By Deepika Sarma
Did you know that women with diabetes face a higher risk of heart attacks than men?
A study conducted in hospitals across Tuscany, Italy, looked at over three million people between 2005 and 2012 for the differences between diabetic men and women for h
eart attack, stroke and congestive heart failure. Women showed increased risk for all three conditions, but particularly for heart attack. The “risk window” for heart attacks in diabetic women opened after 45 or around menopause, while for stroke and congestive heart failure, it was in post-menopausal years, around the age of 55.
Another study by Chinese researchers, which looked at 19 previously conducted studies done between 1966 and 2014 involving nearly 11 million people from North America, Europe and Asia, found that women with diabetes were 38 percent more likely than men to experience heart attacks. The authors say:
“We should avoid sexual prejudice in cardiovascular disease, take all necessary steps to diagnose it early, and control risk factors comprehensively to guarantee the most suitable treatments and best possible outcomes in female patients.”
What do they mean by “sexual prejudice”? It’s no secret by now that we know very little about how differences of sex influence our susceptibility to or experience of disease, or our response to drugs. It wasn’t until recently that it came to be known that women can experience symptoms of heart attack differently than men, or that women respond better to lower doses of medicine for certain diseases.
Why does this knowledge gap exist? The short answer to this is that we allow our prejudices about gender to colour how we approach biological differences between men and women (for more on this, head here). Until recently, medical research only used male test subjects, even for diseases that were not gender-specific. Males are seen as being the standard in medical research – the ‘control’, while females are deviations from the norm because of their hormones, perceived to skew test results. Science, however, proves otherwise, and shows that biological differences in men and women can influence the way disease manifests, and influence the way people respond to disease and medication. It’s just that for ages, no one’s bothered to find out exactly how these differences can have an impact.
The universe is still taking baby steps on this front, but universities and research institutions are increasingly making efforts to improve. The latest positive step in this regard came earlier this month, from the League of European Research Universities (LERU), which is comprised of 21 research-intensive institutions and aims to influence research policy in Europe. In an advice paper released in September, titled ‘Gendered Research and Innovation: Integrating Sex and Gender Analysis into the Research Process’, LERU points out why the gender skew in medical research is a problem:
“LERU universities aim to significantly contribute to creating new knowledge and to finding solutions to global challenges, such as climate change, security and public health. LERU universities realise that in order to do so effectively, they need to take into account potential sex and gender differences with respect to the way research is designed, carried out and implemented. Without considering sex and gender analysis in research and innovation (GRI), the scope, impact and utility of research results may not be equally valid for both men and women.
[…] For too long, medical research has not systematically focused on differences in disease prevalence, progression, clinical outcomes and responses to treatment between women and men. Too often it has been, and still may be, assumed that men can be used as the norm group for the entire population. [Emphasis ours] As a result, women (and people who do not fit in the binary male-female scheme) continue to be underrepresented in clinical trials and are frequently subject to medical practices based on data from a predominantly male population (Wizeman, 2012). Treatment guidelines are predominantly based on data on men (Wizeman, 2012). It is crucial that GRI-informed findings are translated into initiatives to bring sex differences in health to the public’s attention…”
Importantly, the paper says that producing research results that apply both to men and women “has the potential to improve lives and save money”. Money is important here in another respect, as the paper points out – “Funding agencies decide on the research areas to be funded and thus promoted, and could play an important role in integrating sex and gender analysis into funded research. Researchers’ behaviour and awareness are more likely to change when research money is at stake.”
LERU recognises that sex and gender differences in research are important in fields not restricted to medicine, pointing out that even the European Commission (the executive body of the European Union, which also provides research grants) designated “over 130 subfields where data show that gender analysis can benefit research – these range from computer hardware and architecture to nanotechnology, oceanography, geosciences, organic chemistry, aeronautics, space medicine, biodiversity, ecology, biophysics, among others.”
And integrating gender into research means taking a number of factors into account, LERU points out: “Considering GRI encompasses the entire research cycle: from making decisions about priorities for research spending, through deciding on the research focus, methodology and data collection, to analysing and reporting data, and even to disseminating and applying the results.”
For more on the best practices that can be followed in research, do read the entire paper here. Here’s hoping Indian universities and research institutions are taking notes.
Meanwhile, back to the subject of medicine, research isn’t the only field in which we need to watch out for gender-based prejudice; it trickles down to medical practice too. A new study by LTMG Hospital in Sion shows how women and the elderly were morely likely to delay seeking help for heart attacks, mistaking the signs for acidity. And as Menaka Rao reported in The Caravan this month with regard to tuberculosis, gender does make a difference to how seriously a disease is taken by doctors as well as loved ones, with women drawing the short straw when it comes to seeking treatment, being diagnosed, or receiving treatment.
Image: “Artificial Intelligence” CCO Public Domain via Pixabay