Gender-specific medicine is necessary

Couple

What’s gender-specific medicine?

As stated in a well-known article, “Gender-specific medicine is the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, psychological and social impact. It is a neglected dimension of medicine.” Medical research conducted over the past 40 years has focused almost exclusively on male patients.

How men and women are different?

Differences could lead to wrong diagnosis, symptoms underestimation, and even premature death. Differences appear in a variety of domains such as:

  • PKPD (pharmacokinetics & pharmacodynamics): efficacy and side effects profiles as well as drug-drug interactions.
  • cardiovascular diseases: risk factors for these diseases; clinical manifestations; influence of drugs (see below for more).
  • cancer: incidence; aggressiveness and prognosis.
  • liver diseases: epidemiology and progression.

The main goal

The main goal of gender medicine is focused on understanding the differences of patho-physiology, clinical signs, prevention and treatment of diseases equally represented in men and women.

Advocacy

Advocacy in this field is emerging with amazing women like Marianne Legato, Alyson McGregor and Noel Bairey Merz, whose conference and TED Talks below really show the decisive importance of this discipline.

Conclusion

Traditionally, research has been done almost entirely on men and those conclusions were then applied to both men and women. Even though the law requires that women be included in studies, the gender-different results are almost never analyzed. Instead, they are blended. This is detrimental to both men and women. Perhaps now is the time for everything in research and medicine to be reviewed in the light of potentially significant gender differences.

Additional resources:

The Foundation for Gender-specific Medicine

Why Sex Matters

Women’s Heart Attacks Look Nothing Like Men’s – TIME – 2016

Gender-Specific Medicine in the Genomic Era – Clinical Science – 2015

Sexism In The Doctor’s Office Starts Here – Even actual lab rats are subjected to science’s male bias – HuffPost – 2015

Why Gender-Specific Medicine Matters in the Emergency Department – Emergency Physicians Monthly – 2015

Gender medicine: a task for the third millennium – Clinical Chemistry and Laboratory Medicine – 2013

Men and women get sick in different ways: Developing gender-specific medicine is a major challenge of the future – Science Daily – 2013

Incorporating and evaluating an integrated gender-specific medicine curriculum: a survey study in Dutch GP training – BMC Medical Education – 2009

 

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The future of medicine? Cells not pills

Siddhartha Mukherjee is a visionary cancer doctor and the writer of an awesome book about cancer published few years ago.

In the TED talk below, he takes us through a fantastic journey about the future of medicine and how it could change soon.

Medicine started with simple principles, such as have disease, take pill and kill something. It worked and is still functioning as of today for specific diseases. However, the future is elsewhere.

The natural world gives us some clues about how one might think about illness. In fact, the natural world is organized hierarchically upwards, not downwards. It begins with a cell that give rise to self-regulating, semi-autonomous units called organs, and these organs coalesce to form humans, and these organisms ultimately live in environments.

Siddhartha Mukherjee takes the example of cancer. To tackle this disease, we started to kill cells with chemotherapeutic agents and targeted therapies, then we realized that it would be a nice idea to harvest the immune system in the war against cancer. This gave birth to immuno-oncology drugs bringing extraordinary outcomes to patients. The next step is to change the environment but it is much more challenging…

Stem cells are also part of the solution according to Siddhartha Mukherjee. However, it raises tons of questions… as what’s at stake is not killing something, but growing something. This means that we need to think upside-down and shift our views as well as our traditional thinking.

  • Could your medicine be a cell and not a pill?
  • How would we grow these cells?
  • What we would we do to stop the malignant growth of these cells? Could we implant suicide genes into these cells to stop them from growing?
  • Could your medicine be an organ that’s created outside the body and then implanted into the body? Could that stop some of the degeneration? What if the organ needed to have memory?
  • Could your medicine be an environment? In every culture, shamans have been using environments as medicines. Could we imagine that for our future?

It is very often said that the reason we haven’t had the transformative impact on the treatment of illness is because we don’t have powerful-enough drugs, and that’s partly true. But perhaps the real reason is that we don’t have powerful-enough ways of thinking about medicines.

A word about the gene-editing technology, called Crispr-Cas9 – WSJ

DNA_strand

There has been a lot of buzz going around about the Crispr-Cas9 gene-editing technology

But what it is? and what impact could it have on drug development, innovation and new treatments?

What it is?

A fascinating short video created by the McGovern Institute for Brain Research at MIT explains the key characteristics of the technology.

Why is it so exciting?

A Wall Street Journal article reveals what this technology could allow regarding the development of potential new treatments and why it is so exciting.

This new technology will enable the “editing” of defective genes and their replacement by healthy (or normal) genes. Pharmaceutical companies are just starting to explore how to use it as drug discovery would probably be revolutionized. Diseases like cancer, cystic fibrosis,… caused by a mutated gene will eventually find a solution.

Another key advantage is the ease of use. Unless other technologies, Crispr-Cas9 gene-editing technology is much easier to handle than prior methods.

Is it already used?

Yes, it is selected to create genetically engineered research animals for the time being but there is more to come…

Is it dangerous?

It could be, if it is not used correctly and ethically. In April 2015, Chinese scientists used this method to manipulate the DNA of human embryos. This raised fears that it could be used to tune babies up before birth. Manipulating life has to be ethically monitored in order to protect life.

In another article that was then retracted, it seems that Crispr technology caused nearly 2,000 unexpected mutations — 10 times what was previously observed (in two mice that it cured of blindness). It is not the “death” of the technology but it proved that we don’t know yet how it really works.

Studies, published in Nature Medicine, revealed that edited cells might cause cancer.

What are the technical hurdles to overcome before creating a drug treatment based on this technology?

Today we do not know how to deliver a drug that could target the right DNA in the right cells. Inactivated viruses or nanoparticles could lead be used as potential carriers.

What’s next?

Overcoming drug delivery hurdles, perfecting the technology, translating it into drugs able to cure genetic disorders will be a fantastic improvement in health sciences. It will bring hope to many patients suffering from these diseases without any cure today.

As the technology is very promising, scientists and universities are currently fighting on the legal battlefield to know who will be the owner of the patents and who will make money from the technology and its application. More details

Additional Articles

As it moves out of the lab, CRISPR brings tough questions into the clinic – STAT – October 2018

A flawed study shows how little we understand CRISPR’s effects – Wired – April 2018

Biotechnology: At the heart of gene edits in human embryos – Nature – August 2017

Redesigning Life: How Genome Editing Will Transform the World – London School of Economics Book Review – September 2016

Beyond CRISPR: A guide to the many other ways to edit a genome – Nature – August 2016

Do CRISPR enthusiasts have their head in the sand about the safety of gene editing? – STAT – July 2016

Federal panel approves first test of CRISPR editing in humans – Washington Post – June 2016

Riding The Gene Editing Wave: Reflections On CRISPR/Cas9’s Impressive Trajectory – LifeSciVC – May 2016

Scientists solve CRISPR’s “Energizer bunny” problem – STAT – April 2016

CRISP biotech Intellia strikes licensing deal with Regeneron, readies for IPO – BioPharmaDive – April 2016

Bill Gates, together with other well-known investors, recently invested in Editas Medicine as part of CRISP-Cas9 frenzy.

Medical specialists urge more debate on gene-editing technology – Reuters – September 2015

CRISPR player Intellia looks IPO-ready after $70M round – FierceBiotech – September 2015

Editing humanity – The Economist – August 2015

Eight Things You Might Not Have Known Until Editas Filed Its S-1 – Xconomy – January 2016

Historic CRISPR Patent Fight Primed To Become Head-To-Head Battle – Xconomy – January 2016

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What if we prescribed video games, and not Ritalin, to treat ADHD? – Medium

gamers

How digital games can inspire and motivate children — and result in better learning outcomes

An extremely interesting article on gaming and its impact on children learning skills will maybe lead to the prescription of game sessions in the treatment of psychological ailments.

We are entering in an emerging field called therapeutic neurogaming.

“It’s built on two basic ideas: First, that the brain is “plastic” for far longer than scientists once believed, so healing can be achieved in schoolchildren of all ages without drugs, through basic neurofeedback therapy. Second, that therapy doesn’t just happen — it requires work and patience and a regular dose of practice.” (Quote from Medium Article)

I’m a strong believer that games will be fully part of our lives and not only part of our hobbies in the near future.

Three years ago I read a book written by Jane McGonigal, an expert in gaming and gamification: Reality is broken. I have only one word: brilliant. She walks you through the gaming universe explaining you all the type of games and how they can be used to improve life, well-being, relationships,… She is about to publish another book in September 2015: SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver and More Resilient–Powered by the Science of Games. I’m really looking forward to it.

It is a real trend we have to count on. The nice fact: it is not a boring trend… it is fun!! and there is probably more to come!!

Medium Article

More on the benefits of gaming:

The Game Believes in You: How Digital Play Can Make Our Kids Smarter – 2015 – Greg Toppo

Cognitive Benefits of Playing Video Games – 2015 – Psychology Today

The Benefits of Playing Video Games – 2014 – American Psychologist

The DeanBeat: Neurogaming is a nascent market fueled by brain games and sensors – 2013 – Venture Beat

Reality Is Broken: Why Games Make Us Better and How They Can Change the World – 2011 – Jane McGonigal + her TED Talk

Gamification to improve our world – 2011 – Yu Kai Chu – TEDxLausanne

Companies or Institutions developing therapeutic neurogaming:

Gazzaley Lab (Neuroracer)

Akili Interactive Lab (Project: EVO)

PlayNice Institute (MindLight)

PuzzleBox (Orbit Helicopter)

Emotiv (EEG for game control)

 

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Obesity as a “Brain Disease”, a Driver for New Therapies – Medscape

obesity

We all know that obesity is an unstoppable epidemic of this century. New analysis of this disease could maybe lead to solutions

Obesity is not only an issue in itself; it drives the emergence of other diseases, like cancer for example. Obesity is a complex multifactorial disease that should actually be viewed as a brain disease, bariatric surgeon Carel Le Roux, MBChB, PhD, of University College Dublin, Ireland, argues.

Saying obesity is a brain disease could allow us to better understand it and help us develop new treatments with this paradigm shift.

External factors (stress, sleep deprivation, depression,…) and internal factors (hormone levels and disruptions) could have their say in obesity. Each individual will have different factors influencing his/her condition as well as different reactions to the treaments prescribed. A personalized approach is crucial in this disease.

Beyond treatment, prevention is equally important. More should be done in collaboration with food producers and agribusinesses.

Medscape Article

More on obesity:

Impact of the Obesity Epidemic on Cancer – 2015 – Annual Review of Médicine (subscription required)

Ending Childhood Obesity – 2015 – WHO

USA – The State of Obesity – 2014 – Trust for America’s Health

 

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Mental Health – Awareness and Care vs. Stigma

DepressionMental Health Awareness is Starting to win over Stigma

During the last week I read several articles on mental health (you can see the list at the bottom of my post). I think that there is something going on, more awareness on how sick or sad people feel and what can we do about it. It has been found by a recent study that if nothing is done, the burden would be unbearable in the coming years.

Marilyn Wedge has wonderful insights in her article. Some of her quotes are revealing the sick and sad truth about our society:

– “The notion of mental health or mental illness is relative to the values of a particular society at a particular time in history. Our hectic society paradoxically frowns on overly active children—even children as young as four or five years old. Our society wants children to be restrained, orderly, and eager to please adults.”

– “There is another aspect of ADHD that worries me. As stimulants have come to be prescribed for ever larger numbers of children, our society’s very perception of childhood has changed. Instead of seeing ADHD-type behaviors as part of the spectrum of normal childhood that most kids eventually grow out of, or as responses to bumps or rough patches in a child’s life, we cluster these behaviors into a discrete (and chronic) “illness” or “mental health condition” with clearly defined boundaries. And we are led to believe that this “illness” is rooted in the child’s genetic makeup and requires treatment with psychiatric medication.”

– “In Prozac Nation, Elizabeth Wurtzel also discusses the one drug/one disease phenomenon. She says that her doctors defined her illness as “depression” because she responded to a specific antidepressant drug, Prozac. The drug defined her disease. Like Kramer, Wurtzel also noticed that a psychiatric drug not only came to define a particular mental disorder, but the drug also expanded that disorder across society. She observed, too, that the process was driven by profits to drug companies. The discovery of a new drug to treat depression resulted in many more patients being diagnosed with depression.”

– “As Wurtzel points out, the process of defining a disease by a drug is illogical and backward. Medicine has traditionally defined diseases by their causes, not by the drugs to which patients with similar symptoms respond. If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?”

In conclusion, we really need to change the perception of our human behaviors: normality doesn’t exist and will never exist. We are all different and we have to accept ourselves with our own personality and identity. Something is changing and I hope that more people will find relief by being accepted as they are (as a starting point!).

 

Out of the shadows – 2015 – The Economist

The ADHD Fallacy: It’s Time To Stop Treating Childhood as a Disease – 2015 – TIME

It’s Time To Stop Using These Phrases When It Comes To Mental Illness – 2015 – Huffington Post

Probiotics May One Day Be Used To Treat Depression – 2015 – Huffington Post

Mental Health and Integration – 2014 – The Economist Intelligence Unit & Janssen

Mental Health Atlas – 2011 – WHO

 

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Emotions are driving our physical health – 2 TED Talks

Beautiful examples of our mental wellbeing affecting our health

The first talk from Nadine Burke Harris: How childhood trauma affects health across a lifetime. It is inspiring and providing us with a better understanding about the real impact of childhood trauma and toxic stress on children’s health.

She is a pediatrician raising awareness about childhood trauma and its impact on global health. “In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed.”

How to measure it and how to see the impact all life long? It has been done by the ACE Study. Two conclusions from this study: 1. childhood trauma is common and 2. the more trauma you suffered from, the more at risk you are to develop COPD, cancer, depression, heart disease… “We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children.”

She created the Center for Youth Wellness to prevent, screen and heal the impacts of toxic stress.

Adverse Childhood Experiences Study    Center for Youth Wellness

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The second talk from Guy Winch: Why we all need to practice emotional first aid. Taking care of our emotions and our minds is crucial for our global health.

His talk is full of hints to live better like: “By taking action when you’re lonely, by changing your responses to failure, by protecting your self-esteem, by battling negative thinking, you won’t just heal your psychological wounds, you will build emotional resilience, you will thrive.”

This talk showed us why it is necessary to be conscious about our emotional health and why we need to take care of it. If we don’t, it can have devastating effects and even lead to premature death. We need to teach these tips to children to help them cope better with failure, rejection, lack of conviction and rumination.

Guy Winch Book

Doctors Are Now Inviting Patients To Help Design Their Own Medical Treatment – Huffington Post

Doctors are now proposing more than one option to cancer patients

CollaborationIt is a great step forward in collaborative thinking for the treatment of patients. Including patients opinion in the decision for their own treatment and quality of life will empower them and allow them to feel they have a voice which is heard.

In many hospitals around the world, oncologists and surgeons simply tell cancer patients what treatments they should have. But in the US, at UC San Francisco, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care.

Each patient is unique and there is no single answer to treat them all with the same combination of drugs and therapies.

Huffington Post article    Collaborative thinking in healthcare

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The Power of Herd Immunity – TED Talks

How do vaccines prevent disease — even among people too young to get vaccinated?

child_patient_vaccineIt’s a concept called “herd immunity,” and it relies on a critical mass of people getting their shots to break the chain of infection. Health researcher Romina Libster shows how herd immunity contained a deadly outbreak of H1N1 in her hometown.

Today we have TOOLS (vaccines) that can protect the lives of the most vulnerable people. Why some people still refuse to use them?

Listen to this insightful talk    How vaccines work?

Smartphone diagnosis – The Economist

smartphoneSmartphone diagnosis can help us in the developed world but could also be a better way to care for patients in developing countries

By offering lab-type diagnostics to almost any population with access to a smartphone, such devices would be particularly useful in remote and resource-poor areas. But they are bound to give hypochondriacs yet another reason to fiddle with their handsets.

The Economist article

Treat infections with artificial viruses – The Economist

Very interesting article on bacteriophages

LambdaPhageViruses that will attack bacteria. Renewing interest in phages could probably help tackle resistant bacteria. It is not new but has been forgotten for a long time… Some Western researchers are believing in phages, hoping, with modern methods, to turn them into tailored treatments for infection.

Read the article in The Economist    More on Phages    More on the company Synthetic Genomics

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How a 15-year-old CEO is bringing eyesight to those in need – Fast Company

A great story of charity and vision from this teenage girl

LillianPravdaLillian Pravda was born with a cataract and endured several surgeries. The more time she spent in the hospital, the more she learned not all children were as fortunate as she was to have access to care. At age 8, Lillian set out to help children in need of sight-saving eye surgeries and vision services, making sure they would get the care they need and deserve.

More on Lilian:

Short video about her vision   Her website  The award she won