Medical research has historically excluded women from clinical trials, treating them as 'small men,' which has resulted in incomplete, sometimes harmful health advice for women; this gap is now being addressed through new research initiatives, including Australia's first mandate requiring researchers to consider women in their studies, and through personalized medicine approaches like pharmacogenomics (PGX) that can help prescribe medications more effectively based on individual genetic profiles.
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Dr. Stacy Sims and other world-leading experts on living longer and healthier | Full documentaryAdded:
Okay, Liz, we're ready to go.
>> This is not the way we're used to seeing Liz Hayes.
>> That's a surprise.
>> This time, she's the guinea pig.
>> Chest up. Chest up. Chest up.
>> Putting herself through a series of tests to find ways to improve women's health and potentially extend their lives. Well done.
>> But on this journey, she's discovering some uncomfortable truths about women and the medical system.
>> And that's what it is. We have been part of an experiment.
>> Yes.
>> According to leading experts across the globe, when it comes to health, women's biology has been largely ignored. I think your mantra is pretty basic and that is >> women are not small men >> and the consequences have been dire.
>> Like I could have very easily died in that moment.
>> Hello and welcome to Spotlight. I'm Michael Asha. For Liz and half the population, about 14 million women and girls, health advice has been built on incomplete, sometimes poor, and even harmful information. Tonight, Liz Hayes investigates what that means for women and what's being done to change it.
For over a decade, Libby Trickett was Australia's darling.
four times Olympic gold medalist with one silver and two bronze to boot.
Liby's going to touch it and get it.
>> In her day, she broke records, >> world record >> in freestyle, butterfly, and multiple relays.
>> The stuff of legends.
But last year at the age of 40, the seemingly healthy mom of five suddenly felt very unwell.
>> I was going to my girl's school. I was going to take them to their swimming lessons, which is located at the school, and I just remember feeling just a tightness in my chest that felt really scary. and then just an overall feeling of unease, this sense of impending doom.
>> It was unlike anything Libby had experienced.
She'd welcomed her youngest child, Archie, just 2 months before.
>> My lovely GP, who I've been seeing for over a decade, uh basically put it down to a panic attack.
And so, as you do, after having what I thought was a panic attack, I went home and made dinner for everybody and kept on moving with my life.
But it wasn't a panic attack. And incredibly, it took 8 months before Libby received a shocking diagnosis.
The cardiac MRI showed that I had scarring consistent with a um myioardial inffection.
>> That is a heart attack, >> which is correct.
>> In fact, Libby had suffered what's called scad, a spontaneous coronary artery dissection, a tear in the wall of a heart artery. It is a catastrophic event and sometimes fatal and it can occur during or after pregnancy.
The reason the diagnosis took so long is probably because it's a poorly researched condition.
And that means without answers, Libby lives in fear it will happen again.
easier, but we'll make it through.
When times get hard, I'll come to you.
>> At this stage, I can't go on roller coasters with my daughters. That's going to make me cry. I want to have adventures with them. Sorry.
I obviously want to be around to see my kids grow up and see them thrive and >> have their adventures. Like that is something that god I get so excited about.
>> But the idea that I can't then necessarily experience it with them, that makes me really sad.
The amount of families that are destroyed because the the woman has this catastrophic event is more than I can bear.
And I think we need to as a society, as scientists and researchers and as you know our government need to put more funding into research for women in all of the areas that affect women.
Libby has joined a long list of women who are fighting for health equality.
The problem is, and I can't quite believe it, is that for so long, medical research has not required women to be included in clinical trials. And the reason for that is somewhat alarming.
Well, it's a century old story, unfortunately. And it begins with this assumption that women and men are not different to one another, aside from reproduction.
Professor Bromewin Graeme is recognized as a worldleading expert in women's health.
>> Well, we'll just study males. They're a simpler model.
>> Based at the University of New South Wales, Professor Graham is the director of the Center for Sex and Gender Equity in Health and Medicine at the George Institute for Global Health.
She says the huge gaps in knowledge about women's health means treatment involves a whole lot of guesswork.
Well, essentially it means that health and medical research has been designed for and tested on males and then it has been put out into the wider population which of course is much more diverse than that. And there the great experiment begins.
>> And that's what it is. It's we have been part of an experiment.
>> Yes. Women absolutely.
So as a consequence, we know that women are more likely than men to experience adverse reactions to drugs and to vaccines. Eight out of 10 drugs removed from market were done so because of adverse effects, greater adverse effects in women than in men. And it would be reasonable to conclude that's because women haven't been included in the testing. Professor Graham says this has an enormous effect on the treatment of some of the biggest issues we confront.
So mental health is actually the anxiety disorders in particular the biggest burden across a woman's lifespan greater than cardiovascular disease.
But we deliver our health treatments for psychiatry and psychology in a totally genderneutral lens. We know that many mental health conditions present differently in males and females. One example would be trauma. Um, and we know that when males discuss their trauma symptoms, they are more likely to get a PTSD diagnosis, whereas women discussing their trauma symptoms are more likely to get a diagnosis of a personality disorder. And certainly all of the early work on PTSD was done in male veterans.
>> I mean, we we've been left out in the cold for a long time, haven't we?
>> A really long time. Yes.
>> In some cases, the discrepancy is more obvious to the eye. Most training for CPR is done using mannequins with androgynous torsos. Do you think that has an impact on those um who might find themselves having to resuscitate a woman?
>> It absolutely does. And so what that means is that when a person is confronted with a woman with breasts having a heart attack, they're confronted with questions like, "What do I do with the bra? What impact does the breast tissue have on my ability to do CPR?"
>> This bias, and that's what it is, doesn't stop there. As more and more of us turn to AI for health answers, women are being shortchanged again, but on a much larger scale. Chat GPT alone says millions seek advice on medical issues.
I've come to London to meet a man whose research is so significant that it's forced Google to reassess its AI models.
I think in 2026 we know that AI is being used really quite widely and the question is how do we mitigate the risks of AI?
Sam Rickman, a principal data scientist and AI researcher, analyzed case notes from 3,000 patients.
Using identical details for each case, he changed only the patients gender to see whether artificial intelligence would recommend different treatment advice.
What he discovered was that Google's AI tool, Gemma, interpreted the health needs of men and women differently and often to the detriment of women.
Well, that was the risk that this evaluation uh on gender uh created a bias which could see am I right that women um would potentially not get the care they needed urgently or or be viewed as seriously.
>> Yeah, absolutely. I I think you know if you could imagine a busy local authority department that's deciding how do we you know we've got a natural use of these kinds of tools and if there's this systematic um under emphasis of women's needs then it would be surprising if it was not the case that women were not seen as quickly as men who have the same level of care needs.
>> Well I mean how does that happen? I think we need to accept that at least while AI is broadly how it is now, we're never really going to know why it acts the way it does and we just need to treat it as a black box and try to make sure that we evaluate it properly. Um, >> it's a red flag though, isn't it?
Particularly for those at the front line.
>> Yeah, absolutely. And I I don't think this is something that you could expect a doctor to notice.
AI is only as good as the information that is being put into it and the people who are training the algorithms as well on that information. And so it is absolutely logical that when you have a health and medical research foundation that has been biased against women and that has been built for tested in men that when we use that information to train AI to provide diagnosis or to provide treatment avenues that that is also going to be replicating those biases.
I have to say that none of this is making me feel terribly confident now that I've just turned 70. But there is some good news that I hope will put all women on the right path. My next stop is across the Tasine to New Zealand.
Up next, >> I think your mantra is pretty basic and that is >> women are not small men.
>> Plus, how this Australian woman is helping women live longer and better.
>> In essence, you're telling me we can grow bone.
Three, two, and march. Two, three, four.
One, two, three, two, three, four.
Back in the 80s, exercising was all about leg warmers and leotards and cardio.
One burn. Three.
Squeeze.
>> I don't want to do this anymore. And my buttons, they don't feel nothing like steel.
>> Today, the leg warmers are gone, but women are still seeking the best way to keep fit. at gyms and on social media where there is plenty of advice.
>> Here's an effective full body workout you can do with just dumbbells. Let's go.
>> What I eat in a day to have high protein.
>> Healthy but realistic. What I eat in a day.
>> Women's health has become a hot topic around the world. It seems everyone is talking about it. And I've come to New Zealand to meet a potent player in the discussion. And she's about to upend everything we thought we knew about exercise and nutrition for women.
Hey, I'm a scientist and as I've said before, science evolves and the more information we have, the more I can disseminate and get it out to you as a listener.
>> Dr. Stacy Sims is a social media star with more than a million followers worldwide, >> a frequent guest on the world's biggest podcasts like this one with Mel Robbins.
>> So 30 and up, your hormones change, and now the 10 to 12 reps that we've all been socialized to do >> does not work. Which is why we all start bitching about the fact that our bodies are not responding to what we always used to do. This makes a lot of sense, Dr. So when you're doing the higher reps, it's more of what we call metabolic stress. So that's more like muscle contraction using fuel. Yeah.
>> But it's not an impetus to build lean mass or to become stronger.
>> Stacy is a scientist and researcher with a PhD in exercise physiology and metabolism.
>> I can talk macronutrient numbers all day, right? But as a scientist, how do I translate that? I just love it when someone comes in. I don't get it. My husband and I are doing the exact same kind of diet and I'm getting slow and fat and tired and he's leaning up.
>> Yeah.
>> It's because you're different.
>> She says women for too long have been basing their exercise programs on male research.
>> If women had had a seat at the table when scientific design first started, we wouldn't have this gap. Right now we're at the precipice where new scientific design is occurring and women need to have a seat at the table so that we are not left behind.
>> I think your mantra is pretty basic and that is >> women are not small men >> and that's really what you're trying to drive home.
>> Yes, >> we are different.
>> We are >> and our health outcomes will be different until we understand that.
>> Right. Last week I woke up and I was like, I would just like to wake up one day to a system that was built for me instead of having to fight a system all the time. But women are always fighting the system.
>> Is that what you feel like? You're fighting the system >> sometimes.
>> You're having to constantly argue the point >> and advocate for women's health. Yeah.
Otherwise, things just kind of get pushed to the side and women are not optimized.
Stacy's message is simple. Women need to concentrate on strength >> and not weight loss with extreme diets and radical cardio. And with her guidance, Stacy shows me how fitness can start with very basic exercises. I feel that.
>> So, it's kind of like doing a crunch, but it's a functional one because you're using your entire body to contract.
Slam.
There you go. Perfect.
>> There's something satisfying about that, Stacy.
>> Yeah.
>> There's something about Get out anger.
>> Coming up on your toes, slamming.
>> The takehome for women of all ages, but especially as we get older, is build those muscles.
>> It's really important for women to be muscle.
>> Build your muscle.
>> Build your muscle. Use the muscle by lifting loads, pushing loads, being active however you can because it's so important to maintain muscle muscle function, muscle quality, especially as you get older.
Not that cardio is out, it's not. Just now it's about shorter, sharp bursts.
Stacy is equally invested in women's nutrition, especially plants and protein.
>> So on this platter here, >> I could eat pretty much all of it. Is there anything wrong on this platter?
>> Nothing's wrong. It depends on the amount that you have.
>> Okay.
>> And once again, I'm on a learning curve.
>> So this is all fiber and there's protein in there. So, we try to talk about 30 different plants a week and people freak out, but we're talking about our fruit, our veg, our herbs, our spices, our nuts, our seeds.
>> Okay. Prote protein is the big deal.
>> Yeah, protein is the big deal.
>> Protein we need. And protein is >> meats.
>> It's everything. Everything has protein in it.
>> Everything has protein in it.
>> Yeah.
>> Why have I not known this?
>> Cuz people have the idea that >> protein I look I wouldn't have picked a grape to have protein. It does low amount, but it does help. So, when we're trying to get protein at every meal, it's not like a big slab of meat. It's not a whole plate of pushcido. It is let's try to have again fruit and veg and grains because all of that comes together to make protein.
>> In in this whole food conversation though, is are we changing that because of the research we have about women now?
>> We're starting to. Yeah.
>> So, here's the deal. Um, as long as I've been alive, I've been through various stages of being uh made to believe what's good for me.
>> Yeah, exactly.
>> Um, I've been through the food triangle and I've been through the Jane Fonda workout. All of that, you would argue now is not right for me. The more we get into the research and the more research that we do and the more technology comes on to allow us to look at on the cellular level, we know that all that high cardio stuff is not beneficial, especially as we get older because our metabolism inherently changes.
>> I just heard of this new diet hack called the three bite rule of things that are unhealthy to kind of like satisfy the craving.
>> Food fads and diets are not a woman's friend, says Stacy.
>> One of them has less calories. one of the best diets out there.
>> And fasting too, >> is fasting a good way to lose weight?
>> Needs to be better understood.
>> We want to fuel the body throughout the day because that's when we need it to stop eating after dinner and have 2 to three hours before bed so that you have that 12 or 13hour overnight fast so your body can do all that it needs to do that we hear about the benefits of fasting.
>> You know, it sounds like common sense.
>> It is, but it gets convoluted when you have trends. It's three like three meals a day uh according to what suits you.
>> But um that's pretty how it used to be.
>> Yeah, I know.
>> But it's that perennial pressure to be impossibly thin that Stacy sees as one of the greatest impediments to women's health. Women still want to lose weight.
>> Unfortunately, there's a big push.
>> You don't want that.
>> I don't want people to focus on weight loss. I want people to focus on body composition.
So, with women so wrapped up on the aesthetics and weight on the scale, they're missing the point.
>> What do you make of uh medicines that assist weight loss? Then >> I did kind of a kitchen rant after the Grammys because I was like, "Oh my gosh, it is the GLP1 effect here." because now it's really trendy to be ballerina thin with a little bit of tone and it isn't healthy because we see the very first thing that goes with the weight loss doses is muscle and bone and this is where it gets really frustrating when I'm trying to say we want muscle, we want bone and then you see like Sharon Osborne show up and she's uber thin and people are like oh but this is what I'm supposed to look like.
Up next, Liz's journey to longevity.
>> Go, go, go. Squeeze nice and hard.
>> The new tests and techniques made for women.
>> When it came time to measure the bone, were you uh a little nervous?
>> I was.
>> And later, could this take the guesswork out of your medication?
>> Liz, we've got a result for you.
I've decided to do some health tests.
So, I'm on my way for a checkup. A look under the bonnet, if you like.
>> Hey, Brendon.
>> Hey, Liz.
>> Nice to meet you.
>> Lovely to meet you, too.
That means we're going more than skin deep.
One test of particular interest is the DEXA scan that measures bone density.
So there's nothing there that's outside of what we would consider normal range health here.
>> So go go go go. Squeeze nice and hard.
>> And a grip test to see if I can still carry the shopping >> and release.
>> And both results take me to my next stop.
a rather unassuming suburban building where inside lives are being dramatically changed and hopefully mine too. I'm in Brisbane and this place is a great example of what happens when you get funding and a strong focus on women's health.
It's where Dr. Belinda Beck is conducting groundbreaking research into bones.
>> I think the assumption is that once you are old, you're really just patching things up.
>> Dr. Beck is tackling osteoporosis, a disease affecting an estimated 1.2 million Australians. Another 6.3 million are living with low bone density.
And if you're wondering, this is what osteoporosis looks like. It's the reason for more than 100,000 hospital admissions each year. So this is a chunk of what would be nice healthy bone. Whereas this is an osteoporotic bone where the struts and beams are very much thinned so that they are much more easy to break. It is something that is the specialty of the aging me.
>> Yeah.
>> Is that where we find ourselves with age?
>> Yeah. Look, I don't want to say osteoporosis is inevitable because it's not. But it certainly is associated with aging because I believe we become more sedentary as we get older and we stop doing the kinds of things that bone responds best to.
But osteoporosis doesn't just come for the sedentary. Sharon Gillard always considered herself pretty fit, a long-distance cyclist who spent years on the road.
>> When did you realize that you had osteoporosis?
>> I went to um my GP who was a new GP and she um asked me if I'd ever had a bone scan and I said no. And it was 2020 during CO and um wasn't expecting to get bad news. And when she was telling me about the results over the phone, it was very devastating. When I was trying to find out more about it on the internet, it was very confusing. There was sort of um lots of contradictory information. It was very pessimistic most of it. Um most of it said at best you could only improve your bone density very slightly.
>> Yeah. Certainly no cure.
>> No.
Sharon didn't know that cycling, like swimming and walking are great exercise, but critically they don't build bones.
To see if she could maybe remedy her bone loss, she volunteered to be part of Professor Beck's research. Along with the other recruits, her bones were scanned before beginning a carefully supervised weight loading program.
>> We started them very gradually. We introduced it at a level that people were able to handle. We increased the weight slowly. But you know what? We were so conservative to begin with. And after a while, our participants were just saying, "This is too light. Let's just get stuck in." And we did.
>> When it came time to measure the bone, were you a little nervous? I was it was one of those I remember where I was experiences. It was a Saturday and my PhD student had just done the scanning on on his first participant who had finished their eight-month intervention and he called me and said this person's just gained 9% of the spine and I said, "That's just not true. That doesn't happen. I don't believe it." And he said, "Well, come and have a look. We see what you get." I analyzed that scan again and sure enough she'd grown 9% at the spine and that is pretty unheard of from an exercise study and blew me away but obviously you can take the smile off my face in ess.
>> Sharon's bone growth surged beyond expectations with results improving at every stage of the trial. I've been coming for four years now and I've had annual scans here and I've had dramatic re reversal of the bone loss. I've been um improving my bone density by over 9% some years.
>> Could you believe that?
>> I It was better than my my wildest expectations.
>> And that must make you feel amazing.
>> Well, I'm just so relieved actually.
It's given me hope to keep improving even further.
I've gone from being devastated and quite scared about what my future might be to being very positive and hopeful that I can just keep improving my bone my bone strength each year throughout the rest of my life.
>> We know that swimming and uh walking and yoga for example don't produce the same results. You don't want them to stop doing that necessarily.
>> No. I think what I'd like people to do is think differently about their exercise priority. In the course of a week, you've got seven days. Bone doesn't need a lot of strain at one time. Twice a week, 30 minutes.
>> Twice a week and 30 minutes.
>> 30 minutes each time. That leaves you 5 days a week to do all your aerobic exercise. And I 100% think you should be doing it. And that could include walking and swimming and cycling and hiking and yoga and all of those things that don't grow bone. But they are absolutely fabulous for your heart, your metabolism, and your mental health.
>> Number one rule, you don't want, I'm presuming, people like me just randomly going up picking up some weights.
>> Yeah, that's right. You don't want to be doing this lifting without somebody who knows how to supervise and take care of you. So, it's absolutely a supervised program, >> but I would recommend um to all people and especially women in their 30s and 40s to do this. I I wish I'd known about this when I was much younger. I would have been doing it through my 30s and 40s just to >> build up bone in the bank as Belinda says, and I wouldn't be trying to catch up at a later stage in life where it's a bit harder to to do it when you um when you're working from a deficit.
Belinda's research is seeing women of all ages across Australia lifting weights and I've joined them. She's developed a specific exercise program to build bones. Small classes conducted by trained and accredited supervisors.
It is never too late. We've got people in their 90s here and they're absolutely blowing it out of the water.
>> I almost personally want to thank you.
I am your quintessential patient. You know, I'm right there in the heartland.
>> Yeah.
>> I feel like I'm a bit blessed to be finding this out. Although a little out of sorts that I'm finding it out at a late stage of my life.
>> But at least I'm finding out.
>> You are. And you're a spring chicken.
You've got so many years ahead of you.
>> Up next, the test that changed the way Liz thought about medication.
>> Liz, we've got a result for you.
So, this is a fairly straightforward swab. I basically take the cap off of this, place it in my mouth.
I've taken a DNA test designed to reveal which medications may work for me as a woman and which may not um it is fairly straightforward. I've put it straight back into the the cap and that's it. I firm.
>> It's one way I may be able to ensure I get the right information for me and not that which has been based on the research of men. It's personalized medicine that could change the way treatments are prescribed. The test is called pharmarmaccogenomics also known as PGX.
PGX is, you know, a real a real gamecher in removing the the trial and error of prescribing for individuals based on their DNA.
>> Professor Kim Miner is a senior genetic pathologist at Genomic Diagnostic.
One of those areas where there's been a lot of research is mental health. The patients are actually about 70% more likely to achieve remission and improvement in their symptoms from that medication.
Almost everyone has a variant in their DNA and that affects how we process medication. Knowing that information can avoid unwanted side effects and help understand why some medications may not be working.
We test a set of 11 genes that contain the code or instructions for making proteins and molecules in your body that process medications.
And then we can use that information to predict how you may respond to a medication and therefore help your doctor to choose the best medication for you at the correct dose from the outset.
And these are at this stage um all medications or just certain medic medications >> just some medications certain groups and that's based on the fact that PGX is a a very strongly evidence-based test. So we would only provide guidance on relationships between genes and medications that there was good evidence that if we acted on that guidance it would change your outcome.
There have been questions about whether this test is absolutely foolproof. And at a cost of around $150, it's not accessible to everyone. But most agree it's research that's headed in the right direction. After a few weeks, it's time to get the results.
So, um, what are you able to tell me about my tests? Oh, well, I mean, Liz, we've got a result for you. Um, there are some medication classes for you where your PGX profile indicates you may not respond to a medication or you might need a higher dose than is standard. So, one example is codine, which you may have heard of. It's a pain medication.
Um, quite quite common one. uh your result indicates that you may not achieve an adequate response to a standard dose but the report also provides alternative medications that your doctor could prescribe for you if you're in need of pain relief.
>> So just be just before you go on. So with codine the the suggestion is that I might need a higher dose >> potentially although it may be more appropriate to just choose an alternative medication that is processed differently to codine by your body.
>> Okay, that's handy to know. I have to say >> it's a test anyone can take male or female but may make the difference for women. What I would hope for the future is that that awareness continues to increase and we have more women accessing this test for personalized uh prescribing guidance.
Up next, a breakthrough in women's health and Libby Tricketts hopes for the future. It's the sadness that it's happened, but then the gratitude that it was a shot across the bow rather than anything more >> Yeah.
>> um catastrophic.
>> I'm so grateful that I'm here. Yeah, like I could have very easily died in that moment. I didn't.
>> It's fair to say Libby Trick has never taken life for granted.
>> But Libbyy's going to touch it and get it >> and even more so now since suffering a heart attack, but she realizes her future really is now in the hands of researchers. What would you like to say to a researcher if you could sit down with them?
>> We are more than 50% of the population and we need to make sure that we're doing the best for all of us.
Ultimately, that is of benefit for everyone. Um, so don't forget that those closest to you will benefit from this kind of research. And I think if we can constantly humanize that and constantly remind ourselves of how important your role is in creating a better, more well life for women. I just the benefits will be enormous.
There is positive news. The National Health and Medical Research Council has just announced Australia's first mandate, stating applicants must consider women in their research work when applying for funding. Still, we've got a way to go, haven't we?
>> We have a long way to go. After the research is done, it has to be translated into practice. And that means that health and medical educators need to adapt that new knowledge into their curriculara and teach health and medical students about sex differences where they exist. We know that right now that's not really happening very well.
I acknowledge it is progress, but I still can't believe it has taken so long to include women. more than half the population in many more clinical trials and I do have a great appreciation for the work being done by women like Brahman Graham, Stacy Sims and Belinda Beck who are seeking not just fairness but simply good science.
Right now we are in a situation where women are still under represented in clinical trials for conditions that are their biggest killers. So that includes cardiovascular disease, cancers and psychiatry. And so even when women are over represented in the population of people who experience those conditions, they are under represented in the work that is designed to treat those conditions. That is absolutely perverse.
>> That's all from us tonight. And if you have any stories you'd like Spotlight to explore, please email us at the address on the screen. That's spotlight 7.com.au.
I'm Michael Asha. Thanks for watching.
Good night.
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