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Women's Health: More Than 'Bikini Medicine'


I'm Michel Martin and this is TELL ME MORE from NPR News. Later in the program, we will talk about Passover, which begins at sundown tonight. It commemorates the Jewish people's escape from slavery in Egypt to freedom.

We were wondering what it's like to observe when you are not free, so we'll speak with the former lobbyist, Jack Abramoff, about that. You might remember that he served more than three years in prison for fraud and tax evasion. He'll be with us in just a few minutes.

But first, it's also Women's History Month and, through this month, we've been speaking with women who've been game-changers in their fields. Today, we speak with a leader in the field of women's health and when you hear that term, you could be forgiven if you thought reproductive health. Some people even called it bikini medicine because, for so long, the focus of research and medical practice seemed to be almost exclusively on the areas of the body you'd cover with a bikini.

But our next guest has broadened our understanding of how gender affects health, as well as the career path for those interested in the issue. Her name is Dr. Janine Austin Clayton. She is the director of the National Institute of Health's Office of Research on Women's Health. She is a clinician and she also sets policy for how NIH does research in women's health and she's with us now.

Welcome. Thank you so much for joining us.

JANINE AUSTIN CLAYTON: Thank you for having me.

MARTIN: You come from the field of ophthalmology and it was there, in studying eyes, that you discovered specific eye diseases that disproportionately affect women and I'm fascinated by how you drew that conclusion, how you even came up with the idea to look at this.

CLAYTON: So there are hormones that actually circulate within the eye, as well as the rest of the body, and that was being recognized by research and so the preponderance of women that I was seeing as patients time after time, nine out of 10 of the people I was seeing as patients were women and that kind of sparked my interest and combined with the research data that was becoming available at the time.

MARTIN: So there are objective scientific differences between men and women that need to be taken account into the field of health in your view?

CLAYTON: Absolutely, absolutely. From head to toe, there are differences. Any five-year-old kid could tell you there are differences between males and females, and goes beyond that. From head to toe, our diseases present differently. Sometimes, the course of the disease is different. The treatments - we respond to the treatments differently, males and females - and there may be differences in adverse outcomes related to therapy. So this is a safety issue, as well as a health care/clinical issue.

MARTIN: But, you know, you were also telling us that it was not long ago that women were actually excluded from medical research and your department, the Office of Research on Women's Health, was instrumental in changing that, but that's a relatively recent change.

CLAYTON: Absolutely.

MARTIN: Why is that?

CLAYTON: Earlier on, before 1990 when the office was formed as a result of a lot of work by many individuals, including the Women's Caucus, women were excluded because of a protectionist attitude. They thought that women - certainly, women who might get pregnant during a study and that could be harmful to the fetus, so there was an attitude of - we want to protect women. It wasn't necessarily a malevolent exclusion.

Also, the notion was, if we do this in men, it's fine. We can just apply those findings to women. It wasn't well recognized; the major differences between males and females, down to the level of each cell having a sex based on the chromosomal complement.

MARTIN: You were saying that - you were telling us, for example, that one major difference is the relatively recent awareness that heart disease presents very differently - excuse me - in women and men, that this has all sorts of important implications. Could you just talk about that?

CLAYTON: Absolutely. Heart disease is a number one killer worldwide. It's the number one killer of men and women in this country and, unfortunately, the crushing chest pain, the elephant sitting on your chest, is a classic presentation for a man, not necessarily women. Women do have chest pain, but unfortunately, women can be having a myocardial infarction, having a heart attack, and have no chest pain. They may just have more fatigue than usual, difficulty with sleep, other problems, headache, stomach ache, indigestion without the chest pain. So, because women don't know that, they may not seek help when it could be life saving, for example.

MARTIN: And I think many people might remember that the recent revelation that drugs act differently in men and women, for example, was made clear when the Food and Drug Administration recently cut doses of the drug Ambien in half for women - the recommended dose for women in half. And you've been quoted as saying that that's just the tip of the iceberg.

I just have to ask you, though. Do you feel that the course of research would be different if there were more women involved in research or is it really more a matter of changing our consciousness about the fact that all types of people need to be involved in research?

CLAYTON: I think we need both. We definitely need more women and we need people of diverse backgrounds. Data has actually shown that when you put people together from diverse backgrounds - racially, ethnically, sex, gender - you solve problems in more comprehensive ways than if you have the same people who have the same background. So we have complex problems and we need diverse folks involved in the studies.

MARTIN: Well, to that end, you've been very active in the NIH's working group on women in biomedical careers and part of the agenda here is to maximize the potential of women scientists and engineers. What are some of those barriers to participation? You know, why is this - why is there a need for a specific focus on this?

CLAYTON: Many, many women have work-life balance issues that coincide with the time that they're building their career. The biological clock - we can't change that, so between 20 and 35, women are having children and they may need to drop out or drop back in to a research career or a science career or any other career, for that matter, in order to take care of their families. That is a barrier because we don't have consistent, regular, systematic child care available in this country and the issue related to maternity leave is also a problem. There's very limited maternity leave in this country.

In terms of a science career in particular, a science and a research career require a sustained record of publication and sustained involvement in the field. It's very difficult to drop out and drop back in. So we have developed programs like a reentry supplement that's supported by the Office of Research on Women's Health and other institutes and centers that funds young ladies and women who've been in research, who had to drop out and helps them to reenter.

MARTIN: We want to talk more about this and, unfortunately, we don't have time today and so this is an important area and I hope you'll come back and talk more about this, but I can't help but mention, if you don't mind my mentioning, that you are yourself married and a mother. And I just am interested in how you manage to combine both high level research and these other responsibilities in your own life. As briefly as you - tell us the story of your life in the next sort of minute that you have left or if you can even perhaps pose this is the manner of advice to other women who'd like to follow in your footsteps.

CLAYTON: Absolutely. For other women, I'd say the first thing is, go for it. Absolutely go for it. There are many, many things that we see as barriers. Sometimes, they are barriers in our own mind. There are so many opportunities available to us and we need to be at the table to contribute to solving problems.

No. It's not easy at all and I've got five things I kind of thought about that have helped me get through this myself and the number one for me is my faith and my family. And then there were a couple of others. Focus on what you're trying to do. Flexibility, so that when it's not quite going right - and we've all had those and I've certainly had disappointments and I thought that was the end of the world for me that I didn't get this thing that I wanted to have - to display fortitude at that time when you are being taxed.

And the legacy of women that have come before and folks that did not get to have these opportunities really drives me to take advantage of every opportunity that I have.

MARTIN: Dr. Janine Austin Clayton is director of the National Institute of Health's Office of Research on Women's Health. She was kind enough to join us from our studios here in Washington, D.C.

Dr. Austin Clayton, thank you so much for joining us. We hope we'll speak again.

CLAYTON: Thank you for having me. Transcript provided by NPR, Copyright NPR.