If you’re a man with heart failure, then thanks to advances in medical technology, the future looks promising. If you’re a woman with heart failure, you might have to wait a bit longer.
This week, futurist Zoltan Istvan wrote a column for Motherboard about the exciting prospect of fully artificial heart implants, and other transhumanist-style health fixes. As technology advances, we’ll have more and more solutions to formerly fatal conditions. But they won’t be equally accessible to everyone.
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Much has been written about the inequality that’s set to arise owing to the prohibitive costs of life-improving devices, but technology can discriminate on other grounds too. When I looked further into the heart Istvan wrote about, made by French company Carmat, I came across an astonishing figure: While this revolutionary device fits 86 percent of men, it’s only suitable for about 20 percent of women.
That huge discrepancy comes down to a basic physical constraint: women are generally smaller than men. Caroline Carmagnol, a Carmat representative, told me in an email that, “The artificial heart has fixed dimensions and the thoracic cavity of men has slightly more space to adequately fit the device. For example, in our database we found that the internal distance from spine (back) to sternum (front), which is critical to fit the device, is 2.3 cm less in women compared to men.”
She confirmed that the company is not currently working on a smaller model, something that “would entail significant investment and resources over multiple years.”
In the case of artificial hearts, men are more often affected by heart failure and therefore more likely to need the device. It’s of course fantastic that they’re getting access to these potentially life-saving products. But heart disease is still the leading cause of death for women in the US, so there’s a clear demand for an equivalent female-friendly version.
In some cases, making devices smaller necessarily requires waiting for further technological advancements; just think of how smartphones shrunk through the years as the tech was refined (before phablets took them in the other direction). But especially when it comes to devices that are implanted in the body, this has a disproportionate impact on people of smaller stature—which means women are more likely to be left behind.
Artificial hearts are a striking example, and the Carmat model isn’t the only one that favours male patients. For example, the SynCardia artificial heart—meant for temporary use before a transplant in patients with a certain type of heart failure—was approved by the FDA in 2004 and is “designed for use in patients with a Body Surface Area (BSA) of 1.7m² or greater,” which the company describes as suitable for “a majority of men and some women.”
SynCardia ultimately made a smaller version, which it said was suitable for “many women and adolescents,” but that was only ready for FDA approval in 2013—almost a decade after the original design.
Even when materials are available, technology is often clearly designed for men. The results of this range from intensely annoying to the downright exclusionary.
No one can help the fact that women’s bodies are generally smaller, and Carmagnol said that she thought women would have equal access “as soon as new miniaturised materials are available for this type of application.”
But the simple fact is that, even when materials are available, technology is often clearly designed for men. The results of this range from intensely annoying (devices made for great big hulking man hands) to downright exclusionary (life-improving tech inaccessible to women).
A 2010 expert paper prepared by Danish researchers for the United Nations stated that, “The basic premises for developing advanced electronic products, like a TV, a hifi-system, a mobile phone or a GPS, seem to a large degree to be dominated by male thinking.”
It’s not hard to see the effects. Sociologist Zeynep Tufekci reported her irritation at not being able to document tear gas use in Turkey because her phone was too big for her to take pictures one-handed. “All my photos from that event are obviously unusable for one simple reason: good smartphones are designed for male hands,” she wrote in a post on Medium, and explained that she couldn’t find a smaller phone that met her other requirements.
“I cursed that what was taken for granted by the male designers and male users of modern phones was simply not available to me,” Tufekci recalled. It’s a frustration I’ve shared many a time, and I’m not small—by women’s standards. It’s just that women’s hands are on average a whole 17mm shorter than men’s.
Designs often fail to take into account these basic and unchangeable physical limitations of smaller (and therefore more often female) bodies; many apparently unisex gadgets might as well carry a “for men” label. That’s without even considering the different needs and desires of women when it comes to actual technical functionality, not to mention the failure of most tech companies to take women into account in their marketing efforts. A product that women can physically comfortably use doesn’t seem much to ask.
Back to artificial hearts, and even when there’s no physical reason women can’t use a device, the evidence suggests they won’t have equal access. Carmagnol pointed me to a study that showed women were more likely than men to benefit from a particular type of pacemaker—but less likely to get it.
FDA researchers explained that one reason for this was that treatment guidelines for the pacemaker were based on clinical trials, and the clinical trials were mainly done in men. But women benefited from the device at a different level of heart function than men, so the guidelines didn’t reflect their needs. Though the design was ostensibly unisex, it was clearly geared towards men.
It all goes to show how the different requirements of the sexes need to be considered at every stage of design, to avoid the risk of denying around half the population the opportunity to benefit from technological innovations. I can’t help but think that if an apparently universal device were unsuitable for use by more than 50 percent of men, it would simply be considered unfit for purpose.
xx is a column about occurrences in the world of tech, science, and the internet that have to do with women. It covers the good, the bad, and the otherwise interesting gender developments in the Motherboard world.
