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An almost unexplored search

Giovannella Baggio has been involved in AGESCI (Italian Association for Guides and Scouts) and held the roles of President of the Central Committee (1980-1985), and of Guide Leader of Italy, (1996-1999), that is, the highest rank in the scouting world. AGESCI is an educational association for boys and girls which provides a diarchy in all posts of responsibility: from the leaders to all the provincial, regional and national offices. And perhaps this experience of life in a male and female organization was not alien to the birth of her scientific interest in medicine and pharmacology, differentiated according to gender. This is a type of research which, Baggio herself tells us, remained almost unexplored until a few years ago: “Indeed, in medicine there was a gaping hole in knowledge: as if it had remained stuck in the 1940s. The discoveries in medicine of the past 50 years were in fact obtained by work in which the female gender was disregarded. We must therefore start by studying gender differences in all fields: from anatomy to physiology, from clinical medicine to pharmacology. But to do this ample funding is required, and it is necessary to deal with the scant collaboration of the pharmaceutical multinationals: they are terrified that people will realize that their products – tested mainly on men – may be considered useless by the other half of the population, women”.

A professor since 1995, holding the first and only chair in Italy of gender medicine since 2013, and head physician of medicine in Padua, in 2009 she was the first woman in Italy to dedicate a congress to this “global shame” and to found a national study centre on health and gender medicine, “Which is a new dimension of medicine, not a new speciality, which studies the influence of sex and gender on physiology, physiopathology and human pathology”. “Today we know that men and women should be treated in different ways”, she declares, “we have appalling observations, especially in cardiology”. An example? While in the past 30 years mortality from cardiovascular diseases has been reduced by 40 per cent in men, for women, on the contrary, with equal prevention it has decreased by barely 3-4 per cent (but in the United States by 20 per cent). Then in the first months following a heart attack 26 per cent of women will probably die, while the equivalent figure for men is only 11 per cent. There are many differences, baby aspirins, for example, are of no use to women as a primary preventive treatment for forestalling an infarction, and diabetes is three times more dangerous for women than it is for men. Even the symptoms of a heart attack differ (in women its presentation is atypical), so that for women the diagnosis of an infarction is frequently erroneous or delayed. And then all cardiovascular medicines have worse side effects in women.

The researcher added: “In addition to infarction, women are also more subject to osteoporosis, to senile dementia and to depression. But we do not yet know precisely why or how to treat them. We have mapped out the human genome, we shall soon be prescribing medicines on the basis of a tiny point of difference in the dna (precision medicine), but we have given very little consideration to the chromosomes xx and xy that distinguish men from women”.

For centuries we have been concerned solely with the health of men, who brought food home and had to live longer. We have been victims of the bikini syndrome: only the organs of our reproductive apparatus were studied: breasts, uterus and ovaries.

And although it is true that the average lifespan of women is five years longer than that of men, these years of survival are largely marked by illness and disability.

But, we asked Baggio, how it is it that women are excluded from clinical research? Is it only a cultural matter? “I would say for practical reasons. Take blood tests: for a woman patient, should glycemia be measured before, during or after the menstrual cycle? Working on women or on animals costs more!”.

However, if gender medicine is so important, why, in the case of a transplant, is attention not paid to whether the organ comes from a donor of a different sex than the recipient? “The literature on this subject is very recent. The size of the organs is checked: those from males may be too large to be transplanted into a woman. Instead we cannot underestimate the immune system. Let us take the example of a patient who is the mother of a child: during pregnancy, in order to coexist with a living being recognized by her organism as not female, she will have developed protective antibodies against antigens coded by the y chromosome which after birth become quiescent. This is the wonder of human physiology. If an organ from a male is transplanted into her these antibodies are reactivated. If she has had more than one pregnancy carrying a male child, the transplant becomes dangerous”.

In your opinion, do psychological components play a role in the different reactions to illness? “Certainly a woman’s social role induces a delay in the request for help, while on the contrary frequent recourse to a general practitioner usually often depends on the fact that she bears the burden of the whole family’s problems…”.

The variables which determine illnesses are numerous, in addition to the difference between the sexes. Is it possible to get one’s bearings in this multiplicity of factors? “Yes of course. Epidemiology has precisely this function: the study of many variables in populations monitored for many years (longitudinal studies). Unfortunately in such studies women are poorly represented; it is on these studies that the guidelines which direct the doctor’s behaviour are based and it is in turn on the basis of these guidelines that doctors find themselves answering before the judges. 

Lucetta Scaraffia

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