usage

Condition, Disease, Disorder

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“Disease often fortifies the system against the action of remedies.”

“Disorder often fortifies the system against the action of remedies.”

Which of these sentences is correct? As it happens, the first is an actual quote (H. C. Wood, 1879)1(p445) and so in that sense is the “correct” one. However, the question remains: What are the differences, if any, between disease and disorder? For that matter, where does the often-used condition fit in? While these terms are frequently used interchangeably, differences between them do exist and can assist the person wishing to use them in more specific senses.

Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for the provision of health care (eg, pregnancy). The term might also be used to indicate grades of health (eg, a patient might be described as in stable, serious, or critical condition). While this term is often used in medical discussions to specifically indicate the presence of pathology or illness, Dorland’s Illustrated Medical Dictionary provides no definition of the term used in this sense. Merriam-Webster’s Collegiate Dictionary, however, defines condition as “a usu. defective state of health,”2(p258) and the Oxford English Dictionary similarly opines that it denotes “[a] state of health, esp. one which is poor or abnormal; a malady or sickness.”1(p309) In lay conversation condition is sometimes used euphemistically when a discreet term is desired for reference to a state of health, either well or ill—for example, delicate condition was once commonly used to refer to either pregnancy or alcoholism. Similarly, condition understood specifically to indicate the presence of pathology or illness is sometimes used as a value-neutral term when a stronger term might not be desirable. When such considerations do not come into play, a condition conferring illness can be further classified as a disease or a disorder.

“He was full of such disease. That he may nought the deth escape” (1393).1(p445)

Disease is often used in a general sense when referring to conditions affecting a physical system (eg, cardiovascular disease) or a part of the body (eg, diseases of the foot). The term also may be used in specific senses—for example, a writer might refer in general terms to neurologic disease or in specific terms to Alzheimer disease. But disease is perhaps most often used when referring to a condition that possesses specific characteristics. In this vein, Merriam-Webster’s defines disease as “a condition of the… body or one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms…”2(p358); the Oxford English Dictionary defines the word similarly but particularly stresses structural change as a cause.1(p445) Dorland’s concurs with these sources but makes clear that the impaired functioning associated with the diseased state may constitute “any deviation from or interruption of the normal structure or function…” and further elaborates that “the etiology, pathology, or prognosis may be unclear or unknown.”3(p535)

“A Fever is the first disorder that affects the Blood and Vessels” (1725).1(p449)

Compared with disease, disorder is less restrictive: Merriam-Webster’s defines it simply as “an abnormal physical or mental condition,”2(p360) a definition with which Dorland’s largely concurs.3(p555) The Oxford English Dictionary emphasizes that disorder involves a disturbance of function but again further stresses structural change, this time in negative terms, stating that disorder is “usually a weaker term than DISEASE, and not implying structural change.”1(p449) This emphasis on functional rather than structural change has been in place since at least the late 1800s, when the Lexicon of Medicine and Allied Sciences stated that disorder is “a term frequently used in medicine to imply functional disturbance, in opposition to manifest structural change.”1(p449) Because disorder, like condition, is relatively value-neutral when compared with disease, it is often used in place of the latter term when a less stigmatizing or less alarming term is desirable—eg, a clinician might at first refer to a patient’s disease as a disorder to reduce the patient’s initial anxiety; similarly, the same patient might initially refer to his or her recently diagnosed disease as a disorder in conversations with family and friends.

In short, what distinguishes condition, disease, and disorder from one another would seem to be their relative emphases on functional change, structural change, presence of signs and symptoms, and, perhaps to a lesser extent, the gravity a writer wishes to convey:

• Condition simply indicates a state of health, whether well or ill; a condition conferring illness might be further classified as a disease or a disorder—however, condition might be used in place of disease or disorder when a value-neutral term is desired.
• Disease denotes a condition characterized by functional impairment, structural change, and the presence of specific signs and symptoms. As an aside, Dorland’s equates the terms illness and sickness with disease; while these are often used to indicate the state or experience of disease, they are also sometimes used as value-neutral alternatives for disease.
• Disorder, in contrast, denotes a condition characterized by functional impairment without structural change and, while certain disorders or categories of disorders might be accompanied by specific signs and symptoms, their presence is not required for a condition to be termed a disorder. Like condition, disorder is sometimes used as a value-neutral term in place of disease.—Phil Sefton, ELS

1. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991.
2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA; Merriam-Webster Inc; 2003.
3. Dorland’s Illustrated Medical Dictionary. 31st ed. Philadelphia, PA: Saunders; 2007.

Quiz Bowl: Study Designs

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Okay, show of hands, who knows the difference between a cost-effectiveness study and a cost-benefit analysis? Can you explain what makes a study retrospective vs prospective? What’s the name for the study that pools the results of 2 or more studies to address a hypothesis?

Let’s admit it. Most manuscript editors are at a loss when it comes to understanding the different medical study designs, but at least a cursory knowledge in this area will help as you edit manuscripts. This month’s AMA Manual of Style quiz is on study designs. Test your knowledge in this area by answering the following sample question from the quiz:

Which type of study compares those who have had an outcome or event with those who have not?

case-control study

case series

cohort study

meta-analysis

Here’s the answer (use your mouse to highlight the text box):

case-control study

Of the multiple answer options given, case-control study is the most appropriate. According to the AMA Manual of Style, “Case-control studies, which are always retrospective, compare those who have had an outcome or event (cases) with those who have not (controls). A case series “describes characteristics of a group of patients with a particular disease or patients who have undergone a particular procedure.” A cohort study “follows a group or cohort of individuals who are initially free of the outcome of interest.” Finally, a meta-analysis “is a systematic pooling of the results of 2 or more studies to address a question of interest or hypothesis.”

If you want more examples to test your knowledge on study designs, take the Study Design Quiz on the AMA Manual of Style online.—Laura King, MA, ELS

Cheat Sheet for Abbreviations Style

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Abbreviations are a convenience, a time saver, a space saver, and a way of avoiding the possibility of misspelling words. However, a price can be paid for their use. Abbreviations are sometimes not understood. They can be misread, or are interpreted incorrectly. … The person who uses an abbreviation must take responsibility for making sure that it is properly interpreted.—Neil M. Davis1

Abbreviations are used widely in medical articles, and great care should be taken to provide expansions that define these abbreviations. The AMA Manual of Style includes a straightforward rule regarding the use of abbreviations: Define abbreviations at first mention by providing the expanded term first, followed by the abbreviation in parentheses, and the abbreviation is used thereafter.

But for every rule, there are exceptions.

Some Exceptions:

• Avoid creating abbreviations for terms that are easy to spell out and do not take up a lot of space. For example, it is not advisable to abbreviate “catheter ablation” as “CA” or “immune response” as “IR.” Also, avoid using too many abbreviations in any one article.

• If a term is better known as an abbreviation, provide the abbreviation first with the definition following in parentheses. “The TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling) staining assay was carried out using an apoptosis detection kit.”

• It is inelegant to begin sentences with abbreviations, unless the expansion is so unwieldy that using the abbreviation makes sense. The previous example, TUNEL, also works here. Rather than begin a sentence with the cumbersome expansion, it is acceptable to begin the sentence with the abbreviation TUNEL.

• Abbreviations should not be introduced in headings. If an abbreviation is being used for the first time in a heading, expand the abbreviation in the heading; then, at first mention in the running text after the heading, expand the abbreviation again, with the abbreviation following in parentheses. Use the abbreviation thereafter.

• Some very common abbreviations do not require expanding at first mention, such as AIDS, TNM, UV, and CD-ROM. A complete list of these abbreviations is provided in section 14.11, with those that do not require expansion denoted by an asterisk.

• The efficiency of using an abbreviation is lost if the abbreviation is used only one time, so as a rule of thumb, introduce an abbreviation only if it is used at least 2 or 3 times.

Items of Note:

• Tables, figures, and abstracts are treated as separate items from the text, so abbreviated terms must be reexpanded in each of these items.

• Use the appropriate article (a or an) before an abbreviation according to the sound following the article (eg, a UN resolution, an HMO plan).

• Use a lowercase s (and no apostrophe) when making abbreviations plural (eg, NSAIDs).—Lauren B. Fischer

1. Davis NM. MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety. 13th ed. Warminster, PA: Neil M Davis Associates; 2007:1.

Masterful, Masterly

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Writers are often taught that masterful and masterly mean different things and to ensure that they are used correctly. Masterful, so such thinking goes, is taken to mean “suggestive of a domineering nature,” or “inclined and [usually] competent to act as master,”1 whereas masterly is used to denote “having the power and skill of a master.”1

However, the use of masterful to mean “skillful” is now widespread; as Bernstein, clearly a proponent of maintaining the distinction, pithily puts it, “masterly is never misused; masterful often is….”2 Moreover, it seems that the distinction has not always been observed. Whereas masterful has been used in the sense of “domineering” since the 1330s,3 it also was used to mean “skillful” as early as 1613.3 And whereas masterly was used in the sense of “skillful” since the mid 1600s,3 it also was used to mean “domineering” as early as the 1530s,3 although that use has been obsolete since the late 18th century.3

In short, both words have been used to indicate “skillful” since roughly the time of King James I of England. However, the idea that writers should distinguish between them is comparatively new1—and such a late addition of a distinction is the reverse of the more common case, in which a distinction between words ceases to hold sway as the language evolves.

The origin of the distinction? Merriam-Websters posits that it was “excogitated by a 20th century pundit”1—this “pundit” apparently none other than Henry Watson Fowler, editor of The Pocket Oxford Dictionary, coeditor of The Concise Oxford Dictionary and The King’s English, and author of A Dictionary of Modern English Usage.4 In the latter work, Fowler established a distinction between masterful and masterly that was taken up by authorities such as Bernstein2 and that continues to be trumpeted to this day.5 Fowler’s reason for introducing the distinction? Masterly has only 1 sense (at least since its use to mean “domineering” became obsolete), so masterful should be limited to a single sense as well.1

However, some also have argued for the use of masterful in place of masterly in adverbial constructions, pointing out that although masterly is properly used as an adverb as well as an adjective, its use as an adverb seems awkward, even incorrect; eg, “He paints masterly.”2 Moreover, masterly, like many words ending in “y,” is what Bernstein (who nevertheless advocates distinguishing between the words) calls a “reluctant” adverb—ie, a word that resists serving as or being turned into an adverb.6 To make matters worse, masterly takes another adverbial form, the admittedly horrid masterlily.

Where does this leave the conscientious writer? Like Fowler, several modern authorities deem the distinction a valuable one5 and often advocate recasting a sentence to allow a more mellifluous use of a reluctant adverb5,6: hence, the sentence “Its wooden gables… showed how masterly they had been carved of old”3 might be recast as “Its wooden gables… showed the masterly manner in which they had been carved of old,” or similar. “A retreat of this kind,” Bernstein maintains, “is better than clumsy bravado.”6

At least one like-minded authority, however, has conceded that the battle to maintain the distinction—whatever its merits—has likely been lost.5 The prevalence of masterful in everyday usage confirms that opinion, receiving further support from the fact that the words have developed in roughly parallel fashion over time.3 Merriam-Websters concurs, maintaining that masterful used in the sense of “skillful” “has continued in reputable use all along; it cannot rationally be called an error.”1 Moreover, it has been suggested that using masterful in its original sense might even confuse readers now accustomed to the use of masterful to mean “skillful.”7

The bottom line:

● Using masterful in place of masterly to mean “skillful”? You’re in good company, and that usage has a long history. However:

● Set on maintaining a distinction between masterful and masterly? You can’t go wrong there, either. True enough, some readers might be confused by the use of masterful in its original sense—but since when do writers shrink from using words correctly to avoid confusion?—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:764.

2. Masterful, masterly. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:269.

3. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1045.

4. Sheidlower J. Elegant variation and all that. The Atlantic Online Web site. http://www.theatlantic.com/past/docs/issues/96dec/fowler/fowler.htm. December 1996. Accessed September 16, 2011.

5. Masterful, masterly. Good English Rules! Web site. http://www.goodenglishrules.com/masterful_masterly.htm. Accessed September 16, 2011.

6. Adverbs, reluctant. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:27.

7. Masterful vs. masterly. Grammarist Web site. http://www.grammarist.com/usage/masterful-masterly/. Accessed September 16, 2011.

Purposely, Purposefully

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These words sound similar, and over time their meanings have come to overlap somewhat. Generally, however, they are regarded as having different meanings and uses—although the differences are admittedly subtle—and in choosing between them, writers should carefully consider the message they wish to convey.

Purposely—meaning “with a deliberate or express purpose”1 or “intentionally”2—was first on the scene, entering usage in the late 1400s.2 A second meaning, “to good purpose; effectively,” came into use about 100 years later but is now considered obsolete.2

In contrast, purposefully—meaning “full of determination”1—was a relative latecomer, not coming into use until the mid 1800s,2 and is still used in those senses. Over time, though, purposefully also has come to be used interchangeably with purposely in the sense of “intentionally,”2 perhaps because something done with determination is also done intentionally. But of course the reverse is not necessarily true, which suggests that writers should use purposely when referring to intention alone.

To some ears, however, purposely sounds uneducated or incorrect, leading some writers to instead use purposefully in error; moreover, writers simply looking for a more impressive word will also sometimes instead use purposefully—again incorrectly.3 But even when purposefully is the correct choice, writers should take care that their intended meaning is not misconstrued. For example, the statement “On occasion, a clinician might purposely elicit pain” likely simply means that the clinician is intentionally eliciting pain (for the purpose of making a diagnosis). On the other hand, the statement “On occasion, a clinician might purposefully elicit pain” might imply that the clinician is determinedly eliciting pain (again—one can only hope—for the purpose of making a diagnosis). In both instances, careful handling of the context can make clear that the elicitation of pain is a necessary evil in service of a worthy end. For example, simply ending either of the above statements with “to help make a diagnosis” can go a long way toward ensuring that the clinician is not construed as something of a sadist.

The bottom line:

●Is “intentionally” the intended message? Use purposely.

●Is “full of determination” the intended message? Use purposefully.

●In both cases, however, take care to ensure that the context helps readers determine the intended meaning.—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:1011.

2. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1474.

3. Purposefully, purposely. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:376.

Jarring Jargon

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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

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“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

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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.

Quiz Bowl: It’s All Greek to Me!

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Is it interferon-gamma or interferon-γ? Do we use kappa or κ free light chain? I don’t know—it’s all Greek to me! If you’re like me, you struggle with whether to use Greek words or letters.  Test your knowledge on the usage of Greek letters vs words by selecting which italicized term is correct in the following sentence. For further explanation of the correct answer, refer to chapter 17 (pp 781-783 in print). Then check out this month’s quiz, which subscribers can find at http://www.amamanualofstyle.com/ for more questions.

An elevated serum alpha-fetoprotein or α-fetoprotein level before orthotopic liver transplantation is predictive of mortality after orthotopic liver transplantation for hepatocellular carcinoma.

So, what do you think? Would you use alpha-fetoprotein or α-fetoprotein? Here’s the answer (use your mouse to highlight the text box):

An elevated serum α-fetoprotein level before orthotopic liver transplantation is predictive of mortality after orthotopic liver transplantation for hepatocellular carcinoma.

The AMA Manual of Style recommends the use of Greek letters rather than spelled-out words, unless usage dictates otherwise. Consult Dorland’s and Stedman’s medical dictionaries for general terms. These sources may differ in the representation of terms, ie, α-fetoprotein (Stedman’s) and alpha fetoprotein (Dorland’s). If the Greek letter, rather than the word, is found in either of these sources for the item in question, use the letter in preference to the word (§17.1, Greek Letter vs Word, p 781 in print).

If you want to learn more about usage of Greek letters vs words, take the full quiz on the AMA Manual of Style online—Laura King, MA, ELS

Questions From Users of the Manual

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Q: I’m not sure when I should use “rheumatologic” vs “rheumatological.”  Is there a subtle difference I don’t know about?

A: The use of “-ic” vs “-ical” is addressed in the Manual on page 396 in the Correct and Preferred Usage chapter.  You’ll note that there are a few instances in which the choice of ending does make a difference in meaning.  With “rheumatologic” vs “rheumatological” I do not believe there is such a difference in meaning and we would be more likely to choose the “-ic” ending for the rationale described on page 396.

Q: I’ve always followed Edie Schwager’s advice in Medical English Usage and Abusage (p 153):

If you remember to prevent, you’ll never choose the obsolete “preventative” instead of “preventive.”  The noun is prevention, not “preventation.”

Do you agree?

A: We agree with Edie.  We also prefer preventive.  Webster’s 11th edition shows the 2 words as equal in meaning but shows a preference for preventive as well.  Consensus!

Q: In section 3.15.3 of the Manual, the words “Web site” are used in examples 1 through 3 and 6, but are not used in examples 4 and 5.  What is the rationale for these differences?

A: This is an excellent question and points out an inconsistency that should be corrected.  I would include “Web site” in examples 4 and 5 as well.  In our next edition, I think we will need to consider if the inclusion of “Web site” is necessary or helpful.  In the current edition, we decided to drop the inclusion of “Available from:” before the URL as we thought that URLs were now well enough known that they did not need this extra identifier.  Perhaps this will also become the case with “Web site.”

Q: When an author’s surname includes 2 names not joined by a hyphen, which name should be included in the reference citation?

A: To assist in answering this question, I consulted Lou Knecht, Deputy Chief, Bibliographic Services Division, at the National Library of Medicine (NLM).  She said that the surname is determined by the preference of the author and she stressed the important role played by the author in presenting this information clearly to the publisher. Publishers also play an important role in clarifying the surname, for example, by using some  typographic device (eg, boldface on the author’s surname in the byline or in the table of contents) to make clear which is the surname.  She notes, “If the journal does not use some sort of surname indicator technique, then both the journal and NLM are left to make their best guesses.  And we frequently guess wrong.”   If NLM is contacted by an author to correct an incorrect surname (ie, the name is presented in direct order in the text and you cannot tell what the surname is), they will gladly do this.  They also monitor authors’ preferences for surname, so once NLM is contacted the first time about an incorrect surname, they enter the complicated surname into a table for the future.  If, however, the surname is published incorrectly, this requires an erratum.—Cheryl Iverson, MA