"Gender medicine is not a women’s issue"

Osteoporosis is considered a typical women’s disease and is therefore often diagnosed too late in men. At the same time, medications can affect women differently than men. Physician and National Councilor Bettina Balmer explains how gender medicine moves from research into practice and policy, and why this improves care.

Dr. med. Bettina Balmer

Ms. Balmer, you are a pediatric surgeon at the University Children’s Hospital Zurich, a member of the National Council, and president of FDP Women Switzerland. What do these roles have to do with one another?

Bettina Balmer: A great deal. In my everyday work as a physician, I see very concretely where the health care system is under pressure and where we can take action so that medical care remains high-quality and affordable. As a politician, I can take this knowledge to the places where rules are made and funding is allocated. At the same time, I repeatedly notice that medical knowledge we take for granted in the hospital is sometimes simply not present among the general public or even in politics. If I reach 245 members of parliament, all of whom then also have an amplifying role, that is a major opportunity.

Can you give an example?

Gender medicine. Or perhaps better: individualized medicine. The word gender quickly triggers defensive reactions, especially among center-right politicians. Sometimes the debate is over before it has even begun. But if I say: We want to tailor medicine more precisely to the individual person, many people immediately understand what it is about.

So you avoid the term in order to advance the issue?

I would say: I translate it. As a politician, I know that the name, or if you like, the “label,” is central. If you want to anchor something in the population, you need a word that does not first trigger resistance. Gender medicine does not simply mean: women are different from men. It is about biological differences, but also about role models, living conditions, health behavior, and social expectations. All of that is contained in the English word gender, but it is not so easy to translate into German.

What does that mean in concrete terms in medicine?

At the children’s hospital, we calculate medication for children very precisely according to weight. In adults, by contrast, we often give a standard dose: man, woman, 50 kilos, 120 kilos, all the same. That cannot be the future. A petite woman and a heavy, muscular or obese man do not automatically process medications in the same way. We need to look more closely.

So you are saying that medicine is still too imprecise?

Yes. We talk a lot about precision medicine, but in everyday practice we sometimes treat people with surprising imprecision. Yet we have long known that body composition, fat and muscle mass, hormones, enzyme activity, or metabolism influence how medications work.

Which medications does this apply to?

One example is immunosuppressants: women metabolize them faster, so women tend to need more of them than men to achieve the same effect. With certain blood pressure medications, it is the other way around: men metabolize them faster, and women may be more likely to be overdosed if the dosage is based on male patterns. For some sleeping pills, such as zolpidem, for example, it was found that women break down the active ingredient more slowly on average. As a result, higher drug levels were still present the next morning, increasing the risk of fatigue and traffic accidents. That is why lower initial doses for women have been recommended in some countries. Sex-specific differences can also be clinically relevant for certain heart medications, antidepressants, and pain medications.

Gender medicine is often perceived as a women’s issue. Is that wrong?

Yes, that is too narrow. Men benefit just as much. Osteoporosis is a good example. Many people think of it as a classic women’s disease. Yet men are also affected, more often than was long assumed. When their testosterone levels decline with age, bone density can also decrease in men. If we only think of women, we overlook men in this area.

So would it be enough simply to adjust dosages?

That would not be sufficient, because medicine always also has to do with behavior, language, and expectations. Taking a patient history is extremely important; as a rule of thumb, it is said to account for 60 to 80 percent of the diagnosis. If a female patient describes her symptoms differently, if she is not taken seriously, or if a physician fails to correctly interpret certain signals, information is lost. Then the medicine is worse, even if all the lab values may be correct.

So the consultation itself is part of the problem?

It can be part of the problem, yes. Women may sometimes present differently from men when giving their medical history. These are not minor details. If physicians know this, they ask differently, listen differently, and get to the information they need more quickly.

What would need to change in medical education?

Gender medicine must become a matter of course. If differences are included in drug information, students learn them automatically. That would have a pop-up effect. This requires professorships, courses, and people who represent the topic in everyday medical practice. Zurich has taken an important step with the first professorship in gender medicine, and Bern has as well. But it takes time for this knowledge to truly reach clinical practice.

And how do you advance this politically?

Through education, parliamentary work, and the allocation of funding. I have already organized a roundtable on this with the Federal Office of Public Health. We are also in the process of establishing a parliamentary group on women’s health. If studies are well designed, gender aspects should be given greater consideration when funding is awarded. That is money well invested.

Why should this also convince those who have little interest in equality policy?

Because better medicine leads to better outcomes. If we dose medications correctly, patients have fewer side effects and better effects. Fewer side effects mean lower follow-up costs. That is a logical causal chain. You do not have to be ideologically convinced first to see that this makes sense.

If you could implement one political decision immediately, what would it be?

I would want individualized medicine to become an established element of the health care system. It should not remain a niche topic, but become a natural parameter in research, education, and clinical practice.

Interview: Marita Fuchs