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Cover Note

Before and just after 1900, medicine fought often-losing battles against infectious diseases that ravaged populations. The victims died young of virulent conditions that afflicted men and women impartially. Medicine had neither the luxury nor the justification for dealing with biological and therapeutic distinctions between men and women. Eventually, however, the conquest of yellow fever, cholera, typhus, smallpox, malaria, and other scourges made it possible for medicine to focus on areas extraneous to infectious disease, concomitant with a greatly increased store of knowledge and more sophisticated research techniques to bring to their study. More advanced science uncovered increasing evidence that different human groups are biologically distinct, have different disease patterns, and respond to diseases and treatments differently. The image of humans and disease began to shift from a unified model of “the human being” to a more nuanced one of various overlayered human groups. Increasing knowledge and related shifts in scientific techniques changed the focus further—today, in the light of the human genome project and the medical future it opens, it is clearer than ever before that individuals are distinguished by highly specific, even unique, predispositions relevant to their health and to the diagnosis and treatment of diseases. Biomedicine is moving toward a highly individual model.

We are only on the edge of the world that genomic medicine will create, but the medical world has firmly established the differences between groups. We recognize myriad group characteristics directly relevant to medical care. Some, such as the distinctions among blood groups, are old news; others, such as the other compatibility factors vital in organ transplantation, have more recently become apparent. We have learned that some racial or ethnic groups are prediposed to certain inherited diseases. We understand the genetic mathematics operating in families with hereditary diseases such as cystic fibrosis and Huntington's chorea.

Of course, the most fundamental division in the species is between male and female, and we are beginning to learn the ways in which disease processes, symptoms, and responses to therapeutic modalities do, and do not, differ between men and women. Research continues to find enough differences to make it imperative that the question of such difference be raised for all processes and interventions, including those not specifically related to the reproductive system. Only in that way can the differences be “charted” and made part of physicians' normal medical knowledge. Beyond the physiologic distinctions lie the equally important but often more difficult psychosocial differences between men and women that affect history taking, patient education, and the doctor—patient relationship as a whole.

The authors of the articles in this theme issue do not shy away from the difficulties of presenting sex-difference education in the curriculum. Ultimately, it is a question of taking a wider, not a narrower, view of medicine. The issue is not merely women's health, although integrating the health and illness of women across the whole medical curriculum is certainly important in its own right. Current concerns about women's health in the curriculum point directly to the larger changes in our medical understanding of the human species. The focus on women's health in this collection is not yet another call to be given part of the educational turf. Rather, it is to propose that the challenges posed by women's health can be the catalyst for new ways of conceptualizing and constructing the medical curriculum as biology and culture teach us increasingly of our true similarities and differences.

© 2000 Association of American Medical Colleges