0:00:00.706,0:00:03.417
Some of my most wonderful memories of childhood

0:00:03.417,0:00:06.968
are of spending time with my grandmother, Mamar,

0:00:06.968,0:00:10.768
in our four-family home in Brooklyn, New York.

0:00:10.768,0:00:13.843
Her apartment was an oasis.

0:00:13.843,0:00:15.888
It was a place where I could sneak a cup of coffee,

0:00:15.888,0:00:19.769
which was really warm milk [br]with just a touch of caffeine.

0:00:19.769,0:00:22.303
She loved life.

0:00:22.303,0:00:24.798
And although she worked in a factory,

0:00:24.798,0:00:27.970
she saved her pennies and she traveled to Europe.

0:00:27.970,0:00:31.299
And I remember poring over those pictures with her

0:00:31.299,0:00:35.411
and then dancing with her to her favorite music.

0:00:35.411,0:00:40.033
And then, when I was eight and she was 60,

0:00:40.033,0:00:42.086
something changed.

0:00:42.086,0:00:44.440
She no longer worked or traveled.

0:00:44.440,0:00:46.131
She no longer danced.

0:00:46.131,0:00:48.884
There were no more coffee times.

0:00:48.884,0:00:51.068
My mother missed work and took her to doctors

0:00:51.068,0:00:53.454
who couldn't make a diagnosis.

0:00:53.454,0:00:58.791
And my father, who worked at night, [br]would spend every afternoon with her,

0:00:58.791,0:01:01.876
just to make sure she ate.

0:01:01.876,0:01:06.576
Her care became all-consuming for our family.

0:01:06.576,0:01:08.223
And by the time a diagnosis was made,

0:01:08.223,0:01:10.928
she was in a deep spiral.

0:01:10.928,0:01:14.489
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.

0:01:23.562,0:01:27.253
And back then, so little [br]was known about depression.

0:01:27.253,0:01:30.658
But even today, 50 years later,

0:01:30.658,0:01:33.932
there's still so much more to learn.

0:01:33.932,0:01:38.840
Today, we know that women [br]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,

0:01:46.952,0:01:53.239
women are misdiagnosed between [br]30 and 50 percent of the time.

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Now we know that women are more likely

0:01:56.172,0:02:01.560
to experience the symptoms [br]of fatigue, sleep disturbance,

0:02:01.560,0:02:04.105
pain and anxiety compared with men.

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And these symptoms are often overlooked

0:02:06.804,0:02:09.767
as symptoms of depression.

0:02:09.767,0:02:13.550
And it isn't only depression in which [br]these sex differences occur,

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but they occur across so many diseases.

0:02:18.069,0:02:20.064
So it's my grandmother's struggles

0:02:20.064,0:02:23.797
that have really led me on a lifelong quest.

0:02:23.797,0:02:27.025
And today, I lead a center in which the mission

0:02:27.025,0:02:30.804
is to discover why these sex differences occur

0:02:30.804,0:02:32.906
and to use that knowledge

0:02:32.906,0:02:35.865
to improve the health of women.

0:02:35.865,0:02:39.998
Today, we know that every cell has a sex.

0:02:39.998,0:02:43.951
Now, that's a term coined [br]by the Institute of Medicine.

0:02:43.951,0:02:47.712
And what it means is that [br]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 [br]across all of our organs.

0:02:57.094,0:03:02.589
From our brains to our hearts, our lungs, our joints.

0:03:02.589,0:03:06.473
Now, it was only 20 years ago

0:03:06.473,0:03:10.300
that we hardly had any data on women's health

0:03:10.300,0:03:13.183
beyond our reproductive functions.

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But then in 1993,

0:03:16.084,0:03:20.696
the NIH Revitalization Act was signed into law.

0:03:20.696,0:03:23.299
And what this law did was it mandated

0:03:23.299,0:03:27.772
that women and minorities [br]be included in clinical trials

0:03:27.772,0:03:31.823
that were funded by the National Institutes of Health.

0:03:31.823,0:03:34.750
And in many ways, the law has worked.

0:03:34.750,0:03:38.420
Women are now routinely [br]included in clinical studies,

0:03:38.420,0:03:40.671
and we've learned that there are major differences

0:03:40.671,0:03:42.764
in the ways that women and men

0:03:42.764,0:03:45.300
experience disease.

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But remarkably,

0:03:47.465,0:03:52.559
what we have learned about these [br]differences is often overlooked.

0:03:52.559,0:03:56.384
So, we have to ask ourselves the question:

0:03:56.384,0:04:00.897
Why leave women's health to chance?

0:04:00.897,0:04:03.540
And we're leaving it to chance in two ways.

0:04:03.540,0:04:07.237
The first is that there is so much more to learn

0:04:07.237,0:04:09.646
and we're not making the investment

0:04:09.646,0:04:13.814
in fully understanding the extent [br]of these sex differences.

0:04:13.814,0:04:18.536
And the second is that we aren't [br]taking what we have learned,

0:04:18.536,0:04:22.240
and routinely applying it in clinical care.

0:04:22.240,0:04:26.229
We are just not doing enough.

0:04:26.229,0:04:28.488
So, I'm going to share with you three examples

0:04:28.488,0:04:32.194
of where sex differences have [br]impacted the health of women,

0:04:32.194,0:04:34.864
and where we need to do more.

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Let's start with heart disease.

0:04:36.876,0:04:42.078
It's the number one killer of women [br]in the United States today.

0:04:42.078,0:04:44.974
This is the face of heart disease.

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Linda is a middle-aged woman,

0:04:47.255,0:04:49.840
who had a stent placed in one of the arteries

0:04:49.840,0:04:51.940
going to her heart.

0:04:51.940,0:04:55.191
When she had recurring symptoms [br]she went back to her doctor.

0:04:55.191,0:04:57.829
Her doctor did the gold standard test:

0:04:57.829,0:05:00.116
a cardiac catheterization.

0:05:00.116,0:05:02.533
It showed no blockages.

0:05:02.533,0:05:04.605
Linda's symptoms continued.

0:05:04.605,0:05:07.078
She had to stop working.

0:05:07.078,0:05:09.830
And that's when she found us.

0:05:09.830,0:05:13.978
When Linda came to us, we did [br]another cardiac catheterization

0:05:13.978,0:05:17.395
and this time, we found clues.

0:05:17.395,0:05:19.869
But we needed another test

0:05:19.869,0:05:22.463
to make the diagnosis.

0:05:22.463,0:05:27.043
So we did a test called an intracoronary ultrasound,

0:05:27.043,0:05:29.348
where you use soundwaves to look at the artery

0:05:29.348,0:05:32.079
from the inside out.

0:05:32.079,0:05:34.017
And what we found

0:05:34.017,0:05:36.468
was that Linda's disease didn't look like

0:05:36.468,0:05:39.538
the typical male disease.

0:05:39.538,0:05:42.734
The typical male disease looks like this.

0:05:42.734,0:05:46.046
There's a discrete blockage or stenosis.

0:05:46.046,0:05:50.347
Linda's disease, like the disease of so many women,

0:05:50.347,0:05:52.189
looks like this.

0:05:52.189,0:05:55.726
The plaque is laid down more evenly, more diffusely

0:05:55.726,0:05:59.698
along the artery, and it's harder to see.

0:05:59.698,0:06:03.104
So for Linda, and for so many women,

0:06:03.104,0:06:06.796
the gold standard test wasn't gold.

0:06:06.796,0:06:09.783
Now, Linda received the right treatment.

0:06:09.783,0:06:11.961
She went back to her life and, fortunately, today

0:06:11.961,0:06:13.713
she is doing well.

0:06:13.713,0:06:15.319
But Linda was lucky.

0:06:15.319,0:06:17.945
She found us, we found her disease.

0:06:17.945,0:06:20.856
But for too many women, that's not the case.

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We have the tools.

0:06:23.171,0:06:26.852
We have the technology to make the diagnosis.

0:06:26.852,0:06:30.249
But it's all too often that these sex diffferences

0:06:30.249,0:06:32.553
are overlooked.

0:06:32.553,0:06:34.726
So what about treatment?

0:06:34.726,0:06:37.436
A landmark study that was published two years ago

0:06:37.436,0:06:39.858
asked the very important question:

0:06:39.858,0:06:44.913
What are the most effective treatments [br]for heart disease in women?

0:06:44.913,0:06:48.572
The authors looked at papers [br]written over a 10-year period,

0:06:48.572,0:06:51.050
and hundreds had to be thrown out.

0:06:51.050,0:06:55.823
And what they found out was that [br]of those that were tossed out,

0:06:55.823,0:06:59.477
65 percent were excluded

0:06:59.477,0:07:03.841
because even though women [br]were included in the studies,

0:07:03.841,0:07:10.197
the analysis didn't differentiate [br]between women and men.

0:07:10.197,0:07:13.418
What a lost opportunity.

0:07:13.418,0:07:15.449
The money had been spent

0:07:15.449,0:07:17.596
and we didn't learn how women fared.

0:07:17.596,0:07:20.397
And these studies could not contribute one iota

0:07:20.397,0:07:22.814
to the very, very important question,

0:07:22.814,0:07:25.205
what are the most effective treatments

0:07:25.205,0:07:28.100
for heart disease in women?

0:07:28.100,0:07:33.592
I want to introduce you to [br]Hortense, my godmother,

0:07:33.592,0:07:37.035
Hung Wei, a relative of a colleague,

0:07:37.035,0:07:39.226
and somebody you may recognize --

0:07:39.226,0:07:42.873
Dana, Christopher Reeve's wife.

0:07:42.873,0:07:47.233
All three women have something [br]very important in common.

0:07:47.233,0:07:50.808
All three were diagnosed with lung cancer,

0:07:50.808,0:07:53.737
the number one cancer killer of women

0:07:53.737,0:07:56.438
in the United States today.

0:07:56.438,0:08:00.314
All three were nonsmokers.

0:08:00.314,0:08:05.480
Sadly, Dana and Hung Wei died of their disease.

0:08:05.480,0:08:11.620
Today, what we know is that women who are[br]nonsmokers are three times more likely

0:08:11.620,0:08:14.357
to be diagnosed with lung cancer than are men

0:08:14.357,0:08:16.343
who are nonsmokers.

0:08:16.343,0:08:20.033
Now interestingly, when women are [br]diagnosed with lung cancer,

0:08:20.033,0:08:23.212
their survival tends to be better than that of men.

0:08:23.212,0:08:25.087
Now, here are some clues.

0:08:25.087,0:08:27.486
Our investigators have found that there are

0:08:27.486,0:08:32.158
certain genes in the lung tumor [br]cells of both women and men.

0:08:32.158,0:08:34.350
And these genes are activated

0:08:34.350,0:08:36.440
mainly by estrogen.

0:08:36.440,0:08:39.258
And when these genes are over-expressed,

0:08:39.258,0:08:41.989
it's associated with improved survival

0:08:41.989,0:08:44.656
only in young women.

0:08:44.656,0:08:46.330
Now this is a very early finding

0:08:46.330,0:08:49.973
and we don't yet know whether it has relevance

0:08:49.973,0:08:52.414
to clinical care.

0:08:52.414,0:08:56.273
But it's findings like this that may provide hope

0:08:56.273,0:08:59.040
and may provide an opportunity to save lives

0:08:59.040,0:09:01.587
of both women and men.

0:09:01.587,0:09:02.968
Now, let me share with you an example

0:09:02.968,0:09:06.946
of when we do consider sex differences,[br]it can drive the science.

0:09:06.946,0:09:09.274
Several years ago a new lung cancer drug

0:09:09.274,0:09:10.920
was being evaluated,

0:09:10.920,0:09:15.292
and when the authors looked [br]at whose tumors shrank,

0:09:15.292,0:09:18.725
they found that 82 percent were women.

0:09:18.725,0:09:21.688
This led them to ask the question: Well, why?

0:09:21.688,0:09:23.243
And what they found

0:09:23.243,0:09:26.723
was that the genetic mutations [br]that the drug targeted

0:09:26.723,0:09:29.450
were far more common in women.

0:09:29.450,0:09:31.149
And what this has led to

0:09:31.149,0:09:33.331
is a more personalized approach

0:09:33.331,0:09:37.485
to the treatment of lung cancer [br]that also includes sex.

0:09:37.485,0:09:39.580
This is what we can accomplish

0:09:39.580,0:09:43.406
when we don't leave women's health to chance.

0:09:43.406,0:09:46.614
We know that when you invest in research,

0:09:46.614,0:09:48.140
you get results.

0:09:48.140,0:09:52.648
Take a look at the death rate [br]from breast cancer over time.

0:09:52.648,0:09:54.573
And now take a look at the death rates

0:09:54.573,0:09:57.905
from lung cancer in women over time.

0:09:57.905,0:10:01.515
Now let's look at the dollars [br]invested in breast cancer --

0:10:01.515,0:10:04.484
these are the dollars invested per death --

0:10:04.484,0:10:08.712
and the dollars invested in lung cancer.

0:10:08.712,0:10:13.633
Now, it's clear that our investment in breast cancer

0:10:13.633,0:10:15.422
has produced results.

0:10:15.422,0:10:17.755
They may not be fast enough,

0:10:17.755,0:10:19.981
but it has produced results.

0:10:19.981,0:10:21.785
We can do the same

0:10:21.785,0:10:26.776
for lung cancer and for every other disease.

0:10:26.776,0:10:30.102
So let's go back to depression.

0:10:30.102,0:10:32.412
Depression is the number one cause

0:10:32.412,0:10:37.004
of disability in women in the world today.

0:10:37.004,0:10:39.139
Our investigators have found

0:10:39.139,0:10:40.955
that there are differences in the brains

0:10:40.955,0:10:42.432
of women and men

0:10:42.432,0:10:45.551
in the areas that are connected with mood.

0:10:45.551,0:10:47.624
And when you put men and women

0:10:47.624,0:10:49.499
in a functional MRI scanner --

0:10:49.499,0:10:54.046
that's the kind of scanner that shows how the brain is functioning when it's activated --

0:10:54.046,0:10:58.089
so you put them in the scanner [br]and you expose them to stress.

0:10:58.089,0:11:01.976
You can actually see the difference.

0:11:01.976,0:11:04.505
And it's findings like this

0:11:04.505,0:11:07.486
that we believe hold some of the clues

0:11:07.486,0:11:11.239
for why we see these very significant sex differences

0:11:11.239,0:11:13.493
in depression.

0:11:13.493,0:11:15.051
But even though we know

0:11:15.051,0:11:17.918
that these differences occur,

0:11:17.918,0:11:20.571
66 percent

0:11:20.571,0:11:24.567
of the brain research that begins in animals

0:11:24.567,0:11:26.893
is done in either male animals

0:11:26.893,0:11:31.240
or animals in whom the sex is not identified.

0:11:31.240,0:11:34.859
So, I think we have to ask again the question:

0:11:34.859,0:11:39.661
Why leave women's health to chance?

0:11:39.661,0:11:42.489
And this is a question that haunts those of us

0:11:42.489,0:11:44.300
in science and medicine

0:11:44.300,0:11:50.659
who believe that we are on the verge [br]of being able to dramatically improve

0:11:50.659,0:11:52.335
the health of women.

0:11:52.335,0:11:54.821
We know that every cell has a sex.

0:11:54.821,0:11:57.763
We know that these differences [br]are often overlooked.

0:11:57.763,0:12:02.051
And therefore we know that women [br]are not getting the full benefit

0:12:02.051,0:12:05.950
of modern science and medicine today.

0:12:05.950,0:12:07.601
We have the tools

0:12:07.601,0:12:11.483
but we lack the collective will and momentum.

0:12:11.483,0:12:14.227
Women's health is an equal rights issue

0:12:14.227,0:12:17.781
as important as equal pay.

0:12:17.781,0:12:19.965
And it's an issue of the quality

0:12:19.965,0:12:23.120
and the integrity of science and medicine.

0:12:23.120,0:12:30.583
(Applause)

0:12:30.583,0:12:35.128
So imagine the momentum we could achieve

0:12:35.128,0:12:37.239
in advancing the health of women

0:12:37.239,0:12:40.098
if we considered whether these [br]sex differences were present

0:12:40.098,0:12:43.687
at the very beginning of designing research.

0:12:43.687,0:12:47.566
Or if we analyzed our data by sex.

0:12:47.566,0:12:49.514
So, people often ask me:

0:12:49.514,0:12:51.285
What can I do?

0:12:51.285,0:12:53.619
And here's what I suggest:

0:12:53.619,0:12:57.792
First, I suggest that you think about women's health

0:12:57.792,0:12:59.535
in the same way

0:12:59.535,0:13:05.580
that you think and care about other [br]causes that are important to you.

0:13:05.580,0:13:08.762
And second, and equally as important,

0:13:08.762,0:13:10.974
that as a woman,

0:13:10.974,0:13:13.615
you have to ask your doctor

0:13:13.615,0:13:18.027
and the doctors who are caring [br]for those who you love:

0:13:18.027,0:13:22.903
Is this disease or treatment different in women?

0:13:22.903,0:13:26.491
Now, this is a profound question [br]because the answer is likely yes,

0:13:26.491,0:13:30.188
but your doctor may not know [br]the answer, at least not yet.

0:13:30.188,0:13:34.564
But if you ask the question, [br]your doctor will very likely

0:13:34.564,0:13:36.846
go looking for the answer.

0:13:36.846,0:13:39.183
And this is so important,

0:13:39.183,0:13:41.345
not only for ourselves,

0:13:41.345,0:13:43.998
but for all of those whom we love.

0:13:43.998,0:13:48.482
Whether it be a mother, a daughter, a sister,

0:13:48.482,0:13:52.179
a friend or a grandmother.

0:13:52.179,0:13:54.322
It was my grandmother's suffering

0:13:54.322,0:13:56.255
that inspired my work

0:13:56.255,0:13:59.240
to improve the health of women.

0:13:59.240,0:14:01.590
That's her legacy.

0:14:01.590,0:14:06.259
Our legacy can be to improve the health of women

0:14:06.259,0:14:08.398
for this generation

0:14:08.398,0:14:11.420
and for generations to come.

0:14:11.420,0:14:13.569
Thank you.

0:14:13.569,0:14:16.851
(Applause)