Title: Womens Health Through the Eyes of Medicines Lady Giants
1Womens Health Through the Eyes of Medicines
Lady Giants
- Womens Club
- January 25, 2006
- Nancy W. Dickey, MD
2Through 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)
3Weve 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
4Longevity
5Well, 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.
6James 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
7Women 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
8Women/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
9Women who have made a difference.
10Gynecology
- 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
11Maternity 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
12Not 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
13 - And
- What
- Has It
- Gotten
- Us?
14Heart 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
15- 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.
16Cancer
- 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
17Breast 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. " )
18Partly 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
19Rosalyn 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.
20Improved 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.
21Women 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!
22And 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.
23An 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
24But 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.
25Youve come a long way baby!