S06.E21: Bias in Medicine

[PrincessPurrsALot]

Riots in Hong Kong; Greenland not for sale; gender-based bias in medicine.

Original air date 2019.08.18

[Annber03]

"I'd like to speak to your supervisor." Yep, that'll do it, all right :D. Great ending (also, I am definitely referring to it as Ibu-fucking-profen from now on, thank you, Wanda). 

Good lord, "pesky hormones"? It never ceases to amaze me how men will act all tough and badass in virtually every situation imaginable, will brag about their injuries to anyone in earshot, and take pride in their scars and things of that sort...but the moment the subject of menstruation comes up, suddenly they get all squirmy and weird and uncomfortable. We can clearly see the effects of ignorance on how women's bodies work in how it affects the laws our politicians make regarding women's health issues. This stuff has far-reaching effects and it's well past time for men to grow the hell up and educate themselves. 

And that nursing book. Dear god. If I didn't know better, I'd swear that was written in the 1800s and nobody bothered to update it at any point. That poor husband who lost his wife. The fact that he felt too scared to even try and speak up and express his genuine anger and frustration because of how it might look is just... I hope, if he can find some way to get the necessary answers and justice for his wife's death, he's able to do so. He deserves that. 

As for other topics...*Sighs at Trump, as always, and cheers on the protesters in Hong Kong*

Sucks that there's another break coming. 

[ahisma]

Pumpkin Spice Spam?! This truly is the darkest timeline. 

Wanda Sykes is a national treasure—I love that John got her! The circumstances, though, are horrifying. This is one of the major reasons why the “America is #1” jingoists can take a flying leap.

[Annber03]

11 minutes ago, ahisma said:

This is one of the major reasons why the “America is #1” jingoists can take a flying leap.

It'd be really interesting to throw that information about our high mortality rate at them. I'd be both very curious and very scared to see what their response would be. 

[swanpride]

Not living in the US but I can confirm this. I am currently looking for a new doctor whose solution for my problem (which is an unexplained constant lack of Iron while also being unable to stomach Iron tablets) is NOT "have you been to your woman's doctor?"

[BabyVegas]

To answer that one guy's question: it's called a pumpkin spice latte despite not having any pumpkin in it because the flavoring in the latte is the same flavoring as the spices used in pumpkin pie. Also, Starbucks has the stuff for a pumpkin spice latte all year round. People just like to make fun of pumpkin spice lattes because they are a thing traditionally associated with young women.

Speaking of women...YEESH that main segment. Everything about that was upsetting. It wasn't my first exposure to the gender/race bias that occurs in medicine, but it still made me sick. Pesky hormones?! I mean, first of all, men have hormones too, so the idea that women are men+hormones is insane on a base level. But also one does not even need to be a doctor to know that those "pesky hormones" serve functions other than fucking with your mood. So if women have different hormones then of fucking course you need to account for that! Insanity.

And the information about health issues that primarily affect women not being well researched is sadly so common. As far as I can tell, if you have an issue that affects or involves your uterus, the general medical solution is "have you tried birth control." 

[Annber03]

47 minutes ago, BabyVegas said:

As far as I can tell, if you have an issue that affects or involves your uterus, the general medical solution is "have you tried birth control." 

Regarding that bit about men studying issues relating to the uterus without, y'know, actually having a woman present, I don't know what was more troubling to me: the fact that these men decided to do that in the first place, or the fact that no man, at any point during the study, apparently thought to speak up and say something along the lines of, "Um, hey, guys...I think there's a problem with this particular study..."

[swanpride]

The subjects where most likely just glad about the money. It's the doctors who deserve the blame there. I mean, really? The idea that a woman is some medical mystery is frustrating.

And yes, I got the "maybe you should try birth control" line, too. One could think that the pill is some sort of "heal everything" wonder, which takes care of everything from pain over mood swings to the condition of your skin.

[DEL901]

2 hours ago, swanpride said:

The subjects where most likely just glad about the money. It's the doctors who deserve the blame there. I mean, really? The idea that a woman is some medical mystery is frustrating.

And yes, I got the "maybe you should try birth control" line, too. One could think that the pill is some sort of "heal everything" wonder, which takes care of everything from pain over mood swings to the condition of your skin.

The pill, while not the cure all some men think it is, does help with some non pregnancy prevention issues and so, of course, some are trying to make that harder to get....exhibit one... Hobby Lobby.  

[swanpride]

Oh, nothing against the pill. But it seems the standard answer for "don't know what is going on with you, must be hormones".

[peeayebee]

6 hours ago, BabyVegas said:

To answer that one guy's question: it's called a pumpkin spice latte despite not having any pumpkin in it because the flavoring in the latte is the same flavoring as the spices used in pumpkin pie.

Right. It's not pumpkin [and] spice latte, it's pumpkin-spice latte.

It's hard to believe it was just in the 1990's that a study on uteruses was done with male subjects.

I liked seeing John wave in the opening credit graphics as he turned around. 😄

When he said doctors in the 30's diagnosed "gross throat," it made me think of episodes of Poldark where one of the ailments was putrid throat.

[Robert Lynch]

I must admit, I did laugh with John Oliver's brief take on the Michael Jackson Vangaurd MTV Award of 2019 to Missy Elliot. "The are still doing that?" Best response ever. 

[arachne]

From Wikipedia: "The Pumpkin Spice Latte is a coffee drink made with a mix of traditional fall spice flavors, steamed milk, espresso, and often sugar, topped with whipped cream and pumpkin pie spice. Since 2015, it has also contained a small amount of pumpkin puree." 

[DoctorAtomic]

9 hours ago, BabyVegas said:

To answer that one guy's question: it's called a pumpkin spice latte despite not having any pumpkin in it because the flavoring in the latte is the same flavoring as the spices used in pumpkin pie.

I had no idea. It looks awful.

[swanpride]

What kind of spices are used in pumpkin pie?

[PrincessPurrsALot]

Typically cinnamon, nutmeg and mace.  They added pumpkin because of media stories that there was no pumpkin in a pumpkin spice latte. Seriously.

I wish they had been able to include Serena Williams in the discussion on medical bias.  She almost died from a blood clot in her lung after giving birth because medical professionals wouldn't listen to her. Personally I have either gotten recommendations for birth control or to lose weight for items in no way related to hormones or weight. 

[attica]

Pumpkin by itself has not much flavor. Which is why it's good to put in other dishes to up the fiber/veg content without changing the flavor profile.  I put it in chili, I put it into my mac and cheese sauce, I put it in shepherd's pie. And then I swan about, feeling stealthy and virtuous.

[Lantern7]

"Eye-boo-fuckin'-profren" for the win. And Wanda Sykes got that after a double mastectomy. All jokes aside . . . DAMN.

Why does John take shots at "Corporate Daddy"? I never got that bit.

[meowmommy]

As a registered nurse for 34 years...fuck doctors.

I called my period the curse from the first moment it arrived in 1968 until it went away somewhere in the 2000s.  My mother tried to tell me it was my friend.  I had wicked cramps and it came every 21 - 24 days.  With friends like that, who needs enemies?

I used to teach advanced cardiac life support.  I always included in the module on myocardial infarction how women's MIs have been historically ignored and misdiagnosed, partly because doctors didn't understand that women present differently in MI, partly because doctors assumed women's symptoms are all in their head, and partly because doctors assumed that estrogen protects pre-menopausal women from cardiac disease.  Women died.

Every now and then, a medical journal hiccups and admits that the results of some piece of research done only on men don't actually apply to women.  

I think John looks for excuses to break out his Australian accent.

I can't look at Larry David any more without seeing Bernie Sanders.

[Xantar]

1 hour ago, Lantern7 said:

Why does John take shots at "Corporate Daddy"? I never got that bit.

I'm not sure which part you don't get, but AT&T now owns Warner Bros which owns HBO. John is making "biting the hand that feeds you" humor.

I've seen Charles Johnson (the husband of the woman who died in childbirth) speak at a conference, and their story is even worse than you are probably thinking. They noticed a little bit of bleeding, so they called the doctor who examined her and ordered a CT scan "stat" (that's what it says in her charts). An hour later, the CT scan still hadn't happened. Three hours later it still hadn't happened. When he asked what was going on and noted that his wife was becoming pale, a nurse said, "Sir, she's just not a priority right now."

It wasn't until seven hours later that someone took another look, realized that this was a crisis situation, and immediately rolled her into the ER. It was discovered that one of her organs had been nicked during the C-section and she had three liters of blood in her stomach. She had been internally bleeding to death the whole time because nobody would look to find out what was wrong with her.

The most frightening part: this happened at Cedars-Sinai Hospital. Kira Johnson was an upper-middle class, college-educated woman who spoke five languages. It didn't matter. The system failed her anyway. 

There's an ongoing lawsuit, although Mr. Johnson doesn't talk about it much. I normally hate medical malpractice lawsuits, but I hope he makes that hospital hurt.

[peeayebee]

Xantar, I wanted to give a mad emoji to your post, but a sad one was the closest. That story is horrible and enraging.

3 hours ago, PrincessPurrsALot said:

They added pumpkin because of media stories that there was no pumpkin in a pumpkin spice latte. Seriously.

Well. I didn't know there really was pumpkin in it. Ick.

[ahisma]

3 hours ago, PrincessPurrsALot said:

I wish they had been able to include Serena Williams in the discussion on medical bias.  She almost died from a blood clot in her lung after giving birth because medical professionals wouldn't listen to her.

She was the first person I thought of for this story, especially when John was saying that the bias cuts across class and income lines—it really is about race and gender. 

I don't know why all states aren't implementing the California protocols for childbirth.

[swanpride]

Frankly, the Ibuprofen might not be the BEST example. Fun fact: If you, say, break a bone in Germany, the go to "painkiller" you get actually IS Ibuprofen. For two reason: One, you really only get anything addictive at all if your pain is so bad that there is no other option, and two, our doctors prefer to only take away the edge of the pain instead of supressing it completely, because pain is an importing warning sign. Taking it away can hinder the healing process. 

I didn't quite understand what illness she was talking about, though. Maybe it was something which would require opiates to deal with. Otherwise though I would say that she was lucky (in this particular case). American doctors are subscribing opiates way too fast (because the pharma industry has an interest in it). I mean, the opiate crisis is largely related to people getting addicted by their doctor or by taking the stuff as replacement for actual treatment.

[Annber03]

2 hours ago, Xantar said:

I've seen Charles Johnson (the husband of the woman who died in childbirth) speak at a conference, and their story is even worse than you are probably thinking. They noticed a little bit of bleeding, so they called the doctor who examined her and ordered a CT scan "stat" (that's what it says in her charts). An hour later, the CT scan still hadn't happened. Three hours later it still hadn't happened. When he asked what was going on and noted that his wife was becoming pale, a nurse said, "Sir, she's just not a priority right now."

What the ever-loving fuck? That's horrendous. 

Yeah. I'm all for a lawsuit after that kind of insanity. Give 'em hell, I say. 

3 hours ago, meowmommy said:

partly because doctors assumed women's symptoms are all in their head

Of all the stupid reasons why men constantly misdiagnose female patients, this particular line of thinking is one I truly can't understand. Why on earth would they think we're just making this stuff up? 

[swanpride]

Because we are hysterical. Didn't you know?

[Victor the Crab]

Fuck to Hell whomever decided to push pumpkin spice products right now. We're still in the middle of summer, FFS. Don't start hawking me that stuff until there's a chill in the air. And a special place in Hell should be reserved to whoever created pumpkin spice Spam. BLLUCH!!! >:P

[meowmommy]

1 hour ago, swanpride said:

our doctors prefer to only take away the edge of the pain instead of supressing it completely, because pain is an importing warning sign. Taking it away can hinder the healing process. 

It really depends on the cause of the pain.  When I took care of patients after open heart surgery, we really pushed them to take pain medication, because without it, they don't cough, they don't take deep breaths, and they don't move, all of which vastly increase their risk of postoperative complications.  When you remember they've literally had their sternum cracked open and wired back together, and zippers put in both legs, you can see how it would hurt to do anything.

Pain is a valuable warning sign, but most often when you are considering a new diagnosis, a change in a current diagnosis, or a change in condition.  It doesn't mean patients with chronic, unrelenting, and/or debilitating pain should not have appropriate pain management.

31 minutes ago, Victor the Crab said:

Fuck to Hell whomever decided to push pumpkin spice products right now. We're still in the middle of summer, FFS. Don't start hawking me that stuff until there's a chill in the air.

As I write this, it's 107 outside, and it's going to be 114 by Wednesday.  The only day it hasn't been in the hundreds since about May was a day with cloud cover.  I expect a chill in the air by Valentine's Day, just in time for spring summer to be around the corner.

[scarynikki12]

1 hour ago, swanpride said:

I didn't quite understand what illness she was talking about, though

She was talking about her double mastectomy which would absolutely require stronger pain drugs than Ibuprofen in the initial days following the surgery.

[mojoween]

I work in short term disability and one time a customer service rep, when noting current meds, wrote out in the comments “I be pro fun” and I have called it that ever since.  Until now.

I cannot tell a lie...I fucking LOOOOOOOVE Starbucks pumpkin spice and cannot wait until 8/27.  I don’t like lattes though but pumpkin spice hot chocolate is heaven in a cup.  

[scottiB]

“I bet you clap on the 1 and the 3 don’t you.”

...dying...

[ombelico]

I think the edit of the 60 Minutes interview was unfortunate because it seemed to imply that the scientist being interviewed, Larry Cahill, himself endorsed the idea that "pesky hormones" are the problem with studying women, when that's not the case. He was characterizing what many other researchers feel about it, not himself - he's actually spent a large part of his career studying sex differences and advocating for more inclusion of women and female animals in research. 

[DoctorAtomic]

I got his meaning. I didn't think he was endorsing pesky hormones. 

[biakbiak]

18 hours ago, PrincessPurrsALot said:

wish they had been able to include Serena Williams in the discussion on medical bias.  She almost died from a blood clot in her lung after giving birth because medical professionals wouldn't listen to her. Personally I have either gotten recommendations for birth control or to lose weight for items in no way related to hormones or weight. 

All examples are infuriating but she is not only rich as fuck she is a world class athlete who’s job necessitates that she is in tune with her body in a way that a lot of us mortals aren’t!   

[RedbirdNelly]

not entirely related but this reminded me of a piece of advice a friend gave me before the birth of my first child--to make sure your husband/partner was there and understood they needed to be your advocate if required. She had an issue with her first child where she was experiencing really bad pain. Unfortunately, this presented right about the time of a nursing shift change. She felt like the new nurse didn't realize that she (my friend) was not a person who complains easily about pain--that this was real. It took a while to get their attention and she was eventually rushed to surgery--luckily she was ok. She felt like if her original nurse (who had some interaction with her) had been on the case, she would have been listened to more quickly. but I understand the reluctance to be "that patient" (even when race is not an issue--my friend is white).

I get very tired of the "oh no, pumpkin spice lattes are already out!" news bits. You can buy or not buy them. No one is forcing you to buy them. Same thing with a store selling Christmas stuff--especially when it is a store that people use to buy supplies for craft projects. I don't craft but I imagine there are some people who start working on projects before Christmas actually gets here. The fact that stuff is for sale does not mean that you have to buy it or start your own personal holiday celebration.

Edited August 21, 2019 by RedbirdNelly
fixing my 2x typo! seriously, spelled store as "story" 2 times!

[Mibbitmaker]

The gender bias story reminded me of all the trouble Gilda Radner went through with male doctors being clueless about her ovarian cancer, and how that hampered her fight against the disease. And that was in the 1980s! Seemed the lesson later on was to make male doctors more responsive to women's needs in that general area. Yet here we are almost in 2020 and that narrative was clearly false. 

In the last segment, as soon as Wanda Sykes was describing her friend, I knew it would be Larry David. Yeah, probably 98% of the audience  guessed that, but it was fun to point at the screen going, "I KNEW IT!" Perfect.

Edited August 20, 2019 by Mibbitmaker
Too many "probably"s

[swanpride]

Yeah, I mean, it is a latte, it's not like they have decked out their shops in Halloween decorations.

[BuyMoreAndSave]

On 8/19/2019 at 2:42 AM, BabyVegas said:

As far as I can tell, if you have an issue that affects or involves your uterus, the general medical solution is "have you tried birth control." 

On 8/19/2019 at 3:51 AM, swanpride said:

And yes, I got the "maybe you should try birth control" line, too. One could think that the pill is some sort of "heal everything" wonder, which takes care of everything from pain over mood swings to the condition of your skin.

My doctor literally told me to never go on birth control ever because it would probably make my anxiety worse. Checkmate!

On 8/19/2019 at 7:12 AM, swanpride said:

Oh, nothing against the pill. But it seems the standard answer for "don't know what is going on with you, must be hormones".

Or they could, you know, actually refer someone to an endocrinologist to SEE if their hormones are actually imbalanced and which ones. But that would take effort! That actually happened to me -- I have heavy and painful periods, I'm really hairy, and last year they found an ovarian cyst and fibrocystic breasts. So my (female) gynecologist referred me to an endocrinologist to get my hormones checked. Turns out my hormone levels are fine and the reason behind all this stuff is "oh well, turns out your body is just annoying for some reason, sucks for you." Good thing I didn't listen to the various doctors before that telling me to go on the pill....

On 8/19/2019 at 3:03 PM, Xantar said:

I'm not sure which part you don't get, but AT&T now owns Warner Bros which owns HBO. John is making "biting the hand that feeds you" humor.

I've seen Charles Johnson (the husband of the woman who died in childbirth) speak at a conference, and their story is even worse than you are probably thinking. They noticed a little bit of bleeding, so they called the doctor who examined her and ordered a CT scan "stat" (that's what it says in her charts). An hour later, the CT scan still hadn't happened. Three hours later it still hadn't happened. When he asked what was going on and noted that his wife was becoming pale, a nurse said, "Sir, she's just not a priority right now."

It wasn't until seven hours later that someone took another look, realized that this was a crisis situation, and immediately rolled her into the ER. It was discovered that one of her organs had been nicked during the C-section and she had three liters of blood in her stomach. She had been internally bleeding to death the whole time because nobody would look to find out what was wrong with her.

The most frightening part: this happened at Cedars-Sinai Hospital. Kira Johnson was an upper-middle class, college-educated woman who spoke five languages. It didn't matter. The system failed her anyway. 

There's an ongoing lawsuit, although Mr. Johnson doesn't talk about it much. I normally hate medical malpractice lawsuits, but I hope he makes that hospital hurt.

F that! That type of stuff is a huge reason why I am never, ever having kids. I've read that doctors often don't monitor the mother very closely for any complications after the baby is born because all their attention is on making sure the baby is ok. Because, you know, women are just baby factories and after that task is done, who cares. It infuriates me so much that we have to worry about this stuff and that women are dying due to not getting a basic standard of care in 2019.

On 8/19/2019 at 5:12 PM, swanpride said:

Frankly, the Ibuprofen might not be the BEST example. Fun fact: If you, say, break a bone in Germany, the go to "painkiller" you get actually IS Ibuprofen. For two reason: One, you really only get anything addictive at all if your pain is so bad that there is no other option, and two, our doctors prefer to only take away the edge of the pain instead of supressing it completely, because pain is an importing warning sign. Taking it away can hinder the healing process.

Last year my husband got all four wisdom teeth out on the same day and was spitting blood into a cup for the next several hours (sorry) and all he got was ibuprofen. They have really cracked down in general and it's not just a women's thing.

Edited August 21, 2019 by BuyMoreAndSave

[ElectricBoogaloo]

John on Trump's comment about Hong Kong: "Somehow there's both a lot and nothing to unpack there."

I've been watching what's been going on in Hong Kong for weeks and I've been terrified that it would end with another Tiananmen Square situation because, you know, China.

The main story was both horrifying and not at all surprising. The truth is that we all have biases as a result of our experiences. The important thing is making a conscious effort not to let those biases negatively impact other people like, say, your patients. Doctors have a lot of leeway when making decisions which is why it's important to use as much data as possible to help keep these decisions as unbiased as possible. The example of weighing the materials to determine the amount of blood is a good example.

In case you need Larry's help:

http://whatslarrysproblem.com/

[swanpride]

And it is important to keep in mind to say "no" once a while. I mean, yeah, doctor's usually know what they are talking about, but sometimes it is a good idea to question them. Ie one time the doctors wanted to repeat a test on me which was very painful the first time around. I asked if that was really strictly necessary and after some prompting they admitted that it actually wasn't but without it they would have to keep me under observation for a couple of additional days. I then pointed out that I would have to stay those days anyway because they wanted to monitor something else.

Also, always double check what medicine you get. Always! No matter in how much pain you are. I learned that the hard way.

[paigow]

On ‎8‎/‎19‎/‎2019 at 12:26 PM, PrincessPurrsALot said:

Typically cinnamon, nutmeg and mace.   

I thought this was a typo...but it grows on the nutmeg tree...besides the temperature, it would be extra painful to be sprayed with a pumpkin spice latte in the face....😉

[andromeda331]

As soon as I saw the title I knew I was going to agree with everything John Oliver said on Bias in Medicine. Been there so many times. When I was dealing with my first medical problem throwing up every three or six months every male doctor I visited insisted I was pregnant. When I insisted I wasn't, wasn't trying and couldn't possibly be pregnant they tell me stories about other women who insisted they weren't pregnant and were, or to check just to be sure and offer to pay for the test. What do you know it was always negative! Also, what kind of pregnancy makes you throw up every three to six month for five years? When I pointed out the previous tests that always came back negative they still ran the test but told me they'd pay for it like they were doing me a big favor. And that's it. No investigating, no other tests, not even referring me to a gastro doctor until one finally did after 5 years that diagnosed me. What do you know? There was a problem!  None of the stories surprised me.

Edited August 24, 2019 by andromeda331

[purist]

On 8/20/2019 at 3:33 AM, meowmommy said:

I think John looks for excuses to break out his Australian accent.

The guy at the airport was a New Zealander. If you know what to listen for, you can tell. Amazingly, John actually seemed to be doing a Kiwi accent. 🙂

Edited August 24, 2019 by purist