Leslie Cannold: Writer, Commentator, Ethicist, Researcher
ARTICLES

Misconceptions in the Blame Cycle

Women must play and active role in protecting their sexual and reproductive health

Last week the Evening Standard reported the findings of a study linking \ use of the Pill with infertility. The British study found that former Pill users took twice as long to conceive than those who had used condoms, with those overweight, over thirty-five or with a history of irregular periods most likely to be affected. Nevertheless, less than a week later Australian experts were hailing the release of a new Pill that will allow women to reduce their periods to four times a year as providing long overdue relief from the unnecessary “pain and inconvenience” of a monthly bleed.

Women are likely to greet these latest findings, and the continued mixed messages from the medical profession about how best to manage their reproductive health, with the same feelings of confusion and outrage that greeted last year’s belated findings that ingesting combination HRT pills to prevent heart disease was not only a waste of time, but a clear risk to overall health. Indeed, the anger of infertile women upon learning this news is likely to be particularly keen, as the medical profession has been swearing for years that the Pill has no negative impact on future fertility.

But how justified are the explosions of female bewilderment and rage that follow media reports of new medical information and, in their wake, revised medical advice? Are medical scientists in general, and prescribing doctors in particular, really to blame for getting it wrong in the first place, or must women also accept some blame for the health consequences of the drugs they choose to ingest?

The truth is somewhere in between.

On the one hand, there is frighteningly little public discussion of the imposed and necessary limits of the testing procedures all new drugs must undergo before being approved for use in Australia. Most patients, for instance, would be shocked to discover that many of the drugs their GPs prescribe have not been properly evaluated, either for safety or effectiveness, for the condition and/or the type of patient for whom they are prescribed. For instance, when doctors began advising all menopausal women to take HRT (rather than the ones with acute menopausal symptoms originally targeted by the drug) there was no good research that it would reduce women’s risk of heart disease. That’s right, you heard me. Absolutely none.

Before doctors prescribe for particular patients, they should ensure that high quality evidence exists that the drug will be both safe and effective for that particular patient. As respected medical journalist Ray Moynihan has pointed out, problems often arise when doctors begin prescribing drugs tested on, say, critically ill middle-aged white men, to patients of all ages and sexes who present with far milder forms of the condition. In addition, doctors need to pay attention to whether the trials have adequately large sample sizes, are randomised and controlled (the gold standard in medical research) and independently conducted (rather than drug-company sponsored). Finally, they must be far more upfront with patients about what isn’t known about a particular drug. The impact of ongoing use is a big one here, simply because when a drug is new, or being prescribed for a new condition, even if someone has had the interest, foresight and financial capacity to study its long term effects, the results won’t be known for years.

With most major medical journals available through on-line prescription, there are few excuses for doctors not to provide patients with up-to-the-minute information about the drugs they recommend.

But women, too, have a role to play in getting and staying well. Before we swallow anything, particularly over months and years, we must ask our doctors about what is, and is not, known about their risks and benefits for a patient like us and what the quality is of the available evidence. And, if such answers are not forthcoming, we must pursue them ourselves. After all, it is our bodies and lives that will be affected – sometimes critically and for life – if we fail to act. Mostly, we must assume that in many instances when we swallow pharmaceuticals – especially in the long term – we are part of a (usually unacknowledged) experiment into their costs and benefits.

Perhaps if we kept this in mind, many of us would choose to take fewer pills, and less of the ones we do. Instead, we might choose to take only those pharmaceuticals we really need, only when less-risky treatment alternatives aren’t available.

Publication History

Misconceptions in the Blame Cycle, Sydney Morning Herald
11 Feb 2004

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Email: leslie@cannold.com Mobile: 0417 114 859 Fax: +61 3 9348 2015 - PO Box 1337, St Kilda South VIC 3182 Australia