Authors: Naomi (Catie) Futhey, MD/PhD Student, University of British Columbia Faculty of Medicine & Graduate Program in Neuroscience | Editors: Romina Garcia de leon, Janielle Richards (Blog Coordinators) | Expert Reviewer: Dr. Liisa Galea
Published: September 20, 2024
Women face disproportionate barriers to healthcare, including longer time to diagnosis and differences in disease presentation, severity, and medication response. Such differences are often ill-defined in the clinical literature. This health disparity is multifaceted but can largely be traced back to a well-intentioned movement at protecting women of childbearing potential after the infamous thalidomide tragedy.
The initial safety concern settled into a blatant exclusion of women from both clinical and preclinical research, under the disillusioned rationale that women’s health can be inferred from studies conducted only in males. Despite this restriction’s reversal in 1993, for NIH-funded clinical trials, the implementation of proper research techniques to analyze sex and gender differences has only begun recently.
It is often said that it takes 17 years for discoveries in research to make their way into clinical practice, a disconnect thought to be related to systemic barriers between research and medicine. Given this timeline, it will be at least a decade before we can expect to see changes to women’s health. Bridging this gaping research-medicine divide is critical, and targeting medical schools is a viable starting point.
We know now that what happens in the male context cannot be blindly generalized. Unique anatomical and physiological contexts yield distinct responses to the same diseases, as well as different diseases entirely. There are many conditions which affect far more women than men, and vice versa. There are also disorders which are gender-specific, such as menopause-related conditions and prostate cancer.
Women have lower body weight, smaller organs, and higher fat content than men, factors which all modify performance of medications. Sex differences have in fact been documented at every stage of pharmacokinetics, the branch of pharmacology focused on how drugs move through the body. Despite this, medications are generally prescribed at the same dosage regardless of sex or gender. It is unsurprising then that women are twice as likely to experience adverse drug reactions. Specifically, studies have shown that antipsychotics—drugs commonly used to treat psychotic disorders, depression, and anxiety—are metabolized differently in men and women. One study found that olanzapine, one such medication, had 59% higher bioavailability in women. To some extent, this is a generalizable phenomenon, suggesting that women are largely being overmedicated.
Despite so many topics demanding dedicated study, research related to women’s health receives disproportionately low funding. This is depicted visually and intuitively in a recent Nature feature. Various initiatives have been enacted in response, including the mandate of sex and gender based analysis as part of the evaluation criteria for each CIHR grant in 2019, and the Canadian Government’s announcement of a $20 million National Women’s Health Research Initiative in 2022.
Despite such enticing proposals, we have yet to see actionable change manifest downstream in the care women receive at the doctor. A British Columbia Women’s Health Foundation 2019 report stated that over half of women in the province felt that a physician had diminished or overlooked their symptoms. Similar qualitative reports broadly echo these patient perspectives.
Patient care isn’t the only thing that suffers from this disparity: poor health translates to lost productivity and missed work. Importantly, a recent report by the World Economic Forum estimates that not only do women spend 25% more time in “poor health” than men, but that prioritizing women’s health research could boost the economy by $1 trillion by 2040.
17 years is too long to wait for clinical change. Augmenting the medical education system is one way to bridge this gap and ensure new and accurate research makes its way into the doctor’s office in a timely manner. Established physicians are often set in their practices and changes can be challenging to integrate. Targeting students early on in their training before these routines set in, however, is a logical solution.
Medical school curricula have changed substantially over the years, but better education in women's health is still an area of need. In particular, a 2021 Toronto survey of 16 Canadian medical school program and course descriptions found that women’s health may not be adequately incorporated into clinical training programs. Only approximately 15% of curricular documents examined specifically mentioned “sex/gender” or “women’s health”. Additional surveys of clinical trainees in the United States have found that the majority feel ill-equipped to deal with sex and gender differences in healthcare.
Bolstering the clinical education of future physicians has the capacity for exponential change in the betterment of women’s healthcare delivery. Doctors of all specialties have direct communication channels to the general public through their patients. This is important not only for individual care, but for the communication of valuable medical knowledge to the population at large. Informed patients are better equipped to understand their own health and when to seek care. Prioritizing medical school curricula has the potential to deliver equitable, quality healthcare to a population which cannot afford any further time delays.
Keep up with Catie Futhey’s work on Twitter/X: @CatieFuthey