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Androcentrism, Feminism, and Pluralism in Medicine

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Abstract

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives.

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Notes

  1. A lot of thorough research has been done in this respect; cf., e.g., Dreifus (1978), Ehrenreich and English (1978a), Fausto-Sterling (1985), Martin (1987), Laqueur (1990), Schiebinger (1999), Tuana (1993).

  2. This is not to be read as a claim about the accuracy and completeness of Laqueur’s account. Historical conceptions of sex and gender might very well be more complex than his description suggests (cf., eg., Voss 2010). However, I want to employ his distinction in order to point out some important differences.

  3. Heavy physical labour, for example in factories, was not quite as controversial (cf. Bullough and Voght 1973, 70 f).

  4. With the development of psychoanalysis, hysteria later became a primarily psychological disease (though connected to the physiological problem of a lacking penis causing envy). In the latter twentieth century, hysteria lost its status as an official diagnosis due to its vague character as well as its pejorative connotation. It might be an interesting question for future research how much of hysteria has actually survived into concepts of PMS and PMDD (Premenstrual Dysphoric Disorder), which has been included as an official diagnosis in the DSM-5 (cf. American Psychiatric Association 2013).

  5. Jeffcoate, Thomas (1967). Principles of Gynecology (3rd edition). London: Butterworth; quoted from Scully and Bart (1973), 1048.

  6. Novak, Edmund; Jones, Georgeanna S.; Jones, Howard (1970). Novak’s Textbook of Gynecology. Baltimore: Williams & Wilkens; quoted from ibid.

  7. Willson James R. et al. (1971). Obstetrics and Gynecology (4th edition). Saint Louis: Mosby; quoted from ibid.

  8. Willson (1971); quoted from Weiss (1978), 217.

  9. Willson (1971); quoted from ibid., 216.

  10. At the time, it was, for instance, common practice for doctors and pharmacists to remove package inserts in order to avoid hysteric, hypochondriac reactions from women.

  11. Oftentimes, complaints were not only not taken serious, but even interpreted in terms of a moral weakness of the female patients:

    “an exaggeration of minor discomfort […] may even be an excuse to avoid doing something that is disliked” (Jeffcoate 1967, quoted from Lennane and Lennane 1973, 288);

    „very little can be done for the patient who prefers to use menstrual symptoms as a monthly refuge from responsibility and effort“(Benson, Ralph C. 1972. Gynaecology and Obstetrics. In M. Krupp & M. Chatton (Eds.), Current Diagnosis and Treatment. Los Altos: Lange Medical Publications, 377–434; quoted from ibid., 289).

  12. It is important to note that there are not only biological but also social factors relevant to CHD in men and women. An example of the latter is the difference in risks such as a low socioeconomic status (a more frequent problem in older women than in men).

  13. This perception as a prototypical male affliction was also informed by cultural background assumptions, for example, about heart attack being the disease of managers and executives or cardiovascular problems being a normal part of ageing (cf., e.g., King and Paul 1996; Riska 2002).

  14. A similar review of published clinical trials in the New England Journal of Medicine, 1994–1999, found an average rate of 24.6 % of female subjects, with only 14 % of the studies actually employing a gender-sensitive analysis of results (cf. Ramasubbu et al. 2001).

  15. This is a recurrent conflict in medicine as an application-oriented science, which has to balance the needs of medical practice and of research, the latter being made much easier (or “purer”) by a reduction of possibly intervening factors that in turn creates problems of applicability.

  16. As Epstein (2007) points out, the NIH’s reaction towards these criticisms in their interpretation of the guidelines has greatly facilitated their acceptance. For example, women need to be included only in Phase-III trials where no data support assumptions of a similarity of the sexes, won by studies on laboratory animals of both sexes. Another point is that the ratio of minorities does not have to be demographically representative or always of a sample size that allows for statistically significant inferences.

  17. It might be countered that not all of these questions were epistemically relevant and therefore need not all be value-free (for instance, decisions on the choice of research projects). For an argument on why such aspects have an indirect impact on justification cf., e.g., Bueter (2015), Ohkrulik (1994), Elliott and McKaughan (2009).

  18. There are of course numerous other accounts in social and feminist epistemology of relevance here; also, Longino’s approach is not without its problems. For reasons of space, I restrain myself here to proposing Longino’s notion of social objectivity as one helpful way to understand the development of gender-medicine. For a detailed discussion of Longino as well as other positions on the question of science and values cf. Bueter 2012.

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  1. Institute of Philosophy, Leibniz Universität Hannover, Im Moore 21, 30167, Hanover, Germany

    Anke Bueter

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Bueter, A. Androcentrism, Feminism, and Pluralism in Medicine. Topoi 36, 521–530 (2017). https://doi.org/10.1007/s11245-015-9339-y

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