The Right to Die: An Old Woman\u27s Formula

On December 26, 1990, Nancy Cruzan died, 12 days after her feeding tube was removed. She had been in an irreversible coma for seven years and her parents had sued for the right to remove the feeding tube that was keeping her alive. The pain and suffering of her family in coming to this decision was certainly compounded by those who disagreed with them and tried to prevent the extubation. Whether one agrees with this particular decision or not, most of us will not be faced with such clear alternatives, ie, leave the tube in or take it out in someone in an irreversible coma. A much more common scenario is having an elderly loved one who is not in a coma, but in a mental state that puts him or her out of touch with reality. What to do for them in terms of keeping them alive is not at all black and white

Finding HIV-infected Women - The Clinician\u27s Role

An estimated 100,000 women are currently infected with the human immunodeficiency virus (HIV) in the United States, and a great majority of them are unaware of their condition. Approximately 20,000 HIV-infected women were identified through publicly funded HIV screening programs in 1989 and 1990, and an unknown number through private screening. Because most HIV-infected women are believed to be in the lower socioeconomic strata, it is unlikely that a significant number were identified in the private sector. Therefore, up to 80% of HIV-positive women may not know they are infected

Women and Crack Addiction

A smokable form of cocaine has recently been introduced to the United States. First documented in New York in 1985, the use of rock cocaine or crack has spread rapidly throughout the country since then. Until crack appeared, noninjectable cocaine use was largely a problem in the middle and upper classes because of its high price. Crack has changed that; five and ten dollar packages are readily available. Crack produces a short-lived high and may enhance sexual desire and performance. The rapidity of the spread of crack in inner cities is extraordinary but the movement into rural areas has been no less astonishing. In many cities and small towns crack has gone from a non problem to the most significant drug problem within two years

Women, Children and AIDS

More than 500 cases of acquired immune deficiency syndrome (AlDS) in children (ages I3 and under) had been reported to the Centers for Disease Control as of August , 1987. Of these children, 78% were infected perinatally by their mothers. The ratio of AIDS cases among women to AIDS cases among ; i children has remained stable at approximately 5:1 for several years. So, for the foreseeable future, we can expect that for every five reports of women with AIDS, one child with AIDS will be reported. As is the CMe with other sexually transmitted diseases, AIDS causes a disproportionately greater burden for infected women than for infected men. The major reason: women are child bearers and can transmit infections to their offspring during either pregnancy or delivery. Tragically, most women who infect their children do so unknowingly. The infections are usually at an asymptomatic stage in the mother or arc unrecognized and come to light only because the child\u27s infection is discovered

The Editor’s Role in Preventing Gender Bias in Scientific Journals: A Challenge

One way to explore whether gender bias exists in the process of scientific publishing is to examine the end product, ie, the published works, using previously validated criteria. Williams and Borins used this method and found significant gender bias in the studies published in the New England Journal of Medicine. This study will be challenged on the basis of the criteria used to detect bias. Are they valid\u27\u27 Who is to decide No generally agreed upon criteria exist to examine gender bias. Indeed, scientific journals have not indicated that they see a need for such examination. But even this method focuses on only a small part of the publication process. It would be of interest to also examine the process that results in the selection of what is published

Three Cheers for Elective Hysterectomy

Hysterectomy is the second (after cesarean section) most commonly performed major surgical procedure in the United States today.1 About [650,000 American women will have hysterectomies in 1989. Thirty-seven percent of all US women will have had a hysterectomy by the time they reach age 60. The number of hysterectomies increased dramatically Born 1965 to 1975, but then leveled off and decreased to the present level of about 7 per 1000 women. The ~ghest rates occur in women aged 35 to 44 years, the age group the so called baby boomers are now entering in large numbers. Therefore, if the age-specific hysterectomy rates remain the same, the number of hysterectomies will increase to 810,000 in 1995 and 854,000 in 2005

AMWA Endorses Uniform Mammography Screening

Breast cancer is gaining on us at an increasing rate each year. In 1990 in the United States alone we expect about 145,000 new cases and 45,000 breast cancer deaths in women. What are we doing about it? What is AMWA doing, and what are women physicians doing- for themselves and their patients? Can we do anything? The answer is yes, we can. We can reduce mortality considerably if the cancer is detected early. The five-year survival rate for women with breast cancer diagnosed in its early (localized) stages is 90%, but for women with cancer diagnosed after it has spread to distant sites the survival rate is only 18%. Therefore, early detection is the major weapon for fighting breast cancer deaths. The methods that we have for early detection are monthly self-examination, yearly examination by a clinician, and screening mammography. If one were to ask which of these will diagnose breast cancer earliest, the answer is undoubtedly screening mammography

Domestic Violence: Physicians a Link to Prevention

Domestic violence may result in more injuries and fatalities for women than automobile crashes, muggings, and rapes combined, but according to a recent editorial, physicians largely ignore the problem. Evidence showed that a majority of women treated at an emergency facility for injuries resulting from violent acts of spouses or other persons known to the victims were discharged without any arrangement being made for their future safety. Physicians rarely inquired about an injury victim\u27s past sexual or physical abuse, living arrangements, or future prospects of safety

War Crimes of the 90s: Rape as a Strategy

Historically, only men went to war. The winners took the losers\u27 women and could rape, enslave, or kill them. As we moved into a more modern civilization, the rights of the winner over the women of the loser became less clear and were only vaguely documented. Even for modern war historians, what happens to the men on and off the battlefield is the main preoccupation. After all, women do not face combat and what happens to them seems unimportant. The rape of women by conquering armies has continued through all wars, but has rarely been considered a war crime, especially if the rapists were part of the ultimate winning forces. Rape committed by the losers has occasionally been punished by war tribunals