Boston Review recently produced a special issue entitled “Big Pharma, Bad Medicine” — and it is well worth reading.

Marcia Angell, former editor of the New England Journal of Medicine (NEJM) and author of “The Truth About Drug Companies,” wrote the lead article — to which many other academics, health writers and industry representatives responded.

Angell’s opening critique of the cozy relationship between the pharmaceutical industry and medical research institutions is devastating. Summarinzing an argument she made in her book — and in many prominent op-eds, interviews and in a NEJM editorial, “Is Academic Medicine for Sale?” — Angell outlines the steps through which big pharma influences, and in many cases controls, the entire process of medical research — from clinical trials of new drugs to continuing education of doctors.

By putting profit before public good, big pharma’s power distorts the medical mission of many universities:

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies — like other investor-owned businesses — are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured — by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.

Angell’s most pointed criticism is not at the drug companies, however, who, apologists could argue, are just trying to do right by their investors. Rather, she is most bothered by the complicity of the academic institutions. Angell ultimately recommends three specific reforms:

First, members of medical school faculties who conduct clinical trials should not accept any payments from drug companies except research support, and that support should have no strings attached. In particular, drug companies should have no control over the design, interpretation, and publication of research results. Medical schools and teaching hospitals should rigorously enforce this rule and should not themselves enter into deals with companies whose products are being studied by members of their faculty.

Second, doctors should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard.

Finally, academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively.

Several of the respondents in the Boston Review pick up on one of Angell’s points and pursue it with more depth. In  ”The Case of H1N1,” Howard Brody, director of the Institute for the Medical Humanities at University of Texas and author of “Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry,” explains how the pharmaceutical company Roche was able to obscure negative or neutral research on the drug Tamiflu while public health agencies around the world stockpiled large supplies. Later, the research in support of Tamiflu was found to be unconvincing.

David Bollier, author of “Viral Spiral: How the Commoners Built a Digital Republic of Their Own” and co-editor of Onthecommons.org, takes Angell’s recommendations a step further with his call to “Restore Medicine to the Commons“:

Understanding academic medicine as a commons helps us appreciate more clearly why it is so important to protect the non-market paradigm of research, education, and clinical care. In this mode, medicine harnesses the power of the scientific method through a transparent, ethical, merit-based process. It mobilizes community judgment and ethical scrutiny. It is insulated from the corrupting influences and self-dealing associated with an unregulated market economy.

Unfortunately, we have not been attentive to the value of academic medicine as a commons. We are suffering mightily as a result.

Suzanne Gordon, author of “When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” reminds us: “Don’t Forget Nurses.” She notes that nurse-practioners, who prescribe a great deal of medicine, have not been overlooked by the pharmaceutical industry, even if they are often forgotten in this type of discussion:

Today nurses no longer have to beg to get noticed. Like medical conferences, nursing conferences are now heavily supported by pharmaceutical and medical-equipment companies, which, like the corporations advertising on public television and radio, demand more and more of the spotlight. Nurses, like physicians, are flown to exotic spots and showered with so-called educational presentations. When I mentioned this phenomenon to a very respected nurse-academic, I expected her to share my concern. Her response: “It’s about time we got ours.”

Perhaps the most poignant — and funny — response comes from Adriane Fugh-Berman, associate professor of physiology and family medicine at Georgetown University Medical Center and director of Pharmedout.org. To show how continuing medical education (CME) is, in Angell’s words, “marketing masquerading as education,” Fugh-Berman creates a fictional scenario:

The gurgles and rumbles of an empty stomach are called, in medical-speak, borborygmi (it is one of the few onomatopoeic medical words). Let’s imagine that a company is developing a drug that prevents borborygmi. The first step would be to encourage people to take the disease state seriously. Marketing messages developed while the drug is still undergoing testing might include:

• While the occasional growling stomach is not a cause for concern, regular episodes could indicate the presence of CLASS (Chronic Loud Atypical Stomach Sounds).

• CLASS is not always benign. The distinction between normal stomach rumbling and a symptom of a serious disease can only be made by a physician.

• CLASS sufferers may limit their travel, work, and recreational activities out of embarrassment; some may become reclusive, fearing social stigmatization.

• CLASS can lead to overeating and obesity because sufferers may eat constantly to prevent audible stomach rumbling.

A pharmaceutical company may then begin to recruit physicians to act as mouthpieces for specific marketing messages …

Fugh-Berman continues the story all the way to the point where other companies are attempting to create “me-too” drugs that piggy-back on the original company’s success.

Angell, in her response to the responders, notes that Fugh Berman’s scenario “would be hilarious if it were an exaggeration, but it’s not. Drug companies frequently engage in such campaigns to prepare the way for a new drug or a new use for an old one. One example was the creation of an epidemic of ’social anxiety disorder,’ formerly known as shyness, and the marketing of Paxil to treat it.”

*In related news, Harvard Medical School just last week announced new restrictions on relationships between its 11,000 faculty members and pharmaceutical and medical device makers. Here’s a summary of the changes.

_ _ _ _ _ _ _ _ _ _

Plus: Drugs, of course, can’t solve everything. Writing in The New Yorker, Atul Gawande explores (in a very humanizing and moving way) how our healthcare system, which can do a great job of prolonging life, is often at a loss when it comes to care for the dying.

“People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others,” writes Gawande. “Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.”

Nancy Chodorow’s “The Reproduction of Mothering” was an instant feminist classic when it was published in 1978. One of the most visionary conclusions was her call for men to take an equal role in the caretaking of children. If they don’t, she argued, women would grow up with a distorted perspective on their own relationships with men.

More than 30 years later, Chodorow’s call appears as challenging as ever — at least in the United States, where parental leave is still unpaid (putting us behind 177 nations, including Haiti and Afghanistan, that provide all women, and in some cases men, income and time off after the birth of a child) and only 12 weeks long, which discourages even willing men from taking over child-rearing duties.

Four years before the publication of Chodorow’s landmark text, however, Sweden had already become the first country to replace maternal leave with parental leave, and Sweden has continued to break new ground by spurring a revolution in male attitudes toward and male participation in childcare. Katrin Bennhold of The New York Times writes:

85 percent of Swedish fathers take parental leave. Those who don’t face questions from family, friends and colleagues. As other countries still tinker with maternity leave and women’s rights, Sweden may be a glimpse of the future.

In this land of Viking lore, men are at the heart of the gender-equality debate. The ponytailed center-right finance minister calls himself a feminist, ads for cleaning products rarely feature women as homemakers, and preschools vet books for gender stereotypes in animal characters. For nearly four decades, governments of all political hues have legislated to give women equal rights at work — and men equal rights at home.

Swedish mothers still take more time off with children — almost four times as much. And some who thought they wanted their men to help raise baby now find themselves coveting more time at home.

But laws reserving at least two months of the generously paid, 13-month parental leave exclusively for fathers — a quota that could well double after the September election — have set off profound social change.

Bennhold goes on to describe the positive effects of this change, such as a lowering of divorce rates and an increase in shared custody when a divorce does occur. It has undeniably transformed what it means to be a man.

Birgitta Ohlsson, European affairs minister, puts it in the terms of an old feminist maxim: “Now men can have it all — a successful career and being a responsible daddy. It’s a new kind of manly. It’s more wholesome.”

For more on how father’s leave in Sweden came to be so popular, read this side piece on politician Bengt Westerberg, who in the 1990s “championed the introduction of the first dedicated father month — 30 days of paid parental leave that could not be transferred to the mother — to encourage reluctant men like himself to do their bit and overhaul Swedish society in the process.”

Despite the fact that Sweden and other countries are far ahead of the United States when it comes to supporting fair and equitable childcare, it’s important to remember that progressives in the United States have been fighting for some form of paid parental leave for almost 100 years.

Yes, 100 years. As Sharon Lerner reminds us in the Washington Post:

As far back as 1919, when the Model T was switching from a crank to an electric starter, the U.S. government came close to signing on to an International Labor Organization agreement, supported by 33 countries, that said women workers should receive cash benefits in addition to job-protected leave for 12 weeks in the period surrounding childbirth. That same year, Julia Lathrop, the chief of the Labor Department’s children’s bureau, issued a report on international maternity leave policy in which she decried the United States as “one of the few great countries which as yet have no system of State or national assistance in maternity.” She had recently returned from Europe, where Germany and France had paid-leave laws that had been in place for decades.

The entire article is a very enlightening history lesson — revealing the twisted politics that have held back justice and common sense for far too long. For more on that subject, check out Lerner’s new book, “The War on Moms: On Life in a Family-Unfriendly Nation.”

Putting HCR in Context: The Guttmacher Institute looks at the pros and cons of health care reform as it relates to reproductive health, including sex education, Medicaid expansion and funding for public health programs.

The research institute notes that insurance companies not only would have to “jump through numerous, unprecedented hoops to estimate the cost of abortion coverage and ensure that the abortion payments never mix with other funds,” but “they also are likely to face extensive public scrutiny and protest around their action.”

All told, according to an analysis by George Washington University’s Sara Rosenbaum, “the more logical response” for private insurers marketing plans within the exchanges — and eventually in the broader market as well — “would be not to sell products that cover abortion services.”

Plus: Drawing from its Congressional record, NARAL flags Republicans who have voted against reproductive rights and who also warned HRC would lead to government intrusion on private medical decisions.

Lasting Consequences: Katha Pollitt talks with Carol Joffe, author of “Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us,” about the effect of HRC on women’s reproductive rights and health. Joffe discusses the good, the bad and the ugly — which refers to the marginalization of abortion.

President Obama and Democratic Congresswomen repeatedly said, “This is a health care bill, not an abortion bill.” I understand why they said it. They felt this was the only way to get the bill through and perhaps they were right. But abortion is health care! One out of three women has an abortion during her reproductive years. One of the best ways to reduce the stigma around abortion is to normalize the procedure within mainstream health care settings. The mantra “this is a health care bill, not an abortion bill” reinforces exactly the opposite message.

Plus: In a separate piece written earlier this month, Katha Pollitt offers concrete suggestions on how the Democratic Party and the Obama administration can repay supporters of women’s rights for cooperating on HRC, including taking steps to improve maternal care and outcomes, and full funding for Title X and the Violence Against Women Act. I love the ending:

Speaking of violence against women, Dems, would you look in the effing mirror? New York’s Hiram Monserrate and David Paterson? Scott Lee Cohen in Illinois? That these men and others like them could get as far as they did says the culture of the party is tone-deaf when it comes to abuse and its warning signs. The only way to detoxify politics of tolerance for violence is to have lots more women in office. If India can pass a law requiring Parliament to be one-third women, surely the Democratic Party can figure out how to achieve equal numbers of women here. Pro-choice women. Feminist women.

Start by backing the grassroots campaign of former teacher and county commissioner Connie Saltonstall, who has announced her intention to challenge Bart Stupak in the August primary. “He has a right to his personal, religious views,” says Saltonstall, “but to deprive his constituents of needed healthcare reform because of those views is reprehensible.” Now there’s a woman with gumption and a gift for stating things clearly.

In Other News …

Revisions to On-Air Abortion Language: NPR reporters will no longer use the terms pro-choice and pro-life to describe both sides of the abortion rights debate. Instead, according to an internal memo:

On the air, we should use “abortion rights supporter(s)/advocate(s)” and “abortion rights opponent(s)” or derivations thereof (for example: “advocates of abortion rights”). It is acceptable to use the phrase “anti-abortion”, but do not use the term “pro-abortion rights”.

Digital News will continue to use the AP style book for online content, which mirrors the revised NPR policy.

Do not use “pro-life” and “pro-choice” in copy except when used in the name of a group. Of course, when the terms are used in an actuality they should remain.” [An actuality is a clip of tape of someone talking. So if a source uses those terms, NPR will not edit them out.]

Georgia Senate Passes Abortion Bill: The latest assault on women’s reproductive health in Georgia is SB 529, a Senate bill that makes it possible to bring criminal charges against doctors, boyfriends, pimps and even parents if they encourage a woman to have an abortion. The bill’s supporters frame it as a way to protect women — especially women of color — but women’s health advocates say the true motivation is to criminalize abortion.

“This bill was created under the false assumption that abortion doctors solicit women of color, particularly, black women,” said Democratic State Sen. Donzella James. “This bill calls into question all who make a deeply private and personal medical decision. Every woman, regardless of ethnic background, should have the ability to make personal decisions. Not the people in this room. It is between, she, her family and God.”

Heidi Williamson of Sister Song has more. “Publicly, white Republican men claim to care about pregnant black women who are allegedly being targeted by the abortion industry. Privately, those same men scramble to ‘opt Georgia out’ of national healthcare reform and find the perfect wedge issue for the mid-term elections to build the Republican base in African-American communities,” she writes.

We previously discussed an anti-abortion billboard campaign in Georgia targeting black women  that proclaims black children are an endangered species. Women’s eNews reports that the campaign may soon go national. For more on the difference in abortion rates among women, see this Guttmacher Institute policy report, which notes that black and Hispanic women have higher abortion rates than white women because they have higher rates of unintended pregnancy.

What’s Up With Lilith Fair?: After announcing that it would donate a dollar from every ticket sold to a women’s organization in each of the 36 host cities, Lilith Fair is coming under fire for including organizations that don’t support a full range of reproductive services.

Apparently, the only vetting Lilith did was to look online for women-focused organizations with federal tax ID numbers. Jessica Hopper interviewed Nettwerk CEO and Lilith cofounder Terry McBride about the selection process and received a less-than-informed response.

“The seeding at the start was done with a basic digital search in each market of woman’s charities,” he said. “It’s not perfect. Nor could it be, as we simply don’t have the local expertise even within our own city of Vancouver.”

Really? Lilith couldn’t have contacted local women’s health advocates, or put a few interns on the project? Perhaps the festival should include a booth for organizers on research skills.

There’s always a chance for improvement. Facebook fans will vote on the selected organizations, and the top three vote-getters in each city will be forwarded to Lilith founders — Sarah McLachlan, Terry McBride, Dan Fraser and Marty Diamond — who will hand pick the winners. And organizations not currently featured can self-submit for consideration. Read more at the Chicago Reader.

We’ve mentioned in previous posts that comparative effectiveness research (research that directly compares the effectiveness of different treatments for the same illness) received funding in the stimulus bill, and that the Institute of Medicine was gathering public input in order to inform a report providing specific recommendations to Congress for prioritizing the expenditure of the funds. On Tuesday, the IOM released that report, “Initial National Priorities for Comparative Effectiveness Research“, which includes a list of 100 top topics (out of 1,268 unique suggestions) that the authoring committee believes should be prioritized for funding.

The committee writes that the list of priorities was determined not just by which conditions affect the largest number of people, but with balance in mind. The full report notes that rare diseases and conditions that disproportionately affect specific segments of the population were also considered. They also explain that while comparative effectiveness research often focuses on comparing drug A to drug B, the committee felt it was important to include a diversity of interventions and different types of therapies, and they also considered where the gaps are in existing research.

The priority list includes several childbirth related topics, including this: “Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.” The report doesn’t specify what “usual care” is, so we can only assume that it means birth in a hospital with an ob/gyn. The list also doesn’t include details on how the effectiveness of birthing care will be judged, but we’ll certainly keep an eye out for more information!

Several other topics that are at least partially specific to women’s health made it into the top 25 priorities (the list of 100 was further broken down into quartiles). They include:

• Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
• Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
• Clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
• Innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing contraceptive methods at public clinics, pharmacies, or other locations).

Other relevant topics include comparison of weight-bearing exercises and bisphosophonates for preventing fractures in older women with osteoporosis, film screen or digital mammography and mammography plus MRI for breast cancer screening in high risk women, outcomes with and without the use of obstetric ultrasound in normal pregnancies, and “strategies for promoting breastfeeding among low-income African American women.”

NOW’s Future: The 2009 National NOW Conference kicks off June 19 in Indianapolis. At issue is who will replace current NOW President Kim Gandy, who is stepping down after eight years: Latifa Lyles, a 33-year-old black woman who has been one of Gandy’s three vice presidents, or Terry O’Neill, 56, a white activist who was NOW’s vice president for membership from 2001 to 2005.

Feministing’s Jessica Valenti is quoted in this Associated Press story on the election and NOW’s generational divide.

Plus: I don’t think I’ve linked yet to Katha Pollitt’s excellent piece in The Nation on feminism’s false waves. It begins:

Can we please stop talking about feminism as if it is mothers and daughters fighting about clothes? Second wave: you’re going out in that? Third wave: just drink your herbal tea and leave me alone! Media commentators love to reduce everything about women to catfights about sex, so it’s not surprising that this belittling and historically inaccurate way of looking at the women’s movement — angry prudes versus drunken sluts — has recently taken on new life, including among feminists.

Losing Celebrity Weight Battles: When famous dieters like Kirstie Alley or Oprah Winfrey talk about being “disgusted” with their bodies, the comments have an effect beyond selling magazines.

“Kirstie looks the same as me, to the inch, height and weight,” Emily Schaibly Greene, 29, recently told The New York Times. “It took me a long time to get there, but I’m feeling good with how I look. But it’s difficult to keep liking the way I look when I’m reading that it’s gross.”

Lesley Kinzel, who writes for the blog Fatshionista, said, “When you have famous people turning their weight tribulations into mass-media extravaganzas, they’re contributing to a culture where passing comments on strangers’ bodies is considered O.K.”

Plus: Nia Vardalos, who rose to fame after starring in “My Big Fat Greek Wedding,” says her recent weight loss is all people want to talk about these days, pushing aside her personal and professional achievements. Her column is awesome.

And if you haven’t yet bought “Lessons From the Fat-O-Sphere,” go. Author Kate Harding – founder of Shapely Prose and contributor to Broadsheet — is still on the book tour this month and is looking forward to speaking at colleges in the fall. 

Summer Reading List: From Women’s eNews: From sensational memoirs to serious sociology, check out what women are writing about and the prizes they’ve been snapping up so far in 2009. Sarah Seltzer has the goods.

Women’s Health Clinic to Close: The University of Chicago Medical Center is closing its women’s health clinic, an essential community health resource, at the end of the month. Ironically, this is being done under the Medical Center’s Urban Health Initiative; U.S. Rep. Bobby Rush has called for a congressional investigation into whether the Medical Center has engaged in “patient dumping” by steering the poor to other health facilities.

“Medical center executives have said the steep downturn in the economy has forced them to trim $100 million from the hospital’s budget to maintain running a prestigious hospital, research center and medical school. They also have said the Women’s Health Center, which cares for thousands of Medicaid patients, is a money loser,” reported the Chicago Tribune last month, in a story on protests against the closing.

Plus: While looking up information about the closing, I came across a 2008 New York Times story on Michelle Obama, who at that time was on leave from her job as vice president of community affairs at the University of Chicago Medical Center. Stories like this made me wonder what she could/would have done about the closing:

When the human papillomavirus vaccine, which can prevent cervical cancer, became available, researchers proposed approaching local school principals about enlisting black teenage girls as research subjects.

Obama stopped that. The prospect of white doctors performing a trial with black teenage girls summoned the specter of the Tuskegee syphilis experiment of the mid-20th century, when white doctors let hundreds of black men go untreated to study the disease.

Too Poor to Make the News: Over on The New York Times op-ed page, Barbara Ehrenreich has written the first in a series on how the recession affects people who don’t neatly fit the downwardly mobile narrative: the already poor.

“This demographic, the working poor, have already been living in an economic depression of their own,” writes Ehrenreich. “From their point of view ‘the economy,’ as a shared condition, is a fiction.” She continues:

The deprivations of the formerly affluent Nouveau Poor are real enough, but the situation of the already poor suggests that they do not necessarily presage a greener, more harmonious future with a flatter distribution of wealth. There are no data yet on the effects of the recession on measures of inequality, but historically the effect of downturns is to increase, not decrease, class polarization.

The recession of the ’80s transformed the working class into the working poor, as manufacturing jobs fled to the third world, forcing American workers into the low-paying service and retail sector. The current recession is knocking the working poor down another notch — from low-wage employment and inadequate housing toward erratic employment and no housing at all. Comfortable people have long imagined that American poverty is far more luxurious than the third world variety, but the difference is rapidly narrowing.

Health Care & the Arts: NPR interviews Anna Deveare Smith about her show “Let Me Down Easy,” which is based on interviews with doctors and patients (previously discussed here). Her newest role: artist in residence at the Center for American Progress, which Smith will use as a perch for studying changes in Washington. Smith also plays a doctor in the new Showtime series “Nurse Jackie.”

Speaking of “Nurse Jackie,” David Bauder of the Associated Press notes that the ethically challenged nurse at the head of the show (wonderfully played by Edie Falco) has appalled some nurses — but is that a bad thing for Showtime? Well, no.

Apologies from California: I meant to post this next one when it first came out, but I still think it’s amusing — San Francisco Chronicle columnist Mark Morford would like you to know California is really, really sorry about the whole Prop 8 thing.

Meanwhile, tony Greenwich, Conn., has become wedding central for same-sex New York couples who no longer have to drive as far as Massachussetts. California sure could have used money spent on wedding bliss.

Here’s a story I meant to mention last week — the Washington Post covers the steamy side of quilting.

Yep. The March/April issue of Quilter’s Home magazine is wrapped up in plastic like Playboy and JoAnn Fabric and Crafts has refused to sell it.

So what’s inside? Monica Hesse has the goods:

Flip past the ads for stencil companies and portable ironing tables to Page 24. Behold, seven straight pages of shocking quilts. We’re talking fabric phalluses. Gun-toting Jesuses. A newborn peering out from his mother’s lady parts (constructed out of lots of soft, embroidered orange cloth).

Some of the images are disturbing — and moving — like quilter Gwen Magee’s “Southern Heritage/Southern Shame,” which depicts five lynching victims hanging in front of a Confederate flag.

Others are whimsical. Consider “Helping Hands,” a Charlottesville quilter’s ode to Viagra. The work was inspired by a present from a friend: “A fat quarter of fabrics with all these itty-bitty penises and sperm,” says Mary Beth Bellah, describing the pile of remnants with delight.

The finished product is asymmetrical and somewhat abstract: dozens of little blue pills spiraling out from a central hand. It’s nothing like what you could buy in Amish country, although it does seem appropriate as a wedding quilt. Bellah considers herself an artist and has displayed her quilts in private shows. At a recent show in a hospital, “Helping Hands” ended up stashed in a closet after a few complaints.

Of course quilting had always been tied with social and political history. Rarely, though, do we hear of quilters making waves.

I appreciated the quotes featured at the end. While these works would hardly be considered “daring” if created using another artistic medium, in the world of quilting, they’re unsettling, and the quilters know their potential impact:

Magee says that the contrast between her soft fabrics and her harsh social messages is exactly what makes her work effective. She did see a letter from one guy protesting her quilts, asking, “Who would want to cuddle under such a thing?” “He had no concept that this wasn’t that kind of quilt,” Magee says.

You can see a close-up of  “Helping Hands,” the ode to Viagra, at Mary Beth Bellah’s website, where she writes: “I personally think the topic is ideal for a hospital setting and someday hope it finds a permanent home in an ED specialist’s office or clinic.”

Today we’re pleased to present an interview with two outstanding contributors to “Yes Means Yes: Visions of Female Sexual Power & A World Without Rape,” a collection of essays recently published by Seal Press.

Lisa Jervis, the founding editor and publisher of Bitch magazine, and Brad Perry, sexual violence prevention coordinator at the Virginia Sexual and Domestic Violence Action Alliance, take on popular perceptions of rape and what needs to be done to transform regressive attitudes toward sexual violence — in both the media and among young men.

In “An Old Enemy in a New Outfit: How Date Rape Became Gray Rape and Why it Matters,” Jervis deconstructs the latest blame-the-victim terminology. Perry’s essay, “Hooking Up With Healthy Sexuality: The Lessons Boys Learn (and Don’t Learn) About Sexuality, and Why a Sex-Positive Rape Prevention Program Can Benefit Everyone Involved,” revisits advice Perry received as a teenager and the more enlightened strategies he has encountered in his work.

Ultimately, they grapple with how to create an atmosphere for a healthy and empowering sexual experience for both women and men.

Please add your thoughts on the discussion, or your questions for Lisa or Brad, in the comments. And don’t miss the next stop on the “Yes Means Yes” virtual book tour: a live chat on Feb. 9 at Shakesville with co-editor Jaclyn Friedman.

Our Bodies, Our Blog: What is the allure of so-called “gray rape” for anti-feminists? How does it help serve a conservative agenda?

Lisa Jervis: The construct of gray rape does two things: it minimizes rape, seeks to make it seem like less of a big deal — if it was a “gray area,” can it really be that bad? — and it also justifies victim-blaming and its close friend, slut-shaming. This actually serves anti-feminists in two really different ways, though they’re both pretty much classics of sexism and misogyny.

The minimizing encourages an attitude of, “What are all those angry women complaining about now?”; and almost every feminist issue has been minimized at some point over the history of the struggle for gender equality.

The victim-blaming part is even more disturbing, as it updates and revitalizes one of the biggest obstacles to transforming rape culture. And it’s particularly insidious because of how it cultivates self-doubt and self-blame even more than previous victim-blaming discourses have. And, especially when paired with slut-shaming — which makes women and girls feel bad about the existence of a strong sex drive and any entitlement they might feel to (gasp!) satisfy their desires — it serves as an attempt to keep a tight cultural lid on women’s sexuality. It’s an updated and vastly more complex version of “good girls don’t.”

OBOB: Brad, how has the notion of “gray rape” complicated your teachings?

Brad Perry: In my experience, the attitude about acquaintance rape (which is what the term “gray rape” is usually referring to) amongst most policy makers, many students, and a good chunk of the general public has not changed drastically since it first entered the public’s awareness 20 years ago. There has been some progress in getting people to understand that usurping another person’s sexual autonomy is rape under any circumstances, but old mindsets die hard.

In that context, the gray rape thing just seems like more of the same but with a new name — as Lisa eloquently discusses in her essay. The only way my work has been complicated by the notion of “gray rape” is that now people have a convenient label. I don’t think it’s necessarily changed many people’s minds on whether or not to take acquaintance rape seriously — the people who are going to deny it are usually going to find a reason to do so until something happens to change their mind — but it has given those folks some hip new contemporary language to dismiss acquaintance rape.

We’re a country found by patriarchal religious fanatics who were (among other things) obsessed with denying human sexuality, so it’s not at all surprising to me that we keep revisiting the issue of social control over women’s sexualities. That’s not too say I think we should throw our hands up and say, “Oh, well” — in order to remember how much history we have to overcome so that we don’t lose our minds trying to make progress.

Read the rest of this entry »

Well, it Wasn’t All Bad: “Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas,” reports The New York Times. Kevin Sack writes:

For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.

As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.

Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.

In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.

(Another) Survey Says: Abstinence Pledges Ineffective: “The new analysis of data from a large federal survey found that more than half of youths became sexually active before marriage regardless of whether they had taken a ‘virginity pledge,’ but that the percentage who took precautions against pregnancy or sexually transmitted diseases was 10 points lower for pledgers than for non-pledgers,” reports the Washington Post.

“Taking a pledge doesn’t seem to make any difference at all in any sexual behavior,” Janet E. Rosenbaum of the Johns Hopkins Bloomberg School of Public Health, whose report appears in the January issue of the journal Pediatrics, told WaPo. “But it does seem to make a difference in condom use and other forms of birth control that is quite striking.”

Abortion Battle Brewing in South Carolina: “Abortion foes in the Legislature have sown the seeds of what could develop into another battle over regulating abortion in South Carolina,” reports The State. “Seven S.C. House lawmakers have prefiled a bill that would require women seeking abortions to be given a list of clinics and other facilities that provide free ultrasounds. That list could include pregnancy crisis centers — many run by antiabortion groups — that actively discourage abortion and encourage women to choose other alternatives.”

Genetic Testing and Ambiguity: “‘Information is power,’ has become a common mantra. But for many people seeking answers through genetic testing, all the DNA probing ends in this twist: Less certainty, not more,” begins this NPR report. The story focuses on Nashville novelist Susan Gregg Gilmore, who sought testing for mutations in the genes BRCA 1 and BRCA 2, which are associated with an increased risk of breast and ovarian cancers.

Cut Costs, Not Care: The L.A. Times has published the first installment of an ongoing feature on reducing health care costs. Part one covers drugs, doctor visits, surgery, flexible spending accounts, preventive care and insurance. Scroll down for links to online resources.

The Year in Medicine A-Z: Time magazine offers its annual alphabetical roundup of health stories and breakthroughs that made the news. (Ed. note – reading through it all requires clicking through 37 pages. “Single page” feature, anyone?)

Don’t Blink: Via Feminist Peace Network: “As we come to the final stretch of 2008, plagued as we are with the usual collection of horrors–Gaza burning, Tennessee buried in toxic ash, women and children being raped and killed in the Congo, and on and on, I’m sure y’all were just as relieved as I was to know that the FDA is considering approval of a glaucoma drug for eyelash enhancement, an idiocy I would have previously thought would be confined to the cable shopping networks.”

Missing on TV: GLBTQ Women: “Though 2008 comes to a close with word of possible new queer female characters on the horizon in the coming year, the prospects for lesbians and bisexual women on television over the last twelve months have been somewhat grim,” writes Karman Kregloe at AfterEllen.com. “This has been particularly true for lesbians, whose numbers on scripted network television have now dwindled to zero.”

Deep Thoughts for the New Year: “As the country plunges into recession, will financial hardship demote the pursuit of physical perfection?” asks The New York Times. A classic response:

“There comes a point when you are putting too much time and money into your vanity,” said Peri Basel, a practice consultant in Chappaqua, N.Y., who advises cosmetic doctors on marketing strategies. “For me, the vanity issue is: Where does it stop? If you are going for buttock implants, do you really need that?”

Now that the election is over, are you feeling a little blue (and not just because of the passage of California’s Proposition 8)?

After months of obsessing over tracking polls and following up-to-the-second campaign news round the clock, much of the nation seems to be going through a withdrawal of sorts. New York Times health writer Tara Parker-Pope points to several news stories about our collective crash, some of which include suggestions from psychologists on how to bounce back and re-focus.

Of course, there are still many important issues that demand our attention. Elissa Epel, an associate professor in the psychiatry department at UCSF, tells the San Francisco Chronicle that we are likely to continue intense discussions, though perhaps on different terms: “People will be less plugged into the political pundits each day. They will start to pay attention to neglected longer-term issues – how to survive the recession, how to take of their family and health better. We may notice we are in one of the most stressful eras in recent history.”

Over at Slate, Farhad Manjoo offers suggestions for new topics to obsess over if you’re still glued to your computer screen. The list also includes social networks to join and cool games to play, if you’re looking to take a vacation from the news.

The publication of “Our Bodies, Ourselves” made Health magazine’s list of best and worst moments in women’s health — as one of the best moments, of course.

Here’s what Stephanie Dolgoff wrote:

Women finally get straight talk about their bodies
If you need to know something about your body, what do you do? Look it up, of course. But before 1970 there weren’t any good resources. That year a group of Boston women published a stapled-together booklet — the precursor to Our Bodies, Ourselves — and fueled the burgeoning idea that women should be full participants in their medical care. Three years later, the radical publication (which discussed such issues as sexuality and birth control) was beefed up and released by Simon & Schuster. It’s now in its eighth edition.

Very cool.

Other standouts: After realizing that what works for white men doesn’t necessarily work for the rest of us, the National Institutes of Health in 1993 started including more women and minorities in clinical trials. And tubal litigation is now a real option. Dolgoff describes when it wasn’t:

Until 1969, a woman couldn’t elect to have her tubes tied unless she fit a formula — her age multiplied by the number of children she’d delivered had to equal 120 or more. (What that means: If you were 30 years old, you would have to have had four kids before a doctor would have agreed that you’d done your share of “women’s work” and sterilized you, unless another pregnancy would have posed a health risk.)

Though the list is supposed to cover “highs and lows in the last 20 years of female wellness,” a number of “best moments” are from older decades — in the case of the tampon’s development in 1929, much older. And some might be remembered more as milestones in popular culture that led to a greater acceptance of women’s health issues: Judy Blume novels (swoon); Edith Bunker going through menopause on “All in the Family” in 1972 — or to a greater respect for women’s physical abilities: U.S. women winning the World Cup in soccer in 1999 and Billie Jean King defeating Bobby Riggs in “The Battle of the Sexes.”

On the more medical side, there are a couple of items that deserve a closer look — such as the FDA in 1960 declaring birth control pills safe for women. It’s great that we have the pill, but it took the work of health activists like Barbara Seaman to improve their safety.

The FDA’s approval of Gardasil, the first vaccine introduced to prevent cervical cancer, also deserves an asterisk. While Gardasil’s approval was met with great fanfare, the distribution and cost has come under scrutiny, and researchers have raised doubts, most notably in the New England Journal of Medicine, about whether Gardasil and another vaccine, Cervarix, will ultimately reduce rates of cervical cancer (read the articles here and here).

Dolgoff nailed the “seven lows in women’s health.” The list includes the refusal of pharmacists to dispense emergency contraception (Plan B), forced sterilization of women of color, and the Virginia Slims campaign — “You’ve Come a Long Way, Baby” — that co-opted feminism in the name of promoting lung cancer and other smoking-related diseases.

My only question is: Why only seven? Many other “worst” moments come to mind, including misinformation about hormone replacement therapy and the Global Gag Rule.

So readers, what other best or worst moments would you add to the list?

On Monday, the U.S. Census Bureau released a new report, Fertility of American Women: 2006 [PDF], using data from the annual American Community Survey and biannual Current Population Survey. Between these two data-gathering efforts, women ages 15-44 were asked how many children they had ever had and the date of birth of their last child, and women 15-50 years of age were asked if they had given birth to any children in the previous 12 months.

The result is a document full of tidbits, trivia and tables on women’s childbearing in the United States. Among the findings:

Of women who had given birth in the previous year:

The report describes geographic differences in the findings. For example, when looking at the national average, women receiving public assistance had a higher fertility rate than those not receiving assistance. I expect that this is a headline you’ll see across the media and blogosphere, despite the disclaimer that “There is no implied causality between fertility rates and receipt of public assistance, as we do not know specifically when the women had a birth or when they began and ended their receipt of public assistance.”

What you likely won’t hear is that in 33 states there was no statistically significant difference between those receiving and not receiving assistance, and in seven states women receiving public assistance were less likely than others to have given birth in the previous twelve months. Figure 5 of the report also reveals a geographic clustering of more women than average living below the poverty line throughout the southern United States.

Planned Parenthood Expands its Reach: “Flush with cash, Planned Parenthood affiliates nationwide are aggressively expanding their reach, seeking to woo more affluent patients with a network of suburban clinics and huge new health centers that project a decidedly upscale image,” reports the Wall Street Journal.

Unfortunately the full story is available to subscribers only, but the WSJ health blog has a summary that includes these remarks:

Despite some critiques to the contrary, Planned Parenthood insists it’s not compromising is long-held focus on serving the poor with birth control, sexual-health care and abortions. Officials there say they take a loss of nearly $1 on each packet of birth-control pills distributed to poor women under a federal program that funds reproductive care. But they make a profit of nearly $22 on each month of pills sold to an adult who can afford to pay full price. That money helps subsidize other operations, including care for the poor as well as pursuing Planned Parenthood’s political agenda.

“It is high time we follow the population,” said Sarah Stoesz, who heads Planned Parenthood operations in three Midwest states. She recently opened three express centers in wealthy Minnesota suburbs, “in shopping centers and malls, places where women are already doing their grocery shopping, picking up their Starbucks, living their daily lives,” she said.

Pregnant in Gloucester: Concerning the 18 high school students pregnant in Gloucester, Mass, that have received national news coverage for supposedly choosing to get pregnant and raise their children together, Kelly McBride, who covers media ethics for Poynter Institute, has an excellent piece on pack journalism in search of a “pact..” Meanwhile, the high school principal who first said their was evidence of a pact defends his comments and his memory.

Plus: Courtney Macavinta of Respect RX discusses her own sex “pact” at age 15 and the cycle of disrespect that leads girls who don’t value themselves to make choices “in which the fine print (that life is about to get even harder) is written in invisible ink.”

Teen Pregnancies at 30-Year Low: Writing in the Chicago Tribune, Lisa Anderson reports on the latest pregnancy statistics released by the Guttmacher Institute.

Pregnancies — whether they end in birth, miscarriage or abortion — among women age 15 to 19 dropped to 72.2 per 1,000 women in 2004, down from a peak of 117 per 1,000 women in 1990 [...]

While some 700,000 women age 15 to 19 become pregnant every year, the rate has declined 36 percent since it peaked in 1990. The rate of abortions among teens also plummeted, to 19.8 per 1,000 women in 2004 from a high of 43.5 per 1,000 in 1988.

But researchers are keeping a close eye on the numbers, as there are some signs that the drop may be reversing:

Despite decades of improvement and for reasons yet unknown, there is statistical evidence that the drop in pregnancy rates, the age of first sexual activity and contraceptive use among teens stalled after 2001.

The exception may be in the teen birthrate. After a 14-year decline, the birthrate, meaning the number of live births, among women age 15 to 19 rose 3 percent in 2006 to 41.9 per 1,000 women from 40.5 per 1,000 women in 2005, according to the U.S. Centers for Disease Control and Prevention. Until more data are compiled, it is unclear whether the 2006 uptick in births was an isolated blip or the harbinger of a more significant and negative change on the teen reproductive landscape, according to David Landry, a senior research associate at the Guttmacher Institute.

Mandating Insurance Coverage for Psychiatric Ailments: Illinois will become the 17th state to mandate insurance coverage for treatment of anorexia and bulimia, assuming the governor signs a bill recently approved by the state Legislature.

Bonnie Miller Rubin and Ashley Wiehle of the Chicago Tribune write:

The measure is part of a larger national debate about addressing inequities in insurance coverage between psychiatric and physical ailments.

More than 12 million Americans, mostly young women, have eating disorders in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders. The organization ranked risk of death as higher with anorexia than with any other mental illness. Among patients with anorexia, almost half of all deaths are suicides, according to ANAD. Yet many insurers balk at covering the tab, which can run as high as $2,500 a day.

“I’ve met so many parents who have had to refinance their homes,” said Rep. Fred Crespo (D-Hoffman Estates), one of the bill’s sponsors.

But others cite the financial cost of such a law. Richard Cauchi, health program director for the National Conference of State Legislatures, said Illinois has taken “an unusual action” for 2008, when the trend is to move away from mandates on business and governments.

“There’s more pressure now to repeal and restrict mandates than to enact new ones,” he said..

“Neglected Infections of Poverty”: “Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation’s poor, according to a report released this week,” writes Wendy Hansen in the L.A. Times.

“Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.”

The study’s author, Dr. Peter Hotez, chairman of George Washington University’s department of microbiology, immunology and tropical disease, says there are 24 diseases affecting at least 300,000 Americans, and possibly millions. Poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico, are the areas most severely affected.

Will Women Give Hormone Maker a Second Chance?: “Can Wyeth win back the 40 million Premarin and Prempro users it’s lost since 2002 — along with $1 billion a year in profits — with a new menopause drug? Or will the once-bitten women who have filed more than 5,000 lawsuits claiming the hormones gave them cancer feel fooled twice?” asks Martha Rosenberg at AlterNet.org, in this look at Wyeth’s hope of marketing Pristiq as the first nonhormonal treatment for menopause symptoms.

Don’t Ask, Don’t Tell Affects Women More: “The Army and Air Force discharged a disproportionate number of women in 2007 under the “don’t ask, don’t tell” policy that prohibits openly gay people from serving in the military, according to Pentagon statistics gathered by an advocacy group,” reports The New York Times.

While women make up 14 percent of Army personnel, 46 percent of those discharged under the policy last year were women. And while 20 percent of Air Force personnel are women, 49 percent of its discharges under the policy last year were women. By comparison for 2006, about 35 percent of the Army’s discharges and 36 percent of the Air Force’s were women, according to the statistics.

The information was gathered under a Freedom of Information Act request by the Servicemembers Legal Defense Network, a policy advocacy organization.

Gardasil Not Approved for Older Women: “U.S. regulators have told Merck & Co they cannot yet approve Merck’s application to expand marketing of its cervical cancer vaccine Gardasil to an older group of women, the drugmaker said on Wednesday,” reports Reuters.

“Merck had applied for the use of Gardasil in women ages 27 through 45. The U.S. Food and Drug Administration said in a letter regarding the application that it has completed its review and there are ‘issues’ that preclude approval within the expected review time frame, Merck said.”

Exercise as a Tonic for Aging: The New York Times reports on an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine, which are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

“Contrary to what many active adults seem to believe, physical fitness does not end with aerobics,” writes Jane Brody. “Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.”

Press speculation is now underway about the type of first lady Michelle Obama might be (comparisons to Barbara Bush? Please).

Writing at Disability Studies, Penny L. Richards, a research scholar at the UCLA Center for the Study of Women, acknowledges that she’s usually not interested in discussing the role of the first lady, but she offers an informative analysis of how the physical disabilities of First Lady Ida McKinley helped shaped the press coverage of her husband’s presidency.

Throughout her adulthood, McKinley had epilepsy, intense headaches and phlebitis, which made walking difficult. She was also under great emotional stress: Both her daughters died young in the 1870s; her only brother was murdered. Richards notes that she was probably overmedicated with sedatives.

A discreet press was mostly silent about her “fainting spells,” and “a special campaign biography” of her was released to frame her health in the most gentle terms. Reporters, forbidden to write about her health, instead focused on her gowns. Her husband, President William McKinley, was devoted to Ida’s care: like many partners, he could see the subtle signs of an impending seizure, and knew how to cover for her during required periods of rest. And that devotion became part of his public reputation. Even her absence on the campaign trail was seen as helpful — a gap that reminded voters of the candidate’s tender personal life. Her “frailty” was held up as ladylike and unthreatening, in contrast to Mary Baird, Mrs. William Jennings Bryan, the trained lawyer and reform-minded woman who was rumored to write her husband’s fiery speeches. [...]

Privately, some in Washington read Ida McKinley as a manipulative “invalid,” using her perceived delicacy to demand indulgences (think of Zeena in Ethan Frome for a well-known literary version of this archetype). She would appear at state events propped in a velvet chair, with the understanding that she would neither rise from her seat nor shake hands. She wore luxurious lacy gowns and jewels, to enhance her persona as a fragile beauty. (She was the first First Lady to appear in newsreels, so she had a much wider audience for her fashion choices than previous First Ladies). Ida McKinley crocheted a lot — a fine sickbed tradition; while in the White House she reportedly made 3500 pairs of slippers to raise money for charities. There’s some evidence that she was sedated not only for medical necessity but to control her “irrational” personality.

Despite her husband’s devotion, the story of Ida McKinley seems to be a lesson in the early power of image and how the first lady becomes the most acute projection of our gendered desires.

For additional reading, Richards lists sources on McKinley and on the representation of feminine illness.

* * * * * *
In other news …

- “Three islanders from Lesbos told a court Tuesday that gay women insult their home’s identity by calling themselves lesbians,” reports the AP. “The plaintiffs — two women and a man — are seeking to ban a Greek gay rights group from using the word ‘lesbian’ in its name.”

- Some great feminist events in New York this week, via Feministing.

- Following up on the study we mentioned last week on how well journalists cover health news, I wanted to mention that the study’s lead author, journalism professor Gary Schwitzer, has his own blog, in addition to publishing Health News Review.

The Washington Post has a front-page story today that’s a shocker: Lfe expectancy for some U.S. women is on the decline, and the data points to a growing inequality between the best-off and worst-off counties. Here’s the rundown:

In nearly 1,000 counties that together are home to about 12 percent of the nation’s women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women’s life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women’s life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

There was some decline noted for men, too, but the decline was smaller (affecting 4 percent of males) and limited to fewer areas of the country. According to researchers, higher HIV/AIDS and homicide deaths contributed substantially to the life expectancy decline for men, but this was not the case for women.

The news comes from this study (PDF) published in PLoS Medicine, an open-access journal of the Public Library of Science. The study is based on mortality statistics from the National Center for Health Statistics (NCHS) and population data from the U.S. Census, gathered for the years 1961-1999, the last year data was available from the NCHS.

Overall, the average life expectancy nationwide increased during that period from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women. (It’s worthwhile noting, as this story does, that life expectancy is “not a direct measure of how long people live,” but is “a prediction of how long the average person would live if the death rates at the time of his or her birth lasted a lifetime.”)

Between 1961 to 1983, life expectancy kept going up everywhere, mostly because the death rate from heart attacks kept going down due to better prevention and improvements in medicine. But then researchers noticed a change:

By the early 1980s, however, the rapid gains were coming to an end. The low-hanging fruit on the tree of heart-attack prevention and treatment had been picked. Further strides tended to happen mostly in places where people were already healthy and long-lived.

As a consequence, the rise in longevity began to stagnate in places with the least-healthy people. In those counties, life expectancy increased by only one year (from 74.5 to 75.5) between 1983 and 1999, while in the healthiest places the life expectancy of women had reached 83.

It was during this interval that women’s life expectancy fell in nearly 1,000 counties. If one adds counties where it rose only insignificantly, then 19 percent of American women — nearly 1 in 5 — are now experiencing stagnating or falling life expectancy.

Precisely why these 1,000 counties are the most affected is something for further study. Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study, tells the Post that it “would be a reasonably obvious strategy” to target them for aggressive public health campaigns.

Campaigns are a positive step, but I wonder whether this news will spark more than well-intentioned programs. Addressing health inequalities in poor communities means addressing everything from access to medical care to access to grocery stores stocked with fresh fruit and vegetables. It means providing real economic opportunity.

Maybe the fact that the life expectancy decline is pretty much to the United States — save for some African countries stricken by the AIDS epidemic, or Russia following collapse of the Soviet Union — will make this country’s shocking health disparities an issue in the presidential campaign, right up there with, say, flag pins.

Score One for the Patient: A breast cancer patient whose medical coverage was canceled by her insurer was awarded more than $9 million from her for-profit insurer, Health Net Inc., reports the L.A. Times. “The award issued by an arbitration judge was the first of its kind and prompted Health Net to announce it was scrapping its cancellation practices that are under fire from state regulators, patients and the Los Angeles city attorney.”

BCA Blasts Approval of Avastin: In a surprise move, the FDA approved the use of Avastin as a treatment for breast cancer. “The big question was whether it was enough for a drug temporarily to stop cancer from worsening — as Avastin had done in a clinical trial — or was it necessary for a drug to enable patients to live longer, which Avastin had failed to do. Oncologists and patient advocates were divided, in part because of the drug’s sometimes severe side effects,” writes Andrew Pollack.

“In the end, the agency found a compromise of sorts. It gave Avastin ‘accelerated’ approval, which allows drugs for life-threatening diseases to reach the market on the basis of less than ideal data, subject to further study.”

Breast Cancer Action blasted the decision. “The FDA has lowered the bar on the approval of breast cancer therapies. At a time when many questions are being raised about how the FDA approves drugs for market, today’s decision is a victory for drug companies, but not for patients,” BCA Executive Director Barbara A. Brenner said a statement posted at Prescription Access Legislation.

Short Maternity Leaves, Long Deployments: The Washington Post reports on the difficulty women in the military face if they want to have children and keep their jobs. Ann Scott Tyson writes:

The wars in Iraq and Afghanistan have placed severe strains on the Army, including longer deployments in which soldiers serve 15 months in the war zone, followed by 12 months at home. Under that system, a woman who wishes to have a child and remain with her unit must conceive soon after returning home so she can give birth, recover and prepare for her next overseas tour.

Female soldiers interviewed over the past year say the tight schedule cuts short precious time for mother and infant to bond and breast-feed, forcing women to choose between their loyalty to their comrades — as well as their careers — and nurturing their families.

Vaccinating Boys for Girls’ Sake?: The New York Times looks at efforts to convince parents to vaccinate boys to prevent the spread of human papillomavirus, or HPV, which can lead to cervical cancer. HPV also causes anal and penile cancers, but these are much more rare. (Read our previous coverage of the HPV vaccine Gardasil here.)

One woman tells the NYT, “You don’t want to say it’s just the girls’ problem … But my sons won’t contract cervical cancer. And genital warts are treatable. I’m very skeptical. What risks will I expose them to?”

Another woman comments, “If there was a vaccine I could take that would get rid of prostate cancer, why wouldn’t I? … If there was a vaccine that sons could get that would get rid of breast cancer, most parents wouldn’t hesitate. But cervical cancer is the ’sex cancer.’”

Do Cellphones Affect Male Fertility?: Some studies suggest as much, but the data is limited, writes Tara Parker-Pope, adding, “There are some global concerns about declining male fertility in industrialized countries, but issues like pollutants, exposure to chemicals and smoking are likely far more worrisome culprits than cellphones.”

The Studies Surrounding DHEA: The L.A. Times “Healthy Skeptic” column looks at the anti-aging claims of DHEA and finds it’s no fountain of youth.

More on Migraines (and Music): I’ve mentioned the group blog on migraines at The New York Times — be sure to check out Paula Kamen’s latest post on leaving the rabbit hole. Kamen, who suffers from chronic daily headaches, also appeared last week on WBUR’s “The Point”.

Jeff Tweedy hasn’t weighed in yet, but I did see Wilco Tuesday and Wednesday (braving cold and limited views) during the band’s five-night run in Chicago. Yeah, OK, that had nothing to do with women’s health, but I had to boast somewhere.

Debating “Juno”: Will “Juno” win best picture? Stay tuned. In the meantime, young birth mothers discuss what they liked and didn’t like about the film’s portrayal of adoption.