Gender medicine: transversal approach in research and teaching for a better appropriateness of care

On the occasion of the Health & Wellness Week of Expo 2020 Dubai, the project of the University Center for Studies on Gender Medicine of Ferrara was presented

Gender medicine (GM) or, better, gender-specific medicine is defined by the World Health Organization (WHO) as the study of the influence of biological (defined by sex) and socio-economic and cultural (defined by the gender) on the state of health and disease of each person.

A growing body of epidemiological, clinical and experimental data indicates the existence of relevant differences in the onset, progression and clinical manifestations of diseases common to men and women, in the response and adverse events associated with therapeutic treatments, as well as in the styles of life and in response to nutrients. Access to care also presents significant gender-related inequalities. (source: Higher Institute of Health)

Gender medicine is becoming increasingly important to implement better, more effective and safer treatments with a view to greater economic, environmental and social sustainability for the research and production of new drugs but also, more generally, of the health system. 

Forum Personalized medicine: news tools and active policies for prevention, diagnosis and therapy

On the occasion of Health & Wellness Week, the thematic week dedicated to health and well-being, a Italy Pavilion of Expo Dubai 2020 the event entitled "Personalized medicine: new tools and active policies for prevention, diagnosis and therapy" .

The forum brought together the universities of Emilia-Romagna who presented their research lines and proposals in the field of personalized medicine

Gender medicine: the transversal training course of the University Center for Studies on Gender Medicine of Ferrara

The University Center for Studies on Gender Medicine of Ferrara has activated degree courses both in medicine and in health care sciences to promote a transversal approach with the aim of creating awareness in the new generations and promoting research projects capable of responding to clinical needs.

During the initiative, the doctor Valeria Raparelli of the Department of Translational Medicine and for the Romagna of Unife illustrated the transversal approach in research and teaching of the University Center for Studies on Gender Medicine of Ferrara.

Valeria Raparelli

“I welcomed with enthusiasm and responsibility to represent the excellence of the University Center for Studies on Gender Medicine of Ferrara at Expo 2020 Dubai. It was an important opportunity to bring not only my experience to an international stage but also that of students and researchers who learn every day and walk along a common path: an approach to science and its application that recognizes in the diversity and complexity of the person. an added value and never a limit ". He told al Journal of Italian Healthcare World Dr. Valeria Raparelli.

"Expo 2020 Dubai - he concluded - represented a way to share and communicate the work of the University Center for Studies on Gender Medicine in Ferrara and to anticipate our commitment to people, who have health needs strictly influenced by sex (biological attributes ) and gender (the complex combination of identity, social and cultural context) that characterize them ". 

The University Center for Studies on Gender Medicine is the first and only University Center for Studies on Gender Medicine in Italy.

Born in 2018, the center is active in the sector of research on gender medicine not only through the publication of scientific articles and the realization of targeted projects, but also thanks to the assiduous participation in seminars and conferences on the subject throughout the national territory.

We interviewed Tiziana Bellini e Fulvia Signani respectively Deputy Director and Member of the Governing Council of University Center for Studies on Gender Medicine University of Ferrara as well as co-founders of the center.

What does the project presented at Expo 2020 Dubai consist of?

This is a transversal training path that, as regards the degree course in Medicine and Surgery of Ferrara, started in 2018 and led to the updating of the Syllabus of the various courses (i.e. the structured program of the course) by inserting the attentive approach to sex and gender differences. 

This means that each subject will be taught considering any sex and / or gender differences so far demonstrated by scientifically detected evidence and learning will then be verified during the exam.

How many teachers have included this approach in their program and what are the objectives?

Currently there are 30/36 courses that have included this approach in their updated program which aims to bring students to a mindset that makes them consider it normal to study the various pathologies considering the differences of sex and gender. . 

This different methodological approach aims to achieve a better appropriateness of treatment, recognition of symptoms that are often different in males and females and to improve the knowledge of the mechanisms by which one gets sick, the therapeutic approach and healing.

As for research, with the University Center for studies on gender medicine, we have promoted research by disaggregating the data and trying to understand the causes of the differences. 

In this way at the university (in particular in the degree course in medicine and surgery but also in all health degrees) the training of students is closely linked to both research and assistance. 

The new method intends to pour new knowledge into the clinic by improving the appropriateness of treatment by also acting on prevention and on the concept of health and disease.

What are the advantages and results achieved to date?

The advantage is to have a competent, updated and scientifically more appropriate approach that completes the training and spills over to assistance. This also represents for us the fulfillment of what we call "True third mission of the university medical area" which consists in taking care of the informative aspect, as well as the formative one.

In these 5 years in the degree course in Medicine and Surgery there has been an increase of 25% of degree theses that address the problem with this approach, a result that gives us hope.

Projects for the future?

Extend this approach to every field of knowledge and thus form a generation that has acquired a more complete method of study, research and clinical practice. This will lead to studying, researching and treating people with greater clinical appropriateness, in line with health policies that are attentive to equity.

What does gender medicine represent?

Gender medicine or rather "the approach based on evidence of sex and gender" (sex and gender based approach) allows for the perpetration of policy choices attentive to substantial equality between men and women (and other sexual and gender identities) by promoting a path of clinical appropriateness that involves investment policies on professional updating (ECM training credits) and training (university), and the promotion of consistent clinical practices (guidelines and recommendations), applications that in Italy are the responsibility of Regions and Companies scientific.

The acknowledgment of the innumerable scientific evidences (over one and a half million accredited researches) as well as hundreds of volumes on the subject, demonstrate the impact of sexual and gender differences, which lead to what in English is briefly defined "gender bias ".

For hundreds of years, medicine has pursued the stubborn belief that a woman could be assimilated to a small man (the only difference being the sexual and reproductive systems) when a scientific episode, a research edited by the first woman Director of the American National Institutes of Health, Bernardine Healy, revealed, to eyes that wanted to see, a systematic neglect of women in the cardiology field (in terms of misunderstanding of perinfarct symptoms, no use of life-saving treatments, fewer days of hospitalization with the same diagnosis, etc.). 1991, it sounded like a real denunciation. 

But while ideally being an interesting, innovative and guaranteeing approach to equitable health application, the one attentive to evidence of sex and gender, has not yet had the dissemination and clinical acceptance that it could promise. In 2016, therefore 25 years after Healy's denunciation, the American Association of Cardiology with a full-bodied Statement (state of the art) on women's cardiological pathologies, denounced the persistence of inequalities of treatment to the disadvantage of women.

There is still a long way to go to achieve effective equality of treatment.

Is gender medicine the future? 

Gender medicine is the present and the future and we hope it will become the normal methodological approach in all fields of knowledge. 

Italy is the only country to have a national standard on gender medicine (art, 3 L.3 / 2018). The devices envisaged by the law: the implementing decrees (Plan for dissemination and Plan for training - in publication), as well as the National Observatory dedicated to Gender Medicine set up at the Istituto Superiore di Sanità are spreading the mandate in the numerous institutional structures application of the sex and gender approach, in the public health service as a whole, in universities, in research laboratories (for this reason article 1 of the same law which deals with basic clinical research affects).

The University of Ferrara has distinguished itself, in addition to promoting the transversality of the approach and the dissemination of knowledge also among the teachers, in a mainstream method, also for the birth in 2018 of the first - and so far only - University Center of Studies on Gender Medicine which we personally helped to found and which is still active today.