The New Science of Gender-Specific Medicine

Excerpted from
The Groundbreaking Guide to Women's Health
By Marianne J. Legato, MD, FACP

Eve's Rib is not just about women's health, but about the health of both sexes and the new science of gender-specific medicine. Until now, we've acted as though men and women were essentially identical except for the differences in their reproductive function. In fact, information we've been gathering over the past ten years tells us that this is anything but true, and that everywhere we look, the two sexes are startlingly and unexpectedly different not only in their normal function but in the ways they experience illness.

As a rigorously trained biomedical scientist, I've always been interested in the excitement of exploring a new idea and finding out how to prove it true or false. Until the last decade, we've made the assumption in medicine that it's necessary to study only men, and that the data we harvest can be extrapolated to women without modification. To a certain extent, the assumption was forced upon us: studying women, particularly premenopausal women, is not without risk both to the subject herself and to a fetus that might be conceived during the course of an investigation. Thus, we've found it difficult to recruit women for study unless their reproductive years were behind them, and those supporting research have been justifiably wary of incurring huge damages as a consequence of harming an unborn child. Furthermore, because of the cyclic variations in younger women's hormonal levels, any investigation that included them would require larger numbers of them than of men to really come to a firm conclusion about whether or not gender differences exist. So we've excused ourselves-and women-from including them in biomedical investigation on the grounds of its being too dangerous and too expensive-even unfeasible in terms of finding sufficient numbers-to do so. But all that has begun to-and must-change.

It has been women themselves who have demanded a change in the way American scientists and doctors do business. With an increasingly more coherent and powerful voice, women have forced the federal government and the biomedical establishment it supports to define the differences between males and females. The results have been nothing short of astonishing. As we compare men and women, we are finding that in every system of the body, from the very hairs of our heads to the way our hearts beat, there are significant and unique sex-based differences in human physiology. The new data are transforming the way we prevent and treat disease. We are refashioning our male models of health and illness by asking questions we never even would have framed until we studied both sexes. The answers to those questions are turning out to be completely unexpected and fascinating.

We haven't solved every problem about the difficulties in studying women, particularly those still involved in building their families. But as the Belmont conference observed, it is a principle of justice that if women are to share in the benefits of medical research, they must also share in the risk that research inevitably entails when we are testing the safety and usefulness of a new drug or intervention. Every woman who wants more attention to her health must be willing to help harvest the new information and bear a personal responsibility for helping to generate credible answers to the questions that we are asking.

Somehow, Eve's gift of an apple to Adam became a metaphor for our banishment from an ideal world of perfect harmony to an existence troubled with suffering, sorrow, and eventually death. The reality is quite the opposite. If we are courageous, persistent, and intelligent about using Eve's gift to expand the new science of gender-specific medicine, the next decade of research will inevitably produce significant improvements in our ability to improve and lengthen human life. Eve's Rib explains why.