John Botson, MD, RPh, CCD, Talks About Gout Stereotypes in the Media

John Botson, MD, RPh, CCD, discusses a study that found movies and television shows released since the 1990s portray gout as a humorous and embarrassing disease caused by poor diet and excessive drinking, ultimately reinforcing the stigma and misconceptions about the serious and painful disease that impacts an estimated 9.2 million Americans.

DocWire News: Why does gout continue to be misrepresented in movies and in television?

Dr. Botson: You’re referencing an interesting study that was recently published in the BMC Rheumatology, which it basically portrayed in the television and in fictional characters, patients and people that have gout. And what the study stated was that 61% of the patients or the cases that they looked at were due to this overindulgence of food or drink, and only about 12% that actually referenced a medical condition or a biological cause.

And this is interesting because traditionally in these media settings and on television, the gout is really depicted based on gluttony, based on overindulgence. Depending on the setting of the show, it might be medieval times, say, but even in more recent contemporary shows, gout is used as something that explains why a character couldn’t come to work on time, or why a character was doing something where they weren’t showing up to an appointment or something like that. And I think that’s pretty interesting because they’re probably using this for humor. And that’s probably why this keeps coming up in the television shows and in these types of outlets. But that’s really difficult for us as clinicians to try to help these patients. Because the creation of humor in these shows really almost reflects badly on patients that are dealing with this on a daily basis or in life.

DocWire News: What needs to be done in the future to address these misrepresentations?

Dr. Botson: We have to do a better job as clinicians and as educators. We really need to try to change that stigma that gout is not a humorous disease. It is, in fact, a systemic disease. It’s one that needs to be treated just like hypertension or high cholesterol or some of our other diseases that really are a genetic problem. You’re born with this. It’s not just the choices that you make. Yes, sometimes the choices can exacerbate these things. But just like hypertension, we don’t depict these patients as being humorous or belittling them because they have high blood pressure or high cholesterol. So essentially, we need to change this perception. We, as educators, need to educate our patients. Maybe we, as rheumatologists, need to educate our primary care physicians, that this is a real problem, a systemic problem that needs to be treated like any other chronic disease.

DocWire News: Can you talk about the implications of misconceptions to addressing gout?

Dr. Botson: There’s a lot of implications on this. And basically it revolves around how quickly we can care for our patients. The implications, if a patient feels that they’re going to be belittled or they’re going to be yelled at. I use the example with my patients of smoking. A patient doesn’t want to tell us that they’re smoking because they’re afraid that their doctor, one more time, is going to tell them they have to quit. Well, if a patient comes in because they have a gout flare, they feel like based on what they’ve seen in the media and amongst their friends, that if I go into my doctor and I say, “I have a gout flare,” that they’re going to look at me like I just had a big steak and lobster dinner and [was] binge drinking. And that’s going to be something that they’re going to look down upon.

When that’s really not the case. That’s not what this is. This is a flare of a chronic disease that really needs to be managed on a daily basis. So these patients, they push off seeking care until it just gets to that breaking point where they can’t work, they can’t function in life. They miss social events. And they finally, sort of tail between their legs, come in to seek care. And that’s not healthy. And that’s not what we want to see from our patients.

DocWire News: Why is the urgency to treat gout imperative for optimal patient outcomes?

Dr. Botson: Well the urgency comes because of the long-term outcomes from untreated gout. It’s not a specific joint disease. It’s a systemic disease. So over time, you see a lot of chronic inflammation, you see a lot of exacerbations of other diseases like hypertension and diabetes in these patients that can be very complicated. And basically it delays care. So it’s imperative that we see these patients and we offer them the medications that we have out there. We have a number of medications that we can use now to treat gout. Some of these are oral daily medications that are often where we start. But then trying to find those refractory cases so that we can be more aggressive with even intravenous (IV) medications that we have available for patients.

DocWire News: Any final thoughts you’d like to add?

Dr. Botson: One thing that I think to tell all of my colleagues out there and others, that the rheumatologists, we really need to be the educators here for our patients and for our other colleagues. I think it’s really important that we educate and we let people know that this is a treatable disease. I think that there’s been a lot of research, a lot of science that’s been going on in the last couple of years. I was lucky enough to be a part of a study that used an IV medication called pegloticase for these most refractory patients. And we found ways to make this better, to work better with using other medications.

And these are the kind of research things that are still going on, making the patient experience better, making the medications easier to tolerate and really preventing all of those long-term damage things that occur with gout, the erosions, the damage of joints, the dysfunction, the loss of work and social events. And so I think maybe just adding to the education and really looking out there for other options for patients is my take-home message for other rheumatologists out there and primary care providers alike. And maybe for the patients, don’t be afraid to talk about gout to your primary care provider. And then particularly, [at] times when you’re not flaring, when patients are not hurting so that we can prevent this from happening in the future.