Richard Smith: The corruption of medical language

richard_smith_2014A young doctor friend sends me a link to a piece he has written in the Guardian newspaper. I praise the simplicity and clarity of the language and suggest that next time he sends a piece to an academic journal he uses the same language. “But will the editors accept it?” he asks me. I’d like to think that they’d prefer it, but I fear that his anxiety about a piece in clear, simple language being rejected may be right, at least with some editors. Why on earth should that be?

Almost everything, I believe, can be expressed in simple, clear language that everybody can understand, and authors often use complex language because they don’t fully understand what they are trying to say. “Good prose,” said George Orwell, “is like a window pane”: you see straight through it to what the author is trying to say. I accept that there are ideas—as in theoretical physics—so complex that simple language will not suffice; but even with theoretical physics I think of the marvellous writing of Carlo Rovelli, who shows to everybody how theoretical physics has the magic of poetry. Of course, the language of theoretical physics is not words at all but mathematics—and few of us know enough maths to understand it.

I accept as well that if writing for a technical audience then it makes sense to use their language. Doctors will know what you mean by “glomerulonephritis,” and it wouldn’t make sense when writing for doctors to explain each time what it is, especially as some doctors, most obviously nephrologists, will have in their minds a whole mountain of information about glomerulonephritis. But there aren’t ideas in that mountain that could not be explained in clear, simple language if the author wanted to.

Too often, I suggest, academic journals are filled with complex language because authors are too lazy or too incompetent to write clearly or, worst of all, because they want to make their writing seem grander and more important than it actually is. Michael O’Donnell, one of medicine’s best writers, famously called this style of academic writing “decorated municipal gothic.” Such writing, he said, “must be long, tortuous, opaque, uninteresting, and possess a ‘built-in quality of unreadability.’” Its main purpose, he argued, was not to inform the reader but to ennoble the writer.

O’Donnell identified two causes of “decorated municipal gothic.” One is that academic writers are not concerned with readers but rather with extending their list of publications. Real writing is about condensation of ideas, whereas academics are often trying to get as many words as possible from a small amount of information.

The second cause is relevant to my young friend in that they believe that there is “a norm out there to which they must conform.” Understandably, they read the turgid prose in academic journals and think that is the way they must write to be published. In addition, they have often been badly taught—taught, indeed, to write badly. They half remember, said O’Donnell, “the rules their decrepit chemistry teacher taught them all those years ago: never use the first person; always use the passive construction; no colloquialisms; and Latin and Greek give an air of erudition—rules that are totally outdated.”

I can remember being taught to write “decorated municipal gothic” when writing a thesis as a medical student. I rage particularly about being told to write in the passive voice—“the cat was sat on by the mat” rather than “the cat sat on the mat,” in case you are not sure. My teasing example immediately shows you that the active is easier to read. It also gives more information: instead of writing “the experiment was conducted,” you have to disclose who conducted it. “I did the experiment,” or “Mickey Mouse did it.” “Did” is Anglo-Saxon, “conducted” is the Latin (or is it Greek?). Indeed, the passive voice is dishonest and self-deluding: we fool ourselves that when doing science we become wholly objective, discarding all the human foibles that can get in the way of excellent science.

The snobbish tendency to rank “decorated municipal gothic” above plain language is not unique to medicine. My wife, an artist, refers to the “art bollocks” that is used by art academics. J K Galbraith and A J P Taylor, both wonderful and insightful writers, were looked down on by academics for writing so clearly in a way that non-academics could read and enjoy. I suspect jealousy.

The best piece of writing on writing that I know is George Orwell’s Politics and the English Language. In the short essay he enumerates the rules of writing good English (mostly the opposite of those of the “decrepit chemistry teacher”), but his central argument is that politics corrupts language. Good writing is saying something as clearly and simply as possible, but politicians are usually concerned with the opposite—making grand statements that have no substance because substance is commitment. Political language, wrote Orwell, “is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.”

“Decorated municipal gothic” is not quite concerned “to make lies sound truthful and murder respectable,” but it may be trying “to give an appearance of solidity to pure wind” or at least to make a few trivial observations seem important.

I urge my young friend to persist with his simple language, but reading the language in many scientific journals I fear that he may have to translate his words into “decorated municipal gothic” in order to advance his career. How sad.

Author’s note: Since writing this blog and finishing the Elements of Eloquence: How to Turn the Perfect English Phrase by Mark Forsyth I have partially recanted. You can read my recantation here.

Richard Smith was the editor of The BMJ until 2004.

Competing interests: None declared.