WHEN the first kidney dialysis machines became available in 1960 there were so few of them that access had to be rationed. That meant decisions had to be made about who was to benefit from them, so panels were formed to assess the claims of candidate patients. Famously, a review of the decision-making process found that those who were getting treatment tended to be noticeably similar in age, sex and social class to the people on the panels.
This discovery was educative, and it increased awareness about the biases that creep into choice-making, not least concerning which research projects are worth pursuing and where research funds should go. For example, it is often pointed out that diseases afflicting better-off westerners are more intensively researched than those afflicting people in what used to be called 鈥淭hird-World countries鈥�, especially in sub-Saharan Africa. In fact, it is not just tropical diseases that get less attention, but treatment of curable conditions in poor communities and provision of prophylactic measures such as sanitation, clean water supply, vaccines and condoms.
But it is not necessary to travel to Africa to be reminded of how bias affects what gets researched. Many states spend more on 鈥渄efence procurement and development鈥� 鈥� arms, in plain English 鈥� than on other forms of technology or on scientific and medical research. More telling yet is the fact that even advanced economies spend relatively little on health problems that are specifically female.
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鈥淩elatively little research spending goes on female health problems鈥�
Take, for example, the sometimes severely life-affecting experience of 鈥渉ot flushes鈥� (鈥渉ot flashes鈥� in the US) experienced by women undergoing menopause. This is one of the commonest features of the climacteric, and widely recognised as such in the medical profession. Yet its physiology and causes are still not fully understood, and the best that can be done to help women who suffer from it is to give general advice on managing symptoms.
Menopausal hot flushes are unlike other flushing phenomena, such as blushing. Increased heart rate and peripheral blood flow are accompanied by a decrease in galvanic skin resistance, and it is this combination of symptoms that is diagnostic for the condition. Such research as there has been implicates disturbance of the temperature-control mechanism in the hypothalamus, and recognises the critical role of reduced oestrogen levels in the blood, but just how the latter causes the former, and what other mechanisms are involved, remain a mystery. Matters are complicated by the fact that there may be other factors in play, too. Women in the Far East do not have hot flushes with the frequency and severity of women in western countries, prompting questions about genetics and diet: is it either, or both?
Tofu, derived from soya milk, and soya sauce are both staples in the east Asian diet, and soya is high in phytoestrogens. A few studies have looked at whether supplementing western diets with phytoestrogens could work as an alternative to hormone replacement therapy. Results have been disappointing, and claims about the benefits and disbenefits of phytoestrogens on other aspects of health have been ambiguous.
Women are left with the advice to drink less alcohol and coffee, avoid curries and (best of all, because it is said without irony) keep cool. Such advice might help, but not nearly as much as a serious endeavour to understand the complex mechanisms at work.
It is too tempting to remark: 鈥淚f men underwent menopause鈥︹��, but a major reason for the lack of attention is that hot flushes are not life-threatening as well as not masculine, a combination that too frequently makes for neglect. Now that more definite links are being made between oestrogen, menopause and the serious condition osteoporosis, it鈥檚 time that changed.