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Case Study Options to focus on:

1.The Thalidomide Tragedy: How lack of drug testing on pregnant women led to birth defects.

2.Heart Disease & Gender Bias: Why women are underdiagnosed and undertreated.

3.Pain & Misdiagnosis: How women’s pain is often dismissed as "hormonal" or "psychological."

4.Endometriosis Neglect: Why this condition takes an average of 8-10 years to diagnose.

5.Maternal Mortality & Racial Disparities: How systemic bias leads to preventable deaths.

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Prompts to strengthen your discussion:

1.What injustice can you identify in the case study?

2.What were the consequences for women’s health?

3.How does this reflect broader social biases in medicine?

4.What solutions could help prevent this issue?

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Ayesha

Cardiovascular disease was predominantly seen as a 'man's disease'.

Mostly male doctors and healthcare professionals were the ones who dismissed heart attacks as gastric pain or anxiety.

Women are referred to futher hospitalisation less than their male counterparts.

Women consider themselves at lower risk of heart disease.

Women were offered less diagnostic test than male counterparts, due to lack of knowledge.

Women and men both have the same risk of developing a cardiovascular disease, but women are 50% more likely to be misdiagnosed.

Different symptoms for heart disease between genders has been known for over two decades, but the both are treated the same (men's symptoms of CVD) despite guidelines that say otherwise.

Mortality linked in women for heart disease is higher globally than men.

Women have a sudden increase risk around the age of 60.

Diagnosis of heart diseases is not easy as some symptoms may be delayed, unlike mens where they are not.

As a result of years of medical misogyny, women are less likely to report symptoms or even know the symptoms of cardiovascular disease.

Lack of reported symptoms has led to inadequate treatment and diagnosis.

Which has led women to believe that they are less at risk when they are not.

A consequence for women's health is that they are less likely to take their symptoms seriously as well as be diagnosed correctly.

Lack of trust in healthcare professionals

To help prevent biases healthcare providers must undergo training to understand heart disease in women and how to treat and diagnose them.

More research needs to conducted on the female body all aspects.

More awareness is needed among the public on the differences of symptoms women experience in relation to CVD.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10945154/#:~:text=In%20comparison%20to%20men%2C%20women,CVDs%20as%20men%20%5B4%5D.

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Injustice Identifed in the case Study: Pain and Misdiagnosis: Elle & Diviya

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Injustice Identifed in the case Study: Pain and Misdiagnosis: Elle & Diviya

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As we know womens pain is often not taken seriously and are often misdiagnosed. Conditions like endometriosis, autoimmune diseases and heart attacks are frequently misdiagnosed and delayed. Theres a lot of gender bias in medicine where womens symptoms are mainly seen as emotional where as mens pain are seen as real. Also because when a man report pain its seen as a real issue where as a women would be dismissed as anxiety or stress. https://www.ucl.ac.uk/news/2021/apr/analysis-womens-pain-routinely-underestimated-and-gender-stereotypes-are-blame

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The suspicion that gender stereotypes could lead doctors to underestimate women's pain has been confirmed by research which found healthcare staff, both men and women, often discount women's pain, says Professor Amanda Williams (UCL Clinical, Education & Health Psychology).

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Analysis: Women's pain is routinely underestimated, and gender stereotypes are to blame

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The suspicion that gender stereotypes could lead doctors to underestimate women's pain has been confirmed by research which found healthcare staff, both men and women, often discount women's pain, says Professor Amanda Williams (UCL Clinical, Education & Health Psychology).

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The lack of comprehensive preclinical and clinical trials for thalidomide was a major factor in the tragedy. Ensuring thorough testing, including animal studies, could have identified its harmful effects.Aditionally ,Systems in place for monitoring and reporting adverse drug reactions could have flagged the issues earlier.Action based on these reports would have helped prevent further harm

Furthermore the drug was marketed as completely safe, even for pregnant women, without sufficient evidence. Ethical marketing practices and accurate information analysis are crucial to prevent such tragedies. Diwakaran

Thalidomide: was the tragedy preventable? - The Lancet

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Christian

Thalidomide did not undergo clinical trials for pregnant women and was mainly used on rats and mice.

They also wanted to rush it into the market so that they can get profit instead of patient safety.

They ignored the early warning signs about the drugs risk

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1. Women are underdiagnosed with heart disease and other cardiovascular conditions, research on the effects on women from these diseases is neglected as it is mostly carried out on men.

2. Women are often misdiagnosed in these circumstances as the present different symptoms to men such as back pain, nausea amongst others that are often attributed to other conditions common in women such as menopause; men often have chest pain and burning. Because of this, women even after being treated for heart conditions don’t receive the necessary therapies for recovery.

3. This reflects a portion of the vast amount of social bias in medicine, many conditions that both men and women experience may present symptoms differently, this is often overlooked to research that is exclusive to one sex as well as symptoms being assigned to other unrelated conditions. There are also racial biases in medicine, when training medical professionals are often taught how certain skin conditions such as fungal infections or melanomas are shown on lighters skin, this leads to these conditions being overlooked or undetected on darker skin tones.

4. To prevent these issues, research should be highly regulated to encompass people of varying backgrounds and of both sexes to evaluate how symptoms present and effect different people. This would reduce the chances of these conditions/ diseases from being overlooked or being attributed to others.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1199011/#:~:text=Women%20may%20have%20more%20atypical,the%20process%20of%20their%20disease.

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What were the consequences for womens health? Elle & Diviya 

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What were the consequences for womens health? Elle & Diviya 

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Delayed Diagnoses: Because people tend to dismiss womens pain, it can lead to a delay in diagnosing serious conditions, for example endrometriosis, and auto immune diseases.

Increased mortaility rates: for conditions like heart attacks, women are less likely to recive life saving intervations. Research shows that women experiencing heart attacks are more likely to be misdiagnosis

Mental Health: Being dismissed can cause emotional distress and loss in trust in healthcare systems.https://pmc.ncbi.nlm.nih.gov/articles/PMC3111774/

https://pmc.ncbi.nlm.nih.gov/articles/PMC3111774/

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Defining Gender Disparities in Pain Management

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Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors. The purposes…

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Broader Social Biases In Medicine: Elle & Diviya 

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Broader Social Biases In Medicine: Elle & Diviya 

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Medical research has historically focused on men, which leads to a lack of understanding of how these issues or conditions may present in women. Drug trials and Clinical trials exclude women which result in not considering the difference in symptom and responses to meds https://pubmed.ncbi.nlm.nih.gov/36038207/

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Sex and gender differences in pain - PubMed

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Chronic pain affects 20% of adults and is one of the leading causes of disability worldwide. Women and girls are disproportionally affected by chronic pain. About half of chronic pain conditions are more common in women, with only 20% having a higher prevalence in men. There are also sex and gender …

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Christian

Dr William Bride claimed that the drug can cause alleiiated morning sickness.

It causes birth defects for the children causing them to have phocomelia (shortening or absence of limbs)

It increased the risk of of miscarriage and still birth.

Mothers will experience mental health issues such as depression and anxiety

Mothers may experience some PTSD

https://www.helix.northwestern.edu/2009/07/28/the-thalidomide-tragedy-lessons-for-drug-safety-and-regulation/

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To prevent these issues, medical professionals should be better trained to suspend personal biases and treat all patients equally to ensure they receive the correct level of care. Also, research should be highly regulated to encompass people of varying backgrounds and of both sexes to evaluate how symptoms present and effect different people. This would reduce the chances of these conditions/ diseases from being overlooked or being attributed to others. This will lead to a reduction in preventable deaths.

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Q3: How does this reflect broader social bias in medicine?

A: The Thalidomide tragedy is an example of how bias has been implemented in today's medicine through things such as gender bias which is also related to the lack of research done on a particular marginalised group as well as not taking in to consideration the voices of these people. This can be shown in today's medicine as in some cases gender bias in women is still currently shown by health practitioners not giving enough consideration and or not investing enough time into research of women's medicine.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8812498/

As shown in this link above, there is still a gap in gender equality from the time of Thalidomide tragedy, however there being an increase in awareness there are still cases that occur. As said men are more likely to recieve better care, research and respect in medicine rather than women an example of this can be of waiting times for diagnosis. As said on the case study "Females account for >50% of the global population and, therefore, a significant proportion of the patient population,⁴ yet women wait longer than men for both a diagnosis⁵ and pain relief, and⁶,⁷ are more likely to be misdiagnosed or discharged during serious medical events.⁵

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Increased research on womens health: NHS england has initiated the rollout of women health hubs and appointed womens health chapions to enhance support and care for women

Policy Changes: Implementing guidelines to ensure equal pain management and accurate diagnoses for women. A UK parliamentary report by the Women and Equalities committee highlighted medical misogyny within the NHS leading to delayed diagnoses and inadequate treatment for conditons like endometriosis https://pubmed.ncbi.nlm.nih.gov/36038207/

https://www.theguardian.com/society/2024/dec/11/medical-misogyny-condemns-women-to-years-of-gynaecological-pain-mps-told

https://pmc.ncbi.nlm.nih.gov/articles/PMC3111774/

https://www.thesun.co.uk/health/32231010/women-girls-pain-dismissed-nhs-medical-misogyny-mps/

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Sex and gender differences in pain - PubMed

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Chronic pain affects 20% of adults and is one of the leading causes of disability worldwide. Women and girls are disproportionally affected by chronic pain. About half of chronic pain conditions are more common in women, with only 20% having a higher prevalence in men. There are also sex and gender …

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How systemic bias leads to preventable deaths

systemic bias perpetuates inequalities that make certain groups more susceptible to preventable deaths through barriers to healthcare, violence, lack of resources, and poor education. Addressing these biases requires comprehensive policy changes, education, and a commitment to equity at all levels of society.

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Frances Bell endured 17 years of misdiagnosed endometriosis, initially dismissed as IBS. Despite severe pain, doctors labeled her symptoms as exaggerated. A delayed diagnosis in 2014 revealed Grade 4 endometriosis, leading to infertility and extensive surgeries, including a hysterectomy. Nottingham University Hospitals NHS Trust admitted to negligence, resulting in a £500,000 compensation. Bell's story highlights the ongoing struggle for women with chronic pelvic pain to be taken seriously. She later had a son via IVF.

1. The injustice in this case study lies in the long delay/ late diagnosis. Patients face physical, emotional, and financial burdens, with limited access to specialists, reflecting a broader pattern of gender bias and inequality in healthcare.

2. The consequences for women's health are, untreated pain disrupts daily life, work, having to undergo surgeries, leading to possible cancer, takes an emotional toll - anxiety, depression and loss of trust in the healthcare system, financial burden.

3. This case study reflects broader social biases in medicine, particularly the tendency to dismiss or minimize women’s pain, a phenomenon often referred to as the "gender pain gap." Frances Bell’s experience, where her severe symptoms were misattributed to IBS and labeled as exaggerated, mirrors how women, especially those with chronic pain or reproductive health issues, are frequently overlooked or misdiagnosed. It underscores systemic issues where female patients' symptoms are more likely to be seen as psychological or overblown rather than investigated thoroughly.

4. To prevent issues like the one Frances Bell faced, solutions could include better education for healthcare professionals on conditions like endometriosis, with specialized training in chronic pain and reproductive health. Doctors should be taught to actively listen to patients and validate their concerns, addressing gender biases in medical practice through workshops. Improving access to specialist care, such as establishing endometriosis clinics and implementing standardized diagnostic guidelines, would also help reduce misdiagnosis and delays in treatment, ensuring patients receive timely and accurate care.

5. References:

https://www.bbc.co.uk/news/uk-england-nottinghamshire-53822993

Hudson, N., 2022. The missed disease? Endometriosis as an example of ‘undone science’. Reproductive Biomedicine & Society Online, 14(14), pp.20–27. doi: 10.1016/j.rbms.2021.07.003.

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‘Doctors missed my endometriosis for 17 years’

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Frances Bell, whose condition caused her years of chronic pain, receives £500,000 compensation.