In the recent past, scientists abroad have discovered that significant biological and physiological differences exist between the sexes everywhere. For example, in the composition of bone matter, metabolism of certain drugs, experience of pain and the rate of neurotransmitter synthesis in the brain (courtesy Society for Women's Health Research). This makes it necessary for drugs and treatments to be tested on men and women equally. For example, medicines given specifically to prevent heart arrhythmias in men, can actually cause them in women!

While the importance of incorporating these parameters in research and of including women in clinical trials has been accepted abroad, this Sex-Based Biology, as it is termed, has yet to gain any recognition in India. Serious efforts need to be made to raise awareness of these issues.

Women are not used in clinical trials for several reasons; the main one being the stereotypical assumption that a woman's body is essentially the same as a man's, only smaller. Dr Marianne Legato, who set up the Partnership of Gender Specific Medicine at the University of Colombia, says, "Women and men differ in almost every system of their body and they respond quite differently to drugs.'' Lesley Doyal, Professor of Health and Social Care, University of Bristol, says, "What's not good science is to treat half the population with a drug you haven't tested on them."

Gender prescribing is not a trend of the near future. Researchers have found that with heart diseases, women are more likely to show symptoms like shortness of breath and extreme fatigue rather than chest pain. Some autoimmune diseases like multiple sclerosis affect women eight or nine times more than men. Insensitivity to these differences could lead from misdiagnosis to lethal side-effects.

A darker side of unethical practice is revealed by certain activist websites like INCITE (Women of Colour Against Violence). It alerts women to the deliberate misuse of prescription drugs in 'off-label usage' - using a drug for treating a condition other than what it is meant for. Off-label is legal when done with the patient's interest at heart and with his/her consent. INCITE gives instances of misuse of Quinacrine, an anti-malarial drug being distributed in many developing countries including India. Quinacrine is a dangerous form of chemical sterilisation inserted in the form of a pellet during routine pelvic examinations where it dissolves and causes serious problems. Norplant and Depo-Provera are other forms of family planning with major side-effects, some of them being irreversible.

Proper testing and inclusion of women in clinical trials will definitely lead to better identification and treatment of medical problems and therefore, to timely and appropriate health care for all.

Did You Know That

• Women lack an enzyme in the stomach that breaks alcohol down, so it goes straight into the bloodstream, whereas men start breaking it down the moment it hits the stomach.

• Women's stomachs empty slower than men's, this affects how quickly drugs are absorbed.

• Women's hearts beat faster.

• Women have more body fat in their total body make-up, which can affect the way fat-soluble drugs interact with their bodies.

• Women come out of anaesthesia faster than men,

• Some painkillers work for women but not for men.

• Women have more side-effects with antihistamines, antibiotics, steroids and anti-depressants.