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A medicine that penalizes women

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A medicine that penalizes women

by Tiziano Costantini

On 27 October, at the Sala del Commendatore of the Santo Spirito In Sassia Hospital, a meeting took place promoted by the Alessandro Liberati Library, which once again tried to shed light on the lack of attention to gender differences in medical and pharmacological research.

11 NOV

Although the number of female doctors and researchers has steadily increased in recent decades, gender inequalities persist and are due, at least in part, to implicit biases in the medical-health sphere and even in patients. Biases that negatively affect women in their careers and contribute to slower progression, less favorable ratings, underrepresentation in leadership positions, fewer invitations to conferences and conventions, lower salaries, but above all leading to to an inequality in the response to health needs, to a horizontal medical treatment that often does not take into account gender differences, to the fact that men and women get sick differently, have a different disease progression and respond differently to therapies.

There are certainly efforts for directional change, but we are still far from a radical cultural transformation that should lead to gender equity both in the field of diagnosis and therapy and in research.

The Department of Epidemiology (DEP) of the SSR of Lazio – ASL Roma 1 Lazio has always recognized the importance of documenting and monitoring these differences in the various scientific and institutional activities, and in fact published last May the first epidemiological report on the relationship between health and Gender in the Lazio Region, which collects the main epidemiological data produced by the DEP on various health aspects that differ between females and males.

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Aspects explored again in a meeting promoted by the Alessandro Liberati Library, in collaboration with the DEP Lazio, held on the afternoon of October 27 at the Commendatore’s Hall of the Santo Spirito In Sassia Hospital, starting from the book “A medicine that penalizes women. Evidence of an inconvenient truth and some proposed solutions“, from Silvio Garattini e Rita Banziand trying to analyze the dangerous limits of a “male medicine”, together with a stage of expert research and clinical speakers.

Between these Valeria Belleudi, of the UOSD of Drug Epidemiology of the DEP Lazio, which immediately focuses on two key questions: what role does gender play between the use of a drug and any outcomes? And does the prescriber always keep in mind the basic risks to which the man or woman he is facing is exposed?

“Our experience – says Belleudi – leads us to say that although the risks change according to the gender, this is rarely considered as a determinant of the choice of a therapy”.
An equity of treatment that actually hides a discriminating factor for women. Although we are in the era of precision medicine, of personalized medicine, “the basic risks that characterize these two populations are not even taken into account”.

Of the same opinion Filomena Fortinguerraan expert who works for the monitoring office of pharmaceutical expenditure and relations with the regions of AIFA, who states that even today, unfortunately, we are far from the application of fundamental guidelines, especially for women, as in the case of the use of ‘folic acid for the prevention of neural tube defects, the intake of which is recommended for at least one month before conception, while unfortunately “the data from the OSMED report tell us that it does not always happen”.

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And many other examples could be given in other therapeutic categories. Like oncology, of which he speaks Pasquale Lombardi – A. Gemelli IRCCS University Polyclinic, Catholic University of the Sacred Heart of Rome -, which has chosen to submit a survey to its colleagues from which it emerges a considerable percentage according to which sex is not considered an important determinant of response to certain types of treatments. Unfortunately, however, in oncological treatments (and not only), this is not the case: a recent meta-analysis, for example, tells us that women respond worse to therapies, despite the fact that they get less cancer.

We have known this for years, but the data on why are much more recent, as women are included less in clinical trials. “Analyzing also the very recent studies – Pasquali affirms -, in all pathologies women are less enrolled than men, with peaks for some cases such as HCC, which included 87% of males”. Clearly these are data that must be related to the population and the incidence of diseases, but they still make us reflect, because they are the indicator of something that is not working properly.

It is therefore quite obvious that the system should be revolutionized from this point of view. How? For example, “really introducing gender medicine already within the degree course” – Pasquali emphasizes -, making people understand the differences between men and women, who get sick differently and respond differently to the disease and its treatments.

In part, something is already changing, and finally there is a lot of talk about this topic, “but it’s time to deal with it in a concrete way”, he says Rita Banzi, the author of the book, as well as – clinical pharmacologist, head of the Center for Regulatory Policies in Health, Mario Negri Institute. And furthermore, again according to Banzi, there is also “a question of mental training, in perceiving the need to study certain aspects. In fact, it has been shown that if there are more female representatives in the studies, or if the PI is female, more women are enrolled in the study population ”.

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What we can do, as Belleudi reiterates, is “to continue to generate evidence of these gaps, which can create a contrast with commonplaces”, or – according to Fortinguerra – “to increase awareness that there is an attention on the part of the ‘Regulatory agency on the subject, in order to also increase the accuracy of doctors in making a prescription ”.

Finally, a further hope is that even meetings of this type will help to reflect and contribute to setting aside the androcentric approach to medicine and healthcare, recognizing more and more the importance of guaranteeing the knowledge and application of a gender vision in the research, prevention, diagnosis and treatment.

Tiziano Costantini
Department of Epidemiology SSR Lazio

November 11, 2022
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