Six years ago, Dr. Elizabeth Comen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan, held the hand of a patient who was several hours from death.

As Dr. Comen leaned in for a final farewell, she pressed her cheek against her patient’s damp face. “That’s when she said it,” Dr. recalled. Comen themselves.

“’I’m so sorry to sweat on you.’”

In her twenty years as a physician, Dr. Comen discovers that women apologize to her all the time: for sweating, for asking follow-up questions, for not discovering their own cancer sooner.

“Women apologize for being sick, seeking care or standing up for themselves,” she said during an interview in her office:I’m so sorry, but I’m in pain. I’m so sorry, this looks disgusting.’”

These experiences in the exam room are part of what Dr. Comen wrote, “It’s All in Her Head: The Truth and Lies Early medicine taught us about women’s bodies and why they matter today.” In it, she traces the roots of women’s tendency to apologize for their sick or unruly bodies to centuries of degradation by the medical establishment. It’s a legacy that continues to shape the lives of female patients, she argues.

Nowadays women are more likely are misdiagnosed than men and takes longer to be diagnosed heart disease and a little cancers; they could be less likely being offered pain medication; it’s more likely that their symptoms will be written off as anxiety – or, as the book’s title suggests, as something that’s just in their heads.

“The anxious woman, the hysterical woman, is a specter that looms and interweaves throughout medical history,” said Dr. Comen. “It’s a standard diagnosis.”

Collectively, she argues in the book, these injustices help explain why many women report feeling invisible, frustrated or ashamed in doctors’ offices. Shame may be the symptom, but Dr. Comen believes a deeply misogynistic medical system is the disease.

A history of exclusion

Dr. Comen, a mother of three in her mid-40s, is quick with a camera-ready smile, which makes her frequent breast cancer media appearances. She occasionally cries when she talks about her patients.

She once cried at her job at the medical school, and a male resident responded by telling her to “keep herself together.”

“I felt like I had to excuse my reaction,” she said, sitting at her desk. “And now I cry with patients all the time.”

Her approach is shaped by decades of experience, but also by what she learned about the place of the female body in medicine as a history of science major at Harvard.

“The sense that women’s bodies were not only different but also broken is evident not only in the way doctors spoke of female anatomy, but also in the medical vocabulary itself: the female external genitalia were called ‘pudenda’, a Latin word meaning ‘things to do’. ashamed of it,” she wrote.

In ‘All in Her Head’, Dr. Comen is an in-depth look at the ways she believes modern medicine has ignored women. For centuries, she writes, early medical authorities believed that women were merely “small Gentlemen” – although it has no external sexual organs and a similar mental capacity, governed by harmful humors and hormones.

For too long, doctors have “dismissed what could be legitimate physiological problems as irrelevant, as hormonal and therefore not important,” says Wendy Kline, a professor of the history of medicine at Purdue University.

And this was the case for white, affluent women, writes Dr. Comen in the book. If you were a woman of color, or poor, you were seen by medical authorities as having even less authority over your own body, and therefore less worthy of care and compassion.

“For Black women, when we enter a clinical setting, we need to think about race And gender discrimination,” said Keisha Ray, associate professor of humanities and bioethics at UTHealth Houston, who studies the effects of institutional racism on the health of Black people. “It’s often exaggerated, the lack of compassion and the lack of care you receive.”

Take heart disease, for example. At the end of the 19th century, Dr. William Osler, one of the founders of modern medicine, that women who presented with what we now know as symptoms of heart attacks or cardiac arrhythmias – including shortness of breath and palpitations – almost certainly suffering from ‘pseudo-angina’ or false angina, ‘a collection of symptoms caused by neurosis masquerading as a real disease’, writes Dr. Comen.

It is only in the past 25 years that cardiological studies have been included women in significant numbers. Nowadays, there are some heart attack symptoms that are more common in women, such as: jaw and back painare still described as “atypicalSimply because doctors don’t see them as often in men and are less likely to be taken seriously, even though 44 percent of women will. develop heart disease one in five women will die from it at some point in their lives.

“We’ve used the male model for diagnosis, for treatment, as the gold standard,” says Dr. Jennifer Mieres, a cardiologist at Northwell Health and co-author of the book “Heart Smarter for Women.” This has “led to continued misrepresentation, misdiagnosis and underrecognition of heart attacks in women.”

How to advocate for yourself

In each chapter of ‘All in Her Head’ Dr. interviews. Come doctors working to improve the system, starting with taking the complaints of female patients seriously – not just writing down physical symptoms, from chest pain to fatigue to gastrointestinal complaints, to anxiety until, for example, all other causes have been excluded.

Dr. Comen also shares practical tools to better collaborate with an imperfect system.

First, she writes, it is essential that all patients trust their knowledge of their own bodies and advocate for themselves. Before an appointment, ask yourself: What really concerns you about your body?

“Not what you think you need to worry about,” writes Dr. Comen. “Not what you think your doctor will be able to address most comfortably and easily.”

Then if you are concerned about your health or if you are concerned about your health not are heard, enlist a friend or family member to accompany you to appointments. This person can serve as an advocate and as an extra pair of eyes and ears.

Finally, if you don’t like your doctor, find a new one. This is easier said than done, she acknowledged, but a trusting and respectful relationship with your healthcare provider is every patient’s right.

Berish Strauch, a plastic surgeon whose groundbreaking procedures and devices to reattach or replace vital body parts include one of the first toe-to-thumb transplants, a device to reverse vasectomies and, perhaps most notably, the first inflatable penile prosthesis, died December 24 in Greenwich, Conn. He was 90.

His daughter, Laurie Strauch Weiss, said the cause of his death at a hospital was respiratory failure.

From the late 1960s, Dr. Strauch is spearheading a revolution in plastic surgery, especially microsurgery, in which doctors use microscopes and precision instruments to sew together tiny blood vessels, nerves and ligaments, some of which are thinner than a human hair. said dr. June K. Wu, associate professor of surgery at Columbia University, who completed her residency under Dr. Strauch completed.

As the longtime chief of reconstructive surgery at Montefiore Medical Center in the Bronx, Dr. Strauch invented many of the surgical procedures and technologies that are now considered commonplace. Among other achievements, he pioneered techniques to remove excess skin from patients who had lost significant amounts of weight through bariatric surgery – a kind of extreme tummy tuck.

After a New York City firefighter lost his thumb in 1976, Dr. Strauch to reattach it. When that proved impossible, he proposed something more radical: taking one of the man's big toes and sewing it in place of the severed finger.

Not only did the operation work, but within a few months the firefighter was back on the job.

“I don't recommend a transplant for someone who has lost a finger,” he told Midnight newspaper in 1976. “A thumb, yes, because the opposable thumb is what distinguishes us from animals.”

Dr. Strauch was one of the first modern surgeons to use leeches to control blood flow after surgery and remove necrotic tissue – a seemingly medieval technique that, he said, could not be improved upon by human innovation.

“If you had to design an instrument to remove blood,” he told The New York Times in 1987, “you couldn't design one more suitable than the Biblical leech.”

He left a particularly deep mark on the field of urology. He created the so-called Strauch clamp, a device used to reverse vasectomies. And perhaps his most notable but no less important innovation: he invented the first inflatable penile prosthesis.

Artificial penises have been used for centuries, either as a replacement for detached members, as a treatment for erectile dysfunction or for use in sex reassignment surgery. But in most cases they were either permanently limp or permanently erect – neither of which was a particularly satisfying arrangement for anyone involved.

Dr. Strauch designed a prosthetic penis that was connected via a tube to a fluid reservoir that was implanted in the body. When the patient wanted an erection, he could activate a pump to fill the prosthesis (although to reverse it, he would have to manually work the fluid back into the reservoir).

He received a patent for his invention in 1973, after which he sold it to a company called American Medical Systems. One of the company's founders, F. Brantley Scott, subsequently developed the product further and has since received the most honor in the annals of medical history.

Berish Strauch was born on September 19, 1933 in the Bronx, the son of Herman and Anna (Weiss) Strauch. His father cut men's suits in Manhattan's garment district; his mother was a milliner.

As a child, Berish, who went by Bob in informal situations, accompanied his parents to work. He later said that watching them for hours with scissors and knives sparked his interest in surgery.

He attended the Bronx High School of Science and graduated from Columbia, where he studied pre-med, in 1955 and from medical school in 1959. After fellowships at Roosevelt Hospital in New York and Stanford Hospital in Palo Alto, California , he returned to the Bronx to join Montefiore's staff. In 1978 he became head of plastic surgery there.

Dr. Strauch married Rena Feuerstein in 1955. She died just eight weeks before he did. Together with their daughter, he is survived by their son Robert, himself a renowned hand surgeon; seven grandchildren; and his sister, Renee Freed. The Strauchs lived in Rye, NY

Although he never sought attention, Dr. Strauch played a small but important role in one of the biggest tabloid stories of the 1990s.

In 1992, Amy Fisher, a Long Island teenager, shot a woman named Mary Jo Buttafuoco in the side of the head after confronting her about Ms. Fisher's affair with Ms. Buttafuoco's husband, Joey.

Ms Buttafuoco survived, but she suffered extensive damage to her face, including partial paralysis. When Dr. Strauch heard about her case, he contacted her attorney and offered to help.

“This is one of the most fertile areas of medicine,” he told Newsday in 1992. “A whole new level of knowledge has emerged in the past twenty years.”

He performed extensive surgery on Ms Buttafuoco in early 1993, returning most of her face to normal – although it was too late to reverse the extensive nerve damage.

“She will still have some elements of the paralysis, especially of the lower lip,” he told Newsday after the operation. “But she is a beautiful lady and she will look great.”

There’s a problem with the recently approved Alzheimer’s drug, Aduhelm. It can remove some of the amyloid that forms brain plaques characteristic of the disease. But most of the drug is lost because it hits an obstacle called the blood-brain barrier, which protects the brain from toxins and infections but also prevents many drugs from entering.

Researchers wondered if they could improve that grim result by trying something different: They would open the blood-brain barrier for a short time while delivering the drug. Their experimental method was to use highly focused ultrasound pulses along with tiny gas bubbles to pry open the barrier without destroying it.

The researchers at the Rockefeller Neuroscience Institute at West Virginia University, reported their results last week in The New England Journal of Medicine. When the barrier was opened, 32 percent more plaque was dissolved, said Dr. Ali Rezai, a neurosurgeon at the institute, who led the study. The group didn’t measure the amount of antibody that entered — that would require the drug to be radioactively labeled — but in animal studies, opening the barrier allowed 5 to 8 times more antibody to enter the brain, said Dr. Rezai.

The early-stage experiment, which was only attempted in three patients with mild Alzheimer’s, was funded by the university and the Harry T. Mangurian, Jr. Foundation.

It was a preliminary safety study – the first phase of the study – and not intended to measure clinical outcomes.

But when the results were presented at a recent meeting, “our jaws dropped,” said Dr. Michael Weiner, an Alzheimer’s researcher at the University of California, San Francisco, who was not involved in the study.

Researchers said it was an innovative but difficult approach to a problem created by Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, considered one of the most challenging in treating brain diseases: how do you get drugs into the brain?

Antibodies such as the Alzheimer’s drug aducanumab, which the company Biogen sells under the name Aduhelm, are extremely expensive; Aduhelm’s listed price is $28,000 per year. One reason for the high price, said Dr. Koroshetz, is that only 1 percent of antibodies injected into the bloodstream slip past the blood-brain barrier.

However, it took more than a decade to find a safe way to open that barrier. Researchers understood how the barrier worked, but if you opened it without causing any damage, you only had to keep it open for a short time, due to its role in protecting the brain. It is a delicate part of the circulatory system and not what many people imagine based on the name.

“Many people think of it as something that is wrapped around the head,” like a turban for the brain, said Dr. Alexandra Golby, a professor of neurosurgery and radiology at Harvard Medical School.

Instead, the barrier is located at the ends of several large blood vessels that supply blood to the brain. As they enter the head, the vessels branch and divide until they form narrow capillaries with extremely tight walls at the ends. This barrier keeps large molecules out and allows small molecules such as glucose and oxygen to enter.

The challenge was to pry open those walls without tearing apart the capillaries.

The solution turned out to consist of two components. First, patients are injected with tiny microbubbles of perfluorocarbon gas. The bubbles reach inwards mate from 1.1 to 3.3 microns (a micron is approximately 0.000039 inches). Pulses of low-frequency ultrasound are then focused on the area of ​​the brain to be treated. The ultrasound pulses cause waves in the fluid in the blood vessels; the microbubbles expand rapidly and contract with the waves. This opens the blood vessels without damaging them, allowing access to the brain.

Microbubbles, said Dr. Golby, are routinely used in ultrasound studies of the heart and liver because they light up and reveal blood flow. They are filtered from the body by the kidneys and liver.

“They have 20 years of experience in safety,” she said.

For the experiment described in the new paper, researchers used ultrasound on one side of the brain, but not the other, for comparison, and then performed brain scans to check the results.

Although the focused ultrasound approach proved successful as an experiment, all was not rosy. The device is designed to deliver ultrasound to a small target area, but in Alzheimer’s disease, amyloid-containing plaque is everywhere in the brain.

“If you want to get amyloid out of the brain, you have to go in with a paintbrush, not a pencil,” said Dr. Koroshetz.

The researchers deliberately targeted brain areas involved in memory and reasoning, but it remains to be seen whether the treatment improves outcomes. That will require a larger investigation.

The Alzheimer’s study is just one of many studies opening the barrier to delivering drugs to patients with a variety of brain diseases.

They are all in early stages and so far all show that the method works; blocked medications come in.

One group, led by Dr. Nir Lipsman, a neurosurgeon at the University of Toronto’s Sunnybrook Research Institute, and his colleagues opened the barrier to delivering a chemotherapy drug to the brains of four breast cancer patients whose cancer had spread to the brain. The concentration of the drug, trastuzumab, increased fourfold, they said reported.

That work was funded by the Focused Ultrasound Foundation and sponsored by Insightec, which manufactures the ultrasound machine used.

Dr. Lipsman and his colleagues have now treated seven breast cancer patients and are expanding the study. They also conduct preliminary studies on a variety of brain diseases, including cancer, Parkinson, And IF.

Dr. Golby of Harvard Medical School and her colleagues have used the method to treat patients with glioblastoma, a deadly brain cancer.

One of the few chemotherapeutic agents that can enter the brain is temozolomide. But even this is largely blocked; only 20 percent cross the blood-brain barrier.

That’s why the medical center of Dr. Golby and several others received approval from the Food and Drug Administration to conduct a clinical trial, using focused ultrasound with microbubbles to deliver a larger portion of chemotherapy. It was funded by Insightec.

The patients did well, but the purpose of the study, which has not yet been published, was to assess the safety of the technique, not its efficacy, she said.

“I would love to see a trial of a drug that doesn’t normally get into the brain,” said Dr. Golby. There are many drugs that look good in laboratory studies but, she said, “complete failures” because they are blocked by the blood-brain barrier.

For the time being, however, questions remain, such as where in the brain the therapies should be targeted.

But, says Dr. Jon Stoessl, a Parkinson’s expert and professor of neurology at the University of British Columbia, says the method “resolves what has historically been a problem for anyone treating central nervous system disorders.”

Kullervo Hynynen, vice-president for research and innovation at Sunnybrook Research Institute in Toronto, is hopeful.

“If this works and is safe, it will open doors to a completely new way of treating the brain,” he said.

The life of a perro mascot has a predictable drawer. With the time that the older children are not in their student years on their plato, they turn into a mature teenager with an insatiable interest in the age, before maturing like an adult dog, with a delicious food during the siesta and a saludo- ritual.

While, in the years that follow, our articulaciones are durable and their hocico always turns gray. And one day, the inevitable inevitable end of the journey, will finally bring about the move.

“If I adopt a perro, it will be a bright future,” said Emilie Adams, a new owner of three Rodesian crestados. “As time goes on, you get a lot of love because you have to have a moment that you can do. Pero su esperanza de vida is más corta que la nuestra”.

In recent years, scientific knowledge has advanced to develop medications that you can delay to increase the life experience of your new canine friends. Martes, the biotechnology company Loyal has announced that they have an increasing opportunity to bring one of these drugs to market. “These data are sufficient to demonstrate that there is an expected effectiveness,” the company informs about a function of the administration of nutritional and EE medicines. UU. (FDA, por su sigla in dutch) on a recent map. (Loyal le proporcionó una copia de la carta a The New York Times).

It means that agriculture, the fact that Loyaal is an identification for intellectual property rights, is cumplido with one of the requirements for the “authorisation conditional ampliada”There is a fast-track authorization for veterinary drugs that leaves a large number of health needs unsatisfactory and requires entire hospitals. The drug is no longer available to mascots and the FDA today and may review the company’s safety data and manufacturing. Because the authorization, which Loyal received in 2026, is conditional, it allows the company to begin using a drug to extend its lifespan, including before it completes an extended treatment clinic.

“We have had discussions with a number of valuable life extensions,” says Celine Halioua, fund manager and director of Loyal.

If the drug really works, this is a promise. While a small studio suggested that LOY-001 might limit metabolic connections to the environment, Loyal has provided no demonstration that perros life is good.

According to the map, which emerged after discussions between Loyal and the FDA, the idea is for the agency to provide medications for the dog’s longevity, according to Halioua.

Hay más and processo. An equipment of academic researchers has become a reality clinical treatment with rapamicinaClearly it demonstrates that the life cycle of the laboratory is extended. Además, Loyal is a reclutando for an ensayo clinic with another drug candidate, called LOY-002.

These anticipate a series of rituals that accelerate the science and the series with the investigators and controllers leaving a camp that can only be considered a fictional crime. As the plantation began to grow, it was important that Daniel Promislow, a University of Washington biogerontologist and co-director of Dog Aging Projectyou have to do that with rapamicina.

“¿Qué pasaría si funciona?”, dijo. “¿Cuáles son las implicaciones?”.

Lamiendo la fuente de la juventud

The envejecimiento may be unavoidable, but it is not inflexible. Scientific insights have continued to advance, most people and the rate at which genes are changed are related to the environment.

There are many people who have the opportunity to come across scientific drugs that can have the most effects of life extension in their personality. Because there is a research activation, the long term of the canina has recently received more attention, some of the perros are a good example for the human being and some of the mascots that increasingly play with free-roaming mascots, small children of your family.

“There are a lot of things that maintain your zest for life,” says Adams, the owner of Rodesian Crestados.

Some companies need to conduct research in different ways. The rapamic, which has generated great interest as a potential drug for the longevity of human beings, prevents a protein conocida such as mTOR, the regulation of cell growth and metabolism.

This year a scientific equipment that includes Promislow and algunos of our knowledge of the Dog Aging Project has been made public analysis you may be given a dose of rapamicina or a placebo over several periods of time. Now that the child of the last 27 years old, the mascots of the drug are received with information about the salud or behavior, including an addition to the activity or character, and a comparison with 8 for the old the dueños can take a placebo to get.

LOY-001, a long-term release implant intended for large adults, is suitable for a modular connection with another relationship with crecimiento: the factor of crecimiento insulin tipo 1 or IGF-1. The use of IGF-1 has an association with effect and longevity in several species; somehow, if you do one thing papel clave and the determination of the corporal. Although the idea is not likely, the scientific insights are based on the hipness of the old IGF-1 impulses in Nivelles, which creates a rapid crecimiento quickly as an acceleration in the big perros, which generally gets a greater sense of excitement then those pequeños.

The research on Loyal, which has not previously been published, suggests that LOY-001 reduces levels of IGF-1 and increases insulin relationships with the drug. A home observation studio of 500 could indicate that most insulin injections in Nivelles are associated with a less vulnerable and a mayor who is vida.

“It’s a very emotional experience,” confirms Colin Selman, a biogerontologist from the University of Glasgow, who did not take part in the study and did not do any review of the company data.

Because there is an embargo, a farm can extend the lives of the dogs requiring clinical clinics that last much longer. Some people will increasingly expect different results. Regardless of the agricultural sector, the researchers tend to show that some people are good at the lives of a perro, and that they simply prolong their decline, confirmed by the experts.

“If I know that life is going, I am only interested in the period when life lasts longer,” confirms Kate Creevy, veterinarian at Texas A&M and Jefa of Dog Aging Project. “No quiero que mi perro viva dos años más con mala salud”.

Enigmas caninos

It is wise to take medicine for longevity, but Halioua predicts that LOY-001 can get an “average numbers and dollars for me” rank.

For all of our owners, cost is not a barrier, like Karen Cornelius of Illinois, who has owned towers and other “giant” frenzies for decades. Many people are already 9 years old, while Cornelius manages various Facebook groups to earn huge amounts of money.

“I can only discuss one of the things that has to do with the era that my life started and how this house can now be expanded,” he says.

Many e-specialists in this field are concerned with the possibility that this enthusiasm can be exploited, and especially if drugs are announced as young dogs, the security aspects and their effectiveness can be solved on a large scale. You cannot give your consent if you are alone.

“Is it possible that there are more people taking these drugs,” said Rebecca Walker, a philosopher and biologist at the University of Carolina del Norte in Chapel Hill, meaning no drug is needed for longevity if your cobrador dorado, a raza más conocida como golden retrievers. “¿O en realidad les conviene a sus dueños, quienes están muy apegados a ellos?”.

The secondary effect of LOY-001 has a male gastrointestinal level and in time, such as Halioua, a unique reconció that is the safety standard as “extremadamente alto”.

Medicines for longevity are intended for people with common sense, the calculation of which is useful. “A cosa is a perro esté al borde de la muerte en le estés dando un tratamiento tardío,” says Bev Klingensmith, a criadora de perros grand danés in Iowa, who has ten a grand danés and a cobrador dorado. “Manage my life and sano a medicine that the mercado suena receives a poco aterrador”.

Including the medicines that bring many of our promises to the plantations. “If the animals live more, the recursos and the compromises are intended to increase the living conditions of the animals?”, says an electronic correspondent Anne Quain, veterinarian and expert in the field of veterinary practice of the University of Sídney. “Qué pasa si vemos que más perros sobreviven a sus dueños?”.

Reform the practice of the cría that can contribute to the problems that can promote the lives of many people and should increase access to the basic veterinary services, which in a greater way can increase the lives of the dogs, like Quain. “Podemos can save many ‘dog dogs’ that can prevent them from accessing this attention,” he said.

There is much more scientific data on the possible agricultural possibilities for a longer life, the experts confirm that the business properties can help to spread a more blessed message, while making their expenses and proportions much ejercicio and spiritual estimates.

Halioua admits she is weak because of the mayors. “Solo quieren una buena cama para dormir”, like my old rottweiler, Della, taking a dorm siesta. Because we have information and dementia, LOY-001 is not received because we registered in the company’s studios that have a conflict of interest, such as Halioua, but it would be congratulatory.

At the very last moment, an old scientist can recall the fear of a mascot, it is likely that it can disappear completely. “Finally, there is no question of farming for immortality or radical extension of the life cycle,” Halioua confirms in an electronic correo. And you say: “Nada de lo que estamos desarrollando podría hacer que un perro viviera para siempre”.

Emily Anthes is a reporter for The New York Times; it concerns the citizenry and the health and the themes of the pandemic of the coronavirus, the exodus, the pruebas for the virus and the covid and niños. More about Emily Anthes