You don't need a physician to tell you that men and women are different. Unfortunately, many segments of the American scientific community didn't pay a lot of attention to the difference until recently.
Biomedical research studies in this country have traditionally included women. But drug trials rarely involved them since the assumption was results on males would apply to women. And too often the thinking was health problems of women revolve around their menstrual cycles -- young women will have reproductive problems, middle-age women will deal with menopause and then there's old age, which no one has paid much attention to.
Thanks to national leadership from people like Maryland's Sen. Barbara Mikulski and Surgeon General Antonia Novello, scientists will focus more on non-reproductive diseases of women. They also have a better understanding that we cannot make presumptions about women's health when the data are based on research on men.
Q: How do women currently fit into the U.S. health care picture?
A: Not only are women 52 percent of the population, they determine how 80 percent to 90 percent of family health care dollars are spent. Of the 20 most common surgeries, 11 are performed on women exclusively. And two of every three elderly people are women.
Q: Why were women overlooked in so many studies?
A: The medical community has preconceived notions about women's health. For example, studies show that when men are admitted to emergency rooms with chest pain, they receive an electrocardiogram to check their hearts. However, women who have the same symptoms usually are given tests of their intestinal system. Women have been left out of major studies of drugs for diseases like tuberculosis and syphilis. And a large national study of physicians with cardiovascular problems didn't include women because it was thought there weren't enough female doctors to make an impact.
Q: Are there other reasons women weren't included?
A: Yes. Many scientists and pharmaceutical companies felt it was too expensive and complicated to adjust for women's biological cycles, including menstruation and pregnancy, in testing drugs and procedures. Some were afraid of lawsuits after the thalidomide scare of the early 1960s.
Q: What kinds of things could we have known earlier?
A: There are two basic examples.
* Research shows that the pain-relieving drug acetaminophen is eliminated from women's bodies at about 60 percent the rate dTC typically seen in men. In other words, it stays in their bodies longer, on average, so many women don't need to take it as often.
* Some anti-depressants have varying effects depending on the point in a woman's menstrual cycle. As a result, there will be times during the month when the dosage is too high and times when it is too low.
Q: How will the atmosphere change?
A: Researchers will no longer assume that women's health is secondary. Much of the credit goes to Dr. Bernadine Healy, director of the National Institutes of Health, who has vowed to fund more research into diseases that effect women, including breast and uterine cancer and osteoporosis. And thanks also goes to the scores of researchers and physicians in this country who are vocal about the urgent need to focus on women.
Dr. Matanoski is a physician and professor of epidemiology at the Johns Hopkins School of Hygiene and Public Health.