Gillian Einstein, a distant cousin of Albert Einstein, is exploring why brain disorders like Alzheimer’s disproportionately affect women. Her research raises a difficult question: Do cultural practices and health anomalies reflect differences between the sexes, or do they create them?
Toronto Star, by June 3, 2017
Soon after opening her lab at the University of Toronto in 2006, Gillian Einstein began investigating the effects of female genital cutting. For a cognitive neuroscientist, this might seem like an unusual part of the body to study.
“So much of the focus of these women has been on their genitalia and reproductive lives,” Einstein says. “Of course I care about that if that’s important to them. But I actually started out by telling the women, I’m not interested in your genitalia. I’m interested in your brain.”
Einstein began sifting through research on what is sometimes called the sensory “homunculus,” the pictographic map of the brain showing where sensation in each body part is processed. This map, one of the most famous illustrations in neuroscience, looks like a bit like a ghoulish Spartan helmet: a curved hemisphere of cortex with drawings of limbs, digits and organs sprouting from every inch.
Einstein knew that the brain region where sensation from the genitalia is processed sits right beside the spot for sensation from the feet and lower limbs. She wondered, among other questions, if cutting these women’s genitals affected their gait. But as she and her team rummaged through 65-plus years of literature, every illustration of the sensory homunculus depicted a man.
Nobody had mapped a woman’s body. The “hermunculus,” as Einstein later termed it, is mostly blank apart from the breasts and vagina.
Aside from the potent symbolism, this ignorance has real consequences.
The sex and gender bias in clinical health research is long established. Published studies on erectile dysfunction outnumber studies of premenstrual syndrome five to one, though a fraction as many men suffer from ED as women suffer from PMS. Because women were under-represented in clinical trials for decades, the efficacy and safety of therapies are less certain for them; of the 10 prescription drugs withdrawn from the U.S. market between 1997 and 2001, eight were more dangerous for women. Policies to address the clinical trial sex gap have existed since the 1990s.
The imbalance in basic cellular biology is less obvious to non-scientists, and even to some scientists. Researchers often rely on male mice and cells in basic experiments, and assume their findings will hold up in female mice or cells, too: male biology is assumed to be universal. Neuroscience is the discipline in which this bias is most pronounced. One survey found 5.5 times as many neuroscience studies that only used male animal models compared with those that used only females.
In recent years, a chorus of scientists has argued that this assumption is dangerous, and risks occluding sex differences that could help us understand disease in both women and men.
Einstein has staked her career in the middle of this bald desert of ignorance.
She runs the rare lab that focuses almost exclusively on the basic biology of women’s brains. But her research is also bolstered by an even less common concept, at least in neuroscience: that to understand the brain we need to examine not only sex differences like hormones and genetics but also the cultural context of gender, and how social and cultural life experiences are absorbed into our biology. “The world writes on the body,” Einstein often says.
In December, Einstein was awarded the inaugural Wilfred and Joyce Posluns Chair in Women’s Brain Health and Aging, which comes with $1 million over five years to investigate why women are more affected by brain disorders like depression, stroke and dementia. Along with her work on sex differences, the grant specifically supports her research on the cultural and social factors that might be tilting this disease burden onto women.
“This idea that gender is only social, and doesn’t get under the skin,” Einstein says, “is no longer true.”
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