Take this pill, don’t ask questions. Buy this product, and you’ll be better.
Your body does this naturally, but that’s gross, so change it. I feel like my whole life I’ve
been trying to see these messages for what they are and unlearn what they’ve taught me...
and yet here I am, two master’s degrees deep into adulthood, still feeling like so
much of what happens to my body is out of my control. And when I ask the question, which
I always do: ‘isn’t it just supposed to do that?’, or ‘Why is THIS the way it
is?’...The answer, most of the time, is…’we don’t know.’
So, hi. I’m Maren. This is Body Language, and we’re gonna talk about all the stuff
the world usually tells us not to. Because the truth is, what we don’t know
far outweighs what we do.
I mean, we know so little about female reproductive
system in the first place that things like ovarian, uterine and cervical cancers can
go undiagnosed for way longer than they would if we like...actually understood what ‘normal’
is supposed to feel like, or felt more comfortable talking about the fact that, ‘hey, something kind of
weird is happening with my vagina. Maybe I need to get that checked out.'
So, there’s a gap between our common understanding of ‘health’, and what that means
for bodies that aren’t, well… male.
And this gap isn’t exactly something new.
-We have historically considered men and male
animals and even male cells as the default for clinical research. And that's really limited
our ability in terms of research understanding for everybody. When we talk to you about the
difference between women and men, it's not just the cells in our body and how our
organs interact with each other, our systems work together within our bodies, but it's
also about how we experience the environment.
-See, medicine has historically seen women
as reproductive bodies more than anything else, this is a phenomenon sometimes called
‘bikini medicine’. It essentially reduces women’s health to just the body parts that are different from
men: mostly the breasts and reproductive organs. And back before our modern understanding of
anatomy, ye olde doctors of yore actually thought the womb would just like...detach
itself and wander around the body. And that’s what caused illness in women? Really scientific
thinking there, guys. But seriously, medical misinformation like
that was used for centuries to support the idea that things like menstruation and pregnancy
made women the weaker, inferior sex, things that were reflected in society.
Can you imagine?! Making a whole human being and then
pushing it out of a tiny hole in your body making you the weaker sex?! Yeah, ok, sure.
I mean, just having a female body in itself was basically considered an illness.
Take the term ‘hysteria; It first appeared about 4,000 years ago in Ancient Egypt, and
over the centuries, it became a catch-all term for women's pain that doctors couldn’t
diagnose medically. And in the 19th century, it gained that notorious meaning
we know today, used in psychiatry to describe ‘women who couldn't control their emotions’.
-The surgical removal of the uterus was considered a procedure that was performed
for the purpose of improving women's mental health. And by the way, it didn't work. However,
the word for surgical removal of the uterus today is still hysterectomy. And it comes
from that, that idea of hysteria being related to women's reproductive organs.
And while the term hysteria is rarely used in medical settings today, we do still see
the echoes of it. This bias is maybe most obvious in how clinical
trials have typically been conducted. Clinical trials are where we get our most important
scientific knowledge about how medicines or surgeries will affect the human body. And
for most of medical history, researchers... only ever tested stuff on men. Which, once again, seems
like the opposite of scientific thinking, but go off, I guess.
See, in 1977, the FDA passed a policy that banned women of “childbearing age” from
Phase 1 and Phase 2 clinical trials. And in case you’re wondering, that range usually
means women between the ages of 15 and 52. Though women in this age range were allowed
to participate in later trial phases, some argue that the policy still discouraged women
from participating at all. The policy was put in place following a few high profile
cases of drugs that did cause severe birth defects, but it meant that we just didn't get to learn
about how so many drugs affected female bodies. Even though women were eventually
going to be prescribed those drugs if they passed clinical trial.
Now luckily, in the mid-1980s, a National Institutes of Health policy did encourage more
inclusion of women and other minorities in clinical research for exactly this reason,
and later in 1993 the FDA did reverse the ban. But even after that, many studies still
didn’t include women. This is because the scientific community has long-considered the
menstrual cycle and female hormones as variables that would throw their trial data out of whack,
and would make the study more complicated and therefore, more expensive.
And as you can imagine, this has led to some problems.
-We know that mice are not small humans, and women are not small men. So women and men may
metabolize drugs in different fashions, and drugs may be metabolized differently, depending
on the hormonal environment in which the drugs are taken. And so if we haven't studied the
drugs on women and men, we may not be applying the right doses.
-And it’s not just about drugs. It’s also about how healthcare treats women...literally.
Women are more likely to experience delays between the onset of symptoms and a diagnosis.
That’s for all kinds of issues, including many kinds of cancers, and is in part because
their symptoms are still being attributed to ‘stress’...sounds a lot like a modern-day
hysteria.
-The thing that's really dangerous about this
idea that mental health in women is is somehow related to their anatomy, is that it's, it's
led to the dismissal of women's health conditions. When we've gone back and looked in more depth
at some of the conditions that have been traditionally thought of as in women's heads. There's
actually a physiologic basis for many of these conditions.
-One of those conditions Dr. Temkin is talking about is endometriosis. That’s when the
lining of the uterus, or the endometrium, grows outside the uterus, into the pelvis
and abdomen, which can cause a lot of pain. Even though 1 in 10 people with a uterus struggle
with this condition, we don't know what causes it or really, how we can treat it effectively.
In fact, women seeking treatment for abdominal pain are much less likely to be prescribed
pain medication than male patients presenting with the same level of pain.
-They often go from provider to provider and wait years to get a diagnosis or treatment
because their physical symptoms of pain are dismissed as in their heads.
And this is an even bigger problem for those from minority groups. Like one study found
that Black women have an even more difficult time getting diagnosed with endometriosis
than their white peers. Lower income women have less access to health care in the
first place, and studies show that they are less likely to receive important preventative
care, like mammograms.
Trans women and non-straight women are less likely to receive the care they need because
providers don’t receive training on how to properly treat them.
-The way that we interact with the healthcare system can be different based upon some of
our social conditions, such as gender, age, race, ethnicity, ability,
your socioeconomic status, all of these things really intersect with our communities, our
environment and the healthcare system, to determine how we, how we respond to interventions
and how we respond to treatments and how and how well we live,
and how we experience side effects.
-BUT...things are getting better. With improved
policies and laws, women now represent about half of the participants in NIH-funded trials.
I mean, it’s a step in the right direction. And this is why more support and funding for
women’s health—everything from menopause to nutrition to gynecological cancers—
is so necessary. We need to fill that gap that’s been developing for centuries. It’s actually
one of the reasons I went back to graduate school for medical microbiology. Beacuse I have questions,
I’m frustrated with how few answers we have, and I want to be part of finding some of those
answers, which is why I’m studying the vaginal microbiome.
-It's important that women engage in their
own health care. So it can be something as simple as asking your doctor whether a medication
that's prescribed has been tested in women or not. We also encourage women to participate
in clinical trials whenever they're available, you don't have to be sick to participate in
a clinical trial. And, that's a way that everybody can contribute.
Information is power.
And for too long, women’s bodies have been so shrouded in shame and repression that we’ve
been left out of so much of medicine’s progress because our bodies aren’t considered the
‘norm’, or even just for convenience’s sake.
But the more data we have, the more we’ll understand about all these essential questions.
Like what kind of birth control do you need, how is it going to affect your specific body,
or how can you understand your own menstrual cycle to take more control of your health?
So in this new series I hope we can all get a little more comfy with asking some of those
questions, and I’m so excited that you’re along for the ride as we explore the answers
we do have, and highlight the places where we need a little more work .
Our bodies are awesome. And I hope you think so too.
Thank you so much for watching Seeker’s new series Body Language.
I hope you’ve enjoyed this video.
If there’s another women’s health topic you want us to cover, leave it for us a comment.
I'll see you next time!