Why Women May Make Better Doctors

I had spent too many minutes with physicians searching fruitlessly for my skinny, scarred-over veins in my skinny teenaged arms. Doctors were as sure as science when it came to predicting where the few viable vessels were, leaving a groundhog’s trail of holes from my elbows to my wrists as they disproved themselves, time and again.

The blood would be found, inevitably. By nurses. Phlebotomy is a subtle hunt, guided as much by instinct as textbook biology. The oncology nurses, well schooled in patience, brought ritual taps and skin caresses to the art. They, too, had medical training but came to the task with a soft knowing, not a certainty. It worked.

Later I wondered if I had miscast my judgment as a distinction between castes (doctor vs. nurse) rather than genders. The NIH clinic doctors, way back then, were mostly men; the nurses on the 8th floor of Building 10 were mostly women.

I recalled this decades-old memory when I read an investigation published online yesterday in JAMA Internal Medicine entitled, “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs. Female Physicians.” The study, by Yusuke Tsugawa and colleagues at the Harvard T. H. Chan School of Public Health, Harvard Medical School, and other institutions, examined the record of a large random sample of Medicare patients, 65 years or older, who were hospitalized from January 2011 to December 2014.

All told, the researchers reviewed 1,583,028 separate incidents of hospitalization and 1,540,797 occasions when patients were sent back to the hospital within 30 days of their initial discharge. What they found was just plain striking: Patients treated by female internists had lower rates of mortality (within 30 days of hospitalization) and lower rates of readmission than those treated by male physicians.

That was true using various statistical tests and controlling for any number of variables, from length of patient stay to the number of years the physician had been practicing. It was also true, importantly, regardless of the primary condition the patient had going into the hospital. The researchers examined outcomes for eight common medical conditions—from sepsis, pneumonia, and congestive heart failure to renal failure and GI bleeding. In each case, those treated by female physicians had lower mortality and readmission rates, though the differences were relatively modest all around.

The Harvard study joins a growing collection of investigations in the academic literature that attempt to determine whether a physician’s gender plays a role in health outcomes. Some studies suggest it does; some the opposite. When it comes to diabetes care, for example, this German research team found “female physicians provide an overall better quality of care”; this U.S.-based team found “patients of female physicians received similar quality of care compared with patients of male physicians.”

Ashish Jha, the senior author of the JAMA Internal Medicine paper, points out in a blog post that there are reasons why women doctors might well deliver better care, citing research to suggest that they might adhere more closely to established clinical practice guidelines and that patients often report better personal experiences (something that ultimately might lead to better outcomes). But he, too, acknowledges that the evidence is both thin and anecdotal—or at least it was until the study he and his colleagues published yesterday.

Still, there is a rich vein of understanding to be drawn from continuing to ask the question. Researchers Debra Roter and Judith Hall have suggested that differences in patient communication and attentiveness may play a role: In one analysis, in fact, female physicians spent two minutes (10%) longer with patients than male doctors did.

One has to wonder, could the answer be as simple as that? Could patience, in other words, be the secret to helping more patients?

More news below.

DIGITAL HEALTH

Brigham & Women's researchers use gold nanoparticles to boost DNA vaccine delivery. Scientists at the Brigham & Women's Hospital in Boston have used tiny little bits of electrically charged gold to create holes in cell membranes that can then become passageways for delivering drugs. The researchers were working on mouse models and used the method to administer a hepatitis C DNA vaccine. (DNA vaccination is a groundbreaking and increasingly popular method that uses genetically modified DNA, rather than a weakened viral or bacterial strain, to produce an immune response.) "One of the really exciting aspects of this new method is that it enables drug delivery into tissues or cells in a universal way," said lead researcher Hadi Shafiee in a statement. "We are eager to explore its use for other important biological molecules, including RNA." (MassDevice)

Health IT upstart Zipari nabs $7 million in Series A. Brooklyn-based Zipari has raised $7 million in a Series A funding round led by Vertical Venture Partners, the firm announced Tuesday. Zipari is among the upstart tech firms attempting to help the insurance industry glean insight about its customers' health consumption needs and habits via a predictive learning platform. "This capital expands our ability to address insurance carriers' need for analytics to understand customers, and highly customized [customer relationship management] solutions," said Zipari chief Mark Nathan in a statement on the funding round.

Bristol-Myers and PsiOxus want to use an "armed" virus to fight cancer. Bristol-Myers Squibb is trudging on in its quest to become one of the premier faces of cancer immunotherapy, this time striking a deal with PsiOxus to gain access to an "armed" oncolytic virus. (Oncolytic viruses are viruses that specifically infect and destroy cancerous cells.) Bristol-Myers will be paying $50 million upfront for the pre-clinical drug candidate, NG-348, and hopes that it can eventually be used to fight solid cancerous tumors. PsiOxus could also eventually nab nearly $900 million in downstream payments upon clearing certain milestones. What's special about this particular oncolytic virus is the "armed" part—NG-348 is loaded up with a pair of transferred genes that can help produce a more robust immune system response to fighting the virus-infected tumors.

INDICATIONS

Beginning of a new era for Biogen as it names next CEO. Bitoech giant Biogen on Monday announced that the company's chief commercial officer, Michel Vounatsos, will be its next chief executive. Vounatsos will replace outgoing CEO George Scangos, who ran the ship for six years before announcing he would be stepping down this summer (Vounatsos will officially step into the role in January). But the announcement was met with a bit of a lukewarm reaction from investors, and Biogen shares fell nearly 3% in Monday trading. The reason? RBC Capital Markets analysts say that the appointment could hobble the chances of a Biogen sale (although the company hasn't really expressed an active interest in being purchased). "The Street has simply not yet had enough time to get familiar with Vounatsos," wrote the RBC analysts in a note. Vounatsos will certainly have his work cut out for him. With stalling sales of Biogen's flagship therapy for multiple sclerosis, Tecfidera, the company has been investing more heavily in its experimental product pipeline, including a risky gambit on Alzheimer's drug development. (Fortune)

Allergan buys LifeCell for $2.9 billion. From the way that Allergan has been snapping up biotechs and experimental assets, you'd think that CEO Brent Saunders is on a one-man mission to be named 2016's Biotech Man of the Year. And he's ending the year true to form, picking up the regenerative medicine unit of closely-held Acelity LP for $2.9 billion in cash. “The acquisition of LifeCell is both strategically and financially compelling to Allergan and serves as our entry point into regenerative medicine as we create a world-class aesthetic and regenerative medicine business in plastic surgery," said Saunders in a statement. "LifeCell’s regenerative medicine unit is a strong fit with our existing business and can be significantly strengthened with our infrastructure and global reach." The deal has obvious synergies with Allergan's existing portfolio, including its flagship cosmetic product Botox. Under Saunders' leadership, Allergan has concluded a whopping $13.4 billion worth of deals across some 18 separate transactions. (Fortune)

Glaxo HIV combo shines in a pair of late-stage trials. A two-drug combination pill from GlaxoSmithKline's majority-owned ViiV Healthcare unit could become a challenger to traditional three-drug cocktail therapies from companies like Gilead, which is a powerhouse in the space. The experimental combo mixed GSK's dolutegravir and Johnson & Johnson's rilpivirine and found to be just as effective as more convoluted cocktails that are being more commonly used. When drugs are nested on top of each other, they can become more effective—but such combinations also make it more likely that toxic side effects can occur, especially with the kind of prolonged use that HIV patients have to deal with. "The key debate remains whether Gilead will gain the upper hand again or whether a disruptive two-drug regimen becomes standard of care, favoring GSK," said UBS analyst Michael Leuchten in an interview with Reuters. (Reuters)

THE BIG PICTURE

The WHO is rethinking how to respond to outbreaks. The World Health Organization (WHO) is implementing a new program to try and improve the way it responds to major disease outbreaks. The organization was criticized for its response to the 2014 Ebola epidemic in Africa; now, it plans to try and strengthen local health systems in areas where such outbreaks may occur and provide more detailed guidance about how to give medical care to people with deadly infectious diseases that require special (and careful) treatment. (Nature)

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