January 18, 2014

RHEUMATISM IN BRAZIL - A PROBLEM OF COMMUNICATION

 
Is the difference between
"the" rheumatism
and 
"a" rheumatism
the indefiniteness
of the article or of reasoning?





Rheumatism is not a disease. If you are looking for information about rheumatism, this is the main information you need: RHEUMATISM IS NOT A DISEASE.
You can read the statement "rheumatism represents more than 100 diseases" in multiple websites. Some say this. Others, however, say that rheumatism represents "more than 200 diseases," while a few more say it represents "more than 400 diseases." The numerical differences among 100, 200 and 400 are significant and, at a minimum, show disagreement on the number of represented diseases, but the rheumatism theme is much more complex than that. However, despite the complexity, the matter has been handled in an ordinary and unprofessional way.
For example, there are those who say "rheumatism is more than 100 diseases," "rheumatism is more than 200 diseases" or "rheumatism is more than 400 diseases..." The difference between representing and being, in this case, is very subtle, but still important, as we may see later.
In addition, other websites say that there are more than 100 diseases; others state that there are more than 200 diseases, while a few others say that there are more than 400 diseases called rheumatism...
There is a difference between a disease being actually rheumatism and being called rheumatism, but this difference has not yet been explained because the fundamental truth that explains it - THAT RHEUMATISM IS NOT A DISEASE - has never been told.
If you were searching for information about rheumatism on the web because you went to see a doctor due to pain in any part of the body, and after showing the results of lab tests that were ordered you have been told that you “have rheumatism,” or “have some type of rheumatism,” then relax, don't worry, because IF RHEUMATISM IS NOT A DISEASE, then of course you do not “have” rheumatism nor “any type of rheumatism.” No one “has” rheumatism. Nobody may “have rheumatism."
Nevertheless, if rheumatism is not a disease, then what is it? Why people say that a person has rheumatism?
Rheumatism is just a myth about diseases that cause body pain, in the bones, muscles or joints.
A myth about diseases is a word created to explain an apparently incomprehensible disease (or diseases). In the case of rheumatism, the myth was created in ancient Greece, more than 2000 years ago, and the incomprehensible disease that people were trying to explain was the pain in one part of the body that had not been hurt.
Common sense says that hurting any part of the body will cause pain, and it has never needed an explanation. However, when part of the body becomes painful without having been hurt, this needs to be explained. When mankind was learning how to think, starting to build knowledge, the need of explanation was even greater. However, 2000 years ago there was not enough knowledge about the anatomy of the body, on the functioning of organs and on diseases that affect them, about infections and immunology, on the sensitivity to pain and how it can be changed by events of daily life; lastly, there was no basic knowledge about human biology. The ignorance about the phenomena that lead to the emergence of diseases and pain without injury and trauma was the rule. Therefore, at that time, the only possible way to explain the pain and the disease was inventing myths that could make the phenomena understandable, at least to the word level. Therefore, the word "rheumatism" was invented to serve as explanation for the pain and the disease without obvious reason. 
 
When a word is invented to serve as explanation for any natural phenomenon, but the meaning of the invented word is not associated to something that can be scientifically verified, a cultural phenomenon develops around the invented word. The cultural phenomenon that serves of explanation for reality through words without scientific meaning is called myth.
According to the imagination of ancient people, the whole matter existing in nature would be comprised by the combination of four "fundamental elements": fire, earth, water and air.
For life to exist, the four basic elements of nature would be materialized in living organisms through four "rheumas," which would be the body fluids (blood, bile, etc.).
Health and disease were then explained through balance (health) or imbalance (disease) among "rheumas" of organisms. 
 
The word "rheumatism" - invented to give meaning to the imaginary concepts of balance and imbalance among "rheumas" - originally meant "related with rheuma" only (according to the etymology, the suffix "ism" is only intended to associate something with a root, in case the root "rheuma") and was used to describe a disease arising without obvious reason, which presumably would be caused by an imbalance among "rheumas" of the organism.
Meanwhile, whoever acquires scientific knowledge easily concludes that "rheumas" do not exist, that there are no states of "balance" and "imbalance" among "rheumas," that ancient people simply imagined a concept that cannot be verified by trial and that, therefore, does not belong to the field of science.

In addition, science has discovered that the fundamental elements of nature are not four, but "more than 100"... and are didactically represented on the periodic table of elements.
Developed over the course of 100 years, the periodic table of elements was the result of the work of several independent scientists, from Lavoisier to Mendeleyev, who slowly and progressively went on discovering the chemical characteristics of elements and, through them, understood the factual organization and the logic of nature. The chemical characteristics of all elements allow their individual identification in the laboratory, making them natural verifiable phenomena and not just words invented to explain reality, as was the case of "rheumas."
The periodic table of elements is an extraordinary didactic material that shows, at a glance, a complete overview of the structure of the universe itself and how chemical elements react together to form molecules, chemical compounds, stars, planets and living beings. Anyone who learns the chemical organization of nature does not have to resort to the invention of words such as "rheumas" to explain life or diseases.
Ancient people who invented the word "rheumatism" and gave rise to the myth knew nothing about diseases that were rheumatism, or diseases that were called rheumatism or that were represented by the word rheumatism. For them, there was only a mythological entity that explained everything: this myth was "the rheumatism."
Thus, "the pain shows up because of rheumatism" is a mythological explanation and tells nothing about the real cause of pain. Although it is still widely used today to explain pain and diseases, it means nothing in scientific terms. It does not explain the cause of pain simply because it does not tell what disease is causing it.
In order to better explain the issue of myths about diseases, I will provide another example.
In all primitive cultures, the occurrence of seizures has always been associated with demons. "This person is possessed by demons" was the mythological explanation for those who suffered seizures.
The scientific explanation for seizures is a synchronized, rhythmic, repetitive electric discharge produced by neurons (brain cells).
Those who believe in "demonic possessions" need to believe in demons (many people still believe) to explain what we know today by seizure.
On the other hand, in order to accept the scientific explanation for seizures there is no need to believe in demons that cannot be seen or verified by trial. The neurons, on the other hand, can be seen in the brain and the electrical discharge they produce can be measured by means of instruments. You can even produce a seizure by trial if you get the opportunity to apply an electrical stimulus in any area of someone's brain.
Today, a doctor observing a convulsion will never say "this person is possessed by demons." Certainly the doctor will say that "this person is having a seizure." A doctor should always use the scientific explanation, never the mythological explanation.
However, if you are looking for information because someone told you that you "have rheumatism" or "have some kind of rheumatism," you are the proof that some doctors, in some instances, still prefer to use the mythological explanation "it is rheumatism." But I state that telling a person that he or she "has rheumatism" is equivalent to saying that a person with seizures is "possessed by demons." 
 
Review the following expressions: You have appendicitis! You have tonsillitis! You have meningitis! You have osteoarthritis! When a doctor uses expressions such as these to give explanations, the structure of communication is: You have "something". This "something" is the medical diagnosis, which is transmitted from the doctor to the patient as the name of the disease that was identified. The actual disease explains what is happening with the patient. Appendicitis, tonsillitis, meningitis and osteoarthritis are well-known diseases.
When a doctor uses the expression "you have rheumatism" as the explanation for a disease, he or she is using the mythological expression "rheumatism" as a medical diagnosis. However, the correct way to show this information would be simply saying "You have disease 1, or disease 2, or disease 3," and so on, always saying the name of the disease to refer to some of the "more than 100, more than 200 or more than 400 diseases..." 
 
Dear web surfer: I want to clarify that I consider the explanation of rheumatism as "more than 100, more than 200 or more than 400 diseases" useless, but because these numbers are often used to discuss the subject and to make my thoughts clear, I will turn to these numbers, which should be understood only as an irony regarding the explanation "rheumatism comprises more than 100 diseases," which later I will tell you where it came from...
Let's say that the disease 1 is "osteoarthritis."
Someone who listens from a doctor the expression "you have osteoarthritis" and want to search for information about the disease, should seek only information about osteoarthritis, and does not need to waste time searching for rheumatism.
After losing a lot of time, a person seeking information about rheumatism in traditional sources may understand that, for some, osteoarthritis "is a type of rheumatism..." But it is not!
Osteoarthritis is a disease in the cartilage of joints, but rheumatism is not, i.e., rheumatism is not a disease of the cartilage of joints. Rheumatism is just a myth about diseases that cause body pain, in the bones, muscles or joints.
Explaining diseases through the expression "types of rheumatism" is a useless baloney, but it is so often used and causes so much confusion that I will discuss it more in depth. 
 
The human knowledge is organized into nomenclature and classification systems. All things included in one of these systems tend to be regarded as "types" of the same thing. For example, we can say that there are types of cars...
Several items, such as body, engine and four wheels, define a car.
Individual variations in items that define a car result in different "types" of cars, with different bodies, different engines and different wheels.
As an example from medicine, we can say there are types of cancer...
Cancer is the popular name of malignant neoplasms, diseases caused by the appearance of an abnormal cell called "malignant cell" in living organisms.
The malignant cell is a natural phenomenon that can be observed in a lab; therefore, it belongs to the domain of science.
The "types of cancer" vary according to the type of cell that has become malignant: cells from the brain, bones, skin, lungs, etc.
What different "types of cancer" have in common is that there are malignant cells in all of them, which vary according to the location, the organ in which they grow. A disease in which there is no malignant cells cannot be referred to as a type of cancer, just the same way as something that has no engine, body and four wheels cannot be called a type of car.
But if there was a classification entity of cars and such entity decided to include things without body, without wheels and without engine in its classification, such classification of cars would be performed arbitrarily, without scientific grounding, because things with opposite characteristics would be classified as if they were cars. The simplest example for this arbitrariness would be to say that vehicles with and without engine are "automobile..."
What happens with a classification of rheumatism is similar to a classification of vehicles with and without engine as cars... 
 
A classification is considered scientific when the common characteristic used as classification is defined in scientific grounds. Thus, a classification of inflammatory diseases will be scientific if all classified diseases feature inflammation; a classification of infectious diseases will be scientific if all classified diseases feature infection; a classification of autoimmune diseases will be scientific if all classified diseases feature autoimmune phenomena, and so on.
A scientific classification of "rheumatism" and "rheumatic" diseases is impossible, because there is no biological characteristic that can be taken to define a disease as "rheumatism", nor as "rheumatic." Unlike inflammation, infection, and autoimmunity, which are scientific concepts of natural phenomena verifiable by trial, the noun "rheumatism" and the adjective "rheumatic" are just words that do not define any disease in scientific grounds, because they are not based on a verifiable natural phenomenon, and are based on the word "rheuma" only, which was invented by people who knew nothing about diseases, medicine, and human biology.
Despite this, there is a classification of "rheumatic diseases" developed by the American College of Rheumatology, which lists the diseases that were considered as "rheumatic", including inflammatory, infectious, autoimmune, metabolic, degenerative, hereditary, psychological diseases and even cancer in the same group, resulting in an misshapen and nonsense aggregate of diseases that are so dissimilar, such as arthritis, autoimmune diseases, osteoporosis, fibromyalgia and more.
The problem with this classification is that it does not have a common link among the classified diseases, therefore it cannot be considered scientific. It is a scholastic, arbitrary classification imposed by the authority of a classification entity, based on words, not on scientific knowledge. It includes diseases with inflammation alongside diseases in which there is no inflammation, diseases with infection alongside diseases without infection, autoimmune diseases with diseases that are not autoimmune, hereditary diseases and diseases that do not hold such characteristic, metabolic diseases and traumatic diseases, as well as neoplastic diseases with degenerative diseases. Seen as a whole, the diseases included in the classification have nothing in common that allow them to be considered as "types" of the same thing, and they are there only because of the willingness of the classification authorities and the habit at the time of classification. 
 
The communication problems caused by this classification popped when doctors accepted the exclusively linguistic reasoning, whereby the expression "rheumatic diseases" would be synonymous with "rheumatism"; therefore, according to this reasoning, every and each "rheumatic disease" would be "a rheumatism."
Although the words "rheumatic" and "rheumatism" are similar, there is no scientific basis for concluding that they are the same thing.
The expression "rheumatic diseases" was actually invented to avoid the use of the term "rheumatism" in academic circles, but it proved to be a very bad choice.
The similarity between the words prevailed over the intention to differentiate what science is and what myth is, and caused most people to accept that "a rheumatic disease", despite the showy expression, is the same thing as "a rheumatism."
The mythological thinking, which is natural in people who analyze only words without paying attention to scientific evidence, undertook to conclude that, if there are many "rheumatic diseases" (or many "rheumatisms" ), each of these "rheumatic diseases" (each of these "rheumatisms") is a "type of rheumatic disease" (or a "type of rheumatism"). That was how some professionals, mainly in Brazil, began using the expression "types of rheumatism." And, after merely counting the number of diseases that show up in the classification, they invented the explanation that "rheumatism is more than 100 diseases..." 
 
Those using a mythological reasoning consider that each one of the above diseases in the classification of rheumatic diseases is "a type of rheumatism." In other words, for those who think this way, rheumatism simply means to be classified as a rheumatic disease in the classification of the American College of Rheumatology.
Nevertheless, for the population, this is not what "rheumatism" means.
Firstly, because most people do not know that there is an American College of Rheumatology and a classification of "rheumatic diseases."
Then, because people do not know that, for doctors who believe it, rheumatism is just the same thing as being classified as a rheumatic disease by the American College of Rheumatology.
In Brazil, many people who go to an appointment at the rheumatologist due to pain in the joints, bones, muscles or spine and hear the diagnosis of a disease, immediately ask the doctor "is it rheumatism?" The person who asks this question does not want to know if his or her disease is classified as rheumatic by the American College of Rheumatology; the person only wants to know if his or her disease is what he or she understands as rheumatism, no matter the name.
But nobody understands, nobody knows what rheumatism is, because there is no scientific definition for this word. If there is no scientific definition of rheumatism, anyone can explain the meaning of the word the way they want, and anyone can understand it as they wish.
The agonizing question "is it rheumatism, doctor?" reveals all the fears, beliefs and nonsense that are hidden in the minds of people behind what they believe to be rheumatism. Moreover, whoever answers affirmatively to this question is legitimating all beliefs, superstitions and nonsense that are being envisioned by those who ask the question.
If someone has osteoarthritis (or gout, systemic sclerosis, fibromyalgia or any other disease), the important question is not a matter of whether osteoarthritis (or gout, systemic sclerosis, fibromyalgia or any other disease) is "rheumatism" or "a kind of rheumatism." These doubts are useless, they are not scientific and the affirmative answers given to them verge on quackery.
The important question for people who have osteoarthritis (or any other disease) is just "what is osteoarthritis?" (or any other disease). Moreover, the answer to be given to those who have osteoarthritis (or any other disease) for the question "Is it rheumatism?" is only "No, it is not. It is osteoarthritis" (or any other disease).
To be or not to be rheumatism, that is not the question.
For those who are sick, the doubt "to be rheumatism or not to be it" is useless, adds nothing to the knowledge of the disease and does not clarify anybody about any disease.
For those who are sick, the only question that matters is "what disease is it?"
Each disease has a name, but "rheumatism" is no name for any disease. Therefore, rheumatism "is not" a disease, and that is why no one "has" rheumatism.
The questions concerning "having rheumatism or not", "to be rheumatism or not to be it", "being referred to rheumatism or not", "to be called rheumatism or not" reveal the nonsense problem of communication that exists in this regard.
 
When a doctor tells someone "you have rheumatism", he or she should say "you have disease X" by saying only the name of the disease. By hiding the actual name of the disease, the doctor is denying the correct information to the person concerned.
As a rheumatologist, I do not understand the reason why a doctor who diagnoses a disease tells the diagnosis by saying "it is rheumatism", without simply telling the name of the disease, but I believe there are two different situations in which this behavior appears: 1) When the doctor knows which disease the person has (the doctor made a diagnosis and knows the name of the disease), and 2) When the doctor does not know it (the doctor lacks a diagnosis, thus not knowing the name of the disease).
If the doctor knows the name of the disease that has been diagnosed, perhaps the doctor would rather say "it is rheumatism" by considering that the patient is intellectually unable to assimilate the true name of the disease (such as ankylosing spondylitis, for example), choosing the word "rheumatism" (considered easier to understand) to explain what has been diagnosed. Those who hear names of diseases for the first time, such as ankylosing spondylitis, rheumatoid arthritis, systemic sclerosis, dermatomyositis, and many others, may be challenged to understand and to learn new words, but the solution is simple. Just repeat the name sometimes and anyone can learn the new word. There are no names so difficult that cannot be learned.
But the serious problem is when the doctor does not know what disease the person has and, despite not knowing what it is, the doctor uses the expression "you have rheumatism" just for the sake of hiding his or her own ignorance, trying to show a sense of knowledge. In order to explain the disease that he or she did not diagnose and does not know what it is, the doctor uses a communication structure like this:

"You-have-something-that-I-do-not-know-but-I-will-name-it-rheumatism-because-I-know-that-you-will-believe-it."
This happens a lot in Brazil, unfortunately.
Laypeople believe in rheumatism; it is a popular word. Everybody talks about "having rheumatism", "being rheumatism", "types of rheumatism", etc. In addition, to complicate matters, there are technical words of scientific nature, such as rheumatic, rheumatoid, rheumatology, and rheumatologist, that make laypeople think that the word "rheumatism" is a technical term because it is similar to the previous ones.
This confusion of similar words exists because the myth "rheumatism" was improperly preserved by science, when it was used to name a medical specialty (rheumatology, which etymologically means the study of rheumatism) and a medical specialist (rheumatologist, which etymologically means the specialist in rheumatism), even after scientific discoveries began to understand and identify the various diseases that ancient people - unaware of their existence - tried to explain with the invention of the myth. Rheumatology studies comprise so many different diseases that it turns to be a proof of ignorance to restrict it into the "study of rheumatism", and the rheumatologist is an expert in so many different diseases that it happens to be insulting to restrict him or her into a "specialist in rheumatism."
Science has always fought myths because they affect the understanding and acceptance of reality. However, in the case of rheumatism, instead of eliminating the myth of scientific language, old time doctors incorporate it definitively into medicine by choosing correlated expressions, such as rheumatology, rheumatologist, rheumatic, and rheumatoid.
If neurologists had wrongly chosen the words in the same way as rheumatologists did, we would be living with expressions such as "demonpossessioniology", "demonpossessionlogist", "demonic possession", and "demonicoid possession." Wisely, Neurology has abandoned the myth and has chosen a scientific nomenclature, as did all other medical specialties, with the exception of Rheumatology. 
 
Why old time doctors preferred to incorporate the myth of rheumatism into the scientific language rather than simply abandoning it?
For the same reason that sustains the permanence of the myth in the universal culture nowadays. The history of Medicine is full of characters who tried to fight the myth of rheumatism, explaining the true meaning of the word. However, the use of the word, enshrined by more than 2,000 years of history and beliefs, has resisted all attempts at clarification. Until now, at any time, the number of doctors who told people that they had rheumatism has always been higher than those who said that they did not have, i.e., doctors as a whole, and specially rheumatologists, have always been the main defenders of the myth of rheumatism.
Anyone who intends to change the behavior of the defenders of the myth will have to convince those who spent their lives saying "you have rheumatism" to change the speech, which is a difficult task. After all, people need to be humble and selfless to change the way they are used to explain something. Perhaps the easiest step towards this change is first to recognize that rheumatism is just a popular myth, it is not one, or "more than 100, more than 200, or more than 400 diseases..."
The ambition of changing the behavior of health professionals may seem pointless, but if consequences of this behavior are harmful to people, the change becomes necessary and needs to be endeavored. Since it is a cultural problem, the strongest resistance to be overcome in the process of change is represented by those who benefit from the current behavior.
In the cultural reality of least developed countries, the myth of rheumatism benefits only those who exploit it economically, be they laypeople or insiders, with the sale of "treatments for rheumatism" (since "rheumatism" is not a disease, there is no "treatment for rheumatism"; this term is used only to draw the attention of anyone who believes that "rheumatism" is a disease, for which some product needs to be bought). For most people, however, the belief in the myth of rheumatism is harmful, especially to sick people and those less savvy.
Modern medicine recognizes that education about diseases is an important part of the treatment of chronic diseases. In order to educate someone about a disease, we should convey scientific knowledge, starting with the most simple, the name of the disease. When conveying this information, replacing the name of the disease by a myth is the same as resorting to a lie to educate the patient.
Myths are a literary resort often used to explain human behavior. The author who uses myths to explain his or her ideas hopes that the beauty conveyed by words and the analogy that they suggest will facilitate the understanding by readers. Myths can be useful in education through literature, but for science, for the diagnosis and treatment of diseases, educating by myths is educating by lies, because it is impossible to convey a medical diagnosis and its treatment through analogies. For this reason, the myth of rheumatism is harmful to patients, since it keeps them under ignorance regarding their diseases.
Nevertheless, the damage, complications and suffering caused by this problem of communication can be much greater... 
 
This blog was created to reveal and expose to the audience evaluation the problem of communication caused by the use of the word "rheumatism" in explanations given to patients, and to serve as a voice channel for those who went through any experience with this problem. Any comment, for and against what has been explained, will be well received, because it will help to bring to light the most ancient myth of medicine, the myth of "rheumatism."


About the author:
Dr. Luiz Claudio da Silva is a physician, graduated by the Federal University of Parana (Brazil), in 1983. He holds a specialization in Rheumatology from the Clinical Hospital of the same university, in 1995 and 1996.
He wrote the article RHEUMATISMS DO NOT EXIST, published as an editorial in the Brazilian Journal of Rheumatology, in Portuguese, in 1999, which introduced to Brazilian rheumatologists an alternative to communication based on rheumatism practiced by the Brazilian Society of Rheumatology (SBR) in campaigns for public clarification about what rheumatology is and what rheumatologists do.
Lacking support, he abandoned the SBR and started an independent campaign in 2008 for public clarification regarding the myth of rheumatism by launching the blog RHEUMATISM IN BRAZIL - A PROBLEM OF COMMUNICATION (in Portuguese).
With a current record of 2 million visits, more than 100 published articles and thousands of testimonials from readers who experienced the problem of communication caused by the myth of rheumatism, the blog REUMATISMO NO BRASIL - UM PROBLEMA DE COMUNICAÇÃO is the main vehicle broadcasting the ideas of the author.
Hoping to achieve international support for the clarification campaign concerning the myth of rheumatism, the author now launches the English version of the article that initiated the blog, and also intends to post the translation of other articles that are currently available in Portuguese only.






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