Gender-Based Biology

The concept of "gender-based biology" can be traced to the late 1980s, during the formative days of the Society for the Advancement of Women's Health Research. In a discussion with the then president of the Institute of Medicine, Samuel Thier, about the omission of women from the design of clinical trials, Thier commented that there were real gender issues. He also offered that researchers needed to take advantage of the information the exploration of those differences could provide. The challenge was how to expand research, examining medical problems as they affect women while avoiding the politically volatile debate about reproductive health, specifically the politics of abortion. One way to sidestep questions of reproductive health was to concentrate on the health of women age 50 and over. Postmenopausal women do not (in the natural course of things) get pregnant. Therefore, the politics of abortion and contraception would not apply. Also, women start to develop most of their major medical problems after the age of 50. Equating women's health research with reproductive health had created problems. First, diseases that primarily affect women were not taken seriously as an acceptable area of research. Second, because differences in disease manifestation went unrecognized, appropriate treatment was too often delayed. Then the savvy of the members and staff of the Congressional Women's Caucus came into play. When a senior staff member of Sen. Christopher Dodd (D-Conn.) was diagnosed with ovarian cancer, and she found that the National Institutes of Health was sponsoring no clinical trials on this women's-only disease, the political machine began to roll. The more this woman and her colleagues learned about the lack of medical information on women's health issues, the more determined they were to change the underlying system. The result was a well-publicized congressional hearing in 1990. The highlight of that hearing was a discussion of the male-only study of the role of aspirin in preventing heart disease, a condition that affects women as frequently--but differently--than it does men. As we at the Society predicted, the public outcry was enormous. Some changes were quick in coming. Offices to monitor and fund women's health issues were established within the key federal agencies. Some of the critical issues were quickly redressed through regulations. Women were recruited for research protocols. Diseases that uniquely or differently affect women were highlighted and received additional funding. Programs were started to integrate women's health issues into the basic medical school curriculum. Centers of Excellence in women's health were designated by the Department of Health and Human Services to highlight the need for research. While public policy received attention, the scientific issues remained. To move forward on issues related to women's health, we needed to identify and highlight differences in the biology of male and female systems. For example, from conception, who we are is a function of both the gender of the parent who contributed a gene and the genetic makeup of our parents. In the mouse model, the study of different inheritance patterns of a phenotype has been found to depend on the gender of the mouse carrying the gene. Examining the mechanism behind this phenomenon has given us the tools for understanding genetic imprinting. To focus on opportunities provided by phenomena elucidated through gender differences, scientists coined the term "gender-based biology." Science was never gender neutral. Scientists study subjects that are intellectually exciting. Part of that excitement involves a topic's funding potential. As Mary Lasker, the force behind the expansion of the NIH, observed, "Money buys ideas." She was right. The enormous growth in publicly funded medical research was led by men. They were rewarded for studying the diseases that were decimating the preceding generation of researchers; another group overwhelmingly male. Studies of thousands of men were the logical result. It then became reasonable to design new studies to build on that base of knowledge. Including women in the study populations was not logical. Finally, the imbalance became too great and the public outcry too insistent. One result was the Women's Health Initiative (WHI), started by Bernadine Healy, the first woman director of NIH. WHI is the largest study ever done on women's health. This 15-year, $625 million NIH-funded program, started in 1991, involves more than 150,000 women nationwide. It is the first major study to look broadly at the chronic diseases that threaten women most--heart disease, stroke, cancer, osteoporosis, depression--in relation to each other and in the context of women's overall health. It should lead to a series of recommendations about how diet, hormone-replacement therapy, vitamin and mineral supplements, exercise, and a range of other factors affect women's health. Some critics have argued that the WHI is not going to provide any new information, that it is playing catch-up, at best. Those arguments have faded, and the advantages of the study are becoming clear. The research infrastructure developed for the study is as important as the results will be. Because of WHI, more than 40 medical centers now have an economic and professional interest in continuing to study women's health issues. The concept of gender-based biology appeals to another group: those researchers interested in studying gender differences and the funders who are willing to underwrite their work. Scientists who may not be interested in clinical issues may be curious to investigate systems in more than one dimension, to consider if their results occurred because the source of their material was male or female. Some questions that puzzled us in medical school are now being answered because of the study of gender-based differences. For example, when I was in medical school we learned that in one type of stroke, language ability was almost always impaired in men while 50 percent of the women were spared. No one knew why. The team at Yale University led by Bennett and Sally Shaywitz is giving us the first clues (B.A. Shaywitz et al., Nature, 373:607-9, 1995). They have found that many women use the right side of the brain in sounding out words, something few men do. This ability to draw on both sides may be the explanation we were searching for in medical school. We cannot hide the differences--or hide behind them. The differences between men and women are real. Sometimes those differences give men the advantage. Others favor women. The differences are interesting. And they are unlikely to go away, since evolution seems to have favored their development. The concept of gender-based biology validates the work of those who study these differences and provides a platform for their continued exploration. Florence Haseltine, Ph.D., M.D., is senior editor, Journal of Women's Health , and cofounder of the Society for the Advancement of Women's Health Research. She was recently named a Kilby Foundation laureate for her innovative work on behalf of women's health research.

Gender-Based Biology

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