‘Science is far from perfect. It is not the fault of the scientific method but of us. We imperfect creatures sneak into his house and soil his carpets with our feet. We assert ourselves when we should be its respectful guests. […] As unclear as the research is in some areas I have found reassurance that science has everything to offer women and men who want to live in a more just world.’
Medicine and science are not abstract entities but made up of people: people who observe phenomena, analyse data and develop models. However, the same people who contribute to the construction of our society are deeply imbued with prejudices and stereotypes. For a long time, science and medicine have been led and represented by white men, emblems of privilege. It goes without saying that even education in science and medicine is often biased and mirrors the culture of privilege. Even today, when Western society defines itself as the highest expression of progress, certain categories experience the consequences of inadequate treatment and, in the most serious cases, the impossibility of access to care.
For several years now, there has been talk in the medical and health sector of gender medicine, the study of biological, social and cultural differences between men and women and how these differences influence health status. The aim of gender medicine is thus to ensure diagnostic-therapeutic appropriateness by making possible treatments tailored to the individual.
Gender medicine is often spoken of as a solution to the under-representation and exclusion of women in medicine and research. As an approach, gender medicine demands that medical and scientific research and medical personnel consider biological and gender differences.
To talk about gender medicine one must therefore know the difference between sex and gender. The term sex refers to biological differences, which are universal and immutable as they are genetically determined. The term gender, on the other hand, refers to gender identity, everyone’s self-perception and gender role, characteristics socially attributed to each gender.
In terms of life expectancy, health and disease incidence, sex and gender are closely related,’ reports Silvia De Francia, a clinical pharmacologist and researcher at the University of Turin, ’but the sex-specific and gender-specific approaches are very different.
A journalist since 2005, and a populariser of science on the topics of pharmacology and gender medicine, De Francia deals with clinical routine in pharmacology.
‘Women defend themselves better against viruses, bacteria and tumours but, on the other hand, they produce more antibodies than men and manifest more intense adverse reactions to vaccines than the male population. Women also spend the double X chromosome in a higher incidence of autoimmune diseases, such as thyroid diseases, rheumatoid arthritis, lupus, which are more common among women. We are built differently and this predisposes us differently to diseases. In addition, society and the roles it assigns a priori to men and women can be fertile ground for differences in disease’.
Different stress management, care work (which is still heavily borne by women) marginalisation in different contexts that many women experience, are just some of the social factors that impact on women’s health and psychophysical well-being.
Talking about chronic pain during the pandemic gave rise to an interest in the impact that the social environment has on the experience of pain in women. It was precisely during the pandemic that we began to talk more about chronic pain and gender bias (gender pain gap) in relation to invisible chronic conditions.
Endometriosis, pudendal neuropathy, fibromyalgia, and vulvodynia are examples of chronic diseases with considerable diagnostic delay because they are poorly understood.
‘If biological differences exist, we want to know about them. But if we want to build a more equal society, we have to do more: we have to be able to understand these gaps and adapt them,’ says De Francia, who is also a contact person for gender medicine at the University of Turin.
The study of biological differences is therefore fundamental to guaranteeing access and adequate services for everyone, but it cannot ignore the analysis of gender roles. The pandemic experience itself revealed that the virus affected men and women equally in numerical terms, but life expectancy and the course were more severe in the male population. It is important to understand, however, that gender medicine is not women’s medicine, but the medicine of each individual, an approach aimed at studying the biological and gender variables that characterise each and every one.
In Italy we have been talking about gender medicine since the 1990s and the attention has grown over time. In 2005, for example, the National Observatory on Women’s Health and Gender, now known as the ONDA Foundation, was set up to promote gender equity in health and through studies and awareness and information campaigns aimed at health professionals, institutions and the general population.
In 2008, the National Bioethics Committee published the report ‘Pharmacological experimentation on women’, in which it reported on the importance of equal consideration of women in experimentation against the danger of a neutral pharmacology.
In 2011, on the other hand, AIFA set up the Working Group on Drugs and Gender, which, starting from the under-representation of women in medical and pharmacological research and the lack of data analysis from a gender perspective, set itself the goal of actively participating in change through a series of activities such as raising awareness of pharmaceutical companies on the issue and collecting data broken down by gender on consumption, expenditure and adverse reactions. In 2018, a law introducing the concept of gender medicine was passed, while the following year saw the launch of the Plan for the Implementation and Dissemination of Gender Medicine in the National Health System.
The aim is to make gender medicine a reality in educational and cultural institutions, such as universities, but also in hospitals and GP surgeries.