From bones to brains, women differ from men
From bones to brains, women differ from men
Columbia aims to create gender-specific database
If you have an inkling that women and men respond differently to medical care, then you already understand why the growing interest in gender-specific health data is long overdue. Soon, Columbia University will offer a database detailing the myriad physiological differences between the sexes. The project, called "Partnership for Women’s Health," will provide you with information tools to create health care standards and patient education programs. The partnership also plans to design female-oriented patient education materials. This news elicits an enthusiastic response from Judith Macon, RN, MA, program coordinator at the Betty Ford Comprehensive Breast Center in Washington, DC.
"The complaints I hear from colleagues are that we operate on research extrapolated from men," Macon says. "We don’t have any scientific base of data that takes women’s differences into account."
The partnership’s director, Marianne J. Legato, MD, FACP, associate professor of clinical medicine at Columbia University College of Physicians and Surgeons in New York City, explains how the paucity of gender-specific data on heart disease poses a particular threat.
"Half of the women in this country believe that breast cancer is the leading killer of women, but it’s really heart disease," Legato says. (For review of an article supporting this fact, see The Last Word, p. 66.)
Gender differences go beyond the heart, according to Jasmine Martin, MSN, FNP, nurse practitioner at Parker (CO) Family Medicine. Because women’s bodies have smaller muscle mass and fewer proteins and red blood cells, prescription drugs can linger in the cells and cause toxicity unless women drink enough fluid (eight to 10 cups a day) to clear the medicines through the kidneys, Martin explains. "Even the new drugs have different dosing directions for the elderly, but there are still no specifications for gender," she says.
Data not limited to medicine
Female brains have more neurons the implications of which haven’t been fully explored, Legato adds. Due to thinner bone mass in later life, she says, women endure 80% of the 210,000 hip fractures that occur every year.
"The composition of women’s saliva is unique, and it changes during menstruation," Legato explains. Though not medically as important as some gender differences, she says, it does highlight how profoundly the sexes differ.
She uses the differences in salivary composition to outline the implications of these data not only for medicine, but for the corporate world as well. Enter Proctor and Gamble, toiletries manufacturer and partner in the Columbia project.
"If we know that women’s salivary composition is different," Legato illustrates, "then perhaps toothpaste manufacturers will develop different toothpastes for women."
Woman-specific data also might help in developing skin-care products for post-menopausal women whose diminished estrogen production thins and drys the skin. Such commercial developments are still several years away, though.
Currently, Legato and associates are creating a database of gender-specific findings from existing medical research literature. Women’s health providers can obtain reports from the cardiovascular database as soon as next year. It’s too early to specify the costs of the data, but Legato does say figures will vary according to the complexity of the search. A high-end example, she says, could be $250,000 for a comprehensive breakdown of the gender-specific findings in all the available neurological literature.
The Columbia partnership has no intention of targeting its information tools solely to large, well-heeled institutions. Within the next year, it will publish a monthly subscription bulletin for women’s health providers that will summarize woman-centered health data to aid in patient teaching and upgrading women’s health care. You can get on the list for publication notices by contacting the office or watching the World Wide Web site and requesting on-line information when the publication announcements appear. (For details, see source box, below.)
"If there were something like this on line that people could access, it would be extremely well-received," Macon says.
Martin agrees, citing birth control drugs as one instance where women’s health providers lack solid research data for patient teaching. And Legato says that plans are under way for on-line access to the partnership’s data.
"Women are afraid to take perfectly good birth control therapies because they’re afraid of the side effects like weight gain," she says. "It would be so helpful to have specific information that helps our patients understand the risks and benefits of these drugs."
Patient education tools are on the drawing boards, Legato says. (The first one, A Woman’s Place is in the Know, is inserted in this issue.) Recently the partnership assessed the interest in woman-centered health data through a nationwide survey of women over age 18 who had visited a doctor in the past two years. Seventy-seven percent said it’s important to know the gender differences in medical needs, and 63% said health providers should treat them differently on more than reproductive issues.
"We [women] approach health from a health perspective," Martin observes. "We use what we learn to keep ourselves healthy and to take care of our children and our husbands and our aging parents. We’re the main consumers of health information."
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