Language of deception in gynecology: The devil at work

by Hooman Noorchashm, MD, PhD, and Amy J. Reed, MD, PhD

Published Feb. 20, 2015, 9:52 a.m. ET

The words we use matter. Our rhetorical characterizations and the language we use matter. Because they define our understanding of the reality we live and act in. Words are powerful.

We have recently been immersed in a very big fight to protect women across the United States, and worldwide, from the spread of cancer by a common gynecological practice known as "morcellation". It's used to extract enlarged tumors of the uterus through small incisions by mincing them up inside the patient's body. Unfortunately for about 2-3 out of every 100 women with symptomatic uterine pathology requiring surgery, an unsuspected cancer is present. If such "unsuspected" cancers are morcellated, no matter what their frequency, they can be spread and upstaged, with potentially deadly consequences - this is a verifiable fact

Sounds terrible. Right?

And, one would think it's simple enough for any reasonable person, especially doctors, to stop doing this "morcellation" – after all it is totally avoidable and potentially deadly. But unfortunately, this is not the case. High ranking leaders of gynecological surgery and even the doctors who are now analyzing the data and admitting that the risk is far higher than previously thought are failing to abandon this practice. They are using language and words to deceive themselves and the public into believing that their comfortable practice is justified and correct.

So let's analyze their words.

They are saying that the risk of occult or missed uterine cancer in women with symptomatic fibroids is "low". But is "2.7 percent" or almost 3 out of 100 women at risk of having deadly cancers really a "low" number? Of course not! But when a professional in a nice white coat characterizes it like that for an unsuspecting patient, guess who accepts the risk as "low"? It's the woman - whose cancer is at risk of being spread and upstaged, a human sacrifice to the altar of irresponsible language.

They are saying that this potentially deadly practice is a "woman's choice". Of course the words "women's choice" are now sacred bastions of progress in our society. What woman would want her "choice" taken away in America? But what ethical doctor would ever offer a patient an avoidable but potentially deadly treatment under the guise of "women's choice"? It's reprehensible when sacred words, like "women's choice", get hijacked by an industry to sell a lucrative, but potentially deadly product to women – another human sacrifice to the altar of deceptive language.

They are saying that this potentially deadly practice "benefits the majority". Of course these words are tightly linked to our society's sanctification of majority rule – or "democracy". And of course morcellation may have some benefit and comforts for "the majority" of women. But does that make it right? You see, slavery used to "benefit the majority" too, but it was a horrific lapse of human judgment and ethics. Professionals' use of the "benefit of the majority" argument to justify an unacceptable and deadly cost to a minority subset of people is more than deceptive - it's criminal. And this crime is masked and sugarcoated by the sweet democratic language of "majority benefit" – another sacrifice to the altar of deceptive language.

They are saying that morcellation is the same as "minimally invasive" surgery. It is not. And "minimally invasive" surgery is great because it leaves small scars behind, there's less bleeding and fewer hospital days. Is mincing up and emulsifying tumors inside a patient's body for the purpose of extracting the tissues from small incisions "minimally invasive"? We would suggest that to any reasonable person, morcellation is "maximally invasive" surgery through small skin incisions. Again language, used to paint a deceptive picture for unsuspecting patients.

Finally, and perhaps most importantly, the gynecologists use the word "hysterectomy" to describe resection of the uterus in women. This word finds its origin in the root "Hysteria". And the suffix "-ectomy" means removal or resection. So in other words a "hysterectomy" is the removal of the source of hysteria – the uterus. Everyone seems to have accepted the unacceptable when it comes to the word "hysterectomy" – after all "morcellating" the seat of "Hysteria" might be just fine. Just like back in the day, people of African American origin, American-Indians and women were classified using derogatory and dehumanizing language to justify great wrongs. How dehumanizing! How atrocious! But the truth is that when our language is constructed and used in insensitive and dehumanizing ways it becomes very easy for society to act in an insensitive and dehumanizing way to suit. You see "hyster-ectomy" doesn't sound like such a big deal, and it even subliminally suggests that it's rooting out hysteria. But "uterine resection" is more precise, respectful and correct. Why aren't gynecologists using the precise, respectful and correct language? We think it's because of traditional societal prejudice against women – and of all fields of medicine it's persisting in gynecology?! Isn't it time gynecologists start using respectful terminology to refer to women whose uterus is in need of surgical management? It is the year 2015, after all.

So let's rehash the rhetorical defense of morcellation: "The use of morcellation for 'hysterectomy' makes 'minimally invasive gynecology' possible. It is a good thing because it 'benefits the majority', and because it respects 'women's choice'".

But, language is also powerful enough to expose the truth: "The use of morcellation during resection of the uterus using laparoscopic or robotic operations makes small incision surgery a routine in gynecology. However, morcellation will cause the spread and upstaging of unsuspected cancers. It is an ethically unacceptable practice because it causes the avoidable, premature or unnecessary death of an unsuspecting minority subset of women by upstaging their cancers."

You see language is a powerful device. It can expose the truth. Or it can create great deception. The devil himself used language to cause humanity's fall from grace – and he hasn't stopped since he started.

Hooman Noorchashm and Amy Reed, husband-and-wife physicians, have campaigned to ban electric morcellators since December 2013, soon after Reed's unsuspected uterine cancer was spread by the device during a routine hysterectomy.