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The purpose of this paper is to stimulate debate on the implications of the new genetics for health policy. Although there are different streams within the social science literature on the new genetics, the primary focus has been on the meaning of genetic testing from the perspective of the individual tested. While essential to understand, it does not add much to the health policy debate. A very different type of information has been produced by the public health and epidemiological literature, focused on screening for genetic disease and concerned with rates of detection, costs and benefits, and evaluation criteria. These data are very important to planning and implementing the type of prenatal screening program already in existence; they do not deal with issues central to the new genetics, such as commercialization, patenting and insurance. The problem is how best these topics should be researched. The final section of the paper suggests that given a phenomenon--the new genetics--which is both multifaceted and very complex, very new and yet with strong historical and cultural roots, we need a matching research agenda. One that breaks out of traditional paradigms separating one method from another and seeks information on the new genetics wherever it may be found.

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Medicalization usually refers to the process whereby the normal processes of pregnancy, childbirth, menstruation and menopause have been claimed and redefined by medicine. Rather than discussing medicalization and menopause in terms of the number of women taking hormones, or the percentage of physicians convinced they should prescribe them, this paper looks at the visual image of the menopausal woman as portrayed in the pharmaceutical literature and in the mass media. Unlike the depressed and sickly looking women shown in the pharmaceutical advertisements in the 1970s, this 1990s version of the menopausal woman is shown glowing with fitness, with well-maintained teeth, hair and skin, far too fit to break a hip, have a heart attack, or witness the slow destruction of their minds by Alzheimer's disease. This image is not to be confused with the reality of being a menopausal woman, yet the two are intimately intertwined, for the image determines how menopausal women see themselves and how they are seen in the wider society. The final section of the paper discusses how health is the new virtue for women as they age as each individual is held responsible for what happens to her body, particularly in terms of the decisions made at the time of menopause.

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Criticisms of the Canadian National Breast Screening Study (NBSS) assert that reported findings (more deaths in women aged 40-49 allocated to mammography versus no mammography and no difference in mortality between women who had mammography and physical examination versus physical examination alone for those aged 50-59) may be due to more women with prior breast disease being allocated to the mammography arms of the study. The possibility that allocation was not random was examined for NBSS participants in Manitoba, Canada, using health insurance data that were external to and independent of the NBSS. The study design consisted of a retrospective observation study using health insurance (claims) data to construct health histories of breast disease prior to NBSS entry. Self-reported breast disease from the NBSS entry questionnaires was compared to breast disease histories on the basis of health insurance claims. The setting consisted of one NBSS screening center in Winnipeg, Canada. The patient population consisted of 9477 women with at least one health insurance claim in the 24 months prior to NBSS entry. We determined the proportions of women within each study arm who had claims for breast disease, breast disease investigation, or xeromammograms in the 24 months prior to NBSS entry, and compared the proportion of women's self-reports of breast disease or xeromammography with the presence/absence of a claim prior to NBSS entry for breast disease or xeromammography. No significant differences in the proportion of women with prior histories of benign breast disease, investigation, or xeromammograms (p > 0.05) were found across the study arms. Nine women in the mammography group versus one in the no mammography group had one prior health insurance claim for breast cancer, but eight of these women had no subsequent claims for breast cancer. There were no differences across the study arms in the proportion of women who reported a prior history of breast disease or a prior xeromammogram for whom an insurance claim was found. Using data external to the NBSS for Manitoba participants, the study found no definitive evidence to support a nonrandom allocation of women with prior breast disease to the mammography arms of the study. However, generalizability to the other NBSS centers cannot be assured.

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Data from Canada, Massachusetts, and Japan are combined to present a social and health profile of the menopausal woman. The paper examines the difference in perspective of the social scientist relative to the clinician or the medical epidemiologist. It also discusses the importance of a better understanding of the social context of women's lives for the further evolution of menopause research. Illustrative examples are taken from women's use of aspirin, the prescribing practices of physicians relative to hormone replacement therapy, the failure to collect occupational data in osteoporosis research, and the cost-benefit calculations to be made by women advised to take hormone replacement therapy. These examples are used as a way of showing that social data are not "frills" on the basic research of the medical scientist, but are essential to the future understanding of the menopausal experience of women.

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This paper re-examines the association between menopause and depression using data from a study in which 477 women were interviewed 6 times over a 3-year period. Menopause is examined as one of a series of factors which may increase the risk of depression for women in middle age, such as children leaving home, the death and illness of family members, the stresses of daily living, health and the onset of chronic disease. Rather than hormonal changes, it seems to be her health coupled with the shifts and stresses of family life in a woman's menopausal years which may trigger her depression.

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This paper deals with the methodological problems involved in the measurement of physical and psychological morbidity among menopausal women. A sample of 477 women were interviewed six times over a 3-yr period. In addition to questions about their menstrual status, the women were asked at each interview to complete a checklist of physical, menopausal, and psychological symptoms. Factor analysis was performed on the symptom experience to determine if symptoms could be grouped together in ways which would demonstrate clinically useful constructs and be stable over time. One-way analysis of variance showed a significant relationship only between the vasomotor symptoms and menopausal status.

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A population of 324 women who were over 45 and still menstruating were followed for a period of 3 yr. They were interviewed 6 times at 6-mth intervals. This paper presents data on the changes in menstrual status that occurred over the period of the study and relating these changes in menstruation to a woman's age and symptom experience.

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The menopause has been cited as a causal factor in psychotropic drug use among women in midlife. This paper first examines the stereotype of the menopausal woman and the theories which can be used to predict that she will be a high user of psychotropic medication. It then examines the actual use of psychotropics and the relationship between use and menopausal status using data from a study of 2500 women, aged 40-59, living in the Province of Manitoba, Canada.

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Data from the medical records of 113 patients living in Manitoba who had contracted respiratory poliomyelitis between 1952 and 1959 were compared with information obtained from interviews with these patients in 1980. The study was designed to determine whether the patients' respiratory function, mobility, ability to perform daily tasks, and employment, residential and marital status had changed between 1 year after the onset of polio and 1980. The patients' dependence on mechanical aids and other people was also studied. More than half (56%) of the patients perceived their respiratory impairment to be the same as it was 1 year after the onset of polio, 27% perceived the impairment to be increased, and 17% perceived it to be decreased. There was an association between level of respiratory function, mobility and ability to perform daily tasks. The 69 patients who lived at home had better respiratory function, mobility and ability to perform daily tasks than the 24 patients who were assisted by a home care program and the 20 who lived in hospital. The latter group had the lowest levels of respiratory and functional ability.

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A theoretical framework has been presented in which the menopause was treated as an event for which the definition and meaning must vary from one socio-cultural context to another. Depending on whether the stereotype of the menopause and the peri-menopausal woman in a society is positive or negative, it will offer either a benefit or a threat to the self-esteem of women as they enter the peri-menopause. Women whose self-esteem is already high will not be as susceptible to a negative stereotype as women whose self-esteem is low. Among the latter, the further fall in their self-image will be the key aetiological factor accounting for psychological distress among women in the peri-menopause.

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This study investigated whether perimenopausal women had higher physician contact rates and a more negative self-assessment of their health than nonmenopausal women in the same 40--50 band. It also examined the relationship between subjective health status, physician contact rates and scores on a set of vasomotor and a set of psychological symptoms. One group of women were more likely to have seen a physician within the previous 2 wk, to report psychological symptoms and to take a negative veiw of their own health. However, perimenopausal women were no more likely to belong to this group than other women. Most perimenopausal women had seen a physician at least once in the preceding 12 mth, but were rarely women with high levels of physician contact.

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