In an op-ed in Salon (which appears in slightly abbreviated form in the LA Times, Ehrenreich writes that women's response to the Stupak Amendment, which "will snatch away all but the wealthiest women's right to choose," has been "muted" compared with the outcry against the new mammography guidelines. This is despite the fact that mammograms for women under 50 haven't been shown to decrease breast cancer mortality, and some evidence suggests they may even increase cancer risk. Ehrenreich writes,

It's not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has replaced feminism as a focus of female identity and solidarity. When a corporation wants to signal that it's "woman friendly," what does it do? It stamps a pink ribbon on its widget and proclaims that some miniscule portion of the profits will go to breast cancer research. I've even seen a bottle of Shiraz called "Hope" with a pink ribbon on its label, but no information, alas, on how much you have to drink to achieve the promised effect. When Laura Bush traveled to Saudi Arabia in 2007, what grave issue did she take up with the locals? Not women's rights (to drive, to go outside without a man, etc.), but "breast cancer awareness." In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.

On the one hand, Ehrenreich's comments seem like a somewhat heavy-handed indictment of modern feminism. She says, "Once upon a time, grassroots women challenged the establishment by figuratively burning their bras. Now, in some masochistic perversion of feminism, they are raising their voices to yell, 'Squeeze our tits!'" But just as not everything a woman does is empowering, not every extra-scientific position a group of women takes is a blow to feminism. Also, plenty of us have been far from muted on Stupak.

That said, however, there's good evidence that the breast cancer awareness movement as it currently exists isn't necessarily good for women. Though many fear that the new guidelines are simply an attempt by insurance companies to save money, Ehrenreich argues that the old guidelines actually pumped money into the pockets of oncologists, who offered chemotherapy for mammogram-detected cancers that might never have needed treating. Unfortunately, we don't yet know how to distinguish these cancers from those that do merit aggressive treatment — and the treatments we do have could be a lot better. Ehrenreich says,

What we really need is a new women's health movement, one that's sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly life-style) causes of the breast cancer epidemic? Why are existing treatments like chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer's progression from "early" to "late" stages no longer holds, what is the course of this disease (or diseases)? What we don't need, no matter how pretty and pink, is a ladies' auxiliary to the cancer-industrial complex.

Ehrenreich's language is harsh, but as someone who suffered breast cancer herself, she knows whereof she speaks. And while research into cancer treatment is ongoing, the focus of breast cancer awareness could use a shift. Much of the focus is on women themselves — their responsibility to schedule regular mammograms, to lead a healthy lifestyle, and to perform self-exams (a practice also jettisoned under the new guidelines). It makes a certain amount of sense — individual women want to feel that they can have an effect on their health. But there may be systemic factors, like additives and pollutants, that contribute to breast cancer, and the pink-ribbon movement might do well to advocate for more research into those. And although mammograms can save lives, new screening options might be even better — cutting-edge research deserves just as much support as awareness and prevention currently get.

The "pink-ribbon breast cancer cult," as Ehrenreich calls it, may not be the sign of a large-scale failure of feminism. But women are being asked to accept a lot of symbolic gestures — like Sen. Dick Vitter's superfluous mammogram-access amendment — instead of the reproductive rights and truly life-saving treatments they actually need. Ehrenreich argues persuasively that rather than getting angry about new guidelines for a useful but flawed procedure, women should save their anger for what really matters — that we still don't know how to heal our breasts, and that the government is trying to control our wombs.

Slap On A Pink Ribbon, Call It A Day [Salon]
Can Mammograms Increase Cancer Risk For Some Women? [Time: Wellness Blog]
Annual Screening With Breast Ultrasound Or MRI Could Benefit Some Women [EurekAlert]
Targeted Breast Ultrasound Can Reduce Biopsies For Women Under 40 [EurekAlert]
David Vitter Will Protect Ladies From Medical Recommendations [Wonkette]

[Hyderabad, October 27. Image via Getty]

Ten-month old B. Lakshmi, who successfully underwent pediatric cardiac surgery, is cared for by her mother at South Asia's first exclusive children's heart hospital in Hyderabad on October 27, 2009. Nearly 152 000 children are born with cardiac conditions in India every year. AFP PHOTO / Noah SEELAM (Photo credit should read NOAH SEELAM/AFP/Getty Images)

I didn't, although I did have menstrual cramps! This I learned from an actual, human doctor, who wearily suggested that I not consult the Internet to identify symptoms anymore. "It makes our jobs harder...well, and easier," she conceded. Because at least there's also an upswing in people feeling really relieved when they find out they've mis-diagnosed themselves!

Says the Telegraph, "Increasing numbers of people (48 per cent) say that they have used the internet to find out more about an illness according to a report by Ofcom, the media regulator. The research found women are more likely to do so, with 53 per cent admitted to looking online for medical advice, in a trend has become known was ‘Dr Google'."

Please, Dr. Google's a charlatan. All the best people go to Dr. WebM.D.'s practice. Hello, he's an M.D.! But, oddly enough, the same survey found that the diagnoses left people "worried and confused." Okay, hypochondria aside, there are times when I've found web-related medical stuff helpful: message boards and FAQ pages for birth control and medication's side effects, a migraine support group that made me feel like I had it easy! In these cases, the sense of not being alone, of finding out that things were normal, was indeed comforting. And obviously, the net is a font of homeopathic wisdom!

The problem, of course, is when it enables hypochondria. All those "see a doctor immediately" advisories are probably legally advisable - and if they've forced anyone to take something deadly seriously, well terrific. (And you can't help thinking a little light web-surfing might have been a good idea for some of those "I Didn't Know I Was Pregnant" dames TLC is always rounding up.) But I'm guessing the vast majority of people with something very wrong know something's very wrong. And if they're not the sort to go running to the net for the slightest sniffle, chances are they'll be calling a doctor with the other hand anyway. The problem, too, is that it's very tricky to actually tell what's wrong from listing symptoms - most of which can presage something serious anyway. Is there anything really wrong with self-diagnoses? Well, not, I suppose, if you get a real second opinion - ergo, if you have great insurance. Otherwise, yes, reading that you might - or might not! - in fact have meningitis is indeed pretty stressful. As my doctor said, "a little knowledge is a dangerous thing." Or at least, annoying.

Half Of Women Are Diagnosing Themselves Online, Says Ofcom [Telegraph]

According to Alice Park in Time, the discrepancy occurred because in their initial announcement, researchers included all the participants who had started the study. But some got infected with HIV before they had received all six shots of the vaccine, and then had to drop out. Since the point of the research was to measure the effect of all six injections, only those who received all of them should have been included in the data. And when the numbers are run this way, the result is a 26% reduction in risk — a finding that's not statistically significant, meaning it could have occurred by chance.

It's tempting to criticize the researchers, from the National Institute of Health and the US Army, for rushing to release promising results before properly vetting them. According to Park, the researchers decided to publicize their findings in a press conference before they were peer-reviewed or replicated because the government of Thailand, where the study was conducted, "wanted to inform its citizens of the positive findings as soon as possible." However, even before the announcement, a few scientists who had seen the data were expressing concerns.

Even more scientists are speaking out critically now. One AIDS researcher, who spoke anonymously to the ScienceInsider blog, says,

The press conference was not a scholarly, rigorously honest presentation. It doesn't meet the standards that have been set for other trials, and it doesn't fully present the borderline results. It's wrong.

The Army, however, says that it didn't present both the 31% and 26% numbers because that just would've been too complicated. An online statement reads, in part,

The multiple statistical analyses are all consistent with the same conclusion: that the vaccine was modestly effective at preventing HIV. However, explaining the differences between them is complex and the appropriate venue for this technical discussion of statistics is at an open scientific conference and in the scientific publication now under review at a major journal.

If truly explaining the results was only appropriate for a scientific forum, then it does seem that the researchers should have waited for such a forum before publicizing them. The statement claims that the researchers fulfilled the Thai government's request for a public statement in order to honor "our commitment to the volunteers who participated in this trial," but the volunteers would have been better honored by an accurate representation of the findings. The Army appears to be trying to have it both ways, saying that they had to publicize results quickly, but they couldn't possibly publicize the accurate ones because no one would understand them. But there are a lot of ways out of this double bind — it's really not all that hard, for instance, to explain the difference between a 26% and 31% figures. Army researcher Col. Nelson Michael says,

We tried very carefully to make sure that message was crystal clear. There's now hope. But that said, we've tried to be very careful not to oversell this.

It may not have been intentional, but overselling is exactly what they've done.

Behind The Rising Doubts About Hailed AIDS Vaccine [Time]
The HIV Vaccine And Science By Press Release [Wall Street Journal Health Blog]
Unrevealed Analysis Weakens Claim Of AIDS Vaccine "Success" [ScienceInsider]
RV 144 Update [US Military HIV Research Program]

In a piece off-puttingly titled "The Tell-Tale Womb of Lewiston, Maine," NPR talks about the "eureka" moment (or, you know, the bad equivalent) for Dr. Jack Wennberg, whose work has become an important cornerstone of the healthcare-reform debate. In the 1960s, charged with bringing modern methods to isolated New England communities, Wennberg started examining the existing practices, studying every medical record in the state of Vermont. What he found was shocking and bizarre: in some towns everyone had their hemorrhoids removed, in the next town, not; in one town 3/4 of the kids were missing tonsils, while just down the road their neighbors' were in tact. As to Lewiston's hysterectomy mania, well, Wennberg quickly deduced that it was not, as people had always assumed, because the largely Catholic community had more children than others. Rather, it was all the doctors, and it was arbitrary. So Wennberg started getting doctors together and talking with them.

One reason some doctors mentioned was fear of lawsuits; some worried that if they didn't do every possible thing they might get sued. Another reason was temperament - some doctors were clearly just more eager to take action than others....Then there was the role of local medical culture. For example, even though it didn't make sense and wasted a lot of time and money, pediatricians in some communities felt they absolutely positively had to send even mildly sick kids to the hospital.

Doctors were also affected by "peer pressure" from other practices, and, the elephant in the room, money. Simply put, if you do more, you charge more. More procedures, more complexity, is more lucrative. It is not always, surely, malevolent - and generally it doesn't seem, from the piece, like it's doing (overt) "harm" - but it's also true that this may affect why some procedures become industry standard while older ones are phased out. That, and our appetite for innovation and the mind-set that complicated is good - and expensive is good. What's funny about the findings is that wealthier patients - although they got more care - were not necessarily living any longer. Explains the piece,

This is probably because of a something called fragmentation of care. In high-use areas, it's often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.

NPR concludes "the United States spends more than $2 trillion on health care every year. So the cost of that 30 percent unnecessary care annually? $660 billion." This is black-and-white and inarguable. But Surely within that there's plenty of gray - the forementioned community expectations, that'll be a major overhaul, plus the fact that an "unnecessary procedure" that brings comfort to a dying person or his family is a trickier matter than a wholly gratuitous hysterectomy. And the role of malpractice reform, only mentioned in passing here, seems important: if in fact fear of lawsuit and untenable insurance policies are pushing doctors to do more - to do everything - rather than an intuitive safer "less," it seems like an unavoidable piece of the puzzle. The upshot (besides the fact that, yes, we really need some health-care reform)? Second opinions, people. Ideally? Over the town line.

The Telltale Wombs Of Lewiston, Maine [NPR]

Yesterday, CDC and FDA researchers published an analysis of the side effects associated with the human papillomavirus vaccine - which has been linked to 32 deaths since 2006 - in the Journal of the American Medical Association (JAMA). As of June 1, 23 million doses of Gardasil have been distributed, and there was an average of 53.9 complaints filed with the government for every 100,000 vaccine doses, which ABC News reports is similar to the number of complaints filed for other vaccines.

Experts say the complaint data is limited because anyone can file one and the reports are not verified, but only 6.2 percent of the reported complaints were considered serious and lead to hospitalization, permanent disability or death. Compared to other vaccines, users of Gardasil were more likely to report fainting or blood clots, but the JAMA study showed 90 percent of the 56 women who reported developing blood clots had other risk factors like smoking, being overweight, or using oral contraceptives. "Although the number of serious adverse events is small and rare, they are real and cannot be overlooked or dismissed without disclosing the possibility to all other possible vaccine recipients," Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at University of Missouri told ABC News, "The rate of serious adverse events is greater than the incidence rate of cervical cancer."

The FDA and CDC continue to recommend the vaccine for women ages 9 to 26, but now the consensus in the medical community is that doctors need to be more educated about the risk of cervical cancer and the vaccine's side effects. Dr. Joseph Zanga, chief of pediatrics at the Columbus Regional Healthcare system in Columbus, GA, told ABC News that HPV infections may clear up on their own and that routine pap smears are still the best prevention against cervical cancer. He added:

"Perhaps the most important, currently missing 'warning' is that the vaccine may not be forever... we know that it protects for 5-7 years so that a girl getting the series at [age] 11-12 will enter the time of her most likely sexual debut unprotected but believing herself to be."

But finding unbiased information on Gardasil's side effects may have been complicated by the vaccine's manufacturer. A separate article published in the Journal of the American Medical Association reported that at least three medical associations promoted the vaccine using money provided by Merck. The analysis of the pharmaceutical company's marketing techniques by Columbia University public health experts revealed that the American College Health Association, the American Society for Colopscopy and Cervical Pathology, and the Society of Gynecologic Oncologists used the same strategies as Merck to promote the vaccine and did always not disclose that they were accepting money from the company, The Washington Post reports. Merck and the three medical societies say it was not inappropriate for the groups to each accept about $200,000 to $300,000 from the drug company because they money funded education programs about the vaccine but didn't influence their content.

In the JAMA article the Columbia researchers say that the medical societies used arguments that were very similar to Merck's marketing approach, which downplayed the vaccine's potential side effects and overemphasized the threat of cervical cancer to adolescents. According to the American Cancer Society, 11,000 women in the U.S. develop cervical cancer every year, and 4,070 die from it, but USA Today reports that many of the deaths are among poor white women in Appalachia, black women in the South, and Latinas along the Texas-Mexico border. Since cervical cancer can be detected by regular pap smears, these women without access to medical care are most likely to die from it. Dr. Sheila Rothman, the article's co-author, wrote that Merck "practically ignored" these at risk groups, and focused instead on the message that all women are equally at risk, helping the company reach as many customers as possible.

A representative for Merck said that there are several programs that make the vaccine available to poor women, but the JAMA report says these facts were not emphasized in the medical society's marketing material, which often failed to mention that they received Merck funding. "It screeched the message, 'all women are at equal risk, protect yourself from cervical cancer, and this is the way to do it,'" said Rothman, "The fact that the medical societies repeated this message is what concerns us."

Gardasil HPV Vaccine Faces Safety Questions [ABC News]
Medical Groups Promoted HPV Vaccine Using Drug Company Money [The Washington Post]
Report: HPV Vaccine May Be Going To The Wrong Women [USA Today]

She writes,

My answer to the question "If a treatment works on rodents, will it cure us?" is "probably not, based on the weight of evidence to date." Cancer is a good example: former director of the US National Cancer Institute, Dr Richard Klausner lamented: "We have cured mice of cancer for decades, and it simply didn't work in humans." AIDS is another: while at least 80 vaccines work in animals, all 80 have failed in human trials. Similarly, every one of more than 150 stroke treatments successful in animals has failed in human testing. A study in the British Medical Journal found that animal tests accurately predict human response less than 50% of the time.

But while, as the Guardian's Alok Jha acknowledges, "using a mouse can never tell scientists everything they need to know," there are also compelling reasons to do experiments on animals. In an interview with Time last year, president of the nonprofit Foundation for Biomedical Research Frankie Trull said,

when you go back and look at how many compounds fail before they ever get to humans, [it's clear] animals do play a really important role in at least giving early signals - and it's a constantly evolving science.

Many experimental compounds are too uncertain to be legally tested on humans, and while many would say it's unethical to test these compounds on animals, these people also have to acknowledge that without animal testing we might not have many medicines we have today. Penicillin might never have been mass-produced without initial testing on mice, and many vaccines have their origin in mouse research. There are alternatives to animal testing, such as computer modeling. However, says Trull, "people in the research community will be the first to tell you they still don't know enough about how the complex living organism works in order to duplicate it."

Until we can make computerized humans, the most viable alternative to animal testing will be humans themselves, and anyone who wants all medical tests done on people should be prepared either to risk his or her life for others' health, or to accept that many disease that plague us today will not be cured. Is it ethical to value a mouse's life less than a human's? Not necessarily, but it's a tendency we all have, especially when our loved ones are sick and need treatment.

That said, much animal testing (one source claims 94%) is done for cosmetic and not medical purposes. According to Scientific American, the Draize Test, in which "rabbits are placed in restraining stocks and their eyelids are held open with clips-in some cases for days at a time-to keep them from blinking away the test solutions," is still in use by some companies. The rabbits are usually killed after experimentation. Animal-rights campaigns have reduced the popularity of this scary Clockwork-Orange-style test, but it seems reasonable to ask that no cosmetic testing be done on animals, especially now that "considerable information has already been yielded and recorded from past testing." It's one thing to kill a mouse to save a human — it's another to blind a rabbit with lipstick.

The Dead End Of Animal Research [Guardian]
Do Cosmetic Companies Still Test On Live Animals? [Scientific American]
Of Mice And Medicine: If A Treatment Works On Rodents, Will It Cure Us? [Guardian]

Researchers Dan Allman and Melissa Ditmore surveyed sex workers for their report, Good Practice for Sex Workers' Participation in Biomedical HIV Prevention Trials. They found that sex workers didn't necessarily know about research practices and medical ethics, and that researchers didn't know they didn't know. To remedy this, they suggested that researchers — shocker — actually "consult local sex workers at each proposed location before beginning a trial." Allman and Ditmore write,

Many sex workers had recommendations for researchers hoping to work with sex workers such as involving stakeholders from the outset, explaining procedures in non-technical terms and translating all materials and information into local languages.

They also say that many sex workers "wanted to learn more about research and would consider involvement in research providing they were confident it was ethical and participatory." So basically sex workers are interested in participating in clinical trials, provided they know what they're getting into. We wonder if that was the case with the participants recent nonoxynol-9 trials, who experienced no reduction in HIV transmission and an increase in genital lesions. Whether or not these women were truly informed, it makes sense that future studies need to treat sex workers as "stakeholders," and not passive "subjects" with no interests of their own.

Note: The women pictured are Bolivian sex workers protesting for the right to work.

What Do Sex Workers Think About The Ethics Of Biomedical Research Studies That Are Done On Them? [Feministe]

Earlier: Researchers Stop New Male Circumcision Trial In Uganda

According to a report by Bonnie Rochman,

As recently as 20 years ago, some in the medical community were still using the male body as their research prototype and extrapolating for women. The approach, as summarized by Anne Drapkin Lyerly, an obstetrician and bioethicist at Duke University, was "If you happen to have boobs and a uterus, then we'll adjust things."

These days, women are included (the "First Wave"), but, Rochman points out, more data on pregnant women is needed. That's why "an élite group" of 30 doctors, ethicists, scientists and government officials gathered in Washington this spring to launch a movement they're calling the Second Wave of clinical research.

As Rochman notes, Chronic illnesses like depression, diabetes and hypertension don't magically disappear during pregnancy. And more and more women are having children later in life, increasing the chances that they have other health problems. How you you weigh the benefits of certain drugs for the mother versus the health risk to the fetus? Given shifts in her metabolism and weight gain, what is what is the appropriate dosage for a mom-to-be? And, of course, what issues arise regarding testing drugs on pregnant women?

"Everyone thinks, Oh, my God, research on pregnant women! All kinds of ethical flags go up," says Ruth Faden, director of the Berman Institute of Bioethics at Johns Hopkins University. "We don't have to start with high drama." There's enough "low-hanging fruit," she says, "that we could keep lots of medical researchers busy for a long time."

Understanding the Risks (and Rewards) of Pills and Pregnancy [Time]

The case, detailed in today's NY Times, is heart-wrenching. The family was on vacation in Miami when Lisa collapsed, and when they arrived at the hospital a social worker allegedly told Langbehn that she was in an "antigay city and state" and would require health-care proxy forms in order to visit the ER. Although she produced the forms, she was still not allowed to see her partner for eight hours, only permitted access for five minutes while a priest administered last rites, and denied a chance to let the three children say goodbye until after Lisa was brain-dead. When Lisa's sister arrived, she was immediately admitted.

This Miami lawsuit, and a similar case in Washington State, raise an issue that is not a new one; hospital visiting rights is a common theme in the argument for gay marriage. And of course, a positive ruling vis a vis visiting rights could have major implications for all unmarried couples, to say nothing of friends and any number of relationships beyond traditional marriage. If successful, a ruling in Langbehn's favor could compel hospitals to respect a patient's wishes; right now, it's generally subject to a doctor's judgment in the case of emergency care.

Of course, there are legitimate legal reasons for having put such a policy in place - when it comes to questions like life support or other major decisions, it could conceivably get dicey to allow just anyone agency in these matters, to say nothing of legally problematic for hospitals. And certainly we get that you can't have various strangers wandering around the ICU, if that's what medical pros are concerned about. But surely there are simple, practical means of expanding this policy - the insurance equivalent of 'in case of emergency?' In a time when we're more than aware of the fragmentation of many family relationships and the importance of others, such restrictive policies and narrow definitions seem impossibly retrograde - and, when we hear about specific cases like this, inhumane. One of the more depressing aspects of the article, of course, is that legality is not guarantee of fairness - prejudice and cruelty can still find a way - but at least it's a start.

Kept From a Dying Partner's Bedside [NY Times]

Almost everyone agrees that the "zero-tolerance" policy recommended by U.S. doctors is unduly strict, and in Europe pregnant women are generally allowed a glass or two a week with no foreseeable damage to the fetus. So, sure, plenty of people find forbidding an adult woman the occasional drink to be, in a word, paternalistic. But "medical legal expert" Dr Colin Gavaghan has taken the argument a step further, calling such strictures "sexist" and "ethically dubious."

Gavaghan's point, presumably, is that the medical establishment's unilateral ban on alcohol during pregnancy only affects women. Which is inarguable, except I guess in the case of those sensitive fathers-to-be who like to share every facet of the shared pregnancy and willingly abstain from drinking out of solidarity. "Ethically dubious" refers to a sweeping recommendation made on fairly scant evidence - it's not been proven that very moderate drinking harms the baby - and so might be construed more as "medical ass-covering" than "full disclosure." The second part, we suppose we get. But if it's true, we're gonna go out on a limb and say that these same cautious doctors would probably be just as quick to ban pregnant men from drinking, too.

But, logic - and overly free use of words - aside, isn't there always a degree of paternalism to the regulation of alcohol? Kids can't drink. And it's up to a bartender's discretion to decide when someone has "had enough" - even if that person, is, legally, a consenting adult. Also, let's talk turkey: female drinking is up - especially binge-drinking in the UK - and however paternalistic, there's something to be said for making women aware of the risks of their behavior, if it can be done without unnecessary alarmism. To the extent that Gavaghan's argument rests on "informed choice," then yes, we agree. But he undermines it with his absurd sexism charges - and we rather resent the notion that this might have been intended to sway us, the target demo, with a buzzword. As the New York Times' etiquette columnist put it rather more moderately over the weekend, "There's no law requiring pregnant women to become vestal virgins. And a reasonable mother-to-be is the best judge of her behavior." True, but the fiction that we can live any facet of our public health lives, in the modern age, free of paternalism seems disingenuous - particularly to a "legal expert" who should at least recognize that to some, our society must seem too litigious to be trusted with all the facts.

Telling Pregnant Women Not To Drink Is 'Sexist' [Telegraph]
It's Sexist To Tell Pregnant Women Not To Drink, Says Expert [Daily Mail]
Social Q's: Make Mine a Double [NY Times]

Antibiotics are one of the most frequently prescribed treatments for acne, but recently the bacteria that causes acne has started developing resistance to the drugs. Scientists believe that between 10 and 30% of all acne patients harbor some type of mutated resistant bacteria. Often the patient believes that the antibiotics have cured their acne, only to have the problem return, sometimes even worse, months later. The mutant strains of acne also pose a serious health threat. Dr. Peter Lio says that the modified acne-causing bacteria could contribute to deadly drug-resistant staph infections. "If it became bad enough, it would be like the days before antibiotics, when infection was a common cause of death," he said. [MSNBC]

After she gave birth to stillborn twins, Flaherty became manic, producing numerous books and even writing up and down her arms. In time, she came to feel that her recently diagnosed bipolar disorder helped her understand her patients. She says,

What made me empathic was my depressions. People's emotions were pounding me in the face. The mania is like wasps under the skin, like my head's going to explode with ideas. But the depressions help the doctor aspect of me.

Rose Styron, wife of Flaherty's patient, the late writer William Styron, agrees:

Doctors tend to see patients with an overtone of category. Alice never did. She understood Bill's depression and his movement problems. But she really understood his needs, appetites, moods, guilts, sadnesses and potential pleasures.

Now Flaherty works with deep brain stimulation, a technique used for Parkinson's disease and other movement disorders, as well as for depression. The stimulation process can have psychological side effects, and Alice is especially adept at dealing with these. "Neurology and psychiatry should be treating the same organ," she says. Especially in light of new research suggesting that medical school actually makes people less empathetic, she is extraordinary.

Flaherty's empathy seems to come both from her experiences as a patient with a difficult condition and from her bipolar disorder itself, from the "emotions pounding her in the face." Both mania and depression can be extremely hard to live with. Still, Flaherty feels her condition has helped give her skills she might not otherwise possess. This is in line with her holistic view of bipolar: "It was always alienating when people said, 'Oh, that's just bipolar illness talking.' No, hello - that's me." And while some may find comfort through separating the disorder from their sense of self, it's interesting that Flaherty prefers to think of mental illness as part of her, a characteristic with advantages and drawbacks. It's not a model for every patient, or for every disease, but it's easy to see why, for some, it might be very appealing.

From Bipolar Darkness, The Empathy To Be A Doctor [New York Times]

In addition to the difficulty of actually having a psychological disorder, the mentally ill have to deal with how other people stigmatize them, from employers who won't hire them, to friends and family who don't believe their ailments to be real, to health insurance companies that won't cover treatment. People usually divide the mentally ill into those that are violent and dangerous or weak and incompetent, and fear or disdain them accordingly.

In the study, published in the journal Psychological Science, researchers set out to see if gender stereotypes about certain disorders influence how we view the mentally ill, reports EurekAlert. Two Northwestern University psychologists conducted a study in which volunteers from around the country were given the case history of a person with mentally illness. Some read the history of Brian, a man with all the typical symptoms of alcoholism, and others read about Karen, who had a classic case of major depression. For some of the patients, Karen and Brian's names were switched in the reports, so that she was the alcoholic and he was the depressed one.

Researchers found that the subjects expressed more disgust and anger, and less sympathy, toward Brian and Karen after reading their real reports, in which they had the disorder associated with their gender. When the patients acted "out of character," with a depressed Brian and an alcoholic karen, the volunteers said they were more willing to help them and were more likely to see their illness as a genuine biological disorder, instead of just a character flaw. Knowing that gender does play a role in how society treats the mentally ill, researchers say that there should be a campaign to challenge stereotypes about the association of gender with certain disorders.

[Image via Exploding Dog.]

His And Hers: Study Examines The Role Of Gender In The Stigma Of Mental Illness [EurekAlert]