Five years after public awareness that almost all medical research used men as subjects, the women's health movement has matured and built nationwide momentum, influencing not only research but how doctors are trained and women are treated.
In turn, women are flocking to hospitals and universities for daylong forums to soak up information on everything from nutrition to estrogen replacement therapy. Roughly 2,000 attended a seminar last month sponsored by the state's Commission on Women's Health, and about 600 are scheduled to attend one tomorrow sponsored by Johns Hopkins Medical Institutions.
"All that activity at the federal level and on Capitol Hill has had impact and spun off to the state and local level," said Dr. Claudia Baquet, associate dean for policy and planning at University of ,, Maryland School of Medicine, which is planning its women's seminar Nov. 3.
The great interest in women's health is fueled by fear of breast cancer and changing demographics, as baby boomers reach menopause. Also, studies on women -- funded at the instigation of feminists in Congress to right years of neglect -- are beginning to be published, attracting attention.
Medical educators and physicians are debating whether women's health should be its own specialty, or is better taught within the framework of existing training. Some medical schools are integrating women's health into their curricula.
At the University of Maryland, for example, the school is taking aggressive steps to infuse women's health issues into classes and is selecting candidates for two fellowships in women's health.
In the community, physicians are training other practicing doctors on what they should look for in women's exams, from domestic violence to the No. 1 killer of women, heart disease.
"We have spent the past five years really rectifying the long-standing inequities that have put the health of American women at risk," said Dr. Susan J. Blumenthal, assistant surgeon general at the U.S. Department of Health and Human Services. She will give the keynote address at the Hopkins forum tomorrow at the Sheraton Inner Harbor Hotel.
"When I went to medical school, I learned about the 180-pound male, his anatomy and physiology and all the diseases that affected him," Dr. Blumenthal said. "But I can assure you he never went through menopause or ovarian cancer."
Research findings have heightened the issue. They show that women react differently to medicines and have different disease risks and symptoms than men. Hypertension, for instance, is two to three times more common in women than in men, yet all the studies for hypertension drugs have been done on men.
Physicians tend to overuse medication for anxiety and depression in women, and overlook signs of battering, said Dr. Sandra Levison, director of the women's health education program at the Medical College of Pennsylvania/Hahnemann University, one of the first schools to modify its curriculum.
At the federal level, the amount of money devoted to women's health research, education and services has doubled to $2 billion in the past two years, Dr. Blumenthal said. Her office is working on a nationwide survey to assess residencies and fellowships available in women's health. In a few weeks, they are bringing medical school deans to Washington to discuss what is being taught and what needs to be taught.
Also targeted are ways to increase the number of women leaders in medicine.
Only three of the nation's 126 medical school deans are female. Women are also 9 percent of tenured professors and 6 percent of department chairs.
As for making women's health its own specialty, Dr. Karen
Johnson at Stanford University, who proposed the idea in 1982, said creating a women's health physician -- similar to a pediatrician for children -- would go a long way to meeting women's health needs. She said she has met resistance from her colleagues for years, and recently collaborated with other supporters to put together a group to advance the idea.