womens healthcare

Women in Pain: Problems and Mistreatment

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Chronic pain in North America is a major problem for men and women alike, affecting about one-third of adults. Many people of both genders do not receive adequate treatment for their pain. This causes great personal suffering, as well as high costs to the economy through direct health care costs and loss of work productivity for those in pain. However, women with pain face additional problems that suggests there is a systematic bias in the way healthcare is delivered to women. Diseases that affect mostly women are generally poorly understood and understudied, and although women report pain that is more frequent, more severe, and of longer duration than men, in general women’s pain is treated much less aggressively.

Women are at higher risk of developing a chronic pain condition than men. For example, women have triple the risk of autoimmune diseases, which are often associated with chronic pain, compared to men. Women also suffer from certain painful diseases that are rare in men, such as endometriosis and vulvodynia. Endometriosis alone affects one in ten women, and women who have endometriosis often have other painful diseases as well, such as interstitial cystitis/painful bladder syndrome.

However, research into causes and treatments for these diseases that disproportionately affect women is sadly lacking. A report written by the Campaign to End Chronic Pain in Women looked at six conditions common in women that are routinely misdiagnosed and ineffectively treated: endometriosis, vulvodynia, chronic fatigue syndrome, fibromyalgia, interstitial cystitis/painful bladder syndrome, and temporomandibular (TMJ) disorders. Examining funding to these six conditions by the National Institutes of Health (NIH) revealed that on average, the NIH spends $1.33 per affected patient on research into these conditions, compared to $186 per patient for Parkinsons’s disease, or $53 per patient for diabetes.

However, one need not look at diseases that are underfunded, poorly understood, and lacking effective treatments to find evidence of a gender bias in medicine. One of the best examples of gender bias is, surprisingly, in coronary heart disease. When presenting to emergency rooms or hospitalized for a heart attack, multiple studies have shown that men receive faster access to diagnostic tests and treatments, and men are more likely to receive advanced procedures and better care (for example,see here, here, here and here), and these disparities have not changed over time.

Although heart disease can present differently in men and women, atypical presentation in women does not account for all of the difference in delayed or lack of access to tests and treatments. In one study of doctors evaluating hypothetical patients— male patients and female patients presenting with typical heart attack symptoms and identical risk factors– the doctors did not make different recommendations for the male and female patients. However, when stress was included as a risk factor, only 15 percent of doctors diagnosed heart disease in the women, compared to 56 percent for the men. This study suggests that doctors are much more likely to write symptoms off as psychological when the patient is a woman. And women are medicated as if their pain is emotional instead of physical: for example, after coronary artery bypass graft surgery, women are less likely than men to receive opioid pain medication, and more likely to receive sedatives instead.

Many studies have shown that female gender is a major risk factor for the undertreatment of pain, across many different types of pain. After abdominal surgery and appendectomies, women receive less pain medication than men, even though many studies have shown that women are more likely to report higher levels of pain than men. For cancer pain, and pain caused by HIV, women are significantly more likely to be undertreated for pain. Even paramedics are more likely to give opioid analgesics to men suffering from pain pre-hospital admission than to women. In general, doctors and other medical professionals are more likely to view women’s pain as caused by emotional factors even in the presence of positive test results, and are more likely to administer tranquilizers, antidepressants, and non-opioid analgesics to treat women’s pain.

Women face obstacles to getting appropriate care for many different diseases, at every step of the process. Women’s diseases tend to be underfunded, underresearched, and poorly understood, so getting a diagnosis is difficult, especially when there is the additional obstacle of health care providers tending to assume that women’s symptoms are psychosomatic. Once diagnosed, women do not receive the same level of care for their diseases that men do. And if women can be shortchanged on care for cardiac conditions, which tend to be taken seriously in our society, well researched, and have evidence-based guidelines to guide treatment, imagine how poorly women may be treated for diseases like endometriosis, for which myths about causes and effective treatment abound, and their pain cannot be measured with any objective tests.

Until medical care for women’s diseases moves from the 1950s into the present day, the only solution for women is to be extremely persistent. Women need to seek out the few care providers who understand their disease and are up to date on the latest, albeit sparse, research, and they need to be persistent about having their symptoms acknowledged and treated by their care providers. And in general, we need to keep pushing for better awareness of these problems, and funding for research so that women can receive the medical care they deserve.

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Women Are Less Satisfied with Health Care Than Men – Why?

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The New York Times reported that women are less satisfied with their health care than men, citing a study from Health Services Research.

Researchers could see an overall difference between men’s and women’s views, but these differences were even more prominent for particular questions. One question asked patients if they felt they received sufficient information for the medications they were prescribed, and the other question asked whether patients were satisfied with the cleanliness of the hospital.

In both cases, women were less satisfied with health care than men – significantly so. Now the question is, Why?

Perhaps women have just been paying attention to the news. Dr. Mark Hyman explains in the Huffington Post that postmenopausal women are being prescribed cholesterol-lowering medication that increases their chances of getting diabetes – by 71%.

This isn’t the only instance in which women’s health needs were overlooked:

  • Premarin was prescribed to postmenopausal women to prevent heart disease, but it increased their chances of having a heart attack.
  • Studies have found increased osteoporosis in postmenopausal women prescribed osteoporosis medication.
  • Women are prescribed medicine as though they’re men, yet they are more likely than men to have irregular heartbeats due to prescription cocktails.
  • Many doctors don’t realize that pain medication does not have the same impact on women as it does on men. Experiments show Ibuprofen did not reduce pain for women.
  • In fact, the Society for Women’s Health Research and Medco Health Solutions, Inc. presented a study that showed women are prescribed more medication than men, yet they are less likely than men to get the appropriate drug for their needs.
  • The Center for the Study of Sex Differences at Georgetown University in Washington, D.C. explains that your gender can significantly impact how your disease should be diagnosed and treated. Yet the FDA only required that women be included in drug research since 1993.

No wonder women are less satisfied with their health care than men.

Women Are Less Satisfied with Health Care Provider’s Cleanliness

As it turns out, women’s immune systems are more resilient than men’s. Even so, women are more susceptible to certain illnesses and diseases than men are. Some experts suggest a woman’s stronger immune system is the cause for her susceptibility to autoimmune disorders, but the reasons remain unclear.

Sharyn Clough, a philosopher of science at Oregon State University, explained on NPR how society’s emphasis on a girl’s cleanliness could impact her susceptibility to diseases when she gets older, since she may not be exposed to the same bacteria as young boys.

While this may, or may not, be the case, it makes sense for a woman to be more aware of the cleanliness of her environment if she was raised to do so. It is even more reasonable for a woman to consider the cleanliness of her surroundings if she is more susceptible to disease – especially when she is in an institution that treats the sick.

It’s important that health care providers know that women are less satisfied with their health care than men. Voicing our opinions raises awareness, and these industries don’t want to lose half of their market.

It’s entirely possible that women are less satisfied with health care than men because women pay more for health insurance than men – health care that seems to be specifically geared toward the needs of men, not women.

Related Posts:
Women Pay More for Health Insurance
Affordable Care What’s in Effect Now
Falling Through the Cracks

This post was published previously in April 2012. 

 

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Is Medical Abuse of Women the New Standard of Care?

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Over half a million hysterectomies are performed every year in the U.S. Up to 90% are considered to be medically unnecessary. Therefore, healthy hormone-producing sex organs are “routinely” removed. For this reason, removal of healthy sex organs is considered to be the ‘standard of care’ for women. If this doesn’t alarm you, it should. The U.S. leads the world in hysterectomies – not something to take pride in for sure.

I should note here that approximately 60% to 70% of hysterectomies include removal of the ovaries or “castration” which is linked to loss of sexuality, heart disease, Parkinson’s, Osteoporosis and other numerous mental and physical health problems. I wrote about my own story regarding unconsented hysterectomy and castration here. I also wrote about how our hormones animate us here and about how the loss of hormones resulting from castration can lead to severe depression and even suicide here.

Unnecessary Cesarean Births

Now, let’s talk about another alarming and often unnecessary surgery being performed on women daily in the U.S., the cesarean. Cesarean is the now number one surgery. The U.S. leads the world in C-sections rates. In fact, 15% of current in-patient surgeries nationwide are Cesarean deliveries. The following data may help shine a light on why so many C-sections are being preformed. The centers for Medicare and Medicaid have found that the average physician’s charges for uncomplicated vaginal delivery in the U.S. is just under $4,500. But for an uncomplicated cesarean delivery, it is $7,000. Hospitalization costs are doubled, going from an average of a little over $5,000 to over $10,000.

C-sections are necessarily exhausting hospital, surgical, and nursing services and as a result, they’re causing an increase in waiting time and nursing coverage for other needed procedures. Consider that for every 5% increase in U.S. C-section rates, there may be as many as 14 to 32 more maternal deaths and $750 million to $1.7 billion in health-care expenditures. Why then, do C-section rates keep rising? Could money be the incentive? You decide…

Unsafe Birth Control

Money is too often an incentive when it comes to unnecessary surgeries, medical devices, drugs, etc. and this seems to be especially true in reference to women. Birth control is something most every woman has to confront and manage in some way. Birth control pills are long associated with well-known risks such as blood clots, stroke, and heart attack, etc.

One would think that after so many years, there would be a safer method of birth control, but that isn’t the case at all. Many women are undergoing irreversible sterilization every day in our country via a permanent method of birth control known as “Essure”. Hundreds of thousands of unsuspecting women have been coerced by their doctors into agreeing to having the Essure coil implanted. Sadly, this form of birth control is not the risk-free procedure that the gynecological community would have us believe. Instead, many women with the Essure coil in their body are now suffering unspeakable pain and serious medical conditions – some leading to hysterectomy.

The Essure coil intentionally causes an inflammatory response that encourages the growth of scar tissue, which then blocks the openings to the fallopian tubes – thereby preventing pregnancy. The problem is that the inflammatory response is intentionally chronic and the metals all too often evoke severe allergic reactions causing the coil to migrate, become misplaced, or even perforate the uterus, fallopian tube, and other organs. Obviously,  a variety of problems are likely to develop when a woman’s body begins the fight to reject the Essure coil. It’s estimated that over 800 women have filed reports with the FDA (Food and Drug Administration) regarding the adverse effects Essure has had on their physical health.

Morcellation

Let’s move onto another alarming issue in women’s health that has only recently come to light – at least for those of us who aren’t gynecologists or the maker of medical devices. In April 2014, the FDA issued a safety communication discouraging the use of laparoscopic power morcellators for the removal of the uterus and uterine fibroids. Based on an analysis of currently available data, the FDA cited a risk of the spread of unsuspected cancerous tissue.

The strange thing is that most women who undergo hysterectomy or myomectomy (removal of fibroids only) have no earthly idea that something called a morcellator is ever used. Most have never even heard of such a device. In other words, women are not giving their doctors consent to use this device to splice up their uterus or fibroids. When you consider that over 600,000 hysterectomies are performed every year (never mind all the myomectomies performed), the number of women who may have been subjected to morcellators could be quite substantial.

Transvaginal Mesh

Unlike the morcellator, transvaginal mesh is something that has been in the news a lot over the past couple of years. Most people have seen the advertisements on television regarding mesh-related lawsuits. The truth is that transvaginal mesh has been labeled a risky medical device by the FDA due to the high numbers of health complications associated with its use. Thousands of women have filed vaginal mesh lawsuits after suffering from the many complications related to transvaginal mesh surgery.

One urogynecologist, Dr. Richard Reid, told ABC news: “Since a mesh scar is quite fibrous and the bladder is very soft, it’s considered to be a compliance mismatch – which means the same as rubbing a piece of cheese over a metal grater.” In July 2011, the FDA issued a formal warning saying that transvaginal mesh was a “greater risk” with “no evidence of greater clinical benefit”. Johnson & Johnson removed its product from sale earlier this year and class actions are already underway in the U.S., Canada, and now Australia.

The HPV Vaccine

As alarming as all the information I’ve shared so far may be, there is even more alarming information regarding the medical abuse of young girls via an HPV vaccine known as “Gardasil”. As if targeting women wasn’t enough, many doctors are recommending the Gardasil vaccine to girls as young as nine and there’s no shortage of information regarding the many serious side-effects associated with this vaccine.

But, perhaps the most troubling thing about Gardasil is the negative effect it may have on the ovaries.  At least one Gardasil ingredient, polysorbate 80 is a known cause of ovarian deformities. Another Gardasil ingredient, L-histidine, carries significant risks as well. Because it’s a naturally-occurring substance in the human body, injecting it could have the effect of causing an autoimmune response. It would seem very probable that Merck -the maker of Gardasil- would almost have to have known that the vaccine would be putting young girls at risk for ovarian problems and even ovarian failure – leading to full blown menopause and all the associated health risks.

As of September 2013, there have been more than 57 million doses distributed in the United States, though it is unknown how many have actually been administered. There have been 22,000 Vaccine Adverse Event Reporting System (VAERS) reports following the vaccination.

Medical Abuse?

I’ll ask my original question I posed in my title: “Is medical abuse of women  the new standard of care?” While I’m not sure abuse has become the “new standard of care” exactly, I’m very sure that women cannot afford to simply trust that their doctor will do what’s best for them. That kind of blind trust is just not a good idea. The sad reality is that we must take charge of our own health. We cannot rely on doctors to do what is right for us. Doctors are under extreme financial pressure and it is just too easy for them to recommend expensive surgery or an unneeded medication for a condition that can be treated alternatively. Research in women’s health issues remains inconsistent, incomplete and often slipshod. Too often, women wind up being experimental “guinea pigs” for surgeons without ever being told of all the potentially life-shattering risks to which they are being exposed.

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The History and Future of Abortion Laws in America

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The article you are about to read is neither an look at the morality of abortion nor a defense for women’s rights. It is a look at the history, future and constitutionality of abortion laws. I am neither pro-choice nor pro-life. I’m not republican or democrat. I am not a feminist. I don’t believe we should categorize and label ourselves over generalities because each choice we make has the potential to redefine who we are and who we think we are. That being said, it was extremely difficult to drudge through websites to find facts on this subject. The argument for/against abortion has been so politicized that every site has a slant. I did my best to leave politics behind and just look at the facts on this subject.

In the Beginning

When America was founded, abortions were legal. There were those for it and against it then as there are now, but it did not affect the laws. There were homes for unwed mothers and campaigns to “adopt not abort,” but the state did not have any laws on the books until the mid-to-late 1800’s.

The American Medical Association

The American Medical Association (AMA) was the catalyst for the first abortion laws, but for reasons you wouldn’t likely expect. Through criminalizing abortion, the AMA could push midwives, apothecaries, and homeopaths out of business by eliminating their principle procedure – abortions. Think about this, the AMA was against abortion for reasons related to business, position and profit and used the morality argument as the wedge.The AMA set the stage for what we see now.  It introduced the pro-life side so it could corner the market on the abortion business. The AMA argued that abortion was immoral and dangerous and by 1910, every state had laws forbidding it unless it was to save a woman’s life, in which case a physician would perform it. No more midwives, apothecaries or homeopaths.

Did these laws protect women? No, back-alley abortions increased and more women died from complications. These back-alley abortions weren’t necessarily only unwed or unfit mothers either, women who had medical complications with the pregnancy but couldn’t afford to go to a physician could no longer seek out a midwife or other practitioner to conduct the procedure.

Margaret Sanger

In the 1900’s Margaret Sanger started educational campaigns for contraceptives because she opposed abortion. (For more information about Margaret Sanger, her involvement in founding Planned Parenthood, and her involvement in the Eugenics Movement in America read The History of Birth Control and Eugenics). As a proponent of the eugenics movement she had an agenda to keep, “More children from the fit, less from the unfit,” (Birth Control Review, May 1919, p. 12), but she did not pursue this agenda via abortions. As a nurse she cared for many women who died from complications of botched abortions and was very opposed to the practice because of the danger it imposed on women. Interestingly enough, Margaret Sanger founded the American Birth Control League, what we now know as Planned Parenthood. Today, Planned Parenthood performs legal abortions with government funds. Although it is ironic, I suspect that Sanger would likely approve of the procedure today because it is now a much safer procedure for women than it was during her time.

Roe v. Wade

Jumping ahead a bit to 1973, we come to the landmark case of Roe v. Wade. Texas, along with most other states had strict abortion laws that only allowed it if the women’s health was in danger. In this case, a 21-year-old woman brought a class action suit opposing the constitutionality of the law against abortion. She won. The Supreme Court ruled that the laws restricting women from having an abortion violated the Due Process Clause of the Fourteenth Amendment:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Today, this case is still the basis for the approval or rejection, and appeal of state and federal laws.

Today

The controversy remains heated. In 2012, Arizona passed a law that made it illegal for women to have abortions after 20 weeks of pregnancy, but in May 2013, aU.S. Court of Appeals in San Francisco ruled that the measure violates controlling U.S. Supreme Court precedent under the court’s 1973 decision in Roe v. Wade. It was a unanimous ruling. However, prior to the Court of Appeals decision, federal judge James Teilborg ruled the law constitutional because it did not prohibit women from ending their pregnancy, just forced them to do it earlier in the pregnancy.

More recently, on July 18, 2013 Texas Govenor, Rick Perry signed a law making it illegal for a woman to have an abortion after 20 weeks of pregnancy. Texas joins 12 other states with similar laws.

While I’m a firm believer of State rights under the Tenth Amendment (which is why each state has different abortion laws). Legislation should not be based on what is considered right or wrong according to a politician’s beliefs; laws should be based on what is safe for the citizens the law is supposed to protect. Is an abortion after 20 weeks unsafe? That is a discussion we have not had. It’s certainly not common; according to the Guttmacher Institute, an abortion rights organization, it is estimated that only that 1.5 percent of abortions takes place after 21 weeks of pregnancy.

The Slippery Slope

In recent years, several states have passed “wrongful birth” laws. These laws prohibit medical malpractice lawsuits against doctors who withhold information from a woman that could cause her to have an abortion. Who are these laws protecting? The patient? The politicians’ re-election campaigns? The doctors? Take a minute to set your personal beliefs aside and think about this – there are laws that allow doctors to withhold medical information that could jeopardize the life of both the mother and fetus. How is that safe? How is that even remotely constitutional? How is it more morally acceptable to potentially allow both mother and child die in order to prevent an abortion? Yet, we the people have accepted it.

The Future

While most arguments about abortion never make it past debating morality and women’s rights, these laws and debates should dive into much deeper issues – state rights, separation of church and state, and the role of the government in our everyday lives. I can’t say whether or not abortion will be legal or illegal in five years or fifty, but one thing I know for sure is the absurdity of the bills introduced, laws passed, and what politicians say will continue to get out of control. Unless, we as citizen’s speak up.

I’m sure we all remember Representative Todd Akin’s statement in August 2012 on the subject of his opposition to abortion even in the case of rape, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

More recently, in January 2013, a bill was introduced in New Mexico that would prevent abortion in the case of rape or incest because it would be considered “tampering with evidence in cases of criminal sexual penetration or incest.” This bill would make an abortion in the case of rape and incest a third degree felony potentially punishable by up to three years in prison!

I wish I was making this up, but as the saying goes, the truth is stranger than fiction. In my opinion, it’s all razzle dazzle to distract the public from the fact that we don’t need, nor should we have laws for or against abortion, but instead have regulations that monitor the safety of the procedure as it changes with technology. Maybe in the future voters will see the deeper issues in this debate and undo what the AMA set in motion in the pursuit of profit, power and prestige.

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