Men, Women More Different Than Thought

Sep 25, 12:33 PM (ET)

CHICAGO  - Beyond the tired cliches and sperm-and-egg basics taught
in grade school science class, researchers are discovering that men and
women are even more different than anyone realized.

It turns out that major illnesses like heart disease and lung cancer are
influenced by gender and that perhaps treatments for women ought to be
slightly different from the approach used for men.

These discoveries are part of a quiet but revolutionary change
infiltrating U.S. medicine as a growing number of scientists realize
there's more to women's health than just the anatomy that makes them
female, and that the same diseases often affect men and women in
different ways.

"Women are different than men, not only psychologically (but)
physiologically, and I think we need to understand those differences,"
says Dr. Catherine DeAngelis, editor of the Journal of the American
Medical Association.

DeAngelis, who became the journal's first female editor in 1999, says
she has made it a mission to publish only research in which data are
broken down by sex unless it involves a disease that affects just men or

In recent months, two medical textbooks billed as the first devoted to
gender differences in all areas of medicine, not just reproductive
medicine, were published; a widely cited Journal of the AMA report
re-emphasized the neglected fact that lung cancer, not breast cancer, is
the No. 1 cancer killer among women; and the American Heart Association
announced the first-ever heart disease prevention guidelines tailored
specifically for women.

And this fall, the office of Surgeon General will issue its first-ever
report on osteoporosis. The crippling bone-thinning disease
disproportionately affects women, who lose the bone-protecting effects
of estrogen at menopause. The report will emphasize prevention - and
that it's not just a woman's disease - 20 percent of patients are men,
said Wanda Jones, director of the Office on Women's Health at the U.S.
Department of Health and Human Services.

The gender-based medicine movement isn't an effort to diminish the
importance of breast cancer, but is meant to emphasize that "we have
more than one body part, folks. Up until now ... that awareness just
hasn't been there," said Sherry Marts of the Society for Women's Health
Research. That organization seeks to expand the definition of women's
health beyond breast and reproductive health, what some call "bikini

Until the 1990s, scientists frequently excluded women from medical
research, including drug studies. It was largely out of concern over
effects on reproduction but also because of a long-standing belief that
men and women "were biologically the same except for their reproductive
organs," Marts said.

However, recent discoveries suggest that genes, hormones and lifestyle
may be behind many of the differences. For example:

_Heart attacks in women frequently don't involve chest pain and may
involve more vague, flu-like symptoms.

_Women who don't smoke appear to be more susceptible to lung cancer than
nonsmoking men. Women also tend to get lung cancer at younger ages than
men, and they appear to metabolize cancer-causing substances differently
than men.

_Women are less likely than men to get oral cancer.

_Women are more prone to autoimmune diseases, including lupus,
rheumatoid arthritis and multiple sclerosis, in which disease-fighting
mechanisms mistakenly attack the body's own tissues.

_Some AIDS-fighting medicines appear to metabolize more quickly in men
than in women, who may require gender-specific doses.

_Women's symptoms for ulcerative colitis and Crohn's disease -
debilitating intestinal diseases that affect men and women - vary
considerably each month, requiring frequent medication adjustments.

Inflammatory bowel disease, which encompasses both Crohn's and colitis,
is a specialty of Dr. Sunanda Kane, a University of Chicago researcher
who is studying why the problem seems to be on the rise among young

Both diseases damage the digestive tract and in severe cases, doctors
remove part of the colon and patients must wear colostomy bags.

Kane says she got interested in a gender-based approach several years
ago during her training, when there were few other gastroenterologists
who were women.

"Female patients were thrilled to see a woman and they started to tell
me things they'd never tell their (male) doctors," including what their
menstrual periods were doing to their disease, she said.

But as in many areas of gender-based medicine, many important questions
remain, including how aging affects inflammatory bowel disease, Kane

"Anecdotally, people have told me their disease went into remission
after menopause," and some women "are asking me if they can have a
hysterectomy so they can go into remission," Kane said. It's an issue
that could have a huge impact on patients' quality of life - but it's
never been studied, she said.


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