Not testing on women, and particularly avoiding pregnant women, is how to end up with another thalidomide case.
Sure, you wouldn't want pregnant women to be amongst your first field test subjects. But you do want them to be included as part of the carefully monitored testing period, rather than wait until the drug goes commercial and there is not the same focus on looking for and collecting data on side effects.
Are doctors even allowed to ask patients about their gender? That's sensitive private info, right? Also, people are free to choose their own gender and even change their mind about it every other week, so the therapy would need to be adjusted accordingly. /s
I realize this is meant as a joke, but in all seriousness, this does go against some of the absurdist grain of what we're seeing today. No one should be bullied or made fun of for their beliefs, but the idea that biological sex is some type of subjective personal choice is ideological; even religious. Papers like this could seriously face censorship in the future, and it's something we need to address and take seriously.
> No one should be bullied or made fun of for their beliefs, but the idea that biological sex is some type of subjective personal choice is ideological; even religious.
uh thats what the activists believe and its what the first comment was talking about. people in europe are being arrested because they used the "wrong" sex.
of course theres a difference but if everyone accepted that then there wouldnt be a big problem now
This, exactly. If a doctor can be essentially disbarred for providing a recommended treatment specific to one's biological sex regardless of the patient's view on their gender, and that demand is made by the patient _to the patient's detriment_, doctors are put in an impossible situation, forsaking their oath in all courses of action.
I'd ask everyone who came to this article with the assumption that someone would object to or get offended by this finding, to actually observe if anyone does.
I'm talking about biological sex (which implies gender, there isn't anything 'gender' in biology).
The vast majority of cases you see today with people claiming to be the sex they're not are psychological, not physical. They're men with XY chromosomes wanting to be women, or the opposite, women with XX chromosomes wanting to be men. The other cases (e.g. XXY and XYY) are very small in comparison.
> I'm talking about biological sex (which implies gender,
No, it doesn't. Gender (which is distinct from both sex and gender identity, though there is an increasingly popular modern view that gender should be ascribed based on gender identity) is a socially ascribed trait, and different societies have recognized different numbers of genders and used different methods of ascribing them.
> The vast majority of cases you see today with people claiming to be the sex they're not are psychological, not physical.
The idea that there is such a thing as “psychological, not physical” is mystical woo that has no place in fact-based discussion, and divergences between gender identity and gender ascribed based on sex determined by chromosome counting has an observed correlation with other physical divergences from typical traits for the assigned sex.
The facts are that if your chromosomes are XX you're female, and XY you're male. This directly affects things like strength, size of organs, behavior, and more. Anything else is just mental issues. There are inherent differences between men and women whether people want to admit it or not, biology doesn't care about someones feelings
> The facts are that if you're chromosomes are XX you're female, and XY you're male.
The facts are that if you have the sex-determining-region Y (SRY) gene (which usually comes on the Y chromosome, but may be missing or defective, or may be on the X chromosome because genes do funny things), you are most likely biologically more-male-than-not and if you don't you probably are more-female-than-not.
But even SRY-or-not isn't enough: XX male syndrome, which normally occurs because of an unusual recombination event where a copy of SRY ends up on an X chromosome, can also happen without a copy of SRY, and XY females can exist with SRY in complete androgen insensitivity syndrome (largely, because of variations in genes responsible for androgen receptors, which are located on the X chromosome.)
The idea that biological sex is binary and corresponds to XY vs. XX is simply false; there's a lot more than “what shape are your sex chromosomes” involved.
Androgen insensitivity syndrome says something else. Here you have a XY male with female genitalia and secondary traits like say strength of that of a female.
Then we have the world of chimerism, ie a person with two set of chromosomes. Genitals of both sexes may be formed.
Then we have mixed gonadal dysgenesis, also known as X0/XY mosaicism.
dragonwriter mentioned XX male syndrome.
Those are just a few big ones. We then have some lovely research into gender identification through sex differences like the size of organs, brain tissue and so on. Works great, except when you do it with transsexuals. For that group the measurements predict the gender they say they are and not their chromosomes. Those studies are used as evidence that transgender is biological, not psychological.
The human body is a complex analog system, and in complex analog systems there aren't much binary 1 or 0. It is more like a scale which leans towards either one direction depending on the sum of a lot of factors. What we call male is just the state when the sum of those factors point in one direction, female in an other. Occasionally you get scales that balance between the two that you can't actually say where it leans.
There's a considerable evidence that trans identity is correlsted with variations in physical sex-related traits at a more specific level than counting the number of X and/or Y chromosomes (which themselves aren't sex related traits, just things which contribute to the development of such traits in ways mediated by physical environmental factors.)
The article says nothing about how many trans people they had enrolled in the study. I thought we were already past this but no, in 2019 trans individuals are still second class citizens.
It's already difficult to get enough funding as is, you can't realistically expect the researchers to allocate a meaningful amount of resources to survey 0.6 of the population.
The mechanism of action of analgesic drugs is very simple and well-understood.
Considering the fact that the very same painkillers that humans use are effective on drastically different organisms, such as snails or crustaceans, I find it extremely unlikely that gender plays any significant role in their effectiveness.
To be honest, it feels like this study was politically motivated.
Since ibuprofen impairs testosterone production, a key sex differentiating hormone, I'd not be surprised at all if there is a gender correlation in effectiveness or side effects.
The study is not disproving the efficacy of analgesic drugs of most organisms - only suggesting that not all pain mechanisms are well understood, which is a reasonable suggestion. Further, given our (US) current opioid epidemic and death count, I find the implication that "we don't need to study other pain-relieving drugs" dubious.
Finally, do note that most analgesics have harmful side effects (acetaminophen - liver, NSAID - stomach bleeding). Does that mean they do not work as pain killers? No. But when a large portion of 50% of the population needs to take them for several days for 1 week of every month, we have every market incentive to look for other pain-relieving solutions.
Just for a personal example, my mother's period pain warranted a prolonged combination of NSAIDs and acetaminophen all her life, for 1 week of every month. Had the pills been more effective, she might have needed fewer of them in a sitting, and may not be dealing with the stomach bleeding she has now.
the exact mechanism of action of paracetamol [ie acetamophen] remains to be determined. There is evidence for a number of central mechanisms, including effects on prostaglandin production, and on serotonergic, opioid, nitric oxide (NO), and cannabinoid pathways, and it is likely that a combination of interrelated pathways are in fact involved.
That's the most widely-used analgesic in the world, and its mechanism is evidently neither simple nor well-understood.
Some takeaways that underscore the fact that it took the NIH until 2016 to require animal research to feature both male and female animals -
"Women greatly outnumber men among migraine sufferers, and women made up about 85 percent of the participants in the Phase 3 clinical trials of the three anti-CGRP drugs approved by the Food and Drug Administration in 2018. Price wonders if the anti-CGRP drugs aren’t specific to migraines—but to women. His work with mice suggests that the drugs don’t work in males, but block pain in females.
Mogil once emailed a researcher, asking whether a pain drug worked better in men than women. The researcher didn’t know, and couldn’t pursue the question because the data was controlled by the pharmaceutical company. Mogil was left wondering if drugs that looked promising in male-only animal studies might have failed in clinical trials when the results were blended with those in women, depriving men of a viable treatment...
[Meanwhile] medicines that could work best for women wouldn’t make it into the pipeline at all when basic science excluded female animals. Price wonders if unresolved pain among women might have led to their higher levels of chronic pain."
It will be good to figure out which drugs work for which genders so people suffering from pain will know which gender to identify as for the most effective pain relief. If we find that some drugs are more effective on animal models, we can encourage otherkin.
So slowly, it seems we are going back to the primitive healer's approach where they did not had a specific drug for a specific disease, but rather they made a individual combination of drugs (and other methods) for every individuals problems.
Because, of course men and women are different so it should not be surprising that they react differently to drugs, but also men or women in itself are very different, depending on their genes obviously, but also their age, their routines, their diet etc.
So good to hear, that we are going one more step away, from the generalistic approach.
Which was a cheap way, thats why it did produced results as well, but maybe not the best results.
Yes. Ayurveda does treat every individual differently and does customized medicine on case-by-case basis after observing the patient carefully asking questions that provide root cause and then make a medicine that only works for that individual for that issue alone. No side effects. Modern medicine treats every one equal and prints a list of side effects on drugs as if they are nothing. But it is the body's way of saying it is not happy with whatever external chemical he has taken is not for that body! Finally it's a good step which modern medicine is ignoring for ages even after advised by a few before.
Then you don't know anything about true ayurveda. Have you ever met someone practicing ayurveda for anything and got treated? I got cured for 2 things, one of which has no known medicine (only repeated surgery for life) and it never got back in past 18 years.
I don't know very much about medicine either, but it's easy to find double blind studies that show efficacy for all kinds of medical procedures. Is there anything similar for Ayurveda?
That's not how it works. Ayurveda is not a medical pharmacy. It's a way of treating individuals. Like I said earlier, each case is different. There are no common medicines other than a few (6 or 7), which are known to work for any body type. For anything that doesn't get cured through them needs customized medicine. I am no expert either. But there are no lobbyist pharmas backing studies on Ayurveda medicine as they are like open source, free. Since you asked I know one, KSM-66, if you know anyone with depression/insomnia/high heart rate etc. they can try it. That's one of the common one of the 6 or 7 I mentioned above.
Of course you could study it. Give 50% of the participants individualized Arurdvedic medicine and 50% the standard medicine. Give both groups the consultation Adudveric style as a control measure. See if there is a statistically significant difference in results, then you have an answer.
(Your starting point will be people with the same problems/symptoms).
Or am I missing something?
(Your answer comes across as implying "no one is the same we can't possibly disprove / prove this stuff")
The article starts out with saying that drug development begins with studies on male rats and mice, but then goes on to describe difference the biological pathways for pain in men and women. That creates some obvious question. How similar is the pain pathways between humans and rats, and is it more similar than between women and men?
There should basically be 6 sources of differences. Animal M vs Human M, Animal F vs human F, Animal M vs Human F, Animal F vs Human M, Animal F vs Animal M, and last Human M vs Human F.
A difference in any of those could potential cause a wrong conclusion in a study. The question I hope researcher has is which of those are more likely to have a significant difference in pain research
Different model animals are picked for different types of medical studies, or at least they are supposed to be, based on similarities between the model and humans within the context of the functionalities under test.
It is interesting, but since quite a few examples here pertain the brain. By accepting the conclusions of the article we must also accept the idea - presently under attack - that there are indeed clear biological differences between the male and female brains.
There can be statistical differences on average, without requiring that every brain is unambiguously classifiable as "male" or "female" on a biological level based on that trait.
For example- if a drug works well for 80% of women and 15% of men, that implies that there are some men whose brains utilize the "female" pain pathway and some women who use the "male" pain pathway. It also suggests that that drug might be a good first line of treatment for female patients and a secondary or tertiary line of treatment for male patients. Trying to classify brains like this is like trying to classify sex based on height- on average it sort of works, but there's enough overlap between the heights of women and men that you can't actually do it reliably on an individual level.
So tl;dr I don't think that "clear biological differences between the male and female brains" is actually a reasonable conclusion that can be drawn from this research.
Yes, except practically nobody claims that it's black-and-what. This idea which is under attack (for which James Damore got fired, for example) is that measuring equality by setting 50/50 female-to-male ratio as an ideal doesn't reflect reality, because in general sex differences very likely exist beyond culture, and they logically should lead to different representation in various fields of occupation.
70 comments
[ 2.8 ms ] story [ 142 ms ] threadSure, you wouldn't want pregnant women to be amongst your first field test subjects. But you do want them to be included as part of the carefully monitored testing period, rather than wait until the drug goes commercial and there is not the same focus on looking for and collecting data on side effects.
You’re confusing sex with gender.
of course theres a difference but if everyone accepted that then there wouldnt be a big problem now
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
https://pasteboard.co/I6fhTWy.jpg
The vast majority of cases you see today with people claiming to be the sex they're not are psychological, not physical. They're men with XY chromosomes wanting to be women, or the opposite, women with XX chromosomes wanting to be men. The other cases (e.g. XXY and XYY) are very small in comparison.
No, it doesn't. Gender (which is distinct from both sex and gender identity, though there is an increasingly popular modern view that gender should be ascribed based on gender identity) is a socially ascribed trait, and different societies have recognized different numbers of genders and used different methods of ascribing them.
> The vast majority of cases you see today with people claiming to be the sex they're not are psychological, not physical.
The idea that there is such a thing as “psychological, not physical” is mystical woo that has no place in fact-based discussion, and divergences between gender identity and gender ascribed based on sex determined by chromosome counting has an observed correlation with other physical divergences from typical traits for the assigned sex.
The facts are that if you have the sex-determining-region Y (SRY) gene (which usually comes on the Y chromosome, but may be missing or defective, or may be on the X chromosome because genes do funny things), you are most likely biologically more-male-than-not and if you don't you probably are more-female-than-not.
But even SRY-or-not isn't enough: XX male syndrome, which normally occurs because of an unusual recombination event where a copy of SRY ends up on an X chromosome, can also happen without a copy of SRY, and XY females can exist with SRY in complete androgen insensitivity syndrome (largely, because of variations in genes responsible for androgen receptors, which are located on the X chromosome.)
The idea that biological sex is binary and corresponds to XY vs. XX is simply false; there's a lot more than “what shape are your sex chromosomes” involved.
Then we have the world of chimerism, ie a person with two set of chromosomes. Genitals of both sexes may be formed.
Then we have mixed gonadal dysgenesis, also known as X0/XY mosaicism.
dragonwriter mentioned XX male syndrome.
Those are just a few big ones. We then have some lovely research into gender identification through sex differences like the size of organs, brain tissue and so on. Works great, except when you do it with transsexuals. For that group the measurements predict the gender they say they are and not their chromosomes. Those studies are used as evidence that transgender is biological, not psychological.
The human body is a complex analog system, and in complex analog systems there aren't much binary 1 or 0. It is more like a scale which leans towards either one direction depending on the sum of a lot of factors. What we call male is just the state when the sum of those factors point in one direction, female in an other. Occasionally you get scales that balance between the two that you can't actually say where it leans.
https://news.ycombinator.com/newsguidelines.html
Considering the fact that the very same painkillers that humans use are effective on drastically different organisms, such as snails or crustaceans, I find it extremely unlikely that gender plays any significant role in their effectiveness.
To be honest, it feels like this study was politically motivated.
Finally, do note that most analgesics have harmful side effects (acetaminophen - liver, NSAID - stomach bleeding). Does that mean they do not work as pain killers? No. But when a large portion of 50% of the population needs to take them for several days for 1 week of every month, we have every market incentive to look for other pain-relieving solutions.
Just for a personal example, my mother's period pain warranted a prolonged combination of NSAIDs and acetaminophen all her life, for 1 week of every month. Had the pills been more effective, she might have needed fewer of them in a sitting, and may not be dealing with the stomach bleeding she has now.
https://academic.oup.com/bjaed/article/14/4/153/293533 (2013)
the exact mechanism of action of paracetamol [ie acetamophen] remains to be determined. There is evidence for a number of central mechanisms, including effects on prostaglandin production, and on serotonergic, opioid, nitric oxide (NO), and cannabinoid pathways, and it is likely that a combination of interrelated pathways are in fact involved.
That's the most widely-used analgesic in the world, and its mechanism is evidently neither simple nor well-understood.
"Women greatly outnumber men among migraine sufferers, and women made up about 85 percent of the participants in the Phase 3 clinical trials of the three anti-CGRP drugs approved by the Food and Drug Administration in 2018. Price wonders if the anti-CGRP drugs aren’t specific to migraines—but to women. His work with mice suggests that the drugs don’t work in males, but block pain in females.
Mogil once emailed a researcher, asking whether a pain drug worked better in men than women. The researcher didn’t know, and couldn’t pursue the question because the data was controlled by the pharmaceutical company. Mogil was left wondering if drugs that looked promising in male-only animal studies might have failed in clinical trials when the results were blended with those in women, depriving men of a viable treatment...
[Meanwhile] medicines that could work best for women wouldn’t make it into the pipeline at all when basic science excluded female animals. Price wonders if unresolved pain among women might have led to their higher levels of chronic pain."
Because, of course men and women are different so it should not be surprising that they react differently to drugs, but also men or women in itself are very different, depending on their genes obviously, but also their age, their routines, their diet etc.
So good to hear, that we are going one more step away, from the generalistic approach. Which was a cheap way, thats why it did produced results as well, but maybe not the best results.
Or am I missing something?
(Your answer comes across as implying "no one is the same we can't possibly disprove / prove this stuff")
Or am I missing something?"
I don't know much about Ayurveda, but the general idea is, that there are no people with the exact same problems/symptoms.
Which is not, how far I would take it, so you have to do generalisations, but maybe much finer grained.
There should basically be 6 sources of differences. Animal M vs Human M, Animal F vs human F, Animal M vs Human F, Animal F vs Human M, Animal F vs Animal M, and last Human M vs Human F.
A difference in any of those could potential cause a wrong conclusion in a study. The question I hope researcher has is which of those are more likely to have a significant difference in pain research
There can be statistical differences on average, without requiring that every brain is unambiguously classifiable as "male" or "female" on a biological level based on that trait.
For example- if a drug works well for 80% of women and 15% of men, that implies that there are some men whose brains utilize the "female" pain pathway and some women who use the "male" pain pathway. It also suggests that that drug might be a good first line of treatment for female patients and a secondary or tertiary line of treatment for male patients. Trying to classify brains like this is like trying to classify sex based on height- on average it sort of works, but there's enough overlap between the heights of women and men that you can't actually do it reliably on an individual level.
So tl;dr I don't think that "clear biological differences between the male and female brains" is actually a reasonable conclusion that can be drawn from this research.