This International Women's Day special interview on the evolution of neurology with a special focus on women's brain health, we delve into the work of Cheryl Carsel. Using unique perspectives shaped by experiences in both low- and middle-income and high-income countries, this conversation highlights significant disparities in neurological care and outcomes between genders.
Can you tell us how you came to focus on neurology, and more specifically women's brain health?
As a medical student in a low- and middle-income country (Philippines), I was fascinated by neurology. Neurology can accurately diagnose a person's neurological disease by taking the person's medical history and performing a physical exam. This is extremely important in countries with fewer resources such as diagnostic imaging.
During my neurology training, I realized that women typically have more disability or are more likely to die after a stroke, but I didn't know this was a worldwide problem. That was until I started my Ph.D. Researchers from the University of Sydney analyzed a portion of the George Institute Stroke Trial and found evidence that women actually have worse outcomes after a stroke, including reduced quality of life, compared to men.
These trials were conducted internationally, so they were conducted not only in the Philippines, where I had first-hand experience with patients, but also around the world and even in high-income countries.
In your research on sex and gender differences in neurology, what has been the most surprising or enlightening finding regarding how neurological diseases affect men and women differently?
In 2024, it still amazes me that women and men experience these differences. There are two things he wants to emphasize.
We know about the biological differences between women and men, and that these differences can affect our response to illnesses such as stroke. For example, young women are more likely to have a stroke than young men, probably due (in part) to gestational hypertension and gestational hypertension.
However, the gender dimension is more difficult to explain, as it may be related to the role women play in society. Because she has caregiving responsibilities, she may not come to the hospital immediately after the stroke (and therefore she may not receive time-dependent life-saving medications). Or maybe she's older and lives alone and has no one to call an ambulance. Apart from the role women play in society, there may be differences in the treatment of women and men and implicit biases by medical professionals.
Participants enrolled in stroke clinical trials are often not representative of the population experiencing stroke in the community. Women, people of color, and individuals from culturally and linguistically diverse backgrounds (CALD) are under-enrolled relative to the burden of stroke disease. Estimates of treatment efficacy for many medical therapies, including stroke, are based on trial evidence derived primarily from white male populations, limiting the generalizability of safety and effectiveness evidence. Masu.
Given the clear differences in how neurological symptoms manifest and affect men and women, what implications do these insights have for the development of neurological treatments, patient care, and support systems? Do you think it will have an impact?
Research in this area (my own and many others) considers the collection, analysis, and reporting of sex and gender health data to overcome these differences, and clinical trials to provide reliable data. suggests the need to include more diverse populations. Evidence showing how safe and effective new drugs and devices are for everyone. There is also evidence that when women lead clinical trials, trial populations are more inclusive and data are more likely to be disaggregated by gender.
Image credit: Tunatura/Shutterstock.com
What are the most important challenges you face when studying women's brain health, and how can the scientific community address these challenges to ensure more inclusive health outcomes? Do you have a suggestion?
If you had asked me the same question four years ago, my biggest challenge then would have been to convince the medical and research community that sex and gender disparities in stroke and cardiovascular disease were real problems. I would have answered.
All of this growing evidence cannot be ignored, so the next challenge is to find strategies to reduce this health disparity. One of the best ways to do this is to collaborate with end users (people with lived experience, medical professionals, advocacy groups, governments, etc.) to find solutions that work for all involved. .
You advocate disaggregating data in medical research by gender. Can you explain how this approach has influenced your research findings and why it is important for achieving gender equality in healthcare?
Gender equality is one of the United Nations Sustainable Development Goals (Sustainable Development Goal 5). Clinically meaningful sex and gender differences in screening, risk factor prevalence, health-seeking behavior, treatment, and prognosis are increasingly recognized across a range of non-communicable diseases that pose the greatest health burden. .
Why women and men experience and treat the same disease differently, and how this is related to gender structures embedded in society, are underappreciated in medical research and clinical practice. By disaggregating data by gender and, where possible, gender, we are not only doing good science (in the wise words of Professor Rhonda Schiebinger, “Gendered Innovation | Stanford University”); We are extending our knowledge of these differences to the health care system to improve clinical practice. , medical research, health system design, policy, and public health.
Your trials in Nigeria and Peru focus on critical acute stroke care in low-resource settings. How do you think this work will contribute to a more holistic approach to global health, especially when it comes to women's health care in these regions?
This trial is funded by the World Heart Federation and our objectives are twofold. The goal is to improve acute stroke care in low-resource settings and to build research capacity in this area. The coronavirus pandemic has affected this project, which is currently on hold as we work through logistical issues. If this trial yields positive results, clear guidelines for mandatory acute stroke treatment could eliminate implicit and explicit gender bias.
I am also working on another project aimed at improving women's participation in stroke clinical trials. It is important that clinical trials include a balanced proportion of women and men so that key findings can be interpreted separately by gender.
If women are underrepresented in clinical trials, there is a threat that treatments will not be safe or effective, creating the potential for unequal access to treatment. Our ongoing efforts are to develop and evaluate comprehensive and innovative recruitment strategies to improve the representation of women in stroke trials, with the aim of making stroke treatment more accessible to all. is.
As women, we need to be courageous. When you have something to say, speak up and let your voice be heard and counted. You matter and your voice matters.
Based on your experience and research findings, what policies and actions do you think are essential to advance the integration of women's health needs into the national and global health agenda?
A major program of work, a collaboration between the George Institute for Global Health and the Australian Institute for Human Rights at the University of New South Wales in Sydney, is an Australia-wide call to action to incorporate sex and gender analysis into medical research. This work led to the formation of the Sex and Gender Sensitive Research Action Group, which includes 11 of her universities in Australia, the UK and the US, working to analyze and report gender-specific health data.
A charity is currently funding a major project aimed at translating a 'call to action' document. Key outcomes of this project to date include bringing together Australia's key stakeholder organizations engaged in sex and gender research to advocate for policy change, including the National Health and Medical Research Council and the Health Research Future Fund (Australia's leading co-designed workshops with our group, the Australian Association of Medical Research Institutions (AAMRI), a representative body for medical research institutions across Australia, Developed a series of sex and gender policy recommendations for medical research.
Through these policy changes across various stakeholder groups, we hope to achieve critical mass in Australia where sexual and gender health data collection, analysis and reporting becomes not just a good thing but the norm.
This month, we are launching Australia's new National Center for Sex and Gender Equality in Health and Medicine. The center brings together researchers, policy makers, health professionals, and consumer stakeholders interested in addressing the health impacts of biological sex and gender identity. Deliver results and enable greater learning, collaboration, and impact. The center was established in partnership between the George Institute for Global Health, the Australian Institute for Human Rights at UNSW Sydney and Deakin University.
The center aims to develop effective strategies to prevent and treat the leading causes of death and disability for all people. We need comprehensive health and medical research that examines how sex and gender influence different conditions.
Reflecting on this year’s theme for International Women’s Day, what does “Inspire Inclusion” mean to you personally and professionally, and how do you see its implementation in brain health and other areas? What do you envision?
This year's United Nations theme is “Count Her In: Invest in Women.” Accelerate progress. It touches a little bit on economic empowerment, but it also provides equal opportunities to earn, learn, and lead. This is highly relevant to our efforts to improve women's participation in clinical trials. We want to ensure women's participation is counted by ensuring we collect women's health and medical data. And it's safe and effective.
Where can our readers find more information?
About Cheryl Carsel
A/Professor Cheryl Carsel is a neurologist and director of the Brain Health Program at the George Institute for Global Health in Sydney, Australia. 
She is a joint associate professor at the University of New South Wales, Australia. She has been named a World Heart Federation (WHF) Emerging Leader and an Australian Stroke Association Emerging Stroke Clinician and Scientist. The most important role in her life is being a mother to her two young and active children and a wife.
Career highlights:
• Recently promoted to Associate Professor at the University of New South Wales and Head of the Brain Health Program at the George Institute.
• Appointed acting director of the Center for Sex and Gender Equality in Health and Medicine. The Center is Australia's national center addressing sex and gender inequality through world-class research that considers how sex and gender impact health and healthcare.
• Last year, I was invited as one of the keynote speakers at the European Stroke Organization's Stroke Science Workshop. This is an important outcome as this workshop is a conference on clinical and translational research aspects of stroke with a limited number of eminent stroke experts and young scientists. Inviting me as a keynote speaker to this conference suggests that gender and gender differences should be considered as a top priority in stroke.
