Gender bias in therapeutic effort: from research to health care.

María Teresa Ruiz-Cantero, Mar Blasco-Blasco, Elisa Chilet-Rosell, Ana M Peiró

There are relevant dimensions from a gender perspective related to  therapeutic effort. To illustrate and discuss possible gender bias related  to medicines, through the consumption analysis in women, the  prescription of biological drugs according to sex, the potential gender  inequality in adverse drug reactions, and research with clinical trials, as  well as the decisions of international institutions in the marketing of  medicinal products. There is greater tendency to prescribe pain  relievers, regardless of pain, and drugs for low intensity depressive  symptoms in women than in men. The opposite occurs in the  prescription of statins and adequate doses, and with the greater  probability of prescribing anti-tumor necrosis factor in men than in  women with ankylosing spondylitis, despite a similar disease burden.  Adverse drug reactions are observed more frequently in women than in  men, where determinants such as body weight are having little influence on the dosage. It is currently scarcely considered in the prescription that women have differences in the activity of cytochrome CYPP450 enzymes, which can affect the liver's metabolism rate. There  are even immunological, genetic and epigenetic effects (due to heredity  and uneven gene dosing located in the X and Y chromosomes) that can  influence these differences by sex. Finally, through cases of hormonal  therapy clinical trials, a drug for women's inhibited sexual desire and a  contraceptive for men, gender bias and stereotypes are shown to  influence a potential generation of inequalities, especially in adverse  drug reactions to the detriment of women. In conclusion, health  professionals frequently attribute physical symptoms to women's  emotionality, influencing their greater prescription of symptomatic drugs. Whether the same reason influences the lower prescription of  therapeutic drugs in women than in men should be analyzed. There are  biological determinants to consider due to their influence on a greater pharmacological toxicity in women. Clinical trials should improve  according to the gender recommendations by the Food and Drugs  Administration.