How science evolved its views on women's health

Men and women are different.

This might sound like the opening to a comedy routine, 但是，近几十年来，对这些差异的重要性以及如何研究它们的科学理解进展缓慢.

参与历史调查的研究人员表示，科学必须克服自身的盲点.

The awareness has been gradual, said professor Linda Van Horn, 芝加哥西北大学范伯格医学院预防医学系营养科主任.

"It wasn't a moment in time. It was growing recognition, as most things in medicine are," she said.

Eventually, 研究人员认为，弄清楚男女在生理上的差异是值得探索的. "It now seems kind of laughable, if you think about it," Van Horn said.

The contrasts can be critical. Considering heart health alone, women now are known to suffer more from the effects of smoking and can exhibit different heart attack symptoms.

理解这些差异的障碍并不总是简单的性别歧视. Frank Speizer, the Edward H. Kass Distinguished Professor of Medicine at Harvard Medical School in Boston.

"I think everybody knew women got the same diseases" as men, said Speizer, who also is a professor of environmental health at the Harvard T.H. Chan School of Public Health. 但当涉及到心脏病时，公认的观点认为女性在更年期之前是不会患心脏病的. Research would disprove that. "But people thought that at the time. 因此，要想从事一项事业，你必须研究疾病在哪里。. "And the disease was in men."

Speizer was the founding principal investigator of the Nurses' Health Study, one of the most significant studies of women's health ever undertaken.

It aimed to look at the health effects of oral contraceptives. Speizer和他的同事们模仿了一项著名的英国医生调查，该调查将吸烟和癌症联系起来. Based on the groundbreaking science that study accomplished, Speizer planned to survey doctors' wives.

"That just seemed like the logical way to go," he said. And a test run succeeded in England in 1971.

But a follow-up test didn't go so well. 为了反映社会的变化，测试问卷的收信人是“Mrs.," "Ms.或“医生，把这个给你妻子”，看看哪个会得到最多的回应. The "Ms." group fared worst, and in the "Mrs." group, researchers learned that many women had never seen the survey; their husbands had filled out the form for them.

意识到“这是一个不可能的情况，”斯佩泽转向调查护士. The rest became health history, as the study, which launched with 121,700 married nurses in 1976, and its spinoffs continue to generate valuable science. The nurses, he said, became "extraordinarily collaborative, trusted colleagues in providing their health information."

Over the years, 护士健康研究的研究人员将参与者(原始组, reflecting the profession at the time, was 97% white) and research areas, leading to findings about diet and exercise that shaped federal guidelines.

范霍恩是另一个大型研究项目的指导委员会成员 Women's Health Initiative. That study, launched in 1992, recruited more than 161,000 women. Initially, it was to examine the effects of hormone therapy, diet, and calcium and vitamin D supplementation in postmenopausal women. 乳腺癌是研究的主要焦点，但该研究收集了妇女健康的广泛领域的数据.

Today, Van Horn said, 该计划继续提供数据驱动的结果，这些结果基于20多年来的生活方式.

这类研究需要“一些非常强大的女性健康捍卫者”来支持, said Van Horn. She and Speizer both noted the efforts of Bernadine Healy, who, in 1991, became the first woman to run the National Institutes of Health.

1993年，国会修改了法律，要求将妇女纳入医学研究. But some changes have come slowly. 许多早期的药物研究都是只用雄性实验动物来确定合适的剂量, Van Horn noted.

这是合理的，因为激素和月经周期会使研究数据复杂化. "Surprise!" she said. "They complicate life for women."

直到2014年，美国国立卫生研究院才开始要求在研究中使用雄性和雌性实验动物. 范霍恩回忆说，这促使喜剧演员斯蒂芬·科尔伯特(Stephen Colbert)用一整段独白来谈论这个话题, cracking, “任何科学家都知道，消除外来变量至关重要——比如全球一半的人口."

Work remains. 一项关于2000年至2017年心血管健康临床试验的研究显示，只有38%的参与者是女性.

But future research will be able to build on efforts that began decades ago. For example, in the 1980s, Nurses' Health Study researchers began to gather blood, tissue and toenail samples. "Those are just going to pay off in the next probably 10 years," Speizer said, 随着科学家对遗传学以及行为和环境如何影响基因工作的了解越来越多.

In looking to what's next beyond these two landmark studies, 范霍恩对使用精确营养来帮助预防疾病的前景感到兴奋. 很明显，水果、蔬菜、全谷物等对人体有益. “我们仍然不知道的是——我发现越来越吸引人的是——男女之间的差异是什么?"

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