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Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
Women's Health Through the Eyes of Medicine's
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Women's Health Through the Eyes of Medicine's

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  • 1. Women’s Health Through theWomen’s Health Through the Eyes of Medicine’sEyes of Medicine’s Lady GiantsLady Giants Women’s ClubWomen’s Club January 25, 2006January 25, 2006 Nancy W. Dickey, MDNancy W. Dickey, MD
  • 2. Through the actions of many…Through the actions of many… • Although women who aspire to a role inAlthough women who aspire to a role in medicine may be appreciative of those whomedicine may be appreciative of those who came before, clearly our patients andcame before, clearly our patients and communities have much for which to be gratefulcommunities have much for which to be grateful as well. From scientific discovery that changedas well. From scientific discovery that changed lives to commitment to public health and well-lives to commitment to public health and well- being, women have raised standards, createdbeing, women have raised standards, created new understanding, and touched lives.new understanding, and touched lives. Nancy W. Dickey, MD inNancy W. Dickey, MD in Women in Medicine, An EncyclopediaWomen in Medicine, An Encyclopedia (Laura Windsor)(Laura Windsor)
  • 3. We’ve made great strides inWe’ve made great strides in medicine…medicine… • Longevity has improvedLongevity has improved • Substantial progress has beenSubstantial progress has been made in many of the diseasesmade in many of the diseases specific to women likespecific to women like cervical cancer, childbirth,cervical cancer, childbirth, breast cancerbreast cancer • Progress in the safety of ourProgress in the safety of our children has advanced in thechildren has advanced in the areas of congenital disease,areas of congenital disease, safe childbirth, and survivalsafe childbirth, and survival of prematurityof prematurity • And this has happened atAnd this has happened at least partially because…least partially because… • The number of women inThe number of women in medicine has increasedmedicine has increased dramaticallydramatically • Every specialty now hasEvery specialty now has women in its rankswomen in its ranks • Women are included in theWomen are included in the studies done and have studiesstudies done and have studies directed at their issuesdirected at their issues
  • 4. LongevityLongevity 0 10 20 30 40 50 60 70 80 90 1850 1900 1950 2000 2001 2002 2003 Age
  • 5. Well, while we are clearlyWell, while we are clearly living longer…and living thoseliving longer…and living those extra years better…extra years better… • Death is not yet optional…the death rate is stillDeath is not yet optional…the death rate is still 1 per person1 per person • So, let’s look at health advances and specificallySo, let’s look at health advances and specifically how women have contributed to some of thehow women have contributed to some of the advances that improve how long and how welladvances that improve how long and how well we will live.we will live.
  • 6. James Barry, 1795-1865James Barry, 1795-1865 • She masqueraded as a manShe masqueraded as a man all her life – her gender onlyall her life – her gender only revealed on her deathrevealed on her death • Educated at the EdinburghEducated at the Edinburgh School of Medicine – shiedSchool of Medicine – shied away from her classmates!away from her classmates! • Entered the British armyEntered the British army disguised as a man in 1813disguised as a man in 1813 • Bore a child about whomBore a child about whom nothing is knownnothing is known
  • 7. Women in Medicine have made a difference…Women in Medicine have made a difference… Elizabeth Blackwell, MDElizabeth Blackwell, MD 1821-19101821-1910 • First woman physician to receive her degreeFirst woman physician to receive her degree in the USin the US • Said she turned to medicine after a closeSaid she turned to medicine after a close friend who was dying said she would havefriend who was dying said she would have been spared her worst suffering if herbeen spared her worst suffering if her physician had been a womanphysician had been a woman • Upon observing an the exam of a poorUpon observing an the exam of a poor woman, “Twas a horrible exposure,woman, “Twas a horrible exposure, indecent for any…woman to be subject toindecent for any…woman to be subject to such torture; she seemed to feel it, poor andsuch torture; she seemed to feel it, poor and ignorant as she was. I felt more than everignorant as she 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 Infirmary forEstablished the New York Infirmary for Women and Children and it medical collegeWomen and Children and it medical college for womenfor women
  • 8. Women/Medicine/21Women/Medicine/21stst CenturyCentury • In 1970 7.2% of physicians were women and byIn 1970 7.2% of physicians were women and by 2003 25.8% were women2003 25.8% were women • The TAMHSC College of Medicine admits 49-The TAMHSC College of Medicine admits 49- 52% of each class as women52% of each class as women • Women are represented in every specialtyWomen are represented in every specialty though a preponderance continue in primarythough a preponderance continue in primary care and obstetricscare and obstetrics
  • 9. Women who have made aWomen who have made a difference….difference….
  • 10. GynecologyGynecology • Mary Corinna Putnam Jacobi, 1842-Mary Corinna Putnam Jacobi, 1842- 19061906 • Established through research thatEstablished through research that women’s health, strength, and agilitywomen’s health, strength, and agility did not vary during their monthly cycledid not vary during their monthly cycle thereby refuting a frequent argumentthereby refuting a frequent argument about why women could not be treatedabout why women could not be treated “equally”“equally” • Female physicians, it was charged, wereFemale physicians, it was charged, were unreliable due to their monthlyunreliable due to their monthly “instability”, an infirmity akin to“instability”, an infirmity akin to “temporary insanity”“temporary insanity”
  • 11. Maternity Issues – Death ThroughMaternity Issues – Death Through ChildbirthChildbirth • Danish saying, “One tooth per child”Danish saying, “One tooth per child” • The maternal death rate around 1900 was oneThe maternal death rate around 1900 was one mother’s death per every 154 living births. So, "ifmother’s death per every 154 living births. So, "if women delivered . . . five live babies during theirwomen delivered . . . five live babies during their child-bearing years . . . then one of every thirtychild-bearing years . . . then one of every thirty women might have expected to die of childbirth overwomen might have expected to die of childbirth over the course of her fertile years" (Leavitt 25). Thisthe course of her fertile years" (Leavitt 25). This statistic becomes even more shocking when onestatistic becomes even more shocking when one realizes that women of the 1980s fared much betterrealizes that women of the 1980s fared much better odds of one maternal death per every 10,000 liveodds of one maternal death per every 10,000 live births.births. • In 17 countries yet today, women face at least a 1-In 17 countries yet today, women face at least a 1- in-10 chance of dying from pregnancy-related causesin-10 chance of dying from pregnancy-related causes sometime during their lives.sometime during their lives. • More than 500,000 women died ofMore than 500,000 women died of complications related to pregnancy orcomplications related to pregnancy or childbirth in 2000 – 99% of those werechildbirth in 2000 – 99% of those were preventablepreventable
  • 12. Not only women but our babies haveNot only women but our babies have benefited from women physicians…benefited from women physicians… • Virginia Apgar created theVirginia Apgar created the Apgar system forApgar system for evaluating and rating theevaluating and rating the status of newborn babiesstatus of newborn babies • Helen Brooke Taussig wasHelen Brooke Taussig was a pioneer in pediatrica pioneer in pediatric heart surgery helpingheart surgery helping develop an effective waydevelop an effective way of treating “blue babies”of treating “blue babies”
  • 13. AndAnd WhatWhat Has ItHas It GottenGotten Us?Us?
  • 14. Heart Disease – Not Just for MenHeart Disease – Not Just for Men • Heart disease and stroke account for close to 60% of allHeart disease and stroke account for close to 60% of all adult female deathsadult female deaths • Heart disease often does not manifest itself until afterHeart disease often does not manifest itself until after menopausemenopause • Because women were excluded from many clinical trialsBecause women were excluded from many clinical trials and have different symptoms than men, their problemsand have different symptoms than men, their problems often went undiagnosedoften went undiagnosed • Data says women receive less aggressive treatment andData says women receive less aggressive treatment and occasionally no treatment at alloccasionally no treatment at all
  • 15. • Number of tests increased from 1993 to 2001 in all racial andNumber of tests increased from 1993 to 2001 in all racial and gender groupsgender groups – BUT women and non-white men still less likely to get cardiac proceduresBUT 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 patientsrate 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.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 menWomen with the same kind of cardiac problems less likely than men to perceive their illness as severeto perceive their illness as severe – may explain why women are less likely to access services for heart diseasemay explain why women are less likely to access services for heart disease – women tended to be older, less educated, be more symptomatic, and needwomen tended to be older, less educated, be more symptomatic, and need more medications than men.more medications than men. – women had lower capacity for daily activities, lower health-related quality ofwomen had lower capacity for daily activities, lower health-related quality of life and lowerlife and lower physical, mental and general health status than men.physical, mental and general health status than men. • When asked to rate their health status - they were less likely thanWhen asked to rate their health status - they were less likely than men to rate their disease as severe.men to rate their disease as severe. • A cardiologist says "I've often seen women minimize theirA cardiologist says "I've often seen women minimize their symptoms to focus medical attention on a husband, child or other,"symptoms to focus medical attention on a husband, child or other," he says.he says.
  • 16. CancerCancer • Cancer is the leading cause of death in womenCancer is the leading cause of death in women age 40-79age 40-79 • Breast, lung, and colon cancers account forBreast, lung, and colon cancers account for more than half of all new cancersmore than half of all new cancers • Breast cancer is expected to account for nearlyBreast cancer is expected to account for nearly 1/3 of all new cancer cases in women1/3 of all new cancer cases in women • Lung cancer rates are declining in men butLung cancer rates are declining in men but continue to rise in womencontinue to rise in women
  • 17. Breast CancerBreast Cancer Early detection due to increased use of mammography and self exam, andEarly detection due to increased use of mammography and self exam, and improved treatments led to breast cancer mortality finally beginning toimproved treatments led to breast cancer mortality finally beginning to decline between 1992 & 1996.decline between 1992 & 1996. • "These findings confirm that we now have a very"These findings confirm that we now have a very potent weapon against the recurrence of cancer cellspotent weapon against the recurrence of cancer cells that overexpress HER-2," saidthat overexpress HER-2," said Edith A. Perez,Edith A. Perez, M.D.M.D., who chaired the NCCTG trial and is a, who chaired the NCCTG trial and is a medical oncologist at the Mayo Clinic inmedical oncologist at the Mayo Clinic in Jacksonville, Fla.Jacksonville, Fla. • Use of somatostatin receptor scintigraphy (SRS), aUse of somatostatin receptor scintigraphy (SRS), a nuclear medicine imaging technique looks at hownuclear medicine imaging technique looks at how the body functions at the molecular level & maythe body functions at the molecular level & may provide near immediate selection ofprovide near immediate selection of breast cancerbreast cancer patients for endocrine therapy. Using 99mTc-labeledpatients for endocrine therapy. Using 99mTc-labeled depreotide, which binds to somatostatin receptorsdepreotide, which binds to somatostatin receptors and sends out flashes of light detected by a gammaand sends out flashes of light detected by a gamma camera, researchers were able to create an image ofcamera, researchers were able to create an image of the presence of hormone-sensitive lesions in athe presence of hormone-sensitive lesions in a patient's bodypatient's body (Bieke Van Den Bossche, M.D.,(Bieke Van Den Bossche, M.D., Ph.D.Ph.D., nuclear medicine department, Ghent, nuclear medicine department, Ghent University Hospital, Ghent, Belgium. " )University Hospital, Ghent, Belgium. " ) • Physicians likePhysicians like Susan Love, MDSusan Love, MD, spent, spent a lifetime encouraging use of proven,a lifetime encouraging use of proven, less destructive surgeries likeless destructive surgeries like lumpectomy followed by radiationlumpectomy followed by radiation and/or chemotherapyand/or chemotherapy • Study ChairStudy Chair Kathy D. Miller, M.DKathy D. Miller, M.D., of., of the Indiana University Medical Centerthe Indiana University Medical Center in Indianapolis, Ind. Anti-angiogenicin Indianapolis, Ind. Anti-angiogenic drugs, also called angiogenesisdrugs, also called angiogenesis inhibitors, are substances that mayinhibitors, are substances that may prevent angiogenesis, or the formationprevent angiogenesis, or the formation of blood vessels.of blood vessels. • "These results will give clinicians better"These results will give clinicians better guidance and greater choice in decidingguidance and greater choice in deciding which women would benefit mostwhich women would benefit most from various forms offrom various forms of mammography," saidmammography," said senior author,senior author, Etta Pisano, M.DEtta Pisano, M.D., University of North., University of North Carolina at Chapel Hill.Carolina at Chapel Hill.
  • 18. Partly as a result of thesePartly as a result of these contributions….contributions…. • If detected early, the 5-year survival rate for localized breastIf detected early, the 5-year survival rate for localized breast cancer is 97%.cancer is 97%. • During the 1990s mortality rates fell in white women by 2.5During 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.percent a year and in black women, at a rate of 1.0 percent. • Data on changes in incidence and mortality suggest that changesData on changes in incidence and mortality suggest that changes in treatment, not early detection, may play a more important rolein treatment, not early detection, may play a more important role in explaining the recent decline in mortality.in explaining the recent decline in mortality. • An increasing percentage of women now undergo breastAn increasing percentage of women now undergo breast conserving surgery followed by radiation and/or chemotherapyconserving surgery followed by radiation and/or chemotherapy
  • 19. Rosalyn S. YalowRosalyn S. Yalow • American physicist who won the NobelAmerican physicist who won the Nobel prize for development ofprize for development of radioimmunoassays of peptideradioimmunoassays of peptide hormoneshormones • The process made it possible to detectThe process made it possible to detect and measure minute amounts ofand measure minute amounts of hormones, drugs, enzymes, andhormones, drugs, enzymes, and antibodiesantibodies • ““The introduction of radio-The introduction of radio- immunoassay is probably the singleimmunoassay is probably the single most important advance in biologicalmost important advance in biological measurement of the past two decades.measurement of the past two decades. It has revolutionized one majorIt has revolutionized one major discipline and influenced severaldiscipline and influenced several others.”others.”
  • 20. Improved DiagnosticsImproved Diagnostics • Radioimmunoassay:Radioimmunoassay: A very sensitive, specificA very sensitive, specific laboratory test (assay) using radiolabeled (and unlabeled)laboratory test (assay) using radiolabeled (and unlabeled) substances in an immunological (antibody-antigen)substances in an immunological (antibody-antigen) reaction.reaction. • Thyroid dysfunction is extremely common in women andThyroid dysfunction is extremely common in women and has unique consequences related to menstrual cyclicityhas unique consequences related to menstrual cyclicity and reproduction. Even minimal hypothyroidism canand reproduction. Even minimal hypothyroidism can increase rates of miscarriage and fetal death and may alsoincrease rates of miscarriage and fetal death and may also have adverse effects on later cognitive development ofhave adverse effects on later cognitive development of the offspring. Hyperthyroidism during pregnancy maythe offspring. Hyperthyroidism during pregnancy may also have adverse consequences.also have adverse consequences.
  • 21. Women and AgingWomen and Aging • Women live an average of 6-8 years longer than menWomen live an average of 6-8 years longer than men • Life expectancy for women now exceeds 80 years in at leastLife expectancy for women now exceeds 80 years in at least 35 countries35 countries • Rates of disability among older populations is steadilyRates of disability among older populations is steadily decliningdeclining • For those who have reached the age of 65, life expectancyFor those who have reached the age of 65, life expectancy for Americans is 17 years!for Americans is 17 years! • In 1900, just over half of all the women born could expect toIn 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.live to age 65 and about 1 in 4 would live to 85. • Of the women born in 1990, almost 90 percent are expectedOf the women born in 1990, almost 90 percent are expected to live 65 and more than half will live to age 85.to live 65 and more than half will live to age 85. • 4 of 5 centenarians are women!4 of 5 centenarians are women!
  • 22. And the progress should justAnd the progress should just continue to occur…continue to occur… • In 1988 a group of women’s health professionalsIn 1988 a group of women’s health professionals – researchers lobbyists, activists, administrators,– researchers lobbyists, activists, administrators, organized by the society for Women’s Healthorganized by the society for Women’s Health Research - began to demand measurable change.Research - began to demand measurable change. • In 1990 a GAO Report evaluated theIn 1990 a GAO Report evaluated the implementation of NIH guidelines and foundimplementation of NIH guidelines and found that there has been little progress made.that there has been little progress made.
  • 23. An NIH Office for WomenAn NIH Office for Women • In 1990 an Office of Research onIn 1990 an Office of Research on Women’ Health was established at theWomen’ Health was established at the NIH and progress began to occur.NIH and progress began to occur. • Issues in women’s health concern theIssues in women’s health concern the prevention, diagnosis, and management ofprevention, diagnosis, and management of conditions or diseases that may be uniqueconditions or diseases that may be unique to women….or that are more prevalent into women….or that are more prevalent in women than men…or that manifestwomen than men…or that manifest themselves differently in women thanthemselves differently in women than men.men. “I wanted to be the kind of physician who paid attention to my Patients, and didn’t dismiss my patients’ complaints” Vivian Pinn, M.D.
  • 24. But we’re not there yet!But we’re not there yet! • For women to be thought half as good as men, they mustFor women to be thought half as good as men, they must work twice as hard…fortunately, this is not difficult.work twice as hard…fortunately, this is not difficult. – WRONG!!WRONG!! • Women who do work are most often paid less money thanWomen who do work are most often paid less money than men…on average, 77 cents on the dollar…men…on average, 77 cents on the dollar… • Only 9% of women who embark upon college teaching careersOnly 9% of women who embark upon college teaching careers attained the rank of full professorattained the rank of full professor – Men who enter university teaching roles have a 3X greaterMen who enter university teaching roles have a 3X greater chance of making full professor.chance of making full professor. • In 1998-99 women full professors received an average salary ofIn 1998-99 women full professors received an average salary of 12% less than men.12% less than men. • And while it is hard to believe that at the miniscule level of payAnd while it is hard to believe that at the miniscule level of pay for public schools…women make an average of $3,000 per yearfor public schools…women make an average of $3,000 per year less than their male counterparts.less than their male counterparts.
  • 25. You’ve come a long way baby!

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