Thread by @DocElovitz

Lots of discussion about lack of advancement in women's health

Here is the thing. We will NOT advance reproductive/pregnancy/women's health science by continuing to do clinical trials that are NOT based on fundamental mechanisms that drive health & disease

hang on...🧵🧵🧵
1/

Let me explain:

Millions (millions)💲 have been spent to perform clinical trials to decrease adverse pregnancy outcomes such as #preeclampsia

Trials on Vitamin C, E, magnesium, aspirin, calcium

Perhaps, you might be thinking--those are pretty generic interventions 👀

2/

And you would be right. They are.

Vit C & E clinical trial was based on concept that there is evidence of oxidative stress in placentas from preeclamptic individuals

OK. Yes, but oxidative stress is a pretty ubiquitous biological event
3/

and no data saying ox stress was a KEY event in the development of preeclampsia

Fact: We remain uninformed regarding the key molecular pathways that lead to preeclampsia

Fact: Until we know this, clinical trials will *guess* at best intervention.
But, there is more
(sigh)
4/

Let's take #pretermbirth. Lots of clinical trials. Many (most?) focused on progesterone and cerclage (stitch to close the cervix)

Shall we start with progesterone?

In pregnancy, LOTs of progesterone. Its the job of corpus luteum and then placenta

5/

but somewhere along the way (see 1960s & before), idea that not enough PROG so supplementation would prevent preterm birth.

And, so, clinical trials giving PROG by mouth, my shot, my suppository

By rule of stats, we should have a few trials that showed positive outcome.

6/

And we did....along with so many more that have shown no benefit.

FACT: We do not know why vaginal progesterone prevents preterm birth (in studies where it did). I have researched this and yeah, I could not find a molecular mechanism.

7/

So, put a stitch in it?!!?

Cerclages got started because clinically the cervix appeared to 'open' without cause.

You know what the pregnant cervix is?
an incredible organ that has distinct immune, molecular AND BIOMECHANICAL properties.

Ask me what a stitch does to those
8/

👀

Now, that is just 2 examples regarding pregnancy outcomes.

But, it is ALL. OF. WOMEN'S. HEALTH

Let me list a few of the conditions that that we have INSUFFICIENT knowledge regarding the mechanisms that drive these conditions

9/

#endometriosis
#pcos
#fibroids
#Menopause
#infertility

And more.

worth mentioning that sex-specific biology is a driver of health and disease across lifespan and yeah, we do not know enough about that either

10/

You still here? good 🙂

To advance women's health science, we MUST advocate (& do) fundamental & translational research to understand mechanisms of health & disease

Only by doing so can we pursue meaningful clinical trials to improve health for women across their lifespan

11/