Last week, the New York Times Magazine covered a persisting trend: under-representation of women in the fields of science and technology. Regardless of how one aligns on the feminist spectrum, we can recognize that sex discrimination exists and may be a contributing factor to the skewed sex ratio in STEM (Science, Technology, Engineering and Math) careers. Studies have found evidence of sexism in familiar places, from the workplace and associated hiring practices, to our paychecks, academic pursuits and the English language. All these examples have been taken as negative news to us females, and the result has been a growing interest in gender and sexual equality, elevating the cynosure of feminist ideals to egalitarianism. But is this focus on equality distracting us from recognizing instances when we should be treated differently?
Males and females have different chromosomes, different hormones, different anatomy, a different biology — differences which might justify different approaches to male and female medical care. Our current approach to medicine and public health, however, has rarely considered medications, vaccines or other treatments with sex-adjusted dosages. With females 1.5 to 1.7 times more likely to experience adverse drug reactions (Rademaker 2001) it seems odd that this substantially higher risk has not motivated more sex considerations in drug treatments.
Furthermore, many infections exhibit sex differences in severity, symptoms and immunity. Enter the discussion: Coxsackie virus, Toxoplama gondii, influenza, malaria (the list goes on).
Toxoplasma gondii is an extreme example of a parasite that causes different symptoms among the sexes, as this photo from imgur points out:
The other infections mentioned also have skewed incidences in the human population, with more men generally contracting infections than women. Current explanations for sex-biases in infectious diseases include sex hormones affecting the immune response (e.g. testosterone is immunosuppressive) and behavioral differences that affect exposure. A more mechanistic understanding of why sex differences emerge requires further research but has yet to receive adequate attention.
An argument against sex-specific medicine might be that sex doesn’t matter. Herpes provides a convincing example to counter this argument. When the efficacy of the herpes simplex virus vaccine was examined in clinical trials it was deemed ineffective at preventing herpes infection. That was until the data was analyzed by sex. The vaccine appeared to be ineffective overall but in actuality it was 73 percent effective in females and 11 percent effective (or rather ineffective) in males. Because of the initial assumption that it was ineffective (before sex analysis) the vaccine never entered widespread use, when in actuality it could have been a promising vaccine for the female population (Klein 2012).
The idea of gender-specific medicine has eluded recognition in medical and scientific communities, and its few advocates have not generated enough support to change our current sex-neutral approaches. Attempts that have been made have failed to hold traction. This past December, one of the only journals to focus on gender and sex specific research, Gender Medicine: The Journal for the Study of Sex & Gender Medicine, ceased publication. Why did it fail? Perhaps we are focusing so much on equal treatment elsewhere in society that we are failing to see the need for different treatment approaches in medicine.