Handbook of Clinical Gender Medicine. Группа авторов
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to be male or female. The intricate dance between our DNA, experience/environment, hormones, and developmental age is a composite of inextricably intertwined events, all of which produce the ultimate version of our phenotype. Biological sex and gender are not two separate concepts, but follow a final common path; ‘gender-specific medicine’ is a unifying term that includes and takes into account all the contributing factors that produce the functioning organism.
There are many more miles to go before we fill in the blank spots in our understanding of gender-specific science. Three members of the faculty of the Department of Obstetrics and Gynecology at the Feinberg School of Medicine at Northwestern University pointed out in a recent editorial in Nature that women still remain underrepresented in biomedical research [5]. They referred to a 2004 study surveying nine important medical journals that showed only 37% of the participants were women and only 13% of the studies analyzed data by sex [6]. It is not enough, however, to agitate for more carefully balanced investigation: women themselves must acknowledge their duty to participate wherever possible in clinical research as a matter of justice; men should not have to bear the burden of the risks involved alone.
We should be striving to give full weight to all the ingredients that determine our gender-specific function throughout our lives: from the moment of conception to our death we are the product of our biological sex, our hormones, and the impact of our environment and experiences on the very stuff and substance of which we are made. The human genome is not, as some have already pointed out, the Holy Grail, which when decoded will give us a complete understanding of each person’s unique phenotype. A fuller and more accurate understanding of who we are and how we became this way depends on a balanced view of all the components that operate throughout the lives of all of us to produce who and what we are.
References
1 Heraclitus of Ephesus (ca. 535-475 BC) quoted by Plato in: Cratylus, and by Diogenes Laertius in: Lives of the Philosophers Book IX, section 8. http://en.wikiquote.org/wiki/Heraclitus.
2 Yang X, Schadt Wang S, Wang H, Arnold AP, Ingram-Drake L, et al: Tissue-specific expression and regulation of sexually dimorphic genes in mice. Genome Res 2006;16:995–1004.
3 Gregg C, Zhang J, Butler JE, Haig D, Dulac D: Sex-specific parent-of-origin allelic expression in the mouse brain. Science 2010;329:682–685.
4 Gregg C: Parental control over the brain. Science 2010;330:770–771.
5 Kim Alison M, Tingen Candace M, Woodruff Teresa K: Nature 2010;465:688–689.
6 Geller SE, Adams MG, Carnes MJ: Womens Health 2006;15:1123–1131.
Marianne J. Legato, MD
Partnership for Gender-Specific Medicine, Columbia University
903 Park Avenue, Suite 2A
New York, NY 10075 (USA)
Tel. +1 212 737 5663, E-Mail [email protected]
Social and Biological Determinants in Health and Disease
Section Editors
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| Paula R. DeCola, RN, MSc | Justine M. Schober, MD, FAAP |
| Pfizer Inc. | Department of Urology |
| New York, N.Y., USA | UPMC Hamot |
| Erie, Pa., USA |
Social and Biological Determinants in Health and Disease
Schenck-Gustafsson K, DeCola PR, Pfaff DW, Pisetsky DS (eds): Handbook of Clinical Gender Medicine.
Basel, Karger, 2012, pp 10–17
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Gender Effects on Health and Healthcare
Paula R. DeCola
Pfizer Inc., New York, N.Y., USA
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Abstract
With the advent of gender medicine there is the recognition that differences exist between and among men and women in relation to their health due to the interplay of biologically determined and socially derived elements. This has an impact on preventive, curative, and rehabilitative aspects of health and most body systems. The intent is to explore gender-based differences as well as disparities and their effect on health and health care.
Copyright © 2012 S. Karger AG, Basel
Defining Terms and Measurement
Gender-based medicine encompasses sex differences (genetic, biological, and phenotypic) but goes beyond these to include the broader social, cultural, and normative factors that affect health. Its roots are partly embedded in the women’s health movement of the 1970s, since through the recognition of women’s health came the acknowledgement of gender differences. However, gender medicine is not women’s health and it is it not binary. It extends past the health of women to create new prototypes of male health, as well as to encompass the biological and social aspects of lesbian, gay, bisexual, transgender, and intersex (LGBT) people.
As with gender medicine, the working definition of disparities extends past a simple one that only accounts for an identified difference between two groups to subsume the idea of social justice. The term is used in keeping with the World Health Organization’s perspective that notes that disparities include a difference between two groups that is viewed as being unfair and unjust, as well as being both unnecessary and avoidable. Further, when determining disparities, equity and not equality needs to be considered through the assessment of need as well as of outcomes, since equal treatment may in fact perpetuate a disparity.
The Research Void
As noted by Marianne Legato, a leader in gender medicine, women are not little men, and all men are not alike. In fact, there is growing recognition that biomedical and clinical research has focused on males as a relatively heterogonous group. It has, in large measure, ignored women with the exception of reproduction, ignored LGBT populations with the exception of sexually transmitted diseases, and ignored other minorities and largely concentrated research efforts within high-income countries.
In the 1990s, in response to the paucity of research on women, a number of jurisdictions established requirements that sex be considered in study designs in order for grant requests to be eligible for governmental funding. Requirements along these lines can be found in diverse counties such as the USA, South Africa, and Australia. However, no requirement