What Parkinson’s Research Can Learn from the Fashion and Makeup Industry?

I've spent a number of hours this evening preparing a presentation on managing women with Parkinson's for the Parkinson's UK Pharmacy Network. I have tried my damnedest to find sex differences in research on device-aided infusion therapies for people with Parkinson's, and every paper I've looked at says "this paper does not look at the differences between the sexes."

I suddenly thought, is there any industry where sex differences are paramount to the industry? Of course, fashion and make came to mind.

I asked my friendly ChatGPT to help me put together my thoughts on this topic, because at this hour (11 pm), my meds have well worn off and typing is a challenge. I leave you with my thoughts as I go to bed to top up my dopamine by resting my brain overnight, and I look forward to your comments. 

When people think about innovation in Parkinson’s disease, they usually think about neuroscience, genetics, biomarkers, artificial intelligence, or drug development.

Few people would suggest looking to the fashion or makeup industry for inspiration.

Yet if we want to truly understand Parkinson’s disease—and develop treatments that work for everyone—we may need to borrow a page from industries that have spent decades understanding human diversity.

Because while medicine continues to search for the "average" Parkinson's patient, the fashion and beauty industries have already learned a critical lesson:

The average customer doesn't exist.

And neither does the average person with Parkinson's.

The Problem with Averages

For decades, medical research has been built around averages. Researchers recruit participants, test an intervention, and calculate the average response. If the average effect is positive, the treatment moves forward. If it is not, it may be abandoned.

This approach has delivered enormous advances in healthcare, but it also has limitations.

Averages can hide important differences.

Imagine a trial where one group of participants experiences dramatic benefits while another experiences little or no improvement. The overall average might suggest only a modest effect.

Yet buried within those results could be a breakthrough for a specific subgroup of patients.

The challenge is that Parkinson's disease is extraordinarily heterogeneous. Two people can receive the same diagnosis yet have completely different experiences.

One person may develop tremor-dominant disease and continue working for years with relatively mild disability.

Another may struggle primarily with fatigue, anxiety, constipation, sleep disturbance, or cognitive changes long before motor symptoms become problematic.

Some people develop dyskinesia quickly. Others never do. Some respond beautifully to levodopa. Others have a far more complex treatment journey.

When we average all of these experiences together, important signals can disappear.

Fashion Learned This Lesson Long Ago

Imagine walking into a clothing store where every garment came in only one size.

The retailer explains that it was designed using the measurements of the "average" customer.

Most of us would laugh and walk straight back out.

The fashion industry learned long ago that people come in different shapes, sizes, proportions, lifestyles, and preferences.

Successful brands don't design for averages. They design for segments.

Petite, tall, athletic, curvy, maternity, adaptive clothing, plus-size—the industry recognised that understanding differences is not a problem to overcome but an opportunity to serve customers better.

Today, major fashion brands use sophisticated customer data to understand who buys their products, who doesn't, and why.

They continually ask:

Who are we not serving well enough?

Healthcare should be asking the same question.

The Makeup Industry Took Personalisation Even Further

The beauty industry provides perhaps an even more powerful example. Not so long ago, foundation shades were limited. Many consumers simply couldn't find products that matched their skin tone.

The industry's response was transformative. Companies invested in understanding variation.

Instead of assuming everyone fit within a narrow range of characteristics, they developed increasingly diverse product lines designed to meet the needs of different populations.

The result was not only greater inclusivity but better products. The lesson wasn't simply about offering more options. It was about recognising that meaningful differences matter. When variation is ignored, people are excluded.

When variation is understood, innovation accelerates.

Parkinson's Disease Is Not One Disease

Increasingly, researchers are recognising that Parkinson's may not be a single disease at all. Rather, it may represent multiple biological pathways that ultimately produce similar symptoms. Consider some of the differences we already know exist:

Sex Differences

Women and men experience Parkinson's differently.

Women are more likely to develop dyskinesia, often at lower levodopa doses when adjusted for body weight.

Hormonal changes across the lifespan may influence symptom expression and treatment response. Some studies suggest differences in non-motor symptoms, pain, mood, sleep, and quality of life.

Yet many clinical trials are still not designed to fully explore these differences.

Age of Onset

A person diagnosed at 40 may have a very different disease course compared with someone diagnosed at 75.

Younger-onset Parkinson's is often associated with slower progression but a higher lifetime burden of motor complications.

Life circumstances are also dramatically different.

One person may be raising young children and maintaining a career. Another may already be retired.

The challenges, priorities, and treatment goals are not the same.

Genetics

Researchers have identified multiple genetic forms of Parkinson's, including mutations involving genes such as LRRK2 and GBA1.

These groups may differ biologically and may ultimately respond differently to therapies.

Future treatments may need to be tailored to specific genetic profiles rather than prescribed broadly across all patients.

Body Composition and Metabolism

Two individuals receiving the same levodopa dose may achieve very different drug

levels.

Body weight, muscle mass, gastrointestinal function, gastric emptying, liver metabolism, hormonal status, and dietary patterns can all influence treatment response.

Yet dosing recommendations are still largely standardised.

The beauty industry would never expect one foundation shade to suit everyone.

Why should we assume one dosing strategy will?

We May Be Missing Important Discoveries

One of the greatest risks of averaging data is that we may overlook treatments that work exceptionally well for particular groups.

Imagine a future clinical trial where a therapy produces minimal benefit overall.

The study is deemed negative.

Funding disappears.

Development stops.

Years later, researchers discover that the treatment was highly effective—but only in women under 55, or only in people with a specific genetic profile, or only in those with a particular inflammatory signature.

The signal was there all along.

It was simply buried within the average.

This is not a hypothetical concern.

It has happened repeatedly across medicine.

The Rise of Precision Parkinson's

Fortunately, the field is beginning to change. Researchers are increasingly exploring:

• Sex-specific analyses

• Genetic stratification

• Biomarker-defined subgroups

• Digital phenotyping

• Wearable technology data

• Microbiome signatures

• Lifestyle and environmental influences

• Hormonal status

• Body composition measures

Advances in artificial intelligence make it increasingly possible to identify patterns that were previously invisible.

Instead of treating Parkinson's as a single population, we may soon be able to identify dozens of meaningful subgroups.

This shift mirrors what happened in oncology. Cancer was once discussed as though it were one disease. Today, clinicians recognise hundreds of biologically distinct cancers, each requiring different treatment approaches.

Parkinson's is hopefully heading in the same direction.

Beyond Precision Medicine: Precision Living

The implications extend beyond drug therapies and brain surgery.

Nutrition interventions may work better in some populations than others.

Exercise programmes may need to be adapted according to age, sex, symptom profile, frailty, genetics, or disease stage.

Educational programmes may require different approaches for newly diagnosed individuals, carers, younger adults, older adults, or people from different cultural backgrounds.

The future may not simply be precision medicine. It may be precision living.

A future where care is tailored not just to biology but to the whole person.

What If We Started Asking Better Questions?

The fashion and makeup industries transformed themselves by moving away from averages and embracing diversity. They stopped asking:

"What works for the average customer?"

And started asking: "Who are we missing?"

Parkinson's research could benefit from the same mindset.

Instead of asking:

"Does this treatment work?"

We should increasingly ask:

"Who does this treatment work for?"

"Who benefits most?"

"Who benefits least?"

"Why?"

These questions may be harder to answer. 5But they may also be where the next generation of breakthroughs lies.

Because the future of Parkinson's research may not depend on finding a single solution for everyone.

It may depend on recognising that people with Parkinson's are as diverse as the customers who walk into a fashion store or browse a makeup counter—and designing research that reflects that reality.

Only then will we move closer to truly personalised care.

Author's note: As people living with Parkinson's increasingly contribute data through wearables, symptom trackers, digital platforms, patient-reported outcomes, and real-world evidence studies, we have an unprecedented opportunity to understand the diversity of Parkinson's disease. The challenge for researchers is no longer simply collecting data. It is ensuring that we ask the right questions of it. This may be the moment when Parkinson's research stops looking for the average patient and starts understanding the individual.

Richelle Flanagan, Person living with PD, Co-Founder, My Moves Matter