Words Matter: Unintended Side Effects of the Term FINANCIAL TOXICITY

High treatment costs are a major cause of health inequalities. In medical language, the financial burdens associated with medical care are often called "financial toxicity." The term became popular in 2013 through an article by Zafar and Abernethy highlighting the growing out-of-pocket costs faced by cancer patients.

In that article, the authors stated that financial toxicity comprises both the “objective financial burden” and the subjective distress caused by it. They attributed rising costs to four factors:

1. An aging population,
2. More patients accessing treatments,
3. Innovation, and
4. Overuse.

Since 2013, the concept of financial toxicity has gained considerable popularity in oncology literature and has been adopted in other specialties, such as neurology.

The reasons are understandable. Doctors are familiar with the unwanted and sometimes seriously harmful adverse effects of treatments. Chemotherapy agents powerful enough to slow or destroy cancer cells can also damage healthy tissues. Explanations of potential toxicity are therefore routinely included in discussions with patients about proposed treatments.

“Financial toxicity” is a useful phrase that encourages doctors to detect, describe, and manage treatment-related financial problems, just as they do other treatment-related toxicities. However, our choice of language can obscure, rather than illuminate, the causes of the problem and our responsibility to work toward solutions.

Language and Cognition

The words we use and the way we think are intertwined. Since Noam Chomsky's time, philosophers and neuroscientists have explored how language influences thought. Researchers have even found language-based differences in the ability to perceive colors. Language can also affect how we analyze an event and assign blame.

For example, a cross-cultural study compared how English and Japanese speakers described accidental events and attributed responsibility for them. It found that English speakers generally used language assigning responsibility to a particular person or object when explaining events, which helped them remember whose fault an accident was. For example, when English speakers described an event as "That bread was burned," this expression attributed the act of burning bread to a particular person. In contrast, "The bread has burned" described the action more passively and assigned no specific responsibility. The researchers showed that this use of language by English speakers—called "agentive language"—helped them remember more clearly how an event occurred and who was responsible. This demonstrates that language significantly affects how we perceive and remember events.

Thus, the language we use to name a problem not only frames our own thinking but also influences how those we speak to understand its causes and the goals for resolving it. Labeling excessively high treatment costs as "toxicity" steers us toward analyzing and understanding the problem from a biomedical perspective of diagnosis and treatment. Like any drug toxicity, financial toxicity becomes an inevitable adverse effect of treatment, leading only to difficult cost-benefit analyses. This familiar medical framing places the problem within our comfort zone and area of expertise, allowing us to use our particular skills to find solutions.

Using the term "financial toxicity" leads us to treat what is fundamentally a socioeconomic issue as a medical one. This points to a system in which treatment services are distributed like optional consumer products under the laws of supply and demand. In other words, while the term treats the financial burden of healthcare as though it were a medical side effect, it overlooks deeper socioeconomic problems concerning how that burden operates within a market-based healthcare economy.

For example, when insulin prices soared, causing preventable deaths among people who could no longer afford it, this had nothing to do with any change in the drug's toxicity profile. Calling the price increase "toxicity" conceals deliberate actions by pharmaceutical companies to increase their profits. Drug prices are certainly not the only cause of high out-of-pocket costs, but they exemplify a feature embedded in our complex healthcare system and the consequences of perverse profit incentives. Many other factors contribute to out-of-pocket costs, including health insurers' ability to deny claims whenever they choose, complex hospital billing practices, and the power of relative value unit metrics to limit physicians' time with patients.

The term "financial toxicity" treats financial burdens as an inevitable and unwanted side effect of treatment. This understanding leads doctors to focus on standard procedures during treatment. As a first step, doctors are expected to inform patients about treatment's financial risks during informed consent. Zafar and Abernethy proposed this approach in their 2013 article: they argued that potential financial toxicities should be considered in treatment decisions and treatment costs made more transparent. Patients could then make better-informed decisions by weighing health benefits against financial risks. Once treatment begins, doctors watch for signs of financial toxicity and, if such a burden arises, try to alleviate it as effectively as possible. Managing financial toxicity viewed as an inevitable part of treatment is considered the best doctors can currently do.

Finding New Language

But this is not the best we can do. A decade has passed since financial toxicity became a popular concept, and patients' healthcare costs have only increased during that time. The label "financial toxicity" may make the problem feel more manageable, but it also obscures the underlying causes and limits our imagination about possible solutions. As we emerge from a pandemic that disproportionately harmed poor and minority populations, the need for alternative strategies to achieve health equity has never been clearer.

We are not claiming that doctors and researchers who use the language of "financial toxicity" act in bad faith. Rather, we aim to highlight the implicit meaning of this language choice and propose an alternative framework. Labeling high treatment costs as a side effect—or, worse, treating financial vulnerability as though it were a comorbidity—steers doctors toward cheaper, potentially suboptimal treatments, worsening health inequalities.

Patients with poor kidney function may not be suitable candidates for certain types of chemotherapy. Although unfortunate, this is based on medical facts when determining treatment options and is always decided through careful consideration of what is best for the patient's health. In contrast, patients being denied the best treatment because of poverty is an injustice arising from financial barriers rather than medical necessity. It is a consequence of economic conditions, rather than a medical decision about the patient's health.

As becomes clear, high treatment costs are modifiable harms deliberately imposed on patients by a for-profit healthcare system. The term "toxicity" is no longer appropriate because it creates the illusion that these harms are inevitable and inherent in treatment. Instead, it would be more accurate to use "financial exploitation" or, as Lyman and Kuderer suggest, "financial abuse".

This new terminology emphasizes that high treatment costs are not merely an inevitable side effect but also a harm deliberately inflicted by a profit-driven system. Such a change in language may help us question the status quo and seek broader solutions to change that system.

Below is a mind-map diagram summarizing the article:

Conclusions

Changing our language from "toxicity" to "exploitation" is a small but important step.

This shift in framing demands solutions beyond discussing treatment costs during informed consent. It requires us to confront our roles as doctors and researchers within a healthcare system that exploits sick people for profit. We do not blame doctors, nurses, or other healthcare workers for this situation—they, too, are victims of a for-profit healthcare system.

Even before the COVID-19 pandemic, widespread burnout and staff shortages signaled the difficulties faced by people working in this system. Many local efforts seek to ease the financial burdens caused by our healthcare system, including financial counseling, free screening programs, community health fairs, and more. We fully support these initiatives, but broader change is needed to break the cycle of exploitation embedded in our healthcare system.

Decisions by pharmaceutical companies, hospital systems, health insurers, and politicians to maintain this exploitative system may lie beyond our direct individual control. Although changing such an entrenched system can sometimes seem impossible, doctors, medical school faculty, and researchers are integral to it and have the power to change it. Collective action will be needed to bring about systemic changes that prevent further financial exploitation of our patients. Such action may include political activism, using the influence of professional societies, and taking leadership roles in healthcare institutions.

Replacing terms such as "financial toxicity" with more realistic expressions such as "financial exploitation" may be an important step toward drawing attention to the system's fundamental problems and starting the conversations needed to resolve them. This change in language emphasizes that the financial structure of healthcare is not merely a side effect but a consequence of a for-profit system, strengthening the call for more comprehensive intervention and change.