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American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 1534-1536, (2002)
© 2002 American Thoracic Society

Editorial

Compliance (COMmunicate PLease wIth Less Abbreviations, Noun Clusters, and Exclusiveness)

Martin J. Tobin, Editor

Abbreviations: AGA = appropriate for gestational age • AR = arousal • BLM = bleomycin • CTL = control • CTL = cytotoxic T lymphocytes • CR = complete response • DH = dynamic hyperinflation • DH = diaphragmatic hernia • DZ = dizygotic • EIF = electrically induced fatigue • ETX = endotoxin • FLAP = 5-LO-actvating protein • GGEMG/Pepi = genioglossus electromyography/epiglottic pressure • HASM = human airway smooth muscle cells • IRL = inspiratory resistive load • ITGV = intrathoracic gas volume • JEM = job exposure matrix • KO = knockout • LAM = lymphangioleiomyomatosis • LB = lymphocytic bronchiolitis • MAP = mean arterial pressure • MAP = mitogen-activated protein • MAP = multivariate apnea prediction • MIP = macrophage inflammatory protein • MIP = maximum inspiratory pressure • MPP = microorganisms with potential pathogenicity • NTHi = non-typeable Haemophilus influenzae • OI = orthostatic intolerance • OI = oxygenation index • OT = operating theater • PATC = pulmonary antibiotic tissue concentration • QWB = quality of well being • ROFA = residual oily fly ash • SLB = surgical lung biopsy • TWG = total water gradient • TST = tuberculin skin test • TST = total sleep time • UC = usual care • UIP = usual interstitial pneumonia • UIP = upper inflection point • Vuip1 = volume of UIP • UPPP = uvulopalatopharyngoplasty • WG = weight gain • Xrs5 = reactance at 5 Hz with impulse oscillation technique • Yr6 = age 6 years • Zds = impedance of compressible gas

There should be only one reason for researchers to publish a paper: to report new findings and allow others to build on them. But a report that is difficult to read defeats its primary purpose: communication. To reach the widest audience, researchers need to present their findings simply, clearly, and precisely, arrange their ideas in an orderly manner, and use logic as the glue holding the ideas together (1). Good writing is like a clean window, allowing the reader to see directly into the writer's mind (2). Too often, scientific prose is like ground glass, where the reader glimpses only a foggy outline of the content inside.

In this issue of the Journal (pp. 1607–1608), Farber (3) draws attention to the burden that abbreviations impose on readers. The reader must first decipher the writer's code before finding the science within the article. This task is frustrating, and it distracts the reader from concentrating on the science.

An abbreviation is usually made from the first letters (or first two letters) of successive words or important syllables. A casual glance over recent issues of the Journal will uncover abbreviations commencing with every letter of the alphabet: AGA (4), BLM (5), CR (6), DZ (7), EIF (8), FLAP (9), GGEMG/Pepi (10), HASM (11), ITGV (12), JEM (13), KO (14), LB (15), MPP (16), NTHi (17), OT (18), PATC (19), QWB (20), ROFA (21), SLB (22), TWG (23), UC (24), Vuip1 (25), WG (26), Xrs5 (27), Yr6 (28), and Zds (29). How many of these abbreviations do you instantly recognize? (Compare your guess with the authors' intent in the footnote.) Some abbreviations are identical yet have different intended meanings: MAP is used for mean arterial pressure (30), mitogen-activated protein (31), and multivariate apnea prediction (32). Other abbreviations with double meanings include CTL (33, 34), DH (35, 36), MIP (35, 37), OI (38, 39), TST (40, 41), and UIP (42, 43).

If a reader is already familiar with an abbreviation and the writer uses it skillfully, it can ease communication. It's acceptable to use an abbreviation to replace a long or cumbersome word (or phrase) that appears a great many times in a manuscript (44, 45). But allergic rhinitis is not sufficiently cumbersome to need AR. And nine times is not a great many. If an abbreviation appears only five or so times in a manuscript, the reader keeps hunting backward to find what it means. This is an unnecessary chore without any gain. If the author wishes to save space in the journal, there are far better ways of doing so without using abbreviations. A reader should not need a codebook or a glossary to read an article. A simple way of avoiding abbreviations is to use a substitute word. Instead of writing "IRL" for "inspiratory resistive load" (46), simply write "load" after first stating what type.

In our INSTRUCTION FOR CONTRIBUTORS (47) we instruct authors to minimize the use of abbreviations and to avoid them completely in the abstract. For authors who like guidelines in numbers, it is acceptable to substitute a standard abbreviation for an unwieldy word or phrase appearing more than 10 times in a manuscript (44, 45). An abbreviation should never replace 1 short word: do not use ETX for endotoxin (48) or AR for arousal (49), whereas LAM for lymphangioleiomyomatosis (50, 51) and UPPP for uvulopalatopharyngoplasty (52) are acceptable. New abbreviations should not be invented for 1 paper, and all abbreviation should be defined when first used. Readers can generally handle 2 or 3 abbreviations in a paper, but reading becomes exponentially more difficult with each additional abbreviation.

Noun clusters are another burden for readers. English is flexible and allows nouns to serve as adjectives. Using a noun modifier instead of a prepositional phrase enables more concise communication: lung function versus function of the lung. But trouble begins when you add another noun to an already existing noun pair. Nouns pile up, one modifying the next, and clarity is lost (45, 53, 54, 55). Examples include "rat heterotopic tracheal transplant model" (56), "bilateral anterior magnetic phrenic nerve stimulation" (57), "carotid–femoral pulse–wave velocity" (58), "recombinant human soluble complement receptor type 1" (59), and "raised volume rapid thoracoabdominal compression technique" (60). When nouns are packed too close together, like sardines in a tin, the connecting thought gets suffocated. One or more prepositions can be used to disentangle a noun cluster, clarifying the relationship between one word and the next and improving precision. Take "cultured sheep pulmonary artery endothelial cells" (61). Instead of wondering how sheep become cultured, inserting a few prepositions makes the meaning clear: "cultures of endothelial cells from the pulmonary artery of sheep." The untangled version is longer than the original but the goal is clarity, not brevity.

Literary devices that exclude readers are self-defeating. Yet new terms, such as apoptosis (62) and restriction fragment length polymorphism (63), are needed to communicate fresh conceptions and new techniques in an accurate and succinct manner. Without precise technical terms, communication among specialists becomes awkward and time consuming (64). Some specialist terms, however, mask loose ideas and permit overconfident assertions that would never pass in a court of law. Arcane words may be used to impress the reader rather than to express an idea—a means to elevate the writer and magnify the gravity of the thought (65). "Men should use common words to say uncommon things, but they do the opposite," wrote Schopenhauer. The unnecessary use of obscure terminology constitutes a barrier between reading and understanding. Readers feel excluded, as if sitting on the fringe of a cozy conversation among members of an in-club. "Medical obscurity," points out Michael Crichton (66), "may serve an intragroup recognition function, rather like a secret fraternal handshake."

Pulmonary and critical care medicine is too young a field to fragment because of barriers to comprehension. Future growth depends on cross-fertilization. Intensivists reading the Journal should be able to learn the latest advances in the molecular biology of asthma, and asthma specialists should be able to learn the value of permissive hypercapnia when ventilating the asthmatic patient. Publications in pulmonary and critical care journals need to be inviting to readers from other medical subspecialties. Any devise that makes it difficult for a reader to understand an article threatens an essential characteristic of science: its openness to outside examination. The true scientist wants to make all the pertinent facts transparent to readers, enabling them to form their own opinions, and recoils at the thought of hiding information behind a curtain.

But clear prose poses one major risk: it shows up weak thinking for what it is.

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