Cardiologist Dr. Nanette Wenger became the chief of cardiology at Grady Memorial Hospital in 1958, and still today in her 90s, is serving patients in Atlanta. Her view on medical misogyny and a woman’s ability to access health care in Georgia? There’s still much work to be done.
As Professor of Medicine in the Division of Cardiology at the Emory University School, she has been a key participant in Atlanta’s medical establishment for decades, and explains what needs to happen next.
Q: How far have we come since the 1950s?
Dr. Nanette Wenger: Throughout most of the 20th century, when people talked about women’s health, or women’s health research, they thought of Bikini Medicine — the breasts and the reproduction system. Those were considered the areas relevant to the health of the women. Little else was addressed. The rest of the woman was virtually ignored.
I saw it in my area as a cardiologist, but in other areas as well. Heart disease was considered a problem for men, and women were considered protected by pre-menopausal hormones, and post-menopause by hormone replacement therapy — which was then considered a panacea.
Yet, more women for many years died of coronary disease than did men. As we came into an era of gender-specific medicine, we began to see that there are major differences. This is what people have termed ‘gender medicine.’
Q: When did things start to improve?
NW: With coronary disease, most of the data was derived from populations of middle age caucasian men. There were two reports that came from what is now the National Academy of Medicine. The first was that sex matters, and it advocated for a gender-specific research approach to coronary disease. A decade later, a second report looked at the progress made.
Heart disease is a major cause of death in women in the 21st century. When we look at data for women for cardiac mortality, from 2014 mortality among women decreased more quickly than men. As I say in my writing, this is an area in which we as women were happy to take second place.
It is also encouraging that we are starting to gain control over cigarette smoking — and it was simply due to banning smoking in public places. Sadly, many are substituting vaping for smoking.
Q: And for the rest of medicine?
NW: In so many areas, there are things that remain to be explored for women. I’ve written in great detail, and I’ve talked about it as one of the most exciting opportunities for progress. And I will be making this message at a key note I will be giving at the Precision Medicine World Conference in early February.
In medicine, we need to be gender specific and then we have to look at other areas.
For example, cardiovascular disease is a major cause of unhealthy pregnancy. We are seeing women come with so many risk factors to the pregnancy. We not only have to take care of the woman during pregnancy, but also to see that she can be healthy herself during the pregnancy.
Georgia has among the highest maternal mortality rates in the country. We are in what is known as the ‘Stroke Belt.’ We are now saying that we have to prevent the problems that lend themselves to stroke. Hypertension is undertreated nationwide, and Georgia is among the worst.
Q: Where else is improvement necessary?
NW: We have unacceptably high rates of obesity, and unacceptable rates of affordable care. Georgia is one of the states that has not expanded Medicaid. More women than men delay medical care due to out-of-pocket cost. For many young women, it’s the choice between paying rent or paying for medical care.
I believe people need information about what constitutes a healthy lifestyle and an active lifestyle. We stopped physical activities in the schools, and we’ve stopped teaching healthy eating in schools. In the end, it affects women.
Q: What would you like to see from legislators?
NW: The Georgia Legislature now provides Medicaid for one year postpartum. It is stunning and it is helping, especially women who have had complicated pregnancies.
My base of operations, where I do my teaching and my research, is at Grady Hospital. We are a safety net hospital, and that is the population I serve. And we believe in education. Grady has a program called “Food As Medicine,” and right across from the hospital, people can buy heart-healthy food. There are also cooking classes. For a select part of the population, this can be a part of the treatment.
We need to expand women’s access to insurance. I would like to see an expansion of Medicaid in Georgia. I would like to see a school lunch program where children are taught about heart health. So much of this is about information. There are trusted sources that parents could be directed to.
I would hope that access to information be a priority in the Georgia Legislature this year. I ask legislators to look at the White House Initiative on Women’s Health Research because in that program is new information to improve women’s heart health.
Disease is not an old lady’s problem — it cuts across the entire lifespan.
Read the AJC’s 2017 profile of Dr. Wenger here.
