Women’s Health: Cutting Through the Static
By Lisa Rapaport ’06
Susan Wood, former director of the
FDA’s Office of Women’s Health, on
why science should be strong and free.
Susan F. Wood was driving home after quitting her job as women’s health director at the Food and Drug Administration when she nearly wrecked her car, stunned to hear news of her own resignation make the day’s top stories on National Public Radio.
Wood quit in August 2005 to protest the agency’s indefinite delay of a decision on whether to allow over-the-counter sales of the emergency contraception drug Plan B. It came after most of the medical community, including the FDA’s own scientific advisors, had already decided the morning-after pill was safe for non-prescription use. In this instance, the FDA “disregarded quite clearly the scientific and medical evidence and abused the regulatory system,” Wood said.
“It was related to sex so it got more press. Women’s health is so much broader than reproductive health. But sadly, it’s so often reproductive health issues that catch fire,” she said, setting off spirited debate with her keynote address at “Women’s Health: The Press and Public Policy,” a conference sponsored by the Knight-Wallace Fellows at Michigan, the W.K. Kellogg Foundation, and the University of Michigan Health System Women’s Health Program.
There were few ground rules for the talks that followed. Charles R. Eisendrath, director of the Knight-Wallace Fellows, asked only that reproductive health and abortion not dominate discussions. “I think abortion overshadows everything because it is no longer just a health issue for the public, [but] a political issue as well,” he said.
Talk among some of the nation’s top regulators, doctors, scientists, activists and journalists at the conference touched on everything from mammograms to marketing scams while examining media coverage of women’s health in the United States and around the world.
Gina Kolata, medical and science reporter for The New York Times, laid down a simple rule for health journalism that became the refrain of the day. “If you don’t ask the right question, you might end up with something that is not the whole story.”
Take breast cancer. We have all heard that catching cancer early is always best, and we have all heard that women need mammograms and breast self-exams. “The risk of screening is almost never discussed by the media,” Kolata said. Reporters have to ask, “What is the risk of over-diagnosis?”
All cancers are not equally lethal—some aren’t lethal at all. But when screenings turn them up, people want them treated, and all treatments carry some risk, she said. And if it wasn’t really bad cancer you have to ask, “If there is a risk and no benefit, what is the point of this treatment?” Kolata said.
Cynthia A. Pearson of the National Women’s Health Network, Frances M. Visco of the National Breast Cancer Coalition,
and Michigan Surgeon General Dr. Kimberlydawn Wisdom (left to right) field questions from the audience
at the Women’s Health Conference.
Joanne Silberner, health policy correspondent for NPR, offered an oft-told joke to explain why certain stories sometimes dominate the news: “News is something that happens to editors. It’s a cynical view of the world, but there’s something to it.”
Silberner told the story behind the stories NPR did on hormone replacement therapy. In July 2002, scientists abruptly halted a study of this menopause treatment. Millions of women were taking prescriptions mixing estrogen and progestin to ward off brittle bones, heart disease and even wrinkles. Then, researchers said hormone replacement therapy could increase risk for blood clots and breast cancer. “This was something that was happening to women around the office and everyone wanted to know more about it,” Silberner said.
Vivian W. Pinn heads women’s health research at the National Institutes of Health. She was in charge of quickly getting word out to women and their doctors when the hormone therapy study was stopped. “In this case, the media helped us,” Pinn said. It was a moment when reporters were first responders to a public health crisis.
Sometimes, though, the media can create the perception of crisis where none exists, lamented Myrna Blyth, author and former editor of Ladies’ Home Journal. “We see women as victims of stress,” Blyth said. “There’s a word coined for the holiday season—‘Stressmas,’ as if women can’t cope with stuffing a turkey and wrapping a few presents.”
An idea like Stressmas makes news, Blyth said, because pharmaceutical companies see an opportunity to sell drugs that treat this made-up malady. “Without pharmaceutical ads, many magazines wouldn’t exist and there would be no evening news,” she said.
Joann Ellison Rodgers, author and director of media relations for the Johns Hopkins Medical Institutions, recounted one story altered to avoid annoying an advertiser. She recalled doing an assignment for the women’s magazine Cosmopolitan and “getting yelled at for writing that smoking was a risk for women taking oral contraceptives.” Back then, Cosmo had a lot of tobacco advertisements.
Times have changed, at least with respect to the prevalence of tobacco ads in the media. However, Cynthia A. Pearson, executive director of the National Women’s Health Network, said reporters must persist with questions about money. “Journalism today is inextricably targeted with marketing to women,” Pearson said. Reporters must always ask: “Was the story provided by somebody with financial interest in the outcome? Is there a creation of disease where none exists?”
Marcia C. Inhorn, professor of health behavior and director of the University of Michigan Center for Middle Eastern and North African Studies, said that, too often, reporters create the impression that certain medical conditions are more prevalent than they really are.
Inhorn said the media misses many of the “mundane realities” of women’s health in the developing world to focus on “headline grabbers that harm far fewer women.” There’s too much news of relatively small problems—genital cutting, honor killings, dowry deaths and obstetric fistulas—and too little news of widespread medical issues—lack of access to high-quality reproductive health care, reproductive tract infections and maternity and pediatric health services.
Activist and cancer survivor Frances M. Visco, head of the National Breast Cancer Coalition, offered a powerful motivation for reporters to do all they can to get medical stories right. “These issues are complex. They cannot be reduced to sound bites. Individual women often make the wrong decision based on misinformation in sound bites.”
— Lisa Rapaport ’06 is a reporter with the Sacramento Bee.
