“6 Crazy Things People Used to Believe About Vaginas" - from HuffPost

Whenever I get frustrated about the lack of knowledge in our society regarding female anatomy, or the poor care that is so prevalent regarding women's health, I need to be reminded of stuff like this. Seriously? Educating women would harm her reproductive organs? Vaginas have TEETH? Women can't get pregnant via rape? Are you kidding me?

The insanity of this misinformation could only come out of a very sick society.

This underscores for me the importance of supporting women's rights and women's health across the board, nationally and internationally.

Many facets of women's lives have improved dramatically in only a few generations, at least in Europe and the United States - enough so that feminism is sometimes seen as passé, a battle that was fought and won in the 70's - but don't let them fool ya. We still have so much farther to go.

Despite the fact that most women and mothers are in the paid workforce today, they still do more household chores and childcare than men and fathers. The US still hasn't had a female president. In the US women only earn 66% of what men are paid for the same job... The list of inequalities goes on, and touches every aspect of our lives.

Is it any wonder that we receive poor health care?

The lack of research and knowledge about women's health is part of a much broader problem of deeply ingrained sexism and misogyny (and rascism, homophobia, rising income inequality, class divisions, the rich world's poor treatment of refugees and immigrants...) across the world.

All of humankind has a lot of work to do to make our world a place where all people are valued.

Hopefully women and men will continue to work for gender parity, and the gains we make professionally, politically, and personally will influence the world of medicine as well.

Until then...? Well, I'm feeling a lot like the angry face at the top of this post.

“How Medical Care is Being Corrupted''

There was an article in the New York Times, "How Medical Care is Being Corrupted," that caught my eye this week.

The two author-physicians write about how the policies and expectations of insurers, hospital networks, and regulatory groups are created to get good-looking statistics which then undermine the ability of individuals to obtain the most appropriate care.

"For example, doctors are rewarded for keeping the patients' cholesterol and blood pressure below certain targets. For some patients, this is good medicine, but for others the benefits may not outweigh the risks."

The authors go on to note that these risks are not insignificant, and may include an increased risk of developing diabetes - no small problem - and increased fractures and falls amidst the senior population. 

Physicians are not awarded based on giving the best care to each patient. Instead they are financially rewarded and receive better online reviews if they meet the targets, and are financially penalized and suffer negative online reviews if they don't meet the targets.

These are not the only financial incentives out there. Insurers will pay bonuses to doctors for using preferred medications, even if those aren't the best option for a patient.

The creepy thing about this is that it's done behind closed doors. A doctor who was frank with his or her patients about the influences swaying his or her decisions would surely be fired.

* * *

The authors acknowledge that some health policy experts "argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the populations as a whole."

Huh? How is having sick people get sicker best for the population as a whole?

The authors come out strongly against this ideology, stating that "Physicians should never have an incentive to override the best interests of their patients." I agree.

* * *

The posts from this week all have a common theme of how the government and corporations (both medical and consumer goods) are powerful influencers in our medical care system, which frequently does not have our best interests at heart.

From the World Health Organization's fact sheet on the right to health:

• The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being... 
• The right to health means that States must generate conditions in which everyone can be as healthy as possible...

It is ironic that here in one of the most powerful and wealthy nations on the planet we have completely failed to "generate conditions in which everyone can be as healthy as possible."

(While this post focuses on the medical care system itself, our nation has also failed on many other counts to create healthy conditions for people. For instance, we subsidize corn which then gets made into corn syrup which then feeds the epidemic of obesity and diabetes. Our cities are made for cars, which creates excess pollution and contributes to our sedentary society, again contributing to our nation's health crisis. The list goes on, and it is way too big to address here in this post.)

As frustrating as all of this is, the take-away for me is, again, that I need to be in charge of my own health as much as possible. Yes, I will continue to use doctors in my care, but I will weigh their advice carefully. 

* * *

This comment of mine begets a topic for another blog post: I am able to do this only after years of practice, and I have the benefit of citizenship, being a native English speaker, having a college degree, and health insurance.

How can a system this backwards possibly be serving the people who need it most?

These perverse incentives serve a few in the short term, but they are shooting the nation in the foot long term. Not only does poor health get in the way of an individual's "Life, Liberty and The Pursuit of Happiness," but it is a huge drag on the economy.

Those who claim that the bottom line should be the metric by which we measure success should have the business savvy to realize that a sick nation is not a firm foundation for financial reward.

“Underwareness": When Corporate Ad Campaigns Trump Education

Have you seen the "Underwareness" print ad campaign for Depends?  It features models fully dressed on top while wearing nought but Depends adult diapers (and for the ladies, high heels) on the bottom, with the slogan "I dropped my pants for Underwareness."

It is accompanied by a flashy website detailing events such as their launch party and fashion show (featuring Depends) and encouraging people to share the campaign on social media outlets, with the incentive that for each post, tweet, or link they will donate a dollar to charity (United Way and the Simon Foundation for Continence.)

I am so cynical about this.

Why?

NOWHERE on the site does it say that incontinence is treatable. Instead there are links to pages where you can purchase Depends or get a free sample.

Always the optimist, I hope that the effects of the campaign are not all bad. It will perhaps assist in de-stigmatizing a common health problem (incontinence affects 25% of the American population, according to Depends.)

Another point in it's defense is that the purpose of corporations is to make money - why shouldn't their marketing campaign dollars go to marketing their products? 

And yet it is frustrating that our knowledge of health and anatomy is so limited in our country that most people don't know incontinence is preventable and treatable, which allows an ad campaign like this to thrive.

* * *

Consider just one contributor to incontinence: pregnancy and delivery. I couldn't easily find statistics on the rate of postpartum incontinence in the United States* - an indicator of how little we value women's pelvic health here - but anecdotally it is common for women to chalk up incontinence as an unavoidable and untreatable result of carrying and birthing the next generation.

Just yesterday I was eating brunch at a kitschy restaurant with various witty sayings on the wall ("Tis better to have loved and lost than to live with a psycho the rest of your life!"), including one that read "I laughed so hard tears ran down my leg!" That wouldn't be viewed as funny if stress incontinence was known to be curable.

Another common cause of stress incontinence is athletic pursuits. In a YouTube video from 2013 made at the CrossFit Games, athletes laugh about how they pee during workouts and competition, and brag that it is a sign of intensity. The video even feature a gynecologist who claims that "In my professional opinion it is okay to pee during double-unders." (Double-unders are when you jump rope, but swing the rope under your feet twice before landing.)  

Yikes. This is a disturbing example of miseducation regarding pelvic health. When even doctors don't know the facts, how can we expect people to know that continence is an attainable goal?  

Thankfully various physical therapists wrote in response to this video, to educate people that incontinence is indeed a dysfunction. You can find some of the many responses on MoveForwardPt.com, PhysioDetective.com, and PelvicGuru.com.

* * *

I understand that the Depends promos are advertising and not a public health PSA, but I am angry that they take on the veneer of an educational campaign when they are not. This is a blatant example of a company putting the bottom line ahead of the wellbeing of their customers, made even more insulting by putting forward a calculated image of "do-goodery."

Yuck.

It is frustrating that this supposed do-goodery (Spread the word! We'll donate when you do so!) encourages people to share the ad campaign by making them feel like they are promoting health when they are not.

Another gripe: the ad campaign is, like many ad campaigns, sexy and fun. While humor can go a long way in making people comfortable with taboo subjects, since when are health problems sexy and fun??!! 

"Hey baby, let's make love, and don't mind if I unintentionally urinate on you - it's hot."

How on earth is that reasonable? By framing a health problem this way it ignores the very real suffering of the people struggling with it, and makes it seem that help is not available, necessary, or desirable.

* * *

So the Depends campaign is out there, but surely there must be substantial alternative resources where the public can find accurate and complete information on treatment options?

There's a long list of possible treatments listed on the Simon Foundation's website which may be worth a gander. I'm not a medical professional and can't speak to their efficacy, but I'm wary since not only is the website pretty shoddy and not appear to represent a robust organization, this Foundation is apparently willing to take loads of money from a corporation who will benefit from them not doing their job. 

Is there perhaps a better place to direct you to? Interestingly enough, the Google searches "incontinence research," "incontinence education," and "patient education incontinence," turn up not a single first page result for an American organization dedicated to incontinence research and education. (There was an Australian one, sponsored by the Australian government - they have nationalized health care.)

While there are results from reputable resources as the Mayo Clinic and the National Institutes of Health, there are also plenty of sketchy ones.

It is disturbing that such basic health research and information is not prioritized, funded, and made easily available to the public.

* * *

What to do?

• If you or a loved one is suffering from incontinence, check out the Women's Health Section of the American Physical Therapy Association's website. They have a PT Locator where you can find a local PT who specializes in either urinary and/or bowel incontinence. Again, I am not a medical professional, but it's a start.
• Tell me if you are aware of any other reputable resources for continence treatment; I'd love to share them.

And... tell your friends not to drop their pants for "Underwareness," but rather to

Drop your pants for a solidly trained PT.

* * *

*FYI I did find one small study from Norway that was published in the International Urogynecological Journal of Pelvic Floor Dysfunction in 1999 that showed 48% of women had symptoms of incontinence during their pregnancy, and 38% after delivery. The abstract concludes not that pregnant women should start wearing adult diapers, but that "This documents the needs for a strategy to prevent and treat urinary incontinence during these periods." 

Denial Gratitude vs Genuine Gratitude

During my yatrayoni I have come across a line of thinking in which people are grateful to their illness because it supposedly changed their lives for the better. While I appreciate that they could see that good came with the bad, the concept never sat right with me, and I didn't figure out why until recently. 

This approach does not give credit where the credit is due:

to the individual, not the illness.

This "denial gratitude" denies that a challenge was put forth to the individual, denies the role of the individual in overcoming that challenge, and denies the grief and loss that are inherently part of the process.

I am absolutely NOT grateful to my vulvodynia. Nope, nope, nopity-nope. Wouldn't wish these things on anyone, and certainly not on myself.

But I am endlessly grateful for my response to my illness.

By being brave and persistent and compassionate and curious I have turned this challenge into a great learning experience. I used it as an excuse to cut the bullshit out of my life, and make choices that brought me closer and closer to happiness and meaning.

The illness didn't rescue me, I rescued myself.

Owning my power is a refreshingly strong place to be. By giving the credit to myself I do not fall into the trap of erroneously attributing good to evil, or believing that I am dependent on outside forces to fix my life. 

The fact of the matter is that pelvic pain SUCKS.

Good can come from it, but only if I make the decision that it will.

Talk Back: “Nurses, Not Doctors, are the Future of Medicine" ?

I was hoppin' around LinkedIn today and came across this article by Dennis K. Berman, Business Editor of the Wall Street Journal, entitled "Nurses, Not Doctors, are the Future of Medicine."

If you don't feel like reading the entire (short) article, the gist is this: technological advances are taking over the role that doctors play - diagnosing and creating an appropriate treatment plan. But caring and empathy are still important parts of the healing process. Therefore, nurses - who, let's be honest, do more caring and empathy work than doctors in the allopathic world - are the future of medicine.

From the article:

Perhaps this will be a small and strange change of our technological future: A world that venerates the nurse's credo more than the doctor's intellect.

My response: I agree that empathy and caring are an important and irreplaceable part of the healing process.

However - in our current system, nurses are under pressure too, and often don't get the time required for true caring relationships to blossom. The "nurse's credo" is succumbing to the pressures of our dysfunctional health care system.

Is caring dead? No.

In my experience and opinion the reason alternative and complementary care have grown so rapidly in this country is that skills such as listening, respect for the patient's strengths, and creating a healing partnership are front and center in most of these paradigms of care, in a way that does not exist (or has been lost?) in Western medicine. These paradigms take caring and empathy to a new level, flattening the hierarchy of the allopathic medical model and positioning patients as the drivers in their own care, with health care providers performing the roles of educator, consultant and supporter.

I have a thought to share with Mr Berman.

Why not use the exciting technological advances of medicine outlined in the article to free up healthcare providers to prioritize and further develop this emerging model of "caring," the amalgamation and refinement of the skills I mentioned above?

Yes, healthcare does and should include calming nervous family members and doing the dirty work of changing sheets and dealing with blood and urine, as Mr Berman describes, and there will never be a replacement for doing that in a loving, compassionate manner. And yet - our theory of what caring is and what it can accomplish can be so much more.

Even if we place an emphasis on this new, more robust model of caring, I do not believe that doctors need leave their intellect behind. Their intellectual power has led to the creation of much of this emerging technology, technology that plays a crucial part in the improvement of health outcomes; technology that is a form of caring in and of itself.

I propose this:

If we as a nation develop and support a new paradigm of caring, and unite it with a continuously growing body of knowledge, we can create a more powerful and successful medical system than any that has come before us.

Instead of nurses being the future of medicine,

Caring is the future of medicine.