... and ain't i a woman?: Women and medicine

Issue 

Women and medicine

It is 20 years since the US Food and Drug Administration banned the use of diethylstilbestrol (DES), a synthetic hormone given to pregnant women to prevent miscarriage.

The drug was banned after it was linked with a rare vaginal and cervical cancer in the daughters of the women who were prescribed it. It had already been in use for 30 years and given to an estimated 3 million women. Other effects include structural deformity in the reproductive organs. Although the cancer (clear cell adenocarcinoma) is more rare (1 in 1000 women), it is perhaps most horrifying, leaving 80% of survivors with no reproductive organs, reconstructed vaginas and often having to catheterise themselves to urinate.

It is also roughly 30 years since the contraceptive pill was launched on unsuspecting Latin American women, who were used as guinea pigs to test it. And although the pill has improved, the side effects are still daunting enough to make most of us think very carefully about using it. Compare that with the tale of Depo Provera, which began life as a possible male contraceptive. It made men feel ill, so it was passed on to women, for whom it is evidently okay to constantly feel terrible.

Statistics of US heart disease also show a disturbing lack of care. Clot-dissolving drugs are given to 26% of men and 14% of women with heart attacks. Angioplasty (inserting a balloon-tipped catheter into a blocked artery and inflating it) is performed twice as often on men as it is on women. Reasons aren't exactly clear for this gap, but it is believed to be partly due to doctors' lack of understanding of the efficacy of these treatments on women because all studies have involved men only. Another possibility is that heart attacks affect women differently from men and doctors aren't trained to recognise the symptoms in women.

AIDS is another one of those cases where testing of drugs is less than satisfactory. Because most cases at first were male (and doctors were generally male), drugs such as AZT and DDI were tested only on men. There is little scientific knowledge about the effects of such drugs and even the syndrome itself on women's bodies. Women and men, having basic biological differences, will logically be affected differently by a deficiency of their immune systems. For example, pelvic inflammatory disease (PID), which affects HIV-positive women, was not until recently recognised as AIDS-related.

As we approach the 21st century and employ ever more fabulous technology in our lives, the world will change more rapidly than ever before. But until we start using that knowledge to ease suffering and prevent tragedies like DES and AIDS, women will remain unimpressed.

By Janet Fraser

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