Why is there always a queue for the women’s toilets but not for the men’s? Why are doctors often unable to diagnose a heart attack in a woman in time? Why do women risk more than men in traffic accidents? The answer to such diverse questions is unique: “In a society built in the image of men, half the population, women, are systematically ignored. This is evidenced by the shocking absence of available data on women’s bodies, habits and needs”.
In her book ‘Invisible Women‘ (Einaudi 2020), Caroline Criado Perez shares some examples of how the gender data vacuum has created a pervasive and latent prejudice that has a profound, sometimes even fatal, reverberation on women’s lives. Including: smartphones, developed to fit men’s hand sizes; or the average office temperature, calibrated to the male metabolism; or medical research, which excludes women from tests ‘for the sake of simplification”.
Women’s role has been relegated to wives and mothers for centuries, a limitation that has led to a clinical focus on problems related to reproductive function only. Everything else has always been considered curable through studies carried out on men”, explains Silvia De Francia, clinical pharmacologist, lecturer at the University of Turin and scientific advisor on gender-specific medicine and pharmacology, in her book ‘La Medicina delle differenze’ (The Medicine of Differences). “From Hippocrates to Plato, from Galen to Vesalius and, incredibly until the end of the last century, women were regarded as inferior and therefore not worthy of specific attention. Today, it seems natural that women and men, who differ to some extent in their anatomy and physiology, should receive specific care when they fall ill. This was not the case until the end of the 20th century”.
As Giovannella Baggio, a senior scholar at the University of Padua where, from 2012 to 2017, she held the first Chair of Gender Medicine in Italy, explains, “until a few years ago, medicine showed a ‘blindness’ with respect to gender, as research was mainly conducted on male subjects with the results extended to women, assuming that the undeniable biological diversity had no significant repercussions on diseases”. In the last 20 years, however, “thanks to the emergence of gender medicine, we have discovered that men and women manifest the symptoms of the same diseases differently, and therefore need different diagnostic strategies and respond differently to medication.
“Gender pharmacology and medicine are recent developments”, points out Silvia De Francia. “A first approach in Italy took shape in 2016, embodied in Law 3/2018 and then came into force with the 2019 Gender Medicine Implementation Plan. There is still a lot more to do”.
Medicine and legislation are adapting, albeit slowly, to ensure that everyone is treated fairly, i.e. on the basis of the subjective data that each individual brings with him or her from birth. “At this point in time, it is proving important to study the effectiveness of drugs and vaccines against COVID-19 by considering, respecting and valuing the differences in male and female genders”, clarifies Baggio, who is also residing at National Study Centre on Health and Gender Medicine, concerned with understanding how biological differences between men and women influence their overall state of health and illness.
Better surgery for female patients
In January 2022, the Guardian devoted a major article to gender medicine, citing a rather shocking new study which found that women operated by surgeons are 15% more likely to have a poor outcome and 32% more likely to die than women operated by female surgeons. The study was published in December 2021 in the medical journal JAMA Surgery and includes data on more than one million patients. The study includes procedures conducted by 3,000 surgeons, examining the sex of both patient and surgeon, death rate, readmissions to hospital and complications within 30 days. Male patients had similar results whether the operator was male or female, but female patients had significantly different results. “These results are concerning because there should be no sex difference in the results, regardless of the sex of the operator,” said Dr Angela Jerath, a clinical epidemiologist at the University of Toronto and coauthor of the study. Jerath and her team examined Ontario’s records between 2007 and 2019: everything from routine surgery, such as gallbladder removal, to more complicated operations such as aneurysms and heart bypasses. Jerath suggests that this may have been influenced both by the fact that medicine has been built around knowledge of the male body and neglecting knowledge of the female body (imagined as similar in symptoms and reactions) and by differences between male and female doctors in working styles and choices that affect the quality of care women receive.
Women are changing science
“Having more women in science today is changing the way science is done, writes Angela Saini in her work ‘Inferior. How Science Got Women Wrong’ (HarperCollins 2019). “Science is unable to provide neutral answers regarding the functioning of women’s bodies and brains, because virtually the entire corpus of medicine and science has been produced by the very scientists (men) who believed that women were not only different, but also inferior. The same men who kept women out of universities until the 20th century; the same men who denied their achievements”, as in the case of Marie Curie in 1911, and physicist Lise Meitner in 1944.
“For hundreds of years women were considered the inferior sex. Their bodies and minds weaker, their roles enslaved. Even Charles Darwin stated that women were at a lower stage of evolution. Science has continued to tell us that men and women are fundamentally different. Biologists argue that women are better suited to raising families or are, more gently, just empathetic. Men, on the other hand, are described as excellent at tasks requiring logical and spatial reasoning and motor skills. She adds that “questions are being raised today, ones that we have never raised before. And old ideas are crumbling in the face of new ones. A wave of new research is now bringing to light an alternative version of what we thought we knew”.
“I think it is important to fight the gender data gap for two reasons”, concludes De Francia. First of all, because for too long and in too many areas we have acted in a way that is blind, discriminating, partial to the true reality. I believe, therefore, that the time has come to do justice and to act in a truly democratic way. A kind of compensation for the past. And then there is the question of caring for future generations. Today, we need to build an open and inclusive future, free from discrimination and centred on valuing differences”.