This blog posting is the second part of a three-part series on medical jargon or specialized terminology. The first blog posting examined the terms sensitivity and specificity and incidence and prevalence. This blog posting will examine the terms addiction and dependence; case, patient and person; and subject and participant.
Addiction and dependence. According to Kaplan & Sadock's Comprehensive Textbook of Psychiatry--a seminal read for all psychiatrists--in 1964, the World Health Organization suggested that when referring to clinical diagnoses the term addiction be replaced with drug dependence. Furthermore, the term addict is considered pejorative and has taken on colloquial and nonclinical meanings such as a videogame or sex addict. (Of note, various non-drug related behaviors that can be characterized as "addictive" may in fact trigger similar reward centers in the brain.)
The term dependence can be categorized into either behavioral or physical dependence. Behavioral dependence is characterized by substance-seeking activities and pathological use patterns; whereas, physical dependence refers to physiological effects of drugs.
It's interesting (and disappointing) to note that although the World Health Organization's recommendation that the term addiction be replaced by drug dependence was made almost 50 years ago, individuals and media outlets still use the terms addict and addiction.
In my opinion, the inappropriate use of medical terms and jargon stems from ignorance rather than maliciousness. Many writers don't realize that just because the style manual or guide that their publication adheres to fails to properly explain how to refer to diseases, conditions or disabilities, doesn't mean that they should neglect how to properly refer to these diseases, conditions and disabilities in their writing. For example, if a newspaper reporter were writing about drug dependence, the fact that the AP Stylebook fails to distinguish between addiction and drug dependence doesn't mean that the writer can mischaracterize drug dependence as addiction. Rather, the writer should try harder and look to different sources to verify that he or she is properly referring to the term--even if this requires the reporter to spend a few extra minutes thumbing through a psychiatry text or the DSM-IV.
Case, patient and person. According to the AMA Manual of Style, a case refers to an inanimate thing not a person. A case is a particular instance of disease that is evaluated, documented and reported. A patient refers to a person who undergoes medical treatment and testing. Unless a person is undergoing medical testing and treatment, it's best to refrain from characterizing a person as a patient.
Avoid: An 85-year-old case of glaucoma.
Preferred: An 85-year-old woman with glaucoma.
Avoid: Although Edward is a patient with diabetes, each day he drinks several bottles of Pepsi.
Preferred: Although Edward is a person with diabetes, each day he drinks several bottles of Pepsi.
Okay: Many patients in the intensive care unit are on ventilators.
Subject and participant. According to the AMA Manual of Style, when referring to randomized control trials or other clinical experiments, the term participant is preferred to the term subject. The term subject can be misconstrued as derogatory or subservient.
Avoid: There were 3500 subjects in this phase of clinical testing.
Preferred: There were 3500 research participants in this phase of clinical testing.
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