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.
Disa nga kujtimet me te bukura te femijerise jane kohet qe kalova me gjyshen time, Mamar, ne shtepine 4-familjare ne Brooklyn, New York. Apartamenti i saj ishte nje oaz. Ishte vendi ku mund te pija shehurazi nje filxhan kafe, qe ishte ne fakt qumesht i ngrohte me nje pike kafe. Ajo e dashuronte jeten. Edhe pse punonte ne fabrike, kishte kursyer qindarkat dhe udhetonte ne Europe. Mbaj mend si i studionim fotograite e saj dhe pastaj kercenim te dyja me muziken e zgjedhur.
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.
Kur une isha 8 dhe ajo 60, dicka ndryshoi. Ajo ndaloi se punuari dhe udhetuari. Nuk kercente me. Nuk pinim me kafe. Nena ime linte punen qe ta conte ate neper doktore te cilet nuk jepnin dot nje diagnoze. Babai im, qe punonte naten, rrinte me te dites, qe te sigurohej qe ajo hante.
Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
Kujdesi per te u be i veshtire per familjen tone. Kur arriten te japin diagnoze, ajo ishte ne gjendje te rende.
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.
Shume prej jush mund te njohin simptomat e saj. Gjyshja ime kishte depresion. Nje depresion te thelle, qe te ndryshon jeten, nga i cili nuk u permiresua kurre. Ne ate kohe, shume pak njihej per depresionin.
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.
Por, edhe sot, pas 50 vjeteve, ka aq shume per te mesuar. Sot, dime qe grate jane 70 perqind me te prirura te perjetojne depresionin gjate jetes krahasuar me burrat. Edhe me kete prirje te larte, ne 30-50 perqind te rasteve, grate nuk diagnostikohen sakte
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.
E dime qe grate jane me te prirura te kene simptomat e lodhjes, shqetesime te gjumit, dhimbje dhe ankth, krahasuar me burrat. Keto simptoma shpesh neglizhohen si simptoma te depresionit.
And it isn't only depression in which these sex differences occur, but they occur across so many diseases.
Nuk eshte vetem depresioni qe ndodh ku shfaqet dallimi gjinor, kjo ndodh ne shume semundje.
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.
E pra, perpjekjet e gjyshes time bene qe ti hyj ketij kerkimi te vazhdueshem. Sot, une drejtoj nje qender, misioni i te ciles eshte te zbuloje pse ndodhin keto dallime gjinore dhe ta perdore ate njohuri per te permiresuar shendetin e grave.
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.
sot, dime qe cdo qelize ka gjini. Ky eshte term i vene nga Instituti i Mjekesise. Nenkupton qe burrat dhe grate jane te ndryshem deri ne nivele qelizore dhe molekulare. nenkupton qe ne jemi te ndryshem persa i perket organeve. Nga truri te zemra, mushkerite, nyjet.
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.
Vetem 20 vjet me pare nuk kishim ndonje te dhene ne shendetin e gruas pervec funksioneve riprodhuese. Por ne 1993, NIH Revitalization Act u miratua si ligj. Ky ligj mandaton qe grate dhe minoritetet te pershihen ne provat klinike qe ishin financuar nga Instituti Nacional i Shendetit. Nga shume ane, ligji ka punuar. Grate jane pershire ne provat klinike, dhe ne kemi mesuar se ka dallime te rendesishme ne menyrat qe burrat dhe grate i perjetojne semundjet. Por, shume here, e neglizhojme ate qe kemi mesuar rreth ketyre diferencave.
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.
Duhet ti bejme pyetjen vetes: Pse t'ia lesh shansit shendetin e gruas? Po ia leme shansit ne dy menyra. E para eshte se ka kaq shume per te mesuar dhe nuk po bejme investimin per te kuptuar plotesisht shtrirjen e dallimeve gjinore. E dyta eshte qe nuk po marrim ate kemi mesuar, e ta aplikojme ne rutinen e kujdesit klinik. Nuk po bejme aq sa duhet.
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.
Do ndaj me ju tre shembuj sesi diferencat gjinore kane ndikuar shendetin e grave, dhe ku duhet te bejme me shume.
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.
Le te fillojme me semundjen e zemres. Eshte vrasesi numer nje i grave ne SHBA sot. Kjo eshte fytyra e semundjes se zemres. Linda eshte nje grua ne moshe te mesme, qe ka nje stent(tub) ne nje nga arteret qe shkojne te zemra e saj. Kur simptomat iu kthyen, ajo shkoi prape te doktori. Ai beri testin e standartit te arte: kateterizimin kardiak. Nuk tregoi bllokim. Simptomat e Lindes vazhduan. Ajo u detyrua te linte punen. Atehere ajo na gjeti ne. Kur erdhi te ne, beme nje kateterizim kardiak tjeter dhe kesaj radhe gjetem shenja. Por na duhej nje test tjeter te benim diagnozen. Beme nje test qe quhet ultrasaund intrakoronar qe perdor valet e zerit per te pare ne arteret nga brenda jashte.
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.
Ne gjetem qe semundja e Lindes nuk dukej si semundja tipike e meshkujve. Semundja tipike e meshkujve duket keshtu. Eshte nje bllokim i dallueshem ose stenoze. Semundja e Lindes, ashtu si ne shume gra, duket keshtu. Pllaka eshte e shtrire me uniformisht gjate arteries dhe eshte me e veshtire per tu pare. Per Linden dhe shume gra te tjera, testi i standarti te arte nuk ishte vertet i arte.
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.
Tani, Linda mori mjekimin e duhur. Ajo vazhdoi jeten e saj dhe fatmiresisht sot ajo po shkon mire. Por Linda ishte me fat. Ajo na gjeti ne dhe ne gjetem semundjen e saj.
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.
Per shume gra, nuk ndodh. Ne kemi mjetet. Kemi teknologjine te bejme diagnozen. Por eshte shume e shpeshte qe diferencat gjinore te neglizhohen.
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?
Po rreth trajtimit? Nje studim referues qe u publikua dy vjet me pare bente nje pyetje shume te rendesishme: Cilat jane trajtimet me efektive per semundjen e zemres tek grate? Autoret kerkuan ne shkrimet gjate 10 vjeteve, dhe qindra nga to ishin pa vlere. Ata kuptuan se ne ato qe ishin pa vlere, 65 perqind e tyre edhe pse perfshinin gra ne studim, analizat nuk diferenconin grate dhe burrat. Nje mundesi e shkuar kot. Shpenzimi ishte bere dhe nuk arritem te mesonim sesi vajti per grate. Keto studime nuk kontribuonin aspak te kjo pyetje shume shume e rendesishme, se cilat jane trajtimet me efektive per semundjen e zemres te grate?
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.
Dua tju prezantoj me Hortense, kumbares sime, Hung Wei, kusherira e koleges, dhe dikush qe mund ta njihni -- Dana, gruaja e Christopher Reeve. Keto tre gra kane dicka shume te rendesishme te perbashket. Te treja ishin diagnostikuar me kancer ne mushkeri, kanceri vrases numri nje te grate ne SHBA sot. Asnjera nuk pinte duhan. Fatkeqsisht, Dana dhe Hung Wei vdiqen nga semundja. Sot dime qe grate qe s'pine duhan jane tre here me shume te prirura te diagnostikohen me kancer te mushkerise sesa burrat qe s'pine duhan. Interesante eshte qe, kur grate diagnostikohen me kancer mushkerie, tendenca per te mbijetuar eshte me e larte se te burrat. Ja disa ye dhena. Investigatoret tane gjeten se jane disa gene ne qelizat e tumorit te mushkerise ne te dy, burrat dhe grate. Keto gene aktivizohen kryesisht nga estrogjeni. Kur keto gene jane te mbi-shprehur, kjo shoqerohet me tendence per mbijetese vetem ne grate e reja. Kjo eshte gjetje fillestare dhe nuk e dime akoma se sa lidhet me kujdesin klinik. Por jane gjetje si keto qe sjellin shprese dhe mundesi per te shpetuar jete ne te dy, gra dhe burra.
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.
Tju tregoj nje shembull se kur konsiderojme qe dallimet gjinore e shtyjne shkencen. Disa vjet me pare po testohej nje ilac i ri per kancerin ne mushkeri, dhe kur autoret pane te tumoret e zvogeluar, mesuan qe 82 perqind ishin gra. Kjo i drejtoi te pyetja: Pse? Ata gjeten se mutacionet gjenetike qe shenjonte ilaci ishin shume me te zakonshme te grate. Kjo i ka drejtuar te nje perpjekje me e personalizuar e trajtimit te kancerit te mushkerise qe pershin gjinine.
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.
Kete mund ta arrijme kur nuk ia leme shansit shendetin e gruas. Dime qe kur investojme ne kerkim marrim rezultate. Hidhni nje veshtrim ne perqindjet e vdekjeve nga kanceri i gjirit gjate kohes. Tani shihni perqindjet e vdekjeve nga kanceri i mushkerise ne gra gjate kohes. Le te shohim dollaret e investuar ne kancerin e gjirit-- keta jane dollare te investuar per vdekje -- dhe dollaret e investuar ne kancerin e mushkerise. Eshte e qarte qe investimi ne kancerin e gjirit ka dhene rezultat. Mund te mos jete shume i shpejte, por ka dhene rezultat. Mund te bejme te njejten per kancerin e mushkerise dhe cdo semundje tjeter.
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.
Le te kthehemi te depresioni. Depresioni eshte shkaku numer nje i paaftesise te grate ne bote sot. Investigatoret tane kane gjetur qe ka dallime ne trurin e grave dhe burrave ne zonat qe jane te lidhura me gjendjen shpirterore. Kur ve grate dhe burrat ne nje skaner MRI funksional -- ky eshte lloji i skanerit qe tregon si funksionon truri kur eshte i aktivizuar -- pra i ve ne skaner dhe i ekspozon ndaj stresit. Mund te shohesh qarte dallimin. Jane gjetje si keto qe ne besojme se mbajne te dhena se pse shohim kete dallim gjinor kaq te theksuar tek depresioni.
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.
Por edhe pse dime qe keto dallime ekzistojne, 66 perqind e kerkimit ne tru qe fillon tek kafshet behet ose ne kafshe meshkuj ose ne kafshe me gjini te paidentifikuar.
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.
Mendoj qe duhet te bejme pyetjen prape: Pse tja lesh shansit shendetin e gruas? Kjo eshte pyetje qe na shpon ne te shkences dhe mjekesise qe besojme se jemi rrugen e permiresimit dramatik te shendetit te grave. Ne dime qe cdo qelize ka gjini. E dime qe keto dallime neglizhohen. Si rrjedhim e dime qe grate nuk po marrin perfitimin e plote te shkences dhe mjekesise moderne sot. Ne kemi mjetet por nuk kemi deshiren dhe vrullin kolektiv.
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.
Shendeti i gruas eshte nje ceshtje te drejtash te barabarta po aq i rendesishem sa pagesa e barabarte. Eshte problem i cilesise dhe integritetit te shkences dhe mjekesise. (Duartrokitje) Imagjinoni vrullin qe mund te marrim ne avancimin e shendetit te gruas nese konsiderojme se dallimet gjinore jane aty ne fillimet e hershme te dizajnimit te kerkimit. Ose nese analizojme te dhenat tona nga gjinia.
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.
Njerezit me pyesin shpesh: Cfare mund te bej une? Ketu une sugjeroj: E para, qe ju te mendoni per shendetin e gruas ne te njejten menyre qe mendoni dhe kujdeseni per ceshtjet e tjera qe jane te rendesishme per ju. E dyta dhe po aq e rendesishme, qe si grua, ti duhet t'i kerkosh doktorit tend dhe doktoreve te te afermeve te tu: A eshte kjo semundje apo trajtim i ndryshem te grate? Kjo eshte nje pyetje e thelle sepse pergjigjia mund te jete po, por doktori juaj mund te mos e dije pergjigjen, akoma. Por nese ti ben pyetjen, doktori do kerkoje per pergjigjen. Dhe kjo eshte kaq e rendesishme, jo vetem per ne, por per te gjithe ata qe duam. Qofte nene, vajze, moter, shoqe apo gjyshe.
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.
Ishte vuajtja e gjyshes time qe me frymezoi per te permiresuar shendetin e gruas. Kjo eshte legacia e saj. Legacia jone eshte permiresimi i shendetit te grave per kete gjenerate dhe gjeneratat e ardhshme.
Thank you. (Applause)
Falemnderit. (Duartrokitje)