Tag Archives: medicine

Save the People, Not the Boobies: The Ethics of Breast Cancer Awareness

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Few ad campaigns make me as misanthropic as the breast cancer awareness ones I’ve been seeing at an especially high volume for the past month:

There’s also this video (NSFW).

I hate these campaigns for many reasons. First of all, they make breast cancer all about boobs. Yes, it has “breast” in the name, but reducing an illness as complex and life-shattering as breast cancer into a cutesy “save the boobies!” campaign seems callous and inappropriate.

I’m not sure everyone would even agree that the prospect of losing your breasts is the worst thing about breast cancer, and yet that’s what these campaigns almost universally target. It’s not the “boobies” or “ta-tas” that need to be saved–it’s the human beings who have breast cancer.

It’s even worse when the campaigns are created by and/or targeted at men and involve that hint-hint-nudge-nudge assumption that men should care about breast cancer because men love tits. Never mind that men can get breast cancer too, and never mind that men care about breast cancer not (just) because they care about boobs, but also because they care about their friends, girlfriends, wives, mothers, sisters, daughters, and etc. who might get breast cancer, or who already have.

Campaigns like these also completely ignore women who have chosen (or been forced to) undergo mastectomies. If breast cancer research and awareness is all about “saving the boobies,” does losing your breasts mean you’ve lost the fight?

This preoccupation with breasts is probably what inspires awful ads like this one by the Cancer Patients Aid Association, an Indian NGO:

The text at the bottom reads, “One out of every eight women develops breast cancer in her lifetime. Early detection helps recovery. Get yourself examined before it’s too late.” So there you have it. If you get a mastectomy, you’re “making yourself ugly.”

This is all to say nothing of Susan G. Komen for the Cure, the hypocrisy and reactionism of which should by now be well-known. (Incidentally, the former Komen executive who was responsible for that move was not content with merely that; she just had to write a book-length screed against Planned Parenthood, as well.) This unethical organization seems to be the beneficiary of most (if not all) of the sexualized ads I’ve seen. I still refuse to give them a single cent, which is difficult given how easy it is to accidentally pick up one of those pink-ribbon-branded products at the grocery store.

On the bright side, this is a great opportunity to explain what feminists mean when we prattle on about “objectification” and “sexualization,” which are closely related concepts that often (but not always) occur together. Objectification is the reduction of a person to their body parts (usually the sexual ones; hence the frequent co-occurence of objectification and sexualization). An advertisement that objectifies women might show, for instance, a single female leg in front of a flashy car, or a woman lying in a martini glass–literally like an object to be consumed. Sometimes men are objectified too, but that seems to be rarer. Ads that objectify people often don’t show their faces (or eyes), thus making them seem less like people and more like bodies.

Sexualization, meanwhile, is when a person (again, usually a woman) is represented in such a way as to arouse the viewer or otherwise connote sex when the actual purpose of the representation has nothing to do with sex at all. You wouldn’t call pornography “sexualization” because the purpose of pornography is to depict sexual acts and to be arousing. But when an advertisement designed to sell cars or alcohol–or solicit donations for breast cancer research–portrays women in a sexual way, that’s sexualization.

The objectification and sexualization of women in the media has a great deal of negative effects, both on an individual level–for the people who view them–and on a cultural level. Check out the work of Jean Kilbourne if that interests you.

However, I am not a marketing expert. If I were, and if I were charged with designing an ad campaign that elicits as much attention and donations for breast cancer research as possible, there’s a good chance I would feel compelled to create an ad like this, because there’s a good chance that this is the kind of ad that works best.

Hence the misanthropy I mentioned earlier. Marketing people know what they’re doing. If this is really the best way to get people to pay attention to this important cause, I would say that not using ads like these is even more unethical than using them–at least until we shift our culture enough that we don’t need them anymore. But that still means that we’re choosing the lesser of two evils. I would rather more money went to breast cancer research than less, but I would also rather we stopped reducing women to their erogenous zones in our media.

After all, I don’t agree with this rubbish that men are “programmed” or “hardwired” by biology to be obsessed with breasts, at least not to the level that our society seems to think they are. As I already discussed when I wrote about public breastfeeding, the sexualization of breasts is not universal to all cultures and time periods. Even if “sex sells,” breasts don’t necessarily have to always be part of “sex,” and I think it would be beneficial to our society if they were not.

For the record, whether straight men’s love of boobs is entirely biological or not, I don’t think there’s anything wrong with it, as long as it doesn’t infringe upon public policy or trivialize serious illnesses. Besides, you can totally be an awesome (male) feminist and a boob enthusiast at the same time.

Edit: Here’s a great article that basically makes my point for me.

Abortion and Suicide: A Spurious Link

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In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

A Sacrifice They’re Willing to Make: Mississippi’s War on Abortion

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The last remaining abortion clinic in Mississippi is perilously close to shutting down thanks to a new proposed law, Mississippi House Bill 1390. The law would require that all doctors performing abortions be board-certified in obstetrics and gynecology (reasonable), and that they also have admitting privileges at a local hospital (not so reasonable).

The reason that’s not so reasonable is because Jackson, Mississippi, home of the besieged abortion clinic, has two hospitals with Christian affiliations, and any hospital can refuse to grant admitting privileges to a physician for any ol’ reason, such as that said physician is a godless heathen who wants to help women murder their unborn fetuses babies.

To make it even better, the law would give the clinic’s physicians (all of whom are board-certified OB/GYNs but only one of whom has admitting privileges) less than two months to acquire them. As Evan McMurry writes at PoliticOlogy, “This is part of the pro-life’s recent death-by-a-thousand cuts tactic: if they can’t overturn Roe v Wade outright, they’ll make accessing and performing abortions so onerous that the practice will be effectively impossible.”

But of course, as it usually is with these laws, things get even more ridiculous. From the HuffPo article:

The State Senate voted to pass the bill Wednesday, but it was held for further debate on Thursday, when lawmakers had an odd exchange over the bill on the Senate floor. Sen. Kenny Wayne Jones (D-Canton) asked Sen. Dean Kirby (R-Pearl), who chairs the Senate Public Health Committee, whether ending abortions in the state would force women to resort to dangerous, back-alley abortions.

“That’s what we’re trying to stop here, the coat-hanger abortions,” Kirby replied, in reference to the abortions provided at the clinic in Jackson. “The purpose of this bill is to stop back-room abortions.”

Okay, first of all. No reputable doctor performs abortions with a coat hanger. In fact, I’m just going to go out on a limb and amend my statement to say, No doctor performs abortions with a coat hanger.

All of the physicians in question are board-certified in obstetrics and gynecology–a certification that I’m pretty sure Senator Dean Kirby does not have.

Incidentally, you know when dangerous abortions do actually happen? When abortion is made illegal. Research invariably shows this. (I know, I know, Republicans don’t believe in science anyway, but it was worth a shot.)

The truth is that making something illegal, especially if that thing is considered absolutely necessary by many people, does not mean it won’t happen anymore. It just means that it’ll happen out of sight, and therefore without regulation. This is why countries that are more progressive than ours are starting to experiment with drug decriminalization, but that’s a whole other topic.

Drug policy is a different ballgame because, while there are many psychological and societal factors that may lead people to become addicted to drugs, most of us can agree that nobody needs illegal drugs in order to have a decent life. Abortion is another matter, however. Unless conservative lawmakers are willing to provide comprehensive sex education and low-cost (or free) birth control (not to mention end sexual assault), there may not be a way to eliminate the need for abortion. For instance, from a comment on the HuffPo article I linked to:

I live in Mississippi. Yesterday I taught classes in the poorest part of the Delta to pregnant or parenting teens on parenting skills. I would much rather teach classes to teens about safe, effective birth control. The state won’t let me. It doesn’t matter how many facts or statistics I roll out…nobody listens. I am frustrated beyond belief.

So that’s what we’ve got.

Anyway, because politicians in states like Mississippi refuse to provide the resources to prevent abortion from becoming necessary, they must face the fact that women are going to get them whether they’re legal or not. But they don’t face this fact.

In the quote from Senator Kirby, which I provided above, he states that his purpose in making abortion unattainable in Mississippi is to prevent women from having dangerous abortions. So basically, his argument is this: we’re going to restrict women’s access to a safe, standard medical procedure in order to prevent them from obtaining the potentially dangerous, unregulated version of that procedure, despite the fact that restricting the safe thing actually leads to an increase in the use of the dangerous thing.

Kirby’s reasoning makes such a mockery of logic and common sense that I had to read the original quote several times before I understood it.

Mississippi’s Republican governor, Phil Bryant, had this to say about the proposed law: “This legislation is an important step in strengthening abortion regulations and protecting the health and safety of women. As governor, I will continue to work to make Mississippi abortion-free.”

Wait a minute. First he wants to merely “strengthen” abortion regulations. But then he says he wants to “make Mississippi abortion-free.” That should convince anyone who wasn’t already convinced that this law has absolutely nothing to do with making sure that abortions are performed safely. Rather, it has everything to do with making Mississippi “abortion-free.”

That’s right, he didn’t even try to pretend this was about women’s safety.

In my opinion, the fact that criminalizing abortion leads to dangerous back-alley abortions is the strongest argument for keeping abortion legal. It’s the strongest argument because it doesn’t lean on emotion or ideology. We can argue left and right about when life begins and when fetuses feel pain and whether or not women have the right to choose what to do with their bodies (hint: yes), but we cannot argue with the preponderance of evidence that shows that criminalizing abortion does not prevent abortion. It merely makes it dangerous.

Pro-lifers’ continued refusal to accept this argument says one or both of these things about them:

1. They are unwilling or incapable of accepting and understanding basic facts about economics and decision-making. That is, despite all the evidence showing the negative consequences of the criminalization of abortion, these politicians (and voters) continue to believe that banning abortion would plunge us all into Fun Happy No-Killing-Babies Land.

2. They understand these facts, but just don’t care. This is undoubtedly the worse alternative, because it means that the pain, injury, and even potential death that will come to women who try to obtain illegal abortions are, to borrow from Shrek‘s Lord Farquad, a sacrifice that Republicans are willing to make.

So, ignorance or malice? Take your pick.

Obama the Patriarch

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I usually stay away from commenting on Obama’s presidency because, to be honest, I was just a kid during all the previous presidencies I’ve lived through and really have no comparison to make.

However, a recent statement by Obama has caused me to come out of my apolitical cave and rage. After the FDA made a recommendation that Plan B One-Step, a form of emergency birth control that is available over the counter to anyone over 17, be available to girls under 17 without a prescription as well, Kathleen Sebelius, Obama’s secretary of health and human services, overruled the FDA’s recommendation. This is disappointing enough as is, but then Obama came out in support of her and said the following:

“I will say this, as the father of two daughters: I think it is important for us to make sure that we apply some common sense to various rules when it comes to over-the-counter medicine….And as I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old going into a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could end up having an adverse effect.  And I think most parents would probably feel the same way.”

As usual when I write about women’s issues, I literally don’t even know where to start with this. First, and perhaps most obviously, I don’t understand why we’re having all this conversation about 10- and 11-year-olds. The change would have applied to all girls under 17, and the majority of teenage girls who might need to buy Plan B are not 10 and 11. Try 15 and 16. If Obama and Sebelius are that concerned about 10- and 11-year-olds specifically, they could’ve asked the FDA to recommend allowing only girls 12 and over to get Plan B without a prescription.

Second, and also very tellingly, if the FDA has deemed Plan B safe for over-the-counter use, who are Sebelius and Obama to assume they know better? Sebelius has a BA in political science and an master’s in public administration; Obama has a BA in political science and a law degree. Unlike many cynics, I don’t necessarily doubt that these two have the knowledge and ability to perform their respective jobs, but I would not trust them over the doctors and researchers who staff the FDA when it comes to medical issues.

Third, Obama immediately reveals what this is really about when he says, “as the father of two daughters…” Understandably, Obama would be worried for his two daughters if they were ever in a position to need Plan B. However, for all of the battling that Obama has had to do with the Far Right of this country, he clearly doesn’t seem to realize that many girls don’t have daddies like Obama who would care for them, be able to afford doctors’ appointments, support their right to get an abortion, and guide them through a decision. For many girls, it would be a choice between obtaining Plan B on their own or being shamed, abused, disowned, and/or forced to carry a baby to term.

Finally, I’m disturbed by the ageist and patriarchal notion that young women are somehow incapable of making their own decisions about sexual health. Yes, children need and should have access to guidance from adults. In a perfect world, every girl would be able to go to her parents for help with something like this. But that’s not the world we live in, and we must make do accordingly. Not only has the FDA already determined that Plan B is safe, but, unlike many medications that are available over the counter to children, you can’t overdose on it or otherwise fuck it up–when you buy it, you only get one.

Furthermore, there are other ways to make sure young teens know what they’re doing when it comes to emergency birth control. For instance, mandate pharmacists to provide an option for girls to privately ask them questions about how to use Plan B. Pharmacists know a lot. Why not use them as a resource?

Much has been made of Obama’s failure (or lack thereof) to support women’s rights, and it’s a debate I don’t normally follow because one can really spin it either way. On this issue, however, I would argue that Obama has definitively failed to support women and girls. Instead, he has promoted the antiquated notion that beliefs trump science when it comes to reproductive rights.

Antidepressants and Strength of Character

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You're not a bad person if you take any of these roads. I promise.

Spoiler alert: They have nothing whatsoever to do with each other.

There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.

People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.

I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)

This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.

What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.

That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.

Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:

  • Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
  • Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
  • Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
  • Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
  • Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
  • Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
  • Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.

I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.

Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.