At 32, Rekisha Harris isn’t someone you’d think of as having heart disease. Which is why it took her doctors so long—almost too long—to diagnose her condition. After a pregnancy, Rekisha felt fatigued and short of breath; her doctors diagnosed her with pregnancy-induced asthma.
But it wasn’t until she fainted that Rekisha was finally admitted to the hospital. There the physicians found a clot in her heart, which they linked to her pregnancy, and she was sent home. But a month later she was worse, and none of the medicines she’d been given were helping. When Rekisha was admitted to the hospital again, doctors found her heart functioning at just 15 percent of its capacity and decided she needed a heart transplant.
A study released this week by the Society for Women’s Health Research (SWHR), an advocacy group based in Washington, D.C., finds that Rekisha’s story is hardly unique: The research reveals big differences between men and women when it comes to prescription drugs. According to the study, women are prescribed more medications than men across all age groups; they are less likely to stick to the prescribed regimen for medicine; and, like Rekisha, they are sometimes not prescribed appropriate drugs for their disease or condition.
The research was presented in 2012 by SWHR and by Medco, Inc., a pharmacy benefits manager bought last year by Express Scripts. The researchers used Medco’s pharmacy claims database, and insurance records to determine medication use, adherence, and whether or not the right drugs were prescribed for about 30 men and women ages 18 to 65 in 2010.
The researchers found that:
• Women were prescribed more medications than men—an average of five drugs, compared to 3.7 drugs for guys.
• Sixty-eight percent of women were prescribed a drug for chronic or acute conditions, compared to 59 percent of men.
• Women had poorer health following treatment compared to men on all 25 of the measures looking at heart disease and diabetes.
Why these big differences? Experts believe the problem may start in a drug’s earliest start—when it is studied in clinical trials. “To adequately bridge the gender gap in medication management, we need to emphasize more research on women from the very beginning of the drug discovery process,” said Phyllis Greenberger, president and CEO of SWHR. “Research studies need to include women in all trials to determine why women’s adherence to and experience with medication trails behind men’s.”
Greenberg says the Society has long advocated for gender-specific dosing guidelines to reduce side effects and improve health. Last month, the Food and Drug Administration (FDA) did just that with some sleeping pills. The agency announced that it was requiring makers of sleeping pills that contain the active ingredient zolpidem (including the wildly popular Ambien) to lower the recommended doses for women, since women clear the drug more slowly from their bodies than men do, and to consider lowering doses for men. The FDA took action because studies show that current doses can cause impairment in all users the day after the drug is taken.
Chris Carter, Ph.D., M.P.H., vice president, scientific affairs for SWHR, says she found the study results on gender and medication surprising. “You would think [women’s] adherence would be even [with men’s] or better, since women are inclined to be more aware of medication and family health compared to men,” says Carter. “And the really surprising finding was that women are not being appropriately prescribed given the same cardiovascular symptoms. That means doctors are not adhering equally to guidelines for women and for men when it comes to heart disease.”
Dr. Carter says it’s not clear if doctors are treating women differently, and a follow-up study is unlikely because the Society’s research partner for the study, Medco, is now out of business. But she suspects there is an inherent, and sometimes unconscious, bias regarding women’s cardiovascular symptoms. “There’s a common perception that women don’t have as many heart attacks as men, and they do,” notes Carter. “They’re not treated adequately in part because of this common misconception.”
In fact, according to the American Heart Association, heart disease is the number-one killer of women, and more deadly than all forms of cancer. Rekisha thinks the burden falls on women, not just their healthcare providers, to advocate for themselves: “I think we all get used to doing too much and learning to ignore minor ailments or fatigue because that is what women are programmed to do,” she says. “I tell everyone I know to pay attention to any changes in your health and see as many doctors as necessary to be sure your voice is heard.”