0:00:01.040,0:00:03.664 Some of my most wonderful memories of childhood 0:00:03.664,0:00:06.968 are of spending time with my grandmother, Mamar [???], 0:00:06.968,0:00:10.768 in our four-family home in Brooklyn, New York. 0:00:10.768,0:00:13.720 Her apartment was an oasis. 0:00:13.720,0:00:16.289 It was a place where I could sneak a cup of coffee, 0:00:16.289,0:00:19.600 which was really warm milk [br]with just a touch of caffeine. 0:00:19.600,0:00:21.888 She loved life. 0:00:21.888,0:00:24.798 And although she worked in a factory, 0:00:24.798,0:00:27.970 she saved her pennies and she traveled to Europe. 0:00:27.970,0:00:31.608 And I remember poring over those pictures with her 0:00:31.608,0:00:34.935 and then dancing with her to her favorite music. 0:00:34.935,0:00:39.864 And then, when I was eight and she was sixty, 0:00:39.864,0:00:42.024 something changed. 0:00:42.024,0:00:44.440 She no longer worked or traveled. 0:00:44.440,0:00:46.408 She no longer danced. 0:00:46.408,0:00:48.992 There were no more coffee times. 0:00:48.992,0:00:51.408 My mother missed work and took her to doctors 0:00:51.408,0:00:53.578 who couldn't make a diagnosis. 0:00:53.578,0:00:58.976 And my father, who worked at night, [br]would spend every afternoon with her -- 0:00:58.976,0:01:02.008 just to make sure she ate. 0:01:02.008,0:01:06.576 Her care became all-consuming for our family. 0:01:06.576,0:01:08.840 And by the time a diagnosis was made, 0:01:08.840,0:01:10.928 she was in a deep spiral. 0:01:10.928,0:01:14.489 Now many of you will recognize her symptoms. 0:01:14.489,0:01:17.352 My grandmother had depression. 0:01:17.352,0:01:20.688 A deep, life-altering depression, 0:01:20.688,0:01:23.456 from which she never recovered. 0:01:23.456,0:01:27.592 And back then, so little was known about depression. 0:01:27.592,0:01:30.136 But even today, 50 years later, 0:01:30.136,0:01:33.656 there's still so much more to learn. 0:01:33.656,0:01:38.840 Today, we know women are 70 percent more likely 0:01:38.840,0:01:42.216 to experience depression over their lifetimes 0:01:42.216,0:01:44.112 compared with men. 0:01:44.112,0:01:47.168 And even with this high prevalence, 0:01:47.168,0:01:53.024 women are misdiagnosed between [br]30 and 50 percent of the time. 0:01:53.024,0:01:56.480 Now we know that women are more likely 0:01:56.480,0:02:01.056 to experience the symptoms [br]of fatigue, sleep disturbance, 0:02:01.056,0:02:04.736 pain and anxiety compared with men. 0:02:04.736,0:02:07.112 And these symptoms are often overlooked 0:02:07.112,0:02:10.106 as symptoms of depression. 0:02:10.106,0:02:14.032 And it isn't only depression in which [br]these sex differences occur, 0:02:14.032,0:02:18.090 but they occur across so many diseases. 0:02:18.090,0:02:20.512 So it's my grandmother's struggles 0:02:20.512,0:02:23.936 that have really led me on a lifelong quest. 0:02:23.936,0:02:27.395 And today, I lead a center in which the mission 0:02:27.395,0:02:31.128 is to discover why these sex differences occur 0:02:31.128,0:02:33.106 and to use that knowledge 0:02:33.106,0:02:36.112 to improve the health of women. 0:02:36.112,0:02:40.168 Today, we know that every cell has a sex. 0:02:40.168,0:02:44.136 Now, that's a term coined by the Institute of Medicine. 0:02:44.136,0:02:47.728 And what it means is that [br]men and women are different 0:02:47.728,0:02:52.216 down to the cellular and molecular levels. 0:02:52.216,0:02:57.264 It means that we're different [br]across all of our organs. 0:02:57.264,0:03:01.728 From our brains to our hearts, our lungs, our joints. 0:03:01.728,0:03:07.184 Now, it was only 20 years ago that we 0:03:07.184,0:03:10.424 hardly had any data on women's health 0:03:10.424,0:03:13.383 beyond our reproductive functions. 0:03:13.383,0:03:15.992 But then in 1993, 0:03:15.992,0:03:20.712 the NIH Revitalization Act was signed into law. 0:03:20.712,0:03:23.376 And what this law did was it mandated 0:03:23.376,0:03:27.957 that women and minorities be included in clinical trials 0:03:27.957,0:03:32.001 that were funded by the National Institutes of Health. 0:03:32.001,0:03:34.904 And in many ways, the law has worked. 0:03:34.904,0:03:38.420 Women are now routinely included in clinical studies, 0:03:38.420,0:03:40.856 and we've learned that there are major differences 0:03:40.856,0:03:42.841 in the ways that women and men 0:03:42.841,0:03:45.162 experience disease. 0:03:45.162,0:03:47.112 But remarkably, 0:03:47.112,0:03:52.016 what we have learned about these [br]differences is often overlooked. 0:03:52.016,0:03:56.616 So, we have to ask ourselves the question: 0:03:56.616,0:04:00.928 Why leave women's health to chance? 0:04:00.928,0:04:03.787 And we're leaving it to chance in two ways. 0:04:03.787,0:04:07.408 The first is that there is so much more to learn 0:04:07.408,0:04:09.816 and we're not making the investment 0:04:09.816,0:04:14.107 in fully understanding the extent [br]of these sex differences. 0:04:14.107,0:04:18.736 And the second is that we aren't [br]taking what we have learned, 0:04:18.736,0:04:22.256 and routinely applying it in clinical care. 0:04:22.256,0:04:26.168 We are just not doing enough. 0:04:26.168,0:04:28.488 So, I'm going to share with you three examples 0:04:28.488,0:04:32.256 of where sex differences have [br]impacted the health of women, 0:04:32.256,0:04:34.572 and where we need to do more. 0:04:34.572,0:04:37.008 Let's start with heart disease. 0:04:37.008,0:04:41.957 It's the number one killer of women [br]in the United States today. 0:04:41.957,0:04:45.342 This is the face of heart disease. 0:04:45.344,0:04:47.563 Linda is a middle-aged woman, 0:04:47.563,0:04:49.979 who had a stent placed in one of the arteries 0:04:49.979,0:04:52.088 going to her heart. 0:04:52.088,0:04:55.330 When she had recurring symptoms [br]she went back to her doctor. 0:04:55.330,0:04:57.168 Her doctor did the gold-standard test -- 0:04:57.168,0:05:00.424 a cardiac catheterization. 0:05:00.424,0:05:02.688 It showed no blockages. 0:05:02.688,0:05:04.944 Linda's symptoms continued. 0:05:04.944,0:05:07.248 She had to stop working. 0:05:07.248,0:05:10.080 And that's when she found us. 0:05:10.080,0:05:14.240 When Lynda came to us, we did [br]another cardiac catheterization 0:05:14.240,0:05:17.488 and this time, we found clues. 0:05:17.488,0:05:20.084 But we needed another test 0:05:20.084,0:05:22.496 to make the diagnosis. 0:05:22.496,0:05:27.136 So we did a test called an intracoronary ultrasound, 0:05:27.136,0:05:29.904 where you use soundwaves to look at the artery 0:05:29.904,0:05:32.480 from the inside out. 0:05:32.480,0:05:34.479 And what we found 0:05:34.479,0:05:36.776 was that Linda's disease didn't look like 0:05:36.776,0:05:39.432 the typical male disease. 0:05:39.432,0:05:43.015 The typical male disease looks like this. 0:05:43.015,0:05:46.370 There's a discrete blockage or stenosis. 0:05:46.370,0:05:50.578 Linda's disease, like the disease of so many women, 0:05:50.578,0:05:52.899 looks like this. 0:05:52.899,0:05:55.880 The plaque is laid down more evenly, more diffusely 0:05:55.880,0:05:59.776 along the artery, and it's harder to see. 0:05:59.776,0:06:03.104 So for Linda, and for so many women, 0:06:03.104,0:06:06.904 the gold-standard test wasn't gold. 0:06:06.904,0:06:09.953 Now, Lynda received the right treatment. 0:06:09.953,0:06:11.792 She went back to her life and fortunately, today 0:06:11.792,0:06:14.096 she is doing well. 0:06:14.096,0:06:15.504 But Lynda was lucky. 0:06:15.504,0:06:18.176 She found us, we found her disease. 0:06:18.176,0:06:21.180 But for too many women, that's not the case. 0:06:21.180,0:06:23.448 We have the tools. 0:06:23.448,0:06:26.960 We have the technology to make the diagnosis. 0:06:26.960,0:06:30.249 But it's all too often that these sex diffferences 0:06:30.249,0:06:31.816 are overlooked. 0:06:31.816,0:06:34.726 So what about treatment? 0:06:34.726,0:06:37.544 A landmark study that was published two years ago 0:06:37.544,0:06:40.120 asked the very important question: 0:06:40.120,0:06:45.056 What are the most effective treatments [br]for heart disease in women? 0:06:45.056,0:06:48.665 The authors looked at papers [br]written over a 10-year period, 0:06:48.665,0:06:51.312 and hundreds had to be thrown out. 0:06:51.312,0:06:55.578 And what they found out was that [br]of those that were tossed out, 0:06:55.578,0:06:59.432 65 percent were excluded 0:06:59.432,0:07:04.072 because even though women [br]were included in the studies, 0:07:04.072,0:07:10.336 the analysis didn't differentiate [br]between women and men. 0:07:10.336,0:07:13.281 What a lost opportunity. 0:07:13.281,0:07:15.665 The money had been spent 0:07:15.665,0:07:17.904 and we didn't learn how women fared -- 0:07:17.904,0:07:20.659 and these studies could not contribute one iota 0:07:20.659,0:07:23.215 to the very, very important question: 0:07:23.215,0:07:25.436 What are the most effective treatments 0:07:25.436,0:07:28.608 for heart disease in women? 0:07:28.608,0:07:33.408 I want to introduce you to [br]Hortense [???], my godmother, 0:07:33.408,0:07:37.312 Hung Way [???], a relative of a colleague, 0:07:37.312,0:07:39.488 and somebody you may recognize -- 0:07:39.488,0:07:43.120 Dana, Christopher Reeve's wife. 0:07:43.120,0:07:47.480 All three women have something [br]very important in common. 0:07:47.480,0:07:51.224 All three were diagnosed with lung cancer, 0:07:51.224,0:07:53.984 the number one cancer killer of women 0:07:53.984,0:07:56.808 in the United States today. 0:07:56.808,0:08:00.546 All three were non-smokers. 0:08:00.546,0:08:05.048 Sadly, Dana and Hung Way [???] died of their disease. 0:08:05.048,0:08:11.251 Today, what we know is that women who are[br]non-smokers are three times more likely 0:08:11.251,0:08:14.665 to be diagnosed with lung cancer than are men 0:08:14.665,0:08:16.867 who are non-smokers. 0:08:16.867,0:08:20.280 Now interestingly, when women are [br]diagnosed with lung cancer, 0:08:20.280,0:08:23.520 their survival tends to be better than that of men. 0:08:23.520,0:08:25.272 Now here are some clues. 0:08:25.272,0:08:27.656 Our investigators have found that there are 0:08:27.656,0:08:32.128 certain genes in the lung tumor [br]cells of both women and men. 0:08:32.128,0:08:34.504 And these genes are activated 0:08:34.504,0:08:36.872 mainly by estrogen. 0:08:36.872,0:08:39.520 And when these genes are over-expressed, 0:08:39.520,0:08:42.344 it's associated with improved survival 0:08:42.344,0:08:44.903 only in young women. 0:08:44.903,0:08:46.807 Now this is a very early finding 0:08:46.807,0:08:50.082 and we don't yet know whether it has relevance 0:08:50.082,0:08:52.600 to clinical care. 0:08:52.600,0:08:56.104 But it's findings like this that may provide hope 0:08:56.104,0:08:59.240 and may provide an opportunity to save lives 0:08:59.240,0:09:01.526 of both women and men. 0:09:01.526,0:09:03.568 Now let me share with you an example 0:09:03.568,0:09:07.024 of when we do consider sex differences,[br]it can drive the science. 0:09:07.024,0:09:09.552 Several years ago a new lung cancer drug 0:09:09.552,0:09:11.120 was being evaluated, 0:09:11.120,0:09:15.400 and when the authors looked at whose tumors shrank, 0:09:15.400,0:09:18.864 they found that 82 percent were women. 0:09:18.864,0:09:21.904 This led them to ask the question: Well, why? 0:09:21.904,0:09:23.336 And what they found 0:09:23.336,0:09:26.847 was that the genetic mutations that the drug targeted 0:09:26.847,0:09:29.512 were far more common in women. 0:09:29.512,0:09:31.273 And what this has led to 0:09:31.273,0:09:33.578 is a more personalized approach 0:09:33.578,0:09:37.440 to the treatment of lung cancer [br]that also includes sex. 0:09:37.440,0:09:39.704 This is what we can accomplish 0:09:39.704,0:09:43.668 when we don't leave women's health to chance. 0:09:43.668,0:09:46.784 We know that when you invest in research, 0:09:46.784,0:09:48.264 you get results. 0:09:48.264,0:09:52.648 Take a look at the death rate from breast cancer over time. 0:09:52.648,0:09:55.220 And now take a look at the death rates 0:09:55.220,0:09:57.984 from lung cancer in women over time. 0:09:57.984,0:10:01.824 Now let's look at the dollars invested in breast cancer -- 0:10:01.824,0:10:04.192 these are the dollars invested per death -- 0:10:04.192,0:10:08.544 and the dollars invested in lung cancer. 0:10:08.544,0:10:13.757 Now it's clear that our investment in breast cancer 0:10:13.757,0:10:15.653 has produced results. 0:10:15.653,0:10:17.909 They may not be fast enough, 0:10:17.909,0:10:20.181 but it has produced results. 0:10:20.181,0:10:22.001 We can do the same 0:10:22.001,0:10:26.685 for lung cancer and for every other disease. 0:10:26.685,0:10:30.038 So let's go back to depression. 0:10:30.038,0:10:32.474 Depression is the number-one cause 0:10:32.474,0:10:37.189 of disability in women in the world today. 0:10:37.189,0:10:39.309 Our investigators have found 0:10:39.309,0:10:41.341 that there are differences in the brains 0:10:41.341,0:10:42.709 of women and men 0:10:42.709,0:10:45.813 in the areas that are connected with mood. 0:10:45.813,0:10:47.717 And when you put men and women 0:10:47.717,0:10:49.670 in a functional MRI scanner -- 0:10:49.670,0:10:54.002 that's the kind of scanner that shows how the brain is functioning when it's activated -- 0:10:54.002,0:10:58.168 so you put them in the scanner [br]and you expose them to stress. 0:10:58.168,0:11:02.007 You can actually see the difference. 0:11:02.007,0:11:04.782 And it's findings like this 0:11:04.782,0:11:08.149 that we believe holds some of the clues 0:11:08.149,0:11:11.547 for why we see these very significant sex differences 0:11:11.547,0:11:13.217 in depression. 0:11:13.217,0:11:15.221 But even though we know 0:11:15.221,0:11:17.597 that these differences occur, 0:11:17.597,0:11:20.557 66 percent 0:11:20.557,0:11:24.829 of the brain research that begins in animals 0:11:24.829,0:11:27.109 is done in either male animals 0:11:27.109,0:11:31.349 or animals in whom the sex is not identified. 0:11:31.349,0:11:35.023 So, I think we have to ask again the question: 0:11:35.023,0:11:39.555 Why leave women's health to chance? 0:11:39.555,0:11:42.582 And this is a question that haunts those of us 0:11:42.582,0:11:44.517 in science and medicine 0:11:44.517,0:11:50.429 who believe that we are on the verge [br]of being able to dramatically improve 0:11:50.429,0:11:52.582 the health of women. 0:11:52.582,0:11:55.053 We know that every cell has a sex. 0:11:55.053,0:11:57.917 We know that these differences are often overlooked. 0:11:57.917,0:12:02.093 And therefore we know that women [br]are not getting the full benefit 0:12:02.093,0:12:05.829 of modern science and medicine today. 0:12:05.829,0:12:07.709 We have the tools 0:12:07.709,0:12:11.653 but we lack the collective will and momentum. 0:12:11.653,0:12:14.381 Women's health is an equal rights issue 0:12:14.381,0:12:17.781 as important as equal pay. 0:12:17.781,0:12:20.119 And it's an issue of the quality 0:12:20.119,0:12:23.290 and the integrity of science and medicine. 0:12:23.290,0:12:29.232 (Applause) 0:12:29.232,0:12:35.405 So imagine the momentum we could achieve 0:12:35.405,0:12:37.486 in advancing the health of women 0:12:37.486,0:12:40.237 if we considered whether these [br]sex differences were present 0:12:40.237,0:12:43.903 at the very beginning of designing research. 0:12:43.903,0:12:47.813 Or if we analyzed our data by sex. 0:12:47.813,0:12:49.885 So, people often ask me: 0:12:49.885,0:12:51.593 What can I do? 0:12:51.593,0:12:53.850 And here's what I suggest: 0:12:53.850,0:12:57.916 First, I suggest that you think about women's health 0:12:57.916,0:12:59.597 in the same way 0:12:59.597,0:13:05.381 that you think and care about other [br]causes that are important to you. 0:13:05.381,0:13:08.517 And second, and equally as important, 0:13:08.517,0:13:10.837 that as a woman, 0:13:10.837,0:13:13.908 you have to ask your doctor 0:13:13.908,0:13:18.197 and the doctors who are caring [br]for those who you love: 0:13:18.197,0:13:22.966 Is this disease or treatment different in women? 0:13:22.966,0:13:26.661 Now this is a profound question [br]because the answer is likely yes -- 0:13:26.661,0:13:30.512 but your doctor may not know [br]the answer, at least not yet. 0:13:30.512,0:13:34.519 But if you ask the question, [br]your doctor will very likely 0:13:34.519,0:13:37.037 go looking for the answer. 0:13:37.037,0:13:39.414 And this is so important -- 0:13:39.414,0:13:41.622 not only for ourselves, 0:13:41.622,0:13:44.229 but for all of those whom we love. 0:13:44.229,0:13:47.791 Whether it be a mother, a daughter, a sister, 0:13:47.791,0:13:51.781 a friend or a grandmother. 0:13:51.781,0:13:54.477 It was my grandmother's suffering 0:13:54.477,0:13:56.517 that inspired my work 0:13:56.517,0:13:59.365 to improve the health of women. 0:13:59.365,0:14:01.821 That's her legacy. 0:14:01.821,0:14:06.229 Our legacy can be to improve the health of women 0:14:06.229,0:14:08.445 for this generation 0:14:08.445,0:14:11.421 and for generations to come. 0:14:11.421,0:14:12.893 Thank you. 0:14:12.893,0:14:16.221 (Applause)