usage

Jarring Jargon

Posted by

0

Theodore M. Bernstein, in The Careful Writer: A Modern Guide to English Usage, describes jargon as “meaningless, unintelligible speech,” which is how some people might describe their last conversation with their physician. In science and medicine, many barriers to clear communication exist, with jargon being one of them. In fact, it’s so difficult for physicians and patients to communicate clearly that a federal program has been created to promote simplified health-related language nationwide. The Health Literacy Action Plan is a “national action plan to improve health literacy.” The entire action plan is 73 pages (which is probably their first mistake) and it highlights the fact that we have a problem.

As editors, we know that jargon is to be avoided in medical literature. While jargon may evolve for the most innocuous of reasons, it is a vocabulary specific to a profession that sometimes is esoteric or pretentious and that can be confusing to those not familiar with it (sometimes to those familiar with it as well). “Inside talk” can be just that by design—it keeps outsiders out. Therein lies the source of the negative feelings about jargon.

In addition to being exclusive, some jargon is offensive and unprofessional. Have you ever seen an FLK? Probably. That’d be a funny-looking kid. “We bagged her in the ER” sounds ominous; what it means is that a patient was given ventilatory assistance with a bag-valve-mask prior to intubation in the emergency department. Hopefully the emergency department physician didn’t describe the patient as a GOMER. This means “get out of my emergency room” and could refer to, for instance, an elderly patient who is demented or unconscious and near death and who perhaps should die peacefully rather than occupy emergency department resources. In this example, jargon diminishes the complexity of a situation that should be dealt with in a more thoughtful way. As Bernstein writes, “All the words that describe the kinds of specialized language that fall within this classification [of inside talk] have connotations that range from faintly to strongly disparaging.”

Jargon also sometimes violates rules of grammar, eg, turning nouns into verbs, “The doctor scoped the patient,” or creating back-formations, like “The patient’s extremities were cyanosed,” instead of “The patient’s extremities showed signs of cyanosis.” Jargon can sometimes appear to depersonalize, by defining a person in terms of a disease. A “bypassed patient” may be one who has undergone coronary artery bypass graft surgery rather than one who has been overlooked. Sometimes, patients might be referred to by their organs, such as “the lung in room 502” instead of “the patient in room 502 with lung disease.”

The AMA Manual of Style lists examples of jargon to avoid in section 11.4, Jargon. Some other examples that we’ve collected over the years are listed here:

* Collodion baby is better phrased as collodion baby phenotype or “the infant had a collodion membrane at birth.”

* Surgeons perform operations or surgical procedures, not surgeries.

* Rather than say a patient has a complaint, describe the patient’s primary concern.

* Do not use shorthand (eg, exam for examination, preemie for premature infant, prepped for prepared).

* Euphemisms sometimes are not clear and should be avoided: “The patient died” is preferred to “The patient succumbed or expired”; the same holds true for killed vs sacrificed (in discussion of animal subjects).

* Patients aren’t “put on” medication, they’re treated with medication. Also, patients aren’t “placed on” ventilators, they’re given ventilatory assistance.

Certainly jargon does have its place. It is specialized, and those in the same field can use it to communicate precisely and quickly. However, when it comes to medical and scientific publications, jargon is best avoided. Bernstein ends his entry on “inside talk” with the following: “It must never be forgotten that the function of writing is communication.” Clear enough.—Lauren Fischer

Fit/Fitted

Posted by

5

“The curve was fit to the data points.”

“The curve was fitted to the data points.”

Which is correct? The answer can betray some strong opinions. “Using fit that way makes one sound like a backwoods rustic.” “Using fitted that way makes one sound like a pedant.” “Everyone knows that fitted is simply the adjectival form of fit.” In fact, the story is a bit more involved.

Fitted is indeed the adjectival form of fit (eg, fitted sheet), but it also can be used as the simple past or the past perfect verb form. However, whether fit is also acceptable when forming past tenses is in part a matter of geography. In British usage, fitted is considered always correct; however, many authorities of American usage—Merriam-Webster’s, for example—accept either fit or fitted,1 and even among those holding that fitted is always correct, some—Bernstein, for example—make allowances for the use of fit in casual speech.2 Such allowances often open the door for increased acceptance of a given usage in more formal contexts as well; indeed, whereas fitted was once invariably accepted for both the simple past and the past perfect, the -ed form is gradually going the way of the dodo.3 Moreover, when given the choice, many language users in the United States simply prefer fit over fitted.4

Such preferences aside, however, context can make a difference. For example, fitted is used when referring to the tailoring of clothing3; eg, “I was fitted for a new suit.” In other contexts, it can be helpful to consider if fit is being used in the sense of “to conform to a particular shape or size”1; if so, some might hold that fit is correct for both the simple past and the past perfect.5 If, on the other hand, fit is being used in the sense of “to make or adjust to the right shape and size”1—or the closely related meaning alluded to in the opening examples, “to adjust (a smooth curve of a specified type) to a given set of points”1—fitted is used for the simple past and either fit or fitted for the past perfect.5

Fit to be tied? The bottom line:

●Referring to the tailoring of clothing? Use fitted for both the simple past and past perfect.

●Referring to something being a particular size or shape? If you’re British or Canadian, you’re safest using fitted for both the simple past and the past perfect; if you’re from the United States, you’ll be in good company using fit for both, but be aware that some authorities advocate the use of fitted in writing and formal speech.

●Referring to adjusting something (other than clothing) to a particular shape or size? Referring to the fitting of a curve to data? If you’re British or Canadian, you’re still safest using fitted in all instances. If you’re from the United States, you’re safest using fitted for the simple past and either fit or fitted for the past perfect—but again, using fit in the latter context might be frowned on.—Phil Sefton, ELS

1. Fit. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:473.

2. Fit. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:186.

3. O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. New York, NY: Riverhead Books; 1996:65.

4. Fit vs. fitted—two options. Englishpage.com Web site. http://www.englishpage.com/irregularverbs/info/html. Accessed July 15, 2011.

5. Fitted vs fit. English-Test.net Web site. http://www.english-test.net/forum/ftopic19015.html. Accessed July 15, 2011.

Lie/Lay

Posted by

1

If any doctor tells me, as I lie in my hospital bed, that my death will not only help others to live, but be symptomatic of the triumph of humanity, I shall watch him very carefully when he next adjusts my drip.—Julian Barnes1

He lays his hands flat on Addie, rocking her a little.—William Faulkner2(p147)

“[A]s I lie in my hospital bed”? Surely Barnes is correct—although some readers might wonder if this should read “as I lay in my hospital bed.” Similarly, Faulkner’s “He lays his hands flat on Addie” sounds correct, but is it really, in a novel in which sentences such as “You lay you down and rest you”2(p37) are used to so effectively communicate the rich idiom of that fictional world? Moreover, when Faulkner titles his novel As I Lay Dying, is he being grammatically correct or simply giving free rein to Addie Bundren’s vernacular? To further complicate matters, where would “lain” and “laid” fit into all this?

Ah, the joys of irregular verbs. In English, forming the simple past and the past participle forms of most verbs is simple—one simply adds -ed to the root form of the verb and is then free to knock off for the day. However, irregular verbs complicate this otherwise blissful state of affairs by requiring writers to memorize alternate forms for the past tenses. True enough, users of English have things pretty easy in this respect compared with users of some other languages, but English has enough irregular verbs—80 or more—to keep things interesting. Further complicating matters is that even the alternate forms of irregular verbs are sometimes irregularly applied—for example, sometimes the present and the past participle are the same (eg, become [present], became [simple past], become [past participle]), sometimes the simple past and the past participle are the same (deal, dealt, dealt), and sometimes the verb does not change form at all (hurt, hurt, hurt). Fortunately, though, memorizing the alternate forms for most irregular verbs seems to pose little problem for most English users.

So why all the angst when it comes to lie? It is just lie, lay, and lain, right? Well, so far so good—but what leads many English users astray is that lay, the simple past tense of lie, is also the present tense of lay, a different verb with a similar meaning. Lie means “To be or to stay at rest in a horizontal position” or “to assume a horizontal position”3(p717); lay means “To put or set down” or “to place for rest or sleep.”3(p705) The difference is that lie is intransitive, meaning it communicates a complete action by itself; lay, in contrast, is transitive, meaning it needs to act on a direct object to communicate a complete thought. So Barnes’ “as I lie in my hospital bed” is correct—as is an imperative such as “You lie down”—because these sentences need no direct object to communicate a complete action. Similarly, “He lays his hands flat on Addie” is correct, as is As I Lay Dying—the former because the present form of lay describes an action on something (in this case, “his hands”) and the latter because lay in that case is not the present of lay but rather the simple past of lie. On the other hand, Faulkner’s “You lay you down and rest you” is not, in the strictest sense, correct—although this instance is interesting, because while the speaker is correctly using a direct object with the transitive lay, the direct object is not a true object but rather a reflexive (and in this case redundant) element, and the choice of verb is incorrect from the start; in effect, the speaker is saying “place yourself down,” which, if judged apart from the idiom of Faulkner’s novel, would clearly be incorrect. The correct form of the sentence would use the intransitive verb: “You lie down.”

So—presuming the English user wishes to use lie or lay in one of the senses indicated above and is not contemplating telling a lie, communicating with a lay audience, or getting the lay of the land—how to simplify this mess?

A few quick tips:

• Determine the correct verb to be used, remembering that lie is intransitive and lay is transitive and requires an object. It might be helpful to remember that lay is often used to mean “to place (something on)”—or, for the mnemonically minded: “to p-lay-ce (something on).”

• Lied is never correct as either the simple past or the past participle of lie or lay when used in the senses indicated above—lied is used only when, for example, someone has just lied to someone else.

• For lie, the simple past and past participle forms are lay and lain (I lie dying, I lay dying, I have lain dying).

• For lay, the simple past and past participle forms are laid and laid (He lays his hands flat on Addie, He laid his hands flat on Addie, He has laid his hands flat on Addie).—Phil Sefton, ELS

1. Barnes J. Nothing to Be Frightened Of. New York, NY: Alfred A Knopf; 2008:177.

2. Faulkner W. As I Lay Dying: The Corrected Text. New York, NY: Random House; 2000.

3. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

Ventilate or Ventilation

Posted by

0

“The patient was ventilated.”

“We decided to ventilate the patient.”

Such statements are commonly overheard in critical care units and other areas when clinicians discuss the care of a patient experiencing insufficient or absent respiration. Both statements use forms of ventilate in ways that—because they appear in this sense in the latest edition of Merriam-Webster’s Collegiate Dictionary—are correct and so may be used in medical journals. However, writers and editors have a valuable opportunity to ensure the continuing precision of the language through careful use of such terms and their variants, referred to as back-formations.

As discussed in the 10th edition of the AMA Manual of Style, “Back-formation is the creation of a new word in the mistaken belief that is was the source of an existing word” (see §11.3, Back-formations, in the AMA Manual of Style, p 407 in print). Back-formations are formed by the removal of a suffix (either a derivational suffix such as -ion or an inflectional suffix such as the plural -s) from a word that actually appeared first, changing its part of speech and forming a new word. Thus, the verb ventilate when used in the clinical sense may well be such a form, as suggested by its appearance in common use slightly later than the appearance of the noun ventilation (early 1900s vs 1890s, respectively).1 Interestingly, however, users of the English language had been busily back-forming for some time before that: ventilate as used in the closely related sense of exposing the blood to air, now obsolete or nearly so apart from its use in the study of physiology, likely also represents a back-formation that appeared some 50 years after ventilation as used in this sense (1660s vs early 1600s, respectively).2

Back-formation plays a valuable role in language evolution, producing neologisms that often subsequently enter common use. However, coining verbs through back-formation can result in medical jargon (see §11.4, Jargon, in the AMA Manual of Style, pp 408-409 in print) that is vague, depersonalizing, and sometimes downright comical in the images it can evoke. Taking the case in point, for example, what does “the patient was ventilated” mean, exactly? Was the patient perforated? Fitted with louvers? Left outdoors?

While it is commonly understood that the use of ventilated in this sense in spoken English denotes the use of a mechanical ventilator or other means of artificial respiratory assistance (eg, use of a bag-valve-mask apparatus), it typically refers to the former. However, in written materials, the use of mechanical ventilation should be explicitly reported when appropriate. In addition, eschewing the use of assistance altogether is perhaps advisable, and certain constructions (eg, “was” or “on” constructions) should be avoided if they lead to ambiguity such as that noted above. For example, “the patient was ventilated” and “the patient was placed on a mechanical ventilator” should be rewritten to read “the patient underwent mechanical ventilation.” In some instances, it might also be helpful to report additional information to clarify whether the intervention was invasive (ie, required endotracheal intubation, nasotracheal intubation, or tracheostomy) or nonvasive (eg, used a mechanical, sealed-mask approach such as BPAP [bilevel positive airway pressure]).

Writers and editors of medical information, then, should be vigilant when using terms coined through back-formation. Such terms should not be used if they do not appear in a current dictionary of reference. Those that do—eg, ventilated—may be used, but writers and editors should take care to ensure that they are not used in ways that are vague, depersonalizing, or unintentionally comical. Ultimately, however, a bit of back-formation is not a bad thing—for example, edit is a back-formation coined from editor.3—Phil Sefton, ELS

1. Ventilate. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
2. Ventilation. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
3. Back-formation. In: Hoad TF, ed. The Concise Oxford Dictionary of English Etymology. Encyclopedia.com Web site. http://www.encyclopedia.com. Accessed August 5, 2011.

Abbreviation Nation

Posted by

4

Of the reference books I use while editing the Archives journals, my favorite by far is MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety, 13th Edition, by Neil M. Davis. Not only does it have the most wonderfully snarky title I’ve ever seen on a reference book, but it is the Great Decoder, the book that allows me to make sense of the myriad abbreviations I run across in my daily work.

As much as we are a nation of people who speak largely in cliches and mixed metaphors (I will save my rant about the overused and incorrect “magic bullet” for another day), we are a nation of overabbreviators. The number of organizations that are known by their abbreviation are too many to quantify (NFL, AMA, NORAD). We put out APBs, send out CVs, take our OTC meds, surf our Macs and PCs, and occasionally go AWOL. But when you think about it, do these mean anything? A National Football League is a thing. An NFL is not. What about an AC? Is it an air conditioner? An alternating current? Atlantic City? Though sometimes context can tell us what an abbreviation means, just as often it cannot, and it’s my job to sort these out.

As someone who previously tried to argue that texting is a valid and efficient method of communicating, it may seem hypocritical for me to do a mental fist pump every time I read Mr Davis’ snappy title, but I do. It’s because for every abbreviation that I find easily in my AMA Manual of Style or my MED ABBREV, there are so many that I must ask authors about. This worries me, because I don’t think authors would put these in their articles if they weren’t  routinely used. And though they and their colleagues and most of the American medical community may know exactly what they mean, will readers in Zimbabwe, Thailand, or Argentina? Those readers may have their own set of metaphors, jargon, and abbreviations that makes perfect sense to them. Or they may be students who don’t come across them every day. What happens when we let them slide, or when a journal doesn’t have finicky, know-it-all editors to question them? I worry that it will make journals less accessible, and that it will make medical discourse less accessible. I hate the idea of a medical student somewhere in the world not being able to use one of our articles in his research because I didn’t feel like finding out what something means. And believe me, sometimes I don’t feel like it. But I know I must be persistent, as annoying as it feels to harass a busy professional about something that seems so trivial. And that medical student out there better appreciate it.—Roya Khatiblou, MA

Dr Readability: Or How I Learned to Stop Worrying and Love the Pronoun

Posted by

0

In academic writing, the current modus operandi seems to be: the more words the better. Why say “children” when we can say “individuals of pediatric age”? Why “time” when “period of time” sounds so much more substantial? Strunk and White1 would surely disapprove. Extraneous verbiage may make one’s writing sound lofty and important, but it can muddle one’s message. Writers should not use circuitous, rhetorical language to persuade their readers. Strong, clear writing, without extra baggage, creates a confident tone and allows the reader to more easily understand a work’s significance.

Here are a few ways to clean up one’s writing for easier reading:

Use the pronoun. Use it.

Writers often repeat nouns instead of using pronouns, as writers fear that readers won’t understand what the writers are saying. Not horrible, but is there confusion over what they refers to in this revised sentence: “Writers often repeat nouns instead of using pronouns, as they fear that readers won’t understand what they are saying”? Repeating the same word or phrase creates reading fatigue, like listening to someone beat on a drum over and over. Trust that your reader has a longer attention span than the time it takes to read half a sentence and there will be no need to use the same nouns over and over and over…

Here’s an example: “Because many people use vitamin therapy, we must determine the efficacy of vitamin therapy compared with other treatments.”

How about this instead: “Because many people use vitamin therapy, we must determine its efficacy compared with that of other treatments.”

Use the verb.

Editors are in agreement that “to be” constructions are weak and should be replaced with the actual verb. I agree!

Substituting “to be” constructions with actual verbs makes writing stronger and more confident. Researchers often use the phrase, “Our findings are indicative of…” See the “to be” hidden in there? How about “Our findings indicate…”? Were “patients in receipt of the drug” or did they “receive the drug”? Were participants “in attendance” or did they “attend”? The meaning is the same, but the writing sounds a whole lot better with the true verb.

This goes hand in hand with the passive voice. We’re not saying that the passive voice is wrong necessarily, it’s just that it is believed by some people that it is not as strong as it could be. Rather, some people believe that the passive voice is weak. In general, the active voice should be used over the passive voice, especially in cases when the “actor” is present. For example, “Patients were monitored by resident physicians” should be changed to “Resident physicians monitored the patients.”

This is another way to say: Use the delete button.

Close your eyes. Pretend you have a word limit. Now, pretend you have to follow it. Would you rather cut 100 words from the “Results” section or 100 words throughout a manuscript that add nothing of substance substantial? See what I did there?

Here are a few substitutions that reduce wordiness:

–“combined with” instead of “in combination with”
–“important” instead of “of importance”
–“most” instead of “the majority of”
–“can” instead of “is able to”
–“affect” instead of “to have an effect on”

Eliminating exaggerations can also trim one’s writing. How often is quite, very, or rather necessary (or accurate)? Writers should also avoid superlatives like profoundly and significantly when describing a study’s results.

These tips will help eliminate excess verbiage and heighten readability while preserving meaning. What is there to be afraid of fear?—Laura Adamczyk

[author’s note: Some of these ideas came from lectures by Northwestern University professor Bill Savage, PhD.]
1. Strunk W Jr, White EB. The Elements of Style. 4th ed. New York, NY: Longman; 1999.

Ability, Capacity, Capability

Posted by

2

These near-synonyms actually mean slightly different things—but teasing out the subtleties requires a bit of hairsplitting.

To drive the first wedge, distinguish between ability and capacity. Ability denotes actual (as opposed to potential) skill that may be either native or acquired.1 On that point, Merriam-Webster’s Collegiate Dictionary cuts right to the pith, stating that ability is “natural aptitude or acquired proficiency.”2(p3) Capacity, on the other hand, denotes the potential to develop a skill, a native characteristic that one either does or does not have and that cannot be acquired or developed.3 (Language purists might maintain that capacity should be used only to refer to space or volume, but its use to refer to aptitude is well accepted.) Moreover, whereas ability and capacity can each refer to either physical or mental aptitude, capacity is more commonly used in connection with mental aptitude—in particular, to “mental or intellectual receiving power; ability to take in impressions, ideas, knowledge.”4

Persons attempting to keep these subtleties straight might, like William Caxton, well be inclined to exclaim, “My capacity is not sufficient for the proper handling… of such subjects”4—but things get more complicated yet. When differentiating ability from capacity, some language users distinguish between whether a sentence is referring to persons/animals or to things (with ability often used with persons and capacity most often used with either persons or things)1; however, this distinction is rapidly waning, and both words are commonly used to refer either to animate or to inanimate agents. For example, both words are commonly used when referring to inanimate agents such as physiological mechanisms (eg, “The ability/capacity of this pathway to promote….”) or anatomical structures (eg, “The ability/capacity of the liver to clear the body of these toxins….”).

Capability denotes “the quality or state of being capable”2(p182) as well as “a feature or faculty capable of development.”2(p182) Thus, capability comes closer to ability in meaning. However, capability further denotes a unique fitness for achieving a defined end,1 and this specificity makes capability a good choice in contexts requiring a greater degree of precision. So, while capability is all too often simply used as a pretentious substitute for ability—a 10-dollar word lobbed in when a 1-dollar word would have gotten the job done—capability might have been the better choice in the above examples (“The capability of this pathway to promote….”; “The capability of the liver to clear the body of these toxins….”). Furthermore, language users often use capability in place of capacity, likely led astray by the “cap” with which they both begin. However, whereas the use of capability in place of ability is becoming more accepted, particularly when referring to a unique aptitude to accomplish a particular end, the use of capability in place of capacity is usually incorrect.

The bottom line:

Ability = Actual skill, either mental or physical; native or acquired.

Capacity = Potential to develop a skill, usually mental; native, as opposed to acquired.

Capability = Unique fitness for a defined end; sometimes may be used in place of ability, but its use in place of capacity is incorrect.—Phil Sefton, ELS

1. Ability, capacity, capability. Merriam-Webster’s Dictionary of Synonyms. Springfield, MA; Merriam-Webster Inc; 1984:4.

2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

3. Ability, capacity. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:5.

4. Capacity. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:209.

For Against As

Posted by

0

Since I have been copyediting at JAMA, I have been trying to reinvigorate the use of for as a coordinating conjunction when authors use the word as as demonstrated in the following construction.

There was no significant difference between the study population and the 60 participants who were excluded, as for they had inadequate sample volumes for the assay.

When the typescript came back, my for was deleted and replaced with because. Although I have no objection to because, I like for because it is clear, to the point, and efficient. Despite the continued rejection of my edits, I continue to advocate its use through the editing process, hoping it will take hold, hoping to change enough people’s minds that it will become so common that people will not regard it as “highfalutin” or “dated.”

Besides its efficiencies in language, its use has economic implications: it is shorter than because, for it saves ink and paper, which should please bottom-line conscious editors and publishers. Furthermore, it is grammatically correct and occupies the first place in the mnemonic FANBOYS, which can be found in writing guides to help students remember all of the coordinating conjunctions available to them. Why keep it in the writers’ reference manuals if no one uses it, I ask?

Finally, using as as a coordinating conjunction can be confusing and may steer readers in unintended directions. Coordinating conjunctions are used to show that the clauses of the compound sentence are equivalent. Subordinating conjunctions are designed to show that one idea is more important than another. Both as and because find themselves on the subordinating conjunction list. If they should head the second clause, they should stand alone without the aid of a comma, which when used with coordinating conjunctions announces the compound sentence. So as a copyeditor and a reader, when I see the comma preceding the as I think the author is presenting equivalent ideas rather than subordinating ideas, which is why I am compelled to change as to for. My point is that as when presented in a coordinating conjunction construction is ambiguous and can shift an author’s meaning despite his or her intent. For does not.—Beverly Stewart, MSJ

Minority Report

Posted by

0

Risk factors included racial/ethnic minority status, male sex, higher hemoglobin A1c level, use of insulin, longer duration of diabetes, and higher systolic blood pressure.—From This Week in JAMA, August 11, 2010.

The meaning of the adjective minority in this statement may appear to be clear to the reader. However, what constitutes minority status for race/ethnicity? In which country, population, or time? And in this context—risk factors for diabetic retinopathy—why would minority status per se (as opposed to a specific genetic background, or perhaps lower socioeconomic status and resulting lack of access to health care) be a risk factor? This usage points to a common but probably outdated use of the term minority to refer to a population of people. Why is this term to be avoided in this context?

Merriam-Webster’s Collegiate Dictionary1 defines minority as “a part of a population differing from others in some characteristics and often subjected to differential treatment; … a member of a minority group (an effort to hire more minorities)” and The American Heritage Dictionary of the English Language2 states, “A racial, religious, political, national, or other group regarded as different from the larger group.” These definitions evolved from the more basic meaning of minority. Insofar as usage and equity are concerned, however, historian Amoja Three Rivers stated emphatically 20 years ago that “at least four-fifths of the world’s population consists of people of color. Therefore, it is statistically incorrect as well as ethnocentric to refer to [them] as minorities. The term ‘minority’ is used to reinforce the idea of people of color as ‘other.’”3 The white race is becoming a “minority” in many countries where that had previously not been the case, including the United States. Nor are women to be considered minorities simply by their numbers (as an example of this, in the United States in the academic year 2008–2009, among first-year enrollees in medical school, there were 9619 men and 8889 women, compared with 10 576 men and 6205 women in 1988–19894).

When used as a noun to describe and thus label and marginalize a racial/ethnic, gender-specific, physically disabled, or other group of persons with a common trait, minority (and minorities) is an exclusive term that should be avoided.

Note: Minority (and majority) is appropriate to use when describing, for example, the count (number) in an election, an opinion of a nation’s high court, or in common usage to mean less than half (or more than half) of a given sample.—Roxanne K. Young, ELS, with thanks to Margaret A. Winker, MD

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

2. The American Heritage Dictionary of the English Language. 3rd ed. Boston, MA: Houghton-Mifflin Co; 1992.

3. Maggio R. Talking About People: A Guide to Fair and Accurate Language. Phoenix, AZ: Oryx Press; 1997:273.

4. Barzansky B, Etzel SI. Medical schools in the United States, 2008–2009. JAMA. 2009;302(12):1353(appendix I, table 2).

Criterion Standard

Posted by

2

The expression criterion standard, according to the AMA Manual of Style, represents the “diagnostic standard for a particular disease or condition, used as a basis of comparison for other (usually noninvasive) tests. Ideally, the sensitivity and specificity of the criterion standard for the disease should be 100%.” This definition on its face seems a fairly straightforward way to identify the best method for making a diagnosis or the best treatment plan for a given disease.

A controversy, however, emerges in a parenthetical phrase that suggests the alternate expression gold standard be avoided because it “is considered jargon by some.” This assertion is supported by a reference to A Dictionary of Epidemiology, third edition, by John M. Last, published in 1995. Treating it as slang, his entry not only presents gold standard in quotes but, to be sure the reader understands his meaning, follows it with the word “jargon” in parentheses before defining it. Last provides no alternate expression and does not include criterion standard in his dictionary. He does, however, include criterion, which he defines as “[a] principle or standard by which something is judged. See also STANDARD.” And that is defined as “[s]omething that serves as a basis for comparison.”

In his fourth edition, however, Last does not include a gold standard entry. His definitions for both criterion and standard remain the same, and because they have nearly identical definitions could account for his not including an entry for criterion standard.

The gold standard entry returns in the fifth edition, edited by Miquel Porta. It is again presented in quotes but omits the parenthetical naming of it as jargon and defines it as “[a] method, procedure, or measurement that is widely accepted as being the best available. Often used to compare with new methods of unknown effectiveness (e.g., a potential new diagnostic test is assessed against the best available diagnostic test).”

Looking at another source, Annals of Internal Medicine Editor Hal Sox in his book Medical Decision Making never mentions the expression criterion standard. He does, however, talk about gold standard, which he takes out of the realm of epidemiology and into clinical practice by defining the gold standard test as “[t]he procedure that is used to define the true state of the patient.”

Although the “when” of its adoption as the preferred expression for JAMA and the Archives Journals seems to have escaped memory, the “why” remains among most of the medical editors. Some suggest avoidance of gold standard because it crosses disciplines from economics to medicine. As an economic term, it had served as the basic support of paper money. Another consideration, offered by former JAMA Deputy Editor Richard Glass, is that “gold standard …implies more of a sense of permanence than is appropriate for scientific topics.” With new knowledge, he reasons, comes new standards.

Practice, however, defies style preference. A search of JAMA articles in 1998 shows that criterion standard was used 7 times while gold standard was used 42 times. Jumping ahead 10 years, the trend holds: criterion standard was used 9 times; gold standard, 35 times.

Yet the practice of using gold standard over the style recommendation may all boil down to what JAMA Deputy Editor Drummond Rennie wrote in an e-mail. “If we are prepared to consider using ‘criterion standard,’ we should really prefer ‘criterion criterion’ (though ‘standard standard’ sounds a tad less pompous, even if just as meaningless). We all know what ‘gold standard’ means. It has the merit of being customary, memorable, understandable.”

And isn’t that the job of editors? — Beverly Stewart, MSJ