What are we talking about when we talk about gender-specific medicine

Men and women are not the same: only by considering the physiological, biochemical and sociocultural differences will we be able to cure ourselves in the best possible way. And there is good news: Italy is the only country in the world to have a law for gender medicine

(photo: Adobe Stock) We have known this for some time, but Covid 19 and the various vaccines made for stemming the pandemic they reminded us in a clear way: the bodies of men and women are different and there are different ways in which diseases and responses to drugs present themselves. This is what gender medicine studies, a term that we have been hearing more and more often lately. But what is it really about? And where are we in Italy? Let's start by saying that in this article we will talk about gender-specific medicine because, as Giovannella Baggio, president of the National Studies Center on Health and Gender Medicine in Padua and the first teacher to hold a chair on the subject in Italy, explains to Wired, from 2012 to 2017 (at the University of Padua), "today this term is more correct, because all specialties, transversally, must be declined and practiced with a focus on gender". It is not, therefore, a branch of medicine in its own right, or that concerns only women. It is also an area in which our country is at the forefront: we were the first in the world to have approved a law on the matter (the so-called Lorenzin law, of 2018) and to have established, for its implementation, a Plan for '' application and dissemination of gender medicine throughout the country and an observatory at the Higher Institute of Health.

Yentl syndrome and gender-specific medicine

In a story by the Nobel laureate Isaac Bashevis Singer, Yentl. The yeshiva boy, the protagonist, a Polish girl from the early twentieth century, pretends to be male in order to study the Talmud. In 1983 the first film directed by Barbra Streisand was made from the text. A few years later, the American cardiologist Bernardine Healy spoke for the first time about Yentl's syndrome in the New England Journal of Medicine: in the article Healy noted that in her ward women suffering from heart disease, with pathologies or symptoms other than men, remained victims of diagnostic errors and ineffective therapies that could even be fatal. She also stressed that women were not at all or underrepresented in drug trials.

It was a very important moment, which gave a very strong impetus to the development of gender-specific medicine. That is, an approach to the subject that takes into account the physiological, biochemical and even sociocultural differences linked to sex. A disruptive approach, considering that for centuries medicine has been based on the belief that male bodies represent the whole of humanity (except in a few fields, such as obviously gynecology). In the specific case of myocardial infarction, we are talking about the first cause of death among women (48%), who die much more than men, although in the latter cardiovascular diseases are more frequent (data from the White Paper Onda, Medicine of genre, 2019).

"In women, heart attacks appear in a totally different way than in men and, as not everyone knows, symptoms are often ignored - explains Baggio -: contrary to the image that we associate with heart attack, we generally have no chest pain; more frequently we experience back pain or a little anxiety. Furthermore, the risk factors have a different impact: a diabetic woman is three times more likely to develop a heart attack than a man who has diabetes; overweight, smoking or having pre-term births also affect ".

30 years later: Covid seen from a gender perspective

Covid-19 was the most recent confirmation of how important differences can be between men and women in the course of a disease. All the studies conducted so far (from Nature Communications, Science, Global Health 50/50 and the Italian Higher Institute of Health itself, to name a few) have confirmed that men are at risk of ending up in intensive care and dying more than women. Only after the age of 90 does the situation reverse, but simply because there are more women in that age group. This happens despite the fact that women get sick more (probably because they are more involved in nursing, health and medical professions).

It could be due to both biochemical factors (the Ace2 protein, more expressed in women). because encoded by the X chromosome, it would help cells to defend themselves from the virus; moreover, its action would be stimulated by estrogen) and habits (women smoke less and would tend to respect more the rules that reduce the chances of contagion). "We have a stronger immune system than the male one, but then we pay for it with a much higher exposure to autoimmune diseases," emphasizes Baggio. If only now we are beginning to collect gender-specific data on treatments against Covid-19 ("at the beginning the pandemic took us by surprise and we had difficulty in treating everyone, let alone distinguish by sex"), it is true. that "in the vaccine testing phase both sexes were present in a balanced way", explains Baggio. And this is very important, at a time when a certain mistrust of vaccines still resists.

A gender approach, to better treat both women and men

About Covid-19 in the space of a year we have collected a lot of data, and these will be very useful in refining more and more the treatment protocols. Unfortunately, the same does not happen with other pathologies. Caroline Criado Perez in the book Invisibili (Einaudi) denounces the lack of diversified data in medical research (in both animal and clinical experimentation), despite the fact that international scientific bodies and organizations have long imposed a gender approach in their guidelines and ethical codes. "We have a huge lack of information on the female body, a data gap that unfortunately continues to grow," he writes, a deficit that results in incorrect diagnoses and treatments, and often also in episodes in which women are not listened to or believed. by doctors when they tell about their symptoms. Yet the lack of diversified data negatively affects the ability to offer adequate care also to men.

Some examples, cited by Dr. Baggio: "it is true that depression in women has an incidence 2-3 times higher than to men, but all over the world they commit suicide 3 to 4 times more ". And again: “men over 75 can suffer from osteoporosis, and their mortality after a fracture is 4 times higher than that of women. But how many men undergo bone densitometry or osteoporosis therapy? ".

Where are we in Italy

In Italy, with the Lorenzin Law of 2018, we have a plan for gender medicine and an Observatory at the Institute superior of health care for its realization. The objectives of the Plan concern four fundamental areas: not only the review of clinical paths of prevention, diagnosis, treatment and rehabilitation, but also research and innovation, training and professional updating and communication. The challenge facing Italy now "is to truly apply this law - explains Baggio -. Up to now, the progress made has taken place independently of the Plan, thanks to the network that we have painstakingly created over time with hospitals, scientific societies, institutions, centers for gender medicine ”. Yet our law is "very important and unique in the world, fundamental to implement the revolution we need to implement a gender approach in all medical specialties".

Now the ball passes to the regions: "There is there are some that are ahead, like Tuscany and Emilia Romagna, and others that are struggling ”, continues Baggio. "Without uniformity it will be difficult to see concrete effects in the implementation of the Plan. But the law requires them to catch up, so I'm confident ”. So how long could it take to finally see gender-specific medicine applied that goes beyond good intentions and truly heals everyone to the fullest? "I have a lot of faith in young doctors and medical students, in a generation we will finally be able to have the revolution that patients, of any sex, have long deserved".


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