Disease Label Increases Interest in Medicine

People think something with a disease label needs a medicine, even if the medicine won't work. That's one conclusion of a new study of 175 parents. People waiting in a child health clinic were asked to read about a fussy baby and respond as if they were the parents. They read that the baby cried and spit up a lot, so they went to the doctor. The doctor explained the cause and said it probably would go away on its own. Half of the parents read that this condition was called gastroesophageal reflux disease (GERD). The others did not get such a label. All of the parents read that there was a medicine for this problem. But half of them read that it probably would not help. The others got no information about whether the medicine would work. People who were told that the problem was GERD were more likely to want medicine. This was true even if they were told that it wouldn't help. The journal Pediatrics published the study online. HealthDay News wrote about it April 1.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

When kids have a medical label, their parents are more likely to want medicine for them, even when they are told it probably won't work.

That's the finding of a new study published in Pediatrics, the journal of the American Academy of Pediatrics. Researchers from the University of Michigan did the study. They asked parents in a primary care waiting room to imagine they had a fussy 1-month-old who spit up a lot. The baby wasn't getting better despite everything they tried, so the parents brought the baby to the doctor. All the parents got the same description.

All of the parents also read a similar explanation of what happened at the doctor's office. They read that the doctor said the baby had a problem with the stomach not emptying properly. This would cause the breast milk or formula to go back up. The problem generally went away by itself. For half of the parents, this was simply referred to as "a problem." For the other half, it was described as gastroesophageal reflux disease, or GERD.

The researchers then further divided up the parents. All of them read that the doctor said there was a medicine available for this problem. (Remember, all of them had already read that it would go away by itself.) Some parents read that the medicine probably wouldn't help, which is what the medical evidence shows. Half were not told this. So in total there were four groups:

• Given GERD label, not told medicine wouldn't work
• Given GERD label, told medicine wouldn't work
• Not given GERD label, not told medicine wouldn't work
• Not given GERD label, told medicine wouldn't work

Here's what the researchers found:

• Parents who got the GERD label were more interested in medicine, and more interested in using it.
• Parents who got the GERD label were interested in using medicine even when they were told that it probably wouldn't help.
• Parents who didn't get the GERD label were interested in medicine, too -- but not when they were told it probably wouldn't help.

Researchers also asked the parents if they appreciated the doctor offering medicine. If they got the GERD label, they appreciated it. But if they didn't hear the GERD label, they didn't appreciate the offer of medicine -- especially when they were told it wasn't likely to work.

Parents who got the GERD label didn't think the condition was more serious. That wasn't what the researchers found. The results suggested that simply getting the label made parents think that medicine was a good idea -- even if it probably wouldn't work!

What Changes Can I Make Now?

GERD is often overdiagnosed. In fact, it may or may not actually be a condition. It is likely just something that happens to some babies and will pass over time. It doesn't need medicine, but it worries and upsets parents, since life with a fussy, "spitty" baby can be hard. So doctors, in a generally well-meant attempt to do something, may suggest medicine. Yet studies show the medicine isn't likely to do anything at all.

GERD isn't the only condition like this. In the fascinating Choosing Wisely Initiative, medical specialty organizations have made lists of diagnoses and tests that doctors and patients should question. From chest X-rays before surgery to antibiotics for sinusitis, there are many things we shouldn’t be doing as much as we do.

This study tells us that one way to reduce unnecessary tests and treatments is stop labeling things as diseases when they really aren't. You have an important role to play, too. Ask your doctor questions, such as:

• Is this really a medical problem?
• Why are you ordering this test or treatment?
• Is it necessary?
• Are there other options?

What Can I Expect Looking to the Future?

Medical costs are getting out of control. This is costing our society money that could be going to things like education and job creation. Higher costs also make it harder for people to afford health insurance, which is something everyone should have.

This study shows us that simply not labeling something could cut down on medicine use. That would help bring down costs. It also improves care. I hope to see more studies like this one, and have more conversations about how we can be more responsible and thoughtful in how we deliver care.