Opportunities for Women

A slow but gradual increase in interest in women's health issues is currently taking place. This is due to three factors:

1. women are demanding more from their health care providers;
2. a record number of women are being admitted to medical school;
3. more women have risen to positions where they can influence health policy.

The standard reference patient, used in medical school until recently, was the 70 kilogram male. The special health needs of women, (except for female reproductive organs) were not addressed. Now the NIH has an Office of Research on Women's Health (ORWH) and has funded a more than half-billion-dollar 15-year Women's Health Initiative. Increasing numbers of physicians are taking continuing education courses dealing with woman's health, and medical schools are slowly introducing women's health issues into their curricula.

At one time, it was common practice for research projects to omit women from research trials. This was encouraged by the thalidomide and DES tragedies of the 1960s and 1970s, which resulted in pregnant women and those with childbearing potential being prohibited by the FDA from participating in most drug trials. Moreover, the belief that the monthly hormonal changes in women could destabilize research results further served to restrict research studies to males.

In the early 1980s it was noted that the death rate from heart disease and cancer was the same for both sexes. Nevertheless, the 1982 landmark study of coronary artery disease was restricted to 15,000 males. As a result of intervention by some women in Congress, a task force was established in 1983 to examine the status of American women's health. In 1985 the task force reported, among other things, that the lack of attention to women's health issues had indeed “compromised the quality” of women's health care. Subsequently it was learned that only 13.5% of NIH funds went for research on women's health issues. Although NIH issued new guidelines to include women in clinical research study pools, even by 1990 the situation had not significantly changed. The appointment of the first female NIH director in 1992 led to the establishment of the Office of Research on Women's Health, whose permanency was confirmed by being included in the 1993 NIH Revitalization Act. This act mandated the inclusion of sub-populations (women and minorities) in all NIH-funded studies.

In 1992 the Council on Graduate Medical Education (COGME) identified 42 training components considered essential to preparing physicians to provide comprehensive health care for women. Internists and ob/gyn specialists are currently the principal health care providers for women. Both groups are fully trained to provide all these components. This has prompted self-education on women's health issues by physicians through continuing education courses. The American Medical Women's Association (AMWA) has sponsored development of a two-part course based on the life phases of women, rather than on organs.

While universities in the 1960s and 1970s integrated women's studies into their curricula, medical schools are only now just beginning to focus on women's health issues. Several residency programs have also undertaken initiatives in this area.

One reason to feel there will be improvement in the area of women's health is the fact that it is easier to introduce these issues into problem-based curricula. Because this educational approach is becoming increasingly popular, the trend may impact favorably on helping resolve the question of women's health during the present decade.

Medical College of Pennsylvania (MCP), in cooperation with Hannemann Medical College, is doing the pioneering work in this area. Undoubtedly, as women become increasingly represented on medical school faculties, there will be an acceleration of interest in, and attempts to remedy the absence of, medical education on women's health issues at both the undergraduate and graduate levels. The fact that women now make up about half of each entering class will presumably also impact positively. These efforts will also be furthered by the National Academy on Women's Health Medical Education that was jointly formed by the MCP and AMWA.

There are some who advocate establishing a women's health specialty. Others argue that this would be a mistake, since it would suggest that only those specialists would then be knowledgeable about women's health needs and problems. This debate will ultimately be settled by the wishes of women medical students in terms of merely getting an education or wanting specialty training in the area of women's health, and by the choice of women patients.

In summary, there is a consensus that the time is right to introduce women's health education into the general curriculum but the process may take some time to achieve.