WEBVTT

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We all go to doctors,

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and we do so with trust and blind faith

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that the test they are ordering
and the medications they're prescribing

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are based upon evidence,

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evidence that's designed to help us.

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However, the reality is

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that that hasn't always
been the case for everyone.

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What if I told you that the medical
science discovered over the past century

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has been based on
only half the population?

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I'm an emergency medicine doctor.

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I was trained to be prepared
in a medical emergency.

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It's about saving lives.
How cool is that?

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Okay, there's a lot of runny noses
and stubbed toes,

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but no matter who walks
through the door to the ER,

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we order the same tests,

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we prescribe the same medication

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without ever thinking about
the sex or gender of our patients.

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Why would we?

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We were never taught that there were
any differences between men and women.

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A recent Government Accountability study
revealed that 80 percent of the drugs

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withdrawn from the market

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are due to side effects on women.

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So let's think about that for a minute.

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Why are we discovering
side effects on women

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only after a drug has been released
to the market?

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Do you know that it takes years for a drug

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to go from an idea to being tested
on cells in a laboratory,

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to animal studies,

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to then clinical trials on humans,

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finally to go through
a regulatory approval process,

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to be available for your doctor
to prescribe to you,

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not to mention the millions
and billions of dollars of funding

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it takes to go through that process.

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So why are we discovering
unacceptable side effects

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on half the population
after that has gone through?

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What's happening?

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Well, it turns out that those cells
used in that laboratory,

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they're male cells,

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and the animals used
in the animal studies were male animals,

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and the clinical trials have been
performed almost exclusively on men.

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How is it that the male model became
our framework for medical research?

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Let's look at an example that has
been popularized in the media,

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and it has to do
with the sleep aid Ambien.

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Ambien was released on the market
over 20 years ago,

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and since then, hundreds of millions
of prescriptions have been written,

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primarily to women because women
suffer more sleep disorders than men.

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But just this past year,

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the Food and Drug Administration
recommended cutting the dose in half

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for women only,

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because they just realized
that women metabolize the drug

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at a slower rate than men,

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causing them to wake up in the morning
with more of the active drug in the system

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and then they're drowsy and they're
getting behind the wheel of the car,

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and they're at risk
for motor vehicle accidents.

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And I can't help but think,
as an emergency physician,

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how many of my patients
that I've cared for over the years

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that were involved
in a motor vehicle accident

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possibly could have been prevented

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if this type of analysis was performed
and acted upon 20 years ago

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when this drug was first released.

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How many other things
need to be analyzed by gender?

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What else are we missing?

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World War II changed a lot of things,

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and one of them was this need
to protect people

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from becoming victims of medical research
without informed consent.

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So some much-needed guidelines
or rules were set into place,

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and part of that was this desire
to protect women of childbearing age

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from entering into any
medical research studies.

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It was fear, what if something happened
to the fetus during this study?

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Who would be responsible.

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And so the scientists
at this time actually thought

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this was a blessing in disguise,

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because let's face it,

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men's bodies are pretty homogeneous.

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They don't have the constantly
fluctuating levels of hormones

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that could disrupt clean data
they could get if they had only men.

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It was easier. It was cheaper.

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Not to mention, at this time,
there was a general assumption

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that men and women were alike in every way

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apart from their reproductive organs
and sex hormones.

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So it was decided:

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medical research was performed on men

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and the results were later
applied to women.

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What did this do to the notion
of women's health?

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Women's health became synonymous
with reproduction:

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breasts, ovaries, uterus, pregnancy.

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It's this term we now refer to
as bikini medicine.

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And this stayed this way
until about the 1980s,

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when this concept was challenged
by the medical community

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and by the public health policymakers
when they realized that,

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by excluding women
from all medical research studies,

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we actually did them a disservice,

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in that apart from reproductive issues,

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virtually was nothing was known about
the unique needs of the female patient.

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Since that time, an overwhelming amount
of evidence has come to light

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that shows us just how different
men and women are in every way.

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You know, we have this saying in medicine:

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children are not just little adults.

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And we say that to remind ourselves
that children actually have

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a different physiology than normal adults.

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And it's because of this that the medical
specialty of pediatrics came to light.

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And we now conduct research on children
in order to improve their lives.

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And I know the same thing
can be said about women.

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Women are not just men
with boobs and tubes,

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but they have their own anatomy
and physiology

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that deserves to be studied
with the same intensity.

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Let's take the cardiovascular
system, for example.

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This are in medicine has done the most
to try to figure out why it seems

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men and women have
completely different heart attacks.

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Heart disease is the number one killer
for both men and women,

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but more women die within the first year
of having a heart attack than men.

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Men will complain of crushing chest pain.

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An elephant is sitting on their chest.

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And we call this typical.

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Women have chest pain too,

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but more women than men

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will complain of just not feeling right,

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can't seem to get enough air in,

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just so tired lately.

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And for some reason we call this atypical,

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even though, as I mentioned,
women do make up half the population.

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And so what is some of the evidence
to help explain some of these differences?

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If we look at the anatomy,

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the blood vessels that surround the heart
are smaller in women compared to men,

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and the way that those blood vessels
develop disease is different

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in women compared to men,

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and the test that we use to determine
if someone is at risk for a heart attack,

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well they were initially designed
and tested and perfected in men,

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and so aren't as good
at determining that in women.

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And then if we think
about the medications,

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common medications that we use,

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like Aspirin,

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we give Aspirin to healthy men to help
prevent them from having a heart attack,

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but do you know that if you give Aspirin
to a healthy woman,

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it's actually harmful?

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What this is doing is merely telling us

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that we are scratching the surface.

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Emergency medicine
is a fast-paced business.

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How many life-saving areas of medicine
like cancer and stroke?

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Are there important differences between
men and women that we could be utilizing?

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Or even, why is it that some people
get those runny noses more than others,

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or why the pain medication that we give
to those stubbed toes

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work in some and not in others?

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The Institute of Medicine has said

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every cell has a sex.

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What does this mean?

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Sex is DNA.

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Gender is how someone
presents themselves in society.

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And these two many not always match up,

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as we can see with our
transgendered population.

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But it's important to realize
that from the moment of conception,

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every cell in our bodies --

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skin, hair, heart, and lungs --

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contain our own unique DNA,

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and that DNA contains the chromosomes
that determine whether we become

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male or female, man or woman.

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It used to be thought

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that those sex-determining
chromosomes pictured here --

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xy if you're male, xx if you're female --

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merely determined whether you
would be born with ovaries or testes,

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and it was the sex hormones
that those organs produced

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were what was responsible for the
differences we see in the opposite sex.

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But we now know that that theory was wrong
or it's at least a little incomplete.

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And thankfully, scientists like Dr. Page
from the Whitehead Institute,

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who works on the y chromosome,

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and Doctor Yang from UCLA,
they have found evidence

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that tells us that those
sex-determining chromosomes

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that are in every cell in our bodies

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continue to remain active

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for our entire lives,

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and could be what's responsible
for the differences we see

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in the dosing of drugs,

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or why there are differences
between men and women

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in the susceptibility
and severity of diseases.

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This new knowledge is the game-changer,

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and it's up to those scientists
that continue to find that evidence,

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but it's up to the clinicians
to start translating this data

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at the bedside,

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today, right now.

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And to help do this, I'm a co-founder
of a national organization

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called Sex and Gender
Women's Health Collaborative,

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and we collect all of this data
so that it's available for teaching

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and for patient care.

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And we're working to bring together
the medical educators to the table.

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That's a big job.

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It's changing the way medical training
has been done since its inception.

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But I believe in them.

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I know they're going to see the value
of incorporating the gender lens

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into the current curriculum.

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It's about training the future
health care providers correctly.

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And regionally, I'm a co-creator
of a division

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within the Department
of Emergency Medicine

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here at Brown University

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called Sex and Gender
in Emergency Medicine,

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and we conduct the research to determine
the differences between men and women

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in emergent conditions,

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like heart disease and stroke
and sepsis and substance abuse,

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but we also believe
that education is paramount.

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We've created a 360-degree
model of education.

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We have programs for the doctors,
for the nurses, for the students,

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and for the patients.

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Because this cannot just be left up
to the health care leaders.

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We all have a role in making a difference.

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But I must warn you, this is not easy.

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In fact, it's hard.

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It's essentially changing the way
we think about medicine

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and health and research.

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It's changing our relationship
to the health care system.

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But there's no going back.

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We now know just enough

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to know that we weren't doing it right.

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Martin Luther King, Jr. has said,

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"Change does not roll in
on the wheels of inevitability,

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but comes through continuous struggle."

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And the first step towards change
is awareness.

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This is not just about improving
medical care for women.

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This is about personalized,
individualized health care for everyone.

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This awareness has the power to transform
medical care for men and women.

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And from now on, I want you
to ask your doctors

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whether the treatments you are receiving
are specific to your sex and gender.

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They may not know the answer,

99:59:59.999 --> 99:59:59.999
yet,

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but the conversation has begun,
and together we can all learn.

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Remember, for me
and my colleagues in this field,

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your sex and gender matter.

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Thank you.

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(Applause)