Joe Collier: Word watching – checking for tricks

Professor Joe Collier I love words. I love their subtlety, their precision, their power, their influence. For me, they represent the embodiment of our thoughts and so our intellects. The abuse of words hurts as it demeans our minds; likewise the failure to respect words riles as it undermines that most precious of commodities – communication. So what is it that bugs me now, why this rant?

Earlier this month (on 8 May to be precise) the House of Commons debated the Health Select Committee’s report on the National Institute for Health and Clinical Excellence (NICE). The debate, which took place in Westminster Hall, was opened by the committee’s chair, Kevin Barron MP. After summarising the broad recommendations of his report, Barron challenged Dawn Primarolo (Minister of State responsible for NICE) on several of the key positions adopted by Government in its initial written response to the report.

Of particular note, Barron raised the issue of NICE as a rationing body. During the Committee’s evidence sessions it became clear that NICE (and many others) saw the Institute as a rationing body, and in its recommendations the committee argued that Government should work with NICE to make this rationing role more explicit.

Ultimately, it was argued, such a move would enhance the public’s ownership and understanding of NICE’s work.

In its written reply Government failed to address the ‘rationing’ question so now Barron pressed again accusing Government of dodging the issue and asking ‘… that Government should work with NICE to make this (rationing) arrangement clear”.

But again, nothing was forthcoming, and Barron was left ironically congratulating the minister “on speaking for 35 minutes and not once mentioning the ‘R’-word”.
I get peeved when students use words wrongly (‘infection’ when they mean ‘inflammation’, ‘symptom’ when they mean ‘sign’), or upset when clinicians misinterpret patients’ words (and vice versa). 

But when politicians wilfully stifle debate by refusing to use a crucially important word I get a sense of foreboding. Why should we trust a minister who uses this political ploy in an area as important as rationing? 

Individuals do it when not saying ‘sorry’ or not mentioning words such as ‘death’ or ‘cancer’, but when this manipulative and unjust arrangement is institutionalised there is something sinister afoot. Patients and words deserve more respect.

Joe Collier is emeritus professor of medicines policy at St George’s, University of London.