Generation Equality will herald a new era of Gender Based Research and Therapy
“The story of women’s struggle for equality belongs to no single feminist nor to any one organization but to the collective efforts of all who care about human rights” Gloria Steinem
Women are not Mini-Men. Our health needs, risks and goals are different. Our two X chromosomes, our estrogen and other hormones, our body size and composition differ drastically from our male counterparts, requiring a rethinking of biomedical research protocol that has until now eliminated female subjects from early research.
The United Nations has declared the theme for this year’s International Women’s Day as one of “Generation Equality” to herald in a new era of gender parity. However, when it comes to biomedical research and medical innovation equality is not the goal. Rather, women need to be prioritized as unique with their health needs shaping a new agenda of biomedical research that from the start focuses on their unique needs and metabolism rather than systematically excluding them.
Because of the biomedical gender gap, we have a very poor understanding of female specific risks leading to major diseases like heart disease, stroke, cancer and dementia. It is unclear what factors are most relevant for women to address in the early stages of disease to prevent potentially life threatening complication. Men may be more readily diagnosed then women and available treatments are likely to work better, as females are routinely excluded from early stage research. Not only do they work better, but therapies are more likely to be recommended. It is clear that these inequities are hindering medical progress when it comes to women’s health.
Across most health indices, women’s life expectancy and health status has benefited less than men by the medical progress of the past century. While women are outliving men by an average 6.3 years, they enjoy only an additional 1.5 years of disability-free years of life. This paradox points to an emerging gender gap in biomedical advancement.
Indeed, with a “male-centric” focus, biomedical research has yielded meaningful improvements in the detection and management of diseases that affect men, such as heart disease, more so than those that disproportionately affect women; such as chronic pain, depression, autoimmune disease and breast cancer. And it is not only the research agenda that is male-focused, but so too the subjects.
There is a significant sex bias in drug trials with serious under-representation of females throughout biomedical studies; from basic research to human clinical trials. While the average chronic pain patient is a 55-year old woman, the average chronic pain research subject is a male mouse. Females are excluded from both animal and human clinical trials often due to concerns about the variability introduced by their hormonal cycles. Simply, it is easier to study males. As a result, sex differences in drug effects and metabolism have largely been over looked. But they matter. Variable pharmacodynamics or drug metabolism means that there may be risk of drug toxicity or, conversely, a lack of therapeutic effect. Illustrating this problem is the case of “Ambien”, a commonly prescribed sleep medication used in the US. Reports of excess sedation in women due to slower metabolism prompted health regulators for the first time to recommended lower dosages of the drug in women. Gender specific dosing and treatment protocols are likely to be more common in the future.
The study of epigenetics or gene expression is revealing how a shared genetic substrate may be differently expressed in men and women. Approximately 70% of the human genome shows sex-biased expression contributing to the gender differences seen in biology, behavior, and susceptibilities. Lifestyle factors and environmental exposures affect the health of women differently than men. Heart disease is a case in point. The traditional risks, such as high cholesterol and blood pressure, are more specific to men. Diabetes, metabolic syndrome, smoking, hormonal status and stress, increase risk to a greater extent in women than in men. Accounting for the differentiated expression of the genome between the sexes will be necessary to the development of gender specific preventative health strategies.
So what does Generation Equality mean for medical progress in women’s health? Well, firstly that women are NOT equal but rather require unique consideration from target setting to treatment administration. The winds of change are blowing. Women are not mini-men. With this new era of biomedical research, we must require a greater consideration of gender differences that exist from bench to bedside and the development of strategies to prevent, detect and treat disease accordingly.