Washington, D.C. - The exclusion of women from the majority of clinical studies has created gaps in medical knowledge about the effects of disease and treatment of women, according to an editorial in the February 2001 American Journal of Psychiatry.

The concept of gender-based biology applies to all areas of health care, says Nada L. Stotland, M.D., M.P.H., of the department of psychiatry at Advocate Illinois Masonic Medical Center. Stotland, a member of the AJP editorial board, authored a perspective in the Journal that highlights two studies this month, both of which address the differential effects of alcohol abuse on the brains of women and men.

A key problem in providing women with the medical attention they require is that treatments for many diseases are not tested on women at all, which results in a further widening of the gender knowledge gap, Stotland says. "It's not only a question of fairness. By looking at gender differences, you can learn a lot about how diseases work."

In one of the Journal articles, "Evidence for a Gender-Related Effect of Alcoholism on Brain Volumes," the authors conclude that alcoholic women in their thirties show clear evidence of brain shrinkage, compared with nonalcoholic women. Brain shrinkage in alcoholic men is present, yet not as severe.

Lead author Daniel W. Hommer, M.D., chief of brain electrophysiology and imaging of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, says the gender-related effect on brain shrinkage is greater in alcoholism than in other diseases and psychiatric disorders.

"I believe that the most likely reason for this is that while, on average, women are smaller than men, the alcoholic women in our sample drink almost as much as the alcoholic men," Hommer says. "Thus, the women achieve higher blood alcohol concentrations and more organ damage."

The other article, "Sex Differences in the Effects of Alcohol on Brain Structure," finds that alcoholic men and women show different brain deficits relative to same-sex comparison subjects. Edith V. Sullivan, Ph.D., co-author of the article, says studying women is more difficult because recruiting them can be problematic. For one thing, they tend to face more of a stigma than alcoholic men.

Also, women may be unavailable for study because they have children or other dependents to take care of, which limits the time they could spend participating in a study. Women may also have difficulty getting to treatment sites, particularly if they are poor, and they may fear losing their children if they seek help. But that doesn't mean they should be neglected, Sullivan says.

"Despite the difficulty in recruiting alcoholic women, many more rigorous studies of alcoholism's effect on the brains of women are needed to characterize differences in types of brain damage women incur and to identify demographic, genetic and environmental factors that contribute to such differences," Sullivan says.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 40,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses and substance use disorders.

["Evidence for a Gender-Related Effect of Alcoholism on Brain Volumes," by Daniel W. Hommer, M.D., et al, p. 198, American Journal of Psychiatry, February 2001.]

["Gender-Based Biology," by Nada L. Stotland, M.D., M.P.H., p. 161, American Journal of Psychiatry, February 2001.]

["Sex Differences in the Effects of Alcohol on Brain Structure," Edith V. Sullivan, Ph.D., p. 188, American Journal of Psychiatry, February 2001.]

---American Psychiatric Association

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