We Should Consider “Oldhood”

The medical field has made many advances in recent years. People continue to make it known that they are “thankful for modern medicine”. Though this may be the case, the medical field still has much more room to grow. More specifically, it is time for the medical field to pay more attention to the elderly. With the baby boomers now reaching higher ages, geriatric care is in high demand. An article by Claudia Späni spoke about Alzheimer’s, and it sparked my interest in this topic. Through further research I came across another article by Louis Aronson that expanded on this topic.

Claudia Späni said in the article, “Reduced β- amyloid pathology in an APP transgenic mouse model of Alzheimer’s disease lacking functional B and T cells”, stating that “In Alzheimer’s disease, accumulation and pathological aggregation of amyloid β-peptide is accompanied by the induction of complex immune responses, which have been attributed both beneficial and detrimental properties” (Späni, 2015). Though this study was not necessarily looking into immunosenescence, it did touch on it in a way to show how the ageing process negatively impacts an individual’s capacity to respond to immune challenges. The conclusions made from this study could be a protective compensatory mechanism of the adaptive immune system aimed to control or reduce potentially toxic neuroinflammatory responses to A βaggregates, even at the cost of an increased amyloid plaque deposition. The study does acknowledge that a better understanding of the underlying neuroimmunological mechanisms is the next step in creating more therapy options that are effective as well as safe. 

In relation to Späni’s article, Louis Aronson wrote an article, “Stop Treating 70-and 90-Year -Olds the Same”. This article expands on the topic of immunosensescence, and it makes a point to address the issue that stands when lumping all of geriatrics, 65 and older, into one singular category. With the advancement of age, a lot of health concerns follow--including chronic diseases that can compromise the body’s resistance to infectious organism. This includes the immune system weakening, which brings us back to our topic: immunosenescence. Aronson explains how "Older adults who receive tetanus and diphtheria vaccines, for instance, produce less-effective antibodies, and the vaccine's protective effects fade faster than they do for younger patients", which could indicate that Older people may need different types of treatment (Späni, 2015). These differences could include changing the dosage or even trying biologically different vaccines to treat them.

Between these two articles, immunosensescence among geriatrics was not only established but also expounded upon. In the final paragraphs of Louis Aronson’s article, it states that there are two easy steps that would help to not only correct the deficiency in its vaccine recommendations, but also increase equality throughout our healthcare system. First, we should add "old hood" to the list of childhood and adulthood. Second, the National Institutes of Health should require that older adults be included in clinical studies. Though these two steps are not a cure-all, they can be a powerful way to start creating changes in the geriatric field.

Resources:

Späni, C., Suter, T., Derungs, R., Ferretti, M. T., Welt, T., Wirth, F., . . . Kulic, L. (2015). Reduced β-amyloid pathology in an APP transgenic mouse model of Alzheimer’s disease lacking functional B and T cells. Acta Neuropathologica Communications,3(1). doi:10.1186/s40478-015-0251-x

Aronson, L. (2017, August 11). Stop Treating 70- and 90-Year-Olds the Same. Retrieved from https://www.nytimes.com/2017/08/11/opinion/sunday/vaccinations-elderly.html 

One Size Does NOT Fit All

Sexism has been a hot topic recently. While most people would mention the common examples of sexism (e.g. the wage gap, street harassment, etc.), there is a large discrepancy somewhere where people wouldn’t think—medical research. Not only is there an obvious gender bias against women doing the research, but there is a gender bias in how research is conducted.

A Fortune article states that scientists have historically and up until very recently only used male model organisms in their pre-clinical studies, even for studies in diseases prominent in the female population. With the recognition of sexual dimorphism, there was a shift towards requiring both sexes to be included in clinical trials that came about through NIH regulations regarding funding for research. The shift towards studying both sexes was initiated in an attempt to effectively treat both sexes by accounting for their respective differences. 

Although this was a good initiative in theory, it didn’t translate as well into practice. The Fortune article states that, “For animal studies, an international review in 2011 and 2012 found that 22 percent did not state the sex of the animals. Of those that did, 80 percent used only males and 3 percent both sexes.” Even though there were regulations put in place to eliminate sex discrimination, there was still no attention paid to the gender of the animals, and if there was, it was seemingly deliberately sexist. 

The gender gap in medical and pharmacological studies can have a tremendous impact on the disadvantaged gender—women. From incorrect dosages to misdiagnoses (or even inability to diagnose), the effects of male-dominated research subjects are no doubt detrimental to women. Not only are there significantly less women than men in research studies, but even in those that do include women, “the research community has largely taken […] an ‘add women and stir’ approach: Both men and women are usually included in studies, but researchers often do not actually analyze study results to uncover potential differences between the two”; this consequently leads to men and women being treated the same way (a “one size fits all” conclusion).

Adding female subjects into studies shouldn’t be done to meet some standard in order to get enough money to continue a study— it should be done to actually find differences between the two sexes in order to better the treatment of both sexes, even if they would both need different treatments. Finding something that works for males and using it as a blanket treatment for everyone can be detrimental to females. The injustice that arises from sex discrimination in medicine essentially leaves half of the human population without effective treatment while the other has scientifically proven results backing up their diagnoses and treatments. Thus, the medical treatment of males is unjustly superior to females; we could be doing so much better for women’s health, but we’re not. 

This under-appreciated topic is of high interest to Claudia Späni’s research which covers differences between the sexes after TBI (Traumatic Brain Injury). She found that male bias in researching TBI is exemplified in the use of mostly male animals prior to clinical trials and application. Her talk at Loyola University Chicago discussed the fact that female animals aren’t used in pre-clinical testing, which consequently puts women at a disadvantage.

The manifestation of diseases like Alzheimer’s are different between the sexes and using just one sex in research benefits the one used in research the best. NIH regulations pushing for the use of female animals in research is a good step forward, but the aforementioned implementation of these regulations is much harder. It is widely held that research was done mainly on male animals because it was thought that both animals would benefit equally from the treatments or interventions, but with new discoveries, that is being proven wrong. 

Sexism permeates through many realms of society, but the slow march towards elimination of sexism in the pre-clinical research industry will hopefully lead to better care for female patients; women will receive specific care versus general care that wasn’t initially tailored to them and how their bodies work. There needs to be a shift in scientific interest towards wanting to research female animals in order to actually benefit females because as of now, it seems as if most labs are using female animals just to meet the quota for funding. 

In order to receive a patent and the ability to produce and distribute a drug, there should be stricter requirements from the USDA. Labs or companies that wish to introduce a drug or intervention to the general public should provide evidence of research in males and females for the respective drug or intervention; there should be explicit research of the drug in both sexes. This would prevent any unwanted effects of drugs on people and would avoid another situation like the one in the late 90s and early 00s in which, “The US Food and Drug Administration suspended ten prescription drugs producing severe adverse effects on the market. Eight of the ten drugs caused greater health risks in women. Serious male biases in basic, preclinical, and clinical research were the main reason for the problem”. Further, the same article detailed that, “four of the drugs caused more adverse events in women because they were prescribed more often to women than to men. However, the other four drugs had more detrimental effects in women, even though they were equally prescribed to both women and men, suggesting that physiological differences between males and females predispose women to some adverse drug-related health risks”. 

Women are different from men, their bodies work differently, their bodies respond differently; there are two different genders, so why are the same drugs at the same doses being prescribed to both of them? One size doesn’t fit all, especially when it comes to medical research and treatment. 

Footnotes:

¹ http://fortune.com/2017/06/26/sexual-bias-medical-research/  

² https://www.huffingtonpost.com/entry/opinion-dusenbery-medical-sexism-research_us_5a9e01c4e4b0a0ba4ad72a3c  

³ https://www.sciencedirect.com/science/article/pii/S0091302218300086  

⁴ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933211/