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  • Some of my most wonderful memories of childhood

  • are of spending time with my grandmother, Mamar,

  • in our four-family home in Brooklyn, New York.

  • Her apartment was an oasis.

  • It was a place where I could sneak a cup of coffee,

  • which was really warm milk with just a touch of caffeine.

  • She loved life.

  • And although she worked in a factory,

  • she saved her pennies and she traveled to Europe.

  • And I remember poring over those pictures with her

  • and then dancing with her to her favorite music.

  • And then, when I was eight and she was 60,

  • something changed.

  • She no longer worked or traveled.

  • She no longer danced.

  • There were no more coffee times.

  • My mother missed work and took her to doctors

  • who couldn't make a diagnosis.

  • And my father, who worked at night, would spend every afternoon with her,

  • just to make sure she ate.

  • Her care became all-consuming for our family.

  • And by the time a diagnosis was made,

  • she was in a deep spiral.

  • Now many of you will recognize her symptoms.

  • My grandmother had depression.

  • A deep, life-altering depression,

  • from which she never recovered.

  • And back then, so little was known about depression.

  • But even today, 50 years later,

  • there's still so much more to learn.

  • Today, we know that women are 70 percent more likely

  • to experience depression over their lifetimes

  • compared with men.

  • And even with this high prevalence,

  • women are misdiagnosed between 30 and 50 percent of the time.

  • Now we know that women are more likely

  • to experience the symptoms of fatigue, sleep disturbance,

  • pain and anxiety compared with men.

  • And these symptoms are often overlooked

  • as symptoms of depression.

  • And it isn't only depression in which these sex differences occur,

  • but they occur across so many diseases.

  • So it's my grandmother's struggles

  • that have really led me on a lifelong quest.

  • And today, I lead a center in which the mission

  • is to discover why these sex differences occur

  • and to use that knowledge

  • to improve the health of women.

  • Today, we know that every cell has a sex.

  • Now, that's a term coined by the Institute of Medicine.

  • And what it means is that men and women are different

  • down to the cellular and molecular levels.

  • It means that we're different across all of our organs.

  • From our brains to our hearts, our lungs, our joints.

  • Now, it was only 20 years ago

  • that we hardly had any data on women's health

  • beyond our reproductive functions.

  • But then in 1993,

  • the NIH Revitalization Act was signed into law.

  • And what this law did was it mandated

  • that women and minorities be included in clinical trials

  • that were funded by the National Institutes of Health.

  • And in many ways, the law has worked.

  • Women are now routinely included in clinical studies,

  • and we've learned that there are major differences

  • in the ways that women and men

  • experience disease.

  • But remarkably,

  • what we have learned about these differences is often overlooked.

  • So, we have to ask ourselves the question:

  • Why leave women's health to chance?

  • And we're leaving it to chance in two ways.

  • The first is that there is so much more to learn

  • and we're not making the investment

  • in fully understanding the extent of these sex differences.

  • And the second is that we aren't taking what we have learned,

  • and routinely applying it in clinical care.

  • We are just not doing enough.

  • So, I'm going to share with you three examples

  • of where sex differences have impacted the health of women,

  • and where we need to do more.

  • Let's start with heart disease.

  • It's the number one killer of women in the United States today.

  • This is the face of heart disease.

  • Linda is a middle-aged woman,

  • who had a stent placed in one of the arteries

  • going to her heart.

  • When she had recurring symptoms she went back to her doctor.

  • Her doctor did the gold standard test:

  • a cardiac catheterization.

  • It showed no blockages.

  • Linda's symptoms continued.

  • She had to stop working.

  • And that's when she found us.

  • When Linda came to us, we did another cardiac catheterization

  • and this time, we found clues.

  • But we needed another test

  • to make the diagnosis.

  • So we did a test called an intracoronary ultrasound,

  • where you use soundwaves to look at the artery

  • from the inside out.

  • And what we found

  • was that Linda's disease didn't look like

  • the typical male disease.

  • The typical male disease looks like this.

  • There's a discrete blockage or stenosis.

  • Linda's disease, like the disease of so many women,

  • looks like this.

  • The plaque is laid down more evenly, more diffusely

  • along the artery, and it's harder to see.

  • So for Linda, and for so many women,

  • the gold standard test wasn't gold.

  • Now, Linda received the right treatment.

  • She went back to her life and, fortunately, today

  • she is doing well.

  • But Linda was lucky.

  • She found us, we found her disease.

  • But for too many women, that's not the case.

  • We have the tools.

  • We have the technology to make the diagnosis.

  • But it's all too often that these sex diffferences

  • are overlooked.

  • So what about treatment?

  • A landmark study that was published two years ago

  • asked the very important question:

  • What are the most effective treatments for heart disease in women?

  • The authors looked at papers written over a 10-year period,

  • and hundreds had to be thrown out.

  • And what they found out was that of those that were tossed out,

  • 65 percent were excluded

  • because even though women were included in the studies,

  • the analysis didn't differentiate between women and men.

  • What a lost opportunity.

  • The money had been spent

  • and we didn't learn how women fared.

  • And these studies could not contribute one iota

  • to the very, very important question,

  • what are the most effective treatments

  • for heart disease in women?

  • I want to introduce you to Hortense, my godmother,

  • Hung Wei, a relative of a colleague,

  • and somebody you may recognize --

  • Dana, Christopher Reeve's wife.

  • All three women have something very important in common.

  • All three were diagnosed with lung cancer,

  • the number one cancer killer of women

  • in the United States today.

  • All three were nonsmokers.

  • Sadly, Dana and Hung Wei died of their disease.

  • Today, what we know is that women who are nonsmokers are three times more likely

  • to be diagnosed with lung cancer than are men

  • who are nonsmokers.

  • Now interestingly, when women are diagnosed with lung cancer,

  • their survival tends to be better than that of men.

  • Now, here are some clues.

  • Our investigators have found that there are

  • certain genes in the lung tumor cells of both women and men.

  • And these genes are activated

  • mainly by estrogen.

  • And when these genes are over-expressed,

  • it's associated with improved survival

  • only in young women.

  • Now this is a very early finding

  • and we don't yet know whether it has relevance

  • to clinical care.

  • But it's findings like this that may provide hope

  • and may provide an opportunity to save lives

  • of both women and men.

  • Now, let me share with you an example

  • of when we do consider sex differences, it can drive the science.

  • Several years ago a new lung cancer drug

  • was being evaluated,

  • and when the authors looked at whose tumors shrank,

  • they found that 82 percent were women.

  • This led them to ask the question: Well, why?

  • And what they found

  • was that the genetic mutations that the drug targeted

  • were far more common in women.

  • And what this has led to

  • is a more personalized approach

  • to the treatment of lung cancer that also includes sex.

  • This is what we can accomplish

  • when we don't leave women's health to chance.

  • We know that when you invest in research,

  • you get results.

  • Take a look at the death rate from breast cancer over time.

  • And now take a look at the death rates

  • from lung cancer in women over time.

  • Now let's look at the dollars invested in breast cancer --

  • these are the dollars invested per death --

  • and the dollars invested in lung cancer.

  • Now, it's clear that our investment in breast cancer

  • has produced results.

  • They may not be fast enough,

  • but it has produced results.

  • We can do the same

  • for lung cancer and for every other disease.

  • So let's go back to depression.

  • Depression is the number one cause

  • of disability in women in the world today.

  • Our investigators have found

  • that there are differences in the brains

  • of women and men

  • in the areas that are connected with mood.

  • And when you put men and women

  • in a functional MRI scanner --

  • that's the kind of scanner that shows how the brain is functioning when it's activated --

  • so you put them in the scanner and you expose them to stress.

  • You can actually see the difference.

  • And it's findings like this

  • that we believe hold some of the clues

  • for why we see these very significant sex differences

  • in depression.

  • But even though we know

  • that these differences occur,

  • 66 percent

  • of the brain research that begins in animals

  • is done in either male animals

  • or animals in whom the sex is not identified.

  • So, I think we have to ask again the question:

  • Why leave women's health to chance?

  • And this is a question that haunts those of us

  • in science and medicine

  • who believe that we are on the verge of being able to dramatically improve

  • the health of women.

  • We know that every cell has a sex.

  • We know that these differences are often overlooked.

  • And therefore we know that women are not getting the full benefit

  • of modern science and medicine today.

  • We have the tools

  • but we lack the collective will and momentum.

  • Women's health is an equal rights issue

  • as important as equal pay.

  • And it's an issue of the quality

  • and the integrity of science and medicine.

  • (Applause)

  • So imagine the momentum we could achieve

  • in advancing the health of women

  • if we considered whether these sex differences were present

  • at the very beginning of designing research.

  • Or if we analyzed our data by sex.

  • So, people often ask me:

  • What can I do?

  • And here's what I suggest:

  • First, I suggest that you think about women's health

  • in the same way

  • that you think and care about other causes that are important to you.

  • And second, and equally as important,

  • that as a woman,

  • you have to ask your doctor

  • and the doctors who are caring for those who you love:

  • Is this disease or treatment different in women?

  • Now, this is a profound question because the answer is likely yes,

  • but your doctor may not know the answer, at least not yet.

  • But if you ask the question, your doctor will very likely

  • go looking for the answer.

  • And this is so important,

  • not only for ourselves,

  • but for all of those whom we love.

  • Whether it be a mother, a daughter, a sister,

  • a friend or a grandmother.

  • It was my