Let's Focus on the Woman, Not the Easy Solution

John Hopkins Medicine

Personally, I find it insane that we have yet to find a better solution to breast cancer than mastectomy. Why do we need to rely on completely tearing away a part of a woman's body in order to solve the issue of their breast cancer? Certainly there must be a way that is much better for the woman psychologically and emotionally.

We have placed too much faith in the solution of a mastectomy as being a quick way to get rid of breast cancer without recognizing the hurt and pain women go through when they have to deal with this procedure. These women have lived with and learned to love their breasts and to be faced with the idea that they have turned traitor against their own body by having breast cancer is very painful. Since this appears to be the one solution for women who go through breast cancer, they either risk death or have to lose a body part. If we put more research and time into finding additional solutions to breast cancer we might find a solution that is much more preferrable among women. Having additional choices in how to handle their breast cancer may make these women's lives a little more positive.

About 1 in 8 US women will develop breast cancer over the course of her lifetime. In 2018, an estimated 266,120 new cases of breast cancer will be diagnosed in women in the US. Early diagnosal has not made too much of a difference as the estimated amount of women to die from breast cancer in 2018 is 40,920 compared to the 40,290 in 2015. Granted, this wasn't a huge increase in expected deaths from breast cancer, but we should be working on decreasing deaths rather than letting them remain stagnant and continuing.

SRG Tech

A big part of organizations who raise awareness for breast cancer is the push for early detection leading to early diagnosal. The idea behind this is that if women are regularly going in for check ups, screenings, and doing their own self-examinations, that is the best defense against breast cancer. Where this hurts women is that it puts the responsibility and pressure the women to recognize when they have breast cancer and deal with it accordingly. The issue resulting from this responsibilty is that women may not always have the means or resources to get help or know when they have signs of breast cancer. Getting regular check ups and screenings can't always happen if a woman does not have access to health insurance. Recognizing what the signs of breast cancer look like may not be possible either if women do not have access to information on what breast cancer looks like. 

Along with pushing responsibility onto women, early detection lets doctors rely on methods to deal with breast cancer after it has developed rather than coming up with additional methods that would work to prevent breast cancer from ever developing. This then pushes women to accept one method in order to save their lives through a mastectomy. One such individual who was initially only given the option of a mastectomy was Desiree Basila. Desiree had been diagnosed with stage 0 breast cancer. The first surgeon she met showed her a photograph of her right breast and told her there was a slot open the following week for a mastectomy. Desiree
knew she was not ready to have one or both of her breasts cut off, so after talking to another doctor she decided to take a drug called tamoxifen which blocks estrogen and was in a clinical trial with active surveillance. As long as the tumor did not continue to advance, Desiree would not have to go through a mastectomy.

Granted, Desiree's story and her diagnosis was only stage 0 and not one of the more severe forms, if she was able to avoid mastectomy why can't we put more research into breast cancer and find other solutions that do not involve the complete removal of the breasts or to the point where a woman does not have to face death.

I understand that a lot of research and time has been put into breast cancer and I acknowledge that my knowledge of breast cancer and is very limited. I am not fully aware of the all the efforts that have taken place to find a better treatment for women, if there are any.

I hope we can think more broadly about how to treat this cancer rather than just removing the site where it develops - the breasts.

Reading:
Lorde, A. (2006). The cancer journals. Aunt Lute Books.

Not the Woman's Fault

Source: Kimberly Leonard

Today, women advocate for the choice to have birth control which is a good thing. Women should have the choice to get an intrauterine device (IUD) if they want one. But where this argument is lacking is when there isn't enough information about IUDs given to women. 

Most women are not aware of the side effects and complications that may arise with IUDs, and doctors are not always the most willing to give up that information or listen to women when they do experience complications.

When we don't fully understand a product this gives the producers of that product full control. They can create it in the easiest and quickest way so they can get large amounts of it out on the market. They don't think about how it will be used or if it's compatible with its users. This is the case for intrauterine devices.

The fact that birth control researchers thought that one shape of birth control can work for every woman has caused women the most harm. By assuming that one shape would fit all, this assumption made it easy for doctors and the producers of birth control to push the blame onto women if their IUD did not work out for them or completely dismissing women's pain. But there has to come a point where there is too many women with issues with the IUD to be fully on the blame of the women. There has to be a point where the IUD is at fault and women should be made aware of its potential complications and side effects. We cannot keep putting full blame onto women.

There have been many cases where women have experienced pain during insertion of an IUD or who experience their IUD being displaced. A lot of the time, these women are not even aware that their IUD has moved until they see their doctor. Rosalind Stone had gotten a copper IUD which caused her large amounts of pain before she was able to get it removed. When Stone went to another doctor to get the IUD removed, she was told that she should never have been fitted with such a large IUD. While cervix size does not affect whether an IUD works, it mainly affects whether the insertion process is more painful or not. When Stone had her IUD fitted, the doctor told her that he was competing with other doctors to reach higher years' worth of contraception prescribed. He had encouraged her to take the bigger IUD, which offers a higher number of years' protection.

This doctor dismissed any concern for Stone's personal health by encouraging her to take the bigger IUD so he could have a higher years' worth of IUD coverage. The fact that doctors were participating in a competition based on how many years they could get women to take contraception promoted behavior that is harmful to women. This leads doctors' main concern to be whether they can gain credibility within this community of doctors who are competing to be the leading prescriber of contraception.

When Melissa Petro went to have her IUD removed in 2012, she learned that it had migrated out of place. Her doctor encouraged her to leave it in because she didn't have a backup birth control method. When she finally went to have her IUD removed, she learned that the IUD had become embedded in her uterine lining leaving her with symptoms of nausea, vomiting, bleeding, and cramping.

When women are given IUDs without enough information, they are at an increased risk of having complications. When these IUDs are poorly researched with the idea that one size will fit all, they can cause severe pain to women who these IUDs will not work for. Competition being promoted among doctors with IUDs also leads to a higher risk of pain. This increases their risk because doctors will be concerned with their ranking in this race to be the leading prescriber of contraception that they will disregard all the potential risks for pain and will not make women fully aware of all potential complications. In general, there is a complete disregard for women's health and safety within the entire spectrum of IUDs.

Doctors have frequently dismissed women's pain and told them to not worry if the IUD has been displaced. Doctors have been more concerned with their prescription of IUDs than with their patients' safety. In the first case, Rosalind Stone went to get her IUD removed and the doctor found that the IUD had gone missing. He figured that it had been expelled from her vagina and that no removal was necessary, dismissing her lingering pain. After Stone convinced her doctor to schedule an ultrasound, the IUD was revealed to still be inside her. This doctor thought he knew what had happened with the IUD and did not think there was any reason for her pain so he just dismissed it. In the second case, Melissa Petro's doctor had encouraged Melissa to leave the IUD in after finding that it had moved out of place.

This dismissal of women's feelings and pain in combination with the lack of information results in women blaming themselves. After learning that her IUD had become embedded in her uterine lining, Melissa thought it was her fault. She thought that she should have gotten it removed sooner, should have gone for more regular check-ups, or just had not gotten the IUD in the first place. But she was not told of the potential side effects of the IUD. There was no way for Melissa to have known that this could have happened because her doctor never told her it could. The fault really lies with the doctors and the birth control researchers.

There is a good number of women who have gotten an IUD and it worked just fine for them. But, the issue is that there is a growing number of women who have had serious complications with this IUD. Granted it may be impossible to create a perfect IUD that works for everyone, but women should at least be made aware that there is a possibility that the IUD may lead to serious complications. I am not promoting the idea of creating a perfect IUD - which would be great, but highly unlikely - I am simply saying that women need to know the side effects and these IUDs need to be created with their users in mind. 

In creating this product, birth control researchers should have taken into consideration that one size fits all was not the solution here. In giving out this product, doctors should have recognized that these women need to know all of the potential side effects or complications these IUDs come with, so they can make an informed decision about whether to get one or not. Competition among doctors and birth control researchers needs to be erased because it is just hurting women.


Sources:
Takeshita, C. (2012). The global biopolitics of the iud. Massachusetts Institute of Technology.
https://theweek.com/articles/681863/got-iud-nightmare 
https://broadly.vice.com/en_us/article/xyenn4/when-iuds-go-terribly-wrong-mirena
https://www.washingtonexaminer.com/democratic-congresswomen-slam-proposed-birth-control-rule 

A Living Death

200,000 Congolese women and children have been raped during Congo's conflict.

Although that is not accurate. That is the number of reported rapes and is suspected to be too low.

A specialist on sexual violence in conflict for U.N. Women, Pablo Castillo-Diaz says, "Rape is one of the most underreported war crimes that there are. Women, if they survive the attack rarely tell anyone else. We only hear the most brutal incidences or the public ones that the whole community sees."

We only hear of a small portion of the rapes that occur during wartime because the effect that rape leaves on women is oftentimes too much to bear and too much to relive. This is important because we cannot fall into a state of complacency. We cannot assume that because we know 200,000 women and children have experienced rape, that must be the total amount in that country and they do not need any more help. We cannot let that stop us from seeing if they need more help and if there are more women who just have not come forward.

Anne Murray in From Outrage to Courage says that the goal of modern civil wars is not so much to eliminate the opponents as to destroy their culture and the very fabric of society.

Source: Lauren Wolfe

For most countries, this means targeting the women within that country. Rape is the most common weapon in pursuit of that end goal. Sometimes soldiers rape women with the intention of getting them pregnant, so the woman then has to deal with carrying a baby from the enemy soldier and has to live with knowing how that baby was conceived. Most times the community that the woman lives in knows how that baby was conceived as well, but are more disgusted that she is carrying a child from the enemy. 

The woman may try to have an abortion done which is risky. In poorer countries, they do not have the resources for safe abortions. During war, all resources will be sent to the fighting, so women will resort to unsafe practices for the abortion which may result in her death. Or she can keep the baby and have to live with the memories of the rape and the disgust from the community.

Jeanna Mukuninwa says that rape is more powerful than a bomb or bullet. "At least with a bullet, you die. But if you have been raped, you appear to the community like someone who is cursed. After rape, no one will talk to you; no man will see you. It's a living death."

One aspect of rape is the physical impact. In many ways the physical impact of rape also affects the social and mental. Women can get fistulas from rape which leave them with the inability to control their urine or feces. They often smell, even if they clean up constantly. This may result in them being shunned from their community and may result in isolation. This can be detrimental to their mental health if they have been isolated. This may even make them less likely to report their rape.

So, what we need is a way to combine all the aspects of rape on women in wartime - physical, mental, and social - in order to best help women with the ramifications of rape. One program I found is called City of Joy. City of Joy was founded by Christine Schuler-Deschryver and Eve Ensler, both women's rights activists, in the Democratic Republic of Congo in 2011. This program lasts 6 months and is for rape survivors. It combines group therapy with literacy classes, leadership training, self-defense courses and lessons in human rights law.

Source: IMDB

Eve Ensler says in this Time article, "City of Joy is not a refuge. It is a center for transformation. We are literally saying that the violence which was done to you, through a process of love, healing, therapy and education, can be turned into a motor that makes you a leader."

Jeanna Mukuninwa was in the program and said that the therapy helps women understand that the rape was not their fault. The life skills and leadership training give them confidence, and the nurturing atmosphere lets them build support networks that last even after the program finishes. Mukuninwa says, "What City of Joy taught me is that life goes on after rape. Rape is not the end. It is not a fixed identity."

This program could do lots of good for women if executed properly. As Jeanna Mukuninwa stated this program targets the aspects of women's lives that are affected by rape. It places a heavy emphasis on the mental and social aspects, which I believe are the most important because they tend to last in a woman's life longer than the physical aspects do. It gives them the ability to gain confidence through leadership training and also through the group therapy. It provides an environment where women who have similar experiences can come together and bond and create a support system for one another.

More research needs to be done on City of Joy to see if it has really been helpful for women. I think this program could be very useful for the future of helping women with rape. But we need to see more on what kind of progress has been made with the program and see if women continue with the skills and support they had there after they graduate from the program. We need to see if this program truly helps.

Women who have suffered from rape in wartime need support. They need to know that it was not their fault. They need to know that they can reach out and get support from the people around them. We need to get more education out to the communities who are most likely to be affected by wartime rape. We need to set up programs like City of Joy in areas where women are less likely to get support from the community around them. We just need to help. Wartime rape is a needless and unnecessary form of violence against women. It is not okay that women have to suffer through this. It is not okay.

Sources:
Aryn Baker - http://time.com/war-and-rape/
Murray, A. (2008). From outrage to courage: Women taking action for health and justice. Canada: Common Courage Press. 

Actions Speak Louder Than Words

For years now, women have suffered at the hands of drug companies and the Food and Drug Administration. Women have died because of the exclusion of women in drug research trials. The FDA has done the bare minimum to improve the drugs marketed towards women. Even though a large percentage of women are being harmed by drugs, the FDA is very lax about how drug companies conduct their research and who they market towards. I think that we cannot allow the FDA to continue ignoring the needs of women and the women dying because of the drugs that have been marketed towards them. 

Source: Michelle Llamas

Actions speak louder than words. We cannot have an organization - that is meant to prevent citizens from receiving harmful products - that is allowing companies to create drugs and then market them to a gender that they have not tested those drugs on. We cannot have an organization that is creating policies that state that these companies must perform studies with all genders if that organization is not putting in the effort to enforce those policies. What is holding drug companies accountable if there is no enforcement? Nothing. They will do what they view is best for them without care for who they are hurting in the process. 

In Doing Harm, Maya Dusenberry (2018) says the rationale that drug companies provide for not studying their drugs on women is because they are complicated and it is more difficult to study women's results. Because of this it does not make sense to me why researchers won't study their drugs on women but will still market their drugs to them. Obviously drug companies do not care too much if women react poorly to their drugs, so long as they can gain a profit from those women. Because drug companies are not studying their drugs on women, women are being harmed and even dying. One example of pharmaceutical companies harming women by not adequately studying their products is in the product of Essure. Essure is a birth control device that creates scar tissue in the fallopian tubes. In 2002, the FDA approved this device and since then they have received over 5,000 reports of harm being done on women who have this device. 

Source: Paul Venema 

Another example that fits with harm being done by both the FDA and the pharmaceutical companies is what happened to Julie Ann Bronson. In Michelle Llamas article (2018), she lays out how Bronson was convicted after hitting three people with her car and continuing to drive until she was stopped by police. In Bronson's testimony she explained that she had take two Ambien - which is a sleeping aid - after she had some wine and then went to bed. She said she had no memory of what happened. In KSAT's report of the incident and the hearing, a toxicologist Dr. Janci Lindsay testified that sleep driving is one of the side effects of Ambien. If sleep driving was a known side effect why were individuals still being prescribed Ambien? This side effect resulted in damage being done to the three individuals who Bronson hit and to Bronson herself. 

In 2014, 60 Minutes did a report on Ambien. In this report, it was found that doctors wrote about 40 million prescriptions on this drug every year. Eventually, it was revealed that women were being recommended a dosage that was more than they needed and this resulted in an increase of the risk for impaired driving (Llamas, 2018). Julie Bronson must have been one of those individuals who was still taking too much, because of these incorrect dosages, and this may have been the reason why she went driving but could not remember a thing. After this information came the FDA cut back on the dose for women, but it was revealed that the FDA knew about this issue in 1992 when they received data showing that the amount of Ambien in a woman's blood was 45% more than in a man's. The FDA chose not to act until the public became more aware of this issue (Llamas, 2018). 

The FDA has made surface-level steps to try to rectify the wrongs they have caused by allowing pharmaceutical companies to conduct their research however they want. They have created solutions to this issue which are not really solutions. In 1988, the FDA created guidelines which told drug companies to analyze their data by gender, but half of the studies reviewed failed to do so (Dusenberry, 2018). Here the FDA created rules for companies to follow for their studies, but the FDA did not have any enforcement power to ensure that these companies were following these guidelines. So, most of these drug companies continued ignoring the results that their studies conducted with women gave. 

Source: HerStories - Pratt Info School

In 1977, the drug thalidomide - used to prevent morning sickness - was revealed to have caused severe birth defects. After this became public, the FDA banned women who could become pregnant from participating in these studies (Llamas, 2018). This in turn ended up banning practically all women from participating since most women can get pregnant. This may have set a precedent for future studies and led researchers to not include women because they could complicate the results. What's interesting is that the FDA chose to ban women from participating rather than banning the drug. This specific drug is going to be marketed to pregnant women, so if in the studies pregnant women are being harmed this drug should be removed instead. 

For the FDA to just place policies with any real enforcement does nothing for women taking these drugs. Drug companies will continue to study mainly on men and disregard women for being too complicated. For most pharmaceutical companies, their objective is to get more money. So, if they can conduct their studies on the "easier" gender and be able to get their drug out on the market quicker, that is what they are going to do. The Food and Drug Administration needs to put more weight on their words. They need to have some mechanism for punishment for drug companies instead of urging or encouraging drug companies to include more women in their studies. Words are incapable of persuasion in these cases. Actions are much more powerful. 

Sources:
Dusenberry, M. (2018). Doing harm. New York: HarperOne.
Llamas, M. (2018). How the fda let women down. Retrieved from https://www.drugwatch.com/featured/fda-let-women-down/