Wednesday, June 21, 2006

The Weaker Sex

Some years ago I got a beg letter from an organization promoting more research into women's health. The letter explained in great detail how fragile and sickly women were, and I was inspired enough (read: mad as hell) to actually write them a letter giving lots of health statistics about the fact that women, on average, live quite a bit longer than men, on average.

Now Marianne Legato has taken this idea to the extreme in the New York Times, and on Father's Day, of all things. She writes:

WHEN I say I study gender-specific medicine, most people assume I mean women's health. Patients ask me, "Do you take care of men too?"

I may be partly to blame for the confusion: in the years since the revolutionary 1985 report on women's health from the United States Public Health Service, I — along with many of my colleagues — have tried to atone for the fact that for so long the majority of diseases that afflicted both genders were studied exclusively in men.

Over the past two decades, we've radically revised how we conduct medical research and take care of our female patients. And we've made valuable discoveries about how gender helps determine vulnerability to illness and, ultimately, the timing and causes of death. But I now believe that we doctors and researchers may have focused too much on women.

What emerges when one studies male biology in a truly evenhanded way is the realization that from the moment of conception on, men are less likely to survive than women. It's not just that men take on greater risks and pursue more hazardous vocations than women. There are poorly understood — and underappreciated — vulnerabilities inherent in men's genetic and hormonal makeup. This Father's Day, we need to rededicate ourselves to deepening our knowledge of male physiology.

Men's troubles begin during the earliest days in the womb. Even though there are more male than female embryos, there are more miscarriages of male fetuses. Industrial countries are also witnessing a decline in male to female birth ratios, and we don't know why.

Some scientists have argued that the probability of a male child declines as parents (especially fathers) age. Still others have cited the prevalence of pesticides, which produce more birth defects in male children.

Even when a boy manages to be born, he's still behind the survival eight ball: he is three to four times more likely than girls to have developmental disorders like autism and dyslexia; girls learn language earlier, develop richer vocabularies and even hear better than boys. Girls demonstrate insight and judgment earlier in adolescence than boys, who are more impulsive and take more risks than their sisters. Teenage boys are more likely to commit suicide than girls and are more likely to die violent deaths before adulthood.

As adults, too, men die earlier than women. Twice as many men as women die of coronary artery disease, which manifests itself a decade earlier in men than women; when it comes to cancer, the news for men is almost as bad. Women also have more vigorous immune systems than men: of the 10 most common infections, men are more likely to have serious encounters with seven of them.

While depression is said to be twice as frequent in women as in men, I'm convinced that the diagnosis is just made more frequently in women, who show a greater willingness to discuss their symptoms and to ask for help when in distress. Once, at a dinner party, I asked a group of men whether they believed men were depressed as often as women, but were simply conditioned to be silent in the face of discomfort, sadness or fear. "Of course!" replied one man. "Why do you think we die sooner?"

You know what? I feel as angry about this reverse take on the relative health of the sexes, and the reason for my anger in both cases is the same one: Discussions like these may or may not be the springboard for better health research, but they certainly will be used to perpetuate the status quo of power imbalances between the sexes.

It's pretty obvious how an article explaining the weakness and fragility of women can be used that way: Women must be protected from the hurly-burly of jobs and power and political debates. Someone else must decide for them, someone else must regulate their lives so that they will stay healthy. Or so that at least their womb and ovaries will stay healthy.

But the reverse story can lead to the exactly same conclusion. Don't believe me? Here's Legato on that very topic:

Considering the relative fragility of men, it's clearly counterintuitive for us to urge them, from boyhood on, to cope bravely with adversity, to ignore discomfort, to persevere in spite of pain and to accept without question the most dangerous jobs and tasks we have to offer. Perhaps the reason many societies offer boys nutritional, educational and vocational advantages over girls is not because of chauvinism — it's because we're trying to ensure their survival.

It's like that old joke we used tell about communism when I was a tiny goddess: My doughnut is my doughnut. Your doughnut is my doughnut. - Not a very good joke, but it shows the odd way any differences between men and women are obvious explanations for male dominance. It doesn't matter what way the differences would go.

None of this should be intended to read that I don't care about men's possible fragility, compared to us stoic and almost-unkillable women. I do care. Good research in the field is much encouraged, and we might also do something about all those wars that still kill men disproportionately. Also the murders and car accidents which pick out young men more often than young women.

But Legato is exaggerating some of the findings to make her point. For example, there are still more boys than girls being born, even in the industrialized countries. We should remember that when interpreting the sad description of the difficulties that boys have in becoming born in the first place.

The question of depression rates by sex is interesting. I remember reading a study on depression among the Amish sect in the United States. It suggested that the rates were fairly equal by sex, whereas the general consensus is that women are much more likely to suffer from depressive illness. One suggested explanation for the findings among the Amish was that the Amish don't self-medicate with alcohol and that for some reason there is no cultural ban for men to say that they are depressed. Both these factors might disguise male depression in the wider American context. But this was just one study and I can't recollect whether it was well done or not.

We clearly need good research on these issues and probably also programs that support seeking help earlier among men. But I still don't like this current trend of thinking about all of us as just simply generic examples of "male" or "female". A good female friend of mine died young and another woman I knew committed suicide. I had a great-uncle who died at ninety-nine. Programs that would lump all people into treatment groups by sex alone would be as ham-fisted an approach as ignoring the question altogether.