The Hazards of Medicalizing Variants of Normal

* Abbreviations: GERD — : gastroesophageal reflux disease Elsewhere in this issue of Pediatrics there appears an important article pointing to the hazards of using a disease label to describe a common, usually normal physiologic variant, regurgitation in small infants: “Influence of “GERD” Label on Parents’ Decision to Medicate Infants with Excessive Crying and Reflux” by Scherer et al.1 The authors’ concern is that acid-reducing medications are being overused and are rarely indicated. There are a few methodologic issues in their presentation, some of which they discuss, but their evidence is clear that use of the disease label “gastroesophageal reflux disease (GERD)” to diagnose any such regurgitation and crying makes parents more likely to favor the use of medication for the condition, even when there has been no confirmation by endoscopy, and even when the drug offered is acknowledged as being unlikely to be effective. This is compelling evidence that … Address correspondence to William B. Carey, MD, FAAP, Division of General Pediatrics, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399. E-mail: carey{at}email.chop.edu