Healthcare has been a male-dominated field for centuries. From the early days of Hippocrates to the modern era, women have always played a subordinate role in healthcare. Even today, women comprise only around a quarter of the healthcare workforce worldwide. An unbalanced force is not just a problem of equity; it also has implications for data collection and analysis. Healthcare systems are designed primarily with men in mind, leading to problems for women when they try to access care. We could also argue that those problems carry over to finding the proper care, being appropriately diagnosed, and finding the appropriate treatment. Women have to be very self-reliant to navigate the current self-care system, and we all can't be healthcare specialists.
One way that inequity manifests is in clinical trials. Organizations have often excluded women from clinical trials, historically considered too "complicated" to study. This conclusion is attributable to unsubstantiated claims that women experience more significant hormonal fluctuations than men, which can skew results. Women are also more likely to be on multiple medications, complicating results. As a result of this exclusion, women are often undertreated and undertested for many conditions. Women of childbearing age were also excluded from trials because, as the FDA put it, "we must protect the fetus at all costs." All these excuses were bullshit, by the way, but let's move on. Even when included in trials, data regarding their outcomes are often not reported separately from men's data. This lack of data means we don't know how well treatments work for women specifically. It also hampers our ability to design clinical trials that would be more effective for women. The FDA subsequently changed its tune regarding the inclusion of women in clinical trials, eventually updating its guidance on the inclusion of women in 1985, 1993, and again in 2000. And we still haven't reached a point of equity. Now consider this; many factors, including body size, hormonal environment, and even body fat distribution, can affect how drugs metabolize in the body. This could potentially mean that life-saving drugs may not work, may not work as well, or may not work similarly in women as they do in men. And yet, they've been prescribed to us for decades.