Liisa Galea
Dr. Liisa Galea is a scientific lead for the CAMH (the Centre for Addiction and Mental Health) program womenmind™. It’s a community of philanthropists, thought leaders and scientists dedicated to tackling gender disparities in science, and to put the unique needs and experiences of women at the forefront of mental health research.
Womenmind™ Liisa Galea
“You know how to *take* the reservation, you just don't know how to *hold* the reservation. And that's really the most important part of the reservation: the *holding*.”
- Seinfeld, ‘The Alternate Side’, 1991
The National Institute of Health (NIH) in the US introduced a policy* in 1993 where applications for research that plans to involve human subjects for clinical trials must address the inclusion of women, minorities, and children in the proposed research. As a result, the scientists applying for research grants did exactly that. They included women, minorities, and children in their studies. But to what end?
It’s easy to include women, minorities, gender diverse people, but if you don’t look to see if it’s affecting outcomes for those individuals differently, then you’re doing only half of the work – and missing the part that makes inclusion important. But precious little research, since the introduction of that policy, has made that distinction.
*It should be noted that it is quite difficult, at the moment, to ascertain exactly when the NIH instituted that policy, or what the outcomes have been, since the new American presidential administration has scrubbed their websites and resources of any language involving “minorities”, “disparity”, “bias”, and even “women”.
Dr. Liisa Galea leads the Women’s Health Research Cluster at the Centre for Addiction and Mental Health (CAMH) in Toronto. She is the principal editor of Frontiers in Neuroendocrinology, the Past President of the Organization for the Study of Sex Differences and co-Vice-President of the Canadian Organization for Gender and Sex Research. She is also the scientific lead for the CAMH initiative womenmind™ and a Seinfeld fan.
“I grew up in a time when I had to wear a skirt in school because I was a girl. I’m so grateful to my parents for saying I was smart and could do anything I wanted to do…except perhaps become Pope! I was told I was different because I was a girl, but it didn’t upset me – it just made me curious as to why people thought that. When I started university, I got really interested in the area of female brains vs male brains and I wanted to know all about the differences and what that might mean for our health.”
womenmind™ is a community of philanthropists, thought leaders and scientists dedicated to tackling gender disparities in science, and to put the unique needs and experiences of women at the forefront of mental health research. Dr. Galea and Dr. Daisy Singla, a clinical psychologist who specializes in perinatal mental health, are womenmind™ scientists who do a lot of this important work.
The gender disparities in healthcare are real, and they are significant – particularly in the area of mental health. Diagnoses of mental health issues can take up to two years longer for women compared to men. There is a sense in the public sphere that men don’t talk about their feelings as much as women do, and are less likely to seek help with psychological issues. Despite this, just looking at mental health disorders, there is still a delay in diagnosis of more than two years for women. That delay can interfere with treatment plans – if you’re being misdiagnosed or dismissed with your symptoms you’re not getting the treatment you need, and we all know that earlier interventions lead to better outcomes.
A study done by the World Economic Forum showed that globally, women spend 25% more of their lives in poor health than men do. Dr. Galea thinks this is partly due to health science being historically dominated by men studying males.
“In terms of mental health specifically, there are many reasons for the delays in diagnosis, but one of the major reasons I think is because most of our medical knowledge – including the symptoms on checklists for diagnoses – are based on the experiences of men. So much so, that we often call symptoms for mental health disorders in females ‘atypical’. We use ‘atypical’ a lot in the context of neurodiversity – autism, ADHD, and so on. And there are more males diagnosed with those conditions. We see more females than males diagnosed with depression, but we also see that ‘atypical’ label applied to depression in women. If there are twice as many women diagnosed with depression as men, how are their symptoms ‘atypical’? I think it’s because our scales were developed a long time ago, thinking about findings in males and the experiences of men.”
As a result, healthcare providers don’t acquire enough knowledge about sex and gender disparities in disease presentation and symptoms. This has real consequences for women in the healthcare system, but also for funding bodies. As a researcher that’s been in this field for 28 years, Dr. Galea gets a lot of comments from editors and funding agencies that *this [female-centric subject]* isn’t a really important thing to study because it’s “only in a subset of the population”.
Dr. Galea and her team did a review, looking only at male/female studies in neuroscience and psychiatry. 68% of studies were using both male and female participants, but only 5% of those studies looked to see whether sex made a difference. As Dr. Galea says, “you can have 2 females and 8 males in your control group, but the reverse in the treatment group, and you can’t do the analysis properly because you don’t really have the sample size to see if it made a difference.”
27% of the studies were focused solely on males, and 3% solely on females. Dr. Galea’s team then looked at Canadian grants, which resulted in similar percentages. In 2023, mental health specifically for women made up less than 1% of the funding of the Canadian Institutes for Health Research (CIHR), the major federal agency responsible for funding health and medical research in Canada.
Funding for research is, sadly, a hot-button issue at the moment as the new American government tries to shut down funding at the NIH for everything they deem to be “woke”. This has impacted many of Dr. Galea’s colleagues and the work they do, especially since the cuts seem to have been attempted in the most damaging and misguided way possible. The new administration looked for the key words they didn’t like, and cut funding for everything that contained words like “bias” or “diversity” or “environmental”. They also targeted words like “trans”, “non-binary”, “female”, and “woman”.
This could result in the ending of studies into things like the gut microbiome, where one of the measures is alpha-diversity and beta-diversity – referring to the variety of bacteria that live in one’s gut. Electricity studies using vacuum tubes which require a current called “bias”. And studies involving women’s health. Dr. Galea says this is even more dangerous than it seems, because stopping the study of women’s health affects men as well. She gives an example,
“Lazaroids were a drug that was discovered for stroke recovery. It worked miracles for people who had suffered strokes. It was discovered pre-clinically first, where it worked on mice and rats, and then it went to double-blind randomized control clinical trials, our gold standard. It turns out most of the pre-clinical work was done in males. The early clinical trial was done all in men as well, since men are more likely to suffer a stroke earlier in life (but this switches to more women later on in life). It failed phase 3 clinical trials, which included women, and the drug is not on the market. It put the drug company out of business. But when people did secondary analyses, it turns out lazaroids work wonders in men – but not in women. In fact, in women it might have made things worse. But that’s a drug that’s now not on the market that might do wonders for men’s health! Isn’t it in our collective interest to find out what drugs work better in different populations?”
This upheaval could have devastating consequences for the future of women’s health, an area that has critical problems already. Consider menopause. This is something that will happen to 50% of the population. And yet, 0.5 % of all studies in neuroscience, and in the field of brain health in general, are on menopause. Physicians get about 1-3 hours of training on menopause and its effects on health.
When women go through menopause and have significant problems, they get sent to specialists – gynecologists. But – only 30% of American gynecological programs had anything about menopause in them. So well above half the time women get sent to see specialists for this, they’re going to see someone who hasn’t been trained in it, and may have learned very little about it. Says Dr. Galea,
“We have to become our own specialists, but we need informed research to know what we can do to offset our symptoms. Laura Gravelsin (one of my postdocs) and I just had a paper accepted called ‘One Size Does Not Fit All: Type of Menopause and Hormone Therapy Differentially Influence Brain Health’, because there are many hormone therapies and many menopauses, and we have to determine which one works for us individually.”
Not all scientists who study women’s issues are women, and not all women specialize in those issues. But having more girls going into scientific disciplines, and being supported along the way, can’t hurt. This is another of womenmind™’s goals. Dr. Galea points to the fact that there are more female psychologists, and physicians, than there are male. And yet, at the dean level, or director or supervisor level, the proportion of women steadily decreases the higher in rank you go, compared to men. She says,
“Girls are very interested in all scientific fields at a very early age, but as time goes on and we get further and further in our career, the disparity starts to grow. At the university level, you see more women and girls in the sciences, but the gap gets a little wider the further up you go, at the graduate level and then at the assistant professor level.”
With this in mind, womenmind™ has a robust mentorship program for all female and gender-diverse scientists that has seen remarkable results. About 60% of the female and gender-diverse scientists at CAMH have gone through the mentorship program, and there is a staggering 100% approval rate – every single person coming out of the mentorship program has said they would recommend it and they want it to continue.
And continue they will, with the passion and determination of the new scientists and the veterans like Dr. Galea. In addition to womenmind™, she runs her own lab investigating how hormones (mostly estrogens) influence the brain. They focus on stress-related psychiatric disorders like depression, and also Alzheimer's. Dr. Galea also runs the Women’s Health Research Cluster which in the realm of knowledge translation, and seems like a lot of fun! They just had an event in Toronto called ‘Galentine’s Day: Love your Brain’ which was about girls and women and anyone who identified as such loving their brains through hormonal changes like puberty and menopause.
The experiences of women and girls going through hormonal changes are varied and diverse. The path through adolescence, or menopause, is rarely a straight line. Nothing in life is a straight line! Even Dr. Galea’s journey to doing the work she does today (and Parks and Rec fandom) took numerous twists and turns. She says,
“I started in engineering first, and took Psychology 101 with Susan Lederman. She works in perception. She said ‘I’m the first Canadian, the first woman, and the first psychologist to be asked on a NASA panel’. She was there because astronauts were complaining they couldn’t feel anything through their gloves when they were out on a spacewalk. I was hooked. I thought, ‘that’s so interesting, I want to learn that’. It’s not at all what I ended up doing, but I took a lot more psychology as a result. I ended up studying women’s brains, and I’m always going to do it!”
Someone’s got to do it. And someone else entirely has to support them by making it a priority to ensure they continue to get to do it. With initiatives like womenmind™, the Women’s Health Research Cluster, and the research being done by Dr. Galea and her colleagues, the future of gender-inclusive health science looks promising. But if we want to make the most of that promise, the scientific community and policymakers must make it a priority to ensure this research continues.