[QuarterReptile]

>women tended to be underrepresented in western medical literature.

Is there some evidence of this? It's hard for me to picture that women see receive less medical attention than man: completely inconsistent with my culture and every doctor's office I've ever been to. It's more believable (still not very) that they disproportionately avoid studies.

[stevenbedrick]

There is indeed a lot of evidence of this but you've got the direction backwards- it's not that women avoid studies, it's that for a long time studies specifically excluded women. Ditto for people of different races. This is why these days (well, as of today, at least) the NIH has a whole set of very well-established policies around inclusion in clinical trials that include sex, race, and age: https://grants.nih.gov/policy-and-compliance/policy-topics/i...

And this isn't for "DEI" reasons, it's literally because for decades there used to be drug trials that excluded women and as a result ended up releasing drugs that gave half the population weird side effects that didn't get caught during the trials, or just plain didn't work as well on one group or another in ways that were really hard to debug once the drug was on the market. That was legit bad science, and the medical research world has worked very hard over the last thirty years to do better. We are admittedly not there yet, but things are a lot better than they used to be.

For a really interesting take on the history of racial exclusion and bias in medicine, I recommend Uché Blackstock's recent book "Legacy: A Black Physician Reckons With Racism In Medicine" which gave a great overview.

Oh! And also everybody should read Abby Norman's "Ask Me About My Uterus," it gives a fabulous history of issues around women's health.

[marcuskane2]

Also, lots of medical studies have been done on drafted/conscripted soldiers which were all men. As well as lessons learned from treating injured and sick soldiers.

European medical studies had few non-white members because their populations had few such people until recent decades.

Lots of workplace accidents or exposures have led to medical knowledge, which are massively disproportionately male.

[lfmhd]

> It's more believable (still not very) that they disproportionately avoid studies.

Women are definitely strongly underrepresented in medical texts, and it's not typically by choice: https://www.aamc.org/news/why-we-know-so-little-about-women-...

A lot of "the consensus" in medical literature predates the inclusion of women in medical research, and even still there things are not tested on women (often because of ethical risks around fertility and birth defects).

[dragonwriter]

> It's hard for me to picture that women see receive less medical attention than man: completely inconsistent with my culture and every doctor's office I've ever been to

“Medical attention” and “coverage in medical literature” aren't even remotely the same thing, so dismissing a claim about the first based on your anecdotal experience of the second is completely bonkers.

[genocidicbunny]

There's a few factors here:

1. We're talking about a span of 200 or so years. There is plenty of modern medicine that is still based on now century+ old knowledge.

2. The feedback loop. If you were learning medicine in the 1950's, you were probably learning from medical texts written in the 50 or so years before that, when it's not unreasonable to think women would have been less represented. Those same doctors from the 1950's would then have been teaching the next generation of doctors, and they carried those (intentional or not) biases forward. Of course there was new information, but you don't tend to have much time to explore novel medicine when you're in medical school or residency, so by the time you can integrate the new knowledge, some biases have already set in. Repeat for a few generations, and you tend to only get a dilution of those old ideas, not a wholesale replacement of them.

3. If you've been affected by such biases as a patient, you're less likely to trust and be willing to participate with medicine, once more reinforcing the feedback loop.

I don't have any specific numbers or studies for you, but you could probably find more than a few that attest to this phenomenon. I hate to go with 'trust me bro' here, but my knowledge on this topic largely comes from knowing people that are either studying or practicing medicine currently, so it's anecdotal, but the anecdotes are from those in the field currently.

[bryanrasmussen]

Your location seems to be in Cox, Virginia, not sure how widespread beyond that your experience is?

Of course lots of people have already noted that being represented in medical studies is not related to doctor's visits, but I would like to talk about the doctor's visits observation.

At any rate one thing that might cause you to think that Women are receiving lots of medical attention, based on your anecdotal evidence from visits to doctors' offices, there is one type of medical attention that of course is almost all women and that is the medical attention that revolves around pregnancy. That might skew your perception.

Furthermore if AI models and doctors have a tendency to miss disease among women it would seem to me to be reasonable to assume that women would be in the doctor's offices more often.

Example of why this is:

You go to your doctor, there is a man there, doctor says you have this rare disease you need to go to this specialist - you will not see that man in the doctor's office again dealing with his rare disease.

You go to your doctor, there is a woman there that has the same rare disease, the doctor says I think it will clear up, just relax you have some anxiety. That woman will probably be showing up to that doctor's office to deal with that disease multiple times, and you might end up seeing her.

on edit: there was another example of why women might be in doctor's offices more often then men that I forgot, women tend, even nowadays, to be the primary caregiver and errand runner for the family, sometimes if you have issues with children or your husband etc. has had an appointment, needs to drop a sample off, etc. it may be that the woman goes to the doctor's office and takes care of these errands around the medical needs of the rest of the family, and thus you might go to a doctor and see a couple women sitting around and wonder damn, why all these women always being sick, when the meeting isn't even about them.

[adamhartenz]

The history of ADHD research is a common referenced example

[autoexec]

Part of it is that women are less likely to join studies (especially risky ones that might impact their fertility or the health of their future children).

Part of it is that men are seen as disposable and it's more socially acceptable to exploit and experiment on men. It was also much easier to deal with men historically since once women got involved everything got a lot more complicated. This was especially true in the past where women were so infantilized that their husbands/fathers were put in charge of their medical care/choices. Those backwards attitudes had some strange consequences. On one hand women were seen as the property of men who could get their wives/daughters institutionalized or even lobotomized for not conforming, but at the same time women were also seen as delicate over-emotional creatures who had to be protected and whose modesty had to be preserved in ways that just weren't a consideration when men were involved. Basically for a large part of our history both men and women have been treated like crap by society and while things have improved in a lot of ways, our records and knowledge have been tainted by those old stupid biases and so we're stuck dealing with the fallout.

[kaitai]

Here is an academic medicine perspective: https://www.aamc.org/news/why-we-know-so-little-about-women-...

To give you some TL;DR from personal-ish experience, women have historically been excluded from medical trials because:

* why include them? people are people, right? * except when they're pregnant or could be pregnant -- a trial by definition has risks, and so "of course" one would want to exclude anyone who is or could get pregnant (it's the clinical trial version of "she's just going to get married and leave the job anyway") * and cyclical fluctuations in hormones are annoying.

The first one is wrong (tho is an oversight that many had for years, assuming for instance that heart attacks and autism would present with the same symptoms in all adult humans).

The second is an un-nuanced approach to risk. Pregnant ladies also need medical treatment for things, and it's pretty annoying to be pregnant and be told that you need to decide among unstudied treatments for some non-pregnancy-related problem.

The third is just a difficult fact of life. I know researchers studying elite performance in women athletes, for instance. At an elite level, it would be useful to understand if there are different effects of training (strength, speed, endurance) at different times in the menstrual cycle. To do this, you need to measure hormone levels in the blood to establish on a scientific basis where in the cycle a study participant is. Turns out there is significant heterogeneity in how this process works. So some scientists in the field are arguing that studies should only be conducted on women who are experiencing "normal menstrual cycles" which is defined by them as three continuous months of a cycle between 28-35 days. So to establish that then you've got to get these ladies in for three months before the study can even start, getting these hormone levels measured to establish that the cycle is "normal", before you can even start your intervention. (Ain't no one got $$ for that...) And that's before we bring in the fact that many women performing on an elite level in sport don't have a normal menstrual cycle. But from the sports side, they'd still like to know what training is most effective.... so that's a very current debate in the field. And I haven't even started on hormonal birth control! Birth control provides a base level of hormone circulating in the blood, but if it's from a pill it's varying on a daily basis, while if it's a patch or ring it's on a monthly basis (or longer). There's some question of whether that hormonal load from the birth control is then suppressing natural production of some hormones. And why does this matter? Because estrogen for instance has significant effects on cardiovascular health, being cardioprotective from puberty up to menopause. (Yeah, I didn't even get started on perimenopause or menopause.)

Fine, fine, it's just data analysis & logistics. If you get the ladies (only between 21-35) into the lab for blood samples frequently enough and measure at the same time of day every time to avoid daily effects and find a large enough group that you can dump all the ladies who don't fit some definition of normal & anyone who gets pregnant but still get the power for your study, it's all fine, right? You've just expanded medical research to incorporate, like, 10% more of the population....!

[naijaboiler]

I am just tired of skeptics asking innocently. Yes I wish i could take time to look for sources to educate people like you, but I don't. So take my word for it or not. But yes women's medical issue are disproportionately underrepresented, misrepresented and understudied.

[da_chicken]

It's pretty well understood that there's an unfortunate bias towards white men in their early 20s. This is a pervasive sampling problem across all human studies because most researchers have historically been at universities. So their pool of subjects has naturally been nearby college students.

Just as those are the people who have historically been doing that research, the people who they have studied have been drawn from the same population. Over and over we find that problems from the assumption that the young, white, male college student is a model of "normal" for all of humanity.

Honestly, it's such a pervasive finding in medicine, psychology, and sociology that I think it says more about your relative inexperience in those areas than anything else.