Bioethics Discussion Blog: Sexism in Modern Medicine: Advantages, Disadvantages, Cost and Justice

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Saturday, October 20, 2007

Sexism in Modern Medicine: Advantages, Disadvantages, Cost and Justice


Is there sexism in modern medicine? Many people know there was in the past and many people still think, despite laws and some changing cultural beliefs and some actions, that sexism in medicine persists. To get a full picture of extent of the concerns people have on sexism in modern medicine, I would advise my visitors to first go to the Women’s Studies listserv and read both pages posting the subscribers’ comments. The subscribers are generally professionals and present what I think is a rather balanced, informative and civil discussion of the issues. My visitors should then return to this blog and write their views on this general topic focusing on areas that they think should be changed or improved.

As I moderate this blog thread I will accept discussion of virtually all facets of whether there is sexism in modern medicine except one. That one is sexism as related to patient modesty issues. This topic is currently being well covered in my thread “Patient Modesty: A More Significant issue”. Please don’t write to that topic here but go to the Modesty thread where your comments will be welcomed.

As examples of topics which could be covered, what do you think about the roles and employment of nurses with regard to gender… the gender differences, if any, in preventative medicine or medical research… stereotypical views of the professional behavior of one gender vs the other… and so on? The discussion of sexism on the listserv noted above was in 2000, that’s 7 years ago as I develop this thread. Is there documentation of societal or professional changes since then? Any improvements?

I look forward toward a discussion of the facts and the opinions on this subject of sexism in modern medicine. ..Maurice.

The graphic on this page: I hope everyone recognizes, as public signage, the graphic could represent a public expression of sexism. Has anyone seen such a sign with a woman on it?

28 Comments:

At Saturday, October 20, 2007 10:41:00 AM, Anonymous Anonymous said...

I would argue that it is absolutely still sexist, in a variety of ways and for a variety of reasons. One of the arguments made in Dr. Bernstein's link about men being discriminated against was that in Canada, the PSA test is not funded and costs money, where mammography and cervical smears are. This is not universally the case, and in fact in New Zealand and Australia any and all ordered bloodwork (including the PSA) is free of charge, where anything that includes a consultation with a medical practitioner (such as mammography or cervical smears) does attract a charge in New Zealand, and is likely to attract a charge (dependent on your choice of practitioner) in Australia.

I would argue that in the US with the wage gap men are also more likely to have access to the PSA than women are to female-specific health care (given that access is tied to insurance, and insurance is tied to employment in the US -- however, if someone can confirm or deny this, I would be interested to know if my assumption is true).

I would also argue that the PSA is an example of sexism in healthcare -- a blood test has been developed for something men found uncomfortable, and yet pap smears and mammography are still accepted as the gold standard. Only recently has a test for HPV been developed at all, and it is only available for women, as is the HPV vaccine (as was the rubella vaccine until relatively recently). Despite the fact that we could wipe out certain strains of HPV in the community, we choose not to because cervical cancer is a women's problem. I have to wonder if gender roles were reversed, whether girls would be being vaccinated to prevent the future health of boys -- I have to think the answer is yes.

I won't even get into the fact that women's medical records are not private in New Zealand because a male doctor managed to misread a substantial number of cervical smears, nor the non-consensual cervical cancer experimentation done on women right up into the early 80s, but these are further examples of sexism in medicine, to my mind.

Much of the sexism in medicine is inherently tied in to the sexism in society ("children are a woman's responsibility" leads to birth control being a woman's responsibility, for example). I am aware that men face a different set of struggles to get adequate healthcare (it would be really interesting to have some data about preventable disease morbidity and healthcare sought), and that I have spoken very much from a woman's perspective. I apologise for not being able to present a more balanced discussion; I do not know any men with as much interest in or experience of the topic as me (perhaps because as a woman my body is more medicalised from a younger ages than a man's in the same society, I don't know). I look forward to hearing viewpoints from men on this topic.

-- PG

 
At Saturday, October 20, 2007 11:11:00 AM, Blogger Maurice Bernstein, M.D. said...

PG, thank you very much for your posting. Particularly, thanks for presenting views of your side of the world. I think that this is the valuable parts of an internet blog, world coverage. That means, when we have a discussion on the internet, we can read the experiences of people from many different countries and cultures around the world..not just for us in the U.S.A., the American way of life. Especially with regard to sexist ideas and practices, I am sure there are differences in other countries and other cultures and to read about these differences here would be very enlightening. ..Maurice.

 
At Sunday, October 21, 2007 7:45:00 AM, Anonymous js md said...

PG, your concerns are valid that there are no simple screening tests for many women's diseases, but I doubt that it is sexism. If anyone could come up with a simple blood test to screen for breast cancer et al it would be an instant hit and very profitable in our profit motivated society. I doubt that the lack of a simple test is due to lack of effort or concern. And there are plenty of institutes looking into women's health issues with women researchers (though I don't offhand have data).
From a male perspective, it is obvious that women's health issues are emphasized over men’s. Few hospitals don't offer a women's center or breast center. Not many offer men's health. Just look in the phone book and you will likely find many times the numbers of women's health centers advertised versus men's. I'll refer you back to the list serve for data (likely out of date) to compare the annual funds invested on male vs. female health issues. There are many important and prestigious national societies emphasizing women's issues, but few for men. I can't name any.
This is not to deny that there wasn't substantial sexism 50-100 years ago in the USA. But the scene is radically different now.

 
At Sunday, October 21, 2007 1:54:00 PM, Blogger Maurice Bernstein, M.D. said...

js md, If it would not be appropriate to call the difference as due to "sexism", nevertheless hasn't there been a difference in the diagnosis and treatments for coronary artery disease, so that women have been underdiagnosed and undertreated as compared with male patients? ..Maurice.

 
At Sunday, October 21, 2007 3:57:00 PM, Anonymous js md said...

Dr B, I know that there have been many studies and claims about unequal treatment of women who have coronary disease versus men. The major claim is that their symptoms are ignored or taken less seriously. The major physiological difference between the sexes is that women are on the average 10 years older than men when they present and that of course makes a profound difference in treatment. Older patients frequently have multiple problems and do not benefit from therapies that are completely appropriate otherwise. And younger women frequently have atypical symptoms that are indeed more difficult to diagnose. So it is possible that they are indeed missed more often. But the claim that sexism is behind this is very doubtful. I've seen no evidence that cardiologists treat women differently than men when other factors are equal. This may sound like a cynical view, but the truth is that cardiologists have no incentive to turn away business from women, the remuneration is the same. Cardiovascular disease is a major killer of women, but unlike men, a larger number of the deaths are in the elderly and it doesn't have the impact that cancer of the breast has for instance.

 
At Sunday, October 21, 2007 6:19:00 PM, Anonymous Anonymous said...

I can only present from a patient level vs clinical and thus is somewhat basic. Several things from the blog struck me. It has long been known that males die years younger than females, and to some degree this is just accepted as the way it is...it does not draw near the national media attention that breast cancer does. The budget for breast cancer and other women only issues is multiples of prostrate and male only aliments. In as much as, and forgive me I forget the number males are much more likely to have or die from heart attacks than females, that could account for more attention to male heart issues, I understand that is now changing. Now on a strictly observational point, the number of female Dr's has been increasing to the point where over 50% of the medical students are female. There was a real effort to improve what once was a serious embalance. There was an effort to make references gender nuetral, focus and discussion on the issue, and at least in the small college I went to, there was a real effort to encourage females to go into medicine. A large portion of the care in the medical setting is provided by nurses, tech's, etc. and while we have a severe nurse shortage, there has been no such effort to bring males into the nursing field despite the fact that less than 10% are males. This seems to be a bit sexist that a gender embalance wieghted toward males as Dr.'s was an issue and while an embalance in nurses favoring females has had little to no attention at all. If a balance in genders is deamed beneficial for Physicians is deamed beneficial, why then would not a corresponding balance in nurses and other providers be desirable. If you watch TV or read magazines and newspapers, how many nurses are male?
I recently watched a newscaster (female) giggle during her male partners report about prostrate screening suggesting the DRE was needed as well as PSA and many men were avoiding that part of the screening. When he looked at her and said its not really funny, she smirked, snickered and said sooorry. And that was that, had it been reversed and the male newscaster laughed about a report on breast cancer screening...think he would have been around long? No doubt in the past females have been shorted and not treated equally or fairly, anyone that thinks it isn't so must be blind. However in an effort to make things fair, in many cases the pendulem has swung to far of center the other way. JD

 
At Monday, October 22, 2007 4:25:00 PM, Anonymous Theodore said...

The pendulum metaphor seems a bit off. Certainly, our medical system has both anti-male as well as anti-female issues. Because of this, I am also not sure if I can accept PG's argument, if I am reading it right, that since there is a wage gap we should deliberately use more health care funds to cover female conditions. As soon as we get into the realm of compensation things get more so tricky and complicated to balance. Should men get more funding since they are more likely to contribute to the nations military? No. Funding should be distributed based on efficacy and need, and as was mentioned in the link more resources should be made available just not at the cost of those for female conditions.

There is certainly a double sided disparity between females being over prescribed with medications while males need to suffer through without healthcare. Usually, I would instantly discount any sort of biological justification for a gender stereotype, though in terms of medicine it seems wishful and over-idealistic to always ignore the gender of the patient. Hypothetically, for some things treating the sexes differently might be appropriate. It's just that separating those issues that are truly biological from those that are primarily sociological is a really tricky business and we should precede cautiously on a case by case basis.

 
At Monday, October 22, 2007 8:52:00 PM, Anonymous Anonymous said...

JS MD, I would argue that your saying women present with "atypical" heart attack symptoms is an example of sexism in medicine -- medicine is only now beginning to understand that a heart attack looks different in women than it does in men, and calling women's symptoms atypical is making the male heart attack a standard.

I am interested in all the comments talking about how women's health issues receive so much more funding and more attention than men's; like the poster in Dr. B's link (sorry Doctor, I hope you don't mind me abbreviating your name) I think that this is a direct result of a struggle by women to get these issues recognised, and that if men want their issues to be campaigned on, they need to campaign and raise awareness. I'm not saying that letting the court of public opinion (and, to a certain extent, public wallets) determine what gets funded is right, but that is the way it is at present, and we can either change the system completely (ideally) or men need to be their own movers and shakers.

I would argue that there are also different attitudes to the form and function of women's bodies than of men's, in the medical profession. It was announced yesterday that the Australian government would pay $400 for the cost of a breast implant for women who have had medical mastectomies -- not nearly enough to actually get the implant put in place. This same government, however, pays for drugs for erectile dysfunction, and they certainly pay for therapies so that a man can get an erection after prostate surgery. In the US, medicaid funds viagra (scroll down to May 23 2007), but not emergency contraception.

JD, while I agree that it was completely inappropriate for the female newscaster to giggle about men not getting their DREs, that isn't a problem of sexism in medicine, that is a problem of men not getting the necessary health checks. And while I am certainly not justifying her laughing, I know that many women consider the DRE only fair after their years of cervical smears etc.

I'm not arguing that men do not get unequal treatment, but I don't actually believe this is a result of sexism per se -- women's diseases are widely known about because women have campaigned for that, and only now are we beginning to see men asking to have their diseases put on the map (no, they shouldn't have to ask, but neither should the women have had to 20 years ago). Men die younger, but it would be interesting to filter the statistics for sex-linked health concerns (for example haemophilia, which in NZ is much better funded than, say, rheumatoid arthritis, a disease that affects slightly more women than men), and for reckless behaviours (or better, do a lifestyle paired matching and see whether women really live longer when men adopt their lifestyle). I would be interested in hearing examples of differential treatment purely in the basis of gender...anyone got any studies?

--PG

 
At Tuesday, October 23, 2007 1:27:00 AM, Anonymous Theodore said...

I do agree with most of your points; and there are dozens of sexist issues that you seem to have well covered. However, using emergency contraception as evidence is a bit harsh. The vast majority of NIH and the AMA are in support of it, and sadly only a few appointees of George Bush have kept it down. You also seem to be passing the ball in terms of DRE onto the shoulders of the general public to raise awareness, yet seem to be making doctors responsible for the funding decision of politicians. All doctors need to take care of the entire population, and they are responsible for not just the well being but should also guide their choices. General practitioners should be convincing their male patients to have routine DREs. PG, what do you think is the next step for medicine? Any tips for a young soon-to-be med student? Likewise, the shorter lifespan of males would need to be addressed by very intricate and complicate mechanisms, Dr. Bernstein, what ways do you think that medicine could address this issue?

 
At Tuesday, October 23, 2007 8:31:00 AM, Anonymous bob koepp said...

I think discrimination on any but medical grounds is bad for medicine. But with that as a criterion, one needs to look critically at some of what is touted as "health care."

For example, emergency contraception is hardly ever medically indicated. And, yes, viagra is also being prescribed for non-medical purposes. That doesn't mean these things shouldn't be readily available. But forcing them into a "medical mold" distorts perception and understanding.

Also, we should avoid the trap of thinking that one abuse of medical authority justifies another abuse. That doesn't correct errors; it just compounds them.

 
At Tuesday, October 23, 2007 10:32:00 AM, Anonymous js md said...

PG, you raise a valid question concerning heart disease and women, "Do we know what's typical for both men and women"? Unfortunately women's atypical symptoms have no clear pattern and it would be very difficult to identify them by history. They are not unique to women. The incidence of heart disease in young people with atypical symptoms is small, and the problem is difficult. It is not sexism that causes it.
The example of the woman broadcaster giggling about prostate cancer is indeed sexism. Society and many men don't take men's health issues as seriously as they should. Women laughing about it are part of the problem. JD is very right that a man would be fired for laughing about breast cancer.
But saying that DREs are fair revenge is outrageous. We are talking here about promoting equity, justice and good health for all; it has nothing to do with getting even.

 
At Tuesday, October 23, 2007 1:25:00 PM, Anonymous Anonymous said...

In response to PG's comments, I'd hardly consider the PSA an an example of sexism in health care. You might find it interesting that unlike mammography & PAP tests, which have proven benefits, the USPSTF has given both the PSA & DRE an I recommendation. Essentially their conclusion is that there is no evidence that the potential benefits of prostate cancer screening outweigh the potential harm.

To contend that no new developments have been forthcoming for women's diseases is, IMHO, patently ridiculous. Thermography is a technology that shows great promise in the detection of vascular formations that are the precursor to breast tumor growth, and is especially applicable for younger women whose denser breast tissue can make mammography less effective. Likewise, the new HPV test shows great potential, and although it does require a smear sample like the PAP, it may significantly reduce the frequency of testing to as little as once every 3-5 years.

I completely agree with JS MD's post earlier today, especially the last sentence. It's not about getting even or men versus women, it's about doing what's best for everyone.
TT

 
At Tuesday, October 23, 2007 8:48:00 PM, Anonymous Anonymous said...

PG you comments make my point. This should not be about getting even, it should be about getting it right. Justifying a wrong by bringing up another wrong serves absolutley no positive purpose for anyone. I have acknowledged more than once females have been unfairly treated in the past, no question. All justifying current sexist actions with past transgressions does is validate the transgressor's actions to them. If the male newscaster had laughed at a story about breast or cervical cancer I would have thought him to be a jerk. The very point I was making is mens health issues are often not taken as serious by society, thus men themselves do not address them. WE do not feel society will accept our concerns so we keep silent. I do not enjoy the thought of the women in my life having to go through a gyn exam just because I have to go through a DRE, that is just plain wrong. Are we to try to even everything based on past transgressions, should we send thousands of women to die on the battle fields of the next war to even things out? Sorry but your response makes my point, when we look at an issue, and say it is wrong or right without concern for gender, race, or religion...then we will be heading in the right direction.......getting even never solves anything, it only esculates and devides. Why is it that when a male brings up an issue such as sexism it has to be a contest of who has been wronged the most and in order for a male to make a claim of unfair treatment it has to mean the issues women face are some how diminished? JD

 
At Wednesday, October 24, 2007 10:55:00 AM, Anonymous js md said...

We've probably panned JP's comment enough, but it's actually worse than we've stated. But JD is right that it's a typical reply from a woman ?feminist. No wrongs were involved. A woman needs a pap smear period. There's nothing wrong with it.
You might as well propose that because women have to go thru labor pains, men should be given cramps.
Men and women will never be fully equal until someone figures out how to let men conceive and give birth. Don't hold your breath for that.

 
At Wednesday, October 24, 2007 5:17:00 PM, Anonymous Anonymous said...

Hold up. I do not think DRE's are "fair revenge". I also did not say I think they are, but that many women think they are. Please, do not attack me for the reality of what many women think. Is it right that women think that way? Absolutely not. How can this perception be changed? Develop non-invasive, non-painful ways of testing for women's health issues (or at least be visibly seen to e working on it), and treat HPV as a whole population problem, instead of a women's problem.

Theodore, I am certainly not arguing that more funds should be devoted to women's healthcare in the US as a result of the wage gap -- just pointing out a possible source of inequity as a result of sexism. There are a lot of other people who do not have adequate access in the US, and as an outsider, I can't possibly comment on that. However, as a young soon-to-be med student, I would ask you to examine your own attitude to women and women's bodies regularly, and make sure it stays in line with your attitude to men and men's bodies. The other thing I would ask you to do is pull up anyone you hear (for example) writing a woman off as hysterical or "difficult" when she responds with anger or tears to some facet of her medical care, or writing a man off as "recalcitrant" or "pigheaded" because he is resistant to seeking or accepting medical care -- in other words, fight sexism whereever you find it.

I would suggest a move away from sex-specific health conditions in this discussion, because everyone is (clearly) dissatisfied, and we're not comparing apples to apples. I think we're much more likely to understand the extent of sexism in medicine by talking about the care for the same conditions in different genders. I'll start with this story, which demonstrates that it was as recently as 2005 that we understood that aspirin didn't prevent heart attack in women, because women had never been studied. It was simply assumed women's bodies behaved like men's. Recently research has begun looking into how standards of treatment proven to work for men work for women, but I think we have a long way to go. To me, this is an example of a sexist facet of medicine that is only just now being rolled back.

--PG

 
At Wednesday, October 24, 2007 9:49:00 PM, Anonymous Theodore said...

Good advice. I would agree that being gender neutral requires diligence to perpetually question and asses one's own behavior for sexist actions. This is as opposed to simply putting on gender blinders and pretending like one simply doesn't see the sex of the patient. Thanks you.

As I previously mentioned, it is hard to distinguish exactly which health conditions are sex-specific. As it was taught to me during my ER volunteer service (from a respectable, but elderly white man), woman do show different symptoms for heart attack. So I ask whether heart attacks are sex-specific? We might idealistic desire for all heart attack patients to be treated identically; although this may fly in the face of reality. Furthermore, even without a biological reason some sex disparities exist as a result of cultural reasons. Elderly men tend to be much less talkative, and due to this cultural reason might not as easily display characteristics of a stroke. If your patient was grunting would you be more or less worried if they were male or female? Likewise, homosexual males are much more likely to acquire HIV then homosexual females. The biology is relevant, but the cultural baggage should be dropped. And yet, the cultural implications can be very useful for diagnosis and care, and that trumps gender equality. To me, what exactly constitutes a "sex-specific" condition still seems mighty fuzzy.

Bringing in gender biases in medical research, is a relevant ball of knots to untangle. I don't think it is as simply as you describe. Often times men are intentional chosen since the researchers are worried about subjecting patients who are unknowingly pregnant to something risky. (As an aside, how do you ethically test the safety of new pharmaceuticals for pregnant patients? Can the fetus consent?) However, should men bear the burden of being the guinea pig for all pharm tests, and is this the fair price to pay for not having to bear children? Does that help either sex, or medicine in general? How do we know when to question the assumption that the male and female body respond equally to the same medications? Can it ever hold? Should pharm tests thus necessarily include both genders? Do both genders even volunteer equally? How should the results be presented? What if we are worried about it interfering with birth control? Would the woman unfairly be forced to be abstinent? Would they be subject to repeated pregnancy tests, and would this be an unfair invasion into their privacy? I have no clue...

 
At Thursday, October 25, 2007 6:59:00 AM, Anonymous Anonymous said...

Theodore, you raise some interesting points, and ones I had not considered. Certainly I can see your point that there is an element of gender in many health conditions' presentations that may not be linked specifically to gender, and that some conditions require different treatment based on gender (for example aspirin does not work as well for women as for men).

I am of the opinion that pharm tests for medications that are going to be used in the general population should include both sexes; the aspirin example (sorry, too lazy to go find another one) shows that we need to test medicines in both sexes to be sure they are effective for both sexes. I believe excluding women on the basis of a pregnancy that might happen is discriminatory, and even slightly insulting to a woman's intelligence. Of course women (ideally) should not get pregnant with unknown drugs in their system, and if there is concern about the drugs affecting their birth control they should be advised to use alternative methods (for example IUD or partner vasectomy, if partner is willing -- and some of the women volunteers may either be singe or in committed lesbian relationships, both of which are fairly low pregnancy risk). That said, if a woman does get pregnant while on a trial medication, the only way that is any business of the researchers is if they would like to exclude her from continuing the study. In the end, regardless of the risks, the decisions about the pregnancy are hers to make, IMO.

Unfortunately I know the answer to how medication tends to get tested for safety in pregnancy: It becomes a wide-enough-spread use that some women get pregnant while they are on it, and then (if they don't report adverse fetal or perinatal effects) doctors become less paranoid about women being on the medication while pregnant. Certainly this is what has happened with the use of 6 mercaptopurine and azathioprine for autoimmune conditions that strike women during their childbearing years.

--PG

 
At Thursday, October 25, 2007 10:16:00 AM, Anonymous Anonymous said...

PG I did not mean to say YOU said it was fair, but the fact that it is the thoughts of "many females" feel this way indicates part of the problem. Further developing a less invasive way to do pelvic exams really has nothing at all to do with DRE's. To think that inorder for some people to not think DRE's are fair revenge it to develop a different Pelvic exam...what about the guys who really have problems with DRE's, should we feel in order for them to have a more healthy view of what women experience in pelvic exams, we should find a less invasive procdure...while the PSA is a step, no one that I know of says discontinue DRE's if you are having PSA...I hope they come with a less invasive way for both exams, but to connect them is counter productive. If an attitude of action is sexist, it is sexist regardless of who it is for or against. JD

 
At Thursday, October 25, 2007 2:00:00 PM, Anonymous js md said...

OK, PG, you did say that 'some women' consider rectal exams fair play for pap smears, but you didn't say that you were excluded from that company. But no matter where your opinions place you that is much of the sexism we see in the USA. (I don't know where you're from, but most of my comments refer directly only to the USA. I can't knowledgeably discuss what happens in most other countries.) Many women don't take men's health concerns seriously unless it is their immediate family. No male broadcaster would dare make fun of a women's health issue.
I think you have a very unfortunate tendency to prejudge every sex difference in medicine as sexism without looking at the reasons for it. I'd have to review the original work on aspirin and heart disease to see exactly how it evolved, but you're still not fully correct in implying that aspirin is of no use for women. It is of use in preventing secondary heart disease, that is recurrences in both sexes. The study you refer to involved asymptomatic older women only, without known heart disease.
The truth is that medical research is very complicated and VERY expensive. This study had 40000 women in it. One doesn't start by doing a large expensive study on women only, one needs to gain evidence first that you've found something worth studying and then looking into the almost endless possibilities to pin down more specific effects. It's not discrimination against children that most drugs aren't studied originally in kids. They are a special case. Pregnant women are even more special. Researchers start with small samples to find promising venues to study and then hone in on it. But the money is not available to study every permutation. The federal government used to subsidize most research in this country. Now it comes from drug companies who only invest where they see a chance to make a profit. It is true that early studies in most areas used men assuming we were all the same. It's not an evil first assumption, but like many assumptions it's not adequate. Society and medicine evolve.
Good luck in premed.

 
At Friday, October 26, 2007 7:37:00 AM, Blogger Maurice Bernstein, M.D. said...

Moderator’s Notice: Because of the need to meet the responsibilities to my medical students which trumps the responsibilities to this blog, I want to inform the visitors to this thread that I won’ t be moderating and therefore posting your comments to this thread for the next couple of days. Therefore, lets have a brief cooling off period and I will welcome your postings beginning on Sunday Oct. 28th. ..Maurice.

 
At Sunday, October 28, 2007 4:28:00 PM, Anonymous Anonymous said...

The most egregious case of sexism in medicine (in the USA) has been covered here before: Circumcision.

The American medical establishment has yet to fully accept the mindset that keeping your genitals intact (until you're old enough to potentially choose otherwise) is a fundamental right for both males and females. Obviously, medical need is an exception regardless of sex, for this or any other surgery.

===

 
At Sunday, October 28, 2007 9:23:00 PM, Anonymous Anonymous said...

Would anyone care to define what they consider sexism in medicine to be? I've been accused of mistaking sex differences in medicine for sexism (which is debatably true for the PSA vs smear argument, though I still believe if males had to undergo smears medical science would have found a better way. However, I still maintain that assuming the male response to a drug is the "norm" as in the aspirin case -- in men it has a preventive effect of first heart attack, in women it doesn't -- is sexism).

Having said that, I would argue that the religious and social issues surrounding male circumcision make it more complex than just sexism -- boys aren't circumcised merely because they are boys, but rather for a whole host of other reasons (having said that, I don't see the point of it and should I have any sons, they will remain uncircumcised).

So does anyone want to posit a definition of sexism in medicine, so at least we are all talking about the same thing?

Oh, for the person who asked, I'm in Australia, but have also lived in New Zealand for long enough to know their health system.

-- PG

 
At Sunday, October 28, 2007 10:26:00 PM, Blogger Maurice Bernstein, M.D. said...

PG, having initiated this thread I suppose I should answer your question about a definition of sexism in medicine. I would say it is a happening in medical practice where there is evidence of prejudice or discrimination based on gender. It isn't the clinical differences (genetic or acquired) between men and women but the potentially unjust attitude one party has for a party or parties of one particular gender. And of course, the party displaying sexism can either be a healthcare worker or a patient (or their famiy).

After reading the thread on my blog regarding infant male circumcision, I don't particularly agree that healthcare workers are involved in sexist behavior recommending circumcision. I do wonder about Western society's acceptance of male circumcision vs considering female circumcision as "mutilation". However, it may not represent medical sexism currently at all if one considers that there may be medical evidence of specific disease prophylactsis to merit the procedure but present only in males. This then would be a biologic rationale and not discrimination.

With regard to discussion of circumcision on this thread, let's keep it confined solely to the pros and cons regarding true medical sexism and free of all the diatribes which you will find on the circumcision threads. ..Maurice.

 
At Monday, October 29, 2007 1:53:00 PM, Anonymous Anonymous said...

I contend that the biological rationale flows from the sexual discrimination mindset. This mindset flows from the non-medical origins of circumcision, and when medicalized, circumcision represents medical sexism. It probably flows somewhat from a mindset that boys should be tough, able to withstand pain, and survive injury. Native practices of circumcision rites in many cultures suggest it serves this kind of gender forming function. So now American doctors perpetuate the duality that male genitals may be dismembered to whatever degree deemed preferable by parents and doctors, imposing the judgment that males and males alone may be denied maximal and meticlously maintained property rights over the totality of their genitals.

There is no biological rationale that justifies the disparity, even though the disparity strongly influences the direction of the research that takes place.

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At Monday, October 29, 2007 7:08:00 PM, Anonymous Anonymous said...

gve we do not agree on a lot of things, but I would have to agree that medical research should include both genders unless it has a gender specific purpose. It is hard for me to feel not doing so is not sexism as I can see no other justification.

On the other issue of PAP vs DRE One must also consider funding in
looking at these issues. The funding for breast cancer is huge, if that funding was directed to devloping an alternative to PAP smears, perhaps something would be found. Money drives a lot of research, the major drug companies aren't so profitable because they are nice people.
That said, personally I would define sexism as different attitudes, treatment, or actions based on a large part or soley along gender lines JD

 
At Monday, October 29, 2007 8:03:00 PM, Anonymous js md said...

Here's the online Oxford dictionary. It's as good a place to start as any. Funny how even this definition is 'sexist' as it favors women concerning discrimination.

sex·ism (sĕk'sĭz'əm) pronunciation
n.

1. Discrimination based on gender, especially discrimination against women.
2. Attitudes, conditions, or behaviors that promote stereotyping of social roles based on gender

 
At Monday, October 29, 2007 9:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Extending my previous definition of sexism further, I think that sexism is a human (personal or societal)behavior with intent or by assumption to discriminate one gender relative to the other. It has nothing to do with biologic, genetic, anatomic, physiologic, pathologic or any clinical differences between genders but sexism is purely created by people against other people for a specific purpose or out of ignorance. I do think we should look at sexism as a malignant rather than a benign phenomenon and as with a disease, we should try to eliminate it. ..Maurice.

 
At Tuesday, October 30, 2007 8:54:00 AM, Anonymous Anonymous said...

Medical sexism regarding genital alteration is found in medical research, too. Research is often conducted to examine the effect of male genital alteration on various disease outcomes, but there is almost no research conducted examining the effect of female genital alteration on disease. This is the result of a sexually discriminatory mindset. Perhaps one is studied to fish for an excuse, while the other is not studied because no excuse would be deemed sufficient anyway.

This discriminatory mindset runs so deep that ACOG has issued a warning against informed and consenting adult women from seeking genital modifications on themselves, while tolerating their members performing medically unnecessary genital modifications on uninformed, non-consenting young boys.

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