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Women’s Health [Folder 2] [2]
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Melanne Verveer's Subject Files
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. paper
re: Clinotn Campaign Volunteer Activities (2 pages)
n.d.
Personal Misfile
002. letter
Tipper Gore to Phyllis (1 page)
10/27/1992
Personal Misfile
003. letter
Atul Gawande to Phyllis Greenberger (1 page)
11/05/1992
Personal Misfile
004. letter
Hillary Rodham Clinton to Phyllis Greenberger (1 page)
12/01/1992
Personal Misfile
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 6205
FOLDER TITLE:
Women's Health [Folder 2] [2]
2013-0534-S
rc1572
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
MAYOR DALEY'S TASK FORCE ON WOMEN'S HEALTH
URBAN WOMEN'S HEALTH AGENDA
A Project of the Department of Health of the City of Chicago
Richard M. Daley
Mayor
Maggie Daley
Honorary Co-Chair
Mayor Daley's Task Force on Women's Health
Sheila Lyne, RSM
Commissioner of Health
Co-Chair, Mayor Daley's Task Force on Women's Health
Hedy M. Ratner
Co-Chair, Mayor Daley's Task Force on Women's Health
This report was written for Mayor Daley's Task Force on Women's Health
by The Sive Group, Inc.
March 1994
PHOTOCOPY
PRESERVATION
THE FRST LADY
-
HILLARY -
I THINK IT WOULD BE A
GOOD IDEA AT THE CONCLUSION
of THIS DISCUSSION, FOR you
TO TAKE QUESTIONS FROM
THE PRESS FROM WHERE you
ARE sitting.
IT would BE A 10-MINUTE
PEESS AVAILABILITY THAT
WOULD BE OPENED By
HETY BATNER.
12 THIS OKAY? JUST NOD
YES OR NO TO ME.
LISA
I
05. 04. 94 03:55 PM *WOMEN $ HEALTH
P 0 1
HEALTH
OFFICE ON
PUTBLE SE RVICE SA
Women's Health
1798
PHS/OASH/OFFICE ON WOMEN'S HEALTH
HUMPHREY BUILDING, ROOM 730-B
200 INDEPENDENCE AVENUE, S.W.
WASHINGTON, D.C. 20201
PHONE: 202-690-7650
FAX: 202-690-7172
TO: FAX PHONE NO. 202 456-6244
PLEASE NOTIFY OR HAND-CARRY THIS TRANSMISSION TO
THE FOLLOWING PERSON AS SOON AS POSSIBLE:
NAME: Melanne Derver
OFFICE/ADDRESS:
TELEPHONE:
NUMBER OF PAGES TRANSMITTED (INCLUDING COVER): 18
FROM: Suranfrements /202/690-7650
NOTE:
Here are some materials we'n fregard to highlight
nomen's health accomplianests by The Administration
you got a chance. Manks, Smith
for This minsis events. qur me a call n
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P02
HIGHLIGHTS OF THE CLINTON ADMINISTRATION'S COMMITMENT TO
WOMEN'S HEALTH ISSUES
The United States has set an important precedent by being the first country in the
world to establish a senior level health position dedicated to redressing inequities in
the health care system that have put the health of American women at risk. Susan J.
Blumenthal, MD, MPA, a national leader and expert in women's health. has been
appointed the first Deputy Assistant Secretary for Women's Health within the
Department of Health and Human Services. In this role, she provides the lcadership,
direction and support for a comprehensive women's health agenda and coordinates
women's health policies and programs across agencies and offices of the Public Health
Service.
The National Action Plan on Breast Cancer represents this Administration's
commitment to improve research, services and education on and about breast health
and breast cancer. This plan provides an unprecedented opportunity to promote
public-private linkages in an effort to fight breast cancer as a serious threat to the
health of women today and in generations to come. Dr. Blumenthal's Office on
Women's Health is coordinating implementation of the action items outlined in the
National Action Plan on Breast Cancer.
The President's health care plan represents meaningful change for women's health.
Under this plan, every woman will have the security of insurance without regard to
where they live. where or if they work, their level of income or their health status. A
guaranteed basic package of preventive, diagnostic and treatment services is available,
emphasizing, for the first time, preventive care.
The 1995 Public Health Service budget includes a $1.8 billion request targeting
women's health programs, including increases in research, prevention and treatment
activities.
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P03
1700
FACT SHEET
Draft, May 1994
Women's Health Issues
In recent years, the heightened awareness of longstanding biases against
women-in terms of educational, economic, employment, and health-related
opportunities-has catalyzed an expanded focus on women's issues. In the
United States, the Department of Health and Human Services is pursuing a
comprehensive and meaningful agenda for women's health.
Background
Addressing the inequities in social, econom-
Women's health, in the fullest sense, incor-
ic, and health-related opportunities available
porates both the length and the quality of
to women is now a national priority. Wom-
women's lives and reflects the diversity of
en currently comprise 51 percent of the total
their social, cultural, economic, and physical
U.S. population, 60 percent of the U.S. pop-
environments. Unfortunately, women con-
ulation over age 65, and more than 70 per-
tinue to face serious threats to their physical
cent of the U.S. population over age 85.
and mental well-being in this country. For
Women now represent 45 percent of the
example, women who live in poverty and
Nation's workforce and approximately two-
have less than a high school education-
thirds of all employed women have children
many of whom are women of color-have
under age 18. Although women's employ-
shorter lifespans, higher morbidity and mor-
ment outside the home has become increas-
tality rates, and limited access to quality
ingly essential to economic survival of the
health care services. And despite living 8
family, women remain overrepresented in
years longer than men, women suffer poorer
lower wage, hourly, and part-time positions
health outcomes and greater disability from
(without health insurance coverage or other
disease than do men. Lack of attention to
work-related benefits) and continue to earn
women's health issues in both research and
only about 70 percent of what men earn for
clinical practices has resulted in serious
equivalent work. Furthermore, an increas-
gaps in knowledge about the causes, treat-
ing percentage of family households are
ment, and prevention of disease in women.
headed by single mothers, many of whom
are living below the poverty line.
05. 04. 94 03:56 PM *WOMEN'S HEALTH
P 0 4
Special Populations
Minority Women
Adolescents
Despite the social, economic, and cultural
Adolescence represents a time when women
diversity among minority women's groups,
make important choices about lifestyle be-
many of these women continue to suffer
haviors-including diet; physical activity;
disproportionately from premature death,
use of tobacco, alcohol, and other drugs;
disease, and disabilities. For example,
and sexual activity-all of which impact
minority women on average have lower life
their health and well-being throughout
expectancy rates; greater prevalence of
adulthood. A number of health-related con-
chronic illnesses such as cardiovascular dis-
ditions-such as eating disorders, violence,
ease, certain types of cancer, and diabetes;
unintended pregnancy, HIV/AIDS. and othe
and higher maternal and infant mortality
er sexually transmitted diseases (STD's)-
rates than do white women. Homicide and
often compromise the quality of life of
HIV/AIDS are rapidly growing problems
women during this life stage. There is
among black and Hispanic young adult
growing evidence that the socialization of
women in the United States. Socioeconomic
many young girls predisposes them to low
disadvantages contribute to the greater fre-
self-esteem, which in turn influences the
quency and severity of illness among minor-
development of depression, addictive be-
ity women, as evidenced by limited access
haviors, and other mental disorders.
to quality health care, lower utilization rates
for many preventive health services, and
Older Women
poor health status when compared to other
groups of women.
Although women live an average of 7 years
longer than men, they experience higher
Lesbians
rates of poverty, suffer more chronic health
conditions and disabilities, and are more
Lesbians encounter a number of barriers to
likely to live longer without the support of
affordable and effective health care, includ-
family and friends. Older women are less
ing the inability to share partner health ben-
likely than older men to have health insur-
efits, lower household income, and the
ance policies that supplement Medicare ex-
problems of homophobia and heterosexism
penses and have fewer resources that must
in the health care community. Adverse re-
extend over a longer life span. Although
sults of these and other barriers include
coronary heart disease is the leading cause
lower rates for preventive health screenings
of death among American women, evidence
as well as limited knowledge about the
shows that women undergo invasive cardiac
health status and health care patterns of
assessments and treatments less frequently
lesbians. Due to high self-reports for ciga-
than men. Preserving the functional inde-
rette smoking, alcohol use, excessive weight,
pendence of older women is especially chal-
and other risk behaviors, lesbians are at
lenging given their heightened risk of devel-
increased risk of developing cardiovascular
oping arthritis, osteoporosis, urinary inconti-
disease, cancer, and a variety of stress-
nence, and other chronic disabilities.
related conditions, including violence and
substance abuse.
PHS/Office on Women's Health
2
Women's Health Issues
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P05
Priority Women's Health Issues
leading cause of death among all women 15
to 24 years of age, and the leading cause
Maternal/Infant Health
among black women of that age. Suicide
Although the infant mortality rate in the
was the third leading cause of death among
United States has been brought to an all-
young white women that year. In addition,
time low, it is still higher than those of most
an alarming number of women of all ages
other developed countries. This is attrib-
are the victims of assaults, rapes, and other
utable to a number of factors, including lack
personal violence every year, often perpe-
of prenatal care; poor nutrition; use of
trated by their mates or someone they
tobacco, alcohol, and other drugs; and ado-
know.
lescent pregnancy. The problem is most
acute among black women; the mortality
HIV/AIDS
rate for infants of white mothers is 7.6
HIV infection/AIDS is a rapidly growing
deaths per 1,000 live births and for infants
problem among women. Women now com-
of black mothers it is 18 deaths per 1,000
prise the fastest growing group of AIDS
live births. In addition, minority women
patients; from 1991 to 1992 the increase in
are at higher risk of maternal death than are
the proportion of women reported to have
white women.
AIDS was almost four times the increase
among men-9.8 and 2.5 percent, respec-
Reproductive Health
tively. Approximately 75 percent of women
In recent decades, there has been a tremen-
with AIDS are black or Hispanic. In 1992,
dous growth in the number of live births to
for the first time, more women were
unmarried women, many of whom are ado-
infected with HIV through heterosexual
lescents. Between 1980 and 1990, the per-
contact than through intravenous drug use.
centage of live births to unmarried women
increased steadily from 18 to 28 percent.
Sexually Transmitted Diseases
The majority of these births are occurring
In part because young women and men
among women who have the least amount
have become sexually active earlier and are
of economic security: adolescent and minor-
more likely to have multiple sex partners,
ity women. In 1991, contraception was used
the incidence of STD's among adolescent
by 81 percent of sexually active women
and young adult women in the United
aged 15 to 19. However, of the approxi-
States is rising. Chlamydia, the most com-
mately 1.1 million women 15 to 19 years of
mon treatable STD in the United States,
age who become pregnant each year, 85 per-
causes an estimated 2.4 million new cases
cent do not intend to get pregnant. In 1990,
among women each year. Gonorrhea affects
the number of abortions reported to the
an estimated 400,000 women each year.
Centers for Disease Control and Prevention
Syphilis has increased significantly among
(CDC) was 1.43 million, up from approxi-
women over the past decade; in 1991, nearly
mately 1.3 million in 1980.
20,000 cases of syphilis occurred among
women, 85 percent of whom were black.
Violence
The impact of STD's is particularly severe
Violence has become a critical health issue
for women because infections often have
for young American women and is in fact
few, if any, symptoms and may go
more pervasive than statistics indicate
untreated until serious problems develop.
because incidences are widely under-
reported. In 1991, homicide was the second
PHS/Office on Women's Health
3
Women's Health Issues
05. 04. 94 03:55 PM *WOMEN'S HEALTH
POS
Mental Health Issues
Cancer
Mental health is crucial to women's well-
Since the late 1980's, lung cancer has been
being and the performance of life's tasks.
the leading cause of cancer death among
Some of the most common mental disorders,
women in the United States. In the past 30
including depression and anxiety disorders,
years, the lung cancer death rate among
strike approximately twice as many women
American wom has increased nearly 400
as men. According to the 1989 National
percent, almost exclusively due to cigarette
Health Interview Survey, the rate of serious
smoking. Estimates are that by 1995, nearly
mental illness (i.e., any mental disorder
half of the women in the world who die
present during the past year that seriously
from cigarette smoking will be American
interfered with one or more aspects of a
During the 1990's, approximately 2 million
person's daily life) was higher in women
women will be diagnosed with breast or
than men (20.6 compared with 15.5 per
cervical cancer and over one-half million
1,000 persons). The lifetime risk for major
women are expected to lose their lives from
depressive disorder is 20 to 25 percent for
these two diseases. It is estimated that one
women, compared with 7 to 12 percent for
in eight American women will develop
men, It is believed that a complex combina-
breast cancer in her lifetime. As is the case
tion of physiological, social, environmental,
with many other diseases, women of color
cultural, biological, and psychological fac-
have higher mortality rates for both breast
tors contribute to why women experience
and cervical cancer.
depression at a higher rate than men.
Women who have a history of substance
Cardiovascular Disease
abuse or physical or sexual abuse are partic-
Heart disease is the number one killer of
ularly at risk for depression.
American women. Nearly one in two
female deaths in the United States is a result
Substance Abuse
of cardiovascular diseases. Women develop
The abuse of alcohol and other drugs is a
heart disease later in life than men.
serious and growing problem among Ameri-
Approximately 1 in 9 women between the
can women. In 1990, nearly one-third of
ages of 45 and 54 has some clinical cardio-
Americans who abused alcohol were
vascular disease; the rate climbs to 1 in 3 at
women, and surveys indicated that more
age 65 and older. Forty-nine percent of
than 5 million women used drugs at least
women who have heart attacks die within a
once in the preceding month. Many women
year (versus 31 percent of men).
who abuse drugs or alcohol have histories
of sexual or physical abuse, thus compound-
Chronic Disabling Conditions
ing their problems in obtaining adequate
treatment. Women who abuse alcohol or
In large part because they live longer than
drugs are at higher risk for tuberculosis,
men, women are more likely to be affected
HIV/AIDS, and other sexually transmitted
by chronic disabling conditions such as dia-
diseases. Women's substance abuse may
betes, osteoporosis, osteoarthritis, obesity,
affect not only their own social and physical
urinary incontinence, and Alzheimer's dis-
well-being but, in the case of pregnant
ease. These conditions not only limit func-
abusers, that of their children as well.
tion but may be life-threatening: diabetes
mellitus, for example, is among the top 10
leading causes of death for all women aged
25 and over.
PHS/Office on Women's Health
4
Women's Health Issues
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P07
HHS Actions
national leadership positions that impact
women's health and quality of life.
As part of its overall mission to promote
and protect the Nation's health and to pro-
Among the steps taken to achieve these
vide essential human services, HHS is pur-
goals has been the appointment of the
suing a comprehensive agenda for women's
Deputy Assistant Secretary for Women's
health. Through its agencies and offices,
Health at HHS, who, through the Public
and in coordination with other Government
Health Service's (PHS) Office on Women's
agencies and national and international
Health (created in 1991), provides leader-
organizations, HHS is undertaking a range
ship and direction for the women's health
of activities to promote the health of women
agenda. The establishment of the Office of
across the lifespan, to empower women to
Research on Women's Health (1990) at the
make informed choices about their health,
National Institutes of Health (NIH) and the
and to translate policy decisions into effec-
Office for Women's Services (1992) at the
tive women's health programs.
Substance Abuse and Mental Health
Services Administration also indicates the
HHS has established the following goals,
increased awareness of the specialized needs
which provide a framework for the Depart-
of women.
ment's efforts in women's health:
A cornerstone of the Clinton Administra-
To support comprehensive, community-
based health promotion/disease preven-
tion's health care reform plan is the Health
tion programs for women.
Security Act, which guarantees coverage to
all women regardless of health status, mari-
To promote access to a full range of
tal status, employment status, or ability to
gender-appropriate and culturally sensi-
pay. This legislation provides a comprehen-
tive health care services for women of
sive package of benefits, including clinical
preventive services, reproductive health
all ages, all racial and ethnic back-
services, school health education services,
grounds, and all socioeconomic and edu-
cational levels.
long-term care services, inpatient and out-
patient services, and a variety of mental
health and substance abuse treatment
To strengthen and sustain research on
services.
diseases, disorders, and conditions
affecting women and to strengthen and
All PHS agencies with a focus on research-
sustain research on methods to improve
Agency for Health Care Policy and
access to and quality and effectiveness
of health services for women.
Research, CDC, Food and Drug Administra-
tion (FDA), and the NIH-have enacted
To educate and inform women about
policies to ensure that women are included
relevant health issues and activities.
in HHS-sponsored clinical research grant
solicitations. The following PHS agencies
are involved in activities related to women's
To support health professional training
health.
in the recognition and management of
women's health conditions.
The Agency for Health Care Policy and
Research improves the effectiveness of
To promote the appointment of women
health care services for women through
to departmental, national, and inter-
scientific research programs (maternal-
PHS/Office on Women's Health
5
Women's Health issues
05. 04. 94 03:55 PM *WOMEN S HEALTH
P08
infant health, hysterectomy, breast and
women in such areas as reproductive
cervical cancer screening, etc.) and
health, cancer, diabetes, maternal-infant
through the development of clinical
health, and substance abuse. Pap smear
practice guidelines (cancer-related pain,
registries with a tracking system and
depression, early HIV infection, mam-
screening mammography services have
mography determinants, etc.).
been made a ilable in all IHS areas.
The CDC supports numerous health pro-
The Substance Abuse and Mental Health
motion and disease prevention programs
Services Administration's (SAMHSA)
for women. Recent programs have
Office for Women's Services identifies
focused on breast and cervical cancer,
the need for women's substance abuse
HIV/AIDS and other sexually transmit-
and mental health services, recommends
ted diseases, tobacco use, violence,
policy, and promotes collaboration
reproductive health, and the health of
among the three SAMHSA centers focus-
older women.
ing on mental health services, substance
abuse prevention, and substance abuse
The FDA focuses on such issues as par-
treatment. In particular, SAMHSA
ticipation of women in early clinical
works to ensure that the needs of minor-
trials, the safety of breast implants, the
ity women are addressed. It has identi-
need for contraceptive products that pro-
fied six priority issue areas for women:
tect against sexually transmitted diseases
physical/sexual abuse, women as
including AIDS, and the prevention of
mothers/caretakers, HIV/AIDS, aging
neural tube defects through increasing
women, women in the criminal justice
women's folic acid intake. FDA is
system, and multiple diagnosis-multi-
implementing the Mammography
ple mental health and substance abuse
Quality Standards Act, which ensures
problems.
the availability of and access to quality
mammograms. FDA also distributes
The Office of Research on Women's
consumer articles on women's issues.
Health at the NIH works to strengthen
research on disease and other problems
The Health Resources and Services
that affect women, to ensure that
Administration helps underserved and
research conducted and supported by
minority women through health educa-
NIH adequately addresses women's
tion projects and health care provider
health issues, to ensure that women are
training and by increasing access to pri-
represented in NIH-supported biomedi-
mary and preventive health care for
cal and behavioral studies, and to
women at community and migrant
develop opportunities for the recruit-
health centers. Prevention of HIV/AIDS
ment and advancement of women in
among minority women is a key focus of
biomedical careers.
activities like the Training of Trainers
Program, Early Intervention Strategies
NIH's Women's Health Initiative is the
under the Ryan White CARE Act, and
largest clinical trial in U.S. history. It
Advanced Nursing Education Grants.
focuses on diseases that are major causes
of death and disability among women-
The Indian Health Service (IHS) pro-
heart disease, cancer, and osteoporosis.
vides health care services and assistance
The multiyear initiative attempts to
to American Indians and Alaska Native
redress the vast inequities that exist in
PHS/Office on Women's Health
6
Women's Health Issues
05. 04. 94 03:55 PM *WOMEN' S HEALTH
P09
research including women and seeks to
For Further Information
provide practical information to women
and their physicians about hormone
Office on Women's Health
replacement therapy, dietary patterns
U.S. Public Health Service
and supplements, and exercise.
Humphrey Building, Room 730B
200 Independence Avenue, SW
Conclusion
Washington, DC 20201
(202) 690-7650
The Department of Health and Human
Services' goals for women's health are pro-
Office of Research on Women's Health
viding a solid foundation within which to
National Institutes of Health
implement meaningful P licies and pro-
9000 Rockville Pike, Bldg. 1, Room 201
grams in numerous areas, including com-
Bethesda, MD 20892
munity-based prevention and treatment
(301) 402-1770
programs, research on women's health
issues and services, education and informa-
Office for Women's Services
tion dissemination, and professional training
Substance Abuse and Mental Health
in women's health issues. Through a com-
Services Administration
bination of leadership, creativity, and deter-
5600 Fishers Lane, Parklawn Bldg.,
mination, HHS is working to realize a
Room 13-99
healthier future for all women in the United
Rockville, MD 20857
States.
(301) 443-5184
***
PHS/Office on Women's Health
7
Women's Health Issues
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P10
May 1994
DRAFT #2
WOMEN'S HEALTH PROGRAMS AND ACTIVITIES
Office on Women's Health
Public Health Service
U.S. Department of Health and Human Services
OVERVIEW
The Clinton administration is committed to &
comprehensive, equality-minded approach to women's
health. Key examples include:
*
Susan J. Blumenthal, MD, MPA has been appointed
the first Deputy Assistant Secretary for Women's
Health, a senior level health position created by
the Administration to redress inequities in the
health care system which have put the health of
American women at risk.
Women's health concerns are at the center of the
comprehensive benefits package included in the
Health Security Act.
w
The National Action Plan on Breast Cancer provides
an unprecedented opportunity to promote public-
private linkages in an effort to fight breast
cancer as a serious threat to the health of women.
*
The Administration's 1995 Public Health Service
budget request sets aside $1.8 billion for
programs directly targeting the health of women,
reflecting a $145 million (9%) increase over FY
1994 funding. This budget request includes
increases for breast cancer research, funding of
the National Action Plan on Breast Cancer,
research on female-controlled chemical barriers
against HIV infection, as well as other research
on health conditions affecting women. It includes
an increase in the HRSA Family Planning Program
that provides contraceptive and pregnancy services
and routine gynecological screening to low income
women.
BACKGROUND
*
Medical research has often short-changed women.
Heart disease is number one cause of death of women; women
1
05. 04. 94 03:55 PM *WOMEN'S HEALTH
P 1 1
are dying in increasing numbers from lung and breast cancer
and AIDS.
*
More women aren't getting necessary health care because they
have inadequate insurance or none at all.
*
Domestic violence affects millions of women.
Minority and older women receive inadequate care.
INITIATIVES AND ACCOMPLISHMENTS:
The United States has set an important precedent by being
the first country in the world to establish a senior level
health position dedicated to redressing inequities in the
health care system which have put the health of American
women at risk. Susan J. Blumenthal, MD, MPA, a national
leader and expert in women's health, has been appointed the
first Deputy Assistant Secretary for Women's Health within
the Department of Health and Human Services. In this role,
Dr. Blumenthal provides the leadership, direction and
support for a comprehensive women's health agenda, and
coordinates women's health policies and programs across
agencies and offices of the Public Health Service.
The Administration's Health Security Act guarantees
comprehensive health services, including clinical preventive
services and reproductive health care, to all women
regardless of their health, ability to pay, or marital or
employment status.
All PHS agencies with a focus on research--including the
NIH, FDA, CDC and AHCPR-have enacted policies to ensure
that women are included in HHS-sponsored clinical research
programs.
In 1993, the FDA revised its 1977 guidelines to include
women in early phase drug testing.
The NIH Office of Research on Women's Health, whose mission
is to strengthen research on women's health issues, was
signed into law in 1993. The 1995 budget request for the
office is $16.7 million, a 48 percent increase over the
previous year.
The Substance Abuse and Mental Health Services
Administration supports an office for Women's Services,
which ensures that the substance abuse and mental health
needs and services of women are appropriately addressed.
The FDA plans to establish an Office of Women's Health to
2
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advance the agency's women's health agenda. An FY 1995
budget request of $2 million was made to fund this office.
National Action Plan on Breast Cancer:
HHS Secretary Donna Shalala convened a national conference
on breast cancer in December 1993 to develop a comprehensive
plan to research, health care and policy issues pertaining
to the eradication of breast cancer. The outcome of this
conference--the National Action Plan on Breast Cancer--
affirms the importance of public-private collaborations to
fight breast cancer and promote breast health. The Deputy
Assistant Secretary for Women's Health, who heads the PHS
Office on Women's Health, is responsible for coordinating
the implementation of action items outlined in the National
Action Plan on Breast Cancer. This will involve the
participation of representatives of consumer, health care
professional and scientific organizations as well as the
Federal Government.
The NIH Women's Health Initiative, the largest clinical
research study ever conducted in either men or women, has
begun to examine the major causes of death, disability and
frailty in post-menopausal women: heart disease, breast and
colon cancer and osteoporosis. This multiyear study will
examine the effect of dietary patterns and supplements,
exercise, hormone replacement therapy and other
interventions on the prevention of these major disorders in
women.
The President signed into law the Family and Medical
Leave Act.
President Clinton issued an Executive Order lifting the ban
on abortion counseling by Title X (family planning) program
grantees.
The Administration worked to have provisions on violence
against women included in the crime bill Congress has
allocated more than $7 million to the CDC to launch an
initiative on domestic violence.
HHS held the first National Minority Women's Conference on
the Status of Health in April 1994 and scheduled the first
National American Indian and Alaskan Native Conference
on the Status of Women's Health for May 1994.
BREAST CANCER
The disease kills 46,000 women a year and is expected to
strike one in eight women compared to one in 20 women just
two decades ago; the annual incidence of the disease has
3
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increased about 52 percent during 1950-1990.
Breast cancer is an especially high-risk disease for older
women, minority and low-income women.
Thirty-eight percent of women over the age of 40 fail to
have breast cancer screening.
HHS actions include:
*
development and implementation of the National Action
Plan on Breast Cancer, a goal-driven blueprint for
stimulating public-private linkages on health care,
research and policy issues related to breast cancer and
breast health. The PHS Office on Women's Health is
coordinating implementation of action items outlined in
the National Action Plan on Breast Cancer.
w
an FY 1995 budget request that includes $387 million
for breast cancer research, 29 percent over FY 1994.
$10 million in the FY 1995 NIH budget request for
implementation of the Secretary's Breast Cancer
Action Plan, which calls for a wide range of
immediate actions to make progress against the disease.
another FY 1995 budget request for $20 million to continue
implementation of FDA's 1992 Mammography Quality Standards
Act, which ensures all women access to safe and effective
mammography services.
another request for 46.9 million for CDC's State
Breast Cancer Screening and Education program.
another request for $320 million for Medicare
coverage of mammograms.
HEART DISEASE
*
Heart disease is the number one cause of death among all
women and accounted for more than 30 percent of all deaths
among women in 1991.
MHS actions include.
the largest clinical trial in U.S. history -- part of
NIH's Women's Health Initiative -- which includes
studies of the effect of a low-fat diet and hormone
replacement therapy on preventing coronary heart
disease in post-menopausal women.
4
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assuring through the NIH's Office of Research on
Women's Health that women are appropriately represented
in NIH-supported research, including studies on
cardiovascular disease in women.
MATERNAL AND CHILD HEALTH
About 16 million women and nearly 10 million of their
children lack access to primary health care services.
While infant mortality in the nation is lower than ever, it
is still higher than in most developed countries because of
a lack of prenatal care, poor nutrition, drug use and
adolescent pregnancy.
There are 17.6 deaths per 1000 births of black infants
compared to 7.3 deaths per 1000 births of white infants.
HHS actions include
HRSA's provision during 1993 of primary care services
to some four million low-income women and more than
eight million children, including the homeless and
those in public housing.
production in 1993 of HRSA's "Health Diary." the
Maternal and Child Health Bureau handbook for expectant
parents with advice on prenatal and infant care.
an FY 1995 budget request for increases in NIH research
in contraception/reproductive and pregnancy health.
FAMILY PLANNING
Sexual activity rates among females aged 15-19 rose
from 29 percent in 1970 to 42 percent in 1980. The
rate for this age group among males rose from
66 percent in 1979 to 76 percent in 1988. These
trends are creating upturns in unintended pregnancies
and sexually transmitted diseases.
Births to unmarried adolescents 15 to 19 years rose from
29.5 percent in 1970 to 68.8 percent in 1991.
HHS actions include
*
an FY 1995 budget proposal to create a new Office of
Adolescent Health.
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OFFICE ON
PUBLIC S.A. HEALTH RICE SE
Women's Health
1798
PHS/OASH/OFFICE ON WOMEN'S HEALTH
HUMPHREY BUILDING, ROOM 730-B
200 INDEPENDENCE AVENUE, S.W.
WASHINGTON, D.C. 20201
PHONE: 202-690-7650
FAX: 202-690-7172
TO: FAX PHONE NO. 302-456-6244
PLEASE NOTIFY OR HAND-CARRY THIS TRANSMISSION TO
THE FOLLOWING PERSON AS SOON AS POSSIBLE:
NAME: Melenne Derver
OFFICE/ADDRESS:
TELEPHONE:
NUMBER OF PAGES TRANSMITTED (INCLUDING COVER): 18
FROM: /202/691-7650
NOTE:
Here are sime materials we'n prepard to highlight
women's health accompliaments by me Administration
you get a chance. Manks, Smith
for Than works wints. qur me a call
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States who either abuse alcohol or are alcohol-dependent.
HHS actions include.
#
two new residential treatment programs established by
SAMHSA in FY 1933, one for pregnant and postpartum
women, the other for high-risk women and their
children.
a substance abuse prevention demonstration program
established by SAMHSA in FY 1994 focusing on adolescent
women.
n
a National Women's Resource Center funded in FY 1994
to provide information and referral services on
substance abuse throughout the life cycle. The
Center is sponsored by a number of HHS offices and
agencies.
WOMEN AND MENTAL HEALTH
*
Women are twice as likely as men to experience certain
mental illnesses, including depression and panic disorders,
and also suffer more often from phobias and eating
disorders.
One in seven women will be clinically depressed in her
lifetime.
HHS actions include
*
an estimated $66.2 million during FY 1994 for NIH
research on mental illnesses that affect women.
PHS Office on Women's Health co-sponsorship of the
"Promoting Healthy Behaviors in Young Women" Conference
with the Society for the Advancement of Women's Health
Research.
WOMEN AND SMOKING
*
Since 1990, more women die each year from lung cancer than
from any other cander, including breast cancer.
#
Twenty-two million U.S. women 18 and older (23.5 percent)
are smokers.
HHS actions include.
W
CDC funding of a 1994 conference on women and smoking
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that will convene a national network of women leaders.
WOMEN AND AIDS
Women are the fastest growing population with HIV infection
today -- new cases usually result from heterosexual
transmission.
*
AIDS is now the fifth leading cause of death in women aged
25 to 44.
*
Low-income women face major barriers to HIV health and
support services.
HHS actions include...
*
an increase in AIDS funding by 17 percent.
*
a Public Health Service Task Force to
recommend guidelines for the use of AZT in the
treatment regimen of HIV-positive women to prevent
transmission of the virus from mother to child.
*
a CDC Prevention Marketing Initiative for AIDS that
includes public service announcements targeted to
18- to 25-year-old women and men.
*
Health and support services provided through the Ryan
White CARE Act to disadvantaged women infected with
HIV.
MINORITY WOMEN
*
In 1991, the death rate from breast cancer was 31.9 percent,
19 percent higher than for white women.
*
In 1992, AIDS cases per 100,000 population were much higher
among black and Hispanic women than among white women.
*
Minority women are at a higher risk of maternal death than
white women.
HHS actions include..
*
ensuring that grantees under the Ryan White CARE Act of
1990 develop accessible services for disadvantaged
women with HIV/AIDS.
*
an FY 1995 budget request of $2.5 million to fund the
8
05. 04. 94 04:17 PM *WOMEN $ HEALTH
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AHCPR "Patient Outcome Research Team" project to
evaluate ways to prevent low birthweight among infants
of minority and high-risk women.
a wide range of health care services to American
Indians and Alaska Native women by the Indian Health
Service.
health education projects for women of color sponsored
by the PHS Office on Women's Health.
PHS Office on Women's Health co-sponsorship of the
Healthwatch Symposium: "Beating the Odds: Challenges to
the Health of Women of Color," New York Academy of
Sciences.
HEALTH CARE REFORM
The President's Health Security Act provides comprehensive
preventive and medical services to every woman across her life
span regardless of employment, marital or health status.
Specifically, it:
eliminates discriminatory exclusions for pre-existing conditions
and lifetime caps.
*
guarantees free preventive services, including periodic health
examinations, screening mammograms, pap smears, cholesterol
checks and immunizations.
guarantees coverage for reproductive and family planning
services.
*
will include longterm care, which will benefit older women
and women caregivers.
*
will remedy the unjust situation of only 40 percent of
working women receiving insurance through employers compared
to 59 percent of working men.
will include more research on women's health issues.
###
9
file
Women's Checklist For Health Care Reform
The Health Care Security Act Meets The Criteria
Universal Coverage
NOT dependent upon health status or health history
NOT dependent upon marital status, employment status or ability to pay
Discounts for low income families
Comprehensive Benefits
No lifetime limits: no pre-existing condition exclusions
Coverage for preventive care and prescription drugs
Expanded sites for care
Preventive Health Care
Emphasis on regular check-ups. early diagnosis and treatment
Clinical preventive services for high-risk populations: age-appropriate
immunizations. tests, and clinical visits
Screening for breast and cervical cancer including routine mammograms, pap smears
and pelvic examinations
Quality/ Choice
Annual "report cards" of health care providers and health care plans including
important consumer information: e.g., percentage of women who receive
mammograms. number of babies delivered by Caesarean Section
Option to change health care plans once a year
Reproductive Health Care
Full-range of pregnancy-related services
Family planning services
Screening for sexually transmitted diseases
Medical Research Investments
Increases funding for prevention research at the National Institutes of Health.
Research priorities on women's health care concerns including osteoporosis and breast
cancer
Long Term Care
Home and community-based long-term care initiatives
Expansion of nursing home coverage
Increased quality and affordability of private long-term care insurance
WOMEN'S HEALTH
Women face serious obstacles to health care services in today's
system. Women are less likely to have employer-based health coverage,
and less likely to receive necessary care throughout the year, yet they
typically pay more out of pocket for health care than do men. Women
increasingly suffer from life-threatening illness such as breast and
ovarian cancer, yet women's health concerns have traditionally
anchored the bottom of our medical research agenda.
Women make up a larger portion of the population holding part-time
jobs and clerical or sales jobs--jobs which often don't offer health
insurance to employees.
Women tend to live longer and require more long-term and home
health services, but home care is often not available or affordable.
Many women get health insurance through their spouse, and risk of
being dropped if they divorce or if they are widowed.
The President's plan addresses women's health aggressively and
comprehensively, guaranteeing all women coverage, regardless of whether
they are healthy or sick, married or single, working or unemployed, wealthy
or low income. And the President's approach will provide unprecedented
coverage of preventive care, including mammography. It will cover a whole
schedule of preventive screenings, tests and check-ups at no cost: protection
available in only a few of today's insurance policies.
Universal Coverage for Private Insurance
Under the Health Security Act, all women will be guaranteed coverage
regardless of health status, marital status, employment status, or
ability to pay.
Women will be guaranteed a comprehensive package of benefits that
will include hospital care, medical services, pap smears, diagnostic
services, and prenatal care. It will also include prescription drugs,
including oral contraceptives, and the full range of reproductive health
services.
Women's Health
Page 2
Preventive Health
Preventive services included in the comprehensive benefits package
are provided at ages specified by the report of the U.S. Preventative
Services Task Force. These recommendations can be modified by the
National Health Board as new information becomes available.
These services include a schedule of preventive screenings, tests, and
checkups covered in only a few of today's health insurance policies, and
include regular clinical exams, Pap smears, mammograms and other
preventive services.
The comprehensive benefits package will also include coverage of
mammograms for all women who need them, and free coverage for
mammograms every two years for women over age 50--no matter
which health plan --as an extra incentive for those most at risk. (see
attached)
Supports Women's Health Research
New research initiatives will concentrate on child health (including
birth defects, prenatal care, and adolescent health), and illnesses that
primarily strike women -- including breast cancer, ovarian cancer, and
osteoporosis.
Medical research initiatives will be expanded to include efforts to
isolate and cure diseases that are prevalent among women, such as
breast cancer and cervical cancer.
Expansion of Home and Community-Based Long-Term Care Services
The addition of a new home and community-based long-term care
program and the expansion of nursing home coverage will help reduce
the undue burden born by many women caregivers.
Coverage of Mammograms and Other Preventive Services under The Health
Security Act:
Coverage for all women:
Women of any age can receive clinical breast exams and mammograms at
any time when the patient and doctor feel it is medically necessary or
appropriate, and will pay a standard co-pay (for example, ten dollars) set
by their plan.
Extra coverage for women at risk:
Women of any age who are defined to be at risk of breast cancer will
receive additional visits, including clinical breast exams and
mammograms, with no cost sharing.
Additional coverage of mammograms:
For certain age groups, at certain intervals, mammograms are free of any
cost sharing, so there is no charge when a woman goes to the doctor for
these services.
As part of the preventive services package, all women age 50 and older
would have routine mammogram screening every other year, free of
charge. Again, any woman who needs more frequent mammograms would
be covered, and would pay a co-pay.
Additional coverage of clinician visits:
Clinician visits, including clinical breast exams, are covered for all
women, and additional coverage is available for women in certain age
groups. Clinician visits are free once every three years for women age 20-
39, and every other year for women from 40-64.
New investments in combating breast cancer
This year, the National Institute of Health's breast cancer research
budget increased by 44 percent, from $208 million to almost $300 million.
Under reform, new research initiatives will concentrate on the prevention
of illnesses affecting women, including breast cancer, mental health,
reproductive health and osteoporosis.
May,1994
QUESTIONS AND ANSWERS
1) Doesn't the Clinton plan add more layers of government
bureaucracy?
No. The President specifically rejected a government-run system in favor
of guaranteed private insurance. America basically faces 3 choices:
government insurance for everybody
guaranteed private insurance (the President's approach)
leaving people without insurance
The President's approach is guaranteed private insurance. Everyone will
have comprehensive coverage that can never be taken away.
2) But what about these so-called "alliances"?
The purpose of them is very simple -- to give bargaining power to small
businesses and individuals and take it away from the insurance companies.
Today, the deck is stacked against small businesses and individuals. Small
businesses are paying 35% more than big business for the same insurance,
and individuals pay even more.
So we have these consumer-controlled alliances to allow people and small
businesses to band together and get more consumer clout in the
marketplace. Consumer-controlled -- that's the President's idea, not
government-controlled.
Now, Congress will figure out exactly how they should be structured, but
this is an idea that has bipartisan support. The insurance companies don't
like it because it means they have less power, but that's what alliances are
intended to do. And that's why the insurance industry is spending millions
to weaken or destroy the idea.
3) One of those TV ads says that the President's plan will limit my
choice of doctor. Is that true?
No, it's not. You'll be able to choose your own doctor and health plan.
In fact, to make sure that you get the high-quality care you deserve, the
President's approach actually increases the choices most consumers will
have. Because you will choose your doctor and health plan -- your boss
won't and the insurance company won't. So you can choose any doctor
and health plan in your community. Remember who's paying for these
ads: the insurance companies -- who are trying to scare you and preserve
their profits.
4) Won't this plan mean that I'll pay more and get less?
No. In fact, the independent Congressional Budget Office (CBO) analysis
that the Republicans praised said that the President's plan would cost
Americans less money and give them more health benefits. Young,
healthy people may pay a little more -- but that's because we're
prohibiting the insurance companies from charging older people more than
younger people.
Under the President's approach, you'll be guaranteed affordable insurance
you can depend on. We'll make it illegal for insurance companies to jack
up your rates or drop you if you get sick, use lifetime limits to cut off
your benefits, or take away your benefits. The insurance companies won't
be allowed to bleed you dry.
And the President's proposal calls for comprehensive benefits, including
preventive care and prescription drugs. Under the President's approach, no
one -- not your boss, not your insurance company -- can take those
benefits away.
5) Won't your employer mandate cause massive job loss and cause
thousands of small businesses to go bankrupt?
There is no credible evidence to support that claim. The independent
Congressional Budget Office (CBO) analysis that the Republicans praised
said that the Clinton plan would not result in the loss of jobs, and would
benefit all small businesses.
Studies predict that there will, in fact, be job gains as a result of the plan.
The Economic Policy Institute predicts 258,000 manufacturing jobs
created over the next decade, Lewin-VHI, a widely-respected, bipartisan
firm, predicts over one million jobs created by providing long-term care,
and the Employee Benefit Research Institute predicts that the President's
proposal could produce as many as 660,000 jobs.
The President specifically designed his proposal to help small businesses -
- the biggest victims of today's health care crisis. Small business owners
will be able to get rock-solid, comprehensive coverage for their families
and employees. And no longer will they be subject to insurers jacking up
their rates or dropping their coverage when one employee gets sick.
Because those insurance company abuses will be illegal.
6) Why do we need an employer mandate anyway?
If we want to guarantee every American health insurance, we've got to
figure out how to achieve that goal. The President believes every job
should come with health benefits. Most jobs do today because most
employers accept this responsibility to provide worker health benefits.
And yet 8 out of 10 Americans who have no insurance are in working
families. We want everyone to have health benefits guaranteed at work.
And under the President's approach, the government will provide
discounts for small businesses, help cover the unemployed, and continue
Medicare for older Americans. That's how we'll cover everybody.
7) When you try to cut costs and limit the amount premiums can
rise, won't that just lead to rationing?
Absolutely not. The key to this is insurance company premiums can't
continue to rise unchecked. Your money will go to buying you the highest
quality of care and service, not padding the insurance company red tape.
That's why there's a limit on how much insurance companies can raise
your rates. In fact, it will be illegal for insurance companies to drop your
coverage or take away your benefits. You'll be guaranteed affordable
insurance you can depend on.
The President's approach is all about keeping you healthy. You'll have the
right to choose your own doctor and health plan. We want to make sure
you get high-quality care by giving you the choice, not your boss or
insurance company.
8) I've got good insurance. What's in this plan for me?
First -- and most important -- you'll get something that no amount of
money can buy in today's insurance market: guaranteed private insurance.
Comprehensive coverage that can never be taken away. Second, you, not
your boss or insurance company, have the choice of doctor and health
plan to make sure you get the high-quality care you deserve.
Third, unfair insurance company practices will be outlawed. 3 out of 4
insurance policies -- that's 133 million people -- have these lifetime limits
which mean that your coverage could be cut out just when someone in
your family is sickest. No more. No more jacking up prices when you get
sick. You'll have affordable insurance you can depend on. Fourth, we
protect Medicare. We'll cover prescription drugs under Medicare, and give
new options for long-term care in the home and community. And fifth,
everyone will have health benefits guaranteed at work, with the
government providing discounts to small businesses and the unemployed.
Even if you lose your job, you will never have to worry about losing
benefits or being forced to change doctors.
9) Is it true that my doctor can be fined $10,000 for treating me
outside the system?
A: No, that's not true. You can see any doctor you want and pay for any
procedure or treatment. The $10,000 fine refers to the President's
crackdown on insurance company fraud. Fly-by-night insurance companies
will be fined if they try to dupe you by selling you "supplemental"
benefits that you're already guaranteed by law.
[Note: By law, you'll be guaranteed the right to pay to see any doctor in
the country, even if you are in an HMO.]
10) What's going to happen to my Medicare benefits?
A: Older Americans who receive Medicare will continue to receive all the
benefits you do today. And you'll keep the doctor you now have. In
addition, we'll strengthen Medicare by adding prescription drug coverage.
Older Americans will also benefit from new long-term care options in
their homes and communities, where they want to receive care.
11) What happens if the money runs out?
A: Today, when insurance companies go out of business, patients get
struck without health care, and doctors don't get paid. The President's
approach prevents that. It bans fly-by-night insurers, forcing the insurance
industry to set aside funds to protect against bankruptcy or failure.
THE FIVE BIGGEST LIES
ABOUT THE PRESIDENTS HEALTH CARE APPROACH
Lie #1: The President wants a government takeover of the health care system.
Truth: The President specifically rejected a government-run system. His
approach builds on the current system, preserving what's right and fixing what's
wrong. It's the least disruptive approach. building on today's system, where 9 out
of 10 people get their insurance through their employer.
He wants guaranteed private insurance for every American. And his approach
would make two critical changes. First, it would guarantee comprehensive
benefits that can never be taken away. And second, it would provide greater
power for consumers and small businesses to choose quality health insurance at
lower cost.
Lie #2: The President wants the government to choose your doctor and health
plan.
Truth: You will be able to choose your own doctor and health plan. In fact, our
approach actually increases the choices most consumers will have. Under the
Clinton approach, all Americans will be able to choose from several kinds of
health plans, no matter where they work. And everyone will have the option of a
traditional fee-for-service plan, where you go to any doctor you want and pay
individually for each test or procedure. And people will be able to switch plans
every year if they're not satisfied with their care or service.
In fact, it's today's health care system that is limiting people's choices. In 1988
89% of employers offered fee-for-service plans but, by 1993, this number had
dropped to 65%. ["1992 Health Care Benefits Survey", Foster Higgins, 1992;
"Health Benefits in 1993", KPMG Peat Marwick]
Lie # 3: Price controls will cause rationing,
Truth: The President specifically rejected price controls. His approach does
include a limit on how much insurance companies can raise premiums year to
year. And the insurance companies are trying to scare you because that would
limit their freedom to jack up rates. Rationing is a classic scare tactic; but
experience shows that you can control health care costs and provide quality care.
This debate is about insurance companies that want to keep picking and
choosing whom to cover or drop, and when to increase rates. The Clinton
approach puts people in charge. It will be illegal for insurance companies to
drop you, refuse you, or jack up rates because of your medical history or age.
Lie #4: The new system will be a bureaucratic nightmare.
Truth: Nothing could be more complex than what we have now. Today's
patchwork system is the result of insurance companies competing to cover only
the healthiest people.
The important thing is what happens to the consumer and the Clinton approach
will make life easier for people. You'll know what you're getting without having
to read insurance company fine print. And you'll have a Health Security Card
and fill out one standard claims form -- without all the insurance company red
tape -- when you go to the doctor's office. The Washington Post says the
Clinton approach will create a "surprisingly simple" world for consumers.
Lie #5: Reform will be a job-killer.
Truth: High health costs today are killing businesses, large and small. The
Clinton approach will help businesses compete by bringing costs under control.
The Wall Street Journal called the Clinton approach "an unexpected windfall"
for small businesses that currently provide insurance. And all small businesses
will get increased bargaining power and discounts on the price of insurance.
In fact, analysts predict job gains as a result of our approach. An Economic
Policy Institute predicts that 258,000 manufacturing jobs will be created over the
next decade as high health costs drop. There will also be health care jobs
created, as we guarantee coverage for everyone, with one Brookings Institution
analyst predicting 750,000 jobs created in home health care alone. Some people
will certainly be doing different things -- there'll be less people processing paper
and more people giving care.
BACKUP FACT SHEET
People Without Insurance Each Year
58 Million
THE FACT:
"The Bureau of the Census calculated that 50 million Americans
lacked health insurance for at least 1 month during 1987.
Lewin/VHI updated the census estimate, calculating that 58
million people were uninsured for at least 1 month in 1992."
THE SOURCE:
"Dynamics of People Without Health Insurance: Don't Let the
Numbers Fool You," Journal of the American Medical Association
(JAMA), January 5, 1994
People With Pre-Existing Conditions
81 Million
THE FACT:
An estimated 81 million Americans under age 65 have medical
problems for which insurance companies can charge higher
premiums, exclude coverage or deny coverage altogether.
THE SOURCE:
"Health Insurance at Risk - The Seven Warning Signs", Citizens
Fund, June 1991 [with data from National Center for Health Statistics
"Health Interview Survey", further data from the Health Insurance Association
of America "Source Book", and the latest Department of the Census "Current
Population Surveys"]
People With Lifetime Limits on Coverage
133 Million
THE FACT:
The Bureau of Labor Statistics 1991 Survey of Medium and Large
Private Establishments reports that only 1 out of 4 people have
insurance policies without lifetime limits.
THE SOURCE:
Table 45 -- Medical Care Benefits: "Employee Benefits in Medium
and Large Private Establishments", Bureau of Labor Statistics,
1991
CALCULATION: In 1992, 177.5 million Americans had private insurance, according
to the Employee Benefit Research Institute analysis of the March
1993 CPS. Seventy-five percent of 177.5 million is 133 million.
If we don't pass health care this year
American families will pay more for health care with less secure benefits and diminishing
choices. Many workers will continue to trade wage increases or stay locked in jobs that don't suit
them just to hang on to the health benefits they've got.
Health care spending per worker will be over $7,000 in 1994. By the year 2000, health care
spending per worker will rise to $12,386, or 25 percent of compensation.
Without reform, by the year 2000, American workers will lose almost $600 in wages each
year just to keep their health benefits [Commerce Department]
American businesses will drop or pare back coverage, or continue to pay more for employee
health benefits.
One and a half million fewer full-time workers receive health benefits directly through an
employer today, compared to 1988. [University of North Carolina, 8/92]
In the future, 30 percent of small businesses currently providing insurance will drop their
insurance coverage because of the high cost. [Health Affairs, Spring 1992]
Choices will decline for those with insurance, as employers try to stem rising costs by switching
to managed care plans with a small number of "approved" doctors. And as more families find
themselves without insurance, those with any history of illness will join the 81 million
Americans labeled as having "pre-existing conditions".
In 1988 89% of employers offered indemnity (fee-for-service) plans. In 1993, only 65% of
employers offered such plans. ["Health Benefits in 1993", KPMG Peat Marwick]
Up to 30% of employees report that they are afraid to leave their job for fear of losing
continuous health insurance coverage.
Doctors will have less and less control over their practices and the care they provide their
patients, as people at insurance companies without medical degrees second-guess medical
decisions and dictate "necessary care".
The federal budget will be overwhelmed by health care spending on Medicare and Medicaid.
This will add to the deficit, raising the pressure to cut back on benefits in those programs. State
budgets will also be increasingly eaten up by Medicaid, paring back on crime-fighting and
education to pay for health services for welfare recipients.
Two-thirds of the growth in federal spending between 1993 and 1996 will be accounted for
by health care spending.
In 1992, Medicaid spending totaled $102 billion, a 33% increase over 1991. By 1995,
Medicaid spending is expected to reach $198 billion. (National Association of Budget Officers)
In 1993, for the first time, states spent more money on health care than they did on tax-
financed higher education. (National Association of State Legislatures)
FOCUS
HEALTH
JULIE KOSTERLITZ
BACK TO THE FUTURE
F
rom "A Decade of Health Care
But the flood of sick people into
Reform," published in National
the system forced insurers to hike
Journal on April 30, 2004:
their rates to small businesses and
At 11:45 P.M. on Oct. 6, 1994-
individuals by 50 per cent more than
after months of rancorous debate
they had intended. That caused hun-
and just 15 minutes before Congress
dreds of thousands of relatively
was to adjourn and head home to
young, healthy Americans to drop
face the electorate-the American
their coverage. Worried insurers
Good-Enough-for-Now Health Care
complained about "reverse cherry
Reform Act passed. The vote in the
picking" by consumers and doubled
House was 284-149 (and two absten-
the next year's planned premium
tions); in the Senate, it was 79-20,
increases.
with one Senator absent because of
The individuals and small busi-
a heart attack sustained during a
Peter Kuper/INX
nesses who remained in the purchas-
protracted filibuster.
ing cooperatives didn't notice the
Enactment of an incremental
rate hikes right away: Pooling had
reform measure had been some-
lowered their rates significantly the
thing of a foregone conclusion since
first year, and the second-year rate
earlier in the year, when the chairmen of three House commit-
increase persuaded many of them to switch to lower-priced
tees were able to eke out only slim majorities on their panels for
health maintenance organizations (HMOs).
legislation that would guarantee health insurance coverage to all
In the meantime, HMOs discovered that they could make
Americans. A Senate committee defeated similar legislation by
fabulous profits by getting lean and mean. That meant not only
five votes.
getting efficient, but also finding ways to turn away the unin-
A comprehensive reform bill was "simply too much of a bur-
sured. Doctors used to be able to take charity cases and pass
den on small business and the American taxpayer," said Rep.
along the costs to paying patients; now, though, they had bud-
Kent Afford, the critical vote on the House Committee on
gets to meet and could no longer play Robin Hood.
Large and Popular but Expensive Entitlements. It was Afford, a
And there were still plenty of uninsured people. Although the
southern Democrat then embroiled in a tough Senate race,
number dropped initially from 37 million to 36 million, most
whose opposition to the Democratic leadership bill was widely
employers of low-wage workers found that buying insurance
seen as a turning point in the debate.
coverage was still uneconomical. Without help from their
AGENHCRA (pronounced agon-hicra)-as it became
employers, lower-income people could not afford coverage. The
known-took a targeted approach to what ailed America most.
unemployed were out of luck, too.
Or, to be more accurate, to what ailed middle America most.
Uninsured people could go to the new community health cen-
Middle Americans, Congress wisely noted, were largely
ters and affiliated public hospitals. But these facilities were over-
happy with their health insurance and afraid of messing with it.
whelmed, with six-hour waits in the emergency rooms and three-
In fact. the main thing that bothered them was that anyone
month waits for office visits. With medicare and medicaid
with a hangnail risked being turned down for health insurance
reimbursements slashed, many private doctors refused to see
as a bad risk, or charged astronomical sums for it. Bad health,
poor elderly people and welfare recipients; these patients
after all, can strike anyone, and even the insurance industry
showed up at the clinics, too.
recognized that this "cherry picking" was not making for a
Liberals proposed additional spending for the clinics, but the
good image.
1998 Don't-We-Already-Pay-Enough-for-Those-People Budget
And so, AGENHCRA required insurers to take all comers.
Act included no new spending for them. Deficit hawks noted
And they couldn't charge the old or sick an arm and a leg for
that the budget for the clinics had grown at four times the pro-
their policies either-henceforth they could charge only an arm.
jected rate. "I think we all want to provide a safety net for the
Individuals and small businesses could join what would be
truly needy," said Afford, by then a Senator and oft-mentioned
called People's Insurance Purchasing Cooperatives to pool their
candidate for President. "But we also live in an era of limits."
risks and their purchasing power, thereby diminishing the extra
There were a few predictable horror stories-such as the His-
premium that small employers once had to pay. The self-
panic woman who died in childbirth on the lawn of a Miami hos-
employed could take tax deductions for 100 per cent of their
pital. Several Members of Congress proposed requiring health
insurance costs. And for the poor and uninsured, there was the
plans to treat charity patients. But the business community
promise of a new network of community health centers,
balked, saying that would lead to higher prices for insured
financed by cuts in the medicare program for the elderly and the
patients and their employers. In the end, state governments had
medicaid program for welfare recipients. Insurance forms were
to raise taxes to keep the clinics afloat.
streamlined, malpractice suits were banned. Waste, fraud and
It wasn't until the millenium, when the purchasing coopera-
abuse were to be eliminated.
tives collapsed under the weight of their high-risk clientele and
The relief among middle Americans was palpable. On Jan. 1,
recession swelled the ranks of the uninsured by millions, that
1995, a million people who had previously been denied coverage
middle-class Americans took to the streets to demand universal
because of poor health deluged the offices of health insurers
health care coverage.
from coast to coast. The coverage was expensive, but most of
Sen. Afford dropped his presidential bid, retired from the
these bad risks weren't poor, and they were happy to pay.
Senate and joined a prestigious Washington law firm.
NATIONAL JOURNAL 4/30/94 1039
womens
Health
Can
FIRST LADY HILLARY RODHAM CLINTON
REMARKS TO THE WOMEN'S LEGAL DEFENSE FUND
WASHINGTON, DC
JUNE 23, 1994
DRAFT
[Acknowledgments: Judy Lichtman; Ellen Malcolm, Cathleen Chase,
Tim Boggs; Pauline Schneider, whose career distinguishes our
entire profession;]
It's a pleasure to be here in such familiar company.
Whatever people say about there being an overabundance of lawyers
in this town, this assemblage is a reminder that many lawyers do
have hearts, and souls, and convictions.
We're all here today because we believe in the Women's Legal
Defense Fund's capacity to enhance the status of American women.
We believe, as the theme of this luncheon suggests, that women
can shape the future.
Ellen and others have noted that we would not have a Family
and Medical Leave Act without the hard work and leadership of
this organization -- and without a President who was willing to
sign the bill into law. We would not have civil rights laws that
protect women from sex discrimination in the workplace, or laws
that protect pregnant women from losing their jobs. We would not
have made as much progress in highlighting the widespread problem
of domestic violence, which we were again reminded of so
tragically last weekend.
None of these accomplishments was easily won. Each required
perseverance, energy, and faith that the goal was worth fighting
for.
And each victory reinforced a great axiom about our country
-- that, as a people, we have a wonderful history of giving,
volunteering, participating, and helping take care of those in
need.
When de Tocqueville wrote Democracy In America a century-
and-a-half ago, he observed that Americans had a special talent
for forming associations to do good. He was talking about
churches, mercy hospitals, schools, other service institutions.
Luckily that collective spirit is still alive in groups like the
Women's Legal Defense Fund and others that are committed to
strengthening the core values that shape American life.
Today we are in the midst of another long struggle, one that
is testing that determination and that rich history of progress.
1
For 60 years he have talked about health care reform. We've
discussed it, debated it, dissected it. We've done everything but
achieve it.
Yet, over those same six decades, we have found a way to
provide financial security to older Americans -- Social Security.
We have found a way to help our war veterans secure a college
education -- the GI bill. We have found a way to help cover the
medical costs of older Americans -- Medicare.
Often against the objections of critics who bemoaned these
programs, who wrote them off as "socialistic" government
initiatives, we have proven that by reaching out to individual
citizens we strengthen society as a whole.
The idea of caregiving, and the role it plays in our lives
as individuals and as a larger community, is integral to our
progress as a nation. But it's also essential to our appreciation
of the many dimensions women show in their everyday lives.
Health care reform is critical for women -- for health
reasons, for financial reasons, but also for these social and
cultural reasons. Women are loaded down with expectations and
burdens about myriad roles they are expected to play, but too
often their own needs are discarded or ignored. Our health care
system is one place where we can begin to change that pattern.
In a more immediate sense, women have the greatest stake in
health care reform because we are the primary caregivers in
society, and also the medical decision-makers in most families. I
can't remember ever discussing with my husband which pediatrician
we should use, although it's a conversation I had with countless
women friends and mothers.
I, and most of the women I know, are married to men who
never want to go to the doctor and have to be at death's door
before admitting they don't feel good. We -- the women -- end up
pushing and prodding them to call the doctor's office for an
appointment.
We're also the ones most often responsible for caring for
aging parents. So along with whatever professional
responsibilities we're juggling, we're also juggling
responsibilities as mothers of children, as daughters caring for
our own parents, as wives of husbands who are sometimes oblivious
to their own health needs.
And somewhere in that mix we're supposed to find time to
take care of ourselves.
Yet despite our regular contact with doctor's offices,
hospitals, medical bills, and insurance regulations, we usually
2
have been treated as second-class citizens in our health care
system.
When I first began looking into health care last year, I
thought it was a very bad joke to discover in my briefing
materials that the first clinical trials on breast cancer had
been performed on men. I was so incredulous that I called to
verify it and found out that, indeed, it was true.
Unfortunately that example was not a fluke, not an isolated
case.
Coronary disease is the number one killer of women in
America, but until recently women were routinely excluded from
all clinical trials. Until recently, osteoporosis, which
primarily afflicts women, was not considered a high priority for
research. Nor was an often lethal disease like ovarian cancer.
And we still can't find lumps in women's breasts even though
we have the technology to detect objects in spaces millions of
miles away.
Women also have been excluded as professional caregivers.
For decades, many of the finest medical schools in the nation
perpetuated faulty stereotypes about women's health that were
widely taken as gospel.
It wasn't all that long ago that women's health issues were
viewed almost exclusively in the context of reproduction. Medical
students were taught that women would contract endometriosis if
they gave birth after 30. Symptoms of menopause were often
discounted as psychosomatic or as evidence of emotional
instability. In fact, little credence was given to the notion
that women suffer from unique symptoms and illnesses that require
different treatments from men.
Happily we've made some progress. Women's health is
attracting more attention lately in the news media and in the
medical and scientific communities.
Last summer The New York Times ran a graphic and shocking
photo of a breast cancer patient on the cover of its Sunday,
which left an indelible image in the minds of many people.
Television news shows have devoted more time to educating the
public about women's health concerns. And, in the scientific
community, clinical trials are beginning to incorporate women
more and more.
But we still have a long way to go. Too often today, women
cannot get adequate coverage for themselves, let alone their
families. Almost 16 million women and nearly 10 million children
are not insured. Infant mortality remains higher here than in
3
most other developed countries, largely due to an absence of
prenatal care.
A survey last year showed that in the preceding 12 months:
-- 44 percent of women did not receive a mammogram
-- 35 percent didn't receive a Pap smear
-- 36 percent didn't receive a pelvic exam
-- 39 percent didn't receive a physical
These are very disturbing statistics in a country as rich
and civilized as ours.
If we do not achieve universal coverage, the needs of women
will continue to be neglected and women will continue to shoulder
the heaviest burdens.
[Anecdote: We don't insure burning houses]
[Anecdote: New Orleans woman with lump in her breast]
[Anecdote: Nevada women who couldn't get an epidural]
Every facet of the President's reform will benefit women in
unprecedented ways.
Universal coverage that offers guaranteed private insurance
to every citizen. Comprehensive benefits that stress preventive
care, including prenatal care. Outlawing insurance practices that
discriminate against people on the basis of pre-existing
conditions or age. Choice of doctor and health care plans that
will give women -- the primary decision-makers -- more control
over their decisions. Enhancing Medicare so that prescription
drugs are covered, which will help women, who tend to live longer
than men.
And long-term care, a time bomb ticking away for every one
of us in this room.
In the next few weeks and months, Congress' ability to
achieve reform will be a strong signal of the progress we are
willing to make as a nation.
We knew this would be a tough fight. We knew the opposition
would resort to a desperate campaign of distortion and
misinformation to throw us off track.
Like all the important causes the Women's Legal Defense Fund
has fought for year after year, often against the odds, this one
requires guts and a commitment to stick with it until we succeed.
Franklin Roosevelt achieved Social Security 60 years despite
4
fierce opposition. XXX pushed through Medicare in XXXXX.
[end to come]
###
5
Society for the Advancement of
ERE
WOMEN'S HEALTH RESEARCH
1920 L. Street, NW, Suite 501, Washington, D.C. 20036
PHOTOCOPY
PRESERVATION
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4 Pages
Society for the
Advancement of Womens
Health Research
Pamphlet
BOARD OF DIRECTORS
CORPORATE ADVISORY
PRESIDENT
COUNCIL
Florence Haseltine, PhD, MD
Abbott Laboratories
National Institutes of Health
LEGACY
Berlex Laboratories, Inc.
FUNDING INCREASES IN WOMEN'S
SECRETARY-TREASURER
Bock Pharmacal Company
Kathy Bryant,
Bristol-Myers Squibb Co.
HEALTH RESEARCH AT NIH
Associate Director, Government
Burroughs Wellcome Co.
Relations, American College of
Chicago Center for Clinical Research
Obstetricians and Gynecologists
The Chlorine Chemistry Council
OF NEGLECT
Lisa Burns
Eli Lilly & Company
President, Burns McClellan
Genentech, Inc.
$2 Billion
Glaxo Inc.
$1.56
Maria Bustillo, MD
Gynopharma Inc.
Associate Professor, Ob/Gyn
Billion
Johnson & Johnson
$1.39
Director, Reproductive Endocrinology,
Lederle Laboratories
Mt. Sinai Medical Center
Billion
Medarex Inc.
Heart disease is the #1 killer of women in the U.S.
$1.20
Colleen Conway-Welch, PhD, RN
Medco Containment Services, Inc.
Billion
$1.02
Professor and Dean
Merck & Co., Inc.
Vanderbilt School of Nursing
Ortho-McNeil Pharmaceutical
Women are the fastest growing demographic group
Billion
Corporation
infected by the HIV virus.
John C. Fletcher, PhD
$1 Billion
Parke-Davis
Professor of Biomedical Ethics and
Religious Studies, University of Virginia
Pfizer Inc.
Depression afflicts women twice as often as men.
Procter & Gamble
Freda Lewis-Hall, MD
Sandoz Pharmaceutical Corporation
Clinical Research Physician, U.S. Medical
Serono Laboratories, Inc.
1 out of 2 women will develop osteoporosis
it
is
Operations, Eli Lilly & Company
Smithkline Beecham
preventable.
Irma Mebane-Sims, PhD
Solvay Pharmaceuticals
National Institutes of Health
Syntex
1 in 8 women will suffer from breast cancer over her
The UpJohn Company
Mary Lake Polan, MD, PhD
U.S. Healthcare
Society for the
lifetime
yet options for treatment have not changed
Professor and Chair, Department of
Wyeth-Ayerst Laboratories
1991
1992
1993
Ob/Gyn, Stanford University School of
appreciably over the last 30 years.
1994
Medicine
MEDICAL/HEALTH
Irene Pollin, MSW
Since the establishment of the Society,
Linda Pollin Foundation
Advancement of
Many diseases such as lupus, multiple sclerosis,
President and Founder
ADVISORY BOARD
scleroderma and interstitial cystitis, disproportionately
funding for women's health research has
American Academy of Dermatology, Inc.
affect women
Gloria Sarto, MD, PhD
American College of Obstetricians
no one knows why.
Increased approximately 60%.
Professor and Chair, Department of
and Gynecologists
Ob/Gyn, University of New Mexico,
American Medical Association
Albuquerque
American Nurses Association
American Psychiatric Association
WOMEN'S
When Medical Research Is For
Nancy S. Vreeland
American Society of Maxillofacial
Though the Society has made great strides in
Civic Leader and Philanthropist
Surgeons
Men Only Women Suffer!
improving policy and securing greater funding for
Anne Colston Wentz, MD
American Society of Plastic and
Professor, Department of Ob/Gyn
Reconstructive Surgeons
women's health research, overall funding allotted for
Northwestern University Medical School
American Urological Association
HEALTH
- Business Week, July 1990
women's health research remains inadequate.
Association of Women Psychiatrists
Nancy Fugate Woods, PhD, RN
Professor and Director, Center for
Gastroenterology Women's Coalition
Women's Health Research, University of
Magee-Womens Hospital
Washington
Medical College of Pennsylvania
Society for Investigative Dermatology
RESEARCH
MEDICAL RESEARCH HAS TYPICALLY LEFT
PERCENTAGE OF FUNDING FOR
Woman's Hospital of Baton Rouge
WOMEN OUT EVEN THOUGH WOMEN:
Women's Dermatologic Society
WOMEN'S HEALTH RESEARCH
Comprise 52% of the nation's population,
AT NIH
Live longer than men,
Suffer more from chronic illness,
For further information, please contact:
Utilize health care services more frequently,
Women's
health research
Are prescribed prescription drugs more often,
represented
only 14.2% of
Make three-fourths of the health care decisions in
NIH's research
American households,
budget for
1994.
Spend almost two of every three health care dollars
SOCIETY FOR THE ADVANCEMENT OF WOMEN'S
(approximately $500 billion annually).
HEALTH RESEARCH
52% of the population receives barely
1920 L Street, NW, Suite 510
14% of federal health research funding.
Washington, D.C. 20036
Health Research That Excludes Women
Is Bad Science
Telephone 202-223-8224
Fax 202-833-3472
The Chronicle of Higher Education, October 1992
About the Society
language. Through a variety of programs, the Society
seeks to educate consumers and to promote their inter-
FIGHT FOR
action with health care providers.
The practice of medicine is driven by clinical
research. In addition to developing new knowledge on
YOUR LIFE
"A few years ago
a group of
women's health, it is imperative that physicians are
energetic women scientists and grass
informed of these findings. To educate the medical
roots advocates alerted us to the
community, the Society sponsors conferences and pro-
inequities that existed in research and
duces publications including a proprietary scientific
If we are to find cures and treatments for the
funding to try to determine what
journal, Fournal of Women's Health.
variety of devastating diseases and conditions
caused and how to prevent and cure
affecting women, it is imperative that we con-
women's diseases. Groups such as the
WOMEN IN SCIENCE The Society advocates the ad-
tinue the fight for more research that takes
Society for the Advancement of
vancement of women in science, believing that women
women's health needs into account. Together, we
Women's Health Research showed us
should hold leadership positions in America's federal
can work to erase gender inequities in medical
the appalling degree to which women
and academic research institutions and health profes-
research and improve our own health as well as
were routinely excluded from major
sional organizations to help ensure appropriate repre-
that of urmothers, sisters, daughters and friends!
clinical trials of most illnesses."
sentation of the women's perspective among decision-
makers in the research community.
YES! I would like to support the women's health research
-First Lady Hillary Rodham Clinton,
movement; enclosed is my check for:
SOCIETY'S ACHIEVEMENTS
Society Director Phyllis Greenberger, Rep. Nita Lowey, Rep. Patricia Schroeder, Tipper Gore,
July 19, 1993
Rep. Louise Slaughter, Florence Haseltine, M.D. and Susan Blumenthal, M.D. at a Congressional
Prompted the landmark 1989 Congressional review of
$500*
$250
$100
reception hosted by the Society.
the National Institutes of Health, which focused na-
$50
$25
Other
tional attention on the exclusion of women from fed-
WHAT IS THE SOCIETY?
By working with key influences in the research com-
erally-funded medical research.
munity, the Society seeks to redirect research to include
Name
Established in 1990, the Society's mission is to im-
Worked with Congress to establish the Office of Re-
prove the health of women through research. The Soci-
women and to further investigate women's health issues.
search on Women's Health.
ety grew out of a mounting concern that the health of all
Address
STRATEGY FOR CHANGE
American women was at risk due to biases in biomedical
Assisted in drafting federal legislation mandating the
research. Our organization fights for greater research
PUBLIC POLICY AND ADVOCACY The Society seeks
inclusion of women in federally-funded clinical trials
City
funding not only for what are often known as "women's
to shape policy which enforces the inclusion of women
and calling for significant increases in funding for
diseases," such as breast cancer, osteoporosis and repro-
in clinical trials and places an emphasis on increased
women's health research.
State/Zip Code
ductive cancers, but also for diseases traditionally associ-
funding for women's health issues. The Society also
Encouraged the Food and Drug Administration to
ated with men, such as heart disease and lung cancer.
keeps the White House, Congress, the National Insti-
strengthen guidelines in 1993 to promote the inclu-
Phone
tutes of Health, the Food and Drug Administration and
sion of women in privately-funded research.
EQUITY IN RESEARCH
private industry informed of the primary issues affecting
women's health.
Received the 1993 "Trend Setter" Award for "bring-
Please make checks payable to Society for the Advance-
An estimated 50% of all research in this country is
ment of Women's Health Research and mail to 1920 L
ing women's health research issues to the forefront in
Street, NW, Suite 510, Washington, DC 20036. The
conducted by private industry; an additional 39% is
PUBLIC AND PROFESSIONAL EDUCATION It is es-
the public and private sectors" from the National
Society is a 501(c)(3) non-profit organization. Contribu-
funded by the federal government. As consumers and
sential that women consumers receive reliable, up-to-
Health Council.
tions are tax-deductible to the extent allowed by law.
taxpayers, individuals provide 90% of all funding for
date information regarding health promotion as well as
medical research in America. As women, we are support-
Served as vanguard for identifying and prompting sup-
disease prevention, detection and treatment. In its pub-
port for areas of research, such as the first national
Contributions of $500 or more obtain Founding Membership in
ing a system that continues to give inadequate attention
lic education activities, the Society plays an important
the Society's National Policy Task Force and receive complimen-
to our needs.
conference examining environmental determinants in
tary copies of Society publications.
role in translating complex scientific material into lay
women's health and disease.
Society for the Advancement of
WOMEN'S HEALTH RESEARCH
WOMEN'S HEALTH FACT SHEET
Women account for 52% of the U.S. population.
Women make three-fourths of the health care decisions in American households and spend almost two
of every three health care dollars (approximately $500 billion annually).
Over 59% of physician visits are made by women, 59% of prescription drugs are purchased by
women, and 75% of nursing home residents over the age of 75 are women.
Cardiovascular disease:
Heart disease is the number one killer of U.S. women (28% of all deaths); death rates are highest for
women of color.
A long-term study (MR. FIT) examining the relationship of cholesterol and heart disease was
conducted on 15,000 men, but no women.
Women who are diagnosed with heart disease are typically ten years older and sicker than men with
the same condition; a marked increase in incidence is observed after menopause.
Hypertension -- a major risk factor in cardiovascular disease -- is 2 to 3 times more common in
women than men and highest among African-American women. Drugs to treat hypertension have
been tested primarily on white male populations.
Lung Cancer:
If current trends continue, the death rate among women from smoking-related diseases will exceed
that of men by early next century. Teenage women now smoke at higher rates than their male
counterparts.
Smoking lowers a woman's estrogen level and increases her risk for early menopause, pregnancy
complications, and having a low-birth-weight baby. Women sustain more lung damage at an earlier
age than their male counterparts. Some evidence suggests women find quitting more difficult than
men do and that women smoke to be thin.
Studies show doctors are more apt to give stop-smoking messages to male patients than to women,
although such advice greatly increases the likelihood of quitting.
Breast cancer:
Options for breast cancer treatment -- surgery, radiation and/or chemotherapy -- have not appreciably
changed over the last 30 years.
1920 L Street, NW
Suite 510
Washington, D.C. 20036
Telephone 202.223.8224
Fax 202.833.3472
In 1992, an estimated 180,000 women were diagnosed with breast cancer, and 46,000 women died
of the disease. Seventy percent (70%) of new cases are diagnosed in women who have no known risk
factors for the disease. Women of color have poorer outcomes.
Ovarian, Cervical, and Uterine Cancers:
There is no early detection method for ovarian cancer. Yet, there is a 90% survival rate even after
5 years when detected in Stage I (cancer confined to the ovary).
In 1992, 21,000 new cases of ovarian cancer will be diagnosed; 13,000 women will die this year from
this form of cancer. Women of color die from this form of cancer at disproportionate rates.
Nearly one-third of all American women will have had hysterectomies by age 60; this is the highest
rate in the world. Ovaries do not usually need to be removed, but doctors (lacking any alternatives)
often remove them to prevent ovarian cancer.
The incidence of this cancer is four times higher in postmenopausal women on estrogen-only hormone
replacement therapy (HRT) than in women on combined estrogen and progestin therapies.
Menopause:
Menopause, unlike menstruation, is often viewed by the medical profession as a disease rather than
as a natural part of aging.
There is little research data available for women seeking nonpharmacologic techniques and alternative
methods for symptom management of menopause. Data on pharmacologic treatments is only
marginally more available and is often conflicting.
Osteoporosis:
Osteoporosis, a debilitating disease characterized by loss of bone mass, afflicts up to 50% of women
over age 45 and 90% of women over age 75; this disease causes more than 50,000 deaths among
American women annually.
AIDS:
Women are the fastest growing demographic group affected by HIV infection. AIDS is the leading
cause of death of African American women in seven U.S. cities.
We recognize that we have merely touched upon a few of the great number of diseases and conditions
that adversely affect women. Our aim is to highlight several of the alarming gaps in knowledge which
make effective preventive methods, treatments, and cures impossible.
By bringing these inequities in research to the public eye, the Society strives to bring much needed
attention and resources to women's health research.
Statistics were compiled from the following organizations: Congressional Caucus for Women's Issues (Washington, DC); Jacobs
Institute of Women's Health (Washington, DC); NIH Office of Research on Women's Health (Bethesda, MD); the National Institute
on Aging (Bethesda, MD) and the Society for the Advancement of Women's Health Research (Washington, DC).
Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
TOWARDS A WOMEN'S HEALTH RESEARCH AGENDA
FINDINGS
OF THE
SCIENTIFIC
ADVISORY
MEETING
Д
Convened by the:
SOCIETY FOR THE
ADVANCEMENT OF
WOMEN'S HEALTH RESEARCH
1920 L Street, NW
Suite 601
Washington, D.C. 20036
202/223-8224
PROGRAM
DINNER CREDITS
Anne Fleming
Maureen Bunyan
Stephanie Holtz
Producers
Leonard L. Ross, Ph.D.
Gala Chair
DeLancey Printing
Design Cuisine
Robert Essner
Greenworks
Corporate Chair
Joseph E. Seagram & Sons, Inc.
Progressive Beauty System (Nexxus Products)
Viator Associates
Florence Haseltine, Ph.D., M.D.
Phyllis Greenberger, M.S.W.
"WOMEN OF BROADWAY"
SOCIETY STAFF
C. Lynne Beauregard
Program Director
Anita S. Bollt
Chief Operating Officer & Deputy Director
MANY FACES
Stephanie Holtz
Development Director
Many Faces, the painting on the cover of our invitation, symbolizes the
uniqueness of conditions affecting women of all ages and ethnic
Debra E. Isaacson
backgrounds. Mindy Weisel, a nationally recognized painter, has
Staff Assistant
donated the complete edition (25) of this original signed and numbered
print to support the Society for the Advancement of Women's Health
A'dell V. Lee
Administrative Assistant
Research. This limited edition is available for a limited time through the
Society. Each Iris artprint which measures 23.5" by 17" unframed, is
Kristina Rosenthal
available for $800. If you are interested in purchasing this wonderful
Program Assistant
piece of art to aid the Society and add to your collection, please contact
Debra Isaacson at (202) 223-8224.
Lisa F. Sloan
Director of Government Relations
VIDEO CREDITS
The Society for the Advancement of Women's Health Research would
like to thank Medical College of Pennsylvania and Wyeth-Ayerst
Laboratories for their generous grants which the Society earmarked for
DENISE FAUSTMAN, M.D., Ph.D.
HISTORIC PHOTOGRAPHS:
the underwriting of all costs associated with this dinner. Thank you also
Transplantation and Autoimmunity
to our many friends who have helped to make this evening a terrific
Prints & Photographs Collection, History
success. While we are only able to list table purchasers* here, we greatly
Director of Immunobiology Laboratories
of Medicine Division
of Massachusetts General Hospital/
National Library of Medicine
appreciate the support of all who have joined us tonight.
Harvard Medical School. Research
includes the investigation of transplant
CELL IMAGES:
rejection, the pathogenesis of autoimmu-
BENEFACTORS
nity, and the creation of the first islet cell
PAMELA GEHRON ROBEY, PH.D.
transplantation program for diabetes in
Chief, Bone Research Branch
National Institute of Dental Research
Medical College of Pennsylvania
New England.
Wyeth-Ayerst Laboratories
SALOME WAELSCH, Ph.D.
JANET M. HOCK, B.D.S., PH.D.
Eli Lilly and Company
Development Genetics
Lilly Research Laboratories
A Division of Eli Lilly and Company
Dr. Waelsch was awarded the distin-
BREAST CANCER CELL SLIDES:
guished Presidential Medal of Science in
PATRONS
1993 for work in the field of developmental
(courtesy of Medarex, Inc.)
Berlex Laboratories, Inc.
genetics. Currently a Distinguished
MDX-210, Medarex's Bispecific antibody,
BKB
University Professor Emerita in the
is capable of linking the macrophage and
Department of Molecular Genetics at
the targeted breast cancer cell, triggering
Bristol-Myers Squibb Company
Albert Einstein College of Medicine.
the macrophage to consume and destroy
Burson-Marsteller
the cancer cell without the introduction of
MARY HARPER, R.N., Ph.D.
toxic or radioactive substances.
Chlorine Chemistry Council
Mental Health of the Aging
Dow Corning Corporation
VIDEO OF "VIRTUAL
Coordinator of Long-Term Care Program
Edelman Medical Communications
BRONCHOSCOPY":
at the National Institutes of Health/
Fannie Mae
National Institute for Mental Health/
Virtual Reality Imaging:
Fox, Bennett & Turner
Mental Disorders of Aging Research
DAVID J. VINING, M.D.
Branch. She has worked extensively in the
Assistance Professor, The Bowman Gray
Genentech, Inc.
psychiatric field with a concentration in
School of Medicine
General Motors Corporation
mental health in older adults.
Glaxo Inc.
DNA DOUBLE HELIX GRAPHICS:
ETHEL SIRIS, M.D.
Courtesy of GENENTECH, INC.
GynoPharma, Inc.
Metabolic Bone Diseases
San Francisco, CA
Healthcare Leadership Council
Professor of Clinical Medicine at the
Johnson & Johnson/Ortho-McNeil Pharmaceutical
Columbia University College of Physicians
Lederle Laboratories
and Surgeons, Director of Osteoporosis
Merck & Co.
Programs at the Center for Women's
Health, and Associate Program Director of
Pfizer Inc
the Irving Center for Clinical Research at
Procter & Gamble
the Columbia-Presbyterian Medical
U.S. Healthcare
Center in New York. Dr. Siris is engaged
in clinical research, teaching, and clinical
Wang Associates Health Communications
practice in the field of metabolic bone
Warner-Lambert
diseases, particularly osteoporosis and
Zeneca Pharmaceuticals
Paget's disease of the bone.
* Table purchasers as of Fanuary 31, 1995
CORPORATE ADVISORY COUNCIL
CELEBRATE WITH US
Abbott Laboratories
Medarex Inc.
Berlex Laboratories, Inc.
Medco Containment Services, Inc.
Bock Pharmacal Company
Merck & Co., Inc.
Bristol-Myers Squibb Co.
Ortho-McNeil Pharmaceutical Corporation
Burroughs Wellcome Co.
Parke-Davis
Chicago Center for Clinical Research
Pfizer Inc.
The Chlorine Chemistry Council
Procter & Gamble
Dow Corning Corporation
Sandoz Pharmaceutical Corporation
Eli Lilly & Company
Serono Laboratories, Inc.
Genentech, Inc.
Smithkline Beecham
Glaxo Inc.
Solvay Pharmaceuticals
Gynopharma Inc.
Syntex
Johnson & Johnson
The UpJohn Company
Lederle Laboratories
U.S. Healthcare
Wyeth-Ayerst Laboratories
MEDICAL/HEALTH ADVISORY BOARD
American Academy of Dermatology, Inc.
American Urological Association
American College of Obstetricians and
Association of Women Psychiatrists
Gynecologists
Gastroenterology Women's Coalition
American Medical Association
Magee-Womens Hospital
American Nurses Association
Medical College of Pennsylvania
American Psychiatric Association
Society for Investigative Dermatology
American Society of Maxillofacial Surgeons
Woman's Hospital of Baton Rouge
American Society of Plastic and
Women's Dermatologic Society
Reconstructive Surgeons
The Advancement of Women's Health Research
HONORARY COMMITTEE
Established in 1990, the Society's mission is to improve the health of women
through research. The Society grew out of mounting concern that the health of all
Hon. Donna E. Shalala
Susan Blumenthal, M.D., M.P.A.
American women was at risk due to biases in biomedical research. Our organization
Ruth B. Merkatz, Ph.D., R.N.
Vivian Pinn, M.D.
works for greater funding for basic research that incorporates gender differences as
Hon. Neil Abercrombie
Hon. Eliot Engel
Hon. Barbara Kennelly
Hon. Ralph Regula
well as for increased attention to not only what are often known as "women's diseases,"
Hon. Robert Andrews
Hon. Anna Eshoo
Hon. Jay Kim
Hon. Bill Richardson
such as breast cancer, osteoporosis and reproductive cancers, but also diseases tradi-
Hon. Roscoe Bartlett
Hon. Vic Fazio
Hon. Joseph Knollenberg
Hon. Jack Reed
Hon. Max Baucus
Hon. Russ Feingold
Hon. Frank Lautenberg
Hon. Harry Reid
tionally associated with men, such as heart disease and lung cancer.
Hon. Howard Berman
Hon. Dianne Feinstein
Hon. Rick Lazio
Hon. Charles Robb
Hon. Joseph Biden, Jr.
Hon. Jack Fields
Hon. Sander Levin
Hon. Ileana Ros-Lehtinen
The Society seeks to shape policy for the inclusion of women in clinical trials and
Hon. Thomas Bliley
Hon. Bob Filner
Hon. John Lewis
Hon. Marge Roukema
Hon. Peter Blute
Hon. Barney Frank
Hon. Nita Lowey
Hon. Pat Schroeder
increased funding for women's health research and works with the White House,
Hon. Henry Bonilla
Hon. Tillie Fowler
Hon. Connie Mack
Hon. Paul Simon
Congress, the Public Health Service and private industry to address obstacles facing
Hon. Barbara Boxer
Hon. Elizabeth Furse
Hon. Carolyn Maloney
Hon. Alan Simpson
women's health research.
Hon. Bill Bradley
Hon. Sam Gibbons
Hon. Edward Markey
Hon. Louise Slaughter
Hon. Bill Brewster
Hon. Benjamin Gilman
Hon. Jim McDermott
Hon. Olympia Snowe
Hon. Corrine Brown
Hon. Robert Goodlatte
Hon. Buck McKeon
Hon. Arlen Specter
Hon. Sherrod Brown
Hon. Jim Greenwood
Hon. Cynthia McKinney
Hon. Floyd Spence
Hon. John Bryant
Hon. Tom Harkin
Hon. Jan Meyers
Hon. Pete Stark
EXECUTIVE DIRECTOR
Hon. Benjamin Cardin
Hon. Mark Hatfield
Hon. Barbara Mikulski
Hon. Ted Stevens
Hon. Michael Castle
Hon. David Hobson
Hon. Patsy Mink
Hon. Gerry Studds
Phyllis Greenberger, M.S.W.
Hon. John Chafee
Hon. Martin Hoke
Hon. Susan Molinari
Hon. Karen Thurman
Hon. William Clinger
Hon. Ernest Hollings
Hon. Jim Moran
Hon. Peter Torkildsen
Hon. William Cohen
Hon. Amo Houghton
Hon. Connie Morella
BOARD OF DIRECTORS
Hon. Edolphus Towns
Hon. Cardiss Collins
Hon. Kay Bailey Hutchinson
Hon. Carol Moseley-Braun
Hon. Fred Upton
Hon. Pat Danner
Hon. Jim Jeffords
Hon. Frank Murkowski
Hon. Pete Visclosky
Hon. Thomas Daschle
Hon. Eddie Bernice Johnson
Hon. Patty Murray
Hon. Maxine Waters
President
Secretary-Treasurer
Hon. Rosa DeLauro
Hon. Nancy Johnson
Hon. Eleanor Holmes Norton
Hon. Henry Waxman
Florence Haseltine, Ph.D., M.D.
Kathy Bryant, J.D.
Hon. John Dingell
Hon. Bennett Johnston
Hon. Michael Oxley
Hon. Paul Wellstone
Bethesda, Maryland
Hon. Julian Dixon
Associate Director, Government
Hon. Marcy Kaptur
Hon. Frank Pallone, Jr.
Hon. Lynn Woolsey
Hon. Robert Dole
Hon. John Kasich
Hon. Nancy Pelosi
Hon. Ron Wyden
Relations, American College of
Hon. Pete Domenici
Hon. Nancy Kassebaum
Hon. John Porter
Hon. Don Young
Obstetricians and Gynecologists
Hon. Jennifer Dunn
Hon. Ted Kennedy
Hon. Deborah Pryce
Lisa Burns
Irma Mebane-Sims, Ph.D.
DINNER COMMITTEE
President, Burns McClellan
Bethesda, Maryland
Maria Bustillo, M.D.
Irene Pollin, M.S.W.
Jeffrey M. Anders
Priscilla Houghton
Sheila Raviv
Associate Professor Ob/Gyn and
President and Founder
Catherine P. Bennett
Leo C. Jardot
John Reilly
Linda Pollin Foundation
Lynn Blitzer
Millie Kondracke
Director Reproductive Endocrinology
Cokie Roberts
Mt. Sinai Medical Center
Sandra K. Bregman
Morton Kondracke
Michael Roberts
Gloria Sarto, M.D., Ph.D.
Gerald S.J. Cassidy
Vicki Levin
Gerry Sikorski
James H. Cavanaugh, Ph.D.
Professor and Chair
Eleanor Clift
Nancy Loving
Ann Simpson
President
Dept. of Ob/Gyn,
Colleen Conway-Welch,
Priscilla Mack
Robin Smith
HealthCare Investment Corporation
University of New Mexico
Ph.D., R.N.
Alan Madison
Lynn Shapiro Snyder
Colleen Conway-Welch, Ph.D., R.N.,
Susan K. Sudman
Sandra J.P. Dennis
Sacha Millstone
Deborah Steelman
C.N.M., F.A.A.N.
Health Care Management Consultant
Debbie Dingell
Toby Moffett
Catherine Stevens
Professor and Dean
Isabel Dunst
Dorothy Moss
Sheila Tate
Anne Colston Wentz, M.D.
Vanderbilt School of Nursing
Barbara Fabiani
Lynda L. Nersesian
Nancy E. Taylor
Professor, Department of Ob/Gyn
Carl Feldbaum
Ann Marie O'Keefe
Susan Holloway Torricelli
John C. Fletcher, Ph.D.
Northwestern University
Marjorie Crawford Finkelnburg
Mary Rose Oakar
Susan S. Walden
Professor of Biomedical Ethics and
Nancy Fugate Woods, Ph.D., R.N.
Tara Federici
Teel Oliver
Margaret Warner
Religious Studies, Univ. of Virginia
Professor and Director
Rhoda Glickman
Norm Ornstein
Janet Waxman
Freda Lewis-Hall, M.D.
Center for Women's Health Research
Ginny Grenham
Corrine Parver
Sheila Wellstone
Clinical Research Physician
University of Washington
Judy Harris
Carol Pensky
Judy Woodruff
Eli Lilly Corporation
Carolyn Hobson
Irene Pollin, M.S.W.
Society for the Advancement of
WOMEN'S HEALTH RESEARCH
First Lady Lauds Society's Efforts
"A few years ago...a group of energetic women scientists and grass roots advocates
alerted us to the inequities that existed in research and funding to try to determine what
caused and how to prevent and cure women's diseases. Groups such as the Society for
the Advancement of Women's Health Research showed us the appalling degree to
which women were routinely excluded from major clinical trials of most illnesses."
First Lady Hillary Rodham Clinton
July 19, 1993
In a speech at the Iris Cantor Center for Breast Imaging in Los Angeles, the First Lady credited
the Society's efforts to bring to the forefront the disadvantages facing women regarding health
funding, research and treatment.
The "national research agenda is finally recognizing that women have unique health problems,
unique systems, and unique responses to treatment, so we are finally beginning to get attention
to diseases such as breast cancer," Mrs. Clinton said. "But what about, also, cervical and
ovarian cancer, osteoporosis, immunological illnesses such as lupus and MS, certain forms of
mental illness, eating disorders, endometriosis -- all diseases which either exclusively affect
women or disproportionately affect women?"
The First Lady also addressed the lack of understanding surrounding hormone therapy and
menopause, and the need for further research in areas such as drug therapies and RU-486. She
stressed the "need to emphasize primary and preventive health care that includes checkups,
immunizations, Pap smears, mammographies the kinds of early detection and prevention
treatments that will save us money as well as save us lives."
Mrs. Clinton fully supports the Society and other organizations dedicated to eliminating the
inequities that currently exist in our health care system. "If we have the technology, as we do,
sophisticated enough to direct missiles to targets thousands of miles away," she said, "we ought
to work to have technology sophisticated enough to detect every fatal lump in a woman's
breast
"
The Society is delighted to receive the recognition of the First Lady and promises to continue
its efforts to improve women's health through research. We are dedicated to making women's
health not merely a priority but a reality by shaping and stimulating new directions in public
policy which emphasize women's health and women's health research.
1920 L Street, NW
Suite 510
Washington, D.C. 20036
Telephone 202.223.8224
Fax 202.833.3472
LHJ Picks
The Ten
Most
Bernadine P. Healy, M.D.
Important
Women In
Medicine
Flossie Wong Staal, Ph.D.
ess than a generation
Setting the national agenda
ago, women accounted
for only a fraction of
f we can detect missiles in space,
the professionals who
made up the nation's
I
we ought to be able to pick up a
small lump in a woman's0
health-care establish-
breast," says Susan J. Blumen-
ment. But that has
thal, M.D., M.P.A., the country's
changed. Today, most
first-ever Deputy Assistant Secretary
medical-school classes are 40 percent
for Women's Health. She oversees all
female. And female doctors, scientists
women's-health programs and policies
and policy makers have quickly
within the U.S. Public Health Ser-
crashed through the glass ceilings of
vice, including research at the Na-
research labs, university medical de-
tional Institutes of Health (NIH), in
partments and the nation's top hospi-
Bethesda, Maryland, and drug ap-
tals and health institutions.
proval at the federal Food and Drug
Who are the most powerful women
Administration. Trained as a psychi-
in medicine today? Ladies' Home Four-
atrist (she still practices in her spare
nal asked that question of more than
time), Blumenthal, forty-four, is also
a hundred agencies and institutions
one of the founders of the Society
across the country. The top choices:
for the Advancement of (continued)
Florence P. Haseltine, Ph.D., M.D.
128
WOMEN IN MEDICINE
Health Initiative, the largest and most
Continued
extensive study ever devoted to wom-
Women's Health Research, whose
en's health. Currently, she is senior
How They
goal is to increase spending on re-
policy adviser for The Cleveland
search involving women.
Clinic, in Ohio.
Stay
Advocate for the aged
Probing cancer's psychic tolls
Healthy
y the year 2010, one of five
hile most cancer re-
B
Americans will be over age sixty-
W:
ow do the top women in
searchers have doggedly
medicine stay healthy?
five, a fact that Christine K.
pursued new ways to physi-
Primarily, by doing ex-
Cassel, M.D., forty-nine, di-
cally eradicate cancer from
actly what they tell the
rector of the Center on Aging, Health
the body, Jimmie Holland, M.D., a
rest of us to do. Here,
and Society at the University of
psychiatrist, has pursued another line
some of their secrets.
Chicago, doesn't let anyone forget.
of thinking. As a pioneer in the field
On eating sensibly: All experts ad-
She continually urges her colleagues
of psycho-oncology, which deals with
vise a low-fat diet; some-like
to find better ways to treat the chron-
the emotional well-being of cancer
Bernadine Healy and Susan Blumen-
ic diseases that afflict the elderly.
patients, Holland, sixty-six, heads
thal-also take vitamins. Nanette
"There is still very little known about
the program in psycho-oncology at
Wenger, who enjoys gourmet cook-
how to take care of the most common
Memorial Sloan-Kettering Cancer
ing, makes elaborate sauces using a
medical problems in elderly people,"
Center, in New York City. She is
vegetable base instead of a fat base.
says Cassel, who is researching
now studying how emotions affect
On checkups: Florence Haseltine
whether small doses of certain hor-
the outcome of cancer treatments.
had unexplained stomach pains for
mones can postpone the disability
five years before doctors diagnosed
that often accompanies old age.
An outspoken breast researcher
a thyroid problem. "I go for my year-
ly checkups, and if I don't like what
A women's policy maker
nowledge is power, and most
director of the Center for Pop-
A
K
the doctor says, I keep going back
women have been denied real
until I get an answer," she says.
knowledge about their own
On exercising: Finding time to
ulation Research at the NIH,
breasts," says Susan M.
work out is difficult for these super-
Florence P. Haseltine,
Love, M.D., co-founder of the Na-
busy women, but each of them
Ph.D., M.D., fifty-two, has set
tional Breast Cancer Coalition and
makes it a priority. For Christine
policy and found funding for research
director of the Revlon/University of
Cassel, it means getting up at five
on population growth, the reproductive
California at Los Angeles Breast Cen-
o'clock in the morning two or three
sciences, infertility and the development
ter. With a feminist slant, Love, forty-
days a week. For Nanette Wenger, it
of contraceptives. A board-certified ob-
seven, has become one of the most
means riding the stationary bike at
stetrician and gynecologist, Haseltine
outspoken advocates for breast-cancer
eleven P.M. while she watches the
HIOTOS rose MOILY KOBLETS SYGMA CHRIS CARRON ONIY
also helped found the Society for the
research. Author of Dr. Susan Love's
late-night news.
Advancement of Women's Health Re-
Breast Book (Addison-Wesley, 1990),
On relaxing: "You have to make
search. "Women's health has been
which covers everything from breast-
time to do some things that are just
recognized only gradually as an area
feeding to mastectomy, Love urges
for you," says Susan Blumenthal.
of special concern," she says.
women to demand change in the way
"Our psychological state has an im-
the male-dominated medical field
pact on our brain function, which
First woman to head NIH
treats women. Taking a lesson from
has an impact on our immune and
the AIDS movement, she says, we
endocrine systems."
hen Bernadine P. Healy,
need to "take to the streets and yell
W
On hormone-replacement therapy:
M.D., was appointed by
and scream."
"I do take hormone-replacement
President Bush in 1991 to
therapy, but I am not saying that be-
head the NIH, the agency
Directing dollars to women's interests
cause I do, every woman should. Un-
that funnels approximately S11 billion
til we have all the information, each
a year to biomedical researchers, she
ivian W. Pinn, M.D., is the
found herself in a man's world. More
V
woman should consult with her own
first full-time director of the
physician about whether it is in her
than 80 percent of the top officials
Office of Research on Wom-
best interest or not," says Vivian
were men. "Advancing women's
Health, a newly estab-
Pinn. Adds Susan Love: "Each wom-
health is sort of our modern-day suf-
lished arm of the NIH. It's a role
an has to weigh the pros and cons in
frage movement," says Healy, fifty,
that requires a person who can fight
her own life."
who pushed through the Women's
the male establishment, (continued)
131
hree women of three different
T
ages and lifestyles spoke informal-
ly Monday of their own attitudes
A healthy benefit for women
"Women's health always is seen as the
issue of reproduction," said Phyllis Green-
berger, executive director of the society
to women's health issues while
and its staff of eight. "And it isn't,
waiting to rehearse songs they'd perform
although there still is a lingering idea that
later that evening at a black-tie benefit,
it is." The scope of their program includes
which raised $500,000 for the Washing-
"convincing women that not all diseases
ton-based Society for the Advancement of
are breast cancer but how different dis-
Women's Health Research.
eases affect women differently."
All three were New York-based perform-
Funds raised Monday would go toward
ers from different Broadway shows of note
office expenses and new software, she
who are in good health. Their thoughts
said, but the "two issues this year are
reflected well the range of hopes and prob-
obstacles to getting women in clinical tri-
lems that gave rise five years ago to the
als and the factor of liability. A lot of time,
society's broad-based initiative promoting
tests for new devices are done on women
gender equality in medical research.
who are healthy, which can mean more
"I remember when Happy Rockefeller
risk when there are adverse reactions."
got breast cancer and people starting talk-
Has there been any backlash lately from
ing about the subject for the first time.
white males charging discrimination?
Had I known more about the subject then,
"No, we aren't women against men but
I would be further ahead - I would have
the idea of women needing to be included
started on something or another sooner,"
in research and testing," she said.
said Rita Gardner, referring to still-contro-
Among the men attending the event,
versial hormone-replacement therapy.
which was held in the Mellon Auditori-
A member of the original cast of "The
um, were political analyst Norman Orn-
Fantasticks," now in its 35th year, she
stein of the American Enterprise Insti-
currently is with the national tour of
tute ("I'm here because of Phyllis") and
"Kiss of the Spider Woman" and flew in
Rep. John Dingell, Michigan Democrat,
from Montreal for the night.
who said his interest in women's health
Pholo by Karen Ballard/The Washington Times
"There are so many scary issues now,"
Darcie Roberts enchants the crowd with a song from "Crazy for You" at the Society for the
was "saving it from the Republicans."
suggested Darcie Roberts, 21, of Broad-
Advancement of Women's Health Research gala.
Rep. Patricia Schroeder, a longtime
way's "Crazy For You." "I'm constantly
supporter, appeared in an elaborately
amazed at the lack of information, and
patterned cardigan sweater, flowing
young girls are so vulnerable. It's fright-
start talking about such things."
'Hooray.' So many women's health issues
tunic, pants and boots: "This is black-tie
ening not knowing what new diseases are
"I get asked to do so many benefits in
get swept under the rug," said Liz Call-
in Denver," the Colorado Democrat said
out there, although
it's also a lot easier
New York, usually for AIDS, that I
away, 33, mother of a young son and
to well-wishers as she made the rounds.
now to walk into a group of women and
thought when I heard about this group,
member of Broadway's "Cats."
- Ann Geracimos
C12
THURSDAY, FEBRUARY 9, 1995
METROPOLITAN TIMES
THE WASHINGTON TIMES
HEALTH
It's sickening
he folks at Mediscience
profit organization, was launched in
Technology Corp. (MTC)
1990 to bring to national attention
Research on
are virtually beaming. The
the need for greater funding for re-
Cherry Hill-based compa-
search into women's health issues.
diseases affecting
ny recently established a
It also promotes disease-preven-
collaborative research ag-
tion. According to the society's re-
reement with General
search, the causes of such women-
women remains
Electric to develop pho-
centered diseases as osteoporosis and
tonic, or light-based, diagnostic de-
breast cancer, as well as heart disease,
vices for medical applications.
may begin at an early age. That's one
underfunded or
Peter Katevatis, chief executive of
reason Merck & Company, Inc. was
publicly-traded MTC, couldn't be
eager to provide the initial funding
ignored totally. But
happier. This agreement puts the
for the development of a national ed-
company one step closer toward
ucational symposium directed to-
product commercialization, pending
ward teenagers and women in their
that's beginning to
FDA approval.
early 20s.
The company is a pioneer in
According to the society, as many
mediphotonics, an emerging med-
as one half of the two million deaths
change. Slowly.
ical technology that utilizes the
occurring in the United States each
characteristics of light to detect can-
year could be prevented if women
cer and other forms of disease. Not
Very slowly.
quit smoking, limited alcohol con-
only can this non-surgical technolo-
sumption, developed proper eating
gy detect cancer in breast and gyne-
habits, got regular medical exams
cological tissue, but it can identify
and vaccinations, and refrained from
tissue that has even the potential to
unsafe sexual conduct.
become malignant.
One disease that is preventable
That could represent the differ-
through proper nutrition is osteo-
By JENNIFER MASSE
ence between life and death for
porosis, which affects 50 percent of
Photography by Anthony Cericola
women with ovarian cancer; be-
cause of inadequate screening tech-
B
niques, nearly 75 percent of ovarian
cancer cases are not discovered until
after the disease has spread beyond
the ovaries.
Experts believe that light-based
technology will have a huge impact
on early detection of cancer. If
found early enough, cancer has up
to a 90-percent cure rate.
This is good news for everyone,
and especially for women: Research
on many women's diseases has histor-
ically been either underfunded or
ignored totally.
Slowly, however, that is beginning
to change as more attention is placed
on women and their particular health
needs. And since women are living
longer than ever now, those needs are
becoming greater.
In fact, the Washington DC-based
Society for the Advancement of
Women's Health Research, a non-
23
Special
disease. It is the number-one killer of
American women, adding costs in ex-
cess of $9 billion annually to the
services
Woman's
healthcare system.
"Between the ages of 30 to 50.
heart disease is less common in
for a
Health
women, although it can show up in
young women whose families have a
history of high cholesterol," says Dr.
woman's
at Jeanes
Albert N. Brest, a cardiologist at
Thomas Jefferson University Hospital.
That's because estrogen acts as a
special needs
protective shield, helping to prevent
heart attacks in women before they
reach menopause.
"After age 70," says Dr. Brest,
"men and women have basically the
t's no secret that women have special health care
same incidence of heart disease."
needs. That's why we've developed Woman's Health
Experts say that reducing the
amount of dietary fat, coupled with
at Jeanes, a comprehensive program of medical,
exercise, will greatly reduce a
educational and spiritual services designed specifically
woman's chance of developing heart
to meet the needs of women. Through an annual health event,
disease. So will cessation of smoking,
seminar series, newsletter and resource center, the Jeanes
especially while on birth control pills.
Woman's Healthline, and more, Woman's Health at Jeanes will
BUT BEING PROACTIVE TO PRE-
help you get the best out of being a woman.
vent disease is only half the battle,
As the only Quaker-directed acute care hospital in the
most experts agree. More research is
needed for diseases affecting women,
United States, the work we do at Jeanes Hospital is guided by
from ovarian cancer to breast cancer
the Quaker testimonies of Equality, Peace, Simplicity, and
although, to be sure, women are en-
Community. Those ideals combined with a highly-trained staff of
couraged by significant strides in
healthcare professionals, sophisticated technological equipment,
research there, such as the identi-
modern medical facilities and unique pastoral care program mean
fication of BRCA-1, the breast-cancer-
causing gene. And research is under-
we provide patients with quality, cost-effective health care while
way into the causes and prevention of
we continue the Quaker philosophy of compassionate care that
endometriosis, which affects up to
treats the whole person.
half of all women over age 30. It is
believed to be a major cause of infer-
For a brochure about Woman's Health at
tility-and of many of the 600,000
Jeanes, or information on Jeanes Hospital or
hysterectomies performed in America
Jeanes
any of our programs, call us at (215) 728-2300.
each year, the largest number of any
country in the world.
HOSPITAL
7600 Central Avenue, Philadelphia, PA 19111
Endometriosis is a condition that
occurs when endometrial tissue, the
tissue that lines the uterus and is shed
A QUAKER TRADITION OF CARING.
during menstruation, grows outside
the uterus.
"Endometriosis is a major public
women over age 45 and 90 percent of
strong bones.
health problem in America," says Dr.
women over 75.
"All the cola, iced tea and high-
Christos Coutifaris, MD, PhD, associ-
"Osteoporosis is associated with
protein foods that kids consume now
ate director of the University of Penn-
tremendous costs, increased disability
are raising the chances that they will
sylvania Medical Center's Division of
and even death," says Dr. John L.
develop osteoporosis in their later
Human Reproduction, a specialist in
Abruzzo, professor of medicine in the
years," says Susan Ward, MD, a
the area of endometriosis. "Right
division of rheumatology at Thomas
rheumatologist at Jefferson Hospital.
now there's nothing available for
Jefferson University and director of
"If teenagers could only see the ef-
early screening.
the Jefferson Osteoporosis Prevention
fects of osteoporosis-the severe
"But things are being done," Dr.
and Treatment Center.
pain, the fractures and the shrink-
Coutifaris says. "It's slow, but in time
"That's why it's so important to
age-they would take in more calci-
things will change.
stress prevention."
um at a younger age. We recommend
"Those of us in women's health-
In fact, the National Osteoporosis
children, teens and young adults shoot
care think it's long overdue."
Foundation says that the average
for 1,200 mg of calcium per day."
Still, most experts agree, the best
American receives only 30 to 40 per-
Another preventable disorder with
method of disease prevention is prac-
cent of the calcium needed to build
horrifying statistics is cardiovascular
ticing good health habits every day.
24
"FEBRUARY 1995
Volume 3, Number 6
THE BUREAU OF NATIONAL AFFAIRS, INC.
February 6, 1995
Women's Health
health, greater happiness, and greater productivity,"
EMPLOYERS SHOULD MAKE COMMITMENT
she said.
TO ISSUE, HILLARY CLINTON ASSERTS
"The unpleasant truth is that the health of Ameri-
can women should be better than it is today," Clinton
Hillary Rodham Clinton asked employers Feb. 1 to
remarked. In terms of research, education, and treat-
make a commitment to meeting women's health needs
ment, women's health concerns have too often been
through their own initiatives or in partnership with the
discounted or ignored, she added.
federal government.
However, in recent years progress has been made in
"Women's health doesn't just affect women, it af-
focusing attention on these issues, Clinton said. She
fects all Americans," Clinton said at the Women's
described a number of women's health initiatives un-
Health Summit sponsored by the Federal National
dertaken by the Clinton administration, including the
Mortgage Association in cooperation with the Wash-
creation of the Office of Women's Health at the De-
ington Business Group on Health and the Society for
partment of Health and Human Services.
the Advancement of Women's Health Research.
Since President Clinton took office, funding for
"Women usually function as the primary caregivers
breast cancer research at the National Institutes of
for children and aging parents in our society and
Health has increased 65 percent, to $379 million in
women now comprise a large percentage of our work-
1995, Clinton said, with additional research and train-
force," Clinton said. Therefore, ignoring women's
health needs will result in problems for families,
ing grants funded through the Department of Defense.
She announced that the Defense Department is working
workplaces, and the whole society, she told the busi-
ness leaders and health care professionals attending
with the Central Intelligence Agency and the Office of
Women's Health to apply defense related technology to
the meeting.
Clinton lauded FannieMae, the second largest cor-
improve breast cancer screening methods.
poration in the nation and the largest provider of
These initiatives came about not by "arbitrarily
home mortgage funds, for its leadership role in the
slashing programs," Clinton said in a reference to
area of women's health, its "commitment to family-
budget cuts proposed by the Republican-controlled
friendly benefits," and its workplace wellness pro-
Congress.
grams. Clinton said she hoped other companies would
"Women's health is a particular concern of the
follow FannieMae's example in providing benefits
president and he has made it a priority in his budget,"
such as free mammograms for female employees.
scheduled to be released the week of Feb. 6, Clinton
Clinton also called for a renewed public-private
said. Nearly $2 billion has been set aside in this year's
partnership to address women's health needs. Govern-
Public Health Services' budget for women's health,
ment and corporations "need to cooperate and lever-
she said, including breast cancer research, family
age each other's efforts SO we can all promote greater
planning programs, and research on diseases that
primarily affect women such osteoporosis.
Volume 3, Number 4
THE BUREAU OF NATIONAL AFFAIRS, INC.
January 23, 1995
Pharmaceuticals
katz said, calling IRBs "the last bastion of
GENDER ANALYSIS DATA RAISES ISSUES
paternalism."
OF INFORMED CONSENT, FDA OFFICIAL SAYS
Under guidelines developed in 1977, women of child-
Although the Food and Drug Administration has
bearing age were restricted from participating in
clinical trials to prevent possible birth defects. In the
determined that all new drug applications must in-
1980s, questions about women's health prompted ques-
clude gender analysis data, the agency still is dealing
tions about how the guidelines affected the informa-
with the issue of what constitutes informed consent
tion-gathering process during drug development trials.
and demands by "deeply ill patients" to be admitted
Attitudes toward women's participation in clinical
into clinical trials, Ruth Merkatz of FDA's Office of
trials also changed over time as gender bias became
Women's Health said Jan. 19.
more widely recognized, Merkatz said, adding that the
At a forum sponsored by the Society for the Ad-
vancement of Women's Health Research, Merkatz told
principle of autonomy-allowing women to make de-
cisions about assuming risk-also helped effect a
attendees that FDA was scrutinizing informed consent
forms to determine whether manufacturers have bal-
change.
anced the elements of inclusiveness and exclusiveness,
Besides educating staff at FDA on issues related to
and how the forms deal with a subject's choice of
women's participation in clinical trials, she said the
agency will hold a workshop in conjunction with indus-
contraception.
Informed consent is difficult because investigators
try, academics, and consumers on gathering gender
are faced with possible conflicts of interest as they
analysis data in clinical trials. Merkatz also said the
seek informed consent from individuals. In addition,
agency would propose new regulations amending re-
the concept of experimentation versus treatment is
quirements for investigational new drug applications
confusing, Merkatz said, and there is a controversy
and NDAs to keep track of gender analysis data.
over whether consent forms should say anything at all
about any health-related benefits of a trial or say only
that individuals will benefit from participation.
Other difficulties associated with obtaining in-
formed consent include the challenge of constructing a
consent form that gives details of participation that
can be understood by individuals who are asked to
give consent, she said. Informed consent also raises
the issue of preparing individuals to accept the fact
that something can go wrong in a clinical trial, ac-
cording to Merkatz.
Similarly, participation in clinical trials by people
who are desperately ill raises a question of whether
their participation is based on informed consent or
should be considered "grasping at straws." While
FDA's attitude toward the desperately ill is "coming
around" to better balance the need to protect human
subjects with a need for expedited entry into clinical
trials, institutional review boards are less open. Mer-
December 1994
THE MEDICAL HERALD
Page 35
Biotech's Key Role in Women's Health
sis-the bone-thinning disease
Medarex clinical investigators are
of selectivity. He added that ad-
BY AMANDA FUENTES
that disproportionately affects
seeing promising results with
vances in understanding the
women-using advanced im-
paired monoclonal antibodies that
molecular basis of hormone ac-
NEW YORK-Most women
munoassays.
target breast and ovarian cancer
tion have provided a blueprint for
don't know very much about
The roundtable was co-spon-
cells and activate the body's own
the development of new thera-
biotechnology. but this young in-
sored by the Biotechnology
immune killer cells to come and
pies: compounds which will in-
dustry could save and prolong
Industry Organization (BIO) and
destroy them.
teract with intercellular receptors
their lives.
the Society for Advancement of
As ovarian cancer is difficult to
to provide the many health bene-
Among other things, it is de-
Women's Health Research
detect and is often diagnosed too
fits of the hormones, while di-
veloping new and powerful tools
(SAWHR).
late to be treated successfully,
minishing the risk of harmful
to treat breast, cervical and ovar-
Phyllis Greenberger, president
there is a particularly urgent need
side effects.
ian cancers, osteoporosis and
of SAWHR, said the tools of
for effective treatment. Each year
Mary Lake Polan, M.D., chair-
other serious threats to women's
biotechnology "offer real hope for
in the United States, 24,000
man of the Department of
health and well-being. These are
improving the future of women's
women are diagnosed with ovar-
Obstetrics and Gynecology at
just a few of the many research
health." Although women live
ian tumors and 13,600 die of the
Stanford University School of
initiatives that promise to change
longer than men, she said, they
disease.
Medicine, reported on her work
the way doctors detect and treat
suffer more from chronic ill-
with Metra Biosystems to de-
diseases that affect hundreds of
nesses, utilize-health care services
Critical Roles
Holly Atkinson, M.D.
velop improved diagnostics for
thousands of American females.
more often, represent a greater
More and more women are dis-
osteoporosis and other degenera-
"Despite all the medical ad-
portion of the uninsured, obtain
covering that the female sex
tive conditions of bone and carti-
vances in recent years, women are
prescription drugs more often and
Alison Taunton-Rigby, president
steroids-estrogen and proges-
lage such as rheumatoid arthritis
still waiting for help with many of
are less likely to be included in
and CEO of Mitotix, Inc., de-
terone-play critical roles not
and osteoarthritis.
the diseases that terrify them the
clinical research trials.
scribed how biotechnology has
only in reproduction but also in
As many as 25 million
most," said Holly Atkinson, M.D.,
given Mitotix scientists new in-
many other important physiologic
Americans suffer from osteoporo-
executive vice president of
Recent Transformation
sights into the cell cycle, the pro-
processes. After ménopause, di-
sis, a serious disease in which
Reuters Health Information
In recent years, medical sci-
cess by which cells divide and
minished hormone production
bones become brittle and increas-
Services. "Biotechnology holds
ence has been transformed by the
replicate, and the targets for ther-
causes a wide variety of physio-
ingly susceptible to fracture. From
the promise of early detection, tar-
application of such revolutionary
apy that this process represents.
logic problems ranging from hot
1.3 to 1.5 million bone fractures
geted treatments and even preven-
discoveries as recombinant DNA
Taunton-Rigby and her col-
flashes to osteoporosis. Estrogen-
occur annually as a result of os-
tion."
technology, monoclonal antibod-
leagues are developing potentially
replacement therapy has proven
teoporosis. Finding reliable meth-
Atkinson was among the
ies, and polymerase chain reac-
specific drug treatments designed
highly effective in relieving many
ods for early detection is a major
speakers at a recent roundtable
tion. Scientists are now applying
to block the action of enzymes
of the worst effects of menopause
challenge in dealing with this ail-
discussion titled "Biotechnology:
these new technologies to
that regulate the cell cycle in ma-
but it leaves women at increased
ment.
Innovations in Women's Health
women's diseases that have not
lignancy. With specific targets
risk of uterine cancer.
To develop a convenient, inex-
care." Other speakers, including
yet yielded to more conventional
such as breast and cervical cancer,
Robert Stein, M.D., senior
pensive and sensitive test for mea-
noted scientists and industry lead-
approaches.
the researchers believe the drugs
vice president and chief scientific
suring bone resorption, Polan and
ers. reported on pioneering efforts
In breast cancer, for example,
may be more potent and less toxic
officer
of
Ligand
the Metra researchers focused on
to block the progression of breast
some major advances have been
than conventional therapies for
Pharmaceuticals, reported that his
molecules that are released from
and cervical cancer by interfering
made in early detection but not in
these cancers.
company is trying to improve this
the bone as it is resorbed. These
with the replication of malignant
effective treatment for advanced
Donald Drakeman, president
situation with a high-tech ap-
by-products find their way into
cells; to fight breast and ovarian
diseases. In 1993, more than
and CEO of Medarex, Inc., pre-
proach to drug discovery that
the urine and the researchers de-
cancer by activating the natural
182,000 American women were
sented a different but equally
combines the techniques of
veloped a sophisticated im-
cell-killing mechanisms of the im-
diagnosed with breast tumors and
novel approach to treating cancer,
biotechnology with pharmaceuti-
munoassay to measure the levels.
mune system, to safely control the
46,000 women died of the disease.
including breast and ovarian tu-
cal approaches.
Like many other applications
effects of menopause with com-
Many cervical cancers also
mors. This approach concentrates
Ligand's goal, he 'said, is to
of biotechnology. this diagnostic
pounds that mimic the natural ac-
defy treatment. Some 13,500
on directing and enhancing the
develop compounds that will
test seems likely to make real
tion of sex hormones, and to
women were diagnosed in 1993
body's natural disease-fighting
mimic the natural action of hor-
progress against a major threat to
detect the early inset of osteoporo-
and 4,400 died of cervical cancer.
system. According to Drakeman,
mones, but with a greater degree
women's health.