No one knows why certain diseases, such as most types of depression, are more common in women than in men.
Many wonder why, since 45,000 American women die each year of breast cancer, we don`t know more about why some chemotherapy drugs don`t always work to stop recurrence of breast cancer.
It`s unclear, too, whether menopause drugs that can protect women from heart disease cause breast or uterine cancer.
The medical profession doesn`t even know whether many drugs found effective for men also help women, particularly at the same doses. That`s because many drugs have been tested mostly in men, partly because of concerns about birth defects in children of female test subjects if they are in their childbearing years. That problem now is considered surmountable by testing women who have reached menopause or who have finished having families.
Questions like these are being raised in Congress, in top federal health circles and at meetings of medical groups such as the American Medical Association.
The AMA unveiled a Women`s Health Campaign this year to address such issues. Last month, the association brought together seven experts, six of them women physicians or researchers, for a conference to update reporters. Here are some of the highlights:
Depression
Twice as many women get seriously depressed as men, and women take far more tranquilizers, antidepressants and other medications. They also have more adverse reactions to the medicines, said Dr. Margaret Jensvold, a leading Washington, D.C., researcher on depression and women.
According to Jensvold, Wellbutrin, a new antidepressant, was studied almost exclusively in men because of concerns about testing it in women. Physicians have found that women have higher rates of seizures on the drug, particularly if they have bulimia, an eating disorder. Weight and hormonal differences, particularly before menstrual periods, might mean that women need less than standard doses of Prozac, another antidepressant.
More study is needed, Jensvold said, about whether popular drugs, such as oral contraceptives and estrogen drugs for menopause symptoms, trigger depression, and whether women with family histories of premenstrual syndrome are at greater risk of getting it.
Consumer tip: Keep a log of your reactions to medications to help your physicians or psychiatrists monitor how much of each drug you need, and whether doses should be altered during your menstrual cycle.
Breast cancer
The ”single most important reason” breast cancer has not been conquered is because even some of the best chemotherapy drugs can`t stop some tumors, said Dr. Joyce O`Shaughnessy, a top researcher in the National Cancer Institute`s Breast Cancer Section.
The new approach, she said, is to treat breast cancer patients with strong chemotherapy drugs before surgery might be required.
O`Shaughnessy outlined several new drugs, including taxol, being tested in federal research projects.
Taxol, a plant derivative effective in treating ovarian cancer, is given with doxorubicin, which she called ”the best we`ve currently got” in breast cancer chemotherapy drugs.
Two other breast cancer chemotherapy studies are focusing on growth-stimulating factors, natural proteins that boost bone marrow that has been depressed by chemotherapy drugs, O`Shaughnessy said. Yet another study will use self-donated or autologous bone marrow transplants after high-dose chemotherapy to replace depleted bone marrow.
According to O`Shaughnessy, only 1 percent of all cancer patients nationwide participate in federal cancer research studies. She acknowledged some people are reluctant because they realize they may receive only a placebo or sugar pill, or may be randomly selected to receive another drug used for comparison with an experimental medicine. Others have reservations because of insurance, she said.
Consumer tip: Call 1-800-4CANCER anytime to participate in a study of what are considered the best new breast cancer drugs. You may want to ask whether you will receive the main drugs being studied, a comparison drug or a placebo.
Chronic pelvic pain
New research increasingly implicates genital infections in chronic pelvic pain, infertility, ectopic pregnancy and premature births. Yet many women don`t know they have a problem and don`t get help.
Half the infertile women who have had pelvic inflammatory disease (PID), a common genital infection that affects about 1 million U.S. women each year, never had a recognizable symptom, said Dr. David Eschenbach, chief of the division of gynecology at the University of Washington in Seattle.
Other problems following a genital infection: Low birth weight and premature pregnancies may be more frequent.
Consumer tip: See a physician if you have abdominal pain and tenderness, fevers and an unpleasant-smelling vaginal discharge.
AIDS
Women with AIDS are ”tragically discriminated against” because the complicated federal definition of the disease excludes many ailments common in women, said Dr. Nancy Dickey, a member of the AMA Board of Trustees. The definition is used by the Social Security Administration, private insurers and other agencies to exclude women from benefits, the AMA said in a letter released Wednesday to the federal Centers for Disease Control.
The letter asked the CDC to revise the definition immediately. The AMA also said it will file a ”friend of the court” brief in a lawsuit against the Social Security Administration on the issue.
Dr. Deborah Cotton of the Harvard Medical School said women comprise fewer than 5 percent of the participants in community-based AIDS drug studies, even though 80,000 U.S. women have the AIDS virus. Prevention efforts are too male-oriented and rely heavily on condoms, she said.
Cotton brought some good news: Transmission of the AIDS virus from pregnant women to babies may be 20 percent, not 60 percent, as early studies indicated.
Consumer tip: To participate in a federal drug study, call 1-800-TRIALS-A, 9 a.m. to 7 p.m. weekdays.
Menopause, heart disease
Two speakers called for more research into the pros and cons of hormonal drugs to curb menopause symptoms.
The drugs may help protect women from heart disease, bone loss and fractures, but they may contribute to the growing number of women with breast cancer, as well as uterine cancer and gall bladder disease.
In addition, no large clinical studies have been concluded to determine whether cholesterol-lowering drugs or aspirin reduce the risk of coronary heart disease in women, as they do in men, said Elaine Eaker, chief of the CDC`s cardiovascular health branch.
But Trudy Bush, associate professor of epidemiology at Johns Hopkins University, said the known benefits of hormonal menopause drugs outweigh known risks.
Consumer tip: Talk to your physicians about the pros and cons of hormonal drugs. Be sure to mention any family history of breast or ovarian cancer.
Family violence
New hospital accreditation requirements expected this fall will help identify victims of child, family and elderly abuse, said Dr. Anne Flitcraft, a member of the AMA`s steering committee on family violence. The standards require hospital emergency and ambulatory departments to train staff to better spot domestic violence.
Many of the estimated 8 to 12 million American women involved in abusive relationships are treated repeatedly for injuries at hospitals and sent home without any help, Flitcraft said.
Consumer tip: If you have to seek treatment at a hospital for domestic violence, ask for help and referral to agencies that can help you.
