After the turn of the century, financial
problems as well as the 1910 Flexner report
resulted in the closing of some of the all-women
medical schools and the merger of oth-
ers. By 1919 only the original Philadelphia
Medical School for Women remained.
When Johns Hopkins introduced coeducational
medical training in 1893, other med-
ical schools were encouraged to do the same.
However, the door to the admission of
women opened only a crack and unofficial quotas
existed that kept the numbers of
women down to an insignificant
amount.
The reduction of male manpower during World War
I resulted in a small increase in
the number of women accepted into American
schools (from 5 to 6%, as compared with
4.4% in 1900).
The longstanding problem for women to secure
hospital experience remained. Thus,
by the 1920s more than 90% of U.S. hospitals
did not accept women and women did not
attend institutions run by men.
World War II temporarily lowered the barriers
to women gaining admission, since the
number of qualified male applicants was
limited. After the war, the numbers were once
again made smaller so that women were making up
only 5 to 8% of entering classes.
Since 1970 there has been a dramatic increase
in the enrollment of women due to
court decisions and the intense impact of the
feminist movement, which swept aside the
unofficial quota system.
WOMEN'S HEALTH ISSUES
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 dis-
ease was restricted to 15,000 males. As a
result of intervention by some women in Con-
gress, 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 clini-
cal 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.
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