Friday, March 09, 2007

Medical mass nouns

I remember a commercial for a migraine drug from several years ago. I can't remember the drug or the exact wording, but I'll pretend that it was Zomig® (there were a lot of commercials for it back then) and I'll craft a fake pitch:

If you suffer from migraine you should ask your doctor about Zomig®. Zomig®: before migraine controls your day.

That was not the exact wording of the commercial. I only remember the noun form for "migraine."

There was a commercial for Actonel® on television recently that had the tagline:

"Keep fighting fracture with Actonel" (Does the "®" belong in a quote?)

Notice the similarity? The two ailments in the commercial are used as mass nouns instead of count nouns. As these are the only two times I've noticed this I'm not sure if it's a trend. But there must be a reason for these two wording decisions. What could it be?

Migraine and fracture are usually used as count nouns. Sufferers of the former that I've talked to would say "I suffer from migraines" or "I had a terrible migraine yesterday." And I would likely ask "How often do you get them?" or "How bad are they?" Someone with a broken bone would say "I suffered a fracture" or "the x-ray revealed several fractures in my tibia." Notice that the singular of each gets the indefinite article, and the plural of each is...well possible.

There are some conditions that don't get either. No one would likely say "I have a cancer" or "I recovered from two cancers."

Mass nouns can take the definite article (like "the water" or "the air") so mass noun illnesses can as well. This is not in every use. To say "the water is cold" or "the air is dry" refers to a limited portion of water or air. The portion is not always known and the boundaries are not always clear, but there is an implied relevant mass of the air or water that is being described. The same is true for an illness like cancer. That memorable line from The Royal Tenenbaums "He has the cancer" is not standard English unless you're talking about an oncologist holding the bowl after a successful surgery. Of course there are some health conditions that would take the definite article with this "X has the Y" usage: he has the flu, she has the measles, he has the delirium tremens, and about 150 years ago you might have said she has the fever. But you still wouldn't say anyone had "one flu" or "a flu." Fever has switched and now is often (usually?) used as a count known.

So why are a fracture and a migraine more likely to be counted? Is it because they are relatively finite in space or time. Many people will suffer more than one broken bone and those who suffer from migraines know that the pounding and pressure will unfortunately return. But we can see where a fracture is. We know that a migraine will soon abate. (I experienced a migraine headache that lasted a week. Twice. My sympathies to all who suffer them more often.)

When everyone in the office succumbs to the effects of the rhino-virus we don't usually say that "the cold was everywhere." We say that everyone "caught colds" or "a cold." We ask how many colds there were, not "cases of the cold" as we would with the flu.

But I'm getting away from my earlier question. Why would drug companies advertise some count nouns as mass nouns? Does it make the condition sound more serious? My theory is that mass nouns in illnesses sound like a well studied, carefully analysed, scientifically defined and assessed condition. And it sounds just a little more serious. The drug company then sounds like it has a handle on the condition and it has the tools to help those who suffer from it. And perhaps, just perhaps, it's a hint at the chronic nature of the condition -- something that will encourage even a mild sufferer to seek help.


  1. You touched on it right at the end, but I think it's the driving factor here. It is that the drug companies are making mountains out of molehills; chronic conditions out of acute ones. If someone gets 'a migraine' then there's an implicit idea that it is inherently telic, that it will go away at some point. if, rather 'a migraine', it is considered 'an acute manifestation of a chronic underlying condition; migraine' then it implies that 'migraine' never goes away, it just subsides for a while, lies dormant. In which case the best thing to do is take preventative medication, lots of drugs all the time.

    I have no idea of the medical basis of this, it could be completely reasonable for migraine to constitute a chronic condition with acute manifestations. Fractures, on the other hand, are clearly very telic things. I suppose there could be a condition (most likely there is) whereby bone density is significantly reduced, for instance, meaning that bones break and fracture more often. However, I wouldn't term such a condition 'fracture', since 'a fracture' cannot be argued to refer to anything more than any given instance. But to the medical publicist, this could just represent a challenge; re-brand something that's prototypically acute in every possible respect and make the piblic perceive it as chronic. You could just call it 'osteoperosis' or 'reduced bone density', but... well, only old people have those, everyone else just gets fractures or suffers from fracture.

    Why? Well, it's obvious; money. The tag line shows it: before migraine controls your day. In other words, take our drug even if you don't have a migraine, but, due to suffering from 'migraine', expect to get one in the near future. Chronic conditions sell a lot more drugs than acute ones.

  2. That's my favorite line from The Royal Tenebaums.

  3. So awhile back you wrote a few posts about the pronunciation of the title of the movie, "Babel"... anyway, I'm just wondering if you and Buffy saw it and what you thought if you did see it.

    I just finished it...First impression of it was really good, but sometimes I have to give more serious movies some time to sink in... - Denise

  4. I think I have restless leg syndrome. Maybe we can finance the commune by making up an ailment and advertising/selling the cure for it.

  5. Jangari: Actonel is in fact a drug for osteoporosis. And still they focus on fracture as the "condition" that needs treatment. You offer an astute observation that most people will think osteoporosis only affects old people. It's all about getting the viewer to feel like part of the key demographic.

    Brian: You don't really have that do you? Is that why you run so much? I have restless toe syndrome. But that illness is all in my head and it involves counting syllables.


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