“Gender in medicine is not a detail”

Lately, there has been more and more insistence sex medicine and the need to reach one clinical approach that takes into account the biological and genetic differences of those born with a male or female body;. A distinction it does not have nothing to do with gender identitymuch less withsexual orientation, but simply with different objective characteristics of the two sexes, often ignored to the detriment of women, who have always been treated less and worse. “From a physiological point of view, men and women are not the same, and science has never hidden it, it has simply decided not to take care of them as much as it should have,” he explains. Antonella Violaimmunologist, scientific director of the Pediatric Research Institute IRP-Città della Speranza and author of the book, Sex is (almost) everything published by Feltrinelli.

How do you explain that?

“For centuries, this topic has been considered of little interest to the scientific community and pharmaceutical companies, and the reasons are above all cultural. Suffice it to say that until 1993, women were not included in clinical trials conducted to measure effectiveness. and the safety of drugs, and that only that year did the American Food and Drug Administration decide to include them ».

Has things changed since then?

“Partly, but not enough. At the end of the clinical trials, the data are actually still compiled today without distinction, and the evaluation of the efficacy and safety of the therapies is not made on the basis of gender. The reasons in this case are mainly economic, as a genuine use of sex drugs at every step would mean that pharmaceutical companies increase costs significantly “.

Although in perspective for the national health system it could actually prove to be a saving, as incorrect or useless treatments due to inaccurate diagnoses would fall.

“Of course, but unfortunately we live in a world that looks at short-term advantage and does not know how to be foresighted.”

Does the lack of sensitivity of the scientific community to the subject also depend on the fact that most of its members are men?

“Yes without a doubt. The female body has always been less examined than the male, because medical schools were only attended by men who performed examinations and measurements on themselves. Now things are changing, universities are also training doctors in this matter, and in our the world is in question, but in order to achieve real change it is necessary to make sure that politics is interested in that which instead only moves if there is one. it is a popular consensus to reach ».

In which areas is the difference between men and women greatest?

“Second, starting with the immune system. Women are stronger and more reactive and have a greater ability to produce antibodies and respond to infections because, from an evolutionary point of view, it aims to protect the fetus.
However, women suffer more from autoimmune diseases, are prone to develop Alzheimer’s and, despite having Parkinson’s less often than men, have a poorer course and a higher mortality rate.
The female reaction to painkillers is also lower, and for this reason they are often accused of complaining of pain, when in reality they should probably only be treated with higher doses ».

Are gender differences also reflected in diagnostics?

“Absolutely. Take a heart attack, for example: If you ask a person to describe the symptoms, they will almost certainly mention severe pain and constriction in the chest radiating out to the arm. However, this is what happens to men and only rarely for women, where heart attack much more often manifests itself with back pain lasting for days, gastrointestinal disorders such as nausea or vomiting, fatigue and exhaustion. All symptoms not known and consequently ignored ».

The pandemic could have been an opportunity to change course, but again, the same patterns have reappeared.

“Unfortunately. When I started writing this book a year ago, I realized that only 4% of Covid studies had fully included women, despite the differences that the virus works with, there is for everyone to see. For example, it has been seen that men become more seriously ill and have a higher mortality rate, and women are more interesting from long Covid.The latter has also developed many more side effects on vaccines, a very predictable fact as it also exists for other vaccines ».

Can you see changes in the horizon?

“We must ask for them by spreading as much as possible and keeping the attention of the media and politics high.”

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