“What’s in a Word”: from Gendered Suffixes to Medical Spin
There is a much room for improvement in medical language
A note about the authors: Drs. Alderighi and Rasoini are both practicing physicians in Italy. Dr. Alderighi is a Sensible Medicine editorial board member. We hope you enjoy their essay.
In Italy, a debate has emerged regarding the importance of using the feminine suffix “a” at the end of words defining key positions held by women in society, such as “sindaca” (major) or “avvocata” (lawyer), instead of the conventional masculine suffix “o” (sindaco, avvocato).
While this debate has nothing to do with a grammatical issue, it delves into the hypothesis that language has the power to shape our thinking and understanding of the world, including the normalization of female presence in high-level professional roles within historically patriarchal societies.
Is language really that important? In regard to the Italian suffix debate, Vera Gheno, a sociolinguist, recently mentioned the theory of linguistic relativity. This theory hypothesizes that language is one of the chief contributors to our perceptions, because it can shed light on some aspects of reality while obscuring others.
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Despite the Declaration of Helsinki’s requirement that “Authors have a duty to make publicly available the results of their research on human subjects and are accountable for the completeness and accuracy of their reports”, researchers often present their study findings using a language intended to persuade readers that the benefits of treatments or tests are greater than the actual findings indicate.
We call this phenomenon “spin”, and it is widespread in medical literature.
For instance, authors used a manipulative language in 57% of the abstracts and in 67% of the full texts of 93 cardiovascular randomized controlled trials published in high-impact journals that didn’t reach statistical significance with regard to the primary endpoint. Basically, they diverted readers’ attention from the non-significant primary endpoint by putting emphasis on secondary endpoints.
The use of spin in reporting study results might influence readers’ interpretation. In a randomized controlled trial involving 300 clinicians, Boutron et al. showed that clinicians rated experimental treatments as more beneficial when abstracts of oncologic randomized trials with statistically non-significant primary outcomes contained spin.
This phenomenon extends beyond medical professionals reading medical literature. It also affects press releases, health news and doctor-patient relationships.
For example, three randomized trials found that spin in news stories reporting on pharmacologic treatment studies can influence patients’ and caregivers’ interpretation: the more spin in the news, the greater the perceived benefit of a treatment by the readers.
Almost 30 years ago, Richard Horton, who coined the term “spin” for the biomedical context, argued that linguistic analysis of an article should be a “welcome third component of peer review, in addition to qualitative and statistical assessment”. Given the current amount of medical papers marked by spin, his advice seems prophetic.
It should come as no surprise that doctors, fueled by a literature imbued with spin, tend to emphasize the pros rather than the cons of health treatments or tests when discussing them with their patients.
Prejudices favoring medical interventions are embedded in language: just consider the dichotomy “benefit/risk” versus the more balanced “benefit/harm”. By using the former, we communicate to patients that benefit is certain, while the harms, referred to as “risk”, are hypothetical.
This communication style can lead patients to develop a biased perception of treatment benefits and make uninformed and potentially incorrect health choices.
In 2017, the first systematic review on the relationships between language and health decisions was published. It showed that using different terminology for a medical condition can influence management preferences: for example, the more medically-oriented the term or label, the less control a patient may feel over the situation. This increases the perceived severity of the condition and creates the impression that more invasive interventions are warranted.
Language is at the core of the doctor-patient relationship. Yet, despite the growing aspiration of patients to actively participate in their health decisions, medical language remains stuck in its patronizing past. Clinical notes, for example, often contain terms that emphasize doctors’ power (“to send a patient home”), cast doubt on patients’ narratives (“the patient denies…”), or even blame patients if treatments fail ("poorly controlled diabetic”).
Health communication is not neutral. At every stage, what people say and how they say it matters.
Words are not mere vectors to convey information; they can be sharp instruments that contribute to shaping how people think about health and illness, perceive the value of medical interventions, and even make health choices for themselves and others.
There is a much room for improvement in medical language, both in research and in doctor-patient communication. Universities should prioritize teaching medical students critical language analysis of medical evidence and conversations over inconsequential notions.
As doctors, we may certainly overlook the skill of drawing the structural formula of Vitamin B12 without adverse consequences on our work, but we can never neglect the language.