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Science 308 (5728): 1569-

Copyright © 2005 by the American Association for the Advancement of Science

Vive la Différence

Beverly Purnell, Leslie Roberts, Orla Smith

Many a song and poem celebrates the splendid differences between men and women. But obvious physical variation aside, in what ways do we differ mentally, physiologically, and socially? This special issue on Women's Health highlights many points of divergence. However, the title of this issue should not prompt the male reader to put down this copy and wait for a subsequent one. The issue covers many topics that concern men and women equally, such as the HIV/AIDS pandemic, cardiovascular disease, sexuality, and personalized medicine, as well as matters specific to women.

Much of our understanding of sex variation stems from the Women's Health Initiative, an effort launched in the late 1980s to probe gender questions and to increase the number of women in clinical trials. Without doubt, more women are now included in trials, and more studies focus on diseases that especially afflict women, but much improvement is needed; see the Editorial on p. 1517 and News story on p. 1570. Uterine fibroids, a major indication of hysterectomy, have received less attention. See Walker and Stewart on p. 1589. Likewise, mechanistic insight is needed to define preeclampsia, a circulatory disturbance between mother and fetus (see Redman and Sargent, p. 1592). In contrast, Berkley and colleagues (p. 1587) note that substantial progress has been made in understanding endometriosis, particularly the pain associated with it.

Figure 1

CREDIT: PHOTO RESEARCHERS, INC.

The understanding of male/female differences in disease manifestation and drug response has also lagged behind (see News story on p. 1572). For instance, investigators are beginning to probe the differences in brain chemistry and anatomy that contribute to the different patterns of mental illness in men and women (see News story on p. 1574). In a related story (p. 1576), Miller describes how HIV/AIDS and other factors seem to increase risks to mental health for women in developing countries. Greater awareness about gender variation also reveals an increasing "feminization" of the HIV/AIDS pandemic, due in part to the heightened social and biological vulnerability of women, as Quinn and Overbaugh describe on p. 1582.

In dealing with topics that differentiate the sexes, the heart emerges as central. Mendelsohn and Karas (p. 1583) review how the molecular and cellular physiology of the heart and blood vessels differ between males and females during development and in cardiovascular disease. And a News story on p. 1580 reports on gender differences in bone quality and fracture risk, an issue of increasing importance to both sexes in an aging population. Finally, touching on a hot-button topic, Enserink (p. 1578) explores what some call the "medicalization" of female sexuality and whether, in the age of Viagra, lack of desire is a disease requiring drug therapy.

Related materials include Policy Forums in which Greenberger and Vogelstein (p. 1557) and Manasse (p. 1558) debate some pharmacists' refusal to dispense prescriptions for contraception, a Book Review by Aplin on pregnancy loss (p. 1555), and multiple online articles in the Signal Transduction and Science of Aging Knowledge Environments (www.sciencemag.org/sciext/womenshealth/) on topics such as cervical cancer and the role of estrogen in diseases of aging.

In all, this issue contains ample fodder for the ongoing debate about what men and women share and how they are unique--la différence.


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
Gender bias in research: how does it affect evidence basedmedicine?.
A. Holdcroft (2007)
Journal of the Royal Society of Medicine 100, 2-3
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