misdiagnosis article pic 2

The Consequences Of Medical Misdiagnosis

The Consequences Of Medical Misdiagnosis

How Sexism In The Healthcare Industry Is Hurting Women

WHAT YOU CAN DO...

  • Lobby for changes in medical school curriculums to move away from a solely diagnosis-oriented approach and teach doctors to not discount patients’ reports of pain by contacting the Association of American Medical Colleges https://www.aamc.org/

  • Spread awareness of this bias among healthcare providers by calling for more scrutiny from healthcare quality and ethical reviewers by contacting the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) https://www.jointcommission.org/report_a_complaint.aspx

  • Contact your Representative about including women in tests conducted by all healthcare organizations and expanding the NIH 1993 Act to ensure that female and male results are studied separately to allow for proper scrutiny and differentiation

By Josette Barrans

In America, there is an epidemic of women being systematically misdiagnosed by healthcare providers. Women are consistently not given strong enough medication or urgent enough care for their true conditions. Their pain is not taken as seriously as men’s, even being reduced to “female hysteria.'' Not only is this sexist, it forces women to endure more unnecessary pain or face even worse consequences. The last policy which attempted to address this issue was a section in the NIH Revitalization Act of 1993 in which Congress ordered the National Institute of Health to include women in all of its clinical trials[1]. But this did not solve the knowledge gap in women’s medicine. Most studies lump data from all participants together and fail to compare women’s and men’s results separately[2]. As a result, doctors are not focusing in on how women specifically are affected by certain diseases and conditions. Consequently, there are no current policies actively working to prevent the misdiagnosis epidemic affecting female patients. Additionally, drug companies and medical device manufacturers are not required to follow the 1993 rule, meaning women are not accurately represented in their studies[3]To solve this issue, policies are needed that address the knowledge gap of female health starting in medical school curriculums and extending to include women in studies conducted by all healthcare providers.

        In a recent report, a woman underwent eight rounds of electroconvulsive therapy (ECT) because she was misdiagnosed with severe depression and other psychiatric issues. This ECT was essentially forced upon her, despite the woman’s consistent protests that she didn’t have depression, and made her lose around six years of her memory. After continuously begging her doctors to reexamine her, they discovered that she had myalgic encephalomyelitis (ME/CFS), an autoimmune disease that affects many bodily systems. Though it can cause up to 60 differentsymptoms, ME/CFS is often ignored by doctors, with some even believing that it is fake[4]. Consequently, this woman was put through extreme pain and suffering simply due to the inability of her doctors to take her seriously. Her story is not a one-off; countless women in our nation needlessly suffer due to sexism embedded into America’s healthcare system which prevents them from obtaining the treatment they need.

        One prominent example of this epidemic is women suffering from chronic pain. These women are much more likely than men to be given sedative prescriptions rather than pain medication[5]. In fact, research has shown that women experience and report greater and more frequent pain than men[6]. Yet women are consistently treated for pain less aggressively since doctors often hold misperceptions that women are more prone to overreacting and hysteria[7]. This attitude seeps into public discourse as well, causing people to think that women are not accurate portrayers of their pain, essentially discrediting their knowledge of both themselves and their body. It is also typical for women with chronic pain to have no clearly definable conditions, which often leads to doctors taking the easy way out by diagnosing them with a mental health disorder[8]. This indifferent approach not only continues the suffering of the women in pain but  also delegitimizes mental health disorders by making them an extraneous category that women with no clear condition can be lumped into.

        Even more serious medical emergencies are consistently misdiagnosed in women. Women are seven times more likely than men to be misdiagnosed while suffering a heart attack and be discharged from the hospital during the emergency[9]. This can lead to lifelong repercussions or even death. One of the main causes of these mistakes is doctors being taught to recognize symptoms and make diagnoses based on understandings of male physiology. Since women can have completely different symptoms than men for many conditions, including heart attacks, many healthcare providers are not equipped to recognize them. This lack of knowledge costs women dearly. Considering that women represent over half the population, doctors should be taught how to perceive diseases and health issues in both women and men.

        There are many contributing factors for this problem that must be addressed. For instance, even though 78% of healthcare professionals are women, the higher positions are usually filled by men[10]. If more women were making these important decisions, there would likely be less misdiagnoses or dismissals of female patients. This disparity is likely a product of the gender discrimination that still exists in hiring practices, so healthcare organizations need to make a concious effort to make sure women are getting a seat at the table. There also need to be sweeping changes to how medical schools teach symptom recogniziation so that lessons always include both male and female versions of symptoms. There must be more emphasis on evidence-based diagnosis and general awareness of this gender bias in the medical field. Doctors should be trained to take what their patients say into account, and consider their reports of pain seriously. Furthermore, there must be more scrutiny from healthcare quality and ethical reviewers on this issue. One organization that oversees this is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits more than 21,000 US health care organizations. JCAHO has on online form where one can report a patient safety concern or event at a hospital, which could be used as a platform to draw attention to instances where gender bias prevent a woman from receiving proper care[11]. We must also call on Congress to extend their policies to force all healthcare organizations to include women in their studies so that their needs can be properly served.

        Doctors must start believing women and be more willing to admit that they may not be an expert on female symptoms instead of pushing false diagnosis and treatment on these patients. Bringing in specialists can easily solve most of these diagnostic problems, rather than searching for the quickest and easiest solution. Additionally, policies are needed that close the knowledge gap by forcing companies in all industries to include women in their studies and focus on their results and reactions separately from men. Clearly, the idea of a one-size-fits-all solution has been hurting women, as the standard of medicine is typically designed around men. Women are suffering, and even dying, because of sexist doctors and healthcare practices; this must be put to a stop.

 

 


[1] “Including Women and Minorities in Clinical Research Background.” National Institutes of Health, U.S. Department of Health and Human Services, 2019. https://orwh.od.nih.gov/research/clinical-research-trials/nih-inclusion-policy/including-women-and-minorities-clinical

[2] Sagon, Candy. “Women's Health Issues And Medical Gender Bias.” AARP, 2017, www.aarp.org/health/conditions-treatments/info-2016/womens-health-gender-bias-cs.html.

[3] Sagon.

[4] Hirsch, Michele Lent. “9 Rounds of Electroshock Therapy. 6 Years Lost. All Because Her Doctors Got It Horribly Wrong.” Cosmopolitan, Cosmopolitan, 22 Jan. 2019, www.cosmopolitan.com/health-fitness/a25362145/electroshock-therapy-misdiagnosis/.

[5] Kiesel, Laura. “Women and Pain: Disparities in Experience and Treatment.” Harvard Health Blog, Harvard Health Publishing, 7 Oct. 2017, www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562.

[6] Hoffmann, Diane E. and Tarzian, Anita J., The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain (2001). Journal of Law, Medicine & Ethics, Vol. 29, pp. 13-27, 2001. https://ssrn.com/abstract=383803

[7] Seegert, Liz. “Women More Often Misdiagnosed Because of Gaps in Trust and Knowledge.” Association of Health Care Journalists, 16 Nov. 2018, healthjournalism.org/blog/2018/11/women-more-often-misdiagnosed-because-of-gaps-in-trust-and-knowledge/.

[8] Hirsch.

[9] Kiesel.

[10] Joyce, Trish. “Does Healthcare Have a Gender Problem?” Health ECareers, Everyday Health Group, 24 Apr. 2018, www.healthecareers.com/article/healthcare-news/does-healthcare-have-a-gender-problem.

[11] “Report a Patient Safety Concern or Event.” Jointcommission.org, www.jointcommission.org/report_a_complaint.aspx.

gag rule article 5

The “Gag Rule”: Silencing The Right To Choose

The "Gag Rule": Silencing The Right To Choose

The Trump Administration's Attempt To Limit Women's Healthcare Access And Suppress Information About Their Health

WHAT YOU CAN DO...

By Josette Barrans

Throughout his campaign and administration, President Donald Trump has shown he does not care much about women’s rights. From his trivialization of sexual assault to his goal of overturning Roe v. Wade, it was clear that women would be in trouble once he took office. As expected, he has already enacted policies that violate women’s healthcare rights and he continues to chip away at their basic freedoms. Earlier this year, President Trump proposed the reinstatement of a decades old “gag rule” that would ban federally funded clinics from discussing abortion and preventive care[1]. Based on a policy first implemented by Ronald Reagan, the “gag rule” would also prevent clinics from sharing spaces with abortion providers as well as prevent health care providers from referring patients to clinics such as Planned Parenthood for safe and legal abortions[2]. Through this policy, women’s ability to access accurate information about their healthcare would be severely limited.

On May 30th, Trump appointed Dr. Diane Foley as the Deputy Assistant Secretary of Population Affairs for the Department of Health and Human Services[3]. Foley is a long-time anti-abortion activist who believes in abstinence-only education. Her position oversees Title X, the federal grant program dedicated to family planning and preventive health services. Essentially, Foley determines recipients of Title X funding as well as managing the U.S. birth control program. Planned Parenthood clinics are one of the current prominent recipients of Title X funding, but they are not allowed to use this money to fund actual abortions. Under current US law, abortion services cannot be provided by any organization using federal funds[4]. But, Planned Parenthood uses the funding they receive to provide a wide range of healthcare services to women. Under this gag rule, however, Planned Parenthood would be exempt from receiving any Title X funding and would subsequently be unable to serve Title X patients due to the nature of their organization. Though abortion related services only constitute one aspect of what Planned Parenthood does, their existence in the organization would block any other services from receiving funding.

Planned Parenthood immediately took action to publicly oppose and fight this proposal, as this policy clearly targets progressive family planning organizations such as themselves. Though they only make up 13% of health centers funded by Title X, Planned Parenthood serves 41% of patients who receive care through Title X[5]. With this in mind, a blow to Planned Parenthood’s ability to effectively serve patients would burden a large portion of Title X beneficiaries. This policy also has a great impact on poor and uninsured women, being the ones who mainly use Title X funded services, as they can’t afford any other options. In fact, almost two-thirds of patients who use Title X are below the federal poverty line[6]. Additionally, Title X recipients are disproportionately women of color[7]. As a result, a gag rule would prevent these women from receiving information about abortions from the only clinics they can afford to visit. This rule clearly violates the relationship between a patient and doctor, as doctors are supposed to provide patients with all of their medical options and expert recommendations. Being forced to withhold certain information based on partisan preferences in unlawful and unethical. This policy hurts over four million people served by Title X[8].

One woman described the impact Title X funding had on her life. When Rhea lost her job, and health insurance with it, Title X funding at Planned Parenthood was the only way she was able to afford life saving treatment for precancerous cells found in her Pap test[9]. Rhea represents stories from millions of women that illustrate how vital Title X funding is to both people and organizations. If Planned Parenthood is cut off from this funding by the new proposal and the gag rule is implemented, patients like Rhea will be limited in their treatment options and may not even be told about many life-saving procedures. Furthermore, Planned Parenthood is the only family planning organization and birth control provider in many remote areas. Therefore, Title X patients in these locations could be left with no healthcare services[10].

As lawsuits are not permitted until the policy is finalized, Planned Parenthood cannot officially sue Trump over this proposal until its final language is released. Nevertheless, Planned Parenthood has already sued the Trump administration for several other amendments to Title X guidelines made earlier this year, stating that the amendments violated federal laws as they were arbitrary and unfair[11]. These guidelines promoted abstinence-only education and alternative methods to contraception rather than birth control. It also gave funding advantages to organizations that work with community and faith-based groups. The judge sided with Trump in this case, however, meaning that Planned Parenthood is already at a disadvantage to continue to receive Title X funding. If this new gag rule were implemented, their organization’s mission would be further damaged.

Trump’s commitment to eliminating safe and legal abortions extends beyond the scope of the nation. On his fourth day in office, Trump used an executive order to implement a global gag rule[12]. This rule prevents the US government from contributing funds to any international organizations that provide abortions, related services, or even information about abortions. The fact that this was one of his first acts as president demonstrates Trump’s explicit targeting of women’s healthcare rights.

It is easy to see what Trump is actually trying to do: limit women’s access to birth control, other methods of contraception, and safe and legal abortions. He is likely promoting this agenda to appease his conservative and religious base, as there is a large block of single issue voters whose main priority is the implementation of pro-life policy. While his previous attempt to explicitly defund Planned Parenthood was unsuccessful, this proposal is an effective back-door method of achieving his goal. Americans must not let Trump use loopholes to implement his unethical policies. By blocking access to healthcare, Trump is risking the health and lives of women around the country.

 


[1] Planned Parenthood. “What Is the Trump-Pence Administration's ‘Gag Rule?".” Planned Parenthood Action Fund, National - PPACTION, 18 May 2018. https://www.plannedparenthoodaction.org/blog/what-is-the-domestic-gag-rule

[2] Planned Parenthood.

[3] Planned Parenthood. “DIY Speak Up for Planned Parenthood Toolkit.” Planned Parenthood, 2018. https://www.plannedparenthood.org/planned-parenthood-south-texas/diy-speak-planned-parenthood-toolkit.

[4]Siddiqui, Sabrina. “Trump Administration to Revive Reagan-Era Abortion 'Gag' Rule.” The Guardian, Guardian News and Media, 18 May 2018. https://www.theguardian.com/world/2018/may/18/trump-administration-abortion-gag-rule-reagan-era

[5]Durkee, Alison. “Judge Sides with Trump Administration in Planned Parenthood Title X Funding Lawsuit.” Mic, Mic Network Inc., 18 July 2018. https://mic.com/articles/190323/judge-sides-with-trump-administration-in-planned-parenthood-title-x-funding-lawsuit#.ZLTAQPPb3

[6]Rovner, Julie. “Trump Proposes Cutting Planned Parenthood Funds. What Does That Mean?” The Washington Post, WP Company, 22 May 2018. https://www.washingtonpost.com/national/health-science/trump-proposes-cutting-planned-parenthood-funds-what-does-that-mean/2018/05/22/76a3a568-5ade-11e8-9889-07bcc1327f4b_story.html?noredirect=on&utm_term=.85ca3ea4fc82

[7]J. Steinauer, P. Darney. Proposed changes to the Title X family planning program. Lancet, 392 (2018), p. E6. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31733-1/fulltext

[8]J. Steinauer.

[9] Rhea, Planned Parenthood patient. “Trump's Gag Rule Could Have Killed Me.” Planned Parenthood Action Fund, 2018. https://www.istandwithpp.org/trumps-gag-rule-could-have-killed-me-planned-parenthood-title-x?_ga=2.170338275.276421464.1546556242-2136533510.1542323762

[10] Rovner, Julie.

[11] Durkee, Alison.

[12]Starrs, Ann M. 2017. “The Trump global gag rule: An attack on US family planning and global health aid,” The Lancet 389(10068): 485–486. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30270-2/fulltext

dickey amendment

How The Prevention of Gun Violence Research Enables A Public Health Crisis

Dickey's Folly

How The Prevention of Gun Violence Research Enables A Public Health Crisis

WHAT YOU CAN DO...

  • Call your Representatives and ask them to repeal the Dickey Amendment and support the Gun Violence Research Act to restore CDC funding

By Josette Barrans

After the devastating Sandy Hook school shooting in 2012 that left 20 children and 6 staff members dead, President Obama ordered the Center for Disease Control and Prevention (CDC) to conduct research on gun violence and its causes. The call after such a terrible tragedy was “Never Again” and gun control advocates thought this would finally be enough to swing the partisan debate in their favor. Yet, since Sandy Hook, there have been 1,897 more mass shootings and zero studies conducted by the CDC on the causes of gun violence[1].

Considering that gun violence is one of the leading causes of death in the United States, one would assume this would be a public health issue of great importance to both the government and the public. However, the partisan connotations of this issue block any significant progress. Legal roadblocks instituted by pro-gun Republicans, such as the Dickey Amendment, have prevented significant research on gun control over the past 20 years. The Dickey Amendment was introduced by Arkansas representative Jay Dickey and added to the Omnibus Consolidated Appropriations Act of 1997. This amendment states, “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control”[2]. This amendment came in response to a study conducted by the CDC in the previous year showing that having a gun in the home correlated with a higher risk of homicide by a family member[3]. Though these study results were simply factual, the NRA accused the CDC of having an anti-gun bias and convinced congressional Republicans to take action. While the amendment only restricts the CDC from advocating for a certain position on gun violence rather than blocking research on the issue, its passage had underlying implications. The bill also took $2.6 million from the CDC’s budget, which was the exact amount the agency spent on gun violence injury research in the previous year[4]. This sent a clear message to the CDC: stop any and all research on gun violence. Without proper funding, the CDC has no motivation to take that leap of faith and defy the will of Congress. Additionally, the vagueness of what kind of research is permissible combined with the halt of new studies by the CDC discouraged any other organization from funding gun violence research for most of the last 20 years.

This amendment and the CDC’s inaction have gained increasing public opposition over time. In light of many recent shootings, especially the one in Parkland, many healthcare professionals are calling for more tangible solutions to this public health crisis, such as the repeal of the Dickey Amendment. Others are turning the blame to the CDC; in 2013 more than 100 scientists signed a letter that called on the CDC to continue research on gun violence that can identify effective solutions to the crisis[5].  Jay Dickey himself regrets the chilling effect his amendment had on gun violence research, having written an article in the Washington Post discussing the importance of taking steps to reduce gun violence in 2015[6].

The CDC and other healthcare organizations are eager to conduct this research as they face both internal and external pressures to produce tangible solutions.. At least 65% of healthcare providers view gun violence as a major public health threat and wish to take action[7]. Outside advocacy groups and prominent organizations, such as the American Psychological Association and Doctors for America, are calling for gun violence research as they are well aware of the human cost of gun violence. 

Gun violence also poses an internal threat to healthcare organizations, as the cost of it alone justifies its classification as a major public health issue. According to research reported in Mother Jones, the direct and indirect costs of gun violence range from $100 billion to $229 billion dollars per year, costing each American around $700 per year[8]. These estimates don’t even take into account all the long-term costs such as continued medical issues or counselling, as they are too extensive to track.  Furthermore, the results of a 2017 study showed that gun violence research received around 1.6% of the funding you would expect considering its impact on mortality when compared to other leading causes of death[9]. With this in mind, both Americans and insurance providers continue to bear the financial burden of gun violence failing to be classified as a public health epidemic.

The lack of government funding into gun violence prevents the healthcare industry from being able to effectively promote public health and safety. Healthcare providers have seen the real cost of gun violence and know action is needed but are unable to provide Congress with accurate data on the scope of this crisis.. The primary way politicians have been convinced to change their mind on public health issues throughout history was through the presentation of scientific research[10]. Regulations were only enacted on the tobacco industry when research showing an explicit link between smoking and lung cancer was presented to lawmakers. Therefore, Congress in unlikely to do anything about gun control without clear and convincing evidence that only the healthcare industry can provide.

There has been a recent movement on both sides of the aisle to clarify that the Dickey Amendment does not actually ban research in response to outrage at the policy, which has allowed some progress to occur. The National Institute of Health has conducted gun violence studies in recent years, as their much larger budget provides them with less fear of retaliation by members of Congress[11].  While critics have insulted the CDC for their lack of political courage, the CDC has recently acknowledged that they realize they are not actually restricted from conducting research, and will conduct this research as soon as the much-needed funding is allocated to them[12]Nonetheless, President Trump still failed to provide the CDC with funds or lift the ban on advocacy despite adding a provision to the spending bill clarifying that the CDC could conduct research into the causes of gun violence, essentially changing nothing[13]. These kinds of clarifications and amendments are being used by Republicans as a guise of compromise and neutrality toward the subject when their underlying goal clearly remains to scare organizations into silence and block research that will show the danger of guns, and healthcare organizations are still feeling this pressure to stay silent. Even if research into gun violence were conducted, the studies will inherently be considered partisan by pro-gun legislators. The study that caused Republicans to create this amendment in the first place was considered biased simply for showing an obvious factual link, and current study results will likely indicate the necessity of gun control once again. Therefore, Republicans could continue to use the Dickey Amendment to block the use of these findings as evidence in Congress.

While advocating for research funding should be a top priority of Americans, the chilling effect of the Dickey Amendment is still a problem and its repeal would likely empower many organizations to conduct research without fear of backlash. By discouraging research and withholding funding, politicians with ties to the NRA are ensuring that no gun control measures will be taken, thereby allowing more mass shootings to occur. A lack of research would surely result in stagnation, resulting in more lives lost. This can no longer be a political debate - it must be a factual one.

 

 


[1] Lopez, German, and Kavya Sukumar. “Mass Shootings since Sandy Hook, in One Map.” Vox.com, Vox Media, 9 July 2018, www.vox.com/a/mass-shootings-america-sandy-hook-gun-violence.

[2] Omnibus Consolidated Appropriations Act, Pub. L. No. 104-208 (1996).

[3] Rostron A. The Dickey Amendment on federal funding for research on gun violence: a legal dissection. Am J Public Health. 2018;108(7):865–867.

[4] Kellermann AL, Rivara FP. Silencing the Science on Gun Research. JAMA. 2013;309(6):549–550. doi:10.1001/jama.2012.208207

[5] Frankel, Todd C. “Why the CDC Still Isn't Researching Gun Violence, despite the Ban Being Lifted Two Years Ago.”The Washington Post, WP Company, 14 Jan. 2015, www.washingtonpost.com/news/storyline/wp/2015/01/14/why-the-cdc-still-isnt-researching-gun-violence-despite-the-ban-being-lifted-two-years-ago/?utm_term=.facf36580a24.

[6] Dickey, Jay, and Mark Rosenberg. “How to Protect Gun Rights While Reducing the Toll of Gun Violence.” The Washington Post, WP Company, 25 Dec. 2015, www.washingtonpost.com/opinions/time-for-collaboration-on-gun-research/2015/12/25/f989cd1a-a819-11e5-bff5-905b92f5f94b_story.html?utm_term=.65454b1ee8dd.

[7] Jimenez, Sallie. “Health Professionals Declare Gun Violence Public Health Threat.” Nursing News, Stories & Articles, Nurse.com, 31 July 2018, www.nurse.com/blog/2018/03/05/health-professionals-declare-gun-violence-a-public-health-threat/.

[8] Pamela Behrman, Colleen A Redding, Sheela Raja, Tamara Newton, Nisha Beharie, Destiny Printz; Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research, Translational Behavioral Medicine, , ibx040, https://doi.org/10.1093/tbm/ibx040

[9] Stark DE, Shah NH. Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. JAMA. 2017;317(1):84–85. doi:10.1001/jama.2016.16215

[10] Ansari, Sobia. “Why Should Health Care Professionals Care about Gun Control?” KevinMD.com, MedPage Today, 23 Apr. 2018, www.kevinmd.com/blog/2018/04/why-should-health-care-professionals-care-about-gun-control.html.

[11] Rubin R. Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It.JAMA. 2016;315(16):1689–1692. doi:10.1001/jama.2016.1707

[12] Frankel, Todd C.

[13] Greenfieldboyce, Nell. “Spending Bill Lets CDC Study Gun Violence; But Researchers Are Skeptical It Will Help.”NPR, NPR, 23 Mar. 2018.

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