Women’s Health Women’s Health Through the Eyes of Through the Eyes of

Medicine’s Medicine’s Lady GiantsLady Giants

Women’s ClubWomen’s Club

January 25, 2006January 25, 2006

Nancy W. Dickey, MDNancy W. Dickey, MD

Through the actions of Through the actions of many…many…

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

Nancy W. Dickey, MD in Nancy W. Dickey, MD in Women in Medicine, An EncyclopediaWomen in Medicine, An Encyclopedia (Laura (Laura

Windsor)Windsor)

We’ve made great strides We’ve made great strides in medicine…in medicine…

• Longevity has improvedLongevity has improved• Substantial progress Substantial progress has been made in many has been made in many of the diseases of the diseases specific to women like specific to women like cervical cancer, cervical cancer, childbirth, breast childbirth, breast cancercancer

• Progress in the safety Progress in the safety of our children has of our children has advanced in the areas advanced in the areas of congenital disease, of congenital disease, safe childbirth, and safe childbirth, and survival of prematuritysurvival of prematurity

• And this has happened And this has happened at least partially at least partially because…because…

• The number of women in The number of women in medicine has increased medicine has increased dramaticallydramatically

• Every specialty now Every specialty now has women in its rankshas women in its ranks

• Women are included in Women are included in the studies done and the studies done and have studies directed have studies directed at their issuesat their issues

LongevityLongevity

0

10

20

30

40

50

60

70

80

90

1850 1900 1950 2000200120022003

Age

Well, while we are clearly Well, while we are clearly

living longer…and living living longer…and living those those

extra years better…extra years better…• Death is not yet optional…the Death is not yet optional…the death rate is still 1 per persondeath rate is still 1 per person

• So, let’s look at health advances So, let’s look at health advances and specifically how women have and specifically how women have contributed to some of the contributed to some of the advances that improve how long advances that improve how long and how well we will live.and how well we will live.

James Barry, 1795-1865James Barry, 1795-1865

• She masqueraded as a She masqueraded as a man all her life – her man all her life – her gender only revealed on gender only revealed on her deathher death

• Educated at the Educated at the Edinburgh School of Edinburgh School of Medicine – shied away Medicine – shied away from her classmates!from her classmates!

• Entered the British Entered the British army disguised as a man army disguised as a man in 1813in 1813

• Bore a child about whom Bore a child about whom nothing is knownnothing is known

Women in Medicine have made a Women in Medicine have made a difference…difference…

Elizabeth Blackwell, MDElizabeth Blackwell, MD1821-19101821-1910• First woman physician to First woman physician to receive her degree in the USreceive her degree in the US

• Said she turned to medicine Said she turned to medicine after a close friend who was after a close friend who was dying said she would have been dying said she would have been spared her worst suffering if spared her worst suffering if her physician had been a womanher physician had been a woman

• Upon observing an the exam of Upon observing an the exam of a poor woman, “Twas a horrible a poor woman, “Twas a horrible exposure, indecent for any…exposure, indecent for any…woman to be subject to such woman to be subject to such torture; she seemed to feel torture; she seemed to feel it, poor and ignorant as she it, poor and ignorant as she was. I felt more than ever was. I felt more than ever the necessity of my mission.”the necessity of my mission.”

• She gained admission as a jokeShe gained admission as a joke• Established the New York Established the New York Infirmary for Women and Infirmary for Women and Children and it medical Children and it medical college for womencollege for women

Women/Medicine/21Women/Medicine/21stst CenturyCentury

• In 1970 7.2% of physicians were In 1970 7.2% of physicians were women and by 2003 25.8% were womenwomen and by 2003 25.8% were women

• The TAMHSC College of Medicine The TAMHSC College of Medicine admits 49-52% of each class as admits 49-52% of each class as womenwomen

• Women are represented in every Women are represented in every specialty though a preponderance specialty though a preponderance continue in primary care and continue in primary care and obstetricsobstetrics

Women who have made a Women who have made a difference….difference….

GynecologyGynecology

• Mary Corinna Putnam Jacobi, Mary Corinna Putnam Jacobi, 1842-19061842-1906

• Established through research Established through research that women’s health, strength, that women’s health, strength, and agility did not vary and agility did not vary during their monthly cycle during their monthly cycle thereby refuting a frequent thereby refuting a frequent argument about why women could argument about why women could not be treated “equally”not be treated “equally”

• Female physicians, it was Female physicians, it was charged, were unreliable due charged, were unreliable due to their monthly to their monthly “instability”, an infirmity “instability”, an infirmity akin to “temporary insanity”akin to “temporary insanity”

Maternity Issues – Death Maternity Issues – Death Through ChildbirthThrough Childbirth

• Danish saying, “One tooth per Danish saying, “One tooth per child”child”

• The maternal death rate around 1900 The maternal death rate around 1900 was one mother’s death per every was one mother’s death per every 154 living births. So, "if women 154 living births. So, "if women delivered . . . five live babies delivered . . . five live babies during their child-bearing during their child-bearing years . . . then one of every years . . . then one of every thirty women might have expected to thirty women might have expected to die of childbirth over the course die of childbirth over the course of her fertile years" (Leavitt 25). of her fertile years" (Leavitt 25). This statistic becomes even more This statistic becomes even more shocking when one realizes that shocking when one realizes that women of the 1980s fared much women of the 1980s fared much better odds of one maternal death better odds of one maternal death per every 10,000 live births.per every 10,000 live births.

• In 17 countries yet today, women In 17 countries yet today, women face at least a 1-in-10 chance of face at least a 1-in-10 chance of dying from pregnancy-related causes dying from pregnancy-related causes sometime during their lives.sometime during their lives.

• More than 500,000 women died of More than 500,000 women died of complications related to pregnancy complications related to pregnancy or childbirth in 2000 – 99% of or childbirth in 2000 – 99% of those were preventablethose were preventable

Not only women but our babies Not only women but our babies have benefited from women have benefited from women

physicians…physicians…

• Virginia Apgar Virginia Apgar created the Apgar created the Apgar system for evaluating system for evaluating and rating the status and rating the status of newborn babiesof newborn babies

• Helen Brooke Taussig Helen Brooke Taussig was a pioneer in was a pioneer in pediatric heart pediatric heart surgery helping surgery helping develop an effective develop an effective way of treating “blue way of treating “blue babies”babies”

And And

WhatWhat

Has ItHas It

GottenGotten

Us?Us?

Heart Disease – Not Just Heart Disease – Not Just for Menfor Men

• Heart disease and stroke account for Heart disease and stroke account for close to 60% of all adult female deathsclose to 60% of all adult female deaths

• Heart disease often does not manifest Heart disease often does not manifest itself until after menopauseitself until after menopause

• Because women were excluded from many Because women were excluded from many clinical trials and have different clinical trials and have different symptoms than men, their problems often symptoms than men, their problems often went undiagnosedwent undiagnosed

• Data says women receive less aggressive Data says women receive less aggressive treatment and occasionally no treatment treatment and occasionally no treatment at allat all

• Number of tests increased from 1993 to 2001 in all Number of tests increased from 1993 to 2001 in all racial and gender groupsracial and gender groups– BUT women and non-white men still less likely to get cardiac BUT women and non-white men still less likely to get cardiac proceduresprocedures

– rate of cardiac catheterization increased from 31.5 to 50.2 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 per 1,000 patients for white men versus 18.9 to 34.9 per 1,000 patients for others. 1,000 patients for others.

• Women with the same kind of cardiac problems less Women with the same kind of cardiac problems less likely than men to perceive their illness as severelikely than men to perceive their illness as severe– may explain why women are less likely to access services for may explain why women are less likely to access services for heart diseaseheart disease

– women tended to be older, less educated, be more women tended to be older, less educated, be more symptomatic, and need more medications than men. symptomatic, and need more medications than men.

– women had lower capacity for daily activities, lower women had lower capacity for daily activities, lower health-related quality of life and lowerhealth-related quality of life and lower physical, physical, mental and general health status than men. mental and general health status than men.

• When asked to rate their health status - they were When asked to rate their health status - they were less likely than men to rate their disease as less likely than men to rate their disease as severe. severe.

• A cardiologist says "I've often seen women minimize A cardiologist says "I've often seen women minimize their symptoms to focus medical attention on a their symptoms to focus medical attention on a husband, child or other," he says.husband, child or other," he says.

CancerCancer

• Cancer is the leading cause of Cancer is the leading cause of death in women age 40-79death in women age 40-79

• Breast, lung, and colon cancers Breast, lung, and colon cancers account for more than half of all account for more than half of all new cancersnew cancers

• Breast cancer is expected to Breast cancer is expected to account for nearly 1/3 of all new account for nearly 1/3 of all new cancer cases in womencancer cases in women

• Lung cancer rates are declining in Lung cancer rates are declining in men but continue to rise in womenmen but continue to rise in women

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

1992 & 1996.1992 & 1996.

• "These findings confirm that we now "These findings confirm that we now have a very potent weapon against the have a very potent weapon against the recurrence of cancer cells that recurrence of cancer cells that overexpress HER-2," said overexpress HER-2," said Edith A. Edith A. Perez, M.D.Perez, M.D., who chaired the NCCTG , who chaired the NCCTG trial and is a medical oncologist at trial and is a medical oncologist at the Mayo Clinic in Jacksonville, Fla. the Mayo Clinic in Jacksonville, Fla.

• Use of somatostatin receptor Use of somatostatin receptor scintigraphy (SRS), a nuclear medicine scintigraphy (SRS), a nuclear medicine imaging technique looks at how the body imaging technique looks at how the body functions at the molecular level & may functions at the molecular level & may provide near immediate selection of provide near immediate selection of breast cancerbreast cancer patients for endocrine patients for endocrine therapy. Using 99mTc-labeled therapy. Using 99mTc-labeled depreotide, which binds to somatostatin depreotide, which binds to somatostatin receptors and sends out flashes of receptors and sends out flashes of light detected by a gamma camera, light detected by a gamma camera, researchers were able to create an researchers were able to create an image of the presence of hormone-image of the presence of hormone-sensitive lesions in a patient's body sensitive lesions in a patient's body (Bieke Van Den Bossche, M.D., Ph.D.(Bieke Van Den Bossche, M.D., Ph.D., , nuclear medicine department, Ghent nuclear medicine department, Ghent University Hospital, Ghent, Belgium. University Hospital, Ghent, Belgium. " )" )

• Physicians like Physicians like Susan Love, Susan Love, MDMD, spent a lifetime , spent a lifetime encouraging use of proven, encouraging use of proven, less destructive surgeries less destructive surgeries like lumpectomy followed by like lumpectomy followed by radiation and/or chemotherapyradiation and/or chemotherapy

• Study Chair Study Chair Kathy D. Miller, Kathy D. Miller, M.DM.D., of the Indiana ., of the Indiana University Medical Center in University Medical Center in Indianapolis, Ind. Anti-Indianapolis, Ind. Anti-angiogenic drugs, also called angiogenic drugs, also called angiogenesis inhibitors, are angiogenesis inhibitors, are substances that may prevent substances that may prevent angiogenesis, or the formation angiogenesis, or the formation of blood vessels. of blood vessels.

• "These results will give "These results will give clinicians better guidance and clinicians better guidance and greater choice in deciding greater choice in deciding which women would benefit most which women would benefit most from various forms of from various forms of mammography," said mammography," said senior senior author, Etta Pisano, M.Dauthor, Etta Pisano, M.D., ., University of North Carolina University of North Carolina at Chapel Hill. at Chapel Hill.

Partly as a result of Partly as a result of these contributions….these contributions….

• If detected early, the 5-year survival rate If detected early, the 5-year survival rate for localized breast cancer is 97%.for localized breast cancer is 97%.

• During the 1990s mortality rates fell in During the 1990s mortality rates fell in white women by 2.5 percent a year and in white women by 2.5 percent a year and in black women, at a rate of 1.0 percent. black women, at a rate of 1.0 percent.

• Data on changes in incidence and mortality Data on changes in incidence and mortality suggest that changes in treatment, not early suggest that changes in treatment, not early detection, may play a more important role in detection, may play a more important role in explaining the recent decline in mortality. explaining the recent decline in mortality.

• An increasing percentage of women now An increasing percentage of women now undergo breast conserving surgery followed undergo breast conserving surgery followed by radiation and/or chemotherapyby radiation and/or chemotherapy

Rosalyn S. YalowRosalyn S. Yalow

• American physicist who won American physicist who won the Nobel prize for the Nobel prize for development of development of radioimmunoassays of peptide radioimmunoassays of peptide hormoneshormones

• The process made it possible The process made it possible to detect and measure minute to detect and measure minute amounts of hormones, drugs, amounts of hormones, drugs, enzymes, and antibodiesenzymes, and antibodies

• ““The introduction of radio-The introduction of radio-immunoassay is probably the immunoassay is probably the single most important advance single most important advance in biological measurement of in biological measurement of the past two decades. It has the past two decades. It has revolutionized one major revolutionized one major discipline and influenced discipline and influenced several others.”several others.”

Improved DiagnosticsImproved Diagnostics

• Radioimmunoassay:Radioimmunoassay: A very sensitive, A very sensitive, specific laboratory test (assay) using specific laboratory test (assay) using radiolabeled (and unlabeled) substances in radiolabeled (and unlabeled) substances in an immunological (antibody-antigen) an immunological (antibody-antigen) reaction.reaction.

• Thyroid dysfunction is extremely common in Thyroid dysfunction is extremely common in women and has unique consequences related women and has unique consequences related to menstrual cyclicity and reproduction. to menstrual cyclicity and reproduction. Even minimal hypothyroidism can increase Even minimal hypothyroidism can increase rates of miscarriage and fetal death and rates of miscarriage and fetal death and may also have adverse effects on later may also have adverse effects on later cognitive development of the offspring. cognitive development of the offspring. Hyperthyroidism during pregnancy may also Hyperthyroidism during pregnancy may also have adverse consequences. have adverse consequences.

Women and AgingWomen and Aging• Women live an average of 6-8 years longer Women live an average of 6-8 years longer than menthan men

• Life expectancy for women now exceeds 80 Life expectancy for women now exceeds 80 years in at least 35 countriesyears in at least 35 countries

• Rates of disability among older populations Rates of disability among older populations is steadily decliningis steadily declining

• For those who have reached the age of 65, For those who have reached the age of 65, life expectancy for Americans is 17 years!life expectancy for Americans is 17 years!

• In 1900, just over half of all the women born In 1900, just over half of all the women born could expect to live to age 65 and about 1 in could expect to live to age 65 and about 1 in 4 would live to 85.4 would live to 85.

• Of the women born in 1990, almost 90 percent Of the women born in 1990, almost 90 percent are expected to live 65 and more than half are expected to live 65 and more than half will live to age 85.will live to age 85.

• 4 of 5 centenarians are women!4 of 5 centenarians are women!

And the progress should And the progress should just continue to occur…just continue to occur…

• In 1988 a group of women’s health In 1988 a group of women’s health professionals – researchers professionals – researchers lobbyists, activists, lobbyists, activists, administrators, organized by the administrators, organized by the society for Women’s Health Research society for Women’s Health Research - began to demand measurable change.- began to demand measurable change.

• In 1990 a GAO Report evaluated the In 1990 a GAO Report evaluated the implementation of NIH guidelines and implementation of NIH guidelines and found that there has been little found that there has been little progress made.progress made.

An NIH Office for WomenAn NIH Office for Women

• In 1990 an Office of Research on In 1990 an Office of Research on Women’ Health was established at Women’ Health was established at the NIH and progress began to the NIH and progress began to occur.occur.

• Issues in women’s health concern Issues in women’s health concern the prevention, diagnosis, and the prevention, diagnosis, and management of conditions or management of conditions or diseases that may be unique to diseases that may be unique to women….or that are more prevalent women….or that are more prevalent in women than men…or that in women than men…or that manifest themselves differently manifest themselves differently in women than men.in women than men.

“I wanted to be the kind of physician who paid attention to myPatients, and didn’t dismiss my patients’ complaints”

Vivian Pinn, M.D.

But we’re not there But we’re not there yet!yet!

• For women to be thought half as good as men, For women to be thought half as good as men, they must work twice as hard…fortunately, this they must work twice as hard…fortunately, this is not difficult.is not difficult.– WRONG!!WRONG!!

• Women who do work are most often paid less Women who do work are most often paid less money than men…on average, 77 cents on the money than men…on average, 77 cents on the dollar…dollar…

• Only 9% of women who embark upon college Only 9% of women who embark upon college teaching careers attained the rank of full teaching careers attained the rank of full professorprofessor– Men who enter university teaching roles have Men who enter university teaching roles have a 3X greater chance of making full professor.a 3X greater chance of making full professor.

• In 1998-99 women full professors received an In 1998-99 women full professors received an average salary of 12% less than men.average salary of 12% less than men.

• And while it is hard to believe that at the And while it is hard to believe that at the miniscule level of pay for public schools…women miniscule level of pay for public schools…women make an average of $3,000 per year less than make an average of $3,000 per year less than their male counterparts.their male counterparts.

You’ve come a long way baby!