Sexism and Racism in Medical Research

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31 October 2016

 

Sexism in medical research 

A Twitter discussion about how women’s health is not a priority to the pharmaceutical industry, prompted me to do some background reading. On first thought, it doesn’t make sense from a financial perspective for women to not be a priority, because they comprise half the population, but the status quo says otherwise.

A U. S. Government Accountability Office study reported that 80% of drugs removed from the market are due to adverse side effects posing significantly greater risk to women. This is a sobering statistic that raises several questions about how safety testing is carried out in medical research. It turns out that 80% of rodents used in drug efficacy, and safety testing are male. This is because scientists in all their wisdom initially decided that female hormones would be “inconvenient” to the scientific process. They proposed that using female test subjects would give inconsistent results, which of course turned out to be false. Yet somehow, the fact that women make up half of the population is largely still not taken into consideration in medical research.

There are more than enough reasons why sex and gender bias in medical research need to be done away with. For example, there are several diseases, which affect women more than men, including Alzheimer’s, depression, and chronic pain. Depression in women is often caused by hormonal changes at life stages such as puberty, pregnancy, and menopause, yet male models of depression are mostly being used as the standard for understanding depression.

Sex bias in drug testing, extends from rodents to human subjects in clinical trials. Drugs that are specifically for women are being tested on men. An example is Flibanserin (Addyi), a drug that was designed for women with low libidos, and is often described as the “female Viagra”. A safety test to investigate the effects of mixing alcohol with Addyi was carried out, and the test group comprised two female, and 23 male test subjects. One does not need to be a scientist or statistician to know that something is wrong here. Furthermore, it is common knowledge that women and men metabolize alcohol differently. So the alcohol safety study essentially missed out on crucial information about its intended recipients.

A study was carried out that looked into the representation of women in HIV clinical trials, from 1994 to 2012. Trials in search of HIV cures averaged 11% of women participants. On the other hand, HIV vaccine trials had a better representation of women, with an average of 38%, but in some cases women participation was as low as 6%. This is worrying when one considers the disproportionate socio-economic burdens that HIV and AIDS have on women.
Image credit: Saurabh Singh

Race in medical research

There are several genetic factors that affect the way our bodies respond to drugs. Our genes determine whether certain drugs will even work against a disease, and what kind of side effects one will experience. Some of these genetic differences reflect along racial and ethnic lines, with real life consequences when we look at some of the most commonly used drugs. Albuterol, for example is a widely prescribed medication for asthma across the world, yet an American study showed that it did not have an effect on 47% of Black Americans, and 67% of Puerto Rican children. In contrast, another study showed that only 20% of Dutch children did not respond to Albuterol. What does this mean? The likelihood of dying from asthma-related complications is significantly higher for Black and Hispanic children compared to White children. For the most widely used anticoagulant Warfarin, 86% of Asian Americans possess a genetic trait that makes them hypersensitive to the drug. As a result, Asian Americans are at risk of excessive bleeding when they are given dosages normally prescribed for the White population. There are many more examples, and most healthcare providers do not use this type of information as a guide.
Image credit: The Naked Scientists

Genomics and personalised medicine: Potential key to improved healthcare

The completion of the Human Genome Project in 2003 marked the beginning of the era of human genomics. Large studies seeking to determine the genetic differences within, and between populations are being carried out across the world. However, in countries where the leading pharmaceutical companies are based, over 90% of the subjects in the genomics studies are White. If genomics studies were a more accurate reflection of racial diversity, they would reveal a wealth of information on how socio-economic status, culture and environmental factors affect health. This is because race as a social construct when combined with institutional racism, has negative socio-economic effects on vulnerable populations. The correlation between socio-economic status and access to quality healthcare is well established.

Africa faces many challenges in exploiting personalised medicine as a tool for improved healthcare. Firstly, African populations have the highest degree of genetic diversity than the rest of the world combined. The costs involved in carrying out genomics studies to account for this diversity are prohibitive for many countries. African countries are also burdened with healthcare systems that struggle to provide basic services to the majority of the population.

Conclusion: Quest for intersectional healthcare

Sex chromosomes contribute more to our biology than just our sex. Greater effort  therefore needs to be made to understand sex and gender in the context of patriarchal healthcare systems, and to stop practicing men’s health on women. Transgender health also needs to form a larger part of this discourse. Race equally needs a seat at the same table if the most vulnerable populations, which are women and children of colour are to experience a comparable quality of healthcare.