By Phyllis Greenberger. Just as disease affects women differently than men, military women experience different health concerns than their male counterparts. Women veterans are affected by a number of trauma-related disorders, including PTSD, depression, sleep disturbances, and increased use of tobacco and alcohol. In fact, nearly half (48%) of women tested for major depressive disorder in a VA medical study screened positive compared to 39% of men. Osteoarthritis, infertility, urogenital and pelvic floor disorders are some of the other unique issues faced by women veterans.

Realizing the seriousness and magnitude of the problem, SWHR began a multi-year program for women veterans in 2008 when we hosted a conference entitled, “PTSD in Women Returning from Combat Areas.”

SWHR’s president twice testified before the House Committee on Veterans’ Affairs on the important topic of enhancing healthcare services for women veterans and the need for research into sex differences that influence the unique health issues military women face.

In February 2011, SWHR launched Fatigues to Fabulous™ (F2F), an ongoing national campaign to honor and support female veterans as they transition home. Collaborating with veterans’ service organizations and the fashion industry, SWHR is raising awareness about the unique physical, emotional, and psychological challenges female veterans face, and is working to harness resources to support them.

A SWHR scientific conference in July 2011 “What a Difference an X Makes: The State of Women’s Health Research – A Focus on Female Veterans” brought together researchers and clinicians to discuss research gaps and clinician care options for military women.

SWHR believes sex differences must be researched in order to better understand the cau (more…)

The recent outbreak of lethal E. coli in Germany is noteworthy for many reasons. While this time the source was sprouts and the location was Germany, we do not know what or where the next outbreak will be. However, the risk of this or the next outbreak are not equally borne by all in Germany, all in Europe, or all in the U.S.  

The heightened impact of E. coli in women means it joins a growing list of diseases and disorders that have distinct effects on women, perhaps for no other reason than her sex.  Women are experiencing more severe illness during the current E. coli outbreak than men and the only explanation being offered is that infected women may be more likely to consume raw vegetables than uninfected women.  But why are women more likely to be hospitalized with severe symptoms, including abdominal cramping, bloody diarrhea, and kidney injury?

Is it possible this current outbreak and this particular bacterium cause greater cellular destruction in women, leading to more severe symptoms? Science and history suggest that this would not be the first time, as female-biased morbidity and mortality has been documented in past outbreaks.  During the 1992 outbreak of E. coli O157 in Africa, women suffered from severe diarrheal disease more than men. Interestingly, women’s relative risk of infection during the 1992 outbreak was not affected by occupation, travel, or household factors. In other words, the risk of exposure to E. coli may not be the fundamental explanation for why women experience serious and sometime fatal disease outcomes.

From the few studies that have started exploring sex-based differences, we have seen that after exposure to E. coli, women experience greater abdominal symptoms and inflammatory immune responses than men.  Development of drug resistance in E. coli also can differ depending on whether the bacterium is isolated from a man or a woman. Thus, the answer may lie in uncovering how the biology of the human host or of the bacterium within the human host differs depending on whether the host is male or female. (more…)

By Phyllis Greenberger and Marie Manteuffel. Our country has been at war for nearly a decade.  For many reasons, this war is like no other in American history.  Those in uniform represent a mere 1 percent of the U.S. population, with a significant number coming from the South and West.  Aside from reading a daily paper or catching an “In Memory” listing of the fallen on television, it is easy for many Americans to forget the men and women fighting these wars in defense of our nation.

Within this 1 percent is another invisible group:  women.  The recent conflicts are distinguished by the service of the largest ever presence of women deployed.  While not yet officially in combat, the risks seem the same for women and men when an attack can come at any time, and when there is neither a “front” nor a “line”.

As the Pentagon explores changing the policy that bans women from official combat roles, the medical community cannot wait to advance.  Women are coming back from deployments with the same conditions as deployed men, as well as some unique ones, and are lacking treatments that adequately factor in sex and gender differences. 

One area includes the high number of musculoskeletal concerns from women who have deployed.  Military women are holding their own in over 90 percent of military occupations.  This is not a question of women’s strength or capability to serve.  It is a research question needing a medical response.  What impact does the current gear have on female joint alignment?  What percentage of one’s body weight can be safely carried?  What role does increased elasticity play in development of chronic back pain or osteoarthritis after a tour of duty?

The harsh environment and impact of enemy weapons can have both immediate and long term effects on the genitourinary organs, as well.  Extreme temperatures and dehydration can contribute to startling rates of urinary tract infections in women.  Injury to the sex organs from explosives can impact men and women, while frequent heavy weight bearing over time has been suggested as a contributor to urinary issues and possible pelvic floor prolapse later in life.  Depending on the extent of the damage, sexual function and fertility may also be impacted.  (more…)

By Phyllis Greenberger. It has become an established fact, although not universally accepted that the complex interaction of hormones,  genetics, physiology, and the environment have very different effects on health and disease between men and women. We know that there are extreme differences between males and females in the prevalence, susceptibility, severity and time of onset of most conditions that affect both men and women.

An  IOM Report, commissioned by The Society for Women’s Health Research in 1995 and released in 2001 unequivocally stated that “every cell has a sex” and research should take sex differences into consideration from “womb to tomb”. In the years since we have established an international scientific society called OSSD (Organization for the Study of Sex Differences) to enhance the knowledge of sex and gender differences that impact health by facilitating interdisciplinary communication and collaboration among scientists and clinicians of diverse background and recently launched an on line open access scientific journal The Biology of Sex Differences”.

Yet here we are 20 years after changing the NIH policies to include women in clinical trials and 10 years after the IOM Report and we have made little or no progress in actually changing provider’s understanding of sex differences, and equally important, while women and minorities are included in most (still often not inthe numbers they should be) clinical trials the actual study of sex differences is pathetic. For example, no medical school requires sex differences in their required course, and we have been told that it is unlikely that it will be because of the competition between so many specialties; only two out of the ten top medical journal’s require researchers to indicate if women were included in the trials and if any sex differences were noted and according to our review and analysis, and accepting the fact that we might  be  slightly off, in the last ten years, under 1% of grants from the NIH were for studying sex differences. We are not talking about solely women’s diseases, but research to understand why men and women react differently  to medications, diagnostics and  devices. We don’t know if prevention should be different, or diagnosis ,  (for example we know that women with AIDS present differently than men, and for a long time were not properly diagnosed)), symptoms and treatment.

What we need is to make sure that research is funded and encouraged, that the results are translated to the bedside and that understanding of sex differences is incorporated into education about all diseases including  but not limited to cardiovascular, autoimmune, osteoarthritis, depression.

While it is more fulfilling perhaps to contribute and fund specific diseases such as breast cancer or heart disease and we understand the emotional element when you or your family has been affected, we all have to realize that these sex differences affect all of us and our families (men also) in any disease we might have or get and we need to support the research that will unlock the answers to these many questions long ignored.

By Phyllis Greenberger. I, as many of you I am sure, have been following the long drawn out debate about “don’t ask, don’t tell”. Never mind that we need more men and women in the military, that our troops are having way too many tours of duty, that many, if not all of the people this applies to speak farsi are well educated and willing to give their lives for their country. More than I can say for the rest of us and particularly sons and daughters of the Congress, with a few exceptions. But the argument I find most appalling is that it will hurt the morale of the troops.

I have testified three times before Congressional house committees and the most recently on Military Sexual Trauma (MST). Approximately 22% of the women in the military have reported to the VA centers sexual assault or harassment, that is just the women who have left, no one  knows how many currently in the military have been affected and we know that many women who leave active service don’t seek help at the VA for various reasons, one of them being a predominately male culture. So the 22% is a low estimate, some feel it could be twice that number.

The ramifications of MST for women persist long after the initial assault. With most MST assaults being orchestrated by military personnel against military personnel, the environment of trust among those serving is broken, and a chain of command that fails to protect from and respond to MST further degrades unit cohesion.

So, every time I hear the “morale” issue as an excuse I think about the women in the military and  why is it that everyone is so concerned about gays able to serve openly  but not the morale of the women serving our country who are vulnerable to MST while risking their lives for us.

By Phyllis Greenberger. The non-profit advocacy organization, the Society for Women’s Health Research (SWHR), based in Washington DC is widely recognized as the thought leader in research on sex differences, and is dedicated to improving women’s health through advocacy, education, and research.  Because of SWHR’s efforts, women are included in medical research, and scientists are looking at the different ways health and disease affect men and women and the reasons why. SWHR attributes its advocacy and communications successes to using evidence-based policy in multi-pronged education efforts, as well as to its involvement of a mix of healthcare providers and policy makers dedicated to improving women’s health. SWHR’s advocacy and communications efforts extend beyond lobbying legislators and regulators; it includes education of federal legislators and their staff; scientists who are employed by the federal government, academia, industry, as well as the public.

Advocacy and Communication with the Public

In addition to providing the latest research on conditions that affect women differently from men, SWHR’s education and communications efforts also emphasize that women need to become advocates for themselves and their families. SWHR is founded on the belief that health can be improved through research efforts and this new knowledge must be communicated and translated into individual care, which requires an up-to-date, current exchange of information between health care providers and their patients. 

SWHR’s first major public educational effort was the “Woman Can Do” campaign, to educate and recruit more women about becoming involved in medical research. After the regulatory changes mandating women’s participation in research, SWHR was made aware of the facts that researchers had difficulty finding women to participate in research studies. In 2003 nearly 90 other organizations joined SWHR’s Alliance for Women in Clinical Research to educate women about medical research and ways they can participate. The campaign continues today and additional information can be found on the Women Can Do website .

To further help promote the importance of providing the public with valuable and accurate health research information. SWHR annually presents the “Excellence in Women’s Health Research Journalism Awards” to honor journalists who excel in this arena.

SWHR works to provide women, who make about three-fourths of the health care decisions in the United States, with advice that communication with healthcare providers is a two-way street and with the information that allows them to participate in decisions impacting themselves and their family members.  SWHR’s educational programs and written materials, as well as our web site, also serve as resources for practitioners involved in women’s health issues.

SWHR is committed to ensuring that women’s health remains a high priority on the national agenda, that sex differences become more widely recognized as vital to healthcare treatment options and to advocating for  increased funding for related research.  SWHR will continue to partner with the widest possible range of healthcare providers and policy makers to gather evidence-based knowledge and then communicate it to Congress, the scientific research community, as well as to healthcare providers and the public.

By Phyllis Greenberger. I just love this—it happens every time. Leave it to the news media to decide whether something is a real health issue or not. That they know little or nothing about the medical condition doesn’t stop them. The latest example is Hypoactive sexual desire disorder (HSDD), a condition that affects as many as 20% of women. It is a loss of desire or libido without any other concurrent medical condition. But, if these journalists (and I use that term loosely) haven’t heard of a condition, especially this one because it has to do with female sexual dysfunction, they are sure a drug company made it up.

I heard this with PMDD, fibromyalgia, restless leg syndrome, chronic fatigue syndrome. The media and a few doctors said there was no such thing in each of these situations, until time and research proved them wrong. For example, in 2004 when a possible treatment for PMDD was seeking FDA approval, an article in the Washington Post severely criticized Eli Lilly for developing a medication for a made-up condition. Yet, on Tuesday June 22, 2010 the same Washington Post published a lengthy article with personal stories of several women suffering with PMDD and quoted physicians and sited research on PMDD, seemingly now an accepted health condition. By the way, Lilly’s therapy is successfully being used in Europe.

HSDD — Is this a made-up illness? The fact is that years of research and many doctors have treated women who complain about lack of desire– even when young, healthy, and happily married. The research about women’s sexual dysfunction is not new; lack of sexual desire, lack of ability to be aroused, painful sex, and failure to orgasm are all considered sexual dysfunction. Female sexual dysfunction has been listed in Diagnostic and Statistical Manual of Mental Disorders for more than 20 years. In the late 1970’s Helen Kaplan and Harold Lief, who separately were diagnosing lack of desire and calling it by different terms, proposed that APA include this condition in the Diagnostic and Statistical Manual of Mental Disorders III. The diagnosis of Inhibited Sexual Desire (ISD) was added to the DSM III and was published in 1980. There are at least ten recent articles on PubMed discussing HSDD, screeners, and communication about HSDD. (more…)

I am fairly confident that most women—certainly those post-menopausal or peri-menopausal—are aware of the extensive media coverage and dire warnings following the release of the results of the Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in 2002.  At that time, it was stated that HRT is detrimental to a woman’s health, with risks outweighing the benefits.  It stated, pretty unequivocally, that HRT increased risk of breast cancer, cardiac events and stroke.

It would be overstating to say that all of the 2002 results were inaccurate, since, as we know, science is rarely definitive and more information is constantly emerging and being revised; however, women should know that many of the initial results have been found to have been distorted, misunderstood, over-generalized, and in some cases flat out wrong.  While the updated findings have been published in various scientific papers and journals, the mass media continues to refer almost exclusively to the 2002 WHI negative results.  Having received the attention they wanted, they have moved on.  But what if some of the findings turned out to be wrong…

A few recent examples highlight this continuing problem of misinformation:

-The New York Times recently published an article on what is currently known about what causes cancer and what prevents it.  The underlying thesis was that we know very little, but two things we do know:  first, that smoking causes cancer (okay, we can all agree on that); second, that HRT causes breast cancer.

-A November 29 article on sex and menopausal issues, also in The Times, stated that many women stopped taking hormone therapies because of their link to small increases in breast cancer, heart attacks and strokes.

-A November 12 article in HealthDay News posited that the “declining use of HRT” may be driving down rates of a condition called atypical ductal hyperplasia—a known risk factor for breast cancer.  Other articles have gone even further, to say that the incidence of breast cancer is down for the same reason.

Seemingly no one in the mainstream media is quoting the analyses and research that questions all of the 2002 results.  For example, in an article published in The Cancer Journal in 2009, Dr. Avrum Bluming, Clinical Professor of Medicine at the University of Southern California and Master of the American College of Physicians, along with Dr. Carol Travis, debunk many of the previous 2002 research findings.  Their work joins a growing list of reports on the WHI results and newly published research studies, chipping away at the theory that HRT is bad for all women, all of the time.

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The following post represents my personal opinion and not that of any groups or organizations with which I am affiliated.

Okay, it’s enough already! Why is it that women are always the target? First it’s abortions, then mammograms, pap smears following closely, behind and now cosmetic surgery (although that’s not only women!) It looks like the Congress is desperate to find any savings anywhere. Why not tell it like it is, it’s raising taxes. Whether it is through so called elective procedures or levying taxes on devices and diagnostics, to be passed on to the patients, it’s a tax.

Instead of rewriting the rules on mammograms which will cost lives, maybe not that many, but if it is your life that’s all that matters and focusing on false positives and unnecessary screening, why not invest money in better mammograms that are more effective in identifying a lump or even distinguishing a fast growing one from a slow one. Taxing companies who make these diagnostics, while lowering reimbursement rates is not exactly a motivator for more research and innovation.

And by the way, these recommendations for mammograms are a classic example of “comparative effectiveness”, which it very well may be, but the reaction from the American public is an indication of how difficult cutting any services will be—not a great start. And no sooner does the US Preventive Services Task Force come out with recommendations then the Sec of HHS tell us to ignore them. Will private insurers ignore them?

Let’s talk about cosmetic surgery, according to the physician groups, in a survey done of people who are planning on having cosmetic surgery in the next two years, 60% reported a household income of $30K to $90K, 40% of the 60% reported incomes of $30K to $60K, this is the middle class and insurance does not pay for it. While some of the procedures may be considered elective by some, it is in the eye of the beholder and who is to make that distinction, the doctor, the patient or the government? Another bad idea.

Why are women being targeted? I thought this was all about giving women more access to health care, many of the changes in regulations are definitely positive, but what the government gives with one hand, it seems to take away with the other.

With all the chatter and perhaps now “ twitter” about health care reform, one area has gotten a lot of attention and it is an issue that is near and dear to the Society for Women’s Health Research—that is comparative effectiveness research (CER).

Since it is accepted knowledge that women and minorities were not, and are still not, to the degree they should be, included in clinical trials, there is much we are learning and still do not know about sex and ethnic differences in terms of prevention, diagnosis and treatment. My concern with CER, therefore, is how differences in effectiveness and treatment will be determined. Several genetic, hormonal, environmental factors influence health and disease in particularly different ways in women and men. Because of that, CER must study both men AND women and analyze fully any sex based difference in disease prevalence, treatment options and procedures. Those decisions must correlate to real world experiences.

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