A great Slate article this week about the way that women have traditionally been excluded from medical trials.  Not out of an institutionalized sexism, but from a combination of laziness and fear of harming theoretical fetuses.  The upshot being, we don't really know - from a clinical perspective - what a lot of drugs and surgical procedures do to the female body.

This is a bit of a problem, no?

It should be pretty obvious to all concerned that a woman is not just a man who lacks a penis.  There are significant hormonal differences, and nothing interacts with a drug like hormone levels!  Women and men are different right down to the genetic level.  (Reading about the significant genetic differences between women and men always makes me a little surprised we can even reproduce successfully.)

Women's bodies process drugs differently from men's bodies; as the Slate article points out, women will have higher concentrations of antidepressants in their bloodstream, and only require half the amount of flu vaccine compared to men.  According to a study done by the FDA, the drug concentrations between men and women varied by up to a whopping 40%!  

And yet there is not, to my knowledge, any medication with separate dosage instructions for women versus men.  

Women are virtually never included in drug trials, even though there are some diseases (like heart disease and autoimmune disorders) which affect women at a far higher rate than men.  Men don't have a menstrual cycle (as you may have noticed) which makes them a "more homogenous study population."  

There's also the fear - somewhat justified - that a woman will become pregnant during the trial.  The thalidomide disaster is more than a distant memory to clinicians; it's a constant lurking fear.  No one wants to be responsible for the next generation of "flipper babies," nor to suffer the lawsuits that would result.  (Also, clinical researchers like babies just as much as the rest of us.  I don't mean to paint them as heartless automatons.)

The risk to pregnancy motivated the FDA to actually ban women of childbearing age from clinical trials from 1977 to 1993.  In 1993 Congress reversed that decision, and women are now required to be included in clinical trials unless it's specifically contra-indicated (as in trials of a prostate drug).

All of this has created a situation where women seem to be treated as second-class citizens.  As an afterthought; the kid your mom made you play with in order to spare their feelings.  Which raises the question, what would the field of medicine look like if that were not the case?  

The article's author points out that fewer and fewer drugs are making it to market.  (Partly because they fail the placebo test.)  Drugs marketed specifically to women are usually focused on reproductive disorders or, like, eyelash thickness.  

What about a second category of drugs that are tailored to work better in the female body?  Claritin Men versus Claritin Female.  I know that I would pay more for an allergy medicine which had been tailored to work better for women.  If only a half dosage, for half the cost, since women only metabolize medicines half as quickly!

Photo credit: Flickr/JasonTromm