pending further review. In comparison, risk of blood clots caused by hormonal birth control pills is on the order of one in every 1,000, yet the FDA has taken no restrictive action.

A recent study has found that gender stereotypes are decisive in the estimation of patients’ pain. Researchers show that women’s pain is consistently underestimated and not treated as appropriately as men’s. The differences in assessment and treatment by healthcare workers, both men and women, come from the persistent (and false) belief that women are oversensitive to pain, and express or exaggerate it more easily.

Since 1997, FDA has required manufacturers to show evidence of how drugs are safe by age, sex, and race, and scientists must account for the possible role of sex as a biological variable in both pre-clinical and clinical studies. Yet, a lack of biological understanding around the role of gender factors in disease, poor policy choices like under-representing women in clinical trials, and societal biases (e.g., keeping funding for women’s health low for a long time) have perpetuated a state of inequity in the care of women versus men.

Thanks in part to the work of public intellectuals through books such as Doing Harm or Unwell Women, the causes of such disparity and its effects on women’s health are now being recognized and analyzed both through data and compelling individual stories. While this increased attention is welcome, there is still a sizable need for all actors in the healthcare industry to be mindful of the gender gap and to take action to rectify it. From regulators and MDs to scientists, venture capitalists, pharmaceutical groups and computer scientists working on new applications of AI, all must acknowledge existing gender biases and continue work to reduce them. 

Jonathan Friedlander, PhD & Geoffrey W. Smith