THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 504-1 to 504-4

Week: 504.1 Guest: Beth Weinhouse Topic: Women and the Health Care System - Part One Host: Richard Roeder Producer: Ed Graham

ROEDER: This is a four part series on the challenge of better health care for women. My guest is Beth Weinhouse, co-author with Leslie Laurence of Outrageous Practices published by Ballantine Books.

ROEDER: Ms. Weinhouse, as you researched and wrote Outrageous Practices with Leslie Laurence, did you find that things were worse than you had ever originally imagined when you started writing the book in terms of what happens to women when they come in contact with the medical world?

WEINHOUSE: We did. When we started writing we had seen a number of isolated studies about how women were treated by doctors, how they switched doctors more often than men, how women had been discriminated against in medical school. We saw bits and pieces of the picture and as we started reporting, we realized that there was a very pervasive gender bias in medicine that was far worse than we thought because it really begins with the way women are treated in the medical schools, is carried out in research where women are often ignored in favor of studying men's bodies and culminates in what we all know of is the way we're treated in doctor's offices and clinics and hospitals across the country.

ROEDER: One thing you talk about a great deal in the book is the history of what happens when women come in contact with medicine and you go back quite a ways. Talk a little bit about the species that women were viewed to be by male doctors historically.

WEINHOUSE: We started in the 19th century, in the 1800s because that seemed to us the point where the midwives were inched out by physicians, where medicine had reached the point where you could hold them more accountable than previously and what we found is that there were two sets of medicine. There was men's medicine which involved the heart and lungs and kidneys and liver and there was women's medicine which was the reproductive organs and no matter what went wrong with women in the 19th century, it was attributed to the sex organs and the cure or the treatment had to do with either removing the sex organs or treating the sex organs even if that was a sore throat or a headache, it all had to do with reproductive organs and what astonished us is the realization that we really haven't come all that far from that point because most women these days see a gynecologist as their only doctor and yet a gynecologist is a specialist. She specializes in the reproductive organs. We've all accepted the fact that this is women's medicine and the internist, the other specialists, they deal with men but the gynecologists deal with women and the analogy we made is can you imagine a man going to see a urologist or a proctologist as his only doctor.

ROEDER: One of the most frequent targets of these diagnoses seem to result, and we're talking about everything from mental illness to seemingly unrelated organic illnesses and even as you point out in the book even voice problems, frequently the surgical treatment for this was removing some part of a woman's body. Talk a little bit about that.

WEINHOUSE: Hysterectomy and clitorectomy which was the removal of the clitoris, the ovaries, the ovariectomy, all these were very popular operations and they were thought not just to resolve reproductive problems but as you said to resolve anything from migraine headaches to sore throats to fatigue to emotional crying and depression - just about anything and again, obviously we don't believe that anymore and doctors have come a long way and yet you look at the most popular operations in the country and hysterectomy and removal of the ovaries are right up there even though they're still very controversial and being prescribed in cases where they really might not be appropriate.

ROEDER: Join me for part two on women and the health care system with Beth Weinhouse.

Transcripts:

Week: 504.2 Guest: Beth Weinhouse Topic: Women and the Health Care System - Part Two Host: Richard Roeder Producer: Ed Graham

ROEDER: This is part two in a four part series on the challenge of better health care for women. My guest is Beth Weinhouse, co-author with Leslie Laurence of Outrageous Practices published by Ballantine Books.

ROEDER: Talk about some of the role or non-role as it were of women as subjects in medical research. Drug testing, for example.

WEINHOUSE: A few years ago, the Food and Drug Administration had the government audit some of the studies that had been done just to see how women had been included as research subjects and what they found is that most drugs in this country, especially drugs for cardio-vascular problems, for heart disease but also for all sorts of other medical problems are primarily tested on men and the reason for that is since the thalidomide scandal in the 1950s when pregnant women of childbearing age took a drug that had not been properly tested and was found to cause all sorts of deformities, this happened in Europe, they wanted to prevent any possibility of babies in this country being born with deformities due to drugs that were unproven so what they did was exclude all women of childbearing age from these studies and that meant women from 18 to 50 and they didn't take into account the fact that not all women between the ages of 18 and 50 had any intention of getting pregnant, wanted to get pregnant, could possibly get pregnant so that most of the drugs in this country have been tested on men and then prescribed for women. We now know that women's hormones can affect how drugs work in the body and that women's smaller size may affect drug dosage and yet all the drugs right now are based primarily on male studies and women are getting prescriptions that have not been properly tested.

ROEDER: There are certainly distinct differences in men's and women's health needs and physiology in areas such as heart disease just to name one and even alcohol and substance abuse. What are some of those differences between men and women's physiology as relates to things like the heart and how have they been ignored in the past?

WEINHOUSE: Again, because women's hearts were not considered to be a problem, women were thought to be at risk for cancer - men died of heart disease - and yet heart disease has been the leading cause of death in women since the beginning of the century but as late as the 1960s when the American Heart Association sponsored a conference called women and hearts, the conference was actually about how women could take care of their men's hearts, not their own and doctors were taught in medical school that women, especially before menopause, didn't develop heart disease so not only weren't women treated for heart disease, they weren't being studied for heart disease, the drugs weren't being tested on them and again it's now known that women have different risk factors than men. Cholesterol may act differently in women's bodies. The levels might be different. For men, high levels of the bad cholesterol, the LDL cholesterol, are considered the most predictive of heart trouble. For women, it may be more important to have higher levels of the good cholesterol and the ratio may be more important. High fat diets may be different for women, especially pre- versus post-menopausal but the hormone estrogen has to do with fat metabolism. Women's cholesterol is lower before menopause. Women's heart arteries are smaller which may make some of the common treatments like angioplasty and bypass surgery more difficult or requiring different instruments, smaller instruments which weren't developed until recently when it was recognized how much of a problem this was.

ROEDER: Join me for part three on women and the health care system with Beth Weinhouse.

Transcripts:

Week: 504.3 Guest: Beth Weinhouse Topic: Women and the Health Care System - Part Three Host: Richard Roeder Producer: Ed Graham

ROEDER: This is part three in a four part series on the challenge of better health care for women. My guest is Beth Weinhouse, co-author with Leslie Laurence of Outrageous Practices published by Ballantine Books.

ROEDER: A woman who says to her doctor - "I'm having chest pains," still can be treated very differently than a man who spoke the same words, correct?

WEINHOUSE: Correct and part of that has to do with women's own perceptions. I think a man who suffers chest pain probably initially panics and thinks - "Oh my God, it's my heart," and runs to the doctor to be checked. A woman doesn't think of it first because if her doctor hasn't been trained to think of it, certainly women aren't picking up the message that they're at risk also and they may think it's heartburn, it's indigestion, it's abdominal cramps, it's all sorts of things, it's a panic attack but heart disease is apt to be way down on the list and so there have been studies showing that there's a significant delay in women even getting to the emergency room for treatment because they don't initially think they're having a heart attack. They also perceive the pain differently. We spoke with women when we were doing this book who said that when they were having a heart attack they didn't believe it was a heart attack because it didn't seem painful enough. They'd had children and childbirth was so much more painful, they just couldn't believe this was a heart attack. So the message has to be gotten out to the public that women are at risk and then once women do get to the emergency room, they need to be treated properly also. And even in the doctors office, they need to have the testing before the symptoms result in a heart attack.

ROEDER: You write about breast cancer in the book. How inadequate is our approach to the detection and treatment of breast cancer in the United States and why isn't it better?

WEINHOUSE: A lot of the problems with breast cancer research until recently had to do with the lack of funding. I think that's been remedied in recent years in large part because of activists, groups of women who really lobbied for more funding for this kind of research. They took their cue from groups like the Act-Up group for AIDS research and I hate to say the squeaky wheel gets the grease but that's exactly what happened. Diseases are now being pitted against each other for scarce research money so I think the money is now going into breast cancer. What's lacking is some of the basic knowledge about the origins, the physiology, prevention. I think money's being spent on more high-tech detection methods, different kinds of mammograms and other high-tech methods and also surgery, the on-going debate about mastectomy versus lumpectomy but what we still need to know is just who really is at risk and how they can prevent it before it gets to the point where you need all the big guns thrown at you. And so that's going to be a while. Those are the kinds of studies that take decades, that require lots of funding and I think we'll get them but it's going to take a long time.

ROEDER: How adequately do you believe that women in America have been informed about the effectiveness of lumpectomy versus mastectomy though? In your opinion has that information been disseminated adequately yet?

WEINHOUSE: I think women are getting the message from the women's magazines and the popular media but I think in the end, if a physician is reluctant and presents it to a woman as if a mastectomy has a better chance of saving her life, it doesn't matter what she's read. She's going to trust the doctor and I know that some of the physicians, in spite of the research, are still either skeptical of that work or believe that it's easier to do the mastectomy and be done with it rather than have to do a lumpectomy followed by radiation therapy which requires a longer term of treatment so until the information is coming directly from women's physicians, I don't think any amount of popularizing can really get that message across.

ROEDER: Join me for part four on women and the health care system with Beth Weinhouse.

Transcripts:

Week: 504.4 Guest: Beth Weinhouse Topic: Women and the Health Care System - Part Four Host: Richard Roeder Producer: Ed Graham

ROEDER: This is part four in a four part series on the challenge of better health care for women. My guest is Beth Weinhouse, co-author with Leslie Laurence of Outrageous Practices published by Ballantine Books.

ROEDER: How about the opportunities for women in medical professions? How welcome or unwelcome have women been in medicine and research historically?

WEINHOUSE: Historically, not at all. There's a long chapter in the book about the struggle for women to be admitted to medical schools, the problems they have once they were there. There was a class action lawsuit in the '70s that finally got women past the admissions barriers but from the women we've talked to, they're still facing all sorts of discrimination when they're in school now. We talked to women who talked about sex pin-up dolls being used in anatomy lectures. We spoke with a woman who described a doctor giving a lecture on uterine contractions and said to his class "None of you will ever experience this, however..." and he went on without noticing that half his class was women. Women who were given cadavers to dissect in medical school and they were told to cut the breasts off and throw them away as if they weren't worth studying when we all know how much of a problem breast cancer and yet normal human breasts are not worth studying in medical school so I think that again, the medical schools are getting the message. A lot of them have women's committees or women's studies programs now but it takes a long time before that filters down to the students who then go out to practice medicine until there's a real majority of practicing physicians who've gotten the message.

NEMA: Do women as patients generally fare better with female doctors or do most physicians tend to be stamped out of the same history and hence think in a very similar way?

WEINHOUSE: I hesitate to make generalizations because certainly there are plenty of fine, fine male physicians in this country. My father and brother are both physicians and I think they're very sensitive to their women patients and excellent doctors and there are women who are insensitive however if you look at studies that look at doctor/patient relationships, there are in general very different ways that women and men practice medicine and women do tend to stress the doctor/patient relationship more. They are more interested in communication. They're less likely to issue orders to their patients. They would prefer to couch things as suggestions or discuss it with their patients and studies have shown that patients are more receptive to this approach rather than being issued orders that they have no say in.

NEMA: Are there some things that you can say specifically to the women listening to us today that can help them navigate through their own health care and perhaps get better treatment both medically and intellectually from their doctors whether their doctor is a male or a female?

WEINHOUSE: Sure. One of the analogies someone made was of a car, that if you had a car that kept breaking down and took it to a mechanic and you weren't happy with him, you would take it to another mechanic. And that's true here too. One thing is you don't have to see the same physician. You can change physicians and there is no shame in it. I have switched physicians many times. Also you can't know everything about your body that your doctor knows but you can know enough to know what the controversies are in medicine so that you can be aware of whether or not what you're being prescribed is controversial. If someone gives you an antibiotic for a strep throat infection, that's pretty standard. There wouldn't be any reason to really question that. On the other hand, if your doctor recommends a hysterectomy and you know that plenty of medical experts think these operations are being overdone, you might want to question that, get another opinion, see what the alternatives are - if you just know what these issues are that are controversial and we go to pains to point some of them out in the book, which diseases are really the hot spots in medicine now.