Consider this: Both men and women have breasts, but why do we see more cancer in women's breasts?
Both men and women have hearts, but why do women have more chest pain caused by a spasm of vessels and a break-off of cholesterol plaques, while men have more gradual build up of cholesterol that leads to a blockage? In men, why is the blockage picked up on a dye study, yet women might have normal looking vessels, go home and die due to a spasm that was missed with the same study?
Both men and women have colons, but why does colon cancer in women occur higher in the colon than men, making the sigmoidoscope, which only looks at the last portion of the colon (the standard way to diagnose cancer in men) less effective for diagnosis of colon cancer in women?
After decades of using clinical research conducted on men as the basis for the treatment of women, the medical community across the nation is beginning to recognize that gender-specific research is crucial to ensuring proper treatment. The more they look for the differences, the more they are amazed that this information has been invisible for centuries of health research.
Two physicians at
Borgess Medical Center in Kalamazoo are leading figures in the effort to bring women's health issues to the fore using research conducted on women.
Doctors Janice Werbinski and Soundos Moualla play prominent roles at Borgess, and are respected leaders nationally among those interested in research to explore the differences that can threaten women's lives simply because they are not well known.
Moualla is the Medical Director of the Borgess Women's Heart Program and a cardiologist with the Heart Center for Excellence. She received specialized training in specific heart health concerns among women at some of the most respected medical schools in the nation.
Werbinski is the Medical Director of Borgess Women's Health and she recently received the American Medical Women's Association President's Award. She is also president of the American College of Women Health Physicians.
Both contend that better treatment of men and women is possible if gender is considered when exploring causes and treatment of medical conditions.
"Every organ has a sex, a gender, and it stands to reason that the treatment of men and women should be studied individually and not from the same research pool," says Werbinski. "There are many examples of conditions affecting women differently than they do men. We are just now discovering some of them because for so many years, gender-specific research was not being conducted.
"And, even now, when gender-specific research is becoming a more common practice, often physicians are not being made aware of the results," she says.
For example, women with asthma are more likely to suffer attacks the week before menstruation, so understanding a woman's cycle is vital in the treatment of her condition, Werbinski says. Without gender-specific research, this almost certainly would not have been discovered.
Other instances of gender-specific research that has uncovered important treatment techniques involve the standards for qualification for a kidney transplant, or cholesterol levels that appear differently in women than they do in men.
The symptoms of a woman suffering a heart attack are also different than the symptoms of a man.
"Almost everyone is familiar with the symptoms of a heart attack that involve radiating pain in the left arm, and the feeling that an elephant is standing on your chest," Werbinski says. "Well, those are the symptoms of a man suffering a heart attack, not a woman."
Werbinski says gender-specific studies show that "women feel fatigue and pain in their neck and jaw. Often, these are ignored because so many people associate men's symptoms with what everyone should feel when they have a heart attack. Sometimes, the consequences are tragic."
Heart disease, in fact, is the No. 1 killer of women in America. This statistic that might surprise some is just the kind of information gender-specific research and treatment can bring to light, says Werbinski.
When it comes to heart disease in women, Borgess has a leader in the field in Moualla. Now Medical Director for the Borgess Women's Heart Program, Moualla completed a residency and Interventional Cardiology Fellowship at Mayo Clinic in Rochester, Minn., and a Cardiology Fellowship at the Cleveland Clinic in Ohio.
Her electives at Mayo Clinic and Cleveland Clinic were performed in the women's cardiology program. Moualla makes presentations in many parts of the country on women and heart disease, and participates in many national conferences focused on women.
Moualla and Werbinski are not alone in their passion in the area of gender-specific research. A recently-released Institute of Medicine report says that "women's health research has contributed to significant progress in lessening the burden of disease and reducing deaths from some conditions, while other conditions have seen only moderate change or even little or no change."
Research is becoming more specific to gender, say the IOM report, but often it doesn't trickle down to physicians treating women.
"The IOM report echoes our call for more research and specifically research into sex differences and diseases and illnesses which disproportionately, differently, or exclusively impact women," says Martha Nolan, vice president of public policy for the Society for Women's Health Research.
One problem is, even though years of research into differences in
treatment for men and women have been done, the findings remain largely
unknown. Since the Office of Women's Health at the National Institutes
of Health was formed 20 years ago the NIH has monitored all research
there that includes women subjects. Yet very few medical schools have
incorporated the available information into their curricula.
"One of the things I have become passionate about is getting this
information to medical students and residents and physicians in
practice," says Werbinski.
Werbinski is doing her part to spread the word. She is a driving force behind the launching of "Advancing Women's Health," an on-line
digital resource library of gender-specific materials. It is free and accessible to physicians, students and health care workers.
"Until now, sex- and gender-specific evidence-based medicine has not been available in a centralized, accessible location for use in medical education and clinical practice," Werbinski says. "Advancing Women's Health fills that void with a free, web-based, national repository for research results, teaching tools and other teaching aids."
Kelle Barr is a freelance writer living and working in the Kalamazoo area.Photos by
Erik Holladay.
Dr. Soundos Moualla and Dr. Janice Werbinski are leading figures in the effort to bring women's health issues to the fore using research conducted on women.
Dr. Soundos Moualla is Medical Director for the Borgess Women's Heart Program.
Dr. Janice Werbinski is Medical Director of Borgess Women's Health.