Today, heart trouble and gender -- a parable about
experimental science. The University of Houston's
College of Engineering presents this series about
the machines that make our civilization run, and
the people whose ingenuity created them.
I've just given up cream. As
a boy in Minnesota, I loved the rich fatty clots of
cream floating above unhomogenized milk in the old
glass bottles. Now my wife reminds me that I've
promised to outlive her. My love affair with cream
must end. And, oh, how I love rich fatty food.
So she and I play the heart-attack game by
traditional rules. We worry about the male and
ignore the issue in the female. "Don't get between
me and chocolate!" She glowers. We take it on faith
that heart trouble is a male problem.
Doctors have recently faced the charge of sexism in
their treatment of heart disease. They seem to go
after it aggressively in men and ignore it in
women. Are the charges warranted?
Before WW-I, heart attack was often undiagnosed. It
easily passed as gastric trouble -- maybe
indigestion. Doctors began serious treatment of
heart trouble only after WW-II.
It was soon clear that women are far less prone to
heart attack during their reproductive years. At
the age of 40 a man is five times more liable to
heart attack. But after women reach 67, heart
disease becomes their greatest killer.
The problem is, statistics feed themselves in
strange ways. If women's hormones protect them
while they're young, they also lull doctors to
sleep. Men get better preventive care than women
just because they're at greater risk.
We know less about heart disease in women. Their
symptoms develop differently. We haven't learned to
spot trouble as quickly. The result? Women undergo
a higher fraction of emergency treatments.
Emergency treatment is always more dangerous.
The problem is so complex. Traditional male and
female roles are changing. Are women coming under
greater stress? Maybe, maybe not. More women are
smoking. Male and female hormones are a big part of
an equation we don't yet know how to write. We
aren't sure that estrogen protects women before
menopause. Maybe the changes that follow menopause
do the harm. The fact we aren't sure has to reflect
some level of gender bias.
It all says a lot about the supposed objectivity of
science. It reminds us that we can never make
measurements without carrying ourselves into our
observations. The very things we observe determine
what we're willing to see.
So my wife worries about my heart while I take hers
for granted. I probably am at greater risk -- for
the moment. But danger really is catching up with
her, faster than medical science is.
I'm John Lienhard, at the University of Houston,
where we're interested in the way inventive minds
Altman, L.K., Men, Women and Heart Disease: More Than
a Question of Sexism. The New York
Times, Science, Tuesday, August 6, 1991, pp.
B5 & B8.
Shortly after I aired this episode, a friend
suffered a severe heart attack. She's an active
woman -- a mathematics teacher -- 48 years old and
outwardly in very good health. She didn't go
straight to the hospital, but stopped by her family
clinic for an EKG. When she got to the hospital,
suffering from chest pain, radiating pain in her
arms, and nausea, the doctor told her,
"It's a good thing you brought that EKG. I would've
dismissed you as suffering a minor stomach problem.
You don't fit the heart attack profile at all."
Then he hurriedly sent her off for a
triple bypass operation.
The Engines of Our Ingenuity is
Copyright © 1988-1997 by John H.
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