The other day a co-worker of mine claimed that medicine is sexist. Men get better medical care than women. The main argument was that women die more often of heart attacks than men because medical research has focused on men. For this reason a heart attack in a woman is often not recognized and therefore treated too late. I was somewhat surprised by that, as I was under the impression that women were healthier, lived longer lives and received better medical care than men. I felt it was worthy to fact-check the claim.

I mainly studied the American situation as it has the most data easily accessible. A few key numbers I could find are described below.

Medical expenses

Lifetime expenditure on medical care for women is $361,200, while for men it is $268,700. Two fifths of that difference is explained by the higher life expectancy of women. Health Services Research.

Research spending

According to a NIH study 13.5% of all medical research is targeted at specific women's diseases, compared to 6.5% on diseases that only affect men. Spending on breast cancer research is four times higher than on prostate cancer, even though the fatalities of both diseases are comparable. Atlantic.

There is a bias against women in selecting test subjects for medical research. On average women form one third of clinical testing. The problem is even worse when we look at pre-clinical testing. Even in animal testing, researchers tend to use male test subjects. This is no indication of sexism. The main reasons are that 1) female test subjects have an hormonal cycle that leads to greater variability and 2) there was a long ban on using female test subjects because they might get pregnant. In the 1977 a ban was introduced on testing female test subjects for fear of side-effects during pregnancy. Slate. This law has now been reversed, but the effects remain, especially since studies will want to compare newer results against earlier results. The NIH has even mandated that each clinical trial funded by the agency include an equal number of male and female test subjects. This sounds a bit like overkill and it seems more prudent to provide more funding to study sex differences specifically instead of making medical research only about sex differences. Scientific American.

Quality of care

In a 1981 study of 46,868 office visits, it turns out that in two thirds of the cases women received the same medical care as men. "When the care was different, women overall received more diagnostic tests and treatment--more lab tests, blood-pressure checks, drug prescriptions, and return appointments." Atlantic.

Fatalities from heart diseases

According to a Dutch study from 2014 women are more likely to have a first fatal event due to heart disease, 22% versus 18% for men and women over 55, but this result was mainly due to women having their first heart event at a much higher age than men. BMJ

Younger women have higher fatality rates after hospitalization due to heart disease than men. Overall this was 16.7% versus 11.5%. For patients below fifty, the fatality rate for women was twice as high as for men, and after 75 there was no difference. A third of this difference could be explained by other factors, such as the severity of the condition or differences in medical history. NCBI.

There is evidence that younger women are less likely to be treated using cardiovasular surgery compared to younger men. However, this is probably not due to unfair bias, but because the risks of surgery are higher with women since they have smaller coronary arteries, which give surgery a higher risk of complications. Atlantic.

A second disparity is that the symptoms for heart attacks are different for men and women. The most common indicator for a heart attack (chest pain) occurs less often for women. It does not occur for 30-37% of the women while chest pain is absent in 17% to 27% of the men. For both men and women the lack of chest pain is a strong indicator for a wrong diagnosis and late treatment. However, due to this disparity, women are affected by it more. NIH.

These last three reasons seem to go a long way explaining why women have higher mortality rates after heart disease than men. It should be noted however, that men are more than three times more likely to die of heart disease before sixty-five than women. Atlantic

Conclusion

So by and large, if there is evidence for sexual discrimination in the medical practice, it favours to women. Women get to spend more on medical care, they receive overall better medical care and more medical research is targeted specifically at women. Partically as a result of this women are healthier and live longer than men. It is true that women are underrepresented in medical trials and we should research gender differences between medication more. As to the specific claim of my co-worker, that women die more frequently of heart attacks than men, this is mostly caused by the fact that women have heart attacks at a much higher age than men. There is some substance to the claim that much medical knowledge around cardiovascular disease has focused on men, but the same can be said for breast cancer and women. This is more because these diseases affect each gender more.