Women & Pulmonary Background
The gender gap exists for women in pulmonary medicine. According to the Medscape Pulmonologist Compensation Report 2017, female pulmonologists earned 23% less than their male counterparts even though:
- Two percent of women pulmonologists work part time vs 8% of men.
- More women (66%) than men (48%) reported seeking promotion (Grisham, 2017).
Despite ever-growing enrollment rates for women in medical school, female physicians are often underrepresented in academic and research settings, and according to a study published in the Journal of National Medical Association, “between 80 to 90 percent of leadership roles in medicine, like medical school deans, are filled by men” (Morton & Sonnad, 2007).
The discrimination and roadblocks do not stop at the clinician’s door. This gender inequality is evident in the women who are receiving medical treatment as well. There are two major issues that exist for women seeking treatment:
Not being taken as seriously as male patients:
- Women are more likely to be prescribed sedatives for their pain, and men are more likely to be prescribed pain medication (Calderone, 1990).
- Women are more likely to be treated less aggressively in their initial encounters with the health-care system until they prove that they are as sick as male patients with similar symptoms (Hoffmann & Tarzian, 2001).
- Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. (Chen, et al., 2008).
- Multiple studies have shown that female patients’ symptoms are less likely to be taken seriously by doctors, and women are more likely to be misdiagnosed, have their symptoms go unrecognized, or be told what they’re experiencing is psychosomatic (Hoffmann & Tarzian, 2001) (Carnlöf, et al, 2017).
Being diagnosed and treated the same as male patients:
- Up until 1993, when the National Institutes of Health Revitalization Act mandated that all women and minorities be included in clinical trials funded by the NIH, the guidelines and diagnosis for treatment have historically been based off the archetypal patient: a 154-pound white man. Because of this, women are often misdiagnosed or receive treatments that are ineffective or potentially harmful to their health. Even still, researchers frequently do not enroll an adequate number of women or fail to analyze or report data separately by sex (MHC Center, 2014).
- Women and men metabolize drugs differently, yet dosages are rarely broken down by sex. Women also experience different side effects and derive different benefits from the same treatments (Soldin & Mattison, 2009).
- Female patients have a 1.5 to 1.7 times higher chance of having an adverse drug reaction (Rademaker, 2001).
- There are many diseases and conditions that are alarmingly more prevalent among women. Nonsmoking women are three times more likely to get lung cancer than nonsmoking men, according to a comprehensive 2014 report by Brigham and Women’s Hospital in Boston, called “Women’s Health Can’t Wait” (MHC Center, 2014).
- “While the number of women participating in lung cancer clinical trials has risen, women—particularly those from racial and ethnic minorities—are still less likely to enroll in these trials than men. Even when studies include women, researchers often fail to analyze data by sex or include hormone status or other gender-specific factors, making it difficult to uncover differences in incidence, prevalence, and survivability between men and women and to replicate the studies” (MHC Center, 2014).
There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. Respiratory conditions that impact women nearly exclusively include pulmonary hypertension, catamenial diseases, and pregnancy-associated asthma exacerbation (Pinkerton, et al., 2015). Women have been taught to care and take notice of the symptoms of breast cancer, HPV, ovarian cancer, and other “women’s diseases,” and yet more women die from lung cancer than from breast, ovarian, and uterine cancers combined.
A lot of times clinicians are not even thinking about gender differences because the “gold guidelines” for diagnosis and treatment do not take that into consideration. Unless clinicians are proactive about the gender differences in treating and diagnosing their patients, the awareness and knowledge is not there.
Calderone K. The influence of gender on the frequency of pain and sedative medication administered to postoperative patients. Sex Roles. 1990;23(11-12): 713-725.
Carnlöf C, et al. Women with PSVY are often misdiagnosed, referred later than men, and have more symptoms after ablation. Scand Cardiovasc J. 2017; 51(6): 299-307.
Chen EH, et al. Gender disparity in analgesic treatment of emergency departmetn patietns with acute abdominal pain. Acad Emerg Med. 2008;15(5):414-418.
Grisham S. Medscape Pulmonologist Compensation Report 2017. https://www.medscape.com/slideshow/compensation-2017-pulmonary-medicine-…. Accessed Jan 16, 2018.
Hoffmann DE, Tarzian AJ. The girl who cried pain: a bias against women in the treatment of pain. J Law Med Ethics.2001;29(1):13-27.
MHC Center. Sex-Specific Medical Research: Why Women’s Health Can’t Wait. Brigham and Women’s Hospital, Mary Horrigan Connors Center for Women’s Health & Gender Biology. Brigham and Women’s Hospital;2014.
Morton MJ, Sonnad SS. Women on professional society and journal editorial boards. J National Med Assoc.2007;99(7):764-771.
Pinkerton K, et al. Women and lung disease. sex differences and global health disparities. Am J Respir Crit Care Med.2015;192(1):11-16.
Rademaker M. (2001). Do women have more adverse drug reactions? Am J Clin Dermatol. 2001;2(6): 349-351.
Soldin O, Mattison M. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinetics.2009;48(3):143-157.