punctuation

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

   



Grammar Myths

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A Grammar Girl podcast from March 2018 in celebration of National Grammar Day detailed 10 common grammar myths. Some are plainly incorrect, some are overgeneralizations, and some are points of disagreement between different stylebooks. Even good writers (and editors) get it wrong sometimes!

I’ve seen authors use the term “run-on sentence” to describe a sentence that, while grammatically correct, may have overstayed its welcome. Medical articles are full of long sentences: when adding a word, a clause, or parenthetical numerical values makes the meaning clearer or renders a statement more scientifically accurate, we’ll do it! As Grammar Girl points out, “In a run-on sentence, independent clauses are squished together without the help of punctuation or a conjunction. If you write ‘I am short he is tall,’ as one sentence without a semicolon, colon, or dash between the two independent clauses, it’s a run-on sentence even though it has only six words.”

Use of the passive voice (GG’s myth No. 6) falls under the category of overgeneralizations. The active voice is often your best bet. According to the AMA Manual of Style, “In general, authors should use the active voice, except in instances in which the actor is unknown or the interest focuses on what is acted on.” When I first started working in the field of medical editing and my manager advised me to avoid the use of the first person in abstracts even if it meant rewording to use the passive instead of the active voice, it blew my mind a little. I certainly understood when a perplexed author took me to task for edits that changed the wording of a sentence in his abstract from active to passive. (I also learned the value of a comment specifying why I’ve made a change when it’s something that might not be obvious to an author.)

To further confuse things, different style guides have different rules, and when the guides disagree, a variation can seem like a mistake. Myth No. 7 deals with possessives and the apostrophe-s. AMA style is to omit the final s in the possessive form of a name that ends with s, using only an apostrophe. However, even editors sometimes have the admonitions of long-ago English teachers stuck in their heads. In college I learned that an ‘s was always added, except for classical or biblical names. So the phrase, “Harold E. Varmus’ discovery of retroviral oncogenes,” for example, sets off alarm bells in my head. Yet per AMA style, it’s absolutely correct.

My favorite of Grammar Girl’s myths was No. 3: “It’s incorrect to answer the question ‘How are you?’ with the statement ‘I’m good.’” When someone asks me how I am, and I say “good,” and when I ask them how they are in return they say “I’m WELL,” it feels like a citizen’s arrest, and I don’t love it. But I’ve always thought these scoldilockses were technically correct because the verb am should be modified by an adverb, well. Not so! GG points out that “‘good’ isn’t modifying ‘am’ in the sentence ‘I am good.’ Instead, ‘good’ is acting as the subject complement and modifying the pronoun ‘I.’” This one was news to me—turns out even editors fall prey to grammar myths sometimes!—Heather Green

 

 

 

About Semicolons

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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

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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

En Dashes

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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

Punctuation Gets Famous

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It’s great to see that copy editors are finally being given the positive attention we deserve. There are now “copyediting stars” like Mary Norris of The New Yorker; John E. McIntyre of the Baltimore Sun; Lynne Truss, author of Eats, Shoots & Leaves; and author and podcast personality Mignon Fogarty, the “Grammar Girl,” who “sparked what you might call a worldwide, syntax-driven fiesta.”

I have to admit that I am surprised as well as pleased by this trend. A while back, when I was taking a break from editing to be a substitute teacher, I wondered if texting-style spelling, the overreliance on spellcheck, and the absence of diagramming sentences in school meant that attention to proper spelling and grammar would become a lost art in the everyday world. Would people outside of scholarly publishing give a darn about, say, the serial comma?

It turns out they do. Witness the case of the Oakhurst Dairy in Maine. The Maine Legislative Drafting Manual does not approve of the serial comma; therefore, there is none in the state law regulating overtime: “The canning, processing, preserving, freezing, drying, marketing, storing, packing for shipment or distribution of: (1) Agricultural produce; (2) Meat and fish products; and (3) Perishable foods.” The ambiguity created by the lack of a comma after “shipment” resulted in Maine truck drivers winning a lawsuit that could cost Oakhurst Dairy $10 million. Some folks may find the serial comma superfluous—but I say that a little symbol that could save a company $10 million is nothing to sneeze at. That fact that so many articles were written about this case show that there is an interest in such topics.—Karen Boyd

Questions From Users of the Manual

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Q: Is it correct to leave “post” as a separate word in the following sentence? “These activities must take place from prelaunch to post launch.”

A: In section 8.3.1 (“When Not to Use Hyphens”), you’ll see the following:

Note that when post is used as a combining adjectival form, as in postmortem examination, it is set closed up. When it is used as an adverb, as in post hoc testing, it is set as 2 separate words.

So in your example, you would not close up “post launch.” However, the meaning of this sentence is ambiguous to me.  I would suggest rephrasing it to avoid an awkward construction and to clarify exactly what interval you are talking about. How about “These activities must take place both before and after launch.”?—Cheryl Iverson, MA

The Percolating Proofreader

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Editor’s Note: Here begins an occasional series by one of The JAMA Network’s favorite overcaffeinated proofreaders, David Antos. He has a deep affection for parts of speech, punctuation, and widows and orphans. (See what I did there?)

Twice in the past week I’ve done the unthinkable, which, however, I found my mind was eventually willing to grasp, as if the unthinkable could be thought through without losing its privileged status of noble ignorance. Less like a raccoon’s grasping a crayfish than a raccoon’s washing pastry till it dissolves, my mind was the beneficiary of an organic shampooing so dense and luxurious that I got a little smarter right there in the shower. No blinding insight in my trickle-down acuity, but a soft perception that there was meaning to be had in twice forgetting to close a parenthetical expression, which is the horror I’d committed.

Do you call parens open/close or opening/closing? Or left/right? I tend toward overexpression, so you can imagine I favor the suffix, but, to keep this clean and tidy, like my hair, let’s do open/close, even though “close” reminds me of “clothes,” which I was bereft of in the shower though in polite society am usually not. Which is the point my shampooed mind was shoring into, that society becomes impolite when punctuation falters. In 2 emails I’d sent that week I’d properly initiated a parenthetical expression that, when gotten to the end of, nakedly submitted itself to the rest of the sentence without so much as a stitch of close. Well, actually, the 2nd email contained a couple bracketed morsels at its conclusion, and the close paren was likely forgotten in the heat of bracketing. No excuse that, but a circumstance lending a ray of thought to the unthinkable. I’d also preemptively included in each of those emails the assertion that, in the interests of sending them in a timely fashion, I was not going back to proofread before hitting the button of no return. I had my out, yet when, after sending, I did proofread, I felt guilt, shame, inner filth, as if I were Michelangelo’s socks when he finally crept down the Sistine Chapel’s ladder. I’d poured my soul into words and left out the close parens, rendering that soul holier than the aforementioned socks. And not in a good way.

Later, I washed my hair and, as a person does when feeling hair and contemplating sin, reflected on the week that was and the week that will never be. I thought of the close parens that were not allowed to see the light of another’s eyes and of the violent omissions recounted in the week’s headlines, and it began not to seem out of place to think that faulty punctuation is at the heart of a world gone wrong. Not that a sloppy email is to blame for unthinkable atrocities, but the sense of purpose, order, and unblinking inclusion punctuation provides mirrors the sense of moral rectitude we only occasionally achieve in our dealings with each other. Punctuation is never evil, just misplaced or missing, and as I stepped out of the shower I cheerfully anticipated my next trip on public transportation, for I would no longer regard the other commuters as merely people but as pieces of punctuation, possibly shoveled into a seat of crumbs or wedged pielike into each other, but innately good, even angelic. —David Antos

Questions From Users of the Manual

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Q: I would like to know how to reference a Kindle book.

A: This question was addressed on this very blog on May 7, 2012. We love questions, though, so feel free to send them in as well as using the search box on the top right corner of the blog home page. Also, we are working now on revising the manual for the next edition and we will be including lots more examples of online reference styles.

 

Q: How should an “e-pub ahead of print” reference be cited in the reference list?

A: There are a few examples in the current manual, but we plan to include many more examples of citing electronic documents in the next edition—and we are deep in discussions (some might say “arguments”) about a style change, so stay tuned!  See 3.15.1, examples 14 through 17. Note, however, that we have now dropped the words “ahead of print” in the phrase that appears in brackets.   Here is an example from JAMA Pediatrics:

Keren R, Shah SS, Srivastava R, et al. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children [published online December 15, 2014].  JAMA Pediatr.  doi:10.1001/jamapediatrics.2014.2822.

Q: How would I introduce an abbreviation that first appears in a compound word? For example, if my first use of traumatic brain injury was in TBI-related complications?

A: I would recommend the following: traumatic brain injury (TBI)–related injuries. (That’s an en-dash before related.)—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: We are having a discussion about –ic and –ical. Dictionaries often use both. Where does the AMA Manual stand on this?

A: Please refer to the Correct and Preferred Usage chapter in the manual. You’ll see an entry on this very subject. In addition, there are entries on some of the pairs of words where the meaning of the –ic version is different from that of the –ical version (eg, classic/classical, historic/historical).

Q: Does AMA style advise against using a period after the abbreviation Inc?

A: Yes, we advise against using a period after the abbreviation Inc. This is addressed in section 14.7.

Q: In the course of developing a manuscript, an author has retired. Should we delete her affiliation? Or perhaps indicate something about her retirement in parentheses?

A: I would list the author’s affiliation, assuming she was affiliated with this institution while working on the paper. Then, follow the guidance about Author’s Affiliation (section 2.3.3) if a person has moved. This would mean adding an indication that Dr X is now retired. The style used for this notation will depend on the design of the journal involved. —Cheryl Iverson, MA