Every day at grocery checkout stands and in the mass media, we are bombarded with numerous, often conflicting health myths about women. They compete for our attention with mass media reports of growing numbers of health related scientific studies and all kinds of proposed new treatments for ailments. How does a woman (or a man who cares about women) who wants to make good decisions about her health care cut through all the clutter? Clearly, good information is required. And hard to identify. The National Academy of Science' Institute of Medicine (IOM) put together a "Guide to Women's Health Issues" which they call In Her Own Right. Dr. Karen Hein, Executive Officer of the IOM, is the spokesperson for the book.

In this conversation with Paula Gordon and Bill Russell, Dr. Hein talks about pressing needs. 1.) Women and their health care providers need to emphasize prevention instead of treatment, move from thinking about "medicine" to thinking about "health." 2.) Women need to be more responsible for their own health, move away from paternalistic doctor-patient relationships, replace monologues with dialogues. 3.) And there is an urgent need to study women directly, stop extrapolating health care information about women from studies done on men.

"The Institute of Medicine is looking at women's health and health care through a different lens. What's unique to women -- in nature and nurture? There are real gender differences in health. What are they? We need to know the roots of those differences. How do men and women respond to the same situations?

"We must look at the whole range of health issues and prevention that particularly affect women through their entire lifespan. Some examples: Women live longer and also take longer to die because we're frail. Frailty and a host of other disabilities are preventable. For one thing, good nutrition is vital. Adults put teenagers at risk with our mixed messages about sex. We can do something about that. Tobacco is the number one cause of disabilities in the world and has been made particularly attractive to young women. The disabilities that come with the use of tobacco are preventable. Unwanted pregnancies are preventable. As people travel more and more, epidemics are a growing threat. Vaccines prevent all kinds of diseases that affect women and their children everywhere in the global village."

Dr. Hein calls for an end to The Silent Era in women's health care. "If something doesn't feel right, women must speak out -- to their doctors, to their employers or to Congress. The old paternalistic practice of medicine no longer works." Beryl Lieff Benderly, a health and psychology writer, wrote In Her Own Right: The Institute of Medicine's Guide to Women's Health Issues for the IOM. All the studies from which she drew writing the Guide are available on the Internet at www.nas.edu.

Segment 1

Today, most people interested in issues affecting women's health have only fragmentary and changing bits of information. Dr. Karen Hein, in conversation with Paula Gordon and Bill Russell, describes the Institute of Medicine (IOM), part of the National Academy of Sciences. The goal of the IOM's current work with women's health issues is to present an objective picture of the health issues women face so that women -- and the men who care about women -- can make good health related decisions over the course of a lifetime.

Segment 2

Women's health issues span their lifetime. It starts at birth. World-wide, more females are born, but more males survive because of preferential feeding. Girls and boys have different experiences in grade school. Teenage girls have internalized societal attitudes which often lead to wide-spread eating disorders.

Nature-and-nurture/biology-and-culture issues abound. Americans try to prevent teenagers from having sex, while Europeans work to prevent pregnancy. European and American teens have their first sexual experiences at the same time, but European teens have dramatically lower rates of Sexually Transmitted Diseases. "Adults' attitudes have horrendous consequences for our young people."

Mass media and advertising send our teenagers mixed messages about behavior that puts them at risk, particularly messages about sex and tobacco, which is the undisputed Number One cause of disability in the world. But not all teenagers respond to these messages. African-American adolescent girls have far lower use of tobacco than Caucasian adolescent girls. "African-American teenage girls have a lot to teach us."

Women's reproductive years now count for 11% of a woman's lifespan. That changes the ways we need to look at women's health.

Segment 3

The Institute of Medicine compiled In Her Own Right to look at women's health and health care through a different lens, to find what's unique to women. Women and men often respond differently to the same health challenges. Women often turn energy inward, resulting in mental illness and addiction. Men more commonly direct that same energy outward, resulting in antisocial behavior and violence. We're learning more about how genetics and hormones contribute to these differences.

We must change the way we think about women's health: 1.) Women and their health providers need a new relationship. Replace the old paternalism where doctors made decisions on women's behalf, replacing it with doctors who listen and share mutual responsibility with women. 2.) Emphasize prevention. 3.) Study women directly instead of extrapolating about women's health needs from studies done on men. The National Institutes of Health are currently studying heart disease, osteoporosis and breast cancer among 160,000 post-menopausal women in 45 centers at a cost of $625M to begin to fill in today's information void.

Segment 4

Doctors must now treat whole people, not just diseases. We must all shift from a focus on "medicine" to thinking about "health." Prevention is central and requires information. All the studies that went into In Her Own Right are available on the Internet at www.nas.edu. Before going to the doctor, ask yourself, "What do I want to get out of this visit?" The movement toward managed care offers a great opportunity. Most managed care is employer-based. Employees must tell employers what they need in their plans. 40,700,000 Americans are uninsured. Most of them work, and women and teenagers are the most likely to be uninsured. "Vaccines become a good investment in the Global Village".

Segment 5

We need to get serious about new, better contraceptives. "Here's a reasonable goal -- let's make every pregnancy intended." Of the six million pregnancies in America every year, fully half are unintended.

Women are living longer but they also have more disabilities and are taking longer to die. Frailty in old age can be addressed in childhood. 20% of women over age of 65 are taking 21 different medications. Dizziness and falling may be due to anemia or mixed drugs. "If we sort out disabilities, we can prevent many of them in the first place, then treat them differently so we have heartier women. The goal is for people to have a high quality life by their own values. Then when the time comes to no longer live, give people permission to die in supported ways."

Dr. Hein believes history won't be kind to us, that our public policy on health issues that affect women and children is lacking. Women constitute 50% of the population. Vote. Elect people who will do better. If something doesn't feel or sound right, point that out to your employer, your doctor or to Congress. "Hopefully, this is the end of the silent era."

Segment 6

We need to reestablish our sense of community to solve complicated problems. Different views are healthy. Get over today's trend toward being exclusive instead of inclusive. Women must start by taking care of themselves. Develop a dialogue -- not a monologue -- with your doctor. Go for prevention, not just treatment. Take a life-span perspective, help other women locally and globally to stay healthy. Return to a focus on healing and being supportive.

Acknowledgements

Our thanks to Toni Werbell of Toni Werbell Public Relations and Sandra Matthews of the Institute of Medicine for helping gather website materials.

In the course of recording our conversation with Karen Hein, our very sick little cat, Willie, made an unexpected appearance. When we offered apologies, Dr. Hein smiled and said "Why should it bother me to see a loving family being supportive of each other?"

Related Links

National Academy of Science (http://www.nas.edu).