If a woman suffers cardiac arrest on the street, she is less likely to be resuscitated than if the person who collapses from a heart attack is a man. The reasons, says doctor Blanca Coll-Vinent (Barcelona, 59 years old), are varied: “For fear of causing harm, because they did not think that women could really have something serious or for fear of being accused of sexual abuse because “You are going to touch their breasts.” These are the arguments expressed in a survey published in the scientific journal Circulation and also recovers the book You are an exaggeration. Gender and sex bias in health (Raig Verd, 2024) to crystallize the gender and sex bias that medicine carries.
Coll-Vinent, who is coordinator of the Clinical Commission on Sex and Gender in Health at the Hospital Clínic of Barcelona, directs, together with the journalist Isabel Montané, this choral book that describes the lack of a gender perspective in the approach to various diseases. Through the stories of doctors specialized in various fields and patients who have experienced firsthand the effects of androcentric medicine, You are an exaggeration It goes through 13 diseases that are diagnosed and treated “based on a universal man model,” assuming that gender and sex change nothing when, in reality, it changes everything.
Ask. They say in the book that medicine has always had an androcentric view. Do you still have it?
Answer. It has changed, but there is still a long way to go. It still remains a fundamentally androcentric look and, above all, unique. That is to say, it is a unique model that is usually masculine and does not diversify, does not separate, does not take into account the peculiarities of each person and, especially, sex and gender, which are two very important characteristics.
Q. What implications does this have in clinical practice?
R. There may be differences in clinical presentation, in the way in which the symptoms of diseases manifest. The best-known example is coronary ischemia, a heart attack, which may not be oppressive chest pain that goes to the neck, but may be accompanied by fatigue, shortness of breath, discomfort… Women do not identify it as a heart attack. and they may arrive later; and we, healthcare personnel, may not identify it at first and delay the diagnosis.
It may also happen that the mechanism of action of the diseases is different and so is the response to treatment. For example, in cancer, cancer immunotherapy does not have the same effect on women and men. And this is very important because the lives of the affected patients are at stake.
Q. In the book they emphasize that “these gender and sex biases cause discrimination, inequalities and harmful consequences.” What is the most egregious case?
R. The example that worries me the most is that of medication doses. They adjust by age, by weight, by whether there is a kidney defect or not… But they are not adjusted by sex and much less by gender. It is known that women respond differently because we eliminate drugs more slowly. There are many factors that cause us to accumulate more drug and eliminate less, which means we need fewer doses because if not, there is a risk of poisoning. And then it is also important to see that some drugs are effective in men and little effective in women or vice versa.
In medicine there is still an androcentric view”
Q. What is it that they haven’t looked at women well?
R. It’s not that we don’t do it well. We do what we know, we do what the protocols say we have to do. So, exactly, since it has not been studied, I cannot tell you what we do not do and, perhaps, it should be done. We have to study much more to see what has to be done to women that is not done to men or the other way around. It is very important to listen or ask what the needs of the people in front of us are, because the health needs and concerns of women are not the same as those of men.
Q. Are women listened to less in the consultation? Do they take his words less seriously?
R. Here there is also a problem of time and resources: a consultation with the family doctor takes eight minutes, six or 15 and there is not time to listen to many things. I think there is little listening to women in general. And women are the most affected group because they have poorly studied symptoms and since they do not fit us, we directly ignore them, attribute them to anxiety or classify them incorrectly. But I think that, in general, the lack of time and resources is going to hurt everyone. But I insist: the main problem is putting everyone in the same bag.
Q. In coronary heart diseases, the book states that there is a diagnostic delay of 20 minutes in women compared to men. They take longer to consult, but once they arrive at the hospital, what happens?
R. Once we see them, if they do not explain symptoms that we have classified as coronary ischemia, we may miss them. And, sometimes, they do tend to consult for pain, but this pain does not have the same characteristics as the pain that men usually have, because it may not be an oppressive pain that goes to the neck, but sometimes it is a discomfort, or They have it on their back, or sometimes it increases when breathing. It can be different from what the books say it should be to be typical and, in addition, it is often accompanied by other symptoms and these make us lose the diagnosis a little.
Q. For example?
R. Choking, tiredness, discomfort. For example, they may come because diabetes has decompensated. Choking can be a consequence of arriving late, of the heart already failing a little and causing heart failure. The fact that the pain is not the typical one that we say for men and that it is also accompanied by other symptoms, means that we do not think directly about this. And I insist on typical because the pain explained by men is considered typical and all the others are considered atypical when women are 50% of the population. That terminology alone would have to be eradicated.
Q. A few months ago, an article in The Lancet warned of the risk of “excessive medicalization” of natural processes, such as menopause. But there were also complaints about those who resorted only to the fan to alleviate the symptoms. How do you find a balance?
R. The natural processes are normal, but the symptoms are not. We don’t have to normalize having a bad time. It is still common, it happens many times, but it should not be normal to have pain or have unbearable vasomotor symptoms or for menstrual pain to be incompatible with your work. Sometimes, we underestimate symptoms of a natural process or because they are frequent, as if we did not have to give them any importance. Female processes that are frequent does not mean they are normal, especially if they cause symptoms or alter the quality of life.