"Non-traditional" heart attacks

Plus! Children's TV may, in fact, not be passing the Bechdel Test

Well, hello there GFPs, and a happy Autumn to you. This used to be my favourite season. I loved the crisp air, the warm layers and colours, the mists and the mellow fruitfulness. And of course I still do, but since moving up north, the onset of autumn also brings with it the dread of the on-coming and endless damp and dark and skin-biting cold I know is coming my way. Did you know that it can actually hurt to get dressed because your clothes are so cold in the wardrobe that they sting your skin like a thousand icy needles when you put them on? Reader, I do not like it.

Alongside being a soft southerner (and not just of the British variety because my childhood was spent in South America, Southern Europe and Taiwan, so, you know, the South is baked into my increasingly chilled bones) I have, as I’m sure you will all be delighted to hear, further moans.

I think I have briefly mentioned in this newsletter before my long-term problem with gastroesophageal reflux disease (GERD). For those not acquainted with the joys of this chronic condition, it basically means that your stomach acid doesn’t stay where it belongs aka in the stomach (THE CLUE IS IN THE NAME, ACID 😒) and migrates without so much as a by your leave up into your oesophagus where it causes a lot of pain and, eventually, if you don’t get it under control, can lead to oesophageal cancer — and that cancer is not one of the good ones.

I have had this condition since I was nineteen and I have mostly managed to keep it under control with medication and eating like a nun, but recently it has got completely out of control and despite doubling my dose of meds (and occasionally going even higher, as well as trying to spread my dose across the day) and eating even more like a nun than I thought was possible, still the acid comes, preventing me from eating or sleeping properly. Meanwhile, the waiting list for a gastroenterologist appointment in my area is seven months and I have literally no idea how I am supposed to survive without being able to functionally eat or sleep for seven months. I’m not entirely sure why I’m sharing this, as what can any of you do about it, but it is the thing that is, for obvious reasons, most occupying my mind, so it has come spilling out onto the page, rather like the acid is spilling out of my stomach as I type. I guess if anyone has a magic wand they’d like to share with me as I honestly feel like I’m going to lose my mind if I have to live like this much longer?

Anyway, let’s move on from me, because there are apparently things that are of interest taking place outside of my body.

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Misclassified heart attacks

First up, a new study out of the US, suggesting that yet more of our historic default male assumptions about heart disease may not apply.

So. The standard understanding of heart attacks is that they are mostly caused by clogged arteries. In very basic terms, this is how it works: the artery is narrowed by a build up of fat and cholesterol, blood flow to the heart is reduced, eventually some of this build-up ruptures, leading to a blood clot, which leads to a heart attack.

Anyone can have this kind of heart attack and it is the most common cause for a heart attack overall.

But, it turns out, it is far less common in some people. In fact, according to this new study, which examined over 15 years of data, more than half of heart attacks in women under sixty-five may be caused by “nontraditional factors” and I just want to pause there for a moment for a brief language break, we all know how fond I am of those.

In Invisible Women, I wrote about the problem of labelling heart attack symptoms that women are more likely to experience as “atypical,” because it suggests that those symptoms are uncommon and, as the British Medical Journal warned nearly a decade ago now, it “may lead to the under-appreciation of risk associated with this presentation”. (IW, p.219). And while symptoms may be uncommon in men, they are not uncommon, or indeed “atypical” in women — and in a world in which women are already systematically under-diagnosed, under-treated and over-dying from heart disease, it’s probably a bad idea to use labels that minimise their risk any more than we already do.

On which note: “nontraditional”. Now, to be strictly fair, it absolutely is the “traditional” understanding that coronary artery disease is the cause of the vast majority of heart disease, in effect making other causes “nontraditional”. But based on the findings of this study it would seem that tradition has got this extremely wrong, which to me would suggests that perhaps we should be dispensing with it altogether. Perhaps, instead of labelling these causes and symptoms “atypical” and “nontraditional” we should instead be labelling them “common in women”? I dunno, man, I’m just a woman, what do I know?

Still, why does this matter? A heart attack is a heart attack is a heart attack, right? Surely, the important thing is to diagnose it?

Well, yes and no. Obviously it’s preferable that a heart attack gets diagnosed as a heart attack as opposed to, say, indigestion or anxiety or the menopause. But when we get the cause of the heart attack wrong, we also get the treatment wrong. And that, explains lead author Dr Claire Raphael, an interventional cardiologist at Mayo Clinic, “can mean the difference between recovery and recurrence.” This may go some way to explaining the significant sex differences in recovery I reported on in Invisible Women (for example, women are more likely to die following a heart attack than men), because, as this study found, the causes of women’s heart attacks are indeed “frequently missed and misclassified.”

The misclassification of women’s heart attacks is obviously bad news, and yet further evidence of the damage a one-size-fits-men medical system can do. But it’s also good news, because knowledge is power, and the more evidence we have that our current approach is failing women, the better our chances of fixing it, and saving women’s lives.

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In which AI fixes everything…

And now to children’s TV, where everything is, of course, sugar and spice and all things nice.

Except of course it’s not, because as every fool knows those words are genetically female and no human of the male variety has ever liked sugar or indeed spice and they have evolved to despise anything nice. And this is relevant to children’s TV because it is still, a new study reveals, really quite slugs and snails coded (which as everyone also knows, are the genetically coded male preferences).

This study, which analysed US children’s TV between 1960 and 2018, found that across over half a century of programming there has been little change in the portrayal of male and female characters.

Starting with the most basic measure, the number of times words like he/his/man/boy appears versus she/her/woman/girl appears, they found that male words continued to outnumber female words throughout the period. There was some improvement here, (mainly due to a decrease in male words and in gendered words overall rather than an increase in female words) but a “child watching in the late 2010s would still hear about 50% more male words than female words in a typical episode.”

And that was about the end of the good news, such as it was, because when the researchers looked at what the scripts were saying about those male and female characters, things really did not seem to have shifted much since the mid-20th century. Male characters were overwhelmingly presenting as “doers”, with female characters presented as “done-to,” and even though the number of male words declined over time (as seen above) “they did so in a way that simultaneously maintained the conflation of agency with males at the syntactic level.” In fact, the conflation of males versus females with agency actually increased over time. Progress!

Intriguingly, when the researchers tuned their attention to “communion” words, for example “friends”, “relationship” and “wedding”, many such words were more associated with females than males — except for the words related to friendship, and while the authors do caution that this was not the most reliable of their findings it nevertheless makes me EXTREMELY SUSPICIOUS that these kids’ shows are not passing the Bechdel Test. I also can’t help thinking about how women’s friendships have been pathologized over the centuries — consider the evolution of words like “gossip” for example.

Naturally, words related to work were much more likely to be coded male than words related to the home, which were coded female, which makes sense because as we all know, women are biologically wired to mop floors and brows while men are biologically wired to run the world THAT’S JUST SCIENCE and explains why everything is so brilliant everywhere in the world right now.

But don’t worry! As the authors cheerily note, AI is being introduced into screenwriting and that will make everything…well, worse actually because AI is trained on existing scripts and as you may remember from Invisible Women AI doesn’t just reflect our biases back to us, it amplifies them. A lot. For example, when an algorithm was trained on an image database where pictures of kitchens were 33% more likely to have a woman than a man in them, the algorithm then went on to associate pictures of kitchens with women 68% of them. That is, it was labelling men as female simply because they were standing in a kitchen. Which is, of course, where we belong. Guess I’d better stop writing and get back to the stove.

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Poppy pic of the week

That’s it! Until next (hopefully much less acidy) time, my dear GFPs…xoxoxo