I became a sick woman 10 years ago. In October 2010, the cause of the strange pain that had haunted me for years was finally uncovered and I was diagnosed with systemic lupus erythematosus (SLE), a chronic autoimmune disease, the most common form of lupus. Ninety percent of the estimated 3.5 million people who have it are women. Like many other autoimmune and chronic diseases that disproportionately affect women – including multiple sclerosis, Graves’ disease, myasthenia gravis, rheumatoid arthritis, and endometriosis – SLE is incurable and its cause is not fully understood.
In the years since my diagnosis, as I learned to live with my mysterious, unpredictable disease, I looked for answers through my medical history. Unwell women, like so many Russian nesting dolls, emerged from the annals of medicine. Their medical histories often followed similar patterns: childhood illnesses, years of pain and mysterious symptoms, and repeated misdiagnosis. These women were part of my story. But the observations of their disorders and symptoms in clinical trials told only a fraction of their stories. Notes on their cases gave clues about their bodies but said nothing about what it meant to live in them.
I tried to imagine what it felt like to be a sick woman struggling with a disease that defied medical understanding at these different points in history. I felt a close relationship; we shared the same basic biology. What has changed over time is not the female body, but medicine’s understanding of it.
The author, who suffers from the most common form of lupus, was photographed at her home on June 8th.
Photo:
Dylan Thomas for the Wall Street Journal
Specters of doubt and discrimination have haunted medical treatises on women’s health since ancient Greece. The authors of the Hippocratic Corpus, the fundamental treatise of Western medical practice, spoke of the “inexperience and ignorance” of women about their bodies and their diseases. In the 17th century, hysteria emerged as an explanation for a variety of symptoms and illnesses in women. Derived from the ancient Greek word hystera, which means uterus, it was originally believed that hysteria originated from the reproductive organs, which have been considered the source of many female diseases since the Hippocratic era.
In the 19th century, female hysteria “took center stage” and “became the explicit topic of numerous medical texts”, especially when the cause of an illness was not immediately apparent, wrote the British medical historian Roy Porter in “Hysteria Beyond Freud”. . “As the cultural critic Elaine Showalter has shown in her influential story” The Female Malady “, well-known doctors and psychiatrists of the time linked hysteria with the perceived tendency of women to fabricate symptoms for attention and sympathy.
Prejudices about the body, mind and life of women have cast a long shadow over modern clinical and biomedical knowledge. Graves’ disease, an autoimmune thyroid disease that affects 70-80% more women than men, had “female nervousness” in its earliest descriptions in 1835 and was even labeled psychosomatic, even after its autoimmune causality was discovered in 1956. Many women with myasthenia gravis, an autoimmune neuromuscular disease first mentioned in 1877, were diagnosed as mentally ill and dismissed as hypochondriac until the 20th century. Multiple sclerosis has been known to be more common in women since the 1940s, but this prevalence has long been obscured by the assumption that the neurological and motor disorders in women are nervous or hysterical.
In 1955, chronic disease specialists at Johns Hopkins revealed that in the past decade, several women who were eventually diagnosed with lupus had undergone unnecessary psychiatric and surgical procedures – including electroshock therapy, insulin coma, and hysterectomy – after doctors resolved their chronic physical pain misdiagnosed as a symptom of emotional instability. Ulcerative colitis, a chronic bowel disease that affects the reproductive and sexual functions of women in poorly understood ways, has historically been considered to be caused by psychological distress. The recommended treatment for patients in the 1950s was prefrontal lobotomy.
“
As a result of a groundbreaking study in 2001, the gender pain gap was widely recognized only a generation ago.
”
Until almost the end of the 20th century, clinical studies and biomedical research relied disproportionately on male subjects and male laboratory animal models. US law of 1993 required the appropriate involvement of women and minority members in projects funded by the National Institutes of Health. This led, for example, to the first large-scale research on the preventive effects of aspirin on cardiovascular disease in women; previous studies had only men enrolled.
As a result of the groundbreaking 2001 study, The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain, the gender pain gap was generally recognized only a generation ago. Based on clinical data and sociological research collected since the 1970s, authors Diane Hoffmann and Anita Tarzian, academics in medical ethics and health law at the University of Maryland, showed that women were more likely to be prescribed sedatives and antidepressants than referred for further diagnostic referral Chronic pain self-assessment tests. They attributed this inequality to the fact that female pain is “more emotional and therefore less believable”.
Recently, a Swedish team analyzed research on gender and pain, published in the US, UK and Europe since 2001, and concluded that women’s pain is still more “psychologized” and “taken less seriously” than that of men .
Reports from 2019 and 2020 from two related teams based in Toronto analyzed studies on the treatment of heart disease and depression and found that women received fewer referrals and procedures than men. Women were also more likely to describe poor communication with their doctors. The reports suggested that the development of specific “patient-centered” treatment regimens in treating women, including training clinicians in “active listening” and “asking questions”, could change the dynamics, but there has been little practical research into introducing them Practices.
One ray of hope is the increasing number of female doctors. Women themselves report better outcomes in diagnosis and treatment when they are cared for by female doctors, and female patients are more likely to survive a heart attack if their doctors are female, according to a 2018 report by the National Academy of Sciences. Although the number of men among active US doctors remains higher than that of women, women made up 36.6% of the field in 2019, an increase of 8 percentage points from 2007.
SHARE YOUR THOUGHTS
Have you, family or friends seen that women’s complaints are dismissed too quickly compared to men? Join the conversation below.
Last year, the Covid-19 pandemic demonstrated the importance of integrating gender differences into medical research. Studies show that women, especially over 55, are more likely to experience persistent post-viral symptoms such as shortness of breath, fatigue, and brain fog. Women also seem to experience more side effects after vaccination, including some that are life-threatening, but the extent and severity of possible risks are not yet known.
Today, the exact reasons for the gender inequality in the incidence of my disease, SLE, are still largely mysterious, although researchers recognized its prevalence in women more than a century ago. More research is urgently needed to understand how and why confusing chronic and immune-mediated diseases and conditions affect women in far greater numbers, but women must also be valued as accurate reporters of their own experiences of pain and illness. Many of the answers lie in the bodies of women and in the stories their bodies have been writing for centuries.
—This essay is adapted from Ms. Cleghorn’s new book “Unwell Women: Misdiagnosis and Myth in a Man-Made World” (Dutton).
Copyright © 2020 Dow Jones & Company, Inc. All rights reserved. 87990cbe856818d5eddac44c7b1cdeb8
source https://dailyhealthynews.ca/medicines-failure-with-women-in-pain/
No comments:
Post a Comment