“Take these and you’ll feel better…” “It’s safer than pregnancy…” “I’m ordering a few tests…” Those reassuring directives for good health, known as Doctor’s Orders, are familiar medicine to most Americans, but the words are heard particularly often by women, who annually visit physicians seven times more often than men. Many women follow their doctor’s commands as confidently as soldiers marching into battle—a trust that, according to Dr. Robert S. Mendelsohn, can be Just as disastrous. In his recently published Mal(e) Practice: How Doctors Manipulate Women (Contemporary Books, $10.95), Mendelsohn argues that male-dominated modern medicine serves women so poorly that “if you are a woman in America, the greatest danger to your health is, in all likelihood, your own doctor. “Many of Mendelsohn’s peers, including the American College of Obstetricians and Gynecologists, dismiss his indictments as more emotional than scientific. His credentials are unassailable—an M.D. from the University of Chicago in 1951, a pediatric residency at prestigious Michael Reese Medical Center and an associate professorship at the University of Illinois Med School. He also writes a nationally syndicated newspaper column, “The People’s Doctor, “and a monthly newsletter warning against dubious medical procedures. Mendelsohn, 55, shared his outspoken opinions with PEOPLE’s Barbara Kleban Mills.
Why do you say that women are the primary victims of modern medicine?
Women are subjected to more condescension and arrogance from their doctors than men because the vast majority of physicians are male. They also fall prey to greater diagnostic chicanery among their doctors, who have been taught to seek, find and treat disease rather than to help you maintain good health. Consequently, millions of American women are hooked on indiscriminately prescribed drugs or damaged by surgery they didn’t really need.
Take a widely used drug like Valium. Most doctors believe that women are weak creatures prone to anxiety and depression, and so they dole out psychoactive medications like Valium with abandon. Indeed, two-thirds of the 33 million prescriptions written last year for Valium were for women. And what does Valium do for the women who take it to relieve everyday anxiety? The first of Valium’s side effects can be—guess what?—anxiety! Other effects may include confusion, constipation, dizziness and, from overdosage, possibly even death.
What about surgery?
The number of hysterectomies performed in the U.S. has risen alarmingly in recent years—up to 690,000 in 1979. The American Medical Association admits that the operation is not always clinically necessary—but says that hysterectomies are beneficial to women with excessive anxiety over contracting uterine cancer in the future. That view is indistinguishable from the archaic medical opinion of the uterus as the source of women’s hysteria, which is where the word hysterectomy comes from. If a male patient is excessively anxious about developing cancer of the penis, would a male surgeon cure his anxiety by cutting it off?
Are doctors too quick to perform radical mastectomies?
There have never been any proven benefits of the radical mastectomy. It kills more than it saves. It offers no greater benefit than simple mastectomy followed by X-ray therapy. Furthermore, breast cancer increased by 18 percent between 1935 and 1965, and by 50 percent between 1965 and 1975. Yet the mortality rate for breast cancer has remained unchanged for the last 40 years.
What should a woman do if on self-examination she discovers a lump?
First of all, she shouldn’t panic. The odds are very good that it is benign. But even if it is malignant, chances are good that it can be treated successfully by simple excision and radiotherapy. Her job is to make sure that if that’s all she needs, then that’s all she gets.
You teach preventive medicine. But is there any way to prevent a serious illness such as cancer?
Yes, indeed. Women can, for example, reduce the risk of breast cancer. Not by mammography, which like all X-ray procedures is potentially dangerous, but by avoiding the birth control pill and synthetic female hormone therapy such as the estrogens, which have been found to produce breast cancer. I also contend that there is a lower incidence of breast cancer among women who nurse their babies.
Does research support your contention?
There are no definitive controlled studies as yet. But a 1977 study of China’s Tanka boat women, who traditionally nurse their young from the right breast, showed a higher rate of cancer in the unsuckled left breast. And a 1964 study at Roswell Park Memorial Institute in Buffalo, N.Y. found that breast-feeding for 17 months reduced the risk of cancer, with an even greater reduction after 36 months of breast-feeding.
You are especially critical of obstetricians. Why?
From the moment a pregnant woman walks into his office, the typical obstetrician does his utmost to turn the joys of having a baby into a nine-month disease. He cautions her against gaining excess weight when, in fact, she should be enjoying a high-quality diet that includes sufficient calories, protein, vitamins, minerals and liquids. He prescribes drugs like Bendectin for morning sickness, yet its adverse effects include the very nausea and vomiting it is supposed to prevent. Finally, the doctor forces the mother into a hospital on the argument that it is clean and safe. Yet as a University of Wisconsin study has reported, babies born in a hospital risk a higher rate of illness, injury and even death than those delivered at home.
Cesarean sections have increased from about five percent of deliveries in 1960 to more than 16 percent in 1979. Why is that?
One reason is that doctors learn so little about natural birth in medical school; the emphasis is on complications and intervention. What better way for an obstetrician to interfere than with a cesarean section, especially after he has already intervened with fetal monitoring, anesthesia and induced labor. It should also be kept in mind that a doctor makes more money on a cesarean than on a normal delivery.
Might your book make some women so fearful of doctors that they won’t go to one when they should?
My prescription is, stay away from your doctor if you possibly can, especially when you’re healthy. Avoid routine checkups and yearly chest X rays.
When you do see a doctor, how should you protect yourself?
Ask lots of tough questions, especially if he orders an X ray or a routine test. If he prescribes any drugs, ask him to list fully the side effects, then decide whether you want to get the prescription filled. Above all, don’t let your doctor patronize or intimidate you. Make him explain and carefully defend every diagnosis, every drug, every procedure or operation he recommends.
What special advice can you give when seeing an obstetrician?
Check up on his cesarean rate.
You’re a doctor, a product of the same training you attack. Why should anyone trust you?
They shouldn’t. There was a time when I believed what my med school professors taught me. But my attitude changed in the late ’60s and early ’70s when my patients started coming back to me with damage I myself had caused—cancer of the thyroid from simple tonsil radiation therapy, vaginal cancer from prescribing the synthetic female hormone DES; I began to see how doctors abuse the trust patients place in them.
Are women to blame for accepting the sexism in male-dominated medicine?
I know there’s some feeling around that doctors merely mirror what they perceive to be a woman’s helplessness. My own suspicion of medical sexism is that it is heavily reinforced with the birth of a woman’s first baby. The obstetrician is alone with the new mother. He shows her the baby as if to say, “Look what I’ve done for you!” She lavishes gratitude on him, some of which would be better reserved for her husband. She’s tired and dependent then, and that’s where the chauvinistic syndrome of “There, there, dear, don’t worry your pretty little head” begins.
Will the increase of women doctors change anything?
No, because although 36 percent of medical students are now women, only two percent of faculty members are women. Basically, these women are being subjected to the same ridiculous and dangerous dogma as the men.
Are there any hopeful changes?
Yes. The AMA has abandoned its longtime advocacy of the annual physical exam. The American Cancer Society now says that for some patients Pap tests and mammography need not be performed annually. Valium prescriptions have dropped some 40 percent. The National Institutes of Health are cautioning against routine cesarean sections for women who have already had them. Home births have gone up from one percent to three percent since 1978, and the incidence of breast-fed babies is up to 68 percent. In short, women are wising up to their own health.
What do you say to physicians who deny they have immense power over women?
First I laugh. And then I ask them, “How many people can tell you to take off your clothes, and you do it?”