Journal Articles on Sex and Gender Specific Care

Wednesday, March 7, 2012

Bridging Women's Health and Medical Education

March 8 Marks International Women’s Day (IWD)

Today, the Advancing Women's Health Initiative appeals to every Center of Excellence in Women's Health and asks every medical institution to consider how well your programs address sex and gender differences in your academic priorities and in your training.

Commit to reviewing your current curriculum in honor of International Women's Day. Together, we can forge a bridge between the medical practice that is, and the approach to medicine that should be taught with a sex and gender lens. IWD provides a chance for us to recognize the efforts needed to improve our approach to heath care. And, not just today, but all year round until our mission is achieved. 

Commit to creating a more integrated program that assures that the incoming class of physicians will develop a sex and gender lens so that women across the United States and around the world can be assured the best medical care possible.  

Learn more about the Advancing Women's Health Initiative, at AWHI and Medpedia

Wednesday, February 1, 2012

Both Sexes Benefit from Statins, Or Do They?

Statins reduced adverse cardiovascular events and all-cause mortality in both men and women, based on a meta-analysis reported in the February 7 issue of the Journal of the American College of Cardiology.

Statin therapy reduced major adverse cardiovascular events by 19% in women and by 23% in men and all-cause mortality was lowered by 10% and 16%, respectively, according to lead author, William Kostis, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues.

"Statin therapy should be used in appropriate patients without regard to sex," the researchers concluded. "It seems that, with respect to statin therapy, what is good for the gander is good for the goose."

However, there is a healthy difference of opinion among the experts, as excerpted from MedPage Today:

 Lori Mosca, MD, PhD, lead author of the 2011 American Heart Association Guidelines for Cardiovascular Disease Prevention in Women, urged caution, in an accompanying editorial, noting that the analysis focused on relative risk reduction, had a limited number of primary prevention trials, and had a limited assessment of the costs and risks of statin therapy.

"Sex-specific results in cardiovascular prevention trials should be provided for relative and absolute benefits, adverse outcomes, and cost-effectiveness," says Dr. Mosca. "Only then we will know with less uncertainty whether what is good for the gander is also good for the goose. Medicine is still an art."
Although statins have well-established benefits in secondary prevention, published data suggest that statins might not be as effective for women, particularly when used for primary prevention. That's because women without cardiovascular disease have a lower annual risk of mortality and lower cardiovascular risk than men without cardiovascular disease.
"Therefore, the absolute benefit of statins will typically be less for women than men, suggesting it might be appropriate that women receive statins less frequently than men in the setting of primary prevention," says Lori Mosca, MD, professor of cardiology at Columbia University Medical Center, NY.
Despite all of the evidence pointing to differences in cardiovascular response in women, John Messmer, MD, of Penn State College of Medicine, believes that “gender does not mean we treat differently for cardiovascular and cerebrovascular disease," whereas Lee Green, MD, MPH, of the University of Michigan, suggests that "[t]here really isn't much reluctance to prescribe statins to women, but there should be [since] benefit has been asserted where there really isn't evidence for it.”
Barbara H. Roberts, MD, author of The Truth About Statins and Associate Clinical Professor of MedicineAlpert Medical School of Brown University, RI, points to Lori Mosca’s comment in the accompanying editorial, indicating that the absolute benefit of statins will be less for women “suggesting it might be appropriate that women receive statins less frequently than men in the setting of primary prevention.” And as she added “the authors did not have enough data to critically evaluate adverse side effects…”

We have almost no data on the adverse effects of long term use of high dose statins, but we do know that women are more likely than men to have side effects,” adds Barbara Roberts, MD. “Most telling is that 17 of the 18 trials were sponsored by the pharmaceutical companies who made the statins involved.

“While Lori Mosca’s editorial was well-written and brought out several limitations and considerations of this particular study and statin treatment in different sexes, unfortunately publications are generally taken as fact by the majority,” observes Marjorie R. Jenkins, M.D. Executive Director of Laura W. Bush Institute for Women’s Health at Texas Tech University Health Sciences Center, and a leader in the Advancing Women’s Health Initiative, which aims to promote a greater understanding of sex and gender differences in optimizing that medical care for all.

Monday, January 30, 2012

Clinical Research and Reporting Falls Short in Addressing Sex Differences

The Institute of Medicine (IOM) published the workshop summary on Sex Specific Reporting of Scientific Research in response to a 2010 report, Women’s Health Research: Progress, Pitfalls, and Promise that stated, once again and still, that data has not being reported by sex, which has led to slower progress in the optimal delivery of women’s health. Even as women's participation in clinical trials has increased over the past 20 years, we are still underrepresented and the inclusion of women has not translated to results consistently analyzed separately by sex.

This past August, the IOM’s Board on Population Health and Public Health Practice addressed the recommendation that journals should adopt a guideline to have articles share the outcomes of clinical trials for both men and women, reported separately. The workshop focus went beyond clinical trials to look at sex-specific reporting in all types of scientific research. 

The need for sex-specific reporting as well as the benefits of and potential barriers to such reporting are addressed in this report.

Thursday, January 12, 2012

New Research Revives Psychological Differences Between the Sexes


The argument that men and women are more alike than different has been supported by expert consensus among those who study personality differences between the sexes. Most notably, a 2005 study by Janet Shibley Hyde, professor of psychology and women's studies at the University of Wisconsin, Madison, who reported that men and women were actually very similar, not only in personality traits, but in other realms of supposed gender difference, like self-esteem, leadership, and math ability. However, this theory is being challenged given recently published findings that women and men are more appropriately viewed as “different species”. A return to the Men are from Mars and Women Come from Venus way of thinking is revived in a new study that suggest that men and women feel and behave in markedly different ways. For example, men are far more dominant, reserved, utilitarian, vigilant, rule-conscious, and emotionally stable, while women are far more deferential, warm, trusting, sensitive, and emotionally "reactive." The two sexes were roughly the same when it comes to perfectionism, liveliness, and abstract versus practical thinking.

In effect, only 18 percent of men and women match in terms of personality profiles, and that's staggeringly different from the consensus view, according to the newest data. It may that because past research usually compared one variable at a time, this method led to underestimations of sex differences because when personality traits are combined the result provides a more significant variation. And, it appears that researchers may have been biased in their methods in order to reduce any gender difference, but a growing recognition that acknowledging sex differences will improve sensitivity to quality care.

Wednesday, December 14, 2011

Gender Equity Still Long Way Off According to Catalyst Report

Findings from the 2011 Catalyst Census: Fortune 500 Women Board Directors, Executive Officers and Top Earners, indicates that gender equity at the most senior ranks of corporate America remains elusive. Despite some reports that women are hanging on to jobs at a better rate then men, a glimpse at business leadership reflects a workforce in which women remain at the middle and bottom rungs, with a continuing gender gap at the top ranks no better than six years ago. Among the Fortune 500 companies, only 16% of board seats, 14% of Executive Officer positions, and only 7.5% of top earners represented by women. Across all parameters, the trends remain flat. For example:
Photo from

   Less than one-fifth of companies had 25% or more women board
   About one in ten companies had no women serving on their boards.
   Women of color held only 3% of board seats
   Women held only 7.5% of Executive Officer top earner positions, while men accounted for 92.5% of top earners
   Nearly one in five companies had 25% or more women Executive
Officers and more than one-quarter had zero

Another Catalyst report, The Bottom Line: Corporate Performance and Women's Representation on Boards (2004–2008), reflects that gender diversity in the boardroom correlates with better corporate performance, such that Companies with three or more women board directors in four of five years, on average, outperformed companies with zero women board directors—by 84% for return on sales, 60% for return on invested capital, and 46% for return on equity. Given these findings, Catalyst challenges corporations to 'harness American "can-do" spirit to make action synonymous with commitment to achieve gender parity and enable a wealth of talented women to advance and contribute.'

Tuesday, December 6, 2011

Is medicine becoming a woman's world?

Graphic design by James O'Brien

In the UK, women doctors are set to outnumber their male counterparts by 2017. The press has dubbed the rise "worrying" and "bad for medicine" but in an editorial in Student BMJtoday, author Maham Khan ponders the sex specific shift in medicine and asks if too many female doctors is bad for medcine?                       

Jane Dacre, Medical School Director at University College London, believes feminisation is a fact, but disagrees that medicine is becoming overfeminised and suggests that the rise of women doctors is bridging the gender divide. "I don't think we have yet reached an era of feminisation. What we are doing is reaching equality," she says.
Many studies show women dominate in specialties such as general practice, paediatrics, and palliative care, but some branches of medicine, such as cardiology and general surgery, remain closed or unattractive to women, according to consultant cardiologist, Professor Jean McEwan. Other prominent professors agree that women are not reaching the highest positions, and research shows that, unfortunately, a gender pay gap still exists in medicine.
"Medicine is not a profession of gender equality," says Anita Holdcroft, Emeritus Professor of anaesthesia at Imperial College. "Research shows women often feel uncomfortable in negotiations over pay. But yet they are doing the work. And the percentage of women who apply for clinical excellence awards is less than men." She suggests we need to think about how to overcome some of these gender barriers and enable women to "become visible. 
So, why are men becoming an endangered species in medicine? Will Coppola, a senior lecturer at University College London, believes the problem starts at secondary school. "There is a serious problem with underachievement of boys at school," he says, and he suggests that medicine is becoming a less attractive career option for men for reasons such as loss of status, regulation and control, and decreased autonomy.
But is a female future bad practice, asks Khan? Despite the fears propagated by the media, more women in the medical profession could lead to safer practice, she writes. A review of complaints received by the National Clinical Assessment Service (NCAS) shows women are less likely to be subject to disciplinary hearings.And she adds that findings published in a report from the Equality and Human Rights Commission highlight the progress of women in medicine. "With the report saying it will take women 55 years to reach equal status with men in the senior judiciary and 73 years for women directors in FTSE 100 companies, it seems in terms of numbers, female doctors have made giant leaps for womankind," she concludes.
The question for US physicians (rhetorical, of course)  are women good for medicine?! Given the need to adjust clinical trials to reflect sex and gender specific differences, and to report findings that reflect differences in sex and/or gender, and the challenge of caring for women based on their biopsychosocial needs rather than as an estimate of what's good for men, suggests that more women is just the medicine needed to improve the  health of all.

Tuesday, November 22, 2011

Sex and Space: The New Frontier

It’s important to consider Human Factors to tailor care well. -- Saralyn Mark, MD

As the United States plans for a trip to Mars, a conference, Women and Mars, was held at George Washington University to begin the discussion of the role that women are playing and will take as the nation prepares for this monumental voyage and throughout its exploration.
         Of particular interest is the 'Getting to Mars' panel which includes a presention by Saralyn Mark, MD, president of SolaMed Solutions, who speaks to the sex and gender differences that must be considered in preparing the astronauts for travel, particularly for such an extended travel with exposure to radiation and antigravity. Dr. Mark was the first Senior Medical Advisor to the Office on Women’s Health at the Department of Health and Human Services and the National Aeronautics and Space Administration (NASA). Her presentation incorporates findings that appear in a book chapter, "Cosmic Cosmetology".  
To view the panel discussion, Click Here.