I know that when it comes to sex differences in health that women are not just smaller versions of men with a few different body parts — even though that viewpoint prevailed in medical research and among some healthcare providers until about 20 years ago.
The annual gala of the Society for Women’s Health Research (SWHR®), held early in May, however, provided a good reminder of the progress that has been made in recognizing that men and women are not the same in the face of disease as well as the work that still needs to be done to improve and tailor treatment for the benefit of both sexes.
Keynoting the event in a TED-like talk was Dr. Alyson J. McGregor, co-founder for the Division of Sex and Gender in Emergency Medicine at Brown University’s Department of Emergency Medicine.
Here are some of her key take-aways:
1) What we learned from Ambien (zolpidem)
Approved in 1992, Ambien is a popular drug to treat insomnia. But it wasn’t until 2013 that an important relationship was discovered between women and the recommended dosage level. A study found that women had two times the blood levels of Ambien the following morning as compared to men. Dr. McGregor noted that the same type of study is used to test blood alcohol levels and driving with both having been shown to lead to motor vehicle accidents. “Fortunately, the recommended dose for Ambien is now half of what it used to be for women, but it took 20 years and over 700 Ambien impaired driving reports to bring about this change,” she said.
2) Sex differences in health are more widespread than people assume
More women have Alzheimer’s and other dementias than men. Men are more likely to die from sudden cardiac arrest during exercise. Eighty percent of hip fracture occurs in women. And so on. Dr. McGregor said that our diagnostic and treatment cures have not been taking into account the way the tremendous amount of genetic information in the sex chromosomes control a myriad of biological functions at every level. “The first thing we need to do is stop the assumption that men and women will react the same way to any medication,” she said.
Dr. McGregor listed some of the disparities that exist when health care delivery fails to take into account sex and gender differences. She noted that women who have a stroke are less likely to be treated with the only effective medication available and less likely to received evidence-based therapies when having a heart attack. Men are under treated for conditions that are considered women problems like depression and osteoporosis. The answer, she said, is establishing guidelines and protocols that are gender sensitive.
3) Genetic equivalency tests for RX drugs are performed mostly on men
Thanks in large part to the SWHR’s advocacy, more women are being recruited and retained in clinical trials. However, this is not the case then it comes to generic drugs approvals. Dr. McGregor reported that when the Center for Drug Evaluation and Research in the Food and Drug Administration (FDA) review 18 years’ worth of generic drug approvals, it found that only 23 included women. She noted that some of the blood levels for women and men in the studies were very different and posed the question: “What does that actually say about all the generic drugs being used today?”
Dr. McGregor concluded by challenging the health care community to determine the differences in drug metabolism and dose response for men and women for medicines in widespread use today and use this diverging data to improve and tailor treatment for both sexes.