Women's Health News (2): The Invisible Females

There was a time when all-male samples were not infrequently used to study the efficacy of some drug of treatment which, if the results were promising, would then be administered to both male and female patients.  I thought that time was in the past, but I seem to be mistaken. 

In late September, the Food and Drug Administration (FDA) approved a new drug, Descovy, for the prevention of infection with HIV.  It's only the second drug to have been approved in that category.  The first one was Truvada which is widely used.  But the FDA's approval of Descovy comes with strings attached:

The first, Truvada, has become a mainstay of government efforts to turn back the H.I.V. epidemic. But the F.D.A. approved Descovy for use only in men and transgender women, because its maker, Gilead Sciences, tested it only in those groups.
The approval explicitly excludes women, and does not outline a plan for making the drug available to them. Some activists and scientists said the approval sets a dangerous precedent by allowing companies to dodge the expensive trials needed to test medicines in women.
Such an exclusion of women “should be unacceptable in these days and times,” said Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital.
It’s important to test the drug specifically in women, she added, because Descovy may work differently in the vagina than in rectal tissues.
The F.D.A., in fact, will require Gilead to study the Descovy in women, company officials said. Gilead is considering a trial in Africa.

The bolds are mine*.

It's ironic that the maker is called Gilead Sciences.  Never mind, the point here is that the manufacturer just decided to exclude biological females from the study, and the FDA had to require it to conduct a further study on women.
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* That bolded sentence suffers from the same linguistic illness I see all the time online:

It mixes together two different definitions of gender without seeming to notice that it does so.  Note that the inclusion of transgender women in that sentence suggests that gender identity is used as the basis for defining "women" and "men."  Because the gender identity theory decouples gender from biological sex, it should then follow that the category "men" used in that sentence might also include trans men who have biologically female bodies. 

But the whole quote strongly suggests that this is not the correct interpretation.  Rather, the writer took one definition of gender ("men") from the old based-on-biological-sex definition and the other ("transgender women") from the new gender identity definition.

The same confusion is present later in that article:

Descovy contains a newer version of tenofovir, the active ingredient in Truvada. Gilead tested Descovy in a multinational trial that included 5,313 men and 74 transgender women who have sex with men. There were no cisgender women, and 84 percent of the participants were white.
“They did a terrible job of inclusion for a company that dominates the market,” Mr. Johnson said.

The term "cisgender" is used in the gender identity approach to refer to people who don't  identify out of the gender basket associated with their registered biological sex at birth, and the term "transgender" to refer to people who do identify out of the gender basket associated with their registered biological sex at birth and then move into the gender basket associated with the opposite sex.  

The above quote uses that division for women, but not for men.  This is the common form of this error, actually.

Women's Health News (1): Who Gets The Kidneys?

A presentation* at the recent meeting of the American Society of Nephrology looks at live donor kidney (LDK) transplants in men and women and finds that women are considerably less likely to receive a kidney from a live donor than men:

Among 106,260 primary adult LDK transplants reported to the United Network for Organ Sharing/Organ Procurement and Transplantation Network from 1998 to 2018, the overall rate of LDK transplantation was 38.9% for women and 61.1% for men

The findings show all sorts of odd patterns.  For instance, women were less likely to receive a kidney from an unrelated donor than men, white women were less likely to receive a donated kidney than black women and other women of color, and women who were sensitized were actually more likely to receive a LDK than women who were not.  Sensitized patients are expected to have to wait longer for a transplant, in general.

The author of the presentation suggests that these results are more likely to be caused by varying practice patterns than by underlying sex differences in the disease etiology.

That presentation made me Google stuff about sex and gender differences (two different things here**) in kidney disease, and I found a recently published paper using European data  which shows clear sex differences in the likelihood that a kidney patient receives a transplant.  The relevant percentages are sixty for men and forty for women in that study. 

The difference could be explained by a combination of reasons.  Maybe the disease advances more slowly in women, maybe women are more likely to choose conservative treatments and men transplantation etc.  But we cannot rule out the possibility that access to donated kidneys might be different for men and women.

That some social forces do influence who donates live kidneys and who receives them is suggested by the authors of this study, too:

Perhaps more importantly, this finding also needs to be viewed in the context of women being more likely to donate a kidney to their spouse. This hypothesis is supported by a single center study from Canada, where more than a third of the wives who were acceptable donors went on to donate a kidney to their spouse, compared with 6.5% of husbands (36).

Other studies support the finding that women are more likely to donate kidneys than men and less likely to receive them. Why would that be the case? 

Outright or at least unconscious sexism in those who allocate, say, cadaver kidneys to their final recipients could explain some of the differences in who receives kidneys,but simple financial reasons might be more important:

Socioeconomic factors undoubtedly play a role in the inequality of transplantation between sexes, especially in low- and middle-income countries and regions.Generally, men provide the major income for their family, which may discourage them from donating kidneys. Different employment status and incomes between the sexes may contribute to sex differences in transplantation because employment and income status are usually associated with better health care insurance that cover the costs for transplantation.

Those reasons would have their roots in the traditional gendered division of labor which dictates the male breadwinner model and tends to result in lower average lifetime incomes for women.  But the way the health care system interacts with men and women may also play a role here:

Other reports describe disparities in age and sex in access to kidney transplantation, which originate at the time of pre-referral discussions about kidney transplantation; irrespective of age, women were more likely not to have had discussions with medical professionals.
 

Did you find this post boring?  I tried to figure out why I wanted to write it (other than the fact that Echidne sounds like "a kidney") without having reached that fairly advanced stage in research where things become simpler to explain, and I realized that was the reason!  Before one gets to that all-is-simple stage in studying something, the real fuzziness and complications are more evident.

This post, for instance, shows the way different explanations (biological, social, cultural) can all play a role in the final conclusions, but might wound together like a rope.  If we wish to find out how sexism and traditional gender roles affect the observed discrepancies, we need to fray that rope and look at only some of its strands while remembering that they are only some strands in the rope.


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*  I haven't read the presentation, only the linked summary.  Keep in mind that this is not a published peer-reviewed article, so some caution is advised.  I picked it for this post because that's where I first read about existing and large sex differences in the treatment of kidney disease.

** Sex differences in this context mean any differences between male and female patients in the etiology of the disease, the ease with which it is properly diagnosed and in any associated co-morbidities.

Gender differences would be about differences created by the socially constructed gender norms and roles which are regarded as appropriate for either men or women. 

Gender and sex differences are here assumed to apply (and probably do apply) to the same individuals, i.e. gender is assumed to be defined by one's apparent biological sex.

Revolutions Eat Their Daughters

You may remember this iconic picture of a young woman standing on the roof of a car during the revolution which ousted Sudan's president Omar al-Bashir after thirty years of dictatorial rule.

The woman in the picture is Alaa Salah.  Now that the revolutionary work is done, she and other women who participated in it are sidelined:

“Women led resistance committees and sit-ins, planned protest routes and disobeyed curfews, even in the midst of a declared state of emergency that left them vulnerable to security forces. Many were teargassed, threatened, assaulted and thrown in jail without any charge or due process,” Salah told a United Nations Security Council meeting on women, peace and security on Tuesday. “However, despite this visible role, despite their courage and their leadership, women have been side-lined in the formal political process in the months following the revolution.”

This is, of course, not the first time that women have been expected to step back once a revolution has been victorious.  Women were sidelined after the French Revolution, too, and all they ultimately got for their troubles was the Napoleonic Code which stripped them of further rights.  Women were also sidelined after the Arab Spring uprisings.

Let us hope that Salah speaking out about this injustice serves to change things.  I am not, alas, very hopeful.

It would be worthwhile to consider what causes this sidelining.  My off-the-cuff guess would be that it has to do with the way power vacuums are filled.   A vacuum is created when the old hierarchies tumble, and the time to fill that vacuum is a short one.

Power is most likely going to be grabbed by those who already possess the necessary resources (in people, funds and weapons) to wield political power, because they will act the fastest*.  Women have rarely or never been in that position all by themselves.  This means that the likelihood of women sharing in the fruits of the revolution is crucially dependent on their allies in the general population.

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*  In the case of Arab Spring in Egypt,  the conservative religious groups took power first because they had existing organizations and numerical support to do so.  They had very little interest in supporting women's rights.  If anything, the reverse was the case.