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WOMEN'S HEALTH No Time to Relax on Women's Health Research, Academic CareersWomen's health researchers should take a cautionary lesson from the "tunnel vision" that led health authorities to recommend estrogen replacement therapy for millions of women before a clear picture of its risks and benefits began to emerge, said JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital and professor of medicine at HMS.
Keynote speaker JoAnn Manson (left) and Andrea Dunaif, who is director of the HMS Center of Excellence in Women's Health, both took part in the May 25 Women's Health Research Day Conference, which explored research on women's health as well as the professional status of women researchers. Photo by Steve Gilbert Missed RisksIn her keynote address at the May 25 Women's Health Research Day Conference, presented by the HMS Center of Excellence in Women's Health, Manson focused on the hormone replacement story, which she noted "is tremendously instructive in teaching us how far we've come, but how far we still have to go." The first estrogen trial, using diethylstilbestrol on men in the 1970s, was stopped early due to heart attack risk. Later trials enrolled female subjects, but investigators were single-mindedly intent on demonstrating the benefits of HRT and studies were not designed to elucidate the overall risk–benefit profile. It was not until 10 to 15 years ago, when the NIH mandated women's inclusion in trials and created its Office of Research on Women's Health, that studies began to focus on the totality of women's health."We owe a debt of gratitude to the public advocates and the female scientists," including former NIH director Bernadine Healy, who worked to ensure that women's health was properly addressed, Manson noted. Bringing the HRT saga up to date, she said estrogen now appears to increase cardiovascular risks—blood clots, strokes, and heart attacks—in the first year or so, but to decrease long-term heart disease risk, with the result that "it's time to take cardiovascular risk out of the equation" in deciding whether to take HRT, and instead weigh bone-strengthening benefit versus breast cancer risk. Selective estrogen-receptor modifiers like raloxifene offer hope of optimizing hormone therapy, Manson concluded, while a key goal for future research will be to identify subgroups of women who will benefit most. Women's AdvancementAdvancing the careers of female scientists is another goal of the Center of Excellence. "We're moving in the right direction, although we need to do much more" to increase representation of women on the HMS faculty, said HMS dean Joseph Martin. Women now make up 10 percent of full professors, 17 percent of associate professors, and 27 percent of assistant professors.Dean for faculty affairs Eleanor Shore, the second woman to attain the rank of dean at HMS, added that federal policymakers included academic advancement as one goal of its centers of excellence because they recognized that "women need to be in senior leadership positions if they are to affect the course of research in women's health." In the day's other talks, Paula Johnson, HMS assistant professor of medicine at Brigham and Wo-men's Hospital, discussed needs, barriers, and strategies for recruitment of minority women as re-search subjects; Judy Garber, HMS assistant professor of medicine at Dana–Farber, sketched opportunities for women's health research in the post-genome age; Michael Rosenblatt, the George Richards Minot professor of medicine and interim president of Beth Israel Deaconess Medical Center, related the success story (complete with plot twists) of the osteoporosis inhibitor alendronate; and William Crowley, professor of medicine at MGH, outlined advances in infertility treatment based on controlled hormone release. —Tom Reynolds |
