American Medical Association Archives

Was the abortion debate really going on four hundred+ years ago? Indeed. And who knew?

As it turns out, Donald Foster knew. Foster, Jean Webster Chair Professor of English at Vassar College, knows a lot about an astonishing range of things – Jon Benet Ramsey’s possible murderer, the “Anonymous” author of Primary Colors (Joe Klein), Unabomber Ted Kacynzki, Shakespeare – and women’s medicine in the sixteenth century. The first three of those instances of Foster’s endeavors – he provided expert help on all three cases – explain his sometime ID as a “forensic linguist;” the fourth relates to his day job. His day job also covers almost all things literary.

This writer’s esteem for the distinguished professor is of course unrelated to the email he sent which began, and I quote, “Let’s hear three cheers and see three billion readers for Perilous Times.” Well, maybe just a teeny bit. But an opportunity to reinforce the argument for women’s reproductive rights with the scholarly writings of a Vassar professor is not to be ignored.

This essay, henceforth, is shamelessly lifted from an attachment to the above email, excerpted from Volume 2 (pp.355-360) of Foster’s four-volume Women’s Works, a study of the issue covering the years from 900 to 1650.

Abortion, which was decidedly a part of women’s works, was also part of the debate all those centuries ago, beginning (if not earlier) with the “herb-wives – women who supplied the herbs and spices used for health care.” Women not only nursed those who were ill, we learn from Foster’s extensively documented studies, “they supplied much of the medicine, or physic.” They passed along their knowledge and skills from generation to generation, and were appreciated more by some than by others. Foster quotes Robert Green’s Quip for an Upstart Courtier in which a poor man mocks a wealthy lord: “I make my wife my doctor, and my garden, my apot’ecary shop – whereas Master Velvet-Breeches cannot have a fart awry, but he must have his purgations, pills and clysters, or evacuate by electuaries…” (It gets worse, but you’ll have to read the book.)

Getting to the specifics, Foster tells us “It will come as a surprise to some modern readers that there was enormous demand, throughout the medieval, Tudor and Stuart periods, for abortifacient herbs, with many effective recipes and a plentiful supply.” As reported in John Gerard’s Herbal (1597), a handful of herbs seemed to have taken care of the conception needs of barren women, whereas there were “more than sixty herbs used to induce menstruation after one or two missed periods. Not all of the treatments that he names were reliably effective, and some were dangerous, bringing a risk of hemorrhage and death if taken in too strong a dosage.”

Does this sound familiar? If not, we respectfully refer you to the stories in Perilous Times: an inside look at abortion before – and after – Roe v Wade, of women in 20^th — and 21^st – century America who, denied access to safe procedures, wind up dying in back alleys or emergency rooms. The abortifacients have, sometimes, fancier names in the case of contemporary drugs, but taken without proper advice or supervision can leave women with unwanted pregnancies today just as dead as their sisters in Tudor England.

In the same Volume 2 of Women’s Works, Foster offers an historical perspective of the root of the abortion debate, which seems unchanged over the centuries: do rights of the fetus prevail over those of the woman, and whose theology says what? “For the first seventeen centuries of Christianity,” he writes, “no authority of record, either Catholic or Protestant, taught or suggested that the fetus during the first two or three months after insemination was a human being. Ensoulment or quickening was an act of God: in His own good time – typically, in the third or fourth month – God infused the dormant seed with a human soul, created ex nihilo.” About the ensoulment business, Foster adds, “it was deemed an essential point of Christian ontology that the individual life was created by an act of the Almighty in Heaven and not by a horizontal act of the parents.”

God, in other words, probably wouldn’t back the 20-week ban. This writer is disinclined to get into theological argument (despite wishing today’s politics could be dictated by medical science rather than conservative religion.) But you are again referred to the “What’s God Got To Do With It?” chapter of Perilous Times. Or to pages 357 – 360 Vol. 2 of Women’s Works, for a fascinating overview of how assorted popes and Anglicans (“About the sixth month the immortal soul is infused,” wrote Rev. Christopher Carlile in the 16^th century) changed the rules and differed in opinions. Which also sounds familiar.

In 1856, Foster tells us, “Dr. Horatio Storer organized a national drive by the American Medical Association to end legal abortion altogether.” His efforts resulted in actions by the various states and territories to strengthen laws against abortion, and by 1880 there were restrictive laws and practices virtually everywhere mandating that a woman, once impregnated, had no safe or legal means to alter the course of what was going on with her body.

Leaping ahead to 2014, has any progress been made in the name of women’s reproductive justice?

We don’t talk a lot about not treating cancer. But as mentioned recently in this space, leaving it the heck alone is an option that merits consideration, particularly in the case of breast and prostate cancers detected very early on. Now comes further news, reported by New York Times health writer Gina Kolata, of studies showing that some other cancers might also go away by themselves.

Call it the arrow of cancer. Like the arrow of time, it was supposed to point in one direction. Cancers grew and worsened.

But as a paper in The Journal of the American Medical Association noted last week, data from more than two decades of screening for breast and prostate cancer call that view into question. Besides finding tumors that would be lethal if left untreated, screening appears to be finding many small tumors that would not be a problem if they were left alone, undiscovered by screening. They were destined to stop growing on their own or shrink, or even, at least in the case of some breast cancers, disappear.

The Times article cites studies of testicular, cervical, kidney and other cancers that suggest some, left untreated, might simply go away; the trick now is to begin identifying which these would be.

I don’t know anyone who would opt out of treatment when it is likely to offer restored health. But especially for older populations, the choice of not treating a small cancer could be more frequently and seriously discussed.

Cancer cells and precancerous cells are so common that nearly everyone by middle age or old age is riddled with them, said Thea Tlsty, a professor of pathology at the University of California, San Francisco. That was discovered in autopsy studies of people who died of other causes, with no idea that they had cancer cells or precancerous cells. They did not have large tumors or symptoms of cancer. “The really interesting question,” Dr. Tlsty said, “is not so much why do we get cancer as why don’t we get cancer?”The earlier a cell is in its path toward an aggressive cancer, researchers say, the more likely it is to reverse course. So, for example, cells that are early precursors of cervical cancer are likely to revert. One study found that 60 percent of precancerous cervical cells, found with Pap tests, revert to normal within a year; 90 percent revert within three years.

And the dynamic process of cancer development appears to be the reason that screening for breast cancer or prostate cancer finds huge numbers of early cancers without a corresponding decline in late stage cancers.

If every one of those early cancers were destined to turn into an advanced cancer, then the total number of cancers should be the same after screening is introduced, but the increase in early cancers should be balanced by a decrease in advanced cancers.

That has not happened with screening for breast and prostate cancer. So the hypothesis is that many early cancers go nowhere. And, with breast cancer, there is indirect evidence that some actually disappear.

A sister who is six years older than I was diagnosed with breast cancer at 72, had a mastectomy and is cancer free. Six years later I was diagnosed with breast cancer, had a mastectomy and am cancer free. Last week I visited a college classmate who had been diagnosed two weeks ago with breast cancer; she had a mastectomy and is cancer free. Cancer free is good. But what if — just what if — one of those cancers might have disappeared without major surgery?

Disappearing tumors are well known in testicular cancer. Dr. Jonathan Epstein at Johns Hopkins says it does not happen often, but it happens.

It is harder to document disappearing prostate cancers; researchers say they doubt it happens. Instead, they say, it seems as if many cancers start to grow then stop or grow very slowly, as has been shown in studies like one now being done at Johns Hopkins. When men have small tumors with cells that do not look terribly deranged, doctors at Johns Hopkins offer them an option of “active surveillance.” They can forgo having their prostates removed or destroyed and be followed with biopsies. If their cancer progresses, they can then have their prostates removed.

Almost no one agrees to such a plan. “Most men want it out,” Dr. Epstein said. But, still, the researchers have found about 450 men in the past four or five years who chose active surveillance. By contrast, 1,000 a year have their prostates removed at Johns Hopkins. From following those men who chose not to be treated, the investigators discovered that only about 20 percent to 30 percent of those small tumors progressed. And many that did progress still did not look particularly dangerous, although once the cancers started to grow the men had their prostates removed.

In Canada, researchers are doing a similar study with small kidney cancers, among the few cancers that are reported to regress occasionally, even when far advanced.

One of the things we post-mastectomy women were talking about last week was how we might handle a recurrence. The reality is, as we have all already proved: you live long enough, you get stuff. Maybe someone at Johns Hopkins (or elsewhere; Kaiser San Francisco would suit me fine) will undertake a study in which older women with small breast cancers can opt for “active surveillance” rather than major surgery. Should I qualify, I would enroll. To this admittedly untrained and unscientific survivor it seems a study whose time has come.

Cancers Can Vanish Without Treatment, but How? – NYTimes.com.

Tag: American Medical Association

Abortion, Four centuries later…

Leaving Cancer Alone