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Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick by Maya Dusenbery, HarperOne, US $27.99, Pp 400, March 2018

In Doing Harm, Maya Dusenbery argues that a historically male-dominated medical system has created two interlocking problems that affect the quality of care women receive. First, there is a knowledge gap. The average doctor does not know as much about women’s bodies and the health problems that afflict them. It starts at the most basic level of biomedical research, where investigators overwhelmingly used male cells and animals in preclinical studies. And it continues throughout the clinical research process, where women remain underrepresented, analysis by gender is rare, and women’s differing hormonal states and cycles are usually ignored entirely.

Second, there is a trust gap. Women’s accounts of their symptoms are too often not believed. For centuries, Western medicines tended to throw many of women’s inexplicable symptoms into the catchall diagnostic category of hysteria. At the end of the nineteenth century, hysteria came to be seen as a psychological problem but a stereotype that women’s symptoms are likely to be all in their heads” has been hard-baked into medical knowledge itself.

Maya Dusenbery focuses on how gender bias affects medical knowledge and the care women receive when they enter the medical system. She explores how gender bias affects the health care women receive when they are sick. The Affordable Care Act (ACA) provided some key benefits to women especially, which they still have. Before ACA went into effect, approximately 20 percent women of ages eighteen to sixty-four were uninsured, by 2015, that figure dropped to 11 percent. Healthcare reform also corrected some long-standing unjust practices of the insurance industry. Insurers are now required to cover basic preventive care that’s critical to women’s health, like contraception, annual well-woman visits, testing for sexually transmitted infections, breastfeeding support and supplies, and domestic violence screenings, without any copays or deductibles. They are no longer allowed to higher premiums than men for the same coverage.

Maya Dusenbery says that 11.2 million women particularly low-income and immigrant women of color still remain uninsured in the United States. Nineteen states mostly Republican-controlled in the south, have refused to expand Medicaid eligibility. Meanwhile, regardless of insurance status, women have more trouble affording health care than do men. A quarter of women, regardless of income, reported that a reason they went without health care was that they simply didn’t have time to go to the doctor. For low-income women especially, not being able to take time off their work, a lack of transportation and problems finding childcare are also common barriers.

This difference – women’s lower mortality but higher morbidity – has been known as the “gender paradox.” From the seventies through the nineties, some researchers questioned whether women were really as sick as they claimed, suggesting instead that women are actually healthier than men because they are not as likely to die and only rate their health as worse because they are less stoic. Today, Maya Dusenbery argues, it is well accepted that the paradox has a different, straightforward explanation — women have higher rates of debilitating but not life-threatening chronic diseases. Women are not any more likely to report poor health than men with the same medical condition but they’re just more likely to have one. More than half of all American women have at least one chronic health condition, and women are more likely than men to have multiple chronic problems.

Doing Harm is an unsparing and blistering indictment of our healthcare and medical system. In this meticulously-researched and brilliantly-written book, Maya Dusenbery shows how the medical community has misjudged or ignored women’s medical needs over the centuries. Maya Dusenbery also shows that more women remain undiagnosed or misdiagnosed than men even today. Maya Dusenbery argues that Obamacare offers some previously-unavailable health benefits to women. But, unfortunately, they are still deprived of many of them in the Republican-controlled states. Doing Harm is packed with chilling truths. Everybody, particularly women and the medical community, must read this.

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