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Some of my most wonderful memories of childhood

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are of spending time with my grandmother, Mamar,

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in our four-family home in Brooklyn, New York.

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Her apartment was an oasis.

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It was a place where I could sneak a cup of coffee,

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which was really warm milk 
with just a touch of caffeine.

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She loved life.

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And although she worked in a factory,

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she saved her pennies and she traveled to Europe.

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And I remember pouring over those pictures with her

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and then dancing with her to her favorite music.

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And then, when I was eight and she was 60,

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something changed.

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She no longer worked or traveled.

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She no longer danced.

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There were no more coffee times.

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My mother missed work and took her to doctors

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who couldn't make a diagnosis.

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And my father, who worked at night, 
would spend every afternoon with her,

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just to make sure she ate.

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Her care became all-consuming for our family.

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And by the time a diagnosis was made,

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she was in a deep spiral.

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Now many of you will recognize her symptoms.

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My grandmother had depression.

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A deep, life-altering depression,

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from which she never recovered.

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And back then, so little 
was known about depression.

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But even today, 50 years later,

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there's still so much more to learn.

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Today, we know that women 
are 70 percent more likely

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to experience depression over their lifetimes

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compared with men.

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And even with this high prevalence,

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women are misdiagnosed between 
30 and 50 percent of the time.

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Now we know that women are more likely

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to experience the symptoms 
of fatigue, sleep disturbance,

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pain and anxiety compared with men.

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And these symptoms are often overlooked

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as symptoms of depression.

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And it isn't only depression in which 
these sex differences occur,

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but they occur across so many diseases.

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So it's my grandmother's struggles

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that have really led me on a lifelong quest.

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And today, I lead a center in which the mission

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is to discover why these sex differences occur

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and to use that knowledge

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to improve the health of women.

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Today, we know that every cell has a sex.

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Now, that's a term coined 
by the Institute of Medicine.

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And what it means is that 
men and women are different

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down to the cellular and molecular levels.

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It means that we're different 
across all of our organs.

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From our brains to our hearts, our lungs, our joints.

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Now, it was only 20 years ago

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that we hardly had any data on women's health

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beyond our reproductive functions.

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But then in 1993,

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the NIH Revitalization Act was signed into law.

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And what this law did was it mandated

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that women and minorities 
be included in clinical trials

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that were funded by the National Institutes of Health.

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And in many ways, the law has worked.

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Women are now routinely 
included in clinical studies,

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and we've learned that there are major differences

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in the ways that women and men

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experience disease.

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But remarkably,

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what we have learned about these 
differences is often overlooked.

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So, we have to ask ourselves the question:

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Why leave women's health to chance?

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And we're leaving it to chance in two ways.

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The first is that there is so much more to learn

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and we're not making the investment

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in fully understanding the extent 
of these sex differences.

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And the second is that we aren't 
taking what we have learned,

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and routinely applying it in clinical care.

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We are just not doing enough.

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So, I'm going to share with you three examples

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of where sex differences have 
impacted the health of women,

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and where we need to do more.

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Let's start with heart disease.

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It's the number one killer of women 
in the United States today.

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This is the face of heart disease.

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Linda is a middle-aged woman,

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who had a stent placed in one of the arteries

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going to her heart.

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When she had recurring symptoms 
she went back to her doctor.

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Her doctor did the gold standard test:

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a cardiac catheterization.

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It showed no blockages.

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Linda's symptoms continued.

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She had to stop working.

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And that's when she found us.

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When Linda came to us, we did 
another cardiac catheterization

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and this time, we found clues.

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But we needed another test

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to make the diagnosis.

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So we did a test called an intracoronary ultrasound,

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where you use soundwaves to look at the artery

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from the inside out.

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And what we found

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was that Linda's disease didn't look like

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the typical male disease.

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The typical male disease looks like this.

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There's a discrete blockage or stenosis.

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Linda's disease, like the disease of so many women,

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looks like this.

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The plaque is laid down more evenly, more diffusely

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along the artery, and it's harder to see.

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So for Linda, and for so many women,

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the gold standard test wasn't gold.

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Now, Linda received the right treatment.

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She went back to her life and, fortunately, today

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she is doing well.

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But Linda was lucky.

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She found us, we found her disease.

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But for too many women, that's not the case.

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We have the tools.

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We have the technology to make the diagnosis.

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But it's all too often that these sex diffferences

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are overlooked.

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So what about treatment?

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A landmark study that was published two years ago

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asked the very important question:

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What are the most effective treatments 
for heart disease in women?

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The authors looked at papers 
written over a 10-year period,

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and hundreds had to be thrown out.

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And what they found out was that 
of those that were tossed out,

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65 percent were excluded

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because even though women 
were included in the studies,

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the analysis didn't differentiate 
between women and men.

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What a lost opportunity.

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The money had been spent

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and we didn't learn how women fared.

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And these studies could not contribute one iota

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to the very, very important question,

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what are the most effective treatments

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for heart disease in women?

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I want to introduce you to 
Hortense, my godmother,

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Hung Wei, a relative of a colleague,

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and somebody you may recognize --

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Dana, Christopher Reeve's wife.

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All three women have something 
very important in common.

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All three were diagnosed with lung cancer,

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the number one cancer killer of women

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in the United States today.

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All three were nonsmokers.

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Sadly, Dana and Hung Wei died of their disease.

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Today, what we know is that women who are
nonsmokers are three times more likely

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to be diagnosed with lung cancer than are men

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who are nonsmokers.

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Now interestingly, when women are 
diagnosed with lung cancer,

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their survival tends to be better than that of men.

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Now, here are some clues.

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Our investigators have found that there are

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certain genes in the lung tumor 
cells of both women and men.

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And these genes are activated

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mainly by estrogen.

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And when these genes are over-expressed,

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it's associated with improved survival

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only in young women.

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Now this is a very early finding

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and we don't yet know whether it has relevance

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to clinical care.

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But it's findings like this that may provide hope

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and may provide an opportunity to save lives

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of both women and men.

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Now, let me share with you an example

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of when we do consider sex differences,
it can drive the science.

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Several years ago a new lung cancer drug

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was being evaluated,

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and when the authors looked 
at whose tumors shrank,

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they found that 82 percent were women.

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This led them to ask the question: Well, why?

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And what they found

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was that the genetic mutations 
that the drug targeted

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were far more common in women.

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And what this has led to

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is a more personalized approach

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to the treatment of lung cancer 
that also includes sex.

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This is what we can accomplish

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when we don't leave women's health to chance.

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We know that when you invest in research,

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you get results.

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Take a look at the death rate 
from breast cancer over time.

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And now take a look at the death rates

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from lung cancer in women over time.

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Now let's look at the dollars 
invested in breast cancer --

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these are the dollars invested per death --

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and the dollars invested in lung cancer.

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Now, it's clear that our investment in breast cancer

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has produced results.

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They may not be fast enough,

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but it has produced results.

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We can do the same

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for lung cancer and for every other disease.

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So let's go back to depression.

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Depression is the number one cause

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of disability in women in the world today.

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Our investigators have found

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that there are differences in the brains

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of women and men

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in the areas that are connected with mood.

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And when you put men and women

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in a functional MRI scanner --

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that's the kind of scanner that shows how the brain is functioning when it's activated --

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so you put them in the scanner 
and you expose them to stress.

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You can actually see the difference.

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And it's findings like this

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that we believe hold some of the clues

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for why we see these very significant sex differences

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in depression.

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But even though we know

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that these differences occur,

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66 percent

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of the brain research that begins in animals

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is done in either male animals

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or animals in whom the sex is not identified.

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So, I think we have to ask again the question:

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Why leave women's health to chance?

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And this is a question that haunts those of us

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in science and medicine

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who believe that we are on the verge 
of being able to dramatically improve

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the health of women.

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We know that every cell has a sex.

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We know that these differences 
are often overlooked.

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And therefore we know that women 
are not getting the full benefit

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of modern science and medicine today.

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We have the tools

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but we lack the collective will and momentum.

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Women's health is an equal rights issue

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as important as equal pay.

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And it's an issue of the quality

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and the integrity of science and medicine.

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(Applause)

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So imagine the momentum we could achieve

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in advancing the health of women

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if we considered whether these 
sex differences were present

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at the very beginning of designing research.

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Or if we analyzed our data by sex.

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So, people often ask me:

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What can I do?

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And here's what I suggest:

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First, I suggest that you think about women's health

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in the same way

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that you think and care about other 
causes that are important to you.

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And second, and equally as important,

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that as a woman,

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you have to ask your doctor

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and the doctors who are caring 
for those who you love:

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Is this disease or treatment different in women?

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Now, this is a profound question 
because the answer is likely yes,

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but your doctor may not know 
the answer, at least not yet.

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But if you ask the question, 
your doctor will very likely

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go looking for the answer.

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And this is so important,

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not only for ourselves,

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but for all of those whom we love.

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Whether it be a mother, a daughter, a sister,

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a friend or a grandmother.

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It was my grandmother's suffering

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that inspired my work

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to improve the health of women.

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That's her legacy.

266
00:14:01,590 --> 00:14:06,259
Our legacy can be to improve the health of women

267
00:14:06,259 --> 00:14:08,398
for this generation

268
00:14:08,398 --> 00:14:11,420
and for generations to come.

269
00:14:11,420 --> 00:14:13,569
Thank you.

270
00:14:13,569 --> 00:14:16,851
(Applause)