Ahmad Gamal Saad-Eddin

This piece was originally written as an episode for (El-Daheeh).

One day, Joe Fassler woke up in the morning like any typical day, thinking about what he will do, where he will go, and, for sure, what he will have for breakfast! But suddenly he heard his wife screaming in pain while going out of the bathroom, clinching in a strange pain that was holding her from breathing. While she was suffering in silence, Joe felt anxious; his wife wasn’t the person who expressed the pain of the simple matters. In his words, she wasn’t a whiner even when the worst happened. One time she accidentally cut a deep wound in her finger with a kitchen knife that they had to go to the hospital to stitch it. She was laughing and mocking his fear all the way. Seeing her in enormous pain like that meant that there was something beyond serious happening.

Joe called an ambulance and then sat with his wife in their room, fighting to catch her breath. With every single breath she took, she said that she was feeling a great deal of pain and Joe got more and more worried. The ambulance arrived and the medics asked a couple of the usual questions in such cases: When did the pain begin? This morning. On a scale of one to ten, how much pain do you feel? At this point, the wife screamed: ELEVEN, which broke Joe’s patience. What’s exactly happening with my wife?!

I won’t distract you with minor details, and I wouldn’t like you to continue watching the episode just to know what was wrong with her or even who is Joe Fassler to start with. Joe’s wife had a huge problem, Ovarian Torsion; a condition that had complications that might be up to death. Women who have gone through this tough experience described the pain as if their souls were leaving their bodies. Oh dear lord! But what really happened was that once his wife entered the hospital, no one actually cared! Imagine, despite all of this torture, Joe said, everyone who examined his wife said dismissively that it wasn’t a big deal. Don’t you worry! She just wanted to see how much you love her! It must be a kidney stone or something that simple.

This matches the data and statistics we have. For instance, a crucial related review article, published in 2001, titled “The Girl Who Cried Pain,” states that when we observe the way physicians deal with pain, whether they were male or female physicians, we find that the pain of women is always considered as a sort of dramatic. It’s like, “Yes, you’re in pain, but not as much as you show, you must be spicing it up a little.” 

A statistical study on medical care, conducted in the USA in 2008, showed that men wait for 49 minutes, on average, before doctors decide to give them painkillers. On the other hand, women wait for 65 minutes till they get painkillers for the same pain and the same disease.

The study I mentioned earlier, “The Girl Who Cried Pain,” found another peculiar thing. When doctors prescribed medicine to calm a woman’s pain, they often gave her tranquilizers and gave a man painkillers for the same condition; these two are totally different things. The issue is, as the study states, the implied perception that women express their pain in irrational ways and they need, somehow, to get a grip and calm down. So let’s give them tranquilizers!

If I told you to imagine someone is having a heart attack, what picture jumps into your mind? You’ll mostly think of a bold man in his fifties, a bit fat and sweaty, taking off his tie with shaking hands, shocking. You might think that he lost all his money in the stock market or his daughter ran away with her lover. If he’s just a humble employer, he might be accused of embezzlement.

This is what we are taught in the movies. Heart attack is a very masculine condition that mostly happens to men who devour lots of red raw meat. But reality says the exact opposite of this assumption.

In a data analysis of twenty-two million million people living in different parts of the world, like North America, Europe, Asia, and Australia. Researchers found that women are having more heart attacks 25% more than men who have the same economic situation, the middle class. Another study published in the British Medical Journal found that the chance of a woman dying in a hospital after heart disease is twice as high as that of a man.

In her book, “Invisible Women”, Caroline Perez writes that the reason simply is that these women don’t get a diagnosis in the first place. When doctors notice that something serious is happening to her, it would be too late and the complications have gotten out of hand. The question here is: why no one diagnoses these women? The condition is obvious. A person screaming: my heart, my heart, my heart! In fact, women don’t have the same symptoms as men; this has a name; “Yentl Syndrome.”

The most famous example of this syndrome is heart attacks. A heart attack happens to a woman in a totally different way, with symptoms of stomach cramps, vomiting, and dizziness; symptoms related to the gastrointestinal tract/ digestive system. So, naturally, they get a diagnosis related to the digestive system. So a woman complains to her husband that she has a stomachache, vomits, and feels dizzy. Instead of driving her to the nearest emergency room, he would be thrilled that in nine months, he will be a father!

As Perez writes, the problem happens because there is so much research concerning heart attacks conducted only on men. Samples and cases, on which textbooks were written based on, the majority of them were men. So obviously most of the documented symptoms were the ones only men have. What about women? Oh, another round.

But, please hear me out before judging and cursing medicine.

What I’m trying to say is that there isn’t a systematic notion in medicine to be all about men; medics don’t exclude women consciously from medical research because of pure evil. No, it’s nothing like that.

Before the past thirty years, men had more heart attacks than women. In the sixties, the risk of death from heart disease decreased after we discovered that smoking and fast food could cause problems. When men and women reach the age of 60, the chance of having a heart attack is approximately the same. But the chance of a woman dying from heart disease is double. Got the idea?

The problem Perez mentions is exactly here; most of the research that looks for methods of prevention, diagnosis, and surgical interventions was conducted only on men. This makes diagnosis take a long time. A woman suffering from heart disease might take up to seven years after the symptoms appear in her body, and cancer takes two years longer than a man’s to be diagnosed.

The body of a man and a woman is utterly different. I saw it myself! In the biology book of course. Just as there are diseases that affect men more, there are diseases that affect women more. For example, immune diseases affect 8% of people, and 78% of them are women. Another example is Alzheimer’s disease, two-thirds of people with this disease also are women, and there are more. 

In “Doing Harm,” the author, Maya Dusenbery, writes that no one observes this kind of issue, and nobody pays enough attention to it. The reasons for excluding women from this equation are plenty; according to research organizations, often they are genetic and hormonal causes. Some of these organizations clarify that the response of women’s bodies differs based on the time of their period. They would get a result at the start of her period, another different result at the middle of her period, and a third one outside of her cycle. This complicates the outcomes and makes each experiment needs a larger sample of women to be able to avoid mistakes and reach the most accurate possible numbers which increase the cost of research.

There’s another assumption that a drug that worked with men definitely and obviously will have the same effect on women. But this isn’t the case at all.

According to a report issued by the U.S. Government Accountability about drugs that have been withdrawn from the US market, it was found that 8 out of 10 drugs were withdrawn because of side effects, the majority of them happened to women, and some of them happened only to women.

In another article published in Nature, it was clearly stated that between 2004 and 2013, women in the USA suffered from side effects up to two million cases while men only had 1,3 million cases. The reason simply is that the initial studies on medicines didn’t include a sufficient number of women to test any possible side effects.

There’re stranger things; the studies conducted on experimental animals, it is usually performed on male, not female, animals. The reason, according to many research organizations, is that the variables in male bodies are fewer, therefore their ability to study the effect of the drug is better. A piece of cake: inject the drug, test the effect and period. You’re ready to publish a paper and make millions of dollars.

But unfortunately, this is so far from accurate. In a 2014 study, it was found that male rats have the same body changes as females, sometimes even more than females. It isn’t a piece of cake after all.

But it seems things change nowadays. In 1997, the FDA established a new rule; any drug manufacturer is obligated to provide evidence that its product will not be affected by race, age, or sex. When another study was conducted in 2016, to test the influence of this decision, they noticed huge progress in that matter and that lots of official experiments conducted by the US government do consider the drug effects on women, meaning the increase of women participants in the studies. Starting in 2016, the National Institutes of Health in the USA stated that any research proposal is required to conduct experiments on both sexes; male and female lab rats. Or at least provide substantial proof that the drug in question won’t be affected by the sex of the patient.

Medical bias began in the world with the beginning of medicine itself. No, I’d rather say with the dawn of civilization. In her book, “Unwell Women,” the author and academic, Elinor Cleghorn, explains a long series of biases with the female body as an ambiguous mystery. She tries to trace the origins of such biased misinformation. Greek philosophers, for example, those men who literally occupied every single job on the planet, considered the female body as a distorted version of the male one, which was the better and perfect body, to begin with. They also were convinced that the uterus is the source of all the irrational, emotional symptoms, “hysteria”. The word “hysteria” itself is derived from “hystera”, meaning uterus in Greek. As a result, the way women expressed their pain must have some irrationality or exaggeration. The source of their pain isn’t just pain, it’s hysteria. 

Somehow, we could easily say that this idea unconsciously crept into modern medicine. There is no wonder that medicine now doesn’t consider a woman’s body as a distorted or incomplete one. But, the base we follow is still the male body, and make every single thing, from medical textbooks to scientific references, based on it. Moreover, fewer women participants in studies mean fewer data, also lots of symptoms women had are still considered sort of pure drama.

In the end, we have an important question that we must have an answer to. Now that we’ve known the problem, who is responsible for it? Who is the perpetrator? Who is the villain in this story? There is harm that happens to a group of people, who is harming them?

These are all wonderful questions but I don’t think that they all have one answer. The easiest thing we could do when we address such rooted biases at the heart of ancient medicine is to point our finger at someone and say, “Yes, he is the villain. Oh, let’s change the course of medicine, let’s write new medical references, merging all the left-out parties.” Problem solved.  

But when we think this way, we only solve one part of the problem, a crucial part but not the only one. If you asked any doctor or nurse, men or women, of the people Rachel, the journalist Joe Fassler’s wife, dealt with at the hospital. “Tell me doc, are you biased against women? Do you consider their pain less serious? Do they exaggerate? Are you a merciless monster?” They will deny all of these accusations. They would reply honestly that they see the pains of all humans are the same, and the ethical, normal act for any doctor is to treat all people in the same way; examine the case, and decide the right treatment. The surprise is that they aren’t lying and actually do all that they could to help patients.

This is the real danger of biases. They don’t exist in your mind but backstage. Sometimes they control you without you noticing. They direct you to take decisions without knowing on what ground you took them. It’s deeply engraved into your mind; you see a dizzy woman, clinching, so she’s pregnant. You see a man placing his hand on his heart, (though the right place is the shoulder), so he is having a heart attack.   

This is why the right and real solution is to try our best to understand our biases, not to deny or dismiss them, no, but to understand how they influence us and the people who we are dealing with. 

What should we do? Really? A problem that began in the days of Plato and Aristotle, you want me, here on YouTube, to solve it?