Women's Medicine; A Body That Only Has Breasts and Uterus or a Body That Is Different

Recently, during one of the so-called "TED" talks, a topic was introduced that may have been new to many. It was pointed out that medicine and pharmacology have fundamentally been based on male cells and male gender. Even more surprisingly, during the drug development process—which has been ongoing for a long time—initial tests are conducted on male cells, then on male laboratory animals, and even in the early human trials, on men. After this long cycle, the drug hits the market, and only then are its different side effects in women observed or reported. "Alison McGregor," an emergency physician and researcher, and director of the Center for Gender and Sexual Health Research at Brown University in Rhode Island, USA, recently presented the results of a study she has been pursuing for about 10 years in a "TED Talk." This talk, which is also included at the bottom of this article, is part of the independent "TEDx" program. The gist of what Dr. McGregor pointed out was: we are gradually realizing that the male and female bodies operate differently in terms of drug absorption and digestion, and they even show different side effects. During her talk, Dr. McGregor referred to one of the latest statistics from the U.S. Government Accountability Office, stating that nearly 80% of drugs have been withdrawn from the U.S. pharmaceutical market due to "side effects on women." Dr. McGregor also noted that this information is gradually being completed, but for some drugs, it has been proven that the female and male bodies absorb them differently. She also mentioned that the difference in body function was the same factor that led to the establishment of pediatric medicine, as we realized that children's bodies operate differently from adults, and we now conduct tests on children. However, her suggestion is not to separate men's and women's medicine in all areas, but to advocate for greater knowledge at all stages of medicine, education, and pharmacology regarding the differences between male and female bodies. The issues raised in this talk pose many questions. Therefore, we had a phone conversation with Alison McGregor at Brown University. *** Tell us why something as important as this had not been identified before, and can you familiarize us with your research and findings? How is it that an issue affecting half the population remains so unknown? I have been working in the field of gender and medicine and related education for about 10 years, and when I was going through my residency in emergency medicine, I encountered this issue. I read a book at that time called "Gender-Related Therapeutic Principles" by "Marianne Legato," and I found it very interesting that I had gone through medical school and my residency without knowing how different male and female bodies are. My intention was to work on women's health and I thought this would be a good starting point for exploration. This is because what most of us know about women's health is related to obstetrics. In medical school, physiology courses are based on male bodies. When it came to working on women's bodies, the focus was limited to the uterus and ovaries and obstetric services. Ten years ago, if you told someone you wanted to work in women's health, it was quite natural for them to think you meant specializing in the uterus or working in obstetrics or midwifery. When I realized there was a field related to gender-related therapeutic principles, I began to create a network and contacted my colleagues at the national level (in the United States) and established the "Sex and Gender" group to work on the differences in treatment between male and female bodies. However, in my own state and at Brown University in Providence (Rhode Island), and in my specialty of emergency medicine, I realized we do not consider gender differences in our work. With a colleague named "Esther Cho," we established a group for level one trauma at Rhode Island Hospital and began researching how gender differences manifest in emergency medicine, naming it "Gender and Sexuality" in emergency medicine. Thus, I gradually became an activist in emergency medicine and gender differences, as many who watched my TED Talk seemed to have an epiphany. Many later said, "Oh, so there are so many differences, and we were unaware of them." This issue is rooted in pharmacology and medicine, and we need more research and education in this area. Regarding that "aha moment" you mentioned, most people who watched your TED Talk had the same reaction. Personally, I even showed this talk to my wife because you specifically mentioned the drug "Ambien" (generic name Zolpidem), which is absorbed differently in women and men, and my wife has this specific problem. Any dose of Ambien she takes makes her drowsy for three days instead of providing a deep sleep at night, and even though her doctor prescribed it, she cannot use it. You mentioned a very good example. Ambien was approved for the pharmaceutical market in 1992, and by 2007, over 700 cases of Ambien side effects had been reported; however, no one could connect the dots to draw conclusions. Some of these studies were about increased traffic accidents. It was only after that that the drug was tested in male and female bodies, and it was found that women absorb Ambien differently and take much longer to eliminate its effects. This is just the tip of the iceberg, as there are millions of drugs on the market, and we still do not have precise knowledge of how they function differently in male and female bodies. In your talk, you referred to a description of women's medicine called "Bikini Medicine." Did you coin this term, or was it mentioned before? That's a good question; I'm not sure if I was the one who started it, but in the 10 years I have been working in this field with colleagues, we have continuously referred to and used it. I am not certain if I can claim credit for coining the term, but we refer to it a lot. The reason is that it provides a good visual connection to the audience and is clear in raising awareness in the field we work in. To better familiarize readers, if we were to describe this term, you mean that whenever women's medicine is mentioned, everyone thinks it refers to female organs. Exactly. Drug research from its inception until 1993 was specifically conducted only on men—male gender. For example, when it came to women's bodies, it referred to breasts, uterus, and ovaries. In any kind of research, dissection, and education, all research was conducted on male bodies, and women were limited to the organs that men did not have. That is, for lungs, brain, heart, and other body parts, there was no need to research women's bodies; research was done on men and generalized to women as well, except for the organs that women did not have. This is why the term "Bikini Medicine" encapsulates this issue. When you say "many," who exactly are you referring to? Doctors, pharmacists, or patients? In these 10 years, it has mostly been researchers and clinical staff who have shown resistance. So, most of them are in your field. Yes, the field of medical research and emergency medicine. But fundamentally, this issue has been based on male gender. For example, scientists and pharmacists even from the beginning of working on cells or animals choose male cells. For basic researchers, it is hard to change their methods because they work with male cells due to hormonal homogeneity. But if they choose female cells, they have to deal with hormonal variations, which complicates the challenge. In my specialty of emergency medicine, we (in the U.S.) have over a million and 20 thousand daily visits. Emergency departments and emergency medicine are expanding. For many, visiting the emergency room is like visiting a doctor, and there are many who are genuinely considered emergency patients. For an emergency physician, those who come to the emergency room and may stay there for two to twenty hours, it is very difficult to pay attention to details and say, "Let’s try a different dose on this patient because she is a woman and monitor her to see how she differs from men." This makes the work more challenging and different from how it has been done before. Just to make sure I understand your point, you are saying that the opposition you faced or face is due to the way things have been done before, and no one wants to change it. Yes. And is this opposition limited to not wanting to change their methods? I want to see if they are just saying they will not change their usual and normal way or if they also do not accept your research findings and believe that not only will they not change their way, but even nothing has changed or we do not have accurate findings to even want to examine it. One of the biggest challenges is that the more we know, the more serious questions arise that need answers. A significant portion of the resistance we see is due to this, as after one finding, we are faced with a new wave of questions. For example, they say it is true that Ambien research has shown that its digestion and absorption differ in men and women, but how do we know this about other drugs? Or if this is the case, how do we know what prescription to write and how to prescribe? Therefore, in this entire field, there is a lack of evidence, and we do not have enough documentation to show what we should do. The main challenge here is that we do not have all the answers at hand. What I am currently focused on is telling my colleagues to work with the data and information we have and continue to conduct more research. Even right now, we can utilize this limited information in emergency medicine. So, in fact, you are encouraging your colleagues not only to use this current data but also to focus on gathering more data. Yes. I want many academic physicians—meaning those who have decided to continue teaching and researching instead of practicing medicine—to consider these findings now in whatever field they work in; stroke, infection, or trauma, to design their research so that the differences between men and women can be tracked or identified. After that, it is also necessary for medical students or residents or other specialists to be familiar with the results of this research. Even until now, medical students or residents are not taught to pay attention to this—this difference in medicine between male and female bodies. We need to focus on education and teach everyone to learn differently, apply different medicine, and look at the subject differently. Is there a consensus view on this issue—medical differences in male and female bodies—in your specialty? Or is there a patriarchal dominance over it like some other issues? In my specialty, which is emergency medicine, there is a consensus view. Let me give you an example. The first time I realized this issue was very important was in the academic society of emergency physicians, of which I am a member, when I held a meeting to present my research findings. When I completed my work and arrived at the conference hall, which usually has hundreds of physicians present, only two people showed up for this meeting. Sorry, were these two people men or women? That was a good question. One man and one woman, both of whom were my colleagues and friends, and their presence was out of friendship, not attention or interest in the subject of the lecture. Now, fast forward from that time to 2014. This time, in the same society, we were examining consensus and reaching fundamental questions, stating that yes, there are medical differences between men and women, but now what questions in emergency medicine are important and should be raised? In this conference session, hundreds of physicians and researchers at the national level (in the U.S.) attended. Therefore, I now say this issue is no longer avoidable and must be accepted.