Gender Medicine
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re:publica 2016174 / 188
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Transcript: English(auto-generated)
00:19
Thank you very much. Sarah Hiltner, she's research
00:21
assistant at Charité Berlin, will introduce us in the field of gender medicine. Yes, thank you very much. We're waiting for the presentation to be set up. Until then, I can just introduce myself. I'm a physical therapist and also a
00:45
physical therapist. I'm doing my master's in sociology researching how gender medicine is being implemented all over Europe in medical studies. Maybe I help you with the sex gender. In my bachelor's thesis, I looked
01:19
into cardiology textbooks and how the sexes are being
01:23
represented there. It was very fascinating because the books I looked into were from late 2000s and they actually missed most of the current knowledge about heart attack in women and men and how they differentiate, which was very surprising to me because the knowledge has
01:43
been researched for the past 40 years by now. And maybe now I will have a presentation as well. There's also a hashtag. I want to introduce
02:17
this hashtag sexgendermed as an abbreviation for
02:20
sex and gender-sensitive medicine. If you want to reach me on Twitter, it's Sophie Hiltner. I will maybe we'll start seeing something.
02:45
You did a session here two years ago. It was more exercise. Maybe we could do some exercises? Something to wake you all up because you've been probably sitting all day. Please follow me. This is the rabbit. Just do it
03:00
yourself. And this is the hunter. Now, the rabbit is a really smart cookie. So he jumps around, makes a turn and suddenly they switch the row. Yeah, yeah, yeah. Try to just do the hunter and switching the hands. I see some hunters are missing
03:21
the hook. Oh, there's a three-eared rabbit. Okay. Now, the rabbit can usually jump. So only the rabbit jumps, of course. The hunter can't do this because then it won't work. Okay.
03:40
And one more level would be the hunter is shooting, the rabbit is jumping. In case you're really frustrated with your work and you need a break and laugh about yourself, this always does the trick for me. Took me like a year to do it like I do it now. Well, I'm excited to be here. Thank you
04:02
all for being here. Is there a question in advance if you shouted loud enough? I can repeat it. So we have it on. Okay. I will try to just do the
04:21
talk, but I do need my slides for myself. So we're going to start in ancient medicine. That's where it all started because the widespread belief was that there's only one body and that actually all humankind is male but that the females did not have enough
04:41
fire inside them to turn their internal organs out so they're the men. So women were always the imperfect version of a man. Can I continue here? And we call it the one-sex model, meaning that there's only this one sex and later on
05:03
this dominant ideal of masculinity and that the men are perfect leading to women being imperfect and the more sexual, the more carnal versions of man and this was supported by religious beliefs
05:23
and it continued to develop hierarchical models inside society. So actually society reflected this belief and made sure that women were
05:44
dominated and supported and that most privileges were reserved for white educated, healthy, middle and upper class men all based on the belief that these bodies have
06:03
a hierarchical order as well. Now I can't even look at my slides. So there was this one sex model. Everybody is the same. They're all men except the ones that are not men.
06:23
They're imperfect men so they can be dominated by the perfect men. Then times changed. Whoa. Yes. Times changed. Thank you very much. We have a presentation. I wanted to start with this because this is one of the quotes in one of the medical textbooks I have.
06:43
It is referring to a myocardial infarction and in the case of a heart attack that you have to immobilize the patient and remove restricting closes, the tight shirt collar and the neck tie. Unfortunately she's a woman. Wearing a bra while having a heart attack can be quite uncomfortable
07:02
as well. So this is for me a perfect example why women are out of the picture not only in but also explicitly when referring to diseases. So the imperfect men
07:21
we already have. The privileges in modernity we had certain revelations. The microscope was developed. Natural science were developing as well and they all challenged religious and traditional beliefs that there was a hierarchical order but the one that challenged it the most was Darwin when he said
07:44
that the origin of the species actually was in contradiction to what the Bible was saying. So then everybody focused suddenly on genes and on hormones trying to establish the belief that men and women are so differently that it actually during the from the 16th to 19th century
08:04
especially in brain studies the belief changed rapidly. Like on one century men were the emotional ones then women were the emotional ones. Then men were the emotional ones again. So you see that the science with all, they all backed it up by what they called science have helped them to
08:23
show that their difference between the sexes to actually find a validation for a social order that was dominant. Then they moved on to the two sex model and this originated the term bikini medicine as we have it
08:43
today. Like all the parts being covered by a bikini referring only to the reproductive organs of women which are all outsourced in gynecology but assuming that in all other areas of medical education and well as medical treatment actually
09:02
are the same because we still in medical tradition still believe and assume that the actual body of men and women are the same. And that is the problem we are fighting against in sex and gender sensitive medicine. So
09:23
to come to the point today where we actually do research on the differences of the biological sexes and I am referring to your genome and your setup and if it is an XY and XXY or two Xs or one of the other many variations there are you do
09:43
have a genome that is influencing how your body reacts to certain aspects of nature to make you vulnerable to certain diseases and so that we can all do this right now has a long tradition of fighting for rights, fighting for interest
10:02
in those matters and that evolved from human rights movements, women rights movements, then came women health aspects that were very interesting and then the women's out of women's health and that is one problem we always have to fight against when we are talking about sex and gender sensitive medicine is that everybody believes
10:22
it is only for women and well to a certain aspect yes we have to catch up a lot of the research that has not been done for women right now but we also discover a lot of things that are very helpful for men as well and I will come to that in a minute.
10:41
Basic definition of sex and gender actually when I say sex I am talking about your biological setup of your body the way your genome is designed and how these hormones for example will influence how you metabolize medication. When women are actually having a menstrual cycle there are three phases where they react very differently
11:03
to medication and that has not been researched properly because it is very expensive because you would need a group of women that are pre-menstrual, you will have a group of women that are menstruating, you will have a group of women that is post menopause and of all these
11:24
women you also need several groups inside them due to the cycles they go through which makes research in this area very expensive because you would have per age group at least nine groups at least for the women and I am pretty sure that men have cycles as well although they are not as obvious as maybe the female ones.
11:44
When I talk about gender I am referring to gender roles, gender identity that is actually reproduced constantly in society how we act as men, how we act as women, how we act as trans person, how we are classified by our looks and perceived
12:04
and what the expectations to us are and that also influences in medicine for example the way you take your medicine, how you are complying with doctor's orders, women tend to comply a lot better than men, men sometimes do, sometimes don't care about when they take the medication, they are prescribed
12:24
I also want to make sure that it is not all men and all women, I am talking about statistics and most prominent groups. Some results from science, in cardiology for example the heart attack
12:41
has symptoms most people know as a strong chest pain, pain going through the left side of your body and feeling very uncomfortable in women, nausea, vomiting and back pain you'd associate innocently with a heart attack
13:01
unfortunately not yet but they are more prominent in women but they are also men that can have only these symptoms and suffering a heart attack so we need to catch up on research and update all the textbook on it as well. Women have the heart attack a lot later and if you have diabetes you are more prone
13:21
to receive a heart attack in general at least twice as likely as a healthy man and at least four times as likely as a healthy woman so when you are a diabetic and you are female you are having a heart attack is very likely event. In therapy
13:40
oh yes and when you are smoking and taking oral contraception is also endangering you of suffering a heart attack and or a stroke as well and it was only mentioned in one book of the ten I have investigated from the 2008 to 2012 which was a very big surprise
14:00
because the amount of women smoking is increasing as well and oral contraception is also available and being taken very frequently. Aspirin on the other side is preventing men of having a heart attack but not women. In women it prevents more having a stroke why this is? They haven't really found out
14:21
but there is still research going on but that it is a fact has been proven by several researches and what you all can do to prevent a heart attack is do at least one hour of sports a week another thing is that when you have high blood pressure the risk of suffering it depends not only on your age and your sex
14:43
but also on your ethnicity and of course your background and I want to point out, can I point? I can't point like this no can I give
15:07
yes, can you help me with this? What I want to point out is I need to get this window away I want to point out that the numbers for the people of colour being 50 and 60 are actually the same
15:23
as for the white people when they are 60 and 70 so when you are a person of colour you are ten years earlier and being prone to having a heart attack which brings me to the point that actually that the incidences of diseases is often correlated with your
15:44
access to and your understanding of knowledge and the healthcare system so poverty actually makes sick and since more women are on the poor side in all over the world they are more likely to be sick as well
16:03
in psychiatry depression have variations in the symptoms, women tend to react more with anxiety while men tend more to be substance abusers and addicts and also tend
16:20
to turn out their depression and show it in more aggressive behaviour and when you think about it anxiety and aggression are like two parts of a spectrum and they are kind of also related to gender identity because aggression is also seen as a very masculine trait and being timid and rather withdrawn
16:44
a more feminine trait at least what concerns the gender identity in our society which I think is kind of remarkable. In the therapy of severe depression when you need to take medication to come back to life again tricyclical antidepressants are
17:04
more helpful than men and have been proven that they have a better effect than men while SSRIs the selective serotonin reuptake inhibitors are more helpful in women Osteoporosis is in most people known
17:21
as a female disease and yes women are more endangered to having osteoporosis but men we found out are also endangered to suffering from osteoporosis and the most interesting thing is the last part it is the five year survivor rate after your first
17:41
fracture due to osteoporosis and that is when you're a woman you're more likely to survive it because most times the doctors and yourself are more aware that it's actually a possibility to get to have osteoporosis anyway and in men it comes often as a surprise because doctors are still not aware that it
18:02
is possible that it's likely for men to have osteoporosis. In neurology multiple sclerosis and migraine is more prominent in women and amiotrophic lateral sclerosis and epilepsy is more common in men. Now the trait at the end for me is
18:23
always pharmacology because there's so much going on there that is very very bad for particularly women because most test subjects are young healthy men and one example is the Viagra for women that had a measured effect
18:43
in the trial participants of 9 to 14 percent which was the same as the placebo so you actually don't know if it had an effect and the FDA approved it after some trials that included 25 people and since it was a medication only for women
19:03
they even had two women in the test group which I think is so ridiculous that I don't even, I'm missing the words. So hands on, communicate with your doctor particularly if you notice reactions with medication especially as a woman
19:22
most of the medication has not been tried out for men and women a lot of the side effects are heavier in women and particularly if you're a very slender woman the medication might be overdosed for your body weight and height
19:40
and if you want to challenge your doctor ask them if you have to consider your menstrual cycle in any way by taking the medication at a certain point because that does have influence on how your body metabolizes it and how long it stays in your system so ask your doctor if he or she knows about the sex differences because we all have to work together to raise awareness
20:03
for the whole subject because it is still not a part of the curriculum in medical education only a few schools all over Europe have some courses, most of them are not mandatory but electives and we all need to take care
20:23
that our doctors stay up to date with what they know thank you very much and there will be an advanced meet and greet at 2pm at the mattresses behind the dome with my colleagues from Hacking with Care
20:41
they are presenting on stage two right now so please check out their talk when we are all done and it's online because we are collaborating to help activists with their bodies and their well-being yes now it's time for questions and answers thank you very much
21:06
any questions? every now and then you get to read some articles about actually
21:25
the oral contraception for men has been invented but there is no interest in introducing it to society, do you have a stand on that? or statistics even maybe? I don't have a statistics on it
21:41
but it is difficult to bring contraception to men because it is, although there are some voices that cry out and say I want it, I need it as far as I know they haven't had an impact yet to actually develop it and bring it to
22:00
the main market, I would think it would be great to respond to be responsible and take care of your own fertility in that way particularly as a man any other questions? who's next? there's a mic, lady over there
22:21
can you raise your hand to show Fanny where you are? the rabbit is running again you closed by saying we should all kind of question decisions our doctors make
22:44
or at least kind of ask for reasons why they do that don't you think this issue has to be tackled at a different level because I feel like at first doctors are technically in a hierarchical position because we assume
23:03
they have knowledge that we don't have which is the reason why we go to them in the first place and then if we say generally they're not aware of this or of many aspects of this how can we rely on them giving us a reasonable explanation for something that they don't
23:22
really know about so don't you think what other level do you think is necessary to kind of tackle the problem well one thing I think is important is approach and that's what I'm also doing or what we're doing in gender medicine societies is approaching specialist societies
23:42
like the cardiologist society and the society of the neurologists and approach them and tell them like how about that you start at least offering courses where medical doctors I mean every medical doctor at least in Germany has to collect a certain amount of education classes a year and
24:02
they're required to do it or otherwise they lose a license but as far as I know none of the big associations have yet introduced a course for gender sensitive treatment or information for the doctors so that is one part that's really rigid and what I experienced from the medical system because you said it's
24:22
hierarchical when you come as a patient but the medical system inside itself has also a strong hierarchy and it hasn't been yet so gender friendly and sex sensitive so far and there's still only little rules asking researchers to proclaim the sex of their cells but
24:42
every cell has a sex as well and reacts accordingly and every mouse and rat they use also has a sex at least I wouldn't call it gender in their case but they have a sex so there's so much to be done yes and I'm not so optimistic that I will actually benefit from it in a couple of
25:02
years it's more that the generation after us or even that generation after that will actually benefit from all of us working together being aware and even just slightly questioning like are you sure I have to take the whole pill or should I take half a pill twice a day instead of one pill at one time at a day I mean little things like that can actually
25:22
help everyone and if your doctor doesn't know with you he hopefully looks it up and gives you information on it Do we have time for more questions? We have time for questions, no problem. Who's next? Are you all specialists in gender medicine or not?
25:43
Probably. Are there any more questions? Ah yeah. Now please take the mic to give recording. Okay so the other thing I was wondering is because you said in the beginning you know female health was kind of pushed into the gynecology
26:02
sphere where I am wondering do you did you look at that at all because from my experience for example prescribing the pill as a contraceptive in a lot of cases at least with the people I know and with myself also was also connected to me not being entirely informed of what kind of
26:21
long term effect that has on my body Sorry so you're asking about That your doctor wasn't informing you about long term effects of contraception because it was
26:41
just a golden standard. Kind of. You know if you say I have problems with my skin people will tell you. You know you could take the pill but they don't tell you what's you know it's much bigger than having the skin problems. Exactly I was just interested if you kind of looked into that issues around gynecology as well or Not particularly but you have to assume that that medical
27:04
system I mean it is very complex to treat a human being and to to be aware of all the things going on so by adding the dimension of sex and gender will make it even more complicated but I think we are all suited to actually
27:20
understand this kind of complexity and yes this oh there's this new medication that's given to everyone hasn't worked out in the past and unfortunately several examples and like this Viagra for women how medication is approved still is very
27:41
questionable at least if not endangering many people and a lot of medication for treating heart disease in elderly people have led to several women dying because the medication was overdosed for their bodies in particular
28:02
Yes so Thank you very much. Is there a new upcoming question or otherwise I would say thank you very much for this insight in gender medicine. It was very very interesting. Thank you very much. Thank you. Thank you all for listening and the interesting questions.
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