A Missed Diagnosis, A Movement, and a Critical Moment for Women's Health

The patient was 35 years old, African-American and exhibiting all of the symptoms of a heart attack except one. She wasn't a man. Women, to the eyes of this then young cardiology resident, didn't have heart disease. Men -- older men -- did. So I completely missed the diagnosis. The next day she was back in the ED, having suffered a heart attack.

But her case was a story waiting to be told, and on this National Wear Red Day -- a day for mobilizing the fight against heart disease in women -- it's a lesson common sense tells us but that medicine has yet fully to learn: Women's health is different. And contrary to the old saw, what we don't know can hurt us. In the case of women's health, it's killing us.

It's time for that to change -- for a comprehensive national commitment to research that recognizes the unique contours of women's health.

The good news is that the Affordable Care Act has made a comprehensive commitment to closing gaps between men's and women's care. The challenge is that such a commitment will not make the full impact it can until we close gaps in knowledge too. If care for women is to be rooted in science, that science must recognize that men's health and women's health differ -- and that the knowledge gap affects everyone, not just women. Men, too, face unique health concerns that are not adequately understood because gender data is not analyzed.

Those differences are substantial, and they are evident in the disparities in health today. Cardiovascular disease, lung cancer, depression and other illnesses disproportionately affect women, and we do not fully understand the role that gender plays in them.

One reason is that clinical trials are still skewed toward men. Nearly two out of three studies including both sexes do not analyze data by gender. Meanwhile, safety concerns involving pharmaceuticals overwhelmingly affect women: Eight of 10 drugs withdrawn from the market between 1997 and 2000, for example, had higher risks for women than for men. The FDA has acknowledged that the data available on patient subgroups like women and minorities is inadequate.

We know that medical research targeted at the unique needs of women can save lives. When I was director of the National Heart, Lung and Blood Institute, the Women's Health Initiative -- a comprehensive study into the use of hormone replacement therapy launched by then-NIH Director Dr. Bernadette Healy -- completely upended conventional wisdom on the topic. Countless women have been spared heart disease as a result.

Yet the Women's Health Initiative still stands out today as an exception. It ought to be a rule. An effort to close the gap in medical knowledge must, at a minimum, include several steps. First, women should be included in clinical research in numbers reflecting the impact of the disease being studied on them. If women comprise, for instance, half of a disease population, they should comprise half of the patients studied in clinical research. Second, researchers should collect not just overall data on the safety of prescription drugs but data on their impact on patient subgroups, including women. Finally, and most important, researchers should impose a gender lens at every stage of scientific discovery.

That lens would sharpen what common sense already tells us: Women are different. To treat them as simply an extension or a subgroup of men's health -- or, worse, to exclude them altogether -- is to accept willful ignorance that virtually assures worse health outcomes for women. What we don't know is killing women. What we choose to learn can save them. National Wear Red Day is a fitting time to start.