A New Era of Women-Centric Health Research

Alzheimer's disease made significant headlines this summer when the Food and Drug Administration (FDA) approved Kisunla, a new drug to slow cognitive decline for patients in the early stages of the disease. Researchers also determined that a specific protein, reelin, seems to be capable of warding off the condition, even in patients that should definitely be impacted.

But an open secret about Alzheimer's disease is that the condition predominantly impacts women. Two-thirds of Alzheimer's patients are women, and though women live on average five years longer than men, it doesn't fully explain why one gender is more susceptible to a disease than the other. But it's not just Alzheimer's — women are also twice as likely to develop autoimmune conditions than men, and researchers still don't know exactly why.

Yet the tides may be shifting with the Biden Administration's February 2024 announcement of the Initiative on Women's Health Research to fund studies on gender disparities across medical conditions. Irene Aninye, the chief science officer of the Society for Women's Health Research (SWHR) in Washington, D.C., breaks down why these new initiatives are so significant and what it means for disease treatment across the sexes in the future.

Next Avenue: How would you describe SWHR and the significance of your work?

Irene Aninye: As recently as 40 years ago, women were actively excluded from clinical trials [due to] concerns of how it would affect women of childbearing age. The Society for Women's Health Research was founded to do science policy and educational work around that space so that we understand sex differences in research. [For example], Alzheimer's patients are 60% women. Autoimmune disease is 80%. Thyroid conditions, migraines, pain, the cardiovascular system and metabolism are different in women than men through biological processes, sex, gender and hormones.

So many medical conditions, from dengue fever to types of cancers, are extremely mysterious and people still understand very little about them. I imagine that this mystery stems from the idea that only so much money can go into medical research, and only so many conditions are thoroughly understood as they pertain to the general population. Are there certain conditions where the lack of research incorporating women and minorities creates really different trajectories for two patients with the same condition?

Yes, most. There are so many. I'll go the Alzheimer's route. More than 60% of Alzheimer's patients are women versus men, and we need to study it. Everyone agrees. [But] scientists are not studying it in relation to sex and gender. That means that interventions are off and diagnostic processes are off. Women can fare better on [Alzheimer's] verbal tests than men, so they may score better, but the bar for cognitive impairment is lower. She may pass, but may still be on the path to Alzheimer's because the bar was set using men.

Heart disease is another condition that is disproportionately higher in women. Heart disease symptoms and presentation are very different for men and women, because for women, it may feel more like indigestion or heartburn, and health officials say that these are atypical symptoms. [But] if 50% of the population feels these symptoms, this is atypical?

These are nuances, so we have to put the resources behind them to redo those studies, new and old, to shift what we've put out in the past if we're going to have better health care features. It's not a small task, but a task that needs to be done.

To your knowledge, at what point were female patients and women-centered research incorporated into medical studies? How severe has the disparity of male-centric research been historically?

It's been iterative. There were definitely policies by the FDA that actively excluded women in the 1980s. We were founded in the 1990s, and just shortly before in the mid-1980s, the National Institutes of Health (NIH) had a policy that encouraged women to join clinical trials. But a lot of medical research requires peer review, and it's subjective. If your review panel sees the inclusion of women in studies as a priority and you don't do it, they'll ding you. But if it's not a priority, they won't ding you.

The year 1993 was a major uptick. The NIH Revitalization Act mandated the inclusion of women and minorities in medical studies. The FDA also that year rescinded their ban from 1977 on women of childbearing age in clinical trials.

Another big date was between 2009 and 2010, which included the Women's Health Office act, which secured offices in federal agencies for women's health.

Do you think that federal agencies should focus more on disease prevention than treatment?

We need to pay more attention there to disease burden. When a large population isn't affected [by a disease], it may be disproportionate for a subpopulation. For example, cardiovascular disease kills higher numbers of men, but it disproportionately impacts women.

There may be 800,000 men impacted versus 600,000 women, but the number of women dying from this compared [with] other diseases is much higher.

Do you believe that screening for various conditions should happen earlier in life?

I do. Our guidelines for many things are still very old, and it takes a lot to update them. The challenge is looking at maps and dashboards of old data and analysis and extrapolating it out. We need time to see trends. The thought and consensus is that we are seeing cancer diagnoses younger, and earlier. Was it there and we didn't have the technology to recognize it, or is it actually happening [when people were] younger?

Another example is menopause. When women begin showing symptoms at 40, they visit their doctor, but no one ever puts menopause as the label to what is going on. But once you show up at 50 or 55 years old, it's now menopause. Women have had issues in the medical system of dismissal of symptoms where something occurred five years ago, but it's not diagnosed until now.

Karen Fischer is an independent writer. You can find her bylines in CQ Researcher, The Verge, EATER, and other publications on her website at kfischerwrites.com. Read More