Female Forward

Gender does exist in science: inequality in medicine

Depression, anxiety, stress... hysteria? According to the book Perspectiva de género en la medicina by María Teresa Ruiz Cantero, women are more frequently labelled with emotional alterations and mental health problems when they present an illness, often minimising and ignoring their symptoms. The consequence of this is that, worldwide, 700 pathologies diagnosed late in women have been identified.

Gender stereotypes in science have created a double barrier against women. On the one hand, there is still a participation and inclusion gap in STEM (Science, Technology, Engineering and Mathematics) careers, where only 3 out of 10 Mexican women choose to study disciplines that are usually labelled as “men's”. On the other hand, women have also been relegated and under-represented in a multiplicity of research and medical studies as subjects of study.

Why does sex matter?

In 1991, the concept of gender bias was first used in the medical field. The term arose when it was discovered that there was a substantial difference in the number of coronary angiographies performed on men and women: on arrival at the hospital and with chest pain, men were given a study while women were prescribed anxiolytics, which meant a great risk to their health. 

There is a belief that men have a higher risk of suffering a heart attack; however, women are 50% more likely to receive a wrong diagnosis when it comes to cardiovascular diseases. 

Why? Because research continues to focus primarily on men, thus ignoring both the biological and symptomatological differences that women present. This increases co-morbidities, mortality and misinformation: the leading cause of death in women is heart attacks...not breast cancer, as is popularly believed. 

For decades, science has taken men as the model for study. This type of bias in medicine represents a flaw in both theory, methodology and practice because failure to include sex differences in the design and analysis results in inadequate or late diagnoses. 

Medicine cannot and should not be 'unisex' or 'one size fits all', and it has been learnt that treatment models must be tailored to the biological and anatomical differences of the sexes.

In essence, we are not the same

The gender gap is a social and cultural phenomenon perpetuated by gender stereotypes and roles. In the case of scientific work, although it may not be intentional, it is found both in the classroom and in practice and affects both women and men. Because there are preconceptions about their behaviour and needs, diagnoses and treatments may be biassed.

Although this gap persists to date - for example, the lack of incorporation of gender data in clinical trials - since 1994 the NIH has recommended, encouraged and standardised the inclusion of women in scientific research in an effort to recognise its impact and reduce it. 

We still have a long way to go and this became evident during the Covid-19 pandemic. Shortly after vaccination began, testimonials emerged in the form of tweets and online conversations about menstrual changes. While it was initially claimed that there were no side effects linked to menstruation, or that these represented isolated cases, a study published in 2022 by the journal Obstetrics & Gynaecology corroborated that there was a link between them. This side effect was not added to the list of adverse reactions as the first initial clinical trials did not track this information. 

The quality, efficacy and safety of vaccines is not detracted from by a side effect that, at this time, has been confirmed to have no long-term consequences. However, the omission of this variable -a fundamental aspect of female anatomy and health-, besides causing mistrust, favours the emergence of false news that generate rejection, panic and fear of vaccines. 

Taking into account the concerns and testimonies of women, in addition to promoting equity and transparency in scientific research, increases confidence in the vaccine, in this case, and helps to fight misinformation, scepticism and generalised concern.

Latinas in medicine

There are women who have dedicated their careers to study and treat specific ailments of women, a great example is Eva Ramón Gallegos, a Mexican researcher and scientist who has specialized in the search for treatments to eradicate cervical cancer caused by the human papillomavirus. In 2018 she managed to eliminate the virus in 29 women, becoming a world leader in the fight against a disease that infects at least 90 percent of women in Mexico and is the second leading cause of death in women in the country. 

Nubia Muñoz, a Colombian pathologist and epidemiologist, studies the different types of cancer that affect poor populations and has identified the infectious agents related to stomach, liver and HPV cancer. It was she who discovered that the human papilloma virus is the main cause of the latter type of cancer, which earned her the Nobel Prize for Medicine in 2008.

For her part, María Amparo Pascual, a physician and the first Cuban biostatistician, is the founder and director of Cuba's National Coordinating Center for Clinical Trials (Cencec) and for the past thirty years has been dedicated to clinical trials in oncology and other specialities. Her work was accredited in 2011 as an example in the region by the WHO and she has been a key player in improving medical quality, diagnostic standards and treatments for diseases in her country.

An important effort at the regional level is the creation of the Gender and Health Network ALAMES-Cuba, which has focused its work on introducing gender in Cuban medicine and has produced research on sexuality, diseases such as HIV, infertility and has contributed different methodological proposals on the gender approach in clinical trials, all this despite the challenges and difficulties faced by medical and health personnel in Cuba. 

Although there is still a long way to go, the situation has improved in recent decades. In Chile, for example, the Chair of Scientific Research Methodology at the School of Medicine of the University of Valparaiso has developed and published a general methodological series in biostatistics and clinical epidemiology on how sex and gender influence scientific research, you can read an excerpt here. 

More women are now studying and working in STEM careers; 46% of medical students are women. According to one study, the inclusion of women in scientific research results in up to a 30% increase in the likelihood that the work will contemplate sex and gender analysis. 

On International Women's Day, in addition to vindicating the role of women in society, it is also necessary to analyse the state of science for women. The consequences of the lack of inclusion and gender stereotypes are real and tangible: the invisibilization of women in science not only perpetuates the professional gender gap, but also represents a health risk.