The Covid pandemic is highlighting shocking patterns,
revealing how this disease attacks men and women differently.
Men have about a 40% chance of dying compared to women.
40% is massive.
Leading me on a journey to investigate sex differences
in health and medicine.
Wow, is this known by the general public?
I don't think it's known.
What I discover is that even though women generally outlive men,
there is a dangerous gender gap in data and the way women are treated.
Many of the drugs that we give we have actually no idea
how they function in women's bodies.
I learn how biases in diagnosis can be life threatening.
I didn't realise how close I was to dying.
PROLONGED PIP
So, when it comes to our health, how much does sex matter?
And ultimately...
I'm Dr Ronx, an emergency medicine doctor.
Over the last year, hundreds of Covid patients
have come through my hospital.
And it's clear more men needed inpatient treatment
for Covid-19 than women.
It made me ask questions about gender, sex, and race.
And made me want to investigate why some people are affected
much worse than others.
I'm meeting Anna and Dani, a young, active couple.
When we first heard about Covid, we weren't particularly concerned.
Early in the first wave, they both contracted the virus.
We both lost our taste buds and sense of smell.
Whilst my symptoms plateaued and then sort of disappeared
within a week, his got very serious very, very quickly.
He seemed to just be getting worse and worse and worse.
I felt that I was being attacked.
My body was reacting to it, but couldn't fight it.
Hi. Hey, there. How are you?
I'm really well, thank you. Right, come on in.
Thank you. Keep distance, keep distance.
Now, Dani, tell me about when you first realised
that something wasn't right with your body.
So, it was on a Friday in the middle of March.
Wasn't really feeling so well.
Aching bones, loss of taste.
OK. And then what happened?
And that's when it started going downhill.
Started developing a fever as well.
And then the other part of it was the breathing,
because that in a way was the game changer.
And it was as if I was scuba diving, I'm underwater,
and someone is little, little by little turning off that tank.
And I'm just gasping for air.
I can't get it in.
He just had nothing. Nothing to give. No puff.
Are either of you thinking, why did you both have different outcomes?
Yeah, we've been wondering it since the beginning.
Both Anna and I went through the same initial experience,
yet Anna plateaued and started recovering.
And I pretty much went off the cliff.
So, I started thinking about, "All right, is there a difference?
"Why did I get it worse than Anna did?
"Is there a difference between the sexes?"
Anna and Dani aren't alone in wondering that.
Anecdotally, men do seem to be hit harder.
But is there actually data backing that up?
From the very beginning, I was interested in,
whether the virus was affecting men and women differently.
You'd imagine that it would be one of the simplest things
that you could collect on a medical record.
But, even so, we're finding that still,
a majority of countries are not telling us anything
about whether it's men or women that have got Covid.
KNOCKS ON DOOR
Hiya, Sarah. Hi, Ronx, how are you?
I'm really well, thank you for inviting me to your home. Good.
Come on in... Sarah's organisation has been collecting available data
to understand the global disease patterns.
We want to know, is it men getting infected
or is it women getting infected?
If we look at the England data, what we see,
is that we've got slightly more cases confirmed amongst women
in England, but if we look at deaths,
we've got more deaths in men.
And it's very clearly men, as well. It's very, very clearly men.
The rate of men being admitted to intensive care compared
to women is about double.
Really? And men have about a 40% higher chance
of dying compared to women.
So, more men are dying?
And that pattern is repeated again and again across multiple countries.
Across the world more men are dying of Covid than women.
And, in England, men account for nearly 60% of all deaths.
I guess what we now need to find out, is this related to biology?
So, XY chromosomes, XX.
Or is this more about gender and the behaviours within the social
constructs that maybe influence their outcomes?
We can only ask those questions because we've got the sex
disaggregated data that shows a difference.
So, you know, data - it's not the sexiest thing in the world.
It's not the sexiest thing! SHE LAUGHS
But it can be really powerful.
It feels a little bit ridiculous that we have all of this data
that is related to sex, and we aren't using them to discover
whether some sexes, or male or females, do better with diseases.
So much information and it just feels like it's all out there,
but nobody really cares?
Or maybe there's just not money to, to interrogate it.
So, why haven't we been looking at sex differences more closely?
Professor Philip Goulder uncovered sex differences
in his work investigating HIV,
and has his own theory to why it's a little contentious.
You know, it's sort of a taboo subject in a way.
It might be that there's a feeling to want
to make out that people are equal.
That there aren't any differences - and, therefore,
to identify differences or suggest that there might be differences,
could be an unpopular thing to do.
On the other hand, I think now that these differences
are becoming very clear-cut with something like Covid,
people are very interested.
Philip is conducting a study investigating
our immune response to Covid.
In both sexes our immune system is divided into two parts,
the innate and the adaptive.
The innate response is our first line of defence.
It's fast and untargeted.
A fever is a sign it's working, raising the temperature
to kill any potential enemies.
If that fails, the slower adaptive response takes over
with specialised antibodies and blood cells known as T-cells.
The question is how and why do males and females
respond differently to the same virus?
We invited Anna and Dani on the study
because they were a special couple, a special family in the sense that
they were all exposed at the same time.
Philip's colleagues have been taking samples from both sexes to try
and understand how their innate and adaptive responses differ.
One of the reasons we're really interested in studying you guys,
you both, is that your disease outcome has been very different.
And that's reflected across the whole kind of spectrum
of people who have been infected by this virus.
The study will examine differences in Dani and Anna's T-cell
and antibody responses.
If Dani's are higher, it could mean that his first line of defence
was weaker, so his adaptive immune response had to work harder.
And why haven't we been looking at the sex differences more before?
I think, erm...
..for example, in my field of work in HIV,
it took something like 36 years since the epidemic started
to realise that women have five times more chance of completely
suppressing the virus through their immune response than men.
So, if viral infections are hitting men more severely than women,
it's worthwhile understanding what's different between the sexes.
And the most fundamental thing are the X and Y chromosomes.
Most human cells contain 23 pairs of chromosomes.
The 23rd pair, the sex chromosomes, differ between males and females.
Females have two X chromosomes and males have one X and one Y.
Each X chromosome contains around 1,000 genes.
The Y chromosome is smaller with less than 100.
Professor Sabra Klein has been studying how this
and other differences between males and females
can impact how we fight viruses, like Covid.
Sabra, nice to meet you.
It is lovely to meet you.
We know that women tend to generate greater immune responses
to viruses than do men.
And high levels of oestrogens have been associated
with greater immunity in females.
Many genes, over 60 genes that are very important for the
functioning of our immune system, are located on the X chromosome.
And researchers, including myself, are very interested in trying
to better understand how these genes on the X chromosome may serve
to protect females from things like viruses.
Wow. So, when we think about our immune system,
in terms of how effective it is,
it's as basic as our chromosomes, XX and XY?
The simple answer is yes, but we do know that environmental factors
as well as our hormones play distinct roles in contributing
to male-female differences in the functioning of the immune system.
Thank you so much.
Sabra believes that the second X chromosome is a key reason
why females have a better immune response to viruses.
I'm thinking if our sex chromosomes play such an important role
in immunity and disease progression,
why has scientific research not looked more closely at this?
Women outlive men worldwide by an average of six to eight years.
In the SARS and MERS outbreaks, death rates were 50% higher in men.
But it's not just viral infections.
Men are also more likely to develop diabetes
and cancer research shows
that men are around 20% more likely to get cancer
and up to 40% more likely to die from it.
At the Dana-Farber Cancer Institute, Dr Andy Lane has been
investigating why more men die from cancer.
Tell me a bit about your research, then.
So, I'm a physician and scientist and I take care of patients with
leukaemia for most of my time in the clinic.
Many of the diseases that I take care of, those patients have a
slight bias toward there being more men than women.
And it was assumed that it was because men
did more risky behaviours than women,
like they smoked more cigarettes, they drank more alcohol,
and indeed, those things are cancer risk factors
and they do change perhaps the skew of cancer,
but there are a few things that say it's not simply that.
Is the same difference seen amongst boys and girls?
In children, the two main most common cancers in children
are brain tumours and leukaemias.
Both of those have a male bias.
Now, it is not two or three to one,
but it's still 20% or 30% higher in males than in females,
that means boys than in girls,
and so infants are not working in the factory,
being exposed to chemicals, smoking, etc.
So that got us thinking that there might be something intrinsic
to being a male or a female at the level of the cell,
the DNA or the organism that might be contributing.
Obviously, females have two X chromosomes,
males have one X and one Y,
so of course there's going to be differences there.
Having two X chromosomes means double the amount
of genetic information.
For decades, we've understood that the body switches off
one X chromosome in each cell -
X-inactivation.
Scientists now know that up to a quarter of the genes
on the X chromosome escape inactivation and remain turned on,
providing a set of back up genes.
Some of these genes could give females added protection
to diseases like cancer.
In our study, we called them
escape from X-inactivation tumour suppressor genes.
They have a normal function and one of those functions
is to prevent the cell from behaving like a cancer.
So, in terms of your research, there is a relationship
between genes that have escaped X-inactivation
and some cancers and there is a gender bias.
And that's where the overall hypothesis of our work came.
Female cells, by virtue of having the escape,
essentially have extra protection
and that simply was a kind of a new idea that hadn't been
looked at across all cancer types.
Wow!
Is this known by the general public?
I don't think it's known.
I don't think it's known by many physicians and scientists.
The fact that females may have a biological advantage
when it comes to many cancers and diseases
makes me think our bodies are fundamentally different.
But perhaps that's not so surprising.
After all, there are clear everyday examples.
If we think about alcohol,
it's well known that women process alcohol differently from men.
And a simple drug such as paracetamol,
the recommended dose for men and women is exactly the same
but we know that men clear paracetamol from their bloodstream
20% faster than women.
Females process and metabolise alcohol and medicines
differently to males and it's not just because of their size.
It's because they are biologically different.
Women tend to have more body fat than men,
where medicines can accumulate and linger.
Their kidneys are also smaller,
which means it takes longer for drugs to leave their system.
Changing levels of female hormones also means that drugs can be
processed differently over a menstrual cycle.
In the past, women were routinely excluded from drug trials,
partly to protect women's fertility,
but also because fluctuating hormones
meant women's results were often inconsistent
and considered too complicated.
So, drug trials have historically used male cells, male mice
and male humans.
This means most drugs on the market have been predominantly
tested on men.
But what's the situation today?
"Guidelines for phase one clinical trials."
So how to make a good trial?
I'm looking for information about, or guidance in regards, to sex.
OK, so "special populations" - women!
"The inclusion of women as early as possible in a drug
"development might be a valuable clinical strategy".
I don't think it could be valuable. I think it's absolutely important.
Incredibly, even now in the UK,
including females in clinical trials isn't a legal requirement.
And shockingly, women are twice as likely as men to experience
side effects to drugs and have more adverse reactions to vaccines.
But the lack of females in clinical trials is only partly to blame.
In his book on the genetic superiority of women,
Sharon Moalem outlines why he believes
women have more side effects when medicine is involved.
Sharon, nice to meet you. Hello!
Likewise!
Even though women have this biological advantage,
they're still being let down by medicine.
Many of the drugs that we give we have actually no idea
how they function in women's bodies.
This is really scary. It's really scary to hear.
As someone who has XX chromosomes, there's a little bit of me that
feels like, oh, the whole population of men just don't care about women.
I don't think that there was some type of patriarchal conspiracy.
In fact, I think it's the opposite.
It was seen that men are a bit stronger
and they didn't want to harm women's reproduction.
Do you feel that women are being included more
in clinical trials now?
Yes. So, what does that mean?
So, if we start out using male cells and male mice
and then at the end of the trial, we include both men and women,
but not enough of them to get a meaningful result.
It's like mixing red and white wine into a bowl together.
You'll get rose.
And that's the way in which we have drugs approved.
Wow.
So in fact, by including women in clinical trials today
we have less information about the sex differential effects
of the drug.
That's why I'm arguing that why are we developing drugs for both sexes?
Why don't we have two parallel systems?
One we use female cells, female animals, female test subjects,
and then get drug approval for women.
And do the same thing for men.
We might actually learn that some drugs may only work for one
sex or another.
This is literally so fascinating.
If we're not going to take sex into account,
then really we're not going to really be helping both sexes.
Does sex matter?
Nothing matters from the perspective of biology and medicine
greater than sex.
DR RONX LAUGHS
What Sharon say makes perfect sense.
If we metabolise drugs differently,
for example females respond up here and males respond down there,
we mix that data together,
but then it is not clear how each sex has responded.
And so, if we are going to include females in clinical trials,
we need to be examining the data and dividing it by sex,
otherwise we could be doing more harm than good.
And sometimes, even when we do know a drug will have adverse
effects, the information doesn't get through to women.
An example is a drug called sodium valproate,
that has been on the market since 1973.
It's used mainly to treat epilepsy.
Even though regulators have known about the dangers
of this drug for decades
very few patients were told that it could damage unborn babies.
Emma has epilepsy and has been taking sodium valproate
since the age of 12.
Her friend Janet has also taken the drug since her teens.
When they decided to have children, each consulted with their doctor.
The consultant always advised that it would be OK to take during
pregnancy, there would be no risks to the baby,
and that's what I did.
I've got five children and they've all been diagnosed with
Foetal Valproate Spectrum Disorder.
There are many symptoms - autism, epilepsy, cerebral palsy, deafness,
incontinence, neurodevelopmental delays, speech and language delay.
A huge array.
Emma and Janet now know that these issues are all related to the
sodium valproate that they each took in pregnancy.
They were poorly, they weren't developing.
It couldn't just be my bad luck that this was happening.
My sister phoned me one day
and she was she was crying on the phone saying that she'd seen a lady
appealing for women to come forward who had been on sodium valproate.
That was a light bulb moment.
It was that moment where everything I had been saying to everyone,
to health care professionals, doctors, nurses, family...
..that there was something wrong and no-one believed what I was saying.
Very hard, and just to speak to Janet, just to hear somebody
that knew what I was going through, it was...
I'll never forget that moment.
It saved my life, it saved my children's life
because we've now got answers.
Since we met, we decided to start this campaign and try
and help and support other families and try and make a difference
to ensure that these families are looked after the way
that they should be, knowing full well that they weren't at the time.
One family that has joined their campaign are Lisa, Robbie
and their nine-year old son, Kieron.
He's one of around 20,000 children that have been
affected by sodium valproate since it came to market in 1973.
He knows he's different from other people,
other children notice he's different.
He struggles with writing,
anything, fine motor,
speech.
He's still struggling with sight - he's improving.
Yeah, he's got quite a lot.
It went a bit off. It went a bit off!
But he is still special.
We wouldn't have him any other way.
At no point at all did they say you shouldn't be taking this drug
if you're thinking about having a child in the future
or we could wean you off this drug, anything like that.
I thought it was me.
Have I been a bad mum or am I fated to be like this?
I think there'll always be an essence of guilt there.
But today, thanks to the campaigning of Janet and Emma,
women taking sodium valproate are much more aware of the dangers.
So that's a big warning for women and girls
that this medicine can seriously harm your unborn baby.
I started to get these on my medication probably around 2019.
It is something clear and it is something there,
and it's something you take note of,
but there was nothing there, not a thing.
How many families' lives wouldn't have been, not ruined,
but turned upside down, just with a little symbol?
This symbol has finally given women the power to make informed choices.
Emma and Janet tell me it took years of campaigning
for their concerns to be heard.
It feels to me, and I'm pretty cross about this,
that historically, women have not been listened to. Yeah.
Historically, women are seemly being "protected"
from making informed decisions about their bodies.
Absolutely.
And we definitely feel it is...
It's an institutional problem.
Absolutely.
It is agreed that pregnant people on sodium valproate
should be warned about this. Yeah.
But not every pregnant person is.
Is that what we're saying? No.
Yes, exactly.
We know that there are families out there
that still aren't being told about it.
And I think that's what keeps us going.
We know that there were 400 babies harmed by valproate last year.
Janet, Emma, you've done so much already.
You have used kind of personal trauma
to actually make changes to a medication.
You're thinking about future children and you really,
really want women to have the autonomy to make decisions
with correct information about their bodies and their future pregnancies
and I am humbled by you,
but absolutely disgusted that it's taken this long.
The story of these families
highlights many flaws within the system
and the biggest concern of them all
is that women were not listened to and dismissed.
Deliberate or unconscious, in the medical world
bias against women exists,
and this can lead to serious consequences.
It's obvious, but females are biologically different to males.
But it goes way beyond drugs acting on the sexes differently.
Women can also present differently to men for the same conditions.
But because so much of medicine and health care is biased to men,
these differences are often overlooked.
You can see this bias in the diagnosis of autism.
Scientists believe that thousands of women
and girls are going undiagnosed.
And part of the reason is that this condition
is typically linked to boys and men.
Francesca, Hi. I'm Dr Ronx. Hi, nice to see you, come on in.
Thank you.
When I have watched TV programmes or met autistic people,
they tend to always be men, male.
So, we have the stereotype
and it's perpetuated in research, actually.
A lot of studies didn't even recruit females,
cos they didn't expect to get enough.
And that's a real problem, because then that trickles down into
what we know about autism, how we design the diagnostic systems
and so on. So, this male stereotype is a real problem.
We know that some autistic women
develop quite complex masking behaviour.
So they've learnt how to behave
and they maybe watch a lot of films to try and learn, "How do I dress?
"How do I walk? What do I talk about?
"How do I start a conversation?"
Learning quite consciously and deliberately how to fit in.
How does the diagnostic tool that you use cater for this?
I can imagine many young girls,
many women will be able to fake it, for want of a better word.
It's a really important question -
how do we adapt diagnosis to be fair to women and girls?
And at the moment, that hasn't really been done.
We need to focus our research on them so that what
we know about autism isn't just what we know about male autism.
Autistic women and girls often go undiagnosed
partly because they are able to mask or camouflage their autism.
At Limpsfield Grange, a state school comprising mostly of autistic girls,
their headteacher believes that early intervention
is the key to accessing tailored support.
Miss Wild, hello. Hi, Ronx, lovely to meet you.
How are you? I'm very good thank you. How are you?
Parents who suspect that their children are autistic,
or their female child is autistic,
what are the things that they've told you
in terms of difficulties getting diagnosis?
They come up against lots and lots of barriers,
and it's almost like autism isn't even on the list
because you're female.
Actually, it is about medical professionals and GPs, in particular,
having an open mind and really hearing what people say.
It feels quite poignant to hear you say, "Health care professionals
"need to be open-minded and learn to do better and be better."
I am ten years out of medical school now and still
when anybody says the word autistic, autism to me,
I have somebody lining up pencils or cars
or being really intelligent.
Or I've got the really unruly,
difficult to manage non-verbal autistic boy.
In my head, I definitely don't have an autistic woman or an autistic female child.
It's really about just people listening.
And, actually, if you don't make the right call,
you don't listen to all of the information,
you're going to close down doors that you're not even thinking about.
And I guess we all come with our own biases, don't we?
In our workplace, in our social life, etc.
I feel even more worried that the biases that
I hold would prevent a young person being able to access
the care that they need, which could be life-changing.
Hi, everybody, thanks for having me here.
I'm Amina and I'm 13.
I'm Scarlett and I'm 15.
My name is Leila and I'm 15.
I'm Sophie and I'm 12.
Are you able to tell me about when
you were first told that you were autistic?
I was diagnosed formally when I was three.
I think I was about seven or eight.
I was in year five at my old mainstream primary school.
And it was more of a relief to my parents,
cos they were fighting so much to get my diagnosis.
I was nine when I was diagnosed.
And I remember, like, cos my parents, literally, like Scarlett,
they'd been fighting for, like, two years, like, so hard.
You seem very, very confident and socialised.
So do you think that was part
of the reason why your diagnosis came later?
I guess I was just really good at masking,
which I don't know if that's a good thing or a bad thing,
but nowhere would believe that I was autistic.
And that is really something that us doctors need to realise is
that in girls, the way that autism traits and autism can present
sometimes is just so subtle that we mistake it for something else.
Now, tell me how your life has changed being here.
I guess I know who myself is and I know I'm not like the angry
person I was when I was, like, before I was diagnosed.
Now that I'm here,
I've found girls who are just like me.
This school has honestly changed my life.
I think it's created a person out of what
I was at a mainstream school that I could never have done by myself.
The alpacas are quite jittery and they're quite anxious
and so it's quite a good way of talking to the girls about,
"Well you have to be a bit calmer if "you want to spend time with the alpacas."
Just seeing how this school supports autistic girls
really emphasises how important early diagnosis is
for their quality of life.
The gender bias in autism, I don't think it's deliberate,
but definitely needs to be challenged.
We need to be asking specific questions which pick up
female autistic traits.
And I guess as a society,
we need to redefine our understanding of autistic women.
Gender bias exists everywhere.
It prevents women and girls from getting help sooner
and in some conditions, like heart disease,
this delay can be a matter of life or death.
We tend to think of heart attacks as a male problem,
but it is the single biggest killer in women worldwide.
For both sexes, crushing chest pain can be the main symptom.
But as Dr Kunadian explains to me,
women are more likely to present with a wider range of symptoms.
In medical school, I just remember being taught that it's the
"Oh, my God! Oh, my God!"
You know, pale, sweaty, clutching chests.
But in reality, that isn't always what we see.
The gender bias in heart disease is something that we have
known about for a number of years now.
So, when a woman presents or even if she's experiencing,
she doesn't think that she could be having a heart problem herself.
One of Dr Kunadian's patients,
35-year old Jenna,
experienced this bias first-hand.
On TV it seems to be portrayed as a man's problem.
It's always the men that you see hit the floor, holding their arm.
It's not very often you see a woman.
I had no chest pains, no pain in the arm, nothing like that.
No shortness of breath, nothing at all.
I felt like I had a little bit of heartburn.
It felt like there was acid rising from here, like about here,
up my throat,
just to around my lower jaw, but it went as quick as it came.
It started happening at least three, four times a day.
So I thought, "I think it's probably time I went and seen a doctor."
The nurse examined us, she said she could hear a slight crackle
on one of my lungs and gave us antibiotics.
I thought I just had an infection.
I got an episode while I was in Asda
and it lasted about four or five minutes.
So, I just stood still leaning on the trolley,
waited for it to pass, continued doing my shopping.
My sister ended up phoning an ambulance.
When they came into my house,
they just came in, introduced themselves,
put the stuff down on the floor and said,
"Right. Come on, then. We'll stick this ECG machine on you."
And you could tell by his face when he looked at the results,
it was like, "Yeah."
He took my husband into the passage and I could hear him saying,
"Your wife's having a heart attack,
"and if she's not in Freeman's within the next 30 minutes,
"she's not going to make it."
I didn't realise how close I was to dying.
Skinny, 35.
Walking, talking.
But it nearly killed us.
If it can happen to me, it can happen to anybody.
Jenna wasn't having a chest infection,
she wasn't having indigestion,
but she was actually having a full-blown heart attack.
The important thing is that these atypical
characteristics of the heart pain has been described more
prevalent in women when compared to men
and that could be one of the reasons why women's symptoms are ignored.
That has shocked me
and then I think lots of doctors would then be thinking,
"Hmm. I've seen loads of female patients with heart pain or
"chest pain or symptoms that I couldn't quite place.
"They were well, so I've sent them home.
"Maybe I should have sent them to the Rapid Access Chest Clinic
"or to have an angiogram sooner."
Women are 50% more likely than men to receive the wrong
initial diagnosis for a heart attack
and this can often be fatal.
One diagnostic tool used is the coronary angiogram.
It uses X-ray imaging and contrast dye to see if your heart's
blood vessels are allowing blood through as they should.
Most male heart attack patients show very clear blockages like this one.
But this angiogram, of a woman's heart,
reveals they often have a different cause.
What we see is that her arteries further down, they are very narrowed
and some unusual appearances, particularly in that area
and that is a condition which happens
more frequently in women than in men.
Women are more than twice as likely as men
to have only partially blocked arteries.
This means problems are harder to spot on an angiogram.
From the patients to the families to health care professionals,
the bias runs deep and it's actually quite upsetting that only
recently we've become aware of these sex differences.
When women show different symptoms
and health care professionals don't listen,
women are harmed.
This can be avoided.
Things have got to change.
It's now clear to me there's a data gap between the sexes.
Information is missing about women's health
and it's costing women their lives.
But it doesn't stop there.
I feel kind of embarrassed and ashamed that
I haven't thought more openly about sex differences in lots of things.
So, being a feminist, I'm always thinking this world is unequal,
this world is designed for men,
everything is for men, blah, blah, blah, blah,
but I've never actually sat down and thought, actually,
in terms of health outcomes and also just even broader in terms of...
..each...how the world is designed, I've never really sat down
and thought, is there data in regards to this?
This gender data gap is something Caroline Criado Perez
investigated in her best-selling book, Invisible Women.
Caroline! Hello.
Hi! Hi!
How are you? Oh, I'm good, thank you! Hello!
I just couldn't help myself.
I was so horrified to discover
that we were basing medical treatment
and the development of drugs just using male bodies,
and that women were basically dying as a result.
Obviously not in every instance.
And so we just don't notice when we're excluding women
because we're always talking gender neutrally,
when most of the time we're actually talking about men.
And then when women don't conform to that, they're screwed.
And that's the most frustrating thing for me,
is that it does seem really, really, really obvious.
How can this be going on in the 21st century
and it not be, you know, a front-page news story every day?
And that is because of the data gap.
So in the allocation of Government resources,
in how we plan our economy, in public transport,
in private transport,
and you just see it crop up in all sorts of areas.
The solution to the gender data gap is very, very simple.
All you have to do is collect data on men and data on women,
and then label it and then analyse it separately.
I believe it's so important this data gap is filled.
Understanding differences is going to help both sexes.
It's what the Oxford team are trying to do
with their Covid immunity study -
the one Anna and Danny took part in -
and now they've got the results.
Hiya, Anna.
Hello.
Hey. Hi, good evening.
So, should we cut to the chase and tell you what the results are?
Basically, you both have antibody responses.
Excellent.
However, the size of the responses was very different,
and Danny's antibody levels are about 15 -
a bit more than 15 - times higher than yours, Anna.
And then the T-cell response is really, again,
the same sort of pattern, so...
And we know that females make stronger responses,
innate immune responses to viruses and vaccines.
If that innate immune response can block or deal with
most of the virus, then the adaptive immune response has much less
work to do to to clear out the rest of it.
Her first line of defence is much stronger than, let's say,
my first line of defence.
So it broke down my first line defence, got into me, which is
then why I had a lot more of the effect
and a lot more, I guess, now, of antibodies,
where Anna was able to deflect it and still get some of it through,
and I guess built up her immunity as well.
I think that's a good summary of it.
If we could understand why Anna's first line of defence is
so strong, that information could be used to help someone like Danny
and perhaps prevent him ending up in hospital or worse.
This could have massive implications for prevention through vaccines
and for treatment that, together, could save many lives.
The more information we have, the more sex-disaggregated data
we have, the better it will be for both sexes
when it comes to thinking about health,
when it comes to thinking about vaccinations, medicines.
Basically, we can't treat each other as though we are one sex.
It's taken something as awful as a global pandemic for us
to finally start seeing this.
Many individuals in the scientific community
have been pushing for this
and it feels as though that they are slowly starting to be heard.
As are Emma and Janet and the thousands of families
affected by the drug sodium valproate.
A long-awaited review, led by Baroness Cumberlege,
is aired on national TV.
If this Government and the health care system ignores our
review and another medication and medical device damages people to the
extent that we have witnessed, they will and should not be forgiven.
Sodium valproate is an effective medication to control epilepsy,
but, even today, this medication causes harm to unborn children.
Women told us that when they were pregnant
and controlling their epilepsy with sodium valproate,
they were never told that the unborn baby could be seriously damaged.
They didn't know that the chances are one in two.
One in two damaged babies.
What a tragedy.
It's a vindication that we were right.
You know, it's been worth every fight, every tear, every late night,
and to hear that, to see that, it's been worth every moment.
We've got to continue the campaign
because children's lives depend on this now.
The aim for us now, as a family, is to make sure that no families
have to go through all this again - that women get an informed choice,
that they know the risks, the full risks,
and then, obviously we want care plans for our children.
We can't be around forever.
What's become really clear to me
is that there is value in studying sex differences.
The key to protecting us equally
could, in fact, be found in treating us differently.
As doctors, we're gatekeepers.
We must be aware of our biases.
We must also be aware that every decision we make
affects people's lives.
So, does sex really matter?
Definitely.
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