Barbra Streisand knows how to command an audience, whether she’s behind a microphone, a camera, or a podium. After a storied career beguiling theater-goers, Streisand’s new goal is not just to warm hearts but to save them from disease as well.
The Broadway and Hollywood star, a lifelong advocate of health and gender equity, graced the stage of NIH’s Ruth Kirschstein Auditorium on May 15 to give the annual J. Edward Rall Cultural Lecture, named for former Deputy Director for Intramural Research Joseph “Ed” Rall. As this year’s invited speaker, Streisand is in good company; over its 30-year history, the event has featured a variety of celebrities from writer Maya Angelou to musician Yo-Yo Ma to doctor and news correspondent Sanjay Gupta. Streisand took the opportunity to highlight an issue that is — literally — near and dear to her heart: women’s cardiovascular health.
Streisand’s quest to reduce gender disparities in cardiovascular medicine began with her 1983 film Yentl. The movie — which Streisand directed, co-produced, co-wrote, and starred in — tells the story of a young woman living in Eastern Europe in the early 1900s who disguises herself as a man in order to pursue an education. Just like Yentl’s protagonist, gender discrimination dogged Streisand during the film’s production, as Hollywood was hesitant to back a female director.
“It was hard to convince anyone that a female actor could direct and produce, or that a woman could manage a budget, or that a mainstream audience would care about this ethnic and bookish female protagonist,” Streisand recalled during the event. The encounter with Hollywood prejudice was “a life-changing moment” for her, she said.
Eight years after the movie’s 1983 debut, the New England Journal of Medicine published an editorial written by cardiologist and former NIH Director Dr. Bernadine Healy titled “The Yentl Syndrome.” The piece detailed a woefully under-recognized disparity in how physicians treated men and women with cardiovascular disease (CVD). Women admitted to the hospital with signs of a heart attack or other severe cardiovascular ailment were significantly less likely than men to receive the standard tests and treatments. Only “once a woman showed that she was just like a man” by displaying signs of severe heart disease or suffering a heart attack, would she be “treated as a man would be,” Dr. Healy wrote. “The problem is to convince both the lay and the medical sectors that coronary heart disease is also a woman's disease, not a man's disease in disguise.”
Given its relationship to her film, the editorial unsurprisingly piqued Streisand’s interest, prompting her to learn more about the issue of women’s heart health. She was “astonished and upset” to discover the stark gaps in the awareness and diagnosis of CVD in women, as well as the dramatically lower levels of treatment and needlessly inflated death toll that result from them. Much like Healy, Streisand attributed the problem partly to mistaken cultural beliefs and attitudes towards heart disease.
“I think women are embarrassed to talk about heart disease because there is a stigma attached to it,” Streisand said. “It is known as an old man’s disease in a sense, so many people think it just affects older men, but that is not true.” In fact, heart disease is the leading cause of death for both men and women. Moreover, even after adjusting for age, women are 25 percent more likely than men to die, develop heart failure, or experience a stroke within five years of their first heart attack.
In 2008, Streisand helped raise $22 million dollars — including a $10 million donation of her own — for the Women’s Heart Center at Cedar Sinai Medical Center in Los Angeles, which was subsequently renamed after her. Six years later, she co-founded the Women’s Heart Alliance, a non-profit group that advocates for increased research into gender differences in cardiovascular health and medical treatment.
Promisingly, the rise of organizations like the Women’s Heart Alliance and advocates like Streisand have led to considerable progress in closing the gender gap in cardiovascular care. Recent NIH policies encourage, and in some cases require, that NIH-funded research include members of both sexes. These directives pertain not just to human studies but also preclinical studies in which scientists have often limited their experiments to male animals and cells. Streisand specifically highlighted an NIH-funded endeavor called the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), launched in 2015, citing its goal to recruit a diverse cohort in order to examine differences in outcomes between men and women.
Despite these developments, Streisand said, more work remains to be done. She called for increased research funding for the study of sex differences in heart health. The Women’s Heart Alliance is also taking steps to eliminate gender disparities in the quality of cardiovascular care and to educate women about lifestyle changes that reduce the risk for CVD.
“We start from the recognition that, biologically, women and men are not the same,” Streisand said. “We have different equipment, we have different plumbing. And we advocate for funding and research so we can understand even more and apply those breakthroughs to provide prevention, care, treatment, and outcomes for everyone. As we like to say, we want to make sure women’s hearts are on everyone’s minds.”