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Dateline Nigeria (Part 4): When the Name of a Single Disease—HIV/AIDS—Becomes Shorthand for ‘Health Issues,’ Does that Language Indicate Health Policy Tunnel Vision?

Holtz, Andrew MPH

doi: 10.1097/01.COT.0000327556.90310.32

“Our topic today is the role of the media in combating HIV/AIDS and other health crises.” That's how Vision 92.1 FM radio host Chris Okpaengi opened his “Burgami” talk show the morning that I and fellow journalist Duncan Moore were guests.

We were wrapping up our two-week visit to Nigeria. We had come to help with workshops for health journalists. As Okpaengi quizzed us on behalf of his listeners in Abuja, Nigeria, I noticed a pattern. It was something we had been encountering again and again during our trip.

The questions he posed included:

  • Are the media playing an effective role in combating HIV/AIDS?
  • Why are columnists more interested in politics than HIV/AIDS?
  • Are journalists adequately equipped to deal with HIV/AIDS?
  • Are the media putting enough pressure on political leaders to treat HIV/AIDS as a priority issue?

We came to talk about reporting on health and medicine. Nigerians, individually and institutionally, seemed most often to talk about “HIV/AIDS.” The virus is indeed one of the leading killers in Africa. But it is not the only preventable cause of death and disease. Tuberculosis, malaria, maternal mortality, road crashes, and other threats also injure and kill too many.

The topic of this OT column is medicine in the media. This time I am talking about that most basic medium: language. The words we use both reveal—and shape—how we think about the world around us. And so, as I thought about the frequent use of “HIV/AIDS” as shorthand for health threats in general, I began to wonder: What's in a name? Is this common idiom merely a trivial convenience, or does it point out an important underlying framework for the way Nigerians, and perhaps other Africans, think…and act?

This is the last of a four-part series. Parts I, 2, and 3 appeared in the April 25, May 10, and May 25 issues.

In Nigeria, outsiders play a dominant role in health campaigns. There are the non-governmental organizations (NGOs), such as the Gates Foundation, programs funded by individual countries, including the US-funded President's Emergency Plan for AIDS Relief, and international efforts directed by the World Health Organization and others.

A visitor's impression is that HIV/AIDS is where the money is. Indeed a Los Angeles Times investigation at the end of last year reported that the funding aimed at HIV/AIDS and other leading disease targets has sucked trained staff and resources away from health needs that haven't caught the fancy of donors. (A Times Investigation: Unintended victims of Gates Foundation generosity. Los Angeles Times, 12/16/07)

I began to sense that for many Nigerians “HIV/AIDS” has indeed become synonymous with “health threats.” When they look at billboards with health education messages, they see HIV/AIDS slogans and advice. When they turn on their TVs, they see public service announcements and entertainment education highlighting HIV/AIDS. When they go to clinics, the subsidized services (often the only ones they can afford) tend to be connected to foreign-funded HIV/AIDS campaigns.

Is that focus on HIV/AIDS a problem? Since there is no vaccine or cure for HIV/AIDS, public education and testing are essential to holding down infection rates. But fighting HIV/AIDS is not the same as fostering good overall health. Testing negative for the virus does not guarantee a happy, productive life.

When the name of a single disease becomes shorthand for “Health Issues,” does that language indicate health policy tunnel vision?



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Loose Word Use in US Too

My concern with linguistic patterns is not limited to Africa. In the US we have our own kind of loose word use. At CNN, my title was Medical Correspondent, but many of the most important stories I covered involved public health, social issues, economics, and politics, not medicine.

Eventually, when the Nutrition Unit and Medical Unit were merged, the name was changed to the CNN Health Unit. But even today, Sanjay Gupta, Elizabeth Cohen, and Judy Fortin are Medical (not Health) Correspondents. The overwhelming bulk of the National Institutes of Health budget goes toward basic biomedical and clinical research. “National Institutes of Biomedical Research” would be more accurate, if not as catchy.

I don't think I'm just splitting hairs. When people toss around the words “medicine,” “health care,” and “health” as though they all signify the same thing, it shows an important muddling of the concepts in their minds. It's the same confusion that leads people to believe that their health can be restored by discovering the right pill or procedure.

And this year, when candidates, journalists, and voters talk about the importance of health reform, actually they rarely talk about anything beyond the financial structure of health care, which is mostly the medical treatment of chronic disease.

Whether it's interchanging “HIV/AIDS” and “health threats” in Africa, or saying “medicine” when you mean “health” or “health care” in the US, words matter. I wonder how our imprecise language will shape the decisions and actions to come.

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FDA Approves Eloxatin Label Revision

The FDA has approved a revised label of Eloxatin (oxaliplatin for injection) to include six-year overall survival data for Stage III colon cancer patients. This is the first time that overall survival data for the drug, originally approved based on three-year disease-free survival data, will be included in the prescribing information.

Approval of the label followed updated results from MOSAIC (Multi-center International Study of Oxaliplatin/5-Fluorouracil/Leucovorin in the Adjuvant Treatment of Colon Cancer), which demonstrated a 20% reduction in the risk of dying for Stage III colon cancer patients treated with FOLFOX4 when compared with those treated with standard chemotherapy alone at six months of follow-up.

Five-year disease-free survival data for patients treated with the regimen following surgery to remove the primary tumor also showed these patients were 22% less likely to have disease relapse.

© 2008 Lippincott Williams & Wilkins, Inc.
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