Health Technologies: Are They Helping Women?

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Bone mineral density testing has been promoted as a powerful weapon in the 'war' against osteoporosis. It's being presented as the only hope for preventing bone fractures - the only hope to prevent months of pain and incapacity for women suffering from osteoporosis.

It plays on women's hopes and fears about their health. Yet recent research shows that this technology is not only unable to predict which women will go on to suffer major fractures, it has turned low bone mass from a risk into a disease.

Research and development in health technologies, like bone mineral density testing, is a surging growth industry. The media are full of reports about the latest treatment or procedure.

These stories generally imply that all new medical technologies must be of benefit. It is not clear whether the 'advances' being made will help improve women's health.

Technology promoters justify their claims with scientific evidence, but huge financial potential has encouraged a direct marketing approach with women as the target.

When looking at health technologies you can't help but examine the relationship between medical research and commercial interests. It is important to question why new technologies have been introduced into the health care system and become part of clinical standards of practice, without being based on scientific evidence, or without even scientifically proven positive outcomes.

It is not always easy to identify the forces driving these developments, since medical research and changing medical practice involve more than just health concerns or profit. The introduction of technologies in such areas as obstetrics, for example, may have as much to do with an anxious medical profession defending itself against claims of malpractice as it has with protecting the interests of mother and child.

"[E]valuation of both technologic and pharmaceutical interventions are critical in order to protect men, women and children from unnecessary or potentially harmful health care interventions," says Penny Ballem, VP of Women's and Family Health Programs at Children's and Women's Health Centre of British Columbia.

Direct harm from these technologies is also a risk, particularly little-researched drugs. Recent research on the use of Hormone Replacement Therapy (for post-menopausal women) has highlighted serious questions as to whether the benefits can justify the risks.

Women are more likely than men to be offered certain health technologies, including drugs like HRT, devices, medical or surgical procedures, support and administrative systems.

But the reality is that women experience health conditions differently from men not just because of biological differences, but because of social differences related to inequality and gender discrimination.

The final report of the Royal Commission on New Reproductive Technologies noted that increasing medicalization of women's reproductive processes should be of concern, not only because it means women lose autonomy over their bodies and reproductive functions, but also because this process is simultaneously promoting a narrowly-defined medical view of the highly complex social conditions in which reproductive health is rooted.

Because of continuing inequality, women remain vulnerable to little-examined technologies. As long as health care technologies continue to reflect gender bias, women will face potential harm in the health care system. Scientifically-based health technology assessment with a gender analysis will help reduce this potential harm. But to eliminate such bias altogether, women must be involved in health care decision-making at all levels.

Denise Morettin, B.A. B.Sc. is a Research Associate at the BC Office of Health Technology Assessment (BCOTHA).

Carolyn Green, B.HSc. (PT) M.Sc., is Research Co-ordinator at the BCOHTA.


The BCOHTA

The BC Office of Health Technology Assessment is a program of the Centre for Health Services and Policy Research, at the University of British Columbia, and offers critical appraisal of research evidence on current health technology to assist both public and private sectors in policy and planning.

The BCOHTA is taking on research useful to women by examining not only the scientific evidence of the effectiveness of a technology, but also the social context in which it is applied. Social and cultural processes relevant to a women's perspective, in addition to effectiveness assessments, have been investigated in bone mineral density testing, triple marker screening for the detection of down syndrome, ultrasound imaging in pregnancy, home uterine activity monitoring, and collagen implant therapy for stress incontinence.

A pilot study undertaken by BCOHTA and funded by the BC Centre of Excellence for Women's Health was recently completed to establish the relevance and quality of linked data to study women's health.

Bone density testing is not only unable to predict which women will go on to suffer major fractures, it has turned low bone mass from a risk into a disease.