{"id":41672,"date":"2018-03-16T11:55:11","date_gmt":"2018-03-16T10:55:11","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41672"},"modified":"2018-03-23T13:23:13","modified_gmt":"2018-03-23T12:23:13","slug":"jeffrey-aronson-when-i-use-a-word-criteria","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/03\/16\/jeffrey-aronson-when-i-use-a-word-criteria\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Criteria"},"content":{"rendered":"<figure id=\"attachment_41675\" aria-describedby=\"caption-attachment-41675\" style=\"width: 192px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-41675\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/03\/aronson_criteria2.jpg\" alt=\"\" width=\"192\" height=\"241\" \/><figcaption id=\"caption-attachment-41675\" class=\"wp-caption-text\">Henry Cohen (1900\u20131977)<\/figcaption><\/figure>\n<p class=\"c0 c9\">In 1965 Sir Austin (\u201cTony\u201d) <span class=\"c5\"><a class=\"c1\" href=\"https:\/\/www.jstor.org\/stable\/pdf\/2983156.pdf?refreqid%3Dexcelsior%253A864eec7659f917c1bb24d68b96fc085c&amp;sa=D&amp;ust=1521196831983000&amp;usg=AFQjCNFianbjyGCHCRZ-GIukKdvogIOWlA\">Bradford Hill<\/a><\/span>, professor emeritus of medical statistics in the University of London, gave a lecture to the Royal Society of Medicine\u2019s newly formed Section of Occupational Medicine, of which he was the president. <span class=\"c5\"><a class=\"c1\" href=\"https:\/\/livesonline.rcseng.ac.uk\/biogs\/E006354b.htm\">Henry Cohen<\/a><\/span>, Lord Cohen of Birkenhead, was the president of the society itself at the time.<\/p>\n<p class=\"c0\"><span class=\"c2\">In his lecture, titled \u201cThe Environment and Disease: Association or Causation?\u201d, Hill posed a problem: \u201cOur observations reveal an association between two variables, perfectly clear-cut and beyond what we would care to attribute to the play of chance. What aspects of that association should we especially consider before deciding that the most likely interpretation of it is causation?\u201d Hill wisely eschewed a philosophical discussion of the meaning of \u201ccausation\u201d, and instead described what he called \u201caspects of an association\u201d and \u201cnine different viewpoints\u201d that he suggested could help in analysing causation in such associations.<\/span><\/p>\n<figure id=\"attachment_41674\" aria-describedby=\"caption-attachment-41674\" style=\"width: 213px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-41674\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/03\/aronson_criteria.jpg\" alt=\"\" width=\"213\" height=\"275\" \/><figcaption id=\"caption-attachment-41674\" class=\"wp-caption-text\">Austin Bradford Hill (1897\u20131991)<\/figcaption><\/figure>\n<p class=\"c0\">The <span class=\"c5\"><a class=\"c1\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1898525\/\">published version<\/a><\/span>\u00a0of Hill\u2019s lecture has been cited over 7600 times, according to Google Scholar, including over 50 citations of the <span class=\"c5\"><a class=\"c1\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4291332\/\">version<\/a><\/span>\u00a0that was published in the <em><span class=\"c10\">Journal of the Royal Society of Medicine<\/span><\/em><span class=\"c2\">\u00a0in 2015. His nine viewpoints have almost always been called \u201ccriteria\u201d, even though they are, all but one, not criteria at all.<\/span><\/p>\n<p class=\"c0\"><span class=\"c5\"><a class=\"c1\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/03\/09\/jeffrey-aronson-when-i-use-a-word-carnitine\/\">Last week<\/a><\/span><span class=\"c2\">, I discussed the versatile IndoEuropean root (S)KER, with meanings such as cut, pluck, scratch, and separate. A metathetical variant, KREI, extends these meanings to ideas of distinguishing things from each other and sieving as a separating mechanism.<\/span><\/p>\n<p class=\"c0\"><span class=\"c2\">In Greek the verb \u03ba\u03c1\u03af\u03bd\u03b5\u03b9\u03bd means to separate, giving us the many adjectives that describe glands whose secretions separate in different ways:<\/span><\/p>\n<ul class=\"c13 lst-kix_list_27-0 start\">\n<li class=\"c0 c4\"><span class=\"c2\">apocrine\u2014describing glands whose cells lose their protoplasm during secretion;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">autocrine\u2014describing glands whose cells have receptors for the substance they secrete;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">eccrine\u2014describing sweat glands that secrete without loss of protoplasm;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">endocrine\u2014describing glands whose secretions drain into blood or lymph;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">exocrine\u2014describing glands whose secretions drain via ducts into cavities;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">holocrine\u2014describing glands whose secretions are produced by disintegration of\u00a0their cells;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">neurocrine, neuroendocrine\u2014describing secretion by cells of neural origin or in response to neural stimulation;<\/span><\/li>\n<li class=\"c0 c4\"><span class=\"c2\">paracrine\u2014describing hormones whose effects are confined to tissues in the vicinity of the glands secreting them.<\/span><\/li>\n<\/ul>\n<p id=\"h.gjdgxs\" class=\"c0\"><span class=\"c2\">The word \u201csecretion\u201d comes from the same root, through the Latin derivative, cernere, to decide or determine, giving us words such as certain, ascertain, concern, decree, discern, disconcert, discrete, and through secernere, to separate, secret, secretary, secrete, and secretion.<\/span><\/p>\n<p class=\"c0\"><span class=\"c2\">The holes in the cribriform plate in the ethmoid bone, through which the branches of the olfactory nerve pass, give it the appearance of a sieve (Latin cribrum).<\/span><\/p>\n<p class=\"c0\"><span class=\"c2\">Add MEN (to think), and we get KREI-MEN. In Latin crimen means a charge or accusation, distinguishing, through the scrutiny of evidence, whether someone is or is not a criminal.<\/span><\/p>\n<p class=\"c0\"><span class=\"c2\">From \u03ba\u03c1\u03af\u03bd\u03b5\u03b9\u03bd comes the noun \u03ba\u03c1\u03af\u03c3\u03b9\u03c2, discrimination, giving us crisis, the point at which a disease changes, leading to recovery or death. A critic discriminates good from bad, or tries to.<\/span><\/p>\n<p class=\"c0\">A criterion is \u201ca test, principle, rule, canon, or standard, by which anything is judged or estimated\u201d (<em><span class=\"c10\">Oxford English Dictionary<\/span><\/em><span class=\"c2\">). It distinguishes one thing from another by strict tests\u2014criteria need to be met for the tests to be passed.<\/span><\/p>\n<p class=\"c0\"><span class=\"c2\">After describing his viewpoints, Hill wrote, \u201cWhat I do not believe . . . is that we can usefully lay down some hard and fast rules of evidence that must be obeyed before we accept cause and effect. None of my nine viewpoints can bring indisputable evidence for or against the cause-and-effect hypothesis and none can be required as a sine qua non. What they can do, with greater or less strength, is to help us to make up our minds on the fundamental question\u2014is there any other way of explaining the set of facts before us, is there any other answer equally, or more, likely than cause and effect?\u201d Hill\u2019s viewpoints are not criteria. We could just call them, as he did, \u201cviewpoints\u201d or, in the modern style, \u201cguidelines\u201d.<\/span><\/p>\n<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=\"79\" height=\"97\" \/><\/a><em><strong>Jeffrey Aronson<\/strong>\u00a0is 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><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In 1965 Sir Austin (\u201cTony\u201d) Bradford Hill, professor emeritus of medical statistics in the University of London, gave a lecture to the Royal Society of Medicine\u2019s newly formed Section of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/03\/16\/jeffrey-aronson-when-i-use-a-word-criteria\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-41672","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I Use a Word . . . 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