February 23, 1998

Coronary Artery Disease in WomenA Historical Perspective

Joan L. Thomas, MD; Patricia A. Braus, MPh

Author Affiliations Article Information

Arch Intern Med. 1998;158(4):333-337. doi:10.1001/archinte.158.4.333

Abstract

Knowledge about the natural history of coronary heart disease in women was limited until recent years. Few studies included women, despite the fact that heart disease is the No. 1 cause of death in women older than 50 years and the cause of about 500000 deaths annually. Over the past decade, knowledge has increased owing to a combination of greater participation of women in medical studies, improved medical technology, and political pressure. While much remains to be learned, researchers have found that coronary artery disease in women typically follows a different course than it does in men. Women’s risk factors also differ from men’s, in part owing to the key protective role played by estrogen. Increasing knowledge about women and heart disease can provide new tools for physicians caring for women at risk of heart disease.

Women’s health issues that did not concern reproduction received little attention and little research funding prior to 1986. This was particularly unfortunate in the area of heart disease, which was long considered to be a greater threat to men than to women. Researchers have found more recently that, while men typically develop heart disease earlier in life than women, women have a worse prognosis than men once they have had a myocardial infarction.1 Women also face a worse prognosis than men following surgical therapy for coronary artery disease (CAD).2,3 In addition, African American women face mortality rates from heart disease that are double those of white women, leaving CAD to be the leading cause of death in African American women aged 30 to 39 years.4 The delay in addressing heart disease in women as a distinct condition resulted in years of treating men and women at risk of heart disease equally, overlooking women’s special needs.

Until a decade ago, men were the model subjects in most funded biomedical studies. The National Institutes of Health (NIH), Bethesda, Md, the major source of research funding in this country, had no policy about the inclusion of women in large trials addressing heart disease, cancer, and stroke.5 It was then assumed that whatever the findings, the results would hold true in women. Since then, it has become apparent that this generalization was incorrect in many situations.6

The Food and Drug Administration (FDA) policy through the early 1990s prohibited women in their childbearing years from participating in phase 1 drug trials, which test the efficacy, safety profiles, and dosages of new drugs.7 Guidelines also limited women in their childbearing years from participating in the more advanced phase 2 trials. Also, the US General Accounting Office found that in the more advanced phase 2 and 3 trials, adequate analysis of the data looking at sex differences of safety and effectiveness occurred only 50% of the time between 1988 and 1991.7 However, once a new drug was approved and on the market, physicians prescribed these drugs to women as well as men, assuming that women and men would require similar dosages, that the efficacy would be similar, and that side effects would be the same.

Guidelines of the FDA not only prevented women in their childbearing years from participating in clinical trials, but also prevented women who were unlikely to become pregnant, such as women using birth control, women who were sexually inactive, or those with partners with vasectomies, from participating.7 In excluding women from these early clinical trials, researchers risked missing sex-related differences in adverse effect profiles and in appropriate dosing of drugs. As a result, phase 3 trials often were not designed to account for these differences.

Women were excluded from drug trials during their childbearing years for 2 reasons. There was concern about birth defects after the well-publicized thalidomide tragedy in the 1950s and 1960s. In addition, there was concern that women who were postmenopausal, who had undergone a hysterectomy, or who were using estrogen replacement therapy would show variations in estrogen and progesterone levels that would affect the efficacy of the trial drugs.7

February 23, 1998

Coronary Artery Disease in WomenA Historical Perspective

Joan L. Thomas, MD; Patricia A. Braus, MPh

Author Affiliations Article Information

Arch Intern Med. 1998;158(4):333-337. doi:10.1001/archinte.158.4.333

Abstract

Knowledge about the natural history of coronary heart disease in women was limited until recent years. Few studies included women, despite the fact that heart disease is the No. 1 cause of death in women older than 50 years and the cause of about 500000 deaths annually. Over the past decade, knowledge has increased owing to a combination of greater participation of women in medical studies, improved medical technology, and political pressure. While much remains to be learned, researchers have found that coronary artery disease in women typically follows a different course than it does in men. Women’s risk factors also differ from men’s, in part owing to the key protective role played by estrogen. Increasing knowledge about women and heart disease can provide new tools for physicians caring for women at risk of heart disease.

Women’s health issues that did not concern reproduction received little attention and little research funding prior to 1986. This was particularly unfortunate in the area of heart disease, which was long considered to be a greater threat to men than to women. Researchers have found more recently that, while men typically develop heart disease earlier in life than women, women have a worse prognosis than men once they have had a myocardial infarction.1 Women also face a worse prognosis than men following surgical therapy for coronary artery disease (CAD).2,3 In addition, African American women face mortality rates from heart disease that are double those of white women, leaving CAD to be the leading cause of death in African American women aged 30 to 39 years.4 The delay in addressing heart disease in women as a distinct condition resulted in years of treating men and women at risk of heart disease equally, overlooking women’s special needs.

Until a decade ago, men were the model subjects in most funded biomedical studies. The National Institutes of Health (NIH), Bethesda, Md, the major source of research funding in this country, had no policy about the inclusion of women in large trials addressing heart disease, cancer, and stroke.5 It was then assumed that whatever the findings, the results would hold true in women. Since then, it has become apparent that this generalization was incorrect in many situations.6

The Food and Drug Administration (FDA) policy through the early 1990s prohibited women in their childbearing years from participating in phase 1 drug trials, which test the efficacy, safety profiles, and dosages of new drugs.7 Guidelines also limited women in their childbearing years from participating in the more advanced phase 2 trials. Also, the US General Accounting Office found that in the more advanced phase 2 and 3 trials, adequate analysis of the data looking at sex differences of safety and effectiveness occurred only 50% of the time between 1988 and 1991.7 However, once a new drug was approved and on the market, physicians prescribed these drugs to women as well as men, assuming that women and men would require similar dosages, that the efficacy would be similar, and that side effects would be the same.

Guidelines of the FDA not only prevented women in their childbearing years from participating in clinical trials, but also prevented women who were unlikely to become pregnant, such as women using birth control, women who were sexually inactive, or those with partners with vasectomies, from participating.7 In excluding women from these early clinical trials, researchers risked missing sex-related differences in adverse effect profiles and in appropriate dosing of drugs. As a result, phase 3 trials often were not designed to account for these differences.

Women were excluded from drug trials during their childbearing years for 2 reasons. There was concern about birth defects after the well-publicized thalidomide tragedy in the 1950s and 1960s. In addition, there was concern that women who were postmenopausal, who had undergone a hysterectomy, or who were using estrogen replacement therapy would show variations in estrogen and progesterone levels that would affect the efficacy of the trial drugs.7

December 4, 2023

What Is Hanukkah?

How Is Hanukkah Celebrated?

When Is Hanukkah?

Hanukkah (also spelled Chanukah) is one of the most prominent observances during the holiday season in the United States. The eight days of Hanukkah are a time of reflection, celebration, and learning for Jewish people around the world. The holiday is marked by observed rituals, as well as a number of celebratory foods and games that honor Hanukkah’s origin story.

From the ritual of lighting the menorah to the importance of traditional foods and toys, Hanukkah is a holiday with a long history and intricate set of traditions.

What is Hanukkah?

Hanukkah comes from the Hebrew word ḥănukkāh, which literally means “a dedicating.” The name comes from the holiday’s origin story: Hanukkah commemorates the rededication of the Jewish Temple in Jerusalem in the second century BCE.

According to the story in the Torah, Jewish people in Jerusalem fought for three years against the Syrians, who were led by Antiochus IV. Then, around 165 BCE, the Maccabees, led by Judas Maccabaeus, liberated Judea, and Judas ordered that the Temple be restored and cleansed. When the Temple was rededicated, however, it had plenty of lamps but not enough oil.

After liberation, according to the story in the Talmud, there was only a jar with enough oil to light the Temple’s lamps for one day. A miracle permitted the oil to burn for eight days until new consecrated oil was brought in, thus the eight days of Hanukkah.

✡Other names for the holiday

The nicknames for the holiday are also related to the origin story. Hanukkah is sometimes called the Feast of Dedication or, more commonly, the Festival of Lights (or Feast of Lights). This is a reference to the menorah (also called the hanukiah or chanukiah) at the heart of the Hanukkah story and celebrations.

How Hanukkah is celebrated

Lighting the menorah, and the menorah’s connection to the origin of the holiday, is at the heart of Hanukkah celebrations. The menorah is a nine-branched candelabrum. One candle is called the shammes (in Yiddish) or shammāsh (in Hebrew) and is used as a starter to light the other eight. The word shammāsh means “servant” in Hebrew, and this candle is also known as the “helper.” Each evening on the nine days of Hanukkah, one more candle is lit, with special prayers for each lighting.

Early Jewish scholars had two lines of thinking regarding how the lighting should be handled. The scholar Shammai was of the belief that all eight candles should be lit on the first night and then one put out for each night. The scholar Hillel, on the other hand, proposed starting with a single candle and then lighting one more candle each night. Today, Hillel’s method is the one typically followed.

Tradition holds that followers light the menorah just after dark (though on Fridays it’s lit before dark due to Shabbat). The first to get the flame is the shammes that’s typically in the center of the menorah. Families say the Hanukkah recitation that thanks God for his commandments and for performing the original miracle of keeping the oil burning in the rededicated Temple for eight days.

Keep Learning New Words Every Day!

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Then the shammes, and only the shammes, is used to light the subsequent candles. But this isn’t done in just any order. On the first night, the candle is placed in the farthest right position and lit. On the second night, the second candle is placed to the left of the first candle, and the person doing the lighting starts with the second candle. The pattern of placing the candles right to left, and then lighting from left to right, is repeated all eight nights.

Outside of the home, rabbis will often use the holiday to teach the scripture and community—along with dedication, Hanukkah also means education.

Food is another important part of observing Hanukkah. Traditional foods echo the importance of oil to the holiday’s origin. Sufganiyot (doughnuts) and latkes (potato pancakes), both oil-fried, are typically enjoyed. Cheese in the form of blintzes (similar to a cheese-filled crepe) and cheese Danishes are also often on the menu. These are in reference to the story of Judith, who tricked a Syrian-Greek soldier into letting his guard down by offering bread, cheese, and wine. Children are usually given chocolate coins in gold foil. These represent gelt, which is Yiddish for money, and the chocolate coins represent charity and giving.

Finally, there are the games. Cards are standard, as are dreidels. These four-sided tops are especially important, and are engraved with the words nes gadol haya sham, which means “a great miracle happened there” (or “a great miracle happened here” on dreidels in Israel).

Learn the best ways to wish someone a very happy Hanukkah here.

When is Hanukkah?

Hanukkah’s date is guided by the Jewish calendar, so the exact date varies on the Gregorian calendar that most Western cultures follow. On the Jewish calendar, Hanukkah spans from the 25th day of the month of Kislev to the second day of the month of Tevet. This generally falls in December on the Gregorian calendar, but not always.

In 2023, Hanukkah starts on the evening of December 7 and ends on the evening of December 15. In 2024, Hanukkah starts on the evening of December 25 and ends on the evening of January 2.

December 4, 2023

What Is Hanukkah?

How Is Hanukkah Celebrated?

When Is Hanukkah?

Hanukkah (also spelled Chanukah) is one of the most prominent observances during the holiday season in the United States. The eight days of Hanukkah are a time of reflection, celebration, and learning for Jewish people around the world. The holiday is marked by observed rituals, as well as a number of celebratory foods and games that honor Hanukkah’s origin story.

From the ritual of lighting the menorah to the importance of traditional foods and toys, Hanukkah is a holiday with a long history and intricate set of traditions.

What is Hanukkah?

Hanukkah comes from the Hebrew word ḥănukkāh, which literally means “a dedicating.” The name comes from the holiday’s origin story: Hanukkah commemorates the rededication of the Jewish Temple in Jerusalem in the second century BCE.

According to the story in the Torah, Jewish people in Jerusalem fought for three years against the Syrians, who were led by Antiochus IV. Then, around 165 BCE, the Maccabees, led by Judas Maccabaeus, liberated Judea, and Judas ordered that the Temple be restored and cleansed. When the Temple was rededicated, however, it had plenty of lamps but not enough oil.

After liberation, according to the story in the Talmud, there was only a jar with enough oil to light the Temple’s lamps for one day. A miracle permitted the oil to burn for eight days until new consecrated oil was brought in, thus the eight days of Hanukkah.

✡Other names for the holiday

The nicknames for the holiday are also related to the origin story. Hanukkah is sometimes called the Feast of Dedication or, more commonly, the Festival of Lights (or Feast of Lights). This is a reference to the menorah (also called the hanukiah or chanukiah) at the heart of the Hanukkah story and celebrations.

How Hanukkah is celebrated

Lighting the menorah, and the menorah’s connection to the origin of the holiday, is at the heart of Hanukkah celebrations. The menorah is a nine-branched candelabrum. One candle is called the shammes (in Yiddish) or shammāsh (in Hebrew) and is used as a starter to light the other eight. The word shammāsh means “servant” in Hebrew, and this candle is also known as the “helper.” Each evening on the nine days of Hanukkah, one more candle is lit, with special prayers for each lighting.

Early Jewish scholars had two lines of thinking regarding how the lighting should be handled. The scholar Shammai was of the belief that all eight candles should be lit on the first night and then one put out for each night. The scholar Hillel, on the other hand, proposed starting with a single candle and then lighting one more candle each night. Today, Hillel’s method is the one typically followed.

Tradition holds that followers light the menorah just after dark (though on Fridays it’s lit before dark due to Shabbat). The first to get the flame is the shammes that’s typically in the center of the menorah. Families say the Hanukkah recitation that thanks God for his commandments and for performing the original miracle of keeping the oil burning in the rededicated Temple for eight days.

Keep Learning New Words Every Day!

Get the Word of The Day delivered straight to your inbox!

Then the shammes, and only the shammes, is used to light the subsequent candles. But this isn’t done in just any order. On the first night, the candle is placed in the farthest right position and lit. On the second night, the second candle is placed to the left of the first candle, and the person doing the lighting starts with the second candle. The pattern of placing the candles right to left, and then lighting from left to right, is repeated all eight nights.

Outside of the home, rabbis will often use the holiday to teach the scripture and community—along with dedication, Hanukkah also means education.

Food is another important part of observing Hanukkah. Traditional foods echo the importance of oil to the holiday’s origin. Sufganiyot (doughnuts) and latkes (potato pancakes), both oil-fried, are typically enjoyed. Cheese in the form of blintzes (similar to a cheese-filled crepe) and cheese Danishes are also often on the menu. These are in reference to the story of Judith, who tricked a Syrian-Greek soldier into letting his guard down by offering bread, cheese, and wine. Children are usually given chocolate coins in gold foil. These represent gelt, which is Yiddish for money, and the chocolate coins represent charity and giving.

Finally, there are the games. Cards are standard, as are dreidels. These four-sided tops are especially important, and are engraved with the words nes gadol haya sham, which means “a great miracle happened there” (or “a great miracle happened here” on dreidels in Israel).

Learn the best ways to wish someone a very happy Hanukkah here.

When is Hanukkah?

Hanukkah’s date is guided by the Jewish calendar, so the exact date varies on the Gregorian calendar that most Western cultures follow. On the Jewish calendar, Hanukkah spans from the 25th day of the month of Kislev to the second day of the month of Tevet. This generally falls in December on the Gregorian calendar, but not always.

In 2023, Hanukkah starts on the evening of December 7 and ends on the evening of December 15. In 2024, Hanukkah starts on the evening of December 25 and ends on the evening of January 2.

Greetings Beth McLaughlin,
A new Announcement has been posted in H-OralHist.

New episode of “Preserves” podcast released

A new episode of Preserves: A Manitoba Food History Podcast is now available for streaming and download.

Episode 17 – Holiday Food  
Food is an important part of holiday traditions. Whether you gather with family and friends to celebrate Christmas, Hannukah, the changing of the seasons, or something else, holidays are a time to remember who we are and where we’ve come from. They’re also a time to think about our future and who we want to become.

Preserves: A Manitoba Food History Podcast explores the rich history of Manitoba food and the people who make it, sell it, and eat it. Preserves considers the cultural, social, and commercial aspects of Manitoba food and what it means to us. The podcast is produced by the The Manitoba Food History Project research team and hosted by Kent Davies (Oral History Centre) and Janis Thiessen (University of Winnipeg).

Subscribe: Apple Spotify Google

Greetings Beth McLaughlin,
A new Announcement has been posted in H-OralHist.

New episode of “Preserves” podcast released

A new episode of Preserves: A Manitoba Food History Podcast is now available for streaming and download.

Episode 17 – Holiday Food  
Food is an important part of holiday traditions. Whether you gather with family and friends to celebrate Christmas, Hannukah, the changing of the seasons, or something else, holidays are a time to remember who we are and where we’ve come from. They’re also a time to think about our future and who we want to become.

Preserves: A Manitoba Food History Podcast explores the rich history of Manitoba food and the people who make it, sell it, and eat it. Preserves considers the cultural, social, and commercial aspects of Manitoba food and what it means to us. The podcast is produced by the The Manitoba Food History Project research team and hosted by Kent Davies (Oral History Centre) and Janis Thiessen (University of Winnipeg).

Subscribe: Apple Spotify Google