That men and women differ fundamentally, is actually known. Also in medicine, gender-specific diseases are treated accordingly: breast cancer and pregnancy at the gynecologist, diseases of the prostate by the urologist. In the meantime, however, the realization has prevailed that women actually get sick differently from men in many diseases and that new approaches to treatment are necessary, especially in medicine.
Call for differentiated treatment methods
Even though the term "equality" is well established in the world of work, it has not found its way into medicine for a long time. It was not until the 4th World Conference on Women in Beijing in 1995 that the term "Gender Mainstreaming" was used to define a new political orientation for the advancement of women. Since then, women are no longer seen as a homogenous group, but in their social, ethnic and age-related differences.
In medicine, the call for differentiated treatment methods with AIDS research in the United States. Women between the ages of 20 and 40 complained twice as often as men about treatment side effects. On closer inspection, it turned out that the drugs were mainly tested on men and women hardly played a role in the drug studies.
The reasons for this were as understandable as they were ultimately wrong: Women of childbearing potential in a drug study may expose themselves to a high long-term health risk if they become pregnant during the study. In the early phase of drug development, it is often not possible to tell whether the drug is harmful to an embryo. The experience with, for example, the thalidomide scandal has led to keeping women largely out of drug trials, both out of concern and out of fear of recourse.
Women often mistreated
How problematic this attitude is, shows up in the treatment of hypertension. In many studies demonstrating drug efficacy, no or few women were included. But women process drugs differently than men: on the one hand they are usually smaller and lighter, on the other hand, there are demonstrable gender-specific differences in the metabolism of the active ingredients.
Finally, targeted studies have shown that while men benefit from hypertension treatment, women's mortality increases. Only since older women are increasingly used in the drug tests, one can go with safe therapy recommendations in the hypertension treatment.
As a consequence, these findings meant that women were often mistreated until then. For example, only the fewest leaflets contain dosage instructions based on body weight or special instructions for women, which go beyond the information given during pregnancy. For example, the higher body fat percentage of women makes it easier to absorb fat-soluble medicines.
However, the sensitivity for this question has increased significantly in recent years. Both drug regulatory agencies worldwide and pharmaceutical manufacturers take this challenge very seriously.
However, drug research is not the only area in which "gender mainstreaming" is practiced, so to speak the "women's compatibility assessment". Since the end of the nineties there has been an increased effort in the Federal Republic of Germany to incorporate gender-specific considerations into all areas of medicine. The Health Ministers Conference 2001 stated that under-addressing the gender-related needs contributes to over-coverage and misuse of healthcare.
Beyond the well-being of the individual, this approach also has an overall health policy relevance. In 2001, the Federal Government published the first "Women's Health Report", which revealed innovative approaches in practice and research, but also a lot of prejudices, gaps and deficits.
Not a men's business
One of the best examples of the necessary distinction between diseases in men and women is, as already described, the heart attack. Gender differences are also noticeable in the symptoms: while men complain of "typical" symptoms such as shortness of breath, chest pain and numbness in the left arm, a heart attack in women often causes nausea, pressure in the upper abdomen or even back pain. Similarly, when diagnosing a heart attack, women often spend more time than men because the symptoms are ambiguous and the possibility of a heart attack is not taken into account.
It is also interesting that women often describe their symptoms more holistically, while men show clear physical symptoms. On the other hand, men receive too little support for mental illnesses such as depression because they tend to look for physical signs. Thus, both sexes benefit from gender mainstreaming in medicine with a biological-psychosocial approach.
Medical professionals and politicians have recognized the gender-specific approach in medicine as an opportunity. In times of tight budgets, those involved in gender mainstreaming see a possibility for improving the German healthcare system. The Bundestag has meanwhile decided to consider gender-related aspects in all health promotion projects. Lectures on Gender Mainstreaming in medicine are now being introduced at universities and a lot is happening in the medical profession as well.
The Ärztekammer Westfalen-Lippe was the first chamber to set up a committee on gender mainstreaming. The Ärztinnenbund continues to campaign vehemently for more women in higher education and research. Because when more women do research for women, the concerns of the patients are taken into account more.
However, it will take a while for the patients to come up with new dosage recommendations or fundamentally different treatment approaches. Until then, they will only be able to advance the topic through their own interests, to inform themselves comprehensively and to ensure that equal opportunities in medicine become self-evident.