Women remain invisible in medical science, warns pioneer Carme Valls

Carme Valls, a physician and politician who has spent decades advocating for women's inclusion in medical science, sits down with a stark observation: the field that is supposed to heal us has systematically rendered half its patients invisible. Her new book, a reissue of a 2006 work, returns to this theme with what she calls "everything that might be hope for the future"—a careful phrase that hints at how slowly, and how unevenly, medicine has begun to see women as subjects worthy of study rather than afterthoughts to male-centered research.

The numbers tell a story of glacial progress. In 1990 and 1991, cardiac research included only men. Three decades later, women appear in 38 percent of such studies. That means 60 percent of the research still excludes them entirely. But even this modest gain masks a deeper problem: in other areas—chronic pain, the diagnosis of fatigue, the treatment of mental health—medicine has either stalled or moved backward. Women now consume tranquilizers at twice the rate men do, and antidepressants at five times the rate. These are not reflections of greater mental illness among women. They are reflections of a medical system that, when faced with a woman's complaint of exhaustion or pain, reaches for a prescription pad rather than reaching for understanding.

The root runs deep. Valls traces it back through centuries of assumption: Aristotle, the Church fathers, nineteenth-century pseudoscience insisting women had smaller brains. Unconsciously, she argues, every science and every society has treated women's ailments as less important, less real, less worthy of investigation. In laboratories, 75 percent of drug studies still use only male animals. When medications are tested on men and then prescribed to women, the risks are real and often hidden until harm accumulates. The FDA has had to warn against prescribing opioid derivatives to women for pain management because they create severe dependency and increase mortality in emergency rooms. Yet the underlying conditions—thyroid disease, iron deficiency from menstruation, fibromyalgia—go undiagnosed or misdiagnosed as psychiatric disorders, and women end up medicated for illnesses they do not have.

The pandemic exposed this blindness in real time. Of the eighteen major early studies on COVID-19's progression and outcomes, none differentiated results by sex, and those that collected sex-disaggregated data did not analyze it. Researchers could have tracked how many men and women reached intensive care, why, what differed in their trajectories. They did not. Meanwhile, the psychological toll of lockdown—the compounding of domestic labor, childcare, teaching, and remote work all falling on women's shoulders—has driven anxiety and distress upward. Prescription rates for sedatives and antidepressants have climbed. The medication, Valls suggests, is being used to medicate away the exhaustion of impossible demands rather than to address the demands themselves.

Yet there is something shifting. The Ministry of Health publishes epidemiological data disaggregated by sex every two weeks, though the media pays little attention. Medical schools are beginning to incorporate what Valls calls "the science of difference"—the study of how biology, hormones, and lived experience create distinct health patterns in men and women. Most importantly, the new generation of medical and nursing students, the majority of whom are women, have lived in their own bodies the consequences of medical indifference. They have experienced menstruation and menopause treated as taboo or immediately medicalized. They have been dismissed when they reported symptoms. This lived experience is making them more attuned to gender as a fundamental axis of health.

Valls's message to women is twofold: do not accept a sedative when you deserve a diagnosis, and do not believe your body's signals are signs of mental illness when they might be signs of iron deficiency or thyroid dysfunction. Reclaim your life as your own, not as service to others. Spend an hour on yourself. Activate your nervous system through pleasure and desire, which increase endorphins and decrease pain. And to the medical profession: include both sexes in every study you conduct. The hope, she says, lies in that slow penetration of difference-based science into medical education and practice. It is happening worldwide, unevenly, but it is happening. That is what she has tried to gather in this book.