That men and women are fundamentally different is actually well known. Also in medicine, gender-specific diseases are treated accordingly: Breast cancer and pregnancy at the gynecologist, diseases of the prostate at the urologist. In the meantime, however, it has become accepted that women actually become ill differently than men in many diseases and that new treatment approaches are necessary, especially in medicine.
Call for differentiated treatment methods
Even though the term “equality” is already well established in the working world, it did not find its way into medicine for a long time. It was not until the 4th World Conference on Women in Beijing in 1995 that a new political orientation for the advancement of women was coined under the term “gender mainstreaming.” Since then, women are no longer considered as a homogeneous group, but happen in their social, ethnic and age differences. In medicine, the call for differentiated treatment methods emerged with AIDS research in the United States. Women between the ages of 20 and 40 were twice as likely as men to complain of side effects during treatment. On closer examination, it became apparent that the drugs had been tested predominantly on men and that women played hardly any role in the drug trials. The reasons for this were as understandable as they were ultimately wrong: women of childbearing age may expose themselves to a high long-term health risk in a drug trial if they become pregnant during the study. In the early phase of a drug development, it is often not yet possible to say whether the active ingredient is harmful to an embryo. Experience with the thalidomide scandal, for example, has led to women largely being kept out of drug studies, both out of concern and fear of recourse.
Women often mistreated
The problematic nature of this attitude can be seen in the treatment of hypertension. Many studies demonstrating drug efficacy have not included women, or have included only a few. But women process active ingredients differently than men: for one thing, they tend to be smaller and lighter; for another, there are demonstrable gender differences in how active ingredients are metabolized. Finally, targeted studies showed that while men benefit from hypertension treatment, mortality increases in women. It is only since drug trials have increasingly used older women that it has been possible to go into hypertension treatment with firm therapeutic recommendations. As a consequence, these results meant that women were often treated incorrectly until then. Only very few package inserts contain, for example, dosage instructions according to body weight or special instructions for women that go beyond the information given when taking the medication during pregnancy. Women’s higher body fat percentage, for example, makes fat-soluble drugs easier to absorb.
Sensitivity increases
However, sensitivity to this issue has increased significantly in recent years. Drug regulatory agencies worldwide, as well as pharmaceutical manufacturers, are taking this challenge very seriously. Drug research, however, is not the only area where “gender mainstreaming,” or “women’s impact assessment,” so to speak, is practiced. Since the end of the 1990s, there have been increased efforts in the Federal Republic to incorporate gender-specific considerations into all areas of medicine. In this regard, the Conference of Health Ministers stated in 2001 that too little attention to gender-relevant needs contributes to overuse, underuse and misuse in the health care system. Beyond the well-being of individuals, this approach also has relevance for overall health policy. In 2001, the German government published the first “Women’s Health Report,” which revealed innovative approaches in practice and research, but also plenty of prejudice, gaps, and deficits.
Not just a men’s issue
One of the best examples of the necessary distinction between diseases in men and women is, as already described, the heart attack.Gender differences are also noticeable here, for example, in the symptoms: While men complain of “typical” symptoms such as shortness of breath, chest pain and numbness in the left arm, a heart attack in women often manifests itself with nausea, a feeling of pressure in the upper abdomen or even back pain. Accordingly, more time often passes in diagnosing a heart attack in women than in men because the symptoms are not clear and the possibility of a heart attack is not considered. It is also interesting to note that women often describe their symptoms in more holistic terms, while men show clear physical symptoms. Conversely, men receive far too little support for mental illnesses such as depression, because they tend to look for physical signs. So both genders benefit from “gender mainstreaming” in medicine with a biological-psychosocial approach.
Behavior optimistic
Physicians and politicians alike have recognized the gender approach in medicine as an opportunity. In times of tight budgets, those involved see gender mainstreaming as a way to improve the German health care system. The Bundestag has now decided to take gender aspects into account in all health care funding projects. Lectures on gender mainstreaming in medicine are now being held at universities, and the medical profession is also taking action. The Westphalia-Lippe Medical Association was the first chamber to set up a “Gender Mainstreaming” committee. The Association of Women Physicians continues to vehemently advocate for more women in higher education and research. Because if more women do research for women, the concerns of female patients will also be taken into account more. For patients, however, it will be quite some time before new dosage recommendations or fundamentally different treatment approaches become available. Until then, all that remains is for them to drive the issue forward through their own interest, to inform themselves comprehensively, and thus to ensure that equal opportunities in medicine become a matter of course.
