Read the latest HealthWatch newsletter:  Newsletter 116, Summer 2021

by Arianne Shahvisi

In 2008, Hollywood actor Gwyneth Paltrow launched her lifestyle company, Goop, claiming she “wanted it to be a word that means nothing and could mean anything.” Over the last decade, the claims and recommendations made by the company have been widely criticized. Goop claimed that underwire bras cause breast cancer, suggested that women ought to be increasing their sexual energy using vagina eggs and vaginal steaming, and recommended the use of coffee enemas. Experts have shown these recommendations to be spurious and sometimes dangerous.

Around the same time that I heard about Goop, I was becoming more interested in feminism as an area of research. In speaking to other women about their experiences of gender inequality, an issue that came up time and again is the way in which medicine neglects women’s needs. I met several women who were dabbling in alternative remedies only marginally less ridiculous than those espoused by Paltrow’s site. These women were not unintelligent or uncritical. Their serious long-term health issues were not being addressed by mainstream medicine, and they were desperately casting around for other solutions.

It occurred to me that medicine’s poor treatment of women might be pushing them towards alternative remedies that are often expensive or dangerous, and generally just don’t work. I started a research project to investigate women’s relationship to conventional medicine and alternative medicine.

 Women and conventional medicine

One major reason that medicine often doesn’t work well for women is that female participants have long been excluded within clinical trials. While things are gradually improving, we still have poor knowledge of the way diseases present and progress in females, even though we know that there are sex differences in how certain conditions appear clinically, e.g., anaemia, osteoporosis, and cardiovascular disease. This means that women are being given “standard” medical diagnostic tests and treatments which were designed with men in mind, and which are sometimes sub-optimal or unsafe for women.

Other factors relate to the way that women are treated by clinicians. One of the most important experiences that women report is not being believed when they describe their ailments. Studies show that women’s pain reports are often discredited, or attributed to mental health issues. Women are 13-25% less likely to receive painkillers for abdominal pain even when they have the same pain scores as men, and typically wait longer to receive pain medication. Further, women who are admitted to hospital with irritable bowel syndrome are more likely to be offered sedatives and lifestyle advice while male patients with the same symptoms are offered X-ray imaging of the digestive system.

Women are also less likely to receive appropriate treatment for heart attacks, which means that they are more likely to die once a heart attack is underway. They’re also more likely to die in hospital from septic shock, and critically-ill older women are less likely than men to be admitted to intensive care units and receive life-saving treatments, again leading to an increased risk of death. Almost all of these worrying trends are also observed for people of colour, and women of colour fare worst of all.

Given these shortcomings, it’s fairly unsurprising that “medically unexplained disorders” are more common in women, who may be further harmed by the side effects of endless tests and investigations while doctors try, and invariably fail, to figure out what is going on.

Women and alternative medicine

“Alternative medicine” means all therapies that don’t have any proven benefits beyond the placebo effect, and generally do not have any plausible explanation for how they’re supposed to work. Some examples include homeopathy, chiropractic, energy medicine, naturopathic medicine, and faith healing. Studies across populations in high-income settings show that the typical user of alternative medicine is a woman, who is more highly educated, relatively affluent, and often suffering from a long-term health condition.

Those who use alternative medicine say they value it because it is “natural,” has few or no side effects, and it offers a feeling of greater control over their health. Patients are usually much happier with their alternative medicine practitioners than with their GP, and describe their appointments as feeling friendlier, more personal, less rushed, and less authoritative. It is easy to see why alternative medicine can be an attractive possibility for women whose health needs are not being met within conventional medicine.  

Yet alternative medicine raises ethical issues. In order for any kind of medicine to be ethically acceptable, practitioners must make sure they seek informed consent from patients. This means explaining the proposed treatment to the patient to make sure they understand how it works and why it’s been chosen, and then asking them to agree to the treatment. My first worry about alternative medicine is that there are no acceptable explanations that can be offered to patients, so informed consent becomes impossible. Patients must therefore trust alternative medicine practitioners, even though they are not able to offer evidence or explanations. That kind of trust can be easily exploited. My other worry is that, beyond the placebo effect, alternative medicine doesn’t work!

What should happen going forward?

The bottom line then is that alternative medicine is, like Paltrow’s Goop, something “that means nothing and could mean anything”—it doesn’t work, and can easily exploit people. It’s the wrong answer to a very important question: what should we do when medicine lets certain groups down? I think the clue can be found in the reasons people give for using alternative medicine—they get more time with a practitioner, and they feel listened to. We need to make more time in medicine, and everyone will save time in the long run. It’s been shown that longer consultations lead to: a greater likelihood of taking a thorough medical history and providing the right clinical examinations, a lower prescribing rate, a greater likelihood of offering advice about preventative healthcare and fewer follow-up consultations.

But we also need to think more broadly about the way in which we as a society fail to listen to and believe women, which is a problem that also comes up in another context, that of sexual harassment and assault. Women deserve better, and it is up to clinicians and medical researchers to step up, while it’s up to the rest of us to start normalizing the practice of believing women when they say they’re hurting.  

Arianne Shahvisi, senior lecturer in ethics at the Brighton and Sussex Medical School

Arianne Shahvisi is a philosopher whose work explores gender, race, and migration. She is writing a book on the philosophy of social justice, which will be published by Penguin in 2022. She tweets at: @ArianneShahvisi

This essay was first published in the Brighton and Sussex Medical School Magazine Pulse https://www.bsms.ac.uk/_pdf/about/news/pulse/bsms-mag-spring-2019-final-v2-update.pdf and is based on: Shahvisi A. Medicine is patriarchal, but alternative medicine is not the answer. Journal of bioethical inquiry 2018:1-14. https://link.springer.com/article/10.1007/s11673-018-9890-5

 

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