Friday, November 19, 2010

Encouraging News About UAE, An Alternative to Hysterectomy

Recently published research on Uterine Artery Embolization has shown that it is a good alternative to hysterectomy for women suffering heavy menstrual bleeding or pain from uterine fibroid--benign--tumors.

A 5-year follow-up study of women who agreed to be randomly picked for either a hysterectomy or Uterine Artery Embolization (UAE) showed that 7 of 10 women who underwent the organ-sparing procedure had relief of their symptoms that was good enough to have been able to avoid further surgery after five years.

This is important news because 40% of all hysterectomies--275,000 of them--are done each year because of symptoms caused by fibroids. According to best estimates, another 250,000 women a year undergo myomectomies, in which the fibroids are cut out of the uterus but the uterus is spared. Both surgeries usually involve a stay in the hospital and, depending on the technique used for the hysterectomy, recovery periods of up to six weeks. With UAE, women report returning to normal activity, including sex, within two weeks.

In addition, a UAE poses much less risk to a woman's ovaries if she is under 45. Dr. Bruce McLucas, a Los Angeles gynecologist who performed the first UAE in the United States in the early 90s, said in an interview that the incidence of ovarian failure "in my hands is 3%" in women in that age group and about 5% when done by other surgeons. McLucas recently performed his thousandth UAE. However, ovarian failure occurs in about half of all women older than 45 who undergo UAE.

About half of all women who undergo hysterectomies end up without their ovaries--often healthy ovaries-- because gynecologists continue to scare them into consenting to their removal (or yank them out even with no consent) with talk of ovarian cancer. They minimize the adverse impact on women's health that will result from the loss of their ovaries. Most gynecologists still view the low risk of developing ovarian cancer as outweighing the much greater risks of developing heart disease, osteoporosis, loss of sexual pleasure, etc. from castration (the proper word for amputation of women's sex/reproductive organs.)

 McLucas, who practices at the Ronald Reagan UCLA Medical Center and is Clinical Professor in the medical school there, is now engaged in a campaign to publicize the benefits of the procedure. He will be appearing December 1 on the TV show, The Doctors.

I've long wondered why so many women in their early 40s experience such heavy bleeding. McLucas explained that, "In the years running up to the menopause, we have a domination of estrogen in the menstrual cycle," and estrogen fuels the growth of fibroids, which are present in 40% of women over 40. Many women, however, do not experience heavy bleeding or pain from them; only 10 to 20% of women who have fibroids need treatment.

But those who do must deal with monthly hemorrhaging that can last two weeks and require frequent changing of even the most absorbent tampons. Many become anemic.

"The first major myth about fibroids is that waiting for menopause is necessarily a good option," said McLucas. He explained that because fatty tissue produces a substance that mimics estrogen, fibroids in some women will not shrink after menopause. And, if a woman is taking replacement hormones, the fibroids also tend to grow. Waiting for menopause therefore, may or may not be a good idea depending on the individual woman.

So what is UAE? It's an outpatient procedure done under local anesthetic in which a small cut is made in the upper thigh and then in the femoral artery. From there, guided by X-rays, the surgeon plugs the uterine artery with inert particles.

Starved of blood, the fibroids usually--but not always--shrivel to about half their size, calcify and cause no further problems.

But doesn't the uterus then die as well?

Fortunately, the uterus is fed blood by the ovarian artery as well, and will "resupply the uterus within an hour of surgery," according to Dr. McLucas.

He has also published research showing that among women who still wanted to have children after the procedure, about 1/3 had successful pregnancies.

I had a hysterectomy in my early 40s because of heavy menstrual bleeding, and after viewing this new research, I would have tried a UAE if it had been available to me. Maybe it would not have worked, as is the case with a friend of mine, but given the information I now have, it would have been worth a try to keep my uterus.

Even now, many years later, women who want to try this alternative will very likely need to look beyond their usual gynecologist. McLucas thinks he is the only gynecologist doing UAE in the United States. But interventional radiologists--the same doctors who insert cardiac stents--do them, and so do, oddly enough, some cardiologists.

Ideally, women should find a gynecologist who can refer them to a radiologist who will perform the procedure. After that,  the gynecologist will oversee their recovery.

Dr. McLucas predicts that within 10 years there will be at least one gynecologist in each major city who performs UAEs. Until then, women are still on their own in their efforts to keep their precious organs. A good starting place for information is the Fibroid Treatment Collective website, which features Dr. McLucas.

Tuesday, November 2, 2010

An "Essential" Guide to Hysterectomy That Isn't

The title, Women's Hysterectomy Stories:  The Essential Guide," gave me great expectations. Here, available on line for $17, was an e-book that I thought might help to enlighten women about the perils to their long-term health and sexuality from hysterectomies.

So, I sprung for the $17. And was sorry that I did.

This book, written by Ruth Steeves and promoted on her website,, is only for you if you've already made up your mind that you really need a hysterectomy. It will advise you about making arrangements in advance of your surgery for child care, and meals, and what to expect in the hospital, and once you get home.

But just like HysterSisters, which is promoting the daVinci robotic system for the surgery, this book and Steeves' website see the epidemic of hysterectomies through rose-colored glasses. The goal is to eliminate your anxiety about having a hysterectomy.  The furthest they go in bucking the medical establishment is to encourage women to get a second opinion.

HysterSisters has actually launched a "Give Me a Second" campaign whose purpose is "to strengthen the doctor-patient relationship, to improve women's quality of care through awareness of minimally invasive surgical procedures (italics mine) and to increase confidence in their healthcare decisions."

Once again, it's all about finding a doctor who will use laparoscopy or robots for a less traumatic hysterectomy. Not to avoid one altogether and survive with your organs intact.

The problem with the generic advice to get a second opinion is that too many gynecologists disregard all the evidence about the serious after-effects of hysterectomy and removal of the ovaries and won't volunteer any information about them. These are not side-effects--like an infection due to the surgery--but long-term adverse impacts on health and sexual pleasure.

Without a uterus, a woman can not experience what some refer to as a full-body orgasm in which the uterus pulses rthymically. That is not an opinion. It's an incontrovertible fact, but the gynecologist who will warn you about that is a rare individual. You also won't hear about your increased risk of future bladder and back problems, or about your much higher risk of heart attack if your ovaries are removed. There's no controversy at all about these after-effects of hysterectomy. The evidence has been reported in medical journal articles repeatedly over the last several decades.

Yet, to justify the supposed joy of hysterectomy, The Essential Guide  tells one anonymous woman's tale of painful periods ever since she had her first, and her gloriously wonderful life after hysterectomy.

Other than that one, there are only three other stories included as MP3 downloads or PDFs. One of the women had uterine cancer (an absolutely valid and unavoidable reason for a hysterectomy); another had to be on blood thinners for another condition and this had serious effects on her periods (how common is that one? and who knows what alternatives she had?); and the third said she had "passed out" every time she got her period. Again, thankfully, not a common experience. All end up as testimonials for Steeves' book.

That said, yes indeed, women should get second opinions. And third and fourth, if need be, until they find a doctor whose practice is focused on avoiding hysterectomies, not doing them. Some medical centers now have specific hysterectomy alternatives centers. Search for them. But first, arm yourself for these discussions by learning about the anatomy of our reproductive organs and the essential role they play in our health and pleasure for as long as we are alive.

To get that information, I once again recommend the HERS Foundation website where you can watch a plain vanilla explanation, with diagrams but not any sort of bloody video, of the functions of your uterus and organs. You'll be grateful for investing 10 minutes of your time to save your future health and pleasure.


Wednesday, October 27, 2010

Websites Exploit Women Worried About Hysterectomy

There they are on the home page of five attractive women, all dressed in white and smiling broadly. Why are these women so happy? They've had a hysterectomy--and obviously enjoyed it!

Yes, if you believe the claims on both Hystersisters and, having your uterus removed--and likely your ovaries as well--can not only be anxiety-free but also a happy, happy experience.

If you do believe that, as we say in New York, there's a bridge in Brooklyn we'd like to sell you.

Selling, of course, is what both these websites are about. Selling you not on the idea that most hysterectomies--as many as 90%--can and should be avoided because they are so damaging to women's health. No, not that. Instead, both websites are trying to sell you on a different type of hysterectomy, and preferably, in the case of Hystersisters, one done with the daVinci robotic system.

The convenient Find-a-Doctor feature on that website is sponsored guessed it, daVinci!

Intuitive Surgical, Inc., the company that makes the daVinci systems, is bullish on its future. The company's investor relations website reports that for the first half of 2010 revenue was up 49% from the first half of last year to $679 million.

This company's intensive public relations and advertising campaign--I've seen their press releases turned into glowing news stories by naive reporters in several newspapers--is all about getting hospitals to buy the robotic systems for a sweet $1 million to $2.3 million each.

And the revenue stream just goes on from there. Annual service agreement: between $100,000 and $180,000. Disposable instruments and accessories for each procedure: between $1,300 and $2,200.

Is it any wonder that medical costs in this country are impoverishing us?

The websites are a fabulously clever way of putting pressure on doctors and hospitals to buy the systems.

Women who've been told they need/should have a hysterectomy run to their computers for information.

And what they find at Hystersisters is designed to prompt them to ask their doctors--themselves getting pitched by Intuitive sales people--if they use the robotic systems. It's push-pull marketing at its best.

But pushing daVinci isn't the only thing wrong with these two websites, as I'll explain in my next blog in a few days.

In the meantime, any women who's considering a hysterectomy should go to the HERS Foundation website to get the cold, hard facts about the serious health problems and loss of sexuality that the surgery too often brings about.

Tuesday, October 5, 2010

Post Reporter Right to Challenge Paladino

I have to admit I got a good laugh out of the confrontation between a NY Post reporter and Carl Paladino, the Republican candidate for governor of NY State. But it was not just great entertainment. It also offered a good look at a reporter trying to do the job right.

Fred Dicker pressed Paladino for evidence to back up his charge that Andrew Cuomo is an adulterer, just like Paladino himself, who has admitted not only an affair but that he fathered a girl who is now 10. Paladino's admission, of course, was tactical. Rather than wait for someone to out him, he tried to neutralize the situation by openly discussing it. But apparently not satisfied with the public reaction, he accused Cuomo of the same sin.

Too often, reporters respond to this type of situation with what journalists refer to as "he said, she said" stories. That is they report the allegation and then the denial, making no attempt to tell the public who is right. This is what sometimes passes as "objective" reporting, when instead it should be called "stenographic" reporting--just take down what everyone says and put it into some grammatical sentences.

Fred Dicker, on the other hand, was doing what good journalists do: demanding verification of Paladino's charge. He wasn't content to just offer an assist to the mud-slinging unless Paladino showed him the evidence.

His reward was to be called "biased" and a "stalking horse" for the Cuomo campaign. Paladino sounded like a mobster when he told Dicker, "I'll take you out." But one of Paladino's aides caught on the video trying to separate Dicker from the candidate made another threat, one that usually cows journalists into being stenographers. He told Dicker, "You're off our campaign list. You get nothing more from us."

To a reporter, that's a threat with teeth. It means no access to the candidate, no easy way to get comments or advance word about upcoming appearances or policy papers. Ready access to powerful people makes a reporter important to his or her news organization. In Washington, D.C., it makes reporters powerful, virtually guaranteeing front-page or top-of-the-broadcast position.

It also can make reporters dupes for politicians' lies, tools for efforts to sell a war or advance legislation harmful to the public. As we sadly learned about the selling of the Iraq war with a heavy assist from New York Times reporter Judith Miller, a buddy of Dick Cheney.

So it was refreshing to see veteran Albany reporter Fred Dicker get in Paladino's face and demand the evidence.

I showed the video to my Media Ethics class at Hofstra University as an example of a reporter with ethics trying to do his job. Ethical reporting starts with seeking the truth, and Fred Dicker modeled that for everyone to see.

I hope Dicker's career thrives after this episode and that he gets the credit he deserves for doing the job the way it should be done. Washington reporters could well take a lesson from him.

Tuesday, September 7, 2010

In Honor of Ovarian Cancer Month: Hold On To Your Ovaries!

Shame on The New York Times for printing a one-sided article touting the benefits of female castration as a way of preventing ovarian cancer. The article reported on a study of women who had inherited the BRCA1 or BRCA2 mutations that increase the risk for breast and ovarian cancer. Of the women who kept their ovaries, 6 percent developed ovarian cancer, compared with 1 percent of those who gave permission to remove their ovaries.

Ovarian cancer is deadly serious: 15,000 women a year die from it, and the Ovarian Cancer Alliance has marked September for observance of Ovarian Cancer Awareness Month. Fear of ovarian cancer is the major reason why about 300,000 women a year permit doctors to remove their ovaries, usually at the same time as a hysterectomy. However, only a small percentage of those women have the BRCA mutations; they face a lifetime risk of only 1.39% of developing ovarian cancer (or 1 in 72), while the risk of breast cancer over her lifetime is 12.15% (or 1 in 8), according to the National Cancer Institute. So using fear of ovarian cancer to convince a woman who does not have the mutations to have a hysterectomy, is clearly unwarranted.

Now the question is, how warranted is such a recommendation for women who do have the mutation? Well, if all we were talking about was removing some non-essential or at least less-essential body part--even a breast--then trading a 5% risk for a 1% risk of a deadly cancer, for which there is no good treatment, might indeed be a sensible option.

But no woman should make that choice until she understands all that she will be sacrificing along with her ovaries, and the added health risks that accompany this drastic decision.

As I've blogged about before, losing your ovaries is literally castration and brings on not only a sudden, intense menopause, with severe hot flashes, mood swings, loss of energy, etc., but also drastically raises the odds that a women will suffer other serious problems as a result. A study published in the journal The Lancet in October, 2006, found that women castrated before the age of 45 double their risk of death from heart attack. Some previous studies put the increased risk of heart disease at 5.5 times, regardless of age at time of operation.

And then there are the increased risks for osteoporosis and bone fractures and Parkinson's disease and other forms of dementia.

As for women who have enjoyed sex--well, they can say good-bye to their former selves. Our ovaries continue to function long after menopause, still producing some estrogen and other hormones. Without them, welcome to the world of dry. Libido--gone or dramatically reduced. Ability to feel and enjoy--women can't even remember what it felt like. Impact on your relationships--depends on how understanding and tolerant is your partner.

The Ovarian Cancer National Alliance is pushing for an increase in funding for research for a test that would detect ovarian cancer at an early stage, and for a cure. Amen to that.

But the next time The New York Times or anyone else publishes an article about ovarian cancer prevention through castration, they ought to be sure to tell women about the increased risks and poor quality of life that they will be endure as a result.

Wednesday, July 28, 2010

Feeling Un-Sexy in America

The market is huge and tantalizing: in the midst of a culture drenched in sex, one in three American women say they have about as much interest in sex as Monday Night Football.

That's why the recent rejection by the Food and Drug Administration of flibanserin, the latest drug intended to boost female libido, was such a disappointment to the pharmaceutical industry intent on hitting the jackpot with a female Viagra.

Trials of the drug showed it did too little to warrant approval, and that finding, in turn, sparked the latest debate on why it's so much harder to find a sex drug for women than men. After the usual chatter about sexual desire being so much more dependent on women's emotions then men's came the theories that essentially blame women's drive for equality.

For example, after chalking up some of the apathy to a resurgence of 19th century "bourgeois propriety, " Camille Paglia, writing in a New York Times op-ed, blamed Super Moms who've turned men into "cogs in a domestic machine commanded by women." She also slapped at workplaces where women are finally enjoying some modicum of equality with men as leading to a suppression of physicality and then to boredom with each other.

The sad part of this commentary is that is is so ill informed by facts. Take a look at the recent medical literature on women's sexuality, as I have recently in researching a book on the subject, and you find the authors still quoting 1960s work by Masters & Johnson. Our culture glorifies sex but when it comes to doing actual research on the subject we're stuck in old-fashioned prudery.

The best evidence, however, points to far-different culprits than those plucked out of the air by Paglia: the 600,000 hysterectomies a year performed on women plus women's use of birth control pills and medications like Prozac.

By the time a woman in America reaches the age of 60, the chances are one in three that she will have had a hysterectomy. Afterward, it is common for women to report loss of sexual desire, less sexual activity, decreased genital sensation and difficulty achieving orgasm. This is a reality that the surgeons don't want women to know, and that hysterectomized women most often keep to themselves out of shame and fear.

Why does hysterectomy adversely affect sexuality? Part of the answer is that about 300,000 of the women who undergo hysterectomies also lose their ovaries at the same time. Perhaps half the others also suffer a loss of ovarian function as a result of damage from the surgery done to remove their uterus. That means about 450,000 women will lose ovarian function this year, and every year.

When ovaries are removed or cease functioning, that is castration. Castration is an ugly word, but when you cut out someone's reproductive/sex organs, it is the proper medical word. Shrinking from it just allows doctors to continue to recommend the removal of healthy organs as no big deal, and in fact a benefit to women, a way of reducing their chances of ovarian cancer. Not calling it castration helps conceal the fact that without her ovaries, a woman loses not only estrogen--the main concern of men because it enables vaginal lubrication--but also most of her testosterone, often called the "hormone of desire."

For men, the equivalent would be recommending routine removal of healthy testicles to prevent testicular or prostate cancer. Of course, I've never heard of a man willingly giving up healthy testicles unless he's deliberately changing gender. I once knew a man who consented to surgical castration because he had prostate cancer. Afterward, he told me how indifferent he had become to things like sexy movie scenes that before had turned him on.

Women I've interviewed who have been castrated say there is no artificial cocktail of replacement hormones that comes close to making them feel like their old selves. And believe me, they've tried to find one. Before the surgery, they had ample desire. Afterward, zip. This change had nothing to do with their emotional state, only the very drastic loss of the hormones produced by their sex organs.

When it comes to the birth control pill, the manufacturers have long been coy about the effect on women's sex lives, listing as a side effect "sexual changes." Translation: less desire. Loss of desire is also a side effect of anti-depressants including Prozac.

Now, I'm not saying that over-worked women don't have less interest in sex than women who get enough sleep, or that deeply entrenched negative attitudes toward women's sexuality don't still exist. Of course they do. And women suffering from serious depression may have a need for medication that outweighs any worry about the impact on their sex lives.

But it's certainly anti-woman to suggest, as Paglia did, that the culprit is women's desire for equality in the workplace. Or that our excellent organization skills, which make it possible for us to bring in a critical paycheck while raising children and keeping a home, should be criticized as de-masculinizing our partners.

Women are being castrated by the hundreds of thousands every year. That's a fact, and that's where the focus and the outrage should be because there are organ-sparing alternatives as much as 90 percent of the time.

Thursday, June 10, 2010

Let the Gynecologists Hear from You

I've been receiving comments from women who are outraged about the continuing epidemic of avoidable hysterectomies, and it's time the doctors took the heat directly.

The place to voice your feelings is the American College of Obstetricians and Gynecologists, ACOG for short. This is, essentially, the governing body for the doctors, and when they change their standards of practice to say that no healthy ovaries should be removed; that there are organ-conserving alternatives to the vast majority of hysterectomies; then the epidemic will stop.

That's because once the standard is changed, the doctors and hospitals become vulnerable to lawsuits they win now because they always fall back on the defense that, hey, this is the accepted way to deal with women's problems.

So, let them hear from you.

You can call them at 202-638-5577. Either voice your feelings to the person who answers the phone, or ask for the press office and see if you can get through.

You can also send email to:

Friday, June 4, 2010

Gynocologist's Professional Org Ignores Heart Attack Risk

The professional organization that sets the standards of care followed by gynecologists has just released a new patient education booklet on hysterectomy. While this new version from the American College of Obstetricians and Gynecologists is something of an improvement (I'll get to that later), it leaves out completely the most serious risk facing women who are hysterectomized and/or lose their ovaries: heart attack.

I brought that very subject up with my cardiologist recently (yes, I have heart problems), and this is what he said:

"If they're taking out their ovaries, they're giving these women heart attacks. And you can quote me." Dr. Pavel Romano, Huntington, New York.

The "they," of course, is gynecologists. It's brave of Dr. Romano to put his name on a quote like this, but he's really not going out on a limb on the science. As I blogged about recently, solid research has now established that losing your ovaries greatly increases a woman's risk of heart attack; losing your uterus alone also increases that risk, but not by as much.

So I carefully read ACOG's new patient education booklet, expecting to find mention of this risk. Remember, heart attack is the leading cause of death of American women.

And is that risk mentioned? No, it is not.

I asked the spokesperson for ACOG just who is responsible for the contents of the pamphlet, and she ascribed it to "ACOG Fellows" who base the content on the College's Practice Bulletins and Committee opinions.

I've asked to interview one or more of these Fellows, but in the meantime I've now had the pleasure of reading ACOGs "Guidelines for Women's Health Care," published in 2007. Nowhere in that very long description of how doctors should respond to women's various gynecological problems is any mention of the increased heart attack risk brought about by hysterectomy and oopherectomy.

Absent any other explanation, this seems to be a case of a medical truth that's inconvenient for business. Acknowledging the heart attack risk might force the gynos to confront their tendency to just yank out a woman's organs, and that would leave many of them unable to earn their usual fees. It takes a lot more skill than many gynecologists have, and a lot more time, for apparently no bigger reimbursement from Medicaid, for example, to remove only a woman's fibroids instead of her entire uterus. Fibroids are the most common reason for hysterctomizing a woman, and they are never a good reason for a hysterectomy, much less removal of ovaries. Apparently, learning to do the more difficulty surgery is a problem for many gynecologists, who prefer instead the quicker, more lucrative and simpler job of just cutting out entire organs.

As I said earlier, there is some new information in the pamphlet that is helpful to women deciding whether to consent to a hysterectomy. The pamphlet now admits that the menopausal symptoms caused by ovary removal "may be more intense" (oh, yeah, make that will be horrendous) than if a woman went through menopause naturally. And that there is an increased risk of bone fracture due to osteoporosis.

But most of the pamphlet is still devoted to explaining the different ways surgeons can cut out a woman's organs and the details of how a woman is prepped for surgery.

A woman reading this pamphlet would still come away with only a partial understanding of the functions of her organs and of the consequences of surgery that may very well shorten her life.

It's an outrage that complete information is still absent from this booklet, and no woman agreeing to the surgery based on it is giving truly informed consent.

Thursday, May 20, 2010

Maloney Supports Hysterectomy Study, Not Pre-Consent Video

In response to a story I wrote for womensenews, U.S. Rep. Carolyn Maloney, a Democrat from Manhattan, issued a statement today clarifying her position on a video consent requirement.

The story appeared first with a headline saying she would "mull" introducing a law, when she had said only--as the story read--that she would ask the General Accountability Office to look into the matter. The headline caused something of a stir because, as I wrote in my last blog, gruesome pre-consent videos are being used by anti-choice advocates to persuade women not to have abortions.

For that reason, some pro-choice women's groups are just reflexively rejecting the concept of a hysterectomy video.

The headline has now been corrected, and here, for the record, is the statement issued by Maloney's press aide:
Congresswoman Maloney is not contemplating introducing a bill and, in fact, in response to a question from an audience member during the forum, made clear that she is considering looking into if GAO can do a study, not legislation. Indeed, she doesn’t like the idea of Congress mandating that a particular video should be shown prior to any medical procedure. Nonetheless, in 1978 and 1993, Congressional hearings highlighted the issue of unnecessary hysterectomies, and Congress does have a role to play in investigating the reasons why so many women are being encouraged to undergo hysterectomies when less invasive alternatives are often available, particularly since they can have a negative impact on women’s health.

I think that pro-choice women's groups should stop and consider the damage done by hysterectomies and removal of ovaries before they take a position on the video.

One reason avoidable hysterectomies are still being done in the hundreds of thousands every year is because malpractice lawsuits are ineffective against them in all but the most egregious cases. It's a classic catch-22: because so many doctors do them, it's considered standard practice, and juries won't find against doctors when they plead that all they did was what so many other doctors do. So on we go. It seems to me that unless women somehow get the information they need about the health risks of these procedures, surgeons will continue to do these operations despite the evidence against them.

As Rep. Maloney rightly asked, "Where's the outrage?"

Monday, May 3, 2010

Video Consent Requirement May Be the Only Way to Stop Hysterectomy Epidemic

In this second report on the HERS conference, I want to focus on the push to require that women see an informative video before consenting to a hysterectomy.

The HERS Foundation has produced such a video and is hoping for legislative action. But even a proposal to require women to read more about the effects of the procedure before consenting, introduced this year by Indiana legislator, Bruce Borders, (seen here outside the conference room with keynote speaker, U.S. Rep. Carolyn Maloney) has prompted surprising opposition. Of course gynecologists objected, but so did the Indiana chapter of the American Civil Liberties Union.

The women who attended the conference were perplexed by this opposition. Many had told stories all day long of being victimized by doctors who not only failed to inform them about alternatives to losing their uteruses and ovaries, but lied about the benefits of the surgery. Why, the women wondered, would a civil liberties organization oppose an effort to truly empower women with enough information to make an informed decision?

After all, it's not as if it's news that too many women are losing their organs unnecessarily. This effort has been going on for decades. As I've pointed out in earlier blogs, the toll on women's sex lives and health is major, and for many, devastating. Women whose fibroids or bleeding or endometriosis could be treated without removing any of their organs get talked into a hysterectomy. Believing they have no other option, they consent to surgery to remove their uterus--which itself diminishes their sex lives and has other adverse effects--and often wake up to find that their doctor has gratuitously taken out their ovaries, too.

How can this be stopped? With about 600,000 women undergoing hysterectomies every year, what will it take to bring that number down significantly? After 28 years of counseling women, Nora Coffey, who founded HERS, believes required viewing of a video before consent may be the only way.

At the conference, Coffey said she had tried to have a conversation with a woman at the Indiana ACLU about her objections to the Indiana proposal, but had instead been on the receiving end of a loud scolding.

So, I decided to see if I could make sense of the objection, and found this explanation, written by VP, Legislation, Joan Laskowski, in the Spring, 2010 newsletter of the Indiana ACLU:

"Although civil liberty requires informed consent for medical procedures, this bill mandates ideologically inspired information that a woman must certify having read and understood, including risks, discomforts, irreversibility and resulting infertility...This simply parallels for conception the 'informed consent' requirements for abortion and compromises dignity and autonomy protected by reproductive liberty." (Bold face mine.)

Get it? What's disturbing the folks at the Indiana ACLU is the similarity of requiring women seeking abortions to view a video (or jump other hurdles) with efforts to prevent avoidable hysterectomies.

Laskowski, who did not return phone calls seeking comment, seems to be mistakenly assuming that the intent of hysterectomy information is to ensure that women stay fertile, to make sure they can still get pregnant. Note the word "conception" in her commentary.

This argument, of course, first of all ignores the reality that the only real concern most gynecologists have about cutting out a woman's organs is whether she still wants to have babies.

But the fundamental flaw in Laskowski's thinking is that she seems to have reflexively decided that because the form of these consent laws is the same for abortion and hysterectomy that both violate women's dignity and civil rights.

She fails to understand--or perhaps believe--that women are not fully informed by their doctors about the consequences of hysterectomy. This despite testimony at a hearing on the Indiana bill from women who said their doctors lead them to believe they had no choice but hysterectomy. They were coerced by misinformation, incomplete information, and fear-mongering--references to overblown risks of cancer.

It's also worth remembering that this is not the first time that women's health advocates have acted to intervene in the patient-doctor relationship on the grounds that women were not being told the whole story. In 1978, the U.S. Food and Drug Administration mandated that women be given informative information about birth control pills when they picked up prescriptions at the drug store. The FDA had tried years earlier to have doctors give women an informative handout, but the doctors had ignored the material or refused to hand it out.

In an ideal world, physicians' ethics would obligate them to provide women with complete information. But they haven't. The hysterectomy machine grinds on. Doctors and hospitals have financial incentives to keep it up--forever, unless there is a major intervention, yes, between them and their patients.

I teach ethics, with a focus on the media, but the principles for deciding if an action is ethical are the same regardless of the subject. Ethical dilemmas arise when all the means you have of dealing with a problem result in some kind of harm. In the case of the required showing of a video to a patient before consent, you are intruding on the doctor-patient relationship. You are turning an "I trust my doctor" simple decision into a more complex calculation that forces women to question their doctors.

On the other hand, there's the huge evil of avoidable hysterectomies. Since the goal is to protect women's health--not to force a woman to continue a pregnancy or to ensure she remains fertile-- you can ethically justify the intrusion of the video as less harmful than the surgery itself. The contents and tone of the video--or the text a woman must read--however, should be as inoffensive as possible.

This isn't the case with abortion consent laws. Abortion videos show gruesome pictures of actual abortions in what amounts to emotional blackmail. Oklahoma's new abortion consent law--stayed by the courts at the moment--requires women to undergo an ultrasound exam and hear a detailed description of the fetus before having an abortion.

The HERS video shows no gruesome pictures. Using drawings and a calm voice-over, the HERS video attempts to give a non-ideological picture of the functions of a woman's sex organs and their life-long importance to her health. A friend of mine who has spent decades working in the field of doctor and patient education finds some of the wording biased, so I'm sure it's possible to make it even more neutral.

If all women considering a hysterectomy had to view the video, tens of thousands every year might avoid losing their sex organs. Seems to me it's more than worth it to intrude on the doctor-patient relationship.

But if anyone has a better idea of how to stop the hysterectomy epidemic, please speak up. That includes you, Joan Laskowski.

Tuesday, April 27, 2010

The HERS Conference: Dr. Levine Delivers the Truth

The HERS conference last Saturday delivered a mountain of information in an atmosphere charged with sadness. Much of the audience was in tears listening to women tell about how they had become victims of doctors who continue to ignore the facts about avoidable hysterectomies.

In this first report on the conference, I'm focusing on Dr. Mitchell Levine, a remarkable, Boston-based gynecologist whom we would clone if we could. Here's my report:

Dr. Mitchell Levine, who teaches at the Tufts and Harvard Schools of Medicine, doesn't look much different from other tanned and fit 57-year old male doctors. But when he talks about women and their fate as victims of hysterectomy and removal of their ovaries, his tone because so respectful, even reverential, that it is unexpected, almost shocking.

"It's too sacred, it's too complex, to just take things out," he is saying as he sweeps a laser pointer over a full-color diagram of a woman's internal organs. But, he continues, taking a uterus out is so easy to do: "Clamp, clamp, clamp, clamp. Done." He demonstrates with four quick clenches of his hands.

Levine is speaking at the 28th conference of the HERS Foundation in a Manhattan hotel. He's telling the truth about the consequences of this surgery and why he believes that "at least" 90 percent of the 600,000 done each year could be avoided with other treatments, some as simple and cost-free as waiting.

It's a huge contrast to the paternalistic advice most women get: Your uterus is just a cradle. Done having children? Then you don't need it any more. But you'll still have the playpen! Wink. Wink.

And: You'll love life after your hysterectomy. No more periods!

And: If I end up taking out your ovaries, just think, no more risk of ovarian cancer!

"It's part of their training," Dr. Levine explains to me. "That these (the ovaries) are ticking time bombs. Instead, you end up shortening (a woman's) life because you've increased her risk of heart disease." Yes, that's right, a woman 40 to 44 whose ovaries are removed or which stop functioning as a result of a hysterectomy (that happens in better than one in 10 cases) faces twice the risk of heart disease as a woman with intact ovaries. This added risk more than outweighs the possibility of ovarian cancer, according to medical studies.

"Can you imagine if a man went to a doctor for a benign condition and the doctor said, 'I can fix that by cutting your nuts off?'" Levine asked with a laugh.

"He'd turn right around and walk away."

Indeed. Men would never voluntarily give up their virility, their joy in sex, to cure a non-life-threatening problem. They have no confusion about the fact that their organs are sex organs, not just baby-makers. Yet, women's organs have been labeled by the medical profession as "reproductive" instead of sexual, and the medical professions is more interested in us as baby factories than as sexual beings. So they talk us into castration for non-life-threatening fibroids and bleeding that can be managed in other ways. And we enjoy sex less as a result, some of us losing most if not all of our libido and some or most of our ability to feel sexual stimulation.

The situation has become more perilous for women as new surgical techniques make it possible to do hysterectomies on an outpatient basis.

Levine goes into detail about this. There's the traditional way, via a long abdominal incision; and then there are the newer ways, via the vagina or laparoscopically through small, abdominal incisions. For the small percentage of women who truly need their organs removed, these techniques are better, shortening recovery time from the surgery.

But regardless of how the surgery is done, there are the same consequences for women who could have avoided it. No matter how it's done, says Levine, removing the uterus "is still cutting the ligaments and the blood supply" to not just the uterus but to other organs as well.

As a result, 10 to 15 percent of women who have only their uterus removed lose the function of their ovaries anyway, apparently because of the loss of blood supply. This plunges them, whether they are 25 or 45, into an immediate and crushing menopause.

Furthermore, the ligaments that are cut are critical to the support of the bladder and bowel. When the uterus is removed, it leaves an empty space, and lacking their previous support, the other organs can sag and lean on each other. Urinary and bowel problems become much more likely.

The most common reason for hysterectomy is fibroids. But when Dr. Levine sees women with fibroids, hysterectomy is the last thing on his mind.

"For example, if a routine exam shows a fibroid, but the woman has no symptoms, I reassure her and say, 'See me in a year.'

"Or, if she's bleeding a lot but it's manageable, I just tell her to take some iron and wait" if she is near menopause. Estrogen, he explained, makes fibroids grow, and because estrogen levels drop at menopause, fibroids will then shrink.

If the bleeding is severe and menopause too far off, Dr. Levine may do surgery to remove them, leaving the uterus and ovaries intact.

Women at the conference asked what Dr. Levine would do if a woman had multiple fibroids--30 or even 50--or if some of them were very large. He answered that it didn't matter. He could still remove them, explaining that they are usually in a sort of capsule, like a hard boiled egg, and pop out when the capsule is cut.

But here's the kicker: Even though it takes longer to cut out fibroids and stitch the uterus back together than to do a hysterectomy--clamp, clamp, clamp, clamp--Dr. Levine gets paid less money to do the conserving surgery than to hollow out a woman's insides.

As U.S. Rep. Carolyn Maloney said at the conference, "Where is the outrage?"

Monday, April 19, 2010

Evidence Ignored by Doctors Removing Women's Ovaries

I have been deeply affected by the comments of women in response to my last blog about hysterectomy. Their lives have been devastated by--what should I call them? Ignorant? Arrogant? Unethical? Unprofessional? All of these?--doctors who continue to remove healthy ovaries from women in the face of evidence that they are causing irreparable harm to their patients.

Spurred by these comments, and by my need to prepare to attend the HERS Hysterectomy Conference this coming Saturday, I did some research and found a smoking gun right on the website of the American College of Obstetricians and Gynecologists. It's an August, 2005 article (scroll down the search page to the 7th article) that appeared in the journal Obstetrics & Gynecology. Apparently, it's not required reading for the practicing physicians who continue to castrate women.

Called "Ovarian Conservation at the Time of Hysterectomy for Benign Disease," it takes a comprehensive look at the risks and benefits of removing a woman's ovaries at the same time that she has a hysterectomy for non-cancerous problems like fibroids and heavy bleeding. As far as I can tell at this point, it appears to be one of the latest investigations of the issue, which, despite its importance to women, has not been the subject of much research at all.

Here are some of the conclusions:
  • At no age is there any clear benefit to women from removal of the ovaries (oophorectomy).
  • "For women younger than 65 at the time of surgery, oophorectomy increases the risk of dying from coronary heart disease."
  • Evidence from the Nurses' Health Study says that the risk of heart attack was doubled if the women in question were between 40 and 44 years old; and up 40% if the women were older than 50.
  • After losing their ovaries, women have higher bad cholesterol levels, higher blood pressure and more hardening of the arteries.
  • Women who were past menopause when they had an oophorectomy ended up with 54% more bone fractures due to osteporosis than women with intact ovaries.
  • The fractures often were of the hip, and having a hip fracture between ages 60 and 64 meant dying early--a loss of 11 years of life!
  • It also means that many of those women could never leave their homes again on their own. One study found that before breaking a hip, 28 percent of the women were housebound; after the fracture, 46 percent were housebound.
So why do doctors continue to castrate women?

I certainly have no satisfactory answer to that.

But some, apparently, believe that the overriding benefit is to reduce a woman's chance of getting ovarian cancer. But this study notes that removal of the uterus alone lowers the risk of ovarian cancer by 40% below the level of women who retain their uterus.

So, let's see: since men have a risk of testicular cancer, should doctors be removing their testicles just in case? Or treating them with female hormones to reduce the risk of prostate cancer?

We women know that would never happen. Men prize their virility and do everything to keep it. Women prize their sexuality, too, but consent to hysterectomy and oopherectomy too often without realizing what they will be giving up. Thus the need for the HERS Foundation video and consent only after seeing it.

So, is it ignorance of the facts that keeps doctors castrating women? Or what? Theories--and certainly facts--welcome.

Tuesday, April 13, 2010

Tell the Truth About Hysterectomy!

Do women really get the whole truth about hysterectomy before consenting to this all-too common procedure? I know I didn't.

Nora Coffey, head of the HERS foundation, has been convinced for years that women do not realize that they will certainly lose some sexual feeling; will likely have problems with their bladders and bowels; that they may suffer back pain and see their waists enlarge as their internal organs and bones shift in place because where their uterus used to be is now an empty space. In the years since I underwent a hysterectomy in my mid-40s, I have suffered all of these symptoms, and my doctor never mentioned a single one. (It was a woman, by the way.)

On Friday, April 24, the foundation will hold its 28th Hysterectomy Conference at the Hilton New York Hotel in Manhattan to focus attention on an effort to require that women learn about all the possible consequences of hysterectomy before consenting to the procedure. The conference will feature an Indiana state legislator who is the first to introduce legislation requiring such disclosure.

And, the keynote address will be given by U.S. Congresswoman Carolyn Maloney of New York who will reportedly raise the issue of unnecessary hysterectomies in the House-Senate Joint Economic Committee, which she chairs. Experts estimate the cost of unnecessary hysterectomies at $17 billion a year.

I'll be covering the meeting for womensenews, a non-profit that specializes in news of particular interest to women.

But in this case, I certainly think that men would like to know about a medical procedure that will most definitely affect their sex lives along with their female partners!

The HERS foundation is advocating that women be required to view an 11-minute video it produced before consenting to hystserectomy. The video shows in a very matter-of-fact manner, using only color diagrams and voice-over-text, the story of female anatomy that somehow got left out of all our high school health classes.

"Women who watch that get it: they understand this is very serious surgery," says Coffey, who believes requiring the video is the only way to bring down the number of women who lose their uterus every year. As I've blogged about before, an astounding one out of every three American women have had surgery to remove their uterus by the time they are 60, and of those, 75% also lose their ovaries, the equivalent of male castration.

There is precedent for requiring the showing of videos: Utah, for example, requires women who are seeking an abortion to see one. Drug companies are required to put informative inserts into packages of medication, for example in birth control pills, thanks to the historic efforts of women's advocates including Barbara Seaman.

Losing your uterus is not like losing a tooth. Lose a tooth, and you can still chew with the others or get a false one to take its place. Each woman get's only one uterus, and it's so much an integral part of our bodies that you don't even realize you'll miss it until it's gone. And then, it's too late.

Monday, March 15, 2010

Use Your Elected Officials to Cut Through the Bureaucracy

Friends of mine recently told me they were having problems getting to talk to an actual person at Social Security and Medicare. Both programs have so many complicated aspects to them that you need an advanced degree to just figure out your choices. I really don't know how people with limited literacy manage at all.

In any event, I advised my friends to contact their member of Congress if the problems continued.

Sure enough, I got an email from them saying, "Thank you, thank you!"

I was gratified, but not surprised that the strategy had worked to equalize their relationship with the agency in question. Using your elected officials to get help with consumer problems that involve government programs and bureaucrats is almost a sure-fire way to move your problem to the top of the pile. Politicians rely on serving their constituents to build good will that will get them re-elected. At all levels, local to national, they employ staff members whose main job is to provide assistance to people who live in their district.

So, for example, at the state level you might be having trouble with an insurance company. Insurance companies are regulated by the states, so you should contact your state representatives. Maybe your local roads are in bad shape, or you see a really dangerous hazard. Just determine if it's a state, county or town road, and call the appropriate politician.

This works a lot better than contacting the bureaucrat at a highway department who will likely just throw your complaint into the pile. When such a person gets a call from a state elected official or a town council member, their attitude changes; suddenly your problem rises to the top.

But if you're not sure if your problem is related to the federal government, state, or some locality, don't let that stop you. Contact any of your elected politicians, and if the problem isn't in their jurisdiction, they'll refer you to the correct one.

Most of us constantly complain about how much we pay in taxes. Well, this is one sure-fire way to get some bang for your buck and equalize your power. Use your elected officials. Trust me, they're happy to hear from you.

Friday, February 19, 2010

Free To Buy Ineffective, Dangerous Supplements

As they did back in the 90s, the manufacturers of dietary supplements are revving up to protect their multi-billion dollar market from regulation, and they're getting help from liberals and libertarians who seem blind to how they are being manipulated.

It's sad. Clinging to the idea that government regulation is bad, bad, bad, champions of freedom are actually arguing that the public should continue to have the right to waste money on ineffective and possibly dangerous dietary supplements. In a response to my inquiry, the folks behind The Pen--who didn't bother to sign their names--actually equated Americans' right to privacy from government spying on our phone calls, etc., with the freedom to buy dietary supplements that have never been tested for effectiveness or safety.

Hello? Can't you tell when you're being used? Why should for-profit manufacturers be free to put anything on the market without first testing it for safety and effectiveness? Why should we trust these manufacturers any more than we trust auto manufacturers, or for that matter, drug manufacturers? Why do you trust them, you unnamed folks at The Pen? Because you believe, in the absence of any reliable reporting system, that no one died from using a supplement in 2008? (That is their primary argument.) Manufacturers right now aren't even required to register their existence, provide information on exactly what is in their products, or adhere to specific formulations for products so buyers can be sure about what's in those pills.

As I pointed out in my last blog, just because something is natural doesn't mean it's safe. Dr. Sidney Wolfe of the Health Research Group, offers the example of St. John's Wort. This plant, he says is pharmacologically active, just like a drug, and interacts with hundreds of other substances.

Under the 1994 legislation that unleashed the supplement industry from almost all regulation, the FDA has such weak authority that it has been able to ban only one supplement--ephedra--and instead has issued only warnings about comfrey and kava kava, both associated with liver toxicity, for example.

Sen. John McCain, ironically, is being vilified for proposing a bill that would only slightly improve regulation of supplements. This is all part of the right-wing effort to whip up opposition to someone who is not considered conservative enough. Read it yourself. You'll see there's nothing there to warrant the conclusion that anyone's trying to take away your vitamins.

Dr. Wolfe calls the proposal "a step forward" but adds that "80% of what's wrong with supplement regulation will still be wrong even if this bill passes."

What's wrong is that manufacturers, under this bill, would only have to prove the safety of new ingredients. All the ones already out there get "grandfathered" in. And, they need not prove effectiveness. As long as they don't make an actual claim of curing disease--which would then tip the product into the category of a drug--they can just imply it, saying things like "promotes prostate health" or "supports cardiovascular health."

So folks worried about their prostate or heart spend hundreds and thousands of dollars a year on these products, with no proof at all that they'll make any difference at all to their health.

We're babes in the woods when we approach the crowded shelves of supplements. We need help to figure out how to wisely spend our hard-earned money. Sure, the FDA has proven itself susceptible to political and corporate pressure. But let's focus on improving their performance instead of inflaming people with the false notion that someone is trying to take away their vitamins.

Shame on anyone who promotes that point of view.

Wednesday, February 17, 2010

Liberal Group "The Pen" Wrong on Supplement Bill

I'm on the mailing list for the liberal-leaning organization, The Pen, which also uses the name "The Peace Team" on a web page devoted to causes like impeaching George Bush. I usually find I agree with their stance, so I was quite surprised to see their attack on legislation that would require proof of safety before manufacturers could add a new ingredient to a dietary supplement.

The Pen's email starts with this alarmist and outrageous subject line: Big Pharma Is Trying To Kill Us By Trying To Outlaw Natural Food Supplements.

The message then opens with this far-fetched comparison: "It wasn't enough for Congress to kill off the public option. Now they want to kill us directly by trying to outlaw nutritious food supplements."

Wow. First blame Big Pharma, and then link the failure to legislate a public health insurance option with outlawing DANGEROUS food supplements.

Because that's what the bill would do: first, by requiring supplement manufacturers to have evidence that a new dietary ingredient "will reasonably be expected to be safe," and second, by giving the FDA power to recall supplements that "would cause serious, adverse health consequences or death."

The people behind The Pen seem to have forgotten about ephedra. That's the supplement that was a real favorite of athletes. In 2004, the RAND Corporation's Southern California Evidence-Based Practice Center reviewed 16,000 reports of adverse reactions to ephedra. It blamed the supplement for 2 deaths, 4 heart attacks, 9 strokes, 1 seizure and 5 cases of adverse psychiatric episodes.

Don't trust RAND? How about the Public Citizen Health Research Group, which is hated by Big Pharma, Big Insurance and corporate America in general. Director Sidney Wolfe, M.D. says 155 people died from using ephedra, and he castigated the FDA for not acting sooner to ban sales of the substance.

Remember, just because something is "natural" doesn't mean it's safe. The active ingredient in ephedra is ephedrine, which when chemically synthesized is regulated as a drug--and therefore can't be sold unless it is safe and effective for the specified use.

I emailed The Pen to find out if they had any facts to back up their accusations about this legislation. Let's see if they respond.

Right now, everyone should be supporting this proposal, even if one of the two main sponsors is Senator John McCain. Nobody's wrong all the time! And liberals aren't necessarily right--not if they ignore the facts!

Tuesday, January 19, 2010

We Need a Consumer Finance Protection Agency!

So far, we've seen precious little reform of the financial system which enriched the big shot bankers and brought the rest of us to our knees.

One piece of reform that we desperately need--and which the bankers are lobbying mightily against--is a new Consumer Finance Protection Agency.

Unless legislation creating this agency or something similar is passed, regulation of the various players in the finance industry will continue to be split among six different agencies. And, unless you do some research to figure out which one applies to the banking institution that's behind your credit card or your mortgage, you can't tell which one has jurisdiction.

This, of course, makes it really hard for consumers to even make a complaint, much less get any help with it, as I wrote here a while back.

So now's the time to weigh in on this issue, and the easiest way is to sign the petition being circulated by The Campaign for America's Future.

You might also call your Senator in Washington (202 224-3121 is the Capitol Switchboard).

Now's not the time to feel fatigued about fighting the mighty lobbyists. We can prevail if we keep up the pressure.

Tuesday, January 5, 2010

Ammoniated Fat Now Standard Ingredient in McDonald's, Burger King

I've been recovering from shoulder surgery for the past few weeks, so I couldn't react immediately to the latest revelation about the trash that now gets added to hamburgers without any notice to the public.

The New York Times reported a few days ago that fat trimmings from the outer surfaces of beef carcasses are now getting mixed into McDonald's and Burger King burgers as well as the frozen prepared patties sold in supermarkets, and, best of all, to our children as part of the school lunch program. These trimming used to be considered unfit for human consumption because they are so contaminated with bacteria. They used to go only into dog food and cooking oil.

But by treating this garbage with ammonia, an enterprising company was able to kill the bacteria and then got approval from the U.S. Department of Agriculture to sell it to burger makers who are permitted to mix it into the patties--without any labeling! The incentive, of course, was money. The huge agribusinesses that produce pre-made patties save 3 cents a pound by mixing it in.

The news stories that followed the Times's expose focused only on whether the ammonia process is really effective in killing the bacteria. Apparently, the process doesn't work as well as initially expected because the lovely taste of ammonia was detectable. So the manufacturer seems to have cut back on the ammonia.

But this begs the more important question: is junk like this fit for human consumption? When do we decide that the magic of food processing has gone too far? Shouldn't use of such trash at least have to be revealed on the label?

When are we going to stop letting agribusinesses put whatever they want in our food supply so they can increase their profits and put producers of wholesome food at a disadvantage?