By Crystal Phend
Published: Apr 1, 2013

Full Story:  http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/38174

Giving a baby’s minor symptoms the “disease” label may boost parents’ desire to medicate, even if told drugs won’t work, researchers found.

Parents given the same scenario of excessive crying and spitting-up indicated significantly more interest in medication for the infant (P<0.01) when told the symptoms represented gastroesophageal reflux disease (GERD), Laura Scherer, PhD, of the University of Missouri in Columbia, and colleagues reported.

Those told it was GERD were equally likely to favor medication whether the pediatrician described it as ineffective or not, whereas parents not given the disease label were much less interested if told the medication wouldn’t help (P

This may be one reason acid-reducing medications are widely — and inappropriately — used for otherwise healthy infants, the group suggested in the May issue of Pediatrics.

“Doctors may inadvertently encourage the use of questionable medical interventions and foster medicalization of minor pediatric illnesses by using labels that increase patients’ perceived need for treatment,” they wrote.

Spitting-up, even when frequent enough to be annoying to parents, is normal in the first year of life and shouldn’t be considered GERD unless there’s endoscopic evidence to support that diagnosis, William Carey, MD, of Children’s Hospital of Philadelphia, noted in an accompanying commentary.

Even when GERD is confirmed, routine drug treatment, such as proton pump inhibitors, garners little support from the scientific literature for reducing crying and regurgitation, he added.

“This is compelling evidence that the choice of words by physicians can significantly affect parents’ views of their children’s health,” Carey wrote.

“The way we identify and deal with annoying normal or insignificant variations and how we discuss them with parents makes a big difference in the quality of care,” he advised.

The study randomized 175 parents to complete one of four versions of a survey while waiting in the pediatricians’ office. The vignette started:

“Imagine that you are the parent of a 1-month-old infant. At this point, your infant’s life mostly involves eating, pooping, and crying. … Your infant also spits up a lot. Sometimes after feeding, your infant will spit-up a big mouthful onto your shirt or the floor. Often there is so much spit-up that you are amazed that there is anything left in your infant’s stomach.”

Then it proceeded to explain about the excessive crying that was especially bad after eating and was “beginning to take a toll on you.”

The physician consulted in the scenario describes the symptoms as due to a weak valve at the entrance to the stomach that allows food and acid back up into the mouth and either leaves it at that or describes this combination of symptoms as GERD.

Versions were also randomized to inclusion of the statement: “However, studies have shown that this medicine probably doesn’t do anything to help improve symptoms in babies with [GERD/this problem].”

Other than those two factors, family medical history also appeared to have an impact on the parents’ self-reported interest in medicating the hypothetical child.

The 21% of parents who indicated that at least one of their children had been diagnosed with GERD in the past were more interested in medication that other parents (P<0.01 for interaction).

Most of those parents (26 of 37) had opted for medication of their own child.

When asked whether they appreciated the doctor’s offer of medication in the scenario, parents were least appreciative when they were told that the medication was likely ineffective and not given the GERD label.

However, parents told it was GERD but the medicine probably wouldn’t help were “among those most appreciative of the medication offer,” the researchers noted.

“One possible explanation is that in the context of a disease label, information about medication ineffectiveness might be seen as an act of candidness and honesty,” they wrote.

The GERD label didn’t make parents report a higher level of worry about the child or perceive the illness as more severe, which meant it exerted its effect on their assumptions about appropriateness of interventions.

“GERD is certainly not the first or only condition to be suspected of widespread overdiagnosis and overtreatment,” Scherer’s group noted, suggesting the results might generalize in influencing perceived need for unnecessary treatment.

However, one issue in the study that might limit generalizability was that almost all the parents surveyed were highly educated women.

Further study may be necessary to test how disease labels influence real-life medical decision making rather than just hypothetical ones.