Say what you mean

Why cannot people say, or write, what they mean? One reason for obfuscation is that it conceals the banality of what the person says or writes. It can also make something simple sound complex, impressive and highly technical. In a world in which we are subliminally humiliated by the fact that we employ technology whose workings we do not in the least understand, but upon which we are utterly dependent, we all like to think that there is something that we know and master that is incomprehensible to the great mass of mankind. Incomprehensibility thus becomes a sign of superior knowledge and intelligence rather than of laziness or an inadequate mastery of language.

I was struck recently by a phrase in several scientific papers in the New England Journal of Medicine, perhaps the most influential general medical journal in the world. The papers reported trials of relatively short treatment regimes for tuberculosis using a drug called moxifloxacin. Tuberculosis takes a long time to treat and compliance with treatment decreases with its length, causing relapses of the disease (as well as favouring the emergence of drug-resistant germs); therefore a shorter period of treatment, provided it worked, would be advantageous all round. The trials compared 4-month drug regimes with the antibiotic moxafloxacin with 6-month ones that are known to be effective.

All of the reports of the trials reported their results in the following fashion: ‘The 4-month regimen was not noninferior to the control regimen.’

One has to think what this means. I am not against thought, of course, but it should not be exercised – wasted – on trying to work out what something means when it could have been expressed much more clearly. I have tried the above sentence on several highly intelligent people and they have all found it puzzling, often giving a wrong meaning to it initially. Actually, what the sentence means must be ‘the 4-month regimen was worse than the control regime.’ Why not say so?

In one of the papers there was an added verbal contortion: ‘Noninferiority of the 4-month regimen to the standard regimen with respect to the primary efficacy end point was not shown.’ What this means is that the researchers failed to demonstrate that the 4-month regimen was as good as the control regimen.

I try to write clearly. I think that on the whole I succeed. On the other hand, I may just be suffering from a non-inferiority complex. But then again, I might not be.

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