Gender bias in clinical research, pharmaceutical marketing, and the prescription of drugs

Abstract

This thesis is part of the studies of gender bias in health which together with the paradigm of evidence-based medicine shares the empirical assumption that there are inaccuracies in medical practice, in addition to a lack of rigour and transparency. It worked with the distinction between the concepts of sex and gender and between the concepts of sex-related differences and gender inequalities, in terms of applying a gender perspective in the study design and the subsequent analysis. This PhD review presents the research process conducted in Spain, which can provide an example for future research. Study I described a review of 58 clinical trials (CTs) of etoricoxib to assess its compliance with the Recommendations of Evaluation of Gender Differences in the Clinical Evaluation of Drugs. In Study II, key informants from professions related to different areas in drug development and pharmacovigilance held a working meeting to reach a consensus document on recommendations for the study and evaluation of gender differences in CTs in Spain. In Study III, the websites of the eight best-selling hormone replacement therapy drugs in Spain on Google first page of results were analysed. In Study IV, a logistic regression analysis was performed to compare analgesic prescription by sex in regions with a higher or lower Gender Development Index (GDI) than the Spanish average. Gender biases identified in this thesis limited the legitimacy of medicine, which is not based on the best possible evidence. The results also demonstrate the existence of inequalities between men and women that are not due merely to biological differences, but are gender inequalities stemming from the social differences that exist between both sexes.

Sex and Gender Bias in Kidney Transplantation: 3D Bioprinting as a Challenge to Personalized Medicine

“…leading to the mistaken view of men and women as similar (or different) in exposure to risks or in the natural history of disease (.).'' 15 In the first section, we describe sex and gender differences in kidney transplantation and donation. In the second section, we explore sex and gender bias in 3D bioprinting of kidneys.…”

<p>Use of an online medical database for clinical decision-making processes: assessment of knowledge, attitude, and practice of oral health care providers</p>

“…In developed countries, use of online or web-based tools to aid clinical care is a widespread practice. A study in Sweden related to the follow-up care of chronic heart failure patients found that 67% of health care workers used web-based or online resources, with 74% of respondents reporting positive attitudes toward application of information, communication and technology (ICT) in health care; interestingly, up to 96% were optimistic regarding the future positive contribution of ICT in health care.7 On the African continent, limited access to ICT infrastructure and low rates of computer literacy have been cited as an obstacle towards uptake and utilization of web-based health care resources for clinical decision making and providing health care, especially amongst female health care workers, who form the bulk of the health care workforce in Africa.8 In Rwanda, the national ICT policy encourages the leverage of ICT in all sectors to achieve the Vision 2020 goals to improve the overall health status of the population. This also applies to the health sector where electronic medical records (EMR) and electronic health management information system (EHMIS) technologies to enhance patient care are being rolled out.…”

Community Engagement in Support of Moving Toward Universal Health Coverage

“…Access to health care is often a significant part of election manifestos, and increasing access to information means that people are generally better informed about issues that affect their health. 13 Health systems have had to be responsive to changing health priorities, such as the types of services that need to be covered, the needs of different population groups as population demographic profiles change, 14,15 and the types of treatments that may be considered essential and/or optional. 13 In this article, we explore how the process of engagement with communities can be implemented to inform and enhance health systems and support progress toward UHC.…”

“…13 Health systems have had to be responsive to changing health priorities, such as the types of services that need to be covered, the needs of different population groups as population demographic profiles change, 14,15 and the types of treatments that may be considered essential and/or optional. 13 In this article, we explore how the process of engagement with communities can be implemented to inform and enhance health systems and support progress toward UHC. We begin with the assumption that as a constitutional right in most countries, 10 community engagement in the design of health policy and health care is desirable and an important intervention.…”