For more than two decades a Kalamazoo-based physician has dedicated herself to introducing a sex and gender-based health curriculum into medical schools in the United States. Dr. Janice Werbinski knows that such a curriculum would enable medical students to learn about the best approaches to take when treating male and female patients.
With a
new medical school at Western Michigan University scheduled to enroll its first class of students in 2014, Werbinski, an obstetrician and gynecologist with Borgess Women’s Health and a clinical professor at Kalamazoo Center for Medical Studies, sees a real opportunity to establish curricula that focuses on the appropriate course of treatment for women.
Too many in the medical community think that a specialty in obstetrics and gynecology adequately addresses the healthcare needs of women. Werbinski and her colleagues in the American College of Women’s Health Physicians know this is not the case.
Women instinctively know when they’re not being listened to and their problems are not being addressed, Werbinski says, adding that doctors don’t always know that the symptoms for men and women are different, as is the case with heart disease.
"We have been proving that out," Werbinski says. "When a woman comes into some emergency rooms with fatigue, nausea and sweating, classic symptoms of a heart attack in women, she is often diagnosed with anxiety. When a man comes in with his classic symptoms he is evaluated for a heart attack. This is why we need every doctor in every specialty to recognize the differences when treating a man or a woman."
The requirement to treat men’s and women’s healthcare needs differently has largely been ignored by the American healthcare system, however, while its European counterparts have embraced the idea and moved at a rapid pace to include sex and gender health curricula in their medical schools. Werbinski cites schools such as
Monash University in Melbourne, Australia, which has a four-year curriculum in sex and gender medicine as an example of what is possible in the United States.
Currently Texas Tech University in Lubbock, Texas, is the only school in the United States building a four-year sex and gender integrated curriculum. The school also is home to the The
Laura W. Bush Institute for Women’s Health, which was established in 2007 following after eight years of discussions led by Dr. Marjorie Jenkins, professor of Medicine at Texas Tech University’s Health Center, associate dean for Women in Health and Science and chief scientific officer for the Bush Institute.
"It’s not different medicine, we’re just taking into account the basic human variable that we all have," Jenkins says. "Part of it is because we have historically studied males in research and applied those findings to the way we treat men and women."
It took a mandate from the National Institutes of Health to have women included in research studies. Before the NIH decision, the Food & Drug Administration prohibited pre-menopausal women, in other words, most women, from participating in studies. In the 1990’s the FDA ruling changed.
"The NIH mandated that if there was a health issue that affected both sexes, any study had to include representation from males and females," Jenkins says, "but this is still not being globally enforced with researchers and research is still being overwhelmingly conducted on male mice. I recognize that it costs more money to study both sexes, but if you really want to study a particular disease at least indicate what sex was studied."
Jenkins says the United States is at a tipping point in the debate about the need for a sex and gender focused curriculum. She says the need is based on medical evidence.
"It’s not about men and women being equal, it’s about the evidence, and part of the challenge is that people don’t know that the evidence is out there," Jenkins says.
Hal Jensen, founding dean of WMU’s School of Medicine, says he knows medical evaluation and treatment must be conducted differently on men and women, but he does not think the new medical school needs to integrate a sex and gender curriculum. He says such labeling is unnecessary because students and instructors know that when anatomical parts such as the breast or prostate are being treated, they are exclusive to males or females and the treatment will be gender specific.
"Those principles are already included in what we would consider public or community health and they are embedded throughout our curriculum," Jensen says.
Jensen says the new medical school will provide students with every opportunity to learn about the differences in treating men and women. He says he sees no reason to incorporate a curriculum that could potentially be viewed as isolated from the rest of the school’s instruction.
Werbinski says there must be some type of oversight in place to make sure gender specificity is included in all of the school’s curricula.
"I still think we need an endowed chairperson," Werbinski says. "You can’t just go to these teachers and tell them they need to include gender and sex in their courses. You need to get the students passionate about it."
Jenkins says WMU has an amazing opportunity to integrate sex and gender into a new curriculum from the ground up. She says Texas Tech is working on building a curriculum that could be replicated at other schools.
"At the time we began the discussion sex and gender differences was not synonymous with women’s health and the research that was being done was pointing to many differences at all levels," Jenkins says. "It impacts clinical care and how doctors, nurses and pharmacists approach the patient.
"We knew that sex and gender differences were going to be very important to the future of clinical medicine."
Jane C. Parikh is a freelance reporter and writer with more than 20 years of experience and also is the owner of In So Many Words based in Battle Creek.
Photos by Erik Holladay.
Dr. Janice Werbinski in her office.