Are you a woman with a new prescription for some meds? If so, here's a bombshell for you: the chances are reasonable that your your medication was only tested on men in the clinical trials designed to make sure it is safe and effective. And that's a big deal. I'm all for gender equality (feminism is the best, obviously), but the male and female body have some fundamental differences, and we're increasingly discovering that a one-size-fits-all approach to drugs — whether it's about dosing, side effects or effectiveness — is seriously unfair to women.
This isn't a new discovery. In fact, this concern has been circulating in medical circles for decades; Nature, one of the most prominent scientific journals in the world, devoted most of a 2010 issue to three different studies about gender bias in medical testing. The issue's editorial pointed out a pretty startling statistic: in a survey of medical studies across nine different medical journals in 2004, only 37 percent of participants were female; further, only 13 percent of the studies analyzed their results by gender. It's important to note that this testing bias isn't just due to simple sexism: more often, it's about the realities of the female body and how complicated it can sometimes be to test medications on it.
The problem is still massive, though. In September 2014, the National Institute for Health handed out $10.1 million in grants to scientists to learn more about the sex differences present in several major medical conditions, from strokes to migraines. So why are we just playing catch-up on this issue now? Why aren't more women included in biomedical studies? And what can you do to make sure your meds are the right dosage and type for your lady-self?
Why Your Meds May Only Have Been Tested On Men
The main reason that drugs are primarily tested on men isn't actually misogyny: The reality is that scientists prefer testing medications on men because they don't have periods or the possibility of getting knocked up. In other words, their bodies are nice and consistent. "One of the usual reasons given for researchers’ tendency to use more men than women in their studies," writes Melissa Dahl for New York Magazine's Science Of Us, "is that when you include women, you have to account for menstrual cycles or potential pregnancies, which can disrupt the data on the drug being tested."
The fear is understandable. If a subject were to get pregnant accidentally (which is a possibility for many women) during a drug trial, what if the drug potentially harms the child and the mother?That fear actually drove the FDA to ban all women who could potentially get pregnant from participating in clinical trials, from 1977 up until 1993. That meant that many drugs came onto the market in that time period, complete with recommendations for dosages and what kind of side effects to expect, without ever being near a woman aged 15 to 44, let alone tested on one. And even though it's now compulsory for drugs to be tested on women as well as men, the FDA has a really tough time making anybody stick to the rule.
This is a problem because, as we're gradually figuring out, a single-gender approach to drug testing actually leaves a huge amount of information out of the picture. The gender difference in the bodies of men and women isn't just in your underpants; it's in every cell, and that can have pretty massive consequences when you're taking meds.
Why Women React Differently To Drugs
In a TED talk on this problem in October 2015, Alyson McGregor pointed out why testing meds on both genders is so important. "Every cell has a sex," she explained. Our gender affects all our organs, our metabolism and fat levels, our cardiovascular function — almost anything you can think of. Plus, frankly, we're often smaller in stature. And that means women's bodies will react differently to medications than men.
This has all sorts of manifestations. For example, women tend to have higher concentrations of antidepressants in their blood than men on the same dosage. We metabolize medications differently, the New York Times points out, partially due to our menstrual cycle and our higher amount of body fat; drugs that react with body fat are likely to stay present in women's bodies for longer. We also generally have smaller blood vessels than men, and birth control hormones and menopause alter how our bodies respond to drugs. Plus, importantly, diseases often show up differently in the two genders: there are big differences in how the symptoms of heart disease, stroke, diabetes and asthma present in men and women, and that's just the tip of the iceberg.
And the consequences can be massive. Famously, NSAID recommendations for women needed to be completely overhauled in 2014, because the original tests were done entirely on men. And the FDA copped a lot of flak in 2013 when it announced that women should actually take half of the normal recommended dose of the sleeping drug zolpidem. Whoops. 80 percent of the drugs withdrawn from the American market between 1997 and 2001, a Government Accountability study found, were taken out because they caused serious, sometimes life-threatening, side effects in women. So understand that this isn't just me jumping up and down about a hypothetical imbalance; leaving women out of drug tests can have real effects on how you process your meds and recover from illness.
Here Are Some Of The Drugs That Work Differently In Women
Sarah Klein over at Prevention put together a master list of some of the major, U.S. market drugs that may work differently on different genders. The reasons for their difference often vary, but the nitty-gritty is that they aren't absorbed or processed the same way in the bodies of both men and women. Along with NSAIDs and the sleep med zolpidem, the ones that are raising eyebrows include cholesterol-lowering statins, opioid pain medications (which seem to work a lot better on women), and SSRI-style antidepressants.
More horrifyingly, the list also includes general anesthesia. It's now known that women wake up faster than men from the anesthetic propofol, which can result in traumatic situations in surgeries. But gender's only begun to be taken into account in anesthetic administration in the last 15 years or so. (Women, it turns out, are more sensitive to vecuronium and morphine, while men are more thoroughly knocked out by propofol — and giving a woman a "male" dose raises the risk of some serious side effects in surgery.)
What You Can Do To Help The Problem
Basically, you need to do your research. Any time you've been prescribed a new drug, check whether the dosage is different for men and women, and poke around the drug's testing history with your doctor. If you're not satisfied with the answer, get onto the FDA's website, look at its research trials in scientific journals, and see what work's been done regarding women, people of different ethnicities, or anything else that applies to you.
If you're up for being part of a study yourself, join up to ResearchMatch, which collects volunteers and matches them up to scientists looking for people to be in clinical trials. You can still apply if you have pre-existing medical conditions; many studies look for subjects with a wide variety of health conditions, in order to examine the science behind a drug. A lot of universities, hospitals and colleges also have their own sites with guidelines for signing up for studies, so you can be part of the solution. And if you're having side effects from a drug that doesn't seem to have proper gender guidelines or research, talk to a medical professional immediately.
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