Parker Waichman LLP Injury Alerts
WOMENS MEDICO-LEGAL ISSUES (PART III): Miscellaneous RisksJul 1, 2004 In the past two months, we have brought you the latest information regarding some of the most serious health issues and risks facing women today. (May – Hormone Replacement and June – Breast Cancer). This final installment in the series deals with a variety of “other” risks women face from a variety of sources.
Prescription Drugs Posing Greater Risks to Women
In 1990, the Society for Women’s Health Research was founded with the goal of placing a greater emphasis on how certain drugs not only affect women differently from men, but also how those differences often produce adverse consequences in women. Unfortunately, the Society’s warnings are not always heeded with the result that manufacturers do not always specify when a drug may be more harmful to women.
In February of 2001, however, the General Accounting Office examined a list of ten drugs which had been recalled since 1997 and discovered that 8 of the 10 posed more serious health risks to women. Four drugs in particular (Seldane [an antihistamine], Posicor [a cardiovascular drug], Hismanal [an antihistamine], and Propulsid [a gastrointestinal drug]) were found to be among the most dangerous to women posing serious cardiac risks such as Torsades de Pointes, a potentially fatal irregular heartbeat.
There are 11 other drugs still on the market that pose the same threats to women including; amiodarone, bepridil, disopyramide, erythromycin, halofantrine, ibutilide, pentamidine, pimozide, probucol, quinidine, and sotalol. For more information regarding these drugs visit www.torsades.org.
The Society hopes that their report will persuade the FDA and the pharmaceutical industry to conduct more gender-sensitive medical research in order to deal more effectively with this very real threat to women. If you are currently taken any of the aforementioned drugs and feel that you may be experiencing adverse effects, contact your physician immediately.
Birth Control Pills
While birth control pills serve an important function in today’s society, they do pose extremely serious risks to women. The December 2001 issue of the New England Journal of Medicine included results from a study conducted to determine the correlation between the use of oral contraceptives and the risk of heart attack.
Women who used “second-generation” oral contraceptives experienced an elevated risk for heart-attack as compared to women who used “third-generation” oral contraceptives. (These differing types of birth control pills are categorized by the type of active progestagen found in the drug. “Second-generation” oral contraceptives include a type of progestagen called levonorgestrel and “third-generation” oral contraceptives include either desogestrel or gestodene. There may be other variations of active progestagen but these are the most common.)
If you are currently taking birth control pills and believe that you might be at an elevated risk for heart attack or are simply unsure of the type of oral contraceptive you are taking and its side effects, consult your physician immediately. The new birth control “patch” also carries the same warnings with respect to serious side effects. So, while it may be more convenient to use, it must be regarded as no less dangerous.
Female X-Ray Technicians at Risk
In 2002, the Journal of the National Cancer Institute released information pertaining to women who were employed as x-ray technicians prior to 1950. Although the link between breast cancer and radiation exposure has been recognized for some time, the low number of women working in nuclear industry has made it difficult to find a large group of women to assess in terms of their risk for breast cancer.
There are, however, a substantial number of women who work as x-ray technicians in hospitals, medical and dental offices, and laboratories. These women provided the National Cancer Institute with an opportunity to conduct a study to determine the correlation between radiation exposure and breast cancer.
The findings were not surprising and bore a direct correlation to the change in safety measures between the early 1900s and today. Women who worked as x-ray technicians before 1940 are at three times the risk of dying of breast cancer than those who entered the field after 1960. The study group consisted of 62,525 female radiologists who were certified from 1926 through 1982 and were studied for 12 years.
The results indicated that death from breast cancer was 2.92 times more common among women who worked as x-ray technicians before 1940 and 2.44 times more likely for women who worked between 1940 and 1949. Women who began working in 1960 or later were not at a heightened risk since, by then, the levels of annual radiation exposure had been lowered significantly. In the 1920s and early 1930s, women who worked in the field were exposed to about 70 roentgens per year of radiation. By 1958, that number was down significantly to only 5 roentgens per year.
These findings serve to remind us of just how important it is for employers to provide their employees with a safe working environment (including state-of-the-art safety equipment) at all times. Of course, in the early days of x-ray technology, this was not possible since the dangerous effects of over-exposure to radiation were unknown. Even later, the risks were not always taken seriously since long-term research was unavailable and safety equipment was inferior and often inconvenient to use. Today, women should not be wary of accepting jobs as x-ray technicians. They should, however, always follow the mandatory safety instructions and use proper safety equipment in order to avoid the risk of breast cancer later in life.
Female Sexual Dysfunction: Who Benefits – Women or Pharmaceutical Companies?
With all of the real diseases, illnesses, and risks threatening the health and lives of today’s women, it seems unimaginable that anyone would actually find the need to create an additional one. After the success of Viagra for male sexual dysfunction, however, it was only a matter of time before the giant pharmaceutical companies would target women in the same way.
Thus, over the past six years, they have devoted an enormous amount of time and money to a series of conferences with the specific agenda of creating a working definition of “Female Sexual Dysfunction,” a “disease” that is so terribly vague, it would appear that every woman has either had it already, currently has it, or will eventually have it at some point in her life. This working definition was first developed in October of 1998 at an international multidisciplinary conference held in Boston. Those in attendance created a definition which featured disorders of arousal, orgasm, desire and pain. (It is worth noting, however, that 18 of the 19 contributors to the definition of Female Sexual Dysfunction had a financial investment in the creation of this new disease.)
An article in the February 1999 issue of the Journal of the American Medical Association (JAMA) claimed that 43% of all women over 18 suffer from Female Sexual Dysfunction, a figure that has since been disputed as totally inaccurate. This figure, however, became the basis for each pharmaceutical company’s advertising campaign for new drugs relating to this new female sexual arousal disorder.
In an attempt to discredit those who came up with such an outrageously high percentage of women suffering from this still questionable “disorder,” a sociology professor from the University of Chicago reanalyzed the original survey. About 1500 women were asked to answer a series of yes or no questions relating to their sexual experiences. The questions included lack of desire for sex, anxiety about performance, difficulties with lubrication, and ability to reach orgasm. If a woman answered “no” to even just one of the seven questions on the survey, she was classified as having sexual dysfunction. This is a troubling revelation since some of these so-called “problems” are psychological and may not even have anything at all to do with the physical aspects of sex. The 43% figure has subsequently been generally misused and has become quite deceptive.
Dr. Sandra Leiblum, a psychology professor, believes that the use of the 43% figure has lead to what she calls an “overmedicalisation of women’s sexuality, where changes in sexual desire are the norm.” Just because a woman may be disinterested or dissatisfied, does not mean they have a disease that requires a prescription cure.
Dr. John Bancroft agrees with Leiblum, arguing that a decrease in sexual desire for women that is a result of stress, fatigue, or inappropriate behavior by their partner is perfectly understandable and does not require medication. In fact, the instinct to medicate as opposed to investigate will lead to a lack of attention to other areas of a woman’s life which may be more problematic than her sexual activity.
In order for Female Sexual Dysfunction to be assessed in a valid and acceptable manner, a comprehensive evaluation including the measurement of hormonal profiles, vaginal pH, and clitoral, labial, urethral, vaginal, and uterine blood flow must be adopted. Yet even then, medical therapies should not exist in a vacuum, independent from emotional or psychological issues. A more “women-centered” definition of sexual problems, supported by those who wish to keep the definition separate from the one that the pharmaceutical giants are releasing, sounds something like this: “discontent or dissatisfaction with any emotional, physical, or relational aspects of sexual experience.” Instead of a limited definition that defines only the physical, this one includes four categories of causes such as 1) sociocultural, political or economic, 2) relationship related, 3) psychological and 4) medical.
Even with all of the progress in attempting to achieve a more women-friendly definition of sexual disorder, the concern still remains that, in the rush to prescribe the medications that the pharmaceutical industry is in the process of developing, some of the more intricate social, personal and physical causes of sexual problems will be disregarded. After all, drug manufacturers have never been ashamed of placing profits above every other consideration.
If you are a woman and are experiencing sexual difficulty of any kind, the important thing to remember is not to jump to conclusions. Taking a prescription medication should be the last option, not the first. Other remedies may include couples therapy, relaxation techniques to reduce stress, and simply a change of routine. The moral of this story seems to be, don’t make a mountain out of a molehill by convincing yourself that a pharmaceutical company really knows what is troubling you and that its drug is the “silver bullet” that will make your life better.
Your Health May Be Affected By Where You Live
According to a state-by-state analysis of women’s health conducted by the National Women’s Law Center and Oregon Health & Science University, where a woman lives may actually play a role in her overall health. The list was based on whether each state had complied with 67 “key women’s health policies.” These included: Medicaid coverage for breast and cervical cancer; requirements for insurance to pay for mammograms, pap smears, and colorectal cancer screening; access to reproductive services such as contraception and abortion; and economic security issues such as minimum wage, paid family leave, and child support.
The states that ranked in the top five were Minnesota, Massachusetts, Vermont, Connecticut, and New Hampshire. New York, California, and Rhode Island were the only states that met more than half of the pertinent requirements while Idaho, South Dakota and Mississippi met the fewest. An “F” grade was given to Mississippi, Louisiana, Arkansas, West Virginia, Oklahoma and Texas. To obtain a complete list of the states visit http://aolsvc.health.webmd.aol.com/content/article/86/99168.htm.
A Brief Review
In addition to all of the new information included in this month’s Newsletter, we would like to provide you with a short but comprehensive review of some of the other women’s health issues that have been discussed in previous Newsletters. To view the entire Newsletter from a particular month, please visit Parker & Waichman’s complete Newsletter Archive at http://www.yourlawyer.com/newsletter/archive.htm
Specific Risks for Women who Smoke
• Since 1950, there has been a 600% increase in women’s death rates from lung cancer. Three million women have died of diseases caused by smoking or in fires ignited by cigarettes since 1980 and, on average, these women died 14 years prematurely. In the 1990s, American women lost a collective 2.1 million years of life because of smoking.
• Female smokers are at greater risk than non-smokers for infertility. Researchers are now studying the possibility that smoking by pregnant women could damage the ovaries of developing female fetuses and reduce the number of egg cells produced by the female offspring of women who smoke.
• Additional evidence has reinforced previous reports that pregnant women who smoke are at a greater risk of having: (1) a baby with a low birth weight; (2) a stillborn baby; (3) a neonatal death; or (4) a child with sudden infant death syndrome (SIDS). In addition, the children of smoking women have a greater risk of developing asthma, bronchitis, colds and pneumonia.
• Female smokers suffer from lower bone density and experience a premature decline in lung function.
• In addition to lung cancer, women who smoke are at greater risk to develop cancers of the mouth and pharynx, esophagus, larynx, bladder, pancreas, kidney, and cervix. They also have an increased risk of cardiovascular disease, especially when using oral contraceptives.
Hormone Replacement Therapy
Recent studies now show that there are too many health risks associated with HRT to justify its being used automatically or as if it were a woman’s only available option. Women should consult their physicians to discover whether HRT would be a benefit or a detriment given their own particular circumstances. While HRT undoubtedly alleviates a number of menopausal symptoms in many women, for some, the cost of that immediate relief may include unwanted long-term effects.
• Prempro and Premarin, the two major HRT drugs, have been linked to side effects such as ovarian cancer, dementia, Alzheimer’s disease, stroke, blood clots, pulmonary embolisms, lupus, heart attack, and breast cancer.
• A large study found that HRT doubled the risk of Alzheimer’s disease and other types of dementia in women. In addition, HRT may have harmful effects on the general cognitive function of older women leading to mild memory loss amongst other things.
• HRT increases the risk of heart disease and heart attack in the first year of treatment.
• Taking hormones after menopause may raise the risk of ovarian cancer.
• HRT increases the development and recurrence of breast cancer and can lead to inaccurate and abnormal mammograms which only prolong the discovery and subsequent treatment of tumors.
The following is additional information related to HRT not included in our May 2004 Newsletter:
• HRT may also cause hearing loss.
• Women who use HRT run double the risk of developing asthma.
• Women on HRT who developed colon cancer were diagnosed at a later and more deadly stage of the disease thereby limiting possibilities for treatment.
Last month’s Newsletter dealt with information related to breast cancer. The following is a list of just a few important points from that Newsletter.
• Estrogen-Progestin pills, such as Prempro, used in HRT have now been linked to breast cancer.
• Women who use oral contraceptives are placing themselves at a higher risk for breast cancer later in life. One study concluded that the risk of developing breast cancer was 26% greater for women who used birth-control pills at any point in their lives and 58% greater for women who used birth control pills over a 10 year period.
• The mortality rate for African American women may be greater than for Caucasian women due to the fact that the former tend to have larger tumors and more aggressive forms of cancer.
• Post menopausal obesity has been linked to an increased risk of breast cancer as has weight gain after the age of 18.
• Exposure to estrogen-like industrial chemicals, excessive exposure to radiation, frequent under-arm shaving combined with deodorant use, and second-hand smoke are all significant risk factors for the development of breast cancer.
On April 25, 2004, 1.15 million people attended the March for Women’s Lives in Washington D.C. The issues at hand that day were choice, justice, access, health, abortion, and global and family planning. This record-breaking number of people joined forces for a vital cause. The March stands as an encouraging sign that women’s issues are finally being taken seriously in contemporary society.
It also demonstrated that there are a vast number of people devoting their lives to making sure that women receive (amongst other things) the best medical care possible, especially when they need it the most (when stricken with a disease or as they get older). It is up to health care professionals everywhere to help maintain and promote a society where the significance of women’s issues is no longer overlooked or minimized.
If you or anyone you know is currently seeking legal representation or a case evaluation for any of the women’s issues discussed in this three-part Newsletter, please contact the Parker and Waichman immediately.