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Women, Compliance And Medicine

03/18/2010 05:12 am 05:12:02 | Updated Nov 17, 2011

When I was a teenager, I was a candy striper at my local hospital. This was admittedly not from a selfless desire to help others, but was a desperate attempt to bulk up my nonexistent extracurricular resume. That being said, I did learn useful things, such as how to push a wheelchair into an elevator without tipping it over and how to water flower arrangements. I also first heard of the term "compliance," the readiness with which a patient follows medical advice. This reinforced feelings I had secretly already formed about doctors and experts in general. Compliant patients were the good ones, the winners who got better. Woe to those who went their feckless ways, disregarding the expertise of others!

So okay... this week, it's been hard for smugly-compliant me to digest the two bombshell announcements concerning Pap tests and mammograms.

I understand that these are controversial changes that are being feverishly debated even as I type, changes that may have as much to do with our collective mindset about risk and odds as they do about medicine and health. I also understand that they're merely guidelines that should be discussed by all women with their physicians. But having just written a book on menstruation, I'm struck by how once again, conventional wisdom regarding women's health has been seemingly turned on its head overnight; and how it's the most compliant of us, the ones who have spent years dutifully following instructions like the good girls we are who are left the most confused, frustrated, and upset.

Don't get me wrong. I'm not saying medical uncertainty is just something that affects women; who hasn't struggled to make sense of, say, the health benefits of fiber, vitamins, herbal supplements? Yet the history of menstruation is a singularly female and bizarre saga studded with truly hair-raisingly bad advice from the supposed experts of the day.

Hysteria, that poorly-defined catch-all of female complaints, was treated for centuries with not only manual stimulation to orgasm by a doctor, but by a sadistic cornucopia of other supposed panaceas: leeches placed on the vulva, cauterization of the cervix, removal of the clitoris, electrical shocks. Believing that menstruation was a positive process that relieved the body of excess blood, Hippocrates, the so-called Father of Medicine, promoted bloodletting as a medical cure-all, one that successfully managed to weaken and bump off untold thousands of patients (including George Washington) until the 1800s. In the 19th century, doctors argued that female blood rightfully belonged in her uterus and not her brain; thus menstruation became another reason why higher education for girls was actively discouraged. And as recently as 1952 (1952! The same year Singin' in the Rain came out and Isabella Rossellini was born!), people still believed menstrual blood was poisonous, until a Harvard experiment proved them wrong.

Admittedly, these are Madame Tussauds-esque examples: campy, archaic, and creepy. Yet more recently, the evolving story of hormone replacement therapy gives serious pause to women trying to steer their way through menopause. In 1966, HRT burst into the limelight with the publication of Feminine Forever, a book that brashly promised women youth in a prescription bottle. Its author, gynecologist Dr. Robert A. Wilson, wrote that "all post-menopausal women are castrates" and "one of the saddest of human spectacles"; but that with HRT, " her breasts and genital organs will not shrivel." Ye-ouch... with copy like that, who needs Don Draper? His book helped make HRT the gold standard for menopausal women across America for years, even though most of his claims were eventually debunked and serious questions were raised about links between HRT and heart disease, cancer, dementia and stroke. It was also revealed that Wilson had been quietly funded by pharmaceutical companies the whole time. HRT is now currently appropriately prescribed for short-term use by women suffering from menopausal symptoms; it may also provide protection against fractures. Yet recent court documents reveal that pharmaceutical companies like Wyeth continue to quietly pay ghostwriters to write scientific papers enthusiastically backing HRT - playing up the benefits and de-emphasizing the risks.

So when it comes to mammograms and menopause, will I still listen to my doctor? Of course I will; after all, I still have faith in expertise and I'm not the one who went to med school. But I've also learned that medical truth isn't necessarily monolithic, carved on some stone tablet; it's constantly changing and is informed not only by hard science, observation and testing, but also, unfortunately, by money, politics, and prevailing attitudes towards not only health, but life, death, and human relations. Medicine, after all, is human. It just behooves us to try to stay as informed as we can and to participate as meaningfully in our own health as we can. God knows it's damningly, hair-rippingly frustrating at times, and not at all helped by the hellishly complicated and expensive labyrinth that healthcare has become in our country. But what other options do we have?

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