Book review: Gender Medicine
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There needs to be a different branch of medicine for each of the sexes, says Marek Glezerman, who is a professor emeritus of obstetrics and gynaecology at the Sackler School of Medicine in Tel Aviv, Israel.
Men and women are different: Both store fat differently, they are hormonally different, their immune systems are not the same, so they are affected by depression, cancer and heart disease in different ways.
The information is not new, but Glezerman’s new book, Gender Medicine: The Groundbreaking New Science Of Gender- And Sex-Related Diagnosis And Treatment, explains some of the whys too.
Take heart attack, for example. Its “classic” symptoms are well known—excruciating pain in the left chest which radiates to the left shoulder and left arm. Women, however, may exhibit different symptoms, including slowly developing abdominal or chest pain which does not radiate to the left shoulder and arm but rather to the neck and chin. This means that a person may delay going to hospital because she does not link these symptoms to a heart attack. “Sometimes, a doctor may also misdiagnose,” says Glezerman on email, adding: “The single most important factor for successful treatment of heart attacks is the time it takes from diagnosis to treatment. A misdiagnosis of an heart attack in these cases actually kills women.”
Another important area of gender differences is pain. Women experience pain differently, have a different threshold for it, and react differently to analgesics. Commonly used medications like the painkiller paracetamol or aspirin are cleared from the male gastrointestinal system almost twice as fast as from a woman’s. So the dosage for women is often too high, and can enhance the risk of side effects, he adds.
All this and more (how life evolves in the womb, how men are the weaker sex in the evolutionary kingdom, and so on) are explained meticulously, without jargon, in the book.
The book also explains why clinical research in diseases and medication has focused on men. “In the 1950s and 1960s, two disasters shook the medical world, both related to medical treatment for pregnant women, with the subsequent development of severe limb deformations and malignant changes in the genitals of offspring. As a result, in 1977 the US’ food and drug administration issued a directive that women of child-bearing age should no longer be included in certain phases of clinical research. Using male research subjects is easier and cheaper than to use female subjects. Men have less hormonal fluctuations, they do not have menstrual periods, do not get pregnant, and for the most part are not burdened with taking care of the home, all factors liable to disrupt the course of research,” says the author.
Gender Medicine suggests that medical treatment for women should keep these differences in mind. And for that, says Glezerman, regulators such as health ministries, legislative bodies and public health institutions need to invest in gender medicine. He adds, “The pharma industry too will need to invest in research related to medications and prepare for the time when pharmacy shelves will be stocked with different drug preparations for men and women.”