In September, I mentioned here an important book written by Dr. Alyson McGregor, an Emergency physician and associate professor of medicine at Brown University. The book: “Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It“. Her first chapter opens with a story about Julie, a 32-year old woman she met in her Emergency department one day – a story that’s disturbingly familiar to women like me whose heart attack has been misdiagnosed: .
“Julie had visited her primary care doctor several times prior to coming to our Emergency department and had also seen at least two other physicians in the previous 48 hours. She was experiencing chest discomfort and shortness of breath that worsened markedly the more agitated she became. Immediately, I thought to myself, ‘This woman doesn’t look good.’ I had a gut feeling that something was really wrong. But like Julie’s previous doctors, the cardiologist I called in decided that Julie was just displaying symptoms of anxiety. Her EKG, however, was slightly abnormal, so he finally agreed to take her to the cath lab for an angiogram.”
What was identified in the cath lab that day was in fact a blocked main coronary artery. In a man, this cardiac event is often called a ‘widow maker heart attack’, as Dr. McGregor explains:
“We see it all the time in men over 50, and in a number of post-menopausal women. And yet, here was sweet 32–year-old Julie presenting with a condition that if left untreated was likely to kill her in weeks, if not days – and no one had thought to look for it because her symptoms and risk factors weren’t consistent with the classic male model of a heart attack.”
She adds that women’s cardiac symptoms often mimic other diseases and events that are considered more ‘female’ – such as the panic attacks cited by Julie’s previous doctors. She adds something that my regular Heart Sisters readers already know: misdiagnosis is unfortunately common among female heart patients – particularly in younger women.
“As well as being misdiagnosed, women are less likely to be treated quickly, less likely to get the best surgical treatment and less likely to be discharged with the optimum set of drugs. None of this is excusable.”
Dr. McGregor suggests a possible reason to explain those realities:
“If a man comes into the Emergency Department with chest pain and shortness of breath, there’s no question that he may be having an MI (myocardial infarction).
“If a woman comes in with the same issues, and she has a history of anxiety listed in her chart, the consensus will likely be that she’s just suffering muscular or respiratory spasm related to anxiety. If her EKG comes back ‘normal’ or close to normal, she’ll be sent home.
“Women in cardiac distress don’t receive the diagnostic tests they need because our protocols don’t account for the way heart disease presents in women’s bodies.”
That’s a distressing statement for female heart patients to ponder. Because I apparently needed more distress in my life, I took a break from reading Dr. McGregor’s book to watch her compelling 2015 TED talk called “Medicine Often Has Dangerous Side Effects for Women“ – filled with astonishing illustrations of how male-centric medicine can hurt women, starting with her example of the medications that are prescribed for us:
“We know that 80% of the drugs that are withdrawn from the market are due to side effects in women.
“It takes years for a drug to go from an idea to being tested on cells in a laboratory, to animal studies, to clinical studies in humans, finally to a regulatory approval process to be available for your doctor to prescribe – not to mention the millions of dollars in funding this takes.
“Why are we discovering drug side effects in women only AFTER the drug is already approved and introduced in the market?
“In every aspect, our current medical model is based on, tailored to, and evaluated according to male models and standards. We give aspirin to healthy men to help prevent a heart attack. But if we give aspirin to healthy women, it’s actually harmful. (See also: “Should women take daily aspirin to prevent heart attack?“)
“It turns out that those cells used in those research laboratories were male cells. And the animals used in the animal studies were male animals. And the clinical studies have been performed almost exclusively on men.
“How is it that the male model has become our framework for medical research?”
She calls our attention to a drug called Ambien (Zolpidem) – first prescribed over 25 years ago to help people sleep at night:
“Since then hundreds of millions of prescriptions have been written for Ambien, primarily to women because women suffer more sleep disorders than men.
“But the FDA has now recommended cutting the dosage in half for women only – because they realized that women metabolize this drug at a slower rate then men, which causes them to wake up in the morning with more of the active drug in their system. Drug monitoring reports found 1,000 cases of women who, the morning after taking Ambien, were injured in motor vehicle crashes related to being impaired.”
By the way, here’s how Sanofi-Aventis (the drug company that manufactures Ambien) describes that dangerous side effect in an oddly milque-toast way on their own patient information site: “Getting out of bed while not being fully awake and doing an activity that you do not know you are doing.” (I’m guessing that covers activities like driving while asleep).
Dr. McGregor says she now wonders: how many of the car accident-related injuries in women she has treated in Emergency over the years could have been prevented if drug side effect analysis that included women had been performed long before the Ambien they were taking was approved?
She adds that drug companies prefer to do their drug research on men instead of women because “men’s bodies are pretty homogenous”. Men, after all, don’t have the constantly fluctuating levels of hormones that women do. So for decades, medical research has been performed on men, and their results were then automatically applied to women.
And despite current funding requirements for equitable representation of women in new research studies, female participation numbers in research still lag far behind male participants, especially in heart research. See also: Cardiac research and the mystery of the missing facts
Researchers must actively recruit women for their studies, but women too must agree to participate. We know, for example, that women will volunteer for “bikini area“ research (breast and reproductive organs) – but far less often for cardiac studies – likely because many women still consider heart disease to be a man’s problem, as revealed in the discouraging results of the American Heart Association’s latest national survey.
And as Dr. McGregor reminds us:
“Women are NOT just men with boobs and tubes.
“We have our own anatomy and physiology that deserves to be studied. One of the biggest and most flawed assumptions in medicine is: if it makes sense in a male body, it must make sense in a female one, too. But in every aspect, our current medical model is based on, tailored to, and evaluated according to male models and standards.”
“Women are different from men in every way, from their DNA on up. Women’s blood vessels surrounding the heart are smaller in women than men. The way those blood vessels develop disease is different than in men. And the diagnostic tests we use to determine a heart attack were designed and tested and perfected in men – and aren’t as good as determining that in women.”
She lobbies for improved medical education as a key to improving both awareness and skills of future physicians and healthcare professionals – which I see as an extremely important step.
I often say that current students in medical school may well be our next best hope in addressing pervasive disparities in women’s cardiac research, diagnostic tools, treatment and outcomes.
Dr. McGregor believes that we’re now in the midst of what she calls a second women’s revolution.
“The first revolution in women’s health began in the 1970s with the publication of the groundbreaking book Our Bodies, Ourselves. This was the first time women were invited to understand themselves as biologically different from men. Women demanded access to things like birth control and pain relief. . . They demanded autonomy, and when the
establishment resisted, they claimed it anyway.
“There’s no going back now.”
“We need to re-invent modern medicine from the ground up to include the half of the human population it has, until now, marginalized and left behind. We know just enough to know that we weren’t doing it right. This is not only about improving care for women, but about the power to transform medicine for everybody.”
Photo of Dr. Alyson McGregor at Rhode Island Hospital: Benedict Evans/©The Observer
Q: Have you ever encountered a problem with diagnosis or treatment based on male-centric medicine?
NOTE from CAROLYN: I wrote much more about cardiology’s gender bias in Chapter 3 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).
-Dr. McGregor’s 15-minute TED talk called “Why Medicine Often Has Dangerous Side Effects for Women”
–Must women bring an advocate along to help doctors believe us? (more on Dr. McGregor’s book – plus two other must-read books on the gender gap in women’s health care)
-Links to many more Heart Sisters articles on cardiology’s gender bias