Sweden, in 2001. At our 3rd International Congress of Gender Medicine in Stockholm in 2008, we had a preliminary book meeting and many colleagues seemed interested in the project. At about the same time, the Center obtained funding from Pfizer Inc. to support the development of this book.
An executive committee was formed and its members consist of, besides me (Prof. Karin Schenck-Gustafsson, Karolinska Institutet, Stockholm): Paula R. De Cola, RN, MSc, Pfizer, New York, N.Y., USA; Prof. David S. Pisetsky, Duke University, Durham, N.C., USA, and Prof. Donald W. Pfaff, Rockefeller University, New York, N.Y., USA. The journalist Tina Esh, BSc, Tina Esh Communications AB, Stockholm, is the book coordinator.
We first had to decide on the content of the book. High priority was that it should serve as a guide for clinical work. Therefore, most chapters are very clinical while a few are more theoretical or philosophical, depending on the nature of the topic.
The chapters should contain statements about the actual status of knowledge as well as comments about missing facts. We hope that this book will inspire others and lead to more research, more work on clinical guidelines, and more advocacy for gender medicine considerations among groups such as health authorities, ethics committees, editorial boards, research councils, medical product agencies, and biopharmaceutical companies.
It was a long struggle to find a publisher that understood our intentions and shared the beliefs that gender medicine is both for men and women, includes both biological and social aspects of health and disease, is based on top-quality research, and in the future will be a natural part of all research and clinical work. I also believe that our authorities should demand that all medical research include both sexes, show sex-divided statistics, and always analyze results from a sex and gender perspective.
We have engaged authors that are top researchers and top clinicians from Europe, the USA, Canada, Africa, China, and Australia who share my passion for the heightened prominence of gender medicine, and I believe that we have an outstanding book that will contribute to this goal.
Enjoy the reading!
Karin Schenck-Gustafsson, Stockholm
Introduction
Schenck-Gustafsson K, DeCola PR, Pfaff DW, Pisetsky DS (eds): Handbook of Clinical Gender Medicine.
Basel, Karger, 2012, pp 1–4
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aEastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., bEastern Health, Box Hill, Vic., and cDepartment of Surgery, St. Vincent’s Hospital, The University of Melbourne, Melbourne, Vic., Australia
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Abstract
Sex and gender are both critical variables that affect health and illness. Gender is a social science descriptor and sex is a biological one. Gender and possibly sex are not binary variables.That we think of them as such is a political decision rather than a description of the natural world. It may be scientifically more accurate to treat them as continuous variables for the purposes of research. Wherever possible, scientific research will benefit from treating men and women as separate populations, or modeling sex and gender as continuous variables. It is time to move on from the foundation built on the European male as the model human. The dominance of this model is a result of a fierce battle between competing world views over thousands of years. The masculine perspective won that battle, as recorded in the myths and legends of Europe and other cultures. In the process, the feminine was suppressed, women became invisible, and their contributions to the creation of knowledge disappeared. The rule of the fathers brought with it a binary foundation to thinking and the preeminence of rational thought. Feelings, intuition, and nature were abhorred. Nature was a force to be conquered. Distrust of the feminine has been deeply embedded in the development of the science on which medicine is based, with important consequences that are considered by the authors of this textbook. No problem can be solved from the consciousness that created it. It is time to combine the biological and social sciences to unleash a revolution in scientific thought appropriate for the 21st century.
Copyright © 2012 S. Karger AG, Basel
In the age of personalized medicine that seeks to apply targeted individualized therapy, we seem to have missed two of the most overt genotypes and phenotypes that patients present with: those of sex and gender. Personalized medicine requires understanding the impact of the X and Y chromosomes on the molecular profile of women and men, and the health effects of gender roles ascribed to men and women and those with other gender identities.
Western science is now ready to move through the gateway from medical science built on the foundations of reductionist linear thinking that defined all patients in relation to the 70-kg European male, to an expansive capability that includes in scientific understanding of disease and medical care the complexity of the whole person that is the patient.
An example of the importance of identifying the impact of gender and sex can be seen in prostate cancer and lung disease. When masculinity is defined through the qualities of a warrior it is difficult to admit to weakness or to seek care. The resulting delay in responding to symptoms leads to worse outcomes in prostate disease that are a result of gender, not changes in testosterone. In women, the increasing incidence of lung cancer began when it became acceptable for women to smoke, a change in gender rules, not estrogen. It has become apparent that women with lung cancer live longer than men, even when known prognostic factors are controlled for. This is a survival outcome determined by sex, and the research design required to explore this must test the data on women and men separately.
To understand the importance of this textbook in the development of biomedical thought, it is necessary to grasp the essential elements of how things got to be the way they are. We are at a point of transition in the history of thought in the Western tradition. The transition is from 3,000 years in which humans have refined intellectual thought through the use of reason and the order of the father right, to a new point in which the feminine is re-emerging and with it expanded ways of knowing. The consequences are being felt in all spheres of human activity, including in the construction of scientific thought and medicine.
The stories about how things came to be the way they are are told in myths and legends, and we would do well to know what they are, for myths set the tone for a whole society. European myths tell how the feminine was defeated in epic battles between the goddesses and the gods. The gods won, and from that time on men as their representatives on earth took on the roles of leadership, politics, war, and knowledge making. In the process, the feminine was ruthlessly suppressed and women became invisible, their contributions to the creation of knowledge erased from public consciousness.
The mythical defeat of the feminine has its parallel in the real world. One of the most savage ways it manifested in Europe was through
