Vol. 276 May 1, 2022 Time for a Jargon Update

May 1, 2022

Jargon is the verbal sleight of hand that makes the old hat seem newly fashionable; it gives an air of novelty and specious profundity to ideas that, if stated directly, would seem superficial, stale, frivolous, or false.
David Lehman

“BLW” — “baby-led weaning”
BLW often comes with gift certificates, recipe books, sometimes parental tension between “puree moms” and fathers, even #BLW influencers, and , of course YouTube videos.  There is even a Gwyneth Paltrow connection. “In its ideal form, BLW streamlines life by having the baby eat what the rest of the family is eating.” It is the process of starting to feed solids to infants 6 months old by offering them finger foods rather than processed food on a moving spoon, the old “airplane landing” technique. Preferred BLW foods include toast sticks with mashed avocado, sautéed green beans, or a lamb chop. Nuts, popcorn, and carrots cut into interesting shapes are verboten. There are no scientific studies comparing BLW and traditional feeding, so there is no clue if BLW prevents childhood obesity or picky-eater parental exasperation, though currently accepted social media wisdom implies that BLW is the only right way to start your kids on solids. It seems to make no difference to the kids.

“Cheats” – replaces “work arounds”
In the early days of quality improvement in medicine the initial analysis of a process needing improvement almost always identified several actions that people would take to “work around” a faulty step in the process.  Identifying “work arounds” that made the process, or even the whole system, actually work was critical to understanding the process. With the plethora of computerized medical records and the frequent, seemingly almost sequential, switching of proprietary programs that health care providers have to learn, and relearn, at considerable investment of time and effort, “cheats” have replaced “work arounds.” “Cheats” are user-created “smart phrases”, short lengths of text that the physician or other health care provider enters with one click into a medical record when check boxes, long lists of pertinent negatives, or rigid standard diagnostic names and codes don’t tell the story right.

“Yellow stickies”
Yellow stickies, thought to be made obsolete by digital medical records, are now making a come-back because of all of the above. Yellow stickies stuck to the computer screen or keyboard remind you of the name of your smart phrase “cheats”, or remind you that the tiny icon in the upper left corner of the screen will pop up a list of all the patient’s medication, and that the tiny icon in the lower right corner will delete them all. The red stickie on top of the screen reminds you to NEVER confuse the two! 

“they” —
This is the one preferred personal pronoun in the current list that I have the most trouble understanding. “They” is plural; how it can fit one person? One of my granddaughters explained it to me this way: If you and a friend are sitting in your living room, and there is a knock at the door. By the time you two decide who is going to get up to answer the knock, you open the door, and there is no one there. As you sit back down your friend asks, “Who was it?”, and you answer, “I don’t know where they went.” Gender and numerically neutral!

“BA.1.1, BA. 2,  BA.2.12.1.” — If you don’t know what these refer to, you have not only been on a true  lockdown, but you have also been living under a rock.

“Medicine is male” — A persuasive essay in the NEJM makes the case that medical school teaching, intern and resident training, and medical practice is, in fact, not gender neutral, but is overwhelmingly male-oriented. “Physicianhood is a masculine construct, emphasizing power positions, procedures, profit, and execution of tasks as measures of success.” The so-called “soft skills”, read female, of human connection, presence, and compassion contribute as much to the both the science and art of medicine. Studies in surgery, internal medicine, and cardiology have shown that patients treated by female physicians have lower mortality rates, fewer hospital readmission rates, and less post-operative complications than patients of male physicians. –  NEJM 386:13 March 31, 2022 (with 39 research citations) Lombarts, Ph.D. and Verghese, MD

How to evaluate medical study results as reported by the media
Watch out for percentages — Breaking News: “Drug A has 50% fewer side effects than Drug B” or ”Procedure A has a 40% better outcomes than procedure B”  — Watch out for percentages and significance of side-effects! What is the number of patients studied.? 500 of a 1000 patients having fewer dehydrating bouts of diarrhea is more significant that 2 of 4 patients not having sneezing attacks or a mild rash.

“Non-inferior result” — This is current medical jargon summarizing results from a comparison study in an attempt to avoid some of  the pitfalls of “breaking news” as above. This is pretty much still just doctor jargon, not quite ready for prime time, but a “non-inferior result” in a study is like “after a year of physical therapy and exercise, patients with back (or knee) pain are just as well off as those who had surgery”.

“Patients to treat”— This is another way to place a study’s results in a more meaningful context. If a drug, or a treatment, or a diagnostic test is shown to be “better” than another one, the “number of patients needed to be treated in order to obtain significant benefit” gives you an idea of the benefit probability. If 100 patients have to be treated to have 6 patients benefit from the treatment or test, so what? That is a small benefit. Of course, if you are the patient that benefits, it is 100% for you. Ask your health care provider, “What is the number of patients to treat to get the benefit” when they (whoa, a gender neutral pronoun!) suggest a new treatment.

“If you benefit, it’s a 100% benefit” — Remember that all medical studies are based on statistics which are numbers applied to populations. Each and every individual patient can have a unique experience. If 70% of patients die within 5 years of a diagnosis, there may be no reason at all that if you have that diagnosis, you can’t be one of the 30%  survivors.

“Harm reduction” has just been recognized by the federal government for the first time. President Biden has sent to congress the first national plan to reduce drug overdose deaths, which topped out at 107,000 in the past 12 months, through harm reduction which prevents death and illness in drug users while trying to engage them in care and treatment. Usual harm reduction plans substitute “Just Say No” and “heightened criminalization” with needle exchange programs, public distribution of Narcan (naloxone), and even “safe”, clean injection facilities. Harm reduction supposedly has bipartisan support in Congress as nurtured by a recent congressional commission report. Harm reduction has been a focus of many state and non-governmental medical programs abroad and in the U.S. for years. We shall see if an over-due federal initiative will benefit the cause.

Deja Vu! — aka nothing really changes, not even the jargon.
“Weather experts are seeking the causes and effects of global warming — the ‘greenhouse effect.’ . . . Now is the time to examine how this worldwide warm-up may affect our lives. . . .The greenhouse effect would make forest fires, such as the one that devoted millions of acres of U.S. forests in 1988, more common . . . Waterfront cities such as New York would experience major flooding and destruction.”
The Futurist Journal, September-October 1989 *

* Thanks to Allen White for this 33 year old fun fact from one of his stacks of saved literature.

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