Dr. Bernadine Healy: Trailblazer for Women’s Health Equity

How can women’s health be truly evaluated without enough women in research and medical leadership?

For decades, few even dared to ask this question. Medicine was a man’s field, and women were an afterthought in both the medical profession and in clinical research. When I was a medical resident, only 1 in 4 OB-GYNs were women.

Today, women make up over 80% of gynecology residents – and this shift couldn’t have occurred without many important women who broke down assumptions about women’s health and representation in leadership, the clinic, and in research design.

As we close out Women’s History Month, I’d like to honor a trailblazer who fought for women’s health throughout her career, ensuring that our experiences are represented both as patients and as practitioners. Dr. Bernadine Healy’s groundbreaking work in inclusive clinical trials at one of the world’s most important health care organizations paved the way for women’s health equity, and her commitment to questioning long-held practices that excluded women continues to inspire the next generation of female leaders in medicine.

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Dr. Bernadine Healy: Breaking Glass as a Woman in Medicine

Healey came from humble beginnings, as the third of four sisters who all sought out careers in science and medicine. At 12, she decided she wanted to be a physician and graduated cum laude from Harvard Medical School in 1970, one of only 10 women in the class of 120 students. Next, she trained at Johns Hopkins in cardiology and rose to become the first female faculty in this traditionally male-dominated field. More than fifty years later, only 18% of cardiology trainees and 10-15% of practicing cardiologists are women. ?

She continued to break barriers in her career by holding key leadership positions within academia, non-profit and government sectors at a time when women rarely had the chance to hold such visible positions of power. Notable roles included research leadership at the Cleveland Clinic Foundation, deputy director of the White House’s Office of Science and Technology Policy, president of the American Heart Association, and dean of the Ohio State University, to name a few. ?

Blazing new trails is never easy and Healy faced endless sexism and bruising criticism for challenging the status quo. Healy was inspired by her role model, Clara Barton, a nurse and founder of the American Red Cross, which Healy later led as president and CEO. Barton had given Healy proof of the vital role of women in medicine and the importance of sticking to your sense of what is right, even when the world doubts or degrades you. A famous quote attributed to Barton reads, “It irritates me to be told how things have always been done. I defy the tyranny of precedent.'' This mindset characterizes Healy’s entire career of questioning why the “status quo” rested on the exclusion of women’s leadership and experiences.

Healy wrote extensively in the area of cardiovascular medicine, preparing her for perhaps the most consequential position she held affecting women’s health then and now.

Champion for Women’s Health

Bernadine Healy became the first female NIH director, and 13th overall, in 1991. She did the equivalent today of ‘exploding the medical internet’ in an editorial she wrote entitled “The Yentl Syndrome” in the New England Journal of Medicine in 1991, describing two studies in the journal demonstrating conclusively the sex bias in the management of cardiovascular disease in women, leading to delay in recognition, diagnosis and treatment of heart disease. Once a woman’s disease presented just like a man, then she was treated as a man would be.?Hence, the Yentl Syndrome, a reference to a story by Isaac Bashevis Singer about a young Jewish girl who had to disguise herself as a boy as the only way to gain entrance to education. Of these findings, Healy said, “The problem is to convince both the lay and medical sectors that coronary heart disease is also a woman’s disease, not a man’s disease in disguise.”

Prior decades of sex-exclusive research reinforced the myth that coronary artery disease was a uniquely male disease. Worse, the data sets generated from prior research established men as the normative standard. Healy’s “break the glass” policy response as director of the NIH was to mandate that funding of NIH trials required enrollment of both men and women when the condition being studied affected both sexes, perhaps the start of the concept of inclusive clinical trials in widespread use. The result: research confirmation that for cardiovascular disease, women are not “small men,” with growing evidence of how sex differences influence disease physiology, diagnosis and treatment. This is a key perspective in uncovering relevant sex differences in a range of medical conditions that are more prevalent in women or are expressed differently in women. As someone who has practiced women’s health and worked in health policy myself, I know how much this data is essential to understanding our needs and equipping clinicians with the medical knowledge to treat women properly. Thanks to Healy’s predisposition to disrupt the status quo, more people realize that men’s health experiences are not default or universal.

Healy also drove an awakening about the consequence of the underfunding of women’s health research on the health of half of the population. She noted that the disease burden in women in middle age and beyond is not inevitable, just not understood. Under her leadership, the NIH launched the $625 million Women’s Health Initiative (WHI) to longitudinally study the major causes of death, disability and frailty among women. Healy was one of the only leaders who recognized that all health is women’s health, and thus women’s experiences must be accounted for in research. Without her work, we may not have known how certain diseases look differently in men and women – which is why the WHI is even nicknamed the “moon walk for women.” To this day, the WHI conducts extension studies to better understand women’s health experiences. The impact has been profound: The WHI estimates that there are 76,000 fewer cases of cardiovascular disease and 126,000 fewer breast cancer cases due to this research.

Keeping Dr. Healy’s Legacy Alive

As a leading visionary in women’s health equity and inclusion, Healy advocated for women’s inclusion at one of the most consequential health care agencies in the world. Though Healy had decades of leadership experience, she had to fight for every step to advance her career and her vision. She was not a popular or beloved leader during her time or even now; however, she was determined to further women’s health, no matter the risk to her own reputation. According to the New York Times, she once said to reporters, “I am willing to go out on a limb, shake the tree and even take a few bruises. . . ?I’m not particularly concerned about being popular.”

I am inspired every day by Healy’s commitment and her work on behalf of all women. Her legacy reminds us all that even if what we do is underappreciated at the time, we have a responsibility and a commitment to advance women’s health for the generations to come. Healy said of her career, “Professionally, I am proud that I never compromised my core beliefs, never wobbled on what I believed to be the right path, and had the strength to endure both.”?

To all the women on your own career journeys in medicine and beyond, may Dr. Healy’s example inspire you to question the status quo, stay committed to equity, and not wobble on your path, even if getting a bit bruised.