Advantage, Obama as voting begins in the US

The opinion polls have hardened in favour of the President in the last days of the campaign.

The US goes to the polls today with Barack Obama on the brink of an historic re-election. After a brutal campaign in which the Romney and Obama camps have spent an estimated $6bn between them, making this race comfortably the most expensive election in history, the two candidates are separated by just over one per cent in the national opinion polls. However, Obama holds slight leads in most of the key swing states, including the perennial bellwether state of Ohio. Of the states picked up by Obama against John McCain in 2008, Romney holds poll leads in just Indiana and North Carolina, with Florida and Virginia in a dead-heat.

The two candidates have splurged over $700m on television adverts, most of them negative, in the battleground states. Aside from the presidency, the entire House of Representatives, 34 Senators and 11 governors will be decided today. However, after months of intense campaigning, little is expected to change. The Democrats are poised to retain a narrow majority in the Senate, with the Republicans unlikely to pick up the four seats it needs to take control. In Missouri, Republican candidate Todd Aikin, whose comments about "legitimate rape" rarely leading to pregnancy sparked widespread outrage, is However, the huge gains GOP gains on the back of the Tea Party campaign are not expected to be wiped out, with the Democrats set to fall well short of the 25 gains needed to take a majority in the House of Representatives.

The political deadlock that has existed since the Republicans took control of the House in 2010 is set to continue. In truth, US politics is more divided than it has been for a generation. Despite committing a series of media gaffes, the most notorious being a secretly-filmed video of Romney dismissing the "47 per cent of electors who don't pay income tax and won't vote for me", the former Massachusetts governor has remained in contention. In particular, the Romney campaign was energised by a strong performance against a lacklustre Obama in the first Presidential debate on 3 October. However, after recovering in the final two debates. An opinion poll released over the weekend by the Washington Post found that 79 per cent rated Obama's response to Hurricane Sandy, which ripped through north-eastern America last week, as excellent or good. The President has since been bolstered by October's employment statistics showing that 171,000 jobs had been added to the economy.

Even small factors such as the weather - the forecast for Florida promises rain on Tuesday - may come into play as the party machines complete their 'get out the vote' programmes. However, turnout is expected to be up to five per cent lower than the 57 per cent seen in 2008.

Volunteers at the Romney office in St Petersburg maintain an upbeat demeanour, with a chart on the wall showing the numbers from the minority of favourable opinion polls. But the mood is brittle. Canvassers say they are "scared for their country". One lady tells me that "Obama-care forcing everybody to be equal is just wrong", complaining that the new healthcare regime would force Catholic charities to offer abortions and birth control. She says that she and her husband had to sell their home to pay rising medical bills 'but that's how it works" and proudly states that no Congressional Republicans voted for the bill.

The antipathy to their opponents is not reserved to Republicans. Victoria Yeroian, Young Democrats President at Virginia Commonwealth university in Richmond, describes the Tea Party to me as "an organised version of the Ku Klux Klan".

Democrat party operatives in Virginia and Florida have been in full lock-down mode when it comes to speaking to journalists but seem quietly confident amid the bustle of campaigning activity. The opinion polls have hardened in favour of the President in the last few days, and Democrats have been cheered by New York Times's uber-pollster Nate Silver, who projected a comfortable Obama win on Monday night, placing the vital bellwether state of Ohio, along with Florida and Virginia, in the Democrat column. Silver's formula puts a 92 per cent likelihood on Obama being re-elected, estimating that the President will claim between 310-315 electoral college votes.

As ever, attention will focus on the three big swing states - Pennsylvania, Ohio and Florida. No Republican has ever won the keys to the White House without claiming Ohio, but Romney needs to claim the Buckeye State and either Florida or a clutch of smaller swing states. The world is watching as America votes.

Ben Fox is a political reporter for EU Observer.

Barack Obama calls volunteers as he visits a campaign office in Columbus, Ohio. Photograph: Getty Images.
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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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