Medicine, from the start, has always researched male physiology, as a study sample, when studying pathologies, relegating female health to pathologies linked to specific organs and reproduction. Since the 1990s, however, gender medicine has become widespread, given the innovative approach it uses to study the impact of gender- and all gender variables (biological, environmental and socioeconomic)- on physiology and the characteristics of pathologies.
Some history of Gender Medicine
From 1990-1991, thanks to the impetus given by Bernardine Healy, the first woman in history to direct one of the most important health institutes in the world- the United States National Institute of Health- significant research began on normal cardiac physiology and heart disease in women.
In 1993, the FDA issued a series of guidelines so that both genders would be taken into account in the development of drugs and that statistic results would be evaluated separately for each sex.
From that moment on, the whole world began taking on the challenge towards what we now call gender medicine, which aims at identifying the metabolic, physiological and pathological specificity of women compared to men regarding every type of pathology and, consequently, every type of treatment.
Recently, it was established that the theme of “gender” would be a part of the 2014-19 program of the World Health Organization, from which the various nations will establish its application.
Historically, medicine has studied patients independently of their gender and of sociocultural and environmental characteristics. Consequently, treatment was standardized on the basis of the male subject without taking into account fundamental variables such as gender, social status and level of education.
It is, however, obvious that inequalities related to health factors are correlated to other types of inequalities. It is, thus, essential that inequalities are studied in order to understand their influence on the health conditions of men and women.
Many biases and stereotypes must be overcome in research, including in the experimentation of drugs and in the research of risk factors. The following data gives an idea of how some convictions can be so deeply-seated and yet wrong:
- If you ask a woman what disease she is most afraid of, 50% say “breast cancer” and only 13% “heart disease”. Yet, data indicates that 50% of women die of cardiovascular diseases, 25% of cancer and the remaining 25% of other causes.
- Everyone knows that the average life span of women is longer than that of men (in 2015 the average life span for men was 80,1 years and 84.6 for women). Yet how many of these years are lived healthily? From the age of 50, men are expected to live another 20.63 years of good health and women 20.86 years. Women, thus, can expect longer periods of sickness in their old age.
- The main diseases that afflict women, especially in old age, are heart disease, arthritis and dementia, much more than cancer. And yet, research and talk focus greatly on cancer.
- Few doctors, and even fewer women, know that the symptoms of a heart attack are different in women, who more often than not experience gastric pain that radiates to the spine as a symptom.
- Speaking of tumors, a woman’s real enemy is not breast cancer, but lung cancer. The mortality rates of lung cancer for men have declined in every industrialized nation, but have risen for women. Even still, even lung cancer continues to be considered a “male pathology”.
- Two out of three women suffering from diabetes die from heart disease, and yet female diabetes is less controlled. Rarely do women reach normal blood sugar levels or lead a healthy life style that aids in lowering them.
The problem with gender roles
The example of diabetes is emblematic. Is it more difficult for women to lead a healthy lifestyle than for men? The vital point is the role society “imposes” on women, and we are not only speaking of her role as mother and wife, but the delicate, solitary, physically and psychologically demanding role of caregiver. In fact, 80% of caregivers are women. That is a large number, especially in a country like Italy where the percentage of elderly is extremely high. In addition to the temporary job commitment that takes time away from eventual healthy activities, the psychological and physical burden of the role inevitably brings about changes in metabolism and a weakened immune system, which then leads to less diabetes control and many other pathologies.
Moving towards patient centrality
Gender medicine means research on women’s health is no longer limited to specifically-female pathologies, but is a part of gender-specific medicine that treats the whole patient, allowing us to understand the reason behind historical diagnostic and therapeutic failure with regards to women. Gender medicine has brought about some conclusions that may seem obvious, but in light of research on pathologies and the synthesis of drugs, they are novel: a child is not a miniature adult, the physiology of a women is very different from that of a man and elderly people have very specific medical characteristics. Only by moving in this direction is it possible to guarantee every individual of any gender, age or social condition the right treatment, thus reinforcing the concept of patient centrality and personalized treatment, which Domedica has been active in for some time through its Patient Support Programs, its strong point.
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