| To
prevent this picking, some farmers will remove a portion of the upper beak
on all the chicks. This makes it difficult for them to pick on each
other. It also makes it harder for them to eat. |
BACKGROUND
Boike et al. have estimated
that in the year 2005 approximately 854,000 hysterectomies will be
performed in the United States. Approximately 4,000 of the women who undergo
removal of both ovaries at the time of hysterectomy will avoid the ravages
of ovarian cancer. Boike suggests that if all women over age 40 who undergo
hysterectomy have their ovaries routinely removed, 2,200 additional women
may avoid subsequent development of ovarian cancer. The routine castration
of all women who undergo hysterectomy at age 40 is laudable in its attempt
to avoid ovarian cancer in the future, but it remains a highly inefficient
approach to reduce the risks of developing the disease. Removing 1.7 million
ovaries to avoid 2,200 malignancies is highly inefficient, as 99.75% of
the castrated women are unlikely to develop ovarian cancer.
The posting of the above
quotation from
Prophylactic Oophorectomy
for the Prevention of Epithelial Ovarian Cancer Revisited Author:
P.E. Schwartz, Department of Obstetrics and Gynecology, Yale University
School of Medicine, New Haven, USA
brought forth much argument
which was probably caused by some people having read only the quote, while
others had read the whole article: |
Which part do you
disagree with -- the part that says it's laudable to try to eliminate ovarian
cancer, or the part that says it's inefficient to perform surgery on millions
of healthy women?
I would think it would be the part that
said: "The routine castration of all women who undergo hysterectomy
at age 40 is laudable in its attempt to avoid ovarian cancer in the future,"
("Laudable" seems to be applying to the
"routine castration" phrase more closely than to the "avoid ovarian cancer"
phrase.) It's not laudable! It's stupid. The routine castration
of women undergoing hysterectomy is extreme.
I raise chickens, just as a hobby, but
I have studied some of the methods used by commercial chicken farmers.
Sometimes chickens will pick at each other, and if one gets bloody all
the rest pick on it until it has huge sores. It will even die unless
rescued soon enough. To prevent this picking, some farmers will remove
a portion of the upper beak on all the chicks. This makes it difficult
for them to pick on each other. It also makes it harder for them
to eat.
But, if chickens aren't kept in a crowded
environment, under artificial lighting and conditions, they don't pick.
(I let my chickens free-range in an orchard of about 1/3 acre in size.
In the fifteen years I've been doing this I've never had any chickens pick
on others.) So... why not adjust the housing arrangements for the
chickens instead of mutilating them?
This only is a minor analogy to castrated
women, but still... why mutilate 99.75 percent of the women who are undergoing
hysterectomy, unnecessarily? Why not alter the situation -- study
and develop better ways to diagnose ovarian cancer?
Mutilating healthy chicks to prevent picking
impairs them. Mutilating healthy women by removing their ovaries
impairs them, and to a much greater degree.
(Sorry for getting on my soapbox, but this
is something that really makes me angry!)
Lianne
The recent discussion of the article on
female castration by P. Schwartz et al published on medscape is the focus
of this rant. It was suggested by some asm posters that since the conclusion
apparently favored fewer routine castrations at the time of hysterectomy
this was a pro woman article, and that the authors had merely used clumsy
wording. I disagree.
To consider the routine castration
of women "laudable" regardless of the nobility of the intent is bizarre.
The authors argue for reducing the number of routine castration on the
grounds that this is not an efficient procedure. Nowhere do these authors
suggest that castration *injures* the woman who has been subjected to the
surgery. They do not even deign to acknowledge that castration has lifelong
adverse consequences for the castrate. Someone has suggested that the author's
use of the word castration implies their disapproval of routinely performing
oopherectomies. The body of the article makes it quite clear that these
authors
-
don't disapprove of castration of healthy
women,
-
are actually only concerned with making the
procedure and the selection process, more efficient, even going so far
as to suggest a procedure in which healthy ovaries can be removed at the
time of vaginal hysterectomy (efficiency is the issue remember).
The remainder of this very long article makes
it quite clear that the authors have no ethical or moral problem with routine
castration. They do not see it as harmful to women, merely inefficient,
since the disease they seek to prevent is so rare. They argue that all
postmenopausal women having surgery for benign gyn reasons should be castrated
at that time. Post menopausal ovaries are apparently not only expendable;
post menopausal women are actually better off without them.
I quote
"[Women who undergo vaginal hysterectomy
frequently do not have their ovaries removed. This is regrettable as it
is a relatively straightforward operation. Sheth has been able to show
an approximately 90% success rate in removing ovaries in women who have
undergone vaginal hysterectomies in India. Certainly a laparoscopic-assisted
approach can be employed if one is uncomfortable in the technique
of removing ovaries at hysterectomy through the vaginal approach.There
is little excuse for failing to remove the ovaries in postmenopausal women
at the time of elective hysterectomy (emphasis mine)
They also argue for the routine castration
of forty + year old nulliparous white women who have hysterectomies for
benign reasons.
I quote
"Using the above indications for surgery
the following are examples illustrating how the author would personally
make judgments with patients regarding when the ovaries should be
removed or retained at the time of hysterectomy for benign indications.
A 41 year old nulligravida, Caucasian female who is undergoing a hysterectomy
for the management of pelvic pain ascribed to a benign gynaecologic condition
would do best by having both ovaries removed at that surgery. In turn a
45 year old gravida 5, para 5 African-American female undergoing surgery
for symptomatic uterine leiomyomata is at a low risk for developing ovarian
cancer and, unless the ovaries appeared grossly abnormal on inspection,
would not require removal of the ovaries at the time of elective surgery.
Even in patients with whom the author has an agreement preoperatively not
to plan bilateral oophorectomy on a routine basis as it is the patients'
wish to retain the ovaries, the patient and the author agree in advance
of surgery that ovaries grossly suspicious for malignancy will be removed
at that surgery." (Numbers for cites have been removed)
In short it's perfectly acceptable to
remove healthy ovaries in large numbers of women having hysterectomies,
despite the very small numbers of women who have hysterectomies who go
on to develop ovarian cancer. Just not quite all of them. Apparently some
people see this as a major step forward. I don't. I think these authors
are a group of butchers who clearly show their contempt for women and women's
organs. Can you imagine anyone suggesting that large numbers of testicles
be removed to prevent testicular cancer - say castration of all males undergoing
surgery for benign prostate conditions? After all testosterone and its
derivatives feed prostate cancer so why not while we're in there...? Yet
castration of the male is a very simple matter- far more efficient than
castration of the female.
Tetje
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