"American Institute Directs Itself toward Medical Gender Differences"
September 24, 2005
Translated from the Dutch by Lane Vander Hoek
Women as Research Objects
In the 70’s feminists intoned that men and women are equal, but in the meantime we know that men and women are two totally different beings, with each having their own share of good and bad characteristics. But this knowledge seems to penetrate the medical community only slowly. It seems, for example, that men react to some medications very differently (from women) and that certain diseases strike women more often than men. The Georgetown University in Washington has opened the Center for the Study of Sex Differences in Health, Aging and Disease (CSD, an institute, which specially directs its studies to the research of medical gender differences.
To give some for examples of the medical and biochemical differences between men and women (and we are not talking about the fact that women cannot get prostate cancer, nor men can get uterine cancer), paracetamol and aspirin are less effective for women. Women are more likely to get autoimmune diseases such as multiple sclerosis (MS) and scleroderma (a chronic skin condition). Her stomach digests contents more slowly and women are more frequently than men addicted to sedatives or sleep aids, while men or more likely to be addicted to alcohol. Women react to pain differently from men. These are biological differences that go much deeper than sex organs or hormones.
There are individual researchers in the world who are preoccupied with the differences between men and women (also in Holland) but large institutions scantily so. The Center for the Study of Sex Differences in Health, Aging and Disease (CSD) in Washington DC is one of the few. It houses no less than 60 researchers, headed by Kathryn Sandberg, the woman who spearheaded this idea.
Guinea Pigs (research subjects)
The most important reasons for so little sex specific research are a lack of money and the menstruation cycle. The changes in hormone levels can influence research results. “That is why laboratories generally work with male test animals”, says Kathryn Sandberg, who is also a professor in the medical community and whose specialties are nephrology (the study of kidney diseases) and hypertension (high blood pressure). If one wants to include female subjects in one’s research this become more expensive, since such studies are more complex and also more time consuming. I do think, however, if the pharmaceutical industry were to produce medicines more fitted to women’s needs, women would be willing to pay for those. Investments in such research will ultimately be proven cost effective. “Research into medical gender differences does not, however, benefit only women”, Ms. Sandberg hastened to add. “Those very differences will also provide insights for men.”
According to spokeswoman Rixt Meines of Nefarma, the Dutch Organization of the Research-oriented Pharmaceutical Industry, we also need to take the time period in consideration. If researched used to be focused mostly on “if and how” people were affected by diseases and medicines, today gender is the research trend for medications. “And may be in ten years one can already determine at the DNA level how medicines will work among people,” suggests Rixt Meines. “Here in Europe one has held back from using women as research objects, because of the possible variations resulting from the menstrual cycle and also because a woman might be pregnant without knowing it.” Also because of ethnical considerations and fear for damage suits, one continues to be very careful with such research. Think, for example, about the DES and Softenon scandals in the 60s and 70s. In the US until 1993 it is was actually prohibited to use women of childbearing age in medical research studies.
Still another example of the differences between him and her. In the Western world, heart and vascular diseases are the greatest source of death. Men are more likely to die of these than women (in Holland alone one men in five dies before age 65, and one woman in ten, of heart or vascular disease). “Therefore more research is directed at men than women”, says Kathryn Sandberg. “But women who have a heart attack are twice as likely to die than men. What is the reason for this? The symptoms are different. Men most frequently get a crushing pain behind the breastbone, with the pain flaring out over the left arm. Women have back or stomachaches, or display flu like symptoms. How often has it not happened that a woman has gone to her doctor with these complaints and these were not recognized for what they were: a heart attack?”
Now more examples: In general across the world, women have longer life spans than do men. An illness such as schizophrenia manifests itself differently in women than in men. Women who smoke the same amount as men are twice as likely to develop lung cancer and than also have a greater chance to develop the most severe type. Women react differently to methadone or HIV inhibitors, because these medicines are absorbed into their bodies at a different rate. Professor Sandberg: “How that works exactly, we don’t know yet, but women might need to start at a different stage or might need to receive different dosages.”
Also diseases, such as AIDS, cancer and diabetes are experienced differently by men and by women, and sometimes follow a different course. Women have fewer language difficulties after a stroke. Men have a greater chance to develop kidney problems and the disease progresses faster for them. But women, more than men, suffer from depression and have a higher incidence of posttraumatic stress syndrome after a traumatic experience in their lives. Some medicines take longer to take effect in women, because of the higher fat content of a woman’s body. “Luckily I see and hear that researchers are becoming more interested in gender related differences. An institution such as ours can be a good catalyst, and I hope that other countries will follow our example and start similar research centers, resulting in thousands of lives saved each year. And possibly even more once ethnicity, age, weight and DNA also gain momentum (become increasingly important) in medical and pharmaceutical research.”