Why Medicine Often Has Dangerous Side Effects for Women | Alyson McGregor | TED Talks

Translator: Marili Niglas Reviewer: Aari Lemmik

We all go to doctors.

Me kõik käime arsti juures.

And we do so with trust and blind faith

Usaldame oma arsti selles,

that the test they are ordering and the medications they're prescribing

et analüüsid, mis määratakse ja ravimid, mis välja kirjutatakse

are based upon evidence --

on vajalikud ja tõendatud toimega.

evidence that's designed to help us.

Et on tõendatud, et nendest on abi.

However, the reality is that that hasn't always been the case for everyone.

Tegelikkuses aga ei pruugi see alati nii olla.

Mis oleks, kui ütleksin,

What if I told you

that the medical science discovered over the past century

et meditsiinis viimase sajandi jooksul tehtud avastused

has been based on only half the population?

põhinevad vaid poolte inimeste andmetel?

Ma olen kiirabiarst.

I'm an emergency medicine doctor.

I was trained to be prepared in a medical emergency.

Olen õppinud tegelema erakorraliste haigetega.

It's about saving lives. How cool is that?

See on ju elupäästmine, väga lahe töö!

OK, there's a lot of runny noses and stubbed toes,

Ette tuleb ka palju nohuseid ninasid ja äralöödud varbaid,

but no matter who walks through the door to the ER,

aga hoolimata sellest, kes EMOsse satub,

we order the same tests,

teeme talle ikka samad analüüsid,

we prescribe the same medication,

määrame samad ravimid,

without ever thinking about the sex or gender of our patients.

mõtlemata pikemalt sellele, mis soost meie patsient on.

Why would we?

Ja miks peakski?

Meile pole õpetatud, et naiste ja meeste vahel oleks mingeid erinevusi.

We were never taught that there were any differences between men and women.

A recent Government Accountability study revealed that 80 percent of the drugs

Värske riiklik audit näitas, et et 80% ravimite puhul,

withdrawn from the market

mis on kasutusest tagasi kutsutud,

are due to side effects on women.

on põhjuseks olnud kõrvaltoimete ilmnemine just naistel.

Mõtleme veidi selle üle.

So let's think about that for a minute.

Why are we discovering side effects on women

Miks avastatakse, et ravim tekitab naistel kõrvaltoimeid alles siis

only after a drug has been released to the market?

kui see on juba müügile lastud?

Do you know that it takes years for a drug to go from an idea

Kas teadsite, et võtab aastaid

enne kui ravim jõuab ideest

to being tested on cells in a laboratory,

katsetusteni laborites,

to animal studies,

seejärel loomakatseteni,

to then clinical trials on humans,

siis kliiniliste uuringuteni inimeste peal,

finally to go through a regulatory approval process,

ja lõpuks tuleb saada heakskiit ravimiameti poolt,

to be available for your doctor to prescribe to you?

enne kui arstid saavad hakata rohtu välja kirjutama.

Rääkimata nendest miljonitest ja miljarditest dollaritest,

Not to mention the millions and billions of dollars of funding

it takes to go through that process.

mis see kõik maksma läheb.

So why are we discovering unacceptable side effects

Aga miks avastatakse ravimi soovimatud kõrvalähud

on half the population after that has gone through?

poolte inimeste jaoks alles siis,

kui kogu see kadalipp on läbitud?

Mis toimub?

What's happening?

Well, it turns out that those cells used in that laboratory,

Tuleb välja, et need rakud, millega ravimid testitakse,

they're male cells,

on meeste rakud,

and the animals used in the animal studies were male animals,

ja loomad, keda kasutatakse loomakatsetustel, on isased.

and the clinical trials have been performed almost exclusively on men.

Ja kliinilised uuringud on reeglina läbiviidud vaid meeste peal.

Kuidas on võimalik, et meditsiinilised uuringud põhinevad vaid meestel?

How is it that the male model became our framework for medical research?

Let's look at an example that has been popularized in the media,

Vaatame meedias suurt kajastust leidnud juhtumit

and it has to do with the sleep aid Ambien.

mis oli seotud unerohuga Ambien.

Ambien was released on the market over 20 years ago,

Ambien tuli müügile enam kui 20 aasta eest.

and since then, hundreds of millions of prescriptions have been written,

Selle aja jooksul on seda kirjutatud välja miljoneid kordi,

primarily to women, because women suffer more sleep disorders than men.

peamiselt just naistele, sest naistel on sagedamini unehäireid kui meestel.

Aga viimasel aastal on USA toidu- ja ravimiamet

But just this past year,

the Food and Drug Administration recommended cutting the dose in half

soovitanud vähendada ravimi annust poole võrra

for women only,

ainult naiste puhul.

because they just realized that women metabolize the drug

Alles nüüd saadi aru,

et naised omastavad seda ravimit

at a slower rate than men,

aeglasemalt kui mehed,

causing them to wake up in the morning

mistõttu hommikul üles ärgates

with more of the active drug in their system.

on neil organismis rohkem aktiivset toimainet.

And then they're drowsy and they're getting behind the wheel of the car,

Siis istuvad nad uimastena rooli

and they're at risk for motor vehicle accidents.

ja on risk sattuda avariisse.

And I can't help but think, as an emergency physician,

Kiirabiarstina hakkan paratamatult mõtlema,

how many of my patients that I've cared for over the years

kui paljud mu patsientidest,

keda olen aastate jooksul ravinud,

were involved in a motor vehicle accident

sattusid autoavariisse,

that possibly could have been prevented

mis oleks võinud olemata olla,

kui oleks tehtud vastavad uuringud 20 aastat tagasi,

if this type of analysis was performed and acted upon 20 years ago

when this drug was first released.

mil see ravim esimest korda müügile tuli.

Mida kõike veel tuleks analüüsida soo põhjal?

How many other things need to be analyzed by gender?

What else are we missing?

Mis on veel kahe silma vahele jäänud?

World War II changed a lot of things,

II maailmasõda tõi kaasa suured muutused,

and one of them was this need to protect people

sealhulgas vajaduse kaitsta inimesi selle eest,

et neid ei kasutataks kliinilistes uuringutes

from becoming victims of medical research without informed consent.

ilma nende teadliku nõusolekuta.

So some much-needed guidelines or rules were set into place,

Kehtestati vajalikud reeglid,

osalt ka seetõttu, et kaitsa viljakas eas naisi selle eest,

and part of that was this desire to protect women of childbearing age

from entering into any medical research studies.

et nendega ei tehtaks mingeid kliinilisi katsetusi.

Kardeti, et uuringute ajal võib lootega midagi juhtuda.

There was fear: what if something happened to the fetus during the study?

Kes siis vastutab?

Who would be responsible?

And so the scientists at this time actually thought

Teadlaste jaoks oli see tollal ka omamoodi kergendus,

this was a blessing in disguise,

sest olgem ausad,

because let's face it -- men's bodies are pretty homogeneous.

meeste kehad on enam-vähem ühesugused.

They don't have the constantly fluctuating levels of hormones

Nende hormoonitase ei kõigu pidevalt,

mis segaks ühetaoliste selgete tulemusteni jõudmist,

that could disrupt clean data they could get if they had only men.

mida saab siis, kui testida ainult mehi.

It was easier. It was cheaper.

Nii oli lihtsam ja ka odavam.

Not to mention, at this time, there was a general assumption

Rääkimata, et tol ajal üldiselt eeldati,

that men and women were alike in every way,

et mehe ja naise organism on igas mõttes täpselt samasugused,

apart from their reproductive organs and sex hormones.

välja arvatud suguelundid ja hormoonid.

So it was decided:

Niisiis otsustati,

et kliinilisi uuringuid viiakse läbi meeste peal,

medical research was performed on men,

and the results were later applied to women.

ja tulemusi kohaldatakse seejärel ka naistele.

Mida see tõi kaasa naiste tervise vaatenurgast?

What did this do to the notion of women's health?

Women's health became synonymous with reproduction:

Naiste tervist hakati vaatama vaid reproduktsiooni aspektist:

rinnad, munasarjad, emakas, rasedus.

breasts, ovaries, uterus, pregnancy.

It's this term we now refer to as "bikini medicine."

Seda nimetatakse bikiinimeditsiiniks.

And this stayed this way until about the 1980s,

Selline mõtteviis valitses kuni 80ndateni

when this concept was challenged by the medical community

mil nii meditsiiniringkondades

kui tervishoiupoliitika kujundajate seas

and by the public health policymakers when they realized that

hakati aru saama, et naisi kliinilistest uuringutest kõrvale jättes

by excluding women from all medical research studies

tehakse neile tegelikult karuteene.

we actually did them a disservice,

in that apart from reproductive issues,

Naise organismi eripäradest ei teatud praktiliselt midagi

virtually nothing was known about the unique needs

kui see ei puudutanud otseselt reproduktiivorganeid.

of the female patient.

Since that time, an overwhelming amount of evidence has come to light

Sellest ajast alates on ilmnenud

tohutul hulgal tõendeid selle kohta,

that shows us just how different men and women are in every way.

et mehed ja naised on kõikvõimalikes aspektides väga erinevad.

You know, we have this saying in medicine:

Meedikute seas on selline ütlus,

et lapsed ei ole lihtsalt väikesed täiskasvanud.

children are not just little adults.

And we say that to remind ourselves

Seda öeldakse, et tuletada meelde,

that children actually have a different physiology than normal adults.

et lapsel on täiskasvanuga võrreldes hoopis teistsugune füsioloogia.

And it's because of this that the medical specialty of pediatrics came to light.

Tänu sellele sai alguse pediaatria valdkond.

And we now conduct research on children in order to improve their lives.

Kaasajal teeme lastega uuringuid selleks, et neid paremini aidata.

Olen veendunud, et sama võib öelda naiste kohta.

And I know the same thing can be said about women.

Women are not just men with boobs and tubes.

Naised ei ole nagu mehed, ainult et rindade ja aukudega.

But they have their own anatomy and physiology

Naistel on oma eripärane anatoomia ja füsioloogia,

mis väärib sama põhjalikku uurimist.

that deserves to be studied with the same intensity.

Let's take the cardiovascular system, for example.

Võtame näiteks kardiovaskulaarse süsteemi.

This area in medicine has done the most to try to figure out

Selles meditsiini valdkonnas on tehtud kõige enam selleks, et mõista,

why it seems men and women have completely different heart attacks.

miks naiste ja meeste infarktid paistavad olevat nii erinevad.

Heart disease is the number one killer for both men and women,

Südameinfark on kõige sagedasem surma põhjustaja nii meestel kui naistel,

kuid esimesel aastal peale infrakti sureb naisi rohkem kui mehi.

but more women die within the first year of having a heart attack than men.

Mehed kurdavad rõhuva valu üle rindkeres,

Men will complain of crushing chest pain --

justkui elevant istuks neil rinnal.

an elephant is sitting on their chest.

And we call this typical.

Sellist valu peetakse tüüpiliseks.

Women have chest pain, too.

Naistel on ka valu rindkeres.

But more women than men will complain of "just not feeling right,"

Aga naised pigem kurdavad, et midagi juskui oleks valesti,

"can't seem to get enough air in,"

et nad ei saa piisavalt õhku hingata,

"just so tired lately."

et nad on viimasel ajal nii väsinud.

Millegipärast peetakse seda ebatüüpiliseks,

And for some reason we call this atypical,

even though, as I mentioned, women do make up half the population.

kuigi, nagu ütlesin, on pooled rahvastikust ju naised.

And so what is some of the evidence to help explain some of these differences?

Millised on aga uurimistulemused, mis selgitavad neid erinevusi?

If we look at the anatomy,

Kui me vaadata anatoomiat,

the blood vessels that surround the heart are smaller in women compared to men,

siis on südant ümbritsevad veresooned naistel väiksemad kui meestel,

and the way that those blood vessels develop disease is different

ja haigestumine mõjutab naiste ja meeste veresooni erinevalt.

in women compared to men.

And the test that we use to determine if someone is at risk for a heart attack,

Samas on test, millega hinnatakse infarkti tekkimise riski

algselt väljatöötatud, testitud ja täiendatud meeste peal

well, they were initially designed and tested and perfected in men,

and so aren't as good at determining that in women.

ja seega ei toimi naistel sama täpselt.

And then if we think about the medications --

Kui nüüd vaadata ravimeid -

common medications that we use, like aspirin.

tüüpilised ravimeid, mida kasutatakse, näiteks aspiriini,

We give aspirin to healthy men to help prevent them from having a heart attack,

siis aspiriini antakse tervetele meestele, et ennetada infarkti.

but do you know that if you give aspirin to a healthy woman,

Aga kas teadsite, et tervele naisele

võib aspiriin hoopis kahjulik olla?

it's actually harmful?

What this is doing is merely telling us

Siit näeme vaid ainult

that we are scratching the surface.

jäämäe veepealset osa.

Erakorralise meditsiini puhul on alati kiire.

Emergency medicine is a fast-paced business.

In how many life-saving areas of medicine,

Kui paljudes meditsiinivaldkondades, kus on küsimus elus ja surmas,

like cancer and stroke,

näiteks vähk ja insult,

are there important differences between men and women that we could be utilizing?

on meeste ja naiste vahel erinevusi, mida saaks patsiendi kasuks pöörata?

Or even, why is it that some people get those runny noses

Või miks mõnedel tuleb nohu kergemini kui teistel,

more than others,

või miks valuvaigistid, mida anname äralöödud varba puhul,

or why the pain medication that we give to those stubbed toes

work in some and not in others?

mõnele mõjuvad ja teisele mitte?

The Institute of Medicine has said every cell has a sex.

Meditsiini Instituut on öelnud, et igal rakul on sugu.

What does this mean?

Mida see tähendab?

Sex is DNA.

Bioloogiline sugu on DNA.

Gender is how someone presents themselves in society.

Sotsiaalne sugu tähistab rolli ühiskonnas.

And these two may not always match up,

Ja need ei pruugi alati kokkulangeda,

as we can see with our transgendered population.

nagu näiteks transseksuaalide puhul.

But it's important to realize that from the moment of conception,

Aga on tähtis mõista, et alates eostamise hetkest,

every cell in our bodies --

sisaldab iga meie keharakk -

skin, hair, heart and lungs --

nahk, juuksed, süda, kopsud -

meie unikaalset DNAd,

contains our own unique DNA,

and that DNA contains the chromosomes that determine

ja see DNA sisaldab kromosoome,

mis määravad ära selle, kas meist saab isane või emane, mees või naine.

whether we become male or female, man or woman.

It used to be thought

Vanasti arvati,

et need sugu määravad kromosoomid siin pildil -

that those sex-determining chromosomes pictured here --

XY if you're male, XX if you're female --

XY meestel ja XX naistel -

merely determined whether you would be born with ovaries or testes,

määravad vaid selle, kas inimene sünnib munasarjade või munanditega,

and it was the sex hormones that those organs produced

ja nendest organiste poolt toodetud suguhormoonid

that were responsible for the differences we see in the opposite sex.

tingivad soolised erinevused.

But we now know that that theory was wrong --

Nüüd aga teame, et see teooria oli vale -

or it's at least a little incomplete.

või vähemalt puudulik.

Õnneks on teadlased nagu dr Page Whiteheadi Instituudist,

And thankfully, scientists like Dr. Page from the Whitehead Institute,

who works on the Y chromosome,

kes uurib Y kromosoomi,

and Doctor Yang from UCLA,

ja dr Yang California Ülikoolist,

leidnud tõendeid selle kohta, et sugu määravad kromosoomid,

they have found evidence that tells us that those sex-determining chromosomes

that are in every cell in our bodies

mis on igas meie keharakus,

continue to remain active for our entire lives

on aktiivsed kogu eluea vältel

and could be what's responsible for the differences we see

ja nendest võivad olla tingitud erinevused ravimitele reageerimisel

in the dosing of drugs,

or why there are differences between men and women

või naiste ja meeste erinevused

in the susceptibility and severity of diseases.

vastuvõtlikkuses erinevatele haigustele.

See uus teadmine on pöördelise tähtsusega.

This new knowledge is the game-changer,

and it's up to those scientists that continue to find that evidence,

Edasine tõendamine on teadlaste töö,

but it's up to the clinicians to start translating this data

aga arstide ülesanne on hakata neid avastusi rakendama ravivõtetesse

at the bedside, today.

patsientide ravis juba täna.

Kohe ja praegu.

Right now.

And to help do this, I'm a co-founder of a national organization

Et seda ellu viia käivitasime üleriikliku initsiatiivi,

called Sex and Gender Women's Health Collaborative,

mis kannab nime Sex and Gender Women's Health Collaborative.

and we collect all of this data so that it's available for teaching

Kogume kokku teaduslikud uurimused,

et neid saaks kasutada arstide väljaõppes ja patsientide ravis

and for patient care.

And we're working to bring together the medical educators to the table.

Korraldame arstiteaduse õppejõudude kaasamist sellesse teemasse.

That's a big job.

See on suur ettevõtmine.

See tähendab suurt muutust selles,

It's changing the way medical training has been done since its inception.

kuidas arstiteadust on seni õpetatud.

Kuid mul on neisse usku.

But I believe in them.

I know they're going to see the value of incorporating the gender lens

Ma tean, et nad oskavad näha kasu,

mida annab sooliste erinevuste arvestamine

into the current curriculum.

arstiteaduse õppekavades.

It's about training the future health care providers correctly.

Selle eesmärk on anda tulevastele tervishoiutöötatele õige väljaõpe.

And regionally,

Kohalikul tasandil olen uue õppesuuna kaasasutaja

I'm a co-creator of a division within the Department of Emergency Medicine

siinse Browni Ülikooli erakorralise meditsiini osakonnas,

here at Brown University,

õppesuuna nimi on "Soolised erinevused erakorralises meditsiinis".

called Sex and Gender in Emergency Medicine,

and we conduct the research to determine the differences between men and women

Uurime erinevusi meeste ja naiste vahel

in emergent conditions,

erakorralise meditsiini sekkumist nõudvates situatsioonides,

like heart disease and stroke and sepsis and substance abuse,

nagu näiteks infarkt, insult, sepsis ja narkootikumide kuritarvitamine.

but we also believe that education is paramount.

Oleme veendunud, et vastav haridus on võtmetähtsusega.

We've created a 360-degree model of education.

Selleks oleme pannud kokku 360-kraadise väljaõppemudeli.

We have programs for the doctors, for the nurses, for the students

Oleme koostanud programmid arstidele, õdedele,

üliõpilastele ja ka patsientidele.

and for the patients.

Because this cannot just be left up to the health care leaders.

Sest sellega ei saa tegeleda ainult tervishoiujuhid.

We all have a role in making a difference.

Meil kõigil tuleb aidata kaasa, et asjad muutuksid.

But I must warn you: this is not easy.

Aga pean hoiatama, et see pole kerge.

In fact, it's hard.

Kui aus olla, on see väga keeruline.

Sisuliselt tuleb muuta senist arusaama meditsiinist,

It's essentially changing the way we think about medicine

and health and research.

tervisest ja teadusest.

It's changing our relationship to the health care system.

See muudab meie suhet kogu tervishoiusüsteemiga.

But there's no going back.

Aga tagasiteed siin ei ole.

We now know just enough

Praeguseks võime juba kindlalt väita,

et seni ei tehtud asju päris õigesti.

to know that we weren't doing it right.

Martin Luther King, Jr. has said,

Martin Luther King on öelnud,

et muutused ei teki iseenesest,

"Change does not roll in on the wheels of inevitability,

but comes through continuous struggle."

vaid sünnivad läbi sihikindla võitluse.

And the first step towards change is awareness.

Esimeseks sammuks muutuse teel on teadvustamine.

Asi pole lihtsalt naiste paremas ravis.

This is not just about improving medical care for women.

This is about personalized, individualized health care for everyone.

Eesmärk on tagada kõigile talle sobiv individuaalne ravi.

Läbi teadlikkuse saab meditsiini muuta

This awareness has the power to transform medical care for men and women.

meeste ja naiste vajadusi arvestavaks.

And from now on, I want you to ask your doctors

Tahan, et edaspidi küsiksite oma arstidelt

whether the treatments you are receiving are specific to your sex and gender.

kas see ravi, mis teile määratakse, ikka arvestab teie sooga.

They may not know the answer --

Nad ei oska ehk vastata -

yet.

veel.

Aga teema on lauale toodud ja koos on võimalik targemaks saada.

But the conversation has begun, and together we can all learn.

Remember, for me and my colleagues in this field,

Ärge unustage, et minu ja mu ametikaaslaste jaoks,

your sex and gender matter.

on teie sugu oluline.

Thank you.

Aitäh.

(Applause)

(Aplaus)