For two decades, Women’s Health Research at Yale (WHRY) Director Carolyn M. Mazure, Ph.D., has prompted change in how investigators at the university focus on the “who” and “what” of health research.
As she looks across research institutions today, she sees that the cause she has championed — the inclusion of women as subjects in health research — has become increasingly recognized in scientific circles. Now, she says, we are at a critical point, and the scientific community needs to decide if it will embrace true transformational change in science.
Women’s Health Research at Yale is at the forefront of this change, and one of its next steps will involve a shift in the center’s core message to reflect this goal of transformation. YaleNews talked with Mazure about it. An edited version of the conversation follows:
What is transformational change? Can you explain what you mean?
We are talking about fundamentally changing the conduct of biomedical research and practice across every field to fully include the study of women and of the influence of sex and gender on health and disease.
Is it difficult to communicate the importance of this transformation?
Yes. By way of comparison, it is not difficult to convince people of the importance of studying cancers, heart disease, or other common and frightening health problems. Everyone has been either directly affected by these diseases or knows someone affected by them. However, when many people hear that it is important to study women’s health, or even “the health of women,” they often think solely about the key area of reproductive health, and they stop there. Transformation would involve the study of women in relation to every aspect of health and behavior, not just reproductive health. And, it will require recognizing the study of women’s health as a legitimate area of biomedical investigation.
And that’s not happening?
It is, but not nearly enough. When a woman goes to her doctor, she should be confident that the advice she receives and the decisions they make together are grounded in the best possible understanding of how diseases and conditions are influenced by sex and gender. For example, research has shown that women are more likely to die following a heart attack, develop depression and anxiety, and have acute and chronic pain. Yet, the mechanisms driving these conditions must be better understood, and treatment and prevention strategies must be improved or even discovered. We have made progress, but there is so much more we need to study that requires a genuine, systemic commitment to studying the health of women.
How have WHRY and its partners contributed to this change?
We just celebrated our 20th anniversary as a self-supporting center thanks to the thoughtful generosity of our funding partners. Over these two decades, Women’s Health Research at Yale has led change and collaborated with other academic partners and national health agencies to ensure medical research and practice focuses on the health of women and sex-and-gender differences. These collaborations build on the knowledge, service, and achievements of the Yale community, its connections, and ability to inspire. Together, WHRY and its partners are improving science to account for the unique needs of women and men, offering more effective strategies and methods for attaining and maintaining health.
Why is the work of WHRY important?
Until fairly recently, women were not widely included in studies of human health, and few researchers explored how sex-and-gender differences affect health. Even today, many people in science and most of the general public remain unaware of this history and the importance of changing the way science is conducted so that everyone can benefit.
The type and degree of change we require calls for an influential team with a deep base of interdisciplinary knowledge and experience dedicated to a common purpose. Women’s Health Research at Yale is that team. Our expertise allows us to ask better questions that will improve lives. Questions like: Can the chemical fingerprints of digestion explain why colon cancer risk is different between women and men? Or, can we design and deploy a better way to describe and group heart attacks that accounts for the different ways they can develop in women?
Importantly, our experience and reach allow us to advance ideas beyond Yale that reflect equity and inclusiveness, validated by careful testing and solid data. We are an engine for the movement to get everybody on board with this necessary transformation.
How does WHRY work with its partners?
We initiate and fund research that advances the health of women, and we determine when and how biological and psychosocial treatment and prevention strategies must differ on the basis of one’s sex and gender. Our work also includes forging interdisciplinary scientific collaborations that provide the breadth and depth of knowledge for us to respond to real-world health problems. And, we are dedicated to training the next generation of scientists to further transform research for the benefit of everyone.
Our efforts further include translating our findings so the public can be better informed about their health care decisions, providing our results to the scientific community, and engaging others in studying the health of women. We are committed to using our findings to inform and shape health policy so that we have better systems of care tailored for women and men and families.
What progress has been made in the practice of health research?
When I founded WHRY in 1998, it was not long after the federal government first required the inclusion of women in clinical trials seeking key federal funding. In 2016, official guidelines for that same key federal funding began requiring applicants to include female animals, tissues, and cells in the types of ground-level laboratory studies necessary to lay the foundation for human trials.
That just happened in 2016?
Yes. The National Institutes of Health — the single largest funder of biomedical research in the world — enacted those guidelines just three years ago and now requires the design of all studies to consider sex as a biological variable (SABV).
This latest change is important because, even today, many researchers continue to mix data on males and females together without analyzing how sex or gender might influence their results. Unless researchers take this vital step, they cannot identify potential sex- or gender-dependent paths of disease prevention and treatment.
What is WHRY hoping to achieve? What’s the endgame?
WHRY does all of this for a simple reason. By improving how science is conducted and applied in medical practice, the center is helping people to become healthier, happier, and more productive. Our new phrase following our center’s name, “Better science, better lives,” is more than a tagline. It’s a statement of purpose and a call for forward momentum.
Can you elaborate?
“Better science, better lives” means we are driving a necessary and central change in how biomedical science is conducted and translated into health care. It means we are part of a movement that has reached an irrevocable turning point, where more informed research leads to better health and well-being for everyone — women and men. It also means adopting new ways of thinking that enhance medical science’s capacity to treat the unique needs of every individual.
What new ways of thinking?
Women’s Health Research at Yale is calling for a change in how society and medical science approach the health of women. Moreover, we are asking for restraint in the often unnecessary assigning of value to the word “difference.” Because in health research, difference does not have to mean better or worse. We can study natural variations that undeniably exist between and among women and men without making these kinds of value judgments.
Is this type of thinking catching on? How so?
Absolutely, and it’s tremendously exciting. Researchers across the country are now picking up the pace in studying the health of women and discovering new sex-and-gender differences. For example, WHRY’s faculty partners across Yale School of Medicine are: demonstrating how our body’s own bacteria can affect the development of autoimmune disease, which affects women more than men; implementing a behavioral treatment for autism spectrum disorder tested on girls for the first time, showing a better result for girls than boys; defining the different mechanisms and greater adverse effects of addictions for women, including smoking tobacco and cannabis; as well as increasing the diagnostic clarity of the genetic risks for breast and ovarian cancer.
That’s just a small sample of recent studies. I encourage people to visit our website to learn more about our research.
Has the intent behind this work gained momentum or spread to influence other researchers?
Indeed, it has. By fostering research at the earliest stages with seed grants ranging from $10,000 to $50,000, WHRY ensures that the health of women and the study of sex-and-gender differences become a part of the fabric of how researchers think about their work. In addition, Yale has tremendously talented scientists who influence others through active collaborations and by setting an example. WHRY has launched nearly 100 pilot projects at Yale with $5 million in WHRY funding. Frequently, these are projects that would not be able to take that first step without WHRY’s help. In return, our funded researchers have generated findings to fuel another $102 million in external funding that goes back into their laboratories and clinical research settings. This funding enables the researchers to continue translating their work into medical applications with a practical benefit for the public. As with all of our initiatives, we are building a national effort to make this crucial change to science so that people see the improvement in their daily lives.
For more information about Women’s Health Research at Yale, visit its website or connect with the program on Facebook or Twitter.