Victor Chang Cardiac Research Institute
KEYNOTE ADDRESS: Women Against Heart Disease lunch
1 May 2015
Four Seasons, Sydney
When I hear the name “Victor Chang Cardiac Research Institute”, like all of you, I think world class research into our biggest cause of death: heart disease…research that will improve the lives of many people.
I could just speak to you today about the wonderful achievements of Australian medical researchers, including those at Victor Chang, punching as they do above their weight in global terms… but all is not well in the land of medical research.
Today’s function is about “Women in Focus” and so I am going to focus, as you would expect, on women and heart disease.
The threat of heart disease is vastly under-estimated despite it being the single largest cause of death of Australian women.
To illustrate my point I am going to turn for a moment to Hollywood and one of Barbra Streisand’s lesser known movies about the 19th-century heroine of Isaac Bashevis Singer’s short story, who had to disguise herself as a man to be allowed to attend school and study the Talmud. This movie was called Yentl. But what, might you ask, does this have to do with women and heart disease?
Fast forward to 1991 and the prestigious New England Journal of Medicine. Dr. Bernadine Healy was a physician, cardiologist and academic and she was the first female head of the National Institutes of Health in United States. I remember at the time reading Dr Healey’s article in the journal where she coined the term “ The Yentl Syndrome”. She wrote:
“Being ‘just like a man’ has historically been a price women have had to pay for equality….Being different from men has meant being second-class and less than equal for most of recorded time and throughout most of the world. It may therefore be sad, but not surprising, that women have all too often been treated less than equally in social relations, political endeavors, business, education, research, and in health care.”
Dr Healy then went on to describe the Yentl Syndrome as the huge gap between the diagnostic tests for heart disease, and the medical treatments that result from those tests – depending on whether the patient is a male or a female.
Yes, studies have shown that women hospitalized for coronary heart diseases underwent fewer major diagnostic tests and fewer live-saving coronary procedures and other interventions than men. It is disturbing that survival for six months after acute myocardial infarction is lower in women just one example of this gender gap.
Why is this so? The complete answer is likely to be complex, but it is partly because the vast majority of studies over the decades that have looked at symptoms and treatment of heart disease have exclusively or substantially studied the male experience.
And secondly because women differ in the way they present with heart disease. While men have typical chest pain radiating to the left arm, women are less likely than men to have typical angina and are more likely to have atypical or non-anginal symptoms such as nausea or lower abdominal pain as a sign of their heart disease. Because the symptoms are non-specific, women may not receive the same urgent attention as men. In order to be treated like a man, women would do better to act like a man, medically speaking. Hence the Yentl reference.
Dr Healy’s original article raised the question of the need to develop a new set of diagnostic and treatment guidelines to specifically address this gender gap. Part of the problem now is that even with revised clinical guidelines, they are less likely to be applied to women compared to men.
It seems there may be a need for a Yentl in medical research too.
There is a persistent problem in Australian science: the dramatic drop off of women at each stage of the science career ladder. In December last year, it was reported that fellowship applications to the National Health and Medical Research Council (NHMRC) showed:
- at early career stage, nearly two-thirds of applications are from women but
- by mid-career stage that figure drops to about a third.
- Finally, at the top level – senior principal fellowships – only 11 per cent of the applicants are women.
Clearly something is wrong.
Of course there is the time-worn reason that women take time out to have a family.
Childcare issues are part of the reason that so many women leave science in the early and mid-career stages. Women are often juggling childcare and family commitments just when demands peak to publish work to enable them to move up the ladder. How can we say to women: go for a career in medical research, but don’t expect your chances of seniority to be too good if you take time off to have a family?
Unless the climate for women in medical research changes fundamentally, we will continue to lose irreplaceable intellectual capital as women drop off the promotion ladder.
This is as much a problem of the societal assumption that it will be the mother who alters her career path in favour of family obligations while the father continues relatively undisturbed. I don’t like to make sweeping generalisations, but the numbers speak for themselves.
The other problem for women is that the time spent away from children needs to be spent on income-producing activities. We ran into this issue in medical politics at the AMA where many hours of voluntary time are spent in meetings and policy discussions. It was very difficult for us to recruit women to represent the profession.
In the research sector, the process of spending many hours writing grant submissions which will ultimately be unsuccessful are viewed as “wasted hours” better spent doing what researchers do best. But without ongoing research funding, worthy projects just don’t happen and researchers cannot be retained.
I have very personal experience of how much easier it is to continue on with your career trajectory if someone else is there to make your home and your children their primary focus.
Styereotyping aside, the reality is that women still carry the main burden of career sacrifice to have a family. Women should not have to “act like a man” to get ahead in a career in medical research. Rather than women adapting to a hostile environment in the research sector, it is clear that the medical research sector needs to adapt to the needs of women at critical life stages.
I was pleased to hear that this year, the NHMRC will require institutes to have gender equity plans in place to receive grants.
If there is a perfect funding model for medical research, then Australia has yet to discover it. The Medical Research Future Fund flagged in the last budget was initially welcomed by members of the research community. But that was until the medical profession and the Australian community realized that the funding was to come out of primary care through a copayment to be collected by GPs and funneled back to the Research Fund via the Federal Government. In other words, the plan was to cannibalise the most cost-effective and underfunded sector of the health system to pay for another essential and underfunded sector.
I said at the time that it was “really dumb” to put forward a budget measure like this without consulting with the medical profession first. Fortunately the government realized their mistake and pulled the idea. This leaves us with a need for medical research funding but no guaranteed source for that funding. Enter the latest resuscitation of the Medical Research Future Fund, linked to a review of the Medical Benefits Schedule. This is not an effort to increase the health budget to accommodate research. This will mean higher out of pocket costs for patients who have tests or procedures that have their rebate reduced or eliminated.
So certainly at a government level we are told there is not a lot of money around.
Corporations and individuals had their fingers burnt during the global financial crisis so philanthropic funding also became tight and inconsistent. There is a need for philanthropy to get behind research and innovation and this is perhaps an area that the Federal government could explore. Where altruism is not enough, the lure of attractive tax structures might sweeten the deal and encourage more private funding to go into medical research.
On top of this is the focus of research funding on pharmaceutical treatment and intervention rather than prevention and non-pharmaceutical integrative approaches such as exercise, nutrition and mind-body programs and natural supplements. In medical practice we like everything we recommend to have evidence to support it. That goes for strategies to prevent disease as well as treatments once disease has developed. If an intervention cannot attract funding then it is difficult to amass the evidence to support its recommendation above, say, a drug therapy where the research was funded by a pharmaceutical company.
On a personal level, looking after your own health and wellbeing needs to be a priority, no matter how busy or intense your life is.
We all know the fundamentals for a healthy lifestyle…exercise, sleep, nutrition, stress management, and knowing your numbers: blood pressure, blood sugar level, cholesterol.
But is this something you make a priority?
Individuals, families, workplaces and governments all have a part to play in creating opportunities for healthier lives.
Today there is a health check booth here to get you started. You can have a FINGER PRICK TEST to check for some of your heart disease risk factors:
- cholesterol,
- blood sugar and you can have your
- blood pressure measured too so that you can know your numbers.
You can make a start today to take action against heart disease.