Jun 232013
 

As some of you know, to combat paragraph writing fatigue that comes from relentless blog and essay writing, I’ve been working with poetry for the last few months.  The following is something I wrote in January, prompted by one of the many anti-abortion measures that have been introduced in state legislatures and Congress over the last few years.  After last week’s House vote on the 20 week abortion ban, it occurred to me to share it here.  For all the women everywhere who have faced this decision, especially those who have had to do so in the face of restrictive laws and customs.

An Abortion

An Abortion
Because
The condom broke
We forgot
I was raped
I am too young
I am not ready

Because it is my body

And I must make that decision
Which you dare presume
To make for me
With your laws that
Make me travel all day
To reach the clinic
Where I must wait days
Until I have done my
State-ordered thinking
After you force me to look at what
You dare call a baby
That you see
From a stick thrust up my womb
And tell me that I must
Bear the cost

An abortion
Because my life depends upon it

 –Lucinda Marshall, ©2013

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 June 23, 2013  Posted by on June 23, 2013 Comments Off
Jan 182013
 

Lather Rinse RepeatThe recent horrific assaults on women in Steubenville and New Delhi require a strong response.  Yet as happens all too often, our horror seems to make it difficult for us to fully recognize the pandemic nature of the problem we are addressing.

It is, as other writers have said, essential to make the connection between these incidents. But while they are particularly ghastly, it is a lot more shocking that horrendous violence against women takes place every minute and it is so common place that perversely, we don’t see it as shocking any more.

There is a war against women that has been raging on this planet since the dawn of patriarchy and it continues unabated today.  Women are sold into slavery they are killed as babies because they are female, they are killed to preserve ‘honor’.  Just a few days ago, a report came out about significant numbers of cases of sexual assault in war-torn Syria.  Hardly a surprise because rape and sexual assault have always been defacto tools of war.  We’ve seen it in the DRC, in Rwanda, in Bosnia and in so many other conflicts.

And in the U.S., as Monica J. Casper points out,

While we reel from spectacular violence that horrifies and makes headlines, mundane violence that harms, terrorizes, and kills women (and often their children) goes largely unnoticed. Domestic violence, with three women on average murdered every day, is more than a silent epidemic; it’s a public health emergency.

Rape kits languish unprocessed in evidence lockers for years  and a small number of mostly white male people known as the GOP members of Congress can block critical legislation such as the re-authorization of the Violence Against Women Act (VAWA) and block ratification of the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) for more than 30 years.

In our military, the problem of sexual assault continues despite numerous hearings and commissions and reports.  As Holly Kearl reports,

Only 8 percent of reported military sexual assaults are prosecuted, and only 2 percent of those end in convictions. Overall, reporting is very low.

Many believe that the way sexual assault is reported in the military is a significant part of why sexual assault is rampant and convictions so low.  Yet, according to Kearl,

When members of the commission asked the military leaders if they would be open to changing the reporting process and removing the discretion that the chain of command has over rape reports, the military leaders said no. They felt it was important for commanders to retain control over the reporting and discipline process.

And that is precisely the problem.  I’ve lost track of the number of times I’ve written about hearings and reports about sexual violence in the military.  But little real change comes from them because naming the problem isn’t sufficient– sexual assault has always been a de facto way of asserting military power over, and allowing a change in control over soldiers would open a significant pandora’s box of culpability for the military and for those who wield violence everywhere.  And so reports keep being written and hearings held and nothing much changes.  As Kearl so aptly labels it, what we have is a cycle of lather, rinse, and repeat, which is unfortunately also the perfect descriptor for most of the war that is being waged on women in so many ways.

It is also disheartening but predictable that just a few weeks into 2013, the right-wing attacks on women’s rights in this country are quickly beginning to sound like the same vile misogyny that we’ve been enduring for much too long.  A few days ago Rush Limbaugh told a caller, “You know how to stop abortion? Require that each one occur with a gun.”, and Rep. Phil Gingrey weighed in by doubling down on the now un-elected Todd Akin’s disgusting suggestion that women could shut down pregnancies caused by rape.  The GOP is also not wasting any time re-introducing an ugly assortment of bills that would restrict a woman’s access to abortion, birth control, etc.  In other words, it sounds like 2012, rinse, repeat.

There are a lot of amazing women’s human rights advocates working full tilt to stop the perpetual assault on our lives and to promote constructive and useful changes with the usual assortment of activist tools.  Multiple petitions cross my desk every day, hearings and meetings and rallies are held,  a lather, rinse and repeat response in kind.

These things serve a purpose but they are not sufficient.  The current way of doing things on this planet is failing women miserably and no amount of petitions, hearings and reports is going to change that.  It will require something bigger.  Much bigger.

If there is one woman who knows that and knows how to set such a change in action, it is Eve Ensler, first with the VDay movement that she started and now with her call for 1 Billion Rising which she frames as:

  • A global strike
  • An invitation to dance
  • A call to men and women to refuse to participate in the status quo until rape and rape culture ends
  • An act of solidarity, demonstrating to women the commonality of their struggles and their power in numbers
  • A refusal to accept violence against women and girls as a given
  • A new time and a new way of being

There will be 1 Billion Rising events in many locations on February 14, or start your own, check the link above for more info.  It’s time to end  the lather, rinse, repeat cycle of misogyny and violence.

———-

Many thanks to Holly Kearl for inspiring the title of this piece with her brilliant rinse, repeat analogy.

 

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 January 18, 2013  Posted by on January 18, 2013 Comments Off
Oct 312012
 

As I’ve pointed out too many times before, in the aftermath of any weather disaster, women often face different needs than men.  In particular, people, mostly women and children, who are living in an abusive situation may be more vulnerable to violence because stress is often a trigger for acts of domestic violence as is feeling powerless as one might well feel if you have been flooded or burned out of your home, or you are cut off by water, no transit and no electricity.  And if you are the primary caregiver for children or elder relatives, fleeing an abuser is all the more complicated.

Compounding the problem, shelters and other facilities that might normally be available to help may also be without electricity and phones or have been flooded or be short-staffed and unavailable or less available to help and police may have a harder time responding to calls if the victim even has a phone (which as I write this a great many people in New York and New Jersey still don’t have).

If you know people who may be  particularly vulnerable to intimate violence in their lives and who have been affected by this horrendous storm, please do what you can to reach out to them and also, please consider making a donation to domestic violence shelters that may have been impacted as they may really be scrambling to provide additional services or rebuild.

And while we clean up here in the U.S. please be mindful that we were not the only country impacted by the storm and women in Haiti, still recovering from multiple weather disasters in the last few years,   are very vulnerable, particularly in refuge camps, where rape and sexual assault have been serious problems and where access to such basics as food for infants and feminine hygiene products may be hard to get.

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 October 31, 2012  Posted by on October 31, 2012 1 Response »
Oct 072012
 

While most women readily undergo regular breast squooshing mammography radiation to screen for breast cancer, there are many misunderstandings about, and much we simply don’t know about the widely accepted test.  In The Big Squeeze:  A Social and Political History of the Controversial Mammogram, Handel Reynolds, MD provides a riveting look at the history of mammography that gives us a better understanding of what we do and don’t know about breast cancer screening.

The story of mammography is part science and medicine, but also in large part cultural, political and economic.  At the beginning of his narrative, Dr Reynolds notes that,

As mammography was aggressively promoted int he 1980s to 1990s, utilization rates rapidly increased.  As this occurred, the mundane mammogram became the little pink engine that could, and did, drive the growth of a vast screening-dependent secondary economy.

For many years, women in the U.S. were told to begin annual screening at age 40. In the last few years however there have been numerous reports that come to different conclusions about how often to screen and at what age to start screening.  But it is not widely known that this is hardly a new uncertainty.   The results of the first large study of mammography’s effectiveness, the HIP (Health Insurance Plan of Greater New York) which began in 1963 did not support beginning annual screening at age 40, and according to Dr. Reynolds,

It is important to note that the benefits of screening were seen only in women fifty to fifty-nine years old.  No benefit was demonstrated for women sixty to sixty-nine or forty to forty-nine.

While most of us are all too aware that there are many more cases of breast cancer than there were 50 years ago, what we fail to understand is that a significant part of that increase is due not to actual new cases, but that we are finding them.  In fact the first nationwide screening demonstration program, the Breast Cancer Detection Demonstration Project (BCDDP), which began in 1973 led to a 14% increase in the known incidence of breast cancer in 1974-75, according to Dr. Reynolds.

Concerns about radiation exposure from mammography are also nothing new. As early as 1976, Dr. John Bailar III of the National Cancer Institute (NCI) raised concerns about the risks of radiation-induced breast cancer from mammography which led to warnings about those risks being given to women considering screening and the NCI issued guidelines that said they could not recommend routine screening for women between the ages of 35-49.

But as Dr. Reynolds points out, radiologists have been heavily involved with the American Cancer Society (ACS) and 6 presidents of ACS have been radiologists. Hardly surprising then that  it was ACS that began to make assertions that up to 80% of women in the 35-49 year old age group fell into one or more high risk categories and therefore should be screened.

Dr. Reynolds also writes that the BCDDP study did not have a control group that did not undergo screening, and because of that, it could not answer the question of whether or not screening resulted in less deaths (which is the usual standard of whether such screening is effective).  That however did not stop ACS from  inferring that because the earlier HIP study indicated a mortality reduction in women over 50, it was also reasonable to assume that with improving mammography equipment, younger women would benefit as well and

In 1976…(ACS) adopted a position that women forty to forty-nine years old should be screened every one to three years.  At the time, it offered no scientific justification for this recommendation.  There was none. (emphasis mine)

Dr. Reynolds analysis of how mammography became widely accepted is quite enlightening.  He points to the blatant use of fear as a tool to convince women to get screened in the late 1980s with the American Cancer Society leading the way in telling us that breast cancer rates were rapidly rising despite the fact that the increased numbers of cases were  attributable in part to increased use of screening (as well as by women’s longer life expectancy–you are more likely to die of breast cancer if something else hasn’t killed you at an earlier age).  It wasn’t that the cancer wasn’t there before, it was that we weren’t aware of it or died of something else first.

ACS mounted a huge campaign around the use of the statistic that one in nine women would get breast cancer.  Yet an ACS spokesperson was quoted in the New York Times as saying that it was, “meant to be a jolt…It’s meant to be more of a metaphor more than a hard figure.” (emphasis mine).

As Dr. Reynolds notes, that sort of messaging led to women overestimating their own risk of getting breast cancer as well as overestimating the benefits of mammography and the all too common mis-perception that regular screening can keep you from getting breast cancer.

The book goes on to cover later studies that really brought into question whether there was any benefit to routine screening before the age of 50 and the very real risks of over-diagnosis and treatment for cancers that might not be life-threatening and to what extent screening really decreases fatalities as well as the problems of false negatives and false positives in mammography.  Towards the end of the book Dr. Reynolds takes a look at the problem of DCIS which in some cases would never be fatal but because we don’t know which cases might or might not become invasive, all cases are usually treated.   Dr. Reynolds suggests that we need to re-evaluate that approach because it puts so many women at risk for the complications of unnecessary treatment, suggesting that regular re-evaluation of such cases rather than immediate treatment may be appropriate.

This book is both fascinating and quite readable, and highly recommended.  It tells a necessary part of medical history that is much, much too relevant to anyone facing this disease or who knows someone who is (in other words, all of us).  That said, at the end of the book, Dr. Reynold tells us that we simply don’t know how much the recent drop in breast cancer deaths is due to screening and how much is due to better treatments.  Nor does he mention environmental factors or the role that the decreased use of hormone therapy may make in these rates.  Despite that, he asserts that,

Screening benefits women aged forty to forty-nine and those who are fifty and older.  The magnitude of the benefit however is greater for those over fifty.  With the battle for access essentially having been won, I believe that mammography should and will continue to be available to all women over forty who wish to be screened.

It is also necessary to note that for poor women and women without insurance, mammograms have not necessarily been available.  While I agree with Dr. Reynolds that mammograms should be available to any woman who wants to be screened, the data is far from clear as to just how beneficial non-diagnostic screening is.

A few additional thoughts:

1.  Concerns about the harms of radiation from mammography are as valid today as they were when they were first raised. Particularly in light of the concerns raised by scientists at the FDA about excessive radiation from GE mammography machines.

2.  This chart showing global breast cancer mortality rates is illuminating. The U.S. has lower rates than Canada and some European countries yet higher rates than some South American countries and Australia. While I’ve only been able to gather screening recommendations from English speaking countries, it is worth noting that both Canada and Australia recommend far less screening than is the norm in the U.S., yet one of them has a higher mortality rate than we do and one is roughly the same, leading me to truly wonder how we can say that routine screening is effective. See this map as well.

3.  According to The Telegraph (UK), the recent drop in breast cancer mortality in Europe is due primarily to treatment, not screening, a conclusion drawn because the drop applies to women under 50 as well even though most European countries do not have regular screening programs for younger women,

Professor Carlo La Vecchia, one of the study leaders from the University of Milan, said: “The fact that there will be substantial falls in deaths from breast cancer, not only in middle age, but also in the young, indicates that important advancements in treatment and management are playing a major role in the decline in death rates, rather than mammographic screening, which is usually restricted to women aged 50 to 70 in most European countries.

4.  According to a 2011 Health Day article that looked at the relationship between screening and breast cancer death rates in several European countries, it is not clear whether recent drops in death rates are attributable to screening or to better treatments. A WHO study found that the rates were similar regardless of screening.

5.  You may also want to listen to Uprising Radio’s Sonali Kolhatkar’s interview with Dr. Reynolds here.

What are we to make of all this?  Dr. Reynolds’ book provides some valuable historic context to our understanding and decision-making about mammography.  What I think is abundantly clear (and as Dr. Reynolds points out) is that policies about mammography have been the result of a far from perfect mix of science, medicine, emotion, politics and economic considerations.

It is beyond unfortunate that we need to be skeptical when it is radiologists who push mass screening–on the one hand it is their area of expertise. On the other, we live in a country where medicine is a for profit business and it is in their best interest to recommend their own procedures.  And as the recent Komen for the Cure dustup reminded us, there has been a real price paid for focusing on “curing” cancer rather than finding its cause and the enormous profitability of treating cancer has been one of the reasons. That has to change because the real truth is that  cancer cannot be cured, only treated, and what we need to do is focus on cause and prevention.  Until then, too many of us will keep dying of this disease.

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 October 7, 2012  Posted by on October 7, 2012 2 Responses »
Oct 012012
 

Every year as we approach October, I go on a little window shopping spree to survey the pepto-pinkified merchandise being sold ostensibly to raise money to fight breast cancer. This stuff irritates the bejeepers out of me for several reasons:

  • Because while a portion (often unstated) of the proceeds may go to a charitable cause, most of the money you spend for the pink thingy goes to the company selling it, in other words they make way more money from your purchase than the charity does.
  • Even worse, many of the products contain ingredients that have been linked to cancer–lipsticks, perfumes and nail polish are huge offenders in this category.

I’ve written about this numerous times  (here, here and here for example) and you can also find much more information at Think Before You Pink.

Yes, you really can buy all this stuff.

While there is still plenty of merchandise to be found, my unscientific first impression of about a dozen stores is that the displays are far less prominent than they’ve been in years, no doubt in reaction to the very bad press that pinkwashing got in the wake of  Komen for the Cure‘s public relations disaster  when it decided not to provide funds to Planned Parenthood’s breast health programs earlier this year.

The other purpose of my little shopping expedition was to make my annual trip to the grocery store magazine rack.  Several years ago I wrote a lengthy piece about how breast cancer is covered in the ladies mags.  And each year with sick curiosity, I take a look to see what if anything has changed.

The year that I did the extensive survey, almost all of the magazines included something about breast cancer in their October issues, and the covers were over the top pinkified.  This year, not so much.  Not all of the mags have breast cancer features this month and many of those that do are far more responsible.  Here is what I found:

The October issue of Glamour has an article that includes information that is not usually widely reported–that breast cancer mortality rates  have not fallen much in the last few years and that the majority of funding goes to treating the disease rather than keeping us from getting it in the first place with a very blunt and valid assessment of why this is so.  They also have a roundup of misinformation that women frequently hear when they are diagnosed.

Oprah’s O has a piece on “Breast Cancer Heroes”, which spotlights women who are making a difference in the fight against breast cancer and Women’s Health has a similar piece.  Both stand in sharp contrast to the far more survivor oriented human interest pieces that I found in my original survey and found again this year in Shape, as noted below.

Health magazine had an interesting piece on commonly held mis-perceptions about breast cancer and good information on how exercise can substantially cut your risk.  They unfortunately also had a piece hawking merchandise you can buy to benefit the cause that included less than healthy nail polish and lipstick (both of which frequently contain ingredients that are linked to cancer) and note cards from the Ford Motor Company’s Warrior program (imagine if Ford made a commitment to lowering cancer causing emissions in their vehicles instead).  Only a percentage of the profits from these products goes to breast cancer causes, the rest is pocketed by the companies selling them.  You do the math, far more effective to make a donation directly to your favorite charity.

Shape points towards the controversy over how often or if mammograms are appropriate and the dangers of cancer causing radiation from CT scans.  Shape also has several survivor stories which remind me of one of my pet peeves–the relative youth and whiteness of women featured in survivor stories when breast cancer death rates are far worse among women of color and you are far more likely to get breast cancer after the age of 50.  The magazine also hawked an unfortunate variety of schtuff you can buy that somehow will help fight breast cancer although the specifics seem vague at best–no word on how buying Popchips in a pink bag will make a difference.

Finally, Essence had a mere one paragraph pointing to higher breast cancer death rates among Black women exhorting women to be sure and be screened.

For the most part, this year’s coverage was much more tempered and realistic than it was when I did the first survey.  There was far less of the personal responsibility mantra and less pulling at heart strings and a willingness to point to what we do and don’t know about breast cancer causes, screening and treatment.  Hopefully that trend will continue.

Next week I will have a review and critique of, The Big Squeeze:  A Social and Political History of the Controversial Mammogram by Handel Reynolds, MD which is a fascinating read although I do have issues with some of the conclusions which I will discuss in my review.  In the meantime, please support Breast Cancer Action’s Mandate for Government Action.

If you are interested in some of my other pieces on breast cancer, here are some more links:

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 October 1, 2012  Posted by on October 1, 2012 Comments Off