Monday, March 31, 2008

Nipple Rings, Respect and the Undertreatment of Women's Pain

Nipple Rings, Respect and the Undertreatment of Women's Pain

My adopted home town of Lubbock, Texas was in the news this week—no we haven’t arrested the Chippendale Dancers again—this time the TSA Agents at “Lubbock International Airport” reacted like a bunch of junior high school boys when confronted with the shocking situation of a woman, Ms. Mandi Hamlin age 39, whose personal jewelry set off the metal detector. (helpful visual from Wikipedia!) Apparently this is not all that uncommon--a similar thing happened in Las Vegas to Nicole Richie. But I digress.
I can’t tell the Texas story better than Ms. Hamlin’s lawyer Gloria Allred (more about her later)
But for anyone with a slow connection, here’s how the AP recounts it:
“[Mandi] Hamlin said she was trying to board a flight from Lubbock to Dallas on Feb. 24 when she was scanned by a TSA agent after passing through a larger metal detector without problems. The female TSA agent used a handheld detector that beeped when it passed in front of Hamlin's chest, the Dallas-area resident said.
Hamlin said she told the woman she was wearing nipple piercings. The agent then called over her male colleagues, one of whom said she would have to remove the jewelry, Hamlin said.
Hamlin said she could not remove them and asked whether she could instead display her pierced breasts in private to the female agent. But several other male officers told her she could not board her flight until the jewelry was out, she said.
Hamlin was taken behind a curtain and managed to remove one bar-shaped piercing but had trouble with the second, a ring. She said the officer gave her pliers to remove the ring, a process which caused a physical pain.” .
The "For Grace" Foundation

I’ll admit my first thought on hearing about this event wasn’t about the Women’s Bioethics Blog. But as the week and the story have progressed and, the theme of lack of respect for women led me to see a connection to a conference this May called “Women in Pain: Gender Matters” by a non-profit-organization, “For Grace” whose mission is “to ensure the ethical and equal treatment of all women in pain.”

I do not know anything about the “For Grace” foundation beyond their web site, but I do know that the documented failure of the medical profession to listen to their female patients and to treat their pain adquately is, or at least should be, a core issue in bioethics and needed to be discussed in this blog.
Professor Diane Hoffman
The "For Grace" Foundations' conference caught my eye because the key note speaker, Professor Diane Hoffman of the University of Maryland Law School is someone for whom I have the highest possible respect. Professor Hoffman has done extensive research and written important articles about legal and ethical issues in pain management.
Thanks to the generosity of the University of Maryland in making their faculty's work available on-line, you can read a terrific article by Professor Hoffman and Dr. Anita Tarzian, also of the University of Maryland, entitled “ The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain” Journal of Law, Medicine and Ethics 29 (2001) 13-27.
It all Comes Back to Respect
So here’s the link with the Lubbock Nipple Ring Incident: the issue here is respect. Women’s accounts of pain are not believed, and therefore not treated, because we are not respected. The TSA Agents in Lubbock did not respect Ms. Hamlin's pain or her dignity and neither do many of the people making snide comments about her at various internet sites. It always strikes me as a cheap shot to comment on a situation where a woman is embarrassed or endangered by saying “If it had been a man in a similar situation” but here is one that warrants it. Can you imagine a man being handed a pliers and told to “get it out” under similar circumstances?

The lack of respect for women evidenced by the TSA agent’s actions didn’t stop when Ms. Hamlin left Lubbock. When I first heard the story--through a posting on the Feminist Law Professors Blog!--I got right on the internet and the first account I found was on TMZ.
The Blogosphere Chimes In to Criticize the Victim
As bizarre as the story itself was, what became most fascinating to me were the comments made by readers.

I appreciate that anonymous web comments are often brushed off as harmless. I've never thought that and have always been struck at the horrible, crude things people say about women at relatively mainstream sites. Rosie O'Donnell often points out that of all the things people could not like about her, the most common ephitat in anonymous spewing of venom is "Fat." This Nipple Ring story triggered a similar reaction. People wrote, again and again, that Ms. Allred, who, as a private attorney, has defended the civil rights of women for over 30 years, is “an old bag” and a “media whore” Many questioned what an “Old Bag” like Ms. Handlin was doing with nipple rings. Excuse me? Is John McCain an “old bag?” Is it aesthetically offensive for a woman over 25 to appear in public? Apparently so. “Old Bag” and “whore” are the crudest printable words that can be said about a woman in the English language. After the insults came the disbelief. Many asserted, despite the TSA’s admission that the facts of the event were true, that the woman was ever asked to remove her nipple ring? And even more interesting, many readers expressed disbelief that removing the rings caused Ms. Hamlin pain.
If I am expected to discount these comments as having nothing to do with what people think about women, I would like to know the neuroscience supporting a conclusion that things people say are not things they think.
Here's a little thought experiment I tried. I am following the NCAA Final Four very closely and will be upset if my team, UCONN, does not win. But, if that happens I won't think the Chinese Government has fixed the games. And since I won't think that, it is hard to imagine a circumstance under which I will say or write it. But the things people wrote both about the victim and her prominent attorney, Gloria Allred, reflected thoughts in their heads. And they are ugly thoughts.

A Long History of Treating Women Differently
And here we are back to women, pain, respect and belief. The medical profession's track record on disbelieving women's pain is extensive. There are entire diseases, such as fibromyalgia and chronic fatigue syndrome, whose existence is questioned because they appear to disproportionately affect women.

Treating men and women differently when it comes to health care is so common that it is seldom questioned. There are many examples in the field of Assisted Reproductive Technology where doctors often express views on who should and should not be a mother. For example, the California Supreme Court is currently considering whether a fertility clinic has the right to refuse its services to a lesbian woman seeking to have a baby without benefit of a husband if this violates the doctor’s religious beliefs. Is it disrespectful to ask whether there are there any doctors refusing, for religious reasons, to prescribe Viagra to unmarried men because they have religious objections to sex outside of marriage? How is this O.K.?
Twenty Years of Women Going to Medical Schools Hasn't Really Helped

Many people believed that women's health care would change dramatically when women started going to medical school in numbers equal to men. Well, yes and no. There are thousands of terrfic, empathetic female physicians We are all lucky for their existence, skill and dedication. However, if the opening of the medical profession to women was going to change attitudes and practices it would have happened already. Why hasn't it? Well, first because it is beyond unfair into fanciful to expect that the existence of women doctors is enough to change the fundamental power structure of a profession or indeed a society. Second, people learn what they are taught. Unfortunately it is not uncommon for women doctors to absorb the same prejudices as men about their women patients’ accounts of pain.
Moreover, even if every woman doctor was committed to believing women, despite everything they learn through from their mentors, few are in any positions of power. 17 of the 129 Deans of Medical Schools in the United States are women. and I suspect the numbers of women who are Chiefs of Staff in large medical centers is even lower.
(gain insight into this phenomena by reading this story about Dr. Elizabeth Nadel's withdrawal from consideration for the Deanship of Harvard Medical School because she did not want to leave her husband in Washington, DC.)

And here is more bad news. Specializing in woman’s health is not the path to status and power. As in every other field imaginable, including legal academe, women seeking advancement are highly discouraged from spending their time on fringe topics—like the health and well-being of 50% of the world's population.

In Conclusion

Please save your time and don’t remind me that women today shouldn’t “have” to be interested in women’s health (or women’s rights). Why shouldn’t a woman be just as interested in prostate cancer as breast cancer? Isn’t every patient important? You’re right, they shouldn’t have to. And who knows, maybe the past is not prologue to the future and the women graduating from school today (you know them, the ones who don’t have to worry about the right to contraception because “it’s always been there” and who don’t have to support women candidates because they are “beyond” Feminism) will make things all better. Maybe it is only a matter of time before all of these inequities are resolved through their hard work and determination. But while we’re waiting, the need is here and the time to address it is now.

Whether it is TSA agents in Lubbock or Reproductive Technology Docs in Los Angeles, women are still treated differently and there is a lot more work to do. Please do not dismiss the incident which sparked this post as irrelevant since it happened in Lubbock, Texas. Believe me, save the dust storms and the tumble weeds it is more like everywhere else here than it is different. Rather, it should remind you that the struggle to respect women as they seek health care, and live their lives, is still very much in progress and while all are welcome to join in, it is up to women to step up and advocate for change.

Jennifer Bard

Bonus: Enjoy Lubbock native Natalie Maines and the Dixie Chicks performing “Lubbock or Leave it.” Lubbock International Airport plays a prominent role in the song!


Kelly Hills said...

Full on "word" about society not treating women and pain with any amount of respect. And I admit I've found it much worse on the East Coast than the West; the number of times I've been accused of being an addict and "faking it" back here are truly shocking and horrific. It goes well beyond culture shock...

SabrinaW said...