If someone told me 15 years ago I would be writing about how much sex I wasn’t having, I would’ve laughed in their face. By the time I was 21, I had racked up sex partners in double digits and boasted numerous sex adventures.

In my mid to late twenties I acquired a journalism career, a husband, and two babies. Also, a dwindling sex drive. To be clear, I didn’t hate sex. I liked sex. I really enjoyed sex with my husband. We just weren’t doing it. To admit this out loud to anyone felt like the ultimate embarrassment, so I privately scheduled a series of medical tests, hormone labs, and vaginal examinations. I wanted answers. I wanted cures.

A lower libido is acceptable when you’re six weeks postpartum, but any longer is medically and socially unacceptable. There were seemingly only three valid explanations for my disinterest in sex: 1. I was a selfish wife 2. There was something wrong in my marriage 3. There was something wrong with me, medically. At least, these were the messages I received through the Facebook comments section when I first wrote an article about it. I also received many “thoughts and prayers” in my inbox from those who thought a lack of sex was a terminal illness. People took an intense and bizarre interest in how much sex I wasn’t having.

A lower libido is acceptable when you’re six weeks postpartum, but any longer is medically and socially unacceptable.
Click To Tweet

In the end, all tests came back “normal,” but I couldn’t let it go. Why wasn’t I enthusiastically rumping like a screaming beastie in the night? I turned to Google and discovered Female Sexual Dysfunction.

According to a 2016 study in the Sexual Medicine Reviews, 40.9% of premenopausal women around the world suffer from Female Sexual Dysfunction (FSD). The symptoms include: low libido or lack of sexual desire, diminished vaginal lubrication, painful intercourse, and decreased arousal. That means almost half of women have a sexual dysfunction. Given how widespread FSDs supposedly are, are this many women really suffering from sexual dysfunction, or are their “symptoms” not symptoms at all?

In contemporary sexual culture, it seems the line between dissatisfaction and dysfunction is increasingly blurred. Women with any level of sexual decline or discontent have been cleverly convinced they are defective and need treatment. As such, feminists and clinicians have started to question the possibility that FSD was constructed by pharmaceutical companies through inflated epidemiology and our culture’s sexual illiteracy.

Take my situation as a new mom. Years ago, sexologists would’ve classified my waning lust as a typical postpartum-related sexual decline, but the criteria for FSD makes it a full-blown disease. A temporary stress-related sex decline is now a sickness. A prescription drug side effect causing low libido is now a disorder. Age-related vaginal dryness is pathologized. Dissatisfaction with your partner is now a bona fide medical illness. Lack of interest due to fatigue, work obligations, and child-rearing all fall under the FSD umbrella.

In contemporary sexual culture, it seems the line between dissatisfaction and dysfunction is increasingly blurred.
Click To Tweet

“While we are consistently deprived of useful, relevant, and meaningful information about women’s motivations for sex, how sex works from a pleasure perspective (and not a reproduction perspective), and the tools to manage the anxiety associated with the discomfort we feel about discussing sex, we are left open to interventions that reinforce big pharma, false narrative of “normal” and not pleasure, connection, sensuality, or eroticism,” New York City based therapist, Cyndi Darnell, says.

Despite it being 2018, American girls and women are still left in the dark about their own sexual health. Currently, only 24 states and the District of Columbia mandate sex education and 34 states and the District of Columbia mandate HIV education, according to the Guttmacher Institute. It’s important to note, these sex education programs vary widely in instruction and content. Some states require abstinence to be stressed (without receiving information on contraceptive methods). A number of states require negative information about sexual orientation to be included. Some require the instruction to emphasize the importance of only engaging in sexual activity within a marriage.

As a child growing up in the ‘90s in New York I had access to sex education. I learned to be terrified of having sex (thanks to loads of AIDS hysteria) and I could recite all medical terms for male genitalia. But I couldn’t locate my clitoris. I didn’t know anything about pleasure, masturbation, or female orgasms. I didn’t know sex could exist outside of penis-in-vagina penetration. I didn’t know that across cultures, relationships, sexual orientations, and identities there could be different types of sexuality. And I sure as hell didn’t learn about consent.

I learned to be terrified of having sex and I could recite all medical terms for male genitalia. But I couldn’t locate my clitoris.
Click To Tweet

With sex education still largely lacking in accessibility and information, no wonder flocks of women think a difficulty on the sexual radar is a full-blown medical problem. They’re combining what they learned about sex in school, what they learned from their parents, and what they learned through media portrayals of heteronormative sexuality. Additionally, women and men have internalized commercial marketing schemes which promote adventurous, anything-goes, heterosexual sex as the gold standard, while stigmatizing anyone who doesn’t look “sexy” enough and anyone who doesn’t orgasm a certain way. In fact, straight women are less likely to orgasm, because their partners are more likely to insist on penetrative sex, and ignore other erogenous zones.

“We have become a society more adept at watching sex than talking about it or doing it in ways that are satisfying for all involved. The tendency is presently to consume it rather than create it,” Darnell says. “The further removed we are from its meaning and purpose in our lives, the more likely we are to feel awkward and dysfunctional – and thus open up erroneous diagnoses designed to reinforce a performance “standard” rather than a fulfilling exploration based on mutuality and eroticism.”

Because of this “standard” women are likely to feel sexually inadequate. But, no worries, there’s a little pink pill for that ill too.

Unlike Viagra for men, which concentrates on the genitals, Addyi, or “pink Viagra” as it’s nicknamed, focuses on the brain. A bright pink slogan in block letters on the home page reads, “Your Brain May Be Working Against You When It Comes to Sex.” Call me crazy, but when my brain tells me I shouldn’t have sex, it probably means I shouldn’t have sex. I thought we were all supposed to be saying “no” to sex we don’t want?

Not only is the company’s message concerning, so is the disease it claims to be treating. According to the website, Hypoactive Sexual Desire Disorder (HSDD) is characterized by the following criteria: your desire for sex has decreased, your decreased desire for sex has persisted for six months or more, or your decreased desire for sex is bothering you. It’s pretty obvious that these “symptoms” are extremely broad, and as such, widely open to interpretation. It appears the drug’s maker, Sprout Pharmaceuticals, is good at expanding their definition of dysfunction in order to cast a large net on those even mildly affected.

I’m not a total pharma hater, I benefit from modern medicine in many life-saving ways. I’m also all for sex positivity. I support clinicians and researchers investigating women’s sexual problems. I love scientific and technological advances just as much as anyone else, but there seems to be several key elements missing from the conversation about women’s sexual health. You can’t claim to care about women’s sex lives and welfare, whilst ignoring crucial and omnipresent social and political components which form our sexual health. In our culture we are abused, we are raped, and we are shamed. We don’t have full body autonomy. Those facts alone might make us less inclined to have sex. Then there are the biologically natural hormone fluctuations a woman goes through in her lifetime which play a large part in our sexual response.

How To Talk (And Not Talk) About Abortion With Your Mother
theestablishment.co

“There are hormonally driven cycles that women go through that drastically affect our sexual health,” says Dr Sherry A. Ross, women’s health expert and author of She-ology. The Definitive Guide to Women’s Intimate Health. Period. She cites a woman’s menstrual cycle, pregnancy, postpartum, breastfeeding, perimenopause, and menopause as a few examples. While she believes FSD is a real medical condition, her approach to it isn’t solely concerned with organ functionality, physiology, or ability to orgasm, like much of the mainstream and newslike medical literature on the subject. She’s concerned with the big picture of a woman’s health.

“The daily stresses of work, money, children, relationships, and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms such as a dry vagina, or a history of physical or sexual abuse,” Ross says. But often, we’re not not having sex because there’s something wrong with us, but because there’s something wrong with society.

Looking at the social contexts through which women live and have sex is crucial to the research of women’s sexual health and treatments. Equally important is an intersectional approach to studying sexual experiences of people who are LGBTQ and gender nonconforming, which big pharma and their little pink pill are not addressing.

No one will deny that there are absolute medical issues impacting women and their sex lives that should be investigated and treated. Vaginismus, vulvodynia, endometriosis, STDs, and fibroids, all can cause painful intercourse and make women abstain from sex. Prescribing “pink Viagra” isn’t going to effectively treat or heal those conditions. It just makes the women suffering from them consent to more sex. Sex they might not really want to have.

When pharmaceutical companies hijack the narrative about women’s sexual health and attempt to make a universal or standard version of it, we all lose. We lose our freedom to say “yes” to sex, and we lose our right to say “no” to it. We lose our sexual power. We might even lose our sex drive.

These days, my fantasies about sex have nothing to do with pink horny pills. Instead, I fantasize about my daughters demanding pleasure and enthusiastic consent from their future sexual partners. I look forward to a self-determined sex life for me and my sisters, full of empowerment, connection, and exploration.

It’s not easy to look for a specific boy among hundreds of first graders, especially when they swarm into lines for cupcakes and cotton candy. On this fall bake-sale day, the cafeteria of Public School 106 in the Parkchester section of the Bronx is buzzing with energy and children’s happy shrieks. A few teachers shout across the hall to keep things from spinning out of control. And when I finally spot 6-year-old Asaya Bullock, he seems to be well in hand.

“Ready for your green soup?” Charline, his mother, takes out a thermos with a Spider-Man design on the side.

The green soup is one of the only three things Asaya has ever been able to eat. He drinks it for breakfast, for lunch, for dinner; he drank it for the whole trip that his family took to the Caribbean to visit his mom’s relatives. Luckily, with broccoli, kale, green beans, and some minced meat, Asaya’s soup is at least healthy — and better than the small bowl of potato chips used as comfort food after his bi-weekly belly infusion. The recurring medical procedure helps keep him alive.

The boy takes the thermos and nods silently. His big bright eyes briefly meet mine, although I am a total stranger and the only Asian in this Hispanic and African-American school. Asaya is a bit shy before he launches into his plan to buy another pair of shoes with his pocket money, and then once he starts to talk, he forgets to finish his soup. His slim build and patchy thin hair make me wonder if he feels cold on this chilly October afternoon.

What It’s Like To Only Have Health Care One Day A Year
theestablishment.co

Asaya used to wear his hair in cornrows. But it was too hard to maintain once he got sick again from his rare autoimmune disease. Charline insists on sending him to school, arranging doctors’ appointments only on days without many classes. “Every day counts in first grade,” she told me when we first talked on the phone.

Charline sounds very much like a normal parent, except she’s constantly on the search, desperately looking for something she has one-in-a-billion odds of finding: a life-saving match for Asaya’s bone marrow.

Asaya has been fighting IPEX syndrome since even before he was officially diagnosed at 20 months old. Living with this rare autoimmune disease means the immune system constantly attacks and destroys the body’s own tissues, especially certain intestinal cells. Patients hardly ever live beyond their twenties. And his best bet for a cure is a bone marrow transplant.

Finding matching bone marrow is always hard. The human immune system uses unique cellular tags to distinguish the “self” of one’s own tissues from invading foreign cells. Called human leukocyte antigens (HLAs), these markers are critical to bone marrow transplant success. Transplanting bone marrow with mismatched HLAs will not cure but kill.

What makes Asaya’s situation even trickier is his ethnicity. Because HLAs are inherited, people in need of donations must usually look to others who share their ethnicity and ancestry. But there are far fewer black people in donor registries than white people. According to the donor-matching assistance organization Be the Match, 8.7 million of its adult donors are white and only 845,000 are black.

Organizations and researchers are working hard to study why this disparity exists, and to increase donor diversity. While alternative approaches to getting or creating suitable cells for a transplant like umbilical cord blood and gene editing therapy do exist or are under development, for boys like Asaya, finding a bone marrow match is still where the greatest hope lies.

The question is, what can be done to make that hope more realistic?

Invisible Inequalities

In a bone marrow search, most people try their families first. But 70% end up looking for a match among strangers.

Because there are fewer minority donors in the registry, it’s harder for minority patients to find a match. According to Be the Match, black people have a 66% likelihood of finding a matched, available donor in the registry. It’s 97% for white people.

These numbers have real consequences. A 2015 research paper in Bone Marrow Transplantation discovered that black people experience a “longer time from diagnosis to transplant,” and they are “more likely to have an HLA-mismatched donor …compared with whites.”

As scientists have repeatedly pointed out, the concept of race is fundamentally cultural, not biological. Nevertheless, because some realities of population genetics are unfortunately caught up in the false rhetoric of race, we might have to rely on the construct and acknowledge the biological differences in HLAs in order to save lives.

Black people already have a highly mixed genetic heritage because of the history of involuntary migrations across the world imposed by slavery and colonialism. “As those mixes take place it creates a more complicated HLA type,” much rarer than that of somebody who comes from a single ethnic heritage, says Galen Switzer, a University of Pittsburgh School of Medicine professor. Such diversity in HLA types makes it more difficult even for any two black people to match.

Rethinking Roadblocks

Expanding minorities’ populations in the registry is an obvious solution. But that’s easier said than done. It had been known that ethnic minority groups have lower rates of proceeding to the actual donation than whites. Switzer and his colleagues set out to understand why.

Religious objection seems to play a role. In a 2012 survey participants were asked a series of questions like “Do you believe that your religion might be opposed to bone marrow donation?” Switzer found that white people were less likely than other groups to say religion was important in their lives (a claim largely supported by this Pew survey on religion in America), and less likely to say their religion would keep them from becoming a donor.

Distrust of the medical system is another major issue. Compared with white people, the study has found, black people and other minority groups tend to agree more with statements like “People can get access to my medical records without my approval.” They had even more distrust than white people did when researchers asked whether they think their bone marrow donation would be allocated fairly. Considering black people, Native Americans, and other marginalized populations in America have a history of being experimented on without their knowledge or consent, it’s entirely understandable why there is still suspicion regarding the motives of the medical community.

Nothing Will Really Change Until America Reckons With Race
theestablishment.co

However, according to the survey, “The most consistent factor associated with opting out of the registry across all race/ethnic groups was ambivalence about donation: doubts and worries, feeling unsure about donation, wishing someone else would donate in one’s place.”

Organizations like Be the Match and the Icla da Silva Foundation have been tackling these issues for years. For example, the Foundation deploys staff from the same background of donor targets to talk to people and help arrange doctor checkups after the donation. Now, among their 38,000 new donors per year, 90% are from non-white backgrounds.

The black community is still the hardest to reach, says Mary Halet, director of community engagement at Be the Match. Halet and colleagues have recently launched a campaign featuring Mike Conley of the Memphis Grizzlies speaking about bone marrow transplant as a cure for sickle cell disease. As many black people know individuals who are impacted by sickle cell disease, Halet says, “it cut through the clutter and people tune in.”

Alternative Paths

For patients like Asaya, umbilical cord blood that also contains stem cells with the power of transplanting a whole new immune system could be another source of hope, as it doesn’t have to be as closely matched as adult bone marrow.

Umbilical cord blood is harvested from newborns’ umbilical cord. Newborns have a naïve immune system that hasn’t been challenged by vaccines or infections, and their cord blood won’t react as strongly against a transplant recipient.

But most physicians consider cord blood transplant as a “second line” treatment, mainly because of the limited volume — as little as 100 ml per umbilical cord — and limited numbers of stem cells available.

Of Kin And Kidney Transplants: Living As My Sister’s Keeper
theestablishment.co

Even with matched cord blood, things could go wrong. Asaya’s parents, Charline and Vincent Bullock, gave birth to their daughter Anaya not long after learning about Asaya’s diagnosis. But although Anaya’s cord blood is a 70% match, her donation did not cure her brother. “In 20 days his body started rejection,” Charline remembers. “We spent every week in the hospital.”

That’s why gene editing therapy research is gaining so much momentum — to see if a patient can do without another person’s tissue. The idea is to take out the patient’s own bone marrow stem cells, correct them in lab, and then return the healthy cells back into the body.

In this way, we might arrive at a day when race categorization finally does not matter for treatment anymore.

Hope exists for Asaya’s IPEX syndrome. Dr. Tory Torgerson, an IPEX expert at Seattle Children’s Hospital who’s been in touch with the Bullock family since Asaya’s diagnosis, has used CRISPR gene editing tools to correct the disease-causing gene in cells and mouse models. He says in three years they would be ready for patients. Before then he hopes Asaya finds a match soon and the immuno-suppression drugs will keep working.

We might arrive at a day when race categorization finally does not matter for treatment anymore.
Click To Tweet

On the day of my visit, Asaya received his bi-weekly belly infusion of immunosuppression drugs at home. By avoiding traveling to the hospital, the family saves a lot of time and reduces the risk of infection. Charline told me their doctor had asked them to videotape a session. She wanted to use it to encourage other patients. So I assumed the procedure wouldn’t be a big deal.

But I was wrong.

First, during my visit, the numbing cream didn’t seem to work. After the first needle went in — with Asaya already crying and begging — Charline had to pierce two additional needles through her little boy’s upper stomach skin.

If there is a bright side to any of this, it’s that they go through everything as a family. Vincent, a mellow, quiet man, hovers over his son, whispering a story in which Asaya rides along an exciting mountain trail, to take his son’s mind off the third approaching needle. Anaya is also distressed after seeing the infusion procedure, so Charline comforts the 3-year-old by building her a tent in the living room of their Bronx apartment. “Don’t break it! You! I’ve had it since I was 14,” jokes Charline, as the little girl creates a hexagonal tent base instead of a square.

As more plastic sticks and ball-shaped joints fall into place, the tent rises from 2D to 3D. It seems perfect for hiding from all the worries in the world.

It’s just that Anaya disagrees with Charline again. “We don’t need a door,” she announces.

“No, we are gonna build something on the door and roll it up.”

“How do we do it?” asks the little girl.

Charline doesn’t stop pulling another sheet on top of the tent’s skeleton to make it more comfortable. “We’ll figure it out,” she says. “We always figure it out.”

“Your baby has no heartbeat.”

I stared at the doctor in shock, my eyes instantly stinging with tears as his words sunk in.

I looked back and forth from the devastated look on my husband’s face to the sonogram screen, silently pleading for that tiny little black and white flicker to suddenly appear, unable to believe this was really happening.

How could the baby, who was developing so well for the last nine weeks, just be gone?

Within moments of hearing those devastating words, I was told I would have to have a D&C, that this was my only treatment option.

Ten to twenty-five percent of all pregnancies end in miscarriage. In some cases a woman may wait and see if the body naturally expels the tissue, but this is not a viable or recommended option for many people. This is when a dilation and curettage (D&C) may be needed. A D&C is a surgical procedure, typically done in the first trimester, to remove tissue from inside your uterus after a miscarriage. The patient is placed under general anesthesia — or, in very rare cases, under heavy sedation — while the procedure is done. (There is also a D&E procedure that removes tissue and also requires anesthesia, but this is typically used after the first trimester.)

The Pregnancy Loss Cards That Say ‘It’s Okay To Scream’
theestablishment.co

Historically, the D&C has been the dominant treatment method for people after a miscarriage, and it has generally been considered safe — and for some, it may be necessary. But there is an increased risk of complications whenever anesthesia is used, due to potential reactions to the medication and resulting breathing problems. And for those who already have a history of reacting unfavorably to anesthesia, this can add additional complications.

Recent studies have also found that there may be more risks to a D&C than previously thought. Researchers from the European Society of Human Reproduction and Embryology analyzed 21 different studies on D&Cs and discovered that the procedure is connected with a 29% greater chance of preterm birth (defined as birth occurring before 37 weeks) and a 69% greater chance of very preterm birth (less than 32 weeks) in a future pregnancy. This study of almost 2 million women also found the risk of prematurity was even higher in women with several previous D&Cs.

This is not intended to cause alarm in women who have already had a D&C, or to endorse one procedure over another — but patients should always be advised of every option available to them, not just the standard D&C.

Manual vacuum aspiration (MVA), for instance, is a safe treatment option in an early miscarriage. In this procedure the cervix is numbed and tissue is removed with a hand-held device (MVA) or a small electric device (referred to as an EVA). The procedure lasts, at most, 10 minutes. The patient remains completely awake and alert the whole time, and it is now the recommended method of treatment for early miscarriages by the World Health Organization. The Journal of American Science also reports that the MVA is effective, less time consuming, and less costly, and since it doesn’t require general anesthesia, the risk of complications is less than a D&C.

Patients should always be advised of every option available to them, not just the standard D&C.
Click To Tweet

Another study published in The International Journal of Obstetric and Gynecology reports that the MVA is “an alternative to the standard surgical curettage, performed under local anesthetic. It is a safe, and possibly cost-effective procedure, with advantages for both the patient and the health-care system.”

There is also a medication option where a patient is given misoprostol, a drug that causes the tissue to pass. Patients take the pills at home and often have to follow up with their doctor afterwards to ensure the procedure was effective.

I was not informed of these other options after my own miscarriage by any provider, including my doctor, a highly-regarded physician in New York City, and the staff at the surgical center. As a clinician that has worked in a medical setting, and with patients who have miscarried, I was already aware that other options to the D&C existed, but none of my providers discussed these with me. At one point I was even told by staff at the center that “if you have a miscarriage then you have to get a D&C.”

When I met with the “counselor,” employed by the surgical center to speak with patients before they see the doctor to inform them of treatment options and review consent forms, they only brought the information and consent forms for the D&C and said nothing about the MVA or the option to take misoprostol at home.

I continued to refuse the D&C. Having had difficulty with anesthesia in the past, I saw no need to have this if it wasn’t absolutely necessary, and finally, after going through multiple staff members and supervisors, I was given the proper consent forms for an MVA and was taken to one of the on-duty doctors who confirmed that an MVA is an applicable treatment option in an early miscarriage.

In speaking with many other women who have also been in this situation, they too shared stories of not being informed that there were other options, and many told me they had never been told that the MVA procedure even existed.

Fear-Mongering Among New Mothers Is A Profitable Business
theestablishment.co

There are compelling reasons why patients might not be getting a full picture of their options after a miscarriage, the location of where the procedure is performed being one. Many D&Cs continue to be performed in hospital operating rooms, despite the advances in miscarriage management, and even though, with the exception of certain complicated cases, there is no longer a medical need that necessitates a patient going to the hospital after a miscarriage for a D&C.

This is often due to physician preference rather than what the patient wants. Studies have shown that medical providers’ attitudes toward newer treatment have remained stagnant, that many physicians still utilize the older D&C method and still prefer to treat pregnancy loss in the hospital operating room, according to research published by the Guttmacher Institute and the National Institutes of Health.

Even if a D&C is the right treatment option for a woman, it isn’t medically necessary for this to be done in the hospital and it can be performed in other medical settings, such as a surgical center or a private doctors office. Requiring people to go to the hospital OR (operating room) often adds significant stress, time, and cost to an already painful situation.

New York City-based physicians, Drs. Priypa Praditpa and Anne R. Davis, concluded in at 2015 study, “Manual vacuum aspiration: A safe and effective treatment for early miscarriage,” that the MVA is not only a safe procedure, but that “for too long, patients have blamed themselves for a miscarriage and physicians have relied on the D&C in the OR. Changes in the culture surrounding miscarriage are long overdue.”

At one point I was even told by staff at the center that ‘if you have a miscarriage then you have to get a D&C.’
Click To Tweet

The financial aspect to the D&C likely plays a role and provides an incentive to which procedure doctors perform and where they perform it. Providers can bill insurance companies at a higher rate once anesthesia is administered and even more so if it is done in a hospital. Anesthesiologists typically bill at a base rate and then at each 15-minute interval while the patient is under their care.

Both the MVA and the medication option are considerably less expensive than a D&C, with the average cost of an MVA being less than half the cost of a D&C in the OR — $968 for the MVA, compared to $1,965 for the D&C, according to Praditpa and Davis’s research. The Healthcare Bluebook also lists the “fair” billable price for a provider to charge for a D&C as $2,728, though that can go all the way up to $6,820.

For uninsured women, the cost of a D&C can be staggering; though prices vary depending on provider and location, they often range from $4,000 to $9,000. Insured women have also reported exorbitant out-of-pocket expenses after a D&C, ranging from several hundred dollars to well over a thousand depending on their individual insurance plans. This further skews the incentive for medical providers to offer more economical treatment options.

But it’s not just about money or location. A miscarriage is already an emotional and painful time and it is every woman’s right to know all of their treatment options so they, not the medical staff or office billing manager, can make the best decision for their body — a decision based not on increasing profit or perpetuating unnecessary medical procedures, but on their individual needs.

BE THERE.

THURSDAY DECEMBER 14.
7 PM.
SAN FRANCISCO.

SUPPORT DIVERSE VOICES.

(AND YER FIRST DRINK IS ON US!)

Holy shit though.

Russell Simmons. Lars von Trier. Al Franken. Charlie Rose. Garrison Keillor. Matt Lauer with the hidden button heard round the world. Roy Moore. Jeremy Piven. Jeffrey Tambor. Kevin Spacey. Louis C.K. Dustin Hoffman. Brett Ratner.

…which of course begs the question on everyone’s lips. Just when does President Trump have to respond (or apologize, be impeached, go to jail, formally self-destruct) to the more than TWELVE WOMEN who accused him of sexual assault or harassment?

Bueller…? BUELLER?!

And The List, of course, goes on much MUCH longer than even thishandy dandy one The Washington Post has rolled out — constantly updated with a seemingly never-ending throng of sometimes-sinister, sometimes-manipulative, but always-handsy men keen to touch bodies that aren’t their own!

(My personal forever and ever gut-thorn is a male teacher at my boarding school who lived in the girl’s dorm with his wife and many daughters. He liked to call me a slut. “I see you with all those boys.” He liked to walk into my room without knocking. He liked to smirk, “why don’t you put on a shirt before you come down to the lounge?” glancing down at my double-A, 15-year-old breasts as I tried to lunge into my t-shirt.)

In my mind, I imagine each and every one of these shitty humans in an elaborate domino line; an endless sinewy path of smooth white tablets extending to the horizon.

Women have been trying to topple it for centuries to no avail; we’ve been met with shame, disbelief, firings, silence-ings, and open mockery instead of solace or justice.

But now? All we can hear is the resounding click-click-click-click-click-click-click-click-click as each man falls, toppled by the truth.

And honestly? It sounds like music. Like a hot track I can’t stop shaking my ass to. Or a ballad where everyone is weeping in the rain and they lift their faces to the sky Shawshank style.

But a lot of folks — mostly men — have a newfound worry. They don’t understand what’s appropriate anymore.

They’re worried this whole #metoo thing is actually a PC man-hunt masquerading as a watershed moment, and when the smoke clears we’ll all just be openly menstruating and/or cackling over their steaming corpses I guess.

But you know what? In lieu of your understanding I will take your fear. In place of you being a good person I will take your worry. Gladly. If you don’t know how to be an appropriate being in the world — “not masturbating in front of my colleagues is the easiest thing I do all day” quips Samantha Bee — I’ll take your sweet sweet fear if it means it’ll keep your tongue in your mouth and your dick in your pants.

Let the tales keep coming. Let’s rewrite these horror stories with happy endings — with recourse, redemption, and a touch of revenge.

With love + rage,
Katie Tandy
Co-founder | Creative Director

Dear Al Franken: I’ll Miss You, But You Can’t Matter Anymore

By Ijeoma Oluo

Al, I’m so very sad at you. Is that a thing? I mean, I’m mad at you too, but mostly, I’m very very very sad at you. How fucking stupid and selfish of you to ruin yourself for us like this. We really needed you.

I’m not surprised you felt so safe doing it. I’m not surprised you also felt safe trying to kiss other women without permission, or grabbing their asses or boobs. I’m just deeply disappointed that you wanted to. I thought you’d be good enough to not want to.

I live in Seattle. Right now I’m surrounded by good liberal men who are lining up to say how much they believe women. While they are expressing their outrage, they are secretly hoping that their name won’t show up in a woman’s story.

The Remarkable Intersection Of Anal Sex And Toxic Masculinity

By Katie Tandy

Before I knew it I was happily drunk, drinking whiskey, and chatting with the human equivalent of a pitbull-meatball — a hulking, thick man with a Bic-ed head. He was dressed as, perhaps, an intergalactic monk?

In truth, I don’t know how we got onto the topic. No one believes me, but I really don’t. But we started talking about butt stuff. Straight cis men butt stuff.

And suddenly I heard myself say, “Oh man, my dear friend is a straight guy and he’s very intrigued by his asshole, but he can’t just, like, set himself free. He is so hung up on it. I feel like he’s got all this….” I waved my arm around, “maybe, homophobic shit around his own ass? And it’s just so sad because, like, ass stuff is the best!”

My new companion’s face lit up. Like Christmas.

The Ghosts Of Atomic Past: Nuclear Terror Is Back

By Katherine Cross

For all the talk of how “unprecedented” the Trump era is, what we’re actually seeing is the Greatest Hits album of right wing Americana turned up to 11. What has been so terrifying is not quite that Trump and his sycophants are doing anything new, but that they’re forcing us to relive terrors we’d buried, and amplifying existing ones.

…

In November of ’83, a NATO military exercise called Able Archer (this one was more of a communications and paper exercise, rather than one involving tanks and ships) got underway.

We came perilously close to the apocalypse.

Taking Down Medicine’s Monuments

By Vidya Viswanathan

In 1845, surgeon James Marion Sims purchased slave women with fistulas and housed them on his property for the purposes of medical experimentation geared towards gynecological research.

In his memoirs, he names three of the at least 11 slave women he kept to experiment on — Anarcha, Lucy, and Betsey — brought to him by their owners. For the next four years, he did a series of experiments on them without anesthesia.

According to physician-historian Vanessa Northington Gamble, “there was a belief at the time that black people did not feel pain in the same way.”

Writer Aya de León Tells A Different Story About Sex Work

By Jenee Darden

“Sex work sits at the intersection of gender, commerce, race, nationality, and socioeconomic class,” de León says. “By creating this sex work community, it became a way to comment on all of that — to comment on sex trafficking, the collusion between corporations and sex trafficking.”

De León’s books are published by Dafina, which is known for its catalogue of urban lit, or street lit, books — a genre defined by an inner-city setting, Black main characters, and themes like drugs, violence, sex, gangs, and poverty.

The books — which de León points out have a high readership of young women of color — are sold in Walmart and major bookstores, and can be found in libraries in Black and brown communities.

By Vidya

I can distinctly remember a moment during one of those many (many) days in my first year of medical school when we were sitting in lecture and learning about a disease.

Before my professor described the mechanism of the disease, which involved inflammation of the blood vessels, he paused and cleared his throat. “I want you to know that you may see this disease referred to as ‘Wegener’s granulomatosis’ in textbooks or amongst colleagues. However, we as a profession have decided that we are not calling it ‘Wegener’s’ anymore. Because Wegener, it turns out, was a Nazi.”

He said this solemnly, and then proceeded with the lecture, referring to the disease by its new names. First, in the 2000s, “ANCA-associated granulomatous vasculitis” was used; now, it is often taught as “granulomatosis with polyangiitis” (GPA).

Medicine is rife with old eponyms — diseases or body parts named after their discoverers or researchers — that are beginning to be replaced by more logical names for practical reasons. (The term “rectouterine pouch,” after all, tells us more precisely what we are talking about than “pouch of Douglas”).

But this was the first I had heard of the entire medical profession deciding to change an eponym for the sake of revoking honor from someone whose actions were now deemed immoral. And, more than that, the name change accompanied a small but repetitive teaching of why there was a new name — actively passing on the unethical history that led to greater understanding of a rare disease.

When other diseases gained new names, we were typically allowed to use the original eponym and the logical name interchangeably. But here? We were being told: Don’t use this old name. This man was a Nazi, who used tissue from Nazi prisoners to make his discoveries. And this moment of reflection on the history of this disease’s name happened almost every time I was taught about GPA.

It happened again when we learned about “Club cells,” the dome-shaped cells with short microvilli which serve to protect the lining of our lung’s small airways. We were told that they were originally named “Clara cells,” after the man who first described them in 1937. But Max Clara, we were told, was a Nazi — and so the pulmonary physician community made a dedicated effort in 2012 to have a name-change take effect in January of the next year. They rolled out the change systematically: for two years, they would put “Clara” in parenthesis after “club cell.” After that, “club cell” alone would replace all mentions of the name.

I started thinking about this movement to change names recently in the aftermath of the violence in Charlottesville and the national dialogue on removing monuments. The scientific name changes above signal a systematic effort to remove honor afforded to those who did immoral, horrific things to other human beings in the name of country-sanctioned medical research.

As a medical student, I am proud of the profession for pushing this change and I welcome the continued mention of the change in our medical training — with little effort, it allows us the important benefit of remembering the unethical history of the disease’s discovery without honoring it.

The Statues Must Come Down

But with each of these instances, there is also a growing feeling of disparity in this remembrance.

I rarely encounter the same explanation or historical interludes prefacing some of the tests we use in medicine today, which were developed in the context of racial exploitation in our own country’s history — such as spirometry to test lung function, or the immortalized cell line of Henrietta Lacks.

Soon after I learned how to do a speculum and pelvic exam in medical school, I happened to listen to an NPR Hidden Brain story which detailed the work of surgeon James Marion Sims. Sims, the so-called “father of modern gynecology,” developed the first speculum out of pewter in the 1840s — it was not markedly different from the very same device we use made of steel or plastic today.

There is an important benefit of remembering the unethical history of a disease’s discovery without honoring it.
Click To Tweet

He is also famous for perfecting and pioneering a technique using silver sutures to repair vesicovaginal fistulas—an opening between the vagina and bladder that could result from complicated childbirth, which caused women suffering and social stigma from urine leakage.

In 1845, Sims purchased slave women with fistulas and housed them on his property for the purposes of medical experimentation geared towards gynecological research. In his memoirs, he names three of the at least 11 slave women he kept to experiment on — Anarcha, Lucy, and Betsey — brought to him by their owners. For the next four years, he did a series of experiments on them without anesthesia.

According to physician-historian Vanessa Northington Gamble in the NPR story, “there was a belief at the time that black people did not feel pain in the same way.”

In her book Medical Apartheid, writer Harriet A. Washington describes how, when the subjects of Sims’ experimental surgeries screamed in agony while he cut them with a scalpel, his medical assistants would forcibly hold them down. According to her research, women would be awake and naked while he did the procedure, often with many male assistants or interested physician colleagues watching.

One subject of his experiments, Anarcha, underwent 30 surgeries before he figured out how to properly heal her fistula. After that, Sims did the procedure in clinics — with anesthesia — to heal white women with the same condition. He started a women’s hospital after he moved to New York in the 1850s, where he gained his reputation as a surgeon treating women’s gynecological issues.

He reportedly repaired the fistula of a European empress, and became American Medical Association president in 1876 and president of the American Gynecological Society in 1880. According to Washington’s research, Sims also used black infants as subjects for experiments, using scalp incisions to pry skull bones into new positions based on the false belief that their skulls closed prematurely and caused lower intelligence; he was not blamed or persecuted when the infants died.

Washington writes that eugenics provided a contorted rationale for Sims’ and others’ experimentation on slaves:

“Many researchers argued that blacks were so different from whites — less intelligent, much less sensitive to pain, possessing numerous physical anomalies as well as markedly different patterns of disease immunity — as to constitute a separate species. Given this supposedly vast biological chasm between blacks and whites, how could scientists logically infer results of medical experiments from blacks to whites?”

Throughout August and September I started to see more articles in the press about Sims beyond the NPR story; people spurred by the events in Charlottesville started to organize to protest the statues that exist in tribute to him. There is a statue of Sims across from the New York Academy of Medicine, on Fifth Ave and East 103rd St in NYC. The New York Academy of Medicine has released a statement that it supports removal of the statue, writing that it does not belong to the Academy or its property and is in the control of the Parks and Recreation department.

In August, the activist group The Black Youth Project 100 held a protest in front of the statue, with protestors memorably wearing bloody-appearing hospital gowns. The statue currently still stands, though in the aftermath of Charlottesville, New York City declared that it will be going through a 90-day review of “symbols of hate on city property,” and as part of that, the Sims statue was discussed at a public city hearing in late November.

What Really Happened In Charlottesville

Yet another statue stands on the statehouse grounds in Columbia, South Carolina, Sims’s home state, with an inscription commending him for “treating alike empress and slave.” Columbia mayor Steve Benjamin said in an interview in August that the Sims statue is the most offensive one to him of all the statues on the grounds, and that it “should come down at some point.”

Kwoya Fagin Maples, creative writing instructor at the Alabama School of Fine Arts, helped to organize a protest in front of the statue that took the form of a poetry marathon, to show support for the hastening of its removal.

“There have been no preparations, to my knowledge, for it to actually happen. I suppose the protest was a way to support the mayor’s words in hopes that it would move us closer to giving the eleven or more women he experimented on retribution. I think the monument should contain images of the women he used for his discoveries. Personally, I think his image should not be the focus of the monument, if there at all.”

In September, Nature published an unsigned editorial originally entitled “Removing Statues of Historical Figures Risks Whitewashing History,” in which it argued that names or statues (specifically pointing out Sims) should not be removed but instead supplemented with additional plaques or “equally sized” monuments commemorating their victims:

“Sims was far from the only doctor experimenting on slaves in 1849, despite the fact that the abolitionist movement was well under way in the United States. And his achievements saved the lives of black and white women alike. But some historians argue that his experiments could have been considered unethical even for his time.”

The original article was met with strong backlash in many publications and on social media. Nature changed the title of the piece to “Science must acknowledge its past mistakes and crimes” with some content changes, and with an editor’s note apologizing for the original article being “offensive and poorly worded.”

A few weeks later, Nature editor-in-chief Philip Campbell published an apology statement in the journal:

“Removing such statues or other memorials does not erase these individuals or their acts from history. Beyond that fundamental error in the Editorial, the arguments throughout the piece — including an inappropriate framing of the example of J. Marion Sims — and its overall tone were naive and unintentionally served to reinforce the insidious notion that women, people of colour and minority groups do not have a place in science. This notion is wrong. We did not recognize how destructive the overall Editorial was and the effects that it could have.”

When I read about this saga in Nature, I remembered Wegener and Clara again. Why propose to build an “equally sized” monument to stand alongside the existing one, when one could build an entirely new monument altogether? In her NPR interview, Dr. Gamble proposed that his subjects Anarcha, Lucy, and Betsey be depicted instead. “I think what the inscription would say is ‘Betsey, Anarcha, and Lucy, the mothers of modern gynecology.’”

Apart from teaching medical students like me about the history behind the modern practice of gynecology, learning about the experimentation by Sims also brings up important conversations regarding the ability to consent.

In the Journal of Medical Ethics in 2006, physician L.L. Wall argued that “Sims’s modern critics have discounted the enormous suffering experienced by fistula victims” and that, based on Sims’ own writings, his original patients were “willing participants in his surgical attempts to cure their affliction.”

But can any people considered property actually consent? And would a woman truly “consent” to 30 surgeries without anesthesia? The argument is fallacious, dangerous, and openly ignores the intent with which Sims purposefully bought black women for his experiments, not to mention the eagerness of slaveholders to have their slaves returned in better condition for physical labor.

Can any people considered property actually consent? Would a woman a truly ‘consent’ to 30 surgeries without anesthesia?
Click To Tweet

While Sims had been criticized by contemporaries as early as 1858 (by African-American surgeon Daniel Hale Williams, according to Washington), Wegener kept his Nazi ties secret for decades. He had joined the Nazi Party in 1932 and it is speculated that he participated in Nazi medical experimentation.

The American College of Chest Physicians awarded him a “master clinician” prize in 1989, a year before his death, but rescinded it after his secret Nazi past was discovered 11 years later through the work of two physicians researching his life in preparation for an intended celebratory article. Sims, for his part, experimented on living women — further exploiting their already harrowing reality of exploitation, using eugenics-based logic to give them no pain medication.

But even more important is the fact that, though Sims practiced 100 years before Wegener and Clara, American assumptions based on false theories of racial difference are still held by some physicians today.

A study last year from the University of Virginia found that a substantial portion of white medical students and residents surveyed believed that black people are biologically less sensitive to pain; in their results, 40% of first and second-year medical students and 25% of residents thought blacks have thicker skin than whites.

American assumptions based on false theories of racial difference are still held by some physicians today.
Click To Tweet

One aspect of knowing the history of American medical experimentation is also understanding and empathizing with the views of black patients who continue to endure bias today. My medical school classmate Shelley Thomas is passionate and outspoken about working towards racial justice in health care, and was one of the classmates I interviewed for this article.

She cited acceptance of intrauterine devices (IUDs), a form of long-acting contraception, as one of many examples of history informing patient skepticism. “There are so many populations that are skeptical of IUDs. Some people think, ‘she’s not looking at the statistics, this is just lack of education,’ without knowing the history of forced sterilization,” she explained.

“When you’re talking about putting something inside of a black woman that will stop her from having kids for 5–8 years, the history is there, and without knowing that history, we can make a lot of assumptions about why people are so hesitant about a lot of these different forms of medical advancement.”

When I worked as a clinical research coordinator, my required online training included a section on research ethics that described the history of the Tuskegee trial. Wouldn’t it make sense to require us to preface our learning about, say, the speculum exam with a lesson about the man behind the device?

I often wonder why these histories don’t already exist in medical curricula; why I come across it almost solely in the lay press. I interviewed Dorothy Charles, a classmate a year ahead of me who is an organizer for the national White Coats for Black Lives movement.

“It would be a great to have syllabi on this in medical school,” she said. “We need medical students to learn these social justice issues in medicine, and be educated about the racial history and myths in medicine.”

She suggested having people who are experts in these topics teach it — not necessarily physicians, but instead social scientists or historians. Some might argue medical school is not the place for medical history, but as both Charles and Thomas pointed out to me, then why comment on the Wegener’s name change at all?

How Medical Schools Are Failing The LGBTQ Community

And, Thomas added, “when we don’t address it and don’t talk about it, now you’re having a child whose pain is being ignored because a resident that has gone through our medical education system thinks that black children don’t experience pain the same way that white children do.”

(Studies show that black children are less likely to receive appropriate pain medication as compared to white children, even for a condition such as appendicitis.)

I wonder if having increasing black representation at academic medical centers would push the process of learning about and introducing stories like that of Sims into medical curricula. In an article in the Journal of Urology in 2011, two urologists write that while lay journalists and historians have increasingly studied and critiqued Sims’s surgical discoveries and accomplishments, “relatively little mention is found in standard urology textbooks or journals.”

“Medical sources have continued to portray him unquestionably as a great figure in medical history. This division keeps the medical profession uninformed and detached from the public debate on his legacy and, thus, the larger issues of ethical treatment of surgical patients.”

The authors found that urological textbooks referred to Sims repeatedly as a surgical innovator in their sections on vesicovaginal fistulas. Though a more recent edition of a urological textbook did have a paragraph on the controversial ethics of his practices, it concluded with: “It is generally believed that Sims was trying to enhance the lives of these women and was in concert with accepted mores.”

Before inpatient rounds one morning earlier this year, Thomas gave a short presentation on GPA, which one of her patients suffered from. “GPA used to be called Wegener’s, but they changed the name — I have some thoughts about that, which we can talk about later,” she said. After the presentation, her resident asked her about it, and we had a short discussion as we walked to the first patient room about the issues with changing some names in medicine while continuing to honor others. But these conversations are difficult to initiate as a medical student who is constantly in the position of being evaluated by our superiors.

I hope that one day, across medical schools, before we are even allowed to do a pelvic exam, we are given the context of Sims and his experiments.

“Just like you do with Wegener’s, give that little one slide about the complicated history here,” Thomas told me. “I think that begins the process of honoring these women who suffered.”

By age 18, my knees hurt.

I didn’t know why, and they didn’t hurt a lot, but they did hurt a bit most of the time. As someone who took a lot of dance classes and played my share of netball, it was annoying, but not something I thought much about. After all, I reckoned, bad knees run in my family.

But by age 20, the pain had gone from a bit annoying to definitely annoying. I decided, for the first time, to see a doctor about it.

She was a brisk woman with close-cropped grey hair, who glanced at me and told me my knee pain was due to early-onset arthritis as a result of my being overweight. My blood tests were negative for rheumatoid arthritis — but that didn’t matter, she told me. The only way to stop my pain from getting worse was by losing weight. So with the resigned sigh of anyone who has grown up fat, I accepted my fate. I was arthritic, at 20.

By 22, things were worse. My knees had gone from hurting a bit most of the time to spontaneously collapsing in blinding pain while I was doing innocuous activities like walking down the street. I went back to the doctor — a different one, because I just saw whoever was available at the student clinic. He asked me about my pre-existing medical conditions. I explained that my arthritis was a result of being overweight. He looked at me incredulously. “That’s not a thing.” No one gets non-rheumatoid arthritis in their twenties as a result of being overweight, he explained.

With the resigned sigh of anyone who has grown up fat, I accepted my fate.
Click To Tweet

Instead, he decided we should figure out exactly why my knees were spontaneously collapsing. He sent me for an MRI, and I had a consultation with a specialist surgeon.

“Patellae chondromalacia,” the surgeon declared. He showed me the shadows on my scan, which indicated rough patches on my knee caps. It was probably hereditary, exacerbated by my weight. “Okay,” I said. “So what can I do about it?”

“You’re just going to have to manage the pain,” he explained. “And once it gets to be too much, you’re going to need your knees replaced. And that will probably be before you’re 30.”

Resigned, I accepted my diagnosis. I said goodbye to yoga and dance, which aggravated the condition, and started wondering about how much two new knees might cost, and how I’d get around on crutches. I had eight years before I turned 30; it felt a bit like a death sentence.

When You Include Your Eating Disorder On A Medical Intake Form
theestablishment.co

At 24, my new housemate decided she was joining our local gym, and in a moment of optimism, I decided to go with her. This gym offered a free short session with one of their personal trainers to help newbies learn the ropes. “I’ll put you with Hao,” the receptionist said. “He’s got a physio background; he’s good with injuries.”

Hao was intimidating — really tall, super buff, thick Chinese accent that was hard to understand at first. “It says here you’ve got an injury,” he told me. “What is it?”

“I’ve got patellae chondromalacia in both knees,” I replied. “It’s-“

“Oh that,” he said, interrupting me. “I can fix that.”

What?

Hao explained to me that what I had was a pretty standard sporting injury that is usually treated successfully using exercise — a fact that none of my doctors had mentioned. I’d probably injured myself as a result of all that dance and netball I did as a teenager, and it might have been exacerbated by my family history of dodgy knees. It’s normally caught early and treated early — it’s very rare for it to get to the point of causing knees to collapse, but that can happen in serious cases with no treatment. “Work with me for 10 sessions,” said Hao. “If you don’t notice a difference, I’ll give you your money back.”

Well, after 10 sessions I noticed a pretty significant difference. After six months, the pain that had plagued me for six years was entirely gone.

I can’t help but think that there’s a whole lot of physical pain I could have avoided if any of the medical professionals I saw had considered the fact that I might have a sporting injury. And I can’t help but wonder if the reason they didn’t has to do with my weight.

When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl — and they based their diagnosis on stereotypes about what that meant. I’m 29 now, and my knees no longer hurt. I don’t need them replaced — but if I’d listened to the weight-prejudiced opinions of my doctors, I might have.

This story is hardly unique.

Research shows that doctors have less respect for patients with higher body-mass indexes (BMI), which can lower the quality of care those patients receive. As one study put it:

“Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide.”

Troublingly, many of the ideas that doctors have about fat patients aren’t even grounded in medical fact. Indeed, too often it’s forgotten that the science around weight loss and health isn’t all that settled.

Does excess weight cause you to live a shorter life? Maybe, maybe not. Countless studies by BMI category have found that overweight people actually have lower rates of all-cause mortality than normal weight people.

When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl.
Click To Tweet

Some researchers think that if you adjust for the increased risks caused by weight cycling (a.k.a. yo-yo dieting) and dangerous weight-loss drugs, you’d find the same mortality rates for normal, overweight, and obese people — yes, even very obese people.

And even without the adjustments, the increased risk for very obese people is only small — not the “you’ll be dead before you’re 30” nonsense often pedalled by purveyors of weight-loss surgeries.

What about serious disease? There’s certainly a correlation between being overweight and some diseases, but multiple studies suggest that the weight might actually be a symptom rather than a cause.

Then there’s the idea that excess tissue “strains” the body. Eminent obesity researcher Dr. Paul Ernsberger has been quoted as saying, “The idea that fat strains the heart has no scientific basis. As far as I can tell, the idea comes from diet books, not scientific books . . . Unfortunately, some doctors read diet books.”

What about dieting? Well, there actually is some scientific consensus there — diets don’t lead to lasting weight loss. Not even if you call them lifestyle changes. After an extensive metastudy of diet and weight loss studies, Dr Traci Mann concluded, “The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.”

So why, then, do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?

Sarah, 29 from Newcastle, Australia, had the misfortune of breaking both legs as a teenager, the result of a freak accident involving her legs falling asleep and then getting twisted to the point of breaking. Not long after learning how to walk again, she was involved in a serious car accident that left her with further damage to her legs. “I’m accident-prone,” she laughs. The multiple injuries have left Sarah with a build up of scar tissue that can make walking painful. But when she went to the doctor, her pain was blamed on her weight.

“My weight is a factor in the healing process,” she says, “But it wasn’t the cause of my injuries — and I’ve got police reports, x-rays, and specialist reports to prove it.”

Why do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?
Click To Tweet

Sarah changed doctors recently, and her new doctor decided to do a full medical history, checking the notes from all the physicians Sarah has seen. What she found shocked her. “She said there’s no record of my injuries with most of my previous doctors,” Sarah said. “They all had written that my leg pain was caused solely by my weight, and that meant I wasn’t getting any useful treatment for the pain. They just told me to diet.” Sarah’s new doctor promptly started her on a physical treatment plan designed for someone with compound injuries and severe internal scarring.

The difference has been immediate.

“Within two weeks I could walk nearly five kilometers. Before I started the treatment, I could only manage one kilometer or less before my knees were so swollen and painful that I couldn’t keep going,” said Sarah. “Getting actual treatment for my injuries, rather than just being told to lose weight and see what happens, has changed everything.”

Just to be clear, I’m not saying that eating healthily and exercising aren’t good for you. The problem is when doctors prescribe diets and weight loss to patients without fully considering their symptoms and other treatment options.

Stigmatization may also, problematically, stop fat people from seeking out medical care in the first place.

“I just don’t go to the doctor,” says Anita, a 28-year-old advertising executive. The last time Anita saw a doctor, it was a routine visit to discuss vaccinations and anti-malarial medication for an upcoming overseas trip. The doctor prescribed the vaccines, and asked a nurse to administer the jabs. It was the nurse who decided Anita had diabetes — without having spoken to her, or seeing anything pertaining to her medical history.

“He kept saying I would get a discount on the vaccines if I registered my diabetes,” Anita explained. “I haven’t got diabetes, but he wouldn’t listen. His whole attitude was like, ‘you know you’re fat, right?’ Um, yeah, I’ve noticed that, actually. Just give me the jabs.” The experience was pretty upsetting, and left Anita firmer in her resolve to avoid doctors wherever possible.

Still, Anita, Sarah, and I are relatively lucky; our experiences have caused us pain and humiliation, but no permanent damage. This is not true for everyone.

What My Kidney Stone Taught Me About Sexism In The ER
theestablishment.co

First Do No Harm is a website that chronicles the experiences of fat people with medical professionals — and it’s filled with harrowing stories.

One woman lost a lot of weight suddenly and was praised for it — with doctors missing the fact that it was a sign of the cancer that shortly killed her.

A man vomited constantly due to MS, but instead of viewing that as a medical red flag, doctors simply celebrated the 120-pound weight loss it caused. The vomiting led to permanent nerve damage, back pain, and tooth decay .

A woman had an emergency-doctor declare that she didn’t need treatment for abdominal swelling after a serious car accident because she was just fat. She nearly died.

A woman went years just being told to lose weight to address her ongoing, multiple health problems. It turns out she has a rare neurological disorder; the diagnosis delay has led to permanent brain damage.

There’s another trove of awful stories on fat prejudice here. And of course Google’s got plenty more.

A consistent narrative runs throughout these stories. Hormonal problems? Lose weight. Broken finger? Lose weight. Migraines? Lose weight. Losing weight is the consistent — sometimes only — treatment offered for every ailment imaginable.

Losing weight is the consistent — sometimes only — treatment offered for every ailment imaginable.
Click To Tweet

For many, changing the narrative around weight is literally a matter of life or death. So what can be done to address the problem?

The good news is that there’s some recognition within the medical profession that this is a serious issue which must be addressed. It’s been noted thatmedical students don’t receive nearly enough training on obesity, and efforts are beginning to try to change that. Researchers are also working on empathy programs and raising awareness about the impact of implicit bias against patients. All of this is a promising start.

At the same time, we can all become our own health advocates. If you’re a fat person, or someone you care about is a fat person, you can develop your critical thinking skills and challenge the classic “just lose weight” prescription if it doesn’t seem to fit the symptoms.

This isn’t easy. There’s an implicit power imbalance between patient and doctor that makes challenging their statements very difficult. By working to become experts in our own health and our own situation, we stand a better chance of being able to call out something that doesn’t feel right.

There’s an implicit power imbalance between patient and doctor that makes challenging their statements very difficult.
Click To Tweet

Doctors are highly educated people, but they’re subject to the same biases as the rest of us, and many of them don’t stay up to date with the latest research. That’s not good enough. If obesity really is a major health concern, it’s essential that doctors stay educated on recent studies and metastudies that look at how to get the best outcomes for fat patients. If doctors really do care about their patients, they need to start looking at the overall picture of a person’s health, not simply the size of their body.

Most of all, doctors need to stop prescribing a treatment that’s proven not to work for conditions that don’t warrant that treatment in the first place.

The medical profession needs to step up. It needs to accept that diets aren’t the universal treatment option for fat people. It needs to accept that fatness isn’t the universal cause of ill health in fat people. It needs to engage with the very real damage caused by its attitudes toward fat people, and with the sub-standard care delivered to many people as a result of their size.

It’s not exaggerating to say that lives depend on it.