In their book "Bad treatment, why women are badly treated", journalists Delphine Bauer and Ariane Puccini return on decades of health scandals during which women almost systematically find themselves on the front line. "Dépakine, Mediator, Distilbène, Agréal, Essure, Levothyrox... Medicines intended for women constitute the bulk of the pharmaceutical scandals of the last sixty years", deplore the independent journalists, Delphine Bauer and Arianne Puccini*. Members of the Youpress collective, specializing in women's rights and health issues. This year they are launching an alert on the inequality between men and women in relation to drugs with their book Bad treatments, why women are badly treated (ed. Seuil, Oct. 2020).
Marie Claire:What led you to list these various health scandals in a book, and for what purpose?
Delphine Bauer: "The aim was to lift the veil on the over-representation of women in drug scandals in recent years, and more generally in recent decades.
We started from the very simple observation that women were in the majority in most of the scandals identified. Indeed, during our investigations, we found only one case of drugs given to men that had caused serious side effects.
We then came to the conclusion that worrying about side effects from drugs was a very feminine issue and we wondered what the reason(s) was for this. Was it just coincidence or was there something behind a system that was ultimately unfavorable to women? We therefore wanted to show how the different stages of the system were intertwined and who could justify this over-representation of women.
From then on, we studied the entire life cycle of a drug, from its conception to its administration, in other words the way it is thought out, produced and then prescribed and administered to women. Then, we looked at the aspect of the fight, when women encounter a problem with a certain type of medicine, from the individual fight to the collective and in front of the justice."
Video of the day:Arianne Puccini :"We wanted to give an overview of women's health issues. The idea was to tell how women's health is subject to preconceptions in medicine with a context that plays rather against it. Medicine being a central element in our way of caring in the West, it was a way of revealing the context, biological but also social, which surrounds the care of patients.
Why are women today more sensitive to the side effects of drugs than men?
Delphine Bauer: "The body of women and that of men do not metabolize in the same way and their way of digesting the molecule of a drug is therefore different. The composition of the body plays a lot in metabolization. We know that that of women has more fat than that of men, but weight and height are also factors that can have an effect on the speed and effectiveness of the molecule.The duration of the molecule's life in the body and its evacuation also fluctuate according to these parameters .
For the flu vaccine, half a dose of the vaccine administered to men would be sufficient for women, because their immune system reacts more quickly. Another example:Aspirin. The organs targeted by the molecule in men and women are different.
Do you have any examples of clinical trials in which women were not included?
Delphine Bauer: "Several examples are mentioned in the book and are still relevant, such as the fact that women have been almost entirely excluded from research on antiretroviral (anti-HIV) drugs. This is explained by the fact that AIDS has long been considered a male disease, whereas today we know that half of contaminations are among women.
In terms of cardiac pathologies, women are also included less often than men in clinical trials, even though we know that cardiovascular diseases are the leading cause of death among women. There is also the case of female viagra, which was based on a panel of men, whereas it is precisely addressed... to women!
We have identified many cases of clinical trials in which women have been excluded, which does not appear at all consistent when we know that the drug will then be intended for them or that it is vital that they can access it."
Pregnant women also remain in the blind spot of drugs...
Arianne Puccini "Including pregnant women in trials is complicated, because the medical world has been traumatized by a tragedy, the Thalidomide scandal, a drug distributed in the 1950s and 1960s which had caused malformations in children when they had exposed in the mother's uterus. It was after this terrible event that we were able to discover the teratogenic risk of drugs (likely to cause malformations in children exposed in utero, editor's note). Children were born with small arms, fewer limbs, which had greatly shocked public opinion and the medical world. Faced with this tragedy, it was decided to no longer expose pregnant women to drugs.
As a result, we do not know what is happening to the pregnant woman, before a drug is put on the market, we can only make observations a posteriori. This requires very large cohorts and high computing capacities, which we did not have until now. Indeed, the first studies on adverse effects in pregnant women date from the 90s. There is therefore a glaring lack of data on the subject, while pregnant women actually take medication. Their number is estimated at 70%.
How are data on adverse drug reactions used?
Arianne Puccini "Social Security knows, using our Carte Vitale, what is prescribed and to whom. This data is then sent to Uppsala, a global pharmacovigilance center and collaborator of the World Health Organization. Thus, we know the proportion of women who report side effects:56% in France. The problem is that these data are not used by French Research.
In writing this book, we wanted to catalog this data, do additional research, see exactly what drugs women take and list those that are dangerous. With the help of the magazine Prescrire, we were able to observe that 2/3 of the dangerous drugs reimbursed by Social Security are prescribed to more than 60% to women. But if we don't dig into the data, we can't know what risks women are really exposed to. Not using the data means taking the risk of exposing women to dosages that are far too high or to molecules that will target the wrong organs, causing adverse effects."
Can you explain to us what "victim blaming" is, a very widespread concept in Canada?
Delphine Bauer: "Blaming the victim, as the expression says for itself, is first of all considering that the victim is himself responsible for his own tragedy. We talk about this in particular when we talk about the Mediator, a medicine prescribed to women.These feel guilty for what is happening to them because they are the ones who wanted to lose weight and who looked into this alternative.When they realize that because of taking this medicine, most of them were close to death, they can't help but feel a sense of guilt, maintained by the Servier laboratory, which manufactured it.
By this notion, we also try to show that the victim does not have to feel guilty for what is happening to him and that it is necessary to go up this chain of responsibilities, which concerns the public authorities such as laboratories and doctors.
Do you think that women would be better considered and cared for by accessing key positions in the medical and scientific fields?
Arianne Puccini :"The eye of women in medicine is really important. We notice today that women are in the majority on the benches of universities, as well as among new members of the Order of Physicians. By conducting our survey, we We were surprised to see that it was above all women who were able to answer our questions. Indeed, men do not ask themselves questions about women's issues, or very few of them, so having women in science is a real asset for to advance knowledge on the health of the latter."
Delphine Bauer: "It has now been proven that allowing a better representation of women in science is not only a question of principles, but above all a question of quality. Women come with questions that men would not necessarily have. eu, leading to new questions and answers."
* Also authors of Zero Impunity, a book-investigation on sexual violence in times of war (Ed. Otherwise, October 2017).
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