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.

Former Pharma: Tremol and the National Infirmary for Bad Legs

What’s the difference between a legitimate medicine and a quack cure? Until medicine regulations were introduced in the 1960s, it was virtually impossible to tell – especially when the product was being marketed by medics at a national hospital. Supposedly.

Step forward Tremol – a cure for “varicose ulcers, varicose eczema, sore legs, swollen legs, painful joints”, widely advertised in story magazines of the 1910s and 1920s. Its purveyors? The National Infirmary for Bad Legs in Manchester. Yes really. They apparently worked from Ward CA (occasionally ER) of the institution on Great Clowes Street in Broughton. “Every form of bad leg succumbs to this new treatment” said the advertisement. “You are cured to stay cured for all time.”

The form the “infirmary” actually took is uncertain – there are no records of any type of hospital on Great Clowes Street. But we do know that the British Medical Association investigated it as early as 1912, and found evidence of pressurised selling. It also found no sign of supervision by a “fully qualified medical man” as the infirmary claimed. “If there is a registered medical man connected with the place, he is certainly acting in a way that makes him liable to be arraigned before the General Medical Council.”

The BMA’s analysis of the “Tremol blood mixture” (one teaspoon to be taken morning and evening) revealed the following ingredients: calcium chloride, ferric chloride, hydrochloric acid, rhubarb infusion, peppermint, water. Nasty. Yet Tremol clearly had a market and continued to be sold until at least 1928. Bad legs make you desperate, you see. 

Deafened by a killer yukka (nearly)

Clogwog/Foter/Creative Commons

Last week I was nearly deafened by a yukka plant. It’s certainly up there, as odd injuries go. You may be interested to know that every year there are around 2,500 household plant-related injuries reported in the UK, though I haven’t been able to find out how many are caused by yukkas.

The overgrown houseplant toppled off the window ledge as I was trying to open a window, and it sent one of its sharp spear-like leave straight down my ear canal. The pain when it hit my eardrum was exquisite. My hearing started to go all buzzy.

The reaction of my doctor (and this is the reason I’m writing about this) improved my morale no end. As I told him what had happened, he actually grimaced (I think I was expecting laughter at my unluckiness). Then, taking up his otoscope, he looked in my ear. He delivered his assessment: “Ouch”, he said. I could have hugged him. 

What we expect from doctors is mild chastisement, or impatience, or bewilderment. What I got was a little bit of honest human empathy, and I didn’t feel such a fool any more. 

“You’ve got a huge blood blister on your ear drum,” he said. “But don’t worry, it should get better by itself. Even if the ear drum is punctured, it should heal over. Come back if it gets any worse.”

More plus marks for my doctor. “It will get better by itself.” That’s what I like to hear. Most things do. I remember another doctor at the surgery, whose first reaction to a mysterious and huge swelling on my daughter’s foot was to squeeze it to see if it popped. “First do no harm” indeed. I’ve never consulted him again.

I can hear fine how.  No buzzing. The yukka has been pushed into a safe corner. And my faith in medicine has been boosted no end by my doctor's well-judged squeamishness and inaction.