health

January is Cervical Health Awareness Month, making it the perfect time to post a follow-up to Part I which featured my concerns about potential unintended consequences of new Pap test guidelines (from ACOG, the American College of Obstetricians and Gynecologists). To recap, it is vital that we do not confuse a recommendation of less frequent Pap tests with the unchanged recommendation of annual pelvic/sexual health exams (see the National Cancer Institute for explanations of both).

So, let’s look back at a letter dated November 20, 2009, in which the President of ACOG clarified:

Cervical cancer screening should begin at age 21 years (regardless of sexual history). Screening before age 21 should be avoided because women less than 21 years old are at very low risk of cancer. Screening these women may lead to unnecessary and harmful evaluation and treatment.

Medically speaking, why should this recommendation disregard an individual woman’s sexual history? His letter continues on to state:

Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year.

Doesn’t this depend on how many new sexual partners a woman has in a given year? Are the revised guidelines assuming monogamy (or at least long-term, serial monogamous relationships) which decrease odds of a woman contracting a new cancer-causing strain of HPV in less than a 2-year period? Where are the conclusive findings of large-scale sexual-behavior surveys to support this assumption?

ACOG’s November 2009 press release featured these quotes from Alan Waxman, M.D.:

Adolescents have most of their childbearing years ahead of them, so it’s important to avoid unnecessary procedures that negatively affect the cervix. Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own.

I agree with GWP reader anniegirl1138 who commented on my previous post that over-treatment is no joke. However, we have not been presented with data that a Pap test — the test, itself, not over-treatment based on test findings — is directly linked to significant increases of any negative health outcome.

Cervical HPV infections can be detected by Pap tests: ACOG acknowledges that, “the rate of HPV infection is high among sexually active adolescents, but counters with, “the large majority of cervical dysplasias in adolescents resolve on their own without treatment.”

Why should that smaller group of girls and young women (whose pre-cancerous lesions do not resolve without treatment) miss the annual opportunity to receive an early diagnosis? Early-stages of cervical HPV infection can often be resolved with less-invasive treatment options.

More-invasive treatment options, such as the “excisional procedures for dysplasia” that have been linked to increased risk of premature births, are one of several medical treatments for cervical HPV.

And, what about the possibility that an increased risk of premature births may not be the paramount concern for every female patient? Not all women want to or can biologically become mothers. What if an individual female patient would rather seek medical treatment for a HPV infection that has resulted in cervical dysplasia so that she has greater peace of mind in knowing that she has reduced her risk of cervical cancer and reduced the likelihood of transmitting HPV to her sexual partner(s) and/or future babies?

Call me a feminist, but I still believe that knowledge is power and that every sexually-active girl and woman should be encouraged to consider the benefits of annual Pap tests. When Pap smear results show “abnormal” cellular changs, then healthcare practitioners should explain the potential for false-positives and discuss the pro’s and con’s of moving forward with different diagnostic and treatment options.  

ACOG acknowledges that, “HPV also causes genital and anal warts, as well as oral and anal cancer.” A Pap test may be a girl/woman’s first chance to learn of a cervical HPV infection, which can result in her having a colposcopy exam. This procedure helps a practitioner find HPV-infected cells not only on the cervix but also in other anogenital areas (the vaginal canal, the labia, the perineum). Beyond the cervix, a Pap test that is positive for HPV may be a wake-up call to get a thorough oral screening for serious oral cancers which have been linked to sexually transmitted HPV.

In addition, my research and others’ studies have found that STI diagnoses can lead to attitudinal and behavioral changes which can decrease risks of contracting other STIs, including HIV. For all of these reasons, a Pap test that leads to a diagnosis of a sexually transmitted cervical HPV infection can bring unintended positive consequences.

In light of the new Pap smear guidelines, I hope that U.S. girls and women who get less frequent Pap tests will more frequently ask their healthcare practitioners to educate them about cervical cancer, about the full range of STIs, and about FDA-approved vaccines against viruses that can be sexually transmitted (HPV and Hepatitis B).

For the medical facts about HPV and HPV vaccines, check out the book The HPV Vaccine Controversy by Shobha Krishnan, M.D., a member of the Medical Advisory Board of the National Cervical Cancer Coalition. 

The Bottom Line: a recommendation for less frequent Pap tests does not mean you should forgo your annual pelvic exam. In our busy lives, e-reminders can make the difference:  PromiseToMe.com allows you to schedule an annual email reminder. [Note for boys/men: make sure to get an annual sexual health exam, too!]

Over the holidays I had several seizures, which led to me being diagnosed with a brain tumor. It’s a low-grade glioma, which is the good news. It’s smack-dab in the middle of the language center of my brain, which is the bad news.

I tell you this in part to let you know why I might not be around for the next few months. I’ll be having brain surgery in February, and I expect at least six weeks of recovery, time in which I’ll be exhausted and may not be up for blogging. I hope to bring in some fabulous guest bloggers for those weeks.

The other reason I’m sharing this, though, is because having a brain tumor in the language center of my brain has raised a lot of hard questions for me, questions that relate to the theme of this column. I’m an academic, a scholar who writes books and teaches classes. I’m the mother of a young child who is doing great but who needs more help, intervention, and encouragement than a typical child. My Ph.D. is in English. I have been a ravenous reader and passionate writer since I was a little, little kid. Potential damage to the language center of my brain feels like something that threatens the heart of who I am. Who will I be if I don’t have the fluency or facility with language that I have right now? I’ve been poking around in the academic world of disability studies for the last several months, but this diagnosis brings disability even more intimately into my life. It’s not only someone I love who’s experiencing life with a disability (my daughter); it may well be me.

Indeed, no matter what the long-term effects are (and the prognosis actually looks quite good), I certainly will be living with disabilities for the weeks and months immediately following the surgery, as I’ll have brain swelling that will lead to some language difficulties and motor function challenges. I’ll have a kind of insider’s perspective on disability.

Who will I be? It’s an academic question as well as a deeply personal one. I can go around and around in my mind, wondering–imagining what it would be like not to be able to talk off the cuff about feminism with the same ease that I do now, or to hear a sentence and not to be able to understand it immediately.  These aren’t effects that the neurosurgeons have promised; in fact, one of the frustrations has been that they can’t tell me much.  We’re very much in a wait and see mode.  One friend pointed out that this may be a great opportunity for me to learn that who I am is not the same as what I do, but she was quick to add that this life lesson is no justification for a brain tumor.

It’s really weird for me to think about so many characteristics of my life—characteristics which in some way feel transcendent or inherent—as being tied to a physical organ. It gives body language a whole different meaning.

It’s my pleasure to introduce a guest blogger today: Natalie Wilson.

Natalie Wilson is a literature and women’s studies scholar, blogger, and author. She teaches at Cal State San Marcos and specializes the areas of gender studies, feminism, feminist theory, girl studies, militarism, body studies, boy culture and masculinity, contemporary literature, and popular culture. She is founder of the blogs Professor, What If…? and Seduced by Twilight. She is currently working on Seduced by Twilight, a book examining the Twilight cultural phenomenon from a feminist perspective.

The Mommy Myth That Will Not Die: Bella Swan and Global Motherhood

Living inside our media-saturated US bubble, one might view motherhood as a competitive sport (ala Kate and her eight), as a fashion statement (think Katie Holmes and her impeccably dressed little Suri), as a way to prove one’s enduring hotness (such as Heidi Klum’s post-partum walk down the runway), or even as a testament that one cares about the world (in Madonna or Angelina Jolie adoption-style).

If these media representations of motherhood are to be trusted, what Susan Douglas named “the mommy myth,” where women are supposed to be perfect, gorgeous, dedicated super-moms, still dominates the cultural imagination.

Twilight, via the character of Bella Swan, breathes immortal life into this myth. In Breaking Dawn, the fourth book of the series, Bella transforms from reluctant wife into exultant expectant mom all in the blink of one headboard-busting sexual encounter.

The celebration of maternal martyrdom and mothering as the be-all and end-all of female existence that the final book of Stephenie Meyer’s saga enacts is hard to stomach, even for me–a mother of two that loves being a mom.

The problem is that Bella is a modern June Cleaver–too perfect, too submissive, and too ready to defer to her Mr. Cleaver (embodied by uber-dad, Edward Cullen). Once she is a vampire mommy, college plans are set aside, vampire adventures delayed, and instead, she becomes that monster we all love to hate: perfect mom.

Bella could not be more privileged; she is white, heterosexual, has endless wealth, super-powers, and a bevy of around the clock vampire and werewolf babysitters at her beck and call. She will never have to worry about stretching her budget, not being able to afford healthcare for her daughter, not having access to clean water.

While Bella and her similarly perfect vampire mother-in-law Esmee convey that motherhood is nothing but a joy and women who don’t desire babies are cuckoo, the text silences non-white, non-first-world mothers. Why does Native American mother Sue Clearwater have no voice in the story? Why are South-American women represented as fierce, untrustworthy animals? And why is Leah, the one lone female werewolf, called a “genetic dead end” due to her infertility? (This strand of the narrative would have been an opportunity to explore the historical sterilization of indigenous women. No such luck, though. Instead, we only learn she is a complaining bitch, an annoyance to the male alpha wolves who hate having to deal with a female in their testosterone fueled midsts.)

Globally, for many women, getting pregnant is one of the most dangerous things you can do. It makes you more susceptible to procuring diseases, to enduring poverty, to dying. Around the world, one female dies from pregnancy or labor every minute. That’s 1,440 females a day. Most of these women are not located in the first world nor can they choose, like Bella, to become vampires.

Twilight, loved by many mothers around the world, fails to give voice to the realities of global motherhood. To do so may be asking too much of this lightweight vampire tale; but could not the billions in profit the series is generating be used in some way to curtail maternal mortality rates? Seeing as the series suggests all women’s lives are made better by motherhood, perhaps it should put its money where its mouth is, giving more women more access to prenatal care and reproductive justice.

Now, that’s a dream I could sink my teeth into.

Recently, I had the pleasure of corresponding with sociologists Chloe Bird and Pat Rieker about their book Gender and Health: Constrained Choices and Social Policies (Cambridge University Press, 2008), credited as the “first book to examine how men’s and women’s lives and their physiology contribute to differences in their health.” I was curious how the authors see their research relating to some of the health topics that have made headlines in recent months.

Nack: Starting off with the topic of mental, health, you’ve written about sex-based differences.  Reflecting on recent articles, like NYT’s In Anxious Times, Medical Help for the Mind as Well as the Body, how does your book add to our understanding of and concern for policies like the Mental Health Parity Act?

Rieker:  Our book provides concrete data for why the Mental Health Parity Act is such a strategic and critical addition to general health care policy.  We focus on gender differences in mental health, particularly depression and substance abuse disorders.  Although the overall rates of mental illness are similar between men and women, if you look at it by specific disease, then you see large gender differences.  Women’s depression and anxiety rates are double that of men’s; while men’s rates of substance abuse and impulse control disorders are double that of women’s. Available research shows that individuals with serious mental health problems also have more physical health issues, including a lower life span. Both social and medical interventions are needed to prevent and treat these socially and financially costly conditions which create enormous health burdens on individuals, who may become unable to perform work and other social roles, and their families, Employers and society, as a whole, bear additional costs. 

Bird:  Also, differences in men’s and women’s lives can affect their utilization of mental health care and the effectiveness of specific interventions. We need systematic assessments of the effectiveness of treatments/approaches for both men and women, which can ultimately lead to better physical and mental health outcomes. The US has fallen behind Canada and other countries which require this approach in federally-funded research. 

Nack: How are the differences between men’s and women’s mental health problems particularly relevant as we consider the impact of the economic downturn, in general, and, with regard to healthcare coverage, the rising numbers of uninsured and underinsured Americans?

Rieker:  In the current poor economic climate, many men and women are experiencing increased stress/anxiety when losing jobs which may have provided dependable incomes and health insurance. Constant worry, itself, leads to ill health and exacerbates existing underlying conditions (e.g., cardiovascular and respiratory conditions).  Our framework of constrained choice illustrates how social and economic policy can reduce or enhance the options and opportunities for individuals to engage in healthy behaviors such as not smoking, not drinking to excess, eating well, and exercising.  While some individuals respond to economic downturns by temporarily limiting costly habits of smoking or drinking, we argue that more could be done at different policy levels to encourage positive health behaviors and coping strategies that improve physical and mental health. more...

The uproar over the change in mammogram and pap smear recommendations have been volatile to the say the least. We’re talking about women’s lives, plain and simple…right? If we take out the absurdity that came with attaching the recommendations to the current health care/insurance reform debate (like say the GOP crying about the government interfering with a woman’s health decision), we might see the recommendations a bit differently.

With possible reductions in screening, many women have pondered whether their BFF or even they would be here to write about. Jill Zimon writes about how the guidelines might cause women to be more passive about breast cancer. Ironically after we have spent years getting women to actually do mammograms. I say the same with pap smears, but when we are dealing with science, especially health science, we have to weigh many other factors.

Feminist health scientists have won many battles in the last 20 years, but is it worth it to fight for maintaining the status quo in relation to screenings?

If we start at the very beginning of the debate, we must first start with lives lost or endangered by the screenings themselves. The Breast Cancer Fund asks, “Why are we still relying on this method of screening when we have long understood that radiation is a known breast carcinogen?” Mammograms involve putting our lives at risk, but presumably the risk is much smaller than the risk of doing nothing. Where is that tipping point? Is it determined on the individual basis or the population basis? If saving your daughter’s life might cost one other woman’s life is it justified? Do we justify use of mammography if we save 100 women and lose 1? Because honestly that is what I believe we need to talk about. Not cost-saving in dollars, but in lives impacted.

Luckily I have feminist women’s health professionals in my circle and for the most part, they agree with the guidelines BUT they wish that the panel had worked with communications professionals to get the message out in a better way. I agree, but I also wish the Obama administration hadn’t sold out the panel so quickly. Bottom line: For low risk women, it might be better for you to skip a mammogram now and then or wait until you are 50. BUT…BUT…you can only decide this with your physician. So while the GOP jumped on this as a sign that the government really was creating death panels, it was actually an affirmation of women working with their medical teams to provide individualized health plans.

During the HPV vaccination debates of 2007, I heard a lot of concern over whether the vaccine was worth the risk for the benefits. I also heard from women (at the 2007 NOW Conference) who talked about how scary and invasive they felt the follow-up screenings for cervical cancer were to them. They weren’t talking about cervical cancer treatment, but the steps between a bad pap smear and cancer treatment itself. How much are their lives worth compared to vaccination injuries and deaths? Again, the feminist health professionals I know say that the new guidelines, which didn’t cause as much uproar as the mammogram guidelines, are essentially what they have known all along. The risk isn’t worth the unnecessary pap smears and the follow-up treatments. Or is it?

And this is why I advocate for scientific literacy for all, especially women. The next time you hear a woman, no matter her age, wave their hands while saying that they aren’t into science, ask them if they are into their health because that’s what we are talking about. Science is not out there in our gadgets, but it’s right here in our bodies. We also need to ensure that our medical science professionals, from the MDs to the PhDs, have a grasp of ethics as well. They need to be in the community not just to serve, but to learn. Drawing up medical recommendations is a balancing act between the science and the ethics of being a human being, having to weigh all the outcomes to find the best solution.

As a science grrl, I don’t know where that line actually is, but I do know it can’t be drawn by unemotional scientists nor by the scientifically under-literate public. There’s a partnership in there, but each side needs to learn more about the others skills too.

Four years ago, Judith Warner made the argument that “hyper-parenting” in the U.S. has caused plenty of mothers to lose all semblance of balance in Perfect Madness: Motherhood in the Age of Anxiety. While the book received its fair share of criticism (for example, see the thoughtful analysis of Warner’s book on The Mothers Movement Online), I recently confronted the bubbling up and spiraling out of my own anxiety–slightly irrational but nonetheless all-consuming–which found its source in the shadowy threat of the H1N1 virus.

A few weeks ago, I was totally caught up in H1N1 anxiety. No doubt some of it had to do with media stories about cases of mortality; the rest of it was wrapped up in having young children. I was managing to control my anxiety surrounding my youngest son, who’s in nursery school, but couldn’t manage to quell the fears about my oldest daughter. J. is in elementary school and has asthma plus multiple food allergies, including to egg; this means she can’t get flu shots. We had plans to travel to see their grandparents for Thanksgiving on two planes. Given our past history of taking her to hospitals for various asthma- and sickness-related issues, both my husband and I were nervous about the whole plan.

What to do? Forego the trip to see aging grandparents because of our generalized anxiety about the possibilities of the kids catching H1N1 (from which plenty of kids have recovered)? Grit our teeth and try our best to get a grip on the anxiety and fear we knew were being influenced by media hype? Silence our concerns about a relatively new vaccine and do everything we could to find out if it was possible for both of our kids to get vaccinated?

In the end, we settled on choice #3. This wasn’t hard for my youngest one, but proved more time- and labor- intensive for my oldest. We finally managed to score a dose of the vaccine from the pediatrician, which we transported to the allergist–where we sat, all morning, watching Sponge Bob in the waiting room while the doctor skin-tested her for reactions to the vaccine and eventually administered the dose in two stages.

So, what does this have to do with global motherhood? For one, our little family drama was set into play by globalization, which not only affects the pathways of pandemic viruses and the constant flow of information about them, but also the fact that we were living two plane flights away from my parents. At the same time, our experience represents parenting from a position of privilege: we had health insurance, access to the vaccine, and the ability to take a whole day off from work in order to vaccinate our daughter. It reminded me how many U.S. families don’t have the resources to access preventative care, or even to navigate relatively minor medical issues.

Subsequent phone conversations with friends in other states made me realize how this global scenario was at the same time very local. My friend in Boston? Couldn’t get the vaccine for her two kids but didn’t seem overly worried about it. The pregnant friend of friends in Atlanta who wanted the vaccine? Wanted it but couldn’t get it. Those same friends in Atlanta? Had one child who got sick with H1N1, recovered, and subsequently got the vaccine with the rest of the family. These geographical differences are exacerbated when we look at other countries, where H1N1 has sometimes not even registered on the radar. In many countries, it’s diseases such as pneumonia, diarrhea, malaria, and HIV/AIDS that threaten children on a daily basis. (Here’s a link to UNICEF’s The State of the World’s Children 2009 report.)

Parenting in the time of H1N1: for those of us with some degree of resources, it highlights how caring for children often boils down to managing risks. Does the risk of a relatively new vaccine outweigh the potential risks of contracting a virus? Or is it the other way around? (For that matter, how risky is a plane flight to visit grandparents? The car trip to the airport? The list goes on and on.) Thoughtful parents perceive and weigh risks in different ways. There don’t seem to be right or wrong answers, except in hindsight, which can be kind or cruel. We can never know in the moment.

Families without resources have fewer choices, less ability to take control of these anxiety-ridden situations. I suspect it’s far more stressful not to have choices, to care for small children when you can’t take control and you can’t battle fate with much more than prayers and crossed fingers. Even if “control” is anything but.

On this national day of gratitude, I find myself giving thanks for many things — including my family, my friends, and my health. I owe my sexual health to the now outdated norm of getting annual gynecological exams, with Pap smears, from the time I became sexually active. As a 20-year-old, in the mid-1990’s, I benefited from U.S. medical guidelines that supported my gynecologist in recommending cryosurgery (application of liquid nitrogen) to kill/remove the HPV-infected cells on my cervix. Early detection and early treatment afforded me a quick recovery from a potentially cancer-causing and highly contagious sexually transmitted infection. Following that treatment, I never had another abnormal Pap test result, got pregnant the first time I tried, and gave birth to a healthy baby. For all of those outcomes, I give thanks.

Today, many teen girls and women may not benefit from the level of medical care that I received. Last week, the American College of Obstetricians and Gynecologists (ACOG) issued new guidelines for pap smear and cervical cancer screening, and this may prove to have unintended, negative consequences for sexually-active Americans.

Until 2008, ACOG had recommended annual screening for women under 30. This month, ACOG summed up their revised recommendations:

…women should have their first cancer screening at age 21 and can be rescreened less frequently than previously recommended. 

Media coverage of this latest revision has not done as good a job distinguishing that a Pap test is just one aspect of a pelvic/sexual health exam. How many girls and women will interpret the new guideline of “No need for an annual pap tes,” as, “No need to get an annual pelvic exam”?

ACOG admits that the Pap test has been the reason for falling rates of cervical cancer in the U.S.

Cervical cancer rates have fallen more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all.

So, why revise the guidelines such that we are likely to see an increase in the number of U.S. women “who are screened infrequently or not at all”?

And, it’s not just teen girls and young women that are the focus of these revisions. ACOG also recommends that older women stop being screened for cervical cancer:

It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years.

How much of this rationale depends upon women over 65 years old being sexually inactive or monogamous? This argument seems predicated upon ageist assumptions about older women’s sex drives and sexual behaviors (or lack thereof).

As the tryptophan from my Thanksgiving feast begins to dampen my ire, I’ll bring this post to a close. These are just a few of the problematic aspects of this new policy recommendation — stay tuned for “Part II” of this post in the near future.

On October 27, the World Economic Forum released its 2009 Global Gender Gap report, which ranks countries according to four categories: economic participation and opportunity, educational attainment, political empowerment, and health and survival. Who wins? Iceland, with the world’s smallest gender gap. Who loses? Yemen, coming in at 134^th place. But lest we point fingers, the U.S. dropped four places, to 31^st place, owing to minor drops in the participation of women in the economy and improvements in the scores of previously lower-ranking countries. (Though we’re top of the heap for educational attainment, we’re #61 for political empowerment. Ouch!)

The authors, Ricardo Hausmann of Harvard University, Laura D. Tyson of the University of California at Berkeley, and Saadia Zahidi of the World Economic Forum, have put together an accessible and informative report. Among many other issues, their report suggests how motherhood can, in a word, kill. Consider a few of the statistics surrounding maternal health in many parts of the world:

Annually, more than half a million women and girls die in pregnancy and childbirth and 3.7 million newborns die within their first 28 days. (Appendix E, “Maternal Health and Mortality”)

Approximately 80% of maternal deaths could be averted if women had access to essential maternity and basic healthcare services. (Appendix E, “Maternal Health and Mortality”)

The need for paying greater attention to maternal health has been underscored by Nicholas Kristof in his New York Times column and his recent book Half the Sky, co-authored with Sheryl WuDunn. And while plenty of criticism has been levied against Kristof’s book, succinctly and fairly voiced by Katha Pollitt in her review in The Nation (thanks to my colleague Amy Kesselman for bringing her review to my attention!), Kristof deserves kudos for bringing media attention to the health issues that needlessly affect mothers in many developing countries, such as obstetric fistula.

The Global Gender Gap report provides other glimpses into how the experience of motherhood varies from country to country. Consider what Ricardo Hausmann, Ina Ganguli, and Martina Viarengo have to say about the relationship between marriage and motherhood, and their impact on the labor force participation gap between men and women:

…while the education gap has been reversed in quite a few countries, the employment gap has not. This gap is related to the compatibility of marriage and motherhood with a lifestyle where women can work.

(Here, the U.S. has a dubious distinction: of those countries where the employment gap has been rising, it has seen the biggest increase.)

Overall, however, there are some signs of positive change when examining the “motherhood gap” within labor force participation globally:

Motherhood has not been a universal obstacle for female labour force participation. In almost half the countries we studied, women with three children work at least as much as women with no children. However, in other countries, especially in Latin America, the motherhood gap is very large, with Chile exhibiting the largest gap. But there is good news: the motherhood gap has been falling in almost two-thirds of the countries, with the biggest reductions shown again by Brazil and Greece, accompanied by Austria and Bolivia.

There isn’t room in this report to explore all the complexities of paid work and mothering–such as who cares for children when mothers work in countries that don’t support working mothers, the working conditions mothers face, and so on–not to mention the wide spectrum of how women experience motherhood according to identity (class, ethnicity, religion), educational background, and geographical location (whether mothers live in a village or an urban environment). Even so, the report provides some broad brushstrokes that help situate the many different kids of gendered gaps in the world.

Last week U of Chicago economist Casey Mulligan argued on the NYTimes Economix blog that paid sick days are an incentive for people to stay out of work–shamming sick days is the suggestion. Paid sick days, the argument goes, encourages people to stay out from work. Well, sometimes people can’t see the forest for the ideology, but help, alas, was on the way the day Mulligan posted.

CEPR senior economist John Schmitt, co-author of a report on paid sick leave in the US and Europe earlier this year, said not so fast! At noapparentmotive.org, Schmitt took issue in two ways: first, as his CEPR report, Contagion Nation, pointed out, the current system of no paid sick leave in the United States provides incentive for people to go to work sick. You see, if we measure cost, we have to measure the cost of a policy of no paid sick leave as well as the cost of some paid sick leave. You can read more about Contagion Nation at girlwpen here.

If that isn’t bad enough, Schmitt catches Mulligan on another sleight of hand. Mulligan, it seems, left off all the countries in the data set he was using that didn’t conform to his thesis that paid sick days are an incentive to stay out sick. As Schmitt explains, “Denmark, Germany, and seven other countries with more generous statutory paid sick days policies all have lower sickness absence rates than the United States. A really interesting question is: how is it that these countries are able to provide both guaranteed paid sick days and lower sickness absence rates? (And why didn’t Mulligan include these countries in his graph?)”

Andrew Leonard discusses the Schmitt response at Salon. He concludes, “Of course people, given an opportunity, will abuse generous benefits. But what explains the situations where they don’t?”

Over at Mother Jones, Nick Baumann was not so cagey in his post Economic Dishonesty. In response to the question, why the selective use of data?, he simply says, “Um, because he was being dishonest?”

I think that making working life humane for all people is a feminist issue, as the Shriver Report recently reminded us. To my mind, rebutting simplistic supply and demand arguments about work/life issues is a feminist act.

Weirdly, the New York Times has not run a correction. What a shame.

PS 11/3/09. NYTimes reported today on the concern among public health officials that lack of sick leave may worsen flu pandemic: “Tens of millions of people, or about 40 percent of all private-sector workers, do not receive paid sick days, and as a result many of them cannot afford to stay home when they are ill. Even some companies that provide paid sick days have policies that make it difficult to call in sick, like giving demerits each time someone misses a day.”

-Virginia Rutter

Some would say this has been true since 2006, when the FDA approved Gardasil for exclusive use in girls/women, and finally the FDA agrees. Last week Merck received FDA approval for Gardasil to be used as a genital warts vaccine in boys/men (ages 9 to 26 years old). However, yesterday, the CDC Advisory Committee on Immunization Practices voted for only “permisive” use in boys, rather than voting for the stronger recommendation of “routine use,” as they had for Gardasil’s use in girls/women.

As reported in Bloomberg.com, this decision had been predicted by some experts:

William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tennessee, said the panel will be asking itself “if we vaccinate all the girls, how much additional benefit will we get by vaccinating the boys?”

The Atlanta Journal-Constitution cited a similar argument from a different expert:

Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, agreed with the findings. “If we can vaccinate a high enough proportion of young girls, then vaccinating boys is not cost-effective,” she said.

This line of reasoning and the ACIP’s conclusion are problematic on two levels. First, there seems to be a privileging of female health over male health. There are compelling reasons “ other than the prevention of cervical cancer” for the ACIP to recommend “routine use” of a safe and effective male HPV vaccine. Second, there seems to be a heterosexist assumption in the ACIP’s decisions — that all boys/men are sexually attracted to (and sexually active with) girls/women and vice versa.

Maggie Fox of Reuters offered a more complete assessment in her article published yesterday:

The main reason the vaccine was approved was to prevent cervical cancer, which kills 4,000 women a year in the United States alone. But various strains of HPV also cause disfiguring genital warts, anal and penile cancers and head and neck cancers. “We know that the later the cancer is discovered, the lower the chance of survival is,” David Hastings of the Oral Cancer Foundation told the committee, asking for a recommendation to add the vaccine to the standard schedule for boys. However, ACIP decided only to consider its use based on its ability to prevent genital warts.

Did the ACIP adequately factor in the clinically proven causal links between certain strains of HPV and potentially life-threatening oral cancers — which do not discriminate on the basis of sex? This seems important, particularly if, “The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer” (Oral Cancer Facts)?

A recent New York Times article reports that the committee will “take up the issue of the vaccine’s effectiveness in preventing HPV-related male cancers at its next session in February, when more data should be available.”  But data has been available since 2007, when results of clinical studies were reported and the Oral Cancer Foundation issued a press release urging male HPV vaccination?

If the FDA believes Gardasil is safe and effective, then we deserve a more thorough explanation of why the vaccine’s potential to protect against oral cancers — in both men and women — is not reason enough for the federal advisory group to issue as strong a recommendation for male vaccination as for female vaccination.