June 13, 2016

Choice Words and Word Choices

A jumble of words flas100/iStock

Do you often find yourself searching for just the right word? As health communicators, a key part of our job is choosing the best term and providing the correct context. But sometimes the words we choose, or how we frame them, may not convey what we actually mean.

How would you describe high cholesterol or insulin resistance? What about shyness or pregnancy? Are they diseases? Are they risk factors? Are they conditions? Are they signs or symptoms? Or are they just normal behaviors or qualities?

It can be tempting to label something a disease when it really isn’t. This may be done to increase sales of a medication or treatment—a practice formally known as “disease mongering.” More broadly defined, disease mongering includes implying a condition that’s normal needs to be treated, turning a normal state into a symptom that needs to be treated, or creating a new disease. These effects can sometimes simply stem from confusion about what terms to use and how best to use them.

Let’s consider a few examples of common terms and their use:

  • Adolescence, pregnancy, and menopause. These are normal, healthy states that we experience as a part of life. They are not diseases or disorders.
  • Shyness. This is a characteristic of normal behavior. It’s not a social phobia and doesn’t need to be treated.1
  • Low red blood cell count. This is a sign, which is an objective, observable measure noted by a healthcare professional. It may be associated with a disease or condition, but it’s not an illness by itself.
  • Stomach ache. This is a symptom, which is an unobservable, subjective characteristic noted by a patient. (Thus we can’t have an “observable symptom.”3) Again, it’s not a disease or illness.

It’s worth spending time carefully considering the words and context we use when discussing diseases and their treatments, not only for the sake of accuracy, but because the choices we make may influence the subsequent actions of our readers in ways we may not have anticipated.

Consider these word choice pairs: impotence vs. erectile dysfunction disorder, high blood pressure vs. hypertension, Lou Gehrig’s disease vs. amyotrophic lateral sclerosis, dandruff vs. seborrheic dermatitis, and sugar vs. glucose. Which of the terms would you use, and why (or when)?

Let’s take a close look at this word pair as an example: lazy eye vs. amblyopia. While “amblyopia” may seem like an overly technical tongue-twister, “lazy eye” can inadvertently imply blame or fault to the person with the condition. In a case like this, it might be appropriate to use both terms in a way that introduces, defines, and encourages use of the less familiar term, such as: “Amblyopia (also called lazy eye) is when an eye has poor vision, because it isn’t working properly with the brain.”

Researchers have found that word choice can influence how serious the public, medical students, doctors, nurses, and legislators perceive a disease to be, as well as how widespread they think it is. The language used can influence a person’s decision to seek care, as well as perceptions of funding needs.2,4,5

What examples of terms have you caught yourself misusing, debating, avoiding or embracing for the sake of clarity? Email us at: sciencehealthandpublictrust@mail.nih.gov

1 Burstein M, Ameli-Grillon L, Merikangas KR. Pediatrics. 2011 Nov;128(5):917-25. doi: 10.1542/peds.2011-1434. Epub 2011 Oct 17. PMID: 22007009.

2 Erueti C, Glasziou P, Mar CD, van Driel ML. BMC Med Educ. 2012 Apr 3;12:19. doi: 10.1186/1472-6920-12-19. PMID: 22471875.

3 Lilienfeld SO, Sauvigné KC, Lynn SJ, Cautin RL, Latzman RD, Waldman ID. Front Psychol. 2015 Aug 3;6:1100. doi: 10.3389/fpsyg.2015.01100. eCollection 2015. Review. PMID: 26284019.

4 Scully JL. EMBO Rep. 2004 Jul;5(7):650-3. PMID: 15229637.

5 Tikkinen KA, Leinonen JS, Guyatt GH, Ebrahim S, Järvinen TL. BMJ Open. 2012 Dec 2;2(6). pii: e001632. doi: 10.1136/bmjopen-2012-001632. Print 2012. PMID: 23204142.