"A woman's body is the key to her fate. … Her physical, social and psychological fulfillment all depend on one crucial test: her ability to attract a suitable male and to hold his interest over many years." Those were the words of Dr. Robert Wilson, a noted New York gynecologist, in his now-controversial 1966 tome "Feminine Forever."
Yes, times have changed, but not quickly enough when it comes to the need for medicine and medical research that takes into account the biological differences between men and women. "Most of the research studies that were being done prior to 1990 were done on the male model. Then the results were applied to women with the assumption that there was no difference. Of course, as time has proven, there are many differences biologically between men and women in terms of diagnosis, the screening tests that are needed, prevention techniques, treatment options and symptoms of diseases," explains L. Jo Parrish, vice president of institutional advancement for the Washington, D.C.-based Society for Women's Health Research.
Parrish adds that medicine's tendency to conduct research using males "was even true with the animal model. Even the mice and the rats typically were males. So almost even from the bench-level research, the female model wasn't being used." She says that before 1990, most medical research done on women tended to deal with reproductive health.
The society was founded in 1990 by women's health professionals who recognized the flawed, and sometimes deadly, status quo and fought for change. Their efforts, in part, resulted in the founding of the Office of Research on Women's Health at the National Institutes for Health. In 1993, the federal Food and Drug Administration issued new guidelines regulating women's participation in pre-market clinical trials. Also, the society worked with the Clinton administration and members of Congress to pass the NIH Revitalization Act of 1993 that explicitly requires the inclusion of women in federally funded clinical research.
Parrish has a surprisingly forgiving stance when she looks back at medical research's exclusion of women. "I think it was a protectionist attitude. It was probably well-intentioned. Since women can become pregnant, having them involved in a research study might cause damage to a fetus," she says. And she points to the thalidomide scare of the early 1960s to make her case. Once marketed as a sleeping aid and treatment for morning sickness in pregnancy, thalidomide was discovered in 1961 to stunt the growth of fetal arms and legs.
Parrish acknowledges that there were other societal deterrents to including women in medical research. "There were the issues of locating women who could actually participate," she says. "If they had a family, then they needed to have child care. And if the women were older, perhaps the issue was transportation. So it was just easier (to recruit men)."
The Society for Women's Health Research is also working to change the nomenclature. While the healthcare industry now refers to "gender-based" medicine and research, "We like to use the word 'sex' versus 'gender,' because sex is biological and gender is sort of how we present ourselves in a social sense," Parrish explains.
So, does sex matter? You bet it does. In a 2001 Institute of Medicine report, basic health differences and needs between men and women were underscored. The society identifies 10 areas where women are more vulnerable, have different symptoms or react differently to some medications.
1. About 80 percent of osteoporosis sufferers are women, resulting in higher rate of lost bone mass.
2. Women are two-to-three times more likely than men to suffer from depression, in part because women's brains make less of the hormone serotonin.
3. Smoking has a more negative effect on cardiovascular health in women than men. Women are also less successful when they try to quit and suffer more severe withdrawal symptoms.
4. Women produce less of the gastric enzyme that breaks down ethanol in the stomach. Therefore, after consuming the same amount of alcohol, women have higher blood alcohol content than men – even allowing for size differences.
5.Women are two times more likely than men to contract a sexually transmitted disease. They are also more likely to experience "wasting syndrome," involuntary significant .
6. Women tend to wake up from anesthesia more quickly than men – an average of seven minutes for women vs. 11 minutes for men.
7. Three out of four people suffering from autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis and lupus, are women. (See related story on Page xx.)
8. Some medications, such as a morphine-like drug known as kappa-opiates, are far more effective in relieving pain in women than in men. Verapamil, a blood pressure medication, works better for women than for men, because of how their livers and enzymes operate.
9. Even common drugs like antihistamines and antibiotic drugs can cause different reactions and side effects in women and men.
10. Heart disease kills 500,000 American women annually. That's more than 50,000 more women than men. Women are more likely than men to have a second heart attack within a year of the first one.
Parrish says that, when it comes to heart disease, women are remarkably different from men. "What research has shown is that women's symptoms at the very beginning for heart disease are often different. Some of them are the same, but many times women have different symptoms when they have a cardiac event or have coronary heart disease," she says. "By not having women in the research, it meant that when physicians and healthcare providers were being trained, they were given information that had to do with male symptoms and male diagnosis and, therefore, male treatment. For example, women may have chest pain, but they also may have back pain. Women sometimes are nauseous as a symptom of coronary heart disease.
"Then, because women's symptoms were different and often not recognized, women have not traditionally been as aggressively treated when they present in an emergency room situation. Their symptoms have been overlooked and been diagnosed as something incorrectly, and then they're sent home. Tragically."
Women traditionally suffer heart problems 10 years or more later than men, which sometimes may also confuse a diagnosis. "By then, a woman sometimes has other issues going on," Parrish says. "She's not as healthy overall, so when she presents in the emergency ward with vague symptoms of nausea and pain, it could be diagnosed as many things. But if a man in his 40s comes in saying, 'I have chest pain,' people jump on it."
Yet times are indeed changing. Parrish says women have available to them more information than ever before and "we're feeling empowered." Thus women have become much better "advocates" for their own health and better communicators with their healthcare providers.
