Posted by on February 5, 2010 - 5:07pm

Every day we hear about a new drug, screening tool or technology that promises to improve our knowledge of health and disease.    Generally, the news is good, or at least hopeful, reassuring the public that important research is progressing.  Often, the new breakthroughs  have been demonstrated in the lab or in animal models and has not yet been studied in humans,  a process that could take years.  Sometimes the lab findings do not translate well to the human and the researcher may have to start all over with a new strategy.   This is particularly frustrating for individuals who have a disease or condition that is debilitating and could be deadly.  The new movie, Extraordinary Measures,  is the story about a father who self-funds a researcher to accelerate the process for a promising drug for Pompe disease because his children have the condition.  It is a great example of how driven and focused we can become when our own loved ones are ill.

The research community is challenged when what we  know now (based on the science technology and data available at the time), changes when new technology allows us to further explore a Slide23particular issue.  Or when there is more data in a statistically significant pool that truly reflects our population diversity and allows us to determine differences that may exist among different races and ethnicities.  This could lead to different approaches for certain populations.    We'd like to think of research as finite but it is a constantly revolving cycle.  One important example is the recent mammography guideline debate.   Several years ago, mammography screening became mainstream:  most women knew the guidelines, advocates worked to pass laws to assure that all women had access,  and early studies showed that finding breast cancer early, in many cases, improved survival rates.   Last November the U.S Preventive Task Force new mammography guidelines that were posted by Candace  questioned the benefit of the current guidelines as applied to the general population.  It should be noted that this is the first update by the Task Force since 2002.   This led to conflicting reports of support verses outrage.  There are some valid arguments on both sides and the new report was based on additional data.  The outrage of strong proponents of mammography often overlooked the details of the report that acknowledged that high-risk women may want to discuss their screening intervals with their health care provider.   On the other hand, the team behind the report were criticized for not fully explaining that there were high-risk populations that required further study.   These exceptions would not change their overall recommendations, but they could have made it clearer that there could be exceptions that do not apply to the population at large and that they were sensitive to the emotional backlash this report would produce.

Advocacy is a powerful activity that has led to increases in research dollars and more sensitive care.   But sometimes advocates are so focused that they do not see the big picture.  An example of advocacy compromising good science is the debate in the 1990's about High-Dose Chemotherapy with Bone Marrow Transplant or Stem Cell Support (HDCBMTSCS) as a treatment for breast cancer.  HDCBMTSCS was seen as a promising aggressive treatment for the growing number of women who were being diagnosed each year with this disease.   As appropriate, randomized controlled clinical studies (the gold standard that compared a new treatment with the latest standard of care) opened and tried to recruit women.   However, many interested women did not want to be in the control group.   After all, more is better!  To respond to this demand from advocates, many hospitals opened bone marrow transplant units and insurance companies were pressured to cover this "experimental"  treatment despite the lack of clinical trial evidence.  And what happened?    Women by-passed the trials and went to the institutions that offered the treatment outside of clinical trials.  This delayed the evidence-based findings that eventually concluded that HDCBMTSCS was not better than standard treatment for breast cancer  (it does offer a good option for certain other cancers) and that many women suffered far more severe side effects (that sometimes resulted in death) with little improvement in outcome.

So what do we do?   It is important for men and women to understand enough science to enable us to interpret studies without the bias of headlines.   Programs like Project Lead sponsored by the National Breast Cancer Coalition trains consumers to understand the basic scientific principles behind research studies.   We need greater participation in well-designed clinical trials so we can get answers sooner so better therapies become available sooner.     Finally,  look for portals to research studies that not only study disease, they also look for better ways to prevent disease.   One such portal is the Illinois Women's Health Registry.  Hopefully, more of these gateways will become available.

Posted by on February 4, 2010 - 10:58am

Research led by Teresa Woodruff, PhD, director of the Institute for Women's Health Research at Northwestern University was featured in the first edition of  Horizons in Bioscience, a publication of the Federation of American Societies for Experimental Biology, that describes scientific discoveries on the brink of clinical application.   This publication is shared with members of Congress who track National Institute of Health funding.

In 2006, Dr. Woodruff coined the term 'oncofertility' to describe the merging of two fields: oncology and fertility. Advances in chemotherapy and radiation have increased survival in cancer patients but many of these life-saving treatments often result in the loss of fertility. Breakthroughs in ovarian tissue cryopreservation and in vitro follicle maturation are brightening the outlook for preserving fertility in young women with cancer and other diseases that are treated with potent therapies. Based on promising science being done in her lab, Woodruff was awarded a prestigious Roadmap Grant from the NIH to advance her work in 2007. She now heads a national Oncofertility Consortium, an interdisciplinary team of biomedical and social scientists, oncologists, pediatricians, engineers, and ethicists from universities across the country--bringing national experts together to accelerate the new field.

For more information about Dr. Woodruff and her work, visit the newly updated website of the Oncofertility Consortium.

Posted by on February 1, 2010 - 10:21am

What is Heart Disease?

Heart Disease is a general term used to describe various diseases and syndromes of the heart and blood vessels.  Included in the definition are diseases such as coronary artery disease, heart arrhythmia, heart valve disease, heart failure, and congenital heart defects, among others.

Heart disease is the number one killer of both men and women worldwide, but may be prevented or treated with healthy lifestyle choices.  The symptoms of heart disease vary dependent on the specific condition but include chest pain, shortness of breath, fluttering in the chest, swelling in the lower limbs, and fatigue.  Symptoms of a myocardial infarction (or heart attack) tend to be different between men and women, with women experiencing more subtle symptoms such as fatigue, shortness of breath and nausea.  Consequently, it may be more difficult for health professionals to diagnose and respond to a heart attack in a woman.  In addition, recent research has shown that women suffer disproportionately than men from coronary artery disease in the small vessels (arterioles) as opposed to the larger arteries.  This may further complicate diagnosis and treatment of heart disease in women.

Causes of heart and cardiovascular disease include poor diet, little exercise, obesity, smoking, and high blood pressure, but may also be caused by congenital defects.  A healthy diet and exercise along with maintenance of blood pressure, cholesterol, and stress may help reduce the risk of heart disease.  Treatments for heart disease include lifestyle changes, medication, and in some cases surgery, and it is best treated when diagnosed early.

Resources at Northwestern for Heart Disease:

The Bluhm Cardiovascular Institute at Northwestern Memorial Hospital offers state-of-the-art treatment in all areas of cardiovascular care.  Patients receive a comprehensive, multidisciplinary approach to treatment and prevention from physicians, nurses and other healthcare providers specializing in cardiology, cardiac surgery, vascular medicine and surgery, cardiovascular anesthesiology, cardiac behavioral medicine and radiology, among others.  The Institute is comprised of six heart health centers for atrial fibrulation, coronary disease, heart failure, heart valve disease, vascular disease, and women’s cardiovascular health.  The Women’s Cardiovascular Health Center offers treatment specifically designed for women, tailoring treatment plans to optimize their specific cardiovascular needs.  The Center is also committed to promoting women’s awareness of cardiovascular health, highlighting the differences in symptoms and risk factors for women.

For more information call: (866) 662-8467 (toll free)

Northwestern Physicians/Researchers specializing in Heart Disease:

Researchers at the Feinberg Cardiovascular Research Institute are committed to exploring complex problems in cardiovascular research including molecular, cellular, stem cell and imaging technology research.   Investigators at the Institute work in areas of basic science and clinical research.  The innovative program in Cardiovascular Regenerative Medicine seeks out new ways of growing new cardiac tissue as opposed to improving function of damaged tissues.  The program provides researchers with the means to bring basic science research into use in clinical trials.  Led by Dr. Douglas Losordo, MD, clinical trials are being conducted for treatment in the areas of coronary artery disease, heart failure, and vascular disease.

For more information visit: http://www.fcvri.northwestern.edu/index.html

IWHR Highlighted Researcher

Dr. Mercedes Carnethon is an Assistant Professor of Preventative Medicine at Northwestern University’s Feinberg School of Medicine.  She earned her PhD in Epidemiology from the University of North Carolina in 2000 and joined the faculty of Northwestern in 2002.  Her research interests include the role of the nervous system on cardiovascular disease (CVD), the relationship between fitness and cardiovascular health and the effects of sleep on the risk for CVD.  She is a member of several professional societies including the American College of Epidemiology and the American Heart Association.  Most recently, Dr. Carnethon has initiated a study to evaluate how sleep duration might affect a patient’s risk for cardiovascular disease.  Previous studies have evaluated patients with major sleep disturbances, such as sleep apnea, or have used sleep deprivation to evaluate the relationship.   Dr. Carnethon’s study will more closely mirror how women and men sleep during a normal week, and compare their sleep duration to indicators of their cardiovascular health.  The study hopes to justify the recommendations for total amount of sleep that an adult might need to maintain his or her heart health.

Photo: The Heart Truth Campaign

Photo: The Heart Truth Campaign

Upcoming Public Events:

NMH Annual Cardiovascular Symposium:  Heart Health – What Smart Women Need to Know, February 24, 2010, Prentice Women’s Hospital

Don't Forget - National Wear Red Day® is February 5th!

Posted by on January 29, 2010 - 11:45am

New information from the Kaiser Family Foundation and the George Washington University School of Public Health and Health Services on family planning services covered under Medicaid has been added and is available for 2009 for all states. The number of states that cover over-the-counter emergency contraception is 26; sterilization (36 +DC); Infertility testing (4); Infertility treatment (0); STD Testing  (11) and Treatment (9); HPV Vaccine for ages 21-26 (29). The report also contains information about family planning eligibility service waivers for each state. The map below demonstrates the emergency contraception coverage.

Coverage for Emergency Contraception

To view the entire report visit

Posted by on January 27, 2010 - 2:51pm

Earlier this week, the Federal Drug Administration (FDA) announced that they had approved a new drug for type 2 diabetes (see the FDA's press release here).  Type 2 is the most common kind of diabetes and can develop at any age despite the old misnomer that it was an "adult-onset" disease.  Essentially, your body does not properly release insulin in response to increases in blood sugar (for example, after a meal).  Therefore, sugar is not properly metabolized and builds up in your blood.

Diabetes is a huge concern not only as the seventh leading cause of deaths in America, but also in the high medical costs for  those afflicted.  Statistics show that more than half of diabetes cases are women.  Pregnant women can be affected by gestational diabetes, which typically goes away after the baby is born but can lead to the development of Type 2 diabetes.  This may contribute to the slight sex bias in Type 2 diabetes, where women comprise 58% of all cases (according to a 1995 study by the National Diabetes Data Group).  There is a nice discussion on sex-specific differences in diabetes on Medscape Today, if you are interested in reading more.  The article is accompanied by a long list of references for more detailed information.

I don't study diabetes and I'm not a doctor, but based on my limited knowledge and reading, it looks like the new drug (which will be sold as Victoza) has a different target in the pancreas than the other drugs already on the market.  (There was a nice overview in this 2001 review article in the journal Nature.)  It's nice to have more possible treatments since not all drugs work to the same effect in every patient.  There's evidence out there that some drugs act differently even between men and women!  Of course, with any new drug, time will tell if Victoza causes any long-term effects.  However, it is promising to have a new option for those dealing with diabetes and their loved ones as well.  Has diabetes affected you or someone you know in any way and if so, what has been your (or their) experience with the current drugs out there already?

Useful info on diabetes from the National Diabetes Information Clearinghouse:

Posted by on January 25, 2010 - 2:35pm

The Food and Drug Administration (FDA) is warning the public about a counterfeit version of the weight-loss drug Alli 60 mg capsules (120 count refill pack) being sold over the Internet, particularly at online auction sites.
The counterfeit product is illegal and unsafe. FDA advises people who believe that they have a counterfeit product not to use the drug and to dispose of it immediately. There is no evidence at this time that the counterfeit Alli product has been sold in retail stores.

Photo of authentic Alli

Photo of authentic Alli

According to the FDA, the counterfeit Alli looks similar to the authentic product, with a few notable differences. Counterfeit Alli has:
* a missing LOT code on the outer cardboard packaging
* an expiration date that includes a month, day and year (real Alli only has month and year)
* plain foil for the inner safety seal without words on it (real Alli has the words "SEALED FOR YOUR PROTECTION" printed on it)
* large capsules with white powder, as opposed to small white pellets found in real Alli
* a slightly taller plastic bottle with a wider cap and coarser ribbing on cap than is seen in real Alli.

Alli is an FDA-approved, over-the-counter weight-loss drug that contains orlistat as its active ingredient. The counterfeit version does not contain orlistat, instead it is made with varying amounts of sibutramine, a stimulant drug. Although sibutramine is the active ingredient in another FDA-approved prescription weight-loss drug, it is only to be used in specific doses and under the supervision of a physician. Preliminary lab tests revealed the counterfeit version contained sibutramine and not orlistat. Since then, FDA lab tests on the counterfeit product show that people may be taking three times the usual daily does (twice the recommended maximum dose ) of sibutramine if they are following the dosing directions for Alli. Side effects from excessive sibutramine include elevated blood pressure, stroke and heart attack if you have a history of heart disease; and anxiety, nausea, heart palpitations, racing heart, insomnia and small increases in blood pressure if you are healthy.
If you have been taking the counterfeit product, stop taking the drug and throw it away; contact your health provider if you are experiencing more than mild symptoms, especially if you have a history of cardiovascular disease; and call FDA's Office of Criminal Investigations at 800-551-3989 or by visiting the OCI Web site

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Posted by on January 20, 2010 - 1:56pm
Melina Kibbe honored at White House

Melina Kibbe honored at White House

Melina Kibbe, M.D., associate professor at Northwestern's Feinberg School of Medicine, vascular surgeon at Northwestern Memorial Hospital and co-chief of the vascular surgery service and director of the Vascular Laboratory at the Jesse Brown VA Medical Center recently received the Presidential Early Career Award for Scientists and Engineers (PECASE) at the White House.   This is the highest honor given by the U.S. government to outstanding scientists and engineers who are in the early stages of their research careers.

Her current research portfolio was primed, in part, by two Pioneer Awards the Institute for Women's Health Research (IWHR) awarded Dr. Kibbe and her postdoctoral fellow in 2008 and 2009, respectively.  Her research focuses on preventing vascular injury and scarring in blood vessels following stent surgery.   It wasn't until Dr. Kibbe  ran into Dr. Teresa Woodruff,  IWHR Director, a few years ago, who asked Kibbe if she was including female animals in her research, that she gave it much consideration. After that meeting, Kibbe searched publications in her field that included sex as a variable and she found there was very little.   With her Pioneer Awards, she proposed to include male and female animal models to study the benefits of nitric oxide (NO)-based therapies following stent surgery and found that the effect was totally different between the sexes!

The Pioneer Awards were developed by the IWHR to encourage researchers to include sex and gender analyses in their studies, and the work done in the Kibbe lab demonstrates how a small amount of funding targeted to sex-based research can produce startling results and change a whole field of study.   The immeasurable aspect of the PECASE award that Dr. Kibbe received is the invaluable  publicity it will give her research.  This may help focus on the importance of including sex variables in future vascular research and open doors to new collaborations and larger funding.

Posted by on January 20, 2010 - 11:20am

We probably all have first hand knowledge of how a bad night's sleep can affect us the next day: we're irritable, in a bad mood, and it can be hard to concentrate. It may not be all that surprising then, that how we sleep can be a very big part of depressive disorders, an incredibly interesting topic covered by Dr. Roseanne Armitage in the most recent installment of the IWHR's Women's Health Research Monthly Forum.

Dr. Roseanne Armitage Photo:www.med.umich.edu

Dr. Roseanne Armitage

Dr. Armitage began her talk by discussing how men and women, even those who do not have depression, sleep in very different ways. Possibly because of the different numbers of hormone receptors  or the over 650 genes that are expressed differently in the brains of males and females, the types of sleep we have also differs. For example, before puberty, boys have more slow wave sleep (stage 3 and 4 sleep, the deep, restorative kind that makes you feel refreshed in the morning) than girls do. After puberty, this changes, and girls are the lucky receivers of more slow wave sleep. Most interestingly, while men have a very slow loss of the amount of slow wave sleep over their lifetimes, women's amount stays relatively level and then drops precipitously during the peri-menopausal years. This is one reason why menopausal women really notice the sudden change in their sleep patterns. In general, women are also more likely to suffer from insomnia and sleep fragmentation than men.

The depression that Dr. Armitage really focused on was untreated MDD (major depressive disorder). MDD is twice as likely to occur in women than in men. Social withdrawal and feelings of worthlessness and guilt are more common in females with depression than in males with depression, who tend to complain more of lack of goal-oriented behavior. Around 80% of people with MDD report sleep problems, and for many people, sleep disturbance is the first presenting symptom of MDD. In adults with MDD, there are increased arousals and episodes of wakefulness, increased stage 1 sleep (the very light sleep), decreased total sleep time, and decreased stage 3 and 4 sleep.

Depression further exacerbates the sex differences in sleep between men and women when faced with a serious change to their normal sleep patterns (such as being asked to stay up for 40 hours consecutively), women with MDD overresponded, staying in slow wave sleep for too long, while men with MDD underresponded.  Sleep in healthy adults also shows a high level of coherence, or a very close association in the activity patterns of the right and left hemispheres of the brain. Women with MDD, however, have a lower coherence during their sleep than other healthy females, healthy males, AND males with MDD.

Dr. Armitage's work also demonstrates the ability to tie sleep disturbances to the likelihood of depression in very young girls. She finds that coherence scores can be a very good predictor of future depressive disorder; girls who were at high-risk for depression because their mothers were depressed demontrate lower coherence in their sleep...even before they have any sign or symptom of depression. Young girls in this high-risk group also had very disorganized sleep-activity patterns, even as disorganized as same aged girls who already suffered from depression. Shockingly, even babies (2 to 30 weeks) of depressed mothers take longer to fall asleep, have decreased total sleep time and sleep efficiency, and spend less time in bright light (known to produce necessary vitamins) than babies of non-depressed mothers.

Our thanks to Dr. Roseanne Armitage for such an eye-opening talk! We encourage you to look at some of Dr. Armitage's published work on the topic:

Posted by on January 18, 2010 - 8:52am

I know what you’re thinking, this is a Women’s Health Blog - but we like men here too.  A recent study published in Nature (and featured in the New York Times) reveals some interesting new insight into the X-chromosome’s somewhat puny-looking counterpart.  Researchers Jennifer Hughes and David Page at the Whitehead Institute have discovered that the Y-chromosome appears to be evolving much faster than the rest of the genome.

Humans have 23 pairs of chromosomes (46 total); two of those chromosomes, called the sex chromosomes, are responsible for determining the sex of a human. Women have two of the same chromosomes, named X (see “What’s with the dancing X chromosomes?"), while men have one X chromosome and one Y chromosome, thus resulting in a mismatched pair.  Scientists have known for quite some time that the Y chromosome originally contained the same genes as the X chromosome, but has lost most of those genes through evolution.  Because of this, scientists have believed that the Y chromosome has been degrading through gene loss and has reached, or will reach a static state.

This new research however may prove otherwise.  In their study, Drs. Page and Hughes compared the genetic makeup of the human and the chimp.  Since chimps and humans shared a common ancestor just six million years ago, the differences in the genomes can help determine rates of evolution in the species.  The researchers found that while the chimp and human genomes differed in less than 1 percent of their DNA, comparison of the Y-chromosomes shows a difference of 30%.  This data indicates that this chromosome in particular is not static, but is in fact evolving at a greater rate than the rest of the genome.

The researchers suggest that some of this rapid evolutionary diversity might be attributable to differences in the mating patterns of humans and chimps and the large role of genes on the Y chromosome in sperm production.  A unique feature of the Y chromosome is that because it occurs in a mismatched pair with the X chromosome, it cannot exchange genes (called crossing-over) prior to meiotic cell division the way that the other twenty-two chromosomes do.   This places increased selective pressure on the Y chromosome, since a change in one gene must affect the reproductive fitness of the others.  In addition, the structure of the Y chromosome provides it with the opportunity to exchange genes with itself, which could accelerate the rate of change in its genetic sequence.

So does this mean that men are evolving faster than women?  No it doesn’t (sorry guys).  However, according to Andrew Clark, a geneticist at Cornell University (see NYT article), the rapid changes of the Y chromosome could have broader effects on the rest of the human genome.  Only further research will tell…

Posted by on January 14, 2010 - 10:58am
Photo credit: Randy Belice

Photo credit: Randy Belice

We welcome the new commentary from the Dean of the Feinberg School of Medicine here at Northwestern University entitled, "Diversity: Essential For Our Success." In it, Dr. Larry Jameson tells of his own personal history of growing up in the age where integration and diversity were just beginning to take hold as ideals of value. He discusses remembering very few women or people of racial minorities in his own medical class, and praises the efforts that have been taken to change this sad statistic in the school admissions, faculty hires, and work opportunities in the years since his school days. Dr. Jameson offers a few new insights, including his own hesitancy to think of race as any true separator;  a consequence of his knowledge regarding genetic similarities between all racial groups. Additionally, Dr Jameson offers this anecdote:

"We were asked (coerced) to take a Meyers-Briggs personality test. Based on the results, we were sorted into small groups with similar or differing profiles. All groups were given the same problem to solve. When we reported out, it was very clear that the more diverse groups had been more open-minded and creative, and had constructively addressed issues that required compromise. In contrast, the more homogeneous groups immediately focused on traditional solutions, were recalcitrant to compromise, and in some cases became too bogged down in old issues to even promote solutions. I generally dislike these kinds of exercises, but I learned that diversity yields better solutions."

That principle is one of the many reasons that the IWHR promotes diversity in the clinic and in the lab, as well as in the patient or study participant pool. We believe that a diverse population within the set of doctors and scientists who direct modern medicine will naturally lead to a greater insight and sensitivity to the needs of the diverse set of patients who benefit from new innovations and treatments.

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