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.
Race in medical research
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.