Sexism, Racism, and Ageism in Medicine Research

The medical system is far from perfect, and this is because certain biases and stereotypes filter into the way in which medical professionals treat their patients. Although this is typically due to preconceived notions bred in the unconscious, some practitioners may hold individual biases towards certain groups of people. Disparities in medical treatment can be a product of gender, race/ethnicity, or age, and again, this can be either conscious or unconscious. By being able to recognize these biases and disparities, one can hope that someday, the medical field may be free of such discriminations.

Sexism

Gender bias is a common issue that finds a place in nearly all aspects of life, but in the medical field, it can be dangerous for those that are having a medical emergency. These differences occur within many different health care settings and across various kinds of health. By this, one could be referring to the gender disparities in both mental and physical health. For instance, according to Just et al. (2016), “women have been shown to receive more aggressive care than men in nontraumatic amputation and ambulatory diabetes control.” Conversely, when it comes to mental health, women have a much easier time expressing and receiving help for their disorder. Research supports that “men are…less likely to seek help, or to delay seeking help, for health-related issues” (Whittle et al., 2015) because “engag[ing] with treatment appears to reflect an incongruence between traditional gender norms, depression, and the process of psychotherapy” (Spendelow, 2014).

Beginning with women, it is no secret that they have not always been taken seriously when it has come to medicine and reporting their pain to medical professionals. Historically, doctors had normally written off migraine and back pain as side effects of stress and sleep deprivation, ignoring the physical signs of distress that they were giving off. This has carried over into the present-day practice of medicine as well. Heidi Miller, a doctor that works out of a clinic, published an article titled “The Right Way To Treat A Woman” where she recounted that “I am well aware that some doctors do not prefer female patients, believing that they talk too much and take up too much time. Since we all have to care for as many patients as we can in a day, many doctors dread any patient who will slow them down, and for some doctors that means women” (Miller, 2014). This shows that not only are there gender biases within clinical medical treatment, but it is not all that unconscious.

One my wish to focus on the mental health sector of health care when it comes to analyzing treatment for men because it is so different from that of treatment for physical health. Typically, men are taken more seriously when they are being treated for a physical injury or sickness, but when it comes to mental health, men are somewhat swept under the rug. A big contributor to this is that men have significantly lower report rates for symptoms of depression than women. Instead of seeking out therapeutic intervention or self-help programs, men “tend to externalize depression, engaging in numbing behaviors such as alcohol and drug misuse, avoidant behaviors, irritability, and emotional withdrawal” (Oliffe & Phillips, 2008 as cited in Whittle et al., 2015).

It is hard to believe that the disparity between how seriously (or not seriously) men and women are taken when it comes to health care treatment has one specific cause. Safran et al. (1997) suggests that “gender-based differences in illness behavior and physician gender biases both contribute to the observed treatment differential.” This same study also cited a study Birdwell et al. (1993) that “found physicians less likely to diagnose and treat cardiac illness in a female patient whose presentation was dramatic and emotional than in one reserved and conservative” (Safran et al., 1997).

Racism

Unfortunately, racism has infiltrated nearly all aspects of one’s life in one way or another, but in the health care community, there exists a countless number of disparitis linked to racial and ethnic minorities.

Ageism

Outwardly speaking, ageism is a problem that afflicts the medical community, and many people are completely aware that it is happening every day. In many cases, practitioners prioritize younger patients because they have a better chance of a positive outcome from the treatment, and other times, their main concern is on the well-being of the elderly patient completely. Studies have shown that there is a lack of personal care within the treatment of elderly patients because typically, the illnesses that afflict the elderly are much more complicated than those that afflict younger patients, so medical professionals must decide if the treatment will actively increase their quality of life or not (Skirbekk & Nortvedt, 2014). “Individual care for elderly patients is rarely given high priority, and this could result in increased suffering and decreased wellbeing for the patients” (Skirbekk & Nortvedt, 2014). In these cases, medical professionals are mainly concerned with giving the patient the most comfort they can with the time that they have left.

According to Skirbekk & Nortvedt (2014), there have been studies done on medical personnel in Norway in an attempt to understand why some patients get better treatment than others. This led to four possible explanations, and they are worth considering in the context of medicine in the United States:

(a) Health professionals discriminate against elderly patients. (b) Health professionals believe elderly patients have gotten their share of government funded treatment during their lifetime already, thus younger patients should be prioritised. (c) Health professionals believe elderly patients cannot benefit from the same kind of treatment as younger patients, and therefore should get more appropriate treatment from outside the hospitals. (d) Health professionals believe elderly patients get the same kind of treatment as younger patients, but elderly patients are in need of more, or different kinds of treatment (Skirbekk & Nortvedt, 2014).

The question always remains that if a treatment cannot guarantee a cure or more time, is it really worth it to inject aggressive medication or preform invasive surgery on the patient? Since younger patients are more resilient, this is usually when the disparity is the most prevalent. Another reason as to why priority tends to go to younger patients is because the recovery time for older patients is typically longer, as well as having a higher risk for post-treatment complications (Skirbekk & Nortvedt, 2014). In a system that does not prioritize elderly patients, regardless of treatment efficacy, there is a decline in the patient’s quality of life. This is due to the lack of attention that these patients receive when it is decided that the treatment will not benefit them to the greatest extent to the medicine.

Ageism can also be prevalent in the way that medical professionals interact with their elderly patients. Often, medical professionals will use “elderspeak” which is characterized by slowing down, increasing the volume of your speech, and using a patronizing tone when talking with an older person (Schroven et al., 2018). Speaking to elderly patients in this way “may make them feel powerless, and can lower their self-esteem’ (Ryan & Butler, 1996, as cited in Schroven et al., 2018). This can be very damaging to one’s self-image. For instance, Schroven et al. (2018) recounted research that was conducted on the effects of using elderspeak when giving directions and it was found that “elderspeak can reinforce stereotypes: when it is used, people make more errors, thus confirming that they do not clearly understand the instructions, which reinforces the interlocutor’s stereotypes (“an elderly is an individual with few communicative skills”),” and actively lowering their self-esteem. Research says that the frequency and intensity that one uses elderspeak on older patients relates to whether they have a positive or negative view of aging (Schroven et al., 2018).

Research

In regards to medical research, the elderly are usually most involved in clinical trials on new medications. Statistically, people over the age of 65 “consume nearly one-third of all medications” (Shenoy & Harugeri, 2015), therefore it is important that clinical trials test their drugs on all age groups. “Typically, clinical trials conducted in adult population include patients between the ages of 18 and 64 years” (Shenoy & Harugeri, 2015). Scientifically speaking, drugs react differently in all kinds of patients, but age is a big factor that can determine the efficacy of that drug. Unless these are tested in elderly subjects, the results of the medication’s effects cannot be generalized to that part of the population.

It is only fair that in a time when medicine is becoming more and more advanced and people are starting to live longer, the population of elderly people help to provide data on the efficacy of drug treatments, as they are the majority sample that will be using these drugs in a real-life setting. “To deny them this opportunity runs counter to the precepts of medical practice and could even be considered unethical” (Shenoy & Harugeri, 2015). Interestingly enough, though, “[f]ederal laws require that cancer trials enroll representative samples of women and members of a minority group… [but] [n]o such law for representative samples of elderly exists today” (Shenoy & Harugeri, 2015).

One of the major issues that arises in medical research when it comes to gender differences is that research is not always conducted with both male and female subjects, so then the results of the study are generalized to the public. Historically, studies and experiments used to only be conducted on men. Researchers believed that because women’s bodies went through a cycle, their hormones were too unstable to deliver accurate, reliable data. This would especially pertain to any study that was conducted over a longer period of time because it was said that a woman’s levels are constantly fluctuating and thus confounding in their research. Other reasons that it was said that women did not participate in research was that they either had no interest in it, or there was no way for them to get to the study. Regardless of which one was true, the results that studies obtained from male subjects were generalized to a larger population, including women. This could be a big indicator into how women’s symptoms for certain illnesses go overlooked. An example of this could be the difference in symptoms of a heart attack in men versus in women. A lot of people are unaware of the warning signs of a heart attack in women because the symptoms that are emphasized in awareness are typically those that are only prevalent in men such as chest pains and pain in the left arm.

Various racial and ethnic minorities find obstacles as well when it comes to participating in medical research. These obstacles come from many different aspects of the research process, such as recruiting research participants. Studies have primarily been conducted by white researchers, and they have typically recruited from all or mostly all white populations. This does not always translate well into recruiting from minority communities due to the wide cultural differences in context, language, and researchers must alter their methods to fit these. “In addition, many researchers fail to facilitate culturally sensitive and meaningful discussions about informed consent to ensure truly informed choices in the [enrollment] process” (George, Duran, & Norris, 2014). This bring everything back to a language barrier that can contribute to the low rates of ethnic minority groups that are involved in research studies. According to the article by George, Duran, and Norris (2014), one of the strongest barriers that contributed to minority groups not participating in research was mistrust. “For example, both African Americans and Native Hawaiians consistently emphasized the importance of community and shared a mistrust of research related to the belief that research may not benefit their communities” (George, Duran, & Norris, 2014). All of these factors can be easily categorized under the idea that research involving ethnic minority groups must be tailored to fit the cultural beliefs of the group to be studied and revised in order to accurately and appropriately inform the potential subject pool on the purpose and procedures of the study. By taking special care to make these adjustments and take the time to address the concerns of the group, researchers can ensure that they are doing everything they can to build trust between themselves and their subjects.

References

George, S., Duran, N., & Norris, K. (2014). A systematic review of barriers and facilitators to minority research participation among african americans, latinos, asian americans, and pacific islanders. American Journal of Public Health, 104(2), e16-e31. doi:10.2105/AJPH.2013.301706

Just, Erica, MD, MSHP, Casarett, David J., MD, MA, Asch, David A., MD, MBA, Dai, D., PhD, & Feudtner, Chris, MD, PhD, MPH. (2016). Differences in terminal hospitalization care between U.S. men and women. Journal of Pain and Symptom Management, 52(2), 205-211. doi:10.1016/j.jpainsymman.2016.01.013

Miller, H. B. (2014). The right way to treat A woman. Journal of General Internal Medicine, 29(8), 1209-1210. doi:10.1007/s11606-014-2770-8

Rodriguez, Y., Irizarry, F., & Carrillo, R. G. (2018). Racial and ethnic healthcare disparities in patients undergoing laser lead extraction. International Journal of Cardiology, doi:10.1016/j.ijcard.2018.07.003

Safran, D. G., Rogers, W. H., Tarlov, A. R., McHorney, C. A., & Ware, J. E. (1997). Gender differences in medical treatment: The case of physician-prescribed activity restrictions. Social Science & Medicine, 45(5), 711-722. doi:10.1016/S0277-9536(96)00405-4

Schroyen, S., Adam, S., Marquet, M., Jerusalem, G., Thiel, S., Giraudet, A. -., & Missotten, P. (2018). Communication of healthcare professionals: Is there ageism? European Journal of Cancer Care, 27(1), e12780. doi:10.1111/ecc.12780

Shenoy, P., & Harugeri, A. (2015). Elderly patients’ participation in clinical trials. Perspectives in Clinical Research, 6(4), 184. doi:10.4103/2229-3485.167099

Skirbekk, H., & Nortvedt, P. (2014). Inadequate treatment for elderly patients: Professional norms and tight budgets could cause ‘ageism’ in hospitals. Health Care Analysis : HCA : Journal of Health Philosophy and Policy, 22(2), 192. doi:10.1007/s10728-012-0207-2

Spendelow, J. S. (2015). Cognitive–Behavioral treatment of depression in men: Tailoring treatment and directions for future research.?American Journal of Men’s Health,?9(2), 94-102. doi:10.1177/1557988314529790

Whittle, E. L., Fogarty, A. S., Tugendrajch, S., Player, M. J., Christensen, H., Wilhelm, K., . . . Proudfoot, J. (2015). Men, depression, and coping: Are we on the right path??Psychology of Men and Masculinity,?16(4), 426-438. doi:10.1037/a0039024    

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