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Notes from the national women’s health day (and national gender-specific medicine day).
On national women’s health day (22 April 2016), we asked Walter Ricciardi, chair of the Italian National Institute for Health (ISS), to introduce the Ministry of Health publication “Gender as a determinant of health. The development of gender-specific medicine to guarantee treatment equality and appropriateness”: “The Publication is intended as a starting point rather than a finish, to help decision-makers adopt policies suited to both men and women, starting from scientific bases. As requested by the Ministry we tried to bring together important scientists and researchers of both sexes, who have been dealing with this topic from their different standpoints for a few years now and we asked them to tell us about their discoveries and positions, based on sturdy data, on specific data, concerning the various different illnesses. I have to say that the result is important, because it allows us to reflect on concrete data and to develop our strategies based on actual scientific discoveries rather than opinion”.
Gender-specific medicine is not women’s medicine
Does the Publication on gender-specific medicine provide clarity regarding this aspect? “Yes, that’s something that comes out very clearly,” Ricciardi, the ISS chair, told us, “in the same way that today has taught us that our citizens are not aware of this, and neither are many sector professionals, who still think that gender-specific medicine is the branch of medicine that deals with women’s health. In actual fact, the gender-specific outlook allows us to understand the specific characteristics that distinguish the conditions of health and illness and, therefore, the strategies to be used to maintain health, control risk factors and intervene in the event of illness in men and women. This is the starting point and we now know that we have to get this message across more effectively. We cannot just discuss it between sector professionals, we have to explain to our citizens that gender-specific medicine may have an impact on both the quality and the duration of their life, because something that we are witnessing at the current time is that quality of life in Italy is also in question”.
Roberta Chersevani, chairperson of FNOMCeO, was also eager to stress that “some people still confuse gender-specific medicine with medicine dedicated to women, which is not the case. Gender-specific medicine means realising that very often symptoms, prevalence and the treatment of illness differ according to whether the affected subject is a man or a woman”. For this reason, FNOMCeO has a working group dedicated to gender-specific medicine. Its leader, Teresita Mazzei, talked us through some of the group’s initiatives: “We have developed training, information and proficiency courses for medical practitioners, to be held in the offices of the various provincial sections of the Association of Physicians, ranging from gender-specific pharmacology to general medicine and that involving the cardiovascular, respiratory and central nervous systems, because we know that, for example, certain types of dementia affect the female population to a greater degree than the male one, whereas, conversely, osteoporosis is hardly studied in men. A whole series of courses that attempt to overcome a gap that still exists in university and post-graduate training for doctors. No one, or very few people, know what gender-specific medicine is and we therefore need to create culture, which is something that we are trying to do through training courses and informative initiatives on this subject”.
The importance of training was also recently stressed in the latest gender-specific medicine bill. Its first signatory, the Honourable Paola Boldrini, reminded us that “our current male and female professionals were trained by the old school, on male bodies. We have to promote a type of training that addresses all those working in the healthcare sector. All this is included in the gender-specific medicine bill”. Indeed, the bill reads that “The Ministry of Health, in concert with the Ministry of Education, University and Research, has drawn up a national training plan for gender-specific medicine that involves the introduction of interdisciplinary courses designed to provide know-how and favour the application of an approach that takes into account sex and gender differences in research, prevention, diagnosis and treatment. These courses are run in all the different healthcare and medical degree courses and are incorporated into local health authority training plans with continuing education in medicine accreditation requisites.” (Article 5 National gender-specific medicine training plan, Bill no. 3603, presented to the Italian Chamber of Deputies on 12/02/2016).
A table for gender-specific medicine
The round table dedicated to gender-specific medicine and women’s health dealt with a number of aspects of gender-specific medicine, such as clinical research and training. We asked Walter Malorni of the Italian National Institute for Health (ISS), who took part in the round table, for a description of the current position of gender-specific research and medicine in the public and private sectors. “They are progressing slowly. The ISS, as a technical and scientific body belonging to the Ministry of Health, has established a dedicated gender-specific medicine centre to coordinate efforts in the public sector and stimulate initiatives. There are also a number of other national institutions, such as AIFA (the Italian Medicines Agency) or ISPEL (the National Institute of Occupational Prevention and Safety), that are dealing with the issue within their respective areas of competence. Of course”, Malorni commented, “we need greater public resources to develop gender-specific research and without which innovation is difficult to achieve. The world of production, in turn, is creating structures and/or tangibly dealing with those aspects involving the sector, such as pharmacological and diagnostic aspects. However, even in this sector it is still early days and appropriate economic incentives are needed”. And how far have we come with regard to training? “At the moment the gender-specific medicine courses during medical degrees in Italian universities are few and far between. And yet, not only are students extremely interested”, says Giovannella Baggio, of the University of Padua, who took part in the round table together with Malorni, “they also feel a great need and desire to stimulate all their future teachers to decline their subjects using a gender-specific approach. We desperately need gender-specific medicine to be incorporated into doctors’ qualification courses”.
A string for the gender-specific medicine universe
Those interested in gender-specific medicine can now make use of a special tool to facilitate research using the MEDLINE database. This feature is the Texas Tech University Health Sciences Center Sex and Gender Speciﬁc Health (TTUHSC SGSH) PubMed Search Tool.
It is introduced in the Journal of Women’s Health, which verifies its sensitivity, i.e. its capacity to identify all the relevant articles, and its specificity, i.e. its capacity to exclude the irrelevant ones or false hits.
The resources page of the Sex and Gender Speciﬁc Health website, in its Literature Search & Database Resources section, provides the information needed to use the tool.
This tool should be useful, its developers and those who validated it assure, in reducing the so-called “number needed to read” (NNTR) i.e. the number of articles to be read before finding those relevant to the area of research in question.
• Song MM, Simonsen CK, Wilson JD, Jenkins MR. Development of a PubMed based search tool for identifying sex and gender specific health literature. J Womens Health 2016, 25(2): 181-187. doi:10.1089/jwh.2015.5217.
• Sex and Gender Specific Health: http://www.sexandgenderhealth.org/