We all go to doctors. And we do so with trust and blind faith that the test they are ordering and the medications they're prescribing are based upon evidence -- evidence that's designed to help us. However, the reality is that that hasn't always been the case for everyone. What if I told you that the medical science discovered over the past century has been based on only half the population?
Todos nós imos ao médico. E imos con confianza e fe cega en que as probas que nos fan e as medicacións que nos receitan están baseadas nas probas --probas deseñadas para axudarnos. Aínda que a realidade é, que non sempre foi así para todo o mundo. Que pasaría se lles dixera que os descubrimentos da ciencia médica ao longo do século pasado estaban baseados só na metade da poboación?
I'm an emergency medicine doctor. I was trained to be prepared in a medical emergency. It's about saving lives. How cool is that? OK, there's a lot of runny noses and stubbed toes, but no matter who walks through the door to the ER, we order the same tests, we prescribe the same medication, without ever thinking about the sex or gender of our patients. Why would we? We were never taught that there were any differences between men and women.
Eu son médica de urxencias. Formeime para estar preparada nunha emerxencia médica. Trátase de salvar vidas. É xenial, non si? Vale, hai moito nariz con mocos e dedas esmagadas, pero non importa quen entre pola porta de Urxencias, nós pedimos as mesmas probas, receitamos a mesma medicación, sen sequera pensar no sexo ou no xénero dos nosos doentes. Por que? Nunca nos ensinaron que había diferenzas entre homes e mulleres.
A recent Government Accountability study revealed that 80 percent of the drugs withdrawn from the market are due to side effects on women. So let's think about that for a minute. Why are we discovering side effects on women only after a drug has been released to the market? Do you know that it takes years for a drug to go from an idea to being tested on cells in a laboratory, to animal studies, to then clinical trials on humans, finally to go through a regulatory approval process, to be available for your doctor to prescribe to you? Not to mention the millions and billions of dollars of funding it takes to go through that process. So why are we discovering unacceptable side effects on half the population after that has gone through? What's happening?
Un estudo recente do Consello de Contas revelou que o 80% dos medicamentos retiráronse do mercado debido aos efectos secundarios sobre as mulleres. Así que pensemos niso un minuto. Por que descubrimos os efectos secundarios sobre as mulleres só despois de que un medicamento se retire do mercado? Saben que un fármaco tarda anos en pasar de ser unha idea a ser probado en células nun laboratorio, a estudos en animais, despois a ensaios clínicos en humanos, e ao final pasar un procedemento para a súa aprobación, ata estar dispoñible para que o seu médico llo receite? Por non mencionar, os miles de millóns de dólares de financiamento que supón todo ese proceso. Entón, por que descubrimos efectos secundarios inaceptables na metade da poboación despois de pasar por todo isto? Que está pasando?
Well, it turns out that those cells used in that laboratory, they're male cells, and the animals used in the animal studies were male animals, and the clinical trials have been performed almost exclusively on men.
Pois resulta que esas células empregadas nese laboratorio, son células masculinas, e os animais empregados nos estudos con animais eran machos, e os ensaios clínicos fixéronse case exclusivamente en homes.
How is it that the male model became our framework for medical research? Let's look at an example that has been popularized in the media, and it has to do with the sleep aid Ambien. Ambien was released on the market over 20 years ago, and since then, hundreds of millions of prescriptions have been written, primarily to women, because women suffer more sleep disorders than men. But just this past year, the Food and Drug Administration recommended cutting the dose in half for women only, because they just realized that women metabolize the drug at a slower rate than men, causing them to wake up in the morning with more of the active drug in their system. And then they're drowsy and they're getting behind the wheel of the car, and they're at risk for motor vehicle accidents. And I can't help but think, as an emergency physician, how many of my patients that I've cared for over the years were involved in a motor vehicle accident that possibly could have been prevented if this type of analysis was performed and acted upon 20 years ago when this drug was first released. How many other things need to be analyzed by gender? What else are we missing?
Como se converteu o modelo masculino no referente na investigación médica? Vexamos un exemplo que se popularizou nos medios de comunicación, e ten que ver co somnífero Ambien. Ambien saíu ao mercado hai vinte anos, e dende entón, prescribíronse centos de millóns de receitas, sobre todo a mulleres, porque teñen máis trastornos de sono que os homes. Pero só este último ano, a Food and Drug Administration recomendou reducir a dose á metade só para as mulleres, porque se decataron de que a muller metaboliza o medicamento a un ritmo máis lento que o home, por isto espertan pola mañá cos efectos do medicamento activos no seu organismo. E entón, están somnolentas e collen o coche, e corren o risco de ter accidentes de tráfico. E eu non podo axudar, pero penso como médica de urxencias, cantos dos doentes aos que atendín ao longo dos anos tiveron un accidente de tráfico que posiblemente se puido evitar se se fixera esta análise, e se actuase en consecuencia hai 20 anos cando este medicamento se aprobou. Cantas outras cousas teñen que ser analizadas por xénero? Que máis estamos perdendo?
World War II changed a lot of things, and one of them was this need to protect people from becoming victims of medical research without informed consent. So some much-needed guidelines or rules were set into place, and part of that was this desire to protect women of childbearing age from entering into any medical research studies. There was fear: what if something happened to the fetus during the study? Who would be responsible? And so the scientists at this time actually thought this was a blessing in disguise, because let's face it -- men's bodies are pretty homogeneous. They don't have the constantly fluctuating levels of hormones that could disrupt clean data they could get if they had only men. It was easier. It was cheaper. Not to mention, at this time, there was a general assumption that men and women were alike in every way, apart from their reproductive organs and sex hormones. So it was decided: medical research was performed on men, and the results were later applied to women.
A II Guerra Mundial cambiou un montón de cousas, e unha delas foi esta necesidade de protexer a xente de ser vítimas da investigación médica sen consentimento informado. Así que se estableceron guías e regras, que eran moi necesarias, en parte porque estaba este desexo de protexer as mulleres en idade fértil de entrar en calquera estudo de investigación médica. Había medo: e se lle pasaba algo ao feto durante o estudo? Quen sería o responsable? E por iso os científicos ao mesmo tempo pensaron que fora unha bendición disfrazada, porque --sexamos realistas-- os corpos dos homes son bastante homoxéneos. Non sofren o cambio constante nos niveis de hormonas que podería alterar a precisión dos datos que se recollerían só en homes. Era máis doado. Era máis barato. Sen mencionar, que daquela había unha asunción xeral de que homes e mulleres eran parecidos en tódolos sentidos, á parte dos seus órganos reprodutivos e as hormonas sexuais. Así que estaba decidido: a investigación médica realizábase en homes, e os resultados aplicábanse ás mulleres máis tarde.
What did this do to the notion of women's health? Women's health became synonymous with reproduction: breasts, ovaries, uterus, pregnancy. It's this term we now refer to as "bikini medicine." And this stayed this way until about the 1980s, when this concept was challenged by the medical community and by the public health policymakers when they realized that by excluding women from all medical research studies we actually did them a disservice, in that apart from reproductive issues, virtually nothing was known about the unique needs of the female patient.
Que supuxo isto para a idea de saúde das mulleres? A saúde das mulleres converteuse en sinónimo de reprodución: peitos, ovarios, útero, embarazo. É o que agora coñecemos como “medicina bikini”. E isto mantívose así ata preto da década de 1980, cando este concepto foi cuestionado pola comunidade médica e polos responsables das políticas públicas de saúde, ao decatárense de que excluíndo as mulleres de tódolos estudos de investigación médica en realidade fixémoslles un fraco favor, xa que ademais dos temas reprodutivos, case non se sabía nada sobre as necesidades propias da doente muller.
Since that time, an overwhelming amount of evidence has come to light that shows us just how different men and women are in every way. You know, we have this saying in medicine: children are not just little adults. And we say that to remind ourselves that children actually have a different physiology than normal adults. And it's because of this that the medical specialty of pediatrics came to light. And we now conduct research on children in order to improve their lives. And I know the same thing can be said about women. Women are not just men with boobs and tubes. But they have their own anatomy and physiology that deserves to be studied with the same intensity.
Dende aquela, unha chea de probas saíron á luz amosándonos como de diferentes son homes e mulleres, en tódolos sentidos. Sabedes que en medicina temos este dito: Os menores non son coma adultos pequenos. E dicímolo para lembrarnos de que os menores teñen unha fisioloxía distinta dos adultos normais. E por iso xurdiu a especialidade de pediatría. E agora facemos investigación en menores para mellorar as súas vidas. E eu sei que se pode dicir o mesmo sobre as mulleres. As mulleres non son homes con peitos e trompas de Falopio. Teñen a súa propia anatomía e fisioloxía que merece ser estudada coa mesma intensidade.
Let's take the cardiovascular system, for example. This area in medicine has done the most to try to figure out why it seems men and women have completely different heart attacks. Heart disease is the number one killer for both men and women, but more women die within the first year of having a heart attack than men. Men will complain of crushing chest pain -- an elephant is sitting on their chest. And we call this typical. Women have chest pain, too. But more women than men will complain of "just not feeling right," "can't seem to get enough air in," "just so tired lately." And for some reason we call this atypical, even though, as I mentioned, women do make up half the population.
Collamos como exemplo o sistema cardiovascular. Esta área médica esforzouse en comprender porque parece que homes e mulleres teñen ataques cardíacos diferentes. As cardiopatías son a primeira causa de morte en homes e mulleres, pero morren máis mulleres ca homes no primeiro ano de ter o ataque. Os homes vanse queixar da esmagadora dor de peito-- teñen un elefante sentado no peito. E chamamos a isto, típico. As mulleres tamén teñen dor no peito. Pero máis mulleres que homes vanse queixar só de "non sentirse ben". "parece como se me faltara vida", "só un pouco de cansazo ultimamente". E por algunha razón chamámoslle a isto, atípico. aínda que como xa dixen, as mulleres son a metade da poboación.
And so what is some of the evidence to help explain some of these differences? If we look at the anatomy, the blood vessels that surround the heart are smaller in women compared to men, and the way that those blood vessels develop disease is different in women compared to men. And the test that we use to determine if someone is at risk for a heart attack, well, they were initially designed and tested and perfected in men, and so aren't as good at determining that in women. And then if we think about the medications -- common medications that we use, like aspirin. We give aspirin to healthy men to help prevent them from having a heart attack, but do you know that if you give aspirin to a healthy woman, it's actually harmful?
Que probas temos para axudar a explicar estas diferenzas? Se miramos a anatomía, as arterias arredor do corazón son máis pequenas en mulleres que en homes e o xeito en que esas arterias desenvolven a enfermidade é diferente nelas ca neles. E as probas que usamos para determinar se alguén poder ter un ataque ao corazón, ben, inicialmente foron deseñadas, probadas e perfeccionadas en homes, e resulta que non son tan boas para determinalo nas mulleres. Se pensamos nos medicamentos --medicamentos comúns que utilizamos, como a aspirina. Dámoslle aspirina aos homes sans para axudalos a previr o infarto, pero sabedes que darlle aspirina a unha muller sa é en realidade prexudicial?
What this is doing is merely telling us that we are scratching the surface. Emergency medicine is a fast-paced business. In how many life-saving areas of medicine, like cancer and stroke, are there important differences between men and women that we could be utilizing? Or even, why is it that some people get those runny noses more than others, or why the pain medication that we give to those stubbed toes work in some and not in others?
Todo isto está a nos dicir que estamos rabuñando a superficie. A medicina de emerxencias avanza moi rápido. En cantas áreas vitais para a supervivencia, coma o cancro e o ictus, haberá diferenzas importantes entre homes e mulleres que poderiamos utilizar? Ou incluso, por que hai xente que ten máis mocos no nariz ca outra, ou porque os medicamentos para aliviar a dor das dedas esmagadas alivian a uns e a outros non?
The Institute of Medicine has said every cell has a sex. What does this mean? Sex is DNA. Gender is how someone presents themselves in society. And these two may not always match up, as we can see with our transgendered population. But it's important to realize that from the moment of conception, every cell in our bodies -- skin, hair, heart and lungs -- contains our own unique DNA, and that DNA contains the chromosomes that determine whether we become male or female, man or woman.
O Instituto de Medicina dixo que cada célula ten un sexo. E iso, que significa? O sexo é o ADN. O xénero é como alguén se presenta a si mesmo en sociedade. E estes dous poden non sempre conxeniar, como podemos comprobar coa poboación transxénero. Pero é importante decatarse disto dende o momento da concepción, cada célula nos nosos corpos --pel, pelo, corazón e pulmóns-- contén o noso propio e único ADN, e ese ADN contén os cromosomas que determinan se seremos, feminino ou masculino, home ou muller.
It used to be thought that those sex-determining chromosomes pictured here -- XY if you're male, XX if you're female -- merely determined whether you would be born with ovaries or testes, and it was the sex hormones that those organs produced that were responsible for the differences we see in the opposite sex. But we now know that that theory was wrong -- or it's at least a little incomplete. And thankfully, scientists like Dr. Page from the Whitehead Institute, who works on the Y chromosome, and Doctor Yang from UCLA, they have found evidence that tells us that those sex-determining chromosomes that are in every cell in our bodies continue to remain active for our entire lives and could be what's responsible for the differences we see in the dosing of drugs, or why there are differences between men and women in the susceptibility and severity of diseases. This new knowledge is the game-changer, and it's up to those scientists that continue to find that evidence, but it's up to the clinicians to start translating this data at the bedside, today. Right now. And to help do this, I'm a co-founder of a national organization called Sex and Gender Women's Health Collaborative, and we collect all of this data so that it's available for teaching and for patient care. And we're working to bring together the medical educators to the table. That's a big job. It's changing the way medical training has been done since its inception.
Pensábase que eses cromosomas que determinan o sexo, representados aquí --XY se es home, XX se es muller-- só determinaban se ti nacerías con ovarios ou testículos, e eran as hormonas do sexo que eses órganos producían as responsables das diferenzas que vemos no sexo oposto. Pero agora sabemos que esa teoría estaba equivocada --ou polo menos, está un pouco incompleta. Menos mal que científicos como o Dr. Page do Whitehead Institute, que traballa no cromosoma Y, e o doutor Yang da UCLA, atoparon evidencias de que eses cromosomas determinantes do sexo presentes en cada célula do noso corpo permanecen activos durante toda a nosa vida e poderían ser os responsables das diferenzas que vemos na dosificación dos medicamentos, ou en por que hai diferenzas entre homes e mulleres na susceptibilidade e gravidade das enfermidades. Este novo coñecemento é un punto de inflexión, e depende dos científicos que continúen ata atopar esa proba, pero depende dos profesionais clínicos empezar a aplicar esa información na consulta, hoxe. Dende agora mesmo. E para axudar a conseguilo, cofundei unha organización nacional chamada Sexo e Xénero Saúde Colaborativa de Mulleres, e recollemos toda a información dispoñible para o ensino e para a atención ao doente. E estamos traballando para que tamén se apunten os formadores médicos. O que é un gran reto. Isto cambia o xeito en que se veu facendo a formación médica desde as orixes.
But I believe in them. I know they're going to see the value of incorporating the gender lens into the current curriculum. It's about training the future health care providers correctly. And regionally, I'm a co-creator of a division within the Department of Emergency Medicine here at Brown University, called Sex and Gender in Emergency Medicine, and we conduct the research to determine the differences between men and women in emergent conditions, like heart disease and stroke and sepsis and substance abuse, but we also believe that education is paramount.
Pero, eu creo neles. Sei que van ver o valor de incorporar as lentes de xénero no actual plan de estudos. Trátase de formar aos futuros profesionais da asistencia médica de forma correcta. E a nivel rexional, compartín a creación dunha sección no Departamento de Medicina de Urxencias aquí na Universidade Brown. chamada Sexo e Xénero en Medicina de Urxencias, e investigamos para determinar as diferenzas entre homes e mulleres en situacións de emerxencia, como infarto e ictus e septicemia e abuso de substancias, pero cremos tamén que a educación é primordial.
We've created a 360-degree model of education. We have programs for the doctors, for the nurses, for the students and for the patients. Because this cannot just be left up to the health care leaders. We all have a role in making a difference. But I must warn you: this is not easy. In fact, it's hard. It's essentially changing the way we think about medicine and health and research. It's changing our relationship to the health care system. But there's no going back. We now know just enough to know that we weren't doing it right.
Creamos un modelo de educación integral. Temos programas para médicos/as, para enfermeiras/os, para estudantes e para os pacientes. Xa que isto non se lle pode deixar só aos responsables sanitarios. Todos nós temos un papel para cambiar a situación. Pero debo avisalos: isto non é doado. En realidade, é complicado. En esencia, está cambiando o xeito no que pensamos a medicina a saúde, e a investigación. Está mudando a nosa relación co sistema sanitario. Pero non hai volta atrás. Agora coñecemos o suficiente para saber que non o estabamos facendo ben.
Martin Luther King, Jr. has said, "Change does not roll in on the wheels of inevitability, but comes through continuous struggle."
Martin Luther King Jr. dixo que "O cambio non chega sobre as rodas do inevitable, pero si vén a través da loita continua"
And the first step towards change is awareness. This is not just about improving medical care for women. This is about personalized, individualized health care for everyone. This awareness has the power to transform medical care for men and women. And from now on, I want you to ask your doctors whether the treatments you are receiving are specific to your sex and gender. They may not know the answer -- yet. But the conversation has begun, and together we can all learn. Remember, for me and my colleagues in this field, your sex and gender matter.
E o primeiro paso cara ao cambio é a conciencia. Isto non trata só de mellorar os coidados médicos das mulleres. Trátase de atención médica personalizada, individualizada para todo o mundo. Esta conciencia ten o poder para cambiar a atención médica de homes e mulleres. E dende agora en diante, eu quero que lle pregunten aos seus médicos se os tratamentos que lles dan son indicados para o seu sexo e xénero. Pode que non saiban a resposta --aínda. Pero a conversa empezou, e todos xuntos podemos aprender. Lembren, para min e os meus colegas neste campo, o seu sexo e xénero importan.
Thank you.
Grazas
(Applause)
(Aplausos)