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

Translator: Aida Zečkanović Reviewer: Nika Kotnik

We all go to doctors.

Vsi obiskujemo zdravnike.

And we do so with trust and blind faith

In slepo verjamemo

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

da preiskave, ki jih opravijo in zdravila, ki jih predpišejo

are based upon evidence --

temeljijo na znanstvenih dokazih --

evidence that's designed to help us.

dokazih, ki naj bi nam pomagali.

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

V resnici pa to ne drži za vsakogar.

What if I told you

Kaj pa, če vam povem,

that the medical science discovered over the past century

da so medicinski izsledki iz zadnjih nekaj stoletij,

has been based on only half the population?

zasnovani le na polovici populacije?

I'm an emergency medicine doctor.

Sem specialistka urgentne medicine.

I was trained to be prepared in a medical emergency.

Izurjena sem bila za ukrepanje v nujnih medicinskih primerih.

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

Rešujem življenja. Ni to super?!

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

Ja, res je veliko prehladov in udarjenih nožnih prstov,

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

ampak vsem, ki pridejo v urgentno ambulanto,

we order the same tests,

opravimo enake preiskave,

we prescribe the same medication,

predpišemo enaka zdravila,

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

brez da bi pomislili na spol svojih pacientov.

Why would we?

Zakaj le?

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

Nikoli nas niso učili, da obstajajo razlike med moškimi in ženskami.

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

Nedavna študija vladne odgovornosti je pokazala, da je 80 % zdravil

withdrawn from the market

s trga odstranjenih

are due to side effects on women.

zaradi stranskih učinkov pri ženskah.

So let's think about that for a minute.

Razmislimo o tem.

Why are we discovering side effects on women

Zakaj ugotavljamo stranske učinke pri ženskah

only after a drug has been released to the market?

šele po tem, ko je zdravilo že na trgu?

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

Veste, da so potrebna leta, da iz ideje razvijemo zdravilo,

to being tested on cells in a laboratory,

ki ga testiramo sprva na celicah v laboratoriju,

to animal studies,

nato na živalih,

to then clinical trials on humans,

potem na ljudeh,

finally to go through a regulatory approval process,

in nato sledi še proces nadzora pred odobritvijo.

to be available for your doctor to prescribe to you?

Šele nato je zdravilo na voljo zdravnikom za predpisovanje.

Not to mention the millions and billions of dollars of funding

Da sploh ne omenjam milijonov in milijard dolarjev,

it takes to go through that process.

ki so potrebni za financiranje takšnega procesa.

So why are we discovering unacceptable side effects

Zakaj torej odkrivamo nesprejemljive stranske učinke

on half the population after that has gone through?

pri polovici populacije po tem, ko smo opravili ta celoten proces?

What's happening?

Kaj se dogaja?

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

Izkaže se, da so tiste celice, ki jih uporabljamo v laboratoriju,

they're male cells,

moške celice,

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

da so živali, ki jih uporabljamo v živalskih študijah, samci

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

in da so tudi klinične študije opravljene skoraj izključno na moških pacientih.

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

Zakaj pa so moški postali modeli za naše medicinske raziskave?

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

Oglejmo si en medijsko razvpit primer.

and it has to do with the sleep aid Ambien.

Gre za sedativ z imenom Ambien.

Ambien was released on the market over 20 years ago,

Ambien je na tržišče prišel pred več kot dvajsetimi leti

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

in je bil od tedaj predpisan na stotinam milijonov pacientov,

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

predvsem pa ženskam, saj imajo ženske pogosteje motnje spanja.

But just this past year,

V zadnjem letu pa je

the Food and Drug Administration recommended cutting the dose in half

Agencija za hrano in zdravila priporočila prepolovitev doze,

for women only,

vendar le pri ženskah.

because they just realized that women metabolize the drug

Saj so ugotovili, da ženske zdravilo presnavljajo

at a slower rate than men,

počasneje kot moški.

causing them to wake up in the morning

Zato se zjutraj zbudijo

with more of the active drug in their system.

z več aktivnega zdravila v telesu,

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

so še omotične, ko se usedejo za volan avtomobila

and they're at risk for motor vehicle accidents.

in zato tudi bolj ogrožene za prometne nesreče.

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

Ne morem si pomagati, da ne bi pomislila,

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

koliko mojih pacientov, za katere sem skrbela v preteklih letih,

were involved in a motor vehicle accident

je bilo udeleženih v prometnih nesrečah,

that possibly could have been prevented

ki bi se jih dalo preprečiti,

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

če bi to analizo zdravila naredili in primerno ukrepali pred dvajsetimi leti,

when this drug was first released.

ko je zdravilo prišlo na tržišče.

How many other things need to be analyzed by gender?

Kaj vse še moramo analizirati po spolu?

What else are we missing?

Česa vsega še ne vemo?

World War II changed a lot of things,

Druga svetovna vojna je prinesla veliko sprememb

and one of them was this need to protect people

in ena izmed njih je bila potreba po zaščiti ljudi

from becoming victims of medical research without informed consent.

pred sodelovanjem v medicinskih raziskavah brez pristanka.

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

Zato so določili nekatere nujno potrebne smernice oziroma pravila.

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

Med drugim so želeli zaščititi ženske v rodni dobi

from entering into any medical research studies.

pred sodelovanjem v medicinskih študijah.

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

Bali so se, da se bo med študijo kaj pripetilo zarodku.

Who would be responsible?

Kdo bi bil odgovoren za to?

And so the scientists at this time actually thought

Takrat so znanstveniki pravzaprav menili,

this was a blessing in disguise,

da je ta uredba pravi blagoslov,

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

kajti moška telesa so precej homogena.

They don't have the constantly fluctuating levels of hormones

Pri moških ni stalno spreminjajočih-se ravni hormonov,

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

ki bi motile jasne podatke, pridobljene le od moških.

It was easier. It was cheaper.

Tako je bilo preprosteje. In ceneje.

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

Da sploh ne omenjam, da so takrat mislili,

that men and women were alike in every way,

da so si moški in ženske enaki v vseh pogledih,

apart from their reproductive organs and sex hormones.

razen v spolnih organih in hormonih.

So it was decided:

Padla je odločitev:

medical research was performed on men,

medicinske raziskave so opravljali na moških,

and the results were later applied to women.

rezultate pa kasneje uporabljali na ženskah.

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

Kaj pa je to pomenilo za koncept ženskega zdravja?

Women's health became synonymous with reproduction:

Zdravstvena oskrba žensk, je postala sinonimna z reprodukcijo:

breasts, ovaries, uterus, pregnancy.

prsmi, jajčniki, maternico in nosečnostjo.

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

Temu danes rečemo "bikini medicina."

And this stayed this way until about the 1980s,

In tako je ostalo do osemdesetih let 20. stoletja,

when this concept was challenged by the medical community

ko so medicinska skupnost

and by the public health policymakers when they realized that

in javnozdravstveni zakonodajalci spoznali,

by excluding women from all medical research studies

da so ženskam z izključitvijo iz medicinskih raziskav,

we actually did them a disservice,

povzročili škodo.

in that apart from reproductive issues,

Saj z izjemo reprodukcije,

virtually nothing was known about the unique needs

ni bilo nič znanega o edinstvenih potrebah

of the female patient.

ženskih pacientk.

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

Od tedaj smo odkrili ogromno dokazov,

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

ki kažejo številne razlike med moškimi in ženskami na vseh področjih.

You know, we have this saying in medicine:

Veste, v medicini imamo izrek:

children are not just little adults.

"Otroci niso le pomanjšani odrasli."

And we say that to remind ourselves

Ta izrek nam služi v opomin,

that children actually have a different physiology than normal adults.

da imajo otroci dejansko drugačno fiziologijo kot normalni odrasli.

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

Zaradi tega je tudi nastala medicinska specializacija pediatrija.

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

Sedaj na otrocih tudi izvajamo raziskave, da bi izboljšali njihova življenja.

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

Vem, da enako lahko rečemo tudi za ženske.

Women are not just men with boobs and tubes.

Ženske niso le moški s prsmi in jajčniki,

But they have their own anatomy and physiology

pač pa imajo lastno anatomijo in fiziologijo,

that deserves to be studied with the same intensity.

ki sta vredni enako intenzivnega preučevanja.

Let's take the cardiovascular system, for example.

Vzemimo na primer srčnožilni sistem.

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

Na tem področju si zelo močno prizadevajo odkriti

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

zakaj imajo moški in ženske drugačne oblike srčnih kapi.

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

Bolezni srca so najpogostejši vzrok smrti tako pri moških kot pri ženskah,

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

vendar, v primerjavi z moškimi, več žensk umre v prvem letu po srčni kapi.

Men will complain of crushing chest pain --

Moški bodo potožili, da imajo tiščočo bolečino v prsih...

an elephant is sitting on their chest.

kot bi jim slon sedel na prsih.

And we call this typical.

In mi rečemo, da je to tipično.

Women have chest pain, too.

Tudi ženske občutijo bolečino v prsih.

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

A ženske pogosteje kot moški potožijo, da se "enostavno ne počutijo dobro,"

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

"ne morejo zajeti dovolj sape,"

"just so tired lately."

"so zadnje čase zelo utrujene."

And for some reason we call this atypical,

In iz nekega razloga mi to označimo za atipično,

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

čeprav, kot sem že omenila, ženske predstavljajo polovico populacije.

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

Kateri dokazi nam torej pomagajo pojasniti te razlike?

If we look at the anatomy,

Če si ogledamo anatomijo

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

vidimo, da so krvne žile okoli srca pri ženskah manjše kot pri moških

and the way that those blood vessels develop disease is different

in razvoj bolezni v teh žilah je drugačen

in women compared to men.

pri ženskah v primerjavi z moškimi.

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

Tudi testi, ki jih uporabljamo za določanje ogroženosti za srčno kap,

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

so bili prvotno zasnovani, preizkušeni in izpopolnjeni za moške

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

in posledično pri ženskah ne delujejo enako dobro.

And then if we think about the medications --

In če si sedaj ogledamo še zdravila...

common medications that we use, like aspirin.

pogosto uporabljena zdravila, na primer Aspirin.

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

Aspirin dajemo zdravim moškim, da preprečimo srčno kap.

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

Ampak ali veste, da je predpisovanje Aspirina zdravim ženskam

it's actually harmful?

v resnici škodljivo?

What this is doing is merely telling us

Kar nam ta primer pove, je,

that we are scratching the surface.

da je to le vrh ledene gore.

Emergency medicine is a fast-paced business.

Urgentna medicina je naglo razvijajoče-se področje.

In how many life-saving areas of medicine,

Na koliko življenjsko pomembnih področjih medicine,

like cancer and stroke,

na primer rakavih boleznih in infarktih,

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

obstajajo pomembne razlike med spoloma, ki bi jih lahko s pridom uporabljali?

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

Celo pri vprašanju zakaj so nekateri pogosteje prehlajeni

more than others,

kot ostali.

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

Ali zakaj protibolečinska zdravila pri tistih udarninah prstov

work in some and not in others?

nekaterim pomagajo, drugim pa ne.

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

Inštitut za Medicino pravi, da ima vsaka celica spol.

What does this mean?

Kaj to pomeni?

Sex is DNA.

Spol je DNA.

Gender is how someone presents themselves in society.

Spol v socialnem smislu, pa označuje kako se človek predstavlja v družbi.

And these two may not always match up,

Ta dva koncepta se ne ujemata vedno,

as we can see with our transgendered population.

kar opazimo pri transseksualni populaciji.

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

Pomembno pa se je zavedati, da od trenutka spočetja

every cell in our bodies --

vsaka celica v našem telesu,

skin, hair, heart and lungs --

kožna, srčna, pljučna ali celica las,

contains our own unique DNA,

vsebuje našo edinstveno DNA

and that DNA contains the chromosomes that determine

in ta DNA vključuje kromosome, ki določajo

whether we become male or female, man or woman.

ali bomo postali moški ali ženska.

It used to be thought

Včasih so mislili,

that those sex-determining chromosomes pictured here --

da spolni kromosomi na sliki,

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

XY za moške, XX za ženske,

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

določajo le, ali se bo človek rodil z jajčniki ali testisi.

and it was the sex hormones that those organs produced

Spolni hormoni, ki jih ta organa izdelujeta,

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

pa naj bi bili odgovorni za ostale razlike med spoloma.

But we now know that that theory was wrong --

Danes pa vemo, da je ta teorija napačna,

or it's at least a little incomplete.

oziroma vsaj nepopolna.

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

Na srečo so znanstveniki kot dr. Page iz Inštituta Whitehead,

who works on the Y chromosome,

ki raziskuje kromosom Y

and Doctor Yang from UCLA,

in doktor Yang iz UCLA,

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

odkrili dokaze, da spolni kromosomi,

that are in every cell in our bodies

ki se nahajajo v vseh telesnih celicah,

continue to remain active for our entire lives

ostanejo aktivni skozi celotno življenje

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

in bi lahko bili odgovorni za razlike

in the dosing of drugs,

pri doziranju zdravil

or why there are differences between men and women

ali za razlike med moškimi in ženskami pri

in the susceptibility and severity of diseases.

dovzetnosti za bolezni in resnosti bolezni.

This new knowledge is the game-changer,

Ta nova spoznanja spremenijo vse

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

in naloga znanstvenikov je, da nadaljujejo z odkrivanjem novih dokazov,

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

vendar pa je tudi naloga zdravnikov, da pričnejo uporabljati te podatke

at the bedside, today.

ob bolnikovi postelji, še danes.

Right now.

Takoj zdaj.

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

Da bi pomagala pri tem, sem soustanoviteljica nacionalne zveze

called Sex and Gender Women's Health Collaborative,

imenovane Spol: Skupnost za zdravje žensk,

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

kjer zbiramo vse te podatke, zato da so dostopni za poučevanje

and for patient care.

in skrb za paciente.

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

Trudimo se vključiti tudi medicinske izobraževalne ustanove.

That's a big job.

To je pomembno delo.

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

Spreminjmo način poučevanja medicine, ki je bil uveljavljen od samega začetka.

But I believe in them.

Vendar jaz verjamem vanje.

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

Vem, da bodo sprevideli koristnost vključitve razlik med spoloma

into the current curriculum.

v sedanji učni načrt.

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

Gre se za to, da pravilno izučimo bodoče izvajalce zdravstvenih storitev.

And regionally,

Regionalno

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

pa sem soustanoviteljica divizije znotraj oddelka za urgentno medicino

here at Brown University,

tu na Univerzi Brown,

called Sex and Gender in Emergency Medicine,

ki se imenuje Spol v urgentni medicini.

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

Tu izvajamo raziskave s katerimi ugotavljamo razlike med spoloma

in emergent conditions,

v urgentnih stanjih,

like heart disease and stroke and sepsis and substance abuse,

na primer srčnih boleznih in kapi, sepsi in zlorabi prepovedanih drog.

but we also believe that education is paramount.

Hkrati pa verjamemo, da je izobraževanje ključno.

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

Razvili smo vse-vključujoč model izobrazbe.

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

Imamo izobraževalne programe za zdravnike, medicinske tehnike, študente

and for the patients.

in za paciente.

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

Kajti tega problema ne moremo prepustiti le izvajalcem zdravstvenih storitev.

We all have a role in making a difference.

Vsi imamo vlogo pri spreminjanju sedanjega stanja.

But I must warn you: this is not easy.

Moram pa vas posvariti, da to ni preprosto.

In fact, it's hard.

Pravzaprav je težko.

It's essentially changing the way we think about medicine

V bistvu želimo spremeniti način, kako razmišljamo o medicini,

and health and research.

zdravju in raziskovanju.

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

Spreminjamo naš odnos do zdravstvenega sistema.

But there's no going back.

A ni poti nazaj.

We now know just enough

Vemo ravno dovolj,

to know that we weren't doing it right.

da se zavedamo, da smo se prej motili.

Martin Luther King, Jr. has said,

Martin Luther King mlajši je rekel:

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

"Spremembe niso neizbežne,

but comes through continuous struggle."

zanje je potreben neprestan trud."

And the first step towards change is awareness.

Prvi korak proti spremembi pa je zavedanje.

This is not just about improving medical care for women.

Ne gre se samo za izboljšanje zdravstvene oskrbe za ženske.

This is about personalized, individualized health care for everyone.

Gre za personalizirano, individualizirano zdravstveno oskrbo za vse.

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

Zavedanje tega lahko spremeni medicinsko oskrbo tako za moške kot za ženske.

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

Želim si, da od sedaj naprej vprašate svojega zdravnika

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

ali je terapija, ki jo prejemate, namenjena prav vašemu spolu.

They may not know the answer --

Mogoče vam ne bodo znali odgovoriti...

yet.

še.

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

Ampak ta pogovor se je že začel in skupaj se lahko vsi učimo.

Remember, for me and my colleagues in this field,

Zapomnite si, da je zame in moje kolege na tem področju

your sex and gender matter.

vaš spol pomemben.

Thank you.

Hvala vam.

(Applause)

(Aplavz)