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Pain and Prejudice: How the Medical System Ignores Women―And What We Can Do About It

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“[A] powerful account of the sexism cooked into medical care ... will motivate readers to advocate for themselves.”— Publishers Weekly STARRED Review A groundbreaking and feminist work of investigative In Pain and Prejudice , acclaimed investigative reporter Gabrielle Jackson takes readers behind the scenes of doctor’s offices, pharmaceutical companies, and research labs to show that—at nearly every level of healthcare—men’s health claims are treated as default, whereas women’s are often viewed as a-typical, exaggerated, and even completely fabricated. The impacts of this bias? Women are losing time, money, and their lives trying to navigate a healthcare system designed for men.  Almost all medical research today is performed on men or male mice, making most treatments tailored to male bodies only. Even conditions that are overwhelmingly more common in women, such as chronic pain, are researched on mostly male bodies. Doctors and researchers who do specialize in women’s healthcare are penalized financially, as procedures performed on men pay higher. Meanwhile, women are reporting feeling ignored and dismissed at their doctor’s offices on a regular basis. Jackson interweaves these and more stunning revelations in the book with her own story of suffering from endometriosis, a condition that affects up to 20% of American women but is poorly understood and frequently misdiagnosed. She also includes an up-to-the-minute epilogue on the ways that Covid-19 are impacting women in different and sometimes more long-lasting ways than men.  A rich combination of journalism and personal narrative, Pain and Prejudice reveals a dangerously flawed system and offers solutions for a safer, more equitable future.

383 pages, Paperback

Published March 8, 2021

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547 people want to read

About the author

Gabrielle Jackson

2 books12 followers
Gabrielle Jackson is an associate news editor at Guardian Australia, and was previously opinion editor there. Before that, she was a senior journalist at The Hoopla. Gabrielle has lived and worked in the USA, UK and Australia as a journalist and copywriter. She currently lives in Sydney and commutes regularly to the Riverina district of New South Wales. Gabrielle was first diagnosed with endometriosis in 2001. In 2015 she was also diagnosed with adenomyosis. After writing about endometriosis for the Guardian 2015, she became interested in how women's pain is treated in modern healthcare systems and has been researching and writing about the topic since then. Gabrielle loves cooking and is a kebab connoisseur. In 2011-2012, she spent eight months travelling from Europe through the Middle East to Asia sampling and researching the history of the kebabs and their journey to the western world. She returned to Australia after being run over by a train in India.

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Displaying 1 - 19 of 19 reviews
Profile Image for Sam S.
748 reviews11 followers
January 21, 2022
I struggle to give this book a rating.

The first third was great! But then the writing style switched from a narrative tone to research paper. While all of the information was relevant and interesting, the order it was provided in was a bit frenzied and chaotic. I got bogged down in the almost constant citations and interview references ("I spoke to Dr X researching Y at the University of Z").

I also strongly feel that the last chapter describing top chronic pain conditions should have been put MUCH earlier in the book.

Overall, I think this was a worthwhile read that I did get some information out of. I just wish it was a bit easier to get through.
Profile Image for Ellie May.
76 reviews2 followers
October 2, 2024
Loved the insight and interviews - definitely make you mad especially if you have your own personal stories that the research validates. But the author inputs a lot of “down with men, the patriarchy!” and while there is bias in the medical field, her points were way better made when she was using statistics and not opinion. She lost me a lot when she went on personal tirades. But shoutout to all my women out there, we are insanely complicated internally and our bodies only started to get studied differently from men in the 70s 🤘 so no, you are not crazy for feeling what you feel
Profile Image for Caitlin Farrell.
41 reviews1 follower
January 23, 2023
I was gifted this book & anticipated it being primarily the authors story with some medical info throughout. It was the opposite, which was a little redundant for me personally. Would be a great read for people with minimal-average knowledge on women’s health.
Profile Image for Tory Welsch.
4 reviews
February 26, 2022
The information in this book will make you livid (especially if you also have endometriosis and other chronic pain like me), but the anger is a necessary price to be informed and is required for collective action. This is absolutely a must-read for anyone with chronic pain or honestly anyone working in any branch of the healthcare industry. Jackson thoroughly explains how deeply engrained structural issues have led to medical systems designed for cis men and the constant dismissal and mistreatment of chronic pain, which is predominantly experienced by cis women. My main critique is that it could have been overall better organized for conciseness and ease of reading. But that aside, I definitely highly recommend.
Profile Image for Britney Billings.
166 reviews10 followers
Read
April 30, 2022
I think it was important read as both a woman and a healthcare worker. The first half was very gripping especially, but slowed down in the second half. I do think there’s a lot of important information and it is very anger inducing how women/chronic pain condition patients are historically treated
Profile Image for Sarah.
690 reviews19 followers
April 10, 2023
This was such an impactful read, first and foremost for the acknowledgement of chronic pain, a pain in which “…medicine itself acknowledged its shortcomings in both knowledge and effective treatments” (225), a pain in which “…at least one in five people experience…” (225). Those 1 in 5 people suffering tend to be those born with female reproductive systems: “…there’s a two-to-sixfold greater prevalence and greater intensity chronic pain syndromes in women compared to men” (227). “Women are more likely to have disabling pain- as in, it prevents them from working and fully participating in life- than men” (228), but “…women’s pain is less likely to be treated” (228). And when it is treated, “…women’s accounts of it are often assumed to be an exaggeration….a form of hysteria- called ‘catastrophising’ in modern pain-management parlance- when medicine fails to understand the body and can offer no explanation or cure” (228). Not only that, “…women and others with female sex organs are more susceptible to pain conditions…they experience more intense pain and pain for longer periods than men…” (229). As the author commiserates, it’s incredibly frustrating and illogical that “…we’re currently in a situation where 70 per cent of chronic-pain patients are women but 80 per cent of pain studies are conducted on men… (232).
In the chapter called “The Pain That Can’t Be Seen”, one of my favorite chapters of the book, the author talks about the multiple issues with chronic pain, one of which I’ve found to be one of the most frustrating aspects personally. Part of the problem, Jackson states, is “...the Western approach to reductionist medicine in which we isolate the body parts and treat them separately” (233). Also of note was a condition that often goes along with chronic pain: central sensitization, a condition where “….a patient actually becomes more sensitive and gets more pain with less provocation…..Their pain also ‘echoes’, fading more slowly than in other people” (242), a condition I’m all too familiar with. That’s how a lot of this book felt, like a book of acknowledgement, down to the very apt description of chronic fatigue: “…it’s like walking through sludge wearing a suit of armour….Thinking feels like driving a car with a dirty windscreen while wearing smudged glasses” (257-258).
One of the other pivotal parts of the book for me was her research findings on what causes pelvic pain, and how it contributes to chronic pain. The revelation that people with female reproductive systems are at greater risk to developing chronic pain simply because of their anatomy (253), was equally illuminating and frustrating, as so many are left in the dark or point blank not believed. Studies on transgender men and women and their hormones were also an important part of the discussion, as those who’ve transitioned to women developed more pain (and those who transitioned to men reported less pain) (255-256). There were so many revelations in this impactful book, and as the author says, “We have to stop believing that pain is a natural state for women” (257). I loved her line too about how “…there’s a suggestion that if only they could be a little more positive, everything would be OK. That’s hysteria, right there, persisting among us” (266). Further, “…it shouldn’t be the default assumption that women with symptoms of generalised pain, distress and fatigue are all somatisers or simply anxious about their health” (266).
Overall, I can’t say enough how much this impactful book needs to be read. As the book so aptly says, “The toll extends far beyond the affected and their families, substantially impacting the health, workforce and productivity of our nation as a whole” (311). I loved how clearly and expertly she addressed gender and racial based biases in the medical field, acknowledged the under-represented populations that suffer from chronic pain and explained why, and gave readers a call to action and resources on what we can do now. An absolute must read.
Profile Image for Marathon County Public Library.
1,508 reviews52 followers
December 4, 2023
This was such an impactful read, first and foremost for the acknowledgement of chronic pain, a pain in which “…medicine itself acknowledged its shortcomings in both knowledge and effective treatments” (225), and a pain which “…at least one in five people experience…” (225). The people suffering tend to be those born with female reproductive systems: “…there’s a two-to-six fold greater prevalence and greater intensity of chronic pain syndromes in women compared to men” (227). “Women are more likely to have disabling pain- as in, it prevents them from working and fully participating in life- than men” (228), but “…women’s pain is less likely to be treated” (228). Why? Because “…women’s accounts of it are often assumed to be an exaggeration….a form of hysteria- called ‘catastrophising’ in modern pain-management parlance” (228). Not only that, “…women and others with female sex organs are more susceptible to pain conditions…they experience more intense pain and pain for longer periods than men…” (229). As the author commiserates, it’s incredibly frustrating and illogical that “…we’re currently in a situation where 70 percent of chronic-pain patients are women but 80 percent of pain studies are conducted on men…" (232).

In the chapter called “The Pain That Can’t Be Seen”, one of my favorite chapters of the book, the author talks about the multiple issues with chronic pain, one of which I know all too well, a condition that often goes along with chronic pain called central sensitization. This is where “…a patient actually becomes more sensitive and gets more pain with less provocation…Their pain also ‘echoes’, fading more slowly than in other people” (242). This whole book felt like one big bowl of acknowledgement, down to the very apt description of chronic fatigue many of us with chronic pain experience: “…it’s like walking through sludge wearing a suit of armour. Thinking feels like driving a car with a dirty windscreen while wearing smudged glasses” (257-258).

One of the other pivotal parts of the book for me was her research findings on what causes pelvic pain, and how it contributes to chronic pain. The revelation that people with female reproductive systems are at greater risk to developing chronic pain simply because of their anatomy (253), was equally illuminating and frustrating, as so many are left in the dark or point blank not believed. Studies on transgender men and women and their hormones were also an important part of the discussion, as those who’ve transitioned to women developed more pain and those who transitioned to men reported less pain (255-256). There were so many revelations in this impactful book, and as the author says, “We have to stop believing that pain is a natural state for women” (257). I loved her line too about how “…there’s a suggestion that if only they could be a little more positive, everything would be OK. That’s hysteria, right there, persisting among us” (266). Further, “…it shouldn’t be the default assumption that women with symptoms of generalised pain, distress and fatigue are all…simply anxious about their health” (266).

Overall, I can’t say enough how much this impactful book needs to be read. As the book so aptly says, “The toll extends far beyond the affected and their families, substantially impacting the health, workforce and productivity of our nation as a whole” (311). I loved how clearly and expertly she addressed gender and racial biases in the medical field, acknowledged the under-represented populations that suffer from chronic pain and explained why, and gave readers a call to action and resources on what we can do now. An absolute must-read.

Sarah M. | Marathon County Public Library
See this book in our catalog.
Profile Image for Alexandria.
205 reviews
March 9, 2023
📖📚 For #InternationalWomensDay, I would love to recommend the book *"Pain and Prejudice: How the Medical System Ignores Women and What We Can Do About It"* by Gabrielle Jackson. 📚📖

In this memoir of a journey searching healthcare for #endometriosis, Gabrielle Jackson brings up how women (and other minorities!) got left behind in medical research as people who were affluent, white, and male were historically becoming doctors. This made medicine blind and bias to the potential differences in medicine and historically reduced differences they could not understand to "hysteria" (another read is *"Medical Muses: Hysteria in 19th Century Paris"* by Hustvedt which is an impassioned take on this history).

Women's health is not just reproductive and no one's ailments should not be reduced for lack of understanding. This book points out that women may have different symptoms than their male counterparts for common conditions such as heart attacks and tend to have more chronic diseases-- AKA: there is a gap in knowledge for women's health. It's a #CallToAction to conduct more research and investigate treatments to bridge this #HealthcareGap. Forevermore, women with minority status (race, sexuality, gender identity, etc.) have even less representation in the research and therefore have a larger barrier in seeking care and increased burden of disease...

I think it's important for health care providers to check their biases, which is why I recommend this book. I also love seeing more and more #WomenInSTEM and increased diversity in healthcare, which should be continuously supported and encouraged.

❓❔❓
What book(s) do you recommend to highlight Women's Day?
❓❔❓

🎧 If you prefer a podcast recommendation, "This Podcast Will Kill You- Ep 88 Endometriosis: Menstrual Backwash" does discuss this topic, as well.

#BiasCheck #BookRecommendation #WomensDay2023 #ReadABook #PublicHealth #CheckYourBias #WomensHealth #ReadingList
Profile Image for Nisha.
48 reviews21 followers
April 4, 2021
I really enjoyed the first couple of chapters, and then the book lost a bit of clarity for me.

It is a well-researched and compassionate discussion of the ways that the medical system inherently fails women, especially in treating chronic pain. If chronic pain is part of your life experience, this book will probably resonate with you more than it did for me.

I would particularly recommend this book to anyone interested in learning about women's chronic pain and the difficulties in treating it. It is eye-opening how medical education is traditionally not well-equipped to deal with the complexity of chronic pain in women (which is rooted in historical narratives of hysteria, and there is an entire chapter dedicated to that). This book also chronicles how the healthcare systems in many countries incentivize treatments that often don’t work for chronic pain, or that don’t take patient treatment goals into consideration.

I would also recommend this to anyone who wants to learn more about chronic pain as it relates to endometriosis, or who wants to read personal experiences with the disease. There is such thorough research and so many personal accounts of the author's endometriosis that I learned a lot about this disease that I did not know before.

Lastly, I would recommend it to anyone who has had COVID-19 and experienced after effects, especially chronic pain. In fact, if you only read one chapter of this book, read the epilogue about COVID and chronic fatigue. This chapter does a great job in normalizing the fact that not everyone is going to recover from COVID within weeks. This chapter shows that not only can COVID make existing chronic pain and fatigue worse, but it may also trigger chronic pain and fatigue in people who did not have them before. Some people need that wake-up call. The pandemic may prove to be the watershed moment that is needed to change the culture around chronic pain and develop effective treatments.

As much as I liked the above aspects, I did struggle with this book in places. Firstly, I found the writing hard to follow sometimes. The grammar was not clear in places which meant I was often unsure what the subject of the sentence was. I also found it repetitive in places, especially the numerous times when endometriosis was explained. Having one strong explanation may have allowed room for in-depth explanations of other conditions that I did not know much about, such as vaginismus.

Sometimes I also had to disagree strongly with some of the analogies. The biggest example was comparing access to hormonal birth control to access to condoms. One of the author’s sources laments the fact that the Australian government rejected a policy change that would have made birth control pills accessible without a prescription. The source then goes on to point out women have to get a prescription for hormonal birth control while men do not have to get a prescription for condoms. I disagree with this comparison because unlike the pill, condoms are not drugs that alter the body's chemistry, with potentially lethal effects if misused. Therefore, it makes sense for the health of the patient to have regular visits to the doctor to make sure the pill is working and not causing harm.

I understand the desire to increase access and therefore increase autonomy for women to manage their own reproductive choices (I myself dislike having to go back to the doctor for refill prescriptions), but safety should still be prioritized. If it isn’t, that increased agency will mean nothing if it causes women to become ill (or worse) through improper use of the pill. Hopefully, we will figure out a way to balance safety with access.
Profile Image for Noelle.
879 reviews18 followers
August 7, 2022
As a labor and delivery nurse, I was looking forward to learning more about how I can help care for those in my care. I didn't learn much of anything.
The first few chapters gave some excellent anatomy and physiology lessons--especially because most who don't work in women's reproductive health don't understand the female anatomy. The latter portion of the book was confusing and rambling. Information was repeated multiple times on the same page.
This is more of a historical recounting (though set in contemporary times) than a visionary look at the future with how we can do better. Of course, this book is not written by someone who works in health care, so that would have been outside of her realm of expertise.
Profile Image for Laura Ruth Loomis.
Author 5 books8 followers
January 21, 2023
This book is part biology lesson, part history, and part polemic. Jackson traces the history of women's medical issues being dismissed as "hysteria," and how a woman with unexplained pain is still more likely than a man to be offered anti-depressants instead of painkillers.

Jackson's proposed solutions appear simple, yet somehow they still elude those in a position to make change. A shift in research funding so that conditions affecting mainly women actually get studied. Including women in all studies of all conditions not exclusive to men. And the most oft-repeated statement from women throughout the book: "If only doctors would listen to their patients!"

Longer review:
http://www.lauraruthloomis.com/whats-...
Profile Image for Katelyn Boose.
16 reviews
March 27, 2022
Very informative and helpful. But a bit hard to get through. Lots of history which I know was needed in order for the reader to get the big picture. I also think a lot of the information was repeated many times. Other than that, I’m still happy I read the book (as a chronic illness/pain woman) and I took away a better understanding of the prejudices in the medical world.
1 review
April 15, 2023
Such a great look at the history of the medical system and how it has, and continues to let down women. I learned a lot from this book. As a future psychologist I plan to recommend this to my clients (and even some friends) who are struggling with women’s health problems and chronic pain.
935 reviews4 followers
April 27, 2021
When women’s medical concerns are dismissed or ignored, the repercussions are enormous and costly. This has to change and reading Jackson’s book is a good first step.
Profile Image for Ant.
337 reviews
September 15, 2021
A strong voice in favour of reshaping our approach to treating chronic pelvic pain. Well researched and argued and, importantly, written in an accessible way. Great read.
Profile Image for Julie.
493 reviews8 followers
October 7, 2021
i think everyone should read this book. There is a lack of actual sex ed in schools and open conversations.

I learned alot from this book.
Profile Image for Pam.
1,798 reviews
March 9, 2022
Nonfiction. I couldn't read this completely. I skimmed it, and it did have good information. The sheer misery some people went through at the hands of the medical system is overwhelming.
Profile Image for Liz (Quirky Cat).
4,986 reviews84 followers
March 8, 2021
I received a copy of Pain and Prejudice in exchange for a fair and honest review.

As you might guess from the title, Pain and Prejudice: How the Medical System Ignores Women – And What We Can Do About It revolves around pain, the medical world, and women. Written by Gabrielle Jackson, this novel is a must-read for any woman who experiences chronic pain. Or for anybody who has a family or friend going through that. Really, it's a vital read for many (if not all) people.

Gabrielle Jackson is an investigative reporter, one with a very personal connection to this novel. She has endometriosis, and her experience looking for (and getting) treatment seemed to start her on this path. It's one that I am personally very familiar with, and is the main reason why I knew I had to pick up Pain and Prejudice.

Okay, I'll confess that the title actually did a fantastic job of catching my attention – being a huge fan of Pride and Prejudice. But it quickly went beyond that.

“Let's look at chronic pain. Currently, 70 percent of chronic-pain patients are women but 80 percent of pain studies are conducted on men or male mice.”

Over the course of this book, Jackson provides a comprehensive view of medicine and women's pain. Everything from the history to modern complications, and everything between. Some of the revelations are deeply unsettling, yet that doesn't diminish the truth in the least. If anything, it increases the import behind reading Pain and Prejudice.

The timing and importance of Pain and Prejudice cannot be overlooked. I know I am almost certainly biased, being a woman who has spent her entire life dealing with chronic pain. Yet I also care about every other person affected, and want to see them have a better life. Learning about the nature of pain, and any biases that might prevent treatment, is the first step.

Check out more reviews over at Quirky Cat's Fat Stacks
Profile Image for Amy.
403 reviews1 follower
didn-t-finish
May 6, 2021
Too much focus on endometriosis and reproductive issues rather than societal and cultural problems with healthcare system
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