Wednesday, 17 September 2014

Cake and regurgitating babies: words, words, words

Think about the words you hear, and how they affect you. When someone says: “Would you like a slice of chocolate sponge cake?” does that somehow paint a different picture in your mind than “Would you like a segment of baked fat-flour mixture?”. Of course it does. It might even affect whether you accepted a piece or not.
Over the past three days, attending a splendid British Medical Journal conference on overdiagnosis in Oxford, it struck me again and again (and to be honest, it’s been a bee in my bonnet for a while now) how the words chosen by doctors, companies, charities, politicians and newspapers to describe our health affect our decisions. Hugely.
The most obvious example is sticking the word “disease” on the end of other words that represent, in themselves, a fairly harmless concept. The "D" word will get a normal person’s stress hormones flowing, induce fears for the future, and influence actions. Most likely, it makes us rush for tests and treatment.
Assistant Professor Scherer, from the University of Missouri, investigated this, and presented her results at the conference. Any parent knows that babies can vomit milk in a rather alarming way: it's often called reflux, colic, regurgitation. Recently, doctors have taken to classifying more extreme cases as gastroesophageal reflux disease (GERD). And interestingly the rise of this "new" condition coincided with a dramatic rise in the use of medications to treat GERD. Even though research indicates the medications bring no benefit whatsoever.
Laura Scherer investigated. She took 275 parents through a scenario, asking them to imagine that their child regurgitated and cried excessively. They were all told that medications didn’t help. But half the parents were told that the doctor in the scenario diagnosed the condition as gastroesophageal reflux disease, and half were not. 
The result? The parents told that the condition had a long name ending in “disease” showed considerably more interest in medicating the child, even though they knew the medicine was unlikely to work. And they were also less likely to believe that the child would get better without medication. In other words, use of the "D" word would lead to them over-treating their child with a useless medicine.
Doctors and policy makers struggle with why people make bad health decisions, or get over-anxious about their health. And often – very often – the answer is that simple. Words, words, words.