杏吧原创

AFICIONADOS of horror stories will relish this racy catalogue of medical misdiagnosis and malpractice. Immerse yourself in the breezy prose favoured by American journalists and read about the Denver sculptor who nearly died of a massive coronary even though her GP assured her that, because she was a thin, diet-conscious woman, she couldn鈥檛 possibly have heart disease. Read on and sympathise with the plight of the New Jersey woman with AIDS who was told she had irritable bowel syndrome. The examples are powerful and compelling but, of course, they do not in themselves establish a 鈥済ender gap鈥� in medical malpractice: doctors make mistakes about their male patients as well.

Nechas and Foley are on firmer ground when they tackle the book鈥檚 central theme, the 鈥渒nowledge gap鈥�, arguing that women鈥檚 lives are endangered because they have been left out of medical research. The scale of the neglect is awesome, they claim, 鈥渓ike ignoring an elephant in the living room鈥�. Sometimes the problem is that 鈥渨omen鈥檚 diseases鈥� are not given the research attention they deserve: breast cancer is the authors鈥� prime example. In other cases, the safety and efficacy of the resulting treatments have been proven only in men. Drugs for heart disease 鈥� big business, particularly in the US 鈥� are the classic examples here. Even in laboratory studies, the rats used are usually male.

The authors draw on interviews with campaigning doctors and politicians in the US who have been fighting what one called 鈥渢he rest room excuse鈥�. For some years, apparently, researchers used a local lack of ladies鈥� lavatories to justify the exclusion of women from major federally funded studies aimed at understanding human ageing 鈥� despite the fact that it is women who, being longer lived, suffer most from 鈥減redeath morbidity鈥�. As one women鈥檚 health activist remarked: 鈥淚t鈥檚 like studying Alzheimer鈥檚 disease in 20-year-olds. It鈥檚 simply the wrong population.鈥�

This wide-ranging book provides a whistle-stop tour of health debates in the US, travelling from menopause and hormone replacement therapy to AIDS and coronary heart disease and on to alcoholism, depression, violence, poverty, premenstrual syndrome, 鈥渇etal rights鈥� and sexual abuse by doctors. It ends with an account of the battle to establish the Women鈥檚 Health Initiative 鈥� a $625 million, 15-year study now under way, designed to investigate the wellsprings of health in older women. The latest challenge, Nechas and Foley argue, is to ensure that this is not a token gesture.

For my part, I am less optimistic that more attention from the medical profession and the research community to women鈥檚 health will prove to be an unalloyed boon for women. Certainly, the authors of Unequal Treatment are aware of the dangers of 鈥渕edicalisation鈥�, noting the medical profession鈥檚 penchant for attributing complex phenomena such as premenstrual syndrome to narrow biological (hormonal) causes. But sadly they do not go on to consider how such deep-seated professional practices and ways of thinking might be challenged.

Yet this book is more of a battle cry than a scholarly tome. Nechas and Foley conclude by urging women to 鈥渞ise up in rage, step out of the blind spot and stay visible, demanding until it is given, their right to health, their right to life鈥�.