WHEN I say I
study gender-specific medicine, most people assume I mean women's health.
Patients ask me, "Do you take care of men too?"
I may be partly
to blame for the confusion: in the years since the revolutionary 1985 report on
women's health from the United States Public Health Service, I along with many of my colleagues have tried to atone for the fact that for
so long the majority of diseases that afflicted both genders were studied
exclusively in men.
Over the past two
decades, we've radically revised how we conduct medical research and take care
of our female patients. And we've made valuable discoveries about how gender
helps determine vulnerability to illness and, ultimately, the timing and causes
of death. But I now believe that we doctors and researchers may have focused
too much on women.
What emerges when
one studies male biology in a truly evenhanded way is the realization that from
the moment of conception on, men are less likely to survive than women. It's not just that men take on greater risks and
pursue more hazardous vocations than women. There are poorly understood and underappreciated vulnerabilities inherent in men's genetic
and hormonal makeup. This Father's Day, we need to rededicate ourselves to
deepening our knowledge of male physiology.
Men's troubles
begin during the earliest days in the womb. Even though there are more male
than female embryos, there are more miscarriages of male fetuses. Industrial
countries are also witnessing a decline in male to female birth ratios, and we
don't know why.
Some scientists
have argued that the probability of a male child declines as parents
(especially fathers) age. Still others have cited the prevalence of pesticides,
which produce more birth defects in male children.
Even when a boy
manages to be born, he's still behind the survival eight ball: he is three to
four times more likely than girls to have developmental disorders like autism
and dyslexia; girls learn language earlier, develop richer vocabularies and
even hear better than boys. Girls demonstrate insight and judgment earlier in
adolescence than boys, who are more impulsive and take more risks than their
sisters. Teenage boys are more likely to commit suicide than girls and are more
likely to die violent deaths before adulthood.
As adults, too,
men die earlier than women. Twice as many men as women die of coronary artery
disease, which manifests itself a decade earlier in men than women; when it
comes to cancer, the news for men is almost as bad. Women also have more
vigorous immune systems than men: of the 10 most common infections, men are
more likely to have serious encounters with seven of them.
While depression
is said
to be twice as frequent in women as in men, I'm convinced that the diagnosis is
just made more frequently in women, who show a greater willingness to discuss
their symptoms and to ask for help when in distress. Once, at a dinner party, I
asked a group of men whether they believed men were depressed as often as
women, but were simply conditioned to be silent in the face of discomfort,
sadness or fear. "Of course!" replied one man. "Why do you think
we die sooner?"
Considering the
relative fragility of men, it's clearly counterintuitive for us to urge them,
from boyhood on, to cope bravely with adversity, to ignore discomfort, to
persevere in spite of pain and to accept without question the most dangerous
jobs and tasks we have to offer. Perhaps the reason many societies offer boys
nutritional, educational and vocational advantages over girls is not because of
chauvinism it's because we're
trying to ensure their survival.
It's possible,
too, that we've simply been sexist. We've complained bitterly that until
recently women's health was restricted to keeping breasts and reproductive
organs optimally functional, reflecting the view that what made women valuable
was their ability to conceive and bear children. But aren't we doing the same
thing with men? Read the questions posed on the cover of men's magazines: how
robust is your sexuality? How well-developed are your abs? The only malignancy
I hear discussed with men is prostate cancer.
It's time to
focus on the unique problems of men just the way we have learned to do with
women. In 2004, the National Institutes of Health spent twice as much on
studies done only on women as only on men. We are not devoting nearly enough
money to men's health; worse yet, we may be spending those insufficient funds
to answer exactly the wrong questions.
The National
Institutes of Health should therefore convene a consensus conference to
identify the most important threats to men's well-being and longevity and issue
a request for research proposals to address them. Would an estrogen-like
molecule postpone the onset of coronary artery disease in susceptible males?
Are there ways to strengthen the male immune system?
Thinking about
how we might correct the comparative vulnerability of men instead of
concentrating on how we have historically neglected women's biology will
doubtless uncover new ways to improve men's health and ultimately, every human's ability to
survive.