Episode 28: Dr. Ben Gonzalez, MD on How Gender Bias Impacts Your Healthcare

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SPEAKERS: Dr. Andrew Wong, Dr. Ben Gonzalez

Gender Bias, what is it and how does it affect your health. How does gender bias affect your health care system and your role in that healthcare system and what can we do about it to make our system better. These are the essential questions we are going to be diving into today very deeply with Dr. Ben Gonzalez.

I am Dr. Andrew Wong Co-founder of Capital Integrative Health. This is a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness.

I would add that today’s podcast is going to be focusing on how we can better the healthcare system itself. Ben Gonzalez is medical director of Atlantis Medical Wellness Center in Silver Spring, Maryland. He believes in the overall holistic approach to maintaining your health, that includes proper nutrition exercise and well-being. He is also a Board-certified Physician with a background in Molecular Genetics and Nutrition and I would add that he’s passionate about bringing gender bias to the forefront of conversations on how to optimize our health care system. Today we’re going to discuss a really important topic how gender bias in research diagnosis and health care overall impacts the care that you receive and the treatment that you deserve. Welcome Dr. Ben Gonzalez to the podcast. Thank you much for coming on today.

Dr. Gonzalez

My pleasure.

Dr. Wong

We’ve known each other for a while now and we’ve talked a lot about integrative health hormones, functional medicine. just kind of informally over the years, but recently we were talking about some other topics that have come up. One of which is really important that we haven’t covered on this podcast yet. That really want to dive into today and you’re an expert on this called “Gender Bias” First of all, let’s talk about what that is and why that’s important in medicine and health?

Dr. Gonzalez

Well sure and in fact when I give these discussions. I start with this story, that kind of accelerated what I already knew, the underlying issues with all this whole subject on gender bias. But it was 16 years ago when I opened up my clinic. I just retired from the military and I was doing some fun things at the time as well. As some lose weight. Functional medicine and some of the fun things, I was doing neurotoxins Botox things like that. A patient 42 year old, Sarah came to see me for simple Botox and I did the usual Dr. Gonzalez thing. Told her, asked her the basic questions and the allergies, then in the end the the intro I said “how are you feeling?” That one question, she literally Just broke down in tears. You can’t speak sobbing and when she and I thought I had offended her in some way or I said something that obviously triggered her. Then when she got her her voice back, she says “I feel miserable” I’m 42 years old I’m overweight. I exercise an hour a day. She was telling me the story about how she loves her husband but she has no desire for sex, She just went on and on and she said the worst part was this morning, right before she saw me, she had gone to her GYN doctor for her annual. She told the same story, as her doctor about how she was feeling. I can’t hardly eats anything. She has three children she loves. She’s trying to keep up and can’t. She feels tired, she told this to her GYN doctor and she looked at me and my GYN doctor looked at me and said honey that’s how you’re supposed to feel.

Dr. Wong

Oh no

Dr. Gonzalez

A 42 years old. She has at least 40 more years of viable life. 3 children to raise and this is how you’re supposed to feel for the rest of your life. This is the worst part ,was a young female GYN specialist. Sarah wasn’t coming there to see by the way. She’s still my patient 16 years later. She wasn’t there to see me for Botox, she was there for anything for something that would make her feel better about herself. She tried the system. She tried exercise. She did all these different diets everything. All she wanted was something to make herself feel better and that’s just one. I hear that story every week, every single week. When I talk about gender bias and medicine. We sually either mean systemic or systematic neglect of either women or miss not just women, but other women are men. But in particular mostly women stereotypes like they’re assumed and assumed gold standards are just are based on studies. Mostly on men with the idea that women are smaller men and this started far back way back I mean way back when Aristotle called

women inside out men. I don’t that, but he called women inside out men. He defined women as medically faulty and effective and this idea of women being the defective sex was perpetuated over centuries. Magnified early in the 1900s, if you notice or not but our current U.S education system was overhauled right around 1920 the Canadian and U.S medical education system was overhauled for better for worse . In the context of women’s health it was for the worse because, this is where the modern gender bias began. First in the overall of first and the overhaul was was to eliminate women as physicians period I mean .

Dr. Wong

You’re talking about the Flexner Report then.

Dr. Gonzalez

Yeah! the Flexner Report Exactly.

Dr. Wong

I didn’t know that actually. That’s crazy though, that doesn’t what was the justification for that.

Dr. Gonzalez

Oh well it was just standardized the idea of standardizing what was all over the place at that time. It was good medicine happening, but there was also just junk and they wanted to standardize but then they and they based this on the the German concept of tying the

medical school to a hospital which was a good thing. I mean, this really there was a lot of good things about this and but unfortunately like I said one of the first things they did was to eliminate all female physicians. Then the second thing was to standardize the idea of focusing on diseases. Only in medical education not in health of course. This is a bit more complex than that but ensure that like gender bias is the systemic neglect of women in our health care system.

Dr. Wong

Wow! there’s much profundity there and I mean women being at least half of the world’s population. Itvdoesn’t make a lot of sense to not have women’s physicians right.

Dr. Gonzalez

Yeah! it’s that time the average age the average lifespan of a woman was about 52 years old. If you’re a woman of color there’s around 38 to 39 years old. You fast forward 100 plus years and now the average age of a woman is 82 and women of color catching up about the same. But we in the healthcare system are stuck in the idea, all the studies are stuck in the idea that women are done at the age of 52. You’re done and we throw prozac at you, for your menopause symptoms thinking that’s going to fix your health for the next 40 50 years. We tell the 42 year old struggling mom of three that this is how you’re supposed to feel.

Dr. Wong

Yeah! it’s rough and I know you’re also certified and felt fellowships and sort of anti-aging medicine or healthy aging. In a way when I hear you speak about this your patient Sarah, that’s 42 years old even I think our language is kind of like, why don’t we call it 42 years young I mean, she has half of her life left. You know we’re almost like age bias too right. Like you said 52 years we’re done menopause and we’re done. That doesn’t, but there’s still like 30 40 maybe more years to go for a lot of women expect based on their life.

Dr. Gonzalez

Viable violent years. Not just we’re going to get you to 82 in the last 10 years of your life here or in a cane or a wheelchair no. We’re talking in order to get to to maintain or get to that point of viable end of life years you have to start early and the gender bias neglects. that

Dr. Wong

Would you say that’s why integrative health which we both practice of course is becoming more popular now among the mainstream. Getting to more like let’s look at both genders or all types of genders would say transgender gender neutral. You know also focusing on both not only disease but also wellness. What are your thoughts about the role of integrative health movement and gender bias?

Dr. Gonzalez

And I want to start off with a negative thought but let’s go there.

Dr. Wong

Let’s go there first. We can always go up you know?

Dr. Gonzalez

Yeah! I went to the University of Arizona for medical school. Studied under the

auspices of a guy named, Dr. Andrew Weil. A lot of fine degraded physicians know Andy and know of his work. He’s still out there 30 years ago, these were the narratives that we were talking about whole foods, organic, eat better, think about prevention of disease,

the exact same narrative that we have now. It’s we haven’t gone anywhere I feel like I’m still lecturing preaching to the choir. I’m still the world. Has the U.S, the world has gotten fatter we’re supposed to be you know that we’re supposed to be in a better place because of what we were thinking. Time that same exact narrative is happening today. It’s very frustrating we are stuck. We in medicine and this is how we’re trained we’re trying to think linearly. We’re trained for our at least gold standard to speak. We’re stuck and it’s hard to change that and the good news is we’re still talking about it. Now we have more standards, we have integrative medicine groups, we have integrative medicine discussions that are trying to standardize this and hopefully we’ll move ahead a little faster in the next three years let alone 30 years well.

Dr. Wong

Thank you, let’s talk about how gender bias impacts different aspects of health. Whether it’s things like clinical trials. Whether it’s treatment in the exam room. Whether it’s patient outcomes, even lack of access to care or maybe even fear of going to receive care,

because of always being shut down. Let’s just talk about all those things that explain.

Dr. Gonzalez

Can you imagine that ? Shut, being shut down over and over and over. I’m not talking about just for each appointment you’ve gone to but for decades as a gender being shut down. It’s frustrating, probably some of those most common example is cardiovascular disease right. The number one killer of women in this country is heart disease. It’s funny when I ask I ask my patients both men and women. Ask what’s the number one killer in this country for women and usually I get things like breast cancer or cardiovascular disease. That’s getting more and more understood but it still surprised me the heart the hype

the high percentage of people that don’t understand. But no! one killer women is heart disease and in fact the absolute numbers for women living with and dying of cardiovascular disease and stroke exceed those of men. In fact about 10 years ago. A study showed that women account for 60% of stroke deaths in the U.S yet and I believe as a direct cause of the majority of studies done in cardiovascular disease was done on men. The avatar of the 70 kg white male and many of these studies border on the ridiculous. Te major studies that have set the so-called gold standard cardiovascular treatments such as aspirin and statins, mostly done and some exclusively only on men

and that’s just one powerful example of gender bias and negative impact on diagnosis. Conditioned gender bias shows up in every aspect of medicine. I mean every aspect. I’m just giving you one quick example.

Dr. Wong

It reminds me of I don’t know if Dr. Alyssa Zingman. She’s in Silver Spring, she’s a musculoskeletal specialist has EDS ( Ehlers Danlos Syndrome ) She’s been on the podcast talking about EDS. She was sharing with us that in her 10 to 15 year journey of trying to get a diagnosis of EDS. As a physician she was shut down multiple times by many doctors. Saying she’s a hypochondriac, they knew she was a doctor I thought that was really and I I would almost wonder like what if she was a guy or what if they would have taken her more seriously .

Dr. Gonzalez

And that’s been studied! Yeah, that’s been looked at I mean over the last century since since that overhaul of our medical education system. We talked about earlier basically women’s health has boiled down to breasts and pelvis. I mean if you Google women’s health you’ll find the top discussions concern. Breast, ovarian, and uterine cancer sprinkled with sexually transmitted diseases and weight loss. All followed by discussions on abuse. In other words mostly victim medicine and that’s kind of where it’s been worse if you go. This drives me nuts and I think about it when you go to the CDC women’s health section the cardiovascular disease and women’s health landing pages. I just checked it this morning wondering if it was still this way but those sections have been missing links

and landing pages for years. Like I said I just checked on this morning just to make sure

that it’s true. Yes basically women’s health has been boiled down over the years to what’s called, what was termed I can’t remember who did it or when I first heard this but bikini health you know.

Dr. Wong

They literally have a broken link on the number one killer in the U.S for the women’s health which is cardiovascular disease. Well let’s just do a PSA because I think that is sad but let’s let’s try to be part of the solution here. What is the number one or number two let’s say what are your top symptoms that you see for women if they have heart disease symptoms. Because then we know that it’s a little different than men right. It’s not always that classic engine or chestpain it could be but.

Dr. Gonzalez

Well it’s funny you should ask do that, because I have a very personal story that I don’t even know if the story and how you get that question in, buti t’s perfect for my wife. My very beautiful in shape, vegetarian, highly active wife. You see her on TV, she does these TV things and you see this very active Latina woman great shape vegetarian. She had her first heart attack at the age of 38.

Dr. Wong

Whoa

Dr. Gonzalez

And also, physicians know heart disease doesn’t start on the day that you had that heart attack. It started years before and and she had symptoms of just being a little tired mostly. GI symptoms, some pulmonary symptoms. In fact she’d seen some specialists for her GI issues and her pulmonary issues she had some great doctors and I’m not disparaging physicians I’ll make that really clear and see that now I’m not disparaging physicians. I’m just frustrated with the system. So my wife she goes to these Docs, gets treated, gets tested, gets all sorts of tests and treat but can’t be your heart obviously you’re 38 and you’re vegetarian in great shape all the way to the point where she had her heart attack and that was when she was 38. I met her four years after that and it surprised me that she was on four different cardiac drugs. Caught me totally off guard, I kind of liked her when I first met her and I put her through my full functional medicine workup. Low and behold there were some things missing some bass and she had a great physicians. In fact her cardiologist was the president of the businesses in D.C, we’re live in the D.C area. Her cardiologist was the president of the women’s cardiology association the U.S, She had great physicians. Now when I did the work up her vitamin D level was in single digits I think it was six I checked it again and it was single digits. Her testosterone levels were non-detectable at 30 at well when I met her 40 to 43 years old non-detectable. Do you think testosterone plays a role in heart function? just a little bit and that’s one of the biases and I know I’mgoing to probably deviate here. If I start talking about hormones, we can talk about that . Hit that later later, that’s a whole podcast. But the bottom line is and those are just a couple of things her magnesium levels, red blood cell. Magnesium levels were low there were multiple things over a period of 18 months correcting those things. Remember things don’t happen, not we don’t fix things overnight right. It takes a little time over 18 months corrected those things and was able to get her off of all her cardiac drugs and by the way she was told she needed to go on a fifth one a beta blocker for heart remodeling all that and I mean her blood pressure was in the 90’s. She just didn’t want to go any more medications. Anyway over 18 months got her off all the all the medications, but don’t get me wrong this is not a discussion about medicine. But it redirected looking at her as a woman, not as a man, not as the gold standards of cardiovascular disease, that’s 70 Kg may a white male. But as a latina woman in her physiology correcting those things and putting her on the right medications to get her into the right place in her last cardiac cath ejection fraction was 45, 46 and her cardiologist said “ what are you doing here” here’s I can go on sorry.

Dr. Wong

This is great

Dr. Gonzalez

Here’s what happened at her last cardiac catheter. This you can’t make this up, she’s in the post cardiac calf. She had a little bit of a chest discomfort, took her to the hospital and cardiac cast doing fine. During rounds all the cardiology fellows, not the interns but all the cardiology fellows came around and they presented and they presented who she was to attending and then the the fellow said and she’s better because of all the cardiac drugs she’s on. Because in her chart it still showed that she was on beta blackers lisinopril, statins etc. . And she looked up and she said I’m not on any of those drugs. I haven’t been on in a while and then the resident, the fellow kind of muffled a little bit. Then said oh well I mean you got better because of those drugs and he said she goes no no. Here’s my list and she gave her the supplements and the medications have shown the vitamin D, the testosterone hormones, all those things and he was a little flabbergasted. He said well you got better because of the drugs. He just kept persisting in saying that

she got better because of the drugs and she had been on him in years and she was a little better on the medication. But still having side effects imagine let alone the other issues that these medications caused. The attending finally stepped in and said “wait, wait, wait, wait, wait, hold on, hold on, let’s listen to her” So the dogma of gold standard to speak is ingrained in us. It’s beating us as physicians and it’s we’re taught to think linearly in medicine and that’s the most dangerous way to think in medicine. In engineering and logistics or whatever one plus one is two, but in medicine one plus one could be pie and chocolate. We have to think away from the linear thought process that’s beat into us in medical school. Then driven hard in residency and then more in postgraduate education. We just have to get away from that. My wife’s a perfect example, frankly I got into medical feminist. If you haven’t figured that out by now that’s awesome. 100 medical feminists and every single thing that I learned was not from the books.It wasn’t from good old Dr. Weil I mean, he pushed me of course but it was from the mistakes that I saw. I made in medicine in the beginning of my career. The mistakes that I saw with my wife, with my sisters, with my mother who suffered from obesity for years. Who had a gastric bypass

in the 70s when I was in high school. Had a gastric bypass in the 70s and we were only doing 5 000 bypasses a year then. Watching her over the decades after that suffer through the diets and the procedures. The torture that the system. When I became a physician thinking I’m going to fix my mom and then making the same mistakes because they were beating into me knowing that there was something wrong inside. There’s something just wrong underneath. What I was saying to my mother my sisters and the women that were in front of me even in trauma and that’s this is where my passion comes from my family. My female patients, my wife, my daughters, my grandchildren who this all starts early with the very first GYN exam. It starts early anyway that’s my thanks thank you

Dr. Wong

Thank you for that personal story and I think we can all agree that women do make up the majority of “patients in the healthcare system” We really do need to be more attuned t

to gender bias and really treating people like individuals right. I want to get into really

a little bit here on since we’re talking about women here but also trans and gender neutral. What is your “about you know”? I’d love for you to educate our listeners on that.

Dr. Gonzalez

Yeah gender bias obviously. I focus on women women’s health. That’s where my discussions come from but yes gender bias true definition involves whether it’s men transgender or otherwise. In fact it was interesting for the very first time at a large conference last november. I heard lectures on the subject of transgender medicine in the context of integrative medicine and I’m not talking about just one hour, I’m talking about there was a whole afternoon dedicated to transgender medicine and it was fascinating. Gender bias, it’s bad enough when we’re talking about women in general. If you’re a woman of color, it’s worse. If you’re an older woman of color, it’s it’s worse. If you’re anywhere in the transgender community it’s probably the worst. There’s no counseling. There’s no minimal studies. We’re guessing and as I do hormones and I do help with transition after counseling. The appropriate counseling and there’s nothing we’re

guessing,we’re taking shots in the dark and and I see these patients come to me on high doses of of hormones and it was dumped in their system. Like in one day no transition to the change. You know in that context we are way behind I was talking about a century, being high in women in general. Think of how much further behind we are with transgender medicine got it.

Dr. Wong

Well this is a lot of eye-opening conversation I hope this is something that we all think about as healthcare professionals, but also as the public we need to kind of be the change and being aware of these issues, I think is the first step. Let’s talk about some some things in terms of diagnosis . We’ll talk about health as well, let’s talk about diagnosis first. We think about certain big topics. We talked about heart disease and the difference in symptoms between women and men even though we’re educated as physicians right. We’re educated as practitioners. That yeah, there is some symptom differences but at the end of the day if we’re kind of like you said. The system kind of hammers into us well a lot of times people are just making this up or something or that’s not really real symptoms even in the context of okay let’s take it seriously, the system is kind of subconsciously telling us not to take it seriously in a way unless we listen with open ears and open overtly.

Dr. Gonzalez

Overtly as well.

Dr. Wong

Yeah exactly, when mental health women are nearly as twice as likely as men to have a mental health condition, but then also that’s more likely to be used as a reason for their symptoms whether it’s mental symptoms, physical symptoms. What we do or how can we kind of change or transform as a healthcare system as practitioners, as well in terms of treating all genders better.

Dr. Gonzalez

First, I guess is the understanding that it exists. First acknowledging that gender bias exists right. It’s everywhere in medicine, everywhere this is where I’ve spent most of my research on this subject. There’s a timeline of neglect to get to an understanding, there’s a timeline of neglect to understand here for providers and let’s jump 50 years ahead of that Flexner Report that we talked about earlier the 1920s 1915. Flexner report that overhaul of the medical education let’s jump 15 years ahead of that. Not much changed in that half century in fact very few women in the medical field mostly men were participants in medical studies in the early 1970s. The percentage of female physicians were still in the single digits. It’s crazy isn’t it ? I mean still in the single digits and that was in the 70s I mean even with title IX in 1972 right. I think timelines 1972 of the education amendments came now. Go ahead 20 years from that time so 1990 and only the OB GYN specialties finally break the 50 mark. But all the other specialties were still less than 15 to 20% women. Jump ahead another 20 years and in the hierarchy of medicine. Deans, full professors, first authors, they all had very low percentage of women and in a 2018 study showed that narrative pretty much is the same. There was an actual this is going to kill you. There was an actual policy an actual FDA policy that excluded women from phase one and phase two drug trials including contraceptives. Now how do you right?

Dr. Wong

Yeah I can’t even wrap my head around that.

Dr. Gonzalez

How do you reconcile that right. It’s this and here’s the justification they were citing and I’m quoting, I’m paraphrasing, I should say it the delicate nature of the fertile female

as the reason we’re not to include them in these trials. I’m not making this up in the late 1980’s. There was a memo circulated in the NIH to encourage the inclusion of women in minorities and studies we’re encouraging. I mean that’s all it was just a memo and it wasn’t until after I was in medical school, that the NIH turned that memo into a policy and it wasn’t even until after my old. Maybe during medical school after medical school that revitalization act. That you hear was that ninety or early 90’s that that policy was turned into law in the 90’s. It’s crazy and it wasn’t until after 2000 after the turn of this new century that the institute of medicine actually recognized that women and men are different and I’m not making this up you know. It’s called this “Sex Matters Report” I was giving this lecture Dallas and I was about 20 minutes into the this this lecture on gender bias. I was giving these discussions, this introduction to the history of what’s going on and it was just right past the history. I was getting into the studies and one of the physicians, she raised

her hand and whatever told all of the audience to bring their questions after we finished speaking. But she raised her hand. She kept putting her hand up and finally she stood up. I couldn’t ignore she stood up, raised her hand and I finished my slide thought and then I thought I said “yes yes what’s up” Okay she says “I don’t believe you” She goes I don’t believe you and and heads were like they were just the cognitive dissonance is incredible. That I mean she stood up and said I i just don’t believe you and I said, they said ”oh give me another 20,30 minutes, it’s going to get worse” I said just don’t throw tomatoes at me. You guys are the physicians are the victims in this system, but ultimately of course it’s the patient that pays the price . I get fired about this you know. There are some really crazy examples. A study out of Rockefeller University Medical School, looked at how obesity impacts breast and uterine cancer. I don’t I don’t know if your audience knows this, but I know this I specialize in metabolism medicine, weight loss and metabolism. There was this, I came across this study and looking at obesity. How it impacts breast and uterine cancer and all the subjects studied All of them 100% were men. Let that sink in, I stay on how obesity impacts uterine and and breast cancer all done on that.

Dr. Wong

How can that even just go to the IRB (Institutional Review Board) ?

Dr. Gonzalez

How can you imagine that IRB discussion. I would love to have sat down go back in time and sat down in that discussion. Just how did that even get justified and this isn’t in the 1920s or 30s. This isn’t is not a university to throw dirt . This is the Rockefeller University in New York City.

Dr. Wong

A very reputable institution, yeah and we’re making our clinical decisions in the exam rooms with patients based on this data right? We need to shine a light on this like you’re doing brilliantly here since your metabolism and healthy weight kind of doctor, this is a

perfect segway into a question I was about to ask you about IF intermittent fasting. What is your thought about IF and gender bias? Right! is IF good for everyone right? I mean if you think about some of those studies if they’ve been done on mostly men that this is one of the questions I have about.

Dr. Gonzalez

Yeah it’s funny I should mention that becausei in my lectures in obesity. I talk about metabolism medicine and obesity hormones,there is a difference between men and women. We unlearn that in in medical school, we get it’s ironic it’s. We unlearn the difference between men and women in medical school and then it gets even more you know beat into us. Like i said earlier in residency, but there’s a difference in our physiology. This goes from everything from reduced oxygen carrying capacity. There’s actually in pharmacokinetics, the standard drug dosage is based on that 70 kg male you know. Even in women the Ion channels react differently in renal and cardiac. Cardio-specific medications differently between men and women and we don’t take that in

consideration a hormonal response. You were asking about intermittent fasting, there’s not a lot of studies done. On studies are poor, there’s the positive studies when it comes to weight loss and and weight loss management metabolism is low. We think there’s a lot of studies out there but most of the studies are done in a gender biased fashion of course. Done on weight loss but not on metabolism and not on the management of metabolism. Maintenance of weight loss all these physiologic differences between women men and women matter when it comes to what diets and exercise. Intermittent fasting as you mentioned when you’re giving that advice now I know this discussion. This goes beyond the podcast but I I hope you don’t mind if I mention a few things of course. That example postprandial metabolismglucose and fat oxidation is different between men and women exogenous. Estrogensfor example, when a lot of women on birth control, if your exogenous estrogens induce the reduction of postprandial free fatty acid oxidation. Translated what that means is if one’s on a medication especially if they’re on a hormone, they’re going to react differently and women know this physicians know this we ignore it. We kind of we see the changes in physiology when we give a medication to a woman as opposed to a man but we kind of ignore it we just blow it off or worse we give

another medication for that side effect. Women burn more fat during exercise. There’s a higher fat glucose burn rate, yet women have a hard time losing weight. Why is that? Well we don’t understand the full reason. Why that is women lose less fat than men with the

same energy deficit. To answer your question about intermittent fasting is that there is a difference between how women and men react intermittent . Does a body good overall for men and women, but we need to be careful of persistent ketones a starvation state

that’s induced. Because a woman or man stops eating as much and they start eating less and less and less. What happens to their metabolism, their metabolism adjusts and starts to slow down and then you throw in intermittent fasting to someone who’s not eating a lot in the first place. You get a different reaction for men and women, you get a different result and yet we give the same advice to both men right.

Dr. Wong

Yeah! you did. Thank you Ben and I think just throwing in like the adrenals thyroid and whole sex hormone access right. Intermittent fasting will affect all those in a different way too.

Dr. Gonzalez

Very differently. Then if you’re on a medication,especially if you’re on a birth control right, we give the same advice. One of my complaints in my field is that we give the same advice

to the 20 year old, the 30 year old, the 4 year old, and the 50, 60, 70 year old when it comes to exercise more, eat less . We don’t adjust our discussion to that same height, same weight woman, who’s 25 versus when she’s 55. All the different medications are on whether they’ve had children or not. Every time a woman has a baby they become a different woman and we need to take that into consideration.

Dr. Wong

It’s really about personalized medicine. It sounds like, What can we do to stop gender bias in the medical field? What are some of the solutions that you foresee here?

Dr. Gonzalez

Right! Educate, educate, educate, right I mean educate, educate, educate, educate. Now my mistake I shouldn’t say a mistake. My focus for years was to educate physicians. Educate physicians and of course the patient in front of me. But now I’ve changed my mind a little bit. I’ve decided to kind of go into the “okay let’s get the general public understanding”. I’m not original on this, there are other great in the end. When we talk about resources, I’mgoing to give you some great individuals. Individual physicians and entities that are doing their best to educate the general public, but I’ve shifted my discussion to physicians. I feel like I beat my head against the wall on this to the general public. I’m actually writing a book about this little late with it. I’ve been talking about this for over six years, very frustrating, but I’mwriting a book on Gender Bias and of course a man, a male physician writing a book on this. But you heard some of the stories I told already on this podcast, I think as women start to relate to what I say in the stories that I think the general public will be more and more outraged about this. But we’re behind right? We’ve talked about this, we’re not just behind by a few years or a few decades. We’re buying by a century and we haven’t even talked drugs and the craziness about drugs, FDA approval for medications for both men and women well.

Dr. Wong

Let’s touch on that for a sec before we get to resources Good I’m glad I kind of hinted there. I’m glad you took it. You can take this smell that head there. Let’s talk about FDA approved drugs and what percentage of those drugs that are approved are actually based on gender bias studies.

Dr. Gonzalez

Another one of those it’s gonna just can’t understand right. So the sex differences of one third of all FDA approved drugs are unknown. There was a 2005 analysis of 300 new drugs shown that it showed substantial pharmacokinetic differences. With no labeled sex specific dosages. Between around the 10th century between 1997, 2000,2001. Eight out of ten medications pulled from the market, were due to harm to women. Eight out of ten and one of my very favorite examples is the drug “Addyi” the generic is “flembansarin”. The female the recently approved femaletouted as a female Viagra, Addyi. I think I’m saying it right? Well does anyone think that alcohol and sex mix right well. Of course and they need to study the effects of alcohol on such types of drugs and the study did happen and it was a small one 25 participants 23 men and two women studied on a drug intended only for women. I’mnot talking 20, 30, 40 years.

Dr. Wong

I don’t know. I just don’t understand how these studies pass IRB.

Dr. Gonzalez

I’m talking about years ago. Sad right?

Dr. Wong

Who’s making these decisions? I just don’t understand.

Dr. Gonzalez

I don’t understand either. I see medications being pulled the big story about the compounding and compounding medications. I see good medications with I mean literally zero documented long-term issues being pulled, or the ability to to reach to these medications being told to help women and men in a non-gender biased way I know that’s it Ben.

Dr. Wong

it is very helpful .First of all let’s since we always talk about root cause medicine on this podcast. I think root cause of the issue here, what’s going on is not enough women are volunteering. Are the people making the decisions kind of steering. It more towards men because they secretly believe that’s still the gold standard for 70 kilo man that in these studies.

Dr. Gonzalez

That’s why honestly. That’s why I bring up the history of gender bias because it’s important to understand what got us here and how the hierarchy of of medical education and of studies got us to this point. I mean like I said it was just a few decades ago that we just started allowing women to be fully participating in in studies. As studies take years and look how long it took for us to get over and we’re still not over it. Women’s health initiative.

Dr. Wong

yeah right!

Dr. Gonzalez

So it’s gonna take a lot of effort and there is at the end of this we’re going to talk and when you’re ready to wrap it up i’ll give you some very positive things that are happening. But the bottom line is we’ve got a lot of dogma and a lot of bias to sort through and we have female you,ng female physicians who are still handing out prozac to the perimenopausal postmenopausal woman because that’s the standard. We still have ignore, I mean we still think the chest pain left arm discomfort is the standard for women’s cardiovascular disease acute, am I got a lot to go through.

Dr. Wong

Yeah, a lot to learn like you said. A lot to probably unlearn and rethink these things. Let’s go with resources and kind of wrapping up, hopefully on a note of optimism. What’s the future of this show can we get more women and healthcare leadership positions as well, but let’s talk about resources first.

Dr. Gonzalez

Yeah. I pulled some things up. I wouldn’t be random, give me a second here let me find him. There’s a [Music] a book justice and the inclusion of women in clinical studies and by the way I’m sure within the podcast you’ll have a way foryou know. We can show this and when I’’ve got a slide, I can show you, I can pass to you and you can pass it on to your . But justice and and the inclusion of women in clinical studies. A conceptual framework, this was done by NIH. Sadly in 1999 about the issues we’re still in the same place but about the issues of inclusion. Women in studies, there’s aapplying a women’s health lens to the study of the aging brain that’s another good one published 2019 now the reason why I like this little discussion and speak discussion is because it talks a lot about the gender bias and the physiologic differences and the pharmacokinetics of men and women. There’s a physician who beat me to it, she beat me to the book Alison McGregor, she wrote a book on sex matters discussing gender bias wonderful book and she’s a great resource Caroline Perez, a UK researcher wrote a book a while back called “Invisible Women” Great resource, that’s an easy one to remember Invisible Women. Then the NIH is coming around the office of research on women’s health. Wonderful director there I’m blanking on her name, but the office of research and women’s health they are getting more and more they’ve got great conference online and in-person conferences on gender biased women’s health. They’re really doing a good job pushing women’s health forward again a little behind like all of us are a little behind on the on research and all that but I mean we talked about this research is minimal for women’s health but we are growing and we are getting in a better place.

Dr. Wong

Well this is great! thank you so much Ben. Thank you so much Dr. Gonzalez for coming on today and really shedding the light. On shining a light on gender bias and how we can treat our mothers and wives and daughters and aunts everyone a bit better people that are gender neutral queer transgender. I ,I think there’s many different categories here that we could really get into but at the end of the day it’s about treating people as whole people individualized. Personalized that people are not numbers, I really think you know. You do a great job of that in your practice with your research and education. Educating physicians and now the public can’t wait to read your book that when it comes out as well.

Good luck with your book. Can we ask you a couple of this year man?

Dr. Gonzalez

This year, this year.

Dr. Wong

All right 2022. Years, a year. What kind of we want to ask our guests too of some fun questions. One question I think would be good. What is your morning routine. We know that morning routines are really great for health to kind of jump start the day. Jump start metabolism. What is your morning routine? coffee yes?

Dr. Gonzalez

No it’s not coffee actually. Okay, all right I had one cup of coffee my entire life. Isn’t that crazy?

Dr. Wong

That you must be a world record holder for that I think yeah.

Dr. Gonzalez

I just don’t like the taste of coffee. it’s kind of funny and I’m talking about military college medical school you know.

Dr. Wong

I’m not a huge cop! I’m not a huge coffee drinker, but either yeah that’s funny.

Dr. Gonzalez

No, I like my tea. I start off with the tea. My morning routine is pretty basic. I just do kind of some stretching when I get out. Followed by kind of I do have a routine I hang on this straight bar and I do 30 reps of these leg lifts. Followed by three reps of 30 push-ups I do that to kind of wake my brain up with my body up. Then depending on the day I knock out some reading and writing then head over to the clinic breakfast, depends on whether I’m fasting or not. That’s kind of a basic routine.

Dr. Wong

Yeah, that sounds good and how can listeners learn more about you, your work, with you your clinic and maybe your learn more about gender bias too if they like.

Dr. Gonzalez

Yeah, well I talk about Gender Bias on my social media and instagram. For example you

can find me at Ben. It’s all one word Ben Gonzalez, MD. My name and Gonzalez is with two Z’s as my dad dies to like to say, we’re real gonzalez. All right, now I just got some of the gonzalez’s out there, ready to throw rocks at me. It’s Ben Gonzalez, MD. That’s my instagram, I talk on that subject there and you can DM me directly on that and then I guide docs and patients to different resources from there. That’s probably the best way to contact me.

Dr. Wong

Great, thank so you much Ben for being on the podcast today and we’ll talk to you soon. Thank you so much for listening out there. If you find this very helpful please like and subscribe and share some of this with your friends and family that may not have known about this. Have a great day everyone thank you

Dr. Gonzalez

Take care and thank you.