Male-centric medicine is affecting women’s health
Introduction
- Exactly three decades ago, the U.S. National Institutes of Health (NIH) Revitalization Act of 1993 mandated the inclusion of “women and minorities” in clinical trials in a bid to reduce health disparities. Yet, to date, the male model of medicine is thriving, and so is the tendency of treating women as smaller men despite a growing body of research insisting on physiological differences (beyond the reproductive organs) between the sexes. The genetic and epigenetic differences between men and women are also extensively documented.
Generic drugs, trials, mental health
- In India, the “pharmacy of the world”, the gender disparity in clinical trials has even bigger implications, thanks to generic drug production and consumption.
- It has been demonstrated in various studies that women’s bodies respond differently to the components of generic drugs.
- It was clear in clinical trials that nearly one-fifth of medications showed a difference in the active dose between men and women.
- It is not just about treatment but also testing and diagnosis where women have been getting a rough deal.
- The study firmly notes that depression rates and the prevalence of anxiety are higher for women than for men worldwide in general.
- Like depression, cardiac issues are now acknowledged as having a slightly more prevalence in women. Yet, they continue to be diagnosed and treated like ‘lesser men’.
- Study after study demonstrates that women are less likely to receive appropriate medications, diagnostic tests and clinical procedures even in developed countries such as Canada and Sweden.
- The stereotype of the “hysterical woman” continues to haunt women even when they need urgent clinical interventions.
Gaps that can be linked to apathy
- The exclusion of women from clinical trials and research projects addressing sex-agnostic critical illnesses such as cancer and heart disease has resulted in a limited understanding of sex-specific symptoms and responses to treatment.
- When it comes to sex-specific illnesses such as breast or endometrial cancers, polycystic ovarian syndrome, and pregnancy-related issues, there are serious gaps in research that can only be explained by an apathy towards “women’s only” issues.
- United States-based studies show that the funding received for research in migraine, endometriosis and anxiety disorders is much lower in proportion to the burden of these illnesses.
- World Health Organization data from 2017 show that “every day about 808 women die due to complications of pregnancy and childbirth”.
- Pregnant women are further down the ladder of representation in clinical trials and research.
Government Initiative to Ensure Health Facilities to Women
- Health and Wellness Centres: India has about 76,000 health and wellness centres which perform screening of 5 types of health issues; hypertension, diabetes, breast cancer, oral cancer and cervical cancer.
- Adolescent Friendly Health Services Program: Rashtriya Kishor Swasthya Karyakram is there where female adolescents are sensitised about their health. The programme also focuses on reaching out all adolescents including Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ).
- Auxiliary Nurse Midwife: Auxiliary Nurse Midwife, commonly known as ANM, is a village-level female health worker in India who is known as the first contact person between the community and the health services.
- Janani Suraksha Yojana (JSY): Janani Suraksha Yojana (JSY)is a safe motherhood intervention under the National Health Mission (NHM). JSY is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and post-delivery care.
- Pradhan Mantri Matru Vandana Yojana (PMMVY): PMMVY is a scheme for pregnant women and lactating mothers. Is a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.
Way forward
- In an equitable world, women would be accepted as an individual category, with race, age and class as subcategories. And an equal amount of time and resources would be spent in finding and providing treatment and health care.
- India’s G-20 presidency may be an opportune time to highlight this issue in alignment with Sustainable Development Goals on women’s health.
Editorial 2: The status of transgenic crops in India
Context
- Three States, Gujarat, Maharashtra and Telangana, have deferred a proposal, approved by the Centre’s Genetic Engineering Appraisal Committee (GEAC), to test a new kind of transgenic cotton seed that contains a gene, Cry2Ai, that purportedly makes cotton resistant to pink bollworm, a major pest. This conflict shows that a broad acceptance of genetically modified crops continues to be elusive.
Genetic Engineering Appraisal Committee (GEAC)
- The GEAC consists of a panel of plant biotechnologists and is headed by a senior official of the Environment Ministry and co-chaired by the scientist of the DBT.
- To resolve the issue of States not according approvals on testing, because of differing attitudes to GM crops, the GEAC is considering a proposal by the DBT to declare some regions across India as ‘notified testing sites’.
- There are 42 such proposed sites and, if it goes through, companies wanting to conduct trials of GM crops at these locations won’t need the permission of States for trials.
Status of transgenic crops in India
- There are an array of crops — brinjal, tomato, maize, chickpea — in various stages of trials that employ transgenic technology. However, cotton remains the only transgenic crop that is being commercially cultivated in India.
- After a long hiatus, the GEAC, the apex technical body approved the environmental release of Mustard hybrid DMH-11 and its parental lines, for seed production and testing. This is one step away from full commercial cultivation.
- However, the GEAC, which is under the Union Environment Ministry, isn’t the final arbiter in the case of GM crops. There is a long-standing litigation in the Supreme Court on the permissibility of allowing transgenic food crops in farmer fields based on petitions filed and asking for a stay on the release of the crop because it would encourage farmers to spray herbicides, which are banned in India.
- In 2010, the GEAC had approved GM brinjal, but this was put on an “indefinite moratorium” by the United Progressive Alliance government.
Process of regulating transgenic crops in India
- The process of developing transgenic crops is an elaborate one as inserting transgenic genes into plants to elicit a sustained, protective response is a mix of both science and chance.
- There are multiple safety assessments done by committees before they are cleared for further tests in open plots of lands, which are located at either agricultural universities or are plots controlled by the Indian Council for Agricultural Research (ICAR).
- A transgenic plant can apply for commercial clearance, only after it has proven to be demonstrably better than comparable non-GM variants on claimed parameters (for instance, drought tolerance or insect resistance) without posing ecological harm to other species that may be being cultivated in the vicinity.
- Open field trials often take place over multiple crop seasons, and types of geographical conditions, to assess its suitability across different States.
Advantages of GMO crops
- It improves production and raises the farmer’s income.
- It reduces the use of pesticide and insecticide during farming that might be great moves for the betterment of the food supply.
- It can feed a rapidly increasing population because it shows dramatically increased yields.
- It can produce more in small areas of land.
Disadvantages
- The production imposes high risks to the disruption of ecosystem and biodiversity because the “better” traits produced from engineering genes can result in the favouring of one organism. Hence, it can eventually disrupt the natural process of gene flow.
- It increases the cost of cultivation and is more inclined towards marketization of farming that works on immoral profits.
- The transgenic crops endanger not only farmers but also the trade, and the environment as well.
- The current safety assessments are inadequate to catch most of the harmful effects from the GM crops. Moreover, the regulatory regime in India about GM crops has never been assessed thoroughly about the GM risk assessment in Indian conditions.
Way Ahead
- The challenges linked to GM crops need to be addressed by governments, especially in the areas of safety testing, regulation, industrial policy and food labelling.
