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Six Feminist Myths: Myth #6
Discrimination? Yes - but against whom?
'Women get poorer health care'
We often hear the claim in the media that women get poorer health care than men. It's the men that count in the health sector and with pharmaceutical companies, it's claimed, and it's claimed that men are therefore prioritised in different ways.
This theory became widespread with the release of the report '(In)equality in health and care - a gender-medicinal information overview' by Sweden's councils and regions. That report should be judged whilst keeping in mind who wrote it. The report is written by gender and culture scientist Goldina Smirthwaite, also known as coauthor of the article 'Feminist Struggle Needed in Many Arenas' and written for 'Yelah - the Anarchy Periodical'.
The claim of poorer care for women can be divided up into several parts - let's take each one in turn.
'Medicines are tested on men for use by men'
One of the most common claims is that medicines are tested on men and therefore don't work as well for women. This myth is so widespread that it's even made its way into the government's official surveys. This is what you find under the header 'The Pharmaceutical Industry' in the investigation SOU 2002:30: 'Despite the fact that the group female patients is larger than the group male patients, medical research is conducted in principle with focus on men'.
But an error doesn't become true simply because it regularly appears in the government's documents.
Let's look at the facts. This is what the Medical Products Agency write at their website.
'Two widespread myths are that new medicines are only tested on men and that there are significant differences in how men and women are affected by medicines. The truth however is that women partake in clinical tests just as much as men. [...] As a rule, the differences in the effects and side effects of a medicine are very small between men and women.'
And this is what Jane Ahlqvist-Rastad at the MPA said in an interview85 in Svenska Dagbladet about the claim that medicines are tested on men: 'Yes, it seems impossible to correct these misconceptions. We regularly publish information to correct this but no one seems to listen. Nothing happens. There's just silence'.
The claim that medicines are tested on men and designed for men is a myth.
'Women get poorer heart care'
Let's move to another widespread claim - 'women get poorer heart care'. This is repeated over and over again, and it's gone so far that the state public service television SVT created a drama series where the alleged discrimination of women in heart care is the theme of the series: 'About a Heart'.
To puncture this feminist myth, 15 cardiac specialists at Swedish university hospitals, mostly professors and lectures and half of them women, wrote a furious op-ed for Dagens Nyheter. Their header is 'A Myth that Women Receive Poorer Heart Care'. I quote the introduction:
'The alarms in the mass media are incorrect: there is no sex discrimination in Swedish heart care. The television series 'About a Heart' and much of the media debate about the show gives a completely false picture of Swedish heart care. This spreads an unjustified fear with both patients and their relatives that women with cardiac illnesses are not properly taken care of. In actual fact, there are a number of old myths here about heart care which very simply are not based on actual facts. We perform thorough and continual quality controls in the Swedish heart registers and can therefore assure our current and coming patients that there is no sex discrimination in the heart care system.'
PhD candidate Rose-Marie Isaksson from the University of Umeå touches upon the same topic a few years later. I quote from TT in March 2011:
'That men and women present different symptoms for heart attack is a widespread belief. But it's a myth as Rose-Marie Isaksson shows in her doctoral thesis for the University of Umeå. Women do not present symptoms different from men and don't have to wait longer to come to hospital. The similarities between the sexes are rather greater than the differences, she arrived at after studying 6,500 heart attacks amongst people 25-74 years of age, according to the newspaper Västerbottens-Kuriren.'86
Even the claim 'women get poorer heart care' is a myth.
Alleged discrimination of women in other forms of health care
There have been many studies and investigations, with varying orientation and quality, that put a gender perspective on Swedish health care. Some of them arrive at conclusions such as 'women have to wait longer for care', 'women get poorer help from ambulance care', and 'women are given cheaper medicines than men'.
I won't challenge the calculations in individual cases, but we should think about the fact that the results one arrives at are to a great extent dependent on the questions asked and on what one decides to measure. It's become politically correct to search for discrimination of women, and I contend that many of these studies are characterised by an ambition to find injustices perpetrated on women. I therefore believe that the existence of a number of such studies does not give us the basis to claim women in general are treated more poorly in the health care sector.
And why not?
Firstly: there are also studies that conclude men get poorer care than women! But these studies won't normally get the same media coverage as when it's supposed to be the other way around. Shortcomings in health care can affect both sexes.
Secondly: it's not certain it's really about poorer care, even if it can appear to be so at first glance. Suppose for example that a study shows that women at a certain clinic on the average have had to wait longer than men for care. It's known that men balk longer than women at seeking medical attention, and therefore seek care at a more progressed stage of an illness than women. And because acute cases must be treated as emergencies, it could turn out that men on an average get care faster, even thought the selection is completely far and nothing is done based on gender. The same reasoning could provide a natural explanation for why men in some situations and on an average can get more 'advanced' care in ambulances than women.
This is what Svenska Dagbladet wrote for their editorial about health care queues:87
'Not everything that appears to be such is unequal care. [...] Four times as many men as women under 60 years of age fall ill with cardiovascular diseases. It is unequal that when a man and a woman in the same age group are sitting in the same waiting room, and one can suspect a possible cardiovascular disease, that one first diagnoses the men? Not necessarily.'
There are essential differences between men and women in terms of biology, medicine, and care, and this can affect statistics without there being any discrimination. The fact that men seek care later than women is an important difference. That women overall contact health care providers to a significantly greater extent than men is another important difference - perhaps women don't think they have to have such serious symptoms as men to ask for care. A third important difference is women's longer average life span which means that in advanced age groups, when one's health is at its worst and the need for care is at its greatest, the domination by women is large.
Women are big health care consumers
It's well known in the health care sector that men are not as ready as women to seek care when they're sick and that they seek care in a later stage of an illness. Let me offer a few sources. One example is Christina Fabian, general practitioner and president of the European Union of General Practitioners. She writes in the magazine Distriktsläkaren:88
'Men seek care more seldom than women, especially when it's about contacting general practitioners and primary care. Perhaps men experience primary care as more inaccessible? Perhaps it's designed for women and children? [...] Most men work full time and won't take time off to visit a GP during work hours. Their attitude is often to take more risks and it might make it more difficult for them to seek care, the way a lack of self-assertiveness might do.'
Researchers at Skania's University Hospital have charted gender differences in health care. One of the researchers is Juan Merlo, chief physician and professor of social medicine. He said in an interview in Kristianstadsbladet:89 'Women seek care more often and men seek care too late'.
The periodical Research & Medicine interviewed Birgitta Hovelius, professor of family medicine at the University of Lund. Birgitta conducts research into gender issues in health care. She says:90 'It could be that men avoid showing weakness, and this contributes to their not reporting ailments or seeking health care to the same extent as women'.
Gender researcher Stina Backman's doctoral thesis was 'The Sick Man'. She was interviewed about this by UNT91 who wrote:
'Many men wait to seek care for suspicion of prostate cancer or impotence, despite the fact that impotence can be a sign of heart or cardiovascular illness and that prostate cancer is the most common form of cancer. That's part of our view of men - the ideal man is competitive and doesn't complain about trivialities, he ignores minor pains and goes to work as usual, says Stina Backman.'
Otherwise, regarding the claim women have to wait longer than men for care, there's even conflicting information. Health care economist Gustav Tinghög studied the queues to six health care areas in Östergötland in 2007. In his doctoral thesis92 he writes that he was unable to find any signs that gender influenced queueing times.
How men get poorer care
As a counterweight to the investigations that concluded women in some situations get or appear to get poorer care than men, I'd like to add a few examples of the opposite - that men get or appear to get poorer care than women.
- First: we can establish that our society spends $5 billion more on women's sickness than men's sicknesses each year. $2 billion of this is cost of care and $3 billion is because women stay at home sick more than men.93 It's not certain that the disparity in the frequency of going on sick list indicates women are more prone to illness than men. Gender role attitudes can play a part, as can the fact that the health care system seems more prepared to give a woman a sick note than a man for the same symptoms (we'll discuss this later in the chapter).
- Women are given significantly more prescription medicine than men. Searching through the database of the National Board of Health and Welfare for statistics for medicines94 shows that for the year 2009 there were 38 million prescriptions written out for men and 60 million for women. Women get 58% more prescriptions. It's also more men than women who get no prescriptions at all. In 2009 prescriptions were written out for 2.7 million men and 3.5 million women.
- Women get more antibiotics than men despite the fact infections are more common amongst men.95
- Approximately 30% of women and 20% of men have sleeping difficulties but women get sleeping tablets prescribed twice as much as men.96
- There are twice as many prescriptions to women for antidepressants as there are to men despite the fact men commit suicide to a significantly greater extent than women (something that's almost always the result of depression).97
- There is research that indicates that the methods of measuring depression are not as effective when diagnosing men as women.98
- Medical research into depression has for a long time excluded men.99
- Women are often called to preventative screening for breast cancer whilst men aren't called to the same for prostate cancer (which causes more fatalities).
- Swedish men are more obese than Swedish women and are affected by related illness due to weight issues earlier in life. But it is much more common that women are operated on or are given medicine to combat their obesity.100
- A study of the use of medicine in the Stockholm region for individuals over 85 years of age ended with this statement:101 'The researchers estimated that some women got too much health care and some men got too little health care'.
- A study for Jönköping county council showed that many women who test for breast cancer are given the results within 24 hours but men who test for prostate cancer have to wait 2-3 week for their results.102
- A national study conducted by researchers at the academic hospital in Uppsala and the Karolinska Institute in Solna together with the National Board of Health and Welfare showed that women diagnosed with epilepsy are treated better than men. They will get treatment by a neurologist to a greater extent than men. And they will more often get anti-epileptic medicine with the new substances lamotrigine and levetiracetam.103
- When Sweden's regions and councils analysed health care in eight regions from a gender perspective, one of their conclusions was that women were received and cared for to a greater extent than men.104
- Statistics from Sweden's regions and councils show that 80% of the so-called 'rehab guarantee' goes to cognitive behavioural therapy and three of four patients are women.105
- They've opened a general clinic in Gothenburg that's exclusively for women.106
It's also been found that in some situations it's more difficult for men to get sick leave than women with the same diagnosis. A gender oriented review of medical journals with regard to the diagnoses aches, pains, and depression has been carried out by the Care Centre in Kålmården. The review showed that only one man in ten (10%) diagnosed with depression was given long term sick leave whilst nine of 15 women (60%) got it. Women with the diagnosis 'aches and pains' were given sick leave twice as often as men.107
So the situation is this: there are several differences between the sexes and their behaviour patterns which can be legitimate causes of variance in health care treatment. In addition: there are some instances where women get or appear to get poorer care than men, but there are other instances where men get or appear to get poorer care than women. In conclusion: there is no basis for the claim women get poorer health care than men.
Who's being discriminated in medical research?
The next claim is that medical research benefits men. The research is conducted on men and is oriented around men's sicknesses with the purpose of helping men - or so they say in the social debate. Is this true?
I've already written about how new medicines are tested on both sexes. What's the situation with other types of research? Is that research of the type 'by men, for men'?
There is no basis for such a claim. Anyone looking into the matter will on the other hand find ample examples of medical research that benefits women, probably for political reasons. One of the most important areas of research is for the widespread disease cancer.
But first a few statistics.108 A few more men than women die in cancer (in 2009 it was 11,686 men and 10,769 women). Most forms of cancer affect the two sexes to about the same extent. From an equality perspective it's interesting to study the grants given to research projects for the two great forms of breast cancer (affects almost only women) and prostate cancer (affects only men).
In 2009 in Sweden 1,378 women (and 18 men) perished from breast cancer whilst 2,424 men perished from prostate cancer.109 The male cancer reaps 75% more lives than the female cancer. But what are our own Cancer Foundation's ambitions for support for research into these two serial killers?
Our Cancer Foundation gave $1.4 million to breast cancer research in 2000 - but only $1 million to prostate cancer research. The women got 27% more. And that gap has only grown: in 2009 the Cancer Foundation gave $5 million to breast cancer research but only $2.5 million to prostate cancer research - precisely double as much for the women as for the men, despite the male form of cancer causing 75% more fatalities.
If you recalculate the research investments to dollars spent per female fatality and per male fatality for each form of cancer respectively you get $3,700 per woman in research for only $1,060 per man in research. So one could rightfully claim that a woman's life is worth almost four times as much as a man's life - using cancer research as a yardstick.
The situation is the same outside Sweden. 'A man diagnosed with prostate cancer gets only a fourth as much research revenues put on his illness as a women diagnosed with breast cancer', wrote the London Times.110 Breast cancer research in the US in 2009 received federal grants for $872 million but grants for prostate cancer research received only $390 million.111 So over twice as much for the female form.
Let's look at the situation for research into cardiac diseases, an area where feminist debaters often claim women are neglected. The previously mentioned 15 cardiac specialists wrote in their op-ed for Dagens Nyheter: 'The final myth we want to put an end to is that women are bypassed in cardiac research'. Yet nevertheless the Heart and Lung Foundation are since 2006 running a permanent donation campaign specifically for research for women's cardiac diseases. It's called 'Save the Female Heart - Go Red'. This should be seen in the perspective of more men perishing from even cardiac diseases than women - in 2009 the figures were 15,915 men and 14,618 women (9% more men than women).112
As far as is known, there are absolutely no fields of research into sicknesses that affect both sexes that specifically are intended to benefit men. That would certainly be regarded as highly unethical. Can you imagine a full page ad with the headline 'Donate to Research into Men's Cardiac Diseases'? But the other way around works fine.
We can conclude that there are no signs whatsoever of women being discriminated in the field of medical research. On the contrary.
Copyright © Pär Ström/Stiftelsen Den Nya Välfärden. Translation copyright © Rixstep. All rights reserved.