Feeling Angry? Good for You!

Contrary to previous studies about anger and the risk of heart disease, new research has found that women with high levels of hostility and anger do not have an increased risk of heart disease compared to women with lower levels of anger. In fact these women were found to have a slightly lower risk, though not enough to be statistically significant. Past studies have shown a link between anger and heart disease and medical models to explain this phenomenon have been proposed. The correlation between angry men and heart disease still holds.

So what is it about women that they may not realize the same health consequences from anger that men do? The study does not answer that question, but a search of the internet reveals some interesting hypotheses. One study from the University of California at San Francisco found that while men and women experience anger differently, both take advantage of their anger in day to day interactions with the same frequency. Women are likely to report anger as feeling akin to frustration or expressing negative feelings about having anger. But they are just as likely as men to act on their anger. The difference seems to be that typically men use their anger directly – to confront people or voice displeasure - whereas women are more likely to channel their anger to create change in a more indirect way. Most people would guess that this difference is one that arises from social expectations and taboos on women expressing strong negative emotions or assertive behavior. Conventional wisdom would tell us that repressing anger is harmful to the body and soul. But apparently repressing it long enough to convert it into another type of action is not only not harmful, it is probably more productive.

A Painful Issue Redux

Art Caplan comments on how abortion politics continue to rip at the social fabric of America in a commentary on proposed fetal pain and abortion laws. It' s hard to imagine that any woman or any physician involved in a such procedure would not discuss this without the mandate of legislation.

First Human Clone Maker Resigns Post

After being dogged for months about the source of the women’s eggs he used to create the first human cloned embryo, the South Korean veterinarian Hwang Woo-suk, apologized Thursday and stepped down as director of The World Stem Cell Hub, an international network of fertility clinics recently established by Hwang to create stem cell lines for research. The ethical violation that he admitted to and resigned because of is that he did not tell the truth about the source of his eggs. In 2004 when pressed he told Nature magazine that his own researchers, including graduate students, did not donate their eggs. But they did, even though they did so under false names and apparently without his knowledge. And he said that no woman was paid to donate eggs. But they were. The Washington Post reports that Roh Sung Il, head of Seoul-based MizMedi Women's Hospital, admitted that he had paid about $1,447 each to 20 women to gather human eggs for Hwang's research. Payment for eggs was not illegal in 2003, but it was banned last January by South Korean law. Talking to the BBC, Dr Hwang explained why standards may have slipped, “We needed a lot of ova [eggs] for the research but there were not enough ova around.” Dr. Hwang himself has published research on a method that would allow stem cell lines from human cloned embryos to be created using 17 women’s eggs instead of the 242 it first took.

South Korea treats Dr. Hwang as a national hero and today in the Korean Times an editorial urges that even though his stem cells were procured unethically, this should not diminish the “remarkable achievement” of their native son. In addition to creating the first human embryo clone, last August he unveiled Snuppy, the world's first cloned dog.

Besides lying, ethical issues in this case include the specter of coercion involved in the harvesting of eggs from junior researchers and graduate students thus violating the ethical necessity of donations being given with informed voluntary consent (with coercion the voluntariness condition is breeched). And the problem of the commodification of women emerges in the act of exchanging ova for money.

On this day of Thanksgiving....

For a wonderful spiritual collection of Thanksgiving blessings, meditations, interviews, and thoughts about what Thanksgiving means check out Beliefnet.com. And have a very Happy Thanksgiving from the WBP blogger team!

Women trade health for a paycheck

In September the President’s Commission on Bioethics published Taking Care: Ethical Caregiving in Our Aging Society. It is a broad review and set of recommendations regarding a number of issues facing society and the special medical care needs of the elderly. Of particular interest to women and justice is the following quote:

“Once the typical caregiver was a woman who did not work outside the home; today the typical caregiver, still a woman, is employed outside the home, and often obliged in addition to care for her own young children. At the same time, there are already shortages of professional caregivers—nurses and geriatricians—and caregiving jobs such as nurse’s aides often lack the levels of compensation and benefits that might attract sufficient numbers of workers.” (Chapter 5, section I, paragraph A, point 4)

This point, and its disproportionate impact on women, has been dramatically illustrated by an article in today’s Chicago Tribune. The point of the article isn’t just that women are more often professional caregivers and that they are underpaid, but that by the very act of taking on a paid caregiver position they are, ironically, left without a way to pay for their own healthcare. The personal stories in the article are gripping and tragic. The article quotes the journal Health Affairs as stating that of the 6 million Americans who joined the ranks of the uninsured between 2000 and 2004, nearly two-thirds were working, mostly in low-wage jobs. Nursing home and home-care aides fall in this category, with median annual incomes of $13,287 and $12,265, respectively. Professional caregivers may or may not have access to employer-sponsored health insurance, but even those who do often pass it up because of the high premiums which can easily be 10% of their gross salary for individual coverage and up to half of their salary for family coverage. And since sick days are not covered by home care agencies, women cannot take the time to stand in line for hours at free clinics. Any serious illness requiring hospitalization and resulting bills will force women and their families into a bankruptcy situation. Thus it’s not surprising that the majority of women who work as professional caregivers do not get routine medical exams and screenings and do not seek care early in an illness. Instead, like other working poor without insurance, many of these women resort to using emergency rooms as their primary mode of health care and suffer health outcomes far inferior to those who have general access to health care.

While the typical reaction to such “news” is to bemoan the sad facts, we have to do more than that as a society. As our population ages, the demand for home care givers is on the rise. If people do not respond to this need by becoming home care workers, we, as a society, have a huge problem of figuring out how to care for this population. On the other hand, if people, predominantly women, do respond to this call and we have not reformed the system, then we are complicit in the unjust treatment of women who literally trade their own health to care for the better-off who can afford it.

Malicious modeling?

CNN.com reports on a Catholic school who has fired a preschool teacher for being unmarried and pregnant. The school claims that they are simply "following the personnel handbook," where teachers are "expected to convey the teachings of the Catholic faith by his or her words and actions." Of course, one bit of irony about this situation is that if Ms. McCusker had decided to terminate her pregnancy, she would have violated Church doctrine...and yet saved her job. Exactly what sort of role modeling does the school have in mind? Ms. McCusker is truly caught between a rock and a hard place.

Lawyers for the fired teacher argue that the rules themselves are unjust. After all, how does the school district monitor male teachers' sexual habits? This is another example of inequitable treatment of women in the guise of observance of religious tenets.

Is this what Sister Sledge meant?

I refer, of course, to the 70s disco hit (and frequent wedding reception boogie tune) "We Are Family." Yesterday's NYT ran a front-page article on the phenomenon of "family reunions" between half-sibs "fathered" by the same anonymous sperm donor.

Novel family arrangements aren't unprecedented--certainly, adoption, divorce, remarriage, same-sex parents, and other arrangements have been around for a while now.

But what's interesting to me is this question: to what extent do genes make family?

Harvard Bioethcists Discover Social Justice

The Inaugural Conference on Health and Ethics sponsored by the Harvard University Program in Health and Ethics was held this past Thursday and Friday with a powerful sense of mission. “This conference maps a new departure for bioethics and initiates its exploration” promised the Call for Participation. A host of the conference, Dan Brock, announced to Thursday morning attendees that the conference heralded the birth of a new bioethics, one that was not dedicated to moral issues arising between doctors and patients, for example, end-of-life issues and informed consent for treatment, but rather to a “broader group of ethical issues that come from a population level.” This new bioethics is to be called “Population Bioethics” and will require the collaborative effort of people working in epidemiology, public health, rational decision theory, economics, bioethics, and others. Harvard is advertising for two new positions in bioethics this fall with the development of scholarship in Population Bioethics in mind.

Population Bioethics not only reorganizes bioethics but it also creates new questions for bioethics, said Dan Wikler, in his presentation on what is distinct about Population Bioethics. He, and his colleague Norman Daniels, are leaders in the field of international health and ethics. The audience learned that the new questions for bioethics that emerge from Population Bioethics include: Who has a moral right to health care? How should scarce healthcare resources be distributed? How can and should health care policy at home and abroad be reformed according to the value of justice? What are the ethical and rational justifications of health care measurements, that is, according to which principles may we justify a summary judgment of the health of a population (like women’s health or a nation’s health)? How do we rationally and ethically justify health priorities? What are ethical justifications of government intervention in potential health crises (like Hurricane Katrina and potential epidemics like avian flu)?

Pass the Beano, Please...

Sally Squires of the Washington Post reports on a study that shows that trading about 10 percent of carbohydrates in the diet for beans and healthful fats such as olive oil can help control high blood pressure and raise the level of "good cholesterol." Not too mention it has long been known that addition of legumes to one's diet also is an excellent way to regulate blood sugar levels. Also, the study provides yet another argument that a diet that uses more renewable, sustainable resources (as opposed to concentrating our resources on the production of meat for a relatively small population of the planet) is good for everyone.

God's Bioethics (part deux) and the Church: The Vatican Rejects Intelligent Design

Yahoo reports that the Catholic Church has weighed in on the intelligent design debate. The Rev. George Coyne, the Jesuit director of the Vatican Observatory, said placing intelligent design theory alongside that of evolution in school programs was "wrong" and was akin to mixing apples with oranges. Coyne was quoted as saying that "Intelligent design isn't science even though it pretends to be...If you want to teach it in schools, intelligent design should be taught when religion or cultural history is taught, not science." In a previous article in a British Catholic magazine, Coyne reaffirmed God's role in creation, but said science explains the history of the universe:

"If they respect the results of modern science, and indeed the best of modern biblical research, religious believers must move away from the notion of a dictator God or a designer God, a Newtonian God who made the universe as a watch that ticks along regularly." Rather, he argued, God should be seen more as an encouraging parent.

So, my question is, where does that leave individuals like religious right-wingers like Pat Robertson and those ultra-conservative Catholics who insist on mixing politics and religion? (Let's hope that no one prays that the Vatican is sruck with disaster -- how unChristian would that be?)

Latest installment in Plan B saga

An investigation by the Government Accountability Office, a nonpartisan investigative arm of Congress, has found that Plan B's rejection by FDA was a foregone conclusion. That is, FDA had decided not to approve over-the-counter sale of the "next-day pill" before the manufacturer's application had been through the scientific review process.

According to an article in the New York Times, top FDA officials were "deeply involved in the decision," which is unusual. The GAO's findings have been denied by FDA leadership. There's a lot of he said/she said going on, from the looks of things.

The drug prevents pregnancy if taken within 72 hours of unprotected sex. It has been targeted by anti-abortion activists, citing concerns about use by minors and the use of Plan B (and similar drugs) in place of contraceptives.

Selling Human Eggs Illegally

South Korean police in Seoul reportedly made their first arrest under a law enacted in January 2005. Police captured a man, identified by his family name Kim, who allegedly sold human ova to infertile couples in South Korea and Japan. Kim was accused of luring indebted women to sell their eggs in exchange for monetary compensation. Following his arrest, police raided four Seoul hospitals, resulting in the charging, but not detention, of two university students and a housewife. Police are investigating at least ten other cases in which the Internet may have been a forum for the now illegal selling of one’s ova.

The new law, which forbids reproductive human cloning, was meant to promote stem cell research for therapeutic cloning. The commercial trading of ovum and sperm is now also illegal, with the broker being more penalized than the donor. Kim’s case and others reveal that donors are usually compensated between 3 and 5 million won for ovum that are then sold for approximately 17 million on the Japanese market. While there is no law banning such sales in Japan, the country’s gynecologists have a regulatory ban, which is strictly adhered to. According to the Japanese daily Yomiyuri Shimbun, Japanese women look to South Korean donors because of their proximity and similar racial features.

Click here for more details

Pop Culture: Teen Breast Implants

Occasionally I actually get to watch a TV show and even more occasionally I get to watch one I like. I was pleasantly surprised this fall by a new sitcom on Fox called “The War at Home.” It is a sleeper that I have no doubt will soon be put to sleep if for no other reason than I have enjoyed watching it. In the very first two months of its first season, it has confronted issues such as teen sex, sexual identity, interracial dating and drug use (not necessarily among teens.). More importantly it has done so not in a preachy way, but in a way that shows these issues are a part of everyday life for the average family and that they may not be as black and white as we think. There is no moralizing on this show – there are just ordinary people getting tripped up by the challenges of living and parenting in our culture. I don’t even know if it knows how smart it is. The people who promote it and choose its advertising sure don’t. Had I named this show it might have been called something like “Everyday Ethics” – which means it surely would have been cancelled by now. So imagine my distress when I watched this past week and found myself booing instead of cheering. This week’s conflict was resolved by the parents agreeing to breast implants for their teenage daughter! What?!?! How could this smart, contemporary purveyor of liberal values get derailed so quickly and easily? Since when are teenage breast implants a pressing cultural problem? What parents in their right minds would agree to that?

After hyperventilating, I started an internet search. Sure enough, there are a plethora of reports out there detailing the trend of cosmetic surgery becoming popular in younger and younger age groups. Last year, over 1800 girls under the age of 18 had their breasts augmented. Parents are taking out financing to do it. The mind reels with all the ways in which this is wrong. Teenagers are still forming their identities and values. They want desperately to fit in and be admired. Learning to accept oneself and find one’s strengths is a skill that needs to be modeled and nurtured by parents. By focusing on breast size and not self worth, such parents are encouraging their daughters to accept the shallow societal depiction of women and their value in the world. I could rant on about this, but others have already done so and done so better than I could. Now my interest is more academic. I always tell my ethics students that in order to understand an issue, in order to make a robust argument, one must examine the arguments on all sides. The problem is, I can’t come up with an argument for getting breast implants for one’s teenage daughter.

The Agony and the Ecstasy, Part II

In my previous blogger life, I had written about the use of Ecstasy for treatment of severe anxiety in terminally ill patients; today in New Scientist magazine, a study warns that regular use of Ecstasy could leave the brain vulnerable to inflammation, invasion by viruses or other pathogens. This potential side effect needs to be weighed and balanced against the potential benefits for clinical use in diseases such as schizophrenia, post-traumatic stress disorder and terminal cancer.

God’s Bioethics?

The Women’s Bioethics Project, a non-partisan, public policy think tank, announced today the release of a report detailing a concerted effort by conservative groups to dominate so-called “bioethical issues” surrounding emerging technologies. The report, titled “Bioethics and Public Policy: Conservative Dominance in the Current Landscape,” analyzes the involvement of both progressive and conservative bioethics centers, including traditional think tanks such as the American Enterprise Institute, as well as religious groups such as James Dobson’s Focus on the Family.

To date, the report says that only conservative groups have devoted substantial resources to pushing a broad bioethics agenda. Bioethical issues ranging from stem cell research to the Terri Schiavo case are the battlefield for defining the kind of world we want to create,” said Jonathan Moreno, bioethicist and senior fellow at the Center for American Progress. “The Women’s Bioethics Project analysis is an important wake-up call to people who care about scientific progress and the ability to decide what is right for their own families. The time to engage in these issues is now.”

“The rapid advance of biotechnology is quickly outpacing our ability as a society to absorb the effect it will have on our lives,” said Kathryn Hinsch, founder of the Women’s Bioethics Project and author of the report,” The institutions we have relied on for guidance on difficult moral issues—whether organized religion, government, or the academy – have failed to keep pace with science or societal implications underlying these issues. Because of this confusion, disarray, and public policy flux, the opportunity to influence the direction of public opinion is up for grabs. Essentially, whoever gets there first will frame the debate on these issues and will affect us all for decades to come.”

Full details of the report can be found at www.womensbioethics.org.

First trimester Down syndrome testing now available

Washington Post reports that a study of more than 38,000 U.S. women found a screening method, which combines a blood test with an ultrasound exam, can pinpoint many fetuses with the common genetic disorder 11 weeks after conception. While the testing has drawn criticism from opponents of abortion, researcher Fergal D. Malone of the Royal College of Surgeons in Dublin, who led the study published in today's issue of the New England Journal of Medicine, felt that it would not result in more abortions.

Good News for Java Lovers

This is really great news for women, like me, who are addicted to their coffee --turns out coffee may be good for you (if you are a woman)...a government sponsored study showed evidence that women who drank four or more daily cups of regular or decaffeinated coffee had a slightly lower risk of developing high blood pressure than those who drank little or none. The same did not hold true for those who drank cola or other sodas containing caffeine. The theory is that coffee has lots of antioxidants, substances that are thought to help protect the heart and reduce risks of cancer.
Same news has been reported at WebMD -- hmmm, I think I'll celebrate with a cup of coffee!

Ha-ha

This might give you a chuckle: Turns out women enjoy a joke more than men. Brain scans indicate that women's brains react more intensely when the punchline is delivered.

Caught in the Schiavo echo chamber

In yesterday's NYT Book Review, William Saletan (Slate's bioethics guy) criticizes Jon B. Eisenberg's new book, Using Terri for, well. . . using Terri.

Clinical Trials in India

While Europeans interested in medical research have, ventured into India before, modern-day globalization has washed a wave of researchers and multinational drug companies onto India’s shores. According to Sean Philpott, managing editor of The American Journal of Bioethics, this wave recalls the gold rush frontier. Not only are research costs low, but there is a skilled workforce to conduct the trials. Though drug companies are undoubtedly enticed by the prospects such as bringing down the price of testing by 60% - their work arguably takes advantage of both India’s educated workforce and individuals mired in poverty, who act as guinea pigs under informed consent after lures of 100 US dollars.

While it may not be for outsiders to judge the significance of such sums to South Asia’s impoverished, many, including Philpott, who cautions that individuals may not even realize they are being coerced, worry that the testing borders on exploitation. Pharmaceutical companies conducting research have come under criticism before. In 2004, before the anti-generic drug rules were enacted, two India-based drug companies, Shantha Biotech and Biocon came under scrutiny for conducting illegal clinical trials without proper consent, actions that led to eight deaths.

Although South Asia’s poor are somewhat used to being enticed by the medical community (particularly when it comes to the sale of vital organs), such testing was not always as prevalent in the region. In the past scientists used foreign produced reverse-engineered drugs, a practice halted after March, when India submitted to pressure by the World Trade Organisation to prohibit local companies from creating generic versions of patented drugs. Considering both relatively lax government oversight and the removed threat of domestic competition, many drug companies are now taking advantage of cost-effective testing ground. By 2010 total spending on outsourcing clinical trials to India could top $2 billion, according to Ashish Singh, vice president of Bain & Co., a consulting firm that reports on the health care industry.

To read more, click here.

Good for the Goose, Good for the Gander?

Interesting commentary in the NY Times.com on how changing technologies will likely change the focus of the debate regards the rights of fathers in reproductive cases. Some of these developments include advancing techniques of the neo-natal intensive care unit, where the threshold of extra-uterine viability has been possibly pushed back to 20 weeks (or five months) gestation, the theoretical possibility of male pregnancy, and perhaps most importantly, the artificial womb. While these developments may not directly answer the debate of the moral status of the fetus or embryo, they will remove the maternal-fetal conflict inherent in the present discussions and disentangle the issue from the rights of a woman over her own body.

What does UNESCO have to say about bioethics?

The governing body of UNESCO has approved a controversial bioethics declaration concerned with the social, legal, and environmental ramifications of medical and technological advancements and procedures, as they affect human beings. Supporters of the doctrine promote it as an ethical framework for the potential standardization of international practices.

While much of the declaration reemphasizes commonly accepted values, such as informed consent, the new emphasis on social responsibility is inciting much more heated debate. Also contentious are the often implicit references to the use of human embryos. Such advisements are particularly pertinent to developing countries that are advancing the sophistication of their scientific capabilities, such as China, India, and South Korea.

Much of the support for UNESCO’s doctrine comes from thinkers on the religious right, who tend to oppose both abortion and the use of human embryos. Conservatives especially value the doctrine’s focus on the concept of ‘human dignity’ and the importance of the individual’s dignity over the sole interest of the state. An advisor to the US delegation at the Paris meeting wrote on the website Christianity Today, "These resonant assertions of the centrality of human dignity and the limitations of science give us hope and ammunition." The Vatican has also promoted the declaration, which essentially backs an anti-abortion position. In an earlier debate, Vatican representative Francesco Follo said that a bioethical system should respect "man and his intrinsic dignity", warning that medical researchers were being tempted "to treat the human person as simple laboratory material".

While conservatives welcome the seemingly ‘moral’ nature of the declaration, academicians are far less enchanted. Arguing that the language used is dangerously vague, they envision a ‘progressive’ view of science, uninhibited by agenda-backed restrictions. Richard Ashcroft, reader in biomedical ethics at Imperial College London, expressed his concern by calling it strange that the document was adopted without being amended after near-universal criticism of the draft declaration by academics.

This declaration is the third document on the topic of bioethics which has been proposed and approved by UNESCO. The first two were the 1997 Universal Declaration on the Human Genome and Human Rights, adopted in 1998, and the International Declaration on Human Genetic Data, approved in 2003, which sought to set ethical standards for collecting, processing, storing and using human genetic data contained in biological samples. This is also unlikely to be the last time that religion and science will clash in the conception of an ethical future.

[Thanks, Ana Lita]

Hubris replaces paternalism as 21st century medical vice

Concern about whether or not childhood immunizations can trigger developmental delays in some children has been a growing question on the minds of parents in a world in which environmental toxins and their health consequences are regularly being exposed. The medical establishment swears up and down that the mercury once used in vaccines is not the type that can cause damage – the same medical establishment that took thirty years to decide if eggs were part of a healthful diet and changed their position several times due to new research findings. The government assures us there is no correlation between autism and childhood immunizations - the same government that allowed civilian exposure to radiation from nuclear testing.

Many parents are now asking to skip certain vaccines or to give the vaccines on a slower schedule to reduce the number of vaccines entering the system at one time. And, yes, some parents are skipping them altogether. Since immunizations are at the heart of pediatric medicine, this has raised an outcry among pediatricians. Many are willing to kick patients out of their practice either for not wanting to vaccinate or for simply asking to slow down the immunization schedule. In a recent study, 39% of pediatricians surveyed indicated that they would be willing to dismiss a family for refusing all vaccinations and 28% would dismiss for refusing select vaccines. The study’s authors urged pediatricians not to dismiss families but instead continue to see the patients so that they would have additional opportunities to educate the family. In fact, the authors recommend that this issue be raised every time the family comes to the office. Ironically, the authors argue that if the pediatrician dismisses the family that the children may have limited access to health care. There is no mention of what effect raising a contentious issue every time they come into the office might have on the family.

The American Academy of Pediatrics (AAP) notes that four percent of pediatricians have refused an immunization for their own children. They also recommend that pediatricians listen carefully and respectfully to parents’ concerns, recognizing that some parents may not use the same decision criteria as the physician and may weigh evidence very differently than the physician does. The main goal of medical ethics is to find the most humane and encompassing solution to a dilemma. A humane and encompassing solution to this conflict would support real listening on the part of both parties and encourage some sort of compromise that could foster mutual respect.

Private correspondence with the study’s main author revealed deeper insight into the study’s recommendation. When asked about a compromise such as delaying the immunization schedule so that vaccines could be given one at a time instead of in batches, the response was twofold: first, that that would delay coverage of children for a few extra months, and secondly, that doing so would encourage parents to think that there was some validity in their beliefs and that wasn’t an acceptable message to send.

How does one foster mutual respect when one party believes that there is no validity to the other party’s stance? Is it possible to agree to disagree? What harm does it do to accept that people may weigh evidence and benefit differently, as the AAP suggests? Flip the question around and ask what good it does to accept that people may weigh evidence and benefits differently. The good is fundamental – it is respect for individual autonomy. Autonomy, rightly or wrongly, is the cornerstone of western medical ethics.

Not so long ago physicians as a group were accused of being generally paternalistic toward patients. Thirty years ago it was common practice not to disclose grave diagnoses to patients when there was little curative treatment that medicine could offer. The rationale was that is would be too distressing for patients to be given a death sentence. That sort of attitude has changed, as well as the state of medicine, and today a physician would be found to have committed malpractice if he or she withheld a diagnosis from a patient. The change was gradual and there has been some meeting of the minds. The intention behind paternalism in most cases was a beneficent one – wanting to spare the patient and family distress. Medical ethics recognizes that beneficent intent and holds that there are limited, justified uses of paternalism even today. But what ethical stance is behind the insistence that immunizations are not harmful? Beneficence? Not likely. Wanting all children to be vaccinated is a form of beneficence because it refers to a desire to spare children and adults from serious illnesses. But the current debate isn’t about whether or not it is a general public good or even a specific individual good to be vaccinated. The fight is not about an ethical principle at all. It is about who is right.

That pediatricians are willing to take the stance that they know vaccines are safe and they are so certain of this that they are willing to dismiss families from their practices is a sure sign to me that hubris is now the biggest threat to individual autonomy.

International Consensus Statement of Women’s Health

Donna E. Stewart, MD, President of International Association for Women's Mental Health, has recently announced that a final version of the International Consensus Statement of Women’s Health is ready (this older version is all I can find on the net). This document was accepted, to her surprise and delight, at the XIII World Congress of Psychiatry in Cairo. Donna E. Stewart is Professor and Chair of Women's Health at University Health Network and University of Toronto. She and her international team are now in the process of getting the statement endorsed by various organizations. The following are the recommendations .

"We recommend that professional mental health and health organizations and providers, governments, the United Nations system, the World Health Organization, other international health and social organizations and appropriate nongovernmental organizations integrate girls’ and women’s mental health as a priority in policy and program development and… Support psychological health promotion programs that encompass the life context of girls and women to include equal access to basic human rights, education and employment, the elimination of violence and discrimination and the reduction of poverty. Support women’s marital, sexual and reproductive choices and ensure access to safe motherhood. Support public education and awareness campaigns that increase recognition and reduce the stigma of mental illness in girls and women Support safe, respectful, appropriate, gender sensitive comprehensive mental health and physical health services for girls and women across the life cycle irrespective of their economic and social status, race, nationality or ethnocultural background. Support timely access to adequately skilled mental health professionals who provide quality of care consistent with best current knowledge and availability of appropriate therapy, technology or drugs and who take women’s special needs into consideration. Support the development and use of culturally appropriate diagnostic systems that consider the sociocultural context of women’s lives, and biological differences when they are salient. Support the provision of accurate information and respect choices in treatment decision making by girls and women whenever possible Support the provision of mental health care for girls and women that is free from breaches in fiduciary responsibility Support increased attention to research on girls’ and women’s mental health including those factors which enhance or inhibit the development of resiliency. Support the provision of core training and education about gender issues for health, and mental health, professionals. Support gender equality in practice and promotion within mental health services and organizations including equal opportunities for advancement and eradication of gender harassment, intimidation or unjustified discrimination on the basis of sex."