Is This Reverse Sexism in Medicine?

Sexism in medicine is nothing new. Even years before someone coined the phrase "evidence-based medicine" medical research largely ignored women. Or, researchers studied their disease of choice in a sample population of healthy young men and simply assumed that the results could be generalized to women. In short, women were considered (in the eyes of medicine) slightly smaller men.

No more. In fact, anyone with a pulse has no doubt noticed that last month was Breast Cancer Awareness Month. And if your neighbourhood is anything like mine, everything that would stand still long enough got a pink ribbon pinned to it. It's nice to see a woman-specific disease garner such attention, although I have to admit I'm starting to think that the pendulum is swinging a bit too far in the opposite direction.

Not to take anything away from breast cancer-- it's a horrible disease (although the much touted "1 in 9" statistic is a bit misunderstood). As is any cancer. But I think many people would be surprised to know that lung cancer is still the number one killer of both men and women. And both the incidence and the mortality are still increasing in women. Much less talked about, much less publicity, much more death. Why the discrepancy? Maybe because it's easy to 'blame' lung cancer on smokers, whereas breast cancer can't be blamed on any particular lifestyle choice.

But it's not breast cancer that is irritating me today. Last year, Gardasil was approved in Canada. Gardasil is a vaccine that effectively prevents against human papilloma virus types 6, 11, 16 and 18. HPV, also known as genital warts, is a sexually transmitted disease (or sexually transmitted infection in the new, more politically correct terminology) that leads to cervical cancer in women. HPV types 16 and 18 together account for about 70% of cases of cervical cancer. The other two subtypes of HPV, 6 and 11, account for 90% of cases of genital warts.

My concern is in the way this vaccine is being marketed. Women, telling women, that this vaccine will prevent most cases of cervical cancer. True. But this vaccine isn't approved for use in men. Is it wrong that I'm bothered by this? Fair enough, the repercussions of cervical cancer, which kills one woman a day in Canada, are significantly more severe than the repercussions of genital warts in a man. But who do you think is passing this virus to women anyways? Targeting only half of the population seems shortsighted. Not to mention the fact that any man who has ever suffered an HPV outbreak would likely donate a kidney for the chance to turn back time and avoid the outbreak.

The following anecdote is not for the squeamish-- I remember seeing a 23-year-old guy in the emergency room during my surgery rotation last year. He had, essentially, a cauliflower growing out of his anus. His genital wart outbreak had not only made his penis nearly unrecognizable, but had formed a protrusion from his rear forming a 10 cm lumpy mushroom. Food analogies aside, this had a significant impact on his life. The smell, a combination of infection, bleeding and inability to clean feces from this mass had caused embarassment to the point that he hadn't left the house in 4 days. He was in the emergency room begging to be seen by a surgeon earlier than the consult that had been set up for him the following week. If there were a vaccine available that would have prevented this guys outbreak, how upset do you think he'd be if he were told it was 'women only'?

And it's not just the fact that the marketing has been directed solely towards women. The vaccine itself, a product of pharmaceutical giant Merck, hasn't even been approved for use in men and boys. Medicolegally, a doctor is not permitted to administer or prescribe it to males.

If I were a guy, I'd be right pissed.

In the interest of all of those blog-readers with sensitive stomachs, I opted to make this post image-free. You can all thank me later.

I am Woman... Does it Matter?

I think I'm lucky to have been born when I was. I'm way too contrary and stubborn to have been submissive and subservient, the way most women were expected to be in the past. And I was lucky to have been raised by parents who believed that women could do whatever men could do. The sky was the limit. I was never encouraged to go into any of the more traditionally female professions. At no point did anyone suggest that I become a nurse rather than a doctor, even after two unsuccessful applications to medical school.

So after growing up in an environment that taught me that I was just as good (if not better) than any man, I've often laboured under the mistaken impression that gender doesn't matter anymore. I had heard the stories about the glass ceiling, read the statistics regarding pay inequalities between men and women, but always explained them away. Glass ceiling? That's mostly in business. Unequal pay? Only because women still chose 'pink collar' jobs over higher-paying ones still dominated by men. But today gender doesn't matter. The inequality has lessened significantly over the past few decades, and will soon be history. Naive? You betcha.

Medicine is changing. The current crop of medical students in Canada is over 50% female. At my medical school (in the interest of remaining anonymous, I won't name it but it's safe to say that it's on the cutting edge of tradition) I was a member of the first medical class in the university's history where women outnumbered men. So the future is bright for women in medicine.

But we're not in the future. We're in the present. And women are still painfully underrepresented in medicine, particularly in academic medicine. Through the course of my medical career I've been interested in three specialties. I started off wanting to do reconstructive surgery. Then, my interests shifted to emergency medicine. Currently, I'm a family medicine resident. Interestingly, I started off in a male-dominated specialty and ended up in a female-dominated specialty.

Surgery often isn't an option for female medical students. The hours are long and hard, and it doesn't let up for the 5 years of residency. Even after residency, many surgeons complain that they don't fell that they're in control of the hours they work. And that's a lot of hours. On my surgical rotation it certainly wasn't unusual to see staff surgeons rounding on their own patients late into the evening or on weekends. And I'm talking about the weekends and evenings that they're NOT on call. I have yet to meet a female role model in surgery. The very few women surgeons I've encountered have either been workaholics or complete bitches, and I have yet to come across any of them that seem to have anything even remotely resembling a balanced life. Which then begs the question-- perhaps none of these 'balanced women surgeons' are around simply because such an animal does not exist.

Emergency medicine was a little better. Although the old guard was still primarily testosterone-driven, the spread of young doctors and residents is now close to 50/50. This is probably because of the 'lifestyle' aspect of the specialty-- if you're the kind of person who copes well with shift work, the idea of throwing your pager out the window for the rest of your career is awfully tempting.

Although family medicine is much more female-heavy than other specialties (with the possible exception of pediatrics and obs/gyn) it's not immune from some of the old school ideas. My preceptor, who isn't all that much older than me, actually said to me that "the problem with physician recruitment targets is the fact that they count women physicians as equivalent to men". Mind-blowing, isn't it?

His point was that women, because they have children, will work less over the course of their career. So if you're looking at replacing a retiring male physician, it would take more than one female physician to pick up his workload. I tried to point out that male physicians are also more interested in life beyond medicine, and are much less likely to subscribe to the 80-hour workweeks and 24/7 call that have traditionally been the hallmark of the family doctor. Many men today aren't content to make lots of money at the cost of their health and family life. What's the point of making lots of money if you don't have time to spend it? Your wife barely knows you, your kids hate you... it's just not worth it. My preceptor was unmoved.

"It's biology," he explained, "women have the children and act as primary caregiver. It's unlikely to change any time soon."

I was horrified, but bit my tongue. My soon-to-be-husband was brought up in a family where mom and dad split child rearing and household chores down the middle. There was no 'men's work' or 'women's work', it was just 'work' and it needed to get done. And it was. As a result, he and I are able to plan a future where we split our allowable parental leave down the middle, and share childrearing responsibilities equally. Maybe I'm underestimating the surge of maternal hormones that will make me want to give up medicine for diapers and Dora the Explorer, but this is the plan we've discussed at length. In fact, if anyone is going to do more than the other it will likely be him. Why don't people even consider this as a possible alternative?

I've started to worry that the assumption that my career will take a back seat the minute I procreate will make the legendary glass ceiling more real than I've ever believed.