Author: Timothy Gray

One for All

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Timothy Gray, PhD, JAMA Network

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If you’re eating candy, it’s “3 Musketeers.”

If you’re reading about the friends of d’Artagnan, it’s The Three Musketeers.

Given that JAMA Network publications are technical instead of literary (A Piece of My Mind and Poetry notwithstanding), we would fall on the candy side of the divide between using numerals and using words (whether candy is technical is a discussion for another day).

The online abstract to Chapter 18.0 in the AMA Manual of Style, Numbers and Percentages, raises “the difficult question of when to use numerals and when to use words, and how to combine the two.” Note the tidy example of spelling a number as a noun. This difficulty is a factor in what I see as numeral inflation in the form of encroaching “1” use.

One of the most obvious places for numeral use is in identifying study populations.

For example, take this hypothetical Delphi consensus group: 5 physicians, 4 nurse practitioners, 3 patient advocates, 2 patient caregivers, and 1 health system leader.

One of the most obvious places for spelled number use is in idiomatic phrasing or in parts of speech. Section 18.2.3, Accepted Usage, advises using words “in circumstances in which use of the numeral would place an unintended emphasis on precise quantity.” When a number appears in text, what is the cutoff point between intended and unintended emphasis?

The manual suggests that “common sense” plays a role in editorial judgment, but one person’s “common sense” is another person’s “thanks anyway.”

As examples of avoiding unintended emphasis on quantity, the style manual lists “one-time variables,” “in one recent case,” and “has become one of the dominant topics.” However, in current publications you will find encroaching “1” use in various “1-time” constructions, the phrase “in 1 recent analysis,” and the wording “has become 1 of the leading reasons.”

How about these uses of encroaching 1?

  • “At least 1 moderate event.”
  • “In 1 large health system.”
  • “More than 1 time zone.”

Numeral use would seem to be justified by the idea that a moderate event, a large heath system, and a time zone are being counted.

Section 18.2.2 advises that we should spell “one” used as a pronoun or a noun, and these 1s are part of a noun phrase as the object of the prepositions “at least,” “in,” and “more than.”

I am “all for one.” It can be a relief to have an automatic edit to make in the name of upholding style, but many of us are not “one for all”—even in cases sanctioned by Accepted Usage. Not every “one” that seems countable should be “1,” and I offer this observation not to get editors into the weeds (an occupational hazard) but rather to help them avoid reflexive editing.

December 9, 2024

New Abbreviations for Liver Diseases

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Timothy Gray, PhD, JAMA Network

The designation “nonalcoholic fatty liver disease (NAFLD)” is no longer accepted across JAMA and the JAMA Network journals, except to reflect the language used in data collection for a study (or search terms for a review).

The directive is based on the recommendations of the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, as well as the Latin American Association for the Study of the Liver.

In collaboration with hepatologists, gastroenterologists, pediatricians, endocrinologists, hepatopathologists, public health and obesity experts, colleagues from industry, regulatory agencies, and patient advocacy organizations, a consensus was developed via the Delphi process for a change in nomenclature.1

The term chosen to replace NAFLD is “metabolic dysfunction–associated steatotic liver disease (MASLD).” In the previous designation, the term nonalcoholic may have been confusing for patients and physicians. The word fatty also has stigmatizing and negative connotations.

The same committee process resulted in another designation change that will be implemented across JAMA and the JAMA Network journals. The designation “nonalcoholic steatohepatitis (NASH)” is now called “metabolic dysfunction–associated steatohepatitis (MASH)” to avoid trivializing the diseases or confusing patients with the possible connotations of the term nonalcoholic.2

It is hoped that these updates will clarify what the diseases are instead of what they are not.

The AMA Manual of Style has added these abbreviations and expansions to the list of clinical terms in chapter 13.11.

References

  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-1986.
  2. Eskridge W, Cryer DR, Schattenberg JM, et al. Metabolic dysfunction–associated steatotic liver disease and metabolic dysfunction–associated steatohepatitis: the patient and physician perspective. J Clin Med. 2023;12(19):6216.

May 24, 2024.

The AMA Garden of Hyphens

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Timothy Gray, PhD, JAMA Network

If your professional life requires adherence to AMA style, you may have gotten lost in the weeds styling hyphenated compounds in titles. No capitalization after a hyphen if a prefix or a suffix, if both parts are considered a single word (requiring a field trip to Merriam-Webster), if the compound is temporary, or if the parts do not carry equal weight.

I have long wondered how parts of a compound carry weight, which isn’t to say that I don’t like the idea. As a practical suggestion, though, it lacks a little, uh, practicality.

If you think of a compound as an entity on its own, any word that may carry weight because of its particular part of speech loses that identity (and drops the weight!) when it gets pulled into that magical realm of a hyphenated compound (all adjectives all the time). So “Short-term Effects” and “Full-time Coverage” have always read as weird to me, especially if they have appeared near “Early-Onset Disease.”

How fitting, then, that the AMA Manual of Style has finally addressed the weed problem with hyphenation. No need to kill them. We can just get them out of our way. Let the weeds live happy lives in some other organization’s style manual.

The new guidance in 10.2.2 reads “In titles, subtitles, and text headings, capitalize both parts of a hyphenated compound.” Hence, “Short-Term Effects” and “Full-Time Coverage.” Take a look in the online manual for more information and other new style guidance.

Now when you review capitalization in titles with hyphenated compounds to align with AMA style, you needn’t make excursions to other sources. You can stay in the AMA garden without getting lost in the weeds.

Published August 1, 2023.