Just Like a Woman: How Gender Science Is Redefining What Makes Us Female - Couverture souple

Hales, Dianne

Couverture souple

ISBN 10 : 055337818X ISBN 13 : 9780553378184

Editeur : Random House Publishing Group, 2000

Synopsis

Book by Hales Dianne

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Unasked Questions

Not long ago, Marianne Legato recalls, a scientist reported his preliminary findings from tests of a new compound on laboratory rats--all male.  "What happens in females?" she asked.

"The same," he replied.

"How do you know?" she inquired.

"Because females respond just like males," he answered.

"But how can you be sure if you haven't tested females?" she pressed.  Flustered, he insisted that he "just knew."

"I couldn't understand how he could possibly be so sure," Legato says.  "Then, finally, it dawned on me: Dolly the sheep wasn't the first clone, Eve was.  This man still assumed that women are essentially small men." (No one ever thinks of the converse: men as large women.)

A lack of actual proof for their premises has never gotten in the way of medical experts' assumption that they "just know" the way women are.  Aristotle "just knew" that women nursed their babies with blanched menstrual blood stored in their breasts.  Medical illustrators in the Middle Ages "just knew" that women were duplicates of men with an inside-out penis for a vagina, an inverted scrotum for a womb, and testicles for ovaries.  Voltaire "just knew" that "the delicacy of women's limbs render them ill-suited to any type of labor or occupation that requires strength or endurance." Physicians of the late nineteenth century "just knew" that removal of a woman's ovaries was the best way to "repair" mental disorders--the reason, according to an 1889 report from the U.S.  Surgeon General, for 51 percent of such operations.

Even today doctors routinely perform tests, prescribe drugs, and recommend treatments on the assumption that they will be as effective and beneficial for women as for men.  How do they know? The truth is they often don't.  From 1977 to 1993 the FDA banned women of childbearing potential from participating in the safety tests of new drugs to prevent possible damage to their unborn children and reproductive capacity.  To scientists, this offered an advantage: They did not have to take into account such messy variables as women's fluctuating hormones or monthly cycles.  As exclusion of women from all sorts of medical testing became common, this ban extended even to women who'd undergone sterilization or were past reproductive age.  In a further attempt to keep the science "clean," laboratory researchers experimented only on male animals.  As a result, in the landmark studies that shaped many modern medical practices, females were written out--and off.

The landmark Multiple Risk Factor Intervention Trials (known, aptly enough, as Mr.  Fit), which studied vulnerability to heart disease, the number-one killer of both sexes, included 12,000 to 15,000 men--and no women.  The Physician's Health Study of the potential benefits of taking an aspirin a day to lower the risk of heart attack looked at 22,071 physicians--none of them women.  A major evaluation of coffee intake and its impact on stroke and heart attack studied 45,589 men--and no women.  Only in 1998 did researchers discover that HIV tests misstate a woman's need for treatment.  Even when a woman and a man have the same amount of virus in their blood, the woman is at a more advanced state of infection and at much greater risk of developing AIDS.  Incredibly, even a study of the impact of obesity on the risk of breast and endometrial cancer--female diseases--extrapolated from only male subjects.

Aging--something women do better, or at least longer--has been primarily studied in men.  In 1958 the federally sponsored researchers who launched what was to become the Baltimore Longitudinal Study of Aging decided not to include women, even though they make up two thirds of the elderly and more than 70 percent of the old old (those over age eighty-five).  The reason was what former congresswoman Patricia Schroeder, one of the first champions of women's health research, dubbed "the rest room excuse."

At the time, the investigators had to work out of a single room at the city hospital.  The study participants had access to only one rest room, which they had to share with elderly male patients in an adjacent hospital ward.  Rather than ask women subjects to use this facility during overnight evaluations, the scientists excluded them altogether.  As the budget for this high-profile project grew, the researchers acquired more space--and more rest rooms.  However, for twenty years their studies included no women--an omission that did not keep the scientists from entitling their initial four-hundred-page report Normal Human Aging.

The very fact that research never took women's menstrual cycling into account has created a black hole in scientific understanding of femaleness.  We know that women's bodies work differently at various times of the month, that temperature fluctuates, that fluid volume and weight increase, and that food moves through the digestive system at different rates.  But only recently have physicians realized that various diagnostic tests, including cholesterol and blood fat measurements, yield different results at different times of the month and that the timing of medical treatments during a woman's cycle can affect their efficacy--sometimes with life-or-death implications.

According to an intriguing report at an American Society of Clinical Oncology meeting, women who undergo breast cancer surgery during the second half, or luteal phase, of their monthly cycles (days 14 to 28) are twice as likely to suffer a recurrence as those who are operated on earlier in their cycles.  Recent research suggests that women with insulin-dependent diabetes may have higher blood sugar levels during the luteal phase of their cycles because fluctuations in sex hormones affect insulin blood levels.

Many medications also have stronger or weaker effects at different times in a woman's cycle and may require adjustments in dosage.  However, the doses of most medications--along with their safety and efficacy--have never been tested in women or studied across the menstrual cycle.  This may account for the fact that adverse drug reactions, including ones as serious as seizures, are reported twice as often in women.

"More than half of the drugs prescribed today have been tested only in men," says psychiatrist Steven Dubofsky, of the University of Colorado in Boulder, who notes that because of differences in size, absorption, metabolism, and liver function, "there can be tremendous gender differences in both beneficial and adverse effects in women." Yet when Dubofsky tested an experimental medication for Alzheimer's disease, the research review committee banned female participants.  "The reason was that women might become pregnant--although the average age in my study was eighty-two."

Even treatments for problems that are more common in women have rarely been tested in them.  Research on aspirin's usefulness in preventing migraine headaches, which strike far more women, included only men.  Appetite suppressants and diet drugs--used far more often by women--have been tested almost exclusively in men.  Men traditionally were the sole subjects of tests of drugs to treat depression, a disorder that affects twice as many women.

The relatively few studies that have been done on pharmacokinetics (how a drug is absorbed) in women have identified potentially significant gender differences.  Women metabolize propranolol, a medication used to treat cardiac arrhythmias, more slowly than men.  Blood levels of Inderal, used for migraines or high blood pressure, rise higher in women.  Other drugs, including acetaminophen and aspirin, several benzodiazepines (antianxiety agents), and lidocaine (a topical anesthetic and a treatment for certain arrhythmias), take longer to clear a woman's body.

Many medications also interact in ways that have a unique impact on women.  Oral contraceptives--used by one in five American women between the ages of eighteen and thirty-four--can raise blood levels of some psychiatric drugs so high that a woman on the pill may require only a fraction of the standard dose.  Other medications, such as the antiseizure drugs carbamazepine and phenytoin, may decrease the effectiveness of birth control pills and increase the chance of an unwanted pregnancy.

When scientists do study the effects of drugs or other treatments on women, they often learn much that can benefit both sexes.  Consider the most significant exception to the no-females-allowed approach to health research, the Harvard Nurses' Health Study, which has followed 121,000 women for more than twenty years.  Its participants, who have filled out questionnaires and sent in blood samples and even toenail clippings over all these years, have taught us much about many common health threats--some exclusively female, such as the risk of breast cancer from birth control pills (which seems minimal), and some universal, such as the most effective means of preventing colon cancer.

Yet any research investigation that excludes half the human race--female or male--shortchanges both genders.  Learning about human health and longevity by looking only at men, one biologist points out, is like trying to run a successful department store by studying only those that went bankrupt.  "More research on women is not a luxury to be indulged in only to pacify feminists, to secure the female vote, or to attract women to a hospital center," says Legato.  "Studying women is not so much a service we offer them as an opportunity they offer medical science to improve health care at all levels." Researchers aren't doing women a favor by including them in research protocols.  They're doing everyone a service.

The Yentl Syndrome

Felicia, an account manager at a New York advertising agency, worked like a man: Overstressed and underexercised, she put in long hours, smoked a pack and a half of cigarettes a day, and didn't pay much attention to what she ate.  At age thirty-four Felicia noticed a burning sensation in her chest when she walked more than a block or two.  "I stopped, and it stopped.  At first I didn't think it was anything serious.  I have a family history of high cholesterol, but I'd never even had a checkup."

Since it was winter, the peak of flu season, Felicia assumed she kept feeling worse because she'd come down with a bug.  For ten days she shrugged off chest discomfort, breathlessness, and a throbbing headache.  Then one day she walked around a corner in her office and couldn't catch her breath.  That's when she got scared.  Felicia called her brother-in-law, an intern at a local hospital.  At his urging, she went to the emergency room.  At first no one suspected a heart attack.  "It wasn't like I clutched my chest and fell to the ground," she recalls.

Few women do.  And because they don't get the classic symptoms of a heart attack, untold numbers of women complaining of breathlessness or vague pressure in their chest have been sent away from emergency rooms or told to stay home and lie down--advice that may have cost them their lives.  Unfortunately, in order to get medical attention, a woman--like Yentl, the girl in Isaac Bashevis Singer's story who had to dress like a boy to study the Torah--has often had to get sick just like a man.

This false and dangerous assumption can occur with many illnesses, but the consequences may be most tragic with heart disease, which many still see as a "guy problem." It is not.  Even among women in their forties, heart disease claims more lives each year than breast cancer.  Yet a woman's heart, though vulnerable, usually doesn't ache or break like a man's.

Men typically develop the first signs of a heart ailment a decade earlier than women--at thirty-five rather than forty-five.  Throughout the reproductive years, estrogen, indeed the best friend a woman's heart could have, prevents the buildup of atherosclerotic plaque in the arteries, boosts levels of the beneficial form of cholesterol, called high-density lipoprotein (HDL), and lowers heart-harming low-density lipoprotein (LDL).

However, estrogen is not a magic potion that guarantees total protection.  As Felicia discovered, a woman who has a family history of cardiac disease, high blood pressure, or high cholesterol may develop serious problems even before she reaches menopause.  As their estrogen levels fall at midlife, the risk of heart disease rises for all women.  After age forty-five, one in nine women has some symptom of heart disease; by sixty-five, one in three does.

"Only in the last eight to ten years have cardiologists realized that heart disease in women has been understudied, underrecognized, underdiagnosed, and undertreated," says Legato.  Since then, an explosion of new research has begun to unlock the secrets of a woman's heart.  We now know that the same risk factors--high cholesterol, high blood pressure, and obesity--endanger both sexes, but they play out differently in women than men.

A healthy norm for a woman's cholesterol is ten points higher than a man's--210 versus 200 milligrams per deciliter--but this figure matters less than her HDL levels.  And even then what's normal for a male may spell trouble for a female.  "We don't know why, but women with an HDL under 45 mg/dl are at greater risk, while men don't seem to be at risk unless their HDL dips below 35," says Legato.

In women HDL is such a precise indicator of the heart's current and future health that some describe it as a cardiac crystal ball.  Total cholesterol, on the other hand, presents a murkier picture--made more complex by menstrual fluctuations.  LDL levels decline in the first half of a woman's monthly cycle.  In pregnancy, LDL levels increase and remain high until birth.  Oral contraceptives, even those with lower estrogen than the original formulations, raise LDL and lower HDL.  Menopause brings a rise in LDL and a small decline in HDL.  And after age fifty, other blood fats--the triglycerides--may be a more telling indicator of risk.
Unlike men, healthy women with high total cholesterol may not benefit as much from some cholesterol-lowering drugs, possibly because these medications cause a drop in helpful HDL as well as harmful LDL.  In some studies, lowering total cholesterol by drugs, diet, or both, which does reduce the danger of dying in men, provided similar benefits only for women with actual heart disease.  In other women, any treatment--dietary or drug--that pushed down a woman's HDL did little good.

Hypertension, or high blood pressure, a unisex risk factor,...

Présentation de l'éditeur

In recent years researchers in many scientific fields have actively focused on what being female really means. Their startling conclusion: Almost every assumption made about women--physical, medical, historical, psychological--turns out to be untested, unproven, or untrue.

Stereotypes about women are as old as time--and as current as still-too-prevalent beliefs based on male models. Acclaimed health writer Dianne Hales brings together the cutting-edge research in anthropology, physiology, psychology, neuroscience, endocrinology, and medicine in a book that reveals the complex interconnections between all aspects of a woman's life from infancy to old age. Gender science is now clearly demonstrating that women are not the second sex but a separate sex, unique in body, mind, and spirit.

Just Like a Woman explains what it means to live in a woman's body, think with a woman's brain, drink in the world with a woman's senses, and react with a woman's sensibility to the stresses and elations of her multiple roles. Refreshingly free of ideology, this meticulously documented book offers a stunningly liberating message that expands our concept of human potential--and will forever change the way every woman views herself.

Détails de l'édition

• Éditeur: Random House Publishing Group
• Date d'édition: 2000
• ISBN 10: 055337818X
• ISBN 13: 9780553378184
• Reliure: Broché
• Langue: anglais
• Nombre de pages: 416