Until last year, women in the US had been unwittingly overdosing on sleeping pills for nearly twenty years.
In January 2013, the American Food and Drug Administration (FDA) ordered drug companies to slash the dosing of Zolpidem (an insomnia drug known as Ambien) by half for women. Side-effects from over-dosing on Zolpidem (known as Stilnox in Australia) include impaired thinking and reaction time, sleep-driving and sleep-eating.
The FDA ordered the makers of Ambien to provide different dosing instructions for males and females. Prior to their decision, the instructions for men and women were exactly the same. Why? Because we still don’t have enough information about how men and women metabolise drugs differently.
Phyllis Greenberger, CEO of the Society for Women’s Health Research in the US wrote just last month in a blog for Huffington Post: “the reality is that we do not know whether a drug will harm women until after they have started taking it.”
It is the year 2014 and women are at risk of harm from easily preventable biomedical errors. How on earth did we get here?
Firstly, drugs are tested on animals before they make it to human trials. Female animals are more difficult to test on, due to a more complex hormonal profile. The neuroscientist Larry Cahill is on record saying that the scientific understanding of women’s neurobiology is pitiful. He explains that 93% of the animals used in neuroscientific research are male, simply because they’re easier to study.
Secondly, medical and health researchers, including neuroscientists and psychologists, avoid studying sex differences out of a fear of being labeled “sexist”. One psychologist consistently name-calls neuroscientists publishing work on sex differences, dismissing such work as “neurosexism” and “neurotrash”. Researchers wanting to enjoy controversy free careers understandably avoid the sex differences arena.
In the field of medicine, heart disease, the number one killer of women in Australia, is known to affect men and women differently. More women die from heart attacks than men and females are at higher risk of extensive bleeding after heart surgery. Women’s brains are also more sensitive to neural deterioration. This leads Alzheimer’s to be more prevalent amongst women compared with men. It follows that research focusing on sex differences at the level of the neural substrate, is a pressing women’s health issue. Implying that it is a niche interest of “neurosexists”, in 2014, is simply reprehensible.
The dismissing of sex difference research stems from a deeply ingrained false assumption – that males and females are the same in matters of biology. To understand this probably unconscious assumption, we have to go back to Rousseau and his idea of the tabula rasa. The “tabula rasa,” means in Latin, “scraped tablet” or to us, that a baby is born with no preconceived ideas, his or her mind being a “blank slate”.
According to the assumption, culture writes upon this blank slate, shaping an individual until they conform to social norms. Tabula rasa thinking has been around for a long time, but it reached its zenith in the 1970s and 1980s when post-modern philosophy became popular.
The post-modern theorist Michel Foucault famously eyed biology and medicine with suspicion. He characterised “knowledge-producing” institutions, such as the medical clinic as potential tools of oppression. According to post-modernists, traditional research agendas were racist, classist and sexist, (albeit often unintentionally).
These ideas have been incredibly influential. In many undergraduate humanities courses – such as English Studies or Gender Studies – a student learns that the scientific method is biased for the fact that “if you ask certain questions you get certain answers”. Simply asking a question about sex differences reinforces a potentially constraining cultural dichotomy.
Today anti-vaccination advocates cite post-modern arguments in their suspicion of the pharmaceutical industry. Anthropologist Anna Kata has written:
Anti-vaccination protestors make postmodern arguments that reject biomedical and scientific “facts” in favour of their own interpretations…these postmodern discourses must be acknowledged in order to begin a dialogue.
Post-modern ideas are often presented in a very complicated language. At their heart however, lies an implicit manifesto of questioning socially received “binaries”, dichotomies hitherto thought to be self evident, such as male versus female, normal versus abnormal, or biology versus culture. Post-modernism tells us that these binaries are arbitrary, that gender is fluid for example, and in doing so has helped many men and women who don’t fit into straight-laced ideals of masculinity and femininity explore sex and gender with an open mind.
Unfortunately however, post-modern philosophy and the cultural baggage of the tabula rasa has not helped women in areas of health and medicine. In fact it has harmed us. This is simply because there is much more to biological sex than reproductive anatomy. And when it comes to testing biomedical hypotheses or interventions, we need to apply strict binaries. We need to test control groups against experimental groups, and women against men, to eliminate noise and bias, so that we can make causal inferences.
Zealous activists may argue that incorporating sex differences in studies may provide ammunition to those wishing to make sexist generalisations about women. However we also need to be aware that a dismissive attitude towards sex differences research constructs an arbitrary binary. If sex differences research is automatically viewed as “bad” while proof of similarities is viewed as “good”, then we are failing to think critically. (If Foucault could see how rigid his inheritors have become, he’d be turning in his grave).
The bottom line is that women’s health needs to be taken seriously. While sex differences research should be treated with a healthy skepticism (like any other research agenda) if we are too afraid to ask the questions, we will end up with no answers.