The Psychology of Gender 4th Edition

Sex Differences in Health: Evidence and Explanations 355

1988). The study was terminated early be-

cause the benefits of aspirin were so large that

it was unethical to withhold this information

from the public. No female physicians were

included in the study. In response to this con-

cern, the National Institutes of Health made a

major commitment to women’s health in the

1990s, first by requiring clinical trials to re-

port the number of women and men in stud-

ies and second by developing the Women’s

Health Initiative in 1991. The Women’s

Health Initiative was a 15-year longitudinal

study of about 164,000 women to evaluate the

effects of diet, vitamins, and HRT on heart

disease, cancer, and osteoporosis.

The fact that diagnostic tests and treat-

ments were developed on men poses two

problems for women. First, because women’s

and men’s anatomy differs, it is quite likely

that a test developed on men’s bodies is not

as accurate in detecting disease in women’s

bodies. Second, a treatment developed for

men may not be as effective for women.

Substantial evidence indicates that

women and men are treated differently by

the health care system with respect to heart

disease. Despite the fact that heart disease is

income, and education each were related to

a decrease in wives’ mortality, with relations

being stronger for occupation and income.

However, it was only wives’ education that was

related to a reduction in husbands’ mortality.

Skalicka and Kunst suggested that the tradi-

tional female role involves taking care of the

family’s health—a role that would benefit from

women’s education.

Physician Bias

Physicians may respond to women and men

differently, contributing to sex differences in

health. Two areas in which this issue has been

well investigated are heart disease and men-

tal health. Physician bias in the context of

mental health will be discussed in Chapter 13.

Here we examine physician bias in the con-

text of heart disease.

Heart Disease. Women have a worse

prognosis from heart disease compared to

men (Berger et al., 2009; Vitale, Miceli, &

Rosano, 2007), in part because women are

older when heart disease is diagnosed but

also in part because women are treated less

aggressively than men for heart disease, de-

scribed in the following paragraphs and sum-

marized in Table 10.6. Why would this be?

One reason women are disadvantaged

compared to men is that diagnostic tests

and treatments have largely been developed

on men. Major clinical trials that have made

important contributions to the treatment of

heart disease have historically included only

men. For example, the Multiple Risk Factor

Intervention Trial Research Group (1983)

was conducted to reduce risk factors of heart

disease. The study included 12,866 men and

0 women. In the Physicians Health Study,

physicians were randomly assigned to receive

aspirin or placebo to see if aspirin protected

against heart disease (Steering Committee,

TABLE 10.6 STAGES OF TREATMENT FOR CORONARY

HEART DISEASE

Women are less likely than

men to:

Prevention have cholesterol checked

receive cholesterol lowering

drugs

Response to

symptoms

be referred to a cardiologist

receive diagnostic tests for

heart disease

Treatment be treated with drugs that

dissolve clots

be treated with angioplasty

be treated with bypass surgery

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