Modern science presents itself as universal knowledge, capable of describing the human being in its entirety. Yet, its history tells a different story: for centuries, medical research has built its certainties by adopting the male body as a reference model. The female body has long been subordinated to a paternalistic vision that reduced it to an object of male control. This paradigm has not only affected the social and cultural spheres, but has also permeated scientific research. The stories of Anarcha Westcott and Henrietta Lacks are emblematic. The former, a young African-American woman enslaved in the 19th century, was subjected to repeated gynecological experiments by the so-called "father of modern gynecology," based on the racist belief that black women experienced less pain. The latter, an African-American woman who died of cancer, was denied consent during her lifetime for the collection of her cells, which later became crucial for biomedical research. Their stories show how medical knowledge has often been built on the female body, transformed into a testing ground and exploitation, rather than recognized as a subject with rights, especially when it belongs to marginalized groups.
These cases are part of a broader tradition of abuse and unethical experimentation on African-American women in the United States. Between 1920 and 1970, thousands of Black women underwent forced sterilizations. The so-called "Mississippi appendectomies" were unnecessary and non-consensual hysterectomies performed in university hospitals, sometimes as an exercise for medical students or as a means of birth control among Black women. The female body, in this context, was not a subject to be treated, but a resource to be utilized.
While some women were exploited as objects of experimentation, others were systematically and institutionally excluded from research. For much of the history of modern medicine, the male body was considered the universal model of the human being. In basic research, animal studies, and clinical trials, men and women have been the norm, while the female body was deemed too complex or unstable due to hormonal cycles. The result is a medicine built on incomplete data, which does not represent half the population.
A crucial stage in this exclusion dates back to 1977, when a US Food and Drug Administration (FDA) guideline recommended excluding women of childbearing age from the early stages of clinical trials. The measure was born in reaction to scandals surrounding drugs like thalidomide, which was responsible for serious fetal malformations in the 1960s. In an attempt to protect potential pregnancies, however, the rule ended up effectively excluding all women with reproductive capacity, including those using contraception or not sexually active. Protection turned into erasure.
For decades, drugs and medical devices were tested almost exclusively on men, and the results were applied to women as if the two bodies were identical, ignoring biological differences related to hormones, metabolism, and physiology. Only in 1993 was the guideline revoked, and the National Institutes of Health mandated the inclusion of women in publicly funded trials. However, the mere presence of women did not automatically guarantee differentiated analyses: data was often aggregated, obscuring differences in treatment response.
This disparity is not only an ethical problem; it has had and continues to have concrete consequences for women's health. Drugs effective in men may be less effective or more risky for women, or require different dosages. It is no coincidence that once drugs are on the market, side effects are more frequent in women: women experience adverse effects almost twice as often as men.
The imbalance is particularly evident in cardiology. Cardiovascular disease is the leading cause of death among women, yet women are underrepresented in trials and less recognized clinically. This results in delayed diagnoses, less access to appropriate treatments, and higher mortality. This is the phenomenon known as Yentl syndrome: women are treated appropriately only when they exhibit typically male symptoms. The male model continues to function as an implicit parameter, and anything that deviates from it risks being overlooked.
The problem extends to other areas: endometriosis, polycystic ovary syndrome, autoimmune diseases, and pregnancy complications remain understudied and underfunded, despite their enormous impact on quality of life. Endometriosis, which affects approximately one in ten women, can take up to ten years to be diagnosed. Polycystic ovary syndrome, in addition to being a leading cause of infertility, increases cardiovascular risk, but for decades was considered solely a reproductive disorder.
More advanced regulations and a growing awareness of the importance of gender-specific medicine have been introduced in recent years. Since 2016, the National Institutes of Health in the United States has required researchers funded by the institute to consider and analyze biological sex differences, including in preclinical research and animal testing.
In Europe, too, the gender perspective has gradually entered research policies: the European Union's framework programs, including the current Horizon Europe, require the integration of sex and gender into study design when relevant. International organizations, such as the World Health Organization, have repeatedly emphasized the need to bridge the gap in women's health research. Despite this, research on diseases that predominantly affect women receives less funding than other areas.
In Italy, with Law 3/2018, gender medicine was formally incorporated into the National Health Service, recognizing the need for a differentiated approach to prevention, diagnosis, and treatment. In 2019, a National Plan for the Application and Dissemination of Gender Medicine was adopted, with the aim of permanently integrating this perspective into research, training, and care pathways.
However, even in Italy, structural and application limitations remain that reduce its concrete impact. Implementation is uneven across the country: some centers have developed structured training programs, others rely on the initiative of individual professionals. Furthermore, teaching about sex and gender differences in medical degree programs and graduate schools is not integrated into the curricula, but at many universities it is offered as optional modules or supplementary seminars.
The disparity in experimental models persists, especially in the early stages of studies and in basic research, where male-dominated models continue to be favored for reasons of simplicity and cost, limiting the possibility of developing truly personalized therapies.
The historical exclusion of women from clinical trials has created a knowledge gap that is still reflected in daily clinical practice today: late diagnoses, less effective therapies, and an incomplete understanding of many diseases. The gap is even more pronounced for women belonging to marginalized groups-Black, migrants, LGBTQIA+, or living in rural areas-who face additional economic, cultural, and institutional barriers to accessing care. Scientific inequalities thus intertwine with social ones, amplifying their effects.
Overcoming centuries of invisibility and exploitation of women's bodies requires more than mere participation quotas. A cultural transformation is needed that recognizes sex and gender as fundamental scientific variables. Overcoming this imbalance is not just a question of representation, but of scientific quality and the right to health: bridging the gap means building more precise, safer, and truly inclusive medicine.
Minerva
https://umanitanova.org/corpi-invisibili-abbattere-la-discriminazione-conquistare-la-salute/
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Link: (en) Italy, FAI, Umanita Nova #6-26 - Invisible Bodies. Breaking Down Discrimination - Achieving Health (ca, de, it, pt, tr)[machine translation]
Bron: A-infos-en@ainfos.ca
Bron: A-infos-en@ainfos.ca
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