ABOUT THE SPEAKER
Paula Johnson - Women's-health expert
Dr. Paula Johnson is a pioneer in looking at health from a woman's perspective.

Why you should listen

Ever think you were having a heart attack? It turns out that many of the well-known early symptoms, such as chest pain and pressure from left arm to jaw, are more typically experienced by men. Women are more likely to experience shortness of breath, unusual perspiration and abdominal discomfort. Dr. Paula Johnson was one of the first to ask big questions about women's experience of cardiac care -- and their access to care that meets their needs.

Johnson and her team at Brigham and Women's Hospital in Boston focus on mentoring, measuring and bringing together expertise from practicing clinicians and academics to improve women's health. She says: "One of our core responsibilities will be to address critical questions ... such as, 'How do sex and gender impact health and health outcomes?' and 'How can health disparities among different groups of women be eliminated?'"

More profile about the speaker
Paula Johnson | Speaker | TED.com
TEDWomen 2013

Paula Johnson: His and hers ... health care

Filmed:
1,178,652 views

Every cell in the human body has a sex, which means that men and women are different right down to the cellular level. Yet too often, research and medicine ignore this insight -- and the often startlingly different ways in which the two sexes respond to disease or treatment. As pioneering doctor Paula Johnson describes in this thought-provoking talk, lumping everyone in together means we essentially leave women's health to chance. It's time to rethink.
- Women's-health expert
Dr. Paula Johnson is a pioneer in looking at health from a woman's perspective. Full bio

Double-click the English transcript below to play the video.

00:12
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 poring 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.
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Our legacy can be to improve the health of women
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for this generation
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and for generations to come.
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
Paula Johnson - Women's-health expert
Dr. Paula Johnson is a pioneer in looking at health from a woman's perspective.

Why you should listen

Ever think you were having a heart attack? It turns out that many of the well-known early symptoms, such as chest pain and pressure from left arm to jaw, are more typically experienced by men. Women are more likely to experience shortness of breath, unusual perspiration and abdominal discomfort. Dr. Paula Johnson was one of the first to ask big questions about women's experience of cardiac care -- and their access to care that meets their needs.

Johnson and her team at Brigham and Women's Hospital in Boston focus on mentoring, measuring and bringing together expertise from practicing clinicians and academics to improve women's health. She says: "One of our core responsibilities will be to address critical questions ... such as, 'How do sex and gender impact health and health outcomes?' and 'How can health disparities among different groups of women be eliminated?'"

More profile about the speaker
Paula Johnson | Speaker | TED.com

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