Nothing is more evident in clinical medicine than the complex and interactive relationship between human biology and the environment in which individuals find themselves. The immune system is weakened by depression, the healthy human heart can fail acutely in response to an emotional challenge, and the relationships we have with other living things affect our susceptibility to disease and the length of our lives.
Everything we experience has an impact on our biology.
Defining, describing, and monitoring the intricate dance between physiology and social experience is the essence of the challenge that faces anyone genuinely interested in understanding the human condition.
I can still remember the shouting matches during the scientific sessions at the Office of Women’s Health Research at the NIH when we began to try to define the term “gender-specific medicine”. There were two camps: the biologists wanted to separate humans into male and female based on their XX or XY chromosomal complement. The anthropologists and social scientists objected that a strictly “biological” system ignored the tremendous impact of the environment on the individual that directly impacted health and the experience of disease. Initially as we shaped our concept of -for want of a better term- we called gender specific medicine, biologists often (and inappropriately) dismissed the product of these allied disciplines as “soft” science. The anthropologists and sociologists complained not only that we didn’t invite their collaboration or integrate their data with our own, but also that we had no regard for their expertise and methodology, calling it “soft” data. In fact, biological research is concerned with the physiologic characteristics of the organism, and when it does attempt to integrate the impact of environment on the data, it necessarily does so in a limited fashion.
Traditional research of all kinds has utilized only one set of skills in investigating differences between men and women, and has not grappled with the extraordinarily difficult and most important task of teasing out which characteristics of the organism are hardwired as a result of biological sex and which are the consequence of social forces and environment. Nobel laureate Eric Kandel’s work is a stunning testament to the fact that what happens to us changes the very structure and molecular behavior of our brain; “hardwired” becomes an elusive and almost impossible-to-define adjective.[1]
Who we are literally and inevitably depends on the interaction of the individual with the environment. Determining what is the result of innate, immutable, and sex-specific characteristics, and what is the result of what happens to and around us, is the most difficult and perhaps never perfectly solved issue in gender-specific medicine. Both components are important. Biology and individual human experience are inextricably interrelated: for example, women in primitive societies who do laundry by the side of streams infested with the bacteria chlamydia trachomatis have a much higher incidence of blindness caused by the infection than do men; the remote, impoverished areas of 40 countries are affected across Africa, Asia, Latin American, the Middle East and the Pacific Rim.
One of the most important insights into how the environment actually changes our physiology has emerged in the last decade: the science of epigenetics, which inspired our symposium “Sex, Gender and Epigenetics: From Molecule to Bedside” held in Italy in 2022.[2] It is clear that every experience registered in the brain of a conscious organism produces a small chemical modification of the way our genes are expressed; our DNA itself is unchanged, but the substance our genes produce is altered. For the first time, we understand that there is an inextricable link between our biology and our experience of the external world. Epigenetics makes it possible for us to adapt to the world around us: to learn new tasks, shape memories and survive the challenges life presents.
The problem is that we have no word for this unifying concept: strictly speaking, “gender-specific medicine” doesn’t reflect the nexus between biology and experience in shaping the individual human. Yes, fundamental differences between the sexes remain but the experience of men and women varies tremendously in all societies. And those experiences have a direct impact on how we function and ultimately, who we are as individual persons. The challenge to investigators to sort out precisely how experience molds identity and function is complex and can never be perfect.
We need a new term for our science: so far, our scholars haven’t come up with a noun that defines what we are really trying to do: untangle and respond to the biological modifications imposed on human function by the environment. As Doctor Gillian Einstein has put it: “The World Writes on the Body”.
Article written by founder Dr. Marianne Legato.
[1] Kandel ER, Schwartz JH, Jessell TM. Principles of Neural Science. 3rd ed. New York, NY: Elsevier; 1991:1135.
[2] Sex, Gender and Epigenetics: From Molecule to Bedside. Marianne J. Legato, Dov Feldberg, Marek Glezerman ed. Academic Press. 2023. London