I actually wanted to talk to you a little bit about your journey as a physician. So you received your m. D. From harvard medical school. You then completed a residency in internal medicine at mount sinai, and youre now a medical oncologist at memorial sloan. But you received your b. A. In history and specifically the history of science. And so i was wondering if you could talk a little about your academic journey and how your undergraduate interest in history sort of has shaped your medical career. Right. Well, i was really fortunate as an undergraduate, harvard, they offered this incredible concentration on this major that allowed us not to have to choose between science and humanities, because i always knew i had an interest in medicine. But really the ability to combine the reality that we know, which is that science and medicine do not exist in a vacuum and that its inextricably linked to culture, politics, religion. And for me, i loved history. I loved old books. I loved the context of who and why we are, the way that we are in science and biology, grounds and understanding and gives us the language to speak about the way that our bodies work. But ive always been fascinated by understanding the lens with which we understand science. And that has carried me through this day, that learning really helped me understand the narrative aspect of medicine. And as an oncologist, so much of what i do is, yes, about the biology and the science that mutations, but perhaps even more so, the stories that patients tell me about themselves, about what makes them want to live, what helps them thrive, and how i can best help them in that journey. Yeah, its clear to me that your history, education and your medical career profoundly shaped this book that you wrote. And because its really an interwoven tapestry of meditations on how the past informs the present. And even in your introduction, if i can quote from it, you write quote, the past is a presence in every Doctors Office and every Research Institution in medical exam rooms and artemis cadaver labs, hospital hallways and operating rooms. It haunts our footsteps as we navigate the medical maze of Womens Health that was built by men whose ideas about women, while sometimes wellintentioned, were limited at best and paranoid, misogynist and abusive at worst. So can you talk a little bit more about this historic presence in medicine and how it and maybe how it motivated you to write this book . Absolutely. So in my own career, ive taken care of thousands and thousands of women. And over time, as i became a mother myself and as a daughter, caring for women in my family, listening to the stories of women and experiencing them myself, i became overwhelmed by these narratives of women feeling dismissed, invalidated for their pain, shamed, blamed, and also understanding just how broad or how much broader the landscape of Womens Health really is. And what i understood it to be, even from my own medical training and for me trying to unpack that legacy that infects us when we show up at the Doctors Office today, whether as a doctor or a patient meant for my training, really going back in time to better understand how was this system built the way that it is. I know professional. You have an interest in history as well that is your career and i honor that. And in my world i really think about everybody, every body that we are in and show up in has a history and the only way for us to collectively understand how we can make our future better is to really understand the history of what we come from. And for me, that meant head to toe, looking at all the ways that i do think that women have been dismissed. And yes, i write about the men that created the system that were in. And the aim of the book is not to say, oh, there were these horrible men and all they did was terrible things. And that no one had any good motivations. Of course, history and human nature is far more complex than that, really more to understand the context of which our system was built and how do we reframe that context and perhaps develop a new and better narrative moving forward . Yeah, and i think you do a wonderful job of capturing some of that complexity, and i hope that will. Well, well get into those details in a moment, because youre right, it isnt just this sort of like, you know, simple narrative of, you know, bad men doing bad things, but that, you know, as you write about it, its its a very complicated story, but i think its actually a really wonderful transition to to get in to talk about, you know, some of the book. Your book is called all in her head. And its really an appropriate title because it really does capture the essence of how male physicians in general have historically approached Womens Health care and. And i was hoping you could talk a little bit more about this, especially the notion that Womens Health complaints have historically been dismissed as even mere as as fantasies or even mental illness. Absolutely. Absolutely. Well, you know, it took a while to come up with the title of of the book. But once we did all in her head, it just immediately clicked because when i say the title of my book is on her head, almost every woman has a story to tell me. Oh, oh, my gosh. When i went to the doctor, i was told this or i was dismissed that it was this thread that kind of wove its tapestry into the cultural narrative that i felt that i was really trying to explore, or in terms of better understanding the history and unpacking some of the stories. One of the things that was so striking to me in my research is how much of the historical focus on Womens Health care was that we were just vessels and hormonal vessels once we discovered those hormones, you go really back in time to the greeks. You know, were all hysterical from this wandering womb that presumably was untethered and and was the nature or the basis for all our medical ills. And once we knew throughout history, obviously, that we were not subject to a wandering womb, it then became our ovaries. And then, you know, once we had the discovery of hormones that we were all bathing in this estrogen that was making us formidable crazy at the lens with which our bodies were studied was really is this atypical improv, irrational version of the reference male. And that theme is carried through throughout medicine even insidiously to today. Yeah. And in the book you provide example after example of sort of complicating some of these, what we might call sort of heroes of medicine. And along the lines of, you know, this idea of of dismissing Womens Health care. And i was particularly as someone who teaches the history of medicine, i was particularly struck by your example of the renowned physician, William Osler, and his belief that heart and heart problems were not necessarily attributed to Heart Disease. Im wondering if you could share some of that story. Yes. So, i mean, throughout my medical training, including when i studied the history of medicine, william sir William Osler, was this godlike founding father of medicine in the United States. He was this canadian who moved to the United States. And ultimately founded the residency system at Johns Hopkins university. As we know it today. And really the father of so, so much of the medicine that we practice today. And when i went back in time to really understand why is it if we think about the present problem, that Heart Disease is the number one killer of women in the United States . We also are taught in medical school in many instances, certainly during my training, that the way that a woman presents with Heart Disease or a heart attack is atypical relative to the man. Lets sit with that for a second. We are greater than 50 of the population is the number one killer of women in the United States. And somehow our symptoms are not average, are not typical. Thats simply ridiculous. And it and it really highlights this how important the legacy of the words that we choose to describe Womens Health disease become so important. And for me, it was necessary to go back in time to understand who laid the groundwork for this. Now, of course, sir William Osler did amazing. Absolutely incredible things for medicine and had so many discoveries. But when it came to Heart Disease and going back to his original treaties and textbooks about what he wrote about womens Heart Disease, its really shocking. Case after case after case, he describes mrs. B or mrs. C because they all just got an initial bill for them as having pseudo angina or even hysterical angina. Angina refers to chest pain. Basically, our chest pain is fake or our chest pain is hysterical. Theres even one line in i just read it the other day. Theres even one line in the textbook where he says, these women do not die or thats not true. We do die. Its the number one killer of women in the United States. Then when you look at how he describes the classic man who has heart attack symptoms, he explains, oh, this is a man whos hard working. Hes white haired with his engines running and running and running. And then he collapses with this elephant, like pressure on his chest. And that is the classic imagery of a man having a heart attack that you expect to see in an emergency room, because thats what youre taught. You see it in movies and its part of the public lore. And then what happens is when women have heart symptoms, theyre not as aware of what they might be because weve not been taught. And then its too often missed by doctors in the hospital. Yeah. And he makes several appearances in your book, right. So its not just about sort of Heart Disease, but also even thinking about ibs. Right, exactly. One of the ways that i did the research for this book was to simply say what are some of these female predominant conditions that i hear day in and day out from interviewing other experts in other fields, or even from my own patients . Irritable bowel syndrome, we know, is a more female predominant disorder, as are summer gastrointestinal disorders. And i went back in time to say, well, who were the first people that coined these terms or first discussed these medical conditions . And and then its like it was an it was an an act of show. Dont tell. I just needed to explain in words, not in their own words, what they said about women. So one of the first articles by William Osler and others was called mucus colitis, and it was about, again, symptoms of irritable bowel syndrome. And what was shocking to me is so much of the article was about the psychological condition of of these patients and not really trying to understand the physical biology of it. And when i thought about my own training and what are some of the biases that i inherited when i even spoke to a gynecologist the other day who said to me, you know, i was afraid for my doctor to put ibs in my chart in my past medical history because i knew that the moment that happened, i would be seen as a difficult patient. And going back in time to what William Osler and others said about these women who were diagnosed with irritable bowel syndrome, worse, theres this whole narrative about those patients are more difficult or challenging to take care of, and no one wants to arrive at the Doctors Office with a Scarlet Letter before they even had a chance to explain what their symptoms are. Thats what this is really about. This book is unpacking the idea that before even women get to the Doctors Office, they arrive with shame. They arrive apologizing, they they arrive blaming and that just simply has to stop because were not allowing women to truly access better care. You know, i think one of the the really great things about your book is how you weave in these past and present narratives. And, you know what youre touching on right now about, you know, looking back in time to see where some of these ideas come from. I think is is it a really important perspective . And im wondering how do you think these ideas that we sometimes think are stuck in the past . How do they filter themselves into present medical education . I think they filter themselves in so many ways. What was really heartbreaking for me and eye opening for me is its one thing to go back in time and to read these just egregious stories, say, oh my god, i cant believe they said that. Okay, were going to remove womens. Its were going to remove their ovaries and all women are crazy. I mean, thats easy to say. Oh, thats terror or thats bad. You know whats even worse in some ways, how subtle . A subtle look into today when i thought about and looked into how often do we ask women about sexual side effects from cancer related medications . In my field as an oncologist, youre two times more likely to ask men about sexual side effects than we are women. And i take care of women of all ages when i really thought about that, there were many ways that we have left women behind. We have assumed that there sexual life, that the way that they choose to find joy and thrive is simply less important than men or dependent on a male narrative. And that and that insidious legacy is, again so heartbreaking when you realize, even for myself as a physician, that i have to drank the koolaid. There were many instances in my practice where i made assumptions about women that were false and i am glad i wrote this book for myself. Its the book that i wish i had had during my training so that throughout the years i could be any informed better doctor, all patients. Yeah, yeah. And im glad that you brought up sexuality because really a significant theme in your book is how physicians, particularly male physicians in the past linked many aspects of Womens Health to sexuality. Whether that was concerns about excessive Sexual Activity or even their endeavors to sort of medicalized womens sexual desires. And you give numerous examples of this in your book and could you can you maybe share some of those examples . And maybe think through why do you think there was such a fixation on womens sexuality among male physicians . Yes, you know, i wasnt expecting to find this the way that i did. I i was shocked in my research at every turn, what i whether i was trying to study the original diagnoses of scullys basis, whether thinking about asthma or whether i was looking into womens skeletons in general, or the way that we exercise. At every turn, i would find some founding father of medicine linking womens sexual desire, a fear of it, or the need to control it as is booming. I dont even have the right word for it. Just looming, overwhelming need to control it, understand it, or prescribe it at a mans whim. So for example, when it came to how we coached women or told women as physicians that they could exercise. Bicycling is a fascinating, fascinating example. I was really interested in the idea that why is it that so much of the history of womens exercise is about either teaching them not to or that the goal is to be thin and small and not strong . Well, at the turn of the century, we know that bicycles were a huge pastime. They were also the symbol of the Suffragist Movement and gave Women Mobility from their home. While there was another problem with them, that in that mobility, in that symbolism, in that sense of freedom, there were lots of doctors that came out in famous medical journals and in the lay press to say, careful, lady, this is really bad news for you. If you exercise well, your face is going to be frozen in a grimace. Youre going to develop bulky muscles. But you know what else is going to happen . Your sexual day is going to go into overdrive. You may even become a chronic masturbator and not even be able to reproduce. And i mean, how do we go from exercise to sexual function . It is just mind boggling to me. The number of times that womens sexuality, their desire is brought up as either something to be feared or something to be prescribed for hysteria, but only but only with your husband and only when he desires it. So there is this constant thread that we know throughout history and culture and politics of the need to control women and the need to control their behavior. And that is woven throughout our medical system when it comes to womens sexuality and their desire and their libido. Yeah, i think one of the favorite examples that you provide in the book is the bicycle example. But i think youre right in that analysis that you give is that there is the bicycle in some ways seems like its a metaphor for the for india, for womens independence. Right. You have this lovely example of like, you know, a concern about women. You know, that maybe its okay if they ride bicycles, but just not too far. Right. We dont want them to go too far. And when i was reading it, i really read this as, again, an example of mens fear over independence. Through this, you know, examination of sexuality. And when i teach this particular history to my students, especially when we talk about the fear of female masturbation, my students always find it really funny. And, you know, there is an aspect of humor there. But i do think what youre saying is correct. And i try to emphasize the real implications for womens agency with these medical diagnosis. And and i know this is true for the past, but how do you think these ideas have entrenched themselves into the sort of medical practice today . First of all, im so thrilled that you teach this to your students. And clearly we are cut from the same cloth. And its incredible to know that there is education going on today for the future and the future even better. I think i see this left and right in my practice in particular, so i take care of a lot of young women who we may have to thrust into chemical menopause because of the nature of their cancer being driven in by estrogen. And so there are women in their twenties who have to suppress their ovarian function and give them further medications that downregulate the amount of estrog