Why does medicine treat women as well as men? | Society


Towards the end of her emergency medicine training at Brown University, Rhode Island, Dr. Alyson McGregor was asked what her “specialty” would be.

“You are expected to have a niche. So my response was, “Well, I like women’s health,” said McGregor. “From that, people thought, ‘Oh, she’s in obstetrics / gynecology’.” So during the shifts in the emergency department of Rhode Island Hospital, the state’s main trauma center, the newly qualified McGregor became everyone’s doctor of choice for pelvic exams because it was supposed to be his particular interest. “I laugh about it now, but it was when I started to realize that there was this assumption that women’s health is wrapped in their reproduction. The women were men with “breasts and tubes”. “

But McGregor was interested in much more than that. By women’s health, it means the health of all women, whose female chromosomes exist in each cell and influence each bodily function. She wanted to know how these differences – in hormones, tissues, systems and structures – affect each disease and how it should be treated. Cardiovascular health has provided its path.

“About 15 years ago, people realized that women with heart attacks presented themselves differently from men,” she says. “They described different symptoms and had worse results, so I started to ask why; and if we are different this way, what about this way? The more I explored, the more I realized the scope of that. In medicine, we have ignored women because we have used men as the norm – and that has not served women well. “

When a doctor writes a prescription, ask, “Is it specific to me as a woman?

McGregor Explained It In His New Book Gender issues. It’s an awakening, a call to action, a scary and fascinating read. The take-home message is that the body of women is different from that of men from the cellular level, but our medical model is based on knowledge drawn from male cells, male animals and men. Inside that there are a multitude of disturbing details – the diseases that we do not systematically understand in women, the drugs that work in men, while being useless, dangerous or even fatal in the remaining 50% Population. At a time when we hear about “personalized medicine” and “targeted therapies”, it is impossible to read this book without feeling overwhelmed by the failure of science to take it all into account earlier. “It’s a common reaction,” says McGregor. “I often hear,” My God, I thought medicine took this into account! »»

We are talking a few weeks before the book is published – although Gender issues certainly not the intended launch. Instead, McGregor worked long hours in the emergency department because of Covid-19. (Her husband is also a doctor – she tweeted photos of the two of them in their protective gear.) When we Skype for her day off, I ask what life is like right now.

“It’s difficult,” she says. “There is anxiety about being at home and worrying about my family, and then my family is worried about us at work. And then be at work, but don’t recognize anyone because we’re all covered. Covid’s cases in his hospital, McGregor says, are “manageable” and, overall, the volume of his patients is going down. “The message was” Stay home, “” she says. “Although that also worries me, because where are the heart attacks, the complications of dialysis, the infections? I see people with underlying psychiatric problems seeking care, as pandemic restrictions have increased anxiety and depression for many. “

“Women's health is supposed to be wrapped up in reproduction. We are considered men with breasts and tubes ”: Dr. Alyson McGregor in Rhode Island.

“Women’s health is supposed to be wrapped up in reproduction. We are considered men with breasts and tubes ”: Dr. Alyson McGregor in Rhode Island. Photography: Benedict Evans / The Observer

In fact, the data on Covid-19 indicates that it is also a disease that affects men and women differently. Although many countries, including the United States and the United Kingdom, have been slow to publish detailed information on sex, those who have suggested that it could have killed up to twice as many men as women. In the UK, an analysis of 4,000 cases by the Office of National Statistics found the same ratio, while figures from New York City Health suggest that men account for more than 61% of Covid’s deaths. Social differences are a possible cause – in China, for example, many more men are smokers. Biological differences are another. Estrogen helps boost the immune system, but the fact that women have two X chromosomes, which contain a high density of genes linked to immunity, could be decisive. (The men were also disproportionately affected by Sars and Mers.)

“I’m trying to appeal to all countries to start collecting Covid-19 data by gender so that we can have this knowledge ahead of time,” said McGregor. “In the H1N1 [swine flu] It wasn’t until we started looking at gender differences that we realized that pregnant women were very susceptible to complications. If we have the information, we can look for explanations and target better treatments. And I still don’t see it. “

McGregor believes the reason can be traced back to the beginnings of organized medical research when it was decided that women of childbearing age should be excluded from the trials – thereby effectively eliminating gender differences. The reason was to protect them, but for the medical profession and the pharmaceutical industry, it also made work faster, easier, and cheaper by removing pesky variables such as menstrual cycles and hormone surges. In Gender issues, McGregor lists several ways in which today’s medications can still cause women to fail as a direct result. Women metabolize drugs differently (there are many reasons, but many are linked to different hormones and different levels of enzymes), so some drugs stay in the system longer or drop to dangerously low levels at certain moments of the menstrual cycle. McGregor also shows how common fillers used in generic drugs – which are usually only tested for two weeks in a group of healthy men – can affect bioavailability (the amount of drug that will reach the body and work as expected) in women up to 24%, which is why she often asks to present to patients if they have recently switched to a generic.

A particularly frightening example is the impact of drugs on our QT – it’s the rest time between heartbeats. A woman’s QT is already longer than that of a man (following a testosterone surge in adolescents) and many prescription drugs – pain relievers, antidepressants, antihistamines, antibiotics – cause an incremental increase in QT as a side effect. For women taking multiple medications (and statistically, women are more likely to take multiple medications), the risk of these combined increases can range from simple arrhythmias to sudden cardiac death.

McGregor gives the example of a patient, a woman in her forties whose back pain led to a common spiral of drugs – pain relievers then sleeping pills then steroids then anti-anxiety drugs, and finally an antibiotic for a urinary tract infection. This cocktail, she thinks, caused the patient’s sudden cardiac death, which she says is “more common than many doctors would like it to be.” A German study found that 66% of patients with long QT syndrome were women – and among them, 60% were drug-related.

“Hydroxychloroquine, the drug tested for the treatment of Covid [and hyped by Donald Trump]also has the side effect of prolonging the QT interval, “said McGregor. “If it’s prescribed to a woman, we should measure her QT interval first, but it’s not even in the discussion. In fact, she is concerned that in the race to find a Covid vaccine, the return to standard research protocols (male cells, male animals and no gender-based analysis of human trials) could lead to dangerous knowledge gaps.

Some of the areas covered by Gender issues are already in the public eye. The British Heart Foundation is halfway through a three-year campaign to tackle what it calls “the gender gap in heart attacks” – a British woman is 50% more likely than a man to receive an initial misdiagnosis for a heart attack and, even after correct diagnosis, much less likely to receive life-saving treatment. One reason could be that the symptoms of women do not always correspond to earlier models centered on men. In men, plaque tends to build up, causing the blood vessels to rupture. In women, the plaque is more likely to erode gradually, making the blood vessels more rigid and less flexible over time.

Julie Ward is a senior heart nurse at the British Heart Foundation who worked with the campaign’s multi-stakeholder parliamentary group. “Coronary care is male-centered,” she says. “Treated by men using research by men on men. We are just beginning to understand the different physiologies. Part of our campaign is to encourage more British women to enroll in the trials, as well as to encourage more women to become cardiologists. “

Another area where women are underserved is our pain treatments. Epidemiological studies clearly show that women are at greater risk of suffering from pain – from migraines to musculoskeletal disorders, from IBS to PMS. The interaction between sex hormones, neurotransmitters, such as dopamine and serotonin, and the central nervous system is one of the main reasons (a study of hormone-treated transsexuals found that half of those who switch from woman to man reported improvement in chronic pain).

When a man says he suffers a little, we think he suffers a lot. When a woman says it, she thinks she is worried

There are also female XX chromosomes that create these aggressive immune responses that are so effective in fighting disease, but also prone to activation of the body itself (autoimmune diseases, such as lupus and osteoarthritis, are much more common in women). Yet women are more likely than men to receive a psychiatric diagnosis than a physical one (panic attack instead of a heart attack), more likely than men to receive lifestyle advice rather than an exploratory x-ray. during the presentation of IBS – and in the case of “women’s conditions” such as endometriosis, very likely to be told that the pain they feel is “normal”. (In the UK, it takes an average of 7.5 years for women to be diagnosed with endometriosis – and even then, we have developed few effective treatments for this debilitating disease.)

Dr. Amanda Williams, a reader in clinical health psychology at University College London, agrees that women’s pain is generally minimized. “Patient studies show it,” she says. “Women are prescribed fewer painkillers. When a man says he suffers a little, we think he really hurts a lot. When a woman says that she suffers a lot, we think she suffers a little, but she worries about it. “

According to Williams, it goes back to Darwinism and the belief in a big “chain of being,” which places men at the top of the hierarchy and women at the bottom. Beliefs about pain reflected power and status. “Black people endured horrible ordeals and brutality, so we said they were less sensitive to pain, and women endured childbirth, which was quite painful, so we thought they were hypersensitive, prone to hysterics. It was decided that the white European men were pretty much right.

It’s a dark picture, but McGregor is confident that it will change. She is now a recognized sex and gender specialist in emergency medicine at Brown (which covers much more than pelvic exams) and co-founded the Sex and Gender Health Collaborative, a national organization that works to integrate knowledge about sex and gender in medical education. and clinical practice. “It was an interesting development,” she says. “When I first started talking about this, nobody really understood what I was saying or didn’t really care. Most doctors are data-driven – and now there is exponential data that shows just how big gender differences can be. Now I see a different answer when I speak. In 2016, the main research funder in the United States said that you should include gender as a biological variable in your research plan. “

It's too big to wait for the change from top to bottom. It took a lot of grassroots effort to take women's reproductive health seriously ”: Dr. Alyson McGregor.

It’s too big to wait for the change from top to bottom. It took a lot of grassroots effort to take women’s reproductive health seriously ”: Dr. Alyson McGregor. Photography: Benedict Evans / The Observer

Sex Matters was written to educate and empower the rest of us. “It’s too big to wait for a change from top to bottom,” says McGregor. “If you look at past experiences, it took great efforts at the local level for women’s reproductive health to be taken seriously. “

The book is packed with specific advice for patients, ranging from volunteering for medical trials to researching gender differences in prescriptions, recording side effects, participating in patient support groups, keeping records careful treatment of symptoms and treatments and the appointment of a lawyer. She also urges women to be more urgent patients. “When a doctor writes a prescription, ask,” Is it specific to me as a woman? Should I have a different dose? Will I have different side effects? Will this affect my birth control? Should I take a different medication at certain times during my menstrual cycle? “A doctor may not know these answers – but most people who attend medical school take an oath of lifelong learning. I hope the doctors say, “Let me take a look.” “

Although McGregor thinks it can be done in 10 years, the magnitude of the change required seems enormous. “Yes,” she agrees cheerfully, “mammoth!” I absolutely agree – and I don’t apologize. Each assumption is based on the one before and the one before – and if it was all male, unfortunately we have to start from scratch. But I think it’s a moral obligation that we have for half the population. “

Gender issues: how Male-Central Drug Endangers women Health and What we Can To do About It, by Dr. Alyson J McGregor, is published by Quercus at € 16.99. Buy a copy of guardianbookshop.com for £ 14.78


Please enter your comment!
Please enter your name here