0:00:00.858,0:00:03.344
We all go to doctors,

0:00:04.944,0:00:09.208
and we do so with trust and blind faith

0:00:09.208,0:00:13.085
that the test they are ordering[br]and the medications they're prescribing

0:00:13.085,0:00:16.336
are based upon evidence,

0:00:16.336,0:00:20.330
evidence that's designed to help us.

0:00:20.330,0:00:23.116
However, the reality is

0:00:23.116,0:00:26.924
that that hasn't always[br]been the case for everyone.

0:00:26.924,0:00:32.380
What if I told you that the medical[br]science discovered over the past century

0:00:32.380,0:00:36.003
has been based on[br]only half the population?

0:00:36.003,0:00:38.696
I'm an emergency medicine doctor.

0:00:38.696,0:00:42.829
I was trained to be prepared[br]in a medical emergency.

0:00:42.829,0:00:48.471
It's about saving lives.[br]How cool is that?

0:00:48.471,0:00:52.117
Okay, there's a lot of runny noses[br]and stubbed toes,

0:00:52.117,0:00:55.762
but no matter who walks[br]through the door to the ER,

0:00:55.762,0:00:57.991
we order the same tests,

0:00:57.991,0:00:59.988
we prescribe the same medication

0:00:59.988,0:01:05.444
without ever thinking about[br]the sex or gender of our patients.

0:01:05.444,0:01:07.348
Why would we?

0:01:07.348,0:01:10.854
We were never taught that there were[br]any differences between men and women.

0:01:10.854,0:01:15.545
A recent Government Accountability study[br]revealed that 80 percent of the drugs

0:01:15.545,0:01:17.518
withdrawn from the market

0:01:17.518,0:01:21.140
are due to side effects on women.

0:01:21.140,0:01:23.416
So let's think about that for a minute.

0:01:23.416,0:01:26.806
Why are we discovering[br]side effects on women

0:01:26.806,0:01:31.357
only after a drug has been released[br]to the market?

0:01:31.357,0:01:35.165
Do you know that it takes years for a drug

0:01:35.165,0:01:40.226
to go from an idea to being tested[br]on cells in a laboratory,

0:01:40.226,0:01:42.270
to animal studies,

0:01:42.270,0:01:44.545
to then clinical trials on humans,

0:01:44.545,0:01:48.237
finally to go through[br]a regulatory approval process,

0:01:48.237,0:01:54.158
to be available for your doctor[br]to prescribe to you,

0:01:54.158,0:01:57.469
not to mention the millions[br]and billions of dollars of funding

0:01:57.469,0:02:01.625
it takes to go through that process.

0:02:01.625,0:02:04.371
So why are we discovering[br]unacceptable side effects

0:02:04.371,0:02:09.802
on half the population[br]after that has gone through?

0:02:11.244,0:02:13.055
What's happening?

0:02:13.055,0:02:16.909
Well, it turns out that those cells[br]used in that laboratory,

0:02:16.909,0:02:18.952
they're male cells,

0:02:18.952,0:02:22.203
and the animals used[br]in the animal studies were male animals,

0:02:22.203,0:02:29.169
and the clinical trials have been[br]performed almost exclusively on men.

0:02:29.169,0:02:34.672
How is it that the male model became[br]our framework for medical research?

0:02:34.672,0:02:38.526
Let's look at an example that has[br]been popularized in the media,

0:02:38.526,0:02:41.823
and it has to do[br]with the sleep aid Ambien.

0:02:41.823,0:02:46.769
Ambien was released on the market[br]over 20 years ago,

0:02:46.769,0:02:51.296
and since then, hundreds of millions[br]of prescriptions have been written,

0:02:51.296,0:02:56.962
primarily to women because women[br]suffer more sleep disorders than men.

0:02:56.962,0:02:59.307
But just this past year,

0:02:59.307,0:03:02.743
the Food and Drug Administration[br]recommended cutting the dose in half

0:03:02.743,0:03:05.367
for women only,

0:03:05.367,0:03:08.409
because they just realized[br]that women metabolize the drug

0:03:08.409,0:03:11.334
at a slower rate than men,

0:03:11.334,0:03:16.628
causing them to wake up in the morning[br]with more of the active drug in the system

0:03:16.628,0:03:20.552
and then they're drowsy and they're[br]getting behind the wheel of the car,

0:03:20.552,0:03:25.219
and they're at risk[br]for motor vehicle accidents.

0:03:25.219,0:03:28.795
And I can't help but think,[br]as an emergency physician,

0:03:28.795,0:03:33.973
how many of my patients[br]that I've cared for over the years

0:03:33.973,0:03:36.434
that were involved[br]in a motor vehicle accident

0:03:36.434,0:03:40.033
possibly could have been prevented

0:03:40.033,0:03:45.211
if this type of analysis was performed[br]and acted upon 20 years ago

0:03:45.211,0:03:49.135
when this drug was first released.

0:03:49.135,0:03:53.268
How many other things[br]need to be analyzed by gender?

0:03:53.268,0:03:55.335
What else are we missing?

0:03:57.531,0:04:01.246
World War II changed a lot of things,

0:04:01.246,0:04:04.581
and one of them was this need[br]to protect people

0:04:04.581,0:04:09.503
from becoming victims of medical research[br]without informed consent.

0:04:09.503,0:04:13.033
So some much-needed guidelines[br]or rules were set into place,

0:04:13.033,0:04:18.234
and part of that was this desire[br]to protect women of childbearing age

0:04:18.234,0:04:22.135
from entering into any[br]medical research studies.

0:04:22.135,0:04:27.452
There was fear, what if something[br]happened to the fetus during this study?

0:04:27.452,0:04:29.959
Who would be responsible?

0:04:29.959,0:04:32.258
And so the scientists[br]at this time actually thought

0:04:32.258,0:04:35.114
this was a blessing in disguise,

0:04:35.114,0:04:37.482
because let's face it,

0:04:37.482,0:04:40.710
men's bodies are pretty homogeneous.

0:04:40.710,0:04:44.091
They don't have the constantly[br]fluctuating levels of hormones

0:04:44.091,0:04:49.245
that could disrupt clean data[br]they could get if they had only men.

0:04:49.245,0:04:53.518
It was easier. It was cheaper.

0:04:53.518,0:04:56.411
Not to mention, at this time,[br]there was a general assumption

0:04:56.411,0:05:00.707
that men and women were alike in every way

0:05:00.707,0:05:05.304
apart from their reproductive organs[br]and sex hormones.

0:05:05.304,0:05:09.042
So it was decided:

0:05:09.042,0:05:12.331
medical research was performed on men

0:05:12.331,0:05:15.414
and the results were later[br]applied to women.

0:05:17.314,0:05:20.797
What did this do to the notion[br]of women's health?

0:05:20.797,0:05:25.185
Women's health became synonymous[br]with reproduction:

0:05:25.185,0:05:30.317
breasts, ovaries, uterus, pregnancy.

0:05:30.317,0:05:34.589
It's this term we now refer to[br]as bikini medicine.

0:05:34.589,0:05:37.468
And this stayed this way[br]until about the 1980s,

0:05:37.468,0:05:40.556
when this concept was challenged[br]by the medical community

0:05:40.556,0:05:44.805
and by the public health policymakers[br]when they realized that,

0:05:44.805,0:05:48.451
by excluding women[br]from all medical research studies,

0:05:48.451,0:05:52.328
we actually did them a disservice,

0:05:52.328,0:05:54.975
in that apart from reproductive issues,

0:05:54.975,0:06:00.826
virtually was nothing was known about[br]the unique needs of the female patient.

0:06:00.826,0:06:06.468
Since that time, an overwhelming amount[br]of evidence has come to light

0:06:06.468,0:06:12.370
that shows us just how different[br]men and women are in every way.

0:06:17.224,0:06:20.034
You know, we have this saying in medicine:

0:06:20.034,0:06:24.724
children are not just little adults.

0:06:24.724,0:06:28.161
And we say that to remind ourselves[br]that children actually have

0:06:28.161,0:06:32.665
a different physiology than normal adults.

0:06:32.665,0:06:37.634
And it's because of this that the medical[br]specialty of pediatrics came to light.

0:06:37.634,0:06:45.180
And we now conduct research on children[br]in order to improve their lives.

0:06:45.180,0:06:47.850
And I know the same thing[br]can be said about women.

0:06:47.850,0:06:54.584
Women are not just men[br]with boobs and tubes,

0:06:54.584,0:06:58.159
but they have their own anatomy[br]and physiology

0:06:58.159,0:07:01.671
that deserves to be studied[br]with the same intensity.

0:07:03.337,0:07:06.820
Let's take the cardiovascular[br]system, for example.

0:07:06.820,0:07:11.580
This are in medicine has done the most[br]to try to figure out why it seems

0:07:11.580,0:07:15.922
men and women have[br]completely different heart attacks.

0:07:15.922,0:07:21.030
Heart disease is the number one killer[br]for both men and women,

0:07:21.030,0:07:27.044
but more women die within the first year[br]of having a heart attack than men.

0:07:27.044,0:07:31.061
Men will complain of crushing chest pain.

0:07:31.061,0:07:34.846
An elephant is sitting on their chest.

0:07:34.846,0:07:37.655
And we call this typical.

0:07:37.655,0:07:40.697
Women have chest pain too,

0:07:40.697,0:07:44.133
but more women than men

0:07:44.133,0:07:48.336
will complain of just not feeling right,

0:07:48.336,0:07:51.261
can't seem to get enough air in,

0:07:51.261,0:07:55.000
just so tired lately.

0:07:55.000,0:07:57.972
And for some reason we call this atypical,

0:07:57.972,0:08:03.266
even though, as I mentioned,[br]women do make up half the population.

0:08:03.266,0:08:09.976
And so what is some of the evidence[br]to help explain some of these differences?

0:08:09.976,0:08:12.414
If we look at the anatomy,

0:08:12.414,0:08:18.660
the blood vessels that surround the heart[br]are smaller in women compared to men,

0:08:18.660,0:08:23.118
and the way that those blood vessels[br]develop disease is different

0:08:23.118,0:08:25.904
in women compared to men,

0:08:25.904,0:08:30.943
and the test that we use to determine[br]if someone is at risk for a heart attack,

0:08:30.943,0:08:35.540
well they were initially designed[br]and tested and perfected in men,

0:08:35.540,0:08:40.137
and so aren't as good[br]at determining that in women.

0:08:40.137,0:08:43.179
And then if we think[br]about the medications,

0:08:43.179,0:08:45.060
common medications that we use,

0:08:45.060,0:08:47.730
like Aspirin,

0:08:47.730,0:08:52.211
we give Aspirin to healthy men to help[br]prevent them from having a heart attack,

0:08:52.211,0:08:56.553
but do you know that if you give Aspirin[br]to a healthy woman,

0:08:56.553,0:08:58.604
it's actually harmful?

0:09:00.361,0:09:02.822
What this is doing is merely telling us

0:09:02.822,0:09:07.141
that we are scratching the surface.

0:09:07.141,0:09:11.576
Emergency medicine[br]is a fast-paced business.

0:09:11.576,0:09:19.006
How many life-saving areas of medicine[br]like cancer and stroke?

0:09:19.006,0:09:24.161
Are there important differences between[br]men and women that we could be utilizing?

0:09:24.161,0:09:30.081
Or even, why is it that some people[br]get those runny noses more than others,

0:09:30.081,0:09:34.493
or why the pain medication that we give[br]to those stubbed toes

0:09:34.493,0:09:39.158
work in some and not in others?

0:09:41.296,0:09:43.432
The Institute of Medicine has said

0:09:43.432,0:09:47.937
every cell has a sex.

0:09:47.937,0:09:50.607
What does this mean?

0:09:50.607,0:09:52.743
Sex is DNA.

0:09:52.743,0:09:57.875
Gender is how someone[br]presents themselves in society.

0:09:57.875,0:10:00.522
And these two many not always match up,

0:10:00.522,0:10:04.631
as we can see with our[br]transgendered population.

0:10:04.631,0:10:09.438
But it's important to realize[br]that from the moment of conception,

0:10:09.438,0:10:11.829
every cell in our bodies --

0:10:11.829,0:10:15.117
skin, hair, heart, and lungs --

0:10:15.117,0:10:18.391
contain our own unique DNA,

0:10:18.391,0:10:23.825
and that DNA contains the chromosomes[br]that determine whether we become

0:10:23.825,0:10:28.329
male or female, man or woman.

0:10:28.329,0:10:30.279
It used to be thought

0:10:30.279,0:10:34.343
that those sex-determining[br]chromosomes pictured here --

0:10:34.343,0:10:37.593
xy if you're male, xx if you're female --

0:10:37.593,0:10:42.864
merely determined whether you[br]would be born with ovaries or testes,

0:10:42.864,0:10:46.765
and it was the sex hormones[br]that those organs produced

0:10:46.765,0:10:52.988
were what was responsible for the[br]differences we see in the opposite sex.

0:10:52.988,0:11:00.046
But we now know that that theory was wrong[br]or it's at least a little incomplete.

0:11:00.046,0:11:04.945
And thankfully, scientists like Dr. Page[br]from the Whitehead Institute,

0:11:04.945,0:11:06.849
who works on the y chromosome,

0:11:06.849,0:11:11.470
and Doctor Yang from UCLA,[br]they have found evidence

0:11:11.470,0:11:14.767
that tells us that those[br]sex-determining chromosomes

0:11:14.767,0:11:17.298
that are in every cell in our bodies

0:11:17.298,0:11:20.502
continue to remain active

0:11:20.502,0:11:24.542
for our entire lives,

0:11:24.542,0:11:28.025
and could be what's responsible[br]for the differences we see

0:11:28.025,0:11:30.254
in the dosing of drugs,

0:11:30.254,0:11:32.971
or why there are differences[br]between men and women

0:11:32.971,0:11:37.566
in the susceptibility[br]and severity of diseases.

0:11:39.008,0:11:42.967
This new knowledge is the game-changer,

0:11:45.338,0:11:48.751
and it's up to those scientists[br]that continue to find that evidence,

0:11:48.751,0:11:53.000
but it's up to the clinicians[br]to start translating this data

0:11:53.000,0:11:55.299
at the bedside,

0:11:55.299,0:11:59.755
today, right now.

0:12:01.498,0:12:04.470
And to help do this, I'm a co-founder[br]of a national organization

0:12:04.470,0:12:07.419
called Sex and Gender[br]Women's Health Collaborative,

0:12:07.419,0:12:12.225
and we collect all of this data[br]so that it's available for teaching

0:12:12.225,0:12:14.245
and for patient care.

0:12:14.245,0:12:19.771
And we're working to bring together[br]the medical educators to the table.

0:12:19.771,0:12:22.116
That's a big job.

0:12:22.116,0:12:29.105
It's changing the way medical training[br]has been done since its inception.

0:12:29.105,0:12:31.722
But I believe in them.

0:12:31.722,0:12:37.720
I know they're going to see the value[br]of incorporating the gender lens

0:12:37.720,0:12:40.738
into the current curriculum.

0:12:40.738,0:12:45.766
It's about training the future[br]health care providers correctly.

0:12:48.299,0:12:51.038
And regionally, I'm a co-creator[br]of a division

0:12:51.038,0:12:53.546
within the Department[br]of Emergency Medicine

0:12:53.546,0:12:55.473
here at Brown University

0:12:55.473,0:12:57.865
called Sex and Gender[br]in Emergency Medicine,

0:12:57.865,0:13:02.462
and we conduct the research to determine[br]the differences between men and women

0:13:02.462,0:13:04.807
in emergent conditions,

0:13:04.807,0:13:09.823
like heart disease and stroke[br]and sepsis and substance abuse,

0:13:09.823,0:13:14.232
but we also believe[br]that education is paramount.

0:13:15.302,0:13:19.250
We've created a 360-degree[br]model of education.

0:13:19.250,0:13:24.961
We have programs for the doctors,[br]for the nurses, for the students,

0:13:24.961,0:13:27.423
and for the patients.

0:13:27.423,0:13:32.392
Because this cannot just be left up[br]to the health care leaders.

0:13:32.392,0:13:36.290
We all have a role in making a difference.

0:13:36.826,0:13:41.842
But I must warn you, this is not easy.

0:13:41.842,0:13:45.046
In fact, it's hard.

0:13:45.046,0:13:49.504
It's essentially changing the way[br]we think about medicine

0:13:49.504,0:13:53.683
and health and research.

0:13:53.683,0:13:57.863
It's changing our relationship[br]to the health care system.

0:13:57.863,0:14:01.322
But there's no going back.

0:14:01.322,0:14:05.061
We now know just enough

0:14:05.061,0:14:09.565
to know that we weren't doing it right.

0:14:09.565,0:14:12.769
Martin Luther King, Jr. has said,

0:14:12.769,0:14:16.763
"Change does not roll in[br]on the wheels of inevitability,

0:14:16.763,0:14:20.339
but comes through continuous struggle."

0:14:20.339,0:14:24.007
And the first step towards change[br]is awareness.

0:14:24.007,0:14:28.558
This is not just about improving[br]medical care for women.

0:14:28.558,0:14:34.990
This is about personalized,[br]individualized health care for everyone.

0:14:34.990,0:14:42.256
This awareness has the power to transform[br]medical care for men and women.

0:14:42.931,0:14:48.550
And from now on, I want you[br]to ask your doctors

0:14:48.550,0:14:54.215
whether the treatments you are receiving[br]are specific to your sex and gender.

0:14:54.215,0:14:57.025
They may not know the answer,

0:14:57.025,0:14:59.045
yet,

0:14:59.045,0:15:03.797
but the conversation has begun,[br]and together we can all learn.

0:15:03.797,0:15:08.240
Remember, for me[br]and my colleagues in this field,

0:15:08.240,0:15:11.397
your sex and gender matter.

0:15:11.397,0:15:13.650
Thank you.

0:15:13.650,0:15:16.491
(Applause)