By: David Warmflash
In recent discussions on federal government medical research funding, we noted that the National Institutes of Health (NIH) website compares funding versus disability and death burden in graphic form for a range categories of diseases. It was noted that there is a loose correlation between money and disease burden, but that advocacy groups also have a major impact on how funding for a disease lines up vis-à-vis the relative burden of the disease on society. Considering this and other societal factors, can we say whether funding for medical research is sexist?
Advocacy, Social Awareness, and Women’s Health
Constantly hearing about a disease category can alter the impression of the disease that exists in society, and sometimes advocacy can come into conflict with the very research that it seeks to support. Perhaps, the best example of this is breast cancer. In the early 20th century, breast cancer was a main focus of women’s health advocacy groups, and activity expanded to encompass a push for research in all cancers, relevant to both genders, leading ultimately to the formation of the National Cancer Institute (NCI). Breast cancer advocacy expanded further in the 1960s and 70s as mammography came to age, along with expert recommendations that it should be able to reduce breast cancer mortality through early detection. This bolstered enthusiasm for performing mammography screening earlier and on younger women. From a science standpoint, this peaked around the late 1990s to early 2000s.
The advocacy followed closely behind, encouraging mammography at increasing intervals, but then the science started to change. The optimal number of mammograms over time was reduced (and the interval between mammograms increased), partly because of improving results of treatments, and partly because mammography is good at detecting the less aggressive types of breast cancer and not good at seeing the most deadly types. But the advocacy trend continued in the direction of more mammograms. All of this should lead us to wonder: Do any similar mismatches occur in connection with males?
Gender and the Biggest Health Problems
A look at the NIH graphs of funding versus disease burden shows breast cancer and prostate cancer roughly in proportion to one another. Prostate cancer is a common cancer that strikes only men, whereas breast cancer is common and strikes mostly women. Breast and prostate cancers both are plagued by the existence of a screening method that is encouraged, but actually has poor specificity (PSA in the case of prostate screening). So there is a kind of equivalence between these two cancer categories, and one could read this as evidence that funding is proportionate for both genders.
But doing so would be very misleading. Traditionally, men have been aware of heart disease, as have the doctors who treat male patients. Awareness of heart disease increased substantially from 1997 to the early 2000s. However, cardiovascular disease is a significant problem for both genders. It kills more people than all cancers combined. Awareness has started to level off, such that it still trails behind breast cancer.
If you look again at the graphic form of funding versus disease burden, cardiovascular disease looks slightly below the line that would follow through the middle of all the diseases. But it is not that far below, since it does receive relatively high funding. However, since cardiovascular disease has been considered a male disease, are we spending funding to develop gender-biased treatments?
An illustrative example, outlined in a Harvard-Radcliff lecture called “The Impact of Gender on the Scope, Funding, and Analysis of Health Research,” is cardiovascular plaque, which affects men and women differently. An arterial plaque tends to explode in men but erode in women, and yet the treatments administered in both genders were developed based on the male mechanism. A study comparing men and women with myocardial infarction with ST elevation found lower survival in women, probably due to women being older upon diagnosis. Might gender itself also come into play, particularly for conditions that have very different pathology in men and women? Such an approach is sure to improve not only cancer screening, but early detection of heart disease as well.
Funding is affected by awareness, and awareness can be sexist, as shown in breast cancer screening and cardiovascular disease. These remain important campaigns, because of the sheer numbers of people affected, but these could be only the tip of an iceberg. Perhaps you know of a particular disease that doesn’t get enough attention because of sexism.