Subj: The Language in Health Care Newsletter, 9-10/2000

Date: 08/30/2000 9:55:51 AM Central Daylight Time
From: ocls@madisoncounty.net (Suzette Haden Elgin)
To: ocls@madisoncounty.net

THE LANGUAGE IN HEALTH CARE NEWSLETTER

Volume 1, Issue 5 -- September/October 2000

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The Language in Health Care Newsletter is written and published every other month by Suzette Haden Elgin, Ph.D. (linguistics), from the Ozark Center for Language Studies (PO Box 1137, Huntsville, AR 72740-1137 USA, e-mail OCLS@madisoncounty.net). It's available by e-mail only, in plain text, and is free to members of the Grandmother World Network (annual dues, $5.00). For more information, contact OCLS.

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IN THIS ISSUE: Editor's Note; Milk Power; Fat Power; Quotes & Comments

EDITOR'S NOTE:

I need to let you know that the November/December issue of this newsletter will be the last; from January 2001 on, I'll be publishing only the Linguistics & Science Fiction, Verbal Self-Defense , and Religious Language newsletters. If one of you members wants to take over _this_ newsletter and continue it, please contact me so that we can discuss it.

MILK POWER

A perpetual problem in medical language is the effect of _naming_, which is most dramatic in those cases when naming creates a disease that would not otherwise exist. Sometimes it's hard to understand why one of these creations persists in medical literature and medical practice; sometimes the reasons are overwhelmingly obvious. "Lactose intolerance" -- difficulty digesting milk -- is an instructive example of what I suggest we refer to as a "neologismic disorder." [No reason why medpros should have all the fun!]

As long ago as 1988, the _American Journal of Clinical Nutrition_ had reported that lactose intolerance was the genetic norm in adults and that lactose activity is "sustained only in a majority of adults whose origins were in northern European or some Mediterranean populations." Ever since that information became available, the claim that there's a disease called "lactose intolerance" has made no sense at all. In a recent issue of _In These Times_, Salim Muwakkil writes that "Health professionals now recommend a change in terminology; those unable to digest milk should be considered normal....while adults who have retained the digesting enzymes should be called 'lactose persistent.' "

But "more than 30 years after health professionals first realized that the inability to digest milk sugar was a normal condition, the USDA persists in recommending two dairy servings each day." Not to mention the extraordinarily successful "milk moustache" advertising campaign waged in the past few years by the dairy industry. [Source: "Food Pyramid Scheme," by Salim Muwakkil; pp. 19-21, _In These Times_ for 8/7/00. Recommended; my thanks to Pat Mathews for sending the copy.]

We don't know how many people who are spending their time and money seeing doctors for digestive problems could stop doing that if they avoided milk; we do know the number is large. I've been there myself. In my thirties I began having severe digestive problems and spent almost six months seeing doctors and having tests and so on. I kept getting worse; I kept getting thinner. Convinced that it was all in my head, my doctor prescribed a placebo -- made of milk sugar. When that didn't help, he just kept increasing the dosage.

Finally I was put on a diet of "nutritional milkshakes" only, which landed me in the hospital, where -- at LAST -- a specialist suggested that I be tested for lactose intolerance. The minute I gave up milk, I was cured. [Final note: Many adults who think milk doesn't bother them have trouble with _powdered_ milk, which turns up in a multitude of products; often people don't realize that it's an ingredient in something they're eating or drinking.]

FAT POWER

Our culture has defined overweight as a disease, named it "obesity," and framed it as an "epidemic" that is a public health problem. On that foundation a multi-billion dollar diet industry has been built (both medical and civilian), and a flood of literature has been produced. And yet, in that same cultural context, a whole array of multi-billion dollar industries bury us in media urging us to buy and consume products and services that rely on fat and sugar and never-lifting-a-finger. It's either perverse or insane. It's enough to make you wonder; see, for example, item #4 below. Here are a few items from my obesity stack....

1. "How Technology Has Influenced Worldwide Obesity," by Tomas J. Philipson and Richard A. Posner; available online at http://www.harrisschool.uchicago.edu/publications/research_summaries/rs_vol1 _num2.html. Philipson and Posner contend that obesity in the U.S. isn't a public health problem at all, and that money spent trying to deal with it as a public health problem is money wasted. They claim that it's an economic problem, that technology has made food cheaper and exercise voluntary, and that people will change their eating and exercise behavior only if the benefits of doing so are sufficiently attractive. Weight, they say, "is the result of personal choices such as occupation, leisure-time activity or inactivity, and food consumption." I think they're trying to say (a) that obesity is not a disease and (b) that calling it one and firing up the entire medical model to deal with it is a waste of time and money.

2. On the other hand, you have Stephen O'Rahilly, physician and medical researcher, who says "People who are not obese believe themselves to be virtuous. But the truth is, they're just lucky." [This is on page 68-70 of the May issue of _Discover_ ; the quote above is on page 70.] On page 68: "Using a combination of old-fashioned clinical observation and modern biochemical analysis, he has shown that a person's appetite and eating behavior can be linked to specific genes -- and that even a tiny defect such as the absence of a single nucleic acid in a sequence of DNA can lead to runaway weight gain."

3. And then there's the idea that obesity is a moral failing. For an excellent discussion of that concept, see "The Weigh & the Truth," by Lauren F. Winner, on pp. 51-58 of the 9/4/00 issue of _Christianity Today_. Winner writes about a number of Christian weight-reduction programs, including Gwen Shamblin's Weigh Down system ("Put your spiritual life in order and you will lose weight"). In a section starting on page 57 headed "Is Fat Sin?" we read that "the underlying assumption that programs like Weigh Down share with the more disciplined programs is the notion that God wants people to be thin." If that's true, it's inexcusable.

4. The most startling thing I've seen on obesity recently is an article by Greg Critser, on pp. 41-47 of the 3/00 _Harper's_. (My thanks to Diana Cook, who sent me both the article and the outraged letters to the editor that followed it in May). Critser explores the horrifying possiblity that the privileged classes of America use food as a way to keep the lower classes in their place. Especially high-caloried, high-fat-content, "fast" food, in enormous low-priced portions, laced with sugar. Overweight stands in the way of success in our culture, especially for women; keeping a population fat would predictably keep it at the bottom rungs of the social ladder. Suppose you live in an inner city and you want (or need) to eat out. You won't find any quiche-and-asparagus places in your neighborhood; you'll find food designed to make you fat. The profits on "supersize" fast foods are also supersize. Suppose you want to exercise, where would you go?

You won't have any golf courses or tennis courts or swimming pools in the inner cities; you might have playgrounds or parks, but it won't be safe to use them. Only the affluent can afford to eat for thinness and exercise regularly; Helen Gamble, the skeletal district attorney on tv's "The Practice," is the perfect icon. I hope with all my heart that Critser is as far off the mark as the furious letter-writers think he is.

QUOTES & COMMENTS:

1. "With her long, graying hair, often in braids, and her flashback 60s clothes, Ina May Gaskin isn't as glamorous as many other prenancy and childbirth 'experts'.... Instead, Gaskin looks like what she is: a hard-working, grandmotherly ex-hippie...." This, Gentle Readers, is the _opening_ of Katie Allison Grandju's _Salon_ article from 6/1/99 titled "The midwife of modern midwifery." Can you imagine any journalist opening an article about a male medical pioneer (and a pioneer in the use of sensible medical language) in that fashion? And Grandju isn't through with her disclaimers. After telling us that Gaskin started the modern home-birth movement, that her book _Spiritual Midwifery_ is a best seller, and that anthropologist Robbie Davis-Floyd endorses her as "the most famous midwife in the world," we're offered this: "Although this sort of professional recognition from academics, physicians, and researchers has become routine for Ina May Gaskin, it is somewhat unusual, considering that this 'most famous midwife in the world' has neither a Ph.D. nor any formal medical training."

Ah, well....never mind. Allow me, yet another non-glamorous hard-working grandmotherly ex-hippie, to add my own endorsement without reservation: Ina May Gaskin and her work are miracles. What she has done is proof that it _is_ possible to turn health care messes around and make health care work properly. If her husband's candidacy for President had made her First Lady, we would have had substantial health care reform in one heck of a hurry.

You can read the article I quoted from above at http://www.salon.com/people/bc/1999/06/01/gaskin/print.html. And I urge you to read Gaskin's 7/12/00 _Salon_ article titled "Cytotec: Dangerous experiment or panacea?" at http://www.salon.com/health/feature/2000/07/11/cytotec./print.html. You will be amazed.

2. From _BMJ_ (_British Medical Journal_) for 10/5/91, pp. 798-799: "There are perhaps 30,000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century. Yet only about 15% of medical interventions are supported by solid scientific evidence." This is quoted from a medical conference presentation by Prof. David Eddy of Duke University. Eddy (originally a surgeon at Stanford) became interested in the topic of medical evidence some years ago. "He decided to select an example of a common condition with well-established treatments and assess in detail the evidence supporting those treatments. Beginning with glaucoma, he searched published medical reports back to 1906 and could not find one randomized controlled trial of the standard treatment. ... The same analysis was done for other treatments....the findings were similar." Keep all this in mind the next time you hear a medical professional start a sentence with "We now know..." [This piece is written by Richard Smith and titled "Where is the wisdom...?: The poverty of medical evidence." My thanks to Stephen Marsh for the copy.]

3. While we're here we might as well tackle the question of where -- given the lack of solid evidence -- the media get those sweeping statements they fling at us in "medical minutes" and "health care minutes." The process of data dredging comes to mind. "Data dredgers can just take 100 food items and personal habits and compare them with 100 different ailments. If necessary, divide and subdivide diseases like cancer according to the organ it effects. Now you have a matrix with 10,000 cells. Even if there is no cause-and-effect relationship in any of those cells, you are still sure to find around 100 stunning correlations about which you can honestly make this claim: 'The chance of this correlation arising by chance is less than 1 in 100.' That's what you publish." Is data dredging a reliable way to make medical decisions? It might be, sometimes; but often it's extremely unreliable, especially if people reading the research aren't skilled at interpreting statistics. The most basic problem: "While surveys like the one going on in Framingham, Mass. for the past 47 years can tell you that high cholesterol correlates with the development of heart disease, that doesn't prove that lowering cholesterol will do you any good. A correlated variable may be a marker, not a cause." Both of these quotes come from an article by Philip E. Ross titled "Lies, damned lies and medical statistics," _Forbes_ for 8/14/95, pp. 130-135 -- on page 135.

4. Many health care professionals are well aware of the curious situation demonstrated by items #2 and #3, which is why medical journals so often have articles with titles like "How to Interpret Research Studies." My favorite article of that kind is "Treating Hypercholesterolemia: How Should Practicing Physicians Interpret the Published Data for Patients?", by Allan S. Brett MD, on pp. 676-679 of the 9/7/89 _New England Journal of Medicine_. What Brett does in this article is lay out carefully and meticulously the very different ways that single items of evidence about cholesterol and health can be stated, and the effects of those variations on doctors' behavior.

There's no way I can do this article justice here; you need to read it. For just one quick example to give you an idea of its content, Brett reports that one respected cholesterol study found a statistically insignificant reduction in coronary deaths -- 30 deaths in patients treated with a cholesterol drug versus 38 in patients not treated with the drug -- but went right ahead and published it as "a 24% reduction in risk." The same study, dealing with the unexpected finding of an increase in violent and accidental death in patients treated with the drug, handled _that_ data quite differently, saying: "Since no plausible connection could be established between [the drug treatment] and violent or accidental death, it is difficult to conclude that this could be anything but a chance occurrence." (All on page 678.)

The tendency, Brett says on the same page, is obvious: "The language that frames results of uncertain significance is determined by whether those results support or detract from the investigators' hypotheses." This article is indispensable for anyone working with medical language -- and for anyone trying to make up their mind about which of several suggested medical treatments to choose. I wouldn't be without it.

5. Before you write and accuse me of X-bashing, there's one thing that has to be said. Controlled randomized double-blind medical research is extremely difficult to do, and often ethically impossible. To get the kind of evidence used in most scientific fields would often mean allowing many people to get sick, suffer dreadfully, and perhaps die -- in order to prove that a group of other people had avoided that fate by following a particular medical regimen. Since that's the situation, medical researchers fall back on statistics; with today's computers, that's not even hard work.

Since that's the situation, every medical research report -- including reports from "alternative" medicine -- should say something like this: "There are five [or whatever number is accurate] different ways to state the results of our research." Each of those ways should then be set down clearly, so that the linguistic effects of the various ways of framing the results would all be there for the reader to examine. And the raw numbers, without being turned into any kind of statistical whatzit, should also be there. That would be fair.

Copyright © 2000 Suzette Haden Elgin

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E-mail newsletters by Suzette Haden Elgin in 2000 include The Grandmother

World Newsletter, The Language in Health Care Newsletter, The Women &

Language Newsletter, The Linguistics & Science Fiction Newsletter, The

Religious Language Newsletter, and The Verbal Self-Defense Newsletter.

Information and sample issues by e-mail from OCLS@madisoncounty.net.

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Date: Wed, 30 Aug 2000 09:06:19 -0600

To: ocls@madisoncounty.net

From: ocls@madisoncounty.net (Suzette Haden Elgin)

Subject: The Language in Health Care Newsletter, 9-10/2000

Subj: Re: The Language in Health Care Newsletter, 9-10/2000 // Request for Permission

Date: 08/31/2000 9:34:54 AM Central Daylight Time

From: ocls@madisoncounty.net (Suzette Haden Elgin)

To: Ethesis@aol.com

>I'd like permission to reprint this newsletter.

>

>Let me know if it would be ok to put this particular issue on the web (no

>others without specific permission).

**Sure. Just add a line that says "Used with permission," for the record.

Best wishes,

Suzette

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