{"id":34158,"date":"2015-05-08T16:52:36","date_gmt":"2015-05-08T15:52:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=34158"},"modified":"2015-05-11T09:01:08","modified_gmt":"2015-05-11T08:01:08","slug":"jeffrey-aronson-when-i-use-a-word-think-about-dis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/08\/jeffrey-aronson-when-i-use-a-word-think-about-dis\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . \u00feink about \u00f0is"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft  wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"155\" height=\"209\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg 223w, https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg 446w\" sizes=\"auto, (max-width: 155px) 100vw, 155px\" \/><\/a>In each of the following pairs of generic drug names one is the International Nonproprietary Name (INN) and the other is not:<\/p>\n<p>\u2022 beclomethasone\/beclometasone<br \/>\n\u2022 betamethasone\/betametasone<br \/>\n\u2022 chlorthalidone\/chlortalidone<br \/>\n\u2022 ethacrynic acid\/etacrynic acid<br \/>\n\u2022 indomethacin\/indometacin<\/p>\n<p>Before you read on, decide which you think is the INN in each case.<!--more--><\/p>\n<p>You may be surprised to see from the entries in the World Health Organization\u2019s website (figure, below, click to enlarge) that in all these cases bar one the INN is the version with the <em>t<\/em> and not the <em>th<\/em> in the name.<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming4.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-34162\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming4-300x102.png\" alt=\"aronson_naming4\" width=\"465\" height=\"158\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming4-300x102.png 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming4.png 695w\" sizes=\"auto, (max-width: 465px) 100vw, 465px\" \/><\/a><\/p>\n<p><em>Extracts from the WHO\u2019s lists of INNs<\/em><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming3.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-medium wp-image-34161\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming3-167x300.png\" alt=\"aronson_naming3\" width=\"167\" height=\"300\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming3-167x300.png 167w, https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming3.png 239w\" sizes=\"auto, (max-width: 167px) 100vw, 167px\" \/><\/a><\/p>\n<p>The exception is betamethasone, and even that is problematic (figure, right). The explanation is in Principle 7\u00a0in the WHO\u2019s &#8220;<a href=\"http:\/\/www.who.int\/medicines\/services\/inn\/innquidance\/en\/\">naming principles for designation of INNs<\/a>:&#8221;<\/p>\n<p><em>To facilitate the translation and pronunciation of INN, &#8220;f&#8221; should be used instead of &#8220;ph,&#8221; &#8220;t&#8221; instead of &#8220;th,&#8221; &#8220;e&#8221; instead of &#8220;ae&#8221; or &#8220;oe,&#8221; and &#8220;i&#8221; instead of &#8220;y&#8221;; the use of the letters &#8220;h&#8221; and &#8220;k&#8221; should be avoided. When devising an INN it is important to be aware of possible language problems. Since the name is used worldwide, not only should certain letters be avoided, but experts need to be aware of unsuitable connotations in the major languages spoken in the world.<\/em><\/p>\n<p>But Principle 7 is not uniformly applied. The t\/th examples show this, as do amfetamine\/amphotericin, netilmicin\/erythromycin, hypromellose and talimogene laherparepvec (yes really), and ketamine and ustekinumab. Furthermore, since English is the scientific lingua franca, the commonly used forms are often not the INNs. I looked for the drug names above in the titles of papers indexed in Pubmed; most authors use <em>th<\/em> (table, click to enlarge).<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming7.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  wp-image-34166\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming7-300x88.png\" alt=\"aronson_naming7\" width=\"368\" height=\"108\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming7-300x88.png 300w, https:\/\/blogs.bmj.com\/bmj\/files\/2015\/05\/aronson_naming7.png 757w\" sizes=\"auto, (max-width: 368px) 100vw, 368px\" \/><\/a><\/p>\n<p>If you make the sound of the hissing phoneme <em>ssss<\/em>, a <a href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/03\/13\/jeffrey-aronson-when-i-use-a-word-pecksniffery\">voiceless alveolar fricative<\/a>, and then move the tip of your tongue to touch your upper teeth the sound will become <em>th<\/em>, as in \u201cthink,\u201d a voiceless interdental fricative. If you phonate at the same time it will be <em>th<\/em> as in \u201cthis,\u201d a voiced interdental fricative. In Old English and Icelandic these two phonemes were called thorn (voiceless <em>th<\/em>) and eth (voiced <em>th<\/em>). The corresponding runes were \u00fe and \u00f0. In Late Old English manuscripts these two symbols (graphemes) were used more or less interchangeably, the voicing being dictated by the surrounding sounds. However, when the Danish philologist <a href=\"http:\/\/www.encyclopedia.com\/topic\/Otto_Jespersen.aspx\">Otto Jespersen <\/a>created a phonetic transcription scheme, he allotted \u00fe and \u00f0 specifically to the two different <em>th<\/em> sounds, voiced (\u00f0) and unvoiced (\u00fe). Later on, \u00f0 was adopted in the International Phonetic Alphabet, but \u00fe was replaced by \u03b8, the Greek theta.<\/p>\n<p>The thorn grapheme is typographically problematic. It was sometimes represented by overtyping <em>b<\/em> and <em>p<\/em> and sometimes by a slash followed by a lower case <em>o<\/em>. And in old English manuscripts it was often represented as y, because of the similarity of the two letters. So \u201cthe,\u201d \u201cthis,\u201d and \u201cthat\u201d became \u201cye,\u201d \u201cyis,\u201d and \u201cyat\u201d or \u201cyt.\u201d If you want your establishment to appear to be old standing you can call it, say, Ye Olde Tea Shoppe, jocularly pronounced \u201coldie shoppie,\u201d or perhaps <a href=\"http:\/\/www.oneidapizza.com\/ordereze\/default.aspx\">Ye Olde Pizza Pub<\/a>.<\/p>\n<p><a href=\"http:\/\/ham549.deviantart.com\/art\/ye-old-periodic-table-297608017\">Ye Olde Periodic Table<\/a> contains four elements, the solid earth (Ea), the transitional water (Wa), and the non-solid Air (Ai), and Fire (Fi). Aristotle would have been impressed, even if Mendeleyev might have demurred.<\/p>\n<p><em><strong>Jeffrey Aronson<\/strong> is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p>Competing interests:\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In each of the following pairs of generic drug names one is the International Nonproprietary Name (INN) and the other is not: \u2022 beclomethasone\/beclometasone \u2022 betamethasone\/betametasone \u2022 chlorthalidone\/chlortalidone \u2022 ethacrynic [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/08\/jeffrey-aronson-when-i-use-a-word-think-about-dis\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-34158","post","type-post","status-publish","format-standard","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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