WHI: Strengthening Women’s Health

WHICould the health and wellbeing of a few million women be improved, and a few billion dollars saved in the process? A very big dream.

When the Women’s Health Initiative was established more than 20 years ago, no one was talking in grandiose terms and few would have anticipated the wide-ranging health benefits (and huge cost savings) that would result in the decades ahead. Many of us were simply saying, “Imagine this. At last we’re studying women to find answers about women’s health issues.”

This writer was proud and happy to enlist in the first WHI study. I joined more than 100,000 other postmenopausal women volunteering to fill out forms, have blood drawn and answer questions over the next 15 years. That initial focus was on tracking the effects of hormone therapy, dietary patterns and/or calcium/vitamin D supplements on prevention of heart disease, cancer and osteoporotic fractures. I had not yet had breast cancer – that would come about 10 years into the study; a family history of osteoporosis added to my personal interest in WHI. Over the years I volunteered to participate in some of the wide-ranging ancillary studies looking at other health-related things like physical activities, lifestyle, tobacco and dozens of peripheral issues. (My personal favorite question appeared on one of the multi-page annual update forms. It read – Yes or No – “When you enter a room full of other people, do you have the feeling they are talking about you?” There may someday be a report on women and paranoia.)

Mysterious questions aside, WHI is serious business. Here, excerpted from the latest Extension Study newsletter are a few facts about what has been learned from the historic initiative, and a little of what is still ahead.

Those hormones millions of postmenopausal women were taking, widely thought to be miracle answers? Studies showed the risks far outweighed the benefits, and millions stopped taking them. Hormones in different combinations had been commonly taken to minimize chances of cardiovascular disease, cancers, fractures, diabetes, gall bladder disease and a variety of quality-of-life measures; quitting the hormones proved a better choice. Health benefits can’t be precisely measured, but the reduction in hormone use has led to a decrease in rates of breast cancer and cardiovascular disease.

And in dollars and cents? Some $37.1 billion, (in 2012 when all costs and quality-adjusted years of life are considered, has been the total economic return of the WHI trial.

By June, 2014, over 1000 papers based on WHI data had been published in scientific journals. What’s ahead? Researchers are looking at pet ownership and risk of cardiovascular disease; physical activity during childhood and risk of Alzheimer’s disease; breast cancer distribution by rural/urban areas and geographic differences in cognitive decline/dementia.

Every year on their birthday, WHI study participants receive a card – some of us call it the “Hooray, you’re still alive” card. For women everywhere, it represents something worth more than gold.

Bone weary in America: contraceptives, celiac disease & other osteo-hazards

You might want to start paying attention to your bones.

Even if you’re not an over-50 hard-drinking guy, or a post-menopausal former-smoker gal — even  if you are, say, just a light-complexioned skinny person, your bones want you to understand they might not be able to keep you together forever.

My bones sent that message not long ago by summoning a few other medical markers. Anemia and exhaustion got my attention and lo! we discovered celiac disease. Who knew? Celiac sprue is a genetic condition half the country seems to have, now that it’s gotten half the country’s attention — and confirmed diagnoses are relatively easy to make. Because I am an asymptomatic celiac person, in my case it was just the ol’ bones sending a signal that they would like a little calcium, please.

Yesterday’s New York Times reported another new finding:

Almost half of all women who use a popular injected contraceptive lose a significant amount of bone mass within two years, and researchers now say the greatest risk is to smokers, women who don’t consume enough calcium and those who have never gone through a pregnancy.

A study that followed women who used the birth-control method — a shot of depot medroxyprogesterone acetate, better known as DMPA or Depo-Provera, every three months — found that 45 percent of the users experienced bone mineral density losses of 5 percent or more in the hip or lower spine, researchers said. The study appears in the January issue of Obstetrics & Gynecology.

More than two million American women use DMPA, including about 400,000 teenagers.

Researchers said the bone loss was of “significant concern” because recovering bone mass can take a long time, and the hip is the most common site for fractures in women later in life.

“We can now tell our patients, ‘Don’t smoke, and take your calcium every day’ — those are modifiable risk factors,” said the senior author, Dr. Abbey B. Berenson, director of the Center for Interdisciplinary Research in Women’s Health at the University of Texas Medical Branch at Galveston. “The flip side is that if I have a patient who smokes, I’m going to be more concerned about giving her Depo-Provera.”

Your bones could be aching for attention even if you’re still none of the above. The World Health Organization now has a nifty new bone-health tool called FRAX to help you figure if you’re at risk for fractures. You can visit their site, plug in country and ethnicity for your personal profile. You can also go to KnowMyBones.com (bones people are having a good time with titles and acronyms) and find out more about healthy bones and how to keep them thus.

Dem bones, as long as you help them, gonna walk around.

Some Women's Views of Health Reform

First Lady Michelle Obama is making the news in support of her husband’s health plan, hoping to tap into the energies of one group who voted for Obama in large numbers: women. Reform is everyone’s concern, but in many ways it occupies a specific gender niche. As reported by Voice of America’s Kent Klein,

Mrs. Obama says health care reform is a women’s issue. “Women play a unique and increasingly significant role in our families.  We know the pain, because we are usually the ones dealing with it,” she said. The first lady spoke Friday to a gathering of women near the White House, and said the state of the U.S. health care system is unacceptable. “For two years on the campaign trail, this was what I heard from women:  That they were being crushed, crushed by the current structure of our health care.  Crushed,” she said.

A host of women’s groups, blogs, newsletters and web writers have also recently joined in. Posting in the National Women’s Law Center blog, Outreach Manager Thao Nguyen told the poignant story of hearing from a friend that she’d just married her long-time hesitant boyfriend. The marriage news was good news, but its terms took the joy out: having lost her job, it was the only way she could get health insurance.

Her point seemed so logical, but the entire idea was couched in such an insane reality I was simply speechless. Lucy is in her early 30s but she has a pre-existing condition so buying individual health insurance and the unfair, overpriced premiums that come with it was out of the question. Lucy has been living with Dan for 10 years, but unfortunately, he works for a company that doesn’t offer domestic partner benefits.

I couldn’t help but think: is this what our broken, unstable health care system means for millions of Americans around the country? As the economy continues to struggle, employers continue to shed jobs, and every day 14,000 more Americans wake up realizing that they are now uninsured and just one illness away from financial ruin. Are reluctant bachelors around the country going to put away their Megan Fox posters, cancel the “poker nights” (aka X-Box marathons we’re on to you), and start settling down?

My own run-in with healthcare weirdness is minor in comparison to most, but I still remember the shock. Making a routine call to renew the prescription for a bone-building drug I had taken for years to stave off osteoporosis, the message center person said she probably should warn me that rather than the $24 co-pay I’d been having per quarter my cost would now be $230. I do need these bones, but couldn’t see them worth $920 a year. I hung up and started drinking more milk. Had to get breast cancer, for which I now take a covered post- cancer drug which my oncologist prescribes… mainly to keep my bones healthy. Something is bizarre here.

Or maybe we women might bend the old macho adage a little: It’s broke, fix it.

VOA News – Michelle Obama Joins Health Reform Campaign.