International Women’s Day: gender equality in medical care
This blog marks this year’s International Women’s Day. Nature’s Daily Briefs recently pointed to this brilliantly inspiring article by Barbara Natterson-Horowitz, a cardiologist. Originally titled “Sisterhood of Species”, a title that reminds us that we humans are also biological creatures, the author stresses the importance of bioinspired medicine and she shares how studying female animals health issues can help better understand often overlooked women’s health issues. More broadly, studying animal diseases could illuminate the understanding of human disease – which is a very different matter from making animal models of human disease (this will be the subject of a future blog).
“I would add that no female stands alone. Members of the sisterhood of species are linked by common ancestry and the shared challenges and joys of being a female animal.”Barbara Natterson-Horowitz
Human medicine seems to hesitate to consider humans as animals (but we are!), and at the same time, and somehow paradoxically, therapeutics development requires that drugs are tested in animal disease models, which may or may not provide useful clues as to how those diseases develop in humans. Regarding women, Medicine (Western world medicine, at least) seems to not really have considered them at all, approaching women’s health as either restricted to reproductive health (and this with several blind sides) or as men’s health in smaller bodies.
Some concrete examples of “Sisterhood of Species” I took for from in the article are :
- investigating why a high number of whales were dying with breast cancer, an unusual disease for these mammals, pointed to the existence of toxic discharges to the environment that was also causing higher than average breast cancer cases in women,
- giraffes avoid cardiac fibrosis (males and females) despite living with high blood pressure and female giraffes avoid gestational hypertension. What we learn about the biology of the giraffes that protects them from cardiac fibrosis and from gestational hypertension may help protecting humans too. In the USA, during 2017–2019, hypertensive disorders in pregnancy prevalence among delivery hospitalizations increased from 13.3% to 15.9%.
There is a very big lack of basic understanding about many women’s diseases, both about diseases related to female biology and also the way some human (all of us, independently of gender) diseases manifest themselves in women, specifically. Awareness of this fact is higher today, thanks in great part to the efforts of private organisations and private individuals that campaigned over the years to make changes happen in public and government policy, and improved many aspects of how women’s health is approached. It is important to remember the social dimension of this lack of understanding: women are poorer than men and constitute the majority of single parent families. Social status has, as we know, a big impact on how patients are cared for.
But things are improving!
Many western countries have recently launched initiatives to support more research into women’s health. Below we highlight a couple that caught our attention.
The inserm (French national institute of medical research) has developed a series of awareness articles, animations and videos on the subject of “gender and health”, accessible from their website.
In a video from June 2022, we can hear about a study conducted in France, on how men and women doctors had different behaviours regarding men and women patients. Men doctors seemed to make fewer notes about their women patients – perhaps because they have less knowledge about their afflictions?
The video also features Yasmine Candau, founder of the NGO “EndoFrance” explaining that it took 15 years from her first approach on the subject to the Ministry of Health (in France) to having a practical outcome: she was asking that endometriosis should be a specialized subject (taught by specialists) in general medical studies. Her first letter was from 2005. The first courses given by specialists took place in 2021. Endometriosis is one of the most frequent chronic illnesses impacting women between menarche and menopause. An estimated 10-15% of European women between the age of 15 and 45 suffer from the illness and yet, it is poorly recognized and it may take seven years for it to be diagnosed (see more here, for example). Period pains are “normal”, right? Wrong!
My other example comes from Denmark. The Bioinnovation Institute’s Women’s Health Initiative “aims to strengthen the European ecosystem for innovative translational research and start-ups that address the high medical unmet needs within women’s health.” This is a future looking initiative, and it will be very exciting to follow it. The Institute wants to support female-specific conditions, reproductive health and conditions with high incidence in women. This initiative was recently launched.
Humans separate themselves from Nature at their own peril. Whether we want to “believe” it or not, our biology is based exactly on the same principles as all animals and everything else alive on Earth. We would be fools to not try to learn and adopt – and adapt – some of the solutions that Nature has had millions of years to develop.