Physicians call for emphasis on women's health research and care
Too few women are getting the healthcare they need, too few researchers are paying attention and physicians have had enough.
“We need to get more women into the healthcare system,” Dr. Nieca Goldberg, medical director at NYU Langone's Joan H. Tisch Center for Women's Health, said in opening remarks at a conference hosted by the Healthcare Businesswomen's Association and HealthyWomen.Org on Tuesday.
Goldberg and her fellow presenters noted that women's health languishes even though women make the majority of the health decisions for their families.
As an example, Goldberg, a cardiologist, said that when female patients come to her they are “shocked to find out they have high blood pressure, high cholesterol,” and that the reason is it's been around 20 years—the time between having children and their children going to college—since they have had time to focus on their own health.
This same lack of attention plays out in statistics like those for cardiovascular diseases. She said 66% of women never make it to the hospital because they die suddenly even though about 90% of women have at least one preventable cardiovascular risk factor, such as a high blood pressure or a smoking habit.
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Goldberg noted that this sort of neglect has financial ramifications. The 2009 study she highlighted noted that women's cardiovascular disease cost $162 billion a year, diabetes cost $58 billion a year and osteoporosis cost $14 billion a year.
When women do visit physicians, common treatments are sometimes insufficient because there is a lack of clinical evidence demonstrating the different ways that therapies react in men and women. “It took more than 20 years to figure out that, unlike men, where aspirin prevents first heart attacks, in women, aspirin did not,” she said.
An example of clinical trials needing to be revisited and why gender inclusion matters includes the FDA's 2013 decision that women and men should be prescribed different doses of the sleep medication zolpidem, which is the generic version of Ambien.
For Goldberg, one solution is to provide a convenience model to medical care. In her practice, a dermatologist shares the same office building as a cardiologist and was able to send over a patient who had high blood pressure. She said this kind of ease of access could be introduced into a clinical research setting simply by tracking and pooling information among healthcare providers, allowing the medical community to identify downstream impacts of health-related conditions that may have been documented by other healthcare professionals. She said, for example, that gestational diabetes can affect women long after childbirth, but an incomplete flow of a patient's health data could be a loss for the patient as well as the larger body of clinical research. She said this same model could work in outpatient settings by tracking and following medication side effects and prescription preferences.
Diversifying the pool of women in clinical trials is also essential and a matter the FDA attempted to improve with its 2014 action plan. MedPage Today noted at the time that reaction was mixed, with supporters saying it was positive and critics saying the plan lacked incentives for compliance.
Dr. Margaret Kemeny, director of the Queens Cancer Center at the Queens Hospital Center in New York City, told the audience the pharmaceutical companies have some responsibility in this regard.
“Industry is not doing enough [to] get minorities into clinical trials,” she said.
Turning public hospitals into clinical trial sites would quickly achieve this while also giving lower-income patients access to new, potentially costly medications, she said. Kemeny's hospital is a clinical trial site, but she said not many public hospitals are.
Dr. Theresa Devins, a clinical trial monitor at Boehringer Ingelheim, agreed that diversifying clinical trials is needed and said BI has been exploring ways to bring a greater variety patients into trials, such as through certain healthcare providers or even pharmacies. She also said that clinical trial participation criteria deserve a closer look because the protocols may exclude women or certain populations. Increasing the number of women investigators may also help increase female participation, she said.
Addressing women's health also makes business sense. Venture capitalist Dr. Anula Jayasuriya said finding projects that focus on women's health and have the potential to make money is not difficult yet she's been told it is a niche business proposition. “How can it be niche?” she said, noting that women make up half the population.
Because women have a disproportionate role in making healthcare decisions for their families, their health is “a much bigger problem than your reproductive system,” Jayasuriya added. She also said the disparity in women's health compared to that of men happens at every income level. She said this does not make sense, considering that women are valued in other realms. She wondered why women are not valued in healthcare as they are in retail, where “everyone understands the importance of women,” she said.