Tag Archives: gender

The patient with a list of questions

patient-with-list-of-symptoms2

When I want to know more about a medical condition, my first Internet destination is the Mayo Clinic’s website. It seems both reputable and decidedly non-alarmist.

Each condition is organized into a series of information packets: definitions, symptoms, causes, risks. There’s invariably a section called “Preparing for your appointment.” Without fail, it recommends that you make a list of your symptoms. Here’s an example:

Before your appointment, make a list that includes:

  • Detailed descriptions of your symptoms
  • Information about medical problems you’ve had in the past
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions you want to ask the doctor

Once you’ve begun interacting with your doctor, it can be easy to forget something you’d intended to ask.

I was somewhat surprised, then, to learn that some doctors are decidedly irritated when a patient brings a list to an appointment. Dr. Suzanne Koven discusses this in a Perspective piece in NEJM: The Disease of the Little Paper. Read more

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The Journal of Medicine and Philosophy — August 2014

sports-doping

The August issue of The Journal of Medicine and Philosophy does not have a specific theme. The nine articles address a number of quite interesting issues, among them:

  • How existential psychotherapy can offer powerful insights to patients recovering from severe mental disorders such as psychosis
  • How a preference in athletics for natural talent over artificial enhancements (such as doping) may reflect “unsavory beliefs about ‘nature’s aristocracy’ ”
  • How rich, educated, white males may be just as, if not more, vulnerable to threats posed by physician-assisted suicide and voluntary active euthanasia than members of marginalized groups
  • When the decision is made not to administer artificial hydration and nutrition, can the responsibility for the patient’s death be attributed to the underlying pathology, even when that is not the cause of death
  • The right to procreate: Is it possible for prospective mothers to wrong prospective fathers by bearing their child

Note that the articles in this journal are not open access and that I have added the emphasis in the following extracts and abstracts. Read more

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Social history of medicine — August 2014

history-of veterinary-medicine

The August issue of Social History of Medicine contains eight original articles:

  • Late 19th/early 20th century food adulteration in an increasingly industrialized and globalized world and the search for safety standards
  • The shift in cancer education in the 1950s, no longer downplaying post-operative recovery
  • The 20th century shift in British veterinary medicine towards small animals (dogs, cats), as the need to attend to horses declined (open access)
  • How complaints about the quality of London drinking water in the 18th century reflected the new popularity of bathing for health and social attitudes towards bathers from the lower classes
  • A re-evaluation of the prevalence of venereal disease at the time of the World War I (open access)
  • How quacks preyed on people with hearing loss in mid-19th century Britain
  • How the 1975 TV play, ‘Through the Night,’ portraying what it was like to experience breast cancer treatment, registered with medical professionals and activists who complained of ‘the machinery of authoritarian care’ (open access)
  • Did Axel Holst and Theodor Frølich actually develop an animal model of experimental research?

There are also a large number of book reviews, including:

  • Writing History in the Age of Biomedicine by Roger Cooter with Claudia Stein
  • Emotions and Health, 1200–1700 by Elena Carrera (ed.)
  • The Age of Stress: Science and the Search for Stability by Mark Jackson
  • Before Bioethics: A History of American Medical Ethics from the Colonial Period to the Bioethics Revolution by Robert Baker

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Why women should not ride bicycles: The medical opinion in 1896

women-bicycles-19th-century

In the 1890s, bicycles became safer and more comfortable to ride (detailed in this Wikipedia entry on the history of the bicycle). This may have something to do with the increased number of women who were attracted to bicycle riding. (There’s a correlation, but the causation is undoubtedly much more complex.)

Some celebrated this development. Susan B. Anthony, for example:

Let me tell you what I think of bicycling. I think it has done more to emancipate women than anything else in the world. It gives women a feeling of freedom and self-reliance. I stand and rejoice every time I see a woman ride by on a wheel … the picture of free, untrammeled womanhood.

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Why are we so willing to undergo cosmetic surgery?

Miss Plastic Surgery finals China
Miss Plastic Surgery pageant, Beijing
A recent article on cosmetic surgery in China observes that, despite the highly publicized death of aspiring pop star Wang Bei (see The death of Wang Bei: Cosmetic surgery as a moral choice), “the ugly side of Chinese obsession with beauty … is a gamble that millions of people are willing to take.” Why is that?

The high rate of cosmetic surgery in Asia has been widely discussed, including an article in The New York Times. What caught my attention in this more recent piece was the postmodern/feminist spin.

Susan Feiner, a feminist economist, offers these comments: (emphasis added)

Parents are caught between a traditional world view and a postmodernist world view. On the traditional side especially, your daughter is your property and potential to social advancement. … On the postmodern side you have this idea that western beauty, this imported beauty ideal, is really a sign of your family’s openness to the future. So those two impulses – a very traditional impulse and the more modern neo-liberalism impulse come together at the moment of submitting your own daughter to the knife. …

On one hand we have all of this acceptance and even approval for women to become doctors and lawyers and political leaders and at the same time what’s been held up to women is this Walt Disney notion of our lives. That really even if you are a doctor or a lawyer or a political leader the best you can really do is to be beautiful and get some wealthy rich man to take care of you, so the best possible outcome for any women is to be both hugely successful professionally and be knock-down beautiful.

Why so much willingness to reshape the body?

What drives the popularity of cosmetic surgery? As bioethicist Carl Elliott notes in one of my favorite books, Better Than Well, medical enhancements, along with body size, are part of the logic of consumer culture: “You cannot simply opt out of the system and expect nobody to notice how much you weigh.” Read more

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Why do we feel bad about the way we look?

Laurie Essig’s new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, includes a chapter on how we learn to want cosmetic surgery. She quotes Joan Rivers, from her book Men Are Stupid . . . And They Like Big Boobs: A Woman’s Guide to Beauty Through Plastic Surgery:

My abiding life philosophy is plain: In our appearance-centric society, beauty is a huge factor in everyone’s professional and emotional success—for good or ill, it’s the way things are; accept it or go live under a rock.

Heidi Montag cultural texts promoting cosmetic surgery

Essig comments:

But Rivers is a TV star. TV and movie stars have always utilized the miracles of cosmetic surgery to look good in the two-dimensional spaces they inhabit. How did the rest of us learn to desire a perfectly plastic body? How did ordinary women and men with ordinary lives and ordinary bodies learn that they need plastic? The answer: the plastic ideological complex, a set of cultural texts that are both highly contested and yet tightly on message. It is itself so ubiquitous that it might even be described as hegemonic. In other words, the “need” for cosmetic procedures is impossible to avoid. Through advertising and TV shows, movies and magazines, we learn to want cosmetic intervention in our aging faces and imperfect bodies. This need is now so firmly implanted in our cultural psyche that it has become “common sense” to embrace cosmetic procedures. Why wouldn’t we want to look more beautiful, younger, thinner, more feminine, better? The question is no longer will you have plastic surgery, but when.

Accept plastic beauty or go live under a rock. Rivers isn’t just joking; she’s also doing the serious work of enacting the ideology of plastic, an ideology that we can no longer avoid. Even if we did live under a rock, whenever we crawled out from underneath it, we would be assaulted by images of perfectly plastic beauty on billboards and the sides of buses and on TV and in movies and even the nightly news. And then there are those damn magazine racks, an unavoidable gauntlet of Dos! and Don’ts! that must be passed through each and every time we buy our food.

A conspiracy of capital to make us feel bad

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Sex, lies, and pharmaceuticals

Sex lies and pharmaceuticals Ray MoynihanJust a quick word in reply to a review of Ray Moynihan’s Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (co-authored by Barbara Mintzes).

First, the reviewer, British sociologist Linsey McGoey, criticizes the book for continuing its attack on the medicalization of life.

A few pages in, it’s hard not to feel déjà vu. Moynihan came out a few years ago with Selling Sickness, a book tackling the problem of medicalization, the tendency for typical life phases or human behaviour such as shyness to be medicalized – treated as disorders and diseases requiring medical treatment.

IMHO, there can never be enough books educating the public about medicalization.

Next she defends the pharmaceutical industry:

They [the authors] want to condemn [the pharmaceutical] industry for preying on human insecurity and profiting from the oldest adage in the book: Sex sells. The problem is, just as Viagra has been embraced by millions, its pink equivalent would be a sure seller – and not because consumers are dupes, or because industry is inherently malevolent, or because doctors are in the pockets of companies. Sure, some are, but such a thesis always oversimplifies the links between human disease and human desire. Most of them [sic] time, people want to be told that a problem is medical in orientation. It helps to exonerate a sense of personal blame.

Eliminating a sense of blame or shame is exactly the tactic pharmaceutical marketing employs. (See How the pharmas make us sick.) Viagra has been embraced by millions because ED has been medicalized! I was just reading about a “renegade” Canadian doctor who’s quoted on the subject: Read more

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Feeling sorry for plastic surgeons

sean-mcnamara-christian-troy-plastic-surgeons-nip-tuckFor her new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, Laurie Essig spent time interviewing plastic surgeons. She was interviewed herself on Salon, where she was asked what else surprised her — besides statistics like 85% of cosmetic surgery is purchased on credit and over 70% of patients earn less than $60,000 a year. (emphasis added)

One of the things that surprised me is how out of control the cosmetic surgeons themselves felt in all this. I felt a lot of sympathy for the cosmetic surgeons, even when they were telling me that I needed a facelift. Cosmetic surgeons are primarily men, well over 90 percent. They’d gone to medical school and they came out with huge amounts of debt themselves, often well over $200,000. They meant to be reconstructive surgeons, they meant to fix people after horrific accidents or cancer, and they started doing some boob jobs on the side and it started to eat up more and more of their practice because it was so lucrative. They want to send their kids to nice schools, they have mortgages, they have family, and you could see that they felt a little bit helpless as well. It wasn’t what they meant to do.

They seemed just as much products of the system as the middle-aged women going in for a facelift or boob job. They were hoping for a better future. Of course, they create the desire — they advertise, people come into their office and they tell them what they need — but I think that if they hadn’t graduated from school with so much debt, most of them would be selling cosmetic procedures a lot less than they are.

A compassionate view and undoubtedly true. For a similar and depressing take on the financial dilemma of primary care physicians, see the comments following my post on KevinMD, Marcus Welby and the relentless growth of specialization. Read more

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Love and marriage in China

Chinese weddingPrevious articles on the “second wives” of well-to-do Chinese men have focused on how unfair it is that mistresses of corrupt officials become exorbitantly wealthy. Or on the government’s foot-dragging in putting marriage databases online. But in an article ostensibly about the branding of luxury goods, Tom Doctoroff, a leading authority on marketing in China, offers a cultural analysis of the phenomenon. (emphasis added)

Because China has never had a humanist revolution, sex and marriage have always been relatively divorced. That is why many Asian cultures have an immensely commercialised and categorised [sex industry]. … [I]f a husband is a man of means, and has a significant income, then he can take on a second wife without violating his obligation to his first wife. …

Second Wife culture is just one part of a much bigger and more interesting area which is the difference between love and marriage in China and the West. Marriage in the west is rooted in romantic passion, and although that passion evolves over time we basically assume that if it’s is [sic] gone from marriage it’s a shallow marriage. Yes, there are other concerns that surround it – children, money – but it’s not the core of the relationship.

In China it’s fundamentally true that a marriage is not between two individuals, it’s between two clans. Marriage is a way that people connect into a broader society in which the individual is not the basic productive unit. This has always been the case.

In China, a romance is not ideal unless it is also accompanied by commitment. In Chinese, when we translate “a diamond is forever”, we don’t mean that passion lasts forever. It translates as “he will do anything for you, forever”. And that’s why people buy a lot of things for their mistresses – that affection needs to be demonstrated, too. Read more

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The death of Wang Bei: Cosmetic surgery as a moral choice

Wang BeiIn my customized Google news, I have a category for cosmetic surgery. Most items that turn up are self-serving PR announcements, but recently there was lengthy coverage of the death during cosmetic surgery of aspiring Chinese pop star Wang Bei.

The details are tragic: She was only 24. Ironic: She was already beautiful. And dramatic: Her mother was having the same procedure at the exact same time. So her mother woke up to discover her daughter was dead. Or perhaps not. According to conflicting reports, her mother was told nothing until the next day. The news reports out of China do not strike me as especially reliable.

For example, Wang Bei’s death was first reported as an anaesthetic accident, but the majority of stories describe the cause of death as bleeding from the jaw. Wang was having facial bone-grinding surgery “to make her jaw line fashionably narrow and her face smaller.” (Chinese women are said to prefer an oval face shaped like a ”goose egg.”)

The blood from Wang’s jaw drained into her windpipe, and she suffocated. Is that an “anaesthetic accident?” Wang’s surgeon claims the operation was a success and that Wang died of an unexpected heart problem several hours after the procedure. Read more

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Afghan women empowered to practice beauty

Afghan girls practice beauty careIndependently of Time’s cover story on Afghan women, the New York Times ran a feature article on Afghan women, the Taliban, and the war. Like Time, it included a photo gallery of Afghan women, including this one.

In Mahmud-e Raqi, 12 teenage girls sat around a small trunk filled with beauticians’ tools — combs, boxes of hair dye, scissors, nail polish, hair spray — and watched closely as the instructor sat one of the girls in a desk chair and demonstrated how to cut off split ends evenly.

In most places in the world this scene would hardly be a sign of women’s liberation, but in this corner of Afghanistan, it meant a great deal. The girls, ages 15 to 17, had been allowed to come from their villages to the provincial capital; they will take home a trunk of beauty goods and can earn their own money in their homes by offering beauty services to women in their village.

The girls are attending a government supported course, one that empowers them to become the Avon ladies of Afghanistan.

Beauty and self-esteem

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Bibi Aisha: Fixing what can be fixed

Bibi AishaThe young Afghan woman on the cover of Time (see last post) is beautiful, as all the photographic cues imply she should be. Except … she doesn’t have a nose. The contrast between the sumptuousness of the photo and the missing nose increases the shock value of the image.

For many in the wealthy West, what this image undoubtedly brings to mind is the thought: “She could get that fixed.”

Sure enough, Time managing editor Richard Stengel tells us:

Aisha will head to the U.S. for reconstructive surgery sponsored by the Grossman Burn Foundation, a humanitarian organization in California.

If we didn’t know the surgery had already been arranged, any number of wealthy individuals or organizations would undoubtedly have stepped forward with an offer. In fact, the organization Women for Afghan Women reports that, in response to their outreach efforts for Bibi Aisha,

the response has been tremendous. We have had several offers from doctors and medical professionals in the United States for free travel to the United States, surgery and care for Bibi Aisha. There have also been Kabul-based doctors who have offered to do her surgery for free. The generous outpouring of offers of help has been moving for all of us, particularly for Aisha.

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Mutilated Afghan woman on the cover of Time

Bibi Aisha on cover of TimeThe woman on the cover of Time is Bibi Aisha, an 18-year-old Afghan woman. Time’s online photo gallery — Women of Afghanistan: Living Under the Taliban Threat, which displays an additional image of Aisha — tells her story:

[She] was dragged from her home by the Taliban after running away from her husband. Despite her pleas that her in-laws had been abusive, that they treated her like a slave, that she had no choice but to escape, a Taliban commander said that she must be punished, lest other girls in the village try to do the same thing. Aisha’s family members carried out the punishment: her brother-in-law held her down while her husband sliced off her ears and nose, then left her to die. She is now hidden in a secret women’s shelter, where she was taken after receiving care from U.S. forces.

The lead paragraph in Time’s story on Afghan women and the Taliban repeats Aisha’s story in slightly more dramatic prose:

The Taliban pounded on the door just before midnight, demanding that Aisha, 18, be punished for running away from her husband’s house. Her in-laws treated her like a slave, Aisha pleaded. They beat her. If she hadn’t run away, she would have died. Her judge, a local Taliban commander, was unmoved. Aisha’s brother-in-law held her down while her husband pulled out a knife. First he sliced off her ears. Then he started on her nose.

A worthy cause or “Afghansploitation”?

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Novartis gender discrimination verdict: Guilty as charged

Sexual harassmentThe Novartis gender discrimination trial has concluded, and damages have been awarded to the plaintiffs. Novartis must pay $3.4 million in compensatory damages and $250 million in punitive damages.

Highlights of the trial’s testimony included the behavior of one manager, Brian Aiello, who asked female sales reps to sit on his lap while he showed them pornography. Novartis took years to respond to complaints about this manager and testified, in its defense, that “every company has a few jerks.”

One of the lawyers for the plaintiffs made this comment on the verdict:

This jury learned that Novartis is not somewhere you would want your wife, your mother, your sister or your daughter to work. Novartis expected its female employees to do more than just go out and market its drugs — Novartis has a corporate culture that expects female representatives to be available and amenable to sexual advances from the doctors they call on. Time and time again, Novartis looked the other way when female representatives complained about inappropriate doctors. And then, to add insult to injury, Novartis paid those same women less, wouldn’t promote them into management, and punished them if they got pregnant. Novartis refused to treat its female employees as the competent and hard-working professionals that they were and are.

A human resources department from hell

The trial included testimony from a highly successful Novartis sales rep who was on the verge of breaking into management. Three men were involved in what appeared to be an arranged rape: The sales rep’s boss, his best friend (a top prescribing doctor), and a buddy of the friend (the rapist). DailyFinance summarizes the sales rep’s testimony:

The rape allegedly occurred after a Novartis golfing event that Salame [the sales rep] had hosted for two doctors. Following the game, Salame’s car keys were missing — she suspects her boss’s friend took them from her purse — and when his buddy offered her a ride, instead of taking her home, he took her to a remote location and attacked her. Although her supervisor was initially supportive, Salame said, that later changed. Within a few weeks, she was being interviewed by a human resources executive and her supervisor in a hotel lobby.

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Are married people happier? Are parents?

Happy Family Hugging Each OtherResearch tells us that married people are happier than the unmarried, that is, they’re happier than those who are single, separated, divorced, widowed, or simply living together. This doesn’t necessarily mean there’s a cause and effect relationship going on here: Get married, be happy. It could be that happy people are more inclined to marry in the first place and that we enjoy staying married to a happy spouse.

While studies (PDF) find that marriage increases a sense of “well-being” (another term for happiness), that state of mind may be only temporary. After a few years, bride and groom seem to return to the level of happiness they enjoyed before the big day.

As Derek Bok points out in The Politics of Happiness, conflicting answers to questions about marriage and happiness may result from observing two different groups: Those who become happier with the years and those whose marriages go sour. When you combine the two, the results may very well cancel each other out.

The end of a marriage. The health benefits of marriage.

So we don’t have a definitive answer to the question “Are married people happier?” What is certain, however, is that the end of a marriage – whether through separation, divorce, or death – is followed by a sharp decline in happiness. On a scale of 100, the average drop in happiness following divorce is 5 points and, following separation, the drop is 8 points. Why the greater unhappiness with separation? Perhaps, as Bok suggests, those who divorce were unhappier with their marriage to begin with, so they now feel some relief. Or perhaps the separated are still adjusting to the change, whereas the divorced have had more time to adapt.

We do know that married people live longer. One study (PDF), for example, found that the impact of marriage on how long we live was much greater than the impact of how much we earn. The longevity benefit for men can be quantified as equivalent to a lifetime of not smoking. The longevity benefits for married women are only half as much as for men. Hmmm.

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Padded bikini bras for seven-year-olds

Padded bikini bra for kids

Source: Fox News

A UK clothing chain, popular discount retailer Primark, reacted swiftly to criticism of its padded bikini bras designed for girls as young as seven. The product has been withdrawn, and Primark announced it would donate any profits from the inappropriately sexualizing items to a children’s charity. The bikinis were selling for £4 ($6).

The British tabloid The Sun broke the story last week and featured it prominently day after day. It congratulated itself on “a victory for The Sun” when Primark announced it would no longer sell the item. Meanwhile, its front page headlines generated considerable sales and not just among readers who were concerned with protecting the innocence of childhood. More often than not, the headlines drew one’s attention to the “Paedo” (pedophile) angle on the story (as in “Paedo bikini banned” and “Paedo Heaven on High Street.”) The Sun is known for its coverage of issues such as Don’t grow up too soon, Miley, complete with photos that encourage the very behavior the text claims to criticize.

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Gender and racial discrimination at a Pharma giant

Sexual harrassment

Source: TopNews

We’ll need government financed incentives to push pharmaceutical companies into developing new antibiotics. Just when we need Pharma to clean up its act and improve its image with the public, we have more unflattering news about the industry.

5,600 women have filed a class action suit against the multinational drug firm Novartis, claiming $200 million in damages. The women claim that Novartis discouraged pregnancies and ignored their complaints of sexual harassment.

Plaintiffs plan to tell the jury that they were denied promotions if they became pregnant or if they took their full maternity leave. One of the plaintiffs was “urged to have an abortion.” Another was asked to give the company “two child-free years.”
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Westboro Baptist Church defeated by tolerance

This is a local story for me: I pass this school frequently and have a niece and nephew who are graduates. It’s also a heartening one that counters some of the more depressing stories from the right end of the political spectrum. Unfortunately, this event seems to have received only local media coverage.
The following is from Hugh Kramer at The San Franciso Examiner:

Westboro Baptist Church is famous for picketing soldiers’ funerals, Jewish institutions, schools that are tolerant of gays and just about anything else in America that they don’t like; but when they came to Gunn High School in Palo Alto, CA on April 1, they got a big surprise. They were greeted with song.

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Are women doctors safer?

women-doctorsNearly half of students in US medical schools are female. Studies show that, compared to their male counterparts, women doctors are friendlier, spend more time with their patients, and are less likely to be sued.

According to Jorge Girotti of the University of Illinois at Chicago Medical School, women doctors are more empathetic, compassionate, and nurturing. “If you bring that attitude in, you’re more likely to see the overall patient as a whole rather than just a disease.” Read more

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Real men don’t use doctors

Too much machismo can be bad for a man’s health. A recent study finds that the John Wayne/Sylvester Stallone types are half as likely as their less “macho” counterparts to visit a doctor for preventive health care.

The study was presented at the annual meeting of the American Sociological Association on August 10, 2009 by its author, Kristen Springer. The men who participated in the study were all 65 years old, and preventive care was defined as annual physicals, testing for prostate cancer, and getting a flu shot.

The men’s “macho quotient” was determined from a questionnaire that asked things like “When a man is feeling pain, he should not let it show. Do you agree or disagree?” Other questions designed to identify traditional masculinity asked whether men should be the main bread winner, act confident even when they’re not, or have the final say in the decision to buy a house.
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Why bike when you can trikke?

girl-on-trikkeThe trikke (pronounced “trike”) is essentially a scooter with two wheels at the rear instead of one. You don’t push your feet against the ground to go forward, however. You lean from side to side, similar to the way you’d propel yourself on skis. It takes a little practice, but it’s not hard to learn. If you watch the video at the end of this post, you can see how it’s done.

Fans of trikking claim that it’s great exercise. On a bike, you use your legs. They move the pedals, which drive a chain, which turns a wheel. On a trikke, you use your whole body to create forward motion. You can even alternate between using your upper body to tilt the handlebars from side to side, using your pelvis to sway the trikke from side to side, or using a combination of both. Riders claim it has the potential to use and tone all the muscles in the body. Read more

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