"Why blog about women's health?" someone asked me. Maybe it's because I'm old enough to remember the days that women didn't talk about breast cancer or when many of us assumed that heart disease was considered something that only happened to men.
Many women of my vintage were shocked and saddened when comedian Gilda Radner went public about ovarian cancer -- a cancer most of us never thought about and knew very little about, a cancer that claimed her in 1989. In 1991, her husband Gene Wilder told People Magazine that she was never asked by doctors about a possible family history: Her grandmother, her cousin and her aunt had ovarian cancer but Radner did not know it. That may sound shocking, but that was the way it was -- we didn't ask, they didn't tell.
Faulty breast implants, the over-prescription of mood-altering drugs, cervical cancer: These things, always women's health issues, were rarely addressed unless in hushed tones. Osteoporosis? My mother never talked about it, yet the women of her generation also suffered from brittle bones post-menopause. Oh, and menopause: We didn't invent it, but my generation medicalized it and the thorny hormone replacement therapy debate is still ongoing.
I think it was only when books like The Boston Collective's Our Bodies, Ourselves (first published in 1970, its latest edition is now its ninth) reshaped women's thinking (in the book's pages you could learn to examine your own cervix -- if you wanted to, that is) that women felt empowered to ask questions and take charge of their health. For instance, it was only mid-70s that researchers wondered: We know birth-control pills work, but do they have long-term health effects?
This struck me the other day when I saw yet another report on women and booze -- until recently, never considered a women's health issue. The report, compared the amount of alcohol consumed and death from all causes among nearly 2.5 million women and men -- a staggering number. The study showed that the difference between the sexes became greater as alcohol intake increased. Women had an increased rate of all-cause mortality conferred by drinking compared with males, especially in heavy drinkers. Is alcohol a women's health issue? You bet it is!
Yet another study released last week underlined how women need to be even more vigilant about making sure they get properly checked. According to researchers at Toronto's Institute for Clinical Evaluative Sciences (ICES is at www.ices.on.ca) and Women's College Hospital (www.womenscollegehospital.ca), women with diabetes are 14 per cent less likely to be screened for breast cancer compared to women without diabetes.
Researchers also found that low socio-economic status is an additional obstacle to preventive care in an already disadvantaged population. This is of particular importance as women with diabetes are already at a higher risk of breast cancer and of poorer survival once diagnosed.
"Managing the demands of a chronic condition such as diabetes is challenging for many women, leaving other preventative actions like cancer screening to fall by the wayside," commented Dr. Lorraine Lipscombe, a staff physician at WCH and an adjunct scientist at ICES. "Given the increasing demands on family doctors today who are seeing more patients than ever before, preventive issues like cancer screening are often overlooked." The lesson here? It's up to us.
Research released today from St. Michael's Hospital in Toronto and published in the Journal of Obstetrics and Gynaecology Canada (www.jogc.com) again illustrates why we can't assume that all is well in women's health. According to Dr. NavPersaud, a family and community medicine physician at St. Mike's, Canada's most commonly prescribed pregnancy drug for nausea may not be as safe as previously thought. The drug pyridoxine-doxylamine, the most commonly prescribed drug for pregnant women suffering from morning sickness in their first trimester (it is used in half of Canadian pregnancies that result in live births and has been prescribed to 33 million women worldwide), does not prevent birth defects even though drug safety data says it does.
When Dr. Persaud re-examined all the data that led to pyridoxine-doxylamine's top safety ranking, he found that the numbers did not add up. Dr. Persaud, who is also a scientist in the hospital's Li Ka Shing Knowledge Institute, noted that "despite claims that it reduced the risks of birth defects, data was much closer to the natural average of birth defects -- between three and five per cent of all pregnancies."
With evidence lacking that the drug reduced birth defects (such as limb malformation or congenital heart defects), Dr. Persaud says that the guidelines that recommend the drug's use should change; the role of pyridoxine-doxylamine as the first-line pharmacological treatment for nausea and vomiting in pregnancy should be reconsidered. Anti-nausea alternatives exist. For example, pyridoxine, without doxylamine, has stronger safety data supporting it but is prescribed less often in Canada.
Pregnant women would naturally think the drug is "standard of care" for nausea and vomiting, especially if they have used it in previous pregnancies. "Vitamin B6 is similarly effective," Dr. Persaud said. "I've changed my practice and now recommend alternatives to pyridoxine-doxylamine that have demonstrated to be safe."