Gray is one of my favorite colors. It is considered "achromatic," or "without color," even though it is formed by mixing black and white. It is considered neither traditionally masculine nor feminine and provides an element of ambiguity.
We use the term “in the gray zone” to describe ambiguity. In medicine, it gives clinicians the opportunity to think outside the norm while treating a patient. A patient may present with signs and symptoms that don't fit nicely into an established disease. Conventional approaches may not work in this case.
This is no more apparent than in the world of women's health. Over the years, one party over another has been deemed the champion to protect and advance the health of women. State and federal legislation and court rulings have impacted the delivery of care and the funding of research and technological advancements, making it easier to identify a foe versus an advocate. But it may not be that simple.
Reproductive health care especially has been politicized by this approach. Instead of building on the achievements of decades of work, women's health has become a target for one side to either destroy or augment it. It is ironic that in the United States, there is a popular saying about loving "baseball, mom and apple pie,” but apparently, not mom's healthcare.
There have been rays of light over the years.
In April 1977, Reps. Elizabeth Holtzman (D-N.Y.) and Margaret Heckler (R-Mass.) convened a group of bipartisan female legislators to form what would become the Congressional Caucus for Women's Issues. Over the decades, they championed the Pregnancy Discrimination Act (1978), the Breast and Cervical Cancer Mortality Prevention Act (1990), the Mammography Quality Standards Act (1992) and the Violence Against Women Act (1994) among many other landmark pieces of legislation. They also codified offices on women's health throughout the government.
In 1990 during President George H. W. Bush's administration, a watershed moment for women's health occurred when members of both parties marched up to the National Institutes of Health demanding that clinical trial research include women and the establishment of the NIH Office of Research in Women's Health.
This was followed by the formation of the Department of Health and Human Services Office on Women's Health in 1991 to coordinate through policy, education and innovative programs. During that year, under the leadership of Dr. Bernadine Healy, NIH launched the Women's Health Initiative, a $625 million study to address health issues causing morbidity and mortality in postmenopausal women.
More groundbreaking programs in women's health were established through bipartisan support, including Sen. Arlen Specter (R-Pa.) introducing legislation in 1996 to establish vanguard National Centers of Excellence in Women's Health, modeled after the Veterans Administration centers, to provide comprehensive, multidisciplinary health care, research, education and leadership opportunities in women's health.
At the turn of the 21st century, exciting developments in women's health occurred across agencies, even at NASA. In 2002, NASA supported the first of two decadal surveys on the impact of gender and sex on adaptation to space, adopted NIH's inclusion language for its clinical trials and implemented a novel “assisted reproductive technology” coverage policy for both male and female astronauts.
Following the George W. Bush administration, support for women's health grew in the private sector with the formation of the Laura W. Bush Institute for Women's Health and other women's health centers and service lines. However, government designations and support remain catalysts for innovation.
Recently, the Biden White House issued an executive order to advance women's health research and innovation at the NIH and across federal agencies. The president has asked Congress to support $12 billion in funding to create a new interdisciplinary research agenda and national research centers. This is in addition to ARPA-H's new $100 million Sprint for Women's Health program, which accelerates research through a sex and gender lens leading to the commercialization of products designed to improve health outcomes.
Skeptics may ask what is the motivation behind these actions? Is it politically driven to draw in female voters angered and disenfranchised by the elimination of reproductive health freedom? This may be the case, but it would not be the first time a president made a bold decision for reasons beyond scientific or humanitarian purposes.
Furthermore, it will take years to establish a legacy from these measures, which will occur during another administration. Think of the space program. President Kennedy established it, but the U.S. landed on the moon during the Nixon administration under a new Congress.
We can live in a state of gray where all parties can work together again to advance the health and well-being of every American. We may not agree on everything, but in the long run, everyone benefits. It's that simple.
Saralyn Mark is the author of “Stellar Medicine: A Journey Through the Universe of Women's Health,” and founder and president of iGIANT (impact of Gender/Sex on Innovation and Novel Technologies) and SolaMed Solutions, LLC. She is a former senior medical policy advisor to the White House, the Department of Health and Human Services and NASA.
