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Offensive Words and Apologetic Quotation Marks: Sorry Not Sorry

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News organizations everywhere had an important editorial decision to make in early January 2018 when President Trump categorized certain countries in a defamatory manner during a closed-door discussion about immigration in the Oval Office with Senators Dick Durbin and Lindsay Graham, among others.

  • “Trump decries immigrants from ‘shithole countries’ coming to US” (CNN headline)
  • “Trump derides protections for immigrants from ‘shithole’ countries” (Washington Post headline)
  • “‘Fox & Friends’ host called for Trump to clarify ‘s—hole’ comment shortly before denial” (The Hill headline)

In scientific reporting, as in politics and life, things sometimes get ugly, and when they do, we turn to apologetic quotation marks. In the examples above, the term shithole is a part of the story; without using the offensive term, the story’s meaning is lost. It’s interesting that these 3 examples apply the apologetic quotation marks in 3 different ways. The first example includes “countries” within the quotation marks, which is not necessary. The Washington Post example gets it right. And the example from The Hill is not fooling anyone. If you’re going to include it, include it. Crossing out a few letters in the offensive term is the literary equivalent to putting black bars over a patient’s eyes to make the patient “unidentifiable.” (←ironic use of apologetic quotation marks.) 

This is not a picture of my cat:

This is not an offensive word:

S—HOLE

You get the point.

The revised edition of the AMA Manual of Style will provide expanded guidance in the “Apologetic Quotation Marks” section of the Punctuation chapter, which currently only states that apologetic quotation marks are “sometimes used around words for special effect or to indicate irony.” Additional guidance will note that in some instances, the use of a potentially offensive term might be unavoidable if it is a direct quotation that is important to an article (eg, in a news story). In such cases, the offensive term may be published within quotation marks. The New York Times occasionally opens up its policy on including offensive terms in print. Ultimately, whether or not to include offensive language in an article is an editorial decision that comes down to how the term relates to the meaning of a story.—Lauren Fischer

   



Looking Forward to the 11th Edition

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At the most recent annual conference of the American Medical Writers Association, we received a sneak peek at some of the changes to come with the AMA Manual of Style 11th edition. AMA Manual of Style Committee Members Cheryl Iverson, Stacy Christiansen, and Annette Flanagin gave an overview of some highlights, including changes to the way references are styled, updates taking into account the growing presence of social media, and changes to nomenclature. Other topics included updates to corrections processes, clarification of authorship guidelines, and data sharing rules.

In this post, I thought I’d share some of the changes that I’m most excited about as an editor, many of which promise to make the editing process easier and more intuitive. Several new guidelines for styling references caught my attention. For example, electronic references in the current edition mirror traditional references with the addition of a URL in the middle of the reference and a date accessed at the end. The new edition will put URLs at the end of a reference, similar to how DOIs currently appear. Another welcome change is the omission of publisher locations from references to books and reports, which seems sensible given the multinational nature of publishing and the increasing move toward digital formats.

An update to the style of tables and figures was also covered in the presentation. Starting with the 11th edition, column heads in tables and axis labels in graphs will appear in sentence case capitalization rather than title case. Table and figure headings and labels in scientific publishing often contain a great deal of text, making it all the more important to display that text in a way that’s as easy as possible for readers to parse. In addition to saving space, the use of sentence case capitalization throughout figures and tables will make these elements appear more standardized and easier to read.

The new edition also makes some helpful distinctions between AMA style preference and alternatives considered acceptable. For example, it is now acceptable to use of “they” as a singular pronoun. In addition to circumstances in which “they” is a person’s preferred pronoun, this construction can also be helpful in preserving patient confidentiality (eg, avoiding the disclosure of patients’ sex in a small sample size to preserve anonymity).

Many other exciting changes are anticipated with the upcoming 11th edition. Stay tuned for more!—Heather Green

 

 

AMA Style in the Wild

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For many years, my best friend Conchita (not her real name—but she’ll appreciate this reference) and I lived accidentally parallel lives. We were band geeks together, shined in the back row of the chorus during high school musicals, and scrambled to compose an extremely derivative opera (a recording of which I’m pretty sure still exists, unfortunately) to satisfy a creative writing assignment in physics class. But whereas I dreaded said physics class with the fire of a thousand burning suns, Connie excelled in all things scientific. It was no surprise to me when she earned her Masters in Public Health, but it was a surprise when we both ended up in careers relating to the medical field. What was especially enjoyable was that the idle chit-chat usually reserved for whichever high school classmate had just had a baby could now be applied to hyperspecific work-related things, including our beloved AMA style.

Although initially I seized on our collective use of AMA style to complain about authors who had only used abbreviations 4 times, I became interested in learning how she used it in her corner, as I had previously assumed that AMA style was the domain of journal manuscript editors. So I gathered some questions together and polled both Connie and Edgar (name also changed), a former colleague of my fellow blogger Iris, to ask how they used AMA style in different areas of medical communications.

Edgar is an editor for a global advertising company whose clients provide products such as pharmaceuticals, medical devices, and guides relating to health and wellness. The writers and account managers creating their copy are required to be familiar with AMA style, and the style guide for each account has a template of “[X drug] uses AMA style with the following exceptions.” These exceptions usually come in the form of client preferences for the text and layout, which leaves Edgar with the challenge of how to be the resident style stickler while keeping the client’s dictates in mind. Ultimately, while a client’s spatial limitations may not allow for the correct number of thin spaces between P values, “no client style guide can match the AMA for depth and breadth” and it is an important organizing tool.   The final product represents a mix of both AMA style and client preferences, but, as Edgar puts it, “One veteran editor told me years ago, rather cheekily, ‘Not even AMA uses AMA style.’ … What he was getting at was that it’s a great tool to be adapted rather than followed in strict orthodoxy.”

In Connie’s previous role in the editorial services group of a medical communications agency, “The AMA Manual of Style was THE BIBLE. Past colleagues achieved mythical status for their ability to recall which section of the AMA manual housed the elusive answer to the day’s grammatical conundrum.” (As you can see, Connie also excelled in English class.) She now works for a pharmaceutical company in their labeling and product packaging divisions, which comes with its own set of complicated rules. The documents she works on (such as a product insert for a specific drug) are not organized with any one editorial style in mind, but rather in terms of their audience (eg, patients vs prescribers). Because these documents are written by multiple authors and pass through many hands before Connie sees them, the text can sometimes represent a hodgepodge of styles. However, because the text is also regulated by the FDA and any changes beyond simple typos would be subject to review by medical, legal, and regulatory teams, these inconsistencies often remain intact. In the rare opportunity when Connie is allowed to make edits on small items, she uses AMA style as a guide on things like italicization, reference lists, and capitalization to make her process more straightforward and efficient.

So my takeaway from these conversations is that while nobody will probably ever apply AMA style as strictly as manuscript editors do (and if we’re honest with ourselves, we probably take some proud satisfaction in that!), AMA style is a useful and important fall-back in other areas of medical communications because of its consistency, specificity, and efficiency. But for your sake, I promise that Connie and I won’t compose an opera about it.—Amanda Ehrhardt

A Due Diligence Excursion Into Nomenclature

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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

Advice for the AMA Style Newbie

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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

A Dirty Look at the AMA Manual of Style

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Remember how much fun you had reading The Elements of Style? How about the times you yukked it up over the ambiguity examples in Warriner’s English Grammar and Composition? Here is a classic to jog your memory:

As soon as the students had left the classrooms, the custodians cleaned them.

That’s entertainment!

You can revisit those days of abandon in the quest for clear writing, even if no one seems to chuckle when they consult the AMA Manual of Style. Maybe this owes to its being a behemoth. If you wish to consult the manual with a smile instead of grim determination, the opportunities are there.

Every so often, a nonassociation style guide becomes a bestseller. Such a chartbuster assumes that usage matters, and that correct usage rules and examples entertain and inform. Authors have climbed the list with pragmatism (thanks, Susan Thurman), charm (hi, Mary Norris), innuendo (I’m talking to you, Lynne Truss), or light-heartedness (howdy, Bill Bryson).

Some even go dirty, quick and dirty, as in Mignon Fogarty’s amazing Grammar Girl. I understand this. A down and dirty read (a basic, practical review and not a backstreet editing assignation) is often called for when deadlines loom.

But pragmatic or dirty, these bestsellers put their readers in good hands. That they entertain and inform offers a springboard for a quick dive into the ways that the style manual, in addition to assuring you that you’re in good hands, can entertain as it informs. Here is a representative down and dirty look at a portion of the manual.

If you hand out Halloween candy, you have seen the proverbial “fun size,” a bite that only leaves you wanting more unless it is a Butterfinger. My idea of fun size would be a candy bar as big as my arm. However, any amount of candy is fun (except a Butterfinger), so in that spirit, small can be fun size. By my original standard, the 1010-page Manual of Style is already fun size, but chapter 11 offers the overlooked qualities of being thought-provoking and entertaining. (So do chapters 7-10, 12, and 13, but that is another post.)

The online manual can take you right to 11 without the papercuts, but the idea is to look at its alignment with the tone of popular usage books. From a certain vantage, this chapter could stand as a compact usage book alongside other usage books that sell well. A fun size AMA style guide!

The “Correct and Preferred Usage” chapter starts with 2 fun quotations, one with empathy for proofreaders and another that mentions a porcupine. The entries begin with word choice examples aplenty (similar to Bryson’s look at troublesome words), with italicized labels and directives that establish a hierarchy (Incorrect, Correct, Also Correct, Avoid, Preferred, Also, and the apotheosis of middle ground, Acceptable).

Sometimes a truth plainly spoken is in itself amusing, and that truth can orient you toward correcting descriptive language. The entry “abnormal, normal, negative, positive” indicates “Examinations and laboratory tests and studies are not in themselves abnormal, normal, negative, or positive.” If you have gone around allowing authors to describe tests as negative, it can be bracing to see such clear direction.

The entry for Jargon offers a similar plain-spokenness. “….[D]rugs are usually neither systemic nor local but are given for systemic or local effect.” Parallelism can sharpen a keen awareness of specificity.

Because redundant words are always funny according to natural law, section 11.2, with its eye-opening list of redundancies, expendable words, and incomparable phrases, can supply abundant levity. You will also encounter a well-known quotation from Yogi Berra.

The legal profession once advocated plain language (ha ha!). Everyone talks about jargon, but the AMA Manual of Style does something about it. Granted, you can violate the manual’s jargon directives and still be allowed to walk around freely, vote, and drive a car, but if you see what Morris Fishbein wrote on page 408, you will never want to use jargon again. Even by accident or in an emergency.

Chapter 11 contains scores of other usage grace notes. Shakespeare’s Polonius says, “brevity is the soul of wit,” and you can verify that by looking up “describe, report” for an example. Even one of the longer entries (“because of, caused by, due to, owing to”) ends with a lovely Clue to usage (a one-off category) that brings it all home in 3 lines.

One-off labels nod toward the gray areas of usage, which are usually skillfully handled in style guides. The manual may be a behemoth, and another one-off category, Possible exception, under “adherence, compliance,” may help explain why. This example shows its accommodation of nuance. Nuance can take space.

Across its chapters, the manual draws from literature (Alexander Pope, Samuel Johnson, Mark Twain, Toni Morrison) for contextual quotations. Medical editing embraces the humanities in its quest for clarity.

For a good time, read chapter 11 of the AMA Manual of Style.  It shares some of the endearing qualities of the bestselling usage guides (except, I think, innuendo). Review the material when you aren’t searching for an answer. It’s not just for reference anymore.—Timothy Gray

 

Raising (Rearing?) Hell

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Besides the dropping energy levels and unsightly wrinkles that daily remind me of my advancing age, I never expected an Associated Press style rule—beaten into me as a young reporter—to deliver the one-two punch that landed me squarely into the “old fogies” category.

I was editing a JAMA Viewpoint about a fairly modern question involving gender identity, hormone levels, and eligibility for women’s athletic events when my knee began to jerk at first sight of the descriptor “raised,” as it applies to how or where someone grew up.

As soon as I saw the word, I heard harsh tones in my head and felt the breeze of a wagging finger: “Corn and cattle are raised, people are reared!” So I dutifully changed “raised” to “reared” as the AP Stylebook commands. Soon, I sent the proof off for review by the senior editors and the authors.

As I had predicted, one of the medical editors deleted “reared” and inserted “raised.” I knew I was right about this! I was poised to cross off the edit when I thought, “Maybe I should look at a newer version of a stylebook, just to see if the rules have slackened over the decades.” (Our own AMA Manual of Style is silent on the matter.) My office was too cluttered to find the newest Associated Press Stylebook, so I turned to Google.

The first search result was titled “Grammar Gremlins: Is it ‘reared’ or ‘raised’?” I clicked—who says a pithy headline doesn’t draw in a reader?  Knoxville News Sentinel Columnist Don Ferguson, who by his photo looks older than me, offered his first sentence:

A recent Associated Press report about an accused terrorist said the man was “born and reared” in America.

He followed with,

Did this use of “reared” instead of “raised” say something about the age of the writer?

Oh my goodness! Who would have thought that old style rule would say more about me than my slowing gait? He noted that youngsters favor “raised.” He cited Garners Modern American Usage’s calculations that “born and raised” is used 8 times more often than “born and reared.”

As with most of often-confused words, he also noted that dictionaries say either is correct.

I dropped my pen and conceded the edit.—Beverly Stewart

 

 

 

Questions From Users of the Manual

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Q: I cannot find anything in the AMA Manual of Style about how to cite an article in a magazine. Please help.

A: You are correct that we do not address citations to magazines, primarily because the material we focus on is more scholarly. However, you could extrapolate from the information on how to cite a journal article (see section 3.11). Here is an example of citation of a magazine article:

Angell R. This old man: life in the nineties. New Yorker. February 17&24, 2014:60-65.

You’ll notice that although we prefer giving the year;volume number(issue number):inclusive pages in our citations to journal articles, some magazines do not use volume and issue numbers but instead rely on the issue date. This seems to be true of the New Yorker, and this article was in a double issue, so you’ll see that I have suggested using issue date:inclusive page numbers.

Q: What is the best way to send a question to you regarding the content of the style manual?

A: You may write to the style manual at stylemanual@jamanetwork.org.

Q: For package insert references, many times the manufacturer and marketing company are the same. However, if they are not, which company should be listed in the reference citation?

A: It might be helpful in the case of a manufacturer and a marketer to list both. In this case, you could separate them by a semicolon:

Onglyza [package insert]. Princeton, NJ: Bristol-Myers Squibb Co; Wilmington, DE: AstraZeneca Pharmaceuticals LP; July 2009.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: Do superscript reference numbers go before or after colons? What about periods and commas?

A: Superscript reference numbers go before colons and semicolons and after commas and periods. See section 3.6.

Q: When will the next edition of the AMA Manual of Style be published?

A: We have begun work on the next (11th) edition but do not yet have a projected publication date. I think 2016 is realistic. In the meantime, I hope you avail yourself of the online updates, which provide policy changes, etc. Those are free, if you do not have an online subscription. The monthly quizzes (which are free to subscribers) are also a good way (between editions) to see more examples.

Q: On PowerPoint slides, how do you recommend citing reference sources: on each slide that is not the presenter’s own, or at the end of the presentation?

A: At present, our style manual does not address style questions related to PowerPoint presentations; however, we are considering adding a few guidelines on this in the next edition. For now, I would suggest adding the reference sources on each slide, as a footer. Because the slides are likely to be pulled apart from the entire presentation and used by others, having the source with the content seems advisable.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: I understand that the second printing of the AMA Manual of Style is now available and that many of the items in the list of Errata on the companion website (www.amamanualofstyle.com) are corrected therein. How can I tell if I have the first or the second printing? Does the second printing have a different ISBN?

A: Yes, the second printing was published in October 2007 and in it the majority of errata listed on the companion website are corrected. You can tell which printing you have by looking at the copyright page of the book (p iv). In the lower left corner of that page is a string of numbers, beginning, on the left, with 9. The number on the far right of that string will indicate the number of the printing. If the last number on the right is a 2, you have the second printing. The ISBN does not change with printings.

Q: Which is correct: “Qvar has similar systemic effects to those of fluticasone” or “Qvar has similar systemic effects as those of fluticasone”?

A: The correct idiomatic form is “similar…to” not “similar…as,” as with “identical…to” rather than “identical…as.” I suspect the use of “as” in this construction comes from a related idiom: “the same as.” You could also rephrase this to “Qvar and fluticasone have similar systemic effects.” or “Qvar has systemic effects similar to those of fluticasone.”

Q: Has the policy on SI units changed? If so, how?

A: Yes. These changes are addressed in detail in section 18.5.10. For laboratory values reported in JAMA Network Journals, factors for converting conventional units to SI units should be provided in the article. In text, the conversion factor should be given once, at first mention of the laboratory value, in parentheses following the conventional unit.

The blood glucose concentration of 126 mg/dL (to convert to millimoles per liter, multiply by 0.055) was used as a criterion for diagnosing diabetes.

For articles in which several laboratory values are reported in the text, the conversion factors may be provided in a paragraph at the end of the “Methods” section. In tables and figures, this information can be provided in the footnote or legend.

Q: Although the 10th edition recommends spelling out state names except in full addresses and the reference list (for location of publishers), I notice that you still show “DC” for District of Columbia. Is this an exception?

A: Yes.

Q: If a state’s full name is spelled out on first mention in running text, per the new style, what do you do when numerous cities in the same state are mentioned in an article? Should the state name be spelled out every time it is mentioned, every time a new city is mentioned, or should the 2-letter postal code be used after the first time the state name is spelled out in running text?

A: The answer will depend on the context. If the article is about cities in a particular state, you might not need to include the state name with the individual cities at all, as it will be clear what the state is, eg, “6 cities in Massachusetts.” If the state name is spelled out at the first mention of each new city, it shouldn’t need to be repeated, unless there are instances in the manuscript of a city that exists in more than 1 state (eg, Springfield, Massachusetts, and Springfield, Illinois).—Cheryl Iverson, MA