17 Medicalising the Female


	Old Sir John Craven always said to us - "Remember ninety per cent of your 	patients will get better whether you treat them or not. Never give them 	anything that may be likely to harm them. Seven per cent or eight per cent 	will require a little attention and some skill; two per cent are going to 	die anyway. But the healing force of nature is the one thing you've got to 	remember." A lot of truth in that.
	Doctors by Jonathon Gathorne-Hardy.

Medical Damaging of Women

Sir John's advice sounds good to me. So, does the medical profession ever give women anything likely to harm them?
Frequently.
Radiotherapy Action Group Exposure was formed after radiation treatment for breast cancer left women with persistent pain and damage. Within 3 years of its founding RAGE received 3,000 letters from women who had lost the use of their limbs or suffered irreversible damage to internal organs. RAGE knows of 6 women who have had arms amputated due to intense pain after breast treatment.
According to RAGE 50% of the injuries occurred in 20% of the hospitals that treat breast cancer. It would seem that some hospitals are more dangerous than others. It was said that sometimes a small number of high dose treatments were given instead of a larger number of lower doses to reduce the total number of treatments and so save money. One expert said that many of the women probably didn't need the treatment anyway.

Pandering to male ideas of desirability women were encouraged to increase their chest measurements by having allegedly safe silicon implants. Many women now know how "safe" these were when silicon leaked into their bodies. The inflammatory reaction of the body can result in fatigue, joint pains, skin lesions, fever and weight loss. Not only are they at risk of developing rheumatic and other auto-immune diseases but there is evidence that their children are likely to be similarly afflicted.
When thousands of women complained about the rigid, tender and painful pectoral lumps with which they were left American manufacturers agreed a $4.25 billion compensation deal involving 440,000 women while asserting that their products are perfectly safe. A year later a court analysis showed that the settlement would pay women only a fraction of what they were originally promised. Full compensation for the 70,000 most severely affected would amount to $24 billion. One manufacturer, Dow Corning Corp, filed for bankruptcy.

When DES (diethylstilbestrol) was first synthesized in 1938, it was also found to be carcinogenic, inducing breast cancer in male mice. However in the 1930s a couple of American researchers, the Smiths, decided that since natural oestrogens increased during pregnancy what pregnant women needed were synthetic oestrogenic chemicals - like DES. They went so far as to claim that DES created "a better maternal environment" for the foetus. From 1945 to 1970 millions of women were prescribed DES to prevent miscarriage, though a 1953 Chicago study, by Dieckmann, showed that DES did not prevent miscarriage and appeared to increase the likelihood of bleeding. In spite of the fact that it had no beneficial actions DES was prescribed for another 20 years, when it became obvious that what it was doing was producing genital abnormalities and cancers in the babies exposed to it.
Besides their higher risk of reproductive cancers DES daughters have increased risks of miscarriage, stillbirth, ectopic pregnancy, premature labour and sterility. They also suffer abnormalities of the womb neck and 40-60% have structural abnormalities of the womb. DES sons have a high incidence of genital tract malformations, semen abnormalities, sterility, infertility and cancer of the testes. Nearly a third have testicular abnormalities. They are also less likely to marry.
And the women who took DES during pregnancy were found to have an increased risk of developing breast cancer, which also occurs at a younger age.
A 1963 Lancet editorial noted that any drug that was effective was also a potential embryo damager and that, "some teratologists (specialists in birth deformities) would not entirely oppose the view that a drug is either a teratogen (baby damager) or a placebo".
The World Health Organisation's report on Having a Baby in Europe remarked that, "The biggest tragedy of the DES story is not that anyone could have predicted the long-term adverse effects of this drug nor that physicians prescribed it in the first place without evidence of its effectiveness, but that physicians continued to prescribe it long after convincing evidence had shown that the drug was useless. The list of drugs dangerous to the fetus grows almost daily, but the gap between this information and the daily practices of health professionals and pregnant women remains wide."
A study in one European city revealed that 82% of all pregnant women had taken medicines, most of them prescribed by doctors. As late as 1985 a Kenyan doctor said she had not known that DES was dangerous as it was still being prescribed to pregnant women at her hospital. And DES was also reported as being used for pregnancy complications in Brazil, Costa Rica, Rwanda, Peru and Zaire.
In 1947 DES was approved for the fattening and caponizing of chickens in the US. In 1954 it was approved as a growth stimulant in cattle, at a dose of 5 to 10 mg daily, and within 3 months 2 million were put on DES-treated feed. Its oestrogenic effects make animals grow to market weight faster and on less feed. This effect is largely achieved by reducing meat quality since more feed is converted to fat, rather than protein. And high animal fat intake has since been found to be associated with the major Western killer - heart disease - as well as diabetes and a number of cancers.
Wild mammals are typically active, lean animals with a total body fat content of about 4% while domestic animals, discouraged from exercise since this would reduce the efficiency of food to flesh conversion, often have body fat levels approaching 25-30%. Also wild animal fat is relatively high in polyunsaturates, commonly about 5 times as much in proportion to saturated fat as domestic animals. Thus domestic animals increase risks of high blood pressure, atherosclerosis, heart disease, and stroke. Diets rich in fat promote ovarian cancer, leukaemia and breast cancer and, by altering bile steroids, encourages carcinogenic bacterial action in the gut leading to intestinal and colonic cancer.
DES residues were found in poultry as early as 1959 and in beef liver in 1966. By 1970 73% of all cattle produced in the US, 30 million a year, were fed on DES. So even women never prescribed DES were probably getting traces of it, along with other pollutants, in their food.

The thalidomide disaster, when pregnant women were prescribed a tranquilliser which resulted in the birth of malformed babies, is a widely known example of pharmaceutical havoc. Promotional material alleged that thalidomide was "completely non-poisonous... astonishingly safe... fully harmless". About 8,000 thalidomide affected children were born in 46 countries and perhaps twice as many died because of damage inflicted by the drug.
One of the clinical testers, Dr Lang, gave high doses of thalidomide to 40 children, most brain damaged, without consulting, or consent from, their parents. One child had circulatory collapse, another died from a congenital heart disease, a baby temporarily lost her vision and a 3 month old died from heart failure. Dr Lang concluded that thalidomide was suitable for use with children.
When cases of peripheral neuritis were noticed the manufacturers told all who related such effects that theirs was the only reported incidence. Even when the drugs full effects became known deformed babies continued to be born since thalidomide was sold around the world under more than 50 different trade names and even doctors were ignorant of whether the drug was actually on sale locally or not.
Thalidomide was pushed in the US by Richardson-Merrell. From 1959 a total of 2,528,412 tablets and smaller quantities of drug containing liquids and powders were distributed to 1,267 doctors. Those interviewed (1,168) had given thalidomide to 19,822 patients and half had no record of the quantities returned or destroyed. Only 276 doctors said they had given written reports to the manufacturer and 102 gave verbal reports, mainly to company reps. The others made no reports at all or did not answer the question. At least 10 thalidomide children were born. In 1971 a Los Angeles jury found Richardson-Merrell negligent and awarded damages of $2.75 million to one thalidomide victim. The drug firm appealed and a secret, out-of-court deal was struck. In less litigious countries victims did far less well. In 1968 blind, deaf, dumb, retarded and partly paralysed Morag McCallum received a paltry £16,000 damages.
In Corporate Crime Braithwaite claims that Fred Lamb, a Richardson-Merrell lawyer, said of the Food and Drug Administration employee who stopped them from marketing thalidomide, Frances Kelsey, "She's a hero. If it hadn't been for her, we'd be out of business." It has been estimated that 10,000 deformed Americans could have been born had Dr Kelsey given in to Merrell's pressure for drug approval.
Even with strong indications of thalidomide's baby-deforming capability the FDA left it to Merrell to conduct a half-hearted recall. Morton Mintz writes in By Prescription Only that as absolute proof was not possible, "the benefit of the doubt in George Larrick's FDA went not to the children who could be spared a life without limbs, but to a drug company with which he was not quarrelling. The benefit of the doubt continued to go to the company even after the FDA knew that it had delayed issuing a warning to most of its thalidomide investigators for three and one half months, even after FDA had declared data submitted by the company on MER/29 fraudulent, and even after all Merrell data had become suspect and put into temporary quarantine for verification."
Thirty years later drug damaged individuals are still battling for adequate compensation for a blighted life. The pressure of coping with disabled children split families and destroyed marriages but the seemingly endless legal fight has probably caused even more damage.
Thalidomide is said to be freely available in Brazil and damaged babies are still being born. In 1994 GRN Jones wrote in the Lancet that, "it is difficult to bring to mind another chemical similar to thalidomide with such severe side-effects, yet for which new applications have been so persistently sought. One wonders how much longer innocent lives must remain hostage to the myth that from under all the horrors and nightmares of the past there is a wonder drug with a golden future bursting to get out."

Before the 1970s Pelvic Inflammatory Disease was usually associated with venereal disease but in 1968 Wright showed a high rate of PID in women using Intra Uterine Devices. It was found that a woman using an IUD was 9 times more likely to develop PID and twice as likely to become infertile as women using other methods of birth control. If she became pregnant while using an IUD, the pregnancy was 7 to 9 times more likely to be ectopic. In the US it is estimated that 250,000 women have become sterile from using IUDs and many of the 200,000 or so women a year who develop PID do so because of IUD use.
The Dalkon Shield, found to be more likely to cause pelvic infection than any other type of IUD, was recalled in 1974 after it had killed at least 17 women. Robins, the manufacturers, had, in 1973, admitted that their files contained over 400 "unfavorable reports", including 75 womb perforations, 28 ectopic pregnancies and at least 1 death. None of this information was passed on and problems with the Shield's design, discovered before marketing, were ignored.
By summer 1985 out-of-court settlements had already cost Robins $378 million, damages awarded in court had gone as high as $9 million, 14,000 lawsuits were still outstanding and nearly 400 new claims were arriving each month. US Federal Judge Miles Lord called the Dalkon Shield "an instrument of death, mutilation and disease". Robins managed to curtail the compensation flood by getting a deadline for claims, by which time 325,000 claims had been received.
As the dangerous nature of the Shield became obvious it was dumped on Third World countries, as dubious contraceptive "assistance" for developing nations. In 1972 Robins had made a large sale of Shields, unsterilised, at a 48% discount, to the US Agency for International Development for use in overseas family planning programs in 42 countries. In all AID bought 697,000 Dalkon Shields for population programs.
Population programs have used bribes of money, government jobs, subsidized housing and higher education to doctors, health workers, and patients to encourage the use of contraceptives and sterilization. As noted in Adverse Effects: Women and the Pharmaceutical Industry the interests of population control bodies and women are not the same. AID in the mid 1970s ranked contraceptives according to effectiveness and urged family planning programs to promote only the most effective methods. The most effective and convenient contraceptives also tend to be the most dangerous to the user (almost invariably the female) and the most difficult to discontinue. Barrier methods pose few known health risks and help to prevent the spread of disease while IUDs and hormonal methods may be much more dangerous and require medical monitoring. Many women in the Third World do not have access to even basic primary health and are unlikely to get adequate medical assessment of risks or counselling from a program which aims only to prevent as many births as possible at the lowest possible cost.
Given the damage inflicted upon American women what, I wonder, was the effect of 697,000 Dalkon shields upon women in the poorest countries in the world, who rarely get regular health care?
Well one interesting fact is that female infertility has now reached 20% in Zaire and the Congo and 17% in the Central African Republic. Dr Koubaka of Brazzaville believes that 70% of this sterility is due to infections or scar tissue caused by infections or botched birth control.
When the FDA refused to approve the injectable contraceptive Depo-Provera, because of side effects, this was also dumped on the Third World and is available in over 80 countries. It can be obtained in Central America without prescription.
The latest variation on implanted contraception is Norplant, said to be effective for 5-7 years. There have been reports from Third World countries, where the clinical trials were done, of absence of informed consent, repeated flat refusal to remove implants and disregard of side effects. It has been suggested that the aim of American birth control agencies is to curb Third World birth rates, seen as a threat to American prosperity, whatever the cost to Third World people. Even in Western countries some women using Norplant have found difficulties in getting implants removed when they suffered unacceptable side-effects, and have sometimes been left with scars. More than 2,300 American women have filed lawsuits in Texas, alleging that they were not properly warned of side-effects, including stroke, massive weight gain, severe headache and menstrual problems, and that many doctors were not properly trained in implantation of the drug. An unusual brain condition resulting in damage to the optic nerve, producing blindness, has also been linked to Norplant use.
Of course if negative effects were consistently ignored during clinical trials how could the manufacturers have warned users about them?
Noting that injectibles are used upon feckless Westerners and Third World paupers Vimal Balasubrahmanyan asks, "why not recruit articulate, well-informed, literate volunteers from the middle and upper classes, who can truly give informed consent, who will be vocal in demanding back-up medical care, and who will reject a drug or device if its side-effects are intolerable? For starters, perhaps the researchers ought to recruit volunteers from amongst their own medical community."
Fat chance!
Pharmaceutical companies use the high cost of research to justify their high profits but $89 (58%) of the $155 million spent world-wide on contraceptive research in 1979 came from the American government. Only about $14 million (9%) was spent by pharmaceutical companies. Most was spent on "high-effectiveness - low user control" methods of contraceptive, with only 2% going to barrier methods of birth control.
The American contraceptive market alone is at least $1 billion a year, 5.5% of the US total pharmaceutical market of $18 billion.

The FDA approved the first oral contraceptive pill, Enovid, in June 1960 and by the late 1970s about 8 million US women were on the pill. Epstein says of this in The Politics of Cancer that "This enormous experiment, in which a nonmedicinal drug was mass-marketed without adequate prior safety testing, took place with the approval of the FDA and an uncritical medical establishment... In this they were aided by a "diplomatic immunity" extended by the press to the pill for nearly a decade after its introduction."
In The Bitter Pill Dr Grant catalogues the many unpleasant effects she found caused by the birth control pill in the "greatest mass pill experiment in history", conducted exclusively on females. Although the experiment was started in the 1950's on both sexes it was soon halted for men when one of them developed shrunken testicles. Unpleasant side effects in the male could not be tolerated but experimentation on females escalated, even when some Puerto Rican guinea pigs died unexpectedly.
The progestogens (called progestins in the US) used are between 1,000 and 5,000 times more powerful than natural progesterone and can have oestrogenic, androgenic or antioestrogenic as well as progestogenic effects. As steroid hormones have the same basic structure with many overlapping effects when a woman's hormone levels are altered other metabolic systems are affected.
Dr Grant found that 9 out of 10 patients developed multiple complaints and 1 in 10 showed life-threatening symptoms and signs. The pill interferes with normal hormonal balance, stress coping mechanism, growth hormones, thyroid activity, food metabolism, liver function, trace mineral balance, salt and water control, immune function including prostaglandin and antibody formation and bone, blood cell and blood vessel development.
Pill users have been found to be at higher risk of divorce, suicide, accidental death and death by violence. Pill use was also associated with depression, headache, loss of sex drive, gall bladder disease, weight gain, heart disease, anorexia, food allergy, respiratory infections, vaginal infections and cervical erosion. Where symptoms are headaches, depression or reduction of sex drive they may be regarded as "neurotic" by the medical profession.
Symptoms developed depend on the balance of hormones in the pill and individual susceptibility to side effects, which can be markedly different - after being given a standard dose of oestrogen women's blood oestrogen levels were found to vary as much as ten fold. As early as the mid 1970's Helton et al noticed a great variability in individual metabolism of pill hormones.
An advertisement for a contraceptive pill in an American journal is followed by the information that, "Serious as well as minor side effects have been reported with the use of all oral contraceptives. The physician should remain alert to the earliest symptoms of serious disease and discontinue oral contraceptive therapy when appropriate. Therefore the physician should be aware of the products full prescribing information, a brief summary of which follows." Overleaf is a full page of small type, half of which is warnings of the pill's association with increased risks of heart disease, blood clots, stroke, gallbladder disease, high blood pressure and liver tumours. In a box a warning in bold type emphasises that the risk of heart disease increases with smoking and age. The risk of serious disease is noticed as being very small - as long as you are under 35, don't smoke and are in perfect health.
As the DES disaster demonstrated, developing tissues are very sensitive to hormonal type drugs and Dr Grant was very concerned about dosing young females, some only 10 years old, with hormonal cocktails. It has now been established that the pill definitely DOES produce an increase in breast cancer when taken long term by young women. The establishment is hoping that this is a premature development of cancer in women who would have developed cancer anyway. If it isn't then in 20 years or so there will be a surge of malignant breasts as the young women prescribed the pill in the 1970's reach the age of high breast cancer risk.
The increase in pill use was accompanied by an increase in cervical cancer, which began to be seen in younger women. It has been said that this cancer increase is due not to pill use but to promiscuity, neatly blaming the victim. However during the nineteenth century London was one of the great whoring centres of the world, with an estimated million women for sale on its streets. The anonymous "Walter" describes in My Secret Life how he fornicated his way across London and Europe throughout the righteous Victorian age. But perhaps high rates of cervical cancer might have been noticed had more of these women lived to reach the age of high cervical cancer risk or even had there been much interest in the causes of their deaths.
For the years 1990-4 the Medline database records only 8 entries for the Index category contraceptive-agents-male-adverse-effects while the same group for women contains 76 entries and the category contraceptive-oral-adverse-effects records 520 references. Because the woman is literally left holding the baby contraception is frequently her sole responsibility, and it is her body alone that suffers the effects of contraceptive hazards. As pregnancy, childbirth and raising children may also be strenuous, time consuming, stressful and hazardous it may be better for a woman to risk the effects of contraception rather than those of reproduction. However she should know the price she pays for her pregnancy control and should be given information on ALL methods of contraception instead of being quickly and conveniently enrolled on the pill experiment.
The risk of blood clotting following many of the low dose pills popular with the Family Planning Association has only recently been acknowledged. The pill manufacturers were not pleased. Although the modern pill contains much smaller doses of drugs it has been estimated that 18 British women die each year because of it and many women are prescribed the pill without being informed of its dangers or being properly monitored for adverse effects. Nearly 200 women are now looking into the possibility of suing GPs and drug manufacturers for failing to warn them of the risks.
Mintz noted that on the subject of possible baby-damaging antihistamines the FDA attitude was "indistinguishable from that in the thalidomide case: when there is, or claimed to be, a doubt, give the benefit of it not to the pregnant woman and her embryo but to the manufacturer. This attitude prevailed although other drugs serving the same purpose... were available and not suspect, just as sedatives other than thalidomide had been available and were not suspect."
A cynic such as myself cannot help wondering if the pill and other drugs released so quickly with little or no proof of safety, and kept on sale in spite of suspicions about their capacity to damage women and their unborn, are so leniently treated precisely because it is merely women that they damage.

Valium has been promoted in a doctor's magazine as producing "a less demanding and complaining patient". A study by the National Institute of Drug Abuse, for the year 1976-77, found that 54,400 US hospital emergency room treatments concerned the use, overuse or abuse of Valium with at least 900 deaths due to Valium and another 200 to Librium.
In the UK 3,500,000 people have taken tranquillisers for more than 4 months and 62% had been taking them for more than 5 years. The tranquilliser was introduced in the same decade as the pill and is prescribed for twice as many women as men, partly perhaps because of the depression the pill can cause, though it must be said that women form the biggest global underdog group, or as John Lennon put it, "woman is the nigger of the world". And depression is a side effect of oppression.
GPs expect women to be depressed and neurotic and frequently prescribe tranquillisers if a woman doesn't have symptoms the doctor can recognise as a physical ailment. In one study two people were presented to a GP with identical symptoms of migraine. The man was taken seriously and sent to a specialist, the woman was told she should get herself a boyfriend and settle down and have children.
The effects of a tranquilliser wear off after a few of weeks and the level of anxiety returns to what it was before. The underlying causes of the anxiety remain untreated and the patient becomes hooked on the drug. Side effects include anger, hostility, tremulousness, fear, apprehension, insomnia, nightmares, suicidal tendencies, brain damage, confusion, birth defects and more depression and anxiety.
In blood taken after accidents sedatives have been more frequently found than alcohol and it has been estimated that tricyclic drugs increase the risk of having a traffic accident 6 fold.
Women are not only twice as likely as men to be prescribed tranquillisers but are twice as likely to be diagnosed as mentally ill as men. It has been said that Ashworth Special Hospital, Merseyside found that 88% of the women detained had suffered sexual abuse. They were first sexually abused by men and then mentally abused and locked up for being disturbed by their mistreatment.
And the numbers of children taken into care increased every year from 1961 up to 1980, as tranquilliser use also appears to be linked with baby battering.

The Medicalisation of Childbirth

Between 1750 and 1850 one of the greatest robberies in British history took place. By 1850 6.8 million acres of land - 4.5 million arable, the rest common and waste land - were enclosed. The small holder, deprived of their meagre livings and common grazing for their pig, was forced off the land to survive as best they could in the city. They laboured long hours in sunless factories and slept in squalid, insanitary slums which did not even have the benefit of the cottage garden to provide a little fresh plant food. In these urban grave pits disease ran riot, the menarche (age at first menstrual period) rose and the life expectancy1 fell.
In the hospitals childbed fever raged. Semmelweis, an unusually honest man for a medic, admitted, "It is owing to the doctors that there is so high a mortality in childbed. As a logical outcome of my conviction I have to acknowledge that God knows how many women I have prematurely brought down into the grave."
Yet in A History of Women's Bodies E Shorter reveals a fall in the London maternal death rate from 14 per 1000 in the years 1701-1746 to 4 in the years 1828-1850. Shorter concluded that labours were prone to complications because they lasted longer but his figures of 1891-1929 show that 93% of births presented normally. Even earlier in the nineteenth century most of those that did not present normally must have been eventually delivered since most women survived the experience, with infection causing the majority of deaths. And before 1860 caesarean section was almost invariably fatal for the woman.
Undernourished, overworked, anaemic, packed in filthy slums, prone to rickets which made them susceptible to birth difficulties, most women still survived childbirth.
Because they're designed to. Mammals, including humans and their ancestresses, have been bringing forth their young for over 50 million years. Birth is, or should be, a natural function, not a disease.
Although there will always be a few individuals who experience difficulties, more today with the medically mediated survival of the less fit such as diabetics, they are still a minority. All other species must, and do, survive birth without medical intervention. They would become extinct if they didn't. And any species with more than minimal birthing difficulties is in evolutionary queer street.
It is therefore obvious that the medically assisted birth should be a small minority and with the much improved sanitation, housing and nutrition of modern western women you would expect fewer birth difficulties, at least for normally healthy women. But in order for obstetricians to gain control of childbirth and pregnancy and eliminate women-midwives, as Diana Scully puts it, "childbirth, whether complicated or normal, had to be considered a pathological state requiring the intervention of obstetricians and their instruments and surgical techniques."
In Dr Mendelsohn's words since doctors are superfluous 95% of the time, "Modern Medicine has had to distort the process of childbirth to create the pathology that doctors will be needed to treat." For the techniques invented by the modern medicine man to make childbirth convenient for themselves make it much more difficult for the mother. Women are stressed by being isolated from their normal surroundings, given unnecessary enemas, ritually shaved for the convenience of the medical attendants, put in the worst possible position to deliver normally, discouraged from even moving, excessively examined (increasing the chance of infection), urged to consent to be drugged which will further reduce their chances of delivering normally, and eventually subjected to ritual episiotomy or even caesarean section. 
And as the World Health Organisation report on Having a Baby in Europe noted, "in most countries a woman giving birth has little choice about the routine procedures to be used during the birth."
When the rituals imposed on pregnant women have been studied they are often shown to be either ineffective or positively harmful. Old doctors' tales you might say.
On enemas and shaving the WHO report recorded that, "These procedures remain in widespread practice despite the fact that scientific study has shown them to be of no value and they are a source of discomfort and humiliation to the woman." In fact as early as 1922 a random controlled trial showed that women shaved before giving birth had more infections than those whose pubic hair wasn't shaved. Yet generations of women continued to be abused and humiliated in this way.
Induction is associated with increased rates of pre-term labour, foetal distress, jaundice, maternal infections and a higher incidence of pain with consequent increased frequency of pain relief and operative delivery. There is no evidence that it reduces perinatal deaths.
Electronic foetal monitoring is not only uncomfortable and restrictive for the woman it may be positively dangerous for the baby. Also because it is difficult to distinguish normal fetal stress during labour from fetal distress, the electronic monitor is often interpreted as showing a problem when none exists, resulting in unnecessary interventions, often ending in unnecessary surgery. Monitoring has been shown to triple the rate of caesarean section.
A randomised trial found that epidurals increased labour times, resulting in increased malposition and increased use of oxytocin and finally increased caesarean section, which rose from 2.2% to 25%, mainly for the indication of dystocia, i.e. slowing of labour.
Monaghan writes of the idea that caesarean section is a relatively safe procedure and almost a panacea for "getting out of trouble" that nothing could be further from the truth (exactly the expression Goldfarb uses to describe the idea that hysterectomy is a relatively risk-free panacea for menstrual aliments). Not only is caesarean section major surgery with the usual operative hazards, including a death rate up to 10 times that of normal birth, drug risks, a high infection rate and the possibility of excessive bleeding resulting in hysterectomy, but Japanese researchers have found that it can cause womb deformity, leading to infertility. From magnetic imaging they found that 14 out of 2,558 women had a pattern of deformity, including elongation of the womb neck, which had apparently resulted from surgery during pregnancy. As only one woman had become pregnant since the deforming surgery it appears to reduce fertility. As Masterson noted the womb heals better after a myomectomy than a caesarean section because of inflammatory changes in pregnancy, womb shrinkage and bleeding problems.
Caesarean sections are also linked with respiratory distress syndrome in the infant, associated with early birth. Some sections are emergencies but studies have shown that 15-33% of cases of respiratory distress syndrome are the result of bad obstetric management.
One study found that a major cause of the increasing c section rate was physician training. Doctors are not taught to assist a labouring woman to deliver. They are trained to inflict high tech interventions upon them.
In the US over 60% of those women allowed to deliver vaginally finish up with an episiotomy cut, in spite of the fact that there is no scientific evidence of any benefit and an Argentinian study found that routine episiotomy is associated with increased pain and healing complications.
In A Woman In Residence Dr Harrison gives the reasons proposed for performing an episiotomy as first, to prevent excessive stretching of the muscles (though this has not been proved to happen) and second to maintain vaginal tightness, presumably for the pleasure of a future sex partner, which sounds strangely like the recircumcision of African women for the pleasure of their menfolk.
Doctors allege that the straight surgical cut is more easily repaired than a natural tear though there is no evidence that it heals better and it seems illogical to inflict injury on all women because some will rip.
An NCT survey found that episiotomy was done unnecessarily and without informing women of what was happening. It made sitting and walking uncomfortable for weeks; sex impossible for months. A Sydney survey found that 3 months later half of women reported that they still had discomfort sitting, walking and having sex.
The WHO report noted that health services fail to evaluate the advice they give to women, such as advising pregnant women to follow a very restrictive diet (a practice followed for decades) and if a procedure is widely practised health workers will often ignore research findings that show that it has no advantages.
Goldberg et al from literature review decided that there was little evidence that bed rest was an effective treatment, though prescribed for many conditions of pregnancy at cost estimated in excess of $250 million a year.
In fact after widespread use some procedures were later found to cause permanent handicap or death to babies. During 1954 the death rate among infants born after premature rupture of the foetal membranes at University Hospital in Birmingham, Alabama, was 29 per 1000. In 1958 infants were given prophylactic antibiotics (chloramphenicol) and the death rate soared to 144 per 1000. When chloramphenicol was discontinued the death rate fell to its previous level.
In the late 1970's an Australian doctor noticed that many cot death babies had been put belly down in their cots. When research established that this position was linked to infant deaths a publicity campaign advising women of this fact resulted in a sharp fall in sudden infant deaths. A Dr Fleming, associated with this campaign, was surprised by the hostile response he received - not from grieving parents but from members of the medical profession. The advice to put infants belly down had been given by health professionals and many unnecessary premature deaths caused by this bad advice. But instead of acknowledging this fact they attacked those who revealed the truth.
There are few who can, like Semmelweis, acknowledge that their bad practices and ignorance have been responsible for deaths or damage to those they were supposed to be caring for.

The WHO report found that, "The present intensive pursuit of a lower mortality rate for babies in industrialized Europe means that approximately 990 women and their babies out of 1000 are subjected to extensive, intensive and expensive clinical procedures in an attempt to save the 10 babies who die. And although they are undoubtedly helpful for some of these 990, there is little evidence that these clinical procedures will help most of the 10 who die or the large majority of the 990. There is even evidence that social care is at least as helpful."
The report also noted that, "Many countries go to great lengths to discourage home births: regulations that pay the services for institutional birth but not home birth; prosecution of midwives assisting home births; prosecution of couples having a home birth; withdrawal of professional care for home birth; threats to physicians who support home birth."
In fact the President of the American College of Obstetricians and Gynecologists referred to home delivery as "the earliest form of child abuse" and it has been said that American paediatricians reported women to the State authorities on charges of child abuse for daring to give birth at home. Pressure from the legal and medical professions against home birth remains oppressive yet for a woman with an uncomplicated pregnancy it has never been scientifically proven that a hospital is any safer than the home to have her baby. And child abuse more often follows hospital than home birth, especially a difficult delivery with high levels of medical intervention followed by separation of the mother and baby.

Mendelsohn says of hospitals, "I have always told my patients that they should avoid hospitals as they would avoid war... After working in hospitals for most of my life I can assure you that they are the dirtiest and most deadly place in town."
One result of hospitalised birth was serious infectious epidemics with many deaths sweeping through the nurseries for normal newborn. Another risk was that of infant mix-up, with years of distress and legal wrangling following after women were given the wrong babies to take home. Child abduction is yet another hospital complication.
Up to a third of hospital patients suffer from iatrogenic (treatment caused) damage, as both drugs and tests can harm patients. In 1974 it was said that adverse drug reactions in the US already accounted for $2 billion in medical and hospital costs and 30,000 deaths a year but the death toll is disputed and some claim that it could be as high as 130,000 for hospital-induced reactions alone.
Besides being plagued by dangerous and exotic germs, and dangerous drugs, hospitals are renowned for their poor food. Stephen Fulder points out that, "Despite the considerable body of knowledge that exists on how food and vitamins support health and recovery hospital diets are impoverished. They are especially low on certain vitamins, such as C, and minerals such as zinc." Moreover, "While in hospital nutritional needs are higher. Drugs destroy vitamins, stress uses them up and antibiotics can prevent them being absorbed."
Women are being forced to deliver in these places, not for their safety or convenience, since in most cases it is not in their best interests to do so, but as a recognition of the importance, power, and influence of the medical profession. And of the subjugation of the mere female to its caprice.
The male-dominated medical campaign to take birth out of the home and the hands of the midwives and place it under its control in the hospital has succeeded. In 1991, 98.1% of US births took place in hospital and midwifery is not only virtually forbidden outside hospitals, in some areas it is actually illegal. Yet America is well down in the infant mortality league and 1991 figures show 21 countries with lower infant mortality rates than the US, including Japan, Netherlands, UK, Greece, Singapore and Hong Kong.
In the Netherlands 36% of babies are born at home and half of hospital births are attended by midwives. But the Dutch mortality rates for both mother and baby are among the lowest in Europe and the caesarean section rate, at 6-8%, is half that of Britain.
And in Japan 42% of women are delivered in small units, some run by midwives, where high tech births are rare. Japan has the lowest perinatal mortality in the world.
To attempt to put birth risks into perspective although the US does not have the best infant mortality record in the world in 1992 only 170 babies died as a result of birth trauma, half the number (355) that were battered to death in first year of life, and a fraction of the number (4,660) that died of sudden infant death syndrome.
Many women believe the days of medical tyranny in childbirth are gone but the vast majority of Western births are still hospitalised, chemical and surgical interferences continue unabated and the British caesarean section rate is still rising, from 13% in 1992 to 14.6% in 1993.
Dr Collier points out that an obstetrician "of the old school is the oracle of all medical wisdom: any unsolicited utterances, questions or opinions from mothers-to-be are a waste of his valuable time." Women are taught that they cannot give birth themselves. It's something that has to be done for them by well paid medical professionals, who never assist but manage the event to suit themselves. As most women are not medically qualified they are regarded as unfit to cope with childbirth, even their own, and are virtually practising medicine without a licence if they do so. A few doctors would even like it to be a legal offence for a woman to deliver her own child. In fact in England having a baby without attempting to involve a professionally qualified person is illegal and Brian Radley, who delivered his son, was taken to court for illegal midwifery by the District Nursing Officer who said he couldn't be allowed to get away with it because other couples might try it. And where would medical professionals be if the pregnant female found that she didn't need their expensive intervention?
If this seems an excessively cynical view it was claimed, in the 1982 Lancet, by J M Goldenring that obstetricians in the US refused to take part in a trial of home births versus birthing-center births and midwife- versus obstetrician-attended births because they were afraid to face the economic consequences had the trial shown they weren't really necessary. In 1995 Howard Blanchette wrote of a clinic for poor Californian women where nurse midwives provided a delivery service as good as that of the gynaecologists private practice. Other doctors reported similar results. Delivery by nurses was no more hazardous than by doctors, and the poor women had a much lower caesarean section rate, which the doctors all ascribed to the private patients having a much higher proportion of older mothers, and not to their doctors being only too keen to cut them up. Many doctors want nothing to do with the unprofitable poor and are only too glad to palm them off on a hospital based midwife who is ultimately under the thumb of the medic. However they dont like even the slightest hint that their total monopoly is being eroded and Dr Loring remarked that in setting up such a clinic, "Probably my biggest hurdle was obtaining hospital privileges for the certified midwives."
The trauma caused by medical insistence on a medically managed birth is shown in the case of a woman sent home in labour (because of hospital bungling) who gave birth without medical assistance but was terrified, praying "Please don't let me have the baby here!" She had been so conditioned by medical hype that taught her that she was an incompetent who must have her delivery performed by "professionals" that when she was left to cope by herself what should, and could, have been a thrilling, natural event became a traumatic "nightmare".
Male domination of pregnancy and birth continues unabated. In 1993 a woman insisted on staying in a water bath to have her baby. Instead of physically dragging her out of the water or leaving her to it the midwives helped her deliver. The head of obstetrics at the East Hertfordshire Trust, who had decided that water births were not safe, called the midwives who had allowed this to happen to heel and gave them a sound thrashing. When they appealed the Trust's administration backed their obstetrician. The chief executive said that if the woman wanted a water birth she should have gone to Harlow for it, whose health professionals do not share Hertfordshire's quibbles about safety. The woman involved had been told that she would be expected to hop out of the water for the actual delivery - but only after she had booked at the hospital.
Some women don't get to hospital and manage without the drugs, the rituals, the surgery. It's strange that the only difficulty most appear to have is the distress they feel from not making it to the medically designated place on time and usurping the work of the medical staff who expected to manage the birth.
Yet not all doctors are imperiously certain of the role of interfering modern medicine. Ms Scully relates that "a very famous obstetrician once said that the obstetrician's single most important tool is a large cigar. You sit down and smoke it and let nature do her work".
Unfortunately most modern doctors appear to be non-smokers.

And does this traumatising of birth really matter? Well, Professor Raine discovered in a Danish study of 4,200 men that 22% of the serious violent crime was committed by the 3.4% who had suffered both birth complications and parental rejection. He suggested that there had been dysfunction or damage in the prefrontal lobe, which is known to be involved in the control of aggression, and suggested that lack of good parental care made recovery from birth trauma much less likely. Yet for decades the western management of birthing women has been to upset them as much as possible with rituals subsequently found to be not only unhelpful but often positively harmful, do everything possible to undermine their confidence and then isolate the baby in a nursery to further alienate it from its parents.
Dr Harrison's verdict on the American medical birth was that it was "pornographic. The woman is degraded. The physician intimidates her and forcefully takes from her both the act of birth and that which she herself has nurtured... The whole experience today was like taking part in some great sacrificial ritual in which women come forth and sacrifice themselves and their newborns."
In the US many people are concerned by what seems to be escalating social violence. A woman is beaten every 12 seconds, 25-45% of them pregnant. Six million woman are beaten in their homes each year, 20% of women who attempt suicide are driven to it by battery and 1 in 5 women have been raped.
Coincidence? Or are some newborns wreaking revenge on the women who allowed their sacrifice?

Here a Cut, There a Cut

American medical schools expanded in the 1960s and the supply of obstetrician/gynaecologists increased from 15,984 in 1966 to 25,215 in 1979. Yet after 1960 the birth rate was dropping while the rates of hysterectomy and caesarean section increased. In the US the caesarean section rate rose from 4.7% to 25.7% over the years 1968-1988, due to an alleged increased frequency of dystocia (arrest of labour), and between 1970 and 1975 alone there was an increase of 24% in the number of hysterectomies. The US National Center for Health Statistics found that surgery increased by 25% during the 1970s (from 77 operations per 1,000 people to 99 per 1,000), paralleling the increasing number of surgeons.
Have surgery rates gone up to ensure that doctors will still get a living by performing surgery more often on the reduced numbers of patients available? Or is some of it done so that the surgeon can plan his day without the inconvenience of delivering women out of office hours?
Though the optimal caesarean rate proposed by various authors has ranged from 6.0% to 11.7% the actual rate was found to vary from 2% to 22% within different hospitals in NY state.
In 1986 the Northwestern Memorial Hospital, Chicago, whose patients are mainly white and solvent, tried to reduce their caesarean rate of 27.3% by encouraging vaginal birth after caesarean, producing guidelines on when to section and circulating c-rates of doctors within the medical profession. Private patients had a higher c-section rate which declined from 30.3% in 1986 to 20.8% in 1991 while the rate for clinic women declined from over 20% to 11.4%.
Myers and Gleicher have stated that individual section rates above 15% are almost always excessive. And at this hospital it was noted that the behaviour of some doctors contributed to the high incidence of caesarean birth in private patients. For the range of individual section rates was 5.2%-42.3% in 1988 and 6.5%-41.1% in 1991. That is although the overall rate of c-section fell the individual range was unchanged and at least one man was still slicing open 4 out of every 10 pregnant women he got his hands on.
Zahniser found that women with private insurance were more likely to be sectioned than women without insurance and, in Massachusetts, Haas et al found that providing health insurance to poor women brought an increase in their chance of being sectioned but no improvement in their health. It has also been found that obstetricians are 3 times more likely to section than family doctors. This suggests that, as Mendelsohn noticed, women are sectioned because they go to a man who does sections. Whether this is because the individual likes surgery and does it as often as possible, because he dislikes having his day disrupted by birthing women, or because he likes the fee he gets I would not know. However the Northwestern hospital might have produced a lower c-rate if the doctors' section rates had been circulated to the pregnant women involved instead of just to members of the medical club.
Besides the risks to women's health, caesarean sections cost at least 50% more than normal births and Finkler and Wirtschafter suggested that insurers should consider paying a flat fee for obstetric services. The money men have taken this advice to heart and Blue Cross decided, from July 1995, not only to pay a flat fee for obstetric services but to pay a bonus if a sectioned woman subsequently has a normal birth.
One doctor said that high caesarean rates were the consequence of doctors being sued if the baby was damaged after a natural birth. He suggested that medics who gave evidence against obstetricians in such cases were responsible for the excessive section rates. However in the Northwestern study the perinatal death rate also fell from 19.5 to 10.3 along with the reduction in c-section rates. Studying a community hospital Sepkowitz found that the 5 fold rise in c-section rate between 1968 and 1987 contributed little, if anything, to reductions in foetal and neonatal death rates. And soaring section rates have had no effect on the incidence of cerebral palsy, which had not changed for 30 years.
During the 1980s the caesarean rate in Dublin's National Maternity Hospital was 5.8% while in Kumasi, Ghana, the section rate increased from 6.7% in 1981 to 9.1% in 1989. As the Ghanian maternal mortality rate was over 1% it is clear that higher rates of c-section do not mean safer births for the women involved. And according to Scheller and Nelson there is no published evidence that caesarean delivery is safer for the neurologic well being of the infant.
It is interesting that although a male will not be operated upon without his consent many in the medical profession will unhestitantly operate upon a woman who refuses a caesarean. The wellbeing of a man's child is of far more weight than the health or wishes of a mere woman. This was noticed by Michelle Harrison during her time as A Woman In Residence in an American hospital, where a nurse said of a woman "She has no right to make that decision, and even if she refused a section, we had the right to operate." As late as December 1993 Chervenah was expounding the right of the medical profession to forcibly slice open women who refused a caesarean section.

One of the hazards still insisted upon by the medical profession is shaving. This does nothing for the patient, except humiliate them. More than twenty years ago Seropian and Reynolds showed that wound infection rates rose from 0.9% in patients whose hair was not shaved to 2.3% in shaved patients. Cruse and Foord found the same infection rates. They also found that where infection was not present before surgery it was contracted by the patient during surgery, not afterwards, and that the rate of infection differed significantly between surgeons; that is poor surgical technique is responsible for some infection. How much is not known since although the writers printed figures on infection related to type, time and length of surgery, use of diathermy, age and complicating ailments of the patient and preoperative hospitalisation, the surgeons' infection rates were so confidential that even the figures were concealed.
For as Ms Scully puts it, "although patients are the object of considerable social, psychological, and medical research, some of it drug-related and dangerous, physicians are reluctant to subject themselves even to mild scrutiny."
In The Unkindest Cut: Life in the Backrooms of Medicine Marcia Millman writes that "professionally sanctioned justifications and excuses for mistakes are ritualized in institutional ceremonies such as the Medical Mortality Review Conferences." She found that "although the avowed purpose of these meetings is to review mistakes and prevent their recurrence, in actuality the meetings are organized and conducted in ways that absolve the doctors from responsibility and guilt and provide the self-assuring but somewhat false appearance that physicians are monitoring each other and their standards of work. In case after case physician errors are systematically excused and justified, and their consequences made to look unimportant."
In cases where physical findings were overlooked, or discounted, the patient was blamed, being "discredited" as crazy, acholic, obnoxious, uncooperative, or otherwise difficult or undeserving. After much was made of one dead patient's "drunkenness" it was revealed that her blood alcohol level was, in fact, measured as being zero. Even after this lie was shown up the doctors continued to blame the woman's death on her own anger and abusive language completely ignoring "the possibility that such behaviour was appropriate for a woman dying in great pain while the doctors around her treated her complaints as the fabrications of a hysterical alcoholic."
As Ms Oakley noticed, "Peer review is a notably inconsistent and unreliable method of quality control, depending more on friendship networks, status-perceptions and plain patronage than on a stable evaluation of scientific principles."

Medicalising the Menopause

Old age is a product of civilisation. In nature the adult animal that cannot support itself is doomed. However modern human manipulation of their environment means that people now survive long past their use by date and suffer the effects of aging. Both men and women undergo hormonal changes associated with increasing years and as the female hormonal cycle is so much more complex so its collapse is more spectacular.
But the male also shows progressive failure of gonadal function. The total amount of testosterone in the blood falls and active testosterone levels fall even more, by about 1% per year between the ages of 40 and 70 years. Loss of androgen is likely to have effects on muscle, fat tissue, blood cell formation, bone, the nervous system and sexual function.
This male aging has been called the "andropause". And there has been some faint suggestion that it be treated with hormone supplements. In The Change Greer writes that at the Eighth IPPF Biomedical Workshop "the learned gentlemen kicked around the idea that encroaching male apathy could be staved off by dosing with testosterone, but this suggestion was thrown out because of the danger of suppressing endogenous testosterone secretion, and of increasing the risk of myocardial infarction and prostatic hyperplasia. The contrast between this conservatism with regard to their own ageing bodies, and their radicalism when confronted with the problem of female loss of interest was marked."
Female aging is called the climacteric and is, as Kase put it, a prolonged period between the ages of 40 to 70, just the same period as the male andropause. During this time the total amount of sex hormones produced falls and the balance changes. The menopause itself is the period during which bleeding stops as the cycle of changes in the womb lining is halted by falling oestrogen levels. 
During the final fertile years, the premenopausal period, there is a fall in the number of ripening eggs and the level of the gonadotrophin FSH rises. While some cycles may be normal some develop no egg at all and in others the ova are overstimulated and ripen early leading to underdevelopment of the yellow body, a fall in progesterone and increase in oestrogen. At this time there is an increase in abnormal womb conditions, both benign and malignant. As the hormonal balance is disrupted women may experience irregular bleeding, polyps, overgrown womb lining, fibroids, mood disturbances and hot flashes, though individual symptoms are variable with about 10% of women having none at all. Finally egg production ceases and oestrogen falls to low levels while levels of the gonadotrophins, FSH and LH, remain high.
However the menopausal ovary increases its output of androgen and Kobayashi et al suggest that it may even still secrete some oestrogen. With increasing age the level of androgen slowly falls and the ovaries shrink.
The decrease in oestrogen is associated with increased risks of heart disease and a fall in bone mineral level, with increased excretion of calcium. And there are an increasing number of medics who regard the menopause as a deficiency disease to be treated by more hormone cocktails. Promotional campaigns of "Feminine Forever" induced 5 million menopausal US women to use oestrogens regularly and by 1977 Premarin was prescribed for about 13% of all women aged 45-64.
However the effects of this treatment are as dubious as those of the birth control pill. Mendelsohn advises, "Don't accept the assurances of a gynecologist that the menopausal symptoms can be managed by using estrogens such as Premarin. They can't always be managed with estrogens, and the estrogens themselves expose the patient to a new set of risks."
Although the drug dosage levels of HRT are lower than those of the contraceptive pill they still provoke unwanted effects in many women. In a study of 34 women using oestrogen patches 5 stopped using them within the year because of side-effects. When Which magazine did a telephone survey of 307 women between the ages of 45-54 they found that a third, 108, had used HRT and 45 had stopped using it, most because of side effects including continuous bleeding, breast tenderness and bad headaches. Varying the type or dosage of treatment may help but a few women had tried different brands of HRT and none was acceptable.
The majority of studies of HRT are directly funded or supported in some way by the manufacturers and while there seem to be many studies on the relative effectiveness of different HRT or pill treatments, the only side effect given much consideration is irregular bleeding - the most frequent reason given by women who stop pill treatment. Work is done on making pill taking more acceptable, rather than investigating its safety. Strangely an Australian journal concluded from studying 847 women aged 15-69 that women on HRT were more likely to experience oestrogen deficiency symptoms associated with the menopause than those not on HRT and another group found that counselling was not only as effective as HRT but had a lower drop-out level, presumably because of the absence of physical side effects.

Some women also find that the menopausal symptoms they have deferred through taking HRT return with increased vigour when the hormones are stopped and they become HRT junkies.
For women with a womb taking oestrogen alone caused an increase in womb cancer and progesterone is now always given to intact women. However progesterone tends to counteract the beneficial effects of oestrogen on blood fat levels, which is the reason for suggesting that oestrogen protects against heart disease.
Embedded in the small print of a HRT advertisement in June 1995 was the information that the risk of endometrial cancer in woman taking unopposed oestrogen was 2-12 times greater than non-users, increasing to 15-24 times after 5 years use. It also noted that although progestins may prevent the risk of endometrial cancer their overall effect on health was not known. Although Drs Studd and Norman can confidently assert that "There are extensive data suggesting that hormone replacement therapy (HRT) is effective.. in protecting against the chronic cardiovascular and cerebrovascular consequence of oestrogen deficiency" in their advertisement for their products the HRT manufacturer is forced to admit that "A causal relationship between estrogen replacement therapy and reduction of cardiovascular disease in postmenopausal woman has not been proven." The apparent protection from heart disease comes from the fact that the women who could afford HRT were richer, slimmer, fitter, healthier and generally more pampered than the American masses.
HRT doubles your risk of developing gallstones, the risk increasing with longer time of use and higher doses. And Orlander et al studying 3,616 women aged 50-69 found that oestrogen use was associated with an increased risk of urinary tract infection in intact, but not hysterectomized, women.
However there is some evidence that HRT will reduce the chance of developing cancer of the colon, possibly due to its effect upon bile products which leads to increased rates of gall bladder disease.
In Hysterectomy: Before and After Dr Cutler believes that it is possible for every woman to find a hormone replacement program which is just right for them. She says that, "Your ideal HRT regime will be a highly individual design based upon a balancing of factors: your individual needs for cardiovascular and bone protection; cancer risks if you are in a high-risk group; the risk of gallbladder disease; and the way your body reacts to one hormone or another. An optimum regimen should make you feel good and should result in good bones, cardiovascular health, and healthy sexual functioning...
As you and your physician plan an HRT regimen, you will need to consider both your immediate health needs and your long-term health plans."
She advises the use of hormones chemically similar to human oestrogen and progesterone rather than the powerful synthetic varieties and writes casually of getting a bone scan done every 6 months or so. The more natural hormones are more expensive, and your chance of getting an individual program, tailored to your own health needs, on the NHS seem to be somewhere between remote to non-existent. As Germaine Greer writes the type of HRT you get from your GP "has more to do with the effectiveness of the latest medical salesman to visit him than with any objective evaluation of the suitability of any particular system for your particular case. Even if your doctor knows that "women are not all alike", there is no way he can assess how they differ. He can only write a script and ask you to tell him how you get on."
Few women are likely to get a single bone scan, never mind a regular one on the NHS. Moreover bone scans are not very accurate, bone mass may not necessarily be directly related to bone strength and regular exposure to radiation is not good for anybody's health. It has even been suggested by a professor of molecular and cellular biology that 75% of breast cancer cases have been caused by medical x-rays and radiation doses given during Mass Chest x-ray campaigns are said to have been high. However breast cancer has also been linked to the high fat levels in the Western diet and chemical pollutants, such as Lindane, which are fat-soluble.
When the hazards of taking oestrogen became obvious the manufacturers stopped pushing the alleged cosmetic advantages of HRT and concentrated on its effect on bone strength. While hormone replacement is being given there is a definite halt to bone mineral loss. However as soon as the hormones are stopped the mineral loss starts again and it is not yet known whether taking HRT for 6-10 years after the menopause reduces bone fractures in women over 70, which is when most osteoporotic breaks occur.
Complications of osteoporosis are the 12th leading cause of death in the US and osteoporotic fractures kill more women than breast cancer, so for a woman who intends to survive for at least her three score and ten this is a serious consideration. However the relationship between oestrogen and bone strength is not a simple one. Oestrogen treatment combined with exercise produced better bone health than oestrogen alone. Oestrogen and magnesium also gave better results. As far as I'm aware oestrogen, magnesium and exercise has not been tried. It has been found that medieval women over the age of 50 had lost about 20% of their bone mass compared with those under 30, a pattern of bone loss similar to those of modern women. However medieval bones showed a lack of the wrist and hip fractures suffered by modern osteoporotics. As modern rural Mayan women also showed reduced oestrogen levels, and bone mineral loss, without evidence of osteoporosis it seems possible that it is physical exercise of bones, rather than simple mineral level, that maintains bone strength.
It may be significant that fluoride treatment has been found to produce definitely denser bones which were, unfortunately, more likely to break.

Unsurprisingly diet has been found to have an effect on bone strength. High protein intake (more than 120g of protein a day) may stimulate bone resorption and encourage long term bone loss and heavy meat eaters lose almost twice as much of their calcium as do vegetarians, especially after the age of 50. Caffeine, alcohol and carbonated drinks all increase the urinary excretion of calcium. Also the amount and kind of fats consumed affects calcium absorption while some chemicals naturally occurring in plants have an oestrogenic effect that may reduce the effects of menopausal oestrogen loss.

For many women HRT relieves symptoms of the menopause but as many women seem to swear at it, as by it. And anyone who thinks getting HRT is uncomplicated should read Sally's experience in Hysterectomy - The Positive Recovery Plan. Castrated at the age of 29 because of ovulatory pain she not only found that hormone treatment was anything but simple but it also brought back her PMT.
If HRT proves no help during the menopause you can at least stop taking it but when the ovaries have been surgically removed from a young woman she must take oestrogen to prevent heart failure and osteoporosis, as well as the severe menopausal symptoms she will almost certainly suffer. She may find that the disease symptoms that she has lost with surgery are merely replaced with symptoms from her hormone medication and if she is to get effective HRT treatment she will have to go to a specialist menopause centre where an endocrine expert may find a concoction which is effective without being awful.
Some horsey people are also concerned about the manufacture of HRT drugs, involving as it does the extraction of hormones from the urine of thousands of perpetually pregnant mares, housed in the equine equivalent of battery hen houses.
In 1992 10% of British women over 50 were taking HRT and the market was worth about £40 million. In the US there were 13.6 million HRT prescriptions in 1982 and 31.7 million in 1992, making Premarin the most frequently dispensed brandname pharmaceutical in the country. The drugs were prescribed mainly by obstetrician-gynaecologists and it is estimated that between 17% and 25% of US women are on HRT, probably due to American enthusiasm for female castration. I can't help wondering if this neutering is some sort of sly revenge on the American matriarch. They may survive their spouses, but by the great gods of medicine, they won't survive intact.
Removing entirely the organs in which they specialise, by castrating the women they hysterectomise, the American doctor produces patients, especially the younger ones, dependant on long term oestrogen prescriptions, maybe even for life. What other field could entirely amputate their organs of interest and finish up with a permanent patient? This must be a capitalists dream come true.
The American Fertility Society has decided to include the menopause in its field of interest, noting that the menopause brings women to the doctor, thus providing an opportunity for "medical interventions to improve health." Or perhaps opportunities for medics to further medicalize female life and perhaps make a few bucks more.
Shingleton and Hunt, authors of Postreproductive Gynecology, which is concerned with the "gynecologic health of all women 40 years of age and older", remark that "Women consume a disproportionate amount of the health care resources." With increasing medicalisation of their lives is it any wonder?

Bleeding Women

As Greer put it, "the endocrinology of femaleness has never commanded sufficient attention or sufficient funding to make a tenth of the advances made in, for example, sports medicine." And it has been sourly noticed that although there is effective treatment for cancer of the male gonad, the testis, that of the ovary still has the same poor outcome that it had 30 years ago.
The menstrual cycle is complex and highly variable, and not only differs considerably between individuals but changes during a woman's lifetime.
The mean menstrual cycle decreases from 35 days at age 12 to a minimum of 27 days at 43 and then increases to 52 days at age 55. From a review of 13 studies up to 1966 normal blood loss was found to range between 17-69 ml. More than 90% of the blood loss occurs during the first 3 days so that flow may be excessive while the period length remains merely average.
Fibroids are the commonest cause of heavy bleeding, rarely disturbing the cycle length so menstruation is regular. But for half of heavy bleeding cases no cause is found. Moreover abnormal bleeding may be due to unrelated disease like hypothyroidism, anaemia, vitamin deficiency or inadequate food intake. Higham and Shaw found that a woman with an underactive thyroid had a menstrual blood loss of 480 mls. After being treated with thyroxine for 2 cycles her blood loss fell to 58 mls. Unfortunately she returned a year later saying that her flow was heavy again and was routinely hysterectomised without any menstrual measurement being done. Her excised womb appeared normal.
Psychological problems or stress may be responsible for heavier periods and if the true source of pain is not found a woman may finish up with her original complaint merely added to by complications from her unnecessary hysterectomy.
Dr Cutler makes the point that in the years before the menopause, changes in the ovarian cycle mean that hormonal patterns are altered, and cycles may produce no mature egg or no yellow body. At this time many women experience an associated change in their bleeding pattern and may bleed more heavily than they used to. Yet an increase in menstrual flow does not always mean an abnormally heavy flow and many women are hysterectomised because of a "heavy flow" which is well within normal limits. On the other hand a study of 20 anaemic Irish women found that 12 with excessive blood losses, averaging almost 300 mls a month, did not think their menstrual flow heavy.
Women's perceptions of what is a heavy loss are very variable yet it is quite uncommon for menstrual loss to be scientifically assessed before proceeding to irreversible mutilation.
The usual way to accurately assess the amount of blood lost is to collect all the sanitary protection used, extract the blood in alkali, estimate its strength and so calculate the amount of blood present. This is tedious, and therefore expensive, and rarely done.
Gleeson et al states that many women find collection of sanitary wear unacceptable and "laboratory staff find the menstrual extraction procedure unpleasant and time-consuming." People who spend their time analysing blood, piss, shit and spit find menstrual flow "unpleasant"!
Do they fear it will curdle their beer?
However in 1990 Higham and Shaw produced a pictorial chart, based on the numbers and saturation of sanitary protection used, which gave a reasonably accurate estimate of actual blood loss. And, as Best magazine pointed out, it is quite easy to get an idea of how heavy your menstrual flow is if you use tampons. These often give the amount of fluid absorbed and this divided by the hours taken to soak a tampon will tell you how much you are losing an hour. If your super plus tampon is lasting less than an hour you are very likely menorrhagic.

As the Scamblers note, "Gynaecologists are principally orientated towards the uncovering of diseases: they show a marked reticence in defining normal menstrual phenomena". But as normal menstrual events are not well understood the abnormal cycle is even more of a mystery. Germaine Greer writes that, "the defect that disfigures all gynaecological investigation" is that, "we do not know enough about the well woman to understand what has gone wrong with the sick one. Gynaecologists are actually like motor mechanics who have never worked on a car that actually went."
Farquhar notes that, although it is common, heavy bleeding has often been poorly researched. Field writes that heavy bleeding is poorly understood and tends to be unsatisfactorily treated. Higham and Shaw remark that little has been reported concerning heavy, irregular or painful periods, and that blood loss estimations are rarely done in spite of the fact that neither medical nor surgical treatments are risk free. Paula Weideger observes that even though menstrual pain is a monthly experience for many women, relatively little research has been done on a cure.
And on endometriosis Booker writes that its natural history is uncertain, its precise aetiology is unknown, the clinical presentation inconsistent, and its treatment poorly standardized.

There may be some effort to treat menstrual bleeding, though this seems to be frequently half-hearted, superficial and unscientific. In The Magic of Magnesium Dr Trimmer tells of Majorie, who having heavy periods for 4 years from the age of 44 was on several occasions treated to the "have a hysterectomy" solution pushed at her by her GP. This is the experience of very many women.
Benagiano wrote that, "Since the first successful report of myomectomy in 1845 treatment of uterine fibroids has been exclusively surgical." and Healy & Vollenhoven also noted that "The management of women with fibroids has traditionally involved surgery." This applies to most female ailments. 
Ms Scully found that gynaecology residents were mainly interested in learning and doing surgery. They were certainly not interested in preventative medicine. She concluded that the interests of the profession conflict with the real health care needs of women. In fact, Scully found that "women suffer not only from diseases and malfunctions of their reproductive organs but also from damage inflicted on them by physicians and the health care system." And it was not surprising that doctors performed unnecessary operations, since that was what they were trained to do.
Though it has been shown that, besides its effect on cardiovascular disease, a third of cancers are affected by diet the medical profession shows little interest in the part diet, vitamins and minerals play in the development of female disorders, or in fact any disorders. As Dr Konner remarked in The Trouble with Medicine "despite the great emphasis on molecular science in medical school, little is taught about diet, one of the most powerful ways of changing the molecular processes of the body."
Dr Harrison found the same disinterest in anything other than surgery and writes of a speaker on nutrition in pregnancy from the school of public health that, "His talk today was exciting, but was met with general hostility by the attendings (doctors), who tend to disregard any aspect of pregnancy except drugs and intervention."
There is a definite link between fat and fibroids. And progesterone seems to halt their development. But there is no advice given to women on how they might avoid fibroids or possibly control them if they do develop. And I found no evidence of any research on this subject either.
Although there are a few drugs which will reduce fibroids the usual treatment is to ignore them until they become big enough, or their symptoms severe enough to hustle their unfortunate owner into a convenient hysterectomy, and maybe a castration as well. Medics are only to pleased to concentrate on cutting women up, instead of actually investigating the causes of their conditions. This is seen by the medical profession as an excellent way of dealing with all female complaints. No wonder Lofts states in the British Journal of Obstetrics and Gynaecology that, "Information on the outcome of hysterectomy for different indications, as compared with alternative treatments, is virtually absent and in particular there is no evidence derived from randomised trials.
Population based evidence on survival after hysterectomy is scarce, and any cost-effectiveness of the procedure has been based on hypothetical rather than empirical life tables." 
And though female castration is increasingly popular among male medics, Schwartz concluded that there is a lack of well designed epidemiologic studies evaluating the risk factors for ovarian cancer and effect of castration at hysterectomy.
It seems that widespread female mutilation and castration is seen as the best solution for women not because there is any scientific evidence for it being so but because a male medical profession cannot see any reason why a person would need an inferior, non male organ.
Gould asserts that, "Unquestioning adherence to established practice, and an undue reverence for received wisdom, are important causes of much unnecessary and possibly harmful medical intervention". Has the medical view of the female reproductive system actually changed since the Middle Ages or are female organs there just to be excised by medics and experimented on by the drug companies?
For the strange thing is that while the woman with an abnormal condition is likely to finish up on the operating table, losing part or all of their reproductive system, the healthy woman is likely to be treated with drugs to "correct" her normal biology.
She will be drugged with the pill to control her reproduction when young, subjected to medical scrutiny when pregnant, have her birthing managed with all kinds of chemical and operative interferences and finally have her menopause treated with HRT.
Her normal existence is treated like a disease and her is disease treated with amputation.

Modern Medicine is not concerned with normal female biology. It studies abnormal conditions and then instead of trying to restore the normal situation looks for what it can rip out. There is little attempt to effect a medical cure and no attempt to prevent complaints developing.
Hysterectomy is a mainstay of gynaecological practice. It is what most gynaecologists do - frequently. It is performed because the gynaecologist is trained to do it, the gynaecologist is paid to do it and the gynaecologist wants to do it. The condition of the patient, physical or mental, is often the least factor to be considered.

Postscript

Based on the current state of ignorance of female biology in 1992 Spicer and Pike came up with a theoretical treatment they calculated would reduce the risk of ovarian, endometrial and breast cancers. All that was necessary was to totally replace the normal menstrual cycle with a synthetic hormonal program. And why not? After all that's what man has been doing for the last 30 years with the contraceptive pill.
For God made man in his own image but woman was made from man's rib. So man feels quite entitled to alter anything he doesn't like or thinks he can improve on.


1 In 1847 life expectancy in Liverpool was 20 years- in rural Ulverston it was 41 years.