Male bias in medicine

[Fishnut]

The Guardian have an extract from a new book, Pain and Prejudice by Gabrielle Jackson, that discusses the way women have been failed by medicine. It's something Caroline Criado-Perez dedicated a chapter to in her book Invisible Women, so it's great that there's now a whole book on the subject. I've loaned my copy of Invisible Women so don't have it to hand to give precise figures, but I remember the massive disparity in research between erectile dysfunction (something experienced by a small percentage of men and, while upsetting, isn't life-destroying) compared to pre-menstrual syndrome (PMS, something experienced by upwards of 80% of women that can cause debilitating symptoms on a monthly basis). In case it's not clear, erectile dysfunction had been the focus of much more research.

The exclusion of women from medical trials, due to the combination of our hormones being "too messy" (because men don't have hormones ) and the fact we only exist to make babies and god forbid we do anything to damage our procreative abilities, has meant that we have no idea what medicines are actually effective on women, and which are doing nothing or worse, actively harming us. It's great that this problem is finally getting attention but I won't be properly celebrating until women become seen as more than Aristotle's "mutilated male" and get the research focus we deserve.

Can you imagine the money that could be made if someone came up with an effective period pain cure?!

[JQH]

Yes. MrsH suffered bad period every month for several days.

Every month for 45 years.

[Fishnut]

Yes. MrsH suffered bad period every month for several days.

Every month for 45 years.

Sympathy to MrsH.

I used to get cycles of increasing pain every month for about 6 months which would peak with me feeling nauseous and in so much pain I'd be close to passing out, then they'd reset. I was sh.t at paying attention to my cycle and the severe symptoms were often my first sign that I'd started, by which point I was unable to take any medication to relieve them because of the nausea. I went on the pill after waking up in agony half way through my cycle and when I went to the doctor was told that you can sometimes get "pseudoperiods" which often indicate you're in for a really rough one when the time comes. I was on the pill for a decade or so, and then went to the Implanon implant which has been a godsend. I've had it for over a decade now, it has to be changed every 3 years but it takes about 5-10 minutes (most of that is spent getting the old one out) and I haven't had a single period in all that time. I hope that I'll stay on it until I get through the menopause.

I've been lucky that contraception has worked for me, and has also prevented my from getting accidentally parasitised, but it doesn't work for everyone and the fact the main way we have to stop period-related problems is to chemically suppress people's fertility is very telling. I know it's a cliché, but I can't help but think that if men had to deal with periods we'd have multiple drugs in multiple forms to deal with the various symptoms, there'd be no taboo around them (possibly even some braggadocio) and time off from work to deal with them would be standard.

[JQH]

Yes. MrsH suffered bad period every month for several days.

Every month for 45 years.

I know it's a cliché, but I can't help but think that if men had to deal with periods we'd have multiple drugs in multiple forms to deal with the various symptoms, there'd be no taboo around them (possibly even some braggadocio) and time off from work to deal with them would be standard.

Probably true that we'd have more means of treating it. Not convinced about the time off from work bit though. For a long time my last place of work had an all female SMT. I'm don't think any such allowances were made. In fact they began subjecting staff who had certified sick leave for any reason to capability procedures.

[spinybear]

The Guardian have an extract from a new book, Pain and Prejudice by Gabrielle Jackson, that discusses the way women have been failed by medicine. It's something Caroline Criado-Perez dedicated a chapter to in her book Invisible Women, so it's great that there's now a whole book on the subject.

There's another book that was out a couple of years ago Inferior: How Science Got Women Wrong by Angela Saini which touches on similar topics. It's great that there's more awareness and discourse.

Question on my mind though: what's the path to change?

[Fishnut]

I love that book! Her follow-up, Superior, on race science was equally brilliant.

Path to change comes, I think, from getting more women and minorities into STEM and fund their research - Criado-Perez's book wrote about researchers who have tried to get funding for women-specific issues and have repeatedly failed because the funders don't think the subject is interesting enough.

[mikeh]

Scuse the self-indulgence here, for the links to a couple of my papers - both of which show the extent to which the UK research environment is male-dominated (too-long-didn't-read summary, about 80% of funding goes to a male lead researcher, 20% female lead researchers)

Infectious disease research funding here - http://bmjopen.bmj.com/content/3/12/e003362.full

Cancer research funding here - https://bmjopen.bmj.com/content/8/4/e018625 (and even in areas of womens health, like cervical or breast cancer research, still a male-led field)

And any closing of the 80/20 gap is very very slow, we didn't see much change in the time periods studied here.

[Fishnut]

Thanks for the links, and even more thanks for actually doing this research!

I attended a women in STEM event a couple of years ago and the keynote speaker noted that people have been talking about 'fixing the leaky pipeline' for over 2 decades and yet very little change has been noticed, despite that being plenty of time for women to have started rising through the ranks. I think it's a problem bigger than just STEM as it's due to societal pressures as much as anything.

[tom p]

Yes. MrsH suffered bad period every month for several days.

Every month for 45 years.

Sympathy to MrsH.

I used to get cycles of increasing pain every month for about 6 months which would peak with me feeling nauseous and in so much pain I'd be close to passing out, then they'd reset. I was sh.t at paying attention to my cycle and the severe symptoms were often my first sign that I'd started, by which point I was unable to take any medication to relieve them because of the nausea. I went on the pill after waking up in agony half way through my cycle and when I went to the doctor was told that you can sometimes get "pseudoperiods" which often indicate you're in for a really rough one when the time comes. I was on the pill for a decade or so, and then went to the Implanon implant which has been a godsend. I've had it for over a decade now, it has to be changed every 3 years but it takes about 5-10 minutes (most of that is spent getting the old one out) and I haven't had a single period in all that time. I hope that I'll stay on it until I get through the menopause.

I've been lucky that contraception has worked for me, and has also prevented my from getting accidentally parasitised, but it doesn't work for everyone and the fact the main way we have to stop period-related problems is to chemically suppress people's fertility is very telling. I know it's a cliché, but I can't help but think that if men had to deal with periods we'd have multiple drugs in multiple forms to deal with the various symptoms, there'd be no taboo around them (possibly even some braggadocio) and time off from work to deal with them would be standard.

With the greatest respect, and agreeing with the other issues you've written about here, I don't think that the emboldened part is true.
Firstly, there are various drugs (you have described 2 different ones which worked great for you) - pain killers, muscle relaxants, contraceptives, antidepressants if necessary & secondly f.cking with hormones, hormone receptors and the interactions with the brain can have all kinds of unexpected consequences and nasty side effects.
Male pattern baldness affects men. Hair sprouting out of noses & ears and all over backs affects men. It makesus feel miserable and old and ugly and affects us at an age when we're usually around our wealthiest & it would need to be a treatment that lasts for years, so there's a huge market out there. Why isn't this sorted? Because it's hormone-driven (increased testosterone) & a consequence of normal bodily function. Changing those kinds of things is really difficult without reducing the other normal functions. I could stop myself from turning into a hairy grumpy old bloke by taking testosterone blockers, but then I'd have chemically suppressed fertility too.

[dyqik]

Male pattern baldness affects men. Hair sprouting out of noses & ears and all over backs affects men. It makesus feel miserable and old and ugly and affects us at an age when we're usually around our wealthiest & it would need to be a treatment that lasts for years, so there's a huge market out there. Why isn't this sorted? Because it's hormone-driven (increased testosterone) & a consequence of normal bodily function. Changing those kinds of things is really difficult without reducing the other normal functions. I could stop myself from turning into a hairy grumpy old bloke by taking testosterone blockers, but then I'd have chemically suppressed fertility too.

It's a derail, but aren't there several options for treating male baldness that don't involve f.cking with hormones? Surgical options like implants, Rogaine, etc. That's before we get to the psychological options for treating the image issues you mention in themselves.

I suspect the reason that the baldness treatments aren't more widespread is more cultural rather than effectiveness, as men don't want to be seen to be that vain.

And of course, being bald all the time is much easier to live with than intense pain, mood swings and everything else, for several days to a week or so per month, which pass and then come back again every month.

[tom p]

Male pattern baldness affects men. Hair sprouting out of noses & ears and all over backs affects men. It makesus feel miserable and old and ugly and affects us at an age when we're usually around our wealthiest & it would need to be a treatment that lasts for years, so there's a huge market out there. Why isn't this sorted? Because it's hormone-driven (increased testosterone) & a consequence of normal bodily function. Changing those kinds of things is really difficult without reducing the other normal functions. I could stop myself from turning into a hairy grumpy old bloke by taking testosterone blockers, but then I'd have chemically suppressed fertility too.

It's a derail, but aren't there several options for treating male baldness that don't involve f.cking with hormones? Surgical options like implants, Rogaine, etc. That's before we get to the psychological options for treating the image issues you mention in themselves.

I suspect the reason that the baldness treatments aren't more widespread is more cultural rather than effectiveness, as men don't want to be seen to be that vain.

And of course, being bald all the time is much easier to live with than intense pain, mood swings and everything else, for several days to a week or so per month, which pass and then come back again every month.

Well, successful hair transplants are pretty recent really, all things considered. Rogaine is one medicine, it's true, but it's much newer than the pill, which has been successfully treating women with PMS for decades.
And none of those treatments tackle gross hairy noses.
Psychological treatments are entirely irrelevant in this discussion, because it's not a cure for baldness or unwanted hairiness. Might as well suggest hypnosis to cope with the pain, or just getting the f.ck over yourself for the mood swings* - seeing yourself looking old and gross every day is draining. If there was a simple pill that blokes could take to reverse or prevent those effects, they would & it would have been as successful and talked-about as viagra. Don't forget, before Viagra the idea of being impotent was awful & it is not something blokes would ever have discussed.

I don't want to seem to diminish the real & severe pain that some women experience; but most don't to such an extent, so any medicines would have to account for that, and it's still the case that it's essentially coming from normal bodily functions, which are the hardest to treat without significant side-effects (look at cancer treatments - cancer is uncontrolled cell growth. Cell growth is a normal bodily function. Preventing or reversing it is very injurious to the person. Look at arthritis medicines - TNF antagonists. TGN1412 - remember that disastrous clinical trial? f.cking with out-of-kilter bodily functions and, especially, messenger molecules like hormones or the start of a cascade and sh.t can go very badly wrong in loads of awful ways).
Is there (usually unrecognised and inadvertent) pro-male bias in medicines? Yes, clearly.
Is it the case that if PMS affected blokes it would be cured or far better-treated by now. I contend not. There might be better provision for care, there might be better palliative treatments. Maybe doctors & nurses would be more willing to dispense painkillers to prevent definitely-about-to-arrive pain rather than as a reward for tolerating some pain, but then again OTC codeine is already available in the UK, as are muscle relaxants. Here's a list of them. They deal with muscle cramps really well.

ETA...
*for the avoidance of doubt, I am NOT suggesting that that is a viable option

[dyqik]

Male pattern baldness affects men. Hair sprouting out of noses & ears and all over backs affects men. It makesus feel miserable and old and ugly and affects us at an age when we're usually around our wealthiest & it would need to be a treatment that lasts for years, so there's a huge market out there. Why isn't this sorted? Because it's hormone-driven (increased testosterone) & a consequence of normal bodily function. Changing those kinds of things is really difficult without reducing the other normal functions. I could stop myself from turning into a hairy grumpy old bloke by taking testosterone blockers, but then I'd have chemically suppressed fertility too.

It's a derail, but aren't there several options for treating male baldness that don't involve f.cking with hormones? Surgical options like implants, Rogaine, etc. That's before we get to the psychological options for treating the image issues you mention in themselves.

I suspect the reason that the baldness treatments aren't more widespread is more cultural rather than effectiveness, as men don't want to be seen to be that vain.

And of course, being bald all the time is much easier to live with than intense pain, mood swings and everything else, for several days to a week or so per month, which pass and then come back again every month.

Well, successful hair transplants are pretty recent really, all things considered. Rogaine is one medicine, it's true, but it's much newer than the pill, which has been successfully treating women with PMS for decades.
And none of those treatments tackle gross hairy noses.
Psychological treatments are entirely irrelevant in this discussion, because it's not a cure for baldness or unwanted hairiness. Might as well suggest hypnosis to cope with the pain, or just getting the f.ck over yourself for the mood swings - seeing yourself looking old and gross every day is draining. If there was a simple pill that blokes could take to reverse or prevent those effects, they would & it would have been as successful and talked-about as viagra. Don't forget, before Viagra the idea of being impotent was awful & it is not something blokes would ever have discussed.

There's a very cheap and guaranteed treatment for gross hairy noses. I bought one at my local CVS for $10, and it's lasted at least three years so far. Removing hair is really not hard, and needs doing maybe once or twice a month. Suggesting that it is in any way in the same category as actual physical pain is laughable.

The psychological treatments are not irrelevant at all - losing hair does not cause physical pain, so any effect of the immediate symptom is psychological, and psychological treatments are the relevant treatment for alleviating the effects of the symptoms. Meanwhile, periods cause actual debilitating physical pain, and suggesting psychological treatment for physical pain would be grossly insensitive, as is suggesting that baldness is of comparable severity.

Anyway, enough of this derail.

[Stephanie]

Tbf to Fishnut, she said "I can't help but think..."

[tom p]

@dyqik: and my wife bought some buscopan from boots for £3. There are treatments available for PMS symptoms. I'm not entirely sure what point you're trying to make any more.

Tbf to Fishnut, she said "I can't help but think..."

I get that, and at no point have I had a pop at fishnut. I've heard people make that claim before and it always struck me as wrong. Not coming from a bad place, but a position of not realising why it's wrong & so it gets incorrectly lumped in with the very real problems of gender bias in medicine.

[Stephanie]

@dyqik: and my wife bought some buscopan from boots for £3. There are treatments available for PMS symptoms. I'm not entirely sure what point you're trying to make any more.

Tbf to Fishnut, she said "I can't help but think..."

I get that, and at no point have I had a pop at fishnut. I've heard people make that claim before and it always struck me as wrong. Not coming from a bad place, but a position of not realising why it's wrong & so it gets incorrectly lumped in with the very real problems of gender bias in medicine.

Right, but perhaps a link to some evidence, rather than starting to talk about a problem affecting men might have been a better strategy?

[tom p]

@dyqik: and my wife bought some buscopan from boots for £3. There are treatments available for PMS symptoms. I'm not entirely sure what point you're trying to make any more.

Tbf to Fishnut, she said "I can't help but think..."

I get that, and at no point have I had a pop at fishnut. I've heard people make that claim before and it always struck me as wrong. Not coming from a bad place, but a position of not realising why it's wrong & so it gets incorrectly lumped in with the very real problems of gender bias in medicine.

Right, but perhaps a link to some evidence, rather than starting to talk about a problem affecting men might have been a better strategy?

Like the links to a list of muscle relaxants, which actually are treatments for one of the worst symptoms of PMS? Is anyone disputing they exist? Or that codeine is readily available in Boots?
Or would you like a link to pictures of men with hairy noses & another link to a basic medical textbook saying it's caused by testosterone?

When what was said is the hypothetical statement that 'if PMS affected men, then it would be better-treated by now', then I'm not doing that dickish thing of making it about men, I'm giving a concrete example of something which is caused by an analogous bodily function (sex hormones) in men (the comparison having already been drawn by fishnut) causing something undesirable & it not being cured. Despite it affecting men at the peak of their earning power, meaning that there is a f.cking huge profit to be made by anyone who could prevent it.
As repeatedly said, I'm not disputing that there's a gender bias in medicine & society at large, I'm merely disputing one hypothetical.

[Stephanie]

Fishnut used an example in a book she'd read which was erectile dysfunction. I can't see where she's spoken about baldness.

I was actually referring to evidence regarding the difficulties with respect to coming up with treatments that involve hormones. There's no need for snarkiness.

[tom p]

Fishnut used an example in a book she'd read which was erectile dysfunction. I can't see where she's spoken about baldness.

I was actually referring to evidence regarding the difficulties with respect to coming up with treatments that involve hormones. There's no need for snarkiness.

I thought that the side-effects of the pill & other hormone treatments were well-known enough not to need it.

The bit from the book was, as I read it, about exclusion from medical trials and then fishnut wrote "can you imagine the money that could be made if someone came up with an effective period pain cure?!" A statement that is self-evidently correct.
Then, in a later post, she repeated an old clichéd claim that such an effective treatment would most likely exist if men got period pain.
I respectfully disagree with her about that 2nd claim. I explained why i disagree. No more, no less.
My counter-example of head baldness & nose hairiness was to show that actually it's not necessarily true that something which is caused by sex hormones, and for which there's a shitload of money to be made, would have been cured by now if it affected men, because that affects men & it's not cured.
It is a counter-example to a hypothetical claim which demonstrates why the hypothetical claim was, in my opinion, incorrect.

[tom p]

Fishnut used an example in a book she'd read which was erectile dysfunction. I can't see where she's spoken about baldness.

I was actually referring to evidence regarding the difficulties with respect to coming up with treatments that involve hormones. There's no need for snarkiness.

I should also say sorry - I didn't mean to come across as snarky.

[Woodchopper]

I just deleted some posts which didn’t follow the rules of engagement for the Nerd lab. There’s other places on the forum where you can refer to your scrotum. But not here please.

[username]

Viagra has an interestingish story as laid out in Invisible Women; the original trials were done in the early 1990s, testing as a medicine for heart disease. I don't know how long approval for such testing would have taken, be we are talking about a drug discovery in 1989 and testing from shortly thereafter. The tests were done on men only (which is crap, and I expect/hope recognized as most current thinking people by now as bad practice, but that was the contemporary M.O.) Though unsuccessful at treating the heart, many study participants did report erections as side effects. Severe ED (as they now call it) affects between 5 and 15% of men depending on age, and about 40% suffer from some degree of it. There's obviously big money in boners, so there were trials and it went to market a couple of years after getting nice shiny new patent.

Now I don't doubt for a nanosecond that there would not be big money in a new and effective PMS treatment as well, but the first nail in the sildenafil citrate as PMS treatment coffin was hammered in when the all-male heart-treatment study was designed 30 years ago. That the research discontinued in 2013 was unable to find funds is without doubt in part because the drug was about to go off-patent (which it did in 2016) and in a commercially oriented research environment it was apparently not deemed to be worth the risk. So specifically on viagra there's a legacy issue about how stuff was done in the 1990s and a current how stuff is funded issue. I'm tempted to say the reason public funding has not been available for dysmenorrhea is 'OK Boomer' as well as gender bias, but that might be unfair. Hopefully this too is changing.

The legacy issue is hopefully being addressed by changes in attitudes to such things, and there may well be hundreds of drugs which don't work well for women because they were not trialed across sexes correctly, and hundreds more which were shelved because they didn't work for men but might work for women. Funding is going to be hard, though, in the commercial sphere, because many patents will have expired.

Thanks for bringing the book up, I look forward to reading it.

[murmur]

In my old bit of the forest it is becoming increasingly accepted that major assessment tools for autism and ADHD may have a built-in male bias from how they were designed and normed. However, I'm a bit out of touch with what is happening and how any changes are being considered.

Mumble, something about institutional sexism, mumble, but lack any bits of research to back it up, just anecdotal accounts from female type folk I know.

[Fishnut]

Another new book, this time on the way a relative dearth of research into pregnancy birth and childcare leads to poor outcomes and an excess of unnecessary interventions. The author has a piece in The Conversation which is worth a read. This part really jumped out at me,

One area where women are more equally funded is in the social sciences. But the discipline’s focus on qualitative methods, such interviews and observations, is sometimes taken less seriously. Many instead consider randomised controlled trials the best way to conduct research, as the element of behavioural choice and any associated demographic factors, such as age, gender or race, are removed.

However, conducting trials in birth and parenting research can have ethical implications. For example, you cannot randomise mothers to have a vaginal or cesarean birth, or to breast or formula feed. Also, qualitative methods are often better able to understand what is important to women, such as understanding their experiences of having labour induced rather than simply physical outcomes.

I used to be one of those who looked down on qualitative methods but the more I learn about them the more I realise that they can be rigorous and hugely effective for answering specific types of questions. It would be great if they could lose their stigma amongst the "hard sciences" community and be welcomed as an important tool in our arsenal.

[Woodchopper]

I used to be one of those who looked down on qualitative methods but the more I learn about them the more I realise that they can be rigorous and hugely effective for answering specific types of questions. It would be great if they could lose their stigma amongst the "hard sciences" community and be welcomed as an important tool in our arsenal.

Indeed. Often talking to people is the only way to understand why they do what they do.

[discovolante]

Another new book, this time on the way a relative dearth of research into pregnancy birth and childcare leads to poor outcomes and an excess of unnecessary interventions. The author has a piece in The Conversation which is worth a read. This part really jumped out at me,

One area where women are more equally funded is in the social sciences. But the discipline’s focus on qualitative methods, such interviews and observations, is sometimes taken less seriously. Many instead consider randomised controlled trials the best way to conduct research, as the element of behavioural choice and any associated demographic factors, such as age, gender or race, are removed.

However, conducting trials in birth and parenting research can have ethical implications. For example, you cannot randomise mothers to have a vaginal or cesarean birth, or to breast or formula feed. Also, qualitative methods are often better able to understand what is important to women, such as understanding their experiences of having labour induced rather than simply physical outcomes.

I used to be one of those who looked down on qualitative methods but the more I learn about them the more I realise that they can be rigorous and hugely effective for answering specific types of questions. It would be great if they could lose their stigma amongst the "hard sciences" community and be welcomed as an important tool in our arsenal.

I appreciate this isn't directly related to your post, but I have read that black women have particularly high problems in pregnancy/childbirth than white women, for all sorts of reasons no doubt but I think there are some biological factors which are ignored. E.g. I think pre eclampsia is more common and symptoms show earlier. But it seems perhaps the symptoms are not picked up on because it's expected that it would develop later. Sorry, I don't have any sources to hand and I have to admit I haven't verified anything properly, so this is a bit of a naff post for the nerd lab, but it seemed worth raising at least. Feel free to treat with a pinch of salt.