"Male as the Norm" - the diagnostic bias

"Male as norm" diagnostic bias in healthcare refers to the tendency for medical research, diagnostic criteria, and treatment protocols to be predominantly based on male subjects. This bias can lead to misdiagnosis, underdiagnosis, or overtreatment, affecting both men and women differently. Women are often underdiagnosed or misdiagnosed because their symptoms may differ from the male-centered standard, while men may experience overdiagnosis in conditions typically considered female-dominated. This article explores the roots, manifestations, and consequences of this bias, along with potential solutions.

1. Research and Clinical Trials

Historically, medical research has predominantly used male subjects, both in animal models and human participants. This has led to a significant gap in understanding how diseases manifest, progress, and respond to treatment in individuals with female biology. As a result:

• Dosages, side effects, and treatment efficacy are often based on male physiology.
• Women's symptoms may be overlooked or misunderstood.
• Conditions that predominantly affect women receive less research funding.

2. Physiological differences overlooked

The "male as norm" bias often overlooks fundamental biological differences influenced by hormones, anatomy, and physiology, which can affect disease presentation and treatment outcomes. For instance:

• Women may experience different symptoms for cardiovascular diseases than men.
• Hormonal variations in women can impact drug metabolism and efficacy.
• Reproductive health conditions, such as endometriosis, are understudied.

3. Diagnostic Bias

3.1 Underdiagnosis in women

Certain conditions historically considered "male," such as heart disease, are often underdiagnosed or diagnosed later in women because their symptoms can present differently. This can lead to delayed treatment and poorer outcomes.

3.2 Psychologizing women's symptoms

Women’s symptoms are sometimes attributed to psychological factors rather than being taken seriously, a phenomenon historically linked to the concept of "hysteria." The term "hysteria" originates from ancient Greek medicine, where it was believed that a woman's uterus could wander through her body, causing emotional and physical symptoms. This concept persisted into the 19th and early 20th centuries when women presenting with various symptoms were often dismissed as "hysterical." Such historical prejudices laid the foundation for a tendency to psychologize women's symptoms, resulting in inadequate investigation of underlying medical conditions.

3.3 Overdiagnosis in men

Conversely, conditions more prevalent in women may be under-recognized in men, leading to delayed or missed diagnoses. For example, osteoporosis, often viewed as a "women's disease," may be underdiagnosed in men, even though they can also suffer from it. Similarly, autoimmune disorders like lupus, which are more common in women, may be overlooked in male patients because of their rarity in men. This under-recognition can result in inadequate monitoring, delayed treatment, or even misattribution of symptoms to other conditions in men.

4. Treatment bias

4.1 Differential pain management

Research suggests that women's pain is often underestimated and undertreated compared to men’s. Women may be offered sedatives or antidepressants instead of appropriate pain relief, suggesting their pain is psychological.

4.2 Variations in treatment intensity

There is evidence that men might receive more aggressive or comprehensive treatment for certain conditions than women with similar symptoms, further perpetuating disparities.

5. Research funding bias

Medical conditions predominantly affecting women, such as endometriosis or menopause, have historically received less funding compared to conditions affecting both genders or predominantly men. This disparity hinders advancements in women’s health.

6. Representation bias

6.1 Lack of Women in Leadership

The underrepresentation of women in leadership roles within medical research and academic institutions perpetuates existing biases, influences research priorities, and limits diverse perspectives.

6.2 Editorial bias

A lack of women on editorial boards of medical journals can influence which research is published, limiting the dissemination of knowledge relevant to women's health.

7. Intersectionality bias

Gender bias in healthcare often intersects with other forms of discrimination, including racial, ethnic, socioeconomic, and LGBTQ+ biases. For instance, women of color face a unique combination of gender and racial discrimination, which can lead to delayed diagnoses, inadequate pain management, and lower quality of care. Studies show that women of color are more likely to have their pain underestimated and undertreated compared to white women. Similarly, transgender individuals may face discrimination in healthcare settings, with their symptoms dismissed or misunderstood due to biases. Socioeconomic factors further compound these issues, as lower-income women may have reduced access to quality healthcare, leading to disparities in outcomes.

8. Stereotyping

Stereotypes about how men and women "should" behave or experience illness can impact how healthcare providers interpret symptoms, leading to diagnostic errors. For example, men may underreport pain due to societal expectations of stoicism.

Conclusion

Addressing "male as norm" diagnostic bias in healthcare requires a multi-faceted approach, including:

• Diversifying research subjects and analyzing data by sex and gender.
• Developing gender-specific diagnostic tools and treatment protocols.
• Training healthcare providers to recognize gender differences in symptoms.
• Promoting inclusive research funding and leadership representation.
  By acknowledging and addressing these biases, healthcare systems can provide more accurate, equitable, and effective care for all patients.