Sex matters and sex sells. Inways we never thought about.Not as far as the pharmaceuticalindustry is concerned however.Despite Viagra and its efforts tofind a similar drug for women(what a boon that would be to menin Trinidad: instant success withlittle effort, though it might be theend of women playing Carnival),the vast and influential pharmaceuticalindustry has been peculiarlyresistant to the idea that disease,and medication to treat thatdisease, is different according tosex. Sex in the sense of biology, ofcourse. Male-female differences.Most doctors would agree withthe drug firms. Since most investigatorsare males, and comfortablywhite at that, it turns out thatmost research on diseases andmedications for diseases has beendone on comfortable, middleclass,middle-aged white males.We are only now learning thatdisease patterns, disease responsesand reactions to medicationsdiffer not only according to yourage-and there is tremendousvariation in response between ababy and a five-year-old -butaccording to your ethnic groupand your sex.
We may now have to startthinking about the pharmaceuticaldifferences between a oneyear-old Chinese male and a oneyear-old East Indian female.The female immune system isdesigned differently than a male's.It has to do with all those crazyimmunological manoeuvresdesigned to tolerate being pregnantso that the woman's bodydoes not, cannot, reject the developingforeigner inside her.This self-obvious fact, knownfor various decades, just does notseem to have bothered hundredsof thousands of doctors whomerrily prescribe the same dose ofa drug to women as they do tomen.
For example, it turns out thatfemales mount a more robustinflammatory response to illnessthan men. Exactly why is notknown as yet. This sounds goodand may explain why womenseem to get better faster after anattack of the flu than men, untilyou realise that this heightenedimmunity contributes to more tissuedamage which is linked todeath and to long-term autoimmunedisease.The bigger and badder inflammatoryresponse may also explainwhy women visit doctors morethan men. It's not only that theycomplain more, it's that they literallyfeel worse because they experienceworse symptoms thanmen.
The increased immune responsehas been dramatically demonstratedin the laboratory. If yougive male and female mice a standarddose of flu virus, none of thefemales survive past two weekswhile more than half of the malesdo.As a corollary to this, a womanneeds about half the flu vaccinedose of a similarly sized male toobtain the same immuneresponse.Yellow fever virus vaccination iseven more dramatic. Antibodiesfrom yellow fever vaccination is10-fold higher in samples collectedfrom females than from malevolunteers.The pattern is similar with thecouple of diseases studied so far. Lyme disease is a recently discoveredillness limited to the mid-Atlantic region of the USA andtransmitted by tick bite. The standardlab test for Lyme disease isnot very sensitive and it may beeven worse for women.Manywomen therefore may go undiagnosed.Lyme disease is easily treatedwith an antibiotic but forunknown reasons some peoplelater develop swollen knees orLyme arthritis. It's twice as commonin men as women.However, 20 per cent of peoplewith Lyme disease also develop avague constellation of painful,debilitating symptoms know asfibromyalgia.
The overall ratio of women tomen is 7:1.Most of these womennowadays end up being told thatthey are just depressed.Heart attacks are quite differentin men and women.Coronarythrombosis in men is sudden, fastand painful. Squeezing chest painis the hallmark.Heart attacks in women occurabout 10 years later in womenthan men and is associated withthe onset of menopause and to thedrop in estrogen.Heart attacks are slower andmore insidious in women andmore difficult to diagnose, even ifyou understand the differences insymptoms. Chest pain is uncommon.Up to half of all women withheart attacks never have chestpain. The major symptoms ofheart attack in women are: "shortbreath," "weakness," "unusualfatigue," "cold sweat," and "dizziness."Except for the "cold sweat"
most doctors unfortunately woulddismiss these symptoms as"woman foolishness," yet "unusualfatigue," together with "persistentindigestion" are the majorwarning symptoms of an impendingheart attack in women.Many of these symptoms areexperienced on a daily basis bywomen and one has to wonderhow many minor heart attacks inwomen are not being diagnosed.Much more research is neededto enable doctors to be able todelineate which of these symptomshas the highest diagnosticclinical value.Treating one sex like the other inadult medicine may be as inappropriateas treating a child like anadult. The equitable treatment offemales and males requires anunderstanding of their biologicaldifferences and not only in bed.