Healthcare "Good News" is Often Bad News For Women

• You don't need a doctor, you don't want a doctor, so here's $150 to see one anyway — employers offer cash incentives to participate in wellness programs
• Was your hysterectomy too slow?  — 14 year old boy invents a timesaving surgical technique
• Two tickets for hysterectomy, please! — how to turn a trip to the operating room into an all expenses paid vacation

At first blush, these three news bites seem like good news. Lurking beyond the silver linings, though, are the dark clouds of some very unhealthy trends. Let’s take a look at each one in more detail.

Good News #1: Many news writers claim that corporate wellness programs reduce healthcare costs, increase productivity, and improve morale. As Melissa McNamara reported in a CBS News online story titled Wellness Programs May Trim Health Costs, “the company—and its employees—save by preventing heart attacks and obesity. ‘We believe that prevention is the right way to go,’" said the head of IBM’s human resources department interviewed in the article (http://www.cbsnews.com/stories/2007/01/22/eveningnews/main2386130.shtml).

Many wellness programs also encourage routine checkups and screening. In the same article, McNamara reports that IBM gives its employees $150 for filling out a “health record, which flags employees to their individual risk of disease.”

What the article fails to point out is that while disease treatment accounts for a major portion of the healthcare dollars spent in this country, misdiagnosed diseases and unnecessary medicine also account for a major portion of our healthcare spending. As health reform advocate and writer Ivan Illich put it, “Unnecessary surgery is a standard procedure.”

Looking for problems in healthy people is unhealthy. Routine medical screenings perpetuate the idea that our bodies are ticking time bombs, ready to explode if they are not routinely inspected for any possible abnormality. Routinized poking and prodding of vaginas, cervixes, uteri, and ovaries is unnatural and may cause pain, discomfort, and millions of unnecessary procedures and surgeries each year, causing far more damage than they prevent.

One of the most common scenarios resulting in unnecessary surgery is the routine wellness exam. And perhaps the most routinized of all exams is the Pap smear, which is part of most gynecological checkups.

The Pap smear is often praised because it may detect cervical cancer. But with about 11,000 cases of cervical cancer detected each year in the U.S. (1/10^th of 1% of the female population, according to the Centers for Disease Control and Prevention, National Center for Health Statistics), cervical cancer is only slightly more prevalent than the incidence of testicular and penile cancer.

What’s more, pap smears are prone to a high percentage of errors. One report puts the error rate of false-positive results—tests that say women have cancer when they actually don’t—at a whopping 44.8%.

Hormonal contraception and false-positive cervical cytology: is there an association? Hoekstra AV, Kosinski A, Huh WK , J Low Genit Tract Dis. 2006 Apr;10(2):102-6 (http://www.ncbi.nlm.nih.gov/pubmed/16633239).

Gynecological exams performed during a so-called well-woman visit are all too often invitations to unnecessary treatment. Nearly all hysterectomies are performed for benign conditions—fibroids, ovarian cysts, “abnormal” cells, or an age bias. And hysterectomy rates vary wildly across the country—highest in the South, lowest in the Northeast.

The National Institutes of Health (NIH) reports that in the last decade on average 621,000 hysterectomies were performed each year, making it the most common non-obstetric surgery performed in the U.S. According to the Hysterectomy Educational Resources and Services (HERS) Foundation, about 98% of those surgeries could be avoided with more conservative treatment—or by not undergoing routine gynecological exams in the first place.

Incentivizing exercise and healthy eating may be money well spent. But as was reported in the National Association of Health Underwriters magazine (http://hersfoundation.org/press_news.htm), eliminating medically unwarranted hysterectomies could save our medical system more than $17B each year.

Good News #2: On June 16, 2009 the Indianapolis Recorder published Jackie Jones’ article “Black Youth Invents Surgical Technique–at 14.” In the article Jones claims that a Florida boy’s surgical technique can be completed “in a third of the time of traditional surgery” (http://www.indianapolisrecorder.com/articles/2009/06/18/news/national/doc4a382654df4fd264703245.txt).

This story is intriguing on many levels. First, there is the surgery in question—hysterectomy. Then there’s the question of why, with thousands of surgeons performing millions of hysterectomies, it took an inexperienced boy to figure out what all those trained surgeons did not. And then there’s the question of who exactly benefits from faster hysterectomies?

Hysterectomy is widely considered the most over-utilized non-obstetric surgery performed in the U.S., second only to C-sections. A hysterectomy is performed every minute of every hour of every day. According to the NIH, one out of every three women in America has been hysterectomized by age 60. Considering these staggering statistics, faster surgeries may be good news for the doctors, hospitals, device manufacturers, and pharmaceutical companies who profit from them, but speeding up the hysterectomy assembly line is bad news for the women who undergo the surgery.

“High school internships and other programs,” Jones reported in the same Indianapolis Recorder article, “are being used by educators to boost the number of young people interested in medicine in the face of projections that there will be a doctor deficit of as many as 200,000 physicians by 2020.” But with vast numbers of unnecessary knee, back, heart, and female pelvic surgeries, is the prospect of fewer surgeons bad news or good news?

And what was the boy who invented this surgical technique taught about the consequences of the surgery he sought to “improve?” One wonders if he would have been inspired to do so if he understood the irreversible damage caused by amputating the uterus.

No matter how good the surgeon’s skill or technique, and no matter what type of hysterectomy is performed, the result is the same: the important lifelong functions of a hormone-responsive reproductive sex organ are permanently gone.

For more information about the consequences of hysterectomy, watch the HERS Foundation’s video “Female Anatomy: the Functions of the Female Organs” at http://www.hersfoundation.com/anatomy/index.html.

Good News #3: Surgeries performed abroad cost less than surgeries performed in the U.S. So much so that employers who are eager to keep down healthcare costs have begun providing incentives to employees who are willing to leave the country for surgery.

Entering an operating room is a frightening experience in any country. But as Parija Kavilanz reported in an August 11, 2010 CNNMoney.com article titled “Surgery and sightseeing on your boss' dime,” surgery for Tina Follett was transformed into a luxurious vacation (http://money.cnn.com/2010/08/11/news/companies/health_care_medical_travel/).

To entice them to seek a cheaper surgery in Panama than what was available in California, Patrick’s employer offered the couple free airfare for two, full medical coverage, free hotel, a complimentary concierge, car service, an interpreter, sightseeing, and a two-week $120 per day allowance. In Tina’s words, “It's been a phenomenal experience, almost like a hotel, and it has cost us absolutely nothing.”

What’s not mentioned in this article is that although the days prior to Tina’s surgery may have been spent in paradise, the most consistent problems women experience after hysterectomy—no matter how seductive a free exotic vacation may be—include a loss of sexual feeling, a loss of vitality, a 25-pound weight gain in the first year following the surgery, joint pain, profound fatigue, and personality change.

And contrary to the CBS News article mentioned in Good News #1, preventative checkups that lead to unnecessary hysterectomies will result in a significant increase in heart disease and obesity. Hysterectomized women have a three-times greater incidence of myocardial infarction (http://www.ncbi.nlm.nih.gov/pubmed/7457522). When the ovaries are removed, women have a seven-times greater incidence of heart disease.

In the CNNMoney.com article, Kavilanz was not reporting on the dark cloud of tens of millions of American women coping with the aftermath of hysterectomy. The article was concerned with the silver lining—a California couple enjoying an all expenses paid vacation to Panama in exchange for saving the company a few bucks on the amputation of Tina’s uterus. Hopefully I’m not the only person reading this article who asked, so what exactly are the female organs worth?

These three articles demonstrate an inherent bias in news reporting in favor of positive findings that artificially support the value of medicine. Likewise, there’s an inherent bias against publishing stories that report negative findings that are unprofitable to the medical industry.

The devil is in the details. It would be wonderful if all reporters were encouraged and compensated to provide thorough investigations of the stories they are assigned to. When that is not the case, we are left to dig deeper ourselves, otherwise we may learn the hard way that good healthcare news is often bad news for women.

Improving employee health and workplace morale is a good thing. But most women who contact the HERS Foundation would trade a lifetime of vacations to get their uterus back again.