Dec 19 2005

Sexist Docbags Screw Women Heart Patients

The female heart, as understood by medical professionals until just last week

The female heart, as understood by medical professionals until just last week

In an astonishing medical breakthrough in the exciting world of heart disease research, it was found by “cardiologists at Johns Hopkins” that — now brace yourself for this shocker — that “many women with cardiovascualr health problems slip through the cracks.”

That’s right. The Framingham Risk Estimate, which is what the entire patriarchally-motivated medical establishment — docbags, if you will — use to predict the probability of heart attacks in any human who crosses their path, works like a charm with men. Unfortunately, it leaves one-third of women flapping in the breeze with undetected clogged arteries. Which is why men, as the default humans, have enjoyed over the past few decades a steady decline in death-by-heart-failure, whereas women, the freaks of nature, continue to drop like flies.


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  1. kcb

    Shocking, indeed. My email isn’t working this a.m., so please allow me to direct your attention to another urpworthy “study,” this one by the good folks at Texas A&M, finding that while boy moneys like to play with trucks, girl monkeys enjoy working with doll butts and cookware:


  2. sunny in texas

    my mother, who had a rare adrenal disorder, was turned away from the hospital several times after they diagnosed her chest pains as panic attacks. did they even once put her on a sonagram machine to check for damage? nope.
    stupid sons of bitches and i feel incredibly guilty to this very day that i wasn’t there, but lived 1450 miles away. when i finally moved back here, her skin was so gray it made me sick and furious.
    she passed away at the ripe old age of 55 of “natural” causes.

    fucking patriarchal medical unprofessionals.

  3. mcmc

    Like boys, some male monkeys moved a toy car along the ground. Like girls, female monkeys closely inspected a doll’s bottom. Males also played with balls while females fancied cooking pots.

    did the females look around for the measuring spoons? did they ask the males to light the stove? did they whomp up a big mess a vittles?

  4. SR

    Ah, the classic Framingham studies. My favourite publication based on the Framingham data is one published in 1983, which concludes that women with advanced education or working outside the home cause heart-attacks in their husbands.

    Quoting now, from the article’s abstract (American Journal of Epidemiology 118(1):23-41 1983):

    “When Type A and Type B men were stratified by the social and personality characteristics of their wives, it was found that the differential rate of heart disease between Type A and Type B men was present only in situations where the wives’ characteristics might be deemed stressful. Type A husbands were 2.5 times as likely to develop coronary heart disease as Type B husbands if married to women with 13 or more years of education, and had 3.5 times the coronary risk of Type B husbands if married to a woman employed outside the home.”

    What fucktard came up with the idea for this study in the first place?

  5. Ms Kate

    As a medical researcher and soon to be Dr. Kate epidemiologist who has worked with data and samples from this study I have to say that the study itself – collecting information from a group of people over the long term – is not the problem.

    This is always the problem. Science is NOT objective, and the more honest us science types are about this simple, basic, and HUMAN fact, the better off we all are. So called “priors” have to be examined furiously for bullshit specs.

    Unfortunately, too many labor in what Pirsig termed “The Church of Reason” and ignore that all science and all research begin with a premise, and all premises are subjective. Hence, all results contain some subjectivity a priori, and all interpretations also contain priors and stink of subjectivity.

    IMHO, far too much emphasis is placed on statistical noise and stastical precision, and far too little is place on whether we are getting a statistically precise and unbiased answer to a fundamentally flawed question!

    The problems come in how studies that use data and samples are designed, and how the results are interpreted through the patriarchometer.

  6. Ms Kate

    oops, a bit garbled. Basic message is the same.

  7. joy

    sunny in texas- you’re not sunny bosco, are you?

  8. Joolya

    A good friend of mine who was having thyroid problems was shunted out of the system any number of times for having “panic attacks” before anyone thought to look at her hormone levels. Panic attacks = the new hysteria?

  9. Indri

    I’ve heard that a lot of women don’t even realize they’ve had heart attacks. Reasons given: “I was too busy to deal with it” (that one I think was a woman throwing a birthday party for her child) and “It didn’t hurt as much as I thought it was supposed to” (because of course we have a higher tolerance for pain) and “I didn’t know what to look for” (because nobody talks to us about heart attacks, just tell us to lose weight and quit smoking).

    All of which says to me that the public health establishment is falling behind on the education front.

  10. sunny in texas

    no, sorry. “sunny” is a knickname.

    i’m a rather new reader of twisty.

  11. zuzu

    I mentioned on an earlier thread that my mother would likely be alive had the idea that the symptoms of a heart attack consisted of shooting pains in the left arm — which is true really only for men — not been so ingrained in the culture.

  12. zuzu

    That’s exactly what happened to my mother (and my grandmother, too). My mother thought she had the flu, and my grandmother thought she had gallstones.

  13. DrSue

    Sunny, how horrible.

    I was initially diagnosed with an anxiety disorder when it turned out I had a not-so-rare autoimmune disorder (Still’s Disease) that was attacking my heart and lung. Fortunately for me I’m a psychologist and was aware that this was a BS diagnosis; someone with less experience in real anxiety disorders might easily have accepted it with dire results. I think anxiety and panic disorders are the default diagnosis for chest pain in women.

  14. ae

    Twisty, for this graphic alone I would marry you. The Martyr Vein is truly inspired.

    sunny and zuzu, so sorry.

  15. Dianne

    The sad thing is that this isn’t news. The fact that we know much less about heart disease in women than in men and that women are more likely to die of heart disease because of it–and because of sexism whether concious or otherwise in doctor’s treatment of men and women– was something I learned in med school 15 years ago. It’s also quite hard to get a study of heart disease in women funded. Why? Because it wouldn’t be fair to men to study heart disease in women only, of course! Just because there are ten thousand prior studies in men only doesn’t seem to mean much to the NIH.

    I do have to say, though, that the problem of people misunderstanding their symptoms and therefore not getting treated in time isn’t restricted to women. When my grandfather had his first heart attack he thought it was the flu because he had nausea and stomach pain rather than chest pain. Therefore, he didn’t go to a hospital until three days later…by which point a lot of damage had been done. He ultimately died of complications.

  16. Hattie

    It is hard to distinguish between heart attacks and panic attacks. However, if a man is showing certain symptoms, docs will think it’s a panic attack, but if it’s a woman, they’ll think it’s a panic attack.

  17. wordgirl

    Same for breast cancer, people. Men don’t give a damn about women’s boobs except with respect to how big they are and how often they get to see them uncovered. It took Susan G. Komen’s sister (at least here in Texas) to raise awareness about breast cancer. Mark my words…if cancer of the dick EVER came close to being the epidemic that breast cancer is…you will see action in the male community like you’ve never seen before. Until then….they’re about as concerned as male monkeys in the cage at the zoo…jerking off around the females and throwing their shit on each other.

  18. frippy

    Your graphic made me both laugh and sigh in despair. My own mother was unfortunately, I believe, a victim of this invisibility for the heart diseases of women. She had gone to her doctor complaining about being extremely tired and out of breath — rather than checking her heart, as he would have done if he saw my father there (my father once showed up at the same doctor complaining of unusual fatigue and shortness of breath and was given a cardiac stress test). He told her to take antidepressants and lose weight. After several more months of still feeling awful and finally getting a second opinion, it turns out she had a defective heart valve and needed a transplant right away. Sadly, it was too late, her heart was severely weakened, and she died six weeks after her surgery. I’ve kept this thought to myself, but I sometimes wonder if Mom had been a male patient presenting with the same set of symptoms, if he wouldn’t have been told basically that it’s just a mental/fat thing. Thanks for your post and its reassurance that I’m not paranoid to have thought this.

  19. amaz0n

    panic attacks = the new hysteria?”

    That and depression. I have a non-specific autoimmune disorder that, among other things, affects my thyroid in funky ways. A few years ago, when the symptoms first started to pop up, my thyroid went into total shutdown mode and caused my body to gain weight, lower in tempature and sleep up to twenty hours a day every day.

    The doctor I went to first told me that I probably had cancer. When he ruled that out, he informed me that I had depression and attempted to prescribe me Wellbutrin. I tore up the prescription in his presence and refused to pay him.

  20. Hattie

    oops. Duh, I meant of course, in men they’ll think it’s a heart attack.

  21. robin

    This link does not address the medical iniquities described here, but the psychological implications of this article are so rich I simply had to make note of it here. Could it be that even Barbie-owning girls subconciously resent and hate Barbie? There’s clearly something about the blank petulant sex-bot attributes of this awful doll which brings out vicious impulses even in children.


  22. robin

    I meant “inequities”. This new comment system does not make for easy proofreading!
    Although perhaps “iniquities” is not so far off the mark..

  23. Sara

    Now hang on a minute – as a decidedly non-sexist second-year medical student, I’d like to point out that things are changing. We just finished our cardiovascular unit, and we were told about the ways in which women’s symptoms can differ from men’s. That said, the fact that the data are based on a survey of men is nothing unique to just heart attack studies; most data about just about anything scientific has been gathered solely on men until quite recently. However, I wouldn’t say that’s the doctors’ fault. We’re not the ones running the studies; we only work with the data they give us. Don’t be hating…

  24. MzNicky

    Six months ago I went to the emergency room because I was having heart palpitations, nausea, and a sudden onset of flu-like symptoms. I knew, from having done breast-cancer research (because of my own personal experience and having done my master’s thesis on how breast cancer is portrayed in women’s magazines, but that’s another story), the symptomology of heart attacks in women and how those indicators vary from the norm (i.e., how they present in men). Fortunately, it turned out only to be a reaction to a medication I was taking.

    A few weeks ago a female friend of mine died from a massive heart attack. She was 61 years old and had no family history of heart disease. She was hospitalized for several hours for flu-like symptoms before she died. Her family was dumbfounded and are still in shock.

    Heart disease is the No. 1 killer of women. I would posit that this is at least in part because women’s presenting symptoms vary from the “norm” (i.e., men’s symptoms) and not enough emergency-room physicians are so informed.

    By the way, Twisty, a larger window for comments and a “preview” button would be good additions to your new site.

  25. mythago

    Indeed they are. A few scrillion more malpractice suits should shake things up nicely.

  26. Twisty

    RE: comments issues: There is a “larger size” option just above the comment window, at least in Safari. As for the preview button, I agree, and am looking into how to pull that off with basically no understanding of anything.

  27. Twisty

    I’m not hatin’ on the practitioners. I’m casting aspersions on the research docs of yore who designed these sexist studies.

  28. AyMayZed

    In my experience, anxiety is the direction of most diagnoses for anything short of frank injury or infection that a woman presents with these days.
    And sadly, there is no symptom more easily laid at anxiety’s door than mistrust of a medico’s diagnosis of anxiety.

    So the anti-anxiolytics are handed out like lollies and …
    Please forgive the threeple dot but words really do fail me at the pity of this whole mess sometimes.

  29. Twisty

    My female niece’s favorite toy is a truck. She also plays with balls. Her mother, my sister, also a female, had, as a child, a collection of Matchbox cars that was the envy of the neighborhood.

  30. wheelomatic

    My (limited) understanding of why there are so few medical studies done on women re: heart attacks, new meds or anything else is the fear of “harming the baby.” Any woman of breedable age is assumed to be pregnant or planning on getting pregnant in the near future so it would be unwise to do anything to jeopardize the new defenseless perfect human waiting in the wings. Or possibly damage to the holy boobies, giver of the only right food for God’s little angels on earth. (Snarkyness entirely mine)

    Plus there is the fear of malpractice suits if the is actual harm done to a ute or ovary, boob or babe.

  31. Ms Kate

    It is nice that medical schools are FINALLY getting the clue. However, there are far too many doctors already trained in patriarchy who perpetuate these abuses and refuse to examine their own practice patterns.

    The problem isn’t just that women have different onset patterns than men. The problem is also that doctors dismiss the SAME symptoms in women as psychological or weight related that would get their male patients immediate attention. THAT is not a matter of all the studies being done on men – it is matter of prejudice masquerading as medical knowledge!

  32. Ms Kate

    Not quite. Heart attack studies which are post-event interview studies or medical record review studies (e.g. what did the now dead person show up complaining about?) do not involve feti or prospective feti.

    The real problem is the former belief that “male” was the basic state of human. Earlier on, women were, like children, not considered to be reliable reporters. After the social scientists demonstrated that they were far more reliable reporters than men (as Mom is in charge of the health ministry in the household), the excuse was that women have hormonal swings due to mensturation and there was simply less noise when studying new drugs. Unfortunately, new therapies and diagnostics were never tested in women afterward.

    A few years back, the NIH cracked down on these critical differences in who is studied. As a researcher who does observational studies on existing data, I still have to submit statistics on how many people of which genders and what races, etc. are in my study groups. If I were to do, say, some prostate cancer research, I’d have to fill out a separate section of my human studies forms to explain why there were no women. If I were to study cystic fibrosis, I’d have to explain why there were no African Americans, etc. This is mostly because women were not included in important studies of mortality and morbidity or drug therapy (actually, they were actively excluded) and because African Americans were used like guinea pigs, but also excluded from beneficial studies.

    These changes are only now bearing fruit. Practice patterns of individual doctors must change to include this new research, but they really have to change period.

  33. wheelomatic

    Thank you MsKate for clarifying.

    Women were not deemed bad sujects due to possble childbearingness, but due those dang hormones (which we all know produce hysteria).


    But, as a woman with a whole family history of cadiovascular disease, I am glad things are changing. And I am glad you are one of the ones doing the research.

  34. Ron Sullivan

    If I were to study cystic fibrosis, I’d have to explain why there were no African Americans, etc.

    Anecdote does not equal data, etc., I know, I know, but here’s one anyway, secondhand as it is. When I switched from the NICU to one of the main tx floors of the pede hospital I worked in, I got the story of one kid who my fellow staffers all knew, who’d recently died there. She was an African American child who’d been there frequently; her new abdominal pains and digestive problems were of course attributed to the sickle-cell disease she was being treated for. I don’t remember why someone thought to test her for CF; maybe somebody kissed her cheek and tasted salt. But she tested positive, and it was the CF that eventually killed her.

    I keep her in mind, myself, as a sort of icon of really bad luck. Or maybe a zebra.

  35. Teenagecatgirl

    Anyone ever seen a monkey, female or otherwise, cooking? I certainly haven’t.

    Come to think of it I’ve never seen one driving a truck, either.

  36. Ms Kate

    Hi Ron,

    I didn’t mean to say that there were no African Americans with CF (or that it wasn’t possible since mutations happen and so does racial mixing), but any wide-enrollment study would turn up fewer African Americans than would be expected from a sample of the general population. NIH would like a paragraph to explain that.

    I myself am a mutt with a hemoglobin mutation not normally found in whites, so I know it goes all ways around.

  37. AyMayZed

    Thought I may as well jump in.
    Plurals of medical and biology terms.
    Plural of fetus is fetus (same spelling, long “u” pronunciation for the plural).

    Prescription for daily use: stick to the anglicised endings. Fetuses is a good word. Sames as forums like this sounds a lot finer than fora.
    The platypodes will thank you ;-)

  38. AyMayZed

    There are many examples of gross error arising from the treated having no input into their treatment – in that medical/hospital factory feeding the human body into the sausage machine without much regard for history and the possibility of diversity.

    My most clear memory of this was of a 65-ish old bloke, tall and with the distinctively Popeye forearms of a carpenter or mason, who’d been admitted with a diagnosis of pleurisy. There he sat on the side of his bed, grunting with every shallow breath and smiling his thanks for each nursing action but pretty much speechless in pain. The oxygen saturation was a real worry.
    And then his daughter – she looked like a carpenter too – walked in and pinned the DON against the wall because her father was in intolerable pain. The boss nurse hand-waved about pleural pain being never too unbearable and about the contra-indications of cns depressant stuff like opioids for breathing.
    The daughter put a rocket under us all when she illustrated her father’s pain threshhold with a story of his driving home with a forearm fracture, locking gear in his workshop and waiting until a babysitter came to watch the family before taking himself to get treatment.

    Her father had a moving blood clot in his lung.
    He apologised for his rude daughter when he left.

  39. Ron Sullivan

    Ms Kate, no problem with your prose; it was clear that you were talking about trends and tendencies and likelihood, as statistics do. I just couldn’t resist throwing that story in, as the poor kid was an exemplar of really long-odds bad luck. (Ms Kate doubtless knows this, but the “zebra” up there is an allusion to hoofbeats, not colors.)

  40. SF Knitter

    Thanks for this.
    I very much appreciate your blog.

  41. Pony

    Sometimes I think it’s better if the medical profession ignores you. Especially if you’re a woman. Speaking as one who has had permanent life-altering disability caused by cholesterol lowering drugs called STATINS, which were tested on men with (dubious) findings even for men and that then extrapolated to women. Here’s your warning. If you are a women “at rish” for cardiovascular disease, take heed. These drugs were not meant for you (if for anyone).

    Do STATINS have a role in primary prevention?

    “A question to us about Letter #48: What is the evidence of benefit for primary prevention in women?

    There were 10,990 women in the primary prevention trials (28% of the total). Only coronary events were reported for women, but when these were pooled they were not reduced by statin therapy, RR 0.98 [0.85-1.12]. Thus the coronary benefit in primary prevention trials appears to be limited to men, RR 0.74 [0.68-0.81], ARR 2.0%, NNT 50 for 3 to 5 years.”

  42. Lloyd Reich

    You got that right – and then some. Take it from a primary care doc (a male, at that!). You wouldn’t believe how many times I’ve sent female patients to the ER for just those symptoms that are most notoriously suspicious of coronary or other heart disease in women – and had them come back with everything from a diagnosis of panic disorder to an accusation of pure fakery. There’s even one with a mildly floppy mitral valve and occasional irregular heartbeat who actually got a pacemaker – only to find that once she was on Florida Medicaid (an un-surance scheme that makes old Ebenezer Scrooge look like Santa Claus) they wouldn’t even cover the battery replacement she needed! Too bad these imbeciles can’t get raped and then have some “moral” pharmacist deny them Plan B. Then they’d get a little taste of their own quack medicine!

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