War metaphors carry consequences

Jeffrey Decoster


Armed and ready to attack, doctors are soldiers on the battlefront of disease. They search for magic bullets and fight the spread of cancers. We too are fine-tuned fighting machines. When viruses invade, our cells unleash armies of antibodies to flag the trespassers. 

The languages of medicine and immunology are rife with war metaphors. Most doctors say these metaphors can be motivational for patients. When it comes to describing disease at a molecular level, however, a growing number of scientists say the war language should be honorably discharged from our vocabulary. Among the attendees of a recent Institute of Medicine conference on this topic, “Ending the War Metaphor” were Stanford’s David Relman, MD, associate professor of medicine and of microbiology and immunology, and Stanley Falkow, PhD, professor of microbiology and immunology.

Relman says that throughout history, we have paid attention to only the bacteria and viruses that harm us. “That’s led, over centuries, to the idea that it’s us against them,” he says.

But in recent years, scientists have found that the relationship between humans and micro-organisms is not as simple as a two-sided war. It’s more like a finicky marriage — can’t live with them, can’t live without them. Simplifying the relationship, and ignoring the legions of micro-organisms that help us, causes problems.

“We tend to think that the only good microbe is a dead microbe,” says Relman. “We have this huge flourishing of commercial products based on antibacterials, with the idea that throwing an antibacterial into anything is good. And that is a misplaced idea.” By using war language to describe the fight against bacteria, we go overkill on cleanliness, which can backfire both by weakening our immune systems and by destroying the good germs we need to survive.

The other use of the war metaphor is in bedside medicine. Barron Lerner, MD, PhD, a Columbia University professor of medicine and public health who has written academic papers and mainstream books discussing metaphors in cancer, is more open to using the fighting language.

 “What do you do if you don’t fight your disease?” he asks. “You just watch it? You work with it?”

Lerner says the war metaphor entered the medical field after World War II, when doctors came home from battle with belligerence pulsing through their veins. “It’s really very pervasive,” he says.

“If you’re interested in rallying the troops, using the language of war makes it more immediate.” But the risk of calling cancer treatment a battle, says Lerner, is that it makes it hard to surrender and accept death. “If you’re a patient and you’ve got the disease, there’s a point where you have to step back,” he explains. Patients with the fighting mentality drilled into them can have trouble realizing that one more surgery or one more round of chemotherapy won’t help them.

Both Lerner and Relman say that the war metaphor in science and medicine is a product of our culture, and is not as prevalent elsewhere in the world. The fight against cancer is ingrained in us, Lerner says. “It’s pretty American in the sense that we feel as a culture when someone gets sick with cancer, that’s what you do. You fight. You do as much surgery, as much radiation, as much chemotherapy as possible.”

So next time you are fighting the flu, battling the blues or killing off germs, think twice about your language — the war may be all in your head.

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