If you (or your mother) were recently saved by a doctor who correctly diagnosed what you thought was indigestion as, in fact, a heart attack, you can thank the small band of mostly female M.D.'s who found a way to make medical gender bias politically sexy. Through backstage maneuvering, they got the members of Congress to look at two massive, federally funded studies of heart disease in 1990 and say, basically, What do you mean, you only looked at men? No women? Heart disease was -- still is -- the leading killer of both sexes. But as doctors now know, it manifests itself differently in men and women.
In 1993, the exclusion of women from any relevant federally funded research was banned by law. Soon after, the Food and Drug Administration began monitoring clinical trials to ensure the inclusion of women. So began the second flowering of the women's-health movement, a kind of hard-science follow-up to the assertiveness training of Our Bodies, Our Selves.
It is now a movement of such scope that the flag is waved by everyone from survivors lobbying for more breast-cancer research to the pharmaceutical giants racing to produce more perfect designer estrogens. Biotech companies, medical-school faculty, senators in tough campaigns -- everyone's paying attention.
But some of those same, mostly female physicians have pushed on toward a next research frontier. Getting women into clinical trials was the easy part, they say. "The fact is that now you have to think about the differences between men and women -- and that's a much bigger problem. How do you design your experiments to include gender differences?" says Dr. Florence Haseltine of the National Institute for Child Health and Human Development (and founder of the influential Washington-based Society for the Advancement of Women's Health Research).
The goal of advocacy groups like the SAWHR has subtly moved beyond getting scientists to give up their reliance on "the male model," steering them toward a more thorough exploration of the basic biological differences between men and women in every organ, system, and function of the body. Gender-specific biology, as this emerging field is called, posits that every medicine you take, every treatment you receive, can have a different effect based on whether you're female or male -- and that those potentially critical differences have barely been explored.
Consider, for instance, differences that researches have found in just the past decade: that women are more likely than men to die within the first year following a heart attack; that women awaken more quickly from anesthesia; that woman smokers get lung cancer more frequently than men who smoke as much; that women are twice as likely to get a sexually transmitted disease and ten times as likely to contract HIV through unprotected sex with an infected partner. Why those things are true is less well known; still, that knowledge informs the way doctors advise and treat patients.
Considerations of gender ought to be integrated into medical research "on such a fundamental level that it really gets embedded in the system," Haseltine says. Not coincidentally, this research shift has a political shading. Budget battles driven by advocacy groups can look like ugly gender wars: Why does breast cancer get more funding than prostate cancer? Research that looks at gender differences in disease, advocates argue, could improve care for both men and women, while filling in knowledge gaps resulting from the exclusion of women in research for so long. "This is not a one-way street," says Phyllis Greenberger, executive director of the SAWHR. "Why are women living longer and getting their heart attacks later? Those are interesting questions. Maybe we can learn from women how to have men live longer and get their heart attacks later."
A critical next step is to excite greater interest among the best medical theorists, whoever they are, the team behind SAWHR believes. "You want both males and females involved," says Haseltine, "because you get more interesting thinking that way, and because you don't want the field to be marginalized."