Is Modern Medicine Sexist?

The following discussion of whether or not modern medicine is sexist took place on WMST-L in October 2000. Because of its length, it has been divided into two parts. For more than 100 WMST-L files now available on the Web, see the WMST-L File Collection. PAGE 1 OF 2

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Date: Wed, 11 Oct 2000 12:04:58 -0700

From: "James H. Steiger" <steiger @ UNIXG.UBC.CA>

Subject: The Sexism of Modern Medicine

Some facts on modern medicine, forwarded to me by a colleague on another list. These types of facts should be dealt with in any rational discussion on the alleged "sexism" and "anti-female" bias of modern medicine: $1.8 billion toward breast cancer research and $376 million to prostate cancer " According to the American Cancer Society in 1997. The number of men that are diagnosed with prostate cancer is about 200,000 per year. Women diagnosed with breast cancer is 175,000 and women diagnosed ovarian cancer is 25,000. Life expectancy: In 1995 the life expectancy for women stood at 79 years; for men, it was 73 years. Projections for 2010 show life expectancy will be 81 years and 74 years, respectively. (1) Health coverage: Men under the age 65 are less likely to be covered under any insurance plan than women. (9) Government spending: The National Institute of Health spends 10 percent of its budget on women's health issues and 5 percent on men's health issues. (1) Cancer: 190,000 more men are diagnosed with a cancer than women each year. (10) 29,000 more men died of cancer in 1992 than women. (2) Prostate cancer: Prostate cancer is almost as serious for men as breast cancer is for women. 44,000 women die of breast cancer while 41,000 men die of prostate cancer each year. (3) Every twelve minutes a man died of prostate cancer in 1997.(4) 334,500 men were diagnosed with prostate cancer in 1997. (4) "Since 1992, the number of American men diagnosed with prostate cancer has risen from 132,000 to 317,000." (3) "The National Cancer Institute directed $1.8 billion toward breast cancer research and $376 million to prostate cancer research projects." (3) "The government spends $250 for each man diagnosed with prostate cancer and about $2,000 for each death, according to the American Foundation for Urologic Disease. It spends $3,000 on every woman diagnosed with breast cancer and $12,000 for each death." (3) The Department of Defense spent "about $20 million for prostate cancer research and $455 million on breast cancer research from 1993 through 1996." (3) Suicide: Males are at least four times more likely to die from suicide than are females. However, females are more likely to attempt suicide than are males. Statistically, every twenty minutes a man commits suicide. (5) Men accounted for 81 percent of suicides from 1980-1992 among persons aged 65 years and older. From 1980-1992, the rate for men in this age group increased 10 percent. The rate for women was unchanged. (5) AIDS: Men will comprise of 86 percent of all deaths from AIDS-related symptoms during the mid-1990's. (6) AIDS is the leading cause of death for men between the ages of 25-44. AIDS is the third leading cause of death for women between the ages of 25-44. (6) Heart attacks: 66 percent of Americans who experience heart attacks are men. (7) Men between the ages 29-44 have a 41 times higher chance of having a heart attack than women. (7) Men still have a higher chance of having heart attack than women between the ages 45-64. That chance is three times higher than women. Only until men and women turn 65 and older women have about equal number of heart attacks. The difference is a 15 percent lower rate for women. (7) Strokes: 54 percent of Americans who experience a stroke are men. (8) Sources: 1- US Census Bureau. 2- National Center for Health Statistics and the American Heart Association. 3- Special Report- "Dying for Dollars," Harry Jaffe, Men's Health, September 1997. 4- American Cancer Society. 5- National Center for Health Statistics at the Centers for Disease Control and Prevention. 6- "Where Women Stand: An International Report on the Status of Women in 140 Countries 1997-1998" by Naiomi Neft and Ann D. Levine. 7- American Heart Association and Framingham Study, 26-year follow-up. 8- American Heart Association and Framingham Study, 24-year follow-up. 9- National Health Statistics and US Census Bureau. 10- American Cancer Society James H. Steiger Department of Psychology University of British Columbia 2136 West Mall Vancouver, B.C., Canada V6T 1Z4 Voice and Fax; (604)-822-2706 EMAIL: steiger @ unixg.ubc.ca

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Date: Thu, 12 Oct 2000 10:34:09 -0700

From: Jenea Tallentire <jltallen @ INTERCHANGE.UBC.CA>

Subject: Re: The Sexism of Modern Medicine

These stats are really interesting and show better funding for some areas of women's health than I thought. They do not, of course, speak at all to the interpersonal aspects of medicine, which includes the treatment of women by their doctors, hospital staff, and specialists. Women's experience in this area has been shown to be very often exclusionary, discriminatory, and dismissive in comparison to men's. See Susan Wendell's work on the gendered nature of psychosomatic illness, where women are 'known' by professionals to be more prone to have illness 'all in their heads' - without any serious research to back up this claim. Anyone know the study where women and men were sent to the same hospitals with the same symptoms of heart attack and most women were sent home with an aspirin and most of the men were given a full workup? I think it was a mid-1990s study. As to the heart disease stats: is it not true that no major national study of heart disease in the US was conducted with women until 1990? (Please correct me if I'm wrong.) It is this 'blank spot' in research that is a key aspect of the 'anti-female' bias in medicine. The continuing lack of a completely safe, cheap birth control option for women is a good example of the lack of serious effort or funding for women-centred medical advances. Also: these are US stats, and cannot speak to the same conditions around the world, which are on the large part deplorable for women - for example the maternal death rate is 340 in 100,000 births in Pakistan. (The maternal death rate for the US is not mentioned.) Nor are these stats broken down into ethnicity and region for the US, which would probably tell very different stories for the same medical conditions. The difference in the cost, effectiveness, success, and physical/emotional factors in the diagnosis, treatment, and life impact of the diseases listed for men and women is also not addressed. Though knowing where women have made advances is very important, to present these stats as advances 'against men' is hardly helpful. Better perhaps to see exactly what advances have been made (taking ethnicity, class, and region into account), when, and why, so advances in other areas can be sought. If there really is some sort of 'loss' of attention or funding to men, that should be established and examined too. Cheers, Jenea Tallentire PhD student, History University of British Columbia Canada jltallen @ interchange.ubc.ca

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Date: Thu, 12 Oct 2000 18:47:50 -0400

From: Linda Bernhard <bernhard.3 @ osu.edu>

Subject: The Sexism of Modern Medicine

James, The statistics you present are important statistics, but taken out of context, statistics can be used to make any case. I see these statistics, unfortunately, taken out of context, as a form of backlash against womenÆs health. There is much more to sexism in medicine than these statistics. However, I agree with you, that a balanced presentation should be a part of ôany rational discussion.ö Still, this approach is an example of precisely what none of us should do, i.e., argue with each other, instead of putting our efforts where they belongàin this case, with a health care system and government that responds unequally to health care for women and men. There should be enough money for health care research on both women and men; we shouldnÆt have to compete for it. Linda Bernhard ******************************************************** Linda A. Bernhard, PhD, RN Tel. 614-292-8336 Associate Professor, Nursing & Women's Studies Fax. 614-292-7976 The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210 Bernhard.3 @ osu.edu ********************************************************

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Date: Thu, 12 Oct 2000 21:15:04 -0500

From: "Margaret E. Kosal" <nerdgirl @ S.SCS.UIUC.EDU>

Subject: Re: The Sexism of Modern Medicine

evenin' Jim :) interesting piece ... & an adroit challenge that i agree is worth being addressed. i (& owned as my opinions) think that the disparities of modern medicine are much more complicated than factoids. "Any rational discussion on the alleged 'sexism' and 'anti-female' bias of modern medicine" should be looking at how modern medicine addresses, or fails to address, diseases, not a simple list of who's dying of what. *Everyone* dies. Some people die of prostate cancer; some of breast cancer. When exploring statistics on death rates, one needs to ask why: Why are these people dying of this cause, and what could be done to prevent it? Concurrently, one also needs to examine prevention and ask, If this could have been prevented, why wasn't it? That's where indications of sexism, racism or classism may appear (and others are significantly more qualified than i to address the latter three.) At 12:04 PM 10/11/00 -0700, James Steiger wrote: >Some facts on modern medicine perhaps a bit of selective facts? just maybe? in the presentation? (i think others here may be better suited than i to analyze the anti-female undertones, implications & bias of this piece of "poplular science" ... internet as disseminator of modern folk magick?) To probe some of the data & specious thinking contained therein: > $1.8 billion toward breast cancer research and $376 million > to prostate cancer " Without more specific information, this figure has little meaning - (as we discussed earlier) does this include projects that nominally mention a specific potential application to breast cancer? > According to the American Cancer Society in 1997. > The number of men that are diagnosed with prostate cancer > is about 200,000 per year. Women diagnosed with breast > cancer is 175,000 Your colleague selectively neglected to finish reporting this statistic: "In 1999, approximately 175,000 new cases of invasive breast cancer will be diagnosed among women, as will nearly 40,000 additional cases of in situ breast cancer." American Cancer Society <www.cancer.org> under "Breast Cancer Facts and Figures." Additionally, according to the American Cancer Society, "an estimated 180,400 new cases (of prostate cancer) in the US during 2000." <www.cancer.org> under Prostate Cancer Facts and Figures. So apparently (by your colleague's figures & the more recent ones available from the American Cancer Society) there has been a drop in incidence of prostate cancer but not in breast cancer (actually it rose during the 1980's but has since "levelled off".) This also contradicts your collegue's assertion w/r/t rates of prostate cancer that he referenced to Men's Health magazine (his ref #3) {Is that peer-reviewed? <g>} > and women diagnosed ovarian cancer is 25,000. According to the NIH http://ugsp.info.nih.gov/BioResearch/budget.htm , $396 million planned for 2001 budget NIH's extensive program is alloted for breast cancer research. According to CRISP (the database of projects funded by the NIH, the FDA, the Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH)) for the most recent fiscal year available (different divisions of NIH have different grant deadlines, i imagine the other agencies do also) there are 10496 funded projects w/r/t breast cancer versus 10427 w/r/t prostate cancer ... not quite the level of disparity portrayed by your colleague, eh? i can't find any source supporting your colleague's assertion of _dramatic_ monetary disparity in funding. There is some evidence to support to his assertion that breast cancer received more research dollars: according to the American Cancer Society's "Trends in Research Funding in Selected Priority Areas FY 1998-1999" breast cancer research received (from the ACS) $16,407,000 while prostate cancer research received $6,364,000; yes, research with nominal association/application to breast cancer did receive more funding, during the fiscal year 1998-99, from the ACS. i need more information to draw a rational conclusion as to the origin of this apparent disparity in funding. Another question is mortality ... what are the relative mortality rates? Is there any evidence that the treatment and detection methods w/r/t prostate cancer is *currently* more successful than those for breast cancer, thereby (perhaps subjectively ?) mitigating a higher investiture of funding at basic research level? ... .. According to American Cancer Society, the overall mortality rate for prostate cancer is 17.7% versus 20.1% for breast cancer - really not a huge difference (and an mega-oversimplification, imo) ... however "during 1992¡1996, prostate cancer mortality rates declined significantly (¡2.5% per year)" and "79% percent of all prostate cancers are discovered in the local and regional stages; the 5-year relative survival rate for patients whose tumors are diagnosed at these stages is 100%." The greater issue would seem to be getting men to get their prostate checked rather than difficulty in detection and treatment (if caught early). [Tangential aside: How about the funding disparity between AIDS and malaria? Now there's a *real* gap in research dollars and funded projects.] > Government spending: > The National Institute of Health spends 10 percent of > its budget on women's health issues and 5 percent on > men's health issues. (1) The US Census Bureau (citation #1) is the reference for the NIH budget ? What year? Which Division(s)? Why not cite the NIH budget? Congressional Record? > Cancer: > 190,000 more men are diagnosed with a cancer than women each > year. (10) Hmmm .... if the diagnosis of cancer is comparable to the gender-based (& age & race) diagnosis of heart disease (to which i believe Jenea was alluding) then your collegues first point may be suspect. >Heart attacks: >66 percent of Americans who experience heart attacks are >men. (7) >Men between the ages 29-44 have a 41 times higher chance of >having a heart attack than women. (7) >Men still have a higher chance of having heart attack than >women between the ages 45-64. That chance is three times higher >than women. Only until men and women turn 65 and older women >have about equal number of heart attacks. The >difference is a 15 percent lower rate for women. (7) The number one cause of death for American women, cardiovascular disease, claims the lives of 1 in 9 women between the ages of 45 and 64 years and nearly 10,000 women younger than age 45 years annually (yes, more men die from cardiovascular disease than women). Half of these deaths are attributed to myocardial infarction (MI), the single largest cardiovascular disease killer.(1) ... [Your colleague cites (his citation #7) the Framingham study --- thatz a huge on-going study (52 years) .... which paper? Thatz about equivalent to citing "the feminist movement of the 1970's". For the first 23 years, only men were part of the Framingham study; in 1971 their adult children and *spouses* were invited to join. The Framingham study also has demonstrated the following gender-based bias (included in my ref.#6):] .... Despite a high mortality rate, women are less likely than men to be diagnosed with an MI or to receive early or aggressive treatment for this condition.(2) Numerous epidemiologic and clinical studies have shown that the short-term prognosis for women who have an acute MI is worse than that for men.(3-10) In addition, women are significantly less likely than men to undergo coronary angiography, percutaneous transluminal coronary angiography, and coronary artery bypass surgery once admitted to the hospital with diagnoses of MI, chest pain, or ischemic heart disease,(11) yet they are more likely than men to die of these conditions.(12, 13) Very recently, it has been shown that ER nurses in triage decisions are less likely to identify women (specifically middle-aged women) as displaying acute MI symptoms.(14) What i find horrifying is the race-based disparity - for a general overview, one available document addressing aspects is _NIH Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities_, available in pdf version at http://www.nih.gov/about/hd/strategicplan.pdf Jim - i appreciate & enjoy your challenges & believe that they serve valid purposes ... and i also thoroughly enjoy observing/comparing/contrasting the approach that others take from our respective disciplines & philosophies :) blue skies, marg nerdgirl @ s.scs.uiuc.edu (references to follow subsequently due to limitations on message size)

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Date: Thu, 12 Oct 2000 21:17:33 -0500

From: "Margaret E. Kosal" <nerdgirl @ S.SCS.UIUC.EDU>

Subject: Re: The Sexism in Modern Medicine

1. American Heart Association. 1997 Heart and stroke: statistical update. Dallas (TX): American Heart Association; 1996. 2. Pittman DA, Kirkpatrick M. Women's health and the acute myocardial infarction. Nurs Outlook 1994;42:207 9. 3. Pulleti M, Sunseri L, Curione M, Erba SM, Borgia C. Acute myocardial infarction: sex-related differences in prognosis. Am Heart J 1984;108:63-66. 4. Wenger NK. Coronary disease in women. Annu Rev Med 1985;36:285-294. 5. Epstein FH. Commentary: epidemiologic studies of fatal and nonfatal coronary heart disease in women. In: Eaker ED, Packard B, Wenger NK, Clarkson TB, Tyroler HA, eds. Coronary Heart Disease in Women. New York: Haymarket Doyma, 1987:7-10. 6. Lerner D, Kannel W. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 1986;111:383-390. 7. Tofler GH, Stone PH, Muller JE, Willich SN, Davis V, Poole WK, Strauss HW, Willerson JT, Jaffe AS, Robertson T, Passamani E, Braunwald E, and the MILIS Group. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol 1987;9: 473-482. 8. Dittrich H, Gilpin E, Nicod P, Cali G, Henning H, Ross J. Acute myocardial infarction in women: influence of gender on mortality and prognostic variables. Am J Cardiol 1988;62:1-7. 9. Fiebach NH, Viscoli CM, Horovitz RI. Differences between women and men in survival after myocardial infarction: biology or methodology? JAMA 1990;263: 1092-1096. 10. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S, and Israeli SPRINT Investigators. In-hospital and 1-year mortality in 1,524 women after myocardial infarction: comparison with 4,315 men. Circulation 1991;83:484-491. 11. Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991;325:221-5. 12. Vaccarino V, Horwitz R, Meehan TP, Petrillo MK, Radford MJ, Krumholz HM. Sex differences in mortality after myocardial infarction. Arch Intern Med 1998;158:2054-62. 13. Vaccarino V, Parsons L, Every N, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. N Engl J Med 1999;341:217-25. 14. Arslanian-Engoren, Cynthia PhD, RN, CNS. Gender and age bias in triage decisions. J Emerg Nurs. 26(2):117-124, April 2000. -- Margaret E. Kosal Department of Chemistry School of Chemical Sciences University of Illinois 600 S. Mathews Ave. 38-6 Urbana IL 61801 phone: 217.333.1532 fax: 217.333.2685 email: nerdgirl @ s.scs.uiuc.edu

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Date: Thu, 12 Oct 2000 23:51:05 -0700

From: "pauline b. bart" <pbart @ UCLA.EDU>

Subject: Re: The Sexism in Modern Medicine

Addresssing the rates of mortality by sex, there is a disparity since conception. More males are conceived than females, 120 to 100 as I recall, but at birth the ratio is 106 to 100. There appears to be some biological diference in the fetus. it has nothing to do with sexism. Male mortality rates are greater than females later and throughout life . Part of it seems biological, continuing the trend when a fetus, combined with, according the the people I have read on this issue, greater male risk taking behavior-smoking, hard drinking, guns. Class of course is relevant. Both working class men and women work in more polluted environments. Sexism in gynecology textbooks was demonstrated in a paper i wrote with Diana Scully, "A Funny Thing Happenned on the Way to the Orifice: Women in Gynecology Textbooks " Amer. Jnl Sociology, 78,4, Jan, l973 and reprinted in other publications. Lennane and Lennane wrote in a medical journal (I don't have the cite) the pain in childbirth, menstrual cramps, neausea during pregnancy and colicky babies were all caused by the mother's not accepting her maternal role (the article is a critique) Many works by Barbara Seaman. I was at a medical school for 25 years (Univ Illinois) and the med students would tell me about instances orf sexism e.g. starting lectures with playboy type slides, using he generically except when speaking of "hysteria" and posting a sign asking the students if their wives had clerical skills. They could have jobs in which their hours could be adjusted to those of their husbands\ (there were many clever student responses to that). A lecture on the kidneys started "this is going to be a difficult lecture. its like rape, so relax and enjoy it". I joined with the students in protesting. While medical education has been somewhat cleaned up, sexual harassment is still a serious problem. Just a fedw years ago a Stanford female provessor of neurosurgery resigned over being sexually harassed. I could go on. Pauline b. bart A rising tide lifts all yachts. Professor Lani Guanier NWSA Meeting, 2000 pbart @ ucla.edu 310-841-2657

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Date: Fri, 13 Oct 2000 07:33:47 -0600

From: Margi Duncombe <MDuncombe @ COLORADOCOLLEGE.EDU>

Subject: Citation for Spontaneous Abortion Stats

Pauline Bart wrote: > Addresssing the rates of mortality by sex, there is a disparity since > conception. More males are conceived than females, 120 to 100 as I > recall, but at birth the ratio is 106 to 100. I share Pauline's understanding that more males are conceived, but I've been asked to document how I know this, and while I have found several reports that repeat the "fact," I have not been able to to find a citation that provides the evidence, including a discussion of the methodology that allows us to know about conceptions. If anyone has a citation for the documentation, I'd be grateful. Please post to me privately, and I'll compile a post to the list if there is interest. Thanks. Margaret Duncombe Sociology, Colorado College mduncombe @ coloradocollege.edu

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Date: Mon, 16 Oct 2000 22:46:25 -0700

From: "James H. Steiger" <steiger @ UNIXG.UBC.CA>

Subject: FW: The Sexism in Modern Medicine

Thanks to the list members for the carefully reasoned responses, both public and private, that I have received on this issue. Some general points and opinions: 1. Nobody (in their right mind) would deny gender-based perceptual bias exists within the medical profession, and that it occasionally leads to some pretty absurd or unfortunate results. 2. As Marg points out, quantifying the *exact* amounts of money spent on male-specific and female-specific medical problems is impossible, given the way scientific knowledge migrates. However, I know of no one who would deny that women get the bulk of the gender-specific funding. 3. Gender roles impact on numerous aspects of the ways doctors interact with patients. Many of these pose very interesting research questions. Coming into the inquiry with the attitude that, because an area has been dominated by men, it is necessarily sexist and anti-female *overall*, can lead one to overlook alternate facts that show that in some cases, gender roles and expectancies can work against men. For example, my original family physician in Canada was a British gent who delivered our second daughter in 1976, shortly after we arrived here. He always gave my wife (by her account) careful, considerate, and thoughtful pelvic exams at her annual physical. My annual physicals tended to be cursory. He'd listen to my heart, have a blood sample taken, and tell me I was in great shape. This doctor eventually contracted cancer and retired, at which point my wife announced that, since our daughters were now in their teens, she wished us to have a female family doctor. I agreed. One day, she announced that we had a "family appointment" with our new doctor. Surprisingly, our new young female doctor turned out to be a former honors student of mine. At my first annual physical, I (blushingly) discovered that my former male doctor had never performed a proper testicular exam during the 13 year period I saw him. (Was this due to homophobia? incompetence? shyness? Who can say.) My new family physician was much more thorough, much easier to "open up to," and much easier to discuss problems with. If my first doctor had not retired, I'd have entered my middle age years receiving inadequate treatment. He was obviously ill-at-ease examining men. Does this mean he was "anti-male"? Not necessarily, but it does illustrate an important point. 4. Men have a lower life expectancy than women. Pauline Bart points out that male fetuses and infants seem "naturally" more vulnerable than female, that part of the lower life expectancy for men relates to their vastly higher death rates in industrial accidents, wars, and stress related diseases. Bart doesn't seem at all concerned about this, and isn't demanding vast amounts of funding to "cure" this "problem" which, indeed, might well be solvable by modern medicine. Her response reflects another reality, and a curious double standard --- the lack of sensitivity of a "male-dominated" culture *and its feminist critics* to male injury. Women are fully complicit in this. For example, right now in British Columbia there is an ad that talks about the fact that, every day in B.C., someone is maimed, and that many of these involve falls, which in turn can be attributed to a failure to properly engage safety gear. The fact that more than 96% of these victims were men is never mentioned. [The ads frequently dwell on the sadness of female survivors, and never deal explicitly with the crushing physical realities of the men's injuries.] 5. There seems little room for doubt -- the medical profession really needs to improve its diagnostic protocols for detecting heart problems in women. This is, indeed, an area where the profession seems to have functioned in a suboptimal way toward women. 5. One list member, a registered nurse, corresponded with me privately about her view that some of the life-expectancy disparity is due to the unwillingness of men to take charge of their own health. This is, of course, an important issue, one that the medical profession itself neglected until recently. In Canada, for example, there are organizations with substantial funding that correspond with women to remind them to have periodic mammography exams. These mammography exams are funded by the socialized medicine system. They are free. On the other hand, there is no such program for PSA exams for men, and the exams are not funded. Moreover, there is no plan to fund them in the near future. As one (male) government official told me, "There is no money." When I suggested splitting the funding currently used for mammography, and having men and women each pay half the cost of their exams, he remarked "frankly Jim, that would be political suicide." 6. A far more interesting, and provocative aspect of the ineffectiveness of men in monitoring their own health is the perspective that gender studies could bring. Some important questions: 1. To what extent does the problem exist? 2. To what extent is the contemporary stereotypical "masculinity" related to this problem? [Many of us are aware of the stereotypical view that gay men take much better care of themselves than straight men.] 3. To what extent is the (destructive) stereotypical masculinity reinforced by female vs. male caregivers? 6. Concerning truly safe and effective birth control: this is of course a complicated issue. Having witnessed my wife's experience with early birth control pills (which wreaked havoc on her body chemistry) and an utterly barbaric IUD, I have to admit that women have born the brunt of what was, in the early days, a very "experimental" yet profitable industry. One might view what happened as a capitalization, by the medical profession, on the desperate need of many women to remain unpregnant. I think this view is slightly harsh. Many areas that seem to furnish powerful evidence of a biased viewpoint seem somewhat less biased when men are actually allowed to relate *their* experiences. Consider a thought experiment I've used in my classes. Imagine men could remain infertile by having a twisted wire implanted in the scrotum. Suppose this would produce "occasional bleeding and discomfort, with abdominal cramping," but be 99% effective in eliminating pregnancy. Would you, as a man, be interested in having this wire implanted in your scrotum? [This gets a rather negative response from undergraduate men.] After making that point, which brings smiles to the faces of my students, I go on to discuss male birth control from another perspective. Vasectomy *is* championed as a birth control solution. It was often portrayed as essentially painless. It involves tying off certain tubes on the basis of the belief that fluids would be reabsorbed. (Think about that.) Every person I know personally who have had a vasectomy had unexpectedly painful consequences (some, possibly, due to the traditional masculine tendency to ignore instructions about "taking it easy.") Two of them were laid up for several weeks. The medical profession is not always effective at policing itself, and those to whom "promising new technologies" are directed are most often at risk. [I recently sat on a plane next to a man who was blinded by a laser surgeon who was supposed to give him 20-20 vision.] While admitting that, in some senses, the medical profession has exercised control over women's bodies, one must credit the medical profession with making HUGE overall gains in caring for women's reproductive health. To argue otherwise is simply to disregard the facts. Look at where women were 100 years ago. Look at where they are now. Consider that most of the innovations were due to research by men. 6. In conclusion: My post was not an attempt to deny assertions of effects of gender roles and related perceptions on clinical outcomes in medicine. It was a call for a mature Women's Studies curriculum to consider a slight change of emphasis, moving away from victimization of women toward a deeper, more balanced view of how "gender perceptions" impinge on medical practice. There are facts out there that suggest that men, too, suffer from consequences of gender stereotypes and inequities. To simply denounce the fast-evolving medical profession as "male-dominated" and "sexist" is an oversimplification that many undergraduates see right through, especially now that men's groups are starting to disseminate counter-information. I would appreciate private mailing of any general references on the issue of sexism in modern medicine, especially from a feminist perspective. I have an interesting article by Cathy Young on this topic that I could forward in PDF form to anyone who is interested. Thanks to all, Jim Steiger James H. Steiger Department of Psychology University of British Columbia 2136 West Mall Vancouver, B.C., Canada V6T 1Z4 Voice and Fax; (604)-822-2706 EMAIL: steiger @ unixg.ubc.ca

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Date: Tue, 17 Oct 2000 11:01:37 -0400

From: Martha Charlene Ball <wsimcb @ PANTHER.GSU.EDU>

Subject: Re: FW: The Sexism in Modern Medicine

I appreciate James H. Steiger's carefully thought-out, engaged response to Marg's and others' responses to his initial posting on sexism in modern medicine. James, I think you're absolutely right when you say that men also suffer from the gender-based bias within the medical profession. The assumption prevails that men are or should be invulnerable to pain, damage, or disease. Or it's thought that they should suffer in silence. I see this as part of the overall patriarchial system. It's partly the results of assuming that women and men should be opposites. The obverse of the strong, silent man is, of course, the vulnerable, disease-prone woman. These are stereotypes, of course. But they affect all our thinking. I'm sure many of us could tell stories of how men -- fathers, husbands, brothers, sons -- have been treated in a cursory and uncaring fashion by members of the medical profession. I know I could. Ending patriarchial systems would benefit men *as humans.* It would take away their power over others, but it would restore them to their full humanity. It would enable them to be human, and to be seen as simply human, with bodies that can suffer, that have needs (in addition to the sexual) instead of being seen by themselves and other as they so often are now seen, as machines. Ending patriarchy means questioning this assumption that men are "naturally" tougher than women. It means questioning war and questioning the assumption that young men are "naturally" suited for war. Yes, we should also question why male fetuses are more vulnerable, and we should see it as a problem. Yet if there had not been a women's movement that asked questions about women, and put questions about women first, these questions that you are now answering would not have been asked, or would not have seemed so right to ask because the groundwork would not have been laid. There had to be a women's movement and women's studies before there could be gender studies, because no one was questioning the gender system until feminists did. The "political suicide" response sounds suspect to me. It sounds like an excuse. There's money somewhere for that project. It shouldn't have to come from the mammagram program. That's a model that I find suspect: that if women have something, that they have it at the expense of men, and that if men get what they (legitimately) need (like prostate exams), then it will have to be at the expense of women. I don't accept that. Your question about how female caregivers might reinforce destructive stereotypical masculinity is intriguing. If doctors give cursory exams (as your male doctor did), that seems to directly result from the "old-school" view of men as strong and invulnerable, and not really "embodied" in the way that women are seen as being. If a female doctor were to give such a cursory exam, of course that would not be right. Just being female does not guarantee that a doctor will be sensitive to gender issues. What we need is more education about women's and men's specific medical needs. You are right that many of men's vulnerabilities have been ignored or given short shrift. However, I can't say that that is the result of feminism. I stil believe that feminist thinking holds a corrective to the problem, and is not the problem itself. Also, I'd like to add that your posting is an example of the careful, reasoned, critical yet thoughtful dialogue that so many of us would like to have seen in the recent exchange with Dr. Patai, and did not. M. Charlene Ball, Administrative Coordinator Women's Studies Institute Georgia State University Atlanta, Georgia 30303-3083 404/651-4633 404/651-1398 fax wsimcb @ panther.gsu.edu http://www.gsu.edu/womenpower

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Date: Tue, 17 Oct 2000 11:10:51 -0700

From: Jenea Tallentire <jltallen @ INTERCHANGE.UBC.CA>

Subject: Re: FW: The Sexism in Modern Medicine

Dr. Steiger wrote: "Look at where women were 100 years ago. Look at where they are now. Consider that most of the innovations were due to research by men." I don't think anyone can deny that much research especially before the last 20 years has been done by men - after all, (white) men dominated the profession. But I don't think we can simplify that into a counter-balance to the systemic sexism (and racism) of medicine. The characterization of the era before the male medical professional as a time of howling ignorance is incorrect. I would argue that the knowledge-base in much of gynaecology - techniques, contraceptives - was not built by men at all. Most basic gyn. practice (with the exception of the use of iron tongs to extract infants from the womb) in the West originated with female midwives through the medieval/early modern European era and were copied and claimed by the rising male medical professional through the 18th and 19th centuries. That may seem irrelevant here, but on the Canadian frontier, midwives were the most common source for care right into the mid-20th century. Their vilification as incompetents or even deviants was carried out here in much the same manner as Europe, when male professionals moved into the area and hospitals were pushed as the only source of knowledge and safe practices. I agree that the 'clinical' studies on 'modern' pharmaceuticals, etc. have been carried out by men (where does the female lab assistant fit here?) but women of the West have had access to similar medicines for centuries. The destruction of the female-run medical system meant the loss of such technologies that midwives would not or could not share with the new male professionals (abortion and contraception were as clandestine as the birthing process itself). To classify female health care as being built up from scratch by modern (male) medicine is in reality a political agenda of those rising professionals who needed women's knowledge then denied them access to the profession. This denial of female competency is a foundation of modern medicine and resonates throughout the profession. As Dr. Ball points out, it was the agitation of the women's movement and women like Margaret Sangster who made the political climate that forced re-evaluations in women's health in general. It allowed men to take up studies into contraceptive practices and less-biased reproductive health. I think it is great that individual men took up such studies (especially those who worked with a feminist agenda), and to talk about sexism should not deny their efforts. But the sheer existence of 'sympathetic' male practitioners does not change the patriarchal nature of the system - any more than the existence of women practitioners challenges it, necessarily. I think the cases of men getting inadequate care are from the same root (as Dr. Ball notes) and so the focus we should have is on where the system is perpetuated - the medical schools, the kinds of studies that get accepted, the kinds of research questions being asked, and (most importantly?) the attitudes that are allowed to perpetuate between colleagues, profs, students. As a Women's Studies student, I do not feel that we are still caught up on a 'victim' phase. I think we are "moving away from victimization of women toward a deeper, more balanced view of how 'gender perceptions' impinge on medical practice" or any other system. I am concerned when arguments are made that a focus on women is 'not enough' or not 'balanced.' Sometimes this means we should spend our energies instead where they 'belong' - studying men. To argue there are systemic biases because of gender does not rule out the experience of men. Keeping women as the centre of our analysis informs our look at such systems and helps find ways to change them. I do not feel that we should abandon this project. The analyses we develop can be enriched with the study of men's experiences, but we do not have to move women from the centre to do so. Cheers, Jenea Tallentire PhD student, History University of British Columbia Canada jltallen @ interchange.ubc.ca

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