Once upon a time, somewhere around the third century BC, a doctor decided to study human anatomy. Since then, our knowledge has grown and evolved - it's still evolving, and our understanding of health and wellness grows more multifaceted almost daily.
However, there was and is a problem; for all our knowledge, much of our approach still stems from the study of the male body. While human beings might be fundamentally the same, other factors, including hormones and gender, do have an impact on our health and wellbeing, predisposition towards certain health problems, as well as the symptoms we present with. As a result, they also have an impact on diagnosis and treatment.
“Medical research in terms of the diagnosis, treatment and prevention of diseases has been focused on this model of white, heterosexual men, who are a minority on this planet, and this does not reflect true diversity” - noted one particular study in 2008. This, of course, does not only present a gender issue, but a much wider problem in terms of delivering the best medical care and support for individuals.
We have learned a lot over the years, but one thing we still haven't quite translated into practice is the understanding that men and women are not exactly the same. Is it the final (critical) legacy of engrained sexual inequality that this continues to shape medical practice, and are planned changes enough
Misdiagnosis as a result of male-oriented symptoms
There's a whole thread on discrimination that begins to unravel here, from heart attacks in women being misdiagnosed because symptoms are based on men and the assumption we're all the same in that regard, all the way through to GP incentives for men's healthcare checks because 'men don't go to the doctor'.
Not merely an issue that's relegated to the presentation of medical textbooks, the historic practice of basing the human form predominantly on the white, male form, leads to tangible disadvantages in women's health today.
As a case in point, we know that women are 50% more likely than men to be given a wrong diagnosis after a heart attack. The longer a heart attack is left undiagnosed and untreated, the more the heart muscle can be damaged irreversibly. The reason is because diagnosis is largely based on male symptoms and women present with a wider range of symptoms than men, many of which are more nebulous.
The Women’s Health Strategy for England
The good news is that the NHS is now shining a light on the need to treat women better. Under their Women’s Health Strategy for England, doctors in England are to be given mandatory training to better treat female medical conditions.
The strategy notes: "Although women in the UK on average live longer than men, women spend a significantly greater proportion of their lives in ill health and disability when compared with men. Not enough focus is placed on women-specific issues like miscarriage or menopause, and women are under-represented when it comes to important clinical trials. This has meant that not enough is known about conditions that only affect women, or about how conditions that affect both men and women impact them in different ways."
It also said: "There are also far too many cases where women’s voices have not been listened to."
The BBC quoted Health Secretary Steve Barclay, saying: "Our health and care system only works if it works for everyone. It is not right that 51% of our population are disadvantaged in accessing the care they need, simply because of their sex."
Treating the whole person
Of course, this bias is not intentional, but knowledge around heart attack symptoms, for example, has been known for a while and menopause is as old as time. Therefore, some degree of healthy skepticism over the depth and effectiveness of these proposals is understandable. However, this speaks to a much wider issue that we need to collectively address - healthcare is about treating people, not symptoms. One of the key areas of notes in the government's plan involving menopause, for example, states:
"reducing the cost of – and improving access to – hormone replacement therapy (HRT)."
That's wonderful, but of the 13 million women in the UK who are currently perimenopausal or menopausal (one third of the entire UK female population), research shows that around seven million seek non-medical support to manage their menopausal symptoms (more than 50%). HRT is great for those who want it and can have it, but not everyone can or does.
Perhaps a more holistic approach will be addressed by the slightly nebulous objective to: "consider where further research is needed to address gaps in the evidence base".
Watch this space.
Does a natural approach to menopause work?