You might have wondered why doctors are so persistent when it comes to your pap test and pelvic exam. You might also have wondered why doctors don’t give you information and offer you a choice in the matter. Here is some information about pap tests and pelvic exams that doctors rarely tell you:
Pap Tests – Undisclosed Information: Pap tests detect abnormal cells on your cervix. What doctors don’t tell you is that the results from a pap smear are often inaccurate (between 10 and 60% of pap smears are inaccurate) and will show a false positive for abnormal cells if you have recently had intercourse, taken a bath, used a tampon, or any number of such things. An abnormal pap smear does not necessarily mean you have cervical cancer, or that you are even at risk of cervical cancer. ehealthmd.com/content/how-accurate-are-pap-smear-results
Cervical Cancer – Undisclosed Information: Doctors also don’t want you to know how rare cervical cancer is. Your odds of getting cervical cancer are 1 in 13,699 (in developed countries). Your odds of dying in a motor vehicle accident each year are 1 in 6,535. In other words, you are more than twice as likely to die in a car accident than you are of getting cervical cancer. Also, the odds of getting cervical cancer are even lower if you are a young to middle aged woman. http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616/tbl/tbla-eng.htm
Extra Fees – Undisclosed Information: Doctors are able to charge extra fees for pap smears. Doctors don’t want you to know that they are making more money from your visit every time you agree to a pap test. http://www.pbs.org/wgbh/pages/frontline/shows/doctor/care/capitation.html
Bimanual Exams – Undisclosed Information: Doctors perform a bimanual exam (insertion of fingers into the vagina) along with the speculum exam. What doctors don’t want you to know is that there is no data to support the relevance of the bimanual exam. Studies have shown that no abnormalities have ever been accurately detected by inserting fingers into a woman’s vagina. jwh.2010.2349 (application/pdf Object
Pleasure – Undisclosed Information: Some doctors enjoy performing pelvic exams. But do not take my word for this – read for yourself a male doctor’s point of view on pelvic exams: http://forwomenseyesonly.wordpress.com/2012/09/09/the-other-side-of-the-speculum-a-male-doctors-point-of-view/
Further Tests – Undisclosed Information: Many women who receive a false positive pap smear result are sent for further and more invasive testing. This leads to further income for medical professionals, but this is also where further damage to the cervix can occur from colposcopies and unnecessary biopsies; resulting in risk of heavy bleeding, infection, irreparable cervical mutilation, unnecessary hysterectomies, and difficulties with pregnancy and giving birth as the following evidence shows:
Based on solid evidence, regular screening with the Pap test leads to additional diagnostic procedures (e.g., colposcopy) and treatment for low-grade squamous intraepithelial lesions (LSIL), with long-term consequences for fertility and pregnancy. These harms are greatest for younger women, who have a higher prevalence of LSIL, lesions that often regress without treatment. Harms are also increased in younger women because they have a higher rate of false-positive results. Magnitude of Effect: Additional diagnostic procedures were performed in 50% of women undergoing regular Pap testing . . . The number with impaired fertility and pregnancy complications is unknown. http://www.cancer.gov/cancertopics/pdq/screening/cervical/HealthProfessional/page1/AllPages#Section_133
So, as you can see, there are many good reasons why your doctor doesn’t want to offer you information and a choice regarding pelvic exams and pap tests. Do your research, protect your healthy mind and body.
While some of your information is acurate, your post leaves the impression that paps and pelvic exams are unnecessary. Cervical cancer is the 2nd leading cause of death in women worldwide. And though routine testing has largely eliminated that risk in the U.S., 3710 American women died in 2006 from cervical cancer. When caught early, cervical cancer is easily cured. When caught late it is terminal — there is no cure and painful horrific death is only a matter of time. I have seen women in their 20s dying of cervical cancer. Paps should begin at age 21 regardless of presence, absence or type of sexual activity. Please do not personally or encourage your readers to neglect their exams!
Dear Dr Pate, you are telling . . . after . . .
1. Crevical cancer is not the 2nd leading cause of death in women worldwide. Not even 20th! Never was, never will be.
2. Pap testing did not “largely eliminate” cervical cancer. It’s a hype used to coerce women into pap smears. There is less than 1% difference in chance of getting cervical cancer between women who pap-smear all their lives and women who never do pap tests.
3. Pap smears are not just unnecessary, they are harmful. 77% of women end with butchered cervixes after biopsies and “treatments” for cancer that only 0.68% will get.
4. You urge women they “should begin at age 21 regardless of presence, absence or type of sexual activity”, which is an outright . . .! A person who never had sexual activity doesn’t have HPV. No HPV = no cervical cancer. You either should go back to school and learn the facts properly, or stop with the deliberate . . .
To the editor of this blog: I don’t mind you editing my comments if you prefer certain words to be removed for your peace of mind. It’s a great blog, and I’m happy with the way you are managing it.
Awesome, thank you!
According to the NIH, Cervical Cancer used to the the leading cause of death in women. The decline in cervical cancer related deaths is attributed to the use of Pap tests. I’m a big fan of using references, see below:
http://www.cdc.gov/cancer/cervical/statistics/
Furthermore, it has been shown that almost all cervical cancers are caused by HPV infection:
http://www.cdc.gov/cancer/hpv/basic_info/
This is why I love science, the truth will out!
James, I was just browsing through your blog and learned that you are against routine circumcision, you call it “infant genital mutilation” and you apologise to your son for having done that to him.
Unless you fully advise women of the high risks and limited benefits of pap tests and make sure they understand that screening is a choice and if they choose to screen, you offer them to follow the Dutch program (5 hrHPV primary triage tests), unless you do all of that, you will have to apologise to all of your patients who endured treatments at the end of your career for having mutilated their genitalia for nothing.
Why did you allow your son to be circumcised? “We didn’t understand the risks. We didn’t understand the permanent damage that we were condoning. We did not understand the history of circumcision in the U.S. nor its root in puritanical aims to deter masturbation. We were simply uninformed and did not understand the gravity of our decision to circumcise our son.”
Women in the US (and apparently doctors too) don’t know of the risks that come with (over-)screening. You, as an OB/GYN resident, really have the opportunity to educate yourself and make a difference…
Cervical cancer is so rare, that most doctors would go for years without ever seeing a woman who has it.
It’s amazing to me how few doctors respect informed consent for women, the use of the word “should” is very concerning and highlights a major problem with the medical profession and their attitudes to female patients.
The routine pelvic exam is NOT recommended in Australia, the UK and in many other countries for good reason, it is of poor clinical value and exposes the woman to risk, even unnecessary surgery. Dr Carolyn Westhoff, an American ob-gyn, partly blames this exam for their high hysterectomy rates and the number of unnecessary oophorectomies. Beware of the routine pelvic exam. (several articles online)
Only one person can decide a screening test is “necessary”…the individual man OR WOMAN. I doubt a doctor would appreciate being told he should or must have a prostate exam, all cancer screening is elective and legally and ethically requires informed consent. There are benefits with some screening tests, but also, there is RISK and only the individual can decide whether the benefits outweigh the risks.
I made an informed decision about 30 years ago not to participate in cervical screening, my risk of cervical cancer is near zero while the risks with testing are high, very high in Australia (and the States) with serious over-screening. The lifetime risk of referral for colposcopy and usually some sort of biopsy is a whopping 77% for a cancer with a 0.65% lifetime risk. Of course, this information is never released to women, you have to do your own research. I also recently rejected breast screening due to the significant risk of over-diagnosis for little or no benefit. (the Nordic Cochrane Institute have produced an excellent summary of the evidence to assist women to make an informed decision, “The risks and benefits of mammograms” is at their website.)
There are no randomized trials for pap testing so we’ll never know for sure whether anyone has been helped, stomach cancer has dropped significantly over the decades with no screening at all…IF women have been helped, the numbers are fairly small, if you take out false negatives and consider natural decline, (this cancer was always rare and in natural decline before testing started) fewer than 0.45% could possibly be helped…and of course, no one considers the HUGE over-treatment rates, especially in Australia and the States. We know many of these women then have damage to the cervix that can mean infertility, high risk pregnancies, premature babies, miscarriages etc
Cervical cancer is more common in Africa (unique risk factors) and the undeveloped world, but this cancer has always been rare in countries like Australia, the UK and the States. To compare cervical cancer rates in Africa and Australia is misleading and inappropriate.
Women in their 20′s dying from cervical cancer – this will happen whether you screen or not. Over decades of testing not one country has shown a benefit pap testing those under 30#..but all have evidence of risk/harm, these women produce the most false positives.
(#See: “Cervical cancer screening” by Assoc Professor Margaret Davy and Dr Shorne, Australian Doctor, July 2006.)
These very rare cases are usually an adenocarcinoma… (the pap test often misses this even rarer type of cc) Countries with evidence based screening like the Netherlands and Finland do not offer pap testing to those under 30 and Finland has the lowest rates of cc in the world (the Dutch no more than us) and both countries refer FAR fewer women for colposcopy/biopsy. (fewer false positives) Pap testing young women can endanger their lives as a false negative result can lead to false reassurance and a delay in seeing a doctor about symptoms and so a later diagnosis and poorer prognosis.
To suggest all women start pap testing at 21, regardless of sexual activity, is a VERY concerning statement. Sexually active women under 30 don’t benefit from pap testing and most countries exclude women who have never been sexually active from this testing for obvious reasons…it’s risk for no benefit.
As I understand it…it’s only the States that promotes pap testing for those not yet sexually active…this can only be about the profession “assuming” all women have been sexually active by age 21…IMO, this is arrogant and inappropriate. Women should be provided with balanced and complete information and left to make up their own minds…the profession should not be assuming anything about women. Many American doctors still coerce women into elective cancer screening and unnecessary exams to get the Pill, so women need to be careful when they choose a doctor and make a formal complaint when faced with this sort of outrageous conduct. Find a doctor who will act in your best interests and respect your right to make an informed decision about testing…to accept or decline as you see fit…and to foster a respectful two-way relationship.
I’d urge all women to look at the evidence before following recommendations or your doctor’s advice – make sure these things are in YOUR best interests.
Thankfully, things are changing and those doctors who promote harmful excess and give women disrespectful orders or misleading information will find fewer and fewer women in their waiting rooms. Speak with your feet…there are great doctors out there, you just have to search for them.
Also, we now know only roughly 5% of women aged 30 or older can benefit from a 5 yearly pap test, those HPV positive. Most women are HPV negative, not at risk and cannot benefit from pap testing. It’s risk for NO benefit.
Population pap testing is now outdated…see the new Dutch program, go to
HPV Today, Edition 24 – replacing their 6-7 pap test program, 5 yearly from 30 to 60 to 5 hrHPV primary triage tests offered at ages 30,35,40,50 and 60 and only the roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test. Women also have the option of self-testing, using the Delphi Screener. (also in use in Singapore, Malaysia and elsewhere)
Dr Pate, please do not insult the intelligence of the women of this forum by telling us that you have seen women in their 20s dying of cervical cancer. Appealing to emotions does not work with this group of informed women. You neglected to mention whether these women who apparently died had paps or not as we are quite aware that pap smears are notoriously inaccurate particularly when it comes to adenocarcinomas. Save your scare tactics for other forums. Also, please support your opinions with peer reviewed references if you want to appear credible. An MD after your name carries no weight around here. We are not gullible women, we are intelligent and capable of reading the literature and making our own informed decisions. The days of doctors telling women any kind of BS to get them to comply are numbered.We can access most of the journals that you read, so telling us misleading information such as cervical cancer is the 2nd leading cause of death worldwide is easily checked by looking at the incidence of the disease in developed countries before screening was introduced. Therefore, we know that the disease was never as prevalent in developed countries as it is in developing countries. Nice try.
Ladies,
I am not going to engage inirrelevant and counterproductive argument regarding statistics and medical recommendation. It was not my intent to “insult intelligence” nor to “use scare tactics.” My point was to reiterate the standard of medical care from the U.S. perspective. Some basic information in support of what I have previously written can be gleaned from the following websites:
http://www.cdc.gov/cancer/cervical/statistics/
http://www.cdc.gov/cancer/cervical/basic_info/screening.htm
http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm
http://www.uptodate.com/contents/cervical-cancer-screening-beyond-the-basics
http://www.who.int/hpvcentre/statistics/en/
To Your Health,
James Pate, MD
Dr. Pate, in your first comment you had stated ” Cervical cancer is the 2nd leading cause of death in women worldwide” but from visiting the WHO website it is possible to see your comment was inaccurate. The WHO states the top ten leading causes of death amongst women worldwide as follows:
Ischaemic heart disease
Stroke
Respiratory infections
COPD
Diarrhoeal diseases
HIV/AIDS
Diabetes
Prematurity and low birth weight
Neonatal infections
Hypertensive heart disease
http://www.who.int/mediacentre/factsheets/fs334/en/index.html
As you can see, cervical cancer does not even make it into the top ten. It is this type of careless misinformation designed to elicit compliance that leads to further mistrust of the medical profession.
Oh, and you had also stated ” Please do not personally or encourage your readers to neglect their exams!” I would like to point out that nowhere on this blog site have I ever encouraged readers to neglect their exams. What I do attempt however, is to encourage readers to do their research, to know they have a choice, to take control of their own bodies and allow themselves peace of mind. What I would like to ask of you is this:
Please offer women accurate information and allow them a choice
Please do not withhold healthcare or medications if a woman decides to not screen
Please do not bully or pressure women into screening against their will
Please do treat women with the same respect as you treat men (drs offer men informed consent regarding prostate screening, there is no coercion or withholding of healthcare when men decline screening – even through prostate cancer is roughly 19 times more prevalent than cervical cancer)
Please attend to other parts of a woman’s body
In addition, Dr. Pate, you’ve neglected to mention that statistically, cervical cancer doesn’t even scratch the top 10 in most common cancers in the United States or the UK, and the lifetime risk of getting cervical cancer is less than 1%. Cervical cancer diagnoses are far fewer than other gyn cancers, such as breast, ovarian and uterine, and for other “rare” cancers such as kidney and pancreatic.
There aren’t any viable screening tests for pancreatic cancer or ovarian cancer, but tell me, how much do you screen your patients for those other cancers?
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf
http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/risk/statistics-on-the-risk-of-developing-cancer
Nor do you mention that the risk of getting cervical cancer for a woman who does NOT have one of the high-risk strains of HPV is somewhere in the neighborhood of .001%. There are several viable options to screen for HPV without a pelvic exam, including the Cervista urine test. If a patient tests negative for HPV, she has a better chance of being struck by lightning than getting cervical cancer. So tell me, do you routinely offer this alternative to your patients, or do you scare them into returning for their exam every year (which, in itself, is due to the high error rate of paps), withhold their birth control to coerce them into Paps, and make them think that cervical cancer is looming to kill them at any second?
http://www.cervistahpv.com/laboratory/cervistahpvhr/index.html
Do you fully inform your patients of the risks of testing, including false positives, incorrect interpretation and the possibility of needless follow ups? If they have these follow ups, such as LEEP, do you inform them fully of the risks of the procedure, such as an impact on their future ability to carry a fetus to term?
Ladies,
You are correct about the “leading causes of death” not including cervical cancer. I am currently away from my computer on vacation and am attempting to contribute to this discussion via iphone which has its obvious limitations. The statistic I unintentionally misrepresented is the following: “Worldwide, cervical cancer is second only to breast cancer as the most common malignancy…”. It’s source is: http://consensus.nih.gov/1996/1996CervicalCancer102PDF.pdf.
“Only one person can decide a screening test is ‘necessary’… the individual man OR WOMAN… all cancer screening is elective and legally and ethically requires informed consent. There are benefits with some screening tests, but also, there is RISK and only the individual can decide whether the benefits outweigh the risks.”
— I completely agree.
“…no one considers the HUGE over-treatment rates, especially in Australia and the States. We know many of these women then have damage to the cervix that can mean infertility, high risk pregnancies, premature babies, miscarriages etc.”
— I can assure you that all medical organizations and competent physicians are constantly weighing the risk-benefit ratio of evaluations and treatments with the goal being the improvement of health. There is a lot of over treatment, however this is felt to be necessary to identify and treat women with early cervical cancer while it is still curable. Fortunately, colposcopic biopsies rarely result in the complications that you mention. There are higher rates of complications with LEEP that should be discussed as part of the informed consent process.
It is very interesting to read your descriptions of different treatment guidelines around the world. I must confess that as a U.S. trained OB/GYN resident (I graduate in 6/2013) that I have not delved into other countries recommendations.
“As I understand it…it’s only the States that promotes pap testing for those not yet sexually active…this can only be about the profession ‘assuming’ all women have been sexually active by age 21…IMO, this is arrogant and inappropriate.”
— We do not assume that all women are sexually active. HPV is incredibly prevalent and up to 80% of the population will be infected at some point in their lives. There are case reports of women who have never experienced coitus developing HPV-related cervical cancer. Thus age 21 has arbitrarily been set by expert panel as the time to begin Paps in the U.S.
“Find a doctor who will act in your best interests and respect your right to make an informed decision about testing…to accept or decline as you see fit…and to foster a respectful two-way relationship.”
— I completely agree. Father does NOT know best and the doctor is not god. Your physician should serve as an expert medical advisor that assists you in making decisions about your personal heath care.
“Also, we now know only roughly 5% of women aged 30 or older can benefit from a 5 yearly pap test, those HPV positive. Most women are HPV negative, not at risk and cannot benefit from pap testing. It’s risk for NO benefit.”
— This is a very bold, unsubstantiated statement. The reason why we continue to do Paps in HPV negative women after age 30 is because humans are terrible at lifelong monogamy. Approximately 1/4 of relationships are impacted by sexual escapades and over 50% of marriages end in divorce. Just because you are HPV negative at one point in time does not mean that you are immune to (re)infection.
“Save your scare tactics for other forums. Also, please support your opinions with peer reviewed references if you want to appear credible. An MD after your name carries no weight around here. We are not gullible women, we are intelligent and capable of reading the literature and making our own informed decisions. The days of doctors telling women any kind of BS to get them to comply are numbered.”
— Having obtained the degree of MD personally I can assure you that no amount of self-study is going to give you an equivalent education. To discount expert “opinion” because you do not see value in our education is to your own loss and detriment. If you truly want to know all the nitty-gritty details of a medical education then I highly encourage you to pursue one legitimately. Be prepared to feel like you are drinking water from a firehose.
“I would like to point out that nowhere on this blog site have I ever encouraged readers to neglect their exams.”
— I am happy to hear this. I only stumbled upon your post and have not investigated your blog in any other depth.
“What I do attempt however, is to encourage readers to do their research, to know they have a choice, to take control of their own bodies and allow themselves peace of mind.”
— I love this and completely agree with this advice.
“Please offer women accurate information and allow them a choice”
— I do.
“Please do not withhold healthcare or medications if a woman decides to not screen”
— I don’t.
“Please do not bully or pressure women into screening against their will.”
— I don’t.
“Please do treat women with the same respect as you treat men.”
— I absolutely do.
“Please attend to other parts of a woman’s body.”
— I do.
Congratulations on your efforts to inform and empower women to take an active role in their health care. Please do not breed animosity against the medical profession as a whole — we share the same goal of improving women’s health. You are wise to educate yourselves about these issues and to raise questions when you have them. On the other hand, to discard medical opinion completely is as foolish as throwing out the baby with the bath water. I hope I have contributed to your discussion in a positive way.
Sincerely,
James Pate, MD
The literature that claims that cervical cancer is “second only to breast cancer” is from 1996, and there are no actual hard numbers in that report to substantiate the claim. In the reports where we DO have biostatistics, cervical cancer repeatedly shows itself to be far rarer than you claim.
As for the statistic that 80% of the population will get infected with HPV, well, you neglect to mention that:
1. There are more than 100 identified strains of HPV.
2. Of those 100 + strains, less than 40 affect the genitourinary tract and less than 20 are thought to be oncogenic.
3. Of those 40, 90% cause genital warts.
4. Only two strains, 16 and 18, are responsible for the vast majority of cervical cancer cases. These strains are covered under the Gardasil vaccine, and are also identifiable with testing.
5. In addition, up to 90% of HPV infections, particularly in younger people, will resolve on their own, so the mere presence of HPV does not in any way guarantee that a person will develop cervical cancer.
That puts that “80% infection rate” into perspective, doesn’t it?
http://jama.jamanetwork.com/article.aspx?articleid=184404
http://www-scf.usc.edu/~uscience/gardasil_vaccine.html
I’d also add that you have no idea what professions the women on this blog have – for all you know, you’re talking to someone with a PhD in epidemiology right now. Frankly, the fact that you’re able to pass the medical boards does not guarantee that you are an expert, and considering the high rates of death and misdiagnosis from medical error in this country, it would be foolhardy to think that doctors are infallible. Many tests, such as the pap smear, are promoted by those who benefit financially from it.
And again, I would ask if you are so zealous in promoting testing and diagnosis for the myriad conditions and cancers that are far more common than cervical cancer.
Also, I’d ask you to take a look at how cervical cancer screening is offered vs. how prostate cancer screening is approached. The latter has a much, much higher rate of incidence and is undeniably the most common cancer in men in most of the industrialized world. In the USA a man’s lifetime risk of contracting prostate cancer is almost 20%. Yet, screening is presented as something optional, the risks of the available tests and overtreatment are addressed, and men are encouraged to weigh the cost/benefit ratio for themselves.
Cervical cancer has less than 1% incidence, the pap is notoriously unreliable (you might notice that some reports encourage yearly screening specifically BECAUSE the pap has such a high rate of error), and overtreatment has longterm effects on sexuality, childbearing potential, et al. Yet paps are seen as a requirement and even here, you’re insisting that every woman needs to have them. Why is screening for a cancer with a >1% incidence rate considered more important and presented as mandatory when screening for a cancer with a 16% incidence rate is seen as optional?
In addition, even though men have the same ability to pass on HPV and other STDs, and can suffer negative effects from it, such as genital warts, as easily as women, there is no compulsory screening for men.
You might want to ask yourself why that’s the case, and wonder if it’s because of the paternalism with which the medical profession treats women. That is not speculation, either, there have been numerous studies that have indicated that women are less likely to have their complaints adequately addressed, less likely to receive complete information on testing, less likely to be treated as active partners in their health care, and less likely to receive adequate pain control than men.
http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1144&context=fac_pubs
http://www.partnersagainstpain.com/hcp/pain-management-resources/gender-pain.aspx (has links to several clinical studies and peer-reviewed articles)
Dr Pate, this is amazing!
You did not possess any correct information about cervical cancer incidence, nor you were able to interpret the manipulated “statistical data” that has been carefully composed and widely employed to coerce women into pap screening for ages, and yet you stated “cervical cancer is the 2nd leading cause of death in women worldwide” and used that as your main point why women should submit to pap smears and why it is so “necessary”.
At the same time, you proudly emphasized that you went through serious training, graduated and consider your knowledge above anyone else’s here. How good is that?
But there is something worse: you will continue telling your patients that pap smears are “necessary” and “save lives”. Just like millions of other doctor do.
” Having obtained the degree of MD personally I can assure you that no amount of self-study is going to give you an equivalent education. To discount expert “opinion” because you do not see value in our education is to your own loss and detriment. If you truly want to know all the nitty-gritty details of a medical education then I highly encourage you to pursue one legitimately. Be prepared to feel like you are drinking water from a firehose.”
Irritating physician arrogance noted!
“Worldwide, cervical cancer is second only to breast cancer as the most common malignancy…”.
This statement is not even close to conveying the meaning of what you said. Where did you attend college?
Dr Pate, you state:
“I can assure you that all medical organizations and competent physicians are constantly weighing the risk-benefit ratio of evaluations and treatments with the goal being the improvement of health. There is a lot of over treatment, however this is felt to be necessary to identify and treat women with early cervical cancer while it is still curable.”
How interesting that you admit that over treatment is considered to be ‘necessary’ according to the ‘risk-benefit evaluations’ of ‘all medical organizations and competent physicians’. If this over treatment is acceptable for women, why is it not acceptable for men with regard to prostate cancer? I don’t understand the disparity.
In the UK, men get information clearly stating that 48 men will need to be treated to save one life (and then left to make up their own minds).
On the other hand, women are given no equivalent information with regard to cervical screening – we are just told that we should screen.
I had to look for information in the BMJ, to find that for every life saved, 150 receive an abnormal result, 80 are referred and over 50 receive treatment.
Not only is this considered by the medical profession to be acceptable, it then patronizes women by not disclosing the real risks of over treatment to women, whilst making sure men have enough information to make an informed decision.
James, I appreciate you have a particular skill set in medicine, however don’t underestimate the research skills that many of us have acquired, you do not need a medical degree to apply critical reasoning when investigating a meta-analysis on cervical screening. Some of us have skill sets in statistical analysis, some of us have an interest in bioethics and most of us are capable of working from a scientific paradigm, don’t just assume that only medical doctors are the experts.
Also, many of us respect your profession and utilise it when needed, though I am aware that medical doctors are also people, and fallible. Doctors work in an imperfect, highly stressful profession, and because of the nature of the work, should be subject to ethical scrutiny, not only by ethical committee’s (that are, by the way, are made of a cross section of people) but also health consumers.
“Also, we now know only roughly 5% of women aged 30 or older can benefit from a 5 yearly pap test, those HPV positive. Most women are HPV negative, not at risk and cannot benefit from pap testing. It’s risk for NO benefit.”
— This is a very bold, unsubstantiated statement. The reason why we continue to do Paps in HPV negative women after age 30 is because humans are terrible at lifelong monogamy. Approximately 1/4 of relationships are impacted by sexual escapades and over 50% of marriages end in divorce. Just because you are HPV negative at one point in time does not mean that you are immune to (re)infection.
You might care to check out the new Dutch program, it’s far from unsubstantiated, it’s just that American, Australian and other women are not offered evidence based screening. Most women endure a lifetime of unnecessary pap testing and a high number go on to even more unpleasant things, like laser treatments and cone biopsies.
The fact is Dutch women will be offered a hrHPV primary triage test at age 30 or they can self-test using the Delphi Screener and if HPV negative, they will NOT be offered a pap test and that will be about 95% of women. The roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test. (presumably until they clear the virus) There is no point doing pap tests on HPV negative women, they’re not at risk.
The program will then offer women a chance to re-test for HPV at ages 35,40,50 and 60 (or self-test) and once again only the roughly 5% who are positive will be offered a pap test….this is to cover the possibility of a new infection.
This takes most women out of pap testing and will greatly reduce referral and over-treatment rates. (and hopefully that means fewer premature babies etc) IMO, this is a massive step forward and will greatly improve the health and quality of life for Dutch women. It is also more likely to prevent this rare cancer…identifying the small number of women actually at risk – the only women with a small chance of benefiting from a 5 yearly pap test.
Those women who test negative for HPV who are also confidently monogamous or no longer sexually active may choose to stop all testing and yes, that should be the woman’s decision, not the doctor’s…we have to move away from this notion that others should make decisions for women, make assumptions about us or our partners or accept risk on our behalf. I make decisions and accept risk every day of my life and take full responsibility for those decisions.
I’ve spent decades researching this subject – initially to protect myself from these programs and to get to the facts, but later out of a sense of outrage at the shameful way women were being treated by the medical profession. Aussie women are still being told they need 26 pap tests, 2 yearly from teens to age 70, maximizing risk/harm for no additional benefit over a 6-7 pap test program, 5 yearly from age 30 to 60 (the Finnish program) and of course, we’re not offered HPV primary testing (that would take 95% out of pap testing)…in this country huge numbers face the ordeal of over-treatment, almost all is unnecessary and was avoidable with screening in ethical hands and now this damage is almost completely avoidable with something like the Dutch program…this should be a scandal, instead doctors remain silent and continue to promote and protect these programs…not good enough, not by miles.
If you include ALL women at age 21 (far too early anyway) you will include women who are not yet sexually active (no genital contact at all)…all women have a right to protect their bodies and health…these women can only be distressed and harmed by pap testing. It is the profession making an assumption that all women have been sexually active by age 21 and that is not true for all women, we’re not all the same.
Informed consent in women’s cancer screening is a foreign concept for most doctors, but a growing number of doctors are now just as concerned as we are…hopefully, you’ll be motivated by our comments to help change deeply entrenched attitudes within the profession.
Also, this level of over-treatment is not about saving lives, the Finns have the lowest rates of cc in the world and refer far fewer women for these “treatments”…it’s been known for a long time that over-screening greatly increases the risk of over-treatment. Finland has had their 6-7 pap test program, 5 yearly from age 30 to 60 since the 1960s, this isn’t new…and we know testing those under 30 simply doesn’t work…the same number of cases will occur, but this age group produce the most false positives and that can lead to over-treatment. There was never a need to refer and over-treat so many women…never.
We still “treat” women without first checking their HPV status…that would rule many women out of over-treatment. So, please don’t try to tell me that this level of over-treatment was necessary to save lives, sadly and tragically, that’s simply not true.
Dr, this comment:
“Having obtained the degree of MD personally I can assure you that no amount of self-study is going to give you an equivalent education. To discount expert “opinion” because you do not see value in our education is to your own loss and detriment. If you truly want to know all the nitty-gritty details of a medical education then I highly encourage you to pursue one legitimately. Be prepared to feel like you are drinking water from a firehose. ”
is directed at me.
Please don’t assume that I merely self studying. I am part way through a medical science degree. You may take the smears, but I may be the one looking at the cells under the microscope and giving you the diagnosis.
“Please attend to other parts of a woman’s body.”
— I do. …….(SmileyFace)……..
I thought the “Smiley Face” icon at the end of this sentence was quite disturbing. What does the good doctor mean?
That James as a man went into the specialty of women’s healthcare as a man says already enough if you ask me..
Jane, apart from the disturbing smileyface, I found it also disturbing he speaks to us using the condescending term ‘ladies’. It’s reflects his view on women as an OB/GYN very well, as just like in the old days- a ‘lady’, delicate as she is, was considered the property of a man .. this is exactly how OB/GYNs must think of women in order to justify their profession, they think women are so delicate they need constant medical surveillance so they can basically own womens’ bodies and claim authority over them.
It’s also ridiculous to call yourself an ‘expert’ if you’re that foolish you can’t even interpret statistics correctly, not to mention the arrogance to claim that “Having obtained the degree of MD personally I can assure you that no amount of self-study is going to give you an equivalent education. ” ! If you can’t even question your own education, you can’t be considered intelligent.
Yassmyne, I’ve found many doctors have a fairly poor understanding of screening, except to recommend it and stick with the official programs. I’ve provided my GP with information on breast screening…there are critical articles in medical journals, but most of it doesn’t get into everyday practice. So it’s almost like…they know and discuss it behind closed doors, but choose not to tell us or even mislead/lie to us and then there are those who haven’t kept up with their reading and haven’t a clue. As we’ve seen here with over-diagnosis in breast screening, they will hide issues that might put women off screening…until they’re forced to face them. ONE doctor in this entire country felt over-diagnosis must be mentioned to women, thank you Assoc Prof Robin Bell…and so for the first time it’s been reluctantly mentioned to women.
My GP queried my total rejection of breast screening and said there was “still some” benefit, although she accepted risk was a factor with over-diagnosis…while there is “some” benefit, doctors will continue to recommend it and definitely when there is a formal program, I think many see it as “safer” for them. I pointed out the revised conclusion by the NCI…little benefit with significant over-diagnosis, they don’t recommend breast screening at all. She was surprised…but I’m sure the next woman will still face a recommendation to have breast screening, it seems if we don’t raise our concerns, they won’t mention them, even if they know about serious risks, no or little benefit and problems with the testing.
Even if a doctor mentions over-diagnosis, it’s usually whitewashed (as we see with Prof Ian Olver and the Cancer Council) – “WE” still believe the benefits exceed the risks and therefore will continue to recommend it to women. It never occurs to Dr Olver or most others that it’s not their call…whether the so-called benefits exceed the risks is MY decision, it’s this sort of paternalism and arrogance that must be challenged.
I respect my doctor’s knowledge in most areas, but there is no doubt my knowledge when it comes to cancer screening, especially cervical and breast screening, exceeds her knowledge. Most GPs don’t expect a debate when they recommend screening, they rely on our acceptance of their bald recommendation…we have to challenge them constantly so they get the message. Real and complete information and respect for informed consent, nothing less, they can manage it for prostate screening, so they can do it for women as well.
Interesting study that confirms many American doctors are still doing unnecessary routine bimanual pelvic exams. It’s concerning to read the study did not cover the visual inspection of the genitals, just the bimanual exam. I cannot imagine a doctor suggesting a routine visual inspection of the genitals…poor American women might be finally rid of the bimanual pelvic exam and have fewer pap tests, only to find they’re expected to deliver up their genitals for unnecessary medical inspection. It’s unnecessary and a horrible violation of bodily privacy and dignity. I think most people in this country would run if a doctor suggested such a thing.
http://www.ucsf.edu/news/2012/12/13312/study-questions-reasons-routine-pelvic-exams
I’ve recently (in the last 2 yrs) been told by two seperate physicians that 1) a pelvic exam is not necessary to procure birth control, and 2) pelvic exams are recommended every 3-5 years. I do think there is progress on this.
Although the high rate of false positives for Pap tests is an issue, one of the strengths of the test is the low probability of false negatives. If cheaper tests were available, I would suggest using the test in triplicate to decrease error. However, when someone’s life is in the balance, I can understand why more thorough exams are performed.
antonmedical,
I couldn’t reply on your other comment in this thread where you ended with “This is why I love science, the truth will out!”, so I reply here.
I assume you meant to write “This is why I love science, the truth will COME out”
Well, if you’re so much in love with science, this blog should be of great interest to you because it refutes the many medical MYTHS concerning pap smears and cervical cancer, backed with real scientific facts.
It’s quite arrogant to then come here and repeat the mainstream nonsense based on these very MYTHS that we are trying to dispel, but you don’t even take the effort to READ but simply *assume* that what we are saying is based on nonscientific ignorance.
To me you don’t come across as a scientist as you don’t seem to be able to question the status quo and rely on information coming from mainstream sites like the NHS. You tell me, what does that have to do with science? Professor Michael Baum, Emeritus Professor of Surgery- a real scientist btw- can already tell you this about the NHS Breast Screening Programme; that they are deceiving women and that many women are having unnecessary surgery.
Then why would you or anyone else even rely on what the NHS has to say about cervical cancer and PAP smears?
Here’s some more info for you and hopefully your love for science is big enough to have interest for information not coming from mainstream sites that base their info on myths:
“The Pap test’s role in the much-heralded “dramatic” decline in the cervical cancer death rate is overstated, according to Foltz and Kelsey, because the rate began to drop well before the Pap test became widely used.
..
Whatever the reasons, the decline in cervical cancer deaths can hardly be described as dramatic. In 1968, there were 7,108 cervical cancer deaths in the U.S. (by 1973, nearly 50% of women reported having had one Pap test during the previous year). In 1976, there were 5,525 deaths. [In 2006, it was 3,700 deaths. For the role of the Pap test in half these deaths in 2006, see below.]
Cervical cancer is not a major cause of death in the U.S. or other Western countries, wrote Foltz and Kelsey, who pointed out that screening people for a disease of low prevalence flies in the face of the medical research standards set by leading thinkers of the time. “The lower the prevalence, the less likely it is that a positive test will correctly identify a woman who really has cancer. This means that many women with positive test results but without disease will be referred unnecessarily for further diagnostic tests and treatment, with concomitant costs and worry,” explained Foltz and Kelsey, respectively, of the Graduate School of Public Administration, New York University; and the Department of Epidemiology and Public Health, Yale School of Medicine.”
http://medicalconsumers.org/2007/03/01/a-critical-evaluation-of-the-pap-test-and-its-role-in-reducing-cervical-cancer-deaths/
BTW the high rate of false positives from pap smears is not just “an issue” that you can shove aside by emphasizing on its supposed strength as the false positives combined with the recommendation of having frequent pap tests from a young age on cause MAJOR DAMAGE, both psychologically and physical which simply doesn’t add up to the small benefit. The point is that frequent pap smearing of all asymptomatic women does more harm than good.
You seem to suffer from ‘tunnel vision thinking’, not able to look at the larger picture of things which I thought was well illustrated in an anecdote about a doctor who said: “The surgery was a success, we have successfully removed the cancerous organ.” Yet the patient died. I hope you can realise what the problem is with this doctor’s idea of a “successful” operation..
Another thing, HPV has never been proven to be the cause of cancer. The FDA knows this since 2003 AND there are women with cervical cancer who were not infected with HPV.
As a last note, I want you to broaden your mind a bit and get out of that tunnel vision thinking and start to ponder upon this: what is the point in scare mongering asymptomatic women worldwide into having invasive pap smear tests on a frequent basis for a very rare disease, with an inaccurate test leading to much unnecessary harm and stress, leading as well to many unnecessary hysterectomies (it is said that 90% of them are unnecessary) and hysterectomies, mind you lead to an increase in heart disease and heart disease is the leading cause of death amongst women! Knowing this, we should be questioning whether the PAP smear programmes across the world are responsible for an *increase* in mortality rates in women, aside from a severe decrease in quality of life, due to iatrogenic medical treatment resulting from the high rate of false positive test results in pap smears.
You’re kidding me? You attempt to refute peer reviewed information by quoting a wordpress blog (medicalconsumers.org)? You do realize that anyone could have written that, right?
“The truth will out” is an old English phrase, please don’t correct my writing ability.
Furthermore, I did not quote the NHS (I think you’re referring to the UK health care system). I did however refer you and your readers to the NIH (National Institute of Health), and the CDC (Center for Disease Control).
I gave data, you wrote with hyperbole and don’t cite your sources.
Ah, medical arrogance once again rears its ugly head.
The irony is that the data you posted above – saying that almost all cervical cancers are caused by HPV – backs up what the women on this blog have been saying, the treatment protocols they’ve been promoting, and the information they’ve provided here.This blog has provided link after link to peer-reviewed research, medical journals and treatment protocols. Nobody’s going to spoonfeed you – try actually reading the links posted above, and elsewhere in this blog. And get over yourself.
The site did not allow me to reply to the relevant post, so I am replying to another of your posts.
antonmedical wrote: ““The truth will out” is an old English phrase, please don’t correct my writing ability.”
“The truth will out” is a Shakesperian idiom, the use of which implies that the truth has been previously concealed (intentionally) and will be revealed. Is this the meaning you meant to convey? Why? It is inconsistent with your other statements on the issue.
By the time this idiom was coined (late 1500s), Old English was non-existent. Middle English was transitioning (rather quickly) to early Modern English by this time. The idiom is not “old English” in the least.
It appears you *need* someone to correct your writing ability. Was the pedagogy available to you at Cal State- East Bay insufficient?
Lol, you obviously didn’t bother to read it or you would have noticed that the non-profit organization attempting to help people make informed decisions concerning their health I linked to, quoted from another article they re-uploaded on their wordpress blog from which the authors are known. Besides, the article you can also find here:
http://www.ncbi.nlm.nih.gov/pubmed/104191
My mistake for misreading about the NIH comment. But speaking of citing sources, there’s plenty of them you can find from previous posters in this thread which you obviously didn’t bother to read or you wouldn’t have stepped in here to arrogantly post stuff we already heard a million of times and constantly have to refute with data you probably don’t like to read, because you just like to be ‘right’ apparently, so who do YOU think you are kidding?
Besides, the first exercise for you should be to broaden your mind, use some common sense and question your beloved peer reviewed journals if you want to know the truth, instead of staying locked up in that tunnel vision mind of yours.
Regardless of your views on pap screening Antonmedical, your dismissive, arrogant attitude makes me want to avoid your type of doctor at all costs. You are insensitive, have zero empathy for women and the adverse effects of treatment for false postives – physical and mental and you are incapable of critical thinking. It’s all the ingredients for being a bad doctor – and you will be getting poor reviews on rateMDs unless you change your thinking.
Antonmedical,
The reason for blogs such as this is because we have had enough of the lack of adequate information fed to us by the medical profession. We have been led to believe that cervical cancer is rampant and that we are taking huge risks if we do not screen. We are also not told of the huge over-treatment meted out to women who are not given the full facts of the pros and cons of screening.
As you can see I am from the UK. In my country men are given adequate information and actually told that for every life saved that 48 men will need to be treated (and then left to make their own minds up). Women are not given equivalent information, we are given a patronising leaflet and basically told to screen ‘for our own good’. Information regarding the risks/benefits of screening is hidden in the British Medical Journal (over 50 women are treated for one life saved).
Perhaps you need to ponder on why the women on this blog are so angry. And to perhaps consider that the ‘hyperbole’ may indeed belong to the medical profession and the ‘information’ they deign to give to women.
http://www.ucsf.edu/news/2012/12/13312/study-questions-reasons-routine-pelvic-exams
Incredible that such an invasive exam is still being recommended and performed by so many doctors when it carries serious risk and is unhelpful. (and this has been known for a long time) The reasons given for doing the exam are shocking….profits, an erroneous belief it’s a screening test for ovarian cancer, (so the doctor is way out of date and incompetent) to reassure the woman (false reassurance, not a good thing) or because she expects a pelvic exam. (usually after years of pressure/coercion, misinformation and this unnecessary intrusion on her body)
It also shows how little they care about our bodily privacy…and our health and well-being. So much for doctor knows best…this is one of the reasons why women must be careful with their choice of doctor and avoid anyone who recommends a routine pelvic exam. IMO, they are very likely to harm you and disgracefully, the talk continues, yet no real action is taken to stop these doctors. (even when it’s clear these exams can lead to unnecessary surgery) It’s clearly up to us….to protect our healthy bodies from the perverse, the incompetent and the unethical in the medical profession.
Happy New Year everyone….let’s save some more women from medical abuse.
This doctor agrees with us…most gyn exams are unnecessary and risk our health.
http://bad4umedicine.blogspot.com.au/2012/03/most-gynaecological-are-unnecessary.html?showComment=1357303900857#c4821358360181991399
This was a great article, nice find Elizabeth! I got so much satisfaction from reading the following:
“Why do we continue with these invasive, unscientific, unpleasant, and illogical examinations? It’s time to recognise that these routine gynaecological examinations are
bad medicine.”
That question sounds familiar, but to hear it coming from a doctor is ultimately gratifying.
“Antonmedical” appearst to believe those contributing to this blog are “irrational.”
“Anton Power
December 30, 2012
Rule 1 of blogging, don’t start flame wars with irrational people on irrational blogs…”
How did you see my private facebook account?
Your facebook “account” is private. However, you had your entire timeline set to public until you cahnged it upon reading the above post.
It takes a bit more brain to understand online security than to insist on shoving instruments into women’s genitals, doesn’t it?
Anonymous the information regarding “flaming” is very interesting. Here is what Wikipedia says about “flaming” or “flame trolling”:
“Flame trolling is the posting of a provocative or offensive message, known as “flamebait”,[17] to a public Internet discussion group, such as a forum, newsgroup or mailing list, with the intent of provoking an angry response (a “flame”) or argument over a topic the poster often has no real interest in.[18] While flaming can occur as a result of legitimate debates or grievances, flame trolling implies the intentional posting of inflammatory, grossly offensive or menacing rhetoric or images for the fun of it in order to cause others harm.”
One does have to wonder about the intentions of a male “hope to be” medical doctor who would comment in a derogatory and uneducated fashion on a site devoted to uncovering medical harms done to women. I would have appreciated it if antonmedical had read the comments on this forum and had educated himself prior to making a comment that appears to have had no other purpose than to cause the women here further harm.
First: all angry responses seemed to be coming towards me. Second: where was I derogatory? I reacted to you response. How else would you expect I would? Third: you are not a legitimate source of scientific information. Your disregard for science is astounding. I refer to the snide comment about “peer-reviewed journals.” I made my intentions clear with my website. Fourth: what does being male have to do with any of this? Finally: If you wrote this post as in the format of a scientific article with references next to every single data value that you used, I may have believed everything that you wrote. However, since your article was meant to insight distrust in not only the people who spend their lives studying human biology, but their theories and ideas, I am convinced that this website is nothing more than an attempt to mislead the public. Next, you’ll be telling everyone to avoid vaccinations.
If you don’t wish to be tested for cancer, that’s your business. But don’t drag unsuspecting victims with you.
I put my name out there so everyone knows where I’m coming from. I’m a scientist. Who are you?
I am hesitant to put a great deal of time into a response to you antonmedical as you appear to have a dubious ability to read/retain information. However I’ll give it a go.
First: Please take some time to consider why you received a response you call “angry”. As a previous poster stated, I am not going to spoon feed you. If you don’t understand why you got the response you did, then I’m afraid I will have to put you in the category of “beyond all hope”.
Second: You were derogatory by assuming you knew better than the women who have spent a great deal of time and energy uncovering facts that are often hidden from us. You were derogatory by assuming you knew better than very well educated women, some of them with twice or more years of education than you yourself possess. You were derogatory by not bothering to take the time to read what had been written on this site.
Third: There are many links contained within the comments on this site which will take
you to peer reviewed articles. But again, I am not going to spoon feed you. Try clicking on some and reading what you find.
Fourth: In case you haven’t noticed, this site is called “forwomenseyesonly”. Not that
men aren’t welcome here, but that should at least be a warning to tread cautiously. In other words, educate yourself and comment with respect for the women here.
Finally, I have provided links to support everything I wrote – but again – you seem incapable of clicking and reading.
In response to the following “If you don’t wish to be tested for cancer, that’s your business. But don’t drag unsuspecting victims with you.” I would like to say that I wish that it were that easy for me. The main message on this blog is to ask the medical community to offer women INFORMED CONSENT in regards to pap tests/pelvic exams. Women are unable to access health care without being bullied into pap tests. In my own and other women’s experiences, we are denied access to health care (kicked out of dr’s offices) and denied medications (especially birth control) unless we submit to screening.
Cervical cancer is rare, pap tests are unreliable, and women face risks of further harm from follow up procedures. However, these simple facts are hidden from women. In fact, women are rarely (if ever) offered information or given a choice to screen. Men are when it comes to prostate screening, even though prostate cancer is roughly 19 times more prevalent than cervical cancer.
Men are treated with respect, women are not. I am not advising women not to screen. What I do attempt is to offer the facts, peace of mind, and to let them know that screening is a choice. Paps are simple cancer screening tests, and ALL cancer screening is optional. Many women are unaware that they are within their rights to say no thank you to screening. That is how well the program has worked – women don’t even know they are “allowed” to decline screening.
antonmedical says: “If you wrote this post as in the format of a scientific article with references next to every single data value that you used, I may have believed everything that you wrote. ”
As a credible academic, I should tell you that as a credible scientist, you should never do this.
antonmedical says: “However, since your article was meant to insight distrust in not only the people who spend their lives studying human biology . . .”
“Insight” is an apprehension of meaning. “Incite” is to encourage unlawful or violent behavior. Neither is an appropriate word for your sentence.
SSe
Fair enough
“Anger” would be hyperbole. Please see my post regarding intellectual generosity. Hyperbole is inappropriate and, frankly, odd.
If you want to be a legitimate source of information, write compelling articles. Don’t attack people who comment on your blog.
Actually, now that I thought about it a little longer… who are you? How do we know your name is Sue? How about Steve, Dan, or Carol?
Anonymity is a dangerous thing when you have a megaphone.
Anonymity is a safe thing when there are people out there such as yourself.
For God’s sake, you are completely missing the point!~
If YOU write an article, it is YOUR responsibility to provide sources for EVERY piece of information you state is true, okay? Your readers are NOT supposed to be the ones looking for information just to prove that what you are saying is true.
The simple fact that you did NOT provide this information IN your articles, any of them, while continuing to attempt to convince your audience that you are right makes YOU dangerous.
That was my whole point. You are so wrapped up in your world of conspiracies against women, that you are completely unable to understand why people don’t believe you.
If and when you attend medical school, many courses will cover issues in medical ethics. Some courses will include curriculum covering the history of the evolution of medical ethics in the United States. I would encourage you to take this seriously, as it will provide you with an understanding of why some people in society have developed a distrust of the medical profession. That distrust is a long-standing, understandable, and rational issue. That you did not glean any of that from your undergraduate education is disconcerting.
As a professional, it is not appropriate to simply yell, “you should trust us, because if you don’t you are an idiot!” You are responsible for building and maintaining that trust, and ensuring integrity. Failing to understand this from the start makes you a liability to the profession. You will need to juggle ethical issues constantly as a medical professional. If you start with the baseline disregard and lack of clarity that you’ve demonstrated here, you will encounter ethical, practical, professional and legal problems. Your general feeling that those stating their concerns are “not as good at science as you” is not a sufficient reason for your confusion on the issue.
If you are unsure about the concept of informed consent and how that plays a role in medical ethics and maintaining integrity in the profession, I suggest starting with these titles:
Beauchamp, Tom L. 2010. Autonomy and consent. In The Ethics of Consent, edited by F. G. Miller and A. Wertheimer. New York: Oxford University Press.
Dworkin, Gerald. 1988. The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.
Manson, Neil C., and Onora O’Neill. 2007. Rethinking Informed Consent in Bioethics. Cambridge: Cambridge University Press.
O’Neill, Onora. 2002. Autonomy and Trust in Bioethics. Cambridge: Cambridge University Press.
If this is more reading than you’d like to do, at a minimum read the Stanford Encyclopedia of Philosophy entry on Informed Consent, available at http://plato.stanford.edu/entries/informed-consent/.
Antonmedical,
Sue mentioned informed consent. This is the issue. Women are treated differently to men with regard to informed consent and respect for our bodily autonomy.
I see nothing wrong in looking for information that I cannot get from my own doctor. No, I am not a medical professional, but I do have the mental capacity to read peer reviewed papers and understand risk versus benefit with regard to medical screening.
No-one has the right to make that judgment for me.
No, they don’t. But I seriously doubt that your doctor is overtly attempting to conceal information from you. If they are, go to a different doctor. If it’s a gender issue, go find a female physician you feel comfortable with.
Just remember, there is always a risk and benefit to all tests. There is no such thing as a perfect test. Even the articles that are cited here from government websites state that is so. I see no grand conspiracy.
antonmedical that is the first thing you have said that makes sense. As for continuing to accuse me of not providing information in any of my articles does make me wonder . . . please provide some specific information. Which claims have I made without providing supporting evidence?
Or are you continuing to flame throw/cause harm? Just what were you discussing in your facebook comments that Anonymous shared with us. Oh, and I do hope you have figured out how to set your account properly so that incriminating discussion where you call women “irrational” has been covered up. Sounds familiar . . . hmmm, which body of people does that type of thing to women?
I change the setting of my facebook to better protect my family from anonymous posters on your blog. Blanket statements about gynecologists who “like” to do pelvic exams is ridiculous. That’s basically slurring. If nefarious did actually happen during an exam, you have the right to notify the police. However, your attempt to discredit the scientific and medical community is pointless and makes readers distrust science, in general. That, in a nutshell, is my problem with your blog. Also, the sources you cite which are legitimate are not attempting to discredit the necessity of pelvic exams. On the contrary, they are simply helping recalculate the parameters under which physicians should be recommending tests. Your statements are disingenuous.
That you didn’t have your facebook timeline set to private from the start shows poor judgment.
No one is actually claiming a “grand conspiracy.” Erecting a straw man is useless. Why would you feel compelled to do it? it would be more respectful to discuss the issues regarding informed consent on their face.
Change my doctor?
In the UK GPs are provided with financial incentives to screen the maximum number of women with regard to cervical screening. This financial payment produces a conflict of interest for doctors.
Why would any doctor supply information that could lead to my declining screening and a loss of revenue for them? Why would changing my doctor make any difference?
There is no such conflict of interest for my husband with regard to prostate screening and he is able to obtain the relevant information to enable him to make an informed decision.
‘Grand conspiracy’? These are your words, not mine and an attempt to belittle and diminish my voice and viewpoint.
He has no understanding of the UK medical system, so he wouldn’t realize the bind you’re in.
And actually, he doesn’t have much understanding of the inherent issues involved in *any* system of medical care; it’s a bit worrisome.
Please excuse the grammatical mistake. “If [something] nefarious…”
Unfortunately, you have made no “grammatical mistakes.” You have, however, demonstrated poor verbal acuity and a lack of reasoning skills. It’s possible to subsist as a medical profesional with that capacity, but any real success “as a scientist” will require you to improve your academic skills.
antonmedical, you thought your facebook account was private, and felt you could freely attempt to discredit me and others on this blog without our knowledge. That doesn’t sound like the work of someone with moral or ethical values.
I was not making “blanket” statements about gynecologists. In case you haven’t noticed I was able to use evidence from a doctor’s comments. It seems with all the convictions of gynecologists and other doctors they are doing a fine job of incriminating themselves and need no help from me.
You still have not provided me with specific examples of where I have made claims without supporting evidence.
Also, you are still missing the point. I am attempting to provide women with the knowledge they have a choice – something the medical community does not do. I am not the one attempting to cover up facts and withhold freedom of choice – the medical community does that.
I made no mention of your blog on my facebook comment. I have no interest in directing more traffic to this website. Comments are anecdotal, and have no value as evidence.
Anecdotes are another thing I attempt to highlight as insufficient evidence on my website. This is a consistent issue with your website, and most media for that matter. People who don’t know what they are talking about attempt to interpret information they are not trained to understand (yes, you do need training to see data without bias). I challenge you: read a few hundred journal articles, understand the structure, purpose, and discussions.
You want an example?
“Pleasure” section- you cite yourself…
“Extra Fees” section- PBS highlights financial incentives, but does not overtly state that doctors do this, only suggests that there is a possibility of abuse.
“Further Tests” section- you highlight the Harm section of the study, forgetting that the authors also provide a Benefit section. This is completely disingenuous to your readers:
Screening With the Papanicolaou (Pap) Test: Benefits
“Based on solid evidence, regular screening of appropriate women for cervical cancer with the Pap test reduces mortality from cervical cancer. The benefits of screening women younger than 25 years are small because of low prevalence of lesions that will progress to invasive cancer. Screening is not beneficial in women older than 60 years if they have had a history of recent negative tests.[1,2]
Magnitude of Effect: Regular Pap screening decreases cervix cancer incidence and mortality by at least 80%.
Study Design: Population-based and cohort studies.
Internal Validity: Good.
Consistency: Good.
External Validity: Good.
There is a basic virtue of intellectual discouse called “intellectual generosity.” It requires, before you attempt to refute another person, that you do the best you can to understand their position. When it is impossible to do that, the only thing to do with integrity is to bow out. It’s unclear why you are acting without honor or integrity here. I would encourage you to cease.
antonmedical says: “Comments are anecdotal, and have no value as evidence.”
Anecdotal evidence does have evidentiary value, both scientifically and legally. I would suggest doing some reading on empirical research and the development of the scientific method. I still do not understand how you managed to graduate from college without understanding these things.
Thank you antonmedical, this is the first time you have provided evidence of having read something on this blog.
“Pleasure” section: I cite myself (true) but the post I cite provides comments made by a male doctor. It also provides comments made from other women who have been victims of harmful practices.
“Extra fees” section: I trust readers to form their own opinions from the link I provided. Here is further evidence if interested: http://www.cbc.ca/news/health/story/2012/12/04/nb-medicare-billing-auditor-general.html
“Further tests” section: The purpose of the task force is to attempt to reign doctor’s overuse of poor medical practices which leads to harm of women, particularly young women who suffer most. As for highlighting the section which was most incriminating – yes I’ll admit I did that. I also provided a link to the entire article in hopes readers would click on it. Again, trusting readers to form their own opinions.
I appreciate you reading the links I provided and attempting to educate yourself. Here is a link to an interesting article written by a doctor: http://bad4umedicine.blogspot.com.au/2012/03/most-gynaecological-are-unnecessary.html?showComment=1357303900857#c4821358360181991399
which basically states what women on this blog have been stating. The link was provided by Elizabeth (above), and you may have more “trust” in something written by a doctor.
http://www.independent.co.uk/life-style/health-and-families/features/why-im-saying-no-to-a-smear-7577967.html
This doctor has a problem with the way screening is presented to women and the lack of respect for our right to decline. Is she misleading women, creating victims, simply by speaking her mind and referring to the studies that have also been cited on this site?
“In the NHS cervical screening programme around 1000 women need to be screened for 35 years to prevent one death
Over 80% of women with high grade cervical intraepithelial neoplasia will not develop invasive cancer, but all need to be treated
For each death prevented, over 150 women have an abnormal result, over 80 are referred for investigation, and over 50 have treatment
Before the 1988 relaunch of screening with strict quality standards, for each death prevented there were 57 000 tests and 1955 women had abnormal results”…
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153831/
You won’t find this information in a screening brochure and I’m yet to meet the woman who was offered screening with a run down of risk and actual benefit. Most women are told they must or should screen with very little (if any) real information and many are coerced into testing.
WHO is misleading women and creating victims?
“People who don’t know what they are talking about attempt to interpret information they are not trained to understand (yes, you do need training to see data without bias). I challenge you: read a few hundred journal articles, understand the structure, purpose, and discussions. ”
Once again I have to comment on your arrogance which seems to know no bounds.God help your patients.
I myself am studying medical science and the references cited here are one generally of high quality. Knowing that Elizabeth has been reading medical journal articles on this subject of cervical screening for over 20 years (probably since before your were born and before the internet so she had to visit university libraries for this information) I would hazard a guess that she is more informed and interested than you on the subject.
So she may in fact have read a few hundred journal artcles on the subject over the last 20 or so years.
If you are so informed on the subject then you would know that Angela Raffle is an expert on the subject of cervical screening. So I would give credence to her papers more than anybody else’s. She also has written a book on cancer screening.
Another expert on cancer screening, but breast screening Peter Gotzsche in his book “Mammography” says that ” a study showed that most gynaecologists think the risk is greater than 80% that a woman with a postive mammogram at screening has cancer, but it is actually only 10%” (pg 17).
So I that illuminates your point “People who don’t know what they are talking about attempt to interpret information they are not trained to understand “
Maybe you are right. I guess I have much more to learn.
Why would you believe otherwise? You’re a young man with a bachelor’s degree and a bit of work experience as a lab monkey. Hubris based on self-perceived potential is rather concerning.
Anomedical, it’s very arrogant to assume that the people on this website do not possess adequate research skills to understand the topic being argued, how could you possibly know someone’s professional and educational background if they haven’t already informed you. I know there’s few of us who have also read many hundreds of peer reviewed journals; reviews and discussions on this topic, compiling a substantial meta-analysis, and the arguments being presented here are sound.
We may not have a similar level of medical training to you, but most of us have access to empirical evidence and the aptitude to comprehend our findings, some of us may even possess analytical skills you do not possess.
Antonmedical: What I find most disturbing is your statement “If you don’t want to screen, don’t”, and that you doubt that a doctor is purposefully “hiding information from you”. Also, “find a female doctor if you are having a problem” as though they are any better.
From my own experience within the last few years I have been to three different doctors trying to locate one that will simply give me a yearly blood panel and cholesterol check without the subject of a pap smear and pelvic exam dominating every visit. I have been unsuccessful. The first doctor was female, and informed me that she would give me something for insommnia ONLY after I let her perform a pap and pelvic. My blood panel which she did a week prior was fine. I faired better with the second doctor for the first visit (male), but the follow-up for my slightly high cholesterol was a nightmare. I was treated like a naughty child for “playing Russian roulette” (his words) with my health. I wonder if he says that to men declining prostate screeening. And now this third doctor. I had blood drawn and was told it is his policy to deliver the results in person. I got a call the other day from his office that I am “due” for a pap smear and they can do it when I come in for my blood results. I told them “no thanks”, but I sense another arguement coming. Doctors don’t like to be questioned or their recommendations declined when the patient is female. That is MY experience.
Thank you for sharing this Anonymous. Your experiences are similar to my own. I have stopped going to see doctors for any reason because the thought of having to do battle to decline a pap is extremely stressful for me. I worry I would not be able to stay calm and rational. My plan for future health care includes alternative practitioners, such as naturopaths. However, there are times you have no choice and I did need to see a doctor a while back. I took a companion with me into the consult room and I was prepared to walk out if there was any issue with paps – but the male doctor did not even mention paps. Companions and recorders are useful in situations where you have no choice but to see a doctor. Suggestions from others include stating you are menstruating (heavily – otherwise they may try to go ahead regardless) and when seeing a male doctor state you only allow female doctors to do paps.
By the way, it appears antonmedical has deleted his blog.
http://www.cbc.ca/news/health/story/2013/01/07/cervical-cancer-pap-hpv-test.html
After decades of testing it’s shocking that so many women have been seriously misled…and that there is so much fear and concern about this rare cancer. (but not other rare cancers)
A doctor has also commented…he can’t see any harm over-screening women, apart from mild discomfort during and after the test. I think it highlights how misinformation is now accepted as fact, even by some doctors (of course, IMO, this makes them incompetent or unethical) and that many women have been brainwashed and misled. Now they want to scale back pap testing, after decades of excess and huge over-treatment, many women are terribly concerned….for decades they’ve been told annual testing is best, lots think they had cervical cancer or that early “treatment” saved them, some think cervix cancer is rampant, that it runs in families, that women not yet sexually active should be tested or that those in lifetime mutually monogamous relationships can also get cervical cancer.
When you set out to deceive, this is the result. When you ignore proper ethical standards and informed consent, this is the result.
It will take decades to change the way many women view this rare cancer and this testing. Many are lost forever in this make believe world of rampant cervical cancer. Hopefully, the next generation of women will be open to real information and not see everything through decades of misinformation or from a survivor’s viewpoint. (after a telling very early “treatment”) It is nothing short of evil that the medical profession has gone out of it’s way to mislead and harm so many women. How many lives have been affected by fear and serious concern about this rare cancer that most never had anyway…living the life of a “survivor”? The numbers are damning…and their daughters are vigilant because, “my mother had cancer cells off at 19, she’d have been dead by 25″…Umm, no, almost certainly she would have been a healthy woman with an intact cervix. So the damage and misinformation extends across generations, “it runs in my family so I get tested every year”…
It was easier to achieve wide coverage by creating this intense fear…by deceiving women and creating this mess.
Before screening started few women worried about cervical cancer, just as few worry about thyroid cancer today. (and thyroid cancer is more common than cervical cancer) If you mentioned to many of these women you were going to channel many more millions into cervical screening and forget heart disease, they’d probably agree, it’s a great idea….yet the reality is most will die from heart disease. By creating this intense fear and pretend world of survivors…it will be difficult to move away from excess and to finally tell women the truth….the brainwashed and the huge numbers of survivors will simply put it down to cost cutting. We greatly fear the rare cancer and ignore far few likely and serious risks to our health.
Oh, what a tangled web we weave when first we practice to deceive……
http://www.guardian.co.uk/society/2002/apr/29/medicineandhealth.lifeandhealth
The daughter of this man has posted over at Blogcritics. I adored my father and cannot imagine how shattering it would be dealing with this…but the sheer number of women who came forward telling strikingly similar stories of abuse, unknown to each other in almost all cases…well, I simply don’t believe all of these women are lying or mistaken. (and these complaints extend over many than 20 years)
Elizabeth, thank you for this link (and for the previous one!). I agree with you, I also cannot imagine how shattering that would be for the daughter. I also agree that the sheer number of women unconnected to one another would not be lying or mistaken.
I found this part of the article particularly disturbing:
“Ayling was convicted of 13 indecent assaults on 10 women patients and jailed for four years in December 2000, but his trial answered none of the most important and disturbing questions about the abuse he perpetrated – such as why he was not stopped years earlier.”
This is an interesting study comparing pap testing in the States and the Netherlands…American women have a lot more pap tests for no additional benefit. (and there is no doubt American women would also end up with lots more false positives, excess biopsies and over-treatment)
http://www.medscape.com/viewarticle/760706
“The result is unnecessary suffering and expenditure of precious resources for no additional benefit,” Dr. Moyer said.
Dr. Brown noted that he’s “worried, as are a lot of people” about the possibility of overuse of the HPV vaccine and HPV DNA testing now coming into use. “Will [these technologies] be used effectively and efficiently? I am a little worried, given what we showed in this study, that they won’t be initially.”
http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00652.x/abstract
The actual study…
Thank you Elizabeth for these excellent links. From the study:
“Conclusions: Cross-country studies like ours are natural experiments that can produce insights not easily obtained from other types of study. The cervical cancer screening system in the Netherlands seems to have been as effective as the U.S. system but used much less screening. Adequate coverage of the female population at risk seems to be of central importance.”
It is so important that women be made aware of what is happening within the scientific community, especially given the lack of information being offered to women by their doctors.