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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Dates vs Figs – Which is Healthier?
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Our Verdict
When comparing dates to figs, we picked the dates.
Why?
Dates are higher in sugar, but also have a lower glycemic index than figs, which makes the sugar content much healthier. On the flipside, figs do have around 3x more fiber.
So far, so balanced.
When it comes to micronutrients though, dates take the prize much more clearly.
Dates have slightly more of most vitamins, and a lot more of most minerals.
In particular, dates are several times higher in copper, iron, magnesium, manganese, phosphorus, selenium, and zinc.
As for other phytochemical benefits going on:
- both are good against diabetes for reasons beyond the macros
- both have anti-inflammatory properties
- dates have anticancer properties
- dates have kidney-protecting properties
So in this last case, another win for dates.
Both are still great though, so do enjoy both!
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Broad Beans vs Sweetcorn – Which is Healthier?
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Our Verdict
When comparing broad beans to sweetcorn, we picked the broad beans.
Why?
Firstly, you may be wondering: “aren’t broad beans fava beans?”, and yes, yes they are, but by convention, broad beans are the young green beans, while fava beans are the mature beans of the plant. Similar situation to the relationship between edamame and soybeans. And, in both cases, you’re more likely to put the young green beans in a salad, thus making the broad beans the more reasonable vegetable to compare to the sweetcorn. On which note…
In terms of macros, the broad beans have more protein and fiber, while the sweetcorn has more carbs. We call that a win for the beans.
Looking at the vitamins, the broad beans have (barely) more vitamin B6, while the sweetcorn has more of vitamins A, B1, B2, B5, B9, E, and choline. An easy win for the corn this time.
In the category of minerals, the situation is reversed: broad beans have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while sweetcorn is not higher in any minerals. So, a clear win for the beans.
Adding up the sections gives a 2:1 win for the beans over the corn, but by all means enjoy either or both—together is great, and diversity is good!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Enjoy!
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Genetic Risk Factors For Long COVID
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Some people, after getting COVID, go on to have Long COVID. There are various contributing factors to this, including:
- Lifestyle factors that impact general disease-proneness
- Immune-specific factors such as being immunocompromised already
- Genetic factors
We looked at some modifiable factors to improve one’s disease-resistance, yesterday:
And we’ve taken a more big-picture look previously:
Beyond Supplements: The Real Immune-Boosters!
Along with some more systemic issues:
Why Some People Get Sick More (And How To Not Be One Of Them)
But, for when the “don’t get COVID” ship has sailed, one of the big remaining deciding factors with regard to whether one gets Long COVID or not, is genetic
The Long COVID Genes
For those with their 23andMe genetic data to hand…
❝Study findings revealed that three specific genetic loci, HLA-DQA1–HLA-DQB1, ABO, and BPTF–KPAN2–C17orf58, and three phenotypes were at significantly heightened risk, highlighting high-priority populations for interventions against this poorly understood disease.❞
For those who don’t, then first: you might consider getting that! Here’s why:
Genetic Testing: Health Benefits & Methods
But also, all is not lost meanwhile:
The same study also found that individuals with genetic predispositions to chronic fatigue, depression, and fibromyalgia, as well as other phenotypes such as autoimmune conditions and cardiometabolic conditions, are at significantly higher risk of long-COVID than individuals without these conditions.
Good news, bad news
Another finding was that women and non-smokers were more likely to get Long COVID, than men and smokers, respectively.
Does that mean that those things are protective against Long COVID, which would be very counterintuitive in the case of smoking?
Well, yes and no; it depends on whether you count “less likely to get Long COVID because of being more likely to just die” as protective against Long COVID.
(Incidentally, estrogen is moderately immune-enhancing, while testosterone is moderately immune-suppressing, so the sex thing was not too surprising. It’s also at least contributory to why women get more autoimmune disorders, while men get more respiratory infections such as colds and the like)
Want to know more?
You can read the paper itself, here:
*GWAS = Genome-Wide Association Study
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An Apple (Cider Vinegar) A Day…
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An Apple (Cider Vinegar) A Day…
You’ve probably heard of people drinking apple cider vinegar for its health benefits. It’s not very intuitive, so today we’re going to see what the science has to say…
Apple cider vinegar for managing blood sugars
Whether diabetic, prediabetic, or not at all, blood sugar spikes aren’t good for us, so anything that evens that out is worth checking out. As for apple cider vinegar…
Diabetes Control: Is Vinegar a Promising Candidate to Help Achieve Targets?
…the answer found by this study was “yes”, but their study was small, and they concluded that more research would be worthwhile. So…
…was also a small study, with the same (positive) results.
But! We then found a much larger systematic review was conducted, examining 744 previously-published papers, adding in another 14 they found via those. After removing 47 duplicates, and removing another 15 for not having a clinical trial or not having an adequate control, they concluded:
❝In this systematic review and meta-analyses, the effect of vinegar consumption on postprandial glucose and insulin responses were evaluated through pooled analysis of glucose and insulin AUC in clinical trials. Vinegar consumption was associated with a statistically significant reduction in postprandial glucose and insulin responses in both healthy participants and participants with glucose disorder.❞
~ Sishehbor, Mansoori, & Shirani
Check it out:
Apple cider vinegar for weight loss?
Yep! It appears to be an appetite suppressant, probably moderating ghrelin and leptin levels.
But…
As a bonus, it also lowers triglycerides and total cholesterol, while raising HDL (good cholesterol), and that’s in addition to doubling the weight loss compared to control:
How much to take?
Most of these studies were done with 1–2 tbsp of apple cider vinegar in a glass of water, at mealtime.
Obviously, if you want to enjoy the appetite-suppressant effects, take it before the meal! If you forget and/or choose to take it after though, it’ll still help keep your blood sugars even and still give you the cholesterol-moderating benefits.
Where to get it?
Your local supermarket will surely have it. Or if you buy it online, you can even get it in capsule form!
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Are You A Calorie-Burning Machine?
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Burn, Calorie, Burn
In Tuesday’s newsletter, we asked you whether you count calories, and got the above-depicted, below-described set of answers:
- About 56% said “I am somewhat mindful of calories but keep only a rough tally”
- About 32% said “I do not count calories / I don’t think it’s important for my health”
- About 13% said “I rigorously check and record the calories of everything I consume”
So what does the science say, about the merits of all these positions?
A food’s calorie count is a good measure of how much energy we will, upon consuming the food, have to use or store: True or False?
False, broadly. It can be, at best, a rough guideline. Do you know what a calorie actually is, by the way? Most people don’t.
One thing to know before we get to that: there’s “cal” vs “kcal”. The latter is generally used when it comes to foodstuffs, and it’s what we’ll be meaning whenever we say “calorie” here. 1cal is 1/1000th of a kcal, that’s all.
Now, for what a calorie actually is:
A calorie is the amount of energy needed to raise the temperature of 1 liter of water by 1℃
Question: so, how to we measure how much food is needed to do that?
Answer: by using a bomb calorimeter! Which is the exciting name for the apparatus used to literally burn food and capture the heat produced to indeed raise the temperature of 1 liter of water by 1℃.
If you’re having trouble imagining such equipment, here it is:
Bomb Calorimeter: Definition, Construction, & Operation (with diagram and FAQs)
The unfortunate implication of the above information
A kilogram of sawdust contains about a 1000 kcal, give or take what wood was used and various other conditions.
However, that does not mean you can usefully eat the sawdust. In other words:
Calorie count tells us only how good something is at raising the temperature of water if physically burned.
Now do you see why oils and sugars have such comparably high calorie counts?
And while we may talk about “burning calories” as a metaphor, we do not, in fact, have a little wood stove inside us burning the food we eat.
A calorie is a calorie: True or False?
Definitely False! Building on from the above… We will get very little energy from sawdust; it’s not just that we can’t use it; we can’t store it either; it’ll mostly pass through as fiber.
(however, please do not use sawdust to get your daily dose of fiber either, as it is not safe for human consumption and may give you diseases, depending on what is lurking in it)
But let’s look at oil and sugar, two very high-calorie categories of food, because they’re really easy to physically burn and they give off a good flame.
A bomb calorimeter may treat them quite equally, but to our body, they are metabolically very different indeed.
For a start, most sugars will get absorbed and processed much more quickly than most oils, and that can overwhelm the liver (responsible for glycogen management), and lead to non-alcoholic fatty liver disease, diabetes, and more. Metabolic syndrome in general, and if you keep it up too much and you may find it’s now a lottery between dying of NAFLD, diabetes, or heart disease (it’ll usually be the heart disease that kills).
See also:
- Which Sugars Are Healthier, And Which Are Just The Same?
- 10 Ways To Balance Blood Sugars
- How To Unfatty A Fatty Liver
Meanwhile, we know all about the different kinds of nutritional profiles that oils can have, and some can promote having high energy without putting on fat, while others can strain the heart. Not even “a fat is a fat”, so “a calorie is a calorie” doesn’t get much mileage outside of a bomb calorimeter!
See also:
A calorie-controlled / calorie-restricted diet is an effective weight loss strategy: True or False?
True, usually! Surprise!
- On the one hand: calories are a wildly imprecise way to reckon the value of food, and using them as a guide to health can be dangerously misleading
- On the other hand: the very activity of calorie-counting itself promotes mindful eating, which is very good for the health
There is a strong difference between the mind of somebody who is carefully logging their pre-bedtime piece of chocolate and reflecting on its nutritional value, vs someone who isn’t sure whether this is their second or third glass of wine, nor how much the glass contained.
So if you want to get most of the benefits of a calorie-controlled diet without counting calories, you may try taking a “mindful eating” approach to diet.
However! If you want to do this for weight loss, be aware, that you will have to practice it all the time, not just for one meal here and there.
You can read more on how to do “mindful eating” here:
Dr. Rupy Aujla: The Kitchen Doctor | Mindful Eating & Interoception
Take care!
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The Power of Self-Care – by Dr. Sunil Kumar
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First, what this book is mostly not about: bubble baths and scented candles. We say “mostly”, because stress management is an important aspect given worthy treatment in this book, but there is more emphasis on evidence-based interventions and thus Dr. Kumar is readier to prescribe nature walks and meditation, than product-based pampering sessions.
As is made clear in the subtitle “Transforming Heart Health with Lifestyle Medicine”, the focus is on heart health throughout, but as 10almonds readers know, “what’s good for your heart is good for your brain” is a truism that indeed holds true here too.
Dr. Kumar also gives nutritional tweaks to optimize heart health, and includes a selection of heart-healthy recipes, too. And exercise? Yes, customizable exercise plans, even. And a plan for getting sleep into order if perchance it has got a bit out of hand (most people get less sleep than necessary for maintenance of good health), and he even delves into “social prescribing”, that is to say, making sure that one’s social connectedness does not get neglected—without letting it, conversely, take over too much of one’s life (done badly, social connectedness can be a big source of unmanaged stress).
Perhaps the most value of this book comes from its 10-week self-care plan (again, with a focus on heart health), basically taking the reader by the hand for long enough that, after those 10 weeks, habits should be quite well-ingrained.
A strong idea throughout is that the things we take up should be sustainable, because well, a heart is for life, not just for a weekend retreat.
Bottom line: if you’d like to improve your heart health in a way that feels like self-care rather than an undue amount of work, then this is the book for you.
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