JREF Swift Blog

CAM And The Language Problem

In graduate school I completed a literature review on the use of oppositional language in medicine. Ever the skeptic, I naturally focused this down on the terminology of complementary and alternative medicine, or CAM. My interest was in the ever-morphing phrases and brandings of this field, and I was curious how terminology affected the perceptions of medicine in general. What I found I called “the language problem.”

It is well known that branding or re-branding a product, service, or movement can drastically affect the way in which that object is viewed. For example, once creationism was ousted by the supreme court from the science classrooms it was trying to burrow into, it adapted the new term “intelligent design” to differentiate itself from the old “brand.” Indeed, this tactic has been (unfortunately) very successful. Similarly, once branded as “unorthodox” and “unconventional” medicine, folk remedies, ancient practices, and New Age beliefs are now being re-branded with terminology such as “alternative,” “complementary,” and “integrative.”

For context, alternative medicine use is on the rise all across the world. Though many sources touting this fact use inflated statistics, because many include therapies that would not fit under the “alternative” designation (such as massage or vitamins), it is without question that alternative medicine is popular. This shift towards increasing alternative medicine use also underlies a cultural shift towards more personalized medicine. Both the view of the patient as a consumer of health products (considering a patient entitled to a wide variety of treatments from different parties at different prices) and the relative ease with which alternative therapies are obtained (over the counter herbal remedies that do not require a doctor’s approval, for example) makes alternative medicine superficially appealing.

Within the groups and organizations concerned with advancing one system of medicine over the other there exists a palpable tension and sometimes even direct conflict. A fledgling alternative medicine movement seeks to publish in reputable journals, create its own organizations, and receive proper recognition from the world’s governments. On the other hand, the conventional medical establishment is fighting against largely untested and unregulated therapies that are being increasingly shoehorned into modern medical practice. The “language problem,” or the divide that is created by oppositional terminology, comes directly out of this current state of affairs.

The Divide

The problem with the terminology used in CAM is that it necessarily creates a divide between patients and science-based physicians. Words and terms become meaningful in their comparison to other words. Therefore, every word can imply its conceptual opposite. For example, when something is defined as “natural,” everything else becomes “unnatural.” Conventional medicine, faced with this naturalistic fallacy, then seems “synthetic,” “harsh,” or “non-holistic.” And patients take notice.

Studies have found that a majority of patients will not tell their physicians about their use of CAM. One study by Giveon, Liberman, Klang, and Kahan (2003) supports the idea that there is a serious lack of communication between patients and doctors. Half of the physicians surveyed indicated that only around 10% of their patients reported using alternative therapies to them. This is in line with previous findings that show that a vast majority of patients (72%, according to Eisenberg et al., 1993) who use alternative therapies do not report their use. This miscommunication is despite the ever-increasing popularity of alternative medicines. Not only does this divide allow for the unsupervised use of potentially harmful therapies like colon cleansing and ear candling, it suspends the seeking of proper medical attention. And with the increasing use of herbal supplements, for example, this becomes a dangerous situation. Inconsistently manufactured herbal remedies have the potential to negatively interact with other pharmaceuticals, making active communication between patient and physician immediately important.

Surveys show that patients rarely tell their physicians about CAM use because they think they either do not know enough about it, do not care, or will admonish them for using it. Other surveys have found that physicians and other health care practitioners tend to label practices that they have the least training in as “alternative.” For better or worse, this oppositional labeling sometimes prevents conventional practitioners from being up to date on the latest evidence on alternative therapies, dismissing it outright.

Widening this divide, CAM therapies tend to speak a different language. It is difficult for a patient to interact constructively with their conventional physician when their acupuncturist has advised them ask about the “slipperiness” of their nerves or their obstructed “qi.” Many times this different language encourages further CAM use. For example, doctors typically prefer “patient” and alternative practitioners prefer “client,” doctors “prescribe” and “diagnose” while alternative practitioners “assess” and “recommend,” and when talking about illness doctors speak of “disease” and “cure” while alternative practitioners use “illness” and “healing.” This shift in terms has been cited as a major reason why people use CAM: the treatments are philosophically congruent to their worldviews. It embraces the language of vitalism, individuality, nature, New Age, and spirituality.

The language and contexts associated with alternative medicine appeal to people’s values, beliefs, and behaviors in a persuasive way. The rhetoric of alternative medicine lets users indulge themselves in an embrace of nature and the natural. This romanticized view of a benevolent and wholesome nature inherently creates opposition in the conventional medical world.

The belief [in alternative medicine] encodes an unambiguous set of moral polarities: natural versus artificial, pure versus toxic, organic versus synthetic, low-technology versus high-technology, and coarse versus processed. [Conventional] medicine automatically suffers in this bifurcation because of its association with sophistication and technology as opposed to the perceived simplicity of undeveloped nature. In this optimistic and hopeful view, any adverse aspects of nature (ranging from anthrax bacillus to deadly nightshade and snakebite) tend to be overlooked (Kaptchuk and Eisenberg, 1998).

The power of language in medicine is undeniable. There are quantified cases of the language divide causing an actual divide between patients and doctors, and between doctors and evolving knowledge about increasingly popular alternative therapies. The use of language influences the perception of all parties involved, and therefore needs to be studied in greater depth to find out where the line is: should the standards of science encourage the oppositional terminology currently used to denote alternative therapies (i.e., there is only medicine that has been adequately tested and medicine that has not), or should the medical establishment bend to the valid patient-centered criticisms of these kinds of characterizations?

Conclusions

After going through 25+ different studies, I concluded that even though language has the ability to influence the perception of medicine and can make it harder for doctors to communicate with their patients, the risk of incorporating either untested or ineffective therapies into conventional practice simply because the treatments are popular or philosophically congruent has a great potential for disaster. What must take precedence is the safety and efficacy of a treatment. If oppositional terminology must remain for this to be the case, the language problem is just another hurdle for modern medicine to vault. The most sensible way through the language problem is to stand the scientific ground and at the same time take seriously the power of terminology in medicine. A disconnect between doctors and patients can still be overcome by proper education, increased interaction with patients and an openness to their medical choices (something that is constantly noted as an appeal of alternative medicine), and effective communication strategies. The integrity of medicine is preserved, the patient feels respected and recognized by the doctor’s knowledge of their newest medical interest, and new treatments with the greatest potential are welcomed into the fold.

References:

Eisenberg, D., Kessler, R., Foster, C., Norlock, F., Calkins, D., & Delbanco, T. (1993). Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328 (4), 246-252.

Giveon, S., Liberman, N., Klang, S., & Kahan, E. (2003). A survey of primary care physicians' perceptions of their patients' use of complementary medicine. Complementary Therapies in Medicine, 11, 254-260.

Kaptchuk, T. J., & Eisenberg, D. M. (1998). The persuasive appeal of alternative medicine. Annals of Internal Medicine, 129, 1061-1065.

Kyle Hill is the JREF research fellow specializing in communication research and human information processing. He writes daily at the Science-Based Life blog and you can follow him on Twitter here.