I stood on the stage at a FemInEM FIX17 event in NYC and stared out to a sold out crown. I was there to deliver one of the many ‘Aha’ moments. While speaking, I noticed the faces in the audience transform into looks of wonder, outrage and then insight and inspiration. I only had ten minutes to make this transformation. Most physicians – in fact you could say most people – do not realize that medicine, science and research have been based upon the male model. That human research subjects are men, animal research is performed using male animals, and even molecular studies are conducted on male cell lines. One hundred years of insight and knowledge gained by experimenting on men has been applied to women.
In fact, the assumption was that if you set aside obvious differences in reproductive systems, men and women were nearly identical. As a result of this, women’s health began to be defined by breast and gynecological health. This “bikini medicine” view seemed status quo until the past decade as more and more questions kept being raised. Why are so many FDA approved medications withdrawn from the market due to unacceptable side effects on women and not men? Why are women more likely than men to develop unusual fatigue and shortness of breath when having a heart attack? The lack of data on women perpetuated the convenient principle that men and women were the same. An informational vortex of mounting evidence that ultimately led us astray.
A major challenge to answering these questions demands that we change the way we think. Initially, the belief was that the sex chromosomes, XX or XY, had a one-time effect, determining the reproductive organs. However, we now know that the sex chromosomes remain active throughout a person’s lifetime and are thought to affect the differences between men and women in the incidence and progression of certain diseases. For example, the preponderance of autoimmune conditions, migraine headaches, and irritable bowl disease in women compared to men are now linked to genes produced by these chromosomes.
Societal roles, defined by gender, also play a crucial role in determining health and susceptibility to disease. Societal norms often condone heavy alcohol consumption in men and not women, which may contribute to increased expression of aggression and lead to greater degrees of violence and traumatic injuries for men. In Vietnam, it is considered unacceptable for women to smoke cigarettes, leading to a striking difference in lung cancer rates by gender. Accounting for our patients’ sex and gender provides us with an opportunity to redefine our current healthcare system into one that accounts for the undeniable influence these inherent parameters have on health and disease.
Challenges remain in finding all the missing pieces in what once was a one-size-fits-all approach to medical research. Advances in molecular genetics are redefining what it means to truly have personalized medical care and the incorporation of the influence of sex and gender is integral to its success. However, the health care system with its many moving parts is often slow to change. Research, medical education and translation of knowledge to the bedside must happen simultaneously in order to affect patient care in any appreciable way.
One way to utilize this new knowledge is with the development of programs similar to the Division of Sex and Gender in Emergency Medicine (SGEM) established in the Department of Emergency Medicine at the Alpert Medical School of Brown University, which conducts research on how sex and gender impact emergency care and creates educational platforms for students, doctors, staff and patients. With formal fellowship training, divisional membership and advocacy programs as well as a community advisory board, the SGEM Division promotes the incorporation of a sex and gender lens as an opportunity to embrace the challenges that this new reality brings to the acute care of patients.
We may have a long way to go before truly individualized health care is mainstream. The overlapping cycle of research, education and patient care must now take into account the sex and gender lens in order for us to have safe, effective and accurate health care. As I walked off the FIX17 stage, many of my conversations with the attendees have one common theme, “It seems so obvious!” I recognized the power of challenging assumptions, the type of transformative power that can illuminate a dark theatre, and for a moment, reveal the differences in men and women.
Link to TED.com = Why Medicine Often Has Dangerous Side Effects for Women
(adapted from the AAWEP fall 2015 newsletter post “The Red Circle: Sex and Gender Make Center Stage”)
Watch the full FIX17 talk below!