When she started in 1991 as the first full-time director of the National Institutes of Health Office of Research on Women's Health, Dr. Vivian W. Pinn said, she had to explain why research on women was even needed.
Now she can point to a number of key victories, from exposing the dangers of hormone therapy to a vaccine against human papillomavirus and cervical cancer. Much about the unique health issues for women, however, still needs answers, she said.
Pinn spoke Wednesday at the Medical College of Georgia on the vision for women's health research in the future.
At first it was a struggle to convince people that women should be a part of clinical research, or that they were even interested in participating, she said.
The Women's Health Initiative helped change that as it looked into widely accepted claims that estrogen-progestin hormone therapy in postmenopausal women helped protect them from cardiovascular disease. Eventually including more than 250,000 women in all components of the study, it was halted early in 2002 because of an increased risk of heart disease, stroke and blood clots in the hormone therapy group.
Though the results attracted critics who still defend the therapy, the decline in cancer since many women went off of it should help answer that, Pinn said.
"At least now there is more information to consider (that wasn't available before)," she said.
The office helped fund some of the early clinical trials of basic research that would become the HPV vaccine, which was tested at MCG and other sites. Some strains of HPV can also cause cervical cancer.
"And I remember for years saying, 'Couldn't this be some of the most exciting research on women's health if we finally have a vaccine that can prevent a sexually transmitted disease?' because we didn't have one before," Pinn said. "And just think, even though cervical cancer is not the most common cancer, it is a cancer for which we should not see any deaths."
Research is continuing to look at gender differences, such as in pain -- women are much more likely to suffer from chronic pain -- or in cardiovascular disease, where some key diagnostic tests could potentially be less effective at picking up the disease in women than in men, Pinn said.
The progress sounds familiar to MCG President Ricardo Azziz.
"In that period of time we started out really with, 'It was nice to do research in women,' to, 'It's probably important to also study women,' to, 'Now we clearly understand that there is a difference in the response of women and men' " he said. "We need to understand that women are not just simply estrogenized men."
As research becomes more sophisticated in hunting down genes and molecular causes, Pinn said, she tries to remember that behavior is important, too.
"A lot of what we're learning is while the science and all of that is important, one of the major contributors to whether we manifest our genetic tendencies or predisposition has to do with lifestyle," she said. "I don't think we should make women feel guilty about the diseases they get that they can't avoid getting, but I think we also have to remind women and men and families that there are conditions they can protect themselves against.
"We can't expect physicians and nurses to cure everything if we can have a role in preventing them."