LA Times culture critic Mary McNamara is oddly angry about the fact that Ozempic can sometimes make women more fertile. I say "oddly" because this is just one of the hundreds of side effects of popular drugs and no one even knows if it's very common. Most of the evidence so far is from TikTok, and research is ongoing.
Anyway, this quickly turns into a more general complaint:
Conditions that predominantly affect men also receive more attention and funding than those that affect women: Despite ranking fifth in lethality among cancers, for instance, ovarian cancer comes 12th in terms of the resources devoted to it.
I get a little tired of this stuff. Ovarian cancer has a high death rate, but it's also uncommon and thus has only a small number of deaths. It ranks around 14th in actual deaths, so 12th in resources is about what you'd expect.
Besides, why cherry pick ovarian cancer when there's a far more obvious comparison available? The two most common cancers, prostate cancer and breast cancer, are nearly identical. They both produce about 300,000 new cases and 40,000 deaths per year. But breast cancer receives more than twice the funding of prostate cancer and about a thousand times more publicity.
The other evidence of bias against women is equally thin. McNamara links to a study suggesting that illnesses that mostly affect women get less funding, but this turns out to be based largely on things like mental illness and migraines, which affect women only modestly more than men. In any case, six of the eight most burdensome diseases affect mostly women, while five of the eight most funded diseases affect mostly women. That's not a big difference.
I wouldn't bring this up except that it's all too common. We've become far too insistent that the medical industry must be unfair to women and minorities just because it has been historically. So writers keep lazily googling and linking to the same few studies, most of which are either low quality or don't say what activists think they say. Biases surely remain in health care, but they're nowhere near as widespread as a lot of people seem to believe. Tuskegee ended more than 50 years ago. Black maternal mortality is unlikely to be a result of racism. Women are not excluded from clinical research studies. Medical students don't have lots of false racial misconceptions. Depression, breast cancer, and other "women's diseases" get tons of funding. Medicare doesn't cover Viagra.
I understand the desire to stay focused on bias and mistreatment in health care, but we shouldn't do it at the expense of promoting outdated and discredited narratives that have long since become little more than urban legends.
Regarding breast cancer v. prostate cancer, isn't it fair that breast cancer gets more resources because it kills at many ages, while prostate cancer kills mostly the very old? I mean, brass tacks, but it's true. (Also prostate cancer is preventable, but this is family blog so I won't go into the details.)
I googled "prostate cancer prevention" and all I get is some stuff about diet that may lower the risk. Nothing like a vaccine that would be close to 100% effective.
not sure why this is all caps makes a good point as long as you avoid the parenthetical statement that is false. There is conflicting evidence as to whether ejaculating more lowers the risk.
The trick is neutraceutical lube, fortified with vitamins.
Slick!
It's not just about death rates. Many men are diagnosed with prostate cancer in middle age and undergo treatment that is life altering in terms of quality of life (incontinence, erectile dysfunction)
I would point out that incontinence in women who have had children is pretty common and it's not given much notice. About that ED, now there's a reason to spend zillions of dollars researching and treating. Can't have that happen to men.
Incontinence in women who have had children can be and routinely is cured by a fairly minor surgical procedure.
Breast cancer mostly kills older women. And prostate kills many younger man. Frank Zappa was 52.
By a number of measures, women have caught up to and even exceeded men and old school sexism narratives no longer apply. But a lot of people grew up with these narratives and will believe them until they die. And these narratives have been taught to a younger generation of women and they repeat them despite some changed circumstances. Questioning these narratives based on data can get you labelled as sexist or even misogynist.
Women's disease have gotten a vastly larger chunk of research money since at least the 60s.
What about endometriosis?
That's the big area where medical sexism *is* still a problem: women's diseases that cause discomfort only, not death, infertility or disability. Pain is invisible and it's all too easy for men to convince themselves that female discomfort is not a big deal. Hence the lack of attention to endometriosis, period pain, and menopause.
Pain generally is an area that seems to be under researched. It's all too easy for doctors, male or female, to convince themselves that discomfort, in men or women, is not a big deal.
Let us know what you think about the current state of menopause research, Kevin. It is the black hole of research and ALL women go through it. Many suffering for years. Nobody wants to talk about it, even many practicing Doctors. Seeing my wife struggle and suffer, often with frustrating help, or lack thereof, offered my our medical establishment has certainly alerted me to its need of MORE research.
Menopause research gets lots of funding. Hence all of the conflicting studies on hormone treatment for it.
I'm more or less with you on the general equality across sexes for most medical issues, possibly excepting menopause. But two biases certainly do remain, in attitude if not in research: weight and age. If you're heavy or if you're old, you just don't receive the same "attention" as others.
Medical fatphobia is definitely a much bigger problem than medical sexism. Yes, bad diets and lack of exercise make people fat and unhealthy... but calorie-restrictive diets are neither effective for lasting weight loss nor truly safe, and dismissing every fat patient's complaints by saying it's because of their obesity and they need to lose weight can kill.
Ah Americans and their victom narratives.
Fatphobia - not that obesity is an actual clear medical problem and health risk, unambigously and clearly in data, no i it s a "phobia" - I suppose on the order of say Cancerphobia, and other diseeasephobias.
along with simplistic declarations of things that do and don't work while somehow outisde of USA and its specific cultural habits and food habits notably...
I don't think that this is worth getting on a high horse. But let's go beyond first level biases here. There certainly can be some issues in how research gets to be prioritized. Even when a disease is as frequent for men and women (or for blacks and whites), modern biology tells us that there are hidden complexities in how a certain individual is likely to react to a given treatment. Gaining this full knowledge is important. Some things may be good for men, and less effective for women (or blacks v.s. whites). Unless this is researched, we don't have an unbiased knowledge of reality.
Anything that gets the discussion off the fact that drugs in the US are wildly more expensive than they could be is a distraction. That cuts across gender, race, and age.
Our entire health care system has devolved into an extortion racket. That is by far its worst feature, and you are absolutely right that all other issues with American medicine are minor in comparison.
Did any one ever study the panic attacks suffered by women pundits when a deadline approaches and they have nothing to pundit about!!!!!!??
I don't think that's actually a woman-specific problem.
We all know that logic is in short supply in MAGA-land, but recently I've seen several assertions on "our side" that are equally deficient. Lazy feels-based "reasoning" has broken out everywhere. Kevin highlights a good example.
“Do women get the short end of the health care stick?”
Though there may be instances where women get the short end, it seems clear that overall the lion’s share of healthcare system resources are devoted toward the health of women.
For biological and cultural reasons, women see doctors far more often through their lives. In later years, when people need health care services the most, it’s usually women getting that care because there are many more of them.
No doubt, the patriarchy has conferred a number of societal advantages to men. But better healthcare is not one of them. Men’s health and well-being have generally not been prime considerations for the roles men are asked to do. Men traditionally are sent to fight wars. When it comes to risky work, it’s usually a man’s job. When safety is a concern, it’s women and children first.
Men more often than women engage in risky behaviors. One factor there is that that’s what society values. How important is men’s health? Not so important, relatively speaking.
Women seek health care because it’s a regular and periodic part of life. Men seek health care when there’s a problem, and often when it’s too late.
Men die on average 5 or 6 years younger than women. That would be a scandal if it were true for any other group, but not for men.
There's definitely a cultural problem here. Caring about your health is considered positively unmanly in many quarters. There are lots of men out there who performatively engage in egregiously unhealthy behaviors as a way of showing off how masculine they are.
With that said, biology is pretty clearly the main reason for the life expectancy gap (women live longer than men in almost every country on Earth). Wherever there is a tradeoff between optimizing a body to win fights and building it to survive hardship, evolution has given men the "win fights" choice and given women the "survive hardship" choice. Even without the regular famines, plagues and wars our ancestors faced, those body features still give women an edge in holding out against the ravages of old age.
I'd be willing to say our evolution and history have given women a slight "natural" edge. But how much, I don't know. I suspect culture, economics, and other societal factors play a more important role in how large an edge women have.
The gap favoring women tends to be smallest (about 1-3 years) in some African countries, where life expectancies tend to be shorter on average. In more industrialized societies (Europe, East Asia), overall expectancies are longest but with a bigger gap favoring women (closer to 5 years, give or take). The biggest gaps tend to be in dysfunctional industrialized countries (Russia and other former Soviet republics), with women living about 9 or 10 years longer than men.
I suspect that you will find that the smallest gaps between male and female life expectancies are in countries with a high birth rate and high maternal mortality. Deaths due to pregnancy generally occur in younger women and can drag the average life expectancy down quite a bit.
This post is basically: "That thing that doesn't affect me? I'm not worried about it."
Sexism/misogyny absolutely still occurs in health care and is detrimental to women.
Drugs are tested far more often on men, not really for sexism concerns but because there is an enormous ethical issue regarding pregnancy. You can not do an ethical test of drugs on a woman who is pregnant at any point during the test, so there are fewer women in the testing pool.
This also shows up in the way approval regimes are set up. My spouse has Type 1 diabetes and uses a CGM and Omnipod. Because my spouse is female, she has a hormone cycle every month that makes her more or less resistant to insulin depending on what's going on with her estrogen, progesterone, and testosterone levels. The latest Omnipod/Dexcom system she has does have an automatic mode, but because of how insulin works and how the software is set up for that system (it is supposed to learn how well insulin works for you over a period of a couple of weeks), and there's no "hi, I'm a woman" mode for the software to account for that, she still has to do everything manually instead of letting technology do it for her - because otherwise what happens is it errs on the side of not letting her glucose levels get too low, but in those times of her cycle when she's insulin resistant due to hormone levels, that means that the algorithm thinks she doesn't need as much insulin as she does. This results in higher A1C.
Just one example where "hey it works for men" and then it's just kind of left alone after that.
Then there are the demonstrated biases against believing women when it comes to their symptoms and experiences of pain.
But hey, Kevin's a male and so are most of the commenters above, who have put on a shocking display of ignorance with sentiments like "health care is biased towards women, akshully."
👍👍👍👍👍👍👍👍
"Drugs are tested far more often on men, not really for sexism concerns: Actually it really was because of sexism in that only men's lives could be risked in drug tests. (these tests really do rarely kill people.)
The way to understand anything is to begin by understanding what interest is being served. The way to misunderstand anything is to begin by ignoring the fact that a specific interest is being served, and ignoring the fact that deducing that interest is not all that difficult, which is by means of reading between the lines.
For example, you can conclude that writers are lazy, I can conclude that writers are hard workers, and our conflicting conclusions are mere speculation until we define "lazy" and look objectively at the evidence.
Is your criticism constructive, or is it saying, in effect, "They're bad, and I'm not like them?"
Alternatively, it's easy to distinguish between people who are practicing journalism -- by informing their readers profitably -- and people who are committing journalistic malpractice -- by profiting from misinforming their readers.
"The purpose of business is to solve the problems of people and planet profitably, and not profit from causing problems." -The British Academy.
For the record, someone at The British Academy understood Adam Smith's Theory of Moral Sentiments, aka the difference between people who practice capitalism and people who are committing capitalistic malpractice.
There's at least three separate issues going on here:
1. Kevin's suspicion that this one article is cherry-picking its data to prove a position it already assumed without data. I'll leave open the question as to whether Mary McNamara's experience with the health industry might be qualitatively different from Kevin's in ways that might lead them to differing basic assumptions. Kevin's objection seems at least somewhat fair, although his counterexample of breast cancer vs prostate cancer may also be unfair in ways similar to the ways he objects to McNamara: men do (rarely) suffer from breast cancer, but do not suffer from ovarian cancer; greater publicity and higher fundraising for breast cancer doesn't prove a lack of sexism, but could evidence sexism successfully overcome by spending money; 5-year survival rates by stage are still lower for breast cancer than for prostate cancer meaning that it is lethal faster, which matters. (For those curious, cancer.org say localized breast cancer has a 99% rate, regional 86% and distant 31% for a total 91% 5-year rate, while prostate cancer is >99% for the first two categories and 34% for the last for a total 97% 5-year survival rate.)
2. It is not clear that looking at raw spending is useful to establish the presence or absence of prejudical decision-making. "But breast cancer receives more than twice the funding of prostate cancer and about a thousand times more publicity." Not sure where Kevin got these numbers (invented?), but the American Cancer Society says grants by cancer type are about 4 times more for breast cancer than prostate cancer, so that's understated. (Publicity Kevin definitely just made up.) So we spend much more researching breast cancer than prostate cancer. But does that prove that breast cancer research is overfunded? Maybe if we could somehow entirely eliminate sexism, those numbers would be even bigger because we should be spending even more? You'd have to prove that a determining factor in funding disparities is discrimination against women; I'm not sure how you do it, but the specific dispute about funding isn't it.
3. Breast cancer death rates increased steadily through 1989 and then dropped precipitiously, meaning that the death rates for breast cancer were even higher than they are now. A short search isn't producing such clear numbers for prostate cancer, but it too became much less lethal in the early 90s, though whether it's because of the same research or unrelated research I can't say. If sexism drove low levels of research in breast cancer and then that stopped, I'd expect something visible at the point it stopped in terms of funding, and then improvements in survival rates subsequent to that. Again, I suspect there's too many factors and you can't isolate sexism to determine where it had influence and when it stopped (if indeed it did, which seems like the more extraordinary claim given the daily evidence sexism generally is still prevalent in American culture). We know when lead gasoline was first used, how it spread, and when it was phased out; sexism is not so easily documented and measured, nor is it as easily regulated.
As a white man who has accompanied women to medical appointments and procedures, I have repeatedly observed male doctors ignoring or disregarding what women have to say. I'd honestly be more interested in seeing the statistics for diversity in medicine professionals (doctors and researchers, mainly) and how that may change results. I don't know if the recent studies showing patients do better when their doctors are women than when they are men are accurate or not, and individual people can be humble or arrogant regardless of gender or sex, but perhaps what we're seeing in terms of improvement must be linked to efforts to make doctors and researchers more responsible and responsive to women (and minorities) than in the past? That wouldn't prove sexism has ended, only that more is being done to counteract its effects, but as we've seen all the way up to the Supreme Court, there are people willing to say "because all these measures have canceled out the effects of racism, that proves racism no longer exists and we can eliminate the measures." Because you can stop chemo if all the cancer is dead, so that means you can stop taking insulin as a diabetic, too.
I'm willing to bet that Kevin doesn't have a hard data source for his claim that breast cancer gets "about a thousand times more publicity" than prostate cancer, but anyone with a functioning pair of eyes knows that the ratio here is extremely lopsided. There is no equivalent to the breast cancer awareness campaigns and all the pink-ribbon stuff for any other type of cancer. Nothing even close.
" If sexism drove low levels of research in breast cancer and then that stopped" Contrary to lying feminists, breast cancer research has always been massively overfunded relative to other diseases. The funding numbers of more than 2 Kevin cites applies only to government funding. Private charitable funding is much more lop sided. And the reduction to 2.5 times more government funding is a relative recent phenomena as a result of much more public awareness of prostate cancer.
Back before the paywall the NYT would post a site called Diagnosis. It was always an interesting read as the cases were always about difficult diagnosis. Most cases were where a person suffers for a long time and getting differing treatments from different doctors util one doctor finds the right diagnosis and treatment.
I can jump the paywall. I read Krugman that way.
My book club is reading "Eve," by Cat Bohannon. One of her points is that men are used predominantly in medical tests. There actually are good reasons for this because pregnancy and hormonal changes make tests with women much more complicated. But a consequence is that we don't get good information on how different medicines and medical conditions affect women differently from men. I haven't read enough yet to have an opinion about how right Bohannon is about this, but it sounds plausible.
Pregnancy is a serious issue for studies (you NEVER EVER want to test a drug on pregnant women until you've established its safety in human adults, human children, and pregnant animals, lest you kill a baby or ruin its life) but "hormonal changes" actually are not. The menstrual cycle has an impact on the body, but it is a lot smaller than men think it is, and the effects of "what time of the month" will wash out in the average of a large sample. Medicine has successfully studied, and accounted for, far more complicated things than this. Pregnancy is a good reason to exclude someone from a study; menstruation is a poor excuse.
For a long time, women and women's health problems were ignored by medical researchers. It was a real serious beef. The way one gets medical research redirected in our society is by making noise. Women made noise, and there is a lot more money spent on women's health. One way to keep the funding flowing and moving into new areas is to keep making noise. This is why having political influence is likened to having a place at the table. If you aren't at the table, no one making decisions knows you are there and you have little or no influence. If you are at the table, you can at least join the negotiating and arguing.
You can argue the details, but women have managed to get themselves a place at the table, and that means we are going to keep making noise and we are going to have arguments about how much and where next rather than silence. Those NIH policies and funding priorities weren't changed by magic.
It is also important to remember that a lot of doctors still dismiss women's symptoms even as more and more women are MDs and other medical professionals. Not everyone working was trained in the last ten or twenty years and not everyone doing training in the last ten or twenty years was fully on the new page. A woman showing up in a random US ER is at much higher risk than a man as her symptoms are less likely to be recognized for what they are.
"Conditions that predominantly affect men also receive more attention and funding than those that affect women: "why do women keep repeating this utterly ridiculous bald face lie. Women's disease get vastly more funding because they are women's diseases. "But breast cancer receives more than twice the funding of prostate cancer and about a thousand times more publicity." It's actually 2.5 times the public funding and about 10 times the private funding (because of that 1000 times the publicity.) . People who make this dishonest claim do not have a shred of honor or integrity anywhere in their being. "Despite ranking fifth in lethality among cancers," Ovarian cancer is 14th in number of cancer deaths caused. It gets a disproportional high level of funding, not low. Assuming the author was talking about survival rate when using the term lethality, ovarian is 7th. The difference in survival rate between the 8th and 21st most 'lethal' cancers is negligible.
"We've become far too insistent that the medical industry must be unfair to women and minorities just because it has been historically."
That's not the full story. The other side of the story has to do with feminism as it exists today vs feminism as it was envisioned in the 60s and 70s (and that we pretend still exists).
The feminism of earlier was about giving women empowerment. This was what a tiny fraction of loud women wanted. But it's not what most women want. And so feminism pivoted. It's now not about empowerment, it's about (just like in relationships) some nebulous web of "being heard" and "being protected" and "having a voice" and similar non-actionable complaints.
It's this sort of "send out vibes, I don't care about the facts" that's driving these complaints, just like it's driving practically every complaint of modern feminism. It's impossible to refute because it's based on pure emotion, not logic, not evidence. And it's an addition, in the sense that it feeds on itself. The more you allow it, the more it demands more of this interaction.
The only reasonable response is as with any addict - walk away. Don't enable it, don't try to argue with it.
Right now 37% of doctors are women. That number is only going to grow. 55% of medical students are women. And yet we STILL hear this sort of complaint.
Look at the poster, kaleberg, just above me. In what world, where male US lifespan is 73 and female is 79 can one complain that "A woman showing up in a random US ER is at much higher risk than a man as her symptoms are less likely to be recognized for what they are."
How does this make any sort of sense?
Because this IS NOT A FACT BASED COMPLAINT, it is a VIBES BASED COMPLAINT. And as an addiction, it does not WANT resolution, it wants more things to complain about.