spelling

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.

Hawaiian Diacritics

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Miriam Cintron, BA, JAMA Network

https://decolonialatlas.wordpress.com/2015/06/03/the-hawaiian-islands/

The islands of Hawaiʻi and its people have a culture rich in history, traditions, and the Native Hawaiian language.

Sadly, use of the Native Hawaiian language began to decline in 1896, when it was banned from schools just 3 years after the Hawaiian monarchy was overthrown.1 Without being taught in schools, the Native Hawaiian language became dangerously close to being completely forgotten. By the early 1980s, fewer than 50 children spoke the language.2

A resurgence in cultural pride and identity in the 1970s led to the resurgence of many Native Hawaiian cultural traditions, including the language.

With this in mind, the AMA Manual of Style strives to be accurate, fair, and respectful in reflecting the identities of individuals and groups. The Manual is adding 2 diacritical marks used in Native Hawaiian to the Accent Marks (Diacritics) section (chapter 12.2).

The okina (ʻ) is a glottal stop and the kahakō is a macron (ā) that lengthens and adds stress to the marked vowel.

The marks are used throughout the language, including in many of the names of the main Hawaiian islands (eg, Hawaiʻi, Kahoʻolawe, Kauaʻi, Lānaʻi, Molokaʻi, Niʻihau, and Oʻahu).

Note that Hawaiʻi has 2 official languages according to the state constitution: English and Hawaiian.3 “Hawaiian” is considered an English word, so it doesn’t take the okina.

  1. Hawaii State Department of Education. History of Hawaiian education. Accessed January 19, 2022. https://www.hawaiipublicschools.org/TeachingAndLearning/StudentLearning/HawaiianEducation/Pages/History-of-the-Hawaiian-Education-program.aspx
  2. The Hawaiian Islands. The Hawaiian language. Accessed January 19, 2022. https://www.gohawaii.com/hawaiian-culture/hawaiian-language-guide
  3. The Constitution of the State of Hawaii. Article XV. Accessed January 22, 2022. https://lrb.hawaii.gov/constitution#articlexv

Updated Guidance on Reporting Race and Ethnicity: Let’s Start With the Why

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Kim Penelton Campbell, BS, JAMA Network

I have used many adjectives to describe myself, but I’ve never referred to myself as other. When teachers called my name during morning attendance, I responded by saying “Here.” I never said, “Invisible.”

In medical literature, the failure to fairly and respectfully recognize and include individuals of all races and ethnicities can severely adversely affect patients’ lives and the quality of care they receive. It can misinform clinicians. It can compromise the credibility of a journal.

This means that race and ethnicity data should be reported in a way that encourages fairness, equity, consistency, and clarity in medical and science journals.1

Changing the b in Black and the w in White to uppercase lettering when describing race is not about mere political correctness—these changes are part of a conscientious movement toward equitable delivery of health care services to all people.

The objective of this post is to emphasize that updated guidance about the reporting of race and ethnicity is important, not because the AMA Manual of Style says so, but because inattentiveness to these changes can contribute to unconscious bias and ultimately affect how patients are treated or unintentionally mistreated.

Bias, when unintentional, is not mitigated—it remains bias all the same. Unintentional bias can occur simply because the writer or editor is removed from the patient’s life experience. When the writer or editor is unaware, they may not recognize how insensitive wording can affect the reader.

Example: “Adherence to the prescribed medication was higher among White patients than among Blacks.”

Consequence: Does this mean that if you are White you are a patient but if you are Black you are nothing? What is a Black?

When a person is called a Black instead of a Black patient or a patient who is Black, the wording detracts from that person’s humanity.

Likewise, use of lowercase lettering for Black and White, as well as referring to people as minorities instead of as members of a racial or ethnic minority group, also diminishes their humanity. Stating race or ethnicity in noun form can be interpreted pejoratively and is akin to labeling patients by their disease (eg, the blind, schizophrenics, epileptics) instead of putting the individual first (eg, a person with schizophrenia).2 Other things that can be interpreted pejoratively and should be avoided are using the term mixed race, which can carry negative connotations, instead of multiracial or multiethnic, merging race and ethnicity with a virgule (ie, race/ethnicity) rather than recognizing the numerous subcategories within race and ethnicity with the term race and ethnicity, and using abbreviations for racial and ethnic terms. Although the writer or manuscript editor may not have intended to negatively portray a group of people, the potential effect on readers remains unchanged.

  • To potential authors, the absence of a single word can indicate that a journal is insensitive to the health care needs of a population of patients.
  • To clinicians with the same racial or ethnic background as the one negatively represented, this can promote the inference that the journal has no diversity on its editorial board or staff.
  • To a practicing physician, this language can translate to offensive or insensitive communication when speaking with a patient or a patient’s family member.
  • To a patient, this wording can indicate that the medical community views individuals from their racial or ethnic group as nonpersons—unseen, unconsidered, and uncared for.
  • For all of these individuals, this can deepen a sense of mistrust.

Language that excludes a racial or ethnic group can subtly influence a medical trainee to “unsee” the humanity in people who are from a different background. If their research and educational sources are written or edited without intercultural competence, the medical trainee may unintentionally miscommunicate or make incorrect assumptions about patients from other backgrounds. This breach can interfere with a clinician’s understanding of the patient and, in response, impede the patient’s trust in the clinician.

Among some patients from communities that have been medically underserved or ignored, information about medical mistreatment can transcend generations. Past miscommunication can lead to mistrust, which can then lead to fear.

A family may never forget that Grandma never came home from the hospital and that no clinician took the time to explain why. Although this family was made to feel invisible because of miscommunication, it is quite possible that the clinician intended no disrespect and had no knowledge of how the family was affected. A patient with a historic burden of oppression can potentially interpret disrespectful communication as an initial step down the road to medical abuse.

My godfather once expressed such fear. He was Black, the clinicians were White, and he had grown up in Mississippi during the 1940s. Although I asked, he refused to ever repeat details of what was said by these physicians many years ago. But decades later, when I was a teenager and a novice driver, my godmother phoned and urgently asked that I come to their home immediately to rush him to our local VA hospital.

On my arrival, she exclaimed, “I think he had a heart attack while gardening in the back yard!” I said, “I’ll call 911. The ambulance will get him there faster.” Then, she stopped me. She pleaded that I drive him there myself. As I rushed to his aid, she continued by telling me that he would die of fear if an ambulance came to their home. She told me that I must speak for him when we arrived, remain by his side, and do everything in my power to keep him calm.

He cried like a baby during the entire ride. He was afraid. He was humiliated about expressing fear in my presence. I did not know what to say. I just kept driving. My heart was broken.

This brief story is an example of deep-seated fear that some Black people experience in a health care setting, a fear that can only begin to be abated with a conscientious effort to ensure that language humanizes Black patients and patients from all racial and ethnic backgrounds.

How does one address suboptimal reporting on race and ethnicity?

  • First, follow the guidelines.
  • Second, write and edit with a raised antenna. Look for what is unsaid in addition to what is written on the page.
  • Try to interpret as if you are a person from a racial or ethnic group unlike your own. Think about how you would you feel as the subject or nonsubject of the article.
  • Consider how wording can be misinterpreted.
  • Consider how inattentiveness to detail can affect the health, safety, or life of someone who is misrepresented.
  • Edit responsibly, but without fear of respectfully questioning the author.

Remember: no one is invisible, and no one is other.

“Not everything that is faced can be changed, but nothing can be changed unless it is faced.”3

James Baldwin

References

  1. Flanagin A, Frey T, Christiansen SL; AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304
  2. Christiansen SL, Iverson C, Flanagin A, et al, eds. Correct and preferred usage. In: AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:547-548.
  3. Baldwin J. As much truth as one can bear. New York Times. January 14, 1962: Book review 1, 38. https://www.nytimes.com/1962/01/14/archives/as-much-truth-as-one-can-bear-to-speak-out-about-the-world-as-it-is.html

Social Media: Dos and Don’ts

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Eman Hassaballa Aly, Social Media Manager; Reuben Rios, Social Media Coordinator; Deanna Bellandi, MPH, Manager, Media Relations (JAMA Network)

“All we want are the facts.”

Sgt Joe Friday, Dragnet

Social media is an important tool for promoting content published in JAMA and the JAMA Network family of journals to the research community, physicians and other health professionals, and lay audiences. Doing that means following a set of guidelines meant to ensure accurate and responsible social media posts.

JAMA Network Social Media Guidelines

  • Content published in social media sites is subject to the same norms, standards, and regulations as is all other published content.1
  • Be respectful.2
  • Use proper grammar, spelling, and capitalization.3
  • Abbreviations may be used provided they can be easily understood in context.
  • Avoid texting jargon, such as “U” for “you” or “L8” for “late.”3
  • Do not use sarcasm, irony, satire, or absurdities.4
  • Reflect diversity.4
  • Use language that is nondiscriminatory.5
  • Do not include negative comments directed at any person, group, or institution.
  • Do not use offensive content (including, but not limited to, racist, sexist, ageist, anti-LGBTQ, and antireligious.)6
  • Do not include sexually suggestive images or video (eg, genitalia, breasts, buttocks) or those that portray sexual assault/abuse.
  • Do not use language, images, or other content that reinforces stereotypes.5
  • Use individuals’ preferred pronouns when known; inclusive pronouns (they/them) are acceptable.4,5
  • When reporting the results of a study or describing a specific journal article, replace personal pronouns (I and we found) with reference to the study or the article type (eg, Viewpoint, Review).
  • When mentioning people/Twitter handles, do not editorialize or designate appellations (eg, do not say, “The great [@Twitter handle] discusses…”).
  • Do not use profanity or vulgarity.2,6
  • Do not include emojis based on gender or race.4
  • Do not include identifiable patient content without permission.1
  • Do not share confidential information.7
  • Do not share information that is embargoed or before publication date and time.
  • Do not include quotes, images, photos, or video from other social networking sites or third-party publications without permission and attribution to the source.8
  • Do not share others’ social media posts that do not follow these guidelines.
  • Correct posts with errors transparently and as soon as possible. For example, add a new post clarifying the correction, and include the word “correction.”

Posts that do not follow these guidelines may be removed.

Tweet Formatting

  • The basic format of a tweet consists of text, links, and hashtags handles with optional attached video and images (up to 4 images per tweet).
  • Length: the maximum length for JAMA Network tweets is 257 characters. Twitter limits to 280 characters, but because JAMA Network always includes a link, 23 characters are reserved for the link.
  • Hashtags should be limited to 3 per tweet.
  • Twitter handles should be included if there is room. Handles should be limited to authors and institutions directly related to the content of the tweet.
    • Example: Tweet text (including relevant @mentions and #hashtags), Link, Other @mentions (if not directly mentioned in the tweet), Other hashtags (if any, and if space permits).

References

  1. Christiansen C, Iverson C, Flanagin A, et al. 5.9.5. Social Media and 5.11.19 Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-5-div2-230
  2. Grossmont-Cuyamaca Community College District. Social Media Guidelines. Accessed April 2, 2021. https://www.gcccd.edu/marketing-communications/social-media-guidelines.html
  3. Christiansen C, Iverson C, Flanagin A, et al. 7.11. Grammar in Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-7-div1-138
  4. Sehl K. How to Create Effective Social Media Guidelines for Your Business. Hootsuite. Blog. February 3, 2020. Accessed April 2, 2021. https://blog.hootsuite.com/social-media-guidelines/
  5. United Nations. Guidelines for gender-inclusive language in English. Accessed April 2, 2021. https://www.un.org/en/gender-inclusive-language/guidelines.shtml
  6. CollegeGrad. 10 Things You Should Never Post on Social Media. Accessed April 2, 2021. https://collegegrad.com/blog/10-things-you-should-never-post-on-social-media
  7. Storey V. Social Media Guidelines or Policy?  Social Media Today. May 17, 2011. Accessed April 2, 2021. https://www.socialmediatoday.com/news/social-media-guidelines-or-policy/475646/
  8. Associated Press. Social Media Guidelines for AP Employees. Revised May 2013. Accessed March 24, 2021.  https://www.ap.org/assets/documents/social-media-guidelines_tcm28-9832.pdf

Updates to Reporting Black and White as Racial Categories

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Everyone in the business of communication has a responsibility to use and promote the use of clear and accurate language, with words that reflect the world around us. As evidenced by perpetual updates to style manuals, dictionaries, and other resources, nomenclature is never a static enterprise.

Specifying the race or ethnicity of an individual can provide information about the generalizability of the results of a specific study. Because many individuals may have mixed heritage, a racial or ethnic distinction should not be considered absolute, and ideally it should be based on a person’s self-designation.

In the JAMA Network journals, we ask authors to provide an explanation of who classified individuals’ race, ethnicity, or both, the classifications used, and whether the options were defined by the investigator or the participant. In addition, the reasons that race/ethnicity were assessed in the study also should be described (eg, in the Methods section and/or in table footnotes).1

We have received a number of queries about the presentation of racial and ethnic terms in the AMA Manual of Style, in particular the manual’s style current preference for using lowercase for the term black. The 11th edition specifies capitalizing racial and ethnic terms that derive from geographic nouns such as Asian, Alaska Native, and Latina (chapter 10.3.2, Capitalization, Proper Nouns, Sociocultural Designations), but the terms black and white have been lowercased as racial designators (because they are not derived from proper nouns).

However, ongoing and recent events spurred us to reconsider this style recommendation. The manual’s committee met several times, conducted research, and sought input on this issue from multiple sources. We deem this issue too important to wait for change.

In weighing the options (keep black and white lowercase, capitalize just Black, or capitalize both Black and White), we reviewed usage recommendations in a variety of sources, including other style manuals (Chicago Manual of Style,2APA style,3 and the AP Stylebook4), writing by an array of scholars, and guidance on diversity from academic and government sources, such as the US National Institutes of Health.5

The committee has concluded that we will now capitalize both Black and White, which aligns with the capitalization preference applied to other racial/ethnic categories. We acknowledge that there may be instances in which a particular context may merit exception to this guidance, for example, in cases for which capitalization could be perceived as inflammatory or otherwise inappropriate.

The online style manual will be updated to reflect this change, including the section on race/ethnicity in the Usage chapter  (chapter 11.12.3, Usage, Inclusive Language, Race/Ethnicity) and the aforementioned entry in the Capitalization chapter.

There are additional language issues to consider, including use of “other” as a category and abbreviating racial and ethnic terms. The nonspecific “other” is sometimes used for comparison in data analysis but may also be a “convenience” grouping/label that should be avoided, unless it was a prespecified formal category in a database or research instrument.

In such case, the categories included in “other” should be defined and reported. Authors and researchers are advised to be as specific as possible when reporting on racial/ethnic categories (even if these comprise a small percentage of participants).

Example (not recommended): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity.”

In this situation, an editor should ask the author for further explanation, considering that the racial/ethnic background of a quarter of the study is not provided.

Example (preferred): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity, which included Chinese, Japanese, Korean, and Native Hawaiian/Pacific Islander and those who reported multiple categories.”

Racial and ethnic terms also should not be abbreviated unless necessary for space constraints (eg, in tables and figures with clear expansion in explanatory footnotes or legends).

The manual’s committee will continue to explore changing trends in usage of other racial and ethnic terms as well, such as Latinx. As with all changes to the style manual, we welcome input from readers. The update to the manual online will be implemented as soon as possible, and the JAMA Network journals will begin to use Black and White as we edit new content.–Stacy Christiansen and Tracy Frey, for the AMA Manual of Style committee

References:

1. Instructions for Authors. JAMA. Updated April 13, 2020. Accessed June 19, 2020.  https://jamanetwork.com/journals/jama/pages/instructions-for-authors#SecReportingRace/Ethnicity

2. Black and White: a matter of capitalization. CMOS Shop Talk. Posted June 22, 2020. Accessed June 22, 2020. https://cmosshoptalk.com/2020/06/22/black-and-white-a-matter-of-capitalization/

3. APA Style. Racial and ethnic identity. Accessed June 20, 2020. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities

4. AP Stylebook. Race-related coverage. Accessed June 22, 2020. https://www.apstylebook.com/race-related-coverage

5. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. National Institutes of Health. Released April 8, 2015. Accessed June 20, 2020. https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html

Exhibit A

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There are times when authors question whether they really need copyediting; occasionally, when edits are especially light and authorial moods particularly dark, I even wonder if the idea of skipping it might even be right. But I am never swayed long, because to copyeditors, it is usually clear how tricky English can be, even in its smallest and seemingly simple parts.

Consider exhibit A: a.

English offers 2 indefinite articles, a and an, and the 11th edition of the AMA Manual of Style includes a simple-but-not-easy rule of when to use them: the a goes before consonant sounds and the an before vowel sounds. The hard part is that the sounds, not the written letters, are the deciding factor.

Because English is nonphonetic, words that start with written consonants (such as h) might begin with a vowel sound (as with hour), and those starting with a vowel may be said as an initial consonant sound (as with one). The only way to know the correct article to use is to know how each word is said aloud.

Medical writing further complicates this with prodigious abbreviations. Exactly half of the letters in the English alphabet, including 8 consonants, are said with initial vowel sounds; for example, an N is pronounced “en” and thus must follow an an when it occurs in acronyms such as NSAID. (The other 7 such consonants are F, H, L, M, R, S, and X.)

Making things even worse, acronyms that are pronounced as words (eg, LASIK) must be matched with the indefinite article that goes with their initial sound (in LASIK, “la-,” which means an a should be used), not the sound that matches the spoken letter (the “el” sound of L, which would go with an an). This means it is essential to know which acronym is said as a word and which as a mere cluster of letters.

It is a relief that nearly all of the letter names that start with consonant sounds (B, C, D, G, J, K, P, Q, T, W, Y, and Z) are for actual consonants, making the a their default article—except that, of course, Y is a consonant (said “ya”) and a vowel (“ee”) with a rather inexplicable spoken name (“why”), and…. well, you get the picture. The complexity never ceases.

Anyone can get this stuff wrong, even native English speakers. For authors using English as a foreign language, including those who largely write in rather than speak the language (and therefore do not sound it out much) and those whose native languages do not include indefinite articles (eg, Japanese, Hindi, Polish, many more)—this might be pretty hard to manage. For everyone, there are copyeditors. We hope to handle this and all the rules in our 1200-page style manual, from a to z.–M. Sophia Newman

Welcome the 11th Edition of the AMA Manual of Style!

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We are pleased to announce the 11th edition of the AMA Manual of Style, now live at https://www.amamanualofstyle.com/ and shipping in hardcover in a few days.

The manual has been thoroughly updated, including comprehensive guidance on reference citations (including how to cite journal articles, books, reports, websites, databases, social media, and more), an expanded chapter on data display (for the first time in full color), a completely up-to-date chapter on ethical and legal issues (covering everything from authorship and open access to corrections and intellectual property), and updated guidance on usage (from patient-first language and terms to avoid to preferred spelling and standards for sociodemographic descriptors).

The section on nomenclature has undergone thorough review and updating, covering many topics from genetics and organisms to drugs and radiology.

The statistics and study design chapter has been extensively expanded, with more examples of usage and terms that link to a related glossary.

Chapters on grammar, punctuation, abbreviations, capitalization, manuscript preparation, and editing feature refreshed examples and new entries (such as allowance of the “singular they”).

The nearly 1200-page book is enriched by a variety of online features. For example, regular updates to address changes in style or policies will be featured in the Updates section. Any corrections will be made online so that you are always looking at the latest guidelines as you use the manual.

New quizzes will be posted to help new or continuing users learn to master the finer points of AMA style, and the units of measure calculator offers easy conversions between the SI system and conventional units, as well as the metric system.

We welcome questions and comments on the manual: write to stylemanual@jamanetwork.org or find us on Twitter (@AMAManual). We look forward to engaging with you. –Stacy Christiansen, for the AMA Manual of Style Committee

A Blueprint for Science Editing

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As a high school student, I stumbled across A Blueprint for Teen-Age Living in a recessed shelf of the library. The book was older than I was with a spine unbroken. Despite these red flags, I believed this William C. Menninger author might have some wisdom for the ages.

The breezy illustrations failed to track against the daily dramas unfolding around me in those years, and its advice did not seem to be applicable to peers. No one else was consulting a book on how to behave. One of the 7 signs of maturity was the ability “to deal constructively with reality.” Real life never arranges itself as in a guide to behavior, so to deal with reality, I began to disregard the Blueprint advice. Let’s just say that A Blueprint did not open any doors.

Happily, as a manuscript editor, I have access to guidebooks that not only open doors but also resolve questions. With the impending arrival of the AMA Manual of Style 11th edition comes the opportunity to take a brief peek at the first edition, which is of about the same vintage as that guide for teenagers.

A reasonable facsimile.

The typeface on the cover is, like the illustrations in A Blueprint, deceptively breezy. The book gets down to business. Even a quick look shows that the book arranged itself according to the real life of an editor. Written by director John H. Talbott, MD, for the Scientific Publications Division, this 70-page Style Book was produced in 1962 for an in-house audience. Stapled with a green cover, it has the look and weight of a fundraising cookbook from church. The Foreword (spelled “Foreward,” a potential mash-up of “foreword” and “forward”) indicates that numerous blank spaces appear on pages for additions the user may wish to enter. How thoughtful, but the version in hand must be a facsimile edition because all pages are jam-packed with scant space for additions.

The Style Book consists of 25 sections, mostly about the conventions of punctuation, with excursions into italics, laboratory values presented as cc instead of mL, drug names, and proofreader’s marks (perhaps the most constant of all sections). The Style Book shouts. CORRECT USAGE. INTERROGATION MARKS. FOOTNOTES. What became of the cover’s breeziness? The CORRECT USAGE section 9 lists “lipid: noun” and “lipoid: adjective,” and “mucous: adjective” and “mucus: noun.” These distinctions have evaporated over the years. In contrast, Section 9.16 advises for “over”: “‘more than’ preferred when numbers are used,” which appears to be an eternal directive.

The current manual directs us not to use a colon if a sentence is continuous without it. No such ruling appears in the first edition, which mentions colons as an indication of an explanation or enumeration to follow, as an introduction to a formal direct quotation, or to separate numbers in time of day, biblical references, and parts of numeric ratios. The book does use colons even when the sentence would be continuous without. In at least one place, the verb “are” is followed by a colon then its predicate nominative string.

One change that won’t surprise those of us in house is the guidance about numbers. NUMBERS 16.00 indicates “In the text all numbers from one through ten should be spelled out.” Current style is to use numbers, which still surprises many authors who return proofs with the instruction to spell out numbers. Another minor change is in capitalization after a colon. CAPITALIZATION 4.00 directs that the first word after a colon in a reference gets capitalized. Now the opposite is true.

In current Common Usage, “utilized” is not preferred because “use” is concise. The Style Book has plentiful examples of “used,” but “utilized “makes at least 1 surreptitious appearance.

It may sound odd to personify a book, but the Style Book has become surer of itself in the last 58 years. I believe it must have gone through the 7 signs of maturity. The original Foreword claims that “Few of the rules contained in this book are inviolable” and that the book “is not to be static,” modest claims presented with a certain authority, not to mention an admirable realism. The current Foreword focuses on the need for communicative writing and the manual’s standing as a more extensive and comprehensive manual than earlier editions.

The upcoming Foreword characterizes the manual as indispensable for medical journalism and communication, which embodies being “not static.” The new manual is 17 times the size of the 1962 edition, whose Foreword also presented the optimistic expectation of a new edition every year. Unlike A Blueprint, the community of users was accurately assessed. I imagine that even in 1962, people who consulted the Style Book felt like part of a community centered around this makeshift blueprint for science editing. Now the community of users extends around the globe. The AMA Manual of Style also opens doors, not just for editors but also for conversations between editors and authors.–Timothy Gray

Check It Twice

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Of all the magic a word processor can perform, I find spell-check to be the most useful, especially while editing dense medical copy. But I’m not too proud to admit that it’s not even the most sinisterly complicated words that my spell-check corrects most often. While I’m focusing on making sure “dysosteogenesis” or “hemocytopoiesis” are spelled correctly, I tend to gloss over the more commonplace language. Sometimes I’ll invert letters (“otolaryngoolgy”) or repeat articles (“the the procedure”) and, thank goodness, spell-check will catch it.

But spell-check is not without its shortcomings. It’s still just a computer program, and it isn’t tuned to the nuances of language with the same attention as a human brain. Spell-check will miss that I meant “through” when I’ve typed “though,” and of course there’s a long list of homophones that spell-check will inevitably ignore (ie, “knew/new,” “waist/waste,” “aisle/isle”). The bottom line is that reading back through your work and not relying solely on spell-check (or any automated process) to do the thinking for you could save you (and has certainly saved me!) a lot embarrassment. For example…

 

 

Spell-check couldn’t have saved those eager tweeters from themselves before they released their thoughts on followers, friends, and family. But a little more attention to detail could have. Tools like spell-check are helpful, but they’re still only tools. When it comes to writing, editing, and engaging in any form of written communication, nothing will serve you better than your own brain— and one more read-through.—Sam Wilder

Right, Almost Right, and Just Plain Wrong: Spelling (and Spacing) Variations

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It is now the work of years for children to learn to spell; and after all, the business is rarely accomplished. A few men, who are bred to some business that requires constant exercise in writing, finally learn to spell most words without hesitation; but most people remain, all their lives, imperfect masters of spelling, and liable to make mistakes, whenever they take up a pen to write a short note. Nay, many people, even of education and fashion, never attempt to write a letter, without frequently consulting a dictionary.—Noah Webster1

The primary nonmedical/nonscientific dictionary used at JAMA and the Archives Journals is Merriam-Webster’s Collegiate Dictionary, and the medical/scientific dictionary of record is Dorland’s Illustrated Medical Dictionary. In the list given below, we show the preferred spelling of frequently misspelled scientific and nonscientific words as indicated by Webster’s and Dorland’s.

Whereas Webster’s shows equal or secondary variants in the entry “head,” Dorland’s uses a single term for the entry head but lists cross-references for variant spellings at the end of the entry for the preferred term. But note that Webster’s also often includes variant spellings in its entries (eg, aesthetic and esthetic). These “equal variants” are indicated by or. If they are given in alphabetical order, “they occur with equal or nearly equal frequency.” If they are given out of alphabetical order, but still joined by or, the first is slightly more common than the second. If they are joined by also, the word given second “occurs appreciably less often” than the first and is considered a “secondary variant.”

The front matter of Webster’s also notes: “Other spelling variants may be flagged with var with some further brief explanation, for example, metre … chiefly Brit var of meter.” Exception: Variant spellings that appear in direct, written (eg, published) quotations should not be changed to US variants.

To maintain consistency within their journals, the editors of JAMA and the Archives Journals prefer the first spelling of the entry of any given word.

Right and Almost Right

acknowledgment (equal variant, out of alphabetical order: acknowledgement)

aesthetic (secondary variant: esthetic)

breastfeeding (Webster’s: breast-feeding)

cutoff (as noun or adjective)

cut off (as verb)

distention (as given in Dorland’s; equal variant in Webster’s: distension)

judgment (equal variant, out of alphabetical order: judgement)

phosphorus (as noun)

phosphorous (as adjective)

sulfur (secondary variant: sulphur)

supersede (secondary variant: supercede)

Just Plain Wrong

accommodate (not accomodate)

ancillary (not ancilary)

arrhythmia (not arhythmia)

brussels sprouts (not brussel sprouts)

cholecystectomy (not cholecysectomy)

consensus (not concensus)

cribriform (not cribiform)

desiccate (not dessicate)

diphtheria (not diptheria)

dyspnea (not dysnea)

embarrass (not embarass)

erythematosus (not erythematosis)

Escherichia (not Echerichia)

fluorescent (not florescent)

fluorouracil (not flourouracil)

Haemophilus (not Hemophilus)

harass (not harrass)

hematopoietic (not hematopoetic)

Legionella pneumophila (not Legionella pneumophilia)

levothyroxine (not levothyroxin)

millennium (not millenium)

minuscule (not miniscule)

Neisseria gonorrhoeae (not Neisseria gonorrhea)

ophthalmology (not opthalmology)

Papanicolaou (not Papanicolou)

pertussis (not pertussus)

pruritus (not pruritis)

sagittal (not saggital)

sinusitis (not sinusitus)

sphygmomanometer (not sphygomamometer)

sulfide (not sulphide)

syphilis (not syphillis)

unwieldy (not unwieldly)

Now, this is nice and neat. But what if the 2 principal dictionaries (medical and nonmedical) differ on the preferred spelling of a word? Which to follow? We make such decisions on a case-by-case basis. For example, anti-inflammatory in Webster’s was chosen instead of antiinflammatory in Dorland’s because the former was considered to be expressed more clearly with a hyphen between the 2 i’s. Similarly, workup (as a noun, meaning a thorough evaluation to arrive at a diagnosis) was chosen over work-up. (But: Use work up as a verb!)

Spacing and punctuation (to hyphenate or not to hyphenate) add further questions of variation. These too are decided on a case-by-case basis. Below is a small sample of some of these decisions.

cost-effective, cost-effectiveness (not cost effective, cost effectiveness)

end point (not endpoint)

health care (not healthcare)

policy maker (not policymaker)

under way (not underway)

A final word to the wise: Until spell-checkers include a read-my-mind function, do not rely on them for solving spelling problems!—Roxanne K. Young, ELS

1. Webster N. An essay on the necessity, advantages, and practicality of reforming the mode of spelling and of rendering the orthography of words correspondent to pronunciation. In: Dissertations on the English Language: With Notes, Historical and Critical, to Which Is Added, by Way of Appendix, an Essay on a Reformed Mode of Spelling, With Dr. Franklin’s Arguments on That Subject. Boston, MA: 1789.