Thursday, May 8, 2008

The euphemistic opposite

"People often use words in a loose way that covers over what they're talking about. I like to choose words that get to the basics."
--Michael DeBakey, M.D.

Webster defines euphemism as the "substitution of a mild, indirect or vague expression for one thought to be offensively harsh or blunt."

Today we have in the field of medicine many expressions and slogans I have dubbed "the euphemistic opposite"--which detail a rosy picture so far as actual or anticipated progress and advances are concerned, but which in reality hide just the opposite. The public image is for the hoped for advances. The reality is often the hidden--"offensively harsh"--opposite.

This subject brings to mind the well-born, clueless son who approaches his father wearing a new naval officer's hat and a navy blazer decorated with gold-threaded anchors and other seafaring insignia. He points to his cap and says to his father with sincerity: "Look, dad. I've bought a boat. I'm a captain now!" The father looks over his son, his new naval blazer, his gold-trimmed officer's cap. "By your friends," he answers his son with equal sincerity, "you're a captain. By your family, you're a captain. By your business associates, you're a captain. But by a captain, you ain't no captain!"

So it is in the field of medicine. We are bombarded by ads, slogans, sayings, expressions, catch words which are geared to make us think that inherently desperate--"offensively harsh"--situations are about to yield their secrets, to give (or are well on their) way to solution. These catch phrases work by implication. The phrases imply that great progress has been made--and there is only a little way left to go. That only simple measures are now needed to result in the complete solution of a complex, mind-shattering problem. That it is within the reach of human beings to at last draw the curtain on devastating disease. "Race for the Cure," the registered trademark of the Susan G. Komen Breast Cancer Foundation, is one of these phrases. This phrase has many implications. It states that much progress has already been made in breast cancer. That humans can pay money and enter a race--that can result in the complete eradication ("cure") of this disease. That it is the "money" that individuals contribute in entering the race that can make a difference in whether this disease gets cured. That the cure to cancer in general may be imminent. But the reality is that this year 200,000 American women will be diagnosed with breast cancer--and over 40,000 will die from this disease, the same as in previous years. As in previous decades. The reality is that the moneys raised in these "races" and "relays" and "walkathons" and "marathons" and "bike-athons" are but a drop in the bucket compared to the overall funding annually earmarked and available for breast cancer in this country--and guess what?--the reality is that much of these moneys find themselves in the hands of the same old scientists and researchers, who sit on the same old federal and large private-sector granting (peer-review) committees of our cancer agencies, frequently for the same old projects or variations thereof. These events--and their slogans--thus occlude with rosy expectations the grim reality of what prevails--the lack of significant progress, despite available funding. However, the moneys raised by these events--by the hundreds of thousands of people who enter these races countrywide--do serve a purpose, in some instances converting their sponsoring organizations to financial powerhouses.

Another example of the euphemistic opposite are the ubiquitous ads--calling attention in all cities to the advantages of one hospital over another for one purported medical reason or another. In Syracuse, New York, for example, the State University Hospital frequently advertises, in newspapers, on buses, on radio and television that it makes the "academic difference"--that it is part of a state medical center, with a medical school, that its departments are peopled by "professors" and an academic house staff--and therefore its medical services are "superior." But the reality is that this hospital was recently cited by the state Health Department as having the highest death rate rate for angioplasty--a common operation that clears out blocked heart arteries--between the years 2003-2005 of any hospital in New York state. And this hospital was cited as having the highest risk-adjusted death rate following all cardiac surgery again in 2005--double the average--of any hospital in New York state. The "academic difference?" Superior services? Again, it is the euphemistic opposite that prevails. It is not that these hospitals want to extend to you in these ads and slogans a better level of treatment. It is simply that they want your money and are willing to lure you in by any means. It is the moneys that this--and similarly inclined hospitals around the country--are trolling for by putting out slogans such as "A Winner of the Conusmer#1 Award."

Another type of ad illustrating the euphemistic opposite which appears with surprising frequency, is the all-female oncology team--surgeons, oncolgists and others--specializing in the treatment of breast cancer. Frequently this ad emanates from moderate-to-large size hospitals which may or may not have a separate oncology unit, and contains the pictures of the various individual--usually young and attractive--doctors making up this all-female team. Their expressions are uniformly hopeful, cheerful, smiling and competent. The ad implies that female doctors better understand and better treat women with breast cancer and extend to them more compassion, as a result of which patients with this disease will have a better chance of cure. The ads also frequently state that "no better care and treatment" are available elsewhere in the country. The primary euphemistic opposite of the ads is the premise that because of gender, female doctors can better treat women with predominantly female cancers. Nowhere is mentioned skill and experience of individual surgeons, oncologists and other cancer specialists. It is implied that treatment benefit will accrue as a result of team treatment, rather than individual expertise which is not a function of gender but of training and experience. And it is stated--falsely--that no better treatment for any type of breast cancer can be obtained anywhere, even in the nation's primary cancer centers, than in these small enclaves. The purpose of these implications and assurances--of these outstanding examples of the euphemistic opposite--is not to offer women with breast cancer better treatment options--but money. To attract as many female patients as possible with this high-incidence cancerous disease--and the expected large sums relating to breast cancer treatment and testing--to these hospitals, for the purpose of contributing to the financial vigor of these medical institutions and their successful fiscal operations.

Another type of euphemstic opposite--frequently seen and heard on radio broadcasts, in headlines, on nightly network news telecasts--is the 'medical breakthrough.' Commonly in the field of cancer, these news stories detail exciting developments that will herald promising new treatments for those seriously afflicted with disease. But where are they? Where are these new medical treatments that will markedly indent cancer and other diseases? How do these 'breakthroughs' get on television? And in our newspapers? The answer is that they are put there--by hired medical publicists or skilled public relations people. But, then, if not to herald new treatments, why the publicity? What is their purpose? The answer is 'money.' If one looks carefully enough, the publicity for many of these 'breakthroughs' occurs at the very time the medical groups responsible for them are being considered for a major grant from the federal government (National Science Foundation, National Institutes of Health, etc.)--or a branch of the federal health establishment (National Cancer Institute, for example) is petitioning Congress for increased budgetary allocations. Thus, while the 'hope' generated by these broadcasts and attention-getting news stories so often vanishes, their underlying 'dynamics' succeed. For the reasons behind these broadcasts and headlines frequently have nothing to do with real innovative advances, but with exerting public pressure on funding mechanisms to increase the 'business' of medical research. Again--as in all medical euphemistic opposites--it is money that is the reason for these frequently dramatic and promising public disclosures. Although the 'big breakthroughs' fade, their 'big business' underpinnings remain.

The euphemistic opposite tends to misinform the American people. To program the minds of countless individuals that all is rosy when it is not. To wrongly influence the judgment of well-meaning segments of our populations who contribute their time, energies and money in behalf of the slogans and ads--"there's only a little way left to go," "we're almost there..."--which daily explode around them, in the hope that their efforts will tip the balance "the rest of the way" toward effective medical treatments.

If people were to understand that the exact opposite of their beliefs pertained--that regarding cancer and other serious disease we are not yet "almost there," we have more than just "a little way to go"--would they behave differently? Would their seeming complacency give way to constructive activism? Would they be capable of influencing our organizations, our government in a truly constructive manner--to use their concern and efforts and money and energies to really bring about change and effective treatments?

Would they send a message to "Race for the Cure" and the "relays" and "walkathons" and "marathons" and "bike-athons"--and others--"Don't numb my mind with your slogans that a cure is just around the corner--then give my money to the same useless projects, to the same individuals who dole it out to the same scientists and researchers. And don't tell me how much progress you've been making. The only progress that's really been made is in early diagnosis, practically none in treatment advances. For God's sake my next door neighbor, 38 years old, just died of breast cancer--left three young kids. No different from ten years ago. I want my money and sponsorship to go to brand new projects! Maybe ones you don't even agree with--that are unpopular with your scientists. We need new ideas!"

And to the medical centers 'trolling' for patients: "Don't try to lure me in to your hospital by telling me how 'good' you are, how you'll take 'better care' of me, how 'superior' your treatment services are to the other area hospitals--because you are part of a medical center, because your 'academic difference' increases the likelihood of my obtaining a good result, or for one reason or another, when there is nothing that distinguishes the quality of your medical services--when in fact during a segment of recent years you are the worst hospital in the community in simple cardiac procedures, when in fact during that same period you have the very worst risk-adjusted death rate in the state, double the average, for all cardiac procedures. And then you have the gall to advertize your hospital as the winner of 'Consumer Awards?' You'll have to do better than that. You'll have to get rid of your 'professors' and your mediocre house staff and others who slide along on your 'academic difference.' You'll have to hire and train real educators and real healers, those whose 'track records' are truly distinguished in their respective fields of medicine, who genuinely make a 'treatment difference.' Who truly make a medical institution great. That's what it'll take for me to be a patient in your hospital."

And to the pictures (hospital ads) of the young female faces shining out: "Do you think I'm stupid enough to believe that because a doctor is a woman, she's able to treat my breast cancer any better? That because my case of breast cancer will be entrusted to a team of exclusively women doctors I will get a better result? More compassion? Are you kidding? That I shouldn't be concerned over who has the best reputation, widest experience, most expertise--surgeon, chemotherapist, radiation oncologist? Are you telling me that in this community there are no male physicians who qualify? Whose 'track record' in the treatment of breast cancer is outstanding, at least the equivalent of, perhaps far superior to any of his colleagues--male or female? I want the best surgeon I can find--the best chemotherapist, the best radiation oncologist. And I know they come in two sexes. There are no gender exclusives. When you can show me a picture of your breast cancer oncology team composed of doctors of both sexes--saying they are the best, the most qualified--then maybe I'll believe you. Maybe I'll really want to be treated by that team!"

To the evening telecast news networks: "I know your science editors are experienced in the medical field, in some cases they are actually medical doctors. So how come they fail to do in-depth investigations of the stories they put forward almost every night? The 'advances' they talk about--turn out not to be advances at all. The 'promising new treatments' disappear. You never hear about them again. They talk about these new studies--in reputable medical journals. Do they actually read the studies and make scientific or medical jusdgments about them? Or do they just take the 'canned PR' that comes with the stories? When they recite a story sent to them by an important medical center or institute, do they first investigate these stories in detail before going on the air with them? To see if they're legit? [But the audiences of these newscasts do not understand the constraints these science editors are frequently under. They do not know that if a science editor refuses to accept a news story, say from XYZ university or cancer center, he may never get another one from them. And if it is an important university or cancer center--and the story has enough "juice" behind it--the editor who refuses to run it, no matter how competent or well known, might suddenly find himself out of a job.]"

There is every reason to believe if these targeted populations--i.e., everyone--rebelled against these 'euphemistic opposites,' i.e., sent e-mails and letters to their sponsoring organizations, to the hospitals, to the medical centers, to the governement medical institutions, to the television and radio networks, to the newspaper and magazine conglomerates, saying "Enought is enough! No more slogans! No more telling it like it isn't!"--there could be a great change in the emergence and development of true advances and new treatments. If our granting organizations--pushed by the demand of countless citizens to reverse the dearth of signifcantly beneficial medical treatments--said, "Let's look over the grant applications of well-qualified scientists and doctors who were refused. Let's see if there were something in these applications we've overlooked. Ever hear of Jane Doaks? I haven't, but look at her credentials--she's well-qualified. The idea she's put forward really outraged the peer-review committee. But you know, she's got a point. Maybe we should see how far she can run....And look at this one from Jack Smith. He doesn't even have his Ph.D. yet. That's why he was turned down. But look at his background. Entered university when he was 16. Bachelors at 19. Masters at 20. He'll only be 22 by the time he gets his doctorate. Maybe the committee shouldn't have acted so hastily. Maybe we should let him run with his idea. It's really way out! But, heck, he couldn't do much worse than we've been doing...."

An educated electorate, an educated population, an educated citizenry who refused to listen to untruths, who demanded that those in charge of our medical research and programs turn their attention and energies and time and concern to new ideas, who demanded the reversal and dissolution of the euphemistic opposite in the field of all medical operations will get, as a result of their effort, new and effective treatments for all kinds of serious disease, and surprisingly swiftly.