The Vitamin Team
Seeking to revolutionise healthcare
She had a textbook medical condition, but it went undiagnosed for more than a year.8 min read
The myth that “younger women don’t get heart disease” points to the danger of what Dr. Katarina Hamberg of Sweden’s Umeå University has called a “knowledge-mediated bias.” While an awareness that men or women have, on average, greater or lesser risks of certain diseases is important and useful up to a point, this awareness can lead to diseases becoming so stereotyped as a “man’s disease” or a “woman’s disease” that doctors are blinded to the individual in front of them—to the extent that the stereotype actually becomes self-fulfilling: knowing a condition is more common in one gender tends to result in its under diagnosis in the other gender.
The history of chronic obstructive pulmonary disease (COPD) illustrates this dynamic well. The fourth most common cause of death in the United States, COPD is closely linked to cigarette smoking. Accordingly, for decades the typical COPD patient was the typical smoker: an older white man. But beginning in the sixties, as tobacco companies began targeting women, the gender gap in smoking rates began to close—and the gap in COPD rates soon followed suit. Between 1980 and 2000, women’s mortality rates from COPD tripled. Since 2000, more women than men have died from COPD each year. In a 2001 study, researchers suggested that COPD was being under-diagnosed in women due to the entrenched stereotype associated with the disease. They asked 192 primary care physicians to consider the case of a middle-aged patient, either a man or a woman, with a chronic cough and a history of smoking. On first pass, 49 percent of the women patients received a COPD diagnosis compared to 64.6 percent of the identical male patients. Once test results pointing to COPD were offered, the gender gap narrowed but still didn’t disappear completely.
As the researchers noted, some would argue that the bias demonstrated in the study wasn’t entirely inappropriate given that “the risk of COPD is truly higher in men than in women given the historically higher tobacco consumption rates in men.” But they point out that this is a circular argument: the accuracy of the epidemiological data that tells us how common diseases are in different groups is dependent on doctors making accurate diagnoses. If COPD was under-diagnosed in women—as the study suggested it was—how would anyone know whether it was still actually more prevalent among men? And even if it was somewhat more common among men, that’s irrelevant to whether an individual woman has it. Yet the image of the male “typical patient” was so strong that the doctors in the study overlooked COPD in female smokers, even though the only reason for men’s historically higher rates of COPD to begin with was their higher rates of smoking. Today, despite now officially having higher rates of COPD than men throughout most of their lifetime, women continue to face delays in getting diagnosed.