by Bill Clayton

Just about the time Madelon Stockwell walked onto the U-M campus to become the University’s first female student, a 56-yearold woman by the name of Lydia E. Pinkham was 1,000 miles to the east, throwing herbs and alcohol into a pot on her kitchen stove.

The year was 1870. For Madelon Stockwell and the University of Michigan, it was the beginning of a new chapter in an awakening women’s movement. For Pinkham, a pioneer in the pursuit of women’s health and social rights, it was the start of a new phase in women’s healthcare, because she was brewing an elixir that would become the most successful patent medicine of the century, and would affect women and women’s healthcare in ways no one could imagine — then or now.

In those days, doctors believed that almost all of women’s sicknesses arose from their reproductive organs. So, gynecologists removed them to “eliminate a woman’s fainting spells, hysteria and sexual desires.” They removed healthy ovaries for little or no reason — a practice that had a mortality rate as high as 40 percent. And, as if to demonstrate how embarrassed they were at their own ignorance, doctors conducted basic gynecological exams by reaching up under a woman’s skirts as she stood there, fully clothed.

Then Lydia Pinkham burst on to the scene, telling women to stop visiting doctors; exercise; eat fresh fruits, vegetables and grains; and take her herbal formula — “Lydia E. Pinkham’s Vegetable Compound.”

Ads called the potion “a sure cure for prolapsus uteri, or falling of the womb, and all female weaknesses including leucorrhoea, irregular and painful menstruation, inflammation and ulceration of the womb, flooding...for all weaknesses of the generative organs of either sex, it’s second to no remedy that has ever been before the public, and for all diseases of the kidneys it’s the greatest remedy in the world.”

Pinkham’s potion flew off the shelves. Why? Because in its many ads, it promised a woman what doctors couldn’t: relief from pain; happiness borne of good health; reproductive assistance; and a way to get healthcare without putting herself in the hands of men, who seemed to control everything, not just medicine.

By the mid-1920s, women had won a number of social and political freedoms, but they still lived in the shadow of men. Feminism had strong undercurrents throughout the next several decades, but didn’t flower until the 1960s and 1970s. The Supreme Court included women in the 1964 Civil Rights Act. Not long after, the Court declared that abortion was legal. Women battled for equal pay, federal support for day-care centers, recognition of lesbian rights and protection from rape and the abuse of wives and children. Unfortunately, a lot of those advances existed in name only. What might best summarize the conditions that women still faced was a speech at a 1972 American Psychological Association conference about covert sex discrimination against women as medical patients.

Feminist, author and pro-abortion lawyer Carol Downer stepped up to the microphone. “In what has been described as the ‘rape of the pelvis,’” she said, “our uteri and ovaries are removed, often needlessly. Our breasts and all supporting muscular tissue are carved out brutally in radical mastectomy. Abortion and preventive birth control methods are denied us unless we are a certain age or married, or perhaps they are denied us completely. Hospital committees decide whether or not we can have our tubes tied. Unless our uterus has ‘done its duty,’ we’re often denied. We give birth in hospitals run for the convenience of the staff. We’re drugged, strapped, cut, ignored, enema-ed, probed, shaved – all in the name of ‘superior care.’ How can we rescue ourselves from this dilemma that male supremacy has landed us in? The solution is simple. We women must take women’s medicine back into our own capable hands.”

And they did.

Taking Control

The women’s movement slowly brought about many of the changes that it was after — not always with good effects. The newfound independence that today’s women enjoy has made them more susceptible to chronic diseases and other health concerns, including cancer, heart disease, stroke, osteoporosis, diabetes, workplace and household injuries, and sexually transmitted diseases.

So, now the movement is challenging doctors, researchers and administrators to reverse these tendencies, and healthcare and medicine are taking on a new look as a result.

Today, medicine is no longer just a man’s world. For example, though men still dominate the ob-gyn field — about 64 percent of the doctors practicing obstetrics and gynecology are male — most of the doctors now training in the specialty are women. This year, women have filled 70.3 percent of the nation’s ob-gyn residencies, compared with slightly less than half 10 years ago. And the shift is increasing.

Allen Lichter, M.D., dean of the Medical School, has been involved in women’s health issues for a long time. He spent the early part of his career in radiation oncology, focusing largely on gynecologic cancers, and the second half of his career to-date dealing primarily with breast cancer. He cares deeply about the issues of women’s healthcare.

“There’s a great deal to say about the important role women have played in influencing the way medicine looks at their healthcare,” he says. “I think probably the most striking example is the change in the way breast cancer is managed, moving from mastectomy to lumpectomy and radiation therapy. This was not a treatment that researchers developed in the laboratory and then tried out on mice and then tried out on rabbits and then finally made an announcement that they were ready to try it on people. This was something that our patients dragged the medical profession to, at least in the late ‘70s and early ‘80s, over tremendous resistance from classical practitioners. It took tremendous courage for women to say they wanted to be treated in this newer way, when so much of traditional medicine was telling women that, by not being treated with standard mastectomy, they were literally risking their lives. So we owe a tremendous amount of respect and admiration to women who helped show us that we could manage an important illness like breast cancer in a fundamentally different way.”

Women’s Healthcare at U-M

At the University of Michigan, gender awareness has created an entirely new dynamic in the U-M Health System. Timothy R.B. Johnson, M.D., Bates Professor of the Diseases of Women and Children and chair of the Department of Obstetrics and Gynecology at the U-M Medical Center, says that the University “has a strong reputation for gender studies — Michigan is seen as a leader. Last year our Women’s Health Program was ranked among the top 10 in the country, and I think justifiably so.”

One pivotal reason for that success has been the Program’s interdisciplinary approach to patient care, educational programming, and gender-specific resources and research.

Juliet Rogers, director of the Women’s Health Program in the U-M Health System and a Ph.D. candidate in Health Management and Policy at the U-M School of Public Health, says that the Program, established in 1994, “doesn’t benefit one single department, but it truly benefits the women who come to us as patients and as community partners. It’s unique. Other institutions have tried to set up something multidisciplinary, but haven’t been successful. We’ve tried to set ourselves up so that we’re a value-added program.”

In fact, when the Women’s Health Program helps secure a grant, the grant goes to another department. It’s a small program that does big things and affects a lot of people – and does those things on a modest budget that, as Rogers points out, is creatively allocated to projects that matter most.

“In hospital terms, we don’t need to become a huge cost center. We have a really small budget, and I think we do a lot with it because what we do doesn’t always take money. We foster partnerships, we foster collaboration, and we encourage people to think about women’s health in the most basic ways. We work with departments to help them make their areas more efficient, more effective and easier for women to use. We help them to package information in ways that we know women want it. We help them with simple things like figuring out what women are really looking for. We’ve also become a complaint center — when women have a complaint, they go to the Women’s Health Resource Center [the physical presence of the Women’s Health Program which acts as a clearinghouse for women’s health information], and they feel safe doing that.”

A Profound Impact on Women’s Health

The Women’s Health Program made such a profound impact with its programming and its service to the community, that the U-M Health System named it “1997 Program of the Year.” That same year, the Program also received national recognition when the U.S. Department of Health and Human Services named the University a National Center of Excellence in Women’s Health. This designation meant that U-M was a model women’s health center in five different areas: clinical care, education, academic leadership, women’s health research, and community outreach and involvement.

“Certain things we follow all the way through,” Rogers says. “Some are goals, some are actual deliverables — from producing original patient-education materials to contributing to setting a national women’s research agenda.”

Deidre S. Maccannon, M.D., co-director of the National Center of Excellence in Women’s Health at the University of Michigan, says that women’s healthcare at U-M is different because it’s “much more woman-friendly. The linkages are established with professionals who are sensitized to women’s specific problems within those specialties and not just to general care. So a woman can move seamlessly through the system, whether it’s for reproductive/ gynecologic care, primary care or psychiatric/ mental health care — the linkages are there.”

It’s ironic that the success and recognition of the Women’s Health Program have also benefited men by creating an environment that produced outreach programs and curricular opportunities designed for young men. This surprising outgrowth was a milestone in gender relations because, when male students started asking why they didn’t have something like the Women’s Health Program, they were looking at the downside of inequity with which women had been so long familiar.

The Shortcomings of Male-Centric Research

For the most part, over the years, health researchers have used male subjects in their studies and excluded women. Why? Investigators point out a number of reasons. For one, it was hard to recruit and retain women in clinical trials. Another reason was the potential for a woman’s hormonal changes to complicate a study’s results. Yet another reason was that researchers not only feared damaging a fetus, they also dreaded the liability they faced if anything did happen to a fetus. (Because of the concerns about damaging a fetus, clinical trials excluded women of childbearing age, until very recently.)

The problems with male-centric research are obvious. If investigators don’t include women in drug trials, for example, the findings won’t show — until it’s too late — whether or not a drug is safe or effective for women, or if the drug might damage a fetus. So, the reasons that researchers have given for excluding women from clinical trials are the very reasons why they must include them.

In response to the challenge of finding willing participants who also fit the parameters of the trials, the Women’s Health Program came up with a highly creative — and original — solution: the Women’s Health Registry (see page 35). In essence, it’s a list that links research investigators to women who have medical profiles that best fit each study.

Dean Lichter realizes the vital role that the Registry will play in research: “We have seen so many advances that have been propelled by the willingness of women to enter clinical research trials, knowing that in some of these trials they would not receive a direct benefit. But they do know their sisters and daughters and neighbors behind them will benefit. It’s a wonderful testament to the commitment and the courage of women to want to improve their health status and the treatment of diseases of women.”

The Women’s Health Registry is one more pivotal step that typifies the long struggle women have waged in the movement to achieve equality in healthcare. And although women haven’t reached the end of their campaign, they have reached a point where they are, however, not likely to be driven to seek solace from the likes of Lydia E. Pinkham’s Vegetable Compound.

Also:

Bitter Pills The Long Struggle To Achieve Equality In Women's Healthcare

Ten Ways Gender Differences Can Affect Health

The Women’s Health Program: Making A Differences Through Education and Information

Lydia Pinkham had company in pioneering improvements in women’s health

The Women’s Health Registry