Roundtable Discussion on COVID-19 Through a Sex and Gender Lens

Although the full and lasting impact of the coronavirus disease 2019 (COVID-19) outbreak is yet to be determined, there is evidence that sex and gender play a significant role in determining patient outcomes across the globe. This roundtable discussion is a transcript of a seminar held by several representatives from Johns Hopkins University on the impact of the global pandemic on women’s health and well-being. They reported on the various pathophysiological aspects of the disease, as well as the social and financial consequences of this global pandemic. Looking at COVID-19 through a sex and gender lens highlights the vulnerabilities and inequalities of people of different genders, races, and socioeconomic conditions, and how care providers can better respond to those differences.

Roundtable Discussion III: The Development and Uses of Artificial Intelligence in Medicine: A Work in Progress

Humans have devised machines to replace computation by individuals since ancient times: The abacus predated the written Hindu–Arabic numeral system by centuries. We owe a quantum leap in the development of machines to help problem solve to the British mathematician Charles Babbage who built what he called the Difference Engine in the mid-19th century. But the Turing formula created in 1936 is the foundation for the modern computer; it produced printed symbols on paper tape that listed a series of logical instructions. Three decades later, Olivetti manufactured the first mass-marketed desktop computer (1964), and by 1981, IBM had developed the first personal computer. Computing machines have become more and more powerful, culminating recently in Google’s claim that it had achieved quantum supremacy in developing a system that can complete a task in 200 seconds that it would take the most powerful type of classical computer available 10 000 years to achieve. In short, we are in a period of human history in which we are creating more and more powerful and complex machines potentially capable of duplicating human intelligence and indeed surpassing/expanding its power. We are solidly in the age of artificial intelligence (AI). Increasing interest in the development of AI and its application to human health at all levels makes a roundtable discussion by experts a valuable project for publication in our journal, Gender and the Genome, the official journal of the Foundation for Gender-Specific Medicine and the International Society of Gender Medicine.

Female Sex and Gender in Lung/Sleep Health and Disease. Increased Understanding of Basic Biological, Pathophysiological, and Behavioral Mechanisms Leading to Better Health for Female Patients with Lung Disease

Female sex/gender is an undercharacterized variable in studies related to lung development and disease. Notwithstanding, many aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. These may manifest as differential gene expression or peculiar organ development. Some conditions are more prevalent in women, such as asthma and insomnia, or, in the case of lymphangioleiomyomatosis, are seen almost exclusively in women. In other diseases, presentation differs, such as the higher frequency of exacerbations experienced by women with chronic obstructive pulmonary disease or greater cardiac morbidity among women with sleep-disordered breathing. Recent advances in -omics and behavioral science provide an opportunity to specifically address sex-based differences and explore research needs and opportunities that will elucidate biochemical pathways, thus enabling more targeted/personalized therapies. To explore the status of and opportunities for research in this area, the NHLBI, in partnership with the NIH Office of Research on Women's Health and the Office of Rare Diseases Research, convened a workshop of investigators in Bethesda, Maryland on September 18 and 19, 2017. At the workshop, the participants reviewed the current understanding of the biological, behavioral, and clinical implications of female sex and gender on lung and sleep health and disease, and formulated recommendations that address research gaps, with a view to achieving better health outcomes through more precise management of female patients with nonneoplastic lung disease. This report summarizes those discussions.

Untangling the Gordian Knot of Human Sexuality

There is increasing interest in and tolerance of the lay public for variations in human sexuality. In contrast, the molecular biology that underlies gender identity, the development of gonadal and genital anatomy, and the factors that define sexual behavior is proving unexpectedly complex and is still incompletely understood. It is now evident that humans cannot be characterized as member of 1 of 2 clearly defined units: male or female. In fact, individuals exist on a continuum: those who do not conform unequivocally to the dyadic view of human sex in terms of anatomy, gender identity, and/or sexual behavior should be characterized as having variations in rather than disorders of sexual development. Such individuals can no longer be regarded as anomalies to be rejected, condemned, and, if possible, “corrected” either psychologically or anatomically.

Integrating topics of sex and gender into medical curricula-lessons from the international community

In the era of individualized medicine, training future scientists and health-care providers in the principles of sex- and gender-based differences in health and disease is critical in order to optimize patient care. International successes to incorporate these concepts into medical curricula can provide a template for others to follow. Methodologies and resources are provided that can be adopted and adapted to specific needs of other institutions and learning situations.

Rethinking Gender-Specific Medicine

The past 15 years have produced enormous advances in our understanding of the unique features of biological sex. Nevertheless, important and different tasks remain. One of these is to address the difficulties inherent in including premenopausal women in prospective, randomized trials characterizing the impact of new drugs and interventions. A second compelling mandate is to expand our knowledge of men using the same concentration on the unique features of male biology as we have used in studying women. The inclusion of men in our scientific investigations is a natural evolution of our development of the discipline of gender-specific medicine and will yield the same rich harvest as has our work in women's health.

Gender-specific care of the patient with diabetes: review and recommendations

BACKGROUND

Men and women differ in their experience of diabetes mellitus (DM). For optimal prevention and treatment of the disease, these differences must be acknowledged. Unfortunately, most studies of diabetes have focused almost exclusively on men.

OBJECTIVE

The purpose of this review was to survey the literature about the sex-specific features of DM and to make recommendations for the gender-specific care of patients.

METHODS

An initial literature search was performed with Google Scholar and MEDLINE (1995-2005) using the search terms sex/gender, women, diabetes mellitus, and coronary artery disease, and specific topic headings such as polycystic ovary syndrome. The bibliographies of articles were used extensively to augment the search, and more specific search terms were included. The strength of each recommendation was assessed.

RESULTS

: Even when women were included in clinical trials, investigators typically made no attempt to assess the impact of sex differences on the reported results. Existing studies, however, reveal several differences between men and women with diabetes. The prevalence of DM is growing fastest for older minority women. Women with diabetes, regardless of menopausal status, have a 4- to 6-fold increase in the risk of developing coronary artery disease (CAD), whereas men with diabetes have a 2- to 3-fold increase in risk. Women with diabetes have a poorer prognosis after myocardial infarction and a higher risk of death overall from cardiovascular disease than do men with diabetes. Women with type 2 DM experience more symptoms of hyperglycemia than do their male counterparts. Obesity, an important contributor to type 2 DM, is more prevalent in women. Women with diabetes have an increased risk of hypertension compared with men with diabetes. Women have a more severe type of dyslipidemia than do men (low levels of high-density lipoprotein cholesterol, small particle size of low-density lipoprotein cholesterol, and high levels of triglycerides), and these risk factors for CAD have a stronger influence in women. Oxidative stress may confer a greater increase in the risk of CAD for women with diabetes than for men with diabetes. Many other sex differences in DM are due to women's reproductive physiology. Polycystic ovary syndrome is an important correlate of insulin resistance and the metabolic syndrome. Gestational diabetes mellitus (GDM) increases the risk of cardiovascular disease and type 2 DM. Women are less likely than men to receive aggressive treatment for CAD and to achieve treatment goals. Critical recommendations for women include exercise, testing for CAD, daily aspirin to counteract the prothrombotic state, depression screening, careful treatment to avoid weight gain, long-term follow-up of children of women with GDM, control of risk factors for CAD, and aggressive treatment with coronary angioplasty for CAD. Disease management programs for patients with diabetes have been shown to save money and improve outcomes, and should continue to incorporate information about sex-specific differences in DM as it becomes available.

CONCLUSION

Gender-specific care of the patient with diabetes should be informed by evidence-based recommendations.

Beyond women's health the new discipline of gender-specific medicine

At its best, women's health is not something to be developed as an isolated discipline. If instead biologic sex is used as an important variable in research protocols, studying and comparing men and women directly, the data prompt the formulation of questions that never otherwise would be asked. In answering those questions, one can fashion more accurate and complete models not only of human physiology, but also of the pathophysiology of disease.