Expert on the topic
Prof Dr Ute Seeland ▸
- Specialist in Internal Medicine and Professor of Gender-Sensitive Medicine at Otto von Guericke University Magdeburg
What would need to change in the design of clinical trials?
Seeland: We need to take sex and gender differences into account from the outset in clinical studies. The most important thing is that data are collected from both sexes. And that the data are then analysed separately by sex. It is of no use if I include 70 per cent men and 30 per cent women in a study and then mix the data together. The probability that drug A or B works in men is then not 100 per cent, but only 70 per cent. And in women it is only 30 per cent. This is also why we need to be careful with artificial intelligence. Its use must not throw us back into the 13th century. If AI learns from data that have not been analysed separately by sex, then everything we have researched over the past 20 years will be undone.
You head a university outpatient clinic for gender-sensitive medicine at Magdeburg University Hospital. What does that mean in practice?
Seeland: We are moving away from a purely organ-based approach to diagnosis towards a systems biology approach. I look at a person’s biological sex — female, male or intersex — and their sociocultural status. I am interested in the roles the person plays during the day. All of us have certain roles, sometimes voluntary and sometimes shaped by society. People often come to me because they can no longer cope with everyday life. They feel very well understood in the outpatient clinic. Take women in the so-called perimenopause, for example; this is a period of seven to ten years around the menopause itself. An incredible amount already happens to the female body during this phase, but it does not exist in the textbooks, nor is it taken into account in clinical trials.
How do you proceed during an examination?
Seeland: We work systematically through biological sex differences: we perform an ECG, measure fat, muscle and water distribution, carry out ultrasound scans of the heart, carotid arteries, thyroid and abdominal aorta, and measure arterial stiffness. In addition, patients are given a questionnaire for a “gender score”. In it, we ask about sociocultural background, education, financial circumstances and factors relating to discrimination. In my view, discrimination — just like high blood pressure or diabetes — is a major risk factor that can make people ill. Through this role-based history-taking, I make initial diagnoses in patients whose suffering has long been overlooked.
Do men also come to your clinic?
Seeland: About 78 per cent are women; the rest are men, often men affected by ADHD, attention deficit or hyperactivity disorder. Or men who do not have any of the classic symptoms of a heart attack, but instead those more commonly diagnosed in women, such as exhaustion, a pulling sensation in the jaw area, or back pain. If you don’t fit the classic textbook picture, you don’t stand much of a chance in our healthcare system.
In June, you are giving a lecture at the Leopoldina on gender-sensitive medicine, which is recognised as continuing medical education. Are your colleagues receptive to the topic?
Seeland: The demand is enormous! That is why I have to do a great deal of teaching — in the winter semester alone, I give seven lectures. It is unique that I have so much scope to train students. And I speak at many conferences. I was recently at a urology congress in Würzburg. After my lecture, a colleague stood up, visibly impressed, and said: “Professor Seeland, I have never heard a lecture like that in my entire life.” That is because I take a different approach, a systems biology one, and I think that impressed him.
Do you remember a particular moment when you realised that sex and gender differences were still not being sufficiently taken into account in medicine?
Seeland: Those were the moments on the wards in my first years of practice, when I noticed a great deal of dissatisfaction everywhere: among the patients — especially the female patients — but also among doctors and nursing staff. I realised that we did not have nearly as many good therapeutic approaches as I had imagined during my medical studies. There are so many people who simply cannot be cured with what we currently know.
But that is changing now?
Seeland: We are already seeing that not only cardiology, but a wide range of specialties within gender-sensitive medicine, are increasingly being given “slots” at their congresses and symposia. Even so, it is still far from self-sustaining; it still requires a major effort. And people who are convinced by this medical approach.
