Gender Competency Gender Competency Training for Medical Training for Medical

EducatorsEducators

2828thth of April 2003 of April 2003

Evidence of gender difference Evidence of gender difference and its clinical significanceand its clinical significance

Ann-Maree NobeliusAnn-Maree NobeliusFaculty of Medicine, Nursing and Health SciencesFaculty of Medicine, Nursing and Health Sciences

Monash University AustraliaMonash University Australia

women are the major consumers of women are the major consumers of health carehealth care

women are the primary decision makers women are the primary decision makers in family health care in family health care

women are the major consumers of women are the major consumers of prescription drugsprescription drugs

2/3 of all pharmaceuticals used to treat 2/3 of all pharmaceuticals used to treat both men and women have only been both men and women have only been tested in mentested in men

2/3 of all diseases that affect men and 2/3 of all diseases that affect men and women have only been researched in women have only been researched in menmen

women have only made up 7% of all women have only made up 7% of all cardiac research subjectscardiac research subjects

more developed medical research systems in more developed medical research systems in countries with white populations of European countries with white populations of European genetic originsgenetic origins

greater levels of funding in these countries with greater levels of funding in these countries with white populations of European genetic originswhite populations of European genetic origins

the teratogenic risk associated with involving the teratogenic risk associated with involving women in clinical trails while in their women in clinical trails while in their reproductive years and potential longer-tem reproductive years and potential longer-tem outcomes for offspring outcomes for offspring

Of these categories of difference gender Of these categories of difference gender is the largest and most obviousis the largest and most obvious

more than 50% of the world’s population more than 50% of the world’s population are womenare women

more or less you are either one or the more or less you are either one or the other on the basis of biological difference other on the basis of biological difference

NIH in the US has recognised the significance of gender blindness NIH in the US has recognised the significance of gender blindness in research and its clinical consequencesin research and its clinical consequences

instituted a policy of requiring research of disease that affect both instituted a policy of requiring research of disease that affect both men and women to include gender as a variable of researchmen and women to include gender as a variable of research

allocates funding in line with this policyallocates funding in line with this policy

resulting in increasing numbers of publications citing difference resulting in increasing numbers of publications citing difference even where none is foundeven where none is found

This information has profound consequences for clinical practice This information has profound consequences for clinical practice

Columbia University’sColumbia University’s

Journal of Gender Specific Medicine Journal of Gender Specific Medicine

http://www.mmhc.com/jgsm/http://www.mmhc.com/jgsm/

Some of the areas of difference Some of the areas of difference that are important for clinical that are important for clinical practice:practice:

Coronary heart diseaseCoronary heart disease Cardiovascular disease and arrhythmiaCardiovascular disease and arrhythmia Brain differences including number of neurons and Brain differences including number of neurons and

plasticityplasticity Differential addiction timesDifferential addiction times Responses to pain medicationResponses to pain medication Eating and digestionEating and digestion Differential drug metabolismDifferential drug metabolism Differential treatment of dyslipidaemiaDifferential treatment of dyslipidaemia Differential carcinogenic and toxic effects of Differential carcinogenic and toxic effects of

tobacco smoketobacco smoke

Differential risk of lung cancerDifferential risk of lung cancer Differential HIV viral loads and treatment optionsDifferential HIV viral loads and treatment options Depression from a genetic levelDepression from a genetic level Sex hormones and cognitive functionSex hormones and cognitive function Differential dietary treatment for obesityDifferential dietary treatment for obesity Gender differences in pre-pubertal childrenGender differences in pre-pubertal children Differential lifetime medical costsDifferential lifetime medical costs Cataract SurgeryCataract Surgery Stress responses and the sympathetic nervous Stress responses and the sympathetic nervous

system system (Taylor et al, in Psychological Review(Taylor et al, in Psychological Review

July 2000, Vol 107. No.3 p411-429)July 2000, Vol 107. No.3 p411-429)