by Valentina Bertuccio D’Angelo
From the beginning of the Sars-CoV-2 pandemic, it became clear how the infection was more dangerous for men than for women. In Italy as in the rest of the world, statistics and studies have confirmed that it is men who risk a serious course of the disease, up to death. The reasons I’m biochemicals, but also sociological. For those who are not experts, this was perhaps the first time we heard about gender medicine. Or better, gender-specific medicine. With this definition we mean a medicine in which “the differences between man and woman (understood both as biological sex and as gender) in front of the health and disease: differences in diagnostic pathways, in therapeutic needs and in the efficacy of drugs “. So writes the doctor Giovannella Baggio, president of the National Center for Health and Gender Medicine of Padua – and the first professor to hold a professorship in our country at the University of Padua -, in the book “From gender medicine to precision medicine” of the Onda Foundation, the observatory in Italy that monitors women’s and gender health. “It is not a question of women’s medicine – explains Professor Baggio -. It is not a specialty, but one transverse dimension to all specialties “. Another observatory, at theCollege of Health, was instituted in 2018 by the government with a pioneering law, the first in the world on gender medicine.
Do we need an observatory? Yes, because gender-specific medicine is not (yet) the norm. For centuries it has taken the male body as a paradigm and object of study (except for gynecological issues). And just think that the Education on the subject they began only in the nineties in the field of cardiology, when the director of the Institute of Cardiology of the National Institute of Health of the United States realized that the scientific research of that institute was conducted only on men. But be careful, it is women but also men who pay for a medicine that does not take into account the differences. Much has changed since the 1990s, but the road is long. Covid forced to accelerate.
Covid and gender medicine
As mentioned, since the beginning of the pandemic it has emerged that the disease is more dangerous for men than for women: according to data published by the ISS, from February 2020 to April 28 2021, in Italy, women who died of Covid were 43.6% of the total of the victims, against 56.4% of men compared to a greater number of infected women (probably due to the greater presence in assistance and care works). And the only age group where most women die (over90) is simply the one in which they are most numerous. “And this is true all over the world, at least in those countries where disaggregated data has been collected,” explains Professor Baggio.
The reasons are biochemical (estrogen, the Ace2 receptor and the X chromosome have to do with it) and socio-behavioral: typically women are more loyal to compliance with anti-contagion rules and they smoke and drink less, thereby reducing risk factors. “In general women have a stronger immune system in the face of viruses – continues Professor Baggio – even if we discount this with a greater propensity to autoimmune diseases ”. The biochemical and immunological differences between men and women, which also emerged in the time of Covid “are very important and can help us understand other diseases more”.
In short, the pandemic as an “accelerator” of a more gender-specific approach in medicine? Let’s say that there is some good news: “In the experiments carried out on vaccines the presence of men and women was balanced. There was no difference in efficacy, although we know that women generally react better to vaccines ”.
A sore point, however, are the adverse reactions: 75% of the less serious side effects concern women. And even the most serious ones, such as thrombosis, seem to be a female problem.
A line of studies concerning the consequences that vaccines can have on the menstrual cycle (intermenstrual bleeding, heavy or low blood flow, painful, late or early menstruation). Consequences that seem to have not been studied ex ante. Data is currently being collected and a causal link is being sought.
Gender-specific medicine: all specialties declined with a gender focus
It is now clear that women and men are subject to diseases in different ways, have different symptoms, respond to treatment differently. Let’s look at the cardiovascular diseases: although the collective imagination says the opposite, heart attack is the leading cause of death not of men but of women (48% vs 38%). But since the symptoms are different in women than in men (chest pains are rare, they occur rather in the stomach, jaw, or anxiety or fatigue), they are often not recognized. “But it’s not just a question of women – underlines Giovannella Baggio -. In psychiatry women suffer from depression much more than men, but it is the latter who take their own lives more frequently. L’osteoporosis it is considered a feminine question but it is not: man too develops it, ten years late. There are some tumors which have a higher mortality in men ”. It is therefore evident that a gender-specific approach in each discipline is for the benefit of all, men and women, who otherwise risk having wrong or late diagnoses.
The situation in Italy
As mentioned, Italy was equipped in 2018 with the first law in the world on gender medicine (Lorenzin law), which provides for a Plan for gender medicine and the Observatory at the ISS, which controls the application of the Plan itself in four areas in which a gender-specific approach is to be developed: clinical paths of prevention, diagnosis, treatment and rehabilitation; research and innovation; professional training and updating; communication and information. It must be said that progress has been made, thanks above all to the network that has been forming in recent years between hospitals, scientific societies, research bodies, civil society. If there is a positive consequence of the pandemic, it is that “even doctors who do not ‘believe’ in gender medicine or do not know it, can be convinced that a more specific approach is important – concludes Baggio -. I hope the scientific world awakens. I trust. Covid has moved a lot, even on a political level, but still not enough“.