The following is a portion of an opinion written by Laurie Edwards, the author of the forthcoming book “In the Kingdom of the Sick: A Social History of Chronic Illness in America” and a writing teacher at Northeastern University.
Doctors and researchers increasingly understand that there can be striking variations in the way men and women respond to drugs, many of which are tested almost exclusively on males. Early this year, for instance, the Food and Drug Administration announced that it was cutting in half the prescribed dose of Ambien for women, who remained drowsy for longer than men after taking the drug.
Women have hormonal cycles, smaller organs, higher body fat composition – all of which are thought to play a role in how drugs affect our bodies. We also have basic differences in gene expression, which can make differences in the way we metabolize drugs. These differences are particularly important for the millions of women living with chronic pain. An estimated 25% of Americans experience chronic pain, and a disproportionate number of them are women. Pain conditions are a particularly good example of the interplay between sex (our biological and chromosomal differences) and gender (the cultural roles and expectations attributed to a person). In 2011, the Institute of Medicine published a report on the public health impact of chronic pain, called “Relieving Pain in America.” It found that not only did women appear to suffer more from pain, but that women’s reports of pain were more likely to be dismissed. This is a serious problem, because pain is subjective and self-reported, and diagnosis and treatment depend on the assumption that the person reporting symptoms is beyond doubt.
For all the medical advances of the past few decades, we still know shockingly little about pain and how to control it. Sex-based research is a crucial part of understanding, not just the underlying mechanisms of pain, but the most effective ways to treat it for men and women alike. Among the improvements must be a renewed focus on discovering why women respond differently to some drugs and diseases, as well as an emphasis on training physicians to better diagnose and manage women’s pain. Part of the reason the diagnosis and treatment of women’s pain lag so much is simply the pace of medical research itself, which is slow to move from publication to clinical practice. Unfortunately, if anything, changes in assumptions about gender evolve even more slowly…… nytimes.com 3/17/13