The fact that women live longer than men says more about our biology than about the care we receive from the medical establishment. And second-rate health care for women in the United States is the result of systemic discrimination in scientific research: women have been consistently excluded from clinical trials, and gender analysis is usually missing from scientific data. Whether the fault lies with spending priorities at the National Institutes of Health–the major source of funding for biomedical research in the United States–or with a medical establishment that is still overwhelmingly male, the state of women’s health care can be summed up in two words: bad science.
“Efforts to streamline studies by using the most homogeneous population possible have filled medical libraries with data on middle-aged white men,” writes Paul Cotton in the JAMA article. Even female rats are commonly excluded from basic research, because the hormonal flux of the menstrual cycle is thought to provide a “confounding” factor. Confounding to whom? Looked at from a different perspective–that of 52 percent of the population–it’s just as confounding to be confronted with medical data that does not take one’s basic biology into account.
Best of Chicago voting is live now. Vote for your favorites »
Contraceptive research, another issue in women’s health, is now at a virtual standstill in the United States, and product-liability litigation is also cited as the reason for that. “Liability insurance–covering both the conduct of clinical trials and the use of a finished product–is prohibitively expensive and, in some cases, nearly impossible to obtain,” states a recent report from the nonprofit Alan Guttmacher Institute, “Contraceptive Development: Why the Snail’s Pace?”
The antiabortion lobby has so far kept the new French drug RU 486, which prevents gestation of the embryo, off the U.S. market by threatening to boycott all the manufacturers’ other products. Bowing to that pressure, the FDA imposed a strict import ban on RU 486, making it unavailable for research even though the drug has shown promise in the treatment of breast cancer, endometriosis, brain tumors, Cushing’s syndrome, and even AIDS. Democratic Congresswoman Pat Schroeder, cochairman of the Congressional Caucus for Women’s Issues, points out that antiabortion pressure has also halted other experiments–as in the case of fetal-tissue research on Parkinson’s disease. “Doctors want to do research,” she says. “They don’t want to spend all their time fighting with right-wing cuckoos. I think they’re terribly afraid to do any kind of research on women, especially of childbearing age. Because if they find out anything that affects fetuses, here comes the right wing again.”
The watershed women’s health issue has been AIDS. Women are now the fastest-growing group infected with the HIV virus, as Robert McClory reported in the Reader last February in “Women and Children Last,” and AIDS has become the number-one killer of black women in New York and New Jersey. However, because AIDS was initially perceived as a disease affecting gay men or intravenous drug users, the majority of whom are men, government-run AIDS clinical trials have enrolled only 5 percent women. The original studies on AZT (the only government-approved AIDS drug) included only 13 women among 282 patients. Recent laboratory studies on female mice at University Hospital in New Jersey now indicate that AZT may cause vaginal cancer.
Last summer the caucus introduced the bipartisan Women’s Health Equity Act, a package of 20 individual bills providing for increased research on a wide range of women’s health issues. It would increase funding for studies of breast cancer (cases of which increased 32 percent between 1982 and 1987, and which will kill roughly 44,000 this year), contraceptive and infertility studies, and research on women and AIDS and on osteoporosis (which kills more women than breast cancer); it would also fund service and treatment programs. During its last session, Congress passed 2 of the 20 individual bills: one providing increased access to breast- and cervical-cancer prevention for low-income women, the other allowing medicare to reimburse mammography costs for women over 65. Perhaps most important, the act includes bills addressing the fundamental reason women receive second-rate health care in America: inequitable research.
