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

Translator: Ángela González Reviewer: Xusto Rodriguez

We all go to doctors.

Todos nós imos ao médico.

And we do so with trust and blind faith

E imos con confianza e fe cega

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

en que as probas que nos fan e as medicacións que nos receitan

are based upon evidence --

están baseadas nas probas

evidence that's designed to help us.

--probas deseñadas para axudarnos.

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

Aínda que a realidade é, que non sempre foi así para todo o mundo.

What if I told you

Que pasaría se lles dixera

that the medical science discovered over the past century

que os descubrimentos da ciencia médica ao longo do século pasado

has been based on only half the population?

estaban baseados só na metade da poboación?

I'm an emergency medicine doctor.

Eu son médica de urxencias.

I was trained to be prepared in a medical emergency.

Formeime para estar preparada nunha emerxencia médica.

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

Trátase de salvar vidas. É xenial, non si?

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

Vale, hai moito nariz con mocos e dedas esmagadas,

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

pero non importa quen entre pola porta de Urxencias,

we order the same tests,

nós pedimos as mesmas probas,

we prescribe the same medication,

receitamos a mesma medicación,

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

sen sequera pensar no sexo ou no xénero dos nosos doentes.

Why would we?

Por que?

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

Nunca nos ensinaron que había diferenzas entre homes e mulleres.

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

Un estudo recente do Consello de Contas revelou que o 80% dos medicamentos

withdrawn from the market

retiráronse do mercado

are due to side effects on women.

debido aos efectos secundarios sobre as mulleres.

So let's think about that for a minute.

Así que pensemos niso un minuto.

Why are we discovering side effects on women

Por que descubrimos os efectos secundarios sobre as mulleres

only after a drug has been released to the market?

só despois de que un medicamento se retire do mercado?

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

Saben que un fármaco tarda anos en pasar de ser unha idea

to being tested on cells in a laboratory,

a ser probado en células nun laboratorio,

to animal studies,

a estudos en animais,

to then clinical trials on humans,

despois a ensaios clínicos en humanos,

finally to go through a regulatory approval process,

e ao final pasar un procedemento para a súa aprobación,

to be available for your doctor to prescribe to you?

ata estar dispoñible para que o seu médico llo receite?

Not to mention the millions and billions of dollars of funding

Por non mencionar, os miles de millóns de dólares de financiamento

it takes to go through that process.

que supón todo ese proceso.

So why are we discovering unacceptable side effects

Entón, por que descubrimos efectos secundarios inaceptables

on half the population after that has gone through?

na metade da poboación despois de pasar por todo isto?

What's happening?

Que está pasando?

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

Pois resulta que esas células empregadas nese laboratorio,

they're male cells,

son células masculinas,

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

e os animais empregados nos estudos con animais eran machos,

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

e os ensaios clínicos fixéronse case exclusivamente en homes.

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

Como se converteu o modelo masculino no referente na investigación médica?

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

Vexamos un exemplo que se popularizou nos medios de comunicación,

and it has to do with the sleep aid Ambien.

e ten que ver co somnífero Ambien.

Ambien was released on the market over 20 years ago,

Ambien saíu ao mercado hai vinte anos,

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

e dende entón, prescribíronse centos de millóns de receitas,

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

sobre todo a mulleres, porque teñen máis trastornos de sono que os homes.

But just this past year,

Pero só este último ano,

the Food and Drug Administration recommended cutting the dose in half

a Food and Drug Administration recomendou reducir a dose á metade

for women only,

só para as mulleres,

because they just realized that women metabolize the drug

porque se decataron de que a muller metaboliza o medicamento

at a slower rate than men,

a un ritmo máis lento que o home,

causing them to wake up in the morning

por isto espertan pola mañá

with more of the active drug in their system.

cos efectos do medicamento activos no seu organismo.

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

E entón, están somnolentas e collen o coche,

and they're at risk for motor vehicle accidents.

e corren o risco de ter accidentes de tráfico.

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

E eu non podo axudar, pero penso como médica de urxencias,

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

cantos dos doentes aos que atendín ao longo dos anos

were involved in a motor vehicle accident

tiveron un accidente de tráfico

that possibly could have been prevented

que posiblemente se puido evitar

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

se se fixera esta análise, e se actuase en consecuencia hai 20 anos

when this drug was first released.

cando este medicamento se aprobou.

How many other things need to be analyzed by gender?

Cantas outras cousas teñen que ser analizadas por xénero?

What else are we missing?

Que máis estamos perdendo?

World War II changed a lot of things,

A II Guerra Mundial cambiou un montón de cousas,

and one of them was this need to protect people

e unha delas foi esta necesidade de protexer a xente

from becoming victims of medical research without informed consent.

de ser vítimas da investigación médica sen consentimento informado.

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

Así que se estableceron guías e regras, que eran moi necesarias,

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

en parte porque estaba este desexo de protexer as mulleres en idade fértil

from entering into any medical research studies.

de entrar en calquera estudo de investigación médica.

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

Había medo: e se lle pasaba algo ao feto durante o estudo?

Who would be responsible?

Quen sería o responsable?

And so the scientists at this time actually thought

E por iso os científicos ao mesmo tempo pensaron

this was a blessing in disguise,

que fora unha bendición disfrazada,

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

porque --sexamos realistas-- os corpos dos homes son bastante homoxéneos.

They don't have the constantly fluctuating levels of hormones

Non sofren o cambio constante nos niveis de hormonas

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

que podería alterar a precisión dos datos que se recollerían só en homes.

It was easier. It was cheaper.

Era máis doado. Era máis barato.

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

Sen mencionar, que daquela había unha asunción xeral

that men and women were alike in every way,

de que homes e mulleres eran parecidos en tódolos sentidos,

apart from their reproductive organs and sex hormones.

á parte dos seus órganos reprodutivos e as hormonas sexuais.

So it was decided:

Así que estaba decidido:

medical research was performed on men,

a investigación médica realizábase en homes,

and the results were later applied to women.

e os resultados aplicábanse ás mulleres máis tarde.

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

Que supuxo isto para a idea de saúde das mulleres?

Women's health became synonymous with reproduction:

A saúde das mulleres converteuse en sinónimo de reprodución:

breasts, ovaries, uterus, pregnancy.

peitos, ovarios, útero, embarazo.

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

É o que agora coñecemos como “medicina bikini”.

And this stayed this way until about the 1980s,

E isto mantívose así ata preto da década de 1980,

when this concept was challenged by the medical community

cando este concepto foi cuestionado pola comunidade médica

and by the public health policymakers when they realized that

e polos responsables das políticas públicas de saúde, ao decatárense de que

by excluding women from all medical research studies

excluíndo as mulleres de tódolos estudos de investigación médica

we actually did them a disservice,

en realidade fixémoslles un fraco favor,

in that apart from reproductive issues,

xa que ademais dos temas reprodutivos,

virtually nothing was known about the unique needs

case non se sabía nada sobre as necesidades propias

of the female patient.

da doente muller.

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

Dende aquela, unha chea de probas saíron á luz

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

amosándonos como de diferentes son homes e mulleres, en tódolos sentidos.

You know, we have this saying in medicine:

Sabedes que en medicina temos este dito:

children are not just little adults.

Os menores non son coma adultos pequenos.

And we say that to remind ourselves

E dicímolo para lembrarnos

that children actually have a different physiology than normal adults.

de que os menores teñen unha fisioloxía distinta dos adultos normais.

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

E por iso xurdiu a especialidade de pediatría.

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

E agora facemos investigación en menores para mellorar as súas vidas.

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

E eu sei que se pode dicir o mesmo sobre as mulleres.

Women are not just men with boobs and tubes.

As mulleres non son homes con peitos e trompas de Falopio.

But they have their own anatomy and physiology

Teñen a súa propia anatomía e fisioloxía

that deserves to be studied with the same intensity.

que merece ser estudada coa mesma intensidade.

Let's take the cardiovascular system, for example.

Collamos como exemplo o sistema cardiovascular.

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

Esta área médica esforzouse en comprender

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

porque parece que homes e mulleres teñen ataques cardíacos diferentes.

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

As cardiopatías son a primeira causa de morte en homes e mulleres,

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

pero morren máis mulleres ca homes no primeiro ano de ter o ataque.

Men will complain of crushing chest pain --

Os homes vanse queixar da esmagadora dor de peito--

an elephant is sitting on their chest.

teñen un elefante sentado no peito.

And we call this typical.

E chamamos a isto, típico.

Women have chest pain, too.

As mulleres tamén teñen dor no peito.

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

Pero máis mulleres que homes vanse queixar só de "non sentirse ben".

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

"parece como se me faltara vida",

"just so tired lately."

"só un pouco de cansazo ultimamente".

And for some reason we call this atypical,

E por algunha razón chamámoslle a isto, atípico.

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

aínda que como xa dixen, as mulleres son a metade da poboación.

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

Que probas temos para axudar a explicar estas diferenzas?

If we look at the anatomy,

Se miramos a anatomía,

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

as arterias arredor do corazón son máis pequenas en mulleres que en homes

and the way that those blood vessels develop disease is different

e o xeito en que esas arterias desenvolven a enfermidade é diferente

in women compared to men.

nelas ca neles.

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

E as probas que usamos para determinar se alguén poder ter un ataque ao corazón,

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

ben, inicialmente foron deseñadas, probadas e perfeccionadas en homes,

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

e resulta que non son tan boas para determinalo nas mulleres.

And then if we think about the medications --

Se pensamos nos medicamentos

common medications that we use, like aspirin.

--medicamentos comúns que utilizamos, como a aspirina.

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

Dámoslle aspirina aos homes sans para axudalos a previr o infarto,

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

pero sabedes que darlle aspirina a unha muller sa

it's actually harmful?

é en realidade prexudicial?

What this is doing is merely telling us

Todo isto está a nos dicir

that we are scratching the surface.

que estamos rabuñando a superficie.

Emergency medicine is a fast-paced business.

A medicina de emerxencias avanza moi rápido.

In how many life-saving areas of medicine,

En cantas áreas vitais para a supervivencia,

like cancer and stroke,

coma o cancro e o ictus,

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

haberá diferenzas importantes entre homes e mulleres que poderiamos utilizar?

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

Ou incluso, por que hai xente que ten máis mocos no nariz

more than others,

ca outra,

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

ou porque os medicamentos para aliviar a dor das dedas esmagadas

work in some and not in others?

alivian a uns e a outros non?

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

O Instituto de Medicina dixo que cada célula ten un sexo.

What does this mean?

E iso, que significa?

Sex is DNA.

O sexo é o ADN.

Gender is how someone presents themselves in society.

O xénero é como alguén se presenta a si mesmo en sociedade.

And these two may not always match up,

E estes dous poden non sempre conxeniar,

as we can see with our transgendered population.

como podemos comprobar coa poboación transxénero.

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

Pero é importante decatarse disto dende o momento da concepción,

every cell in our bodies --

cada célula nos nosos corpos

skin, hair, heart and lungs --

--pel, pelo, corazón e pulmóns--

contains our own unique DNA,

contén o noso propio e único ADN,

and that DNA contains the chromosomes that determine

e ese ADN contén os cromosomas que determinan

whether we become male or female, man or woman.

se seremos, feminino ou masculino, home ou muller.

It used to be thought

Pensábase que

that those sex-determining chromosomes pictured here --

eses cromosomas que determinan o sexo, representados aquí

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

--XY se es home, XX se es muller--

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

só determinaban se ti nacerías con ovarios ou testículos,

and it was the sex hormones that those organs produced

e eran as hormonas do sexo que eses órganos producían

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

as responsables das diferenzas que vemos no sexo oposto.

But we now know that that theory was wrong --

Pero agora sabemos que esa teoría estaba equivocada

or it's at least a little incomplete.

--ou polo menos, está un pouco incompleta.

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

Menos mal que científicos como o Dr. Page do Whitehead Institute,

who works on the Y chromosome,

que traballa no cromosoma Y,

and Doctor Yang from UCLA,

e o doutor Yang da UCLA,

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

atoparon evidencias de que eses cromosomas determinantes do sexo

that are in every cell in our bodies

presentes en cada célula do noso corpo

continue to remain active for our entire lives

permanecen activos durante toda a nosa vida

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

e poderían ser os responsables das diferenzas que vemos

in the dosing of drugs,

na dosificación dos medicamentos,

or why there are differences between men and women

ou en por que hai diferenzas entre homes e mulleres

in the susceptibility and severity of diseases.

na susceptibilidade e gravidade das enfermidades.

This new knowledge is the game-changer,

Este novo coñecemento é un punto de inflexión,

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

e depende dos científicos que continúen ata atopar esa proba,

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

pero depende dos profesionais clínicos empezar a aplicar esa información

at the bedside, today.

na consulta, hoxe.

Right now.

Dende agora mesmo.

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

E para axudar a conseguilo, cofundei unha organización nacional

called Sex and Gender Women's Health Collaborative,

chamada Sexo e Xénero Saúde Colaborativa de Mulleres,

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

e recollemos toda a información dispoñible para o ensino

and for patient care.

e para a atención ao doente.

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

E estamos traballando para que tamén se apunten os formadores médicos.

That's a big job.

O que é un gran reto.

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

Isto cambia o xeito en que se veu facendo a formación médica desde as orixes.

But I believe in them.

Pero, eu creo neles.

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

Sei que van ver o valor de incorporar as lentes de xénero

into the current curriculum.

no actual plan de estudos.

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

Trátase de formar aos futuros profesionais da asistencia médica de forma correcta.

And regionally,

E a nivel rexional,

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

compartín a creación dunha sección no Departamento de Medicina de Urxencias

here at Brown University,

aquí na Universidade Brown.

called Sex and Gender in Emergency Medicine,

chamada Sexo e Xénero en Medicina de Urxencias,

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

e investigamos para determinar as diferenzas entre homes e mulleres

in emergent conditions,

en situacións de emerxencia,

like heart disease and stroke and sepsis and substance abuse,

como infarto e ictus e septicemia e abuso de substancias,

but we also believe that education is paramount.

pero cremos tamén que a educación é primordial.

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

Creamos un modelo de educación integral.

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

Temos programas para médicos/as, para enfermeiras/os, para estudantes

and for the patients.

e para os pacientes.

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

Xa que isto non se lle pode deixar só aos responsables sanitarios.

We all have a role in making a difference.

Todos nós temos un papel para cambiar a situación.

But I must warn you: this is not easy.

Pero debo avisalos: isto non é doado.

In fact, it's hard.

En realidade, é complicado.

It's essentially changing the way we think about medicine

En esencia, está cambiando o xeito no que pensamos a medicina

and health and research.

a saúde, e a investigación.

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

Está mudando a nosa relación co sistema sanitario.

But there's no going back.

Pero non hai volta atrás.

We now know just enough

Agora coñecemos o suficiente

to know that we weren't doing it right.

para saber que non o estabamos facendo ben.

Martin Luther King, Jr. has said,

Martin Luther King Jr. dixo que

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

"O cambio non chega sobre as rodas do inevitable,

but comes through continuous struggle."

pero si vén a través da loita continua"

And the first step towards change is awareness.

E o primeiro paso cara ao cambio é a conciencia.

This is not just about improving medical care for women.

Isto non trata só de mellorar os coidados médicos das mulleres.

This is about personalized, individualized health care for everyone.

Trátase de atención médica personalizada, individualizada para todo o mundo.

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

Esta conciencia ten o poder para cambiar a atención médica de homes e mulleres.

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

E dende agora en diante, eu quero que lle pregunten aos seus médicos

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

se os tratamentos que lles dan son indicados para o seu sexo e xénero.

They may not know the answer --

Pode que non saiban a resposta

yet.

--aínda.

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

Pero a conversa empezou, e todos xuntos podemos aprender.

Remember, for me and my colleagues in this field,

Lembren, para min e os meus colegas neste campo,

your sex and gender matter.

o seu sexo e xénero importan.

Thank you.

Grazas

(Applause)

(Aplausos)