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Women experience adverse drug reactions nearly twice as frequently as men. Here's why.
Science has been male-biased far too long.
- A new study investigates adverse drug reactions in women and men.
- Women are on average lighter in weight and have smaller organs and more body fat, which affects the absorption and distribution of drugs.
- The authors suggest more individualized dosage recommendations moving forward.
The double-blind study has been under fire for years due to the replication crisis: numerous clinical studies cannot be repeated by other researchers. While still considered the gold standard in science—a control is necessary if you want honest results—the double-blind study needs an upgrade.
Sadly, this isn't the only problem in clinical trials.
In a time when pre-prints—submitted studies that have not yet been vetted—are treated as truth, our general faith in science is waning. True, we're approaching a potential COVID-19 vaccine in record time thanks to the hard work and collaborative efforts of researchers around the world. Yet increasing faith in conspiracy theories makes it difficult to sift through headlines.
Then there's the sexism.
Perhaps gender bias is not intentional, at least today. But for decades women were not allowed to be included in clinical trials due to an unfounded fear they could negatively impact fertility. Science was (and some would argue, still is) a man's game tailor-made for male bodies. It was inevitable that the medicine produced with such constraints would harm women.
The history of women in medicine
As we know, women take these drugs, too. As a new review, published in Biology of Sex Differences, details, women are certainly paying the price.
Science has long been about the male body. Gynecologists were men for quite some time—the specialty began in 1889, yet until 1970, women never made up more than 6 percent of any medical school. As of 2019, women now make up more than half of medical students in America.
Still, women are twice as likely to suffer adverse drug reactions (ADRs) because the clinical trial model continues to favor men. Irving Zucker, in the psychology and integrative biology departments of University of California, Berkeley, and Brian Prendergast, in the Department of Psychology and Committee on Neurobiology at the University of Chicago, evaluated 86 drugs, and found that women had higher pharmacokinetics (PKs) and ADRs in women.
Finding ADR information presents its own challenge. As the authors write, "for 59 drugs with clinically identifiable ADRs, sex-biased PKs predicted the direction of sex-biased ADRs in 88% of cases. Ninety-six percent of drugs with female-biased PK values were associated with a higher incidence of ADRs in women than men, but only 29% of male-biased PKs predicted male-biased ADRs."
Photo: Antonio Diaz / Shutterstock
The authors believe the problem might stem from doctors prescribing the same dosages for men and women, despite sex and weight differences, which causes overmedication in women.
While the childbearing myth held for a long time, in 1993 the NIH required that federally-supported phase III clinical trials include women. A study that looked at 300 new drug applications between 1994-2000 found that 31 percent might have been sex-biased. That report also showed that while 11 drugs showed a > 40 percent difference between genders, no dosage requirements were mandated.
The authors found a number of ADRs that affected women more than men, including depression, excessive weight gain, hallucinations, seizures, and cardiac anomalies. Besides lower body weight, women also have smaller organs and more body fat—all factors in how bodies absorb and distribute drugs.
As the authors conclude,
"The present results reveal a striking sex difference in pharmacokinetics: among patients administered a standard drug dose, females are exposed to higher blood drug concentrations and longer drug elimination times than males. This likely contributes to the near doubling of adverse drug reactions in female patients, raising the possibility that women are routinely overmedicated."
There is a movement calling for individualized medicine based on the microbiome. The same should be considered when it comes to gender. As the authors write, dosage requirements should be considered based on gender differences. Science might have been a man's world, but that time has passed.
- Why science research still focuses mostly on males ›
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Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
A leading British space scientist thinks there is life under the ice sheets of Europa.
- A British scientist named Professor Monica Grady recently came out in support of extraterrestrial life on Europa.
- Europa, the sixth largest moon in the solar system, may have favorable conditions for life under its miles of ice.
- The moon is one of Jupiter's 79.
Neil deGrasse Tyson wants to go ice fishing on Europa<div class="rm-shortcode" data-media_id="GLGsRX7e" data-player_id="FvQKszTI" data-rm-shortcode-id="f4790eb8f0515e036b24c4195299df28"> <div id="botr_GLGsRX7e_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/GLGsRX7e-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/GLGsRX7e-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/GLGsRX7e-FvQKszTI.js"></script> </div>
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Can computers do calculations in multiple universes? Scientists are working on it. Step into the world of quantum computing.
- While today's computers—referred to as classical computers—continue to become more and more powerful, there is a ceiling to their advancement due to the physical limits of the materials used to make them. Quantum computing allows physicists and researchers to exponentially increase computation power, harnessing potential parallel realities to do so.
- Quantum computer chips are astoundingly small, about the size of a fingernail. Scientists have to not only build the computer itself but also the ultra-protected environment in which they operate. Total isolation is required to eliminate vibrations and other external influences on synchronized atoms; if the atoms become 'decoherent' the quantum computer cannot function.
- "You need to create a very quiet, clean, cold environment for these chips to work in," says quantum computing expert Vern Brownell. The coldest temperature possible in physics is -273.15 degrees C. The rooms required for quantum computing are -273.14 degrees C, which is 150 times colder than outer space. It is complex and mind-boggling work, but the potential for computation that harnesses the power of parallel universes is worth the chase.
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