Science


As we all know, recent recommendations about mammograms and Pap smears have caused some confusion among both women and doctors. I can understand at a time when we’re discussing cutting costs in healthcare and setting up death panels to kill old people, guidelines to reduce screenings can cause suspicion. Nonetheless, I was surprised that the discussions on my favorite blog (yes, even more than my own!) Feministing generally perpetuated that suspicion/outrage. I expected that feminists would be more skeptical of American healthcare and skeptical of the original mammograms guidelines to be so struck by the changes.

You can read more about the science behind the new guidelines here, and I’m sure in many other blogs. The whole point of revising the once-a-year mammogram rule is that it leads to a lot of over-treatment. Of course, screening too little would be under-treatment. Evidence based guidelines are always trying to find the happy medium, and yearly mammograms are not that happy medium. One author I read complained that the new guideline was not based on new studies, but faults of older studies that lead to the yearly mammogram rule. But if the yearly mammogram rule was based on flawed studies, isn’t that enough reason to question the guideline, especially when it leads to over treatment? A poster on Feministing had asked “how could reduced screening ever be a good thing?” Well, you have to consider the invasiveness and cost of the screening. X-ray imaging, which has more risks, and MRIs which are expensive, are done less often. On the other hand, self breast exams can and should be done more often. I wish the authors of the guideline had done a better job of explaining the reasoning. Instead of highlighting that yearly mammograms lead to unnecessary anxiety, which understandably made women mad, they should’ve made it more clear that previous guidelines were not based on the best evidence, and the risks of over treatment are greater than the benefits of frequent invasive screening. They should’ve also emphasized the importance of breast exams, by self and doctor. It would be useful to know other countries’ policies on this too.

I expected feminists to think about the above reasoning intuitively, given the context of women and healthcare. So I was surprised to see the notion that a right was being taken away, rather than questioning whether yearly mammograms were the best thing to do in the first place. Are we so naive to believe that existing healthcare practices on women’s issues are always in the best interests of women? Haven’t we discussed before that sometimes profit motives of pharmaceutical and biotech companies can interfere with evidence based medicine, and over-pathologize certain issues like PMS and reduced interest in sex, to create a market for drugs? And who can forget “designer vaginas?” Feminist theorists have pointed out that because we have historically considered the male body as the norm, many female bodily processes have seemed inherently pathological. While access to birth control is definitely a positive thing for women, some feminists have also noted the sexism in the drive to regulating women’s fertility with drugs and devices, as opposed to researching birth control on men. For social reasons, women’s bodies are more tampered with on the aspects where women are different from men. In America especially, where healthcare practices are heavily influenced by profit and inequality of access, we tend to have widespread use of technological and pharmacological interventions on women’s bodies, from interventions during labor, C-sections, hysterectomies, pills for PMS, PMDD, etc, etc. It’s not that such high use of gadgetry is unsafe, but it’s not based on scientific recommendations or medical indications either. In countries with more socialized healthcare, cost-effectiveness is always an issue, so the necessity of pills and surgeries are under more scrutiny. I’m not saying that previous mammogram guidelines were based on biotech companies wanting to make more money. I’m saying that given the context of American healthcare, guidelines for less use of gadgets is likely to be a good thing, as the norm for us is usually overuse and waste. Has our widespread use of invasive medical procedures led to much better outcomes for American women? Not really.

I realize that the mammogram issue is different for two reasons, 1) it’s not really in the realm of reproductive health where inequality is clearer, and 2) it’s because of feminist activism that breast cancer awareness and prevention has become such important issues in the first place. Once upon a time, breast cancer research was actually being done on men (!), who comprise a small minority of breast cancer patients. It has been a huge success of feminist activists to shed light on a disease that affected and killed women (for the most part). Breast cancer awareness, screening, and treatment have saved many women’s lives.

But as feminist activism changes society, feminists have to deal with new issues of a new society. Nowadays, breast cancer awareness is so commercialized that merchandise is ubiquitous. Community posts on Feministing have pointed out the sexism in using breast cancer campaign slogans like “Save the Tatas.” It seems now that feminists have legitimized the threat of breast cancer, the interest in the issue is becoming a little sensational. After all, it is about boobies, not non-sexual things like cardiovascular diseases (which kills more women than breast cancer) or colon cancer. So I think we feminists need to take a step back from the notion that fewer mammograms mean that the scientists don’t care about women dying from breast cancer. It just means that as far as we know, fewer mammograms will reduce over-treatment yet not reduce survival rates. This is also an opportunity to think about how breast cancer isn’t women’s only health issue. Let’s start focusing some effort on cardiovascular health, which is also an area where we need more women-specific research.

This was originally a reply I wrote to a post on Feministing.com. It became so long and elaborate that I re-wrote it as a post.

I think feminism and veganism in America are so closely associated with each other because of the extreme cultural significance of meat here. As Carol Adams showed in The Pornography of Meat, advertizing of meat is so sexist and so vile, as are advertisements using women, that it’s impossible for feminists not to see the connection. I don’t think it’s the same in many other cultures, and certainly not this extreme.

Many Hindus are vegetarian (not my family) and traditional Hindus are strict about widows being vegetarian, since they’re supposed to give up all pleasures of life. Growing up in that culture, it was kinda feministic for me to rebel against vegetarianism. I’ve realized later that this is not the way to be radical, as I was basically following a patriarchal model of appearing dominant by oppressing another group of beings. Now I usually never eat meat, milk or fish, or eggs, though I still remember the taste and give in at rare times. I have a lot of respect for feminists who maintain their veganism strictly.

I don’t think it’s universally wrong to consume meat, because in many parts of the world, vegetation is scarce, so people have a meat based diet. Meat consumption also makes sense for some climates and some nutritional reasons, when vegetables aren’t adequate. I think humans have always been a part of the food chain so it’s not “unnatural” to eat meat either. Besides, just as animals have lives, plants have lives and creating a hierarchy between organisms with sensation and organisms without apparent sensation (plants) is just as arbitrary as the hierarchy between humans and animals.

However, what’s wrong is the amount of meat we consume, and many people’s attitudes about meat consumption. Western countries, and countries that are westernizing fast are consuming wayyy too much meat and it shows in our health. Meat is not easy to digest and any food that stresses our digestive system out raises the level of inflammation in our body. If we have meat once in a while, the damage can be repaired, but if we have it so often then the damage can lead to inflammatory diseases, which can predispose someone to everything from arthritis to heart disease to cancer. The concept of factory farming of animals is also wrong to me. Meat is not supposed to be cheap, because we aren’t supposed it eat it as often! Factories grow animals under filthy, high stress environments, then give them antibiotics to promote rapid growth. This not only damages the meat but increases the number of antibiotic resistant microbes in the environment. Then there’s the obvious torture of animals in factory farming (fois gras anyone?), and who knows how it harms the health and psyche of the low-wage factory workers. As for hunting for animals for food, it isn’t wrong to me, but for sports it is.

So I support and admire vegan feminists in this context. Giving up animal products is a strong and effective political statement. There’s no way to defend consumption of factory farmed animal products for feminists who are informed about the issue.

Animal research is another thing I’m conflicted about. For sure it’s unethical from an egalitarian view. We haven’t used results from Nazi experiments on Jews because they were unethical, so it is wrong to not apply the same standard to animals, who in my view are equal to humans. Any experiment that deliberately causes pain is absolutely wrong. However, being a medical student, I can see how much knowledge has been obtained from animal experiments that don’t cause “direct” pain. Ultimately though it doesn’t really matter whether the experiment causes pain or not, because the concept of using an animal for our benefit is unethical. Switching to strictly human based clinical trials or observational studies should provide different, but equally important knowledge. I basically think there are many things we already do know about human medicine, if only Westernized scientists would try to understand other medical systems. I don’t mean in a randomized clinical trial way, that proves whether something is a placebo effect or not; that is evaluating other systems only from a Western medical view. I mean traditional Western medicine has to see other systems completely, and understand that a lot more factors are required in those systems. Substitution of an herb in place of a synthetic drug without making dietary or lifestyle changes is not so-called “alternative” medicine.

Where I disagree with most traditional vegans is the way they defend the ethics of not eating meat. Many vegans tend to think that meat eating is inherently wrong because we are hurting a being, and that is the end of that. I heard from one person that this was an “Utilitarian” argument, which I can understand. But being utilitarian is not being absolutely ethical. We judge the morality of an action by the amount of suffering we PERCEIVE. So let’s say we don’t understand how much suffering a group of people – poor/minority/women – go through, then we won’t see anything wrong with oppressing them. Or let’s say that a person isn’t outwardly expressing suffering, would we be able to judge their action properly and react appropriately?

What I’m saying is that the difference between the suffering of plants and animals is a matter of our perception. Of course there seems to be multiple differences, but it doesn’t mean that we won’t discover later that plants have other ways of showing “suffering.” Besides, if suffering is the main issue, is it okay to anesthetize an animal and then kill and eat it? There are a small number of people who are FRUITARIANS – they eat only fruits that don’t kill the plant while extracting, so no potatoes, cabbage, greens, wheat, etc. Are they at a moral higher ground than vegans? They might even be damaging their own health for the cause of not killing life.

I think this difference between sentient/non-sentient life forms is a weak theory to defend vegetarianism/veganism. For me a much stronger argument is environmental preservation, and health reasons. Environmental preservation includes includes eating very little meat and fish, and not growing mono-crops to make processed food that deplete the soil of nutrients. It also supports local foods, as growing genetecially engineered foods in unnatural habitats, or transporting vegetables from far away is very environmentally degrading. One person commented on this that should we stop sending food to poor countries because it’s environmentally harmful? Well, first of all, many of those countries are now in need of food because of our very agricultural practices. And many of those countries are suffering because of the pollution from industrialized countries causing global warming. The purpose of supporting local foods, vegetables and meat, is to reduce this pollution and make communities self-sustainable, so they’ll need less food aid. Heck, if Americans just ate healthy portions then we wouldn’t spend so much energy making huge amounts of low-grade food that we waste. It’s all about reducing our carbon foot print.

This brings me to another comment someone brought up – if people have all the necessary vegetarian foods, then is it wrong for them to consume meat? Not if those vegetables aren’t locally grown, so it harms the environment in transportation, but the meat is local. If the deer population in your area is high, and you can hunt a deer to feed your family for days, why would you buy more non-local fruits and veggies instead? You may be supporting evil Monsanto by doing that. Now of course in reality many of us don’t plan our diets so ethically and then we are in the wrong. I’m guilty of that too.

So again, I believe eating meat is not inherently wrong. Herbivores eat plats, carnivores eat meat, and omnivores have evolved to eat both. In some cases it may even be more wrong to eat highly processed vegetarian foods that damage the environment. eating meat is only wrong in certain contexts, like the current industrialization of meat. I admire people who’ve made the conscious decision to harm the environment less, and not take part in animal torture, but I see no basis for saying all meat eating is wrong.

This is not an argument against vegetarianism/veganism though. Along the same lines of evolution, humans have evolved to have a conscience, so we can make decisions that are above and beyond our survival. Hence, it’s wrong to eat animals in certain contexts, especially if we have other food options for adequate survival.

Thunder is Not yet Rain is an African proverb. Not yet Rain is a documentary about unsafe abortions, focusing on the situation in Ethiopia and how a more progressive law in 2006 has improved the condition somewhat.

 

Last Weekend I went to an American Medical Women’s Association conference. It was a meaningful experience. I presented a poster from my undergraduate thesis called “Childbirth and the Internal Colonization of Women’s Bodies.” I don’t know if anyone has tried to present an analytical 100-page thesis on a poster, but I found it tricky. Nonetheless the poster wasn’t half bad and I actually won second place! Basically my thesis is that misinformation/lack of information/biased information from medical authorities and popular culture construct American women’s childbirth choices as unhealthy ones.

“While medical authorities today do not force interventions on unwilling women, incomplete advice from them convinces women that obstetric interventions are required, even desirable. Such is “internal colonization,” where the oppressed perpetuate viewpoints of the oppressor even in absence of visible coercion.”

Of course if you don’t think there’s anything wrong with American maternity care, then the thesis won’t make sense to you. But the evidence is out there. America spends the most per women on maternal health, yet is 33rd in maternal mortality stats. All industrialized countries with better maternal and infant health employ midwives as birth attendants for the majority of births (except Canada). The small fraction of high risk births are attended by obstetricians. Rates of all intervention use (Pitocin inductions, epidurals, electronic fetal monitoring, episiotomies, C-sections) are very high in America yet the outcomes are worse than other industrialized countries. American maternity care is highly technologized, but it is not evidence-based-medicine. Some people, hearing my critique, point out that C-sections do save some lives and obstetricians are needed. Well DUH. I’m talking about excessive interventions, not medically necessary ones. Once labor has been induced by Pitocin, or once an epidural is given, the normal process of labor becomes pathological, so further interventions are needed when there was no need for any to begin with. Some people also equate the critique of American maternity care with the fear and ignorance of science, but they’re generally ignorant of better maternity care systems. Overuse of interventions is anything but scientific. For women with normal physiology, natural birth is the healthiest and therefore the most medical. Women have the right to choose unhealthy interventions, just like some women choose plastic surgery, but it’s also their right to be fully informed about the risks. 

So it was disappointing to me to hear the keynote speaker at the AMWA conference, Joia Mukherjee, perpetuate the ignorance of what good maternity care is. Dr. Mukherjee has done and continues to do good public health work in poor countries. Needless to say, I agree with her desire to share the healthcare privileges we have in America with the rest of the world. That’s probably why her narrow, non-scientific beliefs about maternity care were even more disappointing. Much of her speech revolved around how the high maternal mortality in developing countries is unjust and how access to C-sections would solve all that. Of course I know that many women in third world countries die from childbirth from lack of medical care – I’m from a third world country. I know how women’s opinions and their health concerns are ignored, and how patriarchal families often don’t value a woman’s life enough to invest in medical care. But C-sections alone are not the mark of good maternity care. Dr. Mukherjee commented to me that she isn’t concerned with the high rate of C-sections in the US because mothers aren’t dying from unnecessary C-sections. That’s not true. Maybe 500 mothers aren’t dying, but at least 5 are from unnecessary major abdominal surgery. As I wrote before, all developed countries have lower maternal mortality rates than America. In the US, poor communities have very high rates of interventions and C-sections, while wealthier women can assert their “birth plans,” or choose their birth place and attendant without insurance help. So C-sections are no more the sign of privilege in America, though good maternity care is. Dr. Mukherjee failed to make the connection between poor American mothers and poor Haitian mothers. Both groups are deprived of the rights over their bodies. Haitian mothers aren’t considered worthy of emergency surgeries, and American mothers aren’t considered worthy of human monitoring and social support during labor, which are much better forms of care than epidurals and C-sections. If C-sections were the mark for good maternity care, marginalized women wouldn’t have had the highest rates of use.

The WHO estimates that C-section rates between 10-15% indicates good maternity healthcare. It is unjust that many third world women don’t have access to safe and timely C-sections. But anyone whose work focuses on getting enough medical care to third world women should do it with the knowledge of the experiences of American women. Otherwise their stance becomes pro-cesarean and not pro-evidence-based-medicine.It indicates the ignorance of thinking American healthcare is the best healthcare, and promotes the least cost-effective and most inefficient model of maternity care in developing countries. That’s an imperialistic, patriarchal attitude, not a global feminist one. It’s all the more alarming to know how many women in Bangladesh are getting C-sections for no clear medical reasons, but because “that’s what doctors do nowadays.” People are aware of some doctors’ financial motives but they have the false belief that C-sections are best for the baby. (Even if that were true, this is yet another example of patriarchy valuing progeny over women).

Dr. Mukherjee also said that forty years of investing in skilled birth attendants in developed countries has not improved maternity health at all; that she has done “the whole holding hands and singing thing” but that hasn’t made a difference. That comment I find ignorant and offensive. Maternal mortality is high not just because  women aren’t birthing in hospitals, but also because of the malnourishment and early marriage that many third world women still face. Women need GOOD medical care, i.e. skilled midwives, prenatal care, continuous human monitoring during labor, social support, and adequate surgical referral for complicated labors. Talking only about surgery is tunnel vision. The problem to me isn’t just one of giving third world women C-sections, the problem is giving them full human rights. Women often don’t have autonomy of their sexual and reproductive health, both in developing countries and in America. Feminists who don’t make this connection are perpetuating harmful attitudes and practices, even if they think they’re helping. -vidyarthi

pictures are from thebusinessofbeingborn.com. go watch the wonderful documentary! also check out this well written critique.

a post in another feminist blog on women and engineering prompted me to write this reply, and i wanted to add it to my blog as well. i’ve written about sexism in math and science before, but i want to write again, articulating some points differently. this is a passionate issue to me because i know what a difference cultural factors like positive reinforcement, and available opportunities make for women’s careers. some people, including women, have told me there’s nothing wrong with saying perhaps there’s something “innate” about women’s brains that makes them less apt for science. i don’t see scientific basis for that at all.

1) women are underrepresented in almost all good jobs in the public sphere because of historical oppression. women weren’t considered good writers or painters and they’re even underrepresented in professional cooking! i remember someone posted a letter from Disney to his grandmother on Feministing that told her that Disney doesn’t accept female cartoonists – they’re only for secretarial jobs. the lack of women in science has to do with women being confined to the private sphere in all areas of life (except for sex work and cleaning). interestingly, sexists who think women being underrepresented in the sciences is/could be a result of innate differences don’t think that women are over-represented in prostitution because women are innately sex-crazy. they think men are sex-crazy. there was a time when women were considered deficient in typing – oh wait, why then are women secretaries?

2) some studies argue that women are less “spatially” oriented and therefore deficient in math. firstly, even studies done on children have to take into account how culture shapes the brain, let alone studies on adults, whose mental abilities are shaped by they way they have used their brains throughout life. secondly, so what it women are less “spatial?” only some areas of science require spatial understanding and it’s something you can learn. i’ve always gotten A’s in geometry and physics and i can’t play spatial sports to save my life!

3) standards for achievement have been set by men. the scientific process has been defined by men. have you ever heard people complaining about doing poorly in standardized tests even though they do well in class? have you heard of people complaining that they get confused by the way standardized tests frames questions? i have. and it’s because such tests follow a certain system, and to do well you have to understand and work the system, regardless of your level of intelligence/knowledge. similarly,  even if women’s brains were innately different from men’s, women are only challenged in a scientific culture defined by men. which means there’s an even bigger need for women to change the systems for themselves. the fault is not in women’s brains, the fault is in the system.

with all these cultural factors at every step of the analysis, is it anything but sexist to keep on saying perhaps there’s something innately deficient about women’s brains? – vidyarthi