Some of my most wonderful memories of childhood are of spending time with my grandmother, Mamar, in our four-family home in Brooklyn, New York. Her apartment was an oasis. It was a place where I could sneak a cup of coffee, which was really warm milk with just a touch of caffeine. She loved life. And although she worked in a factory, she saved her pennies and she traveled to Europe. And I remember poring over those pictures with her and then dancing with her to her favorite music.
Nekaj mojih najlepših spominov iz otroštva me veže na preživljanje časa z babico, Mamar, v našem domu za štiri družine v Brooklynu, v New Yorku. Njeno stanovanje je bilo oaza. Tam sem lahko popila skodelico kave, ki je bila v resnici toplo mleko s samo senco kofeina. Ljubila je življenje. In čeprav je delala v tovarni, je pridno varčevala in potovala v Evropo. In spominjam se, kako sva se zatopili v fotografije in potem plesali na njeno najljubšo glasbo. In potem, ko sem imela 8 let in ona 60, se je nekaj spremenilo.
And then, when I was eight and she was 60, something changed. She no longer worked or traveled. She no longer danced. There were no more coffee times. My mother missed work and took her to doctors who couldn't make a diagnosis. And my father, who worked at night, would spend every afternoon with her, just to make sure she ate.
Ni več delala ali potovala. Ni več plesala. Nisva več pili kave. Mama je odšla z dela in jo peljala k zdravnikom, ki niso mogli narediti diagnoze. In moj oče, ki je delal ponoči, je bil z njo vsako popoldne, da se je prepričal, da je jedla.
Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
Celotna družina je skrbela zanjo. In ko so končno postavili diagnozo, je bila globoko v začaranem krogu. Veliko vas bo prepoznalo njene simptome.
Now many of you will recognize her symptoms. My grandmother had depression. A deep, life-altering depression, from which she never recovered. And back then, so little was known about depression.
Moja babica je bila depresivna. Globoka depresija, ki spremeni življenje, od katere si ni nikoli opomogla. Takrat je bilo o depresiji malo znanega.
But even today, 50 years later, there's still so much more to learn. Today, we know that women are 70 percent more likely to experience depression over their lifetimes compared with men. And even with this high prevalence, women are misdiagnosed between 30 and 50 percent of the time.
Ampak celo danes, 50 let kasneje, se imamo še vedno veliko za naučiti. Danes vemo, da je za ženske 70 odstotkov večja verjetnost, da bodo v svojem življenju izkusile depresijo, v primerjavi z moškimi. In celo pri tej razširjenosti je pri ženskah diagnoza napačna v 30 do 50 odstotkih. Sedaj vemo, da bodo ženske večkrat
Now we know that women are more likely to experience the symptoms of fatigue, sleep disturbance, pain and anxiety compared with men. And these symptoms are often overlooked as symptoms of depression.
občutile simptome utrujenosti, motenj spanja, bolečine in anksioznosti v primerjavi z moškimi. Te simptome pogosto spregledamo kot simptome depresije. Te razlike med spoloma se ne pojavijo samo pri depresiji,
And it isn't only depression in which these sex differences occur, but they occur across so many diseases.
ampak se pojavijo pri mnogih boleznih.
So it's my grandmother's struggles that have really led me on a lifelong quest. And today, I lead a center in which the mission is to discover why these sex differences occur and to use that knowledge to improve the health of women.
Napori moje babice so me poslali na to življenjsko poslanstvo. Danes vodim center, katerega misija je odkriti, zakaj se pojavljajo te razlike med spoloma, in uporabiti to znanje za izboljšanje zdravja žensk. Danes vemo, da ima vsaka celica spol.
Today, we know that every cell has a sex. Now, that's a term coined by the Institute of Medicine. And what it means is that men and women are different down to the cellular and molecular levels. It means that we're different across all of our organs. From our brains to our hearts, our lungs, our joints.
To je izraz, ki smo ga skovali na Inštitutu Medicine. Pomeni, da se moški in ženske razlikujemo celo na celičnem in molekularnem nivoju. Pomeni, da se razlikujemo v vseh organih. V možganih, srcih, pljučih, sklepih. Pred 20 leti smo imeli komaj kaj podatkov o zdravju žensk
Now, it was only 20 years ago that we hardly had any data on women's health beyond our reproductive functions. But then in 1993, the NIH Revitalization Act was signed into law. And what this law did was it mandated that women and minorities be included in clinical trials that were funded by the National Institutes of Health. And in many ways, the law has worked. Women are now routinely included in clinical studies, and we've learned that there are major differences in the ways that women and men experience disease. But remarkably, what we have learned about these differences is often overlooked.
razen o našem reproduktivnem delovanju. Leta 1993 pa je bil sprejet NIH Revitalizacijski zakon. In ta zakon je zahteval, da so ženske in manjšine vključene v klinične študije, ki jih financirajo Nacionalni inštituti za zdravje. In na veliko načinov je zakon deloval. Ženske sedaj rutinsko vključujejo v klinične študije in naučili smo se, da obstajajo velike razlike v načinu, kako ženske in moški izkusijo bolezen. Ampak neverjetno, kar smo se naučili o teh razlikah, je pogosto spregledano. Zato se moramo vprašati: zakaj prepustiti zdravje žensk naključju?
So, we have to ask ourselves the question: Why leave women's health to chance? And we're leaving it to chance in two ways. The first is that there is so much more to learn and we're not making the investment in fully understanding the extent of these sex differences. And the second is that we aren't taking what we have learned, and routinely applying it in clinical care. We are just not doing enough.
In naključju ga prepuščamo na dva načina. Prvi je, da se moramo še toliko naučiti in da ne vlagamo v popolno razumevanje obsega teh razlik med spoloma. In drugi je, da ne vzamemo tega, kar smo se naučili, da bi rutinsko uporabili v klinični negi. Enostavno tega ne počnemo dovolj. Zato bom z vami delila tri primere,
So, I'm going to share with you three examples of where sex differences have impacted the health of women, and where we need to do more.
kjer so razlike med spoloma vplivale na zdravje žensk, in kjer moramo storiti še več. Začnimo z boleznimi srca.
Let's start with heart disease. It's the number one killer of women in the United States today. This is the face of heart disease. Linda is a middle-aged woman, who had a stent placed in one of the arteries going to her heart. When she had recurring symptoms she went back to her doctor. Her doctor did the gold standard test: a cardiac catheterization. It showed no blockages. Linda's symptoms continued. She had to stop working. And that's when she found us. When Linda came to us, we did another cardiac catheterization and this time, we found clues. But we needed another test to make the diagnosis. So we did a test called an intracoronary ultrasound, where you use soundwaves to look at the artery from the inside out.
Je ubijalec žensk številka ena v ZDA. To je obraz srčnih bolezni. Linda je ženska srednjih let, ki so ji namestili stent v eno izmed arterij, ki gredo do srca. Ker so se ji simptomi ponavljali, je šla nazaj k zdravniku. Ta je naredil zlati standardni test: srčno kateterizacijo. Ni pokazala nobenih blokad. Lindini simptomi so se nadaljevali. Morala je prenehati z delom. In takrat nas je našla. Ko je prišla k nam, smo naredili še eno kateterizacijo in tokrat smo našli sledi. A potrebovali smo še en test, da bi postavili diagnozo. Zato smo naredili intrakoronarni ultrazvok, kjer z zvočnimi valovi pogledamo arterijo od znotraj navzven. Ugotovili smo, da Lindina bolezen ne izgleda kot tipična moška bolezen.
And what we found was that Linda's disease didn't look like the typical male disease. The typical male disease looks like this. There's a discrete blockage or stenosis. Linda's disease, like the disease of so many women, looks like this. The plaque is laid down more evenly, more diffusely along the artery, and it's harder to see. So for Linda, and for so many women, the gold standard test wasn't gold.
Tipična moška bolezen izgleda takole. Tu je diskretna blokada ali stenoza. Lindina bolezen, kot bolezen mnogih žensk, izgleda takole. Plak je položen bolj enakomerno, bolj difuzno preko arterije in ga težje vidimo. Zato za Lindo in za mnoge ženske zlati standardni test ni bil zlat. Linda je prejela pravo zdravljenje.
Now, Linda received the right treatment. She went back to her life and, fortunately, today she is doing well. But Linda was lucky. She found us, we found her disease.
Vrnila se je k svojemu življenju in na srečo ji gre dobro. A Linda je imela srečo. Našla je nas, mi smo našli njeno bolezen. A za preveč žensk ni tako.
But for too many women, that's not the case. We have the tools. We have the technology to make the diagnosis. But it's all too often that these sex diffferences are overlooked.
Imamo orodja. Imamo tehnologijo za postavitev diagnoze. A vse prevečkrat te razlike med spoloma spregledamo. Kako je z zdravljenjem?
So what about treatment? A landmark study that was published two years ago asked the very important question: What are the most effective treatments for heart disease in women? The authors looked at papers written over a 10-year period, and hundreds had to be thrown out. And what they found out was that of those that were tossed out, 65 percent were excluded because even though women were included in the studies, the analysis didn't differentiate between women and men. What a lost opportunity. The money had been spent and we didn't learn how women fared. And these studies could not contribute one iota to the very, very important question, what are the most effective treatments for heart disease in women?
Študija, ki je bila objavljena pred dvema letoma, je zastavila pomembno vprašanje: Katera so najbolj učinkovita zdravljenja srčnih bolezni žensk? Avtorji so pogledali članke, napisane v desetih letih, in na stotine so jih morali zavreči. Odkrili so, da izmed tistih, ki so jih morali izključiti, je bilo 65 odstotkov takih, v katere so bile ženske sicer vključene, vendar pri njih analize niso razlikovale med moškimi in ženskami. Kakšna izgubljena priložnost. Denar smo zapravili in nismo pogledali, kako je šlo ženskam. In te študije niso prispevale niti malo k zelo, zelo pomembnemu vprašanju, katera so najučinkovitejša zdravljenja srčnih bolezni pri ženskah? Predstavila vam bom Hortense, mojo botro,
I want to introduce you to Hortense, my godmother, Hung Wei, a relative of a colleague, and somebody you may recognize -- Dana, Christopher Reeve's wife. All three women have something very important in common. All three were diagnosed with lung cancer, the number one cancer killer of women in the United States today. All three were nonsmokers. Sadly, Dana and Hung Wei died of their disease. Today, what we know is that women who are nonsmokers are three times more likely to be diagnosed with lung cancer than are men who are nonsmokers. Now interestingly, when women are diagnosed with lung cancer, their survival tends to be better than that of men. Now, here are some clues. Our investigators have found that there are certain genes in the lung tumor cells of both women and men. And these genes are activated mainly by estrogen. And when these genes are over-expressed, it's associated with improved survival only in young women. Now this is a very early finding and we don't yet know whether it has relevance to clinical care. But it's findings like this that may provide hope and may provide an opportunity to save lives of both women and men.
Hung Wei, sorodnico sodelavke, in nekoga, ki ga morda prepoznate-- Dano, ženo Christopherja Reeva. Vsem trem ženskam je skupno nekaj zelo pomembnega. Vsem trem so diagnosticirali rak pljuč, najbolj pogost rak, ki je vzrok smrti žensk v ZDA danes. Vse tri so bile nekadilke. Na žalost sta Dana in Hung Wei umrli zaradi bolezni. Danes vemo, da imajo nekadilke trikrat večjo verjetnost, da jim diagnosticirajo raka pljuč kot nekadilci. Zanimivo, ko ženskam diagnosticirajo raka pljuč, je njihovo preživetje boljše od moških. Tu je nekaj sledi. Naši raziskovalci so odkrili, da so določeni geni v celicah pljučnega tumorja pri moških in ženskah. Te gene aktivira predvsem estrogen. In ko so ti geni preveč izraženi, je to povezano z izboljšanim preživetjem samo pri mladih ženskah. To je zelo zgodnje odkritje in še ne vemo, ali je pomembno za klinično oskrbo. Ampak taka odkritja nam dajejo upanje in morda lahko prinesejo priložnost, da rešimo življenja moških in žensk. Naj z vami delim primer,
Now, let me share with you an example of when we do consider sex differences, it can drive the science. Several years ago a new lung cancer drug was being evaluated, and when the authors looked at whose tumors shrank, they found that 82 percent were women. This led them to ask the question: Well, why? And what they found was that the genetic mutations that the drug targeted were far more common in women. And what this has led to is a more personalized approach to the treatment of lung cancer that also includes sex.
ko upoštevanje razlik med spoloma, lahko žene znanost naprej. Pred nekaj leti so ocenjevali novo zdravilo za raka pljuč in ko so avtorji pogledali, čigavi tumorji so se skrčili, so ugotovili, da je bilo 82 odstotkov žensk. To je vodilo k vprašanju, zakaj. Odkrili so, da so bile genetske mutacije, na katere je ciljalo zdravilo, veliko pogostejše pri ženskah. In to je vodilo v veliko bolj oseben pristop zdravljenja raka, ki vključuje tudi spol. To lahko dosežemo, če zdravja žensk ne prepustimo naključju.
This is what we can accomplish when we don't leave women's health to chance. We know that when you invest in research, you get results. Take a look at the death rate from breast cancer over time. And now take a look at the death rates from lung cancer in women over time. Now let's look at the dollars invested in breast cancer -- these are the dollars invested per death -- and the dollars invested in lung cancer. Now, it's clear that our investment in breast cancer has produced results. They may not be fast enough, but it has produced results. We can do the same for lung cancer and for every other disease.
Vemo, da ko investiraš v raziskave, dobiš rezultate. Poglejte razvoj umrljivosti zaradi raka dojke. Sedaj pa poglejte umrljivost zaradi pljučnega raka pri ženskah skozi čas. Poglejmo dolarje, vložene v raka na dojki - to so vloženi dolarji na smrt - in dolarje, vložene v raka na pljučih. Jasno je, da je naše vlaganje v raka dojke prineslo rezultate. Morda niso dovolj hitri, ampak rezultati so. Lahko naredimo enako za raka pljuč in vsako bolezen. Pojdimo nazaj k depresiji.
So let's go back to depression. Depression is the number one cause of disability in women in the world today. Our investigators have found that there are differences in the brains of women and men in the areas that are connected with mood. And when you put men and women in a functional MRI scanner -- that's the kind of scanner that shows how the brain is functioning when it's activated -- so you put them in the scanner and you expose them to stress. You can actually see the difference. And it's findings like this that we believe hold some of the clues for why we see these very significant sex differences in depression.
Depresija je danes vzrok številka ena na svetu za invalidnost žensk. Naši raziskovalci so ugotovili, da obstajajo razlike v možganih moških in žensk v območjih, ki so povezana z razpoloženjem. In ko pregledaš moške in ženske s funkcionalno magnetno resonanco - ta pokaže, kako možgani delujejo, ko so aktivirani - jih daš v skener in jih izpostaviš stresu. Lahko dejansko vidiš razliko. In za taka odkritja verjamemo, da vsebujejo določene razlage, zakaj vidimo vse te razlike med spoloma pri depresiji. Ampak čeprav vemo, da se te razlike pojavljajo,
But even though we know that these differences occur, 66 percent of the brain research that begins in animals is done in either male animals or animals in whom the sex is not identified.
je 66 odstotkov raziskav možganov, ki se začnejo na živalih, narejenih na živalih moškega spola ali na živalih nedoločenega spola. Zato se spet vrnimo k vprašanju: Zakaj prepustiti zdravje žensk naključju?
So, I think we have to ask again the question: Why leave women's health to chance? And this is a question that haunts those of us in science and medicine who believe that we are on the verge of being able to dramatically improve the health of women. We know that every cell has a sex. We know that these differences are often overlooked. And therefore we know that women are not getting the full benefit of modern science and medicine today. We have the tools but we lack the collective will and momentum.
In to vprašanje preganja tiste med nami v znanosti in medicini, ki verjamemo, da smo na robu tega, da bomo lahko dramatično izboljšali zdravje žensk. Vemo, da ima vsaka celica spol. Vemo, da so te razlike pogosto spregledane. In zatorej vemo, da ženske ne uživajo vseh koristi moderne znanosti in medicine. Imamo orodja, a manjkata nam skupinska volja in zagon. Zdravje žensk je problem enakopravnosti, tako pomemben kot enako plačilo.
Women's health is an equal rights issue as important as equal pay. And it's an issue of the quality and the integrity of science and medicine. (Applause) So imagine the momentum we could achieve in advancing the health of women if we considered whether these sex differences were present at the very beginning of designing research. Or if we analyzed our data by sex.
In je problem kakovosti in integritete znanosti in medicine. (Aplavz) Predstavljajte si zagon, ki bi ga lahko dosegli v napredku zdravja žensk, če bi upoštevali, ali so te razlike med spoloma prisotne na začetku načrtovanja raziskave. Ali če bi analizirali podatke glede na spol. Ljudje me pogosto vprašajo: "Kaj lahko storim?"
So, people often ask me: What can I do? And here's what I suggest: First, I suggest that you think about women's health in the same way that you think and care about other causes that are important to you. And second, and equally as important, that as a woman, you have to ask your doctor and the doctors who are caring for those who you love: Is this disease or treatment different in women? Now, this is a profound question because the answer is likely yes, but your doctor may not know the answer, at least not yet. But if you ask the question, your doctor will very likely go looking for the answer. And this is so important, not only for ourselves, but for all of those whom we love. Whether it be a mother, a daughter, a sister, a friend or a grandmother.
In to predlagam: Prvič, predlagam vam, da o zdravju žensk premišljujete na isti način, kot premišljujete in vam je mar za druge pomembne cilje. In drugič, enako pomembno je, da kot ženska vprašate svojega zdravnika in zdravnike, ki skrbijo za vaše bližnje: Je ta bolezen ali zdravljenje pri ženskah drugačna? To je pomembno vprašanje, ker je odgovor verjetno da. A vaš zdravnik morda ne ve odgovora, vsaj ne še. Ampak če vprašate, bo verjetno šel poiskat odgovor. In to je zelo pomembno, ne samo za nas, ampak za vse, ki jih imamo radi. Naj bo to mati, hči, sestra, prijateljica ali babica. Trpljenje moje babice je navdihnilo moje delo na izboljšanju zdravja žensk.
It was my grandmother's suffering that inspired my work to improve the health of women. That's her legacy. Our legacy can be to improve the health of women for this generation and for generations to come.
To je njena zapuščina. Naša zapuščina je lahko izboljšanje zdravja žensk te generacije in naslednjih generacij. Hvala.
Thank you. (Applause)
(Aplavz)