Good evening, everybody. My name is Audrey Stewart and i am so pleased to welcome you one of the latest books by healthcare needs a feminist revolution. Joined tonight in conversation. We are kicking off a new series before we get started i want to let you know the culture of greed and jody and her and megan will discuss their coauthored a book she said breaking the Sexual Harassment story that has ignited a movement. We have a few tickets left for the ones of you are interested, check out the events sooner rather than later. Tonight we will take questions and have a signing at the table. If you havent already you can find a copy of everything below the waist at the register. We are pleased to have cspan book tv taping tonights event. When asking questions during the q a please know you are being recorded and please wait a moment before the microphone can come to you before you ask your question and i want to take a moment to say thank you for buying books from the bookstore. Your purchases support the theories and ensure the future of the local independent bookstores, so thank you and a final reminder to please silence your cell phones. Im so excited to introduce the speakers. An awardwinning independent journalist writing meeting at the intersection of feminism in her writing has appeared in the Washington Post magazine, new york newsweek new york times, la times and many others. Her book explores a womans right to choose how she gives birth as well as the issues within the industry of Public Health. Tonight these pioneers are discussing everything below the waist. This is crucial addressing one of the most important aspects the Washington Post called this a must read for women especially anyone in whoever might need to be a doctor. All of these are in agreement they say read this book the information is essential, the Healthcare System must change and with that labe i will at the office do the talking. Thank you for being here. Hello, everyone. Thank you for being here. Im going to read a little bit from the introduction the problem wit with nader debate, dissent is empowerment. In california a woman returns to the clinic where she had an iud inserted. I went from a happygolucky to a depressed walking zombie in just three weeks. The clinician refuses told her she doesnt think it is a good idea, tells her to wait six months, says what happens when you have an abortion. After missing her case and being denied multiple times competition shaking with anger turns to request into a demand, so the clinician rolls her eyes, takes the device out and leaves the exam room. In new jersey a woman having her second baby is nine out of 10 centimeters dilated hands and knees with her midwife when the obstetrician on call enters the room, asks about the womans previous delivery and tells her she needs a csection this time and when the woman asked questions for doctor threatens to call legal people if she doesnt sign a consent form for surgery. In minneapolis a 46yearold woman at a Medical Center has robotic minimally invasive hysterectomy. Two months later she has concerning symptoms, pain, elevated heart rate, increased respiration. A doctors note anxiety in her chart and enlisted ativan in her ivy without permission. Two days later she wakes up in d became so unbearable she calls for an ambulance. It turns out her intestines had been damaged from surgery. You may already be familiar with a version of the story womens medical care, woman is ignored, woman has to fight. The patientdoctor relationship is among the most sacred. We surrender our modesty and trust physicians especially our ob gyn with our needs and vulnerabilities. In return we expect expertise and respect. Elizabeth blackwell to get a medical degree of gender power and balance and advocated for womens equal representation. It isnt only about what women will do in medicine but also the influence they will exert she lectured in 1959. Today half of our medical students but another goround is no more secure either is our health. The report found the Life Expectancy has risen and women are dying at younger ages than international peers. Its kind that has been worsening. In the years it is worse than men and worse than the previous generation. The 2013 study found that doctors enter adulthood greater risk for the development. In 42 of counties womens Life Expectancy is decreasing. Fact, havent we come a long way from where Cervical Cancer was the number one cause of cancer and the days when Breast Cancer and more awareness, havent we conquered this and arent we already more flexible, shouldnt women have more power now in medicine and the society at large . One can parse the International Differences we know the more toxic environmental is and lack of care and health care as a driver in the industrialized world. Another explanation black women are more likely to die of heart disease, Breast Cancer and pregnancy. However researchers try to determine why its a stress are caused by the daily wear and tear. Health disparities are true. But why was our health slipping when women in the United States have more doctors, surgeries and more prescriptions than men, bias is a problem when in having heart attacks and strokes or was likely to be misguided as diagnosed by er doctors. Women concluded a 27 article are more likely to be misdiagnosed and pretty much any medical situation. Hormones are a problem not necessarily our own but the chemicals everything from motion to tap water. Research on them is also a problem, for example autoimmune disorders affect 20 of the population depending on how many you put them t on a begin blockd some studies [inaudible] it claims a fraction of investigative efforts. Another problem has emerged, too much treatment. In overdiagnosis and overtreatment women are now more vulnerable than men and recommend scans and drugs to treat and machines, diagnosis and treatment for all manufacturers of the industry. The screening came in early 2000 and 80 of them dont do surgeries. They are equally represented and more likely to see a prescribed antidepressant and antipsychotic and recommended electroconvulsive therapy. They are also more likely to be prescribed opioids and 40 more likely to become dependent on them. We are prescribed for drugs and recommended more surgery. In particular, a lot of surgery on our sex organs. For the past several years roughly one third had major surgery that carries serious shortcomings longterm risk to the baby and the mother particularly for future pregnancies. Some of the operations are necessary, many are not. There is a statistical threshold at which the harm outweighs the benefits and Public Health authorities agree that the rate of 32 we are well above the threshold. This raises questions on only of appropriateness to consent. The hospital in Miami Florida women are given more csections and hundreds of hospitals if women have had a previous cesarean or they are carrying a baby in breech position weve no choice but to surgery. At least the scenari this scenan getting more attention recently way that standards very and counties and even individual hospitals and why so many mothers and why countries with better outcomes. In this book i ask similar questions about other things like utility treatment, contraception, Pelvic Surgery to the way miscarriages were handled as one physician put it to me, quote, covering up the symptoms, bypassing the normal functions or removing is generally the treatment protocol and i will leave it there. That opens up some obvious conversation. [applause] that was stressful. [laughter] i have a lot of big central questions to talk to you about but i do want to start there though because it is probably on everybodys mind the uncomfortable but necessary things is the feeling of not knowing who to trust about medical expertise but about health expertise. Like you hear stories of people following folk remedies that are terrible and there are many in the book about the medical industry. I wonder if you can give a little guidance on how to know what the information looks like or what trustworthy conveyors of information like an expert lets say about womens health. What do you look for in information or a person that refers to the United States whether they are focused. That is definitely an interesting place to start because the question of experts and expertise historically has been about 100, 150 years medical doctors have been experts on health care so i think its interesting to put that in context because we have a long history and in the culture they have the state of knowledge. There might be some people in here in the room tonight as well as from the new advisor foundation. One of the important movements was okay, but the cold or is but lets look at the history of how they came into power and control information and the conflict of interest and that the biases in history of medicine is all wrapped up. It is an ugly history and one of the things the movement said we will get back to you in the book about. First of all lets look at our own experiences because what we are reading in textbooks is just one source of information so today we have a totally different situation. It was difficult to get pictur pictures. I cant even imagine and now we have the internet. One side says this is dangerous. One of the things youre going to accompany what do you look for . Who did you know what sources are trustworthy . A uterine massage therapist who i found is to something most physicians dont understand you can barely find the literature about this and i was directed to things like ive had horrible painful. Since i was 17 and i went to this person who removed my uterus and told me exercise [inaudible] that is powerful information and is there an evidencebased medicine, no, are there possible side effects . Yes but some people are not finding everything they needed to treat the problems. They are doing all sorts of things and the bottom line is we dont know what works for everyone. I would say great who are the experts and what is the source of information. Im not scared of that. Ithis keeps coming up in my twitter feed. I mean i am scared of this association to buy some elaborate outfit as a great cost to you that maybe you cant afford. I think its important to look back at medical reversals that are believed to be the right thing to do we could talk about so many things in the book but episiotomy, women were told for decades this will prevent bad tearing. The women worried about this were like that doesnt make any sense. If you cut a piece of material and pull on it because they just intuitively thought this is an idea we can be doing this than they have women around home letting them move around and lo and behold they didnt care. But its not just decades. Michael klein who happens to be the father of naomi klein in this randomized controlled trial shows that its going to cause more harm we are still dealing with this and work against Expert Opinion i still think it is a question of yes, class potential for harm. Its just sort of a condensed. It starts down here and ends over here. We were talking about it this morning saying the inaction of the payroll is like an issue of everything in the book. Its been a difficult conversation. I want to preface this by saying when it became available it was completely different. Abortion was illegal and dangerous you needed a ring on your finger so it was a completely different world and when the pill became available it was very revolutionary on the question of control over their lives. Today i think the world is different and we have a lot more information about the impact without having an ovulatory cycle. There is a lot of research now showing how it has an effect on metabolism and bone density, Mental Health is emerging. Sexuality and response. We have a lot more information about it. One thing i noticed thereve been a couple of books in recent years im thinking of in our control that reaction not just say that there are not problems that the reaction was outside and people assumed she had an abortion. Hormonal contraception isnt just a pill now. It has impact on the quality of our lives and i dont think that we have had a good conversation about it. I did the rain i thought it was the blows. [inaudible] i was crying like dont leave me. I felt like i was just a crazy person. I was on the pill for like seven years mostly for my acne. I think that often times ive pointed out theres a lot of discussion from this critique the conversations end up putting us against each other instead of opening up options and information. How do we have these Difficult Conversations about what we know and we dont know without [inaudible] both of those things are true and the other is more true. The pill liberated women in a lot of ways that are real and also it is sold via china and pharma companies. So, how do we in a way that doesnt just have us squabbling with each other . I think we can handle all the information. So talk about the bigger picture. So can we talk about the good information people give us. It with that contraceptive in plant. And in a trial but enough pile one and of people talk to the media and it started as small numbers. Then to say im having the same problem. But talk about the stories. Can you explain this . You can do it better than i can. We are looking for changes that indicate cancer or precancer or so if you have cim to then you should get the cells removed and with this deceit loan procedure it is a small cut it is the excision of the cells. And that is the research that i wanted to do as the writer. And she talks to a significant amount of people of those capabilities following the procedure and never got it back or not for a few years. And to talk to some experts who said we think this is happening because you have nerves in the cervix. But to map out the clutter and said it has a role. So there is a lot more anatomy. But that the uterus does things during orgasm. So now we are at the level of anecdotal to put it together the physiology and there is a big backlash online from some ob gyns on twitter. This article was irresponsible and dangerous and could scare women away from this lifesaving procedure. I just kept saying cant we handle all this information . If i have something that dangerous in my body that it is cryotherapy then i want to know all the information. But also what was so chilling to me as some psychologist saying so what if this is a side effect . We saved her life. But we would never say that. But the journalist points out there was a similar issue with Prostate Cancer they figured out how to do that so it doesnt impact sexual response. So its not to do it but how do we do it safely because all of those were unaware the nerves were in the cervix but nobody was thinking of the woman as an actual human otherwise does she have cancer. That reminded me what i was doing research there are so many overlapping themes about sexual response or how poorly educated they are about dealing with sexuality. That there was a study i found that shows most women they got Breast Reconstruction are not informed that they could lose nipple sensation. The focus is if it will look and feel real to somebody else instead of you may lose sensation you may prefer to have your nipple with no breast tissue and that with medical science as a whole because there are professionals out there but they dont conceive of us as having that inherent Human Dignity to know at least what the risks are that something is value that they should value what we might value. Right and it hasnt been a question so to talk about the Actual Research on the impact for women for their sexuality there has been very little. And if you want to why we dont have a male tell because i actually designed studies 20 questions how that would affect their sexual response its also not how they decide designed them looking at peoples experience postfix loan hysterectomy. We have city showing there is no effect but the studies only follow them one or two years and then say they ask about frequency so again going back and what information do we trust so what is the initial question . I want to ask you 20 more questions but also people came out to get a chance to get into the conversation. Im sure youve noticed the cameras unless you are in the front row please speak up. I was thinking about. [inaudible] but they use to talk about csections in the same way. And it is directly related to what we are saying. So with that quality and experience when the trust is broken with the system and when that measure is indicated how things will start happening to her. [inaudible] i want to add one specific thing that i forget what the issue is here in the book but there are some where you find trends of men who have similar biological issues how that broken trust even more than women. Its not exclusively an issue for women but that does have a huge health impact. That is such an important aspect for quite a year at the school of Public Health but it is a big question because i was invited on podcast they are promoting unassisted birth to saying no to a midwife even. But they are so distrustful of someone that they perceive as a conflict of interest. Do it by yourself you are better off. And the research pretty clearly shows if you have access to emergency care. When it is not that big of an issue you could be home and taken to the hospital but you need access to emergency care. I understand why that trust has been broken because there are people who have had a cesarean and could not get the ebay ac and then had to have another cesarean and then do not think that they could survive another surgery. Nobody is helping me no doctors healthy me know midwife is helping me. That is the reality and the consequence of our broken system or the patient not retaining true autonomy because they said i know the risk of having to prior csections but i cannot have another planned want to have to have a imaginal birth. We support her. As a midwife they should be able to do that whether hospital policy or insurance policy, a lot of them cant so i think the fixes are on the system side because truly it is on consent. That we dont Call Child Protective Services which happens or we dont try to get the court order.