Women’s Health and the
Media:
Where do we find trustworthy
information?
What are the key challenges?
 Media
portrayals of new
medical research often
inaccurate
A
societal embracing of the
“quick fix” or “pill for every ill”
approach
Key Challenges….
 Increasing
influence of the
pharmaceutical industry over
physician prescribing
practices as well as the
educational and advertising
materials aimed at the
consumer or patient
Amidst the plethora of
websites, ads and other
sources, how does one find
trustworthy information?
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Know the source of your
information and look out for
conflicts of interest
Utilize non-commercial websites
prepared by those who know
how to evaluate the quality of
the research that they cite
Use more than one source
EXAMPLE OF CHILDBIRTH AND
THE RISING CESAREAN
SECTION RATES IN THE
UNITED STATES
Reasons for Rising Cesarean Rates
(IOM 1989 report)
30% of the rise due to diagnosis of
dystocia (abnormal or difficult labor)
 25-30% due to repeat cesarean
section
 10-25% due to breech presentation
 10-15% due to fetal distress

Current reasons for rising
cesarean rates
Primarily changes in obstetrical
practice, such as:
- More repeat cesareans
- More refusals to allow VBACs
- Concerns about malpractice
- More advocates of medicallyunnecessary cesareans
NCHS TRACKING IN 2004

“Cesarean delivery rate rose 6
percent in 2004 to 29.1 percent of all
births, the highest rate ever reported
in the United States”
From:
http://www.cdc.gov/nchs/products/pubs
/pubd/hestats/prelimbirths04/prelimbirth
s04health.htm
TRACKING in 2004 (cont.):
“The rate has increased by over 40
percent since 1996. For 2003–04
the primary cesarean rate rose 8
percent, and the rate of vaginal
birth after cesarean delivery
(VBAC) dropped 13 percent. The
primary rate has climbed 41
percent and the VBAC rate has
fallen 67 percent since 1996.”
NIH Meeting
on Cesareans by “Maternal
Request” (March 27-29, 2006)
Will media coverage of this
meeting and its report result in
more cesareans with no
medical indication (elective
surgery)?
QUESTIONS ADDRESSED AT THE NIH
MEETING:
What is the trend and incidence
of cesarean delivery in the US
and other countries?
 What are the benefits and harms
of cesarean “by request” vs.
attempted vaginal birth (both
short-term and long-term)?
(Cont.)

QUESTIONS (cont.)
What factors influence benefits
and harms?
 What research should be done to
get better evidence for making
decisions regarding cesarean
delivery “on request” vs.
attempted vaginal delivery?

Panel’s Recommendations
Final report at www.consensus.nih.gov/2006


Insufficient evidence, so more
research needed on benefits and
risks of cesarean delivery on
maternal request vs. planned vaginal
delivery
Until better evidence is available, any
decision to do cesareans upon
“maternal request” should be
carefully considered
Recommendations (cont.)

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Not recommended for women
desiring several children given rising
risks of placenta previa and accreta
with each cesarean delivery
No cesareans upon “maternal
request” prior to 39 weeks or without
verification of lung maturity (because
of significant risks of neonatal
respiratory complications)
Recommendations (cont.)

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Effective pain management services
should be available for all women so
that fear of pain is not a motivating
factor for an elective cesarean
NIH (or other appropriate Federal
agency) establish a website with upto-date information
The final report did not
adequately consider many
recognized long-term adverse
outcomes associated with
cesarean surgery and did not take
into account the impact that
avoidable obstetric practices can
cause during vaginal birth.
From the national Listening to Mothers II
Survey of the Childbirth Connection in
NYC (http://www.childbirthconnection.org/article.asp?ck=10401):
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56% of women who wanted a vaginal
birth after having had a cesarean said a
doctor denied them that option.
1 out of every 4 women polled who had
caesarean said they felt pushed into
having the surgery.
Excellent discussions of this meeting:
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Diony Young’s editorial in the September
2006 issue of BIRTH –’ “Cesarean Delivery
on Maternal Request”: Was the NIH
Conference Based on a Faulty Premise?’
Henci Goer’s piece in Lamaze e-news
(June 2006)
Rona McCandlish’s article in MIDWIFERY
(v.22, 2006): “Meeting maternal request
for Cesarean section – paving the road to
hell?”
Possible consequences of these
Recommendations
An increasing trend towards
considering cesarean birth as a
“normal” birth with benefits/harms on
par with vaginal birth
 Misleading coverage in the media
 Continued distortion of the concept of
“women’s right to choose”

“Maternal mortality and severe
morbidity associated with low-risk
planned cesarean delivery versus
planned vaginal delivery at term”
Liu et al. CMAJ Feb 2007
(This study used a breech group as a
surrogate for an elective cesarean
group)
Among healthy women in the
study:
27.3 per 1,000 women in the
planned cesarean group (breech
births) had severe complications
(such as major infections or
blood clots) vs. 9 per 1,000
women in the planned vaginal
group
From the CMAJ commentary:
“This study provides additional
support to a growing body of
evidence suggesting that primary
elective cesarean birth may place
both mother and newborn at
greater risk for adverse
outcomes than planned vaginal
birth”
COSMETIC SURGERY is
the fastest growing
medical specialty in the
U.S.
Breast implants solely for
cosmetic purposes are
increasing in popularity
despite substantial risks
associated with both silicone
and saline implants.
See the booklet prepared by the US
Food and Drug Administration for
photographs and descriptions of
adverse implant outcomes such as
disfigurement, capsular contracture
(when the breast becomes hard and
misshapen), and deflation:
www.fda.gov/cdrh/breastimplants)
Sample Photo from Implant
Maker’s Website
Photo of Capsular Contracture
From FDA Booklet
This is the same 27-year old
woman after her painful
implants were removed
Necrosis in mastectomy
patient with implants for
one week
After removal of one
woman’s leaking silicone
implants
According to the American
Society for Aesthetic
Plastic Surgery, 364,610
women got breast implants
in 2005. The number was
up 9 percent from 2004.
“It's like being set free, from being
trapped in a bad body, to being
set free in a nice body.”
From: ‘More women having ‘mommy
makeovers’ by Kim Baer
The Free Lance-Star
(Fredericksburg, VA) March 13, 2007
A survey by the American
Society of Plastic Surgeons
showed that nearly 40 percent
of plastic surgery patients
believe they should have been
more proactive in learning
about potential side effects
and complications before
surgery.
“There are over-the counter
creams and lotions. And then
there’s Botox Cosmetic. My
doctor says they’re just not the
same. She said only prescription
Botox is approved by the FDA to
treat the frown lines between
your brows…”
A large coalition of groups:
See www.safecosmetics.org
“Skin Deep” a report of the Environmental
Working Group, helps consumers and
workers to better protect themselves from
known or suspected carcinogens and
reproductive toxins.
In October 2005, Governor
Schwarzenegger signed the Safe
Cosmetics Act into California
law. As of January 1, 2007,
cosmetics manufacturers in the
state will be required to disclose
any product ingredients that
cause cancer or birth defects.
Harmful Substances to Avoid

Para-phenylenediamine, a chemical
found in some dark hair dyes (may
increase risk for bladder cancer in
humans)
 Phthalates, typically used as a solvent
and plastic softener and also found in
many shampoos and other hair
products, cosmetics, deodorants and
nail polish (has been linked to cancer
and to birth defects of the male
reproductive system). To learn more,
go to www.nottoopretty.org.
To avoid (continued):

Talc, in talcum powder (has been

Propylene glycol, an ingredient
linked to a 60% increase in the
risk for ovarian cancer in women
who use it in the genital area).
found in some moisturizing
products and skin creams (may
damage the kidneys and liver).
What to do to minimize risk
Read labels carefully and
choose all-natural alternatives,
such as products made with
olive oil, safflower oil or
oatmeal, whenever possible.
Direct-to-Consumer
Advertising of Prescription
Drugs:
Misleading Ads and How
They Hurt Us
The Public Gets Misinformation
Benefits are often overstated,
while risks are understated
 FDA warning letters are issued
after the ads run
 Corrective ads are rarely
required
 Withdrawal of an ad is the only
penalty

 Ads
are geared primarily to
selling more drug product,
not educating the user
 The
ads work: the most
highly advertised drugs,
accompanied by promotional
campaigns geared to
physicians, sell extremely
well
Top selling drug in the
world?
Lipitor (Pfizer)
(with more than 13 billion
dollars in sales in 2005)
Drugs can be quite useful, but
“Pills for Prevention” may not
be the best approach.
Important to promote a view
of public health that stresses
primary prevention –
identifying and eliminating
disease-causing agents in our
food, water, and air.
Precautionary Principle of Public
Health:
When an activity raises threats of
harm to the environment or human
health, precautionary measures
should be taken even if some cause
and effect relationships are not fully
established.
Science and Environmental Health Network:
www.sehn.org
Consider the example of an ad
for SARAFEM (Prozac
repackaged as a pink and
purple capsule) at
www.sarafem.com
(ad since removed):
”Think it’s PMS? Think Again…it
could be PMDD…”
Picture of a young woman trying
to zip her jeans (too bloated?);
picture of another woman
seemingly distressed…
Then text follows:
“Irritability, sadness, sudden
mood changes, tension, bloating.
If you suffer from many of these
symptoms month after month
and they clearly interfere with
your daily activities and
relationships you could have
PMDD…
“…PMDD, Premenstrual
Dysphoric Disorder, is a
distinct medical condition
that is characterized by
intense mood and physical
symptoms right before your
period.”
“Sarafem can help. Doctors can
treat PMDD with medication for
PMDD”
Constantly flashing, each shown
consecutively:
“Mood swings---irritability--bloated feeling”
Drug regulators in Europe
forced Eli Lilly to drop PMDD
as one of the approved uses
for Prozac (Sarafem), as the
data did not provide adequate
evidence of efficacy.
Current content at this website
has changed. Sample quote:
“Many physicians believe that
Sarafem helps to correct the
imbalance of serotonin that
could contribute to PMDD.”
“Antidepressants increased the risk of
suicidal thinking and behavior in
children and teenagers with depression
and other psychiatric disorders.
Patients starting therapy should be
observed closely for worsening
depression symptoms, suicidal
thoughts or behavior, or unusual
changes in behavior.
Sarafem is not approved for use in
patients under the age of 18.”
The ad was misleading because it
mixed “relative risk” with “absolute
risk,” noting, for example, the
following:
44% fewer breast cancers in
women taking tamoxifen vs.
women taking a placebo
But there was NO mention of the
following relative risk: a 252%
increased risk of endometrial
cancer
The ad also noted a risk of
serious problems such as
endometrial cancer or blood
clots at “only” 1-2%
(absolute risk)
But left out was any mention
that women have only a
1.8% chance of benefiting
from the drug (absolute
benefit)
Unpaid advertising also a problem:
Parade magazine, for example, put
model Lauren Hutton on its cover for
a piece on celebrity beauty tips, and
quoted her saying her "No. 1 secret is
estrogen. It’s good for your moods,
it’s good for your skin. If I had to
choose between all my creams and
makeup for feeling and looking good,
I’d take the estrogen.”
The article didn’t mention that
Hutton was a paid spokesperson
for Wyeth Ayerst, and that she
appeared in their ads. It also
didn’t mention that Hutton's
claims for estrogen's benefits
were not backed up by valid
scientific evidence.
“Female Sexual
Dysfunction”
Is this a serious problem
requiring primarily
biomedical solutions, or is
a different approach most
often called for?
In 1999, Pfizer consultants
analyzed one question from a
1994 survey and produced an
overly simplistic conclusion –
that 43% of American
women “suffer from” sexual
dysfunction
Idea Marketing
A disease
awareness
campaign is now
building a drug
market using
the 43% FSD
statistic.
(Slide Courtesy of Leonore Tiefer)
To promote
“The Hunt
for the
Pink Viagra”
(Slide Courtesy of
Leonore Tiefer)
For more information
about female sexual
problems, see the website
of the Campaign for a New
View of Women’s Sexual
Problems:
www.fsd-alert.org
Menopause
Every day 5,000 women in
the U.S. enter menopause,
the so-called “change of life”
What do we think about
menopause?
Some women see it as “the end
of sex” or the “end of youth”
 Some see a passport to freedom
(no fear of getting pregnant, no
messing with pads and tampons,
no more “shoulds” about how
one needs to “look”)
 Possibly more time for oneself

What influences our thinking?
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Media messages that worship
youth, thinness, and suggest “it’s
not OK to grow old”
Conversations with other women
about their actual experiences
with menoapuse
Opportunities for Medicalization
 Less/no
interest in sex
 Hot
flashes/vaginal dryness
and loss of elasticity
 Loss
of bone density
 More
“spreading waistlines”
and sagging skin
 Memory
problems
 Depression
 Problems
with sleep
Approaches to dealing with sleep
problems other than prescription
sleeping drugs such as Ambien
and Lunesta:
Yoga/exercise
 Avoiding caffeine
 Deep breathing/massage at
bedtime from a partner
 Sleep in a cool room

Non-hormonal approaches to
dealing with hot flashes
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Wear layered clothing
Use fans
Put palms or bare feet on a cold
surface
Cold pack under the pillow
Exercise, yoga, deep breathing
Less caffeine, less spicy foods, less
alcohol (especially red wine)
Removing health ovaries
US federal data from the late
1990s:
78% of women 45-64 who have
had a hysterectomy also had
healthy ovaries removed (even
though most were not at
particular risk of developing
ovarian cancer).
Latest research shows that for
women without a family history
of ovarian cancer there is a
significant reduction in death
from heart disease and
complications of osteoporosis IF
THE OVARIES ARE KEPT,
especially until the age of 65.
KEY FINDINGS OF WILLIAM PARKER
et al study in 2005:
For 10,000 women 50-54 yrs old
who undergo a hysterectomy
with oophorectomy, there will be
47 fewer cases of ovarian cancer
by the time these women reach
80 when compared with a similar
group who keep their ovaries.
BUT the oophorectomy group will
suffer 838 additional deaths from
coronary heart disease as well as
158 more deaths from hip
fractures. (Numbers reflect
women who do NOT have
estrogen therapy – there is a
smaller survival benefit to
keeping the ovaries in women
taking estrogen.)
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Ads for bone density screening
now pitched at women around 50
yrs of age
Creation of the ”T” score and a
new classification called
osteopenia (for -1 to -2.5 scores)
Merck stopped by the FDA from
using the claim “menopause is the
single most important cause of
osteoporosis” in their ads
Cloning, Stem Cells and
Inheritable Genetic
Modification
Special case of embryo
cloning (somatic cell nuclear
transfer)
Research: the promises and the
challenges

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Balancing our interest in developing
new medical therapies with the need
to protect research subjects and the
need to preserve values of social
justice and equity
Developing technologies that will be
accessible to most
Often Ignored Concerns

Risks to women’s health

Gateway to “designer babies”

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Unethical experimentation on
humans
Fueling of a new eugenics movement
Risks to Women’s Health from
Research Cloning
Also known as “therapeutic
cloning” or “somatic cell nuclear
transfer” (SCNT), SCNT requires
the collection of many eggs from
women willing to undergo egg
extraction procedures.
Some Concerns about Multiple Egg
Extraction


Use of leuprolide acetate (Lupron™),
a GnRH agonist, to “shut down” the
ovaries, is not FDA-aproved for this
purpose (Antagon™, a GnRH
antagonist that is also used, is
approved for this use.)
Use of drugs that hyper-stimulate the
ovaries to produce multiple follicles
As Spring of 1999, US Food and
Drug Administration (FDA) had
received 4228 reports of adverse
drug events from women using
Lupron.™ 325 of the adverse
events for women reported to
the FDA resulted in
hospitalization, and additionally,
25 deaths were reported.
The Research Cloning Debate
The most vocal participants have
been
Anti-choice conservatives
opposed to the destruction of
embryos, who favor a permanent
ban
 Biomedical researchers and their
allies, who are wary of or
opposed to regulatory oversight
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Good Resources
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National Women’s Health Network (DC)
Breast Cancer Action (SF)
Collaborative on Health and the Environment
Science and Environmental Health Network
Silent Spring Institute (Newton, MA)
Teen Voices magazine (Boston)
Center for Medical Consumers (NYC)
Canadian Women’s Health Network (CWHN)
www.ourbodiesourselves.org
www.ourbodiesourselves.org
May 2005