THE CURRENT issue of the New England Journal of Medicine contains two articles that demonstrate statistically that women receive far less aggressive treatment for heart disease than men. They are less likely to undergo diagnostic and therapeutic procedures like cardiac catheterization, balloon angioplasty and coronary bypass. Even initial symptoms like chest pain are less likely to be taken seriously in the case of women. Why is this so?
Dr. Bernadine Healy, who is the first woman to head the National Institutes of Health, cites a phenomenon she calls the "Yentl Syndrome." The name comes from a story by Isaac Bashevis Singer, the celebrated writer who died just this week, about a young woman in 19th century Europe who disguises herself as a man in order to be able to study the Talmud. Dr. Healy says women have traditionally been treated unequally, even in fields like health care, and that only when a woman demonstrates she is like a man by actually having a heart attack will she be treated as well as a man. When it comes to diagnosis and prevention, unequal treatment persists, though no doubt this will change as women, now 16.3 percent of the nation's doctors and 37.3 percent of all medical students, increase their numbers in the profession.
None of this is meant to imply that physicians don't care about women's health. Until 30 years ago, many more men than women suffered heart attacks in mid-life, and attention was directed toward saving them. But since 1963, the anticipated coronary death rate has gone down 50 percent due to dietary change, more emphasis on exercise and cessation of smoking. Now it is older people who die of heart attacks, and by the age of 60, the rate is roughly the same for men and women. Unfortunately, almost all the major studies of prevention, diagnostic methods and intervention for heart disease have been conducted on men. Dr. Healy is determined to change that bias and has made a commitment to promote more NIH research on women's illness and health.
The studies published this week leave one important question unanswered: Are women receiving too little high-tech care for heart disease, or are men receiving too much? Surprisingly, because there is so little data on women, no one knows. Perhaps new studies of coronary care among women will reveal that some of the aggressive care that men receive does not result in long-range benefits. What is certain, though, is that whatever procedures are found to be safe and effective should be available to male and female heart patients on an equal basis.