Unequal Treatment: what you don't know about how women are mistreated by the medical community
By Eileen Nechas and Denise Foley
Simon and Schuster, 1994
232 pages, US$19.80
REVIEW BY RACHEL EVANS
Unequal Treatment exposes a medical system that exacerbates women's health problems. It uncovers a system that leaves women's illnesses under-researched, overdoses women on drugs only tested on men and disproportionately allocates life-saving treatments to white men over women and racial minorities.
Sexism deems women to be less valued members of society than men. Those who aren't white also get bumped down some rungs on the hierarchical ladder of opportunity and status. As Unequal Treatment highlights, the highly privatised US medical system "naturally" disadvantages the poor (women and non-whites).
The US health-care system is two-tiered. Those earning below US$20,000 a year can apply for Medicaid, giving them access to under-funded, low-quality health care. Those in casual or part-time work and/or whose earnings are just above the Medicaid assistance level have no access to health care, unless they pay up-front. In 1991 that amounted to 36 million Americans.
Medicaid doesn't guarantee health-care access. Unequal Treatment notes that 44% of physicians who provided obstetric services turned away Medicaid patients.
The US poor die at an earlier age — often five to seven years — before more well-off Americans and they are disproportionately women. Since the 1970s, the number of female-headed households has doubled, and they are four times more likely to be poor than other families. Among the poor households, the number headed by African-American or Hispanic women is nearly double the number headed by white women.
About 60% of US patients who visit doctors are women. Heart disease is the No. 1 killer of US women, with women twice as likely to die as men within a few weeks of a heart attack. In 1989, almost three-quarters of the 368,000 heart bypass operations carried out in the US were performed on men. Unequal Treatment uncovers a 15-year-long heart disease study — aptly acronymed MR FIT — conducted on 13,000 people, all of them men.
Cancer is the leading cause of death for US women aged between 35 and 50. More women die of lung cancer, but more women get breast cancer. Breast cancer fares badly in research and funding.
In 1960, US women had a one in 20 lifetime risk of developing breast cancer. In 1992 this had increased to one in nine.
According to one study, widespread use of mammograms could reduce breast cancer deaths by 30%. Yet only 31% of US women have regular mammograms. Unequal Treatment argues that this is because only 37% of US physicians advise their women patients to have regular mammograms.
US women suffer from depression at twice the rate that men do, with 70% of all psychotropic medication prescribed to women. This depression is exacerbated by sexist labelling by the psychiatric establishment.
The Diagnostic and Statistical Manual is produced by the 86% male American Psychiatric Association every year and has within it new "disorders" that afflict "abnormal" humans. In the mid-1980s a group of psychiatrists decided that women who were passive or demure were afflicted with Self-Defeating Personality Disorder.
After six years of protest, SDPD was taken out of the manual, but Premenstrual Dysphoric Disorder remains in it. PDD is based on the claim that women's menstrual cycle tends to make them mentally deranged.
Sexist violence and constantly being treated as inferior are the major reasons for women's depression, argues Unequal Treatment. Nearly three-quarters of all female psychiatric patients in the US been sexually or physically abused, as have two-thirds of women receiving outpatient therapy. One in four US women have been physically battered, and one in five has been raped. One in three is a victim of childhood sexual assault.
Women have also suffered from sexual assault in psychiatrists' offices — a massive violation of doctor-patient trust. In the 1980s, the American Medical Association refused to allow an independent investigative team to examine rates of such assaults. However, one study that was conducted found offending doctors were sending clients who they'd abused to colleagues they knew to be offenders themselves.
One study of male physician students showed as many as 30% admitted they've committed rape.
Unequal Treatment notes that in its 1990 budget the US government allocated $38 billion for military research but only $7 billion for medical research — a small fraction of that going to women's health issues. Another 1990 study into the budget of the National Health Institute — the US government health research body — revealed that only 6% of its funds were spent on programs benefiting women.
Moreover, almost all research into diseases are done on white men. Sixty per cent of drugs are prescribed to US women, but they are virtually invisible in the testing process.
The (mostly) white, male researchers justify this unscientific elimination of 52% of the US population from their studies with cries that involving women participants will "complicate data" because they are "too hormonal" and are "unreliable".
In 1990 almost no research on AIDS treatment had been done on women, although the number of women afflicted with the disease had began to outnumber men. The Rockefeller University conducted a study exploring the impact of obesity on the tendency for women to develop breast or endometrial cancer — a study which used only men.
Phenyl-propanolamine, the active ingredient in many over-the- counter appetite suppressants, was tested primarily on young men — even though those who use diet aids are overwhelmingly women. No wonder that adverse drug reactions occur among women users of these drugs at twice the rate that they occur among male users.
Women are best loved by the system for their ability to produce the next generation. The attacks on women's reproductive freedoms in the US have included the frightening phenomenon of pregnant women being imprisoned for drinking or having sex with their partners against their doctor's advice. By 1992 there were 150 cases documented by the American Civil Liberties Union of women being imprisoned when foetal well-being was presumed by courts to be at stake.
The state's prioritisation of the survival of potential children over the health of pregnant women is resulting in women being cut up and dying unnecessarily. C-91×ÔÅÄÂÛ̳ have a two to four times greater death rate than natural birth and are used when foetal distress reaches a "dangerous" level. Between 1980 and 1985, there was a 225% increase in reported foetal distress — a result of new technology. However, one report showed that only 4% of the women who had "abnormal" foetal monitoring readings actually had a foetus in true distress. Unequal Treatment points to the grassroots campaigning — which, in 1992, resulted in breast cancer funding being given its greatest increase ever — as a way to win women's health demands. However, the material assembled by the authors indicates that women's health will only be given equal treatment with men's health by a society that is committed to eradicating sexism in all its manifestations and its source — the family-based system of private ownership and accumulation of socially produced wealth.
From 91×ÔÅÄÂÛ̳ Weekly, May 5, 2004.
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