Despite significant advancements in medicine and increased longevity, substantial gaps persist in women's health, according to Dr. Elizabeth Comen, a medical oncologist and associate professor at NYU Langone.
"Medicine often mirrors what’s happening in society at large," Comen told Vox. She explained that historical societal inequalities, where women lacked agency over their bodies, are reflected in the trajectory of medical research and practice. These disparities are evident in rising rates of heart disease among women in the U.S., skepticism surrounding birth control, and a reliance on uncredentialed social media influencers for medical information.
The disconnect extends beyond commonly discussed issues like breast cancer and reproductive health, encompassing a wide range of conditions. "The gaps exist head to toe from our neurologic care, our gastroenterology care, how our hearts function, how our immune system functions, how our joints function," Comen stated. "The gaps are real, and the experiences are real."
Historical Neglect in Medical Research
Specialties like urology and gastroenterology are relatively new, emerging in the 20th century. For much of medical history, women were often viewed as "small men" or subjected to dismissive diagnoses such as "hysteria." Furthermore, female caregivers like midwives were gradually excluded as medicine became more codified.
Terms like "perimenopause" are recent additions to public discourse. Even menopause was historically fraught with misunderstanding. In the 1960s and 70s, physician Roger Wilson advocated for hormone replacement therapy (HRT), but the understanding of hormones like estrogen, testosterone, and progesterone was rudimentary in the mid-1800s.
A significant factor contributing to these gaps is the historical exclusion of women from clinical trials. The National Institutes of Health did not mandate their inclusion until 1993. Many foundational studies for commonly used drugs, particularly in cardiology, were conducted solely on men. This exclusion extended to animal models, with female mice not consistently included in drug development until as recently as 2016.
Shifting Perceptions and Modern Challenges
The marketing of HRT has seen dramatic shifts. In the mid-20th century, advertisements often promoted anti-anxiety medications for women struggling with domestic responsibilities. Today, Comen observes a parallel trend with women investing heavily in unproven supplements and treatments marketed online, often due to a perceived lack of adequate care from healthcare providers.
During the 1990s and early 2000s, a perception of HRT being harmful took hold, partly due to studies that Comen suggests may have exaggerated breast cancer risks. This led to widespread fear and a lack of alternative treatments offered to women. While current understanding is more nuanced, Comen believes medical science still has considerable ground to cover.
Rebuilding Trust and Improving Care
The proliferation of misinformation online, particularly from social media influencers, poses a significant challenge. Comen expressed concern over fake imagery and information, urging for greater investment in rigorous, long-term scientific research. The consequences of misinformation, she noted, range from financial loss to wasted resources.
Restoring patient trust in the healthcare system is a complex undertaking. Comen believes it requires building a system that allows physicians adequate time with patients to provide "human to human care." This approach, she emphasized, is crucial for making patients feel seen and heard, moving beyond a purely biological understanding of the body.