by Betsy Nabel, President of Brigham and Women’s Hospital and Harvard Medical School professor.
Knowledge in science is something we never fully grasp because it is continually reshaped by new information. Information – such as the fact that women and men are different, from cells to selves – doesn’t change. Information is bounded in certainty. But we are at a particular disadvantage when the information that serves as the foundation of our limited knowledge is itself shaky. In the case of women’s health, myth and misinformation have been rampant and deadly.
No myth has been more pernicious, or has cost as many lives, as the one that might easily have killed a patient of my own. It was 1983, and I was a young, hotshot cardiology resident, who of course, “knew everything.” One night, a 32-year-old woman arrived in the emergency room where I worked. She described vague symptoms: aches, fatigue, a low-grade fever – nothing terribly specific. I ran some tests, didn’t find anything telling, and sent her home with Tylenol. Two days later she came back with a full-blown heart attack.
The problem was, I knew that was impossible. I had been trained by the best, and the best had taught me what the best had taught them: Heart disease was a man’s disease, and the primary symptom of heart attacks was chest pain, which my patient did not have.
Thank goodness, that woman survived. Her case has driven my career-long commitment to understand the difference between men and women’s health, and to raise awareness of women’s heart health in particular. Today we know not merely that women die of heart attacks, but, crucially, that women experience an entirely different profile of symptoms than men do.
In that case, we simply didn’t know what we were certain we did know. The same was true of a second myth that scarred women’s health for quite some time: that hormone replacement therapy improved women’s health. The model was simple: as women enter menopause, estrogen levels drop, and health problems ensue. The solution seemed intuitive and logical: replace the estrogen.
For years, the medical community relied on dogma — received knowledge — that these treatments worked. Two in five menopausal or post-menopausal women received hormone replacement, in part to prevent heart disease.
But then scientists challenged the known, by putting this “knowledge” to the test. A multiyear, multimillion-dollar study by the National Institutes of Health – the Women’s Health Initiative (which is the brainchild of then-NIH Director Dr. Bernadette Healy) – examined more than 160,000 women and made a startling discovery. Not only did hormone replacement therapy not prevent heart disease; it actually caused it.
That visionary study — undertaken, significantly, by the public sector at sustained public expense — has saved countless women’s lives.
Today, a third myth is killing women, and this one remains enshrouded in misinformation. Just like we used to think heart disease was a man’s disease, today we think of breast cancer as the most important women’s cancer. Of course, in many ways it is. But lung cancer kills more women than any other cancer — nearly 200 every day, most within a year of diagnosis.
Yet, perhaps because of the stigma associated with lung cancer stemming from an inaccurate perception that the only way to get lung cancer is to smoke – which is especially wrong when it comes to women — research in this disease is chronically under-funded, especially measured by the harm it causes to individuals and families.
Women who have never smoked appear to be at greater risk of developing lung cancer than men who have never smoked. Of the 20,000-25,000 nonsmokers diagnosed with the disease each year, more than 60 percent are women. Women also develop lung cancer at an earlier age than men. Yet, unlike breast and prostate cancer, for example, there is no widely accepted screening test for lung cancer.
Lung cancer thus presents a double myth: first, that it is solely a smoker’s disease; and second, that it is a cancer women don’t need to worry about.
These myths are a compelling reminder of the need for researchers and clinicians alike to treat men and women as what common sense tells us they are: different. That means clinical trials need to impose a gender lens at every stage of discovery and explore the unique effects of diseases and therapies on women as well as on men, which will lead to better health for both sexes.
An oft-shunned word, ignorance, carries great importance when we consider it as the driver of scientific inquiry, and thus, the molder of new knowledge. Yet when myths are widely believed to be facts, ignorance can kill. We owe half the world’s population much more than that.
Elizabeth Nabel, the President of Brigham and Women’s Hospital and a professor at Harvard Medical School, shared a personally revealing story on the TEDMED stage that pointed to how the limits of knowledge can be a weakness and how accepting our ignorance can be a strength. We are honored she has written an original piece for the TEDMED blog.