From left: Lynn Roberts, PhD, Assistant Dean of Student Affairs and Alumni Relations, City College of New York; Andrea Dunaif, MD; Veerle Bergink, MD, PhD; Laura E. Riley, MD; Elizabeth A. Howell, MD, MPP; Vivian Pinn, MD; Michael Brodman, MD, the Ellen and Howard C. Katz Chair of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai; Lynne Richardson, MD, Vice Chair for Academic, Research, and Community Programs, Icahn School of Medicine at Mount Sinai; Susan Domchek, MD, Executive Director, Basser Center for BRCA, Penn Medicine; and Stephanie V. Blank, MD, Director of Gynecologic Oncology, Mount Sinai Health System.
Why are more women than men hospitalized for schizophrenia after age 50? How should a bipolar pregnant woman be medicated? What should the study of women’s health encompass?
These were some of the questions posed recently by leading physician-scientists at the inaugural symposium of The Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai—“Cutting-Edge Topics in Women’s Health.”
The keynote speaker of the symposium, held in Davis Auditorium, was Vivian Pinn, MD, the first Director of the Office of Research on Women’s Health at the National Institutes of Health (NIH). She delivered a lesson on the not-so-distant past, saying, “Until the 1990s, most women’s health research was related to the reproductive system or the breasts—what is known as ‘bikini medicine’—and most studies of conditions that affect both men and women were conducted only in men.”
The symposium focused on issues such as equity in research, and health conditions that end women’s lives prematurely or significantly reduce their quality of life.
“These topics are a reflection of the broad research portfolio of The Blavatnik Family Women’s Health Research Institute and our strong commitment to health equity,” said its founding Director, Elizabeth A. Howell, MD, MPP, Vice Chair of Research and Professor of Obstetrics, Gynecology and Reproductive Science, and Professor of Population Health Science and Policy at the Icahn School of Medicine. The Blavatnik Family Foundation in 2018 provided a $10 million gift to establish the Institute and its clinical counterpart, The Blavatnik Family – Chelsea Medical Center at Mount Sinai. Dr. Howell said she is grateful to the family for their generous gift and support of the Institute.
Mental health is one area in which sex differences are clear, said Veerle Bergink, MD, PhD, Professor of Psychiatry, and Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine. Dr. Bergink said women are particularly vulnerable during pregnancy, which she and other panelists called a “stress test” that can trigger underlying autoimmune or mental health disorders. Her evidence-based treatment strategy, published in the December 2016 American Journal of Psychiatry, concluded that women who have bipolar disease or previous postpartum psychosis could avoid a relapse if they are treated with lithium soon after delivery.
An important area for further study is schizophrenia in post-menopausal women, Dr. Bergink said. Until age 50, the disorder is more prevalent in men, but there is a sudden turning point after 50 when more women are hospitalized for schizophrenia than men. An “estrogen hypothesis” proposes that the hormone has a protective effect that declines after menopause. “But we know very little about this,” Dr. Bergink said. ”Most of the schizophrenia research over the last 30 years has investigated men, and very little has focused on women.”
Another area for further study is the influence of pregnancy complications on women’s health in later life, said Laura E. Riley, MD, Professor and Chair of Obstetrics and Gynecology, Weill Cornell Medicine. Dr. Riley said that 7 to 10 percent of pregnant women in the United States are diagnosed with gestational diabetes and up to 9 percent contract preeclampsia, characterized by dangerously high blood pressure. Studies have shown that such complications are associated with cardiovascular disease and type 2 diabetes later in the lives of these women, Dr. Riley said, and there are many medical and behavioral interventions to be explored.
“For those of you looking for research projects, these might be good ones,” she said, “because I don’t think this story is over.”
Attendees received expert grant-writing advice from Andrea Dunaif, MD, Chief of the Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease, and the Lillian and Henry M. Stratton Professor of Molecular Medicine, Icahn School of Medicine, whose groundbreaking research into diabetes and polycystic ovary syndrome has been continuously funded by the NIH since 1985. Dr. Dunaif also addressed more complex challenges, such as adhering to the “sex as a biological variable” policy, which since 2016 has required researchers to factor sex into the design, analysis, and reporting of any study that involves humans or vertebrate animals.
“A little-known fact is that only the males get diabetes in almost all animal models of diabetes. Studies have found that the protection of female sex—both hormonal and chromosomal sex—is powerful,” Dr. Dunaif said. “But that begs the question of why? This is very important scientific question. I’m sure there are many more disease models in which there are major sex differences, and those should be studied.”
Inclusive research is a key legacy of Dr. Pinn, who retired in 2011. The office she led was established in 1990, after four congresswomen called for action on women’s health research. Since then, studies have documented sex differences in the prevalence, age of onset, and severity of autoimmune diseases, depressive disorders, diabetes, and cardiovascular disease. “And there is still much to learn,” she said, “about the process of moving from discovery to treatment.”