On IUDs, IVF, vulvodynia, and the importance of sleep

Welcome to my newsletter!

Glad to have you here! You can read a bit about what you can expect from these emails here.

What I’ve Been Up To

At Shondaland, I interviewed journalist Jennifer Block about her new book, Everything Below the Waist: Why Health Care Needs a Feminist Revolution. Primarily centering reproductive, gynecological, and obstetric care, she shows how women are especially vulnerable to overtreatment and mistreatment. My own book focused more on how women so often have to fight for a diagnosis and treatment, so it might seem surprising that overtreatment is also such problem. But as Jennifer says, “We’re getting too many of the treatments and surgeries that we don’t need and not enough of the ones that we do.”

I chatted with Caren Beilin for her new podcast Blackfishing the IUD. Her memoir about developing rheumatoid arthritis after getting the copper IUD raises important questions about the potential health effects of IUDs—and how medicine responds to women who have bad reactions to the device that aren't readily explained. Caren and I connected when I was working on my Scientific American article about the future of contraception.

Vulvodynia, a chronic pain condition that’s estimated to affect a quarter of American women at some point in their lives, has been getting much more media attention in the last few years. I spoke to Ashley Fetter about the history of the condition for her great piece in The Atlantic about how vulvodynia impacts relationships. And you can catch me talking about hysteria in the first episode of the new podcast Tight Lipped, which explores the long diagnostic delays so many patients with vulvar pain face.

Finally, I wrote a short piece about the knowledge gaps in our understanding of the long-term impacts of IVF and other fertility treatments for a recent special section of the New York Times Magazine focused on fertility. I learned a ton—and then tried to cram as much as possible into a painful 600 words. If you missed the print version, I’m told it will run online next month.

IRL

I’ve done quite a few speaking gigs in the last couple months: I talked to medical students and physicians at Penn State College of Medicine. Employees of a Bay Area biotech company. The annual women’s health conference put on by the Illinois Department of Public Health. And a wonderfully fired-up audience at the Wisconsin Book Festival in Madison.

If you want me to come speak to your organization or university or conference about gender bias in medicine, get in touch. I’m especially eager to do more talks for doctors and future doctors, the people best positioned to transform the system.

The Latest in Doing Harm

The Washington Post covers how implicit biases lead to misdiagnoses. #PatientsAreNotFakingIt trends on Twitter. Hundreds of Australian women harmed by transvaginal mesh devices have won their class action lawsuit. Runner Mary Cain’s story has sparked a conversation about the abusive training many female athletes endure in “a sports system built by and for men.”

There’s a new book on sexism in medicine from Australian journalist Gabrielle Jackson. And another from Kirsten Karchmer, who wants us to stop accepting painful periods and PMS as “normal.” They’re just the latest in “the recent boom in books about women in pain”: “It feels like the beginning of a reckoning with how many women are suffering pain on a daily basis, and how medicine has failed them.”

In the United States, one in six people report “mistreatment” during childbirth—from losing their autonomy to being ignored, threatened, or berated. An article in STAT looks at some efforts to ensure health care providers get feedback about these bad—sometimes traumatic—experiences. This is so critical across all clinical realms. We need better systems in place so that doctors actually learn when their mistakes—whether it’s mistreatment or missed diagnoses—have harmed patients.

According to a new study, Black biomedical researchers are less likely to get funding for their work in part because they are more interested in doing patient-focused research in a system that values “hard” science more. Grant proposals that mentioned “disparities” or “socioeconomic” or even just “patient” got less funding. And the applications that got the least of all? Those using the terms “ovary,” “fertility,” and “reproductive.” This is why simply getting more women or people of color or other historically underrepresented groups into the profession isn’t enough. Even when they have different interests and priorities, even when they want to ask new questions, they are incentivized to play the same old game.

How to Be Well

Amazon warehouses are injury mills. Air pollution is to blame for more than a quarter of deaths from heart disease and lung cancer worldwide. Five-hour work days, four-day work weeks, and other “radical” experiments that reject the idea that “always-on electronic chatter is a good way to efficiently extract value from human minds.” Sleep is “the final frontier of consumer capitalism” and we’re losing: In the West, we sleep, on average, six and a half hours a night. A generation ago: eight hours. A century ago: ten.

Bookend

Speaking of sleep, I’m reading Matthew Walker’s Why We Sleep: Unlocking the Power of Sleep and Dreams. A long-time user of blue-light-blocking glasses (I recommend the extremely attractive Uvex ones), I thought I already knew a fair bit about the importance of sleep, but this book is still astonishing. Clearly and relentlessly, Walker adds study after study to a mountain of evidence showing that a lack of sleep is the root cause of all evil—or at least a major contributing factor in many diseases.

It’s hard to choose among countless scary stats, but here’s one: “After 16 hours of being awake, the brain begins to fail.” And after 19 hours, you’re as cognitively impaired as someone who is legally drunk.