Notes on Engineering Health, June 2023: Notes on Women’s Health

Jonathan Friedlander, PhD
Geoffrey W. Smith

Jonathan Friedlander, PhD & Geoffrey W. Smith

June 28, 2023

“On the Diseases and Cures of Women” is considered the oldest surviving medical text by a woman. Written by Metrodora (meaning gift of the uterus), a physician and medical writer, the document dates from the 5th century AD and is kept in the Laurentian Library. The piece primarily covers gynecological issues, including treatment for vaginal infections and the use of the speculum for medical examination.

Although the definition of Women’s Health has expanded and emerged as a vital area of medical and policy research since Metrodora’s writing, it is still often synonymous only with reproductive health. According to the World Health Organization, though, women’s health should be described broadly and encompass "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Hence it is essential when considering Women’s Health to include biological differences between men and women, but also physiological and social ones in assessing the full state of a woman’s health and well-being.

1. Biological differences
The most apparent differences between men and women are biological. Differences in chromosomes, hormones, reproductive systems, and body composition require specialties such as obstetrics and gynecology. Certain conditions, such as polycystic ovary syndrome (PCOS), endometriosis, and mittelschmerz (ovulation pains), exclusively affect women (or are more prevalent in women). During menopause, for instance, the brain is reshaped, and the hypothalamus doubles in size, which we now know could cause hot flashes experienced by 80% of women. Understanding these conditions and their impact on women's health is crucial for developing effective treatments and preventive strategies.

2. Physiological differences
Women experience certain diseases and conditions differently than men, affecting diagnosis, treatment, and overall health outcomes. We covered some of these differences in our Notes on Engineering Health of June 2021. We gave a few examples of conditions most experienced by women, such as autoimmune diseases, or experiences with differing symptoms in the case of high blood pressure affecting 43% of women. It is also worth mentioning that one in ten women suffers from depression. A recent survey by Gallup showed that over one-third of women report having been diagnosed with depression at some point in their lifetime, compared with about 20% of men. Although the different rates of depression have biological causes, there are no doubt a number of sociocultural factors at play (covered below). New understandings in women’s biology happened only recently, as for example developments between 1977 and 1993 resulted in women of childbearing age being automatically excluded from clinical trials after Thalidomide treatment was found to have caused birth defects. Perhaps as a somewhat unintended consequence of this development, though, women are underrepresented in clinical trials—even though we know drugs metabolize differently in women and men. A classic example of this phenomenon is that acetaminophen, the main ingredient of Tylenol, is eliminated in females at approximately 60% of the rate of elimination documented in males.

3. Sociocultural factors
Women's health is also influenced by social, economic, and cultural factors that differ from those affecting men. These factors can include access to healthcare, societal expectations, and gender-specific stressors. For instance, in the most extensive study conducted in the US, the Mayo Clinic recently reported the staggering cost of menopause for women in the workforce. Addressing these disparities requires a dedicated focus on women's health to identify and address the unique challenges women face in maintaining their health and well-being.

What has been done to reduce the gap in knowledge, funding, and solutions dedicated to improving the health of women, and what is left to be achieved? Studying women's health as a separate discipline allows for a deeper understanding of the unique aspects of women's experiences and physiology, which can lead to improved healthcare for women.

– Dedicated research in women's health. Efforts to bolster the participation of women in clinical studies have ensured that roughly half of the participants in NIH-funded trials are women. The NIH even has an office dedicated to research into women’s health. The agency mandates that researchers use both male and female animals in their studies, as appropriate. Despite this momentum, funding for research in women’s health is lacking. This month, Nature published a detailed and didactic analysis of the gap between funding for conditions that affect women more than men. The article also highlights the work of a non-profit advocacy group, Women’s Health Access Matters (WHAM), that shows that funding in this space would be a worthy financial investment.

– More funding in women’s health innovation. Given that more than 80% of healthcare buying decisions are made by women, that women comprise roughly 70% of all healthcare workers, that they spend more on their health, and are far more likely to use digital health tools than men, the broad field of women’s health as we just described should see more investment and more innovation. Surprisingly, just 3% of the businesses that have raised financing since 2011 are focused on women’s health, according to a Rock Health report. The majority of those financings support companies addressing reproductive health. Additionally, research shows women raise less than half the capital of male founders on average. Despite this poor track record, some momentum has been building on the investment and entrepreneurship side, and the landscape of startups and more mature companies is growing albeit slowly.

Since Metrodora’s time, women’s health has been best researched, written about, and advocated by women themselves, but the issue is all of ours. From her ancient past to the NIH Revitalization Act of 1993 that rescinded the 1977 policy that banned most women from participating in clinical studies to the latest efforts to broaden the definition and enhance the focus on women’s health, closing the gender gap in healthcare has been, and continues to be a lengthy and arduous endeavor. Founders of women’s health startups across the spectrum have a crucial role to play alongside regulators, public health experts, MDs, scientists, pharmaceutical groups, investors, and society at large. By reducing existing biases and focusing on women’s health as a separate discipline, we can drive meaningful change and create a healthier future for women everywhere.

– Jonathan Friedlander, PhD & Geoffrey W. Smith

First Five
First Five is our curated list of articles, studies, and publications for the month. For our full list of interesting media in health, science, and technology, updated regularly, follow us on Twitter or Instagram.

1/ The brain’s response to foods
The ways the brain processes food intake vary, and a recent study published in Nature highlighted key differences in how people with and without obesity respond to meals. While lean individuals had significant cerebral neuronal activity after a glucose and lipid gastric infusion (to avoid mastication biases), obese people had a severely impaired response. A troubling fact was that the neuronal response did not increase after people lost weight, probably contributing to the high rate of weight regain. This well-conducted study proves once more that obesity is a systemic disease and new approaches are necessary to address all its facets.

2/ Seeing death is stressful
It is well-known that stress is a key factor in health and aging, but linking adverse events to specific biological processes is more difficult. Researchers showed that Drosophila melanogaster, the common fruit fly, had a reduced lifespan when in contact with dead flies (of the same species). The Nature study showed that olfactory and visual functions were necessary to shock the flies, for which metabolism was significantly impacted.

3/ Sometimes more virus is better
Diversity has been a hallmark of a healthy gut microbiome. A recent study in Nature Microbiology comparing centenarians with younger adults and older individuals showed that the virome might also play a role. Centenarians had a more diverse virome with a population shift towards higher lytic activity.

4/ Time to cuddle your house plant?
A recent study in Nature Plants showed that, even without nerves, plants could sense when something touched them and when it let go. Scientists showed that individual plant cells responded to the touch of a very fine glass rod by sending slow waves of calcium signals to other plant cells, and when that pressure was released, they sent much more rapid waves. The granularity of the response was not observed before with such clarity.

5/ Understanding diseases differently
A large-scale effort to construct a complex, homeostatic system of human disease interdependence was just published in Nature Computational Science. Combining time-stamped clinical records of over 151 million unique Americans and a UK Biobank cohort with half a million participants, the scientists not only constructed a disease representation where diseases with similar manifestations lie near one another but they also performed a genome-wide association study of newly defined human quantitative traits. This system allowed the researchers to discover new connections between health state and gene variants as well as predict various morbidities.

Digitalis Commons
Public-Interest Technologies for Better Health

Digitalis Commons is a non-profit that partners with groups and individuals striving to address complex health problems by building public-interest technology solutions that are frontier-advancing, open-access, and scalable.

As global temperatures rise, cities across the world are rushing to adapt. Reports like the one recently published in The Lancet Planetary Health highlight the health risk of warming cities—especially Paris!—and the levers available to urban planners and architects to counteract the effects of heat. One such researcher and planner is Holly Samuelson, an associate professor of architecture at the Harvard Graduate School of Design. She focuses on architectural technology and how issues related to building design impact human and environmental health. Her work alongside developers, technologists, and regulators will help shape cities better adapted to a warmer world.

To subscribe to Engineering Biology by Jacob Oppenheim, and receive newly published articles via email, please enter your email address below.