The Medical Word of the Week is Theranostic

The author learned a new word this weekend while attending the annual meeting of the Association of Health Care Journalists in Philadelphia.

In a richly-informative session on ethics of clinical trials, one of the speakers, Dr. Jason Karlawish – a bioethicist, geriatrician and Alzheimer’s researcher at the University of Pennsylvania, taught me a new term: theranostic (alt. spelling: theragnostic).

The neologism calculatingly brings together the concepts of medical therapy and diagnosis. This goes beyond biomarkers, he explained; theranostics are novel tests or diagnostic markers that would identify patients who, as defined, benefit from a particular therapy.

The first international conference on theranostics will be held in June, he told the audience.

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Hot Wasabi, and a Continuing Radiation Crisis

a poem for Wednesday:

I was touched by this headline in yesterday’s news: Japan nuclear crisis may have a silver lining for radiation health research. Yeah, and cancer is a gift.

The wasabi is too hot,

NPR shared yesterday, and I agree.

This radiation story has a long half-life, whether we write on it or not.

Sketch of a wasabi (Japanese horseradish) plant, from an 1828 in botanical encyclopedia, by Iwasaki Kanen (Wiki Commons)

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Stunning Comments on the Risk of Breast Implants, and Cancer

The FDA recently identified a link between breast implants and a rare form of lymphoma. From today’s report in the New York Times:

When talking to patients about a rare type of cancer linked to breast implants, plastic surgeons should call it “a condition” and avoid using the words cancer, tumor, disease or malignancy, the president of the American Society of Plastic Surgeons advised members during an online seminar on Feb. 3.

This is how doctors spoke to patients 50 and 100 years ago, and in some cultures still do, by not mentioning scary words – especially to women, and not calling a cancer what it is.

Cosmetic verbage?

Most cancers aren’t lethal* is one message for 2011: the “big  C” turns out to be a spectrum of hundreds of diseases, each with distinct subtypes, and patients shouldn’t panic when they hear the word. Some are benign in behavior although technically malignant; others behave live chronic illnesses; some, unfortunately, grow fast and can kill.

Oncologists can have a hard time persuading patients that a slow-growing tumor doesn’t need much treatment. It would help if other doctors don’t shy away from the term – keeping it taboo and, ultimately, promoting fear.

shhhhh

*NCI – cancer incidence and mortality summary data, accessed 2/18/11

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Regional Dialects on Twitter, and Other Things You Gotta Know

I was listening to All Things Considered yesterday while preparing dinner. A short, interesting story came on: You Have An Accent Even On Twitter. The NPR host, Robert Siegel, interviewed Jacob Eisenstein, a post-doc at Carnegie Mellon who has been examining regional variances in Twitter usage.

Some highlighted examples of Twitter dialecticisms:

In New York, people tend to do “suttin” (i.e. something, and usually having nothing to do with Sutton Place)

The use of “hella” to mean “very” as in “I’m hella tired” is more commonly iterated by people who’ve lived in Northern California.

(LOL is universally understood.)

I was sufficiently intrigued to track down Dr. Eisenstein’s paper, A Latent Variable Model for Geographical Lexical Variation, presented on January 8 at the annual meeting of the Linguistics Society of America in Pittsburgh. It’s a technical article befitting an MIT graduate, with un-trendy headings like “Cascading Topic Models,” “Inference” and heavy math. Still, I enjoyed the perusal.

Eisenstein and his colleagues started with a Gardenhose Twitter sample stream, which they say contained ~15% of public messages, from the first week of March, 2010. They whittled those down by selecting for tweets geo-tagged to the continental U.S. by authors who sent at least 20 messages during that period, and without URLs. Ultimately, they examined at some 380,000 Twitter messages (tweets) from 9,500 users.

The findings are really cool. (To be clear – that would be “coo” in Southern CA, or “koo” in Northern CA.)

Good to know that “af” signifies “as f-ck” (as in “very”), and is more commonly typed in Los Angeles than in some other parts. “Ima” for “I’m going to” is a New York kinda thing. “Gna” for “going to” is popular in Boston, but sounds familiar to this mother of a teenager in NYC.

From the Carnegie Mellon press release:

Studies of regional dialects traditionally have been based primarily on oral interviews, Eisenstein said, noting that written communication often is less reflective of regional influences because writing, even in blogs, tends to be formal and thus homogenized. But Twitter offers a new way of studying regional lexicon, he explained, because tweets are informal and conversational. Furthermore, people who tweet using mobile phones have the option of geotagging their messages with GPS coordinates.

…Automated analysis of Twitter message streams offers linguists an opportunity to watch regional dialects evolve in real time. “It will be interesting to see what happens. Will ‘suttin’ remain a word we see primarily in New York City, or will it spread?” Eisenstein asked.

I guess we’ll see how this progresses. I’m reminded of sometime around 8 years ago, when I tried cracking the IM code: “POS” meant “parent over shoulder.” That was easy. “Code 9” meant suttin similar, if I recall.

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Why the Term ‘Patient’ Is So Important in Health Care

An on-line friend, colleague and outspoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient” a “consumer” a “customer” or some other noun to describe a person who receives health care.

My vote is: PATIENT.

Here’s why:

Providing medical care is or should be unlike other commercial transactions. The doctor, or other person who gives medical treatment, has a special professional and moral obligation to help the person who’s receiving his or her treatment. This responsibility – to heal, honestly and to the best of one’s ability – overrides any other commitments, or conflicts, between the two.

The term “patient” constantly reminds the doctor of the specialness of the relationship. If a person with illness or medical need became a consumer like any other, the relationship – and the doctor’s obligation – would be lessened.

Some might argue that the term “patient” somehow demeans the health care receiver. But I don’t agree: From the practicing physician’s perspective, it’s a privilege to have someone trust you with their health, especially if they’re seriously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.

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The Word of the Week is Cyberanarchist

The word of the week appears on the front page of today’s New York Times in an article on a crowd-sourced response to WikiLeaks: “the Internet assaults underlined the growing reach of self-described “cyberanarchists,” antigovernment and anticorporate activists who have made an icon of Mr. Assange, a 39-year-old Australian.”

You won’t find a cyberanarchist reference in my old copy of the Oxford English Dictionary. A search led me to a 1998 Chicago Law Review article considering the “fundamental question of whether the state can regulate cyberspace at all.” Another hit led me to a site called cyberanarchy.org, which I don’t recommend to my readers unless you’re really, really into repetitive heavy metal with uninterpretable words set to a screen-filling red anarchism “A” symbol comprised of tiny flickering 0’s and 1’s.

The origins of the compound word are a bit interesting. According to the on-line edition of the Merriam-Webster Dictionary:

Cyber is a new prefix: “of, relating to, or involving computers or computer networks (as the Internet),” with first known use around 1991.

Anarchist is one who rebels against government or espouses anarchy, with origins listed: “Medieval Latin anarchia, from Greek, from anarchos having no ruler, from an- + archos ruler …First Known Use: 1539″

I searched for a deeper meaning of cyber and found little. The only credible thing I came upon in English is on Dictionary.com:

Cybernetics:

…the study of human control functions and of mechanical and electronic systems designed to replace them, involving the application of statistical mechanics to communication engineering.

I’ll let my readers and other word enthusiasts take it from here –

There is, of course, an @CyberAnarchist on Twitter, but as of this morning he or she has only 6 followers, tweets nothing and follows no one. A pre-emptive strategy?

The non-etymological, semi-medical lesson in this: be careful!

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Word of the Week: floccinaucinihilipilificationism

ML learned a new word upon reading the newspaper: floccinaucinihilipilificationism. According to the New York Times now, the late Senator Patrick Moynihan prided himself on coining the 32-letter mouthful, by which he meant “the futility of making estimates on the accuracy of public data.”

Some brief history:

Sometime around 1981, Moynihan invented the word by adding “ism” to an older, 29-letter English word, floccinaucinihilipilification – defined as “the action or habit as estimating as worthless” in a 1971 edition of the Oxford English Dictionary:

from the Oxford English Dictionary (1971)

You can find an open discussion of the roots of floccinaucinihilipilificationism on Wiktionary, which includes hard-to-decipher, clickable audiofiles – just in case you want to try saying the word out loud. Moynihan used the word in the title of his 1981 New Yorker review of a book by economist John Kenneth Galbraith.

More accessible is a somewhat dull, but worth-a-listen clip of the Moynihan discussing the word’s history in a debate on the budget deficit in July, 1999, on C-SPAN. From the Congressional Record:

“Floccinaucinihilipilification is now the second longest word in the Oxford Dictionary. It is from a debate in the House of Commons in the 18th century meaning the futility of budgets. They never come out straight…I added “ism” to refer to the institutional nature of this, so it became floccinaucinihilipilificationism. It is no joke. One never gets it right. It is not because one cannot, one does not try…

It seems to me the term, which was intended for the realm of economics, and projections in that, might bear also on the intricacies of vast amounts of data in science and health, data mining, and understanding the limitations of medical studies and related analyses. But I’m extrapolating here, for sure.

As I read the late Senator’s words, about his word, it seems maybe he’s suggesting that we could “get it right,” i.e. sort out data in a way that has real value, if we try harder to do so.

But who knows?

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The “Survivor” Term After Breast Cancer: Is There a Better Expression?

I hope this post will be the start of a long conversation on breast cancer survivorship. The question is, what’s the right, PC and emotionally-sound, sensitive but not sappy term to describe the situation of a person who’s living after breast cancer?

Some might say, who cares if you’ve had it?

Once, about six years ago, a colleague – an oncologist in my community – I met on the street stopped and asked me how I’d been. I said, well, I’d been out for a while because of some health problems. I mentioned that I had breast cancer among other things. “Who doesn’t have breast cancer?” she quipped, and then we talked about medical offices.

So what? was her point.

Sure, everyone’s got stuff by the time they approach their 50th birthday. Life would be pretty boring if we didn’t. And my personal history happens to include BC.

OK, NBD.

Why it matters, at least in my situation, is that I’m writing about health issues including breast cancer. So I think it would be deceptive to not mention this loaded “credential.” In a few weeks I’ll be teaching med students again, and although I don’t think that episode of my life is central to my capability as a teaching physician, I do think (and hope) it makes a difference.

Thinking more generally:

A lot of women, me included, have major physical changes upon undergoing treatment for BC. My hair was curly for most of a year. My breasts are gone. My bones are thinner and I’m estrogen-deprived. Sound depressing? It is, for as many as 30 to 40 percent of women at some point after their diagnosis. It’s not a minor experience in the physical, emotional or life-changing sense.

TV aside, the problem with the “survivor” term is that, maybe, it implies some sort of heroism or strength. But as an oncologist who happens to have had good insurance, knowledge and friends in the field, I just see it as, largely, the luck of the draw: there’s no reason for me to survive while another woman struggles and succumbs to metastatic disease.

I can’t deny to my readers, family, friends and others that I’ve had breast cancer, because it does affect my writing, feelings, capabilities and outlook. But I wish there were a better term for my status.

Any ideas?

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