Gender Bias in Medical Textbooks

gender issues

Current medical textbooks do not consistently integrate gender-related aspects of coronary heart disease, depression and alcohol abuse, thereby omitting information. When it is available, information mainly applies to epidemiological data and reproduction.

This is not limited to text books but also applies to guidelines and medical curriculum.

The authors selected medical textbooks recommended by at least two medical schools in the Netherlands in the academic years 2004–05 and 2005–06. The medical disciplines which they investigated were cardiology, internal medicine, pharmacology and psychiatry.
They selected one major topic for cardiology: coronary heart disease and one for psychiatry: depression. They also focused on alcohol abuse with relevance to internal medicine, psychiatry and pharmacology. They also focused on gender specific material in pharmacology.

They defined a priori gender specific aspects of each of the topics and screened the text books via the indices and tables of content.

For depressive disorder:

In psychiatry textbooks, gender-specific information is limited to a single note on differences in prevalences of depressive disorders. Gender-related information is also absent from aetiological reflections on depressive disorders, except for a note that hormonal fluctuations contribute to the aetiology of depression in women. Descriptions of symptoms, diagnostic considerations and therapeutic options make no mention of gender as a possible relevant factor. Gender-specific knowledge is not accessible via the indices.

It wasn’t any better for the other topics. The psychiatry text books were Gelder MG, Mayou R, Geddes J. Psychiatry. 3rd ed 2005, and Kaplan HI, Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry. 9th ed 2003. So not some obscure Dutch psychiatric text books.

The text books do not reflect the state of the art on gender specific knowledge and additional educational material is needed to learn these gender related aspects of medicine.

So what gender specific wisdom is missed in depression for instance? A few examples

  • Aetiological factors: Women are at greater risk of sexual abuse and are more sensitive to the effect of adverse experiences in childhood
  • Symptomatology: Women experience more vegetative and atypical symptoms like fatigue, sleep and eating disturbances, anxiety and anger. In men, substance abuse and antisocial behaviour more often dominate the clinical picture
  • Diagnosis: In men a depressive disorder is more often masked by substance abuse and antisocial behaviour and in women more often by anxiety and anger
  • Treatment: Men and women respond differently to anti-depressive medication: for example men respond better to tricyclic antidepressants than pre-menopausal women

Medical textbooks usually are not very up to date, nevertheless gender specific issues important for medical subjects are completely absent. In guidelines and curricula for residents they are also not mentioned or educated.

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Anja F Dijkstra, Petra Verdonk, Antoine L M Lagro-Janssen (2008). Gender bias in medical textbooks: examples from coronary heart disease, depression, alcohol abuse and pharmacology Medical Education, 42 (10), 1021-1028 DOI: 10.1111/j.1365-2923.2008.03150.x