{"id":44339,"date":"2019-03-29T16:14:02","date_gmt":"2019-03-29T15:14:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44339"},"modified":"2019-04-05T21:48:31","modified_gmt":"2019-04-05T20:48:31","slug":"jeffrey-aronson-when-i-use-a-word-medically-meaningful","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/29\/jeffrey-aronson-when-i-use-a-word-medically-meaningful\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . .  Medically meaningful"},"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=\"106\" height=\"131\" \/><\/a><span style=\"font-weight: 400\">I suggested <\/span><a href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/22\/jeffrey-aronson-when-i-use-a-word-truly-meaningful\"><span style=\"font-weight: 400\">last week<\/span><\/a><span style=\"font-weight: 400\"> that \u201cmeaningful\u201d more often means \u201cmeaningless\u201d than any of the other possible meanings that it has acquired. As for the so-called \u201cmeaningful votes\u201d in the House of Commons, is one to believe that all previous votes have been meaningless?<\/span><\/p>\n<p><span style=\"font-weight: 400\">The <\/span><i><span style=\"font-weight: 400\">Oxford English Dictionary<\/span><\/i><span style=\"font-weight: 400\"> (<\/span><i><span style=\"font-weight: 400\">OED<\/span><\/i><span style=\"font-weight: 400\">) offers several definitions of \u201cmeaningful\u201d:<\/span><\/p>\n<p><span style=\"font-weight: 400\">1<\/span> <span style=\"font-weight: 400\">a.<\/span> <span style=\"font-weight: 400\">Full of meaning or expression, significant; communicating something that is not explicitly or directly expressed.<\/span><br \/>\n<span style=\"font-weight: 400\">1 b. Having a serious, important, or recognizable quality or purpose.<\/span><br \/>\n<span style=\"font-weight: 400\">2.<\/span> <span style=\"font-weight: 400\">Of a word, sound, etc.: conveying meaning; (<\/span><i><span style=\"font-weight: 400\">Logic and Philosophy<\/span><\/i><span style=\"font-weight: 400\">) compatible with the rules of a logical language or other sign system; able to function as a term in such a system.<\/span><br \/>\n<span style=\"font-weight: 400\">3.<\/span> <span style=\"font-weight: 400\">Of data or its presentation: accurate and realistic; of practical use<\/span><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Those who coined the term \u201cmeaningful vote\u201d seem to have had meaning 1a in mind.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Modern dictionaries are descriptive\u2014their definitions reflect what those who use the words intend them to mean or think they mean. For example, \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19359252\"><span style=\"font-weight: 400\">fulsome<\/span><\/a><span style=\"font-weight: 400\">\u201d originally (13<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\">C) meant \u201ccharacterized by abundance, possessing or affording copious supply\u201d. Then it came to mean overgrown and rank, rather than simply abundant (17<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\">C). Now, according to the <\/span><i><span style=\"font-weight: 400\">OED<\/span><\/i><span style=\"font-weight: 400\">, it is \u201cchiefly used in reference to gross or excessive flattery, over-demonstrative affection, or the like\u201d. And if enough people think that\u2019s what it means, and use it often enough, then that\u2019s what it means. Fortunately, no-one has yet invented the word \u201cmeaningfulsome\u201d.<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">Collins English Dictionary<\/span><\/i><span style=\"font-weight: 400\"> gives a range of <\/span><a href=\"https:\/\/www.collinsdictionary.com\/dictionary\/english-thesaurus\/meaningful#meaningful__1\"><span style=\"font-weight: 400\">synonyms<\/span><\/a><span style=\"font-weight: 400\"> for \u201cmeaningful\u201d:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">in the sense of significant: important, serious, material, useful, relevant, valid, worthwhile, purposeful;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">in the sense of expressive: suggestive, meaning, pointed, speaking, pregnant;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">in the sense of important: significant, critical, substantial, grave, urgent, serious, material, signal, primary, far-reaching, momentous, seminal, weighty, of substance, salient, noteworthy;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">in the sense of material: relevant, important, significant, essential, vital, key, serious, grave, meaningful, applicable, indispensable, momentous, weighty, pertinent, consequential, apposite, apropos, germane.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">The frequencies with which the term \u201cmeaningful\u201d appears in bioscience papers are shown in Figure 1. It was uncommonly used before 1975, but then, for no obvious reason, its use burgeoned. \u201cClinically meaningful\u201d [or \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3616284\"><span style=\"font-weight: 400\">medically meaningful<\/span><\/a><span style=\"font-weight: 400\">\u201d or \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6014700\"><span style=\"font-weight: 400\">therapeutically meaningful<\/span><\/a><span style=\"font-weight: 400\">\u201d] occurs in just over 15% of all cases (10% of titles), when \u201cclinically relevant\u201d or \u201cclinically important\u201d, which is what it can be taken to mean in most cases, might be better. There are also a few instances of \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11151395\"><span style=\"font-weight: 400\">clinically meaningful difference<\/span><\/a><span style=\"font-weight: 400\">\u201d. By contrast, \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21552532\"><span style=\"font-weight: 400\">statistically meaningful<\/span><\/a><span style=\"font-weight: 400\">\u201d occurs less than 1% of the time.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-44340 alignnone\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/03\/aronson_medical_meaningful.jpg\" alt=\"\" width=\"560\" height=\"586\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/03\/aronson_medical_meaningful.jpg 560w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/03\/aronson_medical_meaningful-287x300.jpg 287w\" sizes=\"auto, (max-width: 560px) 100vw, 560px\" \/><\/p>\n<p><b>Figure 1.<\/b><span style=\"font-weight: 400\"> Instances of \u201cmeaningful\u201d in bioscience publications (source PubMed) as a fraction of all publications 1965\u20132018; top panel \u201cmeaningful\u201d as a text word\u2014between 1946 and 1974 there were 270 instances in all, but in 1975 alone 178; bottom panel \u201cmeaningful\u201d in titles<\/span><\/p>\n<p><span style=\"font-weight: 400\">Occasionally, \u201cmeaningful\u201d is criticized. An excellent example is to be found in a 1971 issue of the journal <\/span><i><span style=\"font-weight: 400\">Science<\/span><\/i><span style=\"font-weight: 400\">, highlighting a requirement of the US Food and Drug Administration (FDA) that the effectiveness of a medicinal product should be demonstrated to be \u201cclinically meaningful\u201d. In Table 1 I have summarized the authors\u2019 cogent arguments against this usage. They ended their analysis thus: \u201cWe hope the scientific community will become aware of the FDA&#8217;s use of the phrase \u2018clinically meaningful\u2019 and respond in a positive fashion to this imminent regulatory development.\u201d The FDA has continued to use the term \u201cclinically meaningful\u201d (currently over 1400 hits on their <\/span><a href=\"https:\/\/search.usa.gov\/search?utf8=%E2%9C%93&amp;affiliate=fda&amp;query=%22clinically+meaningful%22&amp;commit=Search\"><span style=\"font-weight: 400\">website<\/span><\/a><span style=\"font-weight: 400\">). Freund &amp; Preston have been cited relevantly only <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/925189\"><span style=\"font-weight: 400\">once<\/span><\/a><span style=\"font-weight: 400\">. And if the data in Figure 1 are anything to go by, their exhortation seems to have fallen on generally deaf ears.<\/span><\/p>\n<p><b>Table 1.<\/b><span style=\"font-weight: 400\"> A summary of comments by <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4923357\"><span style=\"font-weight: 400\">Freund &amp; Preston<\/span><\/a><span style=\"font-weight: 400\"> on the FDA\u2019s 1971 requirement for evidence of &#8220;clinically meaningful&#8221; effectiveness<\/span><\/p>\n<table>\n<tbody>\n<tr style=\"border: 1px solid black\">\n<td style=\"border: 1px solid black\">\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">\u201cClinically meaningful\u201d defies definition<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Even if it could be defined, it poses the problem of finding a satisfactory way to deal with the inherently multivariate criteria that must be required for even the least complicated disease or condition<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Clinical trials may be inadequate in demonstrating such \u201cmeaningfulness\u201d and there is a risk of rejecting useful medications<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Evaluation will be unpredictable and subject to the whims and prejudices of individual \u201cexperts\u201d (their emphasis)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">There are legal requirements to ensure that there is \u201csubstantial evidence that the drug will have the effect it purports or is represented to have under the conditions of use prescribed, recommended, or suggested in the proposed labeling thereof &#8230;\u201d [quoting from an FDA document], which do not give the FDA a licence to introduce value judgements<\/span><\/li>\n<\/ol>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\">With due deference to the several dictionaries that I have consulted, I suggest that there is another meaning of \u201cmeaningful\u201d, one that I haven\u2019t found in any of them, but which should, I think, be included: \u201cMeaningless, used unintentionally in this sense by those who do not understand the meaning of \u2018meaning\u2019\u201d.<\/span><\/p>\n<p><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>I suggested last week that \u201cmeaningful\u201d more often means \u201cmeaningless\u201d than any of the other possible meanings that it has acquired. As for the so-called \u201cmeaningful votes\u201d in the House [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/29\/jeffrey-aronson-when-i-use-a-word-medically-meaningful\/\">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-44339","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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As for the so-called \u201cmeaningful votes\u201d in the House [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/29\/jeffrey-aronson-when-i-use-a-word-medically-meaningful\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2019-03-29T15:14:02+00:00","article_modified_time":"2019-04-05T20:48:31+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/29\/jeffrey-aronson-when-i-use-a-word-medically-meaningful\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/29\/jeffrey-aronson-when-i-use-a-word-medically-meaningful\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Jeffrey Aronson: When I use a word . . . 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