Is it time for gender-specific medicine?

YES...and about time, too!!!

I've just returned from the annual meeting of the American Medical Women's Association, better known as AMWA. This is an organization that exists to develop women physician leaders and advocate for quality women's health at the local, state and national level. (You can find more information about AMWA at their website: www.amwa-doc.org). This year, the conference theme was focused on Women and Aging, and in addition to getting some medical education credits, I also had the privilege of connecting with some amazing women leaders. Enthusiastic discussions ensued for a full two days, focused on everything from the viability of recent California health reform to the relevance of gender-specific medicine. What a great event for someone like me...who is just itching to connect the dots between what we do as clinicians (who provide healthcare services to individuals, in the short term) and what we do as public health professionals or policymakers (who provide or regulate healthcare to populations, with significant health and economic consequence in the long term).

As I mentioned, the theme of the conference was care of elderly women. What I found troubling, as did several of my colleagues, was the lack of educational sessions that emphasized differences in symptoms, and response to treatment, between men and women who are living with the same disease (like diabetes or coronary artery disease). We now have substantial evidence that suggests women and men tend experience the same disease with different clinical manifestations, to the extent that sometimes women have symptoms that are completely different, or completely absent from the typical man's experience. Women may also respond to a different treatment regimen for the same disease! However, throughout the conference, few presenters actually acknowledged these gender differences as a significantly important issue for continuing medical education.

Heart disease is a great example. More women than men die yearly of coronary heart disease (CHD) than from all cancers, AIDS, and violence combined. However, women tend not to come into the emergency room complaining of chest pain when they are experiencing a heart attack (what we in the clinical realm call a myocardial infarction). In fact, most women usually have normal stress test results even if they have significant blockage in their coronary arteries. As a result, different screening tests, and potentially treatments, are needed to adequately address the burden of this disease in women. I was pleased to hear such a thorough presentation of the testing and treatment protocols for women with CHD at the conference, but there are at least two potential barriers to the future development of comprehensive policy that might allow for the implementation of gender-specific curricula nationwide. First, most medical education curricula continue to reflect the diagnosis, management and treatment of a male patient, often fo the purely historical reason that the best evidence we have is often drawn from studies where men were the population of reference, and we generalize these protocols to women. Second, even when strong evidence or best practices exist, this information is poorly disseminated among practicing physicians. Despite these (and other) challenges, more gender-specific training is needed for both newly-trained physicians and experienced practitioners. Nationwide organizations like AMWA are often one of the best ways to distribute new clinical information to practicing clinicians, and are uniquely suited to meet challenges like the ones I have presented here. A push for medical education policies that acknowledge the importance of gender-specific curricula from medical school to continuing education, also seems appropriate given the national emphasis on quality improvement and patient-centered care. It may be a first, albeit incremental, step towards dramatically improving the quality of care that women receive nationwide.

Learn more about gender-specific medicine at: http://partnership.hs.columbia.edu/