The Proliferation of Wellness

Posted by

0

My interest was piqued by this post on Language Log exploring the ubiquity of the word wellness. It’s a trend I might never have noticed, but now that it’s been brought to my attention I have to admit that wellness is everywhere.

For many, wellness connotes a certain touchy-feeliness that health doesn’t, in particular the integration of mental, emotional, and even social well-being into the concept of health. In this sense it’s very much a word for our times, as science explores the physiological effects of practices like meditation and mental health is discussed more openly. A New York Times article from 2010 referenced in the blog post gives some of the background on the burgeoning popularity of wellness over the years. The author notes that the word has become more popular as society expands its notion of what it means to be healthy. The article traces the origins of this mindset back to the mid twentieth century, quoting from the preamble to the World Health Organization’s 1948 constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” On the flip side, to some wellness has a whiff of the unscientific; one of the commenters on the blog post recalls seeing the word used extensively in sales pitches for alternative medicine.

What makes wellness such a hot property? As Mark Liberman of Language Log points out, wellness has a ring of positivity to it that health doesn’t: “My impression is that ‘health’ has become too much about negatively associated things like doctors, hospitals, insurance companies, and giant pharmaceutical firms—and it was never rigorously positive enough anyhow, since you can have good health or bad health. There’s no such thing as bad wellness.”—Heather Green

 

 

Medical Literature and “Forbidden Words”

Posted by

0

On December 15, 2017, reports emerged that staff at the Centers for Disease Control and Prevention (CDC) were presented with a list of 7 forbidden words or phrases (ie, diversity, transgender, vulnerable, fetus, entitlement, evidence-based, and science-based) when writing budget appropriation requests. Since then, officials from the Department of Health and Human Services clarified the situation, saying that these words should be avoided but were not necessarily prohibited. Regardless, physicians, researchers, marginalized people and their allies, and others have spoken out against this. What is the importance of these words in a medical research context, and what does the AMA Manual of Style say about usage?

Diversity

Including men and women of different races/ethnicities is imperative to research, particularly for understanding drug outcomes. For example, male and female bodies metabolize drugs at different rates. Because women wake faster from sedation with anesthetics, they recover at a slower rate and report more pain events than men. Not including both male and female participants in a study could lead to incomplete results. Race and ethnicity are also important to incorporate in medical research because specific diseases or disorders may be more pertinent in certain groups, such as chronic hepatitis B in Asians and Pacific Islanders or Tay-Sachs disease in the Ashkenazi Jewish population.

Transgender

Transgender refers to people whose gender identity differs from the sex they were assigned at birth. Transgender health care is unique and differs from cisgender health care. Besides gender reassignment surgery, transgender patients may also require special care concerning mental health or substance dependence.

Vulnerable

Clinically vulnerable populations may include persons with Medicaid, no health insurance, low educational attainment, limited English proficiency, and members of racial/ethnic minority groups.

Fetus

A fetus is the unborn offspring in the postembryonic period, after major structures have been outlined. Per AMA style, neonates or newborns are persons from birth to 1 month of age, and infants are children aged 1 month to 1 year. There is a clear difference between a fetus and a newborn or infant. Fetus is a medical term and is not open to political or social interpretation.

Entitlement

Government programs that give assistance to anyone who qualifies are called entitlements. For example, Medicaid, the Children’s Medical Security Plan, and the Vaccines for Children Program are entitlement programs. These types of programs are important for those who may not have easy access to health care.

Evidence-based and science-based

According to some reports, these phrases should be replaced with “CDC bases its recommendations on science in consideration with community standards and wishes.” Evidence-based medicine applies the best evidence from rigorous studies (eg, randomized clinical trials) to clinical decision making, and hopefully, to policies. Without evidence-based medicine, clinicians may not be using the best knowledge base when treating patients.

Even if these words are actually banned from use in CDC budget requests, it is important to note that medical journals with true editorial freedom would theoretically never fall into a similar situation. Editors and publishers/owners must guard against the influence of external commercial and political interests (as well as personal self-interest) on editorial decisions. Editors of such journals should not comply with external pressure from any party that may compromise their autonomy or of their journal’s integrity. The AMA Manual of Style notes these examples, among many others, of inappropriate pressure:

  • Pressure from an owner or a politically powerful or motivated individual or group on the editor to avoid publishing certain types of articles or to publish a specific article
  • Compliance with governmental or other external policy to not consider manuscripts from authors based on their nationality, ethnicity, race, political beliefs, or religion

Read more about editorial freedom and integrity of medical journals in AMA 5.10.—Iris Lo

Pharmaceutical Company Names

Posted by

0

The pharmaceutical industry is ever-changing, and it’s hard to keep up with new ownership and branding. When editing sections of manuscripts with a lot of pharmaceutical company names, such as the conflict of interest disclosures, I typically find all sorts of spellings of the names, even for the same company within the same paragraph. According to the Business Firms subsection (14.7) of the AMA Manual of Style, the name of the company should appear exactly as the company uses it but with omission of the period after abbreviations. Furthermore, terms such as Company and Corporation should be spelled out if the term is spelled out in the company name. The best way to determine how to spell a company’s name is to check the official company website. Following are a few examples of company names that I frequently see misspelled or misrepresented:

Boehringer Ingelheim

Bristol-Myers Squibb

Daiichi Sankyo (hyphenated in the logo but not elsewhere on the company website)

Eli Lilly and Company

GlaxoSmithKline

Merck & Co

Also keep in mind that some pharmaceutical companies have multiple business units (ie, biologics, medical devices) or different names depending on the country. In these cases, it may be necessary to query the author to ensure that the correct name is used.—Sara M. Billings

 

The Biting Edge of Science

Posted by

0

After reading Gabriel’s last post regarding modern preconceptions of premodern physicians and caregivers, I was reminded of an old New Yorker article on leeches that I had only recently read. (I used to subscribe to the New Yorker and have a backlog of old issues.) The article is about an American-born zoologist, Roy T. Sawyer, who was reintroducing the ancient practice of using leeches for medicinal purposes. Sawyer is the founder of Biopharm (an international company and leech farm based in Hendy, South Wales in the United Kingdom) and the author of Leech Biology and Behaviour. In 1983, he created Biopharm with the goal of identifying all the curative chemicals in the leech.

The earliest references to the medicinal uses of leeches appear in ancient Sanskrit writings. Indian physicians applied leeches to snakebites and boils and around diseased eyes. Asian healers mixed dried leeches in water for a variety of symptoms. However, just like bloodletting and trepanning, the use of leeches in medicine came to be viewed as barbaric and devoid of any legitimate purpose. Sawyer has helped to change the misconceptions many hold about the medicinal uses of leeches.

There are more than 650 species of leech. Hirudo medicinales is the primary species that is used for medical purposes. In the course of writing his book, Sawyer became convinced that the medicinal uses of leeches in the past were “based on a high degree of evolutionary adaptation.” In 1884, a British physiologist identified the anticoagulant hirudin in the saliva of H medicinales. Subsequently, it was purified in the 1950s and cloned in 1986.

Like most species of leech, H medicinales has 3 jaws designed for sucking blood, and each jaw has about 100 teeth.* These “medicinal leeches” secrete saliva containing several chemical compounds that are injected into a wound while it is feeding. As already mentioned, hirudin is a powerful anticoagulant; calin is another chemical (ie, a platelet adhesion inhibitor) that is responsible for prolonged bleeding, and it is this continual flow of blood that can provide the time needed for a body part or appendage to reestablish its own circulation after microsurgery. The leech decongests blood as it feeds and promotes continual decongestion long after it has finished feeding and has dropped off.

Roy T. Sawyer’s findings seems to be in line with the finding of the 2 researchers at the University of Nottingham mentioned in Gabriel’s post, the ones who made that surprising medical discovery in an enigmatic 1000-year-old text called Bald’s Leechbook. Also, I like the slogan of Sawyer’s company, Biopharm Leeches: “The Biting Edge of Science.”—Paul Ruich

 

 

*Editor’s note: I think they’re kind of cute! 

 

About Semicolons

Posted by

2

Like a few others in the JAMA Network office, my other life has involved creative writing. Although you’d have to look one cubicle past mine to find someone with a Master of Fine Arts in the subject, I managed to walk fairly deep into creative nonfiction—enough to have published a bunch of essays, in fact.

My other other life has been in health research, so I’m right at home at JAMA Network. But I’m still reminded of creative work sometimes. In particular, semicolons work for me like a weird little literary siren song. No matter how technical the article I’m editing is, the sight of a semicolon tends to bring to mind the novelists Kurt Vonnegut and Aleksandar Hemon.

It’s Vonnegut who strikes first and hardest. In one of his many musings on the craft of writing, the Slaughterhouse Five author once wrote, “First rule: Do not use semicolons… All they do is show you’ve been to college.”

When I read it, I thought of how much I liked the guy—even though I actually don’t agree with his grammatical idea. I think semicolons exist for more than one reason; they serve at least 2 grammatical purposes, and the best of them can work almost like a musical note.

First, there’s the grammatical part. The purpose of a semicolon is to not only to act as a connection between 2 independent sentences that are complete in themselves. It’s also a sort of super-charged comma. It’s a way to separate clauses that already contain commas without adding any confusion for the reader.

Here’s an example from the AMA Manual of Style (which itself explains semicolon use): “Often a comma will suffice if sentences are short; but when the main clauses are long and joined by coordinating conjunctions or conjunctive adverbs, especially if 1 of the clauses has internal punctuation, use a semicolon.” That’s the first use: a semicolon that connects 2 complete sentences. (The Manual notes a similar use for enumerated lists presented in a sentence.)

Here’s another sentence, which needs semicolons even though it lacks independent clauses: “Data collection occurred at health care facilities in Hinode Mizuho, Nishitama district, Tokyo, Japan; Ålesund, Møre og Romsdal, Norway; New York, New York; and Rochester, Minnesota.” Semicolons offer clarity here. Using only commas here would make it harder to determine the number of places listed, while semicolons help the reader infer that there were 4.

The third use of semicolons is to put 2 ideas that go together close beside each other. This is less a matter of grammar than a matter of flow, speed, or style. Sometimes, connecting sentences with a semicolon means that, despite their independence, they read as a single complete thought. Here’s an excellent (nonmedical) example: “The driver’s head was cubical, vines of hair creeping up his neck; there was a gray swirl around his bald spot, not unlike a satellite picture of a hurricane.”

That’s the work of Aleksandar Hemon, the other writer who semicolons bring to my mind. Hemon is an established author and TV scriptwriter (disclosure: he has also been an acquaintance of mine). In a review of one of his books, Hemon is described as “ragingly addicted to semicolons…. You get the feeling that if he ever somehow failed to sneak at least one semicolon into a paragraph, he might suffer some kind of syntactic withdrawal—his overworked right-hand pinkie finger would start to sweat and twitch uncontrollably over its home-key, until he managed to calm himself down with the methadone of a comma splice or an em dash.” (The reviewer furnishes several amusing examples.) Notably, the review is positive, even effusive; the writer describes Hemon’s semicolon use as in part a rhythmic motif.

No word on published research into that particular disorder of semicolon withdrawal, but this makes a good point: Vonnegut can be right. Semicolons can go too far. In Hemon’s case, it’s a matter of stringing multiple sentences together like beads on a necklace. In JAMA Network journals, it’s more often a case of authors placing semicolons in sentences that need only commas (“Data collection occurred in Japan; Norway; and the United States” when “…Japan, Norway, and the United States” would do, for example).

But I can’t criticize. When my life was still centered on creative writing, I once wrote an essay about the work of Aleksandar Hemon (warning: it contains swear words and descriptions of violence). I just checked, and it appears I didn’t go light on the fancy punctuation. Vonnegut’s established disapproval aside, I’d used semicolons 6 times.—Sophia Newman

Faster Than a Sentence Fragment

Posted by

0

My dad held onto his old comic books from when he was a kid — Mad Magazine, Spider-Man, X-Men, and Batman. I know it’s unoriginal, but how could I not fall for the Caped Crusader? I romanticized Batman’s brand of justice: smart, deliberate, vigilante, under the cover of darkness, and always, always for Good. I read both crates of my dad’s comics when I was a boy, but Batman was the only series I came back to as I got older. I took the stories and their Good and Bad morality seriously.

Now I’m an adult and a professional editor. I thought characters like Batman didn’t exist off the page. Then I heard about the Grammar Vigilante. It’s relatively old news, but I only heard about the Grammar Vigilante last month. He’s been correcting storefronts in Bristol, England, for 13 years. When he sees an incorrect apostrophe (“Amy’s Nail’s” is one example), he goes out at night with his homemade Apostrophiser to correct the mistake by covering it with a colored sticker. That’s the kind of real-world vigilante justice I can get behind, and it’s something almost anyone reading this blog can chuckle about.

Strangely, I look at the Grammar Vigilante as seriously as I did Batman. What strikes me is his belief in making these corrections despite the risks. “I do think it’s a cause worth pursuing,” he says in the video. He denies his actions are a crime, quipping, “It’s more of a crime to have the apostrophes wrong in the first place.” Despite the joke, he defaces private property and could face legal action if he is caught.

I believe in the Grammar Vigilante.  The AMA Manual of Style includes chapters on grammar, plurals, and capitalization and quite long chapters on punctuation and correct and preferred usage. As the lattermost suggests, some of these rules are up to interpretation or preference but others are simply right. The primary goal of the written word is to communicate, and that is done most effectively, with the least confusion, using proper grammar and punctuation.

I have a personal tie-in to all of this. In high school, I worked as a server at a restaurant. One day, one of the managers posted a long document about new policies and expectations with explanations for each change. I read it standing next to a coworker and said that I wished I could copy edit the sheet to fix some small errors. She turned to me and looked hurt and disgusted, told me that was insulting, and said that nobody else cares about the right way.

I felt embarrassed, and I didn’t talk about the sheet with anyone else. I didn’t have the ability to put it into words then and still struggle arguing it now, but improper grammar, no matter how small, obscures meaning and harms interpretation. Proper grammar and punctuation aids my reading just as much as it does for those who don’t know or don’t care about it.

Are the Grammar Vigilante’s corrections helpful? Or pretentious? Or even noticed by most? Is there a difference between correcting public storefronts and private postings? By Batman’s morality, is he doing Good or Bad? I don’t know, but I support what he does. He’s not a hero, but I think he’s a silent guardian, a watchful protector. He’s my real-life Dark Knight.—Kevin Brown

A Due Diligence Excursion Into Nomenclature

Posted by

1

You might know the definition of the word “excursion” as it relates to leisure activity. You may also consider its technical definition, which is to do with the movement of something along a path. I recall an unexpected delight once while reading some Prescribing Information. A statement about drug storage and handling indicated that the drug can be stored for up to 4 months at 25°C (77°F). The kicker for me was “excursions permitted to 15-30°C (59-86°F).”

Excursion? Sounds like that drug is in for a treat.

My earliest excursion into professional proofreading and copyediting occurred at a law firm. The required confidentiality agreement lit a fire in me as an initiation into specialized knowledge.

Good, I will know something I am not allowed to talk about.

Flushed with triumph, I sat down to read contracts, deeds, torts, and trusts. Page by page, section by section, paragraph by paragraph, unwieldy sentence by unwieldy sentence, clause by clause, parenthetical phrase by parenthetical phrase.

Confidentiality agreement? A few months into the job revealed that agreement to be a formality. I couldn’t have blabbed about any deals had I wanted to (putting aside the question of who would want to be told any of what I was reading). The baroque legal prose lent itself to pattern recognition instead of language comprehension.

Particular phrasing has stayed with me. Pursuant to. Indemnify, defend, and hold harmless. Any and all claims that arise from or relate to. Including without limitation. As herein before stated. Some terminology has migrated into general use, as when you overhear someone say into a phone, “Do your due diligence, dude.” As a synonym for “preparation,” there are worse choices.

Performing due diligence is a vital component of processing articles for JAMA Network journals. In manuscript editing, the biggest confidentiality issue is the embargoed proof. Knowledge across the specialty journals is not meant to be confidential (after publication). The spread of knowledge requires fixed meanings—or at least is greatly helped by it.

Words slip out of professional and into general use, and from general into professional (although I don’t know the origin of “excursion” in Prescribing Information). A migrated term can lend a patina of mindfulness—“curate” is no longer a member of the clergy in an Anthony Trollope novel but a thing one does on behalf of one’s own “brand”—which once meant the maker of cereal you preferred to eat but now means something like the self you present to the world. Word migration can veer into pretension, depending on your personal threshold.

We routinely consult the AMA Manual of Style to solve usage issues in preparing an article for publication. Changes in usage can be exciting. The manual is too sophisticated to be merely proscriptive; if you admire change, you will find plentiful discussion. If, however, you find yourself wishing to sample a lexicon with a heritage of stability, the AMA Manual of Style is at your service.

Your well-thumbed manual may focus your attention on references, usage, conversion factors, and abbreviations. We all need reminders for those principles that don’t stay in our heads. That raises a question. What about what is not in in our heads to begin with?

You won’t know that you don’t know nomenclature unless you are exposed to what there is to know. Make an excursion into Chapter 15, Nomenclature, the single longest chapter in the manual (followed, in a bit of poetic juxtaposition, by what is likely the shortest, the 5-page treatise on Eponyms).

Why stroll through a 250-page chapter with 17 segments? You will encounter terms for Equipment, Devices, and Reagents, a lexicon of Immunology, and vernacular names for Organisms and Pathogens. One reason to move along this path is that, while editing, you may not realize that usage in your article is imprecise or incorrect. Maybe the author inadvertently mixed up 2 conventions in a single term. The term looks scientific and the author is both MD and PhD, so you might move along with your next task in mind. Perusing Chapter 15, though, can orient you toward terminology in a way that can help you know when to clean it up.

Even though the chapter is enormous, its rationale is simple: “to present style for terms and to explain terms in hopes that they are more easily dealt with.”

In my book, that’s grounds for an excursion.—Timothy Gray

En Dashes

Posted by

1

I didn’t know what an “en” dash was until I started working as a copy editor. Somehow I’d never even noticed them before. I knew when to use hyphens and em dashes, but the en dash was so confusing, no matter how many times I read the official description in the AMA Style Manual:

“The en dash shows relational distinction in a hyphenated or compound modifier, 1 element of which consists of 2 words or a hyphenated word, or when the word being modified is a compound.”

I understood how to use it with a hyphenated modifier, but the compound modifier tripped me up. I was overthinking it, spending too much time debating what the modifier was, and placing the en dash in the wrong place. Then someone explained to me that you use it when a group of words represents a single idea and it started to make sense:

  • US army–enlisted population
  • Geographic Information Systems–based measures
  • gene-dose–dependent manner
  • B-amyloid–negative group
  • apolipoprotein E–related genetic susceptibility
  • estrogen receptor–negative breast cancer

In all of these cases, 2 or more words together represent the single thing (eg, US army, apolipoprotein E), which is your cue to use the en dash before or after the phrase.

Some style manuals recommend using the en dash for ranges, scores, or values that are related, but the AMA Style Manual reserves them for the hyphenated or compound modifier only.—Tracy Frey

Check It Twice

Posted by

3

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

Advice for the AMA Style Newbie

Posted by

5

After several years of working as an editor using the Chicago Manual of Style almost exclusively, I found myself interviewing for a job at JAMA Network. Naturally, I wanted to prepare by learning as much as I could about AMA style. Google searches such as “Chicago vs AMA style” produced little in the way of useful information. Luckily, the AMA Manual of Style offers a free trial subscription option. Poking around here and there, I was able to glean some similarities and differences. But much of what I really needed to know I learned once I started my new job. What follows are some of my thoughts on making the switch from “Chicago style” to AMA.

First, the good news: we’re a lot more alike than we are different! All the wonderful stuff you know and love from CMOS or other guides about matters like subject-verb agreement, parallel construction, misplaced modifiers, and the like are just the same in AMA. Even our much-beloved serial comma retains its place of honor. We’re literally all speaking the same language!

Of course, there are also differences. Many of them are relatively minor, but they take a while to get used to. For example, unlike CMOS, AMA almost never uses periods after abbreviations. “Dr” still looks underdressed to me, even after several months. In a similar vein, while Chicago style advises spelling out numbers 1 to 100 (while acknowledging the alternative rule of spelling out 1-10 and using numerals for anything larger), AMA prefers the use of numerals in nearly every context, the main exception being the beginning of a sentence (CMOS concurs on this point). One habit I’ve had to break is using an en-dash to express ranges of numbers, whereas AMA prefers a hyphen or the word “to,” depending on the context (hyphens are for ranges in tables or in parenthetical expressions). While I generally do prefer a word over a symbol in formal writing, I miss seeing the en-dash around. It’s also strange not to see commas separating the digits of larger numbers—instead AMA keeps 4-digit numbers closed up, and for larger numbers opts for a thin space, a character Chicago rarely uses.

The formatting of references is an obvious point of difference, especially for a journal copyeditor like myself. In my job at JAMA Network, I get to use software with a reference editing component. If you’ve ever spent hours hand-styling journal references, you know what an exciting development this is. Chicago offers 2 systems of source citation, notes and bibliography and author-date references. In AMA style, references are cited in-text with superscript numerals corresponding to a reference list at the end of the article. The style of reference items is generally sparer than in Chicago, with initials for authors’ given names, lowercased article titles, and parsimonious use of punctuation and spacing. It’s a clean style that delivers the necessary information in the most efficient way possible.

My absolute favorite thing about working in AMA style is having a resource developed specifically for the type of content I’m editing. Anyone who’s ever tried to apply the more general Chicago style to a technical or scientific discipline knows that it leaves many questions unanswered. Often these topics will be covered in a house stylebook, but these aren’t always kept current and may not always have the information you’re looking for. Like CMOS, AMA has a guide to correct and preferred usage. But in addition to old standbys like effect vs affect, you’ll also find explanations of why cases are “managed” but patients are “treated.” In my experience, the discipline-specific language of medical editing and the structure of articles have been the 2 major lessons. Luckily, the AMA Manual of Style has you covered on both counts.

If you’re just starting out in the world of AMA style, there are some helpful resources you may want to check out. The quiz section of the style guide’s website has quizzes on a wide range of topics. You can test your acumen (or if you don’t mind spoilers, page through the answers in order to discern major points of the style). If you’re interested in more guided instruction, a medical editing class may be worth looking into. However you go about it, enjoy the learning process, and when in doubt, look it up!—Heather Green