Womens Health Through the Eyes of Medicines Lady Giants

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Womens Health Through the Eyes of Medicines
Lady Giants

• Womens Club
• January 25, 2006
• Nancy W. Dickey, MD

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Through the actions of many

• Although women who aspire to a role in medicine
  may be appreciative of those who came before,
  clearly our patients and communities have much
  for which to be grateful as well. From
  scientific discovery that changed lives to
  commitment to public health and well-being, women
  have raised standards, created new understanding,
  and touched lives.
• Nancy W. Dickey, MD in Women in Medicine, An
  Encyclopedia (Laura Windsor)

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Weve made great strides in medicine

• Longevity has improved
• Substantial progress has been made in many of the
  diseases specific to women like cervical cancer,
  childbirth, breast cancer
• Progress in the safety of our children has
  advanced in the areas of congenital disease, safe
  childbirth, and survival of prematurity

• And this has happened at least partially because
• The number of women in medicine has increased
  dramatically
• Every specialty now has women in its ranks
• Women are included in the studies done and have
  studies directed at their issues

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Longevity
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Well, while we are clearly living longerand
living those extra years better

• Death is not yet optionalthe death rate is still
  1 per person
• So, lets look at health advances and
  specifically how women have contributed to some
  of the advances that improve how long and how
  well we will live.

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James Barry, 1795-1865

• She masqueraded as a man all her life her
  gender only revealed on her death
• Educated at the Edinburgh School of Medicine
  shied away from her classmates!
• Entered the British army disguised as a man in
  1813
• Bore a child about whom nothing is known

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Women in Medicine have made a differenceElizabet
h Blackwell, MD1821-1910

• First woman physician to receive her degree in
  the US
• Said she turned to medicine after a close friend
  who was dying said she would have been spared her
  worst suffering if her physician had been a woman
• Upon observing an the exam of a poor woman, Twas
  a horrible exposure, indecent for anywoman to be
  subject to such torture she seemed to feel it,
  poor and ignorant as she was. I felt more than
  ever the necessity of my mission.
• She gained admission as a joke
• Established the New York Infirmary for Women and
  Children and it medical college for women

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Women/Medicine/21st Century

• In 1970 7.2 of physicians were women and by 2003
  25.8 were women
• The TAMHSC College of Medicine admits 49-52 of
  each class as women
• Women are represented in every specialty though a
  preponderance continue in primary care and
  obstetrics

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Women who have made a difference.
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Gynecology

• Mary Corinna Putnam Jacobi, 1842-1906
• Established through research that womens health,
  strength, and agility did not vary during their
  monthly cycle thereby refuting a frequent
  argument about why women could not be treated
  equally
• Female physicians, it was charged, were
  unreliable due to their monthly instability, an
  infirmity akin to temporary insanity

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Maternity Issues Death Through Childbirth

• Danish saying, One tooth per child
• The maternal death rate around 1900 was one
  mothers death per every 154 living births. So,
  "if women delivered . . . five live babies during
  their child-bearing years . . . then one of every
  thirty women might have expected to die of
  childbirth over the course of her fertile years"
  (Leavitt 25). This statistic becomes even more
  shocking when one realizes that women of the
  1980s fared much better odds of one maternal
  death per every 10,000 live births.
• In 17 countries yet today, women face at least a
  1-in-10 chance of dying from pregnancy-related
  causes sometime during their lives.
• More than 500,000 women died of complications
  related to pregnancy or childbirth in 2000 99
  of those were preventable

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Not only women but our babies have benefited from
women physicians

• Virginia Apgar created the Apgar system for
  evaluating and rating the status of newborn
  babies
• Helen Brooke Taussig was a pioneer in pediatric
  heart surgery helping develop an effective way of
  treating blue babies

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• And
• What
• Has It
• Gotten
• Us?

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Heart Disease Not Just for Men

• Heart disease and stroke account for close to 60
  of all adult female deaths
• Heart disease often does not manifest itself
  until after menopause
• Because women were excluded from many clinical
  trials and have different symptoms than men,
  their problems often went undiagnosed
• Data says women receive less aggressive treatment
  and occasionally no treatment at all

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• Number of tests increased from 1993 to 2001 in
  all racial and gender groups
• BUT women and non-white men still less likely to
  get cardiac procedures
• rate of cardiac catheterization increased from
  31.5 to 50.2 per 1,000 patients for white men
  versus 18.9 to 34.9 per 1,000 patients for
  others.
• Women with the same kind of cardiac problems less
  likely than men to perceive their illness as
  severe
• may explain why women are less likely to access
  services for heart disease
• women tended to be older, less educated, be more
  symptomatic, and need more medications than men.
• women had lower capacity for daily activities,
  lower health-related quality of life and lower
  physical, mental and general health status than
  men.
• When asked to rate their health status - they
  were less likely than men to rate their disease
  as severe.
• A cardiologist says "I've often seen women
  minimize their symptoms to focus medical
  attention on a husband, child or other," he says.

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Cancer

• Cancer is the leading cause of death in women age
  40-79
• Breast, lung, and colon cancers account for more
  than half of all new cancers
• Breast cancer is expected to account for nearly
  1/3 of all new cancer cases in women
• Lung cancer rates are declining in men but
  continue to rise in women

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Breast CancerEarly detection due to increased
use of mammography and self exam, and improved
treatments led to breast cancer mortality finally
beginning to decline between 1992 1996.

• Physicians like Susan Love, MD, spent a lifetime
  encouraging use of proven, less destructive
  surgeries like lumpectomy followed by radiation
  and/or chemotherapy
• Study Chair Kathy D. Miller, M.D., of the Indiana
  University Medical Center in Indianapolis, Ind.
  Anti-angiogenic drugs, also called angiogenesis
  inhibitors, are substances that may prevent
  angiogenesis, or the formation of blood vessels.
• "These results will give clinicians better
  guidance and greater choice in deciding which
  women would benefit most from various forms of
  mammography," said senior author, Etta Pisano,
  M.D., University of North Carolina at Chapel
  Hill.

• "These findings confirm that we now have a very
  potent weapon against the recurrence of cancer
  cells that overexpress HER-2," said Edith A.
  Perez, M.D., who chaired the NCCTG trial and is a
  medical oncologist at the Mayo Clinic in
  Jacksonville, Fla.
• Use of somatostatin receptor scintigraphy (SRS),
  a nuclear medicine imaging technique looks at how
  the body functions at the molecular level may
  provide near immediate selection of breast cancer
  patients for endocrine therapy. Using
  99mTc-labeled depreotide, which binds to
  somatostatin receptors and sends out flashes of
  light detected by a gamma camera, researchers
  were able to create an image of the presence of
  hormone-sensitive lesions in a patient's body
  (Bieke Van Den Bossche, M.D., Ph.D., nuclear
  medicine department, Ghent University Hospital,
  Ghent, Belgium. " )

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Partly as a result of these contributions.

• If detected early, the 5-year survival rate for
  localized breast cancer is 97.
• During the 1990s mortality rates fell in white
  women by 2.5 percent a year and in black women,
  at a rate of 1.0 percent.
• Data on changes in incidence and mortality
  suggest that changes in treatment, not early
  detection, may play a more important role in
  explaining the recent decline in mortality.
• An increasing percentage of women now undergo
  breast conserving surgery followed by radiation
  and/or chemotherapy

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Rosalyn S. Yalow

• American physicist who won the Nobel prize for
  development of radioimmunoassays of peptide
  hormones
• The process made it possible to detect and
  measure minute amounts of hormones, drugs,
  enzymes, and antibodies
• The introduction of radio-immunoassay is
  probably the single most important advance in
  biological measurement of the past two decades.
  It has revolutionized one major discipline and
  influenced several others.

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Improved Diagnostics

• Radioimmunoassay A very sensitive, specific
  laboratory test (assay) using radiolabeled (and
  unlabeled) substances in an immunological
  (antibody-antigen) reaction.
• Thyroid dysfunction is extremely common in women
  and has unique consequences related to menstrual
  cyclicity and reproduction. Even minimal
  hypothyroidism can increase rates of miscarriage
  and fetal death and may also have adverse effects
  on later cognitive development of the offspring.
  Hyperthyroidism during pregnancy may also have
  adverse consequences.

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Women and Aging

• Women live an average of 6-8 years longer than
  men
• Life expectancy for women now exceeds 80 years in
  at least 35 countries
• Rates of disability among older populations is
  steadily declining
• For those who have reached the age of 65, life
  expectancy for Americans is 17 years!
• In 1900, just over half of all the women born
  could expect to live to age 65 and about 1 in 4
  would live to 85.
• Of the women born in 1990, almost 90 percent are
  expected to live 65 and more than half will live
  to age 85.
• 4 of 5 centenarians are women!

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And the progress should just continue to occur

• In 1988 a group of womens health professionals
  researchers lobbyists, activists, administrators,
  organized by the society for Womens Health
  Research - began to demand measurable change.
• In 1990 a GAO Report evaluated the implementation
  of NIH guidelines and found that there has been
  little progress made.

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An NIH Office for Women

• In 1990 an Office of Research on Women Health
  was established at the NIH and progress began to
  occur.
• Issues in womens health concern the prevention,
  diagnosis, and management of conditions or
  diseases that may be unique to women.or that are
  more prevalent in women than menor that manifest
  themselves differently in women than men.

Vivian Pinn, M.D.
I wanted to be the kind of physician who paid
attention to my Patients, and didnt dismiss my
patients complaints
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But were not there yet!

• For women to be thought half as good as men, they
  must work twice as hardfortunately, this is not
  difficult.
• WRONG!!
• Women who do work are most often paid less money
  than menon average, 77 cents on the dollar
• Only 9 of women who embark upon college teaching
  careers attained the rank of full professor
• Men who enter university teaching roles have a 3X
  greater chance of making full professor.
• In 1998-99 women full professors received an
  average salary of 12 less than men.
• And while it is hard to believe that at the
  miniscule level of pay for public schoolswomen
  make an average of 3,000 per year less than
  their male counterparts.

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Youve come a long way baby!