Rhetorical Language In Medicine

Words devoid of real meaning undermine the constructs to which they contribute. The consequences of poorly worded constructs in medicine are dire as they promote insufficient preparation and improper political and financial incentives.  Rhetorical language in medicine is problematic because rather than focusing on the details/boundaries that help navigate medical complexity providers devote too much time to stating the obvious. The intent behind the “evidenced based medicine” movement, ensuring that practice is not contingent upon tradition and intuition alone, is noble.  The term itself, however, is rhetorical.  Consumers don’t want to be treated by non-evidenced based providers.  Moreover, medical providers likely all consider themselves to be “evidenced based”.  Neither the consumer nor the provider would be satisfied with the alternative to evidenced-based medicine.  Any medical intervention should be grounded in sound theoretical and/or empirical justification.  Evidence in medicine and science, however, is not as concrete as DNA or surveillance footage from a crime scene.  The question then becomes what constitutes “good” evidence.  In other words, who is the arbiter of evidence?  Some insights into this very difficult question can be found here.  The “good evidence” conversation is all about the details and often changes from case to case. It's not resolved by a few arbitrary Pubmed citations or a #science.  Puritanical and rhetorical pleas for better science or evidence can be emotionally satisfying but typically neglect to elucidate the degree to which controlled studies transfer to uncontrolled environments (e.g. actual patient care).

Economist Russ Roberts talks about how in his profession statistics are “often just a stick with which to beat your intellectually inferior opponents.”  Scientific research is often bastardized in the same way.  There is no evidenced based medicine and non-evidenced based medicine, just medicine.  Medical providers should embrace the responsibility of legitimizing “medicine” alone. Similarly, the term “alternative medicine” is rhetorical.  Again, there is just “medicine”.  Once a treatment is established as valid (a murky delineation to be sure), it falls under “medicine”.  Any interventions that can’t be justified by the “conventional” medical criteria don’t deserve to be considered ancillary medicine.  Moreover, who is the arbiter of what constitutes conventional vs. alternative medicine?  Typically, “alternative medicine” is cited by non-medical providers to legitimize baseless treatments and perpetuate the oversimplification that “medicine is broken” or by established medical lobbies seeking to politically discredit rival professions who challenge their market share. Lastly, “functional training” implies that there are other forms of training devoid of purpose or function.  A cursory Internet search defines functional as “having a specific purpose” and “designed to be practical and useful”.  Every aspect of a training program should have a useful purpose.  The alternative is wasting time.  Mistakenly, certain movements have been ordained as functional to the detriment of other ones.  Function is context specific.  An isolated movement like a biceps curl might be “functional” for a bodybuilder or grappler but less so for a speed skater.  Nevertheless, one could conceivably justify the inclusion of a biceps curl in a speed skater’s program irrespective of its direct transfer to the skating motion. Sometimes less is more.  Let’s stick with “medicine” and “training” and leave “evidence”, “alternative”, and “function” to circumstances during which these words actually enlighten the discussion.

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