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uterus that made walking and sitting very painful. Other
women's health was ravished by untreated venereal disease
which caused chronic pelvic inflammatory disease.
Maybe this was what the ancient Greek physician Hippocrates
was referring to with his famous aphorism:
"What is woman Disease!"
The result was that a surgical specialty, gynecology,
took over the responsibility of caring for women. And
the rest of medicine was basically let off the hook about
thinking about women. Except in the area of reproduction,
research findings with men were assumed to be
transferable to women. Differences in pathophysiology
between the sexes were considered female deviations
from male norms. This kept many of the legitimate health
concerns of women invisible.
Today, women are no longer leading mainly reproductive
lives. In fact, reproduction may never enter the lives
of many women. For most of us, it is just one aspect of
our lives. We are more than just breasts and a pelvis.
Women have hearts, bone, brains, and immune systems.
We are living equal lives to men in terms of athletics,
education, and professional activities, but our medical and
social institutions haven't yet caught up with that fact.
OTI: Won't creating a women's health specialty further
"genitalize" medicine, by focusing on our differences
from men
EILEEN HOFFMAN: I see just the opposite. Feminists
often get nervous when women are separated out
because our differences have all too frequently been held
against us. But the push for equality or gender neutrality
has not served women well in medicine. We need to
move to an appreciation of the fact that women and men
are different; to recognize these differences respectfully.
There is no "gender neutral" human being we can
study. So, in fact, up until very recently, clinical and animal
studies basically examined men and ignored women.
It was a simpler approach, because studies weren't interfered
with by women's menstrual cycles or pregnancies.
Gender neutrality has kept women invisible.
Today physicians prescribe drugs to women that have
only been studied in men. We perform surgical procedures
with tools designed for the larger male body. We
make interpretations about normal emotional development
and psychiatric illness based on studies of men.
We have not only a fragmented delivery system; we
have a fragmented data base from which doctors are
trained. A case in point: we're now sophisticated enough
to understand that the sex steroids, most notably estrogen,
do a whole lot more than affect reproductive function.
Estrogen acts on the uterus to produce a baby, but it also
interacts with every single one of our organs, be it the
heart, the bones, the skin, the immune system, or the
brain—whether or not a woman ever becomes pregnant.
Yet only gynecologists study ovarian endocrinology.
Today estrogen has entered into the internists' pharmacopoeia
of cardiac active drugs. If we are going to be
using estrogen to treat heart disease, we need to train
doctors to know how our ovarian hormones interact
with our organ systems.
OTI: There's a fear that separate will never be equal, that
dividing female from male medicine will ghettoize
women's health and lead to even less adequate treatment.
EILEEN HOFFMAN: Women's health is aleady
"ghettoized"—to a surgical specialty focusing only on
reproductive health. Even early feminist efforts to
improve women's health care did not break out of that
concept.
When Our Bodies, Ourselves was originally published in
1969, the feminist movement challenged the power relations
between women patients and male physicians. But it
retained the assumption that reproductive health could be
equated with women's health. This narrow focus did
nothing to challenge women's relative exclusion from the
non-reproductive aspects of medicine.
The exclusion has been almost comical. For example, it
was long known that premenopausal women were relatively
immune from coronary artery disease. But this
information was not used to treat heart disease in
women—although it is the number one cause of female
death. Instead, in the heyday of heart-attack hysteria,
estrogen was given to men!
In the last four years we have seen dramatic change in
our concept of women's health. The Women's Congressional
Caucus spurred the federal General Accounting
Office to study the issue, and in 1990 it released a ground
breaking report criticizing the National Institutes of
Health for their failure to include women adequately in
clinical trials. This one statement of fact, at this particular
time in history, raised to new levels the nation's consciousness
about women's health. It occurred within a
cultural climate ready to receive it—a climate poised to
respond to women's demands for inclusion. This time
women will not resort to alternatives outside mainstream
medicine. Instead they, and their male allies, intend to
change the system to meet the legitimate needs of
women.
I believe that creating a place within the hierarchy of
medicine devoted to the comprehensive care of women
from a woman-defined perspective is the only way to
assure that it will not be marginalized and that every
medical student receives training in women's health.
OTI: Do we need a specialty in men's health, too
EILEEN HOFFMAN: No. We're already concentrating
most of our efforts on male medicine.
When pediatrics was developing as a specialty, many
people argued that it was unnecessary. In fact, I'd like to
see a specialty in women's health modeled after pediatrics,
with its emphasis on the whole child. Pediatrics has
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