Healthcare is biased against women.

And there’s countless research to prove it.

It’s a bright, breezy day in March with just the right amount of sunshine. You’re walking down the street, trying to strategize a way to avoid the lines at your go-to café, when you unexpectedly see a person drop to the ground. You rush to see if they need any help but they’re not responsive. There’s no pulse and there’s no visible breathing. Would you stop your plans for the day and perform CPR on this victim? The altruists in us would definitely think that we would. We can claim with 110% assuredness that we would perform CPR, as civilian bystanders.

What if the person affected was a woman? Would your answer still be the same?

The question may seem unnecessary, but a 2018 study published in an American Heart Association journal found otherwise. Women are less likely to receive CPR in public settings and are more likely to die. The researchers found that only 39% women who had a cardiac arrest in public were given the life-saving CPR, compared to 45% men.

Consequently, men were 23% more likely to survive. This spurred several other studies which hypothesized that rescuers worry about touching a woman’s breasts and a general lack of training on the female torso. This is one of the countless examples in healthcare wherein women get the short end of the stick. It’s alarming that medicine — which essentially aims to keep people healthy and alive — is not free of gender bias.

Part of the reason why the public and medical practitioners may be biased to the masculine form is because that’s mostly what we’re exposed to, at schools and in labs. Anatomy models, life-like CPR models, and simulated patients are usually male. You may remember the viral tweet from 2019 which displayed lactating ducts in raw detail on a woman’s muscular system diagram; it took the common and medical world by storm. While it was inaccurate, it sparked a large debate on how frequently medical education, research and treatment protocols presume the male body as the default.

Why is the normal for only half the population considered the standard?

Pain is another classic example through medical history.

Women have been reported to experience pain more frequently, are more sensitive to it and are more likely to report pain compared to men. Yet, counter-intuitively men’s reports of pain are taken more seriously by healthcare providers. In 1990, Calderone found that male patients undergoing coronary artery bypass graft received narcotics whereas their female counterparts were given sedatives more often. The assumption is clear — women were supposed to be more anxious than in pain. The problem persists till date. A 2021 study found that when male and female patients expressed the same amount of pain, observers viewed female patients’ pain as less intense and more likely to benefit from psychotherapy versus medication as compared to men’s pain.

Women’s pain is usually considered emotional or psychogenic in nature, based on pre-existing sexist biases. Would this be a violation of the Hippocratic oath we take? You decide.

Critics termed this phenomenon ‘Yentl syndrome.’

For context’s sake, in the 1983 film Yentl, Barbra Streisand played the role of a Jewish woman who pretends to be a man to receive education. The Yentl syndrome, similarly, describes the phenomenon whereby women are misdiagnosed and poorly treated because their symptoms and/or disease presentation doesn’t conform to those of men. This may have fatal consequences and was previously used to describe the under-recognition of heart attack symptoms in women by primary care centers and the differences in its treatment.

The big question is whether the Yentl syndrome is still alive and thriving in medicine today? The answer is, unfortunately, a resounding yes.

Low dose Aspirin, which is commonly prescribed to prevent heart attacks, is ineffective and even harmful to women in primary prevention. Unlike the supposedly classic presentation of chest and left arm pains, women present with stomach pain, breathlessness, nausea, and fatigue during a heart attack. The labelling of these symptoms as atypical causes an underappreciation of the risks associated with them. A 2016 paper published in the British Medical Journal identified that the normal diagnostic threshold for heart damage biomarkers like troponin are higher in women. This may lead to drastic differences in diagnostic approaches.

The problem is not exclusive to cardiology and extends to other medical disciplines. Women have a higher risk of developing right sided colon cancer but the standard screening, fecal occult blood test may not be as sensitive for right sided tumors. Furthermore, female colons are usually longer and narrower than men, standard colonoscopy protocol may not be adequate. Another example is tuberculosis (TB), which is classically described as a male disease. Female social responsibilities such as, cooking using unclean fuels in small rooms leave them vulnerable to infection. But because the resulting cough doesn’t produce enough sputum and neither do the lung lesions appear as severe, the disease gets a late diagnosis in women. Recent statistics found that TB kills more women than all other causes of maternal mortality. These examples are just the tip of a gigantic iceberg.

All this vast evidence is a consequence of women not being sufficiently recruited in research trials and clinical studies and insufficient studies being done about women.

Premenstrual syndrome (PMS), presenting with a large set of symptoms such as mood swings, bloating, acne, abdominal pain, headaches, affects nearly 90% women. Yet, recent reviews found that that there are five times the number of studies on erectile dysfunction than PMS. Since, they don’t feature in ‘national health priorities’, pharmaceutical companies do not fund research in this direction, and neither are independent researchers offered grants for the same.

Psychiatry isn’t too far behind in their gender bias either. Swedish researchers found that women are two and a half times more likely to be prescribed anti-depressants than men, when they don’t have any reported depression. Why does this discrepancy seem to exist?

Is it because women are simply more ‘feeble-minded” or “irrational” or “over-emotional”? The faults of our bias run deep.

The proof that women are continuously left under-recognized by the upholders of medicine is staggering. The existing data gap in research, along with inherent sexist notions, form the belief that men are the default humans. This isn’t true. They’re just men and data collected on them should not apply to women. There needs to be a revolution that aims to be more inclusive in how we train our medical students, how we approach clinical guidelines and how we design research studies to better understand women and their problems.

Women aren’t lying about their symptoms and neither are they ‘hysterical’; stop dismissing them and be loyal to the oath we make — saving people, without a bias