DR. NANCY SNYDERMAN'S GUIDE TO GOOD HEALTH - What Every Forty-Plus Woman Should Know About Her Changing Body, by Nancy L. Snyderman, MD and Margaret Blackstone. William Morrow and Company, Inc, New York, 1996, xxix & 447 pages, $25

Review by Del Meyer, MD

In our focus on women's issues, this GUIDE TO GOOD HEALTH has a focus on women's health. Nancy Snyderman, a San Francisco otorhinolaryngologist, a woman, a doctor, a medical correspondent for network television, a daughter, a mother to two daughters, a care-giver of female patients, gives us a perspective that is smooth and continuous throughout the volume.

Snyderman points out that, except for the required rotation in gynecology, as late as 20 years ago in her training there were no differences in the medical training of the disease process in men or women. She feels it was her generation of women and those in their 30s & 40s who called attention to the inequities manifested in how we train doctors, establish research, and treat women in the medical establishment.

In outlining the controversies of estrogen replacement therapy, she contends that if the same issues were relevant in testosterone replacement therapy, we would have had the adequate research necessary to answer the problem. We erroneously assume that because women live longer than men they must be healthier. But not by much. People assume that whatever has gone wrong with a woman's health has to do with her reproductive tract. But the three leading causes of death in women are exactly the same as for men, namely heart disease, cancer, and strokes.

She states we give more attention to AIDS which has killed 205,000 since 1980 than to breast cancer which has killed 450,000 during the same time. Women with breast cancer are now becoming proactive. What women want and what they need may be the same--information. Information is needed to make informed decisions. Knowledge is Power. Snyderman states that her book is intended to give women that information.

Snyderman gives us the background for the raging story about unnecessary hysterectomies, (the numbers were extraordinary) that were being performed in the US in 1979 when Walter Cronkite was the premier anchor of his day. CBS had never led with a health story, much less one dealing with women's health. Therefore, the assignment was referred to their female correspondent at the White House, Lesley Stahl, and the story went forward.

The section on sexuality, infertility, getting pregnant (she had a prime-of-life pregnancy at age 42), common conditions during pregnancy, sex & pregnancy, prenatal testing, losing a pregnancy, vaginal childbirth, cesareans, breast feeding, motherhood, adoption (Nancy's oldest daughter is adopted), sleeping with men who are married to someone else, birth control after 40, sex and aging, changes for the male partner, changes for the female partner, sex and society, etc. is a tour de force that only a woman could have written.

Twenty two years later Dr Nancy Snyderman suggested a week long series devoted to women's health for Good Morning America. (GMA is cohosted by Joan Lunden, whose mother Gladyce Blunden is still a member of our Medical Alliance.) Not only did the producers love the idea, they wanted a month's worth of material. There was such positive response to the segment, that every Friday the topic of women's health is addressed. Nancy says, "we have no plans on ever stopping."

In her book, many of the topics start with a quote or anecdote which gives insight and candor. The topics then follow logically and are interestingly written from the 40 and over women's perspective.

This is an authoritative informational treatise from a superb communicator, an excellent physician, an effective health educator who gives us a mountain of highly credible information. It should also help to correct some of the grave inequities between the health care available to men and the care given to women. It elucidates many of the myths which surround women's health. It should also provide a stimulus for corrective action in research and medical education.