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ETHIK UND HYSTEREKTOMIEN
Streit um Hysterektomien
The New York Times
In a Culture of Hysterectomies, Many Question Their Necessity
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By NATALIE ANGIER
Published: February 17, 1997
Hippocrates thought the uterus wandered and so drove women to hysteria, but in that belief he was the mad one. If anything, the womb is the body's Atlas, bearing the weight not only of the human future but of bitter social and medical disputes. The abortion debate can be viewed as a question of who owns the womb -- woman or embryo. The most common surgical procedure in the United States is the much-criticized Caesarean section. And the second most common operation is another, more radical storming of the uterus, the hysterectomy.
The debate over hysterectomies is one of quiet fury. Nobody bombs surgical suites in protest, but for years critics have assailed what they call the hysterectomy industry.
They have campaigned vigorously against the prevalence of the practice, appearing on television and writing articles and books with names like ''The Hysterectomy Hoax'' and ''No More Hysterectomies.'' They have complained that doctors are too quick to take out the uterus at the least sign of trouble, particularly with middle-aged women for whom the organ is supposedly past its purpose anyway. They have blamed greed by doctors and hospitals, pointing out that hysterectomies constitute a $3 billion a year business. They have accused surgeons of laziness, of liking hysterectomies because the procedure is relatively easy.
Each year, about 560,000 women in the United States undergo a hysterectomy, a rate that is among the world's highest.
Now medical experts and women alike are struggling to understand why such a major operation continues to be almost routine. They say too many doctors cling to the hysterectomy as the first-line solution to any gynecological problem of middle-aged patients and can be patronizing or dismissive when a woman asks about alternative treatments.
In 1992, at the age of 45, Sandra Gandsman developed benign uterine growths called fibroids and started bleeding heavily. Seeking medical help, she encountered a medical monolith.
''I went to more gynecologists in the city of Philadelphia than most women see in a lifetime,'' Ms. Gandsman said. ''Every solitary one, and I mean without exception, wanted to do a hysterectomy. I couldn't find one who would talk about alternatives.'' Eventually, Ms. Gandsman, a health care marketing executive, found a doctor willing to simply remove the fibroids alone. At the same time, some in the field insist that rather than being bamboozled or railroaded into having surgery they do not want, many women decide on a hysterectomy only after rejecting the alternatives and after seeing their symptoms become incapacitating.
''A number of recent studies of how women feel after hysterectomy have found that women are much more likely to find their life improved by hysterectomy than not,'' said Dr. Joanna M. Cain of the Pennsylvania State University Medical School in Hershey. ''We tend to look at this as an issue of there being too many unnecessary hysterectomies, but that may be in part because we don't validate the pain and suffering some of these women go through.''
Some experts predict that the number of hysterectomies will decline in the near future, perhaps dramatically, as baby boomer women pass the peak hysterectomy years of ages 40 to 50. Moreover, several new alternatives to hysterectomy are starting to gain attention in clinical trials. Finally, as managed care takes over the medical industry, hysterectomies may no longer be automatically covered, for they are often considered elective procedures.
Whatever happens tomorrow, hysterectomies are a staple of gynecological surgery.
By the age of 60, 1 in 3 American women will have had their uteri removed. In Italy, by comparison, the figure is 1 in 6 women, while in France, it is only 1 in 18.
Link: http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C00E5D8103FF934A25751C0A961958260