Book Review

A New Prescription for Women's Health: Getting the best medical care in a man's world

N Engl J Med 1996; 335:1614-1615November 21, 1996

Article

A New Prescription for Women's Health: Getting the best medical care in a man's world
By Bernadine Healy. 546 pp. New York, Viking, 1996. $24.95. ISBN: 0-670-85550-2

Bernadine Healy is a distinguished physician who has served as professor of medicine at Johns Hopkins School of Medicine, chair of the Research Institute of the Cleveland Clinic Foundation, and director of the National Institutes of Health — the first woman ever to hold the last-named position and, thus far, the only one. With such remarkable credentials, the reader has every reason to expect that her book will provide an authoritative, thoughtful, and entirely readable account of key issues in women's health. That, indeed, is what A New Prescription for Women's Health offers.

In separate chapters, it addresses major issues in women's health: nutrition, reproductive life, sexually transmitted diseases, menopause, cancer, depression and anxiety, heart disease, stroke, osteoporosis, and Alzheimer's disease. Thus, it is a short textbook of medicine for laywomen. Since Dr. Healy is writing for a general, rather than a medical, audience and faces limitations of space, occasional oversimplifications of complex topics are inevitable. For example, the reader is told that “endocrinologists have shown that levels of testosterone in the blood actually correlate with a woman's interest in sex, her responsiveness and satisfaction.” The most recent scholarly review of androgens and behavior (“Androgens, Brain and Behavior,” by D.R. Rubinow and P.J. Schmidt. American Journal of Psychiatry 1996;153(8):974-84) points out that “androgen-replacement therapy increases libido in women who are androgen-deficient . . . but does not affect sexual arousal or behavior in naturally menopausal women.” That is, androgens have a threshold rather than a dose–response effect. However, Dr. Healy does get it exactly right when she points out, “What is perfectly clear to me as a doctor and as a woman is that sexuality . . . is an intricate mix of mind, body and circumstances. Your mind allows you to love and feel the passion and desire for a mate; the circumstances grant you that mate. Your health has a clear impact on your sexuality. If you have a satisfying sex life before menopause, it should continue through and way beyond menopause.” Hear! Hear!

Each of the 10 chapters on medical matters concludes with a set of questions women may want to ask their doctors. Thoughtful answers to these questions will enable patients to understand much more about their own role in restoring and maintaining their health. Committed doctors will welcome these questions as a way to increase understanding between doctor and patient. This section is followed by comments on what women may want to do personally as well as politically about the health matters under discussion in each chapter. Examples from the chapter on reproductive life are pleas for women to speak out on the importance of keeping their reproductive lives free from government intrusion, to advocate federal support for research to improve contraceptive technology, and to demand that law-enforcement authorities take domestic violence and spousal abuse far more seriously than they do at present. The chapter on cancer commends the American Cancer Society as a volunteer health agency because of its effectiveness as a lobby for research and service in educational and screening programs. Women's groups can catalyze the movement to expand hospice services. The chapter on osteoporosis highlights the need for public education to combat the growing plague of osteoporosis, a disease of the elderly but a disease whose characteristics are largely determined by what young girls do in their adolescence. Few American mothers or their daughters understand the importance of adequate calcium intake or of avoiding smoking.

The chapter on depression and anxiety, which poses good questions to ask one's doctor, offers a disappointing commentary on political action. Dr. Healy notes the importance of research on the brain but has nothing to say about research on the psychosocial interventions that have been shown to be as effective as drug therapy. She misses a real opportunity to encourage support for legislation requiring that health insurance cover treatment for mental disorders on the same terms as it does treatment for any other medical problem. She concludes her account of Alzheimer's disease by pointing out that “the only hope lies in funded and focused science, at both the basic and clinical level. I advise you to call and write your representatives and senators, the White House and the statehouse, first asking what each is doing for the elderly with Alzheimer's . . . and then giving your own views.” Well and good, but what about lobbying for home health services, respite for family caretakers, and coverage of long-term care?

In the introductory chapter as well as the epilogue, Dr. Healy reminds us what it was like for women in medicine not so very long ago. She recalls an interview in the mid-1960s with a senior physician who implied that she was making a deviant career choice that must reflect psychological problems. As an intern, she was taunted by a resident who wondered what was wrong with her because she was not at home raising children. As a faculty member, she became the butt of the annual show put on by the all-male Pithotomy Club at Hopkins, a show H.L. Mencken once compared in lewdness to what he had seen “put on by sailors in London.” In response to the degrading way she had been depicted, Dr. Healy wrote a pseudo-legal letter requesting the names of all club members. Although the students were contrite (and frightened), a number of faculty members (including several deans) implored her to withdraw her complaints because the club was so important to student life and because boys will be boys. Her initiative led to the cancellation of the shows until the club reformed. I was at Hopkins in those days, and Dr. Healy's description is right on target. Today's students at Hopkins, male as well as female, owe her an enduring debt of gratitude. When the Pithotomy Club became coeducational, it became necessary to substitute wit for the raunchiness that passes for humor in the men's room. As a result, the quality of the shows increased enormously, as the older men at Hopkins will testify.

This is an excellent book, one physicians can recommend to their patients knowing that it will make them more effective partners in their own health care. Although medical terms are defined when they are used and the author eschews technical terminology, the appropriate readership for this book is likely to be women with at least a high-school degree.

Carola Eisenberg, M.D.
Harvard Medical School, Boston, MA 02115