I was surprised to know that gender and sex have different meanings. During a presentation at Cincinnati Childrens Hospital, Dr. Nick Holford had asked us to explain the differences between sex and gender. There was a moment of silence amongst the students contemplating on the issue. It seems that the scientific community has been using the terms interchangeably. Sex based differences in pharmacokinetics of drugs have been investigated and there is a fair amount of literature suggesting men and women absorb, distribute and metabolise some drugs differently.
Women have been found to have higher gastric PH, slower gastric emptying rate, higher percentage of fat leading to higher volume of distribution, higher rates of metabolism for CYP3A4 substrates and higher rates of clearance for P-gp substrates. In addition, fluctuation in homonal levels have also been implicated for differences in CYP3A4 activity. However, there is a relative paucity of data on sex differences in pharmacodynamics of drugs. Perhaps the most dramatic example is women developing torsades de pointes (a type of ventricular arrythmia) after taking ceratin medications. Women treated with anti-HIV drugs, especially protease inhibtors have also had higher incidences of adverse effects in several studies. They also experienced greater efficacy rates when compared to men, emphasising the need of more prospective studies to identify the mechanisms behind these observations.
As the participation and inclusion of women in clinical trials increases, we will be able to understand the significance of these differences. Going back to the differences in the terminology of SEX and GENDER, Kim & Nafziger in their commentary (reference 1) state that gender and sex are distinct concepts. Sex differences between men and women are attributed to biologocal differences including genetic, hormonal, reproductive and physical differences. While, gender difference are attributed to behavioral and cultural aspects like smoking, alcohol consumption etc. More interesting points on the differences with examples at WHO site
Feel free to comment and correct!
References:
1. Is it sex or is it gender? Clin Pharmacol Ther 2000;68:1-3.
2. Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol. 2004;44:499-523.
3. The influence of sex on pharmacokinetics. Clin Pharmacokinet. 2003;42(2):107-21
3 comments:
There are many postmodern notions about gender that have evolved into a body politics. Judith Butler focuses on this issue exclusively. Other writers include the french writer Monique Wittig.
Bulter and Wittig both make compelling arguments in reference to the formation of gender as cultural, even political. This is the body politics. While I do not personally agree with all of their arguments, I appreciate their cultural scholarship. Check 'em out.
Best in your blogging experience.
Hi Judth, Thanks for your valuable suggestions. It would be great to learn more about political and cultural perspectives on gender, in addition to what we do in drug development.
It seems to me that everything has not only a physical component but a cultural one. Drugs development is no different.
The many commercials that ask us to ask our doctors about a particular drug not only points to the desire to sell products but to make them acceptable culturally.
What do you think?
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