Summary
Overview
In this Doctor's Notes episode, Dr. Chris and Dr. Zand van Tulleken speak with Dr. Chi Ezeifler about endometriosis, exploring why this common condition remains dramatically underfunded and understudied. The conversation delves into the systemic biases in medical research that have historically neglected women's health, the lack of adequate diagnostic tools and animal models, and the promising developments that offer hope for better understanding and treatment in the future.
The Crisis in Endometriosis Research Funding
Chi explains how endometriosis represents a massive failure in reproductive health research funding. Despite being a very common condition, researchers don't understand its causes, lack efficient diagnostic tools, and have limited treatment options. The funding allocated to endometriosis and women's health conditions is far less than what's given to other common conditions that also affect men, revealing stark inequalities in medical research priorities.
- We don't know what causes endometriosis, the best way to diagnose it, or have a wide range of effective treatments
- Endometriosis is likely much more common than currently recognized
- Major funders, including government, allocate far less money to women's health issues like endometriosis than to conditions affecting men
- Science journal called this 'undone science' - research that should have been done but hasn't
" This has roots in our framing of the menstrual cycle in general and the initial writing off of menstrual symptoms as hysteria. And the word hysteria, the hyster comes from the word womb. It means womb in Greek. and hysteria denotes that something is made up, doesn't really exist or that the thing is in the mind. "
Historical Bias Against Women in Medical Research
The conversation explores why endometriosis and women's health have been so neglected. Chi describes how the male body has been treated as the default 'normal' in medical research, while female bodies are viewed as complicated variables to be excluded from studies. This bias has persisted for millennia and continues to affect everything from drug development to safety testing, with profound consequences for women's health outcomes.
- The male body is seen as default normal in most medical scenarios, leaving out 50% of humans
- Many clinical trials used only male animal models or female models without hormonal fluctuations
- Women were largely excluded from clinical trials until the late 20th century, with requirements only around 2005
- We don't have good animal models of endometriosis because we don't have good models of menstruation
- It's only in the last couple of years that crash test dummies with representative female anatomy have existed
- Seatbelts are designed mainly for the male body, affecting safety for women
" Male body is seen as default in many scenarios. We're normal. Normal is the male. And that completely leaves out the fact that 50% of humans are female. And so there's no normality around just 50%. "
" Why do we view the female body as complicated and that that's a problem? Because surely we should actually aspire to know and understand that and be intrigued at how high tech human biology actually is. "
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