Latest / 20-Minute Health Talk / Women's health: Funding better research, saving more lives

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Women's health: Funding better research, saving more lives · 20-Minute Health Talk

0:04
I think there's a lot of muddy
0:06
research around women because we
0:08
really don't define what
0:10
we call an exposure.
0:11
So sort of that risk
0:12
factor very well.
0:13
And sometimes we don't define
0:14
the outcome very well either.
0:16
We really haven't been looking
0:18
for the right things.
0:21
And if you don't,
0:21
if you don't have those
0:22
definitions,
0:23
then you have imprecise
0:25
research.
0:31
Here's a hard truth.
0:33
Up until 1990,
0:35
women were actively excluded
0:37
from clinical trials in the US.
0:40
Progress was slow and
0:42
inconsistent until a 1993 law
0:46
passed through Congress
0:48
requiring women and minorities
0:51
to be included in all
0:52
clinical research.
0:54
Today,
0:55
women,
0:56
and in particular
0:58
minority women,
1:00
continue to be underrepresented
1:02
in clinical trials,
1:03
and we see the consequences
1:05
across a range of health issues.
1:08
On this episode,
1:10
we look at the first major
1:12
initiative from the NIH since
1:14
the 1990s to boost women's
1:17
health research,
1:18
which came in the form of an
1:20
executive order from the Biden
1:22
administration in March,
1:24
promising hundreds of millions
1:27
of dollars in funding and
1:29
sweeping action from various
1:31
federal agencies.
1:32
The president and his wife,
1:35
Doctor Jill Biden,
1:37
leading the charge on
1:38
this initiative,
1:39
say it will galvanize new
1:41
research on a wide
1:43
range of topics,
1:44
including women's
1:46
midlife health.
1:47
Joining me to share their
1:49
perspectives on the renewed push
1:51
for women's health research are
1:54
two remarkable leaders
1:56
in the field.
1:57
Doctor Stacey Rosen is a
1:59
renowned cardiologist and the
2:01
executive director for women's
2:03
health at Northwell Health.
2:05
Doctor Nisha Parikh recently
2:08
joined Northwell as its system
2:10
director for the woman's
2:12
Heart program.
2:13
Before we get to this
2:15
conversation,
2:16
remember to subscribe to 20
2:18
minutes health Talk on your
2:19
favorite podcast platform
2:21
and follow us on social
2:23
mediaorthwell Health for the
2:25
latest updates and episodes.
2:28
Now let's get started.
2:33
All right Doctor Parikh,
2:36
Doctor Rosen,
2:37
welcome to 20 minutes
2:39
health Talk.
2:39
Thank you so much for joining
2:41
me today. Doctor Rosen,
2:43
you'll become the president
2:45
elect of the American Heart
2:47
association starting July 1.
2:50
Congratulations.
2:51
Thank you very much.
2:53
I am honored and humbled
2:54
and very excited.
2:55
It's an organization that I've
2:57
played a volunteer role for
3:00
almost my entire career.
3:01
Well, we're very happy for you.
3:04
So in your new role and as an
3:06
outspoken advocate on women's
3:09
health issues,
3:10
thank you very much.
3:12
What was your reaction to
3:13
President Biden's
3:15
executive order?
3:16
Oh, excitement, exhilaration.
3:18
I can't really think of a word
3:20
that was strong enough.
3:22
the idea that at the very top,
3:25
a focus on
3:28
understudied women's health
3:30
issues was really an exciting
3:33
day for all of us in the
3:34
women's health field.
3:35
Absolutely. So the March 18,
3:39
2024,
3:40
executive order includes $200
3:43
million for research at the
3:46
National Institutes of Health,
3:49
an investment the White House
3:51
described as a first step
3:53
towards a fund on women's
3:55
health. Doctor Parikh,
3:56
how important is something like
3:59
a central fund for women's
4:00
health at NIH?
4:03
I think it's critically
4:04
important.
4:05
the last large investment that
4:07
NIH made towards women's health
4:09
was in the form of the Women's
4:11
Health Initiative,
4:12
and that was back in the 1990s.
4:14
So I think we're long overdue
4:15
for a refresh for an updated
4:19
research agenda and research
4:21
portfolio on women's health.
4:23
It's extraordinary.
4:25
And when President Biden and
4:27
others in the White House signed
4:28
this original proclamation
4:30
in November,
4:31
what was so exciting about it is
4:33
not just the financial support,
4:35
which is truly critical,
4:36
but also the approach that what
4:39
was needed was a unification of
4:41
the different arms of the
4:43
federal government,
4:44
academic health systems like
4:45
ours, philanthropy,
4:47
and even the for profit sector,
4:49
because everyone has to really
4:51
be working together to make up
4:53
for decades of disparities in
4:55
health outcomes for women.
4:57
And Doctor Rosen how will it
4:59
help leaders like you and Doctor
5:02
Parikh at the Katz Institute
5:04
for Women's Health?
5:05
You know, first,
5:06
on the sort of macro level,
5:09
the fact that there is so much
5:11
focus and support on this
5:14
initiative, that women's health.
5:16
Health is different, that,
5:17
you know,
5:17
after decades of a male
5:19
model for health,
5:20
we really need to be strategic
5:22
and focused on how we improve
5:24
the health of women.
5:25
And what's interesting is that
5:27
when we improve the
5:27
health of women,
5:28
we know that women make
5:29
decisions for their families
5:31
and communities.
5:32
But when we do the
5:33
research right,
5:34
we also improve the health of
5:35
men. Sex as a biologic variable,
5:37
looking at,
5:38
actually the genetic makeup of
5:40
the cells we study really
5:42
advances science for all.
5:44
So it's about time we care
5:46
for the caretakers. So,
5:48
Doctor Parikh,
5:49
you've recently been named the
5:51
system director of women's heart
5:54
health at Northwell.
5:56
Congrats to you as well.
5:58
You've said that you plan to
5:59
develop a chest pain program
6:01
that will allow better diagnosis
6:04
and treatment of coronary
6:05
artery disease in women.
6:07
What will this look like,
6:09
and why is this a priority
6:11
for you?
6:11
Yeah, thank you for asking that.
6:13
we're really excited about the
6:15
potential of a chest pain
6:16
program here at Northwell.
6:18
About 50% of men and women that
6:21
present to a hospital with chest
6:23
pain that is consistent with
6:26
heart related pain
6:28
only 50% of them will actually
6:30
have a significant blockage
6:32
in their heart arteries.
6:33
So there are potentially half of
6:37
these individuals that have a
6:39
cause that's not accounted for
6:41
by sort of that classic garden
6:43
variety atherosclerotic plaque.
6:46
And some of those conditions are
6:49
caused by dysfunction in the
6:51
really small arteries.
6:52
They're microvascular meaning
6:55
that we can't see them
6:56
with the naked eye,
6:57
but they're the vessels that
6:58
branch off the large vessels.
7:00
So kind of the tributaries
7:01
of those vessels,
7:02
and there can be abnormalities
7:04
in those vessels.
7:06
We now have ways to
7:07
diagnose those,
7:08
both non invasively
7:09
and invasively.
7:11
When folks go in for an
7:12
angiogram, cardiac cath.
7:14
And what we want to do at
7:16
Northwell is to really enhance
7:17
our expertise in that area so we
7:19
can better serve our patients.
7:21
So why is this a priority?
7:23
This is a priority for the
7:25
women's heart program because
7:27
women tend to develop these
7:29
conditions to a greater
7:31
extent than men.
7:32
many of the conditions,
7:33
I should say,
7:34
including the microvascular
7:36
dysfunction,
7:37
another cause of a condition
7:41
that would cause chest pain.
7:42
But isn't that traditional
7:44
plaque,
7:45
as the underlying mechanism
7:47
would be spasm.
7:49
So it's when the arteries kind
7:50
of spasm and then sort of
7:52
relax back to normal,
7:54
that can even be so severe it
7:55
can cause a heart attack.
7:57
so those are things we can look
8:00
for when we test again
8:03
on an angiogram.
8:05
Cardiac catheterization.
8:14
President Biden's recent
8:16
executive order builds on the
8:19
White House's Women's Health
8:21
Research initiative,
8:23
launched late last year and
8:26
spearheaded by first lady doctor
8:28
Jill Biden and Doctor Rosen.
8:30
You wrote about this in an op ed
8:32
at the time and stated that you
8:34
want this initiative to
8:36
transform how women's health
8:38
research is funded
8:40
and conducted.
8:42
What challenges have researchers
8:44
faced in studying
8:46
women's health?
8:47
You know,
8:48
I think the original challenge
8:51
was the fact that historically,
8:53
we thought that except for
8:55
the reproductive organs,
8:57
every other part of a human
8:59
body is the same.
9:00
And because women do have
9:02
changes throughout their
9:04
menstrual cycle that could
9:05
affect research.
9:06
The decision was made,
9:08
and it seemed so logical at the
9:09
time to only study men because
9:13
we thought that there are those
9:15
who joke about the pesky
9:16
hormones getting in the way.
9:18
But the truth is,
9:20
the NIH taught us that every
9:22
cell in your body has a sex and
9:24
that the sex of your
9:25
cells matter.
9:27
And so we made a lot of
9:29
mistakes. And the cardiac story,
9:31
particularly, for example,
9:33
what Nisha was speaking about
9:34
with chest pain, you know,
9:36
as the classic example,
9:37
we assume that men and women's
9:39
arterial cells are the same,
9:41
and they get heart
9:42
attacks the same.
9:43
And until we specifically
9:45
studied female cells
9:48
in research trials,
9:49
we didn't see the importance
9:51
of this.
9:52
So that was the historic why
9:54
women are less apt to become
9:56
involved and participate
9:57
in clinical trials.
9:58
There's lots of reasons why,
10:00
but that's, you know,
10:01
wholly unacceptable.
10:02
We can't study.
10:03
70% of cardiac trials are
10:06
still done in men.
10:07
And then we extrapolate the
10:09
data. Just not good science.
10:11
So how do we change that?
10:14
You know,
10:15
it's become a priority of all of
10:18
us at cats, but also nationwide,
10:21
at centers that see this
10:23
expanded description of women's
10:25
health, you know,
10:26
beyond the bikini or the bikini
10:27
and beyond, as some say.
10:30
So the Office of Research and
10:31
Women's Health at the NIH has
10:33
two very important initiatives.
10:36
First is that sex,
10:37
as a biologic variable,
10:38
needs to be required that you
10:40
have to include women in trials,
10:42
and you have to display the
10:44
data separated by sex,
10:46
because it's no good if we don't
10:48
report out that men did this,
10:50
but women did that.
10:51
And then secondly,
10:53
looking at why women
10:54
don't participate
10:56
maybe new mom can't get back to
10:59
a research lab three days a week
11:02
to participate in a study.
11:04
How do we use telemedicine?
11:06
How do we use wearables?
11:07
You know,
11:08
we have to really look to the
11:09
ways to redefine how we allow
11:13
individuals to participate in
11:14
trials and encourage them.
11:17
the scientists need to look like
11:19
the patients who they're
11:20
asking for consent.
11:22
So many different opportunities
11:24
to sort of, you know,
11:25
change the whole paradigm
11:26
of how we do research.
11:28
Just to add to that,
11:29
if I may I've done a fair amount
11:32
of research in women of
11:35
childbearing age,
11:36
and you really, you know,
11:37
hit the nail on the head with
11:39
some of the barriers to
11:40
doing good research.
11:42
I think another creative option
11:44
would be to provide childcare in
11:46
the form of a reimbursement for
11:48
our study participants at least
11:50
at the time of their
11:51
study visit.
11:52
so there's a lot of creative
11:54
ways I think,
11:54
we can enhance our
11:56
participation.
11:57
So, as a follow up Doctor Rosen,
12:00
do you think this recent
12:02
executive order will help to
12:04
remove some of those barriers?
12:06
You know,
12:07
I think the fact that we're just
12:08
acknowledging the impact of
12:10
these barriers is so important.
12:12
You know,
12:13
nobody thought we had a
12:13
problem decades ago.
12:15
The funding matters. you know,
12:17
honestly, at the end of the day,
12:19
funding has not kept up with the
12:22
needs of women's chronic
12:23
conditions,
12:24
certain understudied conditions.
12:26
And then finally, I think,
12:28
bringing in the other parts
12:30
of the ecosystem,
12:31
whether it's for profit,
12:33
policymakers,
12:35
philanthropy
12:36
along with large health systems
12:38
and academic medical centers,
12:40
I think will get things going
12:42
more quickly in the
12:43
right direction.
12:44
So,
12:45
you have written extensively,
12:48
and I love to read your
12:49
opinion pieces.
12:51
You also mentioned that for this
12:53
to stick more men need to become
12:56
outspoken and advocate for
12:59
equity and representation.
13:01
So how are some ways in
13:03
which men can do that?
13:05
Yeah,
13:06
I think this goes beyond
13:07
being an ally,
13:09
because as important
13:10
as allyship is,
13:11
allyship allows someone else
13:14
to do the heavy lifting.
13:17
The world's population
13:19
is 51% female.
13:21
we know the financial outcomes
13:24
in communities where women
13:26
cannot stay healthy. So,
13:28
you know,
13:29
we have the ethical reasons
13:31
to do this right.
13:32
We have the good science reasons
13:34
to do this right,
13:35
but we even have the financial
13:36
reasons to do this right.
13:37
When women miss work,
13:39
that's a problem for a family.
13:42
So, you know,
13:42
I think that this is really
13:44
the opportunity to
13:48
you know, get granular,
13:50
get focused,
13:51
and bring all those who are
13:52
empowered to support this
13:54
initiative together.
13:55
Do you see that happening?
13:58
I think it's still a
13:59
bit of a journey.
14:00
We're still pushing rocks up.
14:02
and I guess the last point to
14:05
your initial question, Sandra,
14:06
is that
14:08
the men are still at the head
14:12
of the financial resources,
14:14
the CEO's of companies. So,
14:17
you know,
14:17
I think that the more that the
14:19
leaders see this as being
14:21
a priority for all
14:24
the more we'll get done.
14:25
This isn't just a women's issue,
14:27
this is a societal issue.
14:29
Well,
14:30
we're hoping that after the more
14:32
men hear this podcast,
14:34
everyone has a mother.
14:35
Not a mother, mother, aunt,
14:37
a wife, a girlfriend, sister.
14:40
So we're calling on the men to
14:43
be more outspoken and not
14:45
just say, I'm an ally.
14:47
It's time to speak up and to
14:50
advocate for equity and
14:51
representation.
14:53
doctor Parikh,
14:54
as a researcher and clinician,
14:56
what are some potential areas
14:59
within women's cardiovascular
15:01
health that could benefit the
15:03
most from expanded research
15:05
efforts, and why?
15:07
Well,
15:08
I definitely agree with Stacy
15:09
about clinical trial
15:11
representation,
15:12
since women represent only one
15:14
in five participants in
15:16
cardiovascular disease trials.
15:18
and then also,
15:19
I think that studying women of
15:22
childbearing age is very
15:23
important when we think about
15:25
cardiovascular health,
15:26
because the risk factors develop
15:28
upstream of the heart disease.
15:30
And so,
15:32
in order to understand how to
15:33
best prevent risk factors and
15:36
prevent the disease itself,
15:39
we have to study women
15:40
in that age range.
15:43
and, you know,
15:45
sort of as Stacey mentioned,
15:47
many women who are of
15:48
childbearing age,
15:49
not just because of
15:50
hormonal changes,
15:51
but because they do tend
15:53
to get pregnant.
15:54
They intend to get pregnant,
15:55
or they might be breastfeeding
15:57
have been excluded from
15:59
many of our trials,
16:01
particularly the trials of
16:02
lifestyle intervention that we
16:05
use to guide our management for
16:09
preventing blood pressure,
16:10
diabetes, that type of thing.
16:11
But we really need
16:12
a large effort,
16:13
as we've been talking about.
16:14
We really need a sea change in
16:16
the way that we think
16:17
about research.
16:18
And we have to tackle
16:19
the heart issues.
16:21
we can't just tackle low hanging
16:23
fruit anymore if we really want
16:25
to make a difference.
16:26
Awesome.
16:28
doctor Rosen,
16:29
what other areas of women's
16:32
health are in need of greater
16:34
research and could benefit?
16:36
Oh, gosh, all of them.
16:40
start with some of the ones that
16:41
the White House group
16:43
have mentioned.
16:43
Doctor Carolyn Missouri
16:45
is the head of this,
16:47
and she's a decades long
16:49
researcher on women's health
16:50
from Yale University.
16:51
menopause, for instance,
16:54
that was a time in a woman's
16:55
life that we thought was just
16:57
something to tolerate.
16:58
There was little science.
17:00
And instead, what it is,
17:01
is really a window and an
17:03
opportunity to study not just
17:05
the symptoms that women
17:07
often suffer from,
17:08
but to optimize health
17:10
at that time.
17:11
There are some issues with
17:13
rheumatologic conditions
17:14
that are 80% women,
17:16
yet we still don't fully
17:17
understand why that is.
17:19
Migraine in women,
17:20
certain cancers.
17:22
We could almost go across
17:23
the board, and again,
17:25
foundationally looking about
17:26
what is different
17:28
in women and men,
17:30
for almost all conditions,
17:31
prevention,
17:32
diagnosis and treatment.
17:34
I'm happy that you mentioned
17:36
menopause.
17:37
it's on trend right now.
17:39
Everyone is talking about it.
17:41
So that's a series that we will
17:44
be featuring here on 20
17:46
minutes health talk.
17:47
Part of this executive order
17:50
also talks about improving data
17:53
standards. Doctor Pari,
17:55
can you explain why that
17:56
is needed? Sure.
17:58
I mean,
17:58
I think that part of what was
18:00
mentioned already was really
18:03
examining sex differences in
18:05
a more systematic way.
18:06
So that's one.
18:07
And then also just improving our
18:10
definitions of some of
18:11
these conditions.
18:12
I think there's a lot of muddy
18:14
research around women because we
18:16
really don't define what
18:18
we call an exposure.
18:19
So sort of that risk
18:20
factor very well.
18:21
And sometimes we don't define
18:22
the outcome very well either.
18:24
We really haven't been looking
18:26
for the right things.
18:29
And if you don't have
18:30
those definitions,
18:31
then you have imprecise
18:33
research.
18:34
So I think that's part of
18:36
what that's getting at.
18:37
I can give an example.
18:39
Yeah,
18:39
I can help give an example.
18:40
Yeah,
18:41
I think that would be helpful.
18:42
here's something that
18:43
comes to mind.
18:43
Polycystic ovarian syndrome.
18:45
This is a condition that
18:46
affects many women,
18:48
and it does put you at risk for
18:50
cardiovascular disease,
18:51
for infertility, for diabetes.
18:53
And we really don't have large
18:55
studies because we haven't
18:57
created a very good definition
18:58
of it that would work in
19:01
a really large study.
19:02
And we haven't sort of come
19:04
together around standard
19:05
definitions for this condition.
19:07
So we know very little about it
19:09
as a result, or you know,
19:11
we know less than we should,
19:12
I should say.
19:13
Well,
19:14
that's unfortunate that we
19:16
identify this as a needle,
19:19
but yet we don't have
19:20
a good definition,
19:22
kind of for studying what
19:24
we want to study.
19:25
And so we still know very
19:28
little about this.
19:29
Yes.
19:30
So do you see that changing?
19:32
Can we come together
19:33
on a definition?
19:35
Amy Schumer, the comedian,
19:37
developed a pregnancy
19:38
complication, and in one of her,
19:40
you know,
19:41
skits she talks about when she
19:43
asked her doctor why we don't
19:45
know more about this. She joked,
19:47
though I'm sure it's not a joke,
19:49
that the doctor's response was,
19:50
well, it only happens in women,
19:51
so we didn't study it much.
19:55
Polycystic ovary is another
19:57
example of an understudied
20:00
missed opportunity for
20:01
women's health.
20:02
Well, women's health, as I said,
20:05
is on trend,
20:07
so we expect all of
20:09
that to change
20:10
as we have more women speaking
20:14
up about why women's health
20:16
is important,
20:17
wherever cats Institute
20:19
for Women's Health,
20:19
where women can come and get all
20:22
aspects of their care addressed.
20:24
So we hope to see
20:26
a shift in that.
20:27
And
20:28
doctor Rosen,
20:30
what role can healthcare
20:31
providers and public health
20:33
professionals play in improving
20:36
women's health?
20:37
Yeah,
20:38
it goes from the individual
20:40
level. You know,
20:41
women have a tendency
20:42
to put them,
20:43
their personal health needs
20:44
last. Their family,
20:45
their loved ones, their jobs.
20:47
So, you know,
20:48
start by putting yourself on
20:49
the top of your to do list,
20:51
getting educated,
20:52
finding a clinician whom you
20:53
trust and then share that
20:56
information with your friends,
20:57
family, neighbors.
20:59
Getting involved with policy or
21:01
advocacy groups is
21:02
always helpful.
21:03
It's often very easy to
21:04
do at local levels.
21:06
and so really just spread the
21:08
word about how important this
21:10
is to the health of
21:11
our communities.
21:12
What else do you think we can
21:14
expect from the White House
21:15
initiative on women's health?
21:17
Is there sort of a roadmap?
21:19
Yeah.
21:20
So I've actually been at
21:23
conferences recently where
21:24
Doctor Mazzori and some of the
21:26
other insiders have spoken.
21:29
They are
21:30
looking to spend this
21:32
money wisely.
21:33
They're looking to spend it in
21:34
ways that have maximal impact.
21:37
They are looking for these
21:38
partnerships in corporate,
21:40
academic pharma.
21:43
device companies.
21:44
So really getting very granular,
21:47
very focused.
21:49
Are there any talks of engaging,
21:51
kind of grassroots
21:53
organizations,
21:55
small businesses on the ground
21:57
in these different marginalized
21:59
communities who those
22:01
communities know and trust,
22:02
who are doing great work
22:04
to engage them as well?
22:06
No, absolutely.
22:07
The most formal science has
22:10
taken place in church basements,
22:12
in barber shops, in nail salons.
22:15
You know,
22:15
so we know the value of being
22:18
out in our community
22:20
asking our community how we
22:22
participate, not just telling,
22:24
but listening.
22:25
And so I think that this whole
22:27
initiative will focus on that,
22:29
because that's the most
22:30
effective way to get something
22:31
accomplished.
22:32
Absolutely.
22:33
So I endorse that 100% because
22:37
there are some people in those
22:38
communities doing great work,
22:41
and we really need to.
22:43
It's all hands on deck because
22:45
it's going to be a heavy lift.
22:47
Well, thank you so much.
22:49
It's a victory for me
22:50
to have you both
22:52
here in studios with me to
22:54
talk about you know,
22:56
just the improvements
22:58
in women's health,
22:59
and also to have you at
23:01
Northwell and in key leadership
23:03
roles and just being advocates,
23:06
fierce advocates for
23:08
women's health.
23:09
I think the future of women's
23:10
health is bright,
23:13
and I am super excited.
23:14
So thank you so much for joining
23:16
me here on 20 minutes
23:18
health Talk.
23:19
Thank you, Sandra,
23:20
your ability to get
23:21
the word out,
23:22
some of this communication has
23:24
been really pivotal to the
23:26
success of improving the
23:27
health of women.
23:28
Thank you.
23:30
It's been such a great
23:31
conversation.
23:32
I've learned a lot.
23:33
Thank you so much.
23:40
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23:45
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