How We’re Held Hostage by the Medical-Industrial Complex


Stephanie Mencimer doesn’t much like her annual ob-gyn exam. And medical research increasingly suggests that these annual rituals don’t really do much good. So she asked her doctor if she could just skip it this year. Answer: no. If you want your birth control pills, you have to come in for the exam whether you like it or not:

The doctor had me over a barrel. As it turns out, my experience isn’t unique. Doctors regularly hold women’s birth control prescriptions hostage like this, forcing them to come in for exams that research is increasingly showing are too frequent and often unnecessary and ineffective. A 2010 study published in the journal Obstetrics & Gynecology found that 33 percent of doctors always require a pelvic exam and Pap smear for a hormonal contraception prescription, and 44 percent regularly do so, even though there’s no medical reason for linking the two.

Indeed, there’s a growing body of evidence that the entire annual ob-gyn exam, with the mandatory and miserable pelvic exam where doctors poke around one’s uterus and ovaries with their fingers, is largely obsolete. For instance, there’s no evidence that doctors can diagnose ovarian cancer with a pelvic exam in women showing no symptoms. A clinical trial found that doctors were unable to identify any cancers in test subjects by pelvic exams alone, and the National Cancer Institute no longer recommends the tests for postmenopausal women. Even chlamydia screenings, which are recommended for women under 26 and those at higher risk for the sexually transmitted disease, can be done by simply having women pee in a cup, and don’t require an invasive and expensive exam.

The scientific basis for much of the traditional well-woman ob-gyn annual check-up is so slim that “the routine pelvic examination may be an example of more service leading to worse outcomes,” Dr. Carolyn Westhoff, an ob-gyn at Columbia University, wrote in the Journal of Women’s Health last year.

It’s worth reading the whole thing. And when you’re done, maybe it’s time once again to revisit the evidence that we should sidestep the whole problem by making contraceptives available over the counter. Plenty of other countries do.

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