| Dangerous miscalculation |
In medicine, men have always been regarded as "typical". Disease symptoms often describe how men feel and behave. Such as myocardial infarction, symptoms are chest pain and left arm radiating pain. That's true too, but mostly applies to men. Women with myocardial infarction have the following symptoms: exhaustion, intense discomfort, difficulty breathing, nausea, vomiting, dizziness, shortness of breath, pain in the neck, jaw, back, or upper abdomen, left or right chest pain or pressure.
The example of myocardial infarction clearly shows how uneven the development of the medical system is, and there are many such examples. Men are the standard for everything, whether in textbooks, when describing symptoms of disease, or in diagnosis and treatment. Medical research is also male-oriented. Scientists often draw their conclusions from male cells, male laboratory animals, and male subjects. "For decades, women have been viewed as smaller men, and this has continued to have deadly medical consequences," says cardiologist Vera Regitz-Zagolosek. Since 2008 she has been director of Germany's first Institute for Gender Medicine, established at the Charité School of Medicine in Berlin.
In this way, myocardial infarction is erroneously thought of as a male disease, although women are equally susceptible to the disease, but at a higher average age. In Europe and the United States, women are even more likely than men to die after a myocardial infarction. One reason is that women underestimate their risk of developing cardiovascular disease. They are often unable to be accurate about their pain, always grit their teeth and insist, and the severity of their condition is often underestimated by family members, friends or colleagues: studies have shown that female patients are about one later than male patients after symptoms of myocardial infarction. hours into the emergency room.
Emergency physicians and paramedics are also often dominated by a "male perspective" and may overlook situations because female patients' pain is not as "typical" as described in medical education. Women tend to describe their ailments differently than men: more detailed, but perhaps less urgent. Studies in Sweden and Germany have shown that if a female patient with cardiovascular pain is seen by a male doctor, she is more likely to receive worse treatment than a male patient. A study in the United States has confirmed that the mortality rate of female patients with myocardial infarction is therefore higher.
For a long time, scientists didn't pay enough attention to women when studying diseases.
| Gender Medicine |
Critics often denounce cardiac catheterization as too much overall, but it is certain that women also receive less ideal care than men for what is actually necessary. Regitz-Zagolosek became a pioneer in gender medicine through her early experiences at the hospital heart center. There, she noticed that women were more likely than men to have comprehension problems during treatment and medication use, and were more likely to miss doctor appointments or object to necessary surgery. Communication between male doctors and female patients was particularly poor. Regitz-Zaglossek asks himself: Is this an institutional problem? Should physicians communicate differently to male and female patients in order to better explain planned treatment? Since then, the female doctor has sought answers. Her students benefited: Gender medicine became a compulsory subject at the Charité Medical School in Berlin, where she taught.
Doctors should learn to distinguish between male and female patients from the start. It's not just about biological differences between men and women, it's about X and Y chromosomes, anatomical, cellular, physiological, and hormonal differences, but it's also about behavior patterns, communication styles, gender role perceptions, and stereotypes.
At first, Regitz-Zaglossek and his supporters were questioned and even ridiculed by other doctors in Germany, Austria and Switzerland, as if studying gender medicine were a quirk. Now, everything has changed. In 2018, Regitz-Zagolosek was awarded the Federal Cross of the Order of Merit.
"Previously, 95 percent of our participants were female doctors and scientists, but now more and more men are participating." Sabina Ottert-Prigion, professor of gender medicine at Radboud University in the Netherlands Said, "Obviously, this is an important research direction, not a private area of interest for a particular scientist. I hope that in the future we will naturally take into account gender differences in the process of research, diagnosis and teaching."
Men and women The difference in illness is also reflected in the new crown epidemic. During the first wave, men tended to have more severe Covid-19 symptoms than women, required hospital visits and intensive care units more frequently, and had higher mortality rates.
Experts stress that gender medicine is by no means only for women. "Gender medicine has nothing to do with feminism. Through research, we want to improve medical care for both men and women," Regitz-Zaglossek writes in her book Gender Medicine. Men also suffer from a narrow human view of disease: Depression and osteoporosis are seen as quintessentially female ailments that, when present in men, are often overlooked or underdiagnosed. Prof. Ottert-Prigion cited data: "30-40% of men over the age of 70 suffer from osteoporosis. Unfortunately, this disease is often overlooked. These elderly people often suffer from fractures. You don’t get a diagnosis until you’re in the hospital.”
In addition, we often don’t see an increase in men’s rage and aggressive behavior as a sign of depression, but we tend to think that there’s a psychological problem or stress behind women’s physical pain. Doctors are two to three times more likely than men to prescribe antipsychotics for women.
| Male Orientation of Medication |
The new drugs are often predominantly male, in part because of the 1950s and 60s scandal of thalidomide, a sedative that was used by pregnant women to harm their babies. Women have been excluded from pharmacy research for a long time since then to protect the unborn. In addition, research on female laboratory animals and women is often more complicated due to the influence of female sex hormones and menstrual periods.
Currently, the European Medicines Agency requires manufacturers to study the effects and side effects of active ingredients in medicines by gender. "But it's just non-binding recommendations," Regitz-Zagolosek said. In fact, only 15% of drug licensing studies to date distinguish between men and women. A 2018 study by Regitz-Zaglossek concluded that only 12 percent of studies on cardiovascular disease were disaggregated by gender. “At the same time, in theory, the data for all the studies are readily available, we just didn’t do that analysis,” the researcher said. A cultural issue that concerns the whole society."
Against this background, it is not surprising that women are almost twice as likely to experience adverse reactions when taking medication as men. Women have less muscle, more fat tissue, weaker kidneys, and different enzyme activity. In addition, women have a slower digestive rhythm, taking an average of several hours longer than men to digest and absorb drugs. Some of the active ingredients in commonly used drugs used to be tested mainly on men, with some adverse consequences. For example, a few years ago, some female drivers in the United States took some kind of sleeping pill the day before the accident. They are more effective in women than in men, so the manufacturer should have stated "half the dose for women" in the package insert.
The functioning of the human immune system is also related to gender. "Women tend to be more sensitive, and react more strongly to vaccines such as flu and measles," says Regitz-Zagolosek. But in many cases, researchers have not conducted gender-specific vaccine adverse reaction studies. "90% of allergic reactions occur in women when vaccinated against Covid-19," Regitz-Zagolosek said. Scientists have been investigating the need for different doses of vaccines for men and women more than a decade ago, but research has been slow.
According to statistics, in Germany, about two-thirds of medical students are women, but only 13% of hospital leaders and medical professors with chairs are women. A 2019 study by the Federation of German Women Doctors concluded: "Men currently occupy 87% of medical-related leadership positions, dominate clinical medicine in Germany, determine treatment options, medical concepts, teaching strategies, personnel policies... It is estimated that it will take 32 years to achieve equality between men and women."
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Women with myocardial infarction are admitted to the emergency room about an hour later than men.
62.5% of German medical students are women, but only 13% of attending physicians and hospital leaders are women.
Women are about twice as likely to suffer adverse drug side effects as men. The drug takes several hours longer to pass through the digestive tract in women than in men.
Physicians were more likely to attribute pain symptoms in women to stress or psychological problems, compared with men who were more likely to receive symptomatic treatment. Studies have shown that three days after heart bypass surgery, men are twice as likely as women to use painkillers. For the acute abdomen group, men were given pain medication after an average of 49 minutes and women after 65 minutes, and women were also less likely than men to be hospitalized.
