Notes on Engineering Health, June 2021
XX Versus XY
Does having two X chromosomes set one back when it comes to being understood and treated by the medical profession?
The answer seems to be yes in many instances. Here are five striking examples where there are clear differences between diseases men and women get, as well as the way they are treated:
They affect 8% of the global population, but 78% of those affected are women. Females are three times more likely than males to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis.
While acute cases of Covid-19 have tended to be mostly male and over 50, long Covid sufferers were, by contrast, both relatively young and women outnumbered men four to one.
A classic example in how men and women differentially experience a similar condition is heart disease. Women’s most common heart attack symptom, as with men, is chest pain or discomfort. But women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea, vomiting and back or jaw pain. Because MDs are still overwhelmingly trained to consider symptoms from male patients, women can sometimes be diagnosed wrongly.
Risk & Side Effects
The risk of blood clotting while taking the J&J vaccine against SARS-CoV-2 is roughly of one in every 250,000 people — prompting the FDA to halt its use in the USA pending further review. In comparison, risk of blood clots caused by hormonal birth control pills is on the order of one in every 1,000, yet the FDA has taken no restrictive action.
A recent study has found that gender stereotypes are decisive in the estimation of patients’ pain. Researchers show that women’s pain is consistently underestimated and not treated as appropriately as men’s. The differences in assessment and treatment by healthcare workers, both men and women, come from the persistent (and false) belief that women are oversensitive to pain, and express or exaggerate it more easily.
Since 1997, FDA has required manufacturers to show evidence of how drugs are safe by age, sex, and race, and scientists must account for the possible role of sex as a biological variable in both pre-clinical and clinical studies. Yet, a lack of biological understanding around the role of gender factors in disease, poor policy choices like under-representing women in clinical trials, and societal biases (e.g., keeping funding for women’s health low for a long time) have perpetuated a state of inequity in the care of women versus men.
Thanks in part to the work of public intellectuals through books such as Doing Harm or Unwell Women, the causes of such disparity and its effects on women’s health are now being recognized and analyzed both through data and compelling individual stories. While this increased attention is welcome, there is still a sizable need for all actors in the healthcare industry to be mindful of the gender gap and to take action to rectify it. From regulators and MDs to scientists, venture capitalists, pharmaceutical groups and computer scientists working on new applications of AI, all must acknowledge existing gender biases and continue work to reduce them.
1/ Bugs (Biologic Engineering)
Another recent step forward in the trajectory of biology becoming an engineering discipline was achieved with a report in Science that bacteria with a completely synthetic genome can be engineered to create new proteins from building blocks not naturally found in cells. Our portfolio company GRO Biosciences is also working at the forefront of developing these types of recoding technologies to turn cells into programmable factories for new therapeutics.
2/ More Bugs (On The Subway)
An enormous international team of researchers has recently added a new volume to the mapping of the natural world: an atlas of microorganisms that can be found in the world’s subways. It contains data collected by more than 900 scientists and volunteers in 60 cities on six continents. While each city was found to have its own unique microbial profile, there was consistent “core” set of non-human microbes found in all cities. The work also uncovered more than 10,000 species of viruses and bacteria that had been previously unidentified. These results were recently published in a Cell paper and covered by The New York Times.
3/ Even More Bugs (To Make Us Healthier)
A recent study in Nature Communications concludes that “good” bacteria show promise for clinical treatment of Crohn’s disease and ulcerative colitis.
The authors of this work used a bottom-up rational consortium design approach that combined well-characterized strains of human intestinal bacteria to produce two consortia of metabolically interdependent strains which they propose could treat and prevent relapse for IBD and other inflammatory conditions characterized by unbalanced microbiota and mucosal permeability.
4/ Never Enough Bugs (They Are With Us From The Start)
It may seem like an unusual place to go looking for answers, but the contents of a baby’s first diaper can reveal a lot about a newborn’s future health.
In a recent study published in Cell Reports Medicine, a team of University of British Columbia (UBC) researchers has shown that the composition of a baby’s first poop — a thick, dark green substance known as meconium — is associated with whether or not a child will develop allergies within their first year of life. Meconium, which is typically passed within the first day of life, is made up of a variety of materials ingested and excreted during development, ranging from skin cells, amniotic fluid and various molecules known as metabolites. One of the lead author’s commented, “Meconium is like a time capsule, revealing what the infant was exposed to before it was born. It contains all sorts of molecules encountered and accumulated from the mother while in the womb, and it then becomes the initial food source for the earliest gut microbes.”
5/ Inevitability (Apparently A Feature, Not A Bug)
It turns out that at least between death and taxes, death really is unavoidable due to built in biological constraints. The study supporting this conclusion was recently published in Nature Communications and nicely reported on in The Guardian.
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The early days of the Covid-19 pandemic supported the hope that scientific collaboration both domestic and international would be spurred by the crisis. Unfortunately, this piece in Nature indicates that while things started off well, they have rapidly revered to that status quo ante.