Men, Women More Different Than Thought

Beyond the tired cliches and sperm-and-egg basics taught in grade school science class, researchers are discovering that men and women are even more different than anyone realized.

It turns out that major illnesses like heart disease and lung cancer are influenced by gender and that perhaps treatments for women ought to be slightly different from the approach used for men.

These discoveries are part of a quiet but revolutionary change infiltrating U.S. medicine as a growing number of scientists realize there’s more to women’s health than just the anatomy that makes them female, and that the same diseases often affect men and women in different ways.

“Women are different than men, not only psychologically (but) physiologically, and I think we need to understand those differences,” says Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association.

DeAngelis, who became the journal’s first female editor in 1999, says she has made it a mission to publish only research in which data are broken down by sex unless it involves a disease that affects just men or women.

In recent months, two medical textbooks billed as the first devoted to gender differences in all areas of medicine, not just reproductive medicine, were published; a widely cited Journal of the AMA report re-emphasized the neglected fact that lung cancer, not breast cancer, is the No. 1 cancer killer among women; and the American Heart Association announced the first-ever heart disease prevention guidelines tailored specifically for women.

And this fall, the office of Surgeon General will issue its first-ever report on osteoporosis. The crippling bone-thinning disease disproportionately affects women, who lose the bone-protecting effects of estrogen at menopause. The report will emphasize prevention — and that it’s not just a woman’s disease — 20 percent of patients are men, said Wanda Jones, director of the Office on Women’s Health at the U.S. Department of Health and Human Services.

The gender-based medicine movement isn’t an effort to diminish the importance of breast cancer, but is meant to emphasize that “we have more than one body part, folks. Up until now … that awareness just hasn’t been there,” said Sherry Marts of the Society for Women’s Health Research. That organization seeks to expand the definition of women’s health beyond breast and reproductive health, what some call “bikini medicine.”

Until the 1990s, scientists frequently excluded women from medical research, including drug studies. It was largely out of concern over effects on reproduction but also because of a long-standing belief that men and women “were biologically the same except for their reproductive organs,” Marts said.

However, recent discoveries suggest that genes, hormones and lifestyle may be behind many of the differences. For example:

_Heart attacks in women frequently don’t involve chest pain and may involve more vague, flu-like symptoms.

_Women who don’t smoke appear to be more susceptible to lung cancer than nonsmoking men. Women also tend to get lung cancer at younger ages than men, and they appear to metabolize cancer-causing substances differently than men.

_Women are less likely than men to get oral cancer.

_Women are more prone to autoimmune diseases, including lupus, rheumatoid arthritis and multiple sclerosis, in which disease-fighting mechanisms mistakenly attack the body’s own tissues.

_Some AIDS-fighting medicines appear to metabolize more quickly in men than in women, who may require gender-specific doses.

_Women’s symptoms for ulcerative colitis and Crohn’s disease — debilitating intestinal diseases that affect men and women — vary considerably each month, requiring frequent medication adjustments.

Inflammatory bowel disease, which encompasses both Crohn’s and colitis, is a specialty of Dr. Sunanda Kane, a University of Chicago researcher who is studying why the problem seems to be on the rise among young women.

Both diseases damage the digestive tract and in severe cases, doctors remove part of the colon and patients must wear colostomy bags.

Kane says she got interested in a gender-based approach several years ago during her training, when there were few other gastroenterologists who were women.

“Female patients were thrilled to see a woman and they started to tell me things they’d never tell their (male) doctors,” including what their menstrual periods were doing to their disease, she said.

But as in many areas of gender-based medicine, many important questions remain, including how aging affects inflammatory bowel disease, Kane said.

“Anecdotally, people have told me their disease went into remission after menopause,” and some women “are asking me if they can have a hysterectomy so they can go into remission,” Kane said. It’s an issue that could have a huge impact on patients’ quality of life — but it’s never been studied, she said.
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