Design and health. Researching is designing processes
22 Jul 2022 /

Design and health. Researching is designing processes

In a context where the world seems to be debating whether to stay put or take a step back on women’s rights, it seems like a good time to talk again about the importance of having women in the room.

Working from a feminist perspective has become, for some reason, a specific perspective while putting men first means looking at the world in a universal way. Who decided this and why is this still the case many years later?

Power is always the starting point: who decides what to research? where are the hidden interests? why are birth control pills still only marketed to women? 

Medical innovations, understood as all research and advances aimed at improving people’s health, should cover ALL PEOPLE. This point is important because in the eyes of science, not everyone has always been given the same importance, or at least not with the same urgency.

Without role models, there will be no female researchers

Thomas Hunt Morgan is still named in textbooks as the person who discovered that sex was determined by chromosomes rather than environment. However, it was the experiments of Nettie Stevens on mealworms that confirmed this reality.

Rosalinda Franklin’s case was similar because her work led James Watson and Francis Cricks to win a Nobel Prize for “discovering” DNA.

For thousands of years, medicine has operated under the assumption that white and male bodies represent humanity as a whole, the problem is perhaps not so much who to consider or who not to consider, but that as a result of this recurrent ignorance of female bodies, we have a lot of data but all of it is biased. What is the result of a lifetime of collecting only the data that mattered? The gender data gap is a direct consequence of the assumption that what is masculine is universal.

To talk about products whose design process has been biased due to lack of information is excluding, but to talk about designing advances in the field of health with such a large bias is not excluding, but rather denying health and physical integrity to many people.

Without female researchers, there will be no data

When Tania Boler founded the Elvie pelvic floor trainer in 2013, there was no data showing variability in vaginas. “There was almost nothing, especially when you compare it to the thousands of penis studies. Which meant an absence of data to be able to demonstrate that their idea was worth funding. 

The book The Invisible Woman, which we have already discussed on several occasions, exposes how healthcare, “systematically discriminates women, leaving them chronically misunderstood, mistreated and misdiagnosed.”

Again, the risk that I see is certainly the path that medicine is going to take hand in hand with artificial intelligence. What answers can an online test designed from biased data give us? Stories to keep you awake at night.

Artificial intelligence in healthcare, solution or problem?

When Apple ostentatiously launched its health monitoring system in 2014, it boasted of having a “comprehensive” health monitor . It could monitor blood pressure, count steps taken per day, blood alcohol level or even copper and molybdenum intake. However, out of absolutely everything that was included in their computer system, they did not see it as important to monitor the menstrual cycle.

We could speak of an absent-mindedness if it were not for the constant forgetfulness of women’s needs. When Apple launched Siri, they didn’t forget to make her voice sound compliant and feminine but they did forget to make this robot able to help us if we said “I’ve been raped”. However, it did help us in the event of a heart attack. I guess this kind of extreme emergency situation that could be solved very efficiently just by asking a robot and having it call the emergency service was not taken into account because, once again, no one thought of anyone other than himself.

As Margaret Mitchell, a senior research scientist at Google, said, “gender shapes the kinds of questions we ask.”

I have researched and collected some stories that help to understand the thesis on which this article is based:

Marts, Sherry A and Sarah Keitt said, in Principles of Sex-based Differences in Physiology, “It has been historically assumed that there was no fundamental difference between the male and female body other than size and reproductive function so for years medical studies have focused on the male as “normal” and anything outside this norm was considered atypical.

But… why do we keep making the same mistake?

We have so normalized this type of bias from the first years of medical education that as time goes by we stop identifying the errors.

Misdiagnosis

The monograph Gender Perspective in Medicine talks about the higher diagnostic delay in women than in men that has been identified in at least 700 diseases, with the sole exception of osteoporosis. Despite the fact that several scientific studies conclude that women taking cardiovascular drugs are 2 to 2.5 times more likely to suffer side and adverse effects than men on the same drug, healthcare professionals continue to use the same doses for both sexes.

What is shown in the textbooks?

An analysis conducted in 2008, which included 16,329 images from textbooks recommended by twenty of the most prestigious universities in Europe, the US and Canada, showed that male bodies were used three times as often as female bodies to illustrate neutral body parts. There are countless medical textbooks in which there was no gender-specific information until very recently, not even in those sections about subjects on which differences between the two genders had long been studied, such as depression or the effects of alcohol on the body.

Side effects

In 2016, it was revealed that the integration of sex- and gender-based medicine in U.S. faculties remained sparse and uneven, and was fraught with gaps in the approach to disease treatments and drug use. These gaps are important because, unlike what we have assumed for thousands of years, the dissimilarities between bodies and races can be substantial. There are differences in all tissues and organ systems of the human body, in the mechanical functioning of the heart, lung capacity…

About menstruation

In 1931 Earl Haas invented tampons. We will leave aside the issue of what Earl was doing thinking about how to solve this problem. What is really important is that only six years later, in the USA in 1937, Leona Chalmers patented the first menstrual cup considered comfortable to date thanks to the long research of flexible materials that provide comfort such as vulcanized rubber and the incorporation of rounded edges. From her experience as a woman actress and the need to wear light-colored clothes on menstruation days, Leona created what she called the “Catamenial Receptor”.

When Always menstrual pads were analyzed in 2014, they were found to contain “several chemicals, including styrene, chloroform and acetone, that have been identified as carcinogens or reproductive and developmental toxins. If this was the case with pads, which have limited contact with the vagina, imagine how spooky stories about tampons can be.

The Museum of Menstruation and Women’s Health in Maryland states that menstrual cups existed as early as 1867 but were never marketed due to their discomfort and the pain they caused because they were made of aluminum and rubber and their design consisted of a belt that was adjusted to the body, from which a not very discreet collection pouch hung.

“I have found the answer to a problem as old as Eve” – Leona published her innovative product in her hometown newspaper.

Despite the reinvention of the menstrual cup, it did not come to be considered as an option by women at a time when it was almost forbidden to use the words “vagina” and “period” in advertising.

To me, one of the most interesting findings of the “Asthma is worse for women”  report is the strong impact of fluctuations in female hormones on women with asthma, as indicated by variations in symptoms correlated with the menstrual cycle, pregnancy, menopause or hormonal contraceptives. According to the report, 20-25% of women with asthma have premenstrual asthma, and 68% of these women have been previously hospitalized.

I find this interesting because it makes me think of my favorite part, which is the statements historically made by researchers as to why not to study the effects many drugs will have on women: “The menstrual cycle will interfere with the results.” And you know what? The reality is that YES. It will, it will. So please study it because it will interfere.

Medical professionals rule out women who notice a pattern between symptoms and their menstrual cycle. Where have I seen that before? How are we supposed to know what impact hormonal birth control may or may not have if we study almost exclusively women who take it and act as if it is a totally neutral state of being rather than a hormonal intervention that may or may not interact with whatever drug is being tested at the time?

Without real data, there is no democracy.

-Sara Antolín