Women and Minorities Bear the Brunt of Medical Misdiagnosis
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Charity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.
At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.
About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5½-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.
When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.
She said a cardiologist later told her, “We almost lost you.”
Watkins is among 12 million adults misdiagnosed every year in the U.S.
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical.
Some patients are at higher risk than others.
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.
Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
Weakening of the heart muscle — which led to Watkins’ heart failure — is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.
Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.
Maternal mortality for Black mothers has increased dramatically in recent years. The United States has the highest maternal mortality rate among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are 2.6 times as likely to die as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.
Research shows that Black women with childbirth-related heart failure are typically diagnosed later than white women, said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”
Racial and gender disparities are widespread.
Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.
Black people with depression are more likely than others to be misdiagnosed with schizophrenia.
Minorities are less likely than whites to be diagnosed early with dementia, depriving them of the opportunities to receive treatments that work best in the early stages of the disease.
Misdiagnosis isn’t new. Doctors have used autopsy studies to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.
“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, ‘The doctor didn’t listen to me.’”
Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are less likely to be insured than white patients and often lack access to high-quality hospitals. But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.
In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital.
Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.
“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”
Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”
Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.
In an experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.
“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”
It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
The covid-19 pandemic helped raise awareness that pulse oximeters — the fingertip devices used to measure a patient’s pulse and oxygen levels — are less accurate for people with dark skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.
Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by Black mothers who survive severe childbirth complications.
“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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New News From The Centenarian Blue Zones
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From Blue To Green…
We sometimes write about supercentenarians, which word is usually used in academia to refer to people who are not merely over 100 years of age, but over 110 years. These people can be found in many countries, but places where they have been found to be most populous (as a percentage of the local population) have earned the moniker “Blue Zones”—of which Okinawa and Sardinia are probably the most famous, but there are others too.
This is in contrast to, for example “Red Zones”, a term often used for areas where a particular disease is endemic, or areas where a disease is “merely” epidemic, but particularly rife at present.
In any case, back to the Blue Zones, where people live the longest and healthiest—because the latter part is important too! See also:
- Lifespan: how long we live
- Healthspan: how long we stay healthy (portmanteau of “healthy lifespan”)
Most of our readers don’t live in a Blue Zone (in fact, many live in the US, which is a COVID Red Zone, a diabetes Red Zone, and a heart disease Red Zone), but that doesn’t mean we can’t all take tips from the Blue Zones and apply them, for example:
- The basics: The Blue Zones’ Five Pillars Of Longevity
- Going beyond: The Five Key Traits Of Healthy Aging
You may be wondering… How much good will this do me? And, we do have an answer for that:
When All’s Said And Done, How Likely Are You To Live To 100?
Now that we’re all caught-up…
The news from the Blues
A team of researchers did a big review of observational studies of centenarians and near-centenarians (aged 95+). Why include the near-centenarians, you ask? Well, most of the studies are also longitudinal, and if we’re doing an observational study of the impact of lifestyle factors on a 100-year-old, it’s helpful to know what they’ve been doing recently. Hence nudging the younger-end cutoff a little lower, so as to not begin each study with fresh-faced 100-year-olds whom we know nothing about.
Looking at thousands of centenarians (and near-centenarians, but also including some supercentenarians, up the age of 118), the researchers got a lot of very valuable data, far more than we have room to go into here (do check out the paper at the bottom of this article, if you have time; it’s a treasure trove of data), but one of the key summary findings was a short list of four factors they found contributed the most to extreme longevity:
- A diverse diet with low salt intake: in particular, a wide variety of plant diversity, including protein-rich legumes, though fish featured prominently also. On average they got 57% and 65% of their energy intake from carbohydrates, 12% to 32% from protein, and 27% to 31% from fat. As for salt, they averaged 1.6g of sodium per day, which is well within the WHO’s recommendation of averaging under 2g of sodium per day. As a matter of interest, centenarians in Okinawa itself averaged 1.1g of sodium per day.
- Low medication use: obviously there may be a degree of non-causal association here, i.e. the same people who just happened to be healthier and therefore lived longer, correspondingly took fewer medications—they took fewer medications because they were healthier; they weren’t necessarily healthier because they took fewer medications. That said, overmedication can be a big problem, especially in places with a profit motive like the US, and can increase the risk of harmful drug interactions, and side effects that then need more medications to treat the side effects, as well as direct iatrogenic damage (i.e. this drug treats your condition, but as the cost of harming you in some other way). Naturally, sometimes we really do need meds, but it’s a good reminder to do a meds review with one’s doctor once in a while, and see if everything’s still of benefit.
- Getting good sleep: not shocking, and this one’s not exactly news. But what may be shocking is that 68% of centenarians reported consistently getting enough good-quality sleep. To put that into perspective, only 35% of 10almonds readers reported regularly getting sleep in the 7–9 hours range.
- Rural living environment: more than 75% of the centenarians and near-centenarians lived in rural areas. This is not usually something touted as a Blue Zones thing on lists of Blue zones things, but this review strongly highlighted it as very relevant. In the category of things that are more obvious once it’s pointed out, though, this isn’t necessarily such a difference between “country folk” and “city folk”, so much as the ability to regularly be in green spaces has well-established health benefits physically, mentally, and both combined (such as: neurologically).
And showing that yes, even parks in cities make a significant difference:
Want to know more?
You can read the study in full here:
A systematic review of diet and medication use among centenarians and near-centenarians worldwide
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Eat To Beat Cancer
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Controlling What We Can, To Avoid Cancer
Every time a cell in our body is replaced, there’s a chance it will be cancerous. Exactly what that chance is depends on very many factors. Some of them we can’t control; others, we can.
Diet is a critical, modifiable factor
We can’t choose, for example, our genes. We can, for the most part, choose our diet. Why “for the most part”?
- Some people live in a food desert (the Arctic Circle is a good example where food choices are limited by supply)
- Some people have dietary restrictions (whether by health condition e.g. allergy, intolerance, etc or by personal-but-unwavering choice, e.g. vegetarian, vegan, kosher, halal, etc)
But for most of us, most of the time, we have a good control over our diet, and so that’s an area we can and should focus on.
Choose your animal protein wisely
If you are vegan, you can skip this section. If you are not, then the short version is:
- Fish: almost certainly fine
- Poultry: the jury is out; data is leaning towards fine, though
- Red meat: significantly increased cancer risk
- Processed meat: significantly increased cancer risk
For more details (and a run-down on the science behind the above super-summarized version):
- Do We Need Animal Products To Be Healthy? ← A mythbuster article that outlines many health properties (good and bad) of animal products
- The Whys and Hows of Cutting Meats Out Of Your Diet ← A life-hack article about acting on that information
Skip The Ultra-Processed Foods
Ok, so this one’s probably not a shocker in its simplest form:
❝Studies are showing us is that not only do the ultraprocessed foods increase the risk of cancer, but that after a cancer diagnosis such foods increase the risk of dying❞
Source: Is there a connection between ultraprocessed food and cancer?
There’s an unfortunate implication here! If you took the previous advice to heart and cut out [at least some] meat, and/but then replaced that with ultra-processed synthetic meat, then this was not a great improvement in cancer risk terms.
Ultra-processed meat is worse than unprocessed, regardless of whether it was from an animal or was synthetic.
In other words: if you buy textured soy pieces (a common synthetic meat), it pays to look at the ingredients, because there’s a difference between:
- INGREDIENTS: SOY
- INGREDIENTS: Rehydrated Textured SOY Protein (52%), Water, Rapeseed Oil, SOY Protein Concentrate, Seasoning (SULPHITES) (Dextrose, Flavourings, Salt, Onion Powder, Food Starch Modified, Yeast Extract, Colour: Red Iron Oxide), SOY Leghemoglobin, Fortified WHEAT Flour (WHEAT Flour, Calcium Carbonate, Iron, Niacin, Thiamin), Bamboo Fibre, Methylcellulose, Tomato Purée, Salt, Raising Agent: Ammonium Carbonates
Now, most of those original base ingredients are/were harmless per se (as are/were the grapes in wine—before processing into alcohol), but it has clearly been processed to Hell and back to do all that.
Choose the one that just says “soy”. Or eat soybeans. Or other beans. Or lentils. Really there are a lot of options.
About soy, by the way…
There is (mostly in the US, mostly funded by the animal agriculture industry) a lot of fearmongering about soy. Which is ironic, given the amount of soy that is fed to livestock to be fed to humans, but it does bear addressing:
❝Soy foods are safe for all cancer patients and are an excellent source of plant protein. Studies show soy may improve survival after breast cancer❞
Source: Food risks and cancer: What to avoid
(obviously, if you have a soy allergy then you should not consume soy—for most people, the above advice stands, though)
Advanced Glycation End-Products
These (which are Very Bad™ for very many things, including cancer) occur specifically as a result of processing animal proteins and fats.
Note: not even necessarily ultra-processing, just processing can do it. But ultra-processing is worse. What’s the difference, you wonder?
The difference between “ultra-processed” and just “processed”:
- Your average hotdog has been ultra-processed. It’s not only usually been changed with many artificial additives, it’s also been through a series of processes (physical and chemical) and ends up bearing little relation to the creature it came from.
- Your bacon (that you bought fresh from your local butcher, not a supermarket brand of unknown provenance, and definitely not the kind that might come on the top of frozen supermarket pizza) has been processed. It’s undergone a couple of simple processes on its journey “from farm to table”. Remember also that when you cook it, that too is one more process (and one that results in a lot of AGEs).
Read more: What’s so bad about AGEs?
Note if you really don’t want to cut out certain foods, changing the way you cook them (i.e., the last process your food undergoes before you eat it) can also reduce AGES:
Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet
Get More Fiber
❝The American Institute for Cancer Research shows that for every 10-gram increase in fiber in the diet, you improve survival after cancer diagnosis by 13%❞
Source: Plant-based diet is encouraged for patients with cancer
Yes, that’s post-diagnosis, but as a general rule of thumb, what is good/bad for cancer when you have it is good/bad for cancer beforehand, too.
If you’re thinking that increasing your fiber intake means having to add bran to everything, happily there are better ways:
Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Enjoy!
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What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon
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There are books aplenty to encourage and help you to lose weight. This isn’t one of those.
There are also books aplenty to encourage and help you to accept yourself and your body at the weight you are, and forge self-esteem. This isn’t one of those, either—in fact, it starts by assuming you already have that.
There are fair arguments for body neutrality, and fat acceptance. Very worthy also is the constant fight for bodily sovereignty.
These are worthy causes, but they’re for the most-part not what our author concerns herself with here. Instead, she cares for a different and very practical goal: fat justice.
In a world where you may be turned away from medical treatment if you are over a certain size, told to lose half your bodyweight before you can have something you need, she demands better. The battle extends further than healthcare though, and indeed to all areas of life.
Ultimately, she argues, any society that will disregard the needs of the few because they’re a marginal demographic, is a society that will absolutely fail you if you ever differ from the norm in some way.
All in all, an important (and for many, perhaps eye-opening) book to read if you are fat, care about fat people, are a person of any size, or care about people in general.
Pick Up Your Copy of “What We Don’t Talk About When We Talk About Fat”, on Amazon Today!
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Pomegranate vs Apricot – Which is Healthier?
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Our Verdict
When comparing pomegranate to apricot, we picked the pomegranate.
Why?
Both are great! Top tier fruits. But ultimately, pomegranate does have more to offer:
In terms of macros, pomegranate has more protein, carbs, and fiber (and even a little healthy fat—it’s the seeds); the main deciding factor on macros for fruits is almost always the fiber, and that’s the case here, which is why we hand the win to pomegranates in this category.
In the category of vitamins, pomegranates have more of vitamins B1, B2, b5, B6, B7, B9, K, and choline, while apricots have more of vitamins A, B3, and E. A clear win for pomegranates here.
When it comes to minerals, pomegranate has more copper, calcium, magnesium, manganese, phosphorus, selenium, and zinc, while apricots boast just a little more calcium and iron. Another easy win for pomegranates.
Looking at polyphenols, apricots finally win a category, with greater overall polyphenol coverage.
Which is good, but not enough to overcome the other three categories all being in pomegranates’ favor—hence the overall win for pomegranates here!
Of course, the solution is to enjoy both! Diversity is good, for exactly such reasons as this.
Want to learn more?
You might like to read:
Pomegranate’s Health Gifts Are Mostly In Its Peel ← in other words, the one part of the fruit you don’t normally eat. However! It can be dried and ground into a powder supplement, or else made in pomegranate tea.
Enjoy!
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Why Some Friendships Last And Others Don’t
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Friendships matter a lot, playing a significant role in our wellbeing, physical as well as mental. They bring additional meaning to our lives, help us cope with setbacks, and hopefully will be at our side through the highs and lows of life. And yet, for something that’s in principle good for everyone involved, there can be problems:
Friend to the end?
Firstly, some people find it harder to make (and then further deepen) friendships with others, which can be for a whole host of reasons.
Approaching new people can feel intimidating, but it’s a common struggle. Research shows that people often underestimate how much others enjoy their company, a phenomenon known as the “liking gap.” By reminding ourselves that others are likely to appreciate our presence and expecting to be well-received (the “acceptance prophecy”), we can approach social interactions with greater confidence.
As relationships grow, they often deepen through companionship and closeness:
- Companionship arises from shared hobbies, interests, or values, and it builds rapport.
- Closeness involves sharing thoughts, feelings, and experiences, which can build intimacy together.
An important key to these is consistency, which—whether through regular chats, honoring plans, or showing support—helps strengthen bonds, even in long-distance friendships (something often considered a barrier to closeness).
Even the strongest friendships can face challenges, of course. Conflicts may arise from a lack of support during difficult moments, or worse, betrayal. Or it could all be a misunderstanding. These situations are best addressed through honest, non-judgmental conversations. Avoiding defensiveness or accusations, and instead focusing on sharing feelings and understanding the other person’s perspective, can turn these tough discussions into opportunities for growth and stronger connections.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Beat Loneliness & Isolation
Take care!
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The Oxygen Advantage – by Patrick McKeown
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You probably know to breathe through your nose, and use your diaphragm. What else does this book have to offer?
A lot of the book is aimed at fixing specific problems, and optimizing what can be optimized—including with tips and tricks you may not have encountered before. Yet, the offerings are not bizarre either; we don’t need to learn to breathe through our ears while drinking a glass of water upside down or anything.
Rather, such simple things as improving one’s VO₂Max by occasionally holding one’s breath while walking briskly. But, he advises specifically, this should be done by pausing the breath halfway through the exhalation (a discussion of the ensuing physiological response is forthcoming).
Little things like that are woven throughout the book, whose style is mostly anecdotal rather than hard science, yet is consistent with broad scientific consensus in any case.
Bottom line: if you’ve any reason to think your breathing might be anything less than the best it could possibly be, this book is likely to help you to tweak it to be a little better.
Click here to check out The Oxygen Advantage, and get yours!
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