2022-03-23 | Shrinivas Anikhindi
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Welcome back to Second Opinion. In this edition, we’ll be taking the first of what will be many hard looks at inequity within healthcare and the life sciences industry.
The last ten years have borne a long-awaited recognition that our societies are plagued by historical biases in almost every system from education to urban planning – and unfortunately healthcare is no exception.
We’ve discussed elements of this in the past, most notably in the concept of Social Determinants of Health, but it’s become increasingly clear that this needs to be explored in far greater detail and shared within our industry. As such, our goal is to start a discussion about what inequities exist, where we can tackle them, and how we can start today.
To kick this off, and to align with International Women’s Day, we’re going to explore the role that gender biases play in the healthcare and life sciences industries.
Furthermore, next month we’re set to release an in-depth documentary, featuring interviews with experts from across the industry working tirelessly to support equity in care innovation and delivery for women.
Invisible Biases, Visible Consequences
Holistically describing the impact of a bias that affects 50% of the population isn’t easy. Not only does the nature of the bias vary throughout the healthcare value chain, but knock-on effects can be observed as one problem causes another.
Ultimately, the challenge facing the sector is that the care delivered to women is often different to the care delivered to men. There is a growing body of evidence showing that women receive worse treatment, reduced support and even greater risk of illness than their male counterparts.
There’s a gap in how women receive care, and there’s an opportunity for pharma to step up – both by tackling this gender divide through adaptations to our product strategies, but also by leveraging the vehicle of patient services, which are becoming more and more popular with pharma companies.
Two vastly different patients
In 2014 Dr Janine Austin Clayton, Associate Director of the US research body NIH, told the New York Times: “We literally know less about every aspect of female biology compared to male biology.”
We’ll get onto why shortly, but firstly, let’s look at what that means. It means that male and female biology are not the same, and beyond just reproductive differences: men and women differ in every tissue and organ in the body, even at a cellular level.
Beyond just symptom expression, however, women experience differences from men in terms of their immune responses, their metabolism, and their lifestyles. All of these affect not only medical issues like drug targets and side effects, but also the manner of support required by female patients from healthcare and life sciences companies.
Lack of representation in pharmaceutical innovation
In 2019, a book called Invisible Women by Caroline Criado Perez was released, analysing how systemic biases can critically impact women’s lives. She argued that healthcare is “systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed”.
Perez looked in-depth at clinical trials, and found staggering statistics about the lack of female representation in clinical trials, ultimately leading to a global knowledge gap in the consequences of certain treatments or approaches for women. In one egregious example, a study exploring the impact of mixing a treatment for female sexual dysfunction with alcohol enrolled only two women out of 25 subjects.
We’ll speak about this more in our upcoming documentary, but the key point is this: by disproportionately representing women in clinical trials, products were being developed for only half the population.
This applies to more than just clinical trials too. Consider innovation in digital health, patient services and other around-the-pill solutions. Who are you developing your solutions for? Are you certain you have considered the needs of your entire patient population?
Start listening to what women have to say
There’s no single patch solution for gender biases in a system as large as healthcare, especially when so many of these biases are invisible and inherited from historical processes or structures.
There are a range of interventions required to tackle these biases, and support is required from all parts of the sector to build towards a healthcare system that is truly equitable.
The first step is to include more female perspectives in decision-making across the value chain, from drug discovery to clinical trials, from patient services to operating model strategy.
Designing solutions that solve for these challenges requires three things: Listening to women to understand where the gaps are, disaggregating data analyses by sex, and ensuring that women are included across teams and leadership roles to give a voice to lived experiences.
A Tragedy In Numbers
There’s no shortage of statistics highlighting the extent of the gender health gap. But rather than drown you in numbers, we’ve pulled out three stats which encapsulate the brutal realities that women seeking healthcare often face.
We begin with women’s experiences in the doctor’s office. Doctors face tremendous time burdens, so it’s important to make quick judgements based on their medical knowledge. When that knowledge includes unconscious biases, however, those judgements can be devastating. In a UK government survey, 84% of female respondents had experienced instances where they hadn’t been listened to by healthcare professionals.
The survey featured countless stories from women who had been told that their painful periods or other related symptoms were ‘normal’ or that ‘they would grow out of it’ – rash, biased judgements which risk misdiagnosing relatively common conditions that can have severe health impacts. Recent analysis found that it takes women an average of 7-8 years to receive a diagnosis of endometriosis in the UK healthcare system, with 40% requiring 10+ appointments before being referred to a specialist.
Our final finding is as unbelievable as it is horrifying, but a necessary study to highlight that the consequences of these mistakes and gaps in knowledge can be fatal. A study of 1.3 million patients treated by 3000 surgeons in Canada found that women were 32% more likely to die at the hands of a male surgeon than a female one, with no significant difference for male patients.
One Last Opinion
Further inequity within the female populartion
We mentioned the presence of other inequities which we’ll explore in further issues, but we wanted to highlight that these are not always mutually exclusive. In addition to the health gap observed by women, recent studies show a growing picture of the degree to which these inequities are felt disproportionately by women of colour.
The 2020 ‘Saving Lives, Improving Mothers’ Care Report’ analyses mortality in childbirth within the UK, with one key finding being the gross disparity between childbirth mortalities in Black and Asian versus White populations.
Then there’s Lupus, a disease more predominant in the black female population. One study investigating US Lupus patient groups found evidence of perceived discrimination to be proportional to rates of depression and greater disease damage in African-American patients. We’ve worked with Lupus patients in the past and heard countless stories of women of colour being told by doctors that they were just imagining symptoms otherwise attributed to menopause, or simply ‘being sensitive’.
The stories and statistics describing the gaps in our health ecosystems are manifold, and you should only need to hear a small portion of them before it is clear that we have a responsibility to fix them.
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