9:59:59.000,9:59:59.000 We all go to doctors, 9:59:59.000,9:59:59.000 and we do so with trust and blind faith 9:59:59.000,9:59:59.000 that the test they are ordering[br]and the medications they're prescribing 9:59:59.000,9:59:59.000 are based upon evidence, 9:59:59.000,9:59:59.000 evidence that's designed to help us. 9:59:59.000,9:59:59.000 However, the reality is 9:59:59.000,9:59:59.000 that that hasn't always[br]been the case for everyone. 9:59:59.000,9:59:59.000 What if I told you that the medical[br]science discovered over the past century 9:59:59.000,9:59:59.000 has been based on[br]only half the population? 9:59:59.000,9:59:59.000 I'm an emergency medicine doctor. 9:59:59.000,9:59:59.000 I was trained to be prepared[br]in a medical emergency. 9:59:59.000,9:59:59.000 It's about saving lives.[br]How cool is that? 9:59:59.000,9:59:59.000 Okay, there's a lot of runny noses[br]and stubbed toes, 9:59:59.000,9:59:59.000 but no matter who walks[br]through the door to the ER, 9:59:59.000,9:59:59.000 we order the same tests, 9:59:59.000,9:59:59.000 we prescribe the same medication 9:59:59.000,9:59:59.000 without ever thinking about[br]the sex or gender of our patients. 9:59:59.000,9:59:59.000 Why would we? 9:59:59.000,9:59:59.000 We were never taught that there were[br]any differences between men and women. 9:59:59.000,9:59:59.000 A recent Government Accountability study[br]revealed that 80 percent of the drugs 9:59:59.000,9:59:59.000 withdrawn from the market 9:59:59.000,9:59:59.000 are due to side effects on women. 9:59:59.000,9:59:59.000 So let's think about that for a minute. 9:59:59.000,9:59:59.000 Why are we discovering[br]side effects on women 9:59:59.000,9:59:59.000 only after a drug has been released[br]to the market? 9:59:59.000,9:59:59.000 Do you know that it takes years for a drug 9:59:59.000,9:59:59.000 to go from an idea to being tested[br]on cells in a laboratory, 9:59:59.000,9:59:59.000 to animal studies, 9:59:59.000,9:59:59.000 to then clinical trials on humans, 9:59:59.000,9:59:59.000 finally to go through[br]a regulatory approval process, 9:59:59.000,9:59:59.000 to be available for your doctor[br]to prescribe to you, 9:59:59.000,9:59:59.000 not to mention the millions[br]and billions of dollars of funding 9:59:59.000,9:59:59.000 it takes to go through that process. 9:59:59.000,9:59:59.000 So why are we discovering[br]unacceptable side effects 9:59:59.000,9:59:59.000 on half the population[br]after that has gone through? 9:59:59.000,9:59:59.000 What's happening? 9:59:59.000,9:59:59.000 Well, it turns out that those cells[br]used in that laboratory, 9:59:59.000,9:59:59.000 they're male cells, 9:59:59.000,9:59:59.000 and the animals used[br]in the animal studies were male animals, 9:59:59.000,9:59:59.000 and the clinical trials have been[br]performed almost exclusively on men. 9:59:59.000,9:59:59.000 How is it that the male model became[br]our framework for medical research? 9:59:59.000,9:59:59.000 Let's look at an example that has[br]been popularized in the media, 9:59:59.000,9:59:59.000 and it has to do[br]with the sleep aid Ambien. 9:59:59.000,9:59:59.000 Ambien was released on the market[br]over 20 years ago, 9:59:59.000,9:59:59.000 and since then, hundreds of millions[br]of prescriptions have been written, 9:59:59.000,9:59:59.000 primarily to women because women[br]suffer more sleep disorders than men. 9:59:59.000,9:59:59.000 But just this past year, 9:59:59.000,9:59:59.000 the Food and Drug Administration[br]recommended cutting the dose in half 9:59:59.000,9:59:59.000 for women only, 9:59:59.000,9:59:59.000 because they just realized[br]that women metabolize the drug 9:59:59.000,9:59:59.000 at a slower rate than men, 9:59:59.000,9:59:59.000 causing them to wake up in the morning[br]with more of the active drug in the system 9:59:59.000,9:59:59.000 and then they're drowsy and they're[br]getting behind the wheel of the car, 9:59:59.000,9:59:59.000 and they're at risk[br]for motor vehicle accidents. 9:59:59.000,9:59:59.000 And I can't help but think,[br]as an emergency physician, 9:59:59.000,9:59:59.000 how many of my patients[br]that I've cared for over the years 9:59:59.000,9:59:59.000 that were involved[br]in a motor vehicle accident 9:59:59.000,9:59:59.000 possibly could have been prevented 9:59:59.000,9:59:59.000 if this type of analysis was performed[br]and acted upon 20 years ago 9:59:59.000,9:59:59.000 when this drug was first released. 9:59:59.000,9:59:59.000 How many other things[br]need to be analyzed by gender? 9:59:59.000,9:59:59.000 What else are we missing? 9:59:59.000,9:59:59.000 World War II changed a lot of things, 9:59:59.000,9:59:59.000 and one of them was this need[br]to protect people 9:59:59.000,9:59:59.000 from becoming victims of medical research[br]without informed consent. 9:59:59.000,9:59:59.000 So some much-needed guidelines[br]or rules were set into place, 9:59:59.000,9:59:59.000 and part of that was this desire[br]to protect women of childbearing age 9:59:59.000,9:59:59.000 from entering into any[br]medical research studies. 9:59:59.000,9:59:59.000 It was fear, what if something happened[br]to the fetus during this study? 9:59:59.000,9:59:59.000 Who would be responsible. 9:59:59.000,9:59:59.000 And so the scientists[br]at this time actually thought 9:59:59.000,9:59:59.000 this was a blessing in disguise, 9:59:59.000,9:59:59.000 because let's face it, 9:59:59.000,9:59:59.000 men's bodies are pretty homogeneous. 9:59:59.000,9:59:59.000 They don't have the constantly[br]fluctuating levels of hormones 9:59:59.000,9:59:59.000 that could disrupt clean data[br]they could get if they had only men. 9:59:59.000,9:59:59.000 It was easier. It was cheaper. 9:59:59.000,9:59:59.000 Not to mention, at this time,[br]there was a general assumption 9:59:59.000,9:59:59.000 that men and women were alike in every way 9:59:59.000,9:59:59.000 apart from their reproductive organs[br]and sex hormones. 9:59:59.000,9:59:59.000 So it was decided: 9:59:59.000,9:59:59.000 medical research was performed on men 9:59:59.000,9:59:59.000 and the results were later[br]applied to women. 9:59:59.000,9:59:59.000 What did this do to the notion[br]of women's health? 9:59:59.000,9:59:59.000 Women's health became synonymous[br]with reproduction: 9:59:59.000,9:59:59.000 breasts, ovaries, uterus, pregnancy. 9:59:59.000,9:59:59.000 It's this term we now refer to[br]as bikini medicine. 9:59:59.000,9:59:59.000 And this stayed this way[br]until about the 1980s, 9:59:59.000,9:59:59.000 when this concept was challenged[br]by the medical community 9:59:59.000,9:59:59.000 and by the public health policymakers[br]when they realized that, 9:59:59.000,9:59:59.000 by excluding women[br]from all medical research studies, 9:59:59.000,9:59:59.000 we actually did them a disservice, 9:59:59.000,9:59:59.000 in that apart from reproductive issues, 9:59:59.000,9:59:59.000 virtually was nothing was known about[br]the unique needs of the female patient. 9:59:59.000,9:59:59.000 Since that time, an overwhelming amount[br]of evidence has come to light 9:59:59.000,9:59:59.000 that shows us just how different[br]men and women are in every way. 9:59:59.000,9:59:59.000 You know, we have this saying in medicine: 9:59:59.000,9:59:59.000 children are not just little adults. 9:59:59.000,9:59:59.000 And we say that to remind ourselves[br]that children actually have 9:59:59.000,9:59:59.000 a different physiology than normal adults. 9:59:59.000,9:59:59.000 And it's because of this that the medical[br]specialty of pediatrics came to light. 9:59:59.000,9:59:59.000 And we now conduct research on children[br]in order to improve their lives. 9:59:59.000,9:59:59.000 And I know the same thing[br]can be said about women. 9:59:59.000,9:59:59.000 Women are not just men[br]with boobs and tubes, 9:59:59.000,9:59:59.000 but they have their own anatomy[br]and physiology 9:59:59.000,9:59:59.000 that deserves to be studied[br]with the same intensity. 9:59:59.000,9:59:59.000 Let's take the cardiovascular[br]system, for example. 9:59:59.000,9:59:59.000 This are in medicine has done the most[br]to try to figure out why it seems 9:59:59.000,9:59:59.000 men and women have[br]completely different heart attacks. 9:59:59.000,9:59:59.000 Heart disease is the number one killer[br]for both men and women, 9:59:59.000,9:59:59.000 but more women die within the first year[br]of having a heart attack than men. 9:59:59.000,9:59:59.000 Men will complain of crushing chest pain. 9:59:59.000,9:59:59.000 An elephant is sitting on their chest. 9:59:59.000,9:59:59.000 And we call this typical. 9:59:59.000,9:59:59.000 Women have chest pain too, 9:59:59.000,9:59:59.000 but more women than men 9:59:59.000,9:59:59.000 will complain of just not feeling right, 9:59:59.000,9:59:59.000 can't seem to get enough air in, 9:59:59.000,9:59:59.000 just so tired lately. 9:59:59.000,9:59:59.000 And for some reason we call this atypical, 9:59:59.000,9:59:59.000 even though, as I mentioned,[br]women do make up half the population. 9:59:59.000,9:59:59.000 And so what is some of the evidence[br]to help explain some of these differences? 9:59:59.000,9:59:59.000 If we look at the anatomy, 9:59:59.000,9:59:59.000 the blood vessels that surround the heart[br]are smaller in women compared to men, 9:59:59.000,9:59:59.000 and the way that those blood vessels[br]develop disease is different 9:59:59.000,9:59:59.000 in women compared to men, 9:59:59.000,9:59:59.000 and the test that we use to determine[br]if someone is at risk for a heart attack, 9:59:59.000,9:59:59.000 well they were initially designed[br]and tested and perfected in men, 9:59:59.000,9:59:59.000 and so aren't as good[br]at determining that in women. 9:59:59.000,9:59:59.000 And then if we think[br]about the medications, 9:59:59.000,9:59:59.000 common medications that we use, 9:59:59.000,9:59:59.000 like Aspirin, 9:59:59.000,9:59:59.000 we give Aspirin to healthy men to help[br]prevent them from having a heart attack, 9:59:59.000,9:59:59.000 but do you know that if you give Aspirin[br]to a healthy woman, 9:59:59.000,9:59:59.000 it's actually harmful? 9:59:59.000,9:59:59.000 What this is doing is merely telling us 9:59:59.000,9:59:59.000 that we are scratching the surface. 9:59:59.000,9:59:59.000 Emergency medicine[br]is a fast-paced business. 9:59:59.000,9:59:59.000 How many life-saving areas of medicine[br]like cancer and stroke? 9:59:59.000,9:59:59.000 Are there important differences between[br]men and women that we could be utilizing? 9:59:59.000,9:59:59.000 Or even, why is it that some people[br]get those runny noses more than others, 9:59:59.000,9:59:59.000 or why the pain medication that we give[br]to those stubbed toes 9:59:59.000,9:59:59.000 work in some and not in others? 9:59:59.000,9:59:59.000 The Institute of Medicine has said 9:59:59.000,9:59:59.000 every cell has a sex. 9:59:59.000,9:59:59.000 What does this mean? 9:59:59.000,9:59:59.000 Sex is DNA. 9:59:59.000,9:59:59.000 Gender is how someone[br]presents themselves in society. 9:59:59.000,9:59:59.000 And these two many not always match up, 9:59:59.000,9:59:59.000 as we can see with our[br]transgendered population. 9:59:59.000,9:59:59.000 But it's important to realize[br]that from the moment of conception, 9:59:59.000,9:59:59.000 every cell in our bodies -- 9:59:59.000,9:59:59.000 skin, hair, heart, and lungs -- 9:59:59.000,9:59:59.000 contain our own unique DNA, 9:59:59.000,9:59:59.000 and that DNA contains the chromosomes[br]that determine whether we become 9:59:59.000,9:59:59.000 male or female, man or woman. 9:59:59.000,9:59:59.000 It used to be thought 9:59:59.000,9:59:59.000 that those sex-determining[br]chromosomes pictured here -- 9:59:59.000,9:59:59.000 xy if you're male, xx if you're female -- 9:59:59.000,9:59:59.000 merely determined whether you[br]would be born with ovaries or testes, 9:59:59.000,9:59:59.000 and it was the sex hormones[br]that those organs produced 9:59:59.000,9:59:59.000 were what was responsible for the[br]differences we see in the opposite sex. 9:59:59.000,9:59:59.000 But we now know that that theory was wrong[br]or it's at least a little incomplete. 9:59:59.000,9:59:59.000 And thankfully, scientists like Dr. Page[br]from the Whitehead Institute, 9:59:59.000,9:59:59.000 who works on the y chromosome, 9:59:59.000,9:59:59.000 and Doctor Yang from UCLA,[br]they have found evidence 9:59:59.000,9:59:59.000 that tells us that those[br]sex-determining chromosomes 9:59:59.000,9:59:59.000 that are in every cell in our bodies 9:59:59.000,9:59:59.000 continue to remain active 9:59:59.000,9:59:59.000 for our entire lives, 9:59:59.000,9:59:59.000 and could be what's responsible[br]for the differences we see 9:59:59.000,9:59:59.000 in the dosing of drugs, 9:59:59.000,9:59:59.000 or why there are differences[br]between men and women 9:59:59.000,9:59:59.000 in the susceptibility[br]and severity of diseases. 9:59:59.000,9:59:59.000 This new knowledge is the game-changer, 9:59:59.000,9:59:59.000 and it's up to those scientists[br]that continue to find that evidence, 9:59:59.000,9:59:59.000 but it's up to the clinicians[br]to start translating this data 9:59:59.000,9:59:59.000 at the bedside, 9:59:59.000,9:59:59.000 today, right now. 9:59:59.000,9:59:59.000 And to help do this, I'm a co-founder[br]of a national organization 9:59:59.000,9:59:59.000 called Sex and Gender[br]Women's Health Collaborative, 9:59:59.000,9:59:59.000 and we collect all of this data[br]so that it's available for teaching 9:59:59.000,9:59:59.000 and for patient care. 9:59:59.000,9:59:59.000 And we're working to bring together[br]the medical educators to the table. 9:59:59.000,9:59:59.000 That's a big job. 9:59:59.000,9:59:59.000 It's changing the way medical training[br]has been done since its inception. 9:59:59.000,9:59:59.000 But I believe in them. 9:59:59.000,9:59:59.000 I know they're going to see the value[br]of incorporating the gender lens 9:59:59.000,9:59:59.000 into the current curriculum. 9:59:59.000,9:59:59.000 It's about training the future[br]health care providers correctly. 9:59:59.000,9:59:59.000 And regionally, I'm a co-creator[br]of a division 9:59:59.000,9:59:59.000 within the Department[br]of Emergency Medicine 9:59:59.000,9:59:59.000 here at Brown University 9:59:59.000,9:59:59.000 called Sex and Gender[br]in Emergency Medicine, 9:59:59.000,9:59:59.000 and we conduct the research to determine[br]the differences between men and women 9:59:59.000,9:59:59.000 in emergent conditions, 9:59:59.000,9:59:59.000 like heart disease and stroke[br]and sepsis and substance abuse, 9:59:59.000,9:59:59.000 but we also believe[br]that education is paramount. 9:59:59.000,9:59:59.000 We've created a 360-degree[br]model of education. 9:59:59.000,9:59:59.000 We have programs for the doctors,[br]for the nurses, for the students, 9:59:59.000,9:59:59.000 and for the patients. 9:59:59.000,9:59:59.000 Because this cannot just be left up[br]to the health care leaders. 9:59:59.000,9:59:59.000 We all have a role in making a difference. 9:59:59.000,9:59:59.000 But I must warn you, this is not easy. 9:59:59.000,9:59:59.000 In fact, it's hard. 9:59:59.000,9:59:59.000 It's essentially changing the way[br]we think about medicine 9:59:59.000,9:59:59.000 and health and research. 9:59:59.000,9:59:59.000 It's changing our relationship[br]to the health care system. 9:59:59.000,9:59:59.000 But there's no going back. 9:59:59.000,9:59:59.000 We now know just enough 9:59:59.000,9:59:59.000 to know that we weren't doing it right. 9:59:59.000,9:59:59.000 Martin Luther King, Jr. has said, 9:59:59.000,9:59:59.000 "Change does not roll in[br]on the wheels of inevitability, 9:59:59.000,9:59:59.000 but comes through continuous struggle." 9:59:59.000,9:59:59.000 And the first step towards change[br]is awareness. 9:59:59.000,9:59:59.000 This is not just about improving[br]medical care for women. 9:59:59.000,9:59:59.000 This is about personalized,[br]individualized health care for everyone. 9:59:59.000,9:59:59.000 This awareness has the power to transform[br]medical care for men and women. 9:59:59.000,9:59:59.000 And from now on, I want you[br]to ask your doctors 9:59:59.000,9:59:59.000 whether the treatments you are receiving[br]are specific to your sex and gender. 9:59:59.000,9:59:59.000 They may not know the answer, 9:59:59.000,9:59:59.000 yet, 9:59:59.000,9:59:59.000 but the conversation has begun,[br]and together we can all learn. 9:59:59.000,9:59:59.000 Remember, for me[br]and my colleagues in this field, 9:59:59.000,9:59:59.000 your sex and gender matter. 9:59:59.000,9:59:59.000 Thank you. 9:59:59.000,9:59:59.000 (Applause)