Paula Johnson: His and hers … healthcare Paula Johnson: Sein und ihr ... Gesundheitswesen Paula Johnson: La salud de él y de ella... Paula Johnson : Le sien et le sien ... soins de santé ポーラ・ジョンソン：彼の、そして彼女の......ヘルスケア Paula Johnson: O dele e o dela ... cuidados de saúde 保拉·约翰逊：他和她的……医疗保健 保拉·約翰遜：他和她的……醫療保健

Some of my most wonderful memories of childhood are of spending time with my grandmother, Mamar, in our four-family home in Brooklyn, New York. Certains de mes plus beaux souvenirs d'enfance sont ceux des moments passés avec ma grand-mère, Mamar, dans notre maison quadrifamiliale de Brooklyn, à New York.

Her apartment was an oasis. ||||oaza It was a place where I could sneak a cup of coffee, which was really warm milk with just a touch of caffeine. |||||||zakradać się||||||||||||||| C'était un endroit où je pouvais prendre en cachette une tasse de café, qui était vraiment du lait chaud avec juste une touche de caféine. She loved life. And although she worked in a factory, she saved her pennies and she traveled to Europe. And I remember pouring over those pictures with her and then dancing with her to her favorite music. |||nalewania|||||||||||||| Je me souviens d'avoir regardé ces photos avec elle, puis d'avoir dansé avec elle au son de sa musique préférée. And then, when I was eight and she was 60, something changed.

She no longer worked or traveled. She no longer danced. There were no more coffee times. My mother missed work and took her to doctors who couldn’t make a diagnosis. Ma mère s'est absentée du travail et l'a emmenée chez des médecins qui n'ont pas pu établir de diagnostic. And my father, who worked at night, would spend every afternoon with her, just to make sure she ate. Her care became all-consuming for our family.

And by the time a diagnosis was made, she was in a deep spiral. ||||||||||||głębokim kryzysie|spirali Und als die Diagnose gestellt wurde, befand sie sich in einer tiefen Spirale. Lorsqu'un diagnostic a été posé, elle était déjà dans une spirale profonde. Now many of you will recognize her symptoms.

My grandmother had depression. A deep, life-altering depression, from which she never recovered. |||verändernden|||||| |||zmieniająca|||||| And back then, so little was known about depression. À l'époque, on ne savait pas grand-chose sur la dépression. But even today, 50 years later, there’s still so much more to learn.

Today, we know that women are 70 percent more likely to experience depression over their lifetimes compared with men. |||||sind|||||||||||| And even with this high prevalence, women are misdiagnosed between 30 and 50 percent of the time. |||||częstość|||błędnie zdiagnozowane|||||| Et même avec cette prévalence élevée, les femmes sont mal diagnostiquées dans 30 à 50 % des cas. Now we know that women are more likely to experience the symptoms of fatigue, sleep disturbance, pain and anxiety compared with men. |||||||||||||Erschöpfung|||||||| |||||||||||||zmęczenie||zakłócenie snu||||||

And these symptoms are often overlooked as symptoms of depression. |||||bagatelizowane|||| Ces symptômes sont souvent considérés comme des symptômes de dépression. And it isn’t only depression in which these sex differences occur, but they occur across so many diseases. |||||||||||||||||chorobach

So it’s my grandmother’s struggles that have really led me on a lifelong quest. Ce sont donc les luttes de ma grand-mère qui m'ont poussé à poursuivre ma quête tout au long de ma vie.

And today, I lead a center in which the mission is to discover why these sex differences occur and to use that knowledge to improve the health of women. Today, we know that every cell has a sex. Aujourd'hui, nous savons que chaque cellule a un sexe.

Now, that’s a term coined by the Institute of Medicine. ||||prägte||||| ||||stworzony||||| And what it means is that men and women are different down to the cellular and molecular levels. ||||||||||||||komórkowym||molekularnym| It means that we’re different across all of our organs. From our brains to our hearts, our lungs, our joints. Now, it was only 20 years ago that we hardly had any data on women’s health beyond our reproductive functions. Так вот, всего 20 лет назад у нас почти не было данных о женском здоровье, кроме наших репродуктивных функций.

But then in 1993, the NIH Revitalization Act was signed into law. And what this law did was it mandated that women and minorities be included in clinical trials that were funded by the National Institutes of Health. |||||||nakładała||||mniejszości|||||||||||||| Cette loi exigeait que les femmes et les minorités soient incluses dans les essais cliniques financés par les Instituts nationaux de la santé. And in many ways, the law has worked. Women are now routinely included in clinical studies, and we’ve learned that there are major differences in the ways that women and men experience disease. But remarkably, what we have learned about these differences is often overlooked. |zadziwiająco|||||||||| So, we have to ask ourselves the question: Why leave women’s health to chance? |||||||||zostawić|||| Nous devons donc nous poser la question suivante : pourquoi laisser la santé des femmes au hasard ?

And we’re leaving it to chance in two ways. The first is that there is so much more to learn and we’re not making the investment in fully understanding the extent of these sex differences. ||||||||||||||||inwestycję||pełnym||||||| And the second is that we aren’t taking what we have learned, and routinely applying it in clinical care. Deuxièmement, nous ne prenons pas ce que nous avons appris et ne l'appliquons pas systématiquement dans les soins cliniques. We are just not doing enough. So, I’m going to share with you three examples of where sex differences have impacted the health of women, and where we need to do more. ||||podzielić||||||||||wpłynęły|||||||||||

Let’s start with heart disease.

It’s the number one killer of women in the United States today. C'est la première cause de mortalité chez les femmes aux États-Unis aujourd'hui. This is the face of heart disease. Linda is a middle-aged woman, who had a stent placed in one of the arteries going to her heart. |||||||||stent|założony||||||||| Linda est une femme d'âge moyen à qui l'on a posé un stent dans l'une des artères menant à son cœur. When she had recurring symptoms she went back to her doctor. |||nawracających||||||| Her doctor did the gold standard test: a cardiac catheterization. ||||||||sercową|cewnikowanie It showed no blockages. |||blokady Linda’s symptoms continued. She had to stop working. And that’s when she found us. When Linda came to us, we did another cardiac catheterization and this time, we found clues. |||||||||cewnikowanie serca||||||wskaźniki But we needed another test to make the diagnosis. So we did a test called an intracoronary ultrasound, where you use soundwaves to look at the artery from the inside out. |||||||wewnątrz wieńcowy|ultrasonografia||||fal dźwiękowych||||||||| Dus hebben we een test gedaan met de naam intracoronaire echografie, waarbij je geluidsgolven gebruikt om van binnenuit naar de slagader te kijken. And what we found was that Linda’s disease didn’t look like the typical male disease. |co|||||||||||||

The typical male disease looks like this. ||męska|||| There’s a discrete blockage or stenosis. ||dyskretną|||zwężenie Il y a un blocage discret ou une sténose. Linda’s disease, like the disease of so many women, looks like this. The plaque is laid down more evenly, more diffusely along the artery, and it’s harder to see. |płytka|||||||rozproszono|||||||| So for Linda, and for so many women, the gold standard test wasn’t gold. Now, Linda received the right treatment.

She went back to her life and, fortunately, today she is doing well. But Linda was lucky. She found us, we found her disease. But for too many women, that’s not the case.

We have the tools. We have the technology to make the diagnosis. But it’s all too often that these sex diffferences are overlooked. So what about treatment? |||leczenie

A landmark study that was published two years ago asked the very important question: What are the most effective treatments for heart disease in women? The authors looked at papers written over a 10-year period, and hundreds had to be thrown out. |||||||||||||||wyrzucone| Les auteurs ont examiné des articles rédigés sur une période de dix ans et des centaines d'entre eux ont dû être éliminés. And what they found out was that of those that were tossed out, 65 percent were excluded because even though women were included in the studies, the analysis didn’t differentiate between women and men. |||||||||||wyrzuconych||||wykluczonych|||||||||||||różnicować|||| Et ce qu'ils ont découvert, c'est que parmi les études rejetées, 65 % ont été exclues parce que même si des femmes étaient incluses dans les études, l'analyse ne faisait pas de différence entre les femmes et les hommes. What a lost opportunity. The money had been spent and we didn’t learn how women fared. |||||||||||did fared |||||||||||poradziły sobie L'argent a été dépensé et nous n'avons pas appris comment les femmes s'en sont sorties. And these studies could not contribute one iota to the very, very important question, what are the most effective treatments for heart disease in women? |||||||a tiny amount||||||||||||||||| |||||||ani odrobiny||||||||||||||||| I want to introduce you to Hortense, my godmother, Hung Wei, a relative of a colleague, and somebody you may recognize -- Dana, Christopher Reeve’s wife. ||||||||||||||||||||rozpoznać||||

All three women have something very important in common. ||||||||wspólnego All three were diagnosed with lung cancer, the number one cancer killer of women in the United States today. |||||płuca|rak|||||||||||| Tous trois ont été diagnostiqués avec un cancer du poumon, la première cause de mortalité des femmes aux États-Unis aujourd'hui. All three were nonsmokers. Sadly, Dana and Hung Wei died of their disease. Today, what we know is that women who are nonsmokers are three times more likely to be diagnosed with lung cancer than are men who are nonsmokers. Aujourd'hui, nous savons que les femmes non fumeuses ont trois fois plus de risques de se voir diagnostiquer un cancer du poumon que les hommes non fumeurs. Now interestingly, when women are diagnosed with lung cancer, their survival tends to be better than that of men. |interesująco||||||||||tenduje||||||| Il est intéressant de noter que lorsqu'un cancer du poumon est diagnostiqué chez une femme, sa survie tend à être meilleure que celle d'un homme. Now, here are some clues. Our investigators have found that there are certain genes in the lung tumor cells of both women and men. ||||||||geny|||||||||| And these genes are activated mainly by estrogen. And when these genes are over-expressed, it’s associated with improved survival only in young women. ||||||ekspresji||||||||| Et lorsque ces gènes sont surexprimés, ils sont associés à une amélioration de la survie uniquement chez les jeunes femmes. И когда эти гены сверхэкспрессированы, это связано с улучшением выживаемости только у молодых женщин. Now this is a very early finding and we don’t yet know whether it has relevance to clinical care. |||||||||||||||znaczenie kliniczne||| Il s'agit d'une découverte très précoce et nous ne savons pas encore si elle est pertinente pour les soins cliniques. But it’s findings like this that may provide hope and may provide an opportunity to save lives of both women and men. Now, let me share with you an example of when we do consider sex differences, it can drive the science.

Several years ago a new lung cancer drug was being evaluated, and when the authors looked at whose tumors shrank, they found that 82 percent were women. kilka|lat|||||||||||||||||guzy|skurczyły|||||| Il y a plusieurs années, un nouveau médicament contre le cancer du poumon était en cours d'évaluation et lorsque les auteurs ont examiné le nombre de personnes dont les tumeurs avaient diminué, ils ont constaté que 82 % d'entre elles étaient des femmes. This led them to ask the question: Well, why? And what they found was that the genetic mutations that the drug targeted were far more common in women. ||||||||||||dotykała|||||| And what this has led to is a more personalized approach to the treatment of lung cancer that also includes sex. This is what we can accomplish when we don’t leave women’s health to chance. |||||osiągnąć|||||||| Вот чего мы можем добиться, если не оставляем женское здоровье на волю случая.

We know that when you invest in research, you get results. Take a look at the death rate from breast cancer over time. And now take a look at the death rates from lung cancer in women over time. Now let’s look at the dollars invested in breast cancer -- these are the dollars invested per death -- and the dollars invested in lung cancer. Examinons maintenant les sommes investies dans le cancer du sein - il s'agit des sommes investies par décès - et les sommes investies dans le cancer du poumon. Now, it’s clear that our investment in breast cancer has produced results. They may not be fast enough, but it has produced results. We can do the same for lung cancer and for every other disease. So let’s go back to depression.

Depression is the number one cause of disability in women in the world today. |||||||niepełnosprawności|||||| Depressie is tegenwoordig de belangrijkste oorzaak van handicaps bij vrouwen. Our investigators have found that there are differences in the brains of women and men in the areas that are connected with mood. And when you put men and women in a functional MRI scanner -- that’s the kind of scanner that shows how the brain is functioning when it’s activated -- so you put them in the scanner and you expose them to stress. You can actually see the difference. And it’s findings like this that we believe hold some of the clues for why we see these very significant sex differences in depression. |||||||||||||||||||istotne|||| Ce sont des résultats de ce type qui, selon nous, expliquent en partie pourquoi nous observons des différences très importantes entre les sexes dans le domaine de la dépression. But even though we know that these differences occur, 66 percent of the brain research that begins in animals is done in either male animals or animals in whom the sex is not identified. Mais même si nous savons que ces différences existent, 66 % des recherches sur le cerveau qui commencent sur des animaux sont effectuées sur des animaux mâles ou sur des animaux dont le sexe n'est pas identifié.

So, I think we have to ask again the question: Why leave women’s health to chance? ||||||||||dlaczego||||do|szansę

And this is a question that haunts those of us in science and medicine who believe that we are on the verge of being able to dramatically improve the health of women. ||||||dręczy|||||||||||||||progu|||||||the||| We know that every cell has a sex. We know that these differences are often overlooked. And therefore we know that women are not getting the full benefit of modern science and medicine today. We have the tools but we lack the collective will and momentum. Nous disposons des outils nécessaires, mais nous manquons de volonté collective et d'élan. Women’s health is an equal rights issue as important as equal pay. ||||równe||||||| La santé des femmes est une question d'égalité des droits aussi importante que l'égalité de rémunération.

And it’s an issue of the quality and the integrity of science and medicine. |||||||||integralność|||| (Applause) So imagine the momentum we could achieve in advancing the health of women if we considered whether these sex differences were present at the very beginning of designing research. ||||||||||||||||||||||||||||projektowania| Or if we analyzed our data by sex. So, people often ask me: What can I do?

And here’s what I suggest: First, I suggest that you think about women’s health in the same way that you think and care about other causes that are important to you. And second, and equally as important, that as a woman, you have to ask your doctor and the doctors who are caring for those who you love: Is this disease or treatment different in women? Deuxièmement, et c'est tout aussi important, en tant que femme, vous devez demander à votre médecin et aux médecins qui s'occupent de vos proches : cette maladie ou ce traitement sont-ils différents chez les femmes ? Now, this is a profound question because the answer is likely yes, but your doctor may not know the answer, at least not yet. ||||głębokie||||||||||||||||||| Il s'agit d'une question profonde, car la réponse est probablement oui, mais votre médecin ne connaît peut-être pas la réponse, du moins pas encore. But if you ask the question, your doctor will very likely go looking for the answer. And this is so important, not only for ourselves, but for all of those whom we love. Whether it be a mother, a daughter, a sister, a friend or a grandmother. It was my grandmother’s suffering that inspired my work to improve the health of women. ||||cierpienie||zainspirowało||||||||

That’s her legacy. ||dziedzictwo Our legacy can be to improve the health of women for this generation and for generations to come. Thank you. (Applause)