Pap Test Coercion Getting More Attention

When women visit a doctor they often are not going for the purpose of a pap smear, but find themselves having one anyway.  Frequently this is not because women have asked for one but because their doctor has told them they should have one or that they need one.  Doctors are aware that many women dislike pap tests.  As a result, some doctors have developed and utilize the following coercive tactics to  harness compliance:

  • Doctors make the pap test their first priority, and regardless of the reason for a woman’s visit the doctor will attempt to broach the topic at the beginning of the consult.
  • The question “when was your last pap test?” is often asked ahead of any questions that address the woman’s own health concerns.  Women often feel they must submit to a pap test before the doctor will address the original reason for their visit.
  • After establishing in an authoritarian manner that the woman “needs” to have a pap test because she is “overdue” for one, the doctor will instruct the woman to get undressed and to lay down on the exam bed.
  • The doctor will then quickly leave the room. The doctor’s quick exit has left the woman without the opportunity to discuss or decline the exam, and she also has been left alone with the full weight of the doctor’s expectations and instructions.  Many women in this situation will get undressed and into position rather than risk annoying the doctor.

One definition of coercion is to compel or restrain by force or authority without regard to individual wishes or desires. The way in which doctors present pap tests leaves women with limited  opportunity to have input into whether or not they feel they want or need one. In fact, some women are led into a pap test without any awareness of the purpose of the exam.

Pap test coercion has gone largely unnoticed for years.  Many women have not questioned the methods used by doctors and have complied as a matter of routine.  However, research that highlights the harms of screening, increased access to information, recommendations to increase the age to begin pap smears, recommendations to lengthen the interval between pap smears, and the discovery of alternative and better methods to screen for cervical cancer have recently encouraged more women to ask questions.  More women are beginning to opt out of pap tests, and because some women are beginning to say “no” they are becoming more aware of the coercive tactics used by some doctors that can make refusing a pap test so difficult.

More women are also realizing that they have a right to informed consent.  It is interesting that a number of women who have had a pap test do not know what the test is for or that they have the right to say “no”.  Doctors have failed to inform women of even the most basic details prior to gaining access to their most intimate areas.  Men are treated differently by doctors when it comes to prostate screening.  Men are offered information, are involved in the discussion, and are offered a choice of whether or not to screen. This same respectful treatment has not been extended to women even though women and men have an equal right to informed consent. Coercion has been the norm for far too long in women’s health care – and more women are becoming aware of this.

More on this topic:
Female doctor who does not have pap tests: http://margaretmccartney.com/2012/03/20/why-i-dont-have-smears/
Informed consent missing: http://www.kevinmd.com/blog/2009/11/informed-consent-missing-pap-smears-cervical-cancer-screening.html
What some male doctors do when women say “no”: http://forwomenseyesonly.com/2012/10/17/what-some-male-doctors-do-when-women-say-no/

About forwomenseyesonly

Hi. My name is Sue and I am interested in promoting holistic and respectful health care.
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63 Responses to Pap Test Coercion Getting More Attention

  1. Moo says:

    Part of the reason is financial incentives for screening programmes. The screening programmes promote themselves for their population studies that require large numbers of participants. Where I live, Ontario, women have their personal data and test results recorded into a database without their consent by law. Doctors can bill per consultation but the only time they can double bill per visit is for Pap tests with another reason for the consult. Otherwise, it is one concern per consult. If you want this changed email, phone or write to government representatives. Other issues are unnecessary pelvic exams on anesthisized patients by medical students without prior consent. Health care costs are high enough without doctors getting thousands of $$$ for coercing people into cancer screening. My money, your money, the tax payers money.

    One way to combat this coercion for paps: Refuse to discuss when your last menstrual cycle was unless that is the concern for the visit. Refuse to answer when your last Pap test. (It is probably in the computer file or your chart anyway) For doctors who like to poke abdomens, wear a pad. Put pads in your handbag and have it open for them to see. Some doctors will still try to force a pap if you are menstruating but they cannot see what they are doing if there is bleeding. Liquid pap preps claim that blood can be filtered from their samples. If they ask you to return in a week or two ask them for what purpose.

    Say no thank you. Make it know that you do not want certain parts of a physical exam ahead of time such as omitting a breast exam, pelvic exam or parts of it such as pap, bimanual or rectal exam.

    There is no reason to scream at staff and doctors. If you cannot communicate without getting violent, take a friend, family member or write down what you want and give it to the doctor. Being abusive or violent is a reason for a doctor to drop you as a patient.

    Response like with like. If for example a doctor tells you that he will have to drop you as a patient if you do not submit to cancer screening, ask for a signed and dated letter from the doctor with such reasons stated. Most likely they will not do this because refusing cancer screening is not a reason to drop a patient that most medical associations will accept. Legally it can be a problem for them as well as they cannot abandon a patient’s care.

    You might want to sit down with your doctor and discuss risks and alternatives such as a urine HPV test. The issue might be difficult for women who are having fertility or gynocologicsl problems. It is also your responsibility to do your own research on appropriateness of tests and your health. Be aware of what tests you might or not need for certain conditions. Do not rely on your doctor’s or surgeons advise alone.

    • Alex says:

      You know, I just thought of something: Why not call it “arbitrary” exams instead of “unnecessary?” That’s what it is, after all & phrasing things as “unnecessary” opens the door for doctors to “say this is NEEDED to do that.” Also, it might make it sound like potential utility overrides personal autonomy.

      Plenty of times they connect the dots in a way that sounds like “everything is connected & one thing will effect another,” never mentioning that they are causing detrimental effects in the first place. An infringement of personal inviolability IS, in itself, a major detriment with severe possible ramifications.

      So, if it WAS connected like they were saying it was, they’re causing an issue to begin with. Medicine shouldn’t cause a problem any more than a workout should make you weaker or a blanket should make you colder. I guess what that’s called is “antithetical results.”

    • adawells says:

      Target payments are made to doctors in the UK to get them coerce women into having smear tests. I have been unable to find out exactly how much each smear test is worth to a doctor, but I have found that about £75,000,000 is paid to doctors in bonuses each year for each smear taken. That’s about $100,000,000 I think. All bribes, when this money should be spent on real health care. It is a national disgrace, when our National Health Service struggles financially to provide other services.
      I recently found this article, which looks at some of what was going on in the first 10 years of the UK’s call-and-recall system:

      “Reaching targets in the national cervical screening programme: are current practices unethical?” Foster, P. and Anderson, CM. Journal of Medical Ethics, 1998; vol:24 pp151-157.

      Whilst I don’t think this article goes far enough in addressing the issues, it does show that even way back in 1998, some people were beginning to question what was going on.

      Here’s a couple of extracts:

      As well as producing information leaflets which appear to be designed to persuade as many women as possible to accept invitations to be screened, there are a number of other ways in which screening providers can exert strong influence over their female patients. In recent years general practitioners have been advised by articles in both prestigious medical journals such as the British Medical Journal and magazines distributed free of charge to doctors, such as GP and Pulse, on how to increase the uptake of cervical screening amongst their patients. In 1989 an article in Update entitled “How to Achieve Cervical Cytology Targets” advised GPs that “in women of more than 60 years old the procedure for taking smears can be both painful and yield insufficient material. However, if targets are to be achieved we are going to have to persuade some pensioners of the value of cervical cytology screening”. At least this article did continue: “One must preserve a degree of humanity here and if these patients do not wish to have a smear their opinion should be respected”. In 1994, Dr Gallen, a family doctor in Wellingborough, advised GPs in an article entitled “Hit that target” that it is essential to “List and chase” defaulters who have not responded within three months of the first invitation to a smear test”. An article published in the British Medical Journal in 1990 advised GPs that if a new female patient is due for a smear “offer to perform one straight away… . Similarly a woman attending for reasons unconnected with cervical cytology should have the date of her last smear checked and if appropriate be offered a smear on the spot or a future appointment… . Opportunistic smears can also be offered during health promotion clinics for women … or a hormone replacement therapy clinic”. None of the “advice” articles which we read questioned the ethics of taking “opportunistic” smears nor did they address the issue of whether patients have enough time or information to give their informed consent to a smear test offered to them during a consultation for a quite separate purpose.

      …the system of financially rewarding GPs for reaching high screening targets could be modified. We should emphasise at this point that we have no ethical objections to GPs being rewarded financially for carrying out cervical screening per se, we are simply objecting to the unintended consequence of these financial targets, which is that just one or two women who decline to be screened can, in effect, cost a GP up to two thousand pounds of annual income. Under such circumstances it is hardly surprising if a small minority if GPs put these “refusers” or “defaulters” under considerable pressure to accept a smear test. We would therefore suggest that the screening targets be modified to allow GPs to include in their target numbers any women who have signed a form to indicate that they do not wish to be included in the screening programme. Again we do not envisage that such a change would lead to large numbers of women opting out of the programme but it would prevent women who are quite clear that they do not wish to undergo the test from coming under undue pressure from their GP to accept it.

  2. Sue,

    This was a great article. I just added a link to this article to the article I wrote about pap smears at http://patientmodesty.org/papsmears.aspx.

    Misty

    • Misty, thank you for the wonderful feedback and for linking my article to your own. It is encouraging that more women seem to be aware of their right to informed consent.

    • Anonymous says:

      Misty, I was just reading through your excellent website and came across something new to me, you mention pap tests may only be necessary in a true virgin if she smokes or has smoked. My understanding is that a true virgin is not at risk because it’s most unlikely she’s been infected with hrHPV. Do you have a study that links virgins, smoking and cervical cancer? I suspect it may be propaganda put out by those who want to do pap tests on all women at a certain age.

      Also, you mention HPV can lie dormant for years and then come back. I’ve read that for years, but when you read HPV Today and other unbiased publications they don’t mention this at all, rather they say women can re-test for HPV to guard against a “new” infection. I find it frustrating, a lot of the research is biased and self-serving, probably most in women’s cancer screening.
      I think women have been fed misinformation for so long it’s hard to separate myth from evidence and, of course, no one challenges the myths. So we face a real challenge putting the evidence together for women.

      Also, it’s interesting about pap tests starting at 21 because the long standing evidence says that even sexually active women under 30 don’t benefit from pap tests and that’s why countries like the Netherlands and Finland don’t test young women. Their results are a lot better too….testing just leads to lots of unnecessary and potentially damaging procedures.
      In my opinion, exposure to hrHPV is the critical factor for those aged 30 and older….there are some very, very rare types of cc that some say are not linked to HPV (others say they are linked) but the important thing here is the pap test usually misses these super rare cases anyway…and that’s why dealing with symptoms is the best approach for young women. Pap tests may lead young women (and older women) into a false sense of security. A young Finnish woman is advised to see a doctor with persistent and unusual symptoms for a proper investigation, not a pap test. Young women here and in many other countries are provided with bad medical advice that would result in a few deaths that might have been avoided if they’d been given decent medical advice and heaven knows how many are harmed by the process, the numbers would be very high.
      Also, high risk for cc is still a very low risk, rare is rare.
      Many women will never look for the evidence and question this testing,, but when someone smells a medical rat (often after a distressing experience) it’s great to know there are a couple of sites dedicated to the evidence and respect for consent and informed consent. Keep up the good work.

  3. Beth K says:

    This issue of the discussion with the doctor is all about pap tests, that you “need” one, its importance, to the exclusion or near-exclusion of what my actual complaint is, keeps me from seeking medical care even in cases when it is warranted. I know that the first visit or two will be wasted arguing about pap tests, my refusal of them, and “educating” me about the “importance” of that test. Generally, by the time I can get an appointment where the problem at hand will or can be discussed, it will have gone away on its own or have gotten worse to the point that is a serious problem – or even have gotten me into the emergency room. The latter happens about once a decade, but it should not happen at all if one has sought medical examination and treatment of the problem when it was not so severe.

    I am not the only woman who has this problem. It’s even got a name: “Bikini Medicine”. The infected sore on my foot has nothing to do with a pelvic exam, but they insist upon the pelvic exam before then will do anything else.

    This problem makes actual medical care unavailable to many women. It is one reason for the overutilization of ERs in the US, and is one reason for medical costs to be so high. It is much less expensive to treat a little problem than a big one. If the first 3-4 weeks are spent on “Bikini medicine”, that’s 3-4 weeks for the problem at hand to become much worse. When it keeps the woman out of the doctor’s office, that gives at least as much time for the problem to get much worse and expensive to treat too.

    Moreover, they are wasting so much clinical time pressuring women into pelvic exams and pap smears at the same time there are concerns that there are “too few” doctors or medical providers. If physician time is at a premium, it would seem to make more sense for the doctors to use the time they have to treat actual problems – not use it as a high-pressure sales tactic for something the patient neither needs nor wants.

    If medical visits were kept to the problem or complaints at hand, rather than pressure to submit to a pelvic exam and pap smear, medical care would be more available, less expensive, and more effective.

    • Oz says:

      Well said Beth! I’m just like that too: I avoid seeing doctors even when I do have a big health problem; because, from my past experience, I know that they will be talking about pap smears even if I was dying.
      In the past, I had to pay for 30 minute doctor consults when I came for a 5-minute visit re non-gynecological issue just because the doctors took time to pressure me into a pap smear.
      The outcome for me was:
      - I was angered and annoyed,
      - My real health issue was not addressed,
      - I lost my time for the useless visit to a doctor,
      - I lost money as I was forced to pay for a long consultation I didn’t need or ask for,
      - I left stressed, just as sick as before, with less money and half-a-day taken off work — all because the doctors are interested in incentive payments for stupid and harmful pap smears, not in our health or wellbeing!

      So, I promised myself I will never see a doctor again, unless it is an ER room after some car accident or so. In my life, doctors proved to be arrogant, selfish, greedy and useless.

    • HealthWise says:

      “Bikini Medicine”–interesting! This has happened to me, in a sense. I’m VERY against vaccinations, have not had one in 20 years (I’m so sick with disease—not), and when I was in the emergency room from burns caused by the airbag in the car accident, the DR would not see me untill I had the tetanus shot. REALLY? I asked the nurse, “Is this protocol or is this necessary?.” After a few arguments back and forth, the Dr finally treated my 2nd defree burns with a shot. Don’t let Drs and nurses push you around.

      • HealthWise says:

        -***w/out a shot I meant

      • Beth K says:

        Interesting. Tetnus is a very rare disease in the US now. 233 tetanus cases were reported during 2001–2008 according to the CDC, or just over 30 per year. It was fairly common in the 1940s before the vaccinations, but they have effectively wiped out the pathogen.

        It was another case of focusing on a rare disease – one that you did not even have the risk factor for – when dealing with your burns from the accident, or not dealing with them.

        I’ve learned to stick to my guns. The problem comes in when someone is unconscious or anesthetized. Legal forms/advance directives that state “do not do (procedures)”, with the force of law behind it may. Putting on the blanket consent form when going into the hospital things you withhold consent for gives it the force of law. Also, watch the bill. If they do those unwanted procedures, they’ll charge for them. Now, they’ve either got to admit to (attempted) insurance fraud or assault. (doing what you explicitly did not want)

        This might not work either. There have been cases in teaching hospitals where interns and residents will “form a line to the left” and give a woman a pelvic exam where it was not needed or wanted, or someone a rectal exam where it is not needed or wanted by all of the students! The patient is charged for the anesthesia for that time, and exposes themselves to the risk of a longer anesthesia as well as the damage from those procedures or their repetition.

      • Alex says:

        How did you get burns from the airbag? I’ve heard of broken noses & such, but I’ve never heard of burns. Them trying to give you a tetanus shot seems like trying to arbitrarily do something to you. They frequently try to apply influence at their discretion, if it just so happens to get them some extra cash (or at least make the “team” money) that’s a bonus.

        “Outside orchestration” is a huge point in medical situations & it’s a pretty unfamiliar term. It’s a third-party orchestration of something- which is it’s own issue.

        For instance: if someone told you to jump on one leg & you said “No”. They would most likely say “Why?” & this is were a lot of people get jammed up. The response “Because that’s outside orchestration” is something probably no one expects. Their counter (if there is one) might be “So?” & yours could be “So that’s a problem in itself.”

  4. Moo says:

    I wonder if anyone has made an official complaint against a doctor who delayed or refused medical treatment to a patient who refused a pelvic exam coming in originally for a consultation on a matter totally unrelated to gynocolgy.

    Please remember “I do not consent” is a huge stop sign.

    Educational information about cancer screening can just be giving a patient a pamphlet not a 10 or 15 minute lecture twice a year. Doctors are more worried about covering their butts and warning patients that cervical cancer could result in DEATH. He also resents when he does not get his $2200 bonus because I will not let him give me a Pap test. If he really cared about my health then he would refer me to a female practioners to do or at least offer that solution.

    Pap tests May or may not be the only early warning of precancer and not having them is a risk. I am aware of that but every time I get in my car and put on my seatbelt I know I could be at risk of being injured or killed in a collision. My doctor will go on and on how he wants me to book a physical (which I know includes a pelvic and breast exam) because it is about “preventative health”. Ironically he never gave me the results of my fasting blood glucose and cholesterol. He just said they were ok. This is because he is a pharma whore. (Pharmaceutical prostitute). He only wants the numbers so he can prescribe medication. So I am thinking that he only wants me to have a Pap test because he must have friends at a colposcopy clinic or he wants to treat “warts” that are not there or harmless.

    Even naturopath are finding a market niche for pap testing and “treatments” although their treatments are less damaging.

    • Alex says:

      “Preventative health.” What about preventing the problems from preventative health? Maybe “measures that prevent health” would be a more accurate term?

      That’s very aggravating about naturopaths. I thought that these things are not a part of that style. It’s like the idea of chemicals in organic food- the whole point was the presence of disparity. That fact that it’s NOT that way was the entire reason!

      It seems allopathic medicine is like acid that corrodes anything it touches.

  5. Yazzmyne says:

    I hope it’s getting more attention, because it’s necessary! Especially for girls and younger women who still have to live with their often paranoid and brainwashed mothers *forcing* them to have a pap smear against their will is really disturbing. Recently, a young woman commented on my proboards forum that a gynecological appointment is scheduled for her next month against her will and she is losing sleep and her mind over this (so says her nickname). If you google “mom forces pap smear” you’ll see that many girls are in this situation. I made a meme about it to share on social media because it really bothers me why this is not high on the feminist agenda as it is fucking SEXUAL ASSAULT. But of course, most feminist organizations still believe that gynecology is a feminist thing in itself. :/

    https://www.facebook.com/photo.php?fbid=494031437372398&set=a.108612182580994.15350.108600349248844&type=1&theater

    • Alex says:

      I wonder if any of these girls think to say “Hey, mom- You want to do the honors yourself?” Vulgar, but as vulgar as the situation is. DEFINITELY, if her father were to pull something like that it would be seen as vicariously molesting his child (because the mean MAN is being dictatorial- doesn’t apply to women, though).

      Oddly enough, if he were to smack his children around- that would be seen as an attack. I’ve noticed a lot of women from that generation (the one that throws their daughters into things like this) tend to put up with ABSOLUTELY anything, as long as it’s not a slap in the mouth & a dinner order.

      They don’t teach “your body, your rules” or that properties don’t change because of designation. I’ve honestly noticed that as a cultural trait, not just women & not just a particular generation. Thinking by adjucation & disqualification of a problem is the typical trend in America- announced or unannouced.

      • Karen says:

        Had my mother done this to me, I guess would have gone nuts. (We had a fragile enough relationship to begin with.) I read a post from an other Karen, I think in the sexual abuse thread, and she said something like an abuser, I mean a doctor sent her for a transvaginal ultrasound, when she was 16, for some bogus reason, and the ultrasound was done by a friend of the doctor. Why should these doctors be treated differently than any other criminal gang grooming teenagers, of course they should not.

    • Karen says:

      Whoever does this should be charged with child abuse, no ifs, and no buts, and whoever advocates these exams should be charged with !!HATE SPEECH!!, advocating the abuse of a vulnerable group of society based on their gender. All those obnoxious “responsible women” commenters should be called out, and banned like other trolls, or should local hate speech laws and regulations allow it then prosecuted, and if any doctors DARE give such an advice, condoning the sexual abuse of minors, they should be prosecuted, just like the rest of the girl grooming gangs and pedos. Whether sexual abuse (either adults or minors of course) is acceptable or not is not a matter of civilised debate.

      • Alex says:

        I believe it would be “malicious fraud” rather than “hate speech.” Hate speech is more like ethnic slurs. Those “responsible women” DO drip arrogance, don’t they? Amazing that they think bodily autonomy & self-protectiveness is immature & defective! I guess thinking compositionally is stupid, too?

        Here’s an idea for a newspaper cartoon: A guy’s in prison. He’s bent over a bunk with his pants down & some eager-looking guy is standing behind him. One of the guys (either one would work equally well, actually) is saying “You guys that fight back are all stupid, because…”. The caption could read “Analysis of Women’s Discretion in Healthcare- with a male twist.”

        Anyway, back to the original discussion: Deception vitiates consent (it’s not someone making their own decisions if someone else is lying to them) & in this case it’s “iatrogenic detriment” (any problem caused by medical procedures or advice). So “iatrogenic attack facilitated through mental vitiation in the form of deception” is probably how the description would read.

        Subtle variations of attack are not non-antagonistic. That’s like saying it’s not murder if someone gets killed with a scalpel instead of a hunting knife! In this case, it’s a multi-faceted medical abuse (third-party orchestrated probing is one problem, risks & inaccuracies in the first place is endangering someone & if any of those ramifications are realized it’s now an aggravated assault, there’s also financial detriment through costs for all of this).

    • Jola says:

      But the girl can refuse, just say NO. Will her ”sensible” mum throw her away from home? I don’t think so.

      • Beth K says:

        Her “sensible” Mum probably won’t throw her out of the house, but can and probably will continue to nag her about it. And, she will continue to nag her even after she moves out of the house. Something like that can interfere if not destroy the whole mother/daughter relationship.

        (Another) Beth

      • Alex says:

        Not entirely sure what things are as far as “enforcement” goes. Actually dragging her to the car, locking her in, dragging her into the place & being forcibly examined might be a bit bizarre (although I’d imagine there are plenty of doctors that would love to do that).

        (1) That doesn’t mean that they don’t try “mental vitiation,” though. The whole mental version of wrestling someone down is pretty common in medical settings, anyway (deception is a big one- it’s not somoene making their own choices if they’re being lied to). I guess someone saying “We’re going to/You have to/Do This/Do That/etc…” can have an effect sometimes.

        (2) They could always give the impression that they don’t have any legal support for refusal (like they do in jail/prison/juvie) or lie about someone getting locked up for not permitting these things to happen (like if someone attacked her or someone thinks that’s what happened & they act like it’s countering the investigation).

        (3) When they coerce women into getting these exams for birth control- that’s not legal. It’s a lie when they talk about getting sued for prescribing these pills without giving them these exams, too. It’s interestingthat they don’t worry about legal action for iatrogenic assault or reproductive endangerment- causing a miscarriage isn’t something that they worry they’ll be sued for.

    • Lindsay says:

      Aw, that’s horrible!

      I had disabling periods in high school and, even though birth control would’ve helped me (I got on it later and POOF! No period) I never went to the doctor for it because my mom knew they would want to do a Pap/pelvic exam and she was pretty sure I wouldn’t be able to tolerate that. (She was right.)

      So it sucks that my choices were live with occasional disabling pain/vomiting, or undergo something traumatic, but I’m glad my mom was able to see how traumatic it would be for me and not insist that I do it.

  6. Karen says:

    From the guardian: http://www.theguardian.com/society/2014/jan/14/abnormal-cervix-cells-risk-later-cancer-swedish-study
    ” The NHS cancer screening programme could not say how many women a year are treated for CIN3.”

    Is witholding this information legal at all, I am wondering.

    • Alex says:

      You’re always dealing with actions, never laws. Besides, anything at all can be sanctioned.
      Examples:

      (1) In Romania, under Causescu’s reign, these kinds of things were imposed on women every 1-3 months (plus, their pregnancy was medically managed & they’d actually get in trouble for not getting pregnant). This started with high school girls (saying that this was tied to graduation & going to college).

      (2) In Lithuania, a pelvic exam was tied to a driver’s license. This conditional was recently removed.

      (3) In America during the Cold War, they made pelvic exams compulsory for a marriage license (saying that it would determine if a woman would like sex, have a good sex life with her husband- which would lead to a good marriage, a strong family, and a strong country).

      Side-Note: I’ve noticed America likes to connect the dots to make bullshit look good. There was a case in Stroudsburg, Pennsylvania where they forced pelvic exams on a bunch of 11-year-old girls at school. That whole thing is a long story (and it came up a bunch of times on this site- I think it’s on the Psychological Harms, Sexual Abuse, and Discussion threads). That happened in the mid-90s, not even in the “touch my kid, not my i-phone/TSA shows up to the prom era” that is currently in swing here.

  7. Moo says:

    Now can people see how cervical screening registries could be used for population control? Either they control pregnancy or who gets to be pregnant. The control starts with monitoring. Or the trend might be towards reducing fertility totally.

    Are other types of cancers creening programmes really about “saving lives” , greed or population control in some form?

    • Alex says:

      That somewhat happened already in Romania. There was all kinds of different dictatorial behavior in Germany, too. America has a suprising history along those lines, as well.

      Ever hear of an OODA loop? It means Observe Orient Decide Act. It’s typically in reference to combative things, but the same theme of observing & compiling information so they can Decide & Act comes up in other things. Some times all kinds of official things get hidden for that reason, too.

      You’ve probably noticed how much general monitoring goes on lately & with records stored electronically, this information is easy to transfer. It seems to actually be a law in America for medical records to be stored electronically, which potentially causes a bunch of problems. People also throw a lot of personal information around on the internet, surveys, and forms for different things. I guess that all could be used for playing to the crowd & for specific profiles on people.

      No one thinks they’ll get accused of anything, particularly in paranoid environments.

      • Alex, I personally have big problems with invasion of privacy in my country, Australia. The amount of government registers and databases is growing constantly, they are expanding and merging together. Medical registers, disease databases, immigration department, family assistance, immunisations, Medicare information, health insurance, and now even Australian census are brought together. There are also talks about making eHealth records opt-out rather than opt-in. Legally, Australians have rights to remain anonymous unless it is absolutely impossible to provide the service to an anonymous person, but in reality we are never given that option. Whatever we do – give your name, address, date of birth…. and “when was your pap smear?”.

      • Alex says:

        Australians are losing their privacy- Look up the word “privacy” (if you haven’t already). It applies to so many things & all of them are getting progressively eroded.

        Suprised to hear it’s that bad in Australia. I’d heard it was getting very America-esque, but I figured it was more mild. I’ve also heard that Australia tends to use America as a general guide- they tend to do as the Americans do. Not good, considering how dictatorial America is getting (which is bizarre- since they always talk about all the things OTHER countries do, but steadily have more & more of those themes in common).

        All that talk about being better than the rest of the world & yet they can’t manage to be different on the levels they always claim superiority in. What’s really suprising is that even people that live here tend to believe all these things & then when they go to actually operate under those assumptions, they find out they weren’t really true to being with. It’s like putting your weight on a shell of paint with nothing underneath. This is a personal observation as well as a personal anecdote.

      • Beth K says:

        Moreover, with all of the focus in the US on these screenings, and follow-on tests among the well-off and well-insured, the results do not pan out in terms of life expectency in the US – which has the lowest life expectency of any industrialized country. Even further, there is all of this focus on getting people screened who are considered to be “higher risk” like minorities and lower-income people. At the same time, there’s massive resistance to anything but private insurance to pay for all of this follow-on testing and treatment. What use is it for a woman to get a screening, be told that she’s got an abnormal result, and there being no way for her to get any follow on testing? Is adding the worry – near panic for some – without any further testing or treatment better than no screening at all?

      • Alex says:

        You know, I’ve noticed that the poor are deemed at higher risk of getting these conditions. That poverty is directly corelated with cancer, is the point being maintained. What does that mean? That all the people that have been financially drained by this depression that’s going on is now at a higher risk of developing cancer?

        It’s interesting that these are people that are being marketed to, as well. “Hey, you over there! The people we haven’t marketed anything to, yet. Did you know that you’re likely to get cancer because of that? No, no- it’s not a threat, it’s just scientific fact.”

      • Oz says:

        Alex, unfortunately, it is true that Australia is copying USA in many aspects. And the saddest thing is that it selectively copies bad things: depriving people of their privacy; mass surveillance and spying; putting money and profits above people’s benefits; coercing women into screening that is good for the system, not for women….

        I wish Australia, if it so wishes to copy something from America, would rather copy good things: develop its own industry, for example. It is nearly impossible to buy anything made in Australia. We were able to manufacture Australian goods before, but now everything is imported.

        Australia is unable to make the most basic things, and yet it thinks it can shove tools into womens genitals and tell women what they should do with their own bodies.

    • Karen says:

      Sounds like some far-fetched conspiracy -until you think about it- the less affluent and lucky are bombarded with (even more) propaganda (that is what actually happened in the UK, as the crying boy posters were designed to reach ACORN group N, M, O, single mothers, uneducated etc etc, and maybe then the labs processing these smears can have higher targets for CIN III etc., and such policies can be rationalised by referring to the higher incidence of cervical cancer among women with lower socio-economical backgrounds, and then these women can be “saved” and have all the fertility damaging treatments.

      http://www.cervicalscreeningproject.com/whatdidwedo/developandtest/phase2/servicepush2.php

      I am off to do some more research about postcodes and nhs targets.

      • Moo says:

        abnormal paps and postal codes. Sure the control being that poor women or women on welfare should be offered higher rates of fertility destroying treatments. It costs society too much money in child rearing costs. Importing poor immigrants is so much more effective as cheap labour that home grown. Even if the rich are given the same treatments they are going to delay childbearing, have fewer children and pay $$$ for fertility treatments and IVF. The medical community makes more money, welfare goes down, educational costs are minimized. win win win. The anti-child economy in which countries?

        Sweden is different in many regards. mothers staying home with toddlers, childcare subsidies, more liberal attitude towards sex, less cervical cancer screening.

  8. Anonymous says:

    I encourage you all to look at a misguided article about cervical cancer at http://www.medicalnewstoday.com/articles/271262.php. You will notice that I commented at the bottom of this article.

    • Alex says:

      Couldn’t find any comments.

      Cervical cancer (or, really, any cancer that only a woman can get) is harped on all the time, even though other cancers are equally uncommon or even more common. It seems throughout the various discussions of these cancers, leading a non-cancerous lifestyle is NOT what’s mentioned as a preventative measure. What is mentioned are invasive tests that have low utility & high risk.

      • Alex says:

        I know I’ve posted a bunch of times, but I really would like to make a point about how the American trend of medicine isn’t a world-wide thing. Lots of places don’t do things the same way or have anywhere near the same antithetical philosophy- America tends toward things that don’t work for solving problems.

        I don’t know if Sue got this, but I figure a thread on Childbirth & one on Alternative Methods would be useful. I was just reading Rainforest Home Remedies & it’s good. There’s another one called Birth In Four Cultures (it covers Yucatan, Holland, Sweden, and the U.S.). Just thought I should mention those.

      • Alex, thank you for your ideas and suggestions. The discussion thread was a great idea and has been a good addition to this blog. Childbirth and Alternative Methods are also great suggestions but they are already the main focus on a number of other sites. They are well covered under women’s health and childbirth threads by Yazzmyne: http://womenagainststirrups.proboards.com/ There are many interesting links and comments as well. This is also a good site for childbirth information: http://humanwithuterus.wordpress.com/

      • Alex says:

        Oh, wow. Didn’t know about those, thanks. I’d seen a couple of sites on childbirth, though.

        I’m a lttle suprised there hasn’t been a pamphelt made of natural childbirth that sums up the basics of it (at least). Like how there are edible & medicinal plant guides that are entire books, but there are also pamphlets that at least give you an ability to take a swipe at it & get you started.

    • ADM (Canada) says:

      I’m always amused when I see articles using numbers to attempt to incite fear by making the cancer look like a real threat. There were 12,000 cases of CC and 4,000 deaths last year but when you look at the population of females in the US which is approximately 158,745,000 you see how rare the cancer really is. Then look at heart disease which killed 292,188 women in 2009. Which is the bigger threat to our health. And yet no Dr has ever broached the topic of heart disease and prevention with me but it has been presented that I will die if I don’t have a pap smear.
      There is a real misunderstanding in our society as to how much of a killer cancer really is. I was at the eye Dr and they had a video going which stated that lung cancer is the number one killer of men and women. Again that is not fact. Heart Disease is the number one killer. Lung cancer is the number one cancer killer.

      • Alex says:

        Good points. And the weird thing is when it’s extremely low risk with this the idea of “But what if it’s you?” comes up, but with more prevalent cancers or rare diseases the idea is “Why worry about it? You could get struck by lightning, too.”

        The subject of low-utility tests for these “what if?” concerns never comes up. So you should worry about these situations & get tests for them, but not effective ones? Sound reasoning & an indicator of effectiveness.

        The subject of testing risks doesn’t come up either, whether inherent or induced. Apparently, it’s “one in a million” that the doctor would cause an injury or infect somene with a disease, by accident or on purpose. If they’re already imposing something of this nature on someone & not coming clean on risks & inaccuracies (or incentive payments for reaching target quotas), it’s not very plausible that it’s a safe environment to begin with.

        I’ve got to ask: Why was a video on lung cancer running at the eye doctor?

  9. Elizabeth (Aust) says:

    ADM, so true and this deliberate manipulation of our perception of risk means women spend far too much time worrying about a rare cancer, while the big threats are largely forgotten. Also, how many women now avoid doctors because of pap test pressure? A woman online “manages” her diabetes, another her asthma, both avoid medical care after the trauma of pap test coercion.

    The system IMO, focuses on commercial cancers – so breast and cervical cancer get top billing. When 77% of women have something done to their cervix thanks to the screening process to try and prevent a cancer with a 0.65% lifetime risk, that’s great business, it drags most women into the day procedure room. Also, pap testing everyone is far more lucrative than concentrating your efforts on the 5% actually at risk, so saving lives is the last thing on their minds, it’s maximizing profits.
    So they’ve convinced many women this is the most important test to prevent a major threat. UNTRUE.
    I cannot imagine the damage done to women because of this testing, it would be HUGE.

    Also, the loudest voices get the most attention, so political sensitivity and meddling by vested interests means there is an endless supply of funding for the “pin-up” cancers. It defies common sense to waste scarce health resources on a rare cancer.

    Breast cancer has been commercialized, it’s now BIG business. Most of the funding is spent on “raising awareness” and that’s mostly about screening…we should be diverting more funding to research to find better treatments for breast cancer, that’s if this was about saving as many lives as possible, it’s not, so we concentrate on hype, screening and profits.

    It certainly means political and vested interests should be kept OUT of these programs. The NCI should review all programs before they’re funded and constantly monitor them to ensure they remain current, responding to new evidence and always doing what’s best for the target population. We also, need an independent ethical committee to oversee these programs to ensure informed consent is being respected. The entire model needs scrapping.

    I believe the current mess was started by a few factors, including a very paternalistic medical profession who viewed women as easy targets for exploitation and abuse. Unhealthy attitudes are now accepted as normal in women’s healthcare. Only individual women can change that by totally rejecting the existing model used in women’s cancer screening.

    • Judy says:

      Elizabeth, what an excellent summary of the coercion and oppression that masquerades as women’s healthcare. Count me in as another who avoids healthcare because of this. I haven’t set foot in a doctor’s office in fifteen years because I just can’t deal with the pressure to have pap smears and mammograms and the lack of informed consent. During those fifteen years I’ve crossed over from youth to middle age and know I should now have some baseline tests for blood pressure, diabetes, etc., but just don’t want to have to deal with our healthcare system. Something has to change.

    • Alice says:

      Elizabeth, you have just coined an excellent term — “commercial cancers“!

      As to “raising awareness”? I simply can’t stand those mass, public sheep-herding experiments that inconspicuously push people into unnecessary tests, anxiety and medical procedures. For example, I can’t watch the pink test cricket on Sydney Cricket Grounds. I hate it, I can’t stand it the hype and lies.

      A suggestion: the rename the “heathcare” into “healthscare“.
      That will be a better name for this vested-interest-infested system.

      • Alice, Good idea, healthscare, exactly…
        As for awareness, we’re drowning in awareness when it comes to a rare cancer and breast cancer, in the meanwhile most people will continue to dir from die from heart disease/attacks. The awareness stuff is so blatantly commercial in nature, scaring people into delivering up their healthy bodies. Vested interests rely on numbers and that’s why evidence based screening is unlikely to happen in places like the States, Canada and Australia. So many women greatly fear cervix cancer, but never mention heart disease, so this commercial skew of risk will cost many people their lives. We forget about the real risks to our health and lives. Personally, I think fear and stress are bad for us, screening produces both of these things, so many women live stressful lives on the pap-biopsy roundabout or having breast biopsies. Just the stress many women feel having these tests and waiting for results is IMO, bad for us, it negatively affects our quality of life. It’s awful to think this continues right through life for many women.
        The best advice: go back to basics.

      • Alice (Australia) says:

        Elizabeth, you are so right about fear and stress — far more common and dangerous “killer” than a rare cancer.

        Recently, I’ve heard statistics about breast cancer (unfortunately, I don’t remember the exact source — a research from some uni), they were advertising — as per usual — breast screening using the usual mix of white-coat interviews and “survivors” fairy tales, and were mentioning numbers along the way here and there. Because I always ignore the hype and blurb, I was able to pay close attention to the numbers. And…
        …while the “mortality” from breast cancer was lower amongst the women who regularly deliver their bodies for screening, the incidence of breast cancer was higher amongst the screening women and lower for those who refuse screening.
        These numbers weren’t mentioned together — some in the beginning of the program, some at the end, and so a normal person would have been too distracted by the hard sale hype to notice the shocking truth. That also must have been the reason why the sad fact hasn’t been noticed by the creators of the program to edit it out.

        So, whether we can blame the mammogram radiation or breast tissue damage through pressure, of the fear and stress caused by the screening, but the fact is there: breast cancer screening does not prevent cancer, it causes it!

        Same goes for cervical cancer screening: scraping cervix during pap smears inevitably causes micro-abrasions and lets HPV get deeper into the cervix tissue. Which means that the body has lesser chance to heal the infection and is more likely to develop the cancer.

      • Elizabeth (Aust) says:

        Alice
        “while the “mortality” from breast cancer was lower amongst the women who regularly deliver their bodies for screening”
        This is deceiving as well, Professor Baum’s article in the BMJ last year was enlightening, these statistics do not take into account women who die from heart attacks and lung cancer after being over-treated, their deaths would not be recorded as breast cancer, so lower mortality from breast cancer in the screened group doesn’t tell the whole story. (as usual)
        The NCI and Professor Baum and many others are now saying the risks with breast screening exceed any benefit at all when you factor in this group of women – those who die as a consequence of treatment. (and we know about 50% of screen detected breast cancers are over-diagnosed)
        I think increasingly the breast screening brochures will have to tip toe through a mine field to get to happy-screening-story land.
        I’m a firm believer if it’s not broken, stay the hell away from it.
        I also, think stress is something we should avoid as far as possible and being fearful, embarrassed, stressed, upset etc. right through life is very bad for your health, I think it must also, detract from the lives of lots of women, just reading through the cervical cancer support forums makes me feel stressed. (most of these women have been over-treated by the way, but most call themselves “survivors”…that’s stressful right there, there is a HUGE difference between survivor and being over-treated)

  10. OverItAll says:

    I just got off the phone with an update from my midwife (who was between births). She’s looked into Trovagene and this is what she told me: “Any dr/nurse/midwife can order it, just ask for it at least a few days BEFORE your appointment. The FDA has not cleared it for approval because the FDA has said Trovagene is ‘not necessary’. Just ask any dr for it, it’s about as reliable as a pap. If you want to do it, I’ll order it for you now and you can do it when you come in for your kidney test.” So the TRUE reason it isn’t available is because doctors don’t want to have it available. I still don’t understand why there’s so much hype over such a rare cancer, especially when brain tumors are FAR more common (http://www.abta.org/news/brain-tumor-statistics/) and far more deadly (http://www.cancer.net/cancer-types/brain-tumor/statistics)!

    On an unrelated note, my mother said she talked to her dr about thermography instead of mammos and he immediately changed his mind about the double mastectomy. I had her call him while she was out here so I could talk to him and he let this tidbit slip: While her insurance will only cover UP TO $10,000 of the surgery (and leave her with the rest, not what he originally told her), the insurance would give the dr $15,-20,000 as a “thank you” to do the mastectomy and saving THEM!

    • Alex says:

      Don’t understand how the insurance part of that situation works. Up to $10,000 is paid by insurance, she pays the rest, and insurance pays the doctor $15,000- $20,000 (which is higher than they were willing to pay off of her bill, originally)? They are willing to pay from half again to double as much to the doctor as they would to her to pay her bill?

      Sounds to me like they just like doctors to do mastectomies.

      • Mary says:

        Alex insurance companies, from what I have read on forums, like to get doctors to remove as many body parts as possible. I have read on hysterectomy support sites of insurance companies calling up patients about to have a hysterectomy, calling themselves “patient advocates” asking them that why don’t they also get their ovaries,appendix etc removed as well? (you know, to protect against possible future cancers, etc) I think that from their perspective, the fewer organs a person has the less chance they will have of paying for future medical costs. If they had their way they would have everybody existing with everything but the most minimal organs to sustain life.

      • Alex says:

        That’s pretty damn creepy. “Hey, you want an appendectomy with that?” That’s like something out of a serial killer movie!

        If their existance is because of the high price of medical things, why is that not attacked? The insurance is paying for massively expensive “services,” so that price is the issue. It’s odd that all these entities act like enemies & then somoene wonders what they’d do without them. Oh, and everything is the fault of someone higher them- never mind the implementation level.

  11. Karen says:

    “it’s about as reliable as a pap” – that is a good reason to stay away from it!

  12. Moo says:

    The HPV cotesting with the pap is the cause of more scare tactics. In some places you have to pay for the HPV test out of pocket. The the push with a pot positive HPV test regardless of pap result will be colposcopy just in case because the pap is not so reliable. Sorry, the problem is not the HPV test or Pap test so much as the system that abuses and exploits women.

    I guess pap and breast screening programmes were so exploitively profitable that now they extend the abuse to everyone over 50 with colon screening. FOBT test is not reliable and the same coercion tactics are being used as with paps and mammograms.

  13. Excellent blog. And what you say is right. Women, as well as men, do have the right for informed consent. Second opinions are also a right a patient has. Hugs, Barbara

  14. Here’s an article about how to fire your gyno: http://www.utsandiego.com/news/2014/Jan/23/change-records-renew-prescriptions/?#article-copy
    From the article:
    “The last time I saw my gynecologist, she glossed over the issue I’d come in for and gave me a test I didn’t want — without even discussing it with me. In my previous visit, she ordered a mammogram and brushed off my attempts to discuss the exam’s harms and benefits. It’s clear we have a communication problem, and frankly I’m ready to fire her — but how?”

    • Beth K says:

      How to fire a doctor with whom there’s a communication problem, or that doctor does tests which you did not consent to or authorize is simple: You don’t go back to them. In the case of an HMO, it’s more difficult, but not impossible. Just get the HMO to assign you to a different doctor.

      I don’t understand why this is somehow hard.

      • Alice (Australia) says:

        It may not be “hard”, but going from doctor to doctor to get some decent care for your real concerns may be:
        - Time consuming: doctors tend to work 9 to 5, which means the patient has to leave their work.
        - Costly: paying for a consult only to discover that the doctor is going to pap-wash your brain is a waste of hard-earned money (plus the loss of income for the time taken off work to see the quack).
        - Not safe for privacy: to see a doctor, the patients have to fill the paperwork first, and that means giving a huge amount of personal data to a doctor or medical business they may never want to see again.

        If people could do “doctor-shopping” after-hours, anonymously and for free, who would complain?

  15. I doctor shopped before finding my GP, interviewed and passed on about.4 doctors. I knew within a few minutes whether I could work with the doctor. It was worth my time, it’s nice to know I can see my doctor or anyone else in the practice and know pap tests, mammograms and colonoscopies will not be mentioned to me, my consult time Is my time, not Papscreen’s time or anyone else’s time.
    Of course, this was with the confidence of a 36 year old woman, prior to that I mostly avoided doctors. That reminds me my GP has been working “with” me for almost 20 years.

  16. Moo says:

    Irony!!!!!
    I googled “birth control coercion” and the result was several articles about gynocologists asked to be aware about women being abused by having their partners sabotage their birth control or try and force them to get pregnant. How ironic when doctors themselves are denying women access to birth control and healthcare when women refuse pelvic exams or Pap tests.

    • Alex says:

      Withholding birth control IS sabotaging someone’s birth control.

      The doctors force women into getting internal exams that may also damage their reproductive ability & the partners are the possible threat?

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