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Gender Competency
Training for Medical
28th of April 2003
Evidence of gender difference
and its clinical significance
Ann-Maree Nobelius
Faculty of Medicine, Nursing and Health Sciences
Monash University Australia
 women are the major consumers of
health care
 women are the primary decision makers
in family health care
 women are the major consumers of
prescription drugs
 2/3 of all pharmaceuticals used to treat
both men and women have only been
tested in men
 2/3 of all diseases that affect men and
women have only been researched in
 women have only made up 7% of all
cardiac research subjects
 more developed medical research systems in
countries with white populations of European
genetic origins
 greater levels of funding in these countries with
white populations of European genetic origins
 the teratogenic risk associated with involving
women in clinical trails while in their
reproductive years and potential longer-tem
outcomes for offspring
 Of these categories of difference gender
is the largest and most obvious
 more than 50% of the world’s population
are women
 more or less you are either one or the
other on the basis of biological difference
 NIH in the US has recognised the significance of gender blindness
in research and its clinical consequences
 instituted a policy of requiring research of disease that affect both
men and women to include gender as a variable of research
 allocates funding in line with this policy
 resulting in increasing numbers of publications citing difference
even where none is found
 This information has profound consequences for clinical practice
Columbia University’s
Journal of Gender Specific Medicine
Some of the areas of difference
that are important for clinical
 Coronary heart disease
 Cardiovascular disease and arrhythmia
 Brain differences including number of neurons and
 Differential addiction times
 Responses to pain medication
 Eating and digestion
 Differential drug metabolism
 Differential treatment of dyslipidaemia
 Differential carcinogenic and toxic effects of
tobacco smoke
Differential risk of lung cancer
Differential HIV viral loads and treatment options
Depression from a genetic level
Sex hormones and cognitive function
Differential dietary treatment for obesity
Gender differences in pre-pubertal children
Differential lifetime medical costs
Cataract Surgery
Stress responses and the sympathetic nervous
system (Taylor et al, in Psychological Review
July 2000, Vol 107. No.3 p411-429)