科学对女性健康的看法是如何演变的

男人和女人是不同的.

这听起来像是喜剧的开场, but scientific understanding of the significance of those differences – and how to study them – evolved slowly in recent decades.

Researchers 谁 have been part of historic investigations say science had to overcome its own blind spots.

这种意识是逐渐形成的, 琳达·范·霍恩教授说, chief of the nutrition division in the department of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago.

“这不是一个时刻. 就像医学中的大多数事情一样，人们越来越认识到这一点，”她说.

最终, researchers accepted that figuring out how men and women are different biologically was worthy of exploration. “如果你仔细想想，现在看起来有点可笑，”范霍恩说.

这种对比是至关重要的. 单从心脏健康的角度来看，现在的女性更健康 遭受更多的痛苦 与吸烟的影响可以表现出不同 心脏病发作症状.

The barriers to understanding such differences were not always simple sexism, said Dr. 弗兰克·斯派泽，爱德华·H. 波士顿哈佛医学院卡斯杰出医学教授.

“我想每个人都知道女性和男性患的疾病是一样的。, 说Speizer, 他也是哈佛大学环境健康教授.H. 陈公共卫生学院. But when it came to heart disease, accepted wisdom declared women were protected until menopause. 研究将会反驳这种说法. “但当时人们是这么想的. And therefore, to make a career, you had to study where the disease was," 他说. “这种疾病发生在男性身上."

Speizer是该项目的创始首席研究员 护士健康研究这是有史以来对妇女健康进行的最重要的研究之一.

该研究旨在研究口服避孕药对健康的影响. Speizer and his colleagues modeled their work after a famous English survey of doctors that linked smoking and cancer. 基于这项研究完成的突破性科学, 斯佩泽计划调查医生的妻子.

“这似乎是合乎逻辑的做法，”他说. 1971年在英国试运行成功.

但随后的测试并不顺利. Reflecting how society was changing, test questionnaires were addressed to "Mrs.," "Ms." or "Doctor, give this to your wife" to see which would generate the most responses. “女士.组表现最差，而在“Mrs.”组, researchers learned that many women had never seen the survey; their husbands had filled out the form for them.

Realizing "it was an impossible situation," Speizer shifted to surveying nurses. 其余的成为健康史, 作为研究, 它以121启动,1976年有700名已婚护士, 它的衍生品继续产生有价值的科学. 护士, 他说, 变得“非常合作”, 值得信赖的同事提供他们的健康信息."

多年来, the 护士健康研究 researchers diversified both the participants (the original group, 反映了当时的职业, 97%是白人)和研究区域, 导致了饮食和运动方面的发现，从而形成了联邦指导方针.

Van Horn is on the steering committee for a different massive research project called the 妇女健康倡议. 这项研究于1992年启动，招募了16.1万多名女性. 最初, 这是为了检验激素疗法的效果, 饮食, 以及补充钙和维生素D. Breast cancer was the primary focus, but the study collected data on broad areas of women's health.

今天, 范霍恩说, the initiative continues to offer data-driven results on outcomes that are based on lifestyles led for more than two decades.

It took "some pretty strong champions of women's health" to build support for such research, 范霍恩说. 她和斯佩泽都注意到了伯纳丁·希利的努力, 谁, in 1991, 成为美国国立卫生研究院的第一位女性院长.

In 1993, Congress rewrote laws to require the inclusion of women in medical studies. 但有些变化进展缓慢. Many early drug studies to determine appropriate dosages were done using only male lab animals, 范霍恩指出.

This was rationalized on the grounds that hormones and menstrual cycles can complicate research data. “惊喜!她说. “它们让女性的生活变得复杂."

It was only in 2014 that the NIH started requiring both male and female lab animals to be used in studies. Van Horn recalled how this prompted comedian Stephen Colbert to devote an entire monologue to the topic, 破解, "Any scientist knows it's crucial to eliminate extraneous variables – like half the global population."

工作仍然. One study of clinical trials about cardiovascular health between 2000 and 2017 showed only 38% of the participants were women.

但未来的研究将能够建立在几十年前开始的努力的基础上. 例如, 在20世纪80年代, 护士健康研究的研究人员开始采集血液, 组织和脚趾甲样本. “这些可能会在未来10年内得到回报,斯佩泽说, as scientists learn more about genetics and how behaviors and environment affect how genes work.

看看这两项里程碑式的研究之后会发生什么, Van Horn is excited about the prospects for using precision nutrition to help prevent disease. It's clear that fruits, vegetables, 谁le grains and the like are good for people. "What we still don't know – and what I'm finding more and more fascinating is – what are the male-female differences?"

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