Dupont Hospital to implement sex-based health care

Treatment plans will reflect studies that show disease, drugs affect men and women differently.

By Jennifer Boen of The News-Sentinel

Men and women are different. Now, a new initiative from Dupont Hospital — gender-based health care — makes the difference clearer than ever.

“Our goal is to try to raise the awareness that gender does play a role (in care),” said Karen Springer, Dupont’s chief operating officer.

As a result, hospital staff could get continuing education about the differing ways men and women react to medications. Patients, meanwhile, could be armed with information about the treatment differences between men and women.

Consider:

If you are a woman with heart blockage requiring bypass surgery, you’re nearly twice as likely to die afterward than a man.
While lung cancer mortality rates among men have dropped, they have risen in women the past 15 years; lung cancer is now the No. 1 cause of cancer deaths in women.
While men are rarely screened for osteoporosis, one in four will have an osteoporosis-related fracture after 50; for women it’s one in two.
While women and men get colon cancer at about the same rates, more men get a screening colonoscopy than women.

These facts from the National Center on Health Statistics, the U.S. Centers for Disease Control and Prevention, and the American Heart Association are proof that men and women need different types of health care.

“People didn’t think that there were gender differences in medicine,” said Dr. Kathryn Sandberg, director of Georgetown University’s Center for the Study of Sex Differences in Health, Aging and Disease in Washington, D.C. “While they understood dosage had to be altered for women compared to men because of weight differences, they didn’t realize there was more to it than that.”

In her own research on gender differences, Sandberg has found estrogens protect both females and males from the development of kidney and cardiovascular disease, while androgens, such as testosterone, hasten the progression of the disease in both sexes.

“Hormones are key in studying these diseases,” she said.

The chromosomal differences between men and women also are significant factors in how disease affects men and women.

Because of the protective nature of estrogen, “for a long time there’s been a bias in the medical community that we just don’t have to worry as much about the female,” Sandberg said.

As recently as nine years ago, a Gallup survey said 88 percent of doctors didn’t realize there were different symptoms in men and women for diagnosing heart attacks.

Changing traditional thinking and putting the new paradigm into action is what Springer and Eastlund envision for Dupont.

“What we want to do is develop clinical pathways of care that address the role gender plays,” said Dr. Marvin Eastlund, vice president of Dupont Hospital/physician liaison and women’s health.

At the hospital, staffers might need continuing education in the different ways men and women metabolize pain medications. For example, ibuprofen, the drug found in Advil, has been shown to provide significant relief for men but not women. Women respond well to kappa opioids, the morphine-like painkiller often used in dental surgery. Those opioids, however, can actually increase men’s pain at certain dosages. It is believed the difference centers on the fact men and women use different parts of the brain to elicit pain relief.

Research also has shown the female hormone estrogen affects the amount of dopamine released into the blood stream. Dopamine is one of the “feel-good” chemicals in the body. If a woman uses an addictive substance, like tobacco or alcohol, the increased dopamine spikes a woman’s pleasurable sensations, making it more likely she’ll be the victim of addiction.

If a woman’s addiction to smoking is stronger than a man’s, she faces a double whammy because she metabolizes tobacco’s carcinogens differently than a man. Female smokers are more likely to develop two types of lung cancer that are more fatal than a more treatable form that men are more likely to develop.

Patients must be armed with as much information as possible, Springer said. “I envision a rack of information for men and women when they go for outpatient lab work or to their primary health care physician’s office.”

Because women are primary promoters of health in families, “we’ll have to address other ways of getting the information to men,” she said.

Differences must be addressed not only before and during treatment but also after hospitalization. For example, a woman who enters the hospital for hip replacement surgery is likely to have different instructions upon her release than a man, Springer said. “The reality is, for women, they may go home and still try to do the laundry and other things around the house that are their normal responsibility.”

Eastlund said as gender-based health care takes shape, Dupont staff will gather data and look at outcomes.

Sandberg said more hospitals and caregivers will follow Dupont’s lead. “I think we’re definitely moving in the direction of giving gender-specific medicine. We’re going to see there really are differences. What we learn about women can benefit men and vice versa.”

Women, men and heart disease

Perhaps heart disease is most indicative of differences between men’s and women’s health-care needs:

The majority of sudden cardiac deaths occur in women, but only 20 percent of all implanted cardiac defibrillators are placed in women.
Within one year of a recognized heart attack, 38 percent of women will die; 25 percent of men will.
Women currently comprise only 25 percent of all participants in heart-related research studies.
Typical symptoms for men having a heart attack include crushing chest pain, cold sweats and pain radiating to the shoulder, neck, back or arm. Women’s symptoms are less predictable, according to studies by the National Institutes of Health. They might include weakness, body aches, overall feeling of illness, a burning sensation in the chest similar to heartburn, and mild discomfort in the chest or back.
A study from the National Institutes of Health showed 95 percent of female heart attack survivors had new or unusual symptoms a month or more before attack. Seventy percent reported unusual fatigue, 48 percent reported sleep disturbance and 42 percent shortness of breath.

Sources: National Institutes of Health, National Heart Savers Association, American Heart Association