Women are more resistant to infectious diseases than men and more vulnerable to autoimmune ones; some cardiovascular diseases are expressed differently according to sex; Medicines affect men and women differently … A specialty, gender medicine , is responsible for these and many other peculiarities, so incipient in countries like Spain that it literally sounds like Chinese to many health professionals. Part of an evidence: their physiology is different, and, therefore, the prevention and diagnosis of many diseases, as well as the therapies that are applied, must be as well.
Numerous studies have shown that the symptoms experienced by women in a heart attack differ from those experienced by men, and failure to identify them results in misdiagnoses and generally poorer quality care. Almost two decades after the first investigations in this regard appeared, some doctors still do not take them into account, and only six months ago that the Spanish Ministry of Health, Consumption and Social Welfare incorporated the gender perspective into its disease prevention plans cardiovascular
There is a social perception that these problems have a basically male profile, and yet this is not the case.
Mortality from cardiovascular diseases
According to the National Institute of Statistics, 30% of female mortality is due to these diseases, five percentage points more than in the case of men –25% -. The difference is significant, and responds to factors that gender medicine studies and that could be corrected. The delay in the diagnosis of heart attacks in women is not only influenced by the fact that the symptoms are sometimes not identified with a heart attack; The time that elapses until they are attended is also decisive. “We suffer more than men, we minimize the symptoms, we attribute them to other things, and when it comes to requesting health care it is invariably later, there is always something to do before,” Natalia Royuela, coordinator of the Cardiology Unit, explains to VERY Critics of the Hospital Marqués de Valdecilla de Santander.
These and similar circumstances exemplify why gender medicine has adopted this name. It does not respond to a fashion, and focuses on the feminine – and in that sense it has an ideological component -, but the most relevant from the medical point of view is that it vindicates scientific evidence. In addition to the physiological differences between men and women, it considers, among other things, the social roles that one and the other play, an aspect generally ignored in health care , but essential due to the repercussions it has on our well-being.
The consequences of the change of vision that gender medicine advocates would be beneficial, above all, to women, because until now, in general, the model in research on diseases and therapies has been men . “This has led to ailments that are invisible, misdiagnosed and poorly treated. The knowledge provided by the gender perspective would improve women’s health, allow diseases to be addressed in a more effective way and could be used in the prevention and promotion of the health of women who are still healthy ”, explains María José Cao, dean from the Faculty of Nursing at the University of Valladolid and coordinator of the Gender Perspective in Health course, which was held last November in the city of Castile-Leon.
Spondyloarthritis, a chronic form of arthritis – formerly known as ankylosing spondylitis – is an example of this invisibility. In men it manifests with stiffness in the spine, while in women the symptoms appear in the feet and hands . However, this differential diagnosis is often not taken into account. “This causes patients to be misdiagnosed with fibromyalgia, for example, when what they have is a serious disease that needs biological and expensive treatments so that it does not evolve,” explains María Teresa Ruiz Cantero, professor of Preventive Medicine and Public Health from the University of Alicante. The main consequence is that some women, from consultation to consultation, take up to nine years to find out what disease they suffer.
Overdiagnosed and overmedicalized
At other times the symptoms do not change according to the sex of the patient, but the diagnosis does. To begin with, there is a singularity: specialists in this field of medicine agree that women are overdiagnosed and overmedicalized. This occurs, for example, in some natural processes, such as pregnancy, childbirth and menopause. Marta Evelia Aparicio, professor at the Faculty of Psychology of the Complutense University of Madrid and the Master’s in Gender Studies, points out that “if a man goes to the doctor and tells him that he is tired, that he is sad and that he does not feel like having sex, this does not diagnose depression, but gives you some vitamins; if a woman goes, the most normal thing is that she leaves the consultation with a prescription for an anxiolytic or an antidepressant ”.
Since the beginning of the century, the consumption of psychotropic drugs in Spain has tripled, to the point that it constitutes the group of drugs that has registered the greatest growth. Almost one in five people consume anxiolytics, sleeping pills or antidepressants, and the number of women who take them is double that of men , according to data from the Spanish Society of Family and Community Medicine (SEMFyC). Is that difference justified?
In the opinion of the specialists consulted by ‘VERY’, many patients could immediately do without the psychotropic drug, because it will not solve their problem and will lead to it becoming chronic. Aparicio considers the following: “Maybe what they have is an overload of roles. If so, what is appropriate is to reorganize time and delegate functions to other people. When the overload is reduced or disappears, the anxiety levels decrease ”. This work is a personal matter, but it also concerns the healthcare professional, because, in order to establish an accurate diagnosis, it is essential to determine the origin of the symptoms.
Noelia Somarriba, Professor of Economics at the Gender Chair at the University of Valladolid, participates in a research group that studies the socioeconomic factors that influence health and explain why women have it, in general, worse than men. To overcome this gender bias, she considers that one of the most powerful tools is education: “On the one hand, it provides more knowledge of everything related to health and, on the other, it allows higher levels of income that give access to mechanisms that they favor conciliation. As a consequence, women have less stress and better health levels ”.
Specialists in gender medicine point out that the knowledge it contributes to many other branches, such as cardiology and pharmacology, is key to the sustainability of the health system, since it would improve its efficiency. For this, it is essential that the medical profession – of all specialties – recognize the fact that the needs of men and women, in many aspects of health, are different. These dissimilarities are often born from the mere physiological differences of their bodies, which were developed over millions of years to improve the chances of survival and today, although they no longer represent an evolutionary advantage, they are still present.
Effects of pesticides
Environmental medicine specialist Marion Moses has a research center in San Francisco (USA) specializing in the medium and long-term effects of pesticides. They are well known for the massive use of pesticides in agriculture since the commercialization of dichloro definyl trichloroethane – better known as DDT – and for the many problems it has caused in 1945. In his research, especially in rural populations, Moses has documented a relationship between the use of this chemical compound and the increase in reproductive disorders, Parkinson’s disease and some types of cancer; and has also obtained a revealing data: the incidence of these problems is higher in women than in men. Why?
Carme Valls-Llobet, endocrinologist, explains the common characteristic that insecticides share with chlorinated cleaning products, used as disinfectants, which turn these substances into a pump in the female body: “They are fat soluble and are deposited in the fat cells of the body. . As the body of women has 15% to 20% more fat naturally than that of men, the long-term consequences last longer and are more intense in women than in men ”.
The sequelae that pesticides produce in the female body are also increased by their neurotoxic effects, which could explain, at least in part, why the frequency of some neurological diseases is higher in women than in men. “The damage to neurons is more intense when they have low oxygenation –anemia– or have a lack of ferritin –a lack that prevents the transport of iron. As most women suffer from different degrees of anemia or iron deficiency during their childbearing years, their vulnerability to neurotoxic agents increases ”, says Dr. Valls-Llobet.
Gender medicine is closely related to environmental medicine, because exposure to chemical substances depends on factors such as the work performed by each individual and the use of certain products according to sex or social role. For example, the risk that women have of suffering the potentially toxic effects of some cleaning products is increased because today they continue to take on more tasks in the home than men, which includes hygiene tasks.
If there is one characteristic that defines environmental pollution, it is ubiquity. We live with 80,000 chemicals, and what is more alarming: the toxic effects of the 3,000 most used are unknown. As a sample, a button: the relationship between parabens – used for years in cosmetics – and the increase in breast cancer cases is under study.
Although the regulations oblige manufacturers to specify the content on the containers, the name is usually put in a miniscule size and camouflaged with a prefix attached to the term: methylparaben, butylparaben, ethylparaben … In her book Environment and health , Dr. Valls- Llobet points out that there are aloe vera hand creams that contain up to seven of these compounds.
Given the controversy that exists, specialists in gender medicine call for an investigation by public health agencies to determine its potential relationship with the increase in cases of breast cancer.
One of the main challenges facing this fledgling medical specialty is getting drugs to be tested equally on both sexes . It should be done, but pharmaceutical companies argue that in many trials the percentage of women does not reach 50% so as not to harm a potential pregnancy. Some experts, on the other hand, see only an economic interest in this practice: it is cheaper to test the active principle in men, because among the women recruited, lower rates are registered during clinical trials, motivated by the overload of obligations that they usually have. What is evident are the consequences, which are very harmful, as Professor Ruiz Cantero explains: “There are innovative drugs that cannot be used in women because their efficacy and safety have not been proven, which means that they do not have access to new treatments.” .
In the United States, lawsuits for drug misprescription for adverse effects are the order of the day, which has given rise to a defensive medicine. If the efficacy of the drug has not been demonstrated – in this case, in women – it is not used. And since there the Food and Drug Administration (FDA) establishes the conditions of use with which this active principle will be marketed, when it is marketed in Europe it does so with the same conditions.
The vast majority of the active ingredients that have been used so far have been tested in a very defined profile of patients: men weighing 70 kilos.
The norms of use in women were governed by a principle as simple as it was far from science. The dose, for example, was calculated based on their average weight, and other determining factors pointed out by Professor Ruiz Cantero were ignored: “Drugs interact with hormones and that changes their effects. The fact that women have hormonal variability during life and throughout the month that men do not present is more than enough reason for them to be tested on us as well ”. Another factor that is also overlooked is that the higher proportion of fat in the female body causes the drug to be more retained.
There is the paradoxical situation that even a specific drug for women has been tested only in men. It happened in 2015 with flibanserin, commonly known as female viagra, according to the medical journal The Lancet . When it was marketed, it was found to have serious adverse effects when taken with alcohol. Chief among them was a drop in blood pressure that even caused fainting spells.
When a test was carried out to analyze the cross-relationships of the active principle with alcohol, the sample chosen was twenty-five men and two women. Ruiz Cantero qualifies it very clearly: “This is called bad science.” It is an example, specialists indicate, of how urgent it is to incorporate the scientific evidence that already exists about the undeniable differences of gender and sex to the medicine of the 21st century.
