Sex Cells is a shofar blast and battle cry to the world, alerting all who will listen that women need equitable healthcare and sex-specific medical research. While women deserve to be treated equally, their bodies are simply not the same as men’s. In Sex Cells, Phyllis Greenberger, a trailblazing advocate for equity in women’s healthcare for the past thirty years, educates us about the historical lack of knowledge and research in the area of sex differences. As one reviewer notes, “She tells us of the battle to have female cells, lab animals and humans brought into medical research so that women can receive treatment that is appropriate and effective.”
Sex Cells, which Greenberger wrote with journalist Kalia Doner, details the ongoing challenge of getting researchers, practitioners and medical institutions, as well as the manufacturers of pharmaceuticals and devices, to understand and accept that sex differences exist. Chapter after chapter, Sex Cells describes areas where womens’ symptoms, diagnosis and care differ from mens’, from the presentation of cardiac symptoms to how medication is absorbed and processed into the body differently, to why women are biologically more prone to certain conditions like depression and anxiety. It also explores the additional impact of not tailoring medical research and treatment on minority populations.
Greenberger also shares candidly with readers about the healing power of creativity and her personal grief journey. Her husband Robert Greenberger, who was a Wall Street Journal foreign correspondent and beloved Moment contributor, died in March 2022 after a 15-year battle with Alzheimer’s. Painting and writing were tools to help Greenberger cope and pull her through what she calls a “rut with grief.”
Greenberger is the senior vice president for research and advocacy for HealthyWomen. She previously served as CEO and president of the national non-profit organization, Society for Womens’ Health Research (SWHR). The U.S. The Department of Health and Human Services Office of Women’s Health awarded Greenberger the Trailblazer Award in 2016. She also received the Perennial Hero Award in 2021 from the Alliance for Aging Research. Most recently she was the recipient of the Women in Government Relations Lifetime Achievement Award.
What inspired you to write this book now, and what did you hope to accomplish with its publication?
We need to get the awareness out there, and then the funding for the research behind it. The amount of research into women’s health is pathetic at this point, and the basic science isn’t being looked at. It has to start at the basic biological level, and it’s not. Women’s health is currently only 5 percent of the research budget at NIH, and 2.5 percent globally. I learned this from Marsha Henderson who is the former associate commissioner for Women’s Health at the Food and Drug Administration (FDA).
There also remains an issue with peer-reviewed journals. Not all of them require it to be clear whether the research has been conducted on men or women or minorities, or whether there was a clinically relevant difference.
How do you suggest women advocate for themselves and their health?
I think if women go to their doctor’s office and feel like they aren’t being taken seriously, they need to find another doctor. I know it’s hard if you are a patient to criticize the doctor, but if something isn’t working, you need to say so. Find a support group. Do some investigation and research on your own if you need to get the correct information. It may be necessary, especially in some areas where you might not be taken seriously.
“All the artificial hips and knees were based on the male anatomy. You don’t have to be a genius or a doctor to figure out there’s something wrong with that.”
The experience of women’s symptoms being ignored is so common. Since I’ve written the book, a friend emailed me that she was turned down by doctors and not taken seriously when she was having a heart issue. She went to some five cardiologists before anyone listened to and diagnosed her. And I just read something the other day about how doctors don’t take pain seriously in women.
Years ago, a friend of mine suffered from a heart attack in her forties or very early fifties. She went to the American Heart Association and asked if they had a support group for women with cardiovascular issues and at the time they only had it for men. And you’re not going to believe this but they didn’t think women had heart attacks because women were never in the clinical trials for heart attacks. I had to convince the organization that women had heart attacks. I also worked with my friend to establish an organization for women with cardiovascular problems.
How did the research on sex differences get started?
When I was the CEO of the Society for Women’s Health Research, we brought together scientists who were known in their various fields, whether it was cardiology, neurology or osteoporosis, to meet regularly and discuss the issue of sex differences. We were able to secure support for research projects that they would design and identify people to conduct it. And then they would do the research and publish the results. So we had these networks regularly for every part of the body.
You’ve been working on equity in women’s health for thirty years. How did you go about the process of taking your experience and translating it into an interesting and relatable book?
I contacted all the researchers and the physicians whom I had worked with over the years from the government and from private industry and told them about the book. Kalia Doner had a great deal of experience, having written multiple health books. So I told the researchers and physicians she would be interviewing them. They spoke with her and provided links to their research. She did a great deal of research on scientific articles and summarized them for the book. The story and the historical perspective was mine. Originally, my thought was that I wanted to pass along the history and make people aware of the lapse.
What are the obstacles of getting women into clinical trials and have there been any advancements?
It is still an issue getting women and minorities into clinical trials. For years, you wouldn’t know if someone was pregnant for a long time, so there were liability concerns with having women in clinical trials. Now there are instant tests so that’s not an issue. Childcare and travel are challenges for women and with minority populations. Sometimes there is a concern about the safety of the trials given some prior issues. It’s getting a lot easier in the digital age. You can register online for a trial, and my understanding is you have to present yourself in person for the opening, and then after that, a lot of the tests and information gathering can be done electronically, so that you don’t have to physically appear.
As an example, why do sex differences matter when it comes to medication and treatment for chemical substance abuse? Women have more body fat, less stomach acid. Medications are absorbed differently.
Alcohol is absorbed differently. Withdrawal can be more difficult for women. The gastric emptying time for women is different. And it’s just everything about them. It’s just stunning, whether it’s your heart or your brain.
Years ago, I was the only woman on a medical device board; all the others were men, and they were all heads of the major device companies. And at the time, all the artificial hips and knees were based on the male anatomy. You don’t have to be a genius or a doctor to figure out there’s something wrong with that. I remember pointing this out and them looking at me like, “Hmm, you know, that’s interesting.” And then they did something about it. I remember going to a couple of meetings later, and they were talking about it like they had known all along. They were so proud of themselves.
What gave you the determination to take on this issue? Was there anything in your own personal history that made you particularly passionate about women’s health?
People often ask me that, but no, there wasn’t anything in my childhood or young adulthood. I look back and I can’t believe I had the chutzpah. It was like I just had this thing I needed to do, and I went for it.
My first job after college was in publishing at the Viking Press. And then I started working at the American Psychiatric Association, and one thing sort of led to another. I remember going to a meeting on AIDS and speaking to doctors, and then there was another meeting attended by most of the representatives from the different medical societies, as well as the pharmaceutical companies. I would go to meetings for the American Dermatology Association and see that they were doing all the tests for products for women on males—on male penises actually.
You’ve promoted the book on various podcasts and in speaking engagements. How has it been received by medical institutions and organizations?
The American Biotechnology Association and the National Pharmaceutical Association have all bought copies of Sex Cells, and in recent history have established women’s research committees. I’ve been attending their meetings for a long time, and it is a positive development. Long overdue. I’m disappointed however that, as far as I know, this still isn’t part of medical school curricula. So I’m speaking to everyone I can. The book is really just the beginning, although my staff and I have been working to increase awareness for years.
Who do you hope will read Sex Cells?
Pre-med and medical students are the perfect audience for Sex Cells. And I’ve met with a producer who has been following this issue, and I’m hoping she can get funding to make a documentary that will include the book. I’m going to try to meet with people I know from the pharma industry and device companies to see if they will support the documentary as well as research.
People don’t realize it, but these companies help fund nonprofits like the American Diabetes Association, the American Heart Association, The American Cancer Society and the Society for Women’s Health Research. The fact that they are focusing on women’s health is important. It’s long overdue and certainly important.