Women's Health Through the Eyes of Medicine's Presentation Transcript
Women’s Health Through the Eyes of Medicine’s Lady Giants Women’s Club January 25, 2006 Nancy W. Dickey, MD
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)
We’ve 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
Well, while we are clearly living longer…and living those extra years better…
Death is not yet optional…the death rate is still 1 per person
So, let’s 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.
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
Women in Medicine have made a difference… Elizabeth Blackwell, MD 1821-1910
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 any…woman 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
Women/Medicine/21 st 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
Women who have made a difference….
Mary Corinna Putnam Jacobi, 1842-1906
Established through research that women’s 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”
Maternity Issues – Death Through Childbirth
Danish saying, “One tooth per child”
The maternal death rate around 1900 was one mother’s 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
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”
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
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.
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
Breast Cancer Early 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.
"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. " )
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.
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
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.”
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.
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!
And the progress should just continue to occur…
In 1988 a group of women’s health professionals – researchers lobbyists, activists, administrators, organized by the society for Women’s 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.
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 women’s 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 men…or that manifest themselves differently in women than 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.
But we’re not there yet!
For women to be thought half as good as men, they must work twice as hard…fortunately, this is not difficult.
Women who do work are most often paid less money than men…on 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 schools…women make an average of $3,000 per year less than their male counterparts.