Who would have thought that in 2014 we would be fighting to ensure that women are included in research on diseases and medical drugs and devices? If you find it outrageous, you are not alone.
The fact is that women are different from men. The science backs this up.
Start with our hearts since heart disease is the number one killer of women in America [1]. First, cardiovascular disease in women is different than in men, and women die more often than men after a heart attack [2]. Women's arteries and heart vessels are different than a man's [3]. The symptoms during a heart attack are different, and women bleed more after a heart procedure [4].
Or take Alzheimer's disease, which is more prevalent in women than in men with damage to the brain from Alzheimer's more severe for women [5,6]. Science has shown that women's brains are less tolerant of neural deterioration than men so, as a result, it requires less deterioration of a woman's brain to induce Alzheimer's [7].
Even something as simple as pain shows significant differences in women and men. They can differ in the way they experience pain and pain management [8], including:
•How brains and bodies experience painful sensations
•Behavioral and emotional reactions to dealing with pain
•What influences how and when to talk about pain
These are all important differences yet today they are chronically understudied by the medical community. All of us need to insist upon equal consideration in scientific research for both men and women.
Why would we not want to include women in clinical trials and medical research? Why would we not insist upon something so basic that affects over half of our population?
It is about time that we recognize the importance that sex differences have for health care. For example, medical researchers already know that drugs affect women differently from men: they metabolize drugs differently and they experience side effects differently [9].
Yet too often, drug dosage is based on clinical trials that primarily or exclusively studied men. So this begs the question: Should women feel safe about the medications they take?
We should not assume that drugs affect women just the same way they do men. Although our nation has made progress, more needs to be done to design clinical trials that include women and encourage them to participate.
Researchers also need to analyze and report on biological differences when both women and men are included in a clinical trial. Currently any information about how those differences may impact effectiveness, dosage or possible side effects is usually not known until after the product is on the market. The reality is that we often do not know whether a drug will harm women until after they have started taking it [10].
This means dosage instructions on drug labels should be sex-specific. There are very few prescription drugs in the U.S. with suggested doses that are separate for men and women. If the drug has not been tested on women, then the label should include a disclaimer that says they may be taking something that essentially has not been tested on them.
There are a wide range of sex and gender differences that affect the onset, prevalence and severity of diseases and conditions in women and men. More knowledge of these distinctions is vitally needed as we increasingly move to more personalized care.
Bottom line: The more women know how diseases and treatments may affect them differently from men, the healthier they will be.
The Society for Women's Health Research (SWHR) is dedicated to highlighting how diseases, conditions and treatments affect men and women differently. SWHR also advocates for women to get equal treatment in medical research along with greater analysis of sex differences.
Check back often for the latest facts about sex differences and how to get involved in the fight for health equality. Women deserve better.
Phyllis Greenberger, MSW, is the president and CEO of the Society for Women's Health Research, the national thought leader in the study of biological sex differences.
SWHR advocates for increased public and private funding for women's health, greater inclusion of women and minorities in medical studies, and analysis of the biological differences between men and women in disease and health issues. For more information, visit SWHR.org.
References:
1)Leading Causes of Death in Females United States, 2010. Centers for Disease Control and Prevention.
2)Women More Likely to Die After Heart Attack. WebMD.
3)Bairey Merz CN, Mark S, Boyan BD, et al. Proceeding from the Scientific Symposium: Sex Differences in Cardiovascular Disease and Implications for Therapies. Journal of Women's Health. 2010; 19:1059-1072.
4)McSweeney JC, Marisue C, O'Sullivan P, Elberson K, Moser DK, Garvin BJ. Women's Early Warning Symptoms of Acute Myocardial Infarction. Circulation. 2003; 108: 2619-2623.
5)Greenberger P, Wider J, eds. The Savvy Woman Patient. Herndon, VA: Capital Books Inc; 2006.
6)Vest RS, Pike CJ. Gender, sex steroid hormones and Alzheimer's disease. Hormones and behavior. February 2013; 63:301-307
7)Perneczky R, Drzezga A, Diehl-Schmid J, Li Y, Kurz A. Gender Differences in brain reserve: An 18F-FDG PET study in Alzheimer's disease. Journal of Neurology. 2007; 254: 1395-1400.
8)LeResche L. Gender Considerations in the Epidemiology of Chronic Pain. In: Crombie IK, ed. Epidemiology of Pain. Seattle: IASP Press; 1999: 43-52.
9)Booji LHDJ. Sex, Age and Genetics in Anesthesia. Current Opinion in Anesthesiology. 2008; 21: 462-466.
10)Drug Safety: Most Drugs Withdrawn in Recent Years Had Greater Health Risks for Women. Washington DC: General Accountability Office; 2001.