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The New Republic
By Cathy Young | MARCH 19, 2001
On valentine's day, activists held a Capitol Hill press conference to deplore medicine's neglect of an entire gender. Nothing is new about that; for years feminists have been clamoring that patriarchal health care shortchanges women. But there was a twist: This time the focus was on the neglect of men. The occasion was the introduction of the Men's Health Act, under which a newly created Office of Men's Health within the Department of Health and Human Services would "coordinate and promote the status of men's health." Men's health advocates say that while the government has lavished resources on women's health for years, men's concerns--from prostate and testicular cancer to higher mortality rates--have gotten short shrift. When it comes to health, author Armin Brott, one of the speakers at the press conference, wrote recently in the Albany Times Union, "it's about time we started treating men as well as we treat women."
Maybe; maybe not. Sure, special-interest lobbying has produced a disproportionate focus on female-specific health issues. But parallel pleading on behalf of men may compound rather than solve the problem-- furthering the unhappy trend of viewing medicine through the lens of gender politics.
Women's health first gained political prominence in the early '90s, when the Congressional Caucus for Women's Issues took up the cause. Armed with damning statistics--for instance, the fact that in 1987 less than 14 percent of National Institutes of Health funds went to research on women's health-- and aided by outrage over a large all-male study, first reported in 1988, of aspirin's role in preventing heart attacks, the congresswomen secured a women's health office at the NIH and increased research funding for diseases afflicting only, or predominantly, women.
But there was always less to the problem than met the eye. The bulk of the NIH's research budget, for instance, went to studies that benefited both sexes, not just men; male-specific health projects accounted for less than 7 percent of total expenditures, half of what women's health was getting. As Johns Hopkins School of Public Health Professors Curtis Meinert and Adele Gilpin report in a recent article in the journal Controlled Clinical Trials, there is little evidence to suggest that researchers excluded or overlooked women and their problems. From 1966 to 1986, for instance, researchers conducted more than 400 clinical trials on breast cancer, compared with just 121 on prostate cancer (which causes nearly as many deaths, though at a later age). While some clinical trials were indeed limited to men, it was often for compelling reasons: When investigating heart-attack prevention, for example, it makes sense to start with a relatively high-risk group such as middle-aged men, who are three times more likely than women to suffer a fatal heart attack before age 65.
Certainly women's health activism has had some salutary effects, like drawing greater attention to heart disease and breast health in women. But it has also fostered new gender antagonism with wild charges that sexist legislators and policymakers don't care about women's lives. And, over time, it has produced new disparities. Today, thanks to aggressive, legally mandated efforts to expand women's inclusion in medical trials, fewer than one-third of NIH subjects are men. William Harlan, director of disease prevention at the NIH, attributes this to female-only trials needed to replicate earlier all-male heart studies. Yet the lowest proportion of men-- 29 percent--is in cancer studies, in which women were never underrepresented.
Men's health activists, likewise, have some worthy goals. They have successfully pushed for much-needed research on prostate cancer. (Government funding for prostate cancer research still lags behind funding for breast cancer research, but the gap has narrowed.) And few would object to their call for initiatives to educate men about taking better care of themselves.
But there is a downside as well. For one thing, making health care into a gender issue often produces bad or dubious medicine. Take regular, universal prostate cancer screening after age 50: Men's health advocates champion it as a necessary counterpart to mammograms for women, and an Office of Men's Health would likely promote such testing. Yet researchers and medical professionals vigorously disagree about whether the benefits of early detection outweigh the risks of unnecessary surgery. The danger is that men's health activists may win the same misguided "victory" on prostate cancer testing that women's health activists won on mammograms. In 1997 an NIH panel decided not to recommend routine annual mammograms for women in their forties, pointing out that frequent false positives in that group resulted in unnecessary biopsies and alarm. The decision was widely condemned as insensitive to women. The Senate quickly passed a resolution defending routine early mammography, and under heavy political pressure the National Cancer Institute eventually did as well.
Another danger is that gender-based medical research, secured by powerful constituent groups, will end up displacing gender-neutral work that may ultimately be more important. The NIH's budget, after all, is finite; when interest groups push through more funding for their pet causes, the money available for other research goes down. That's worrisome, since some of the diseases whose funding could be cut--lung cancer and heart disease, for instance--kill more women and men than any sex-specific condition.
Curiously, many women's health activists are cautiously sympathetic to the men's health movement. "If men are starting to talk about prostate cancer and gender-specific issues," says Bernadine Healy, who championed women's health as director of the NIH in the early '90s and now heads the Red Cross, "that is a positive consequence of focusing on women's health, which led to a recognition of gender differences." But not everyone thinks that recognition is such a good thing. Andrew Kadar, a physician at Cedars-Sinai Hospital in Los Angeles who has argued against feminist claims about medicine in The Atlantic Monthly, is put off by the alarmist language of the Men's Health Act, with its talk of a "silent health crisis" at a time when the health and longevity of Americans of both sexes are steadily improving. But as long as the women's counterpart exists, he's holding his tongue. "Since women's health advocates have exploited victim politics, men's health activists are responding in kind," says Kadar. "Unfortunately, it may be the only way to play this game." Unfortunately, he may be right.