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Medicine based on sex and gender: essential for prevention and holistic and personalized care

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Medicine based on sex and gender: essential for prevention and holistic and personalized care

by F. Franconi, M. Bettoni, I. Campesi

This will be discussed at the next Risk Management Forum. The aim is to increase awareness of the importance of the sex-gender variable, so that health and care are increasingly implemented which, abandoning the dominant androcentrism, put the person at the centre, and this cannot happen without considering gender -gender

14 NOV

Also this year at the Risk Management Forum in Arezzo we are talking about that dimension of medicine known as gender medicine but which, as many authoritative experts from all over the world maintain, it would be better to call medicine based on sex and gender.

This year, in the symposium: “the sex-gender in infectious diseases: a global view” a theme is being addressed that the recent pandemic has imperatively placed before our eyes. The symposium, promoted by the “Health and Social Policies Commission of the Tuscany Regional Council and by Women’s Tuscany: the reason for value” also addresses these issues to overcome inequalities and promote sensitive approaches to sex and gender.

The sex-gender approach in medicine was born from the feminist battles of the seventies – to then organize and structure itself in the nineties of the last century – when in the New England Journal of Medicine, one of the most prestigious if not the most prestigious medical journal, it was published the editorial “Yentl Sindrome”, which unequivocally showed the treatment disparities between men and women in cardiology.

This article, which takes its name from a story by Isaac B. Singer, incontrovertibly showed the male chauvinism of medicine. Unfortunately, despite the recommendations, rules and laws, two recent surveys and some articles published in international journals have shown that, up to now, little progress has been made in the field of sex and gender based medicine. In particular, one of these highlights that, although there was a 30% increase in the number of manuscripts that included men and women, only 19% of these had an appropriate experimental design for sex-gender searches and only the 5% analyzed sex-gender as an independent variable, which was 2% in 2009 (Rechlin et al 2022).

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The second shows that out of 11 therapeutic areas, in 7 of them, such as HIV/AIDS, kidney disease, cardiovascular disease, etc., there is still an under-recruitment of women. This under-enrollment is slightly lower than that found prior to 1993 (when women in the USA were excluded from clinical trials)[Feldmanetal2019)Someauthorspointoutthatonlyinpharmacologyhavetherebeenasignificantincreaseinstudiesthatincludethesex-gendervariablebetween2009and2019(Woitowichetal2020)[Feldmanetal2019)Alcuniautorievidenzianochesoloinfarmacologiasianosignificativamenteaumentatiglistudicheincludonolavariabilesesso-generetrail2009edil2019(Woitowichetal2020)

Even in a disease that immediately showed the importance of sex and gender like Covid-19, this variable has been underestimated. In fact, out of 4,420 Covid-19 studies registered on the ClinicalTrials.gov website between January 1, 2020 and January 26, 2021, some authors observed that 21.2% limited themselves to reporting sex and gender only in the recruitment, 5.4% underline the sex/gender variable also in other phases, but only 4% include it as an analytical variable (Brady et al. 2021). The same authors also point out that only 17.8% of published papers report stratified data or do subgroup analyses.

However, even if so far we have only talked about women, we must clarify and strongly emphasize that sex and gender based medicine is not women’s medicine but it is the medicine of all people including the population that does not recognize itself in a binary sexual dimension In short, it is the medicine of diversity, which in our country is still often considered a negative factor, and which instead is wealth.

Finally, the authors of this article argue that in addition to being everyone’s medicine, sex and gender medicine has another strong point because it goes beyond the body, considering the environment in which a person lives, his culture, his socioeconomic status, which too often we forget and which instead is an important factor for the prevention and for the onset of infectious diseases and chronic-degenerative diseases such as diabetes, obesity, myocardial infarction and so on. In this sense, the gender approach is a holistic approach.

L’gender approach is therefore a multidisciplinary approach: includes the health system and the social system, and must involve all the components of a community, from medicine to architecture, from philosophy to the economy. Because if we want to build health and medicine based on sex and gender, it is necessary to build a world that is more suitable for everyone and this obviously requires a change of mentality.

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Stefano Vella will be present at this symposium coordinated by Monica Bettoni and Mojgan Azadegan: one of the leading researchers in the field of AIDS, who among other things is also one of the fathers of Italian gender medicine having edited the book “Farmacologia di Genre” published in 2010 by Seed Torino and having been the coordinator of the strategic project “Gender medicine as a strategic objective for public health: the appropriateness of treatment for the protection of women’s health” made in 2007. Prof. Vella, now at the Catholic University, will speak about the influence of gender on viral diseases in a global context.

Next, Dr. Fabrizio Gemmi, of the Regional Agency of Tuscany, will analyze the epidemiological data of Tuscany in relation to infectious diseases by putting the lenses of sex-gender. While professor Anna Teresa Palamara, a great connoisseur of micro-organisms, of the Istituto Superiore di Sanità, will talk about how viruses act according to the gender of the host, while prof. Valeria Raparelli of the University of Ferrara and member of the University Center for Studies on Gender Medicine of the University of Ferrara will focus on the differences in the presentation and impact of infectious diseases in men and women.

Subsequently, Prof. Amelia Filippelli of the University of Salerno and member of the Prices and Reimbursement Committee (CPR) of Aifa will talk to us about antiviral drugs, highlighting the differences in the efficacy and safety of medicines between men and women (Conti et al, 2022) and the population that does not recognize itself in a binary sexual dimension, when possible given the chronic under-recruitment of this last subpopulation.

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The chronic under-recruitment of women is accompanied by poor recruitment of female animals and experiments on cultured cells, as if they were not XX and XY, thus making it difficult to detect pharmacodynamic differences. A phenomenon, that of the so-called “sex-gender bias”, increasingly debated among pharmacologists, also in view of the methodological problems it creates (Franconi et al, 2019).

Finally, Dr. Elena Ortona, Reference Center for Gender Medicine of the Istituto Superiore di Sanità, will talk about the long Covid. Long COVID is a syndrome that occurs more than 4 weeks after SARS-CoV-2 infection and persists for weeks or months after recovery from COVID-19. It presents a clinical picture that can vary from patient to patient. Dr. Ortona will focus on how this syndrome is influenced by gender.

Therefore, during the Risk Management Forum, the aforementioned issues will be discussed to increase awareness of the importance of the sex-gender variable, so that health and care are increasingly implemented which, abandoning the dominant androcentrism, put the person at the centre, and this cannot happen without considering sex-gender (Campesi et al, 2021).

It is our opinion that there can be no personalized medicine if only the biological body is considered, because life experiences profoundly modify it (such as not thinking, for example, of the modifications induced by stress on all pharmacokinetic parameters) ( Campesi et al 2021; Franconi et al 2019) therefore the time has come for it to be taken into due consideration.

Flavia Franconi

National Laboratory of Gender Medicine and Pharmacology-Interuniversity Consortium Biostructures and Biosystems

Monica Bettoni
Physician Member of the National Observatory on Gender Medicine, Scientific Committee of the Forum Risk Management in Healthcare

Ilaria Campesi
Department of Biomedical Sciences, University of Sassari; member of the regional technical group for the planning of gender medicine dissemination activities (Sardinia Region)

November 14, 2022
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