Why sex matters in medicine

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The last time I saw Maria-Rosa, she was on a stretcher, surrounded by frantic nurses and interns who were trying, without success, to restart her heart through CPR.

Before Maria-Rosa’s back pain sent her into a “treatment spiral,” her heart appeared perfectly healthy. So how could this happen? Shouldn’t her doctors have worried that the combination of her pain medications, anti-anxiety pills, steroids, and antibiotics were creating a deadly cocktail?

Perhaps. But they didn’t have a reason for concern because if Maria- Rosa had been a man, such a combination would likely not have produced the same effect—or even been dangerous at all.

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In short, men’s hearts need less time to recover between contractions (i.e., heartbeats) than women’s do. Many prescription drugs—such as painkillers, anti-inflammatory drugs, steroids, sleep aids, antibiotics, antihistamines, and antidepressants, to name a few—have the effect of incrementally increasing a person’s QT interval.

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Because her doctors outside the ED may have been unaware of female sex as an independent risk factor for serious drug interactions, because women are more likely to have multiple or over- lapping providers and prescribers (with each provider potentially unaware of existing prescriptions unless the patient reports them), and because our current system isn’t set up to take QT interval into account when prescribing new drugs, Maria-Rosa wasn’t offered the tests and alternatives that could have prevented her death.

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