Why Trials Focused on Females are Necessary

Until recently, I never thought about the fact that many studies have uneven ratios of men vs women. I didn’t realise that many trials show results based on the majority of men.

How could I be so mistaken?

Throughout my medical school and training as a surgical registrar (surgeon in training), we were never taught to look at how many women that were enrolled in trials. Most specialists talking about experiments also did not mention this. 

Most trials excluded women because researchers thought it would lead to bias within the study, especially if they had younger women in them. There was also no knowledge of the possible impact on female fertility.

Whether these concerns were reasonable or not, the problem was that researchers assumed that results would be the same for women. Then us, doctors propagated trial results to female patients not knowing whether these drugs would actually work on them.

Take, for example, the use of aspirin in the prevention of heart attacks and strokes. Aspirin was found to decrease the number of heart attacks and strokes. However, we were not told that the large study that we based our recommendations to patients on had been done purely on men. So then doctors developed guidelines to treat everyone with aspirin to decrease the number of heart attacks. 

The problem was that aspirin turned out to be ineffective in decreasing the number of heart attacks in women younger than 65. It was, however, useful in preventing strokes in women. Aspirin was also effective for women who had a high risk of strokes and heart attacks or women who previously developed these medical conditions.

Another example was when Viagra was first tested as a heart medication, the effects on erectile dysfunction on men were discovered. At that stage, the trial was stopped, and Viagra was marketed for use in males for treatment of erectile dysfunction.  

Viagra had generated around 2 billion dollars for Pfizer yearly from 2003 to 2012 (when Viagra was on a patent). Since then, revenue has dropped to 640 million dollars per year for the same company (Source: www.statista.com).

Interestingly, Viagra was also known to stop or significantly reduce period pain in women. But was Viagra ever used for this? NO. Big Pharma never considered marketing Viagra to be used for period pain, which affects over 50% of women.

So why was Viagra never offered to treat this problem? This would be because men run big Pharma (as well as most other industries). They understood (and most likely related) to the issue of erectile dysfunction in men which was given priority over the issue of period pain which they didn’t experience. I bet they missed out on a considerable revenue not looking into this further.

And this is only the beginning.

Often women also don’t have the same symptoms of medical conditions as men. As medical students, we were taught that heart attacks usually present with symptoms of chest pain, jaw pain and left arm pain. This is how heart attacks typically show in men which can be different from women. In women heart attacks can present with stomach pains, nausea, fatigue and shortness of breath. Due to this, heart attacks are diagnosed less in women, which increases their chance of dying from it. 

There are many poorly researched medical conditions that are present in women only—for example, endometriosis. I believe we need to demand more female-orientated medical research. This way, we doctors, will be able to diagnose medical conditions in women quicker and treat accordingly.