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Sex Matters: Gender-based Medical Research
  
By Barbara J. Culliton


Commentary

Women are more likely than men to experience cardiac arrythmia after taking antibiotics, antihistamines, and even antiarrhythmic drugs. On the other hand, women who receive kappa-opioids for pain relief after surgery are much more likely to get relief than men given the same potent pain killers. Why women are more responsive to kappa-opioids is unknown.

Some research suggests that women on cholesterol-lowering drugs benefit more from the therapy than men. In one study, women had a 46 percent reduction in heart attacks and other coronary events whereas the reduction of coronary events in men was only 20 percent. Angiotensin converting enzyme (ACE), which plays important roles in regulating the cardiovascular system and is the basis of a common type of heart medication, behaves differently in men and women—probably because of genes. Alterations in the gene that produces ACE in men have been shown to increase the size of the heart, which can lead to congestive heart disease. The same genetic alterations in women seem to have no negative effect on the heart. Why?

The incidence of autoimmune disease is much higher in women than in men, but women’s immune systems are more resistant to infection.

When it comes to cancer, a number of gender differences have been observed but not fully explained. Lung cancer, despite popular assumptions to the contrary, is the number one cause of cancer deaths among women, who for some reason seem to be more susceptible to carcinogens in cigarettes. Men and women are equally likely to get colon cancer—that is, taking no preventive measures, their risk is the same. However, a high fiber diet appears to be more protective in men than women. More women get melanoma than men but women tend to survive much longer. Bladder cancer is more frequent in men, though no one is sure why this is so. The way in which men and women metabolize certain carcinogens may hold a clue. In fact, gender differences in metabolism have been documented for food, alcohol, and environmental toxins.

Gender-based differences in mental health, including mental acuity, have also been observed. According to one study, men show a measurable decline in attention, as well verbal and spatial memory, by the young age of 45. Women remain as sharp as ever.

These differences between men and women admittedly are based on preliminary observations. Definitive work is needed to affirm these and other apparent differences that are medically significant and to explain the mechanisms that account for them. Gene expression and regulation no doubt are central elements here.

What’s important is that gender-based studies now hold an important place on the research agenda. A decade ago, this was not so.

In the early 1990s, the Society for the Advancement of Women’s Health Research effectively argued that excluding women from most clinical research makes for bad medicine. Physiological differences between men and women extend way beyond sex hormones and anatomy, the women researchers said, and their voices were heard. The Women’s Health Initiative, launched by the National Institutes of Health in 1991, is proof of that. Along the way, the importance of gender in all aspects of biomedical research became apparent, as has the importance of gene expression. The Society will sponsor a new series of conferences on the Biology of Sex and Gender Differences in 2000. The first of these, on Sex and Gene Expression (SAGE), took place last month and is reported in this edition of the Genome News Network. It is a harbinger of things to come.

For additional information on gender-based medicine contact the Society for Women’s Health Research at information@womens-health.org

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See an interesting overview by Paula M. Thompson and Jacqueline L. Wolf. The sexual revolution in science: What gender-based research is telling us. Journal of Investigative Medicine , 47, No.3, 106-113 (March 1999).
 

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