Taking sex into account in medicine

Throughout Europe, despite women often forming the majority of students at university, fewer women than men are appointed to high-level jobs in medicine and science. Evidence presented at the first European Gender Summit in Brussels (Nov 8–9) illustrates that without targets or quotas, it will take decades, maybe centuries, to reach equality at the top. Female role models, mentors, and family friendly employment policies encourage and allow women to aim high. Moreover, gender-diverse teams have higher team IQs and promote innovation. But the case for equality is not only about who makes it to the top, it is also about medicine itself. What women can do for medicine is one thing; what medicine can do for women is also important. In medicine too, the common assumption is that men and women experience disease and react to treatment in the same way. Increasingly, though, there is evidence to the contrary. A systematic review published in August online in this journal showed that women who smoke have a higher risk of coronary heart disease than do male smokers. Female smokers also have a higher risk of lung cancer than do male smokers. Overall, in most types of cancer, women have higher 5-year survival than do men. In stroke, atrial fibrillation is one example of a more important risk factor in women than in men. Overall, in many diseases, women have more side-effects from treatment than do men. When the pharmacokinetic and pharmacodynamic characteristics of drug metabolism in men and women are analysed, in some cases the unexpected finding would be if sex had no effect. Body surface area, body mass, and the amount of adipose tissue can all affect response to treatment. Therapeutic drug monitoring is the ideal, but impractical in many settings. Being male or female might be a more important determinant of health, illness, and response to treatment than is known. To find out, and to aid metaanalysts, The Lancet encourages researchers to enrol more women into clinical trials of all phases, and to plan to analyse data by sex, not only when known to be scientifically appropriate, but also as a matter of routine.

The Lancet - Vol. 378 - No. 9806 - November 26/December 2, 2011 - Editorial, page 1826. www.thelancet.com