We have some strange terms in the pharma industry, one that new entrants find most difficult to grasp is that of suspected unexpected serious adverse reactions – SUSARs. The term refers to an adverse event that occurs in a clinical trial subject, which is assessed by the sponsor and or study investigator as being unexpected, serious and as having a reasonable possibility of a causal relationship with the study drug. That’s a mouthful – yes?

It's not just the pharmaceutical industry that uses obscure terms. On February 12, 2002 (12 years ago today), Donald Rumsfeld gave a response to a question at a US Department of Defense news briefing, about the lack of evidence linking the government of Iraq with the supply of weapons of mass destruction. Rumsfeld stated:

“Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say, we know there are some things we do not know. But there are also unknown unknowns – the ones we don't know we don't know. And if one looks throughout the history of our country and other free countries, it is the latter category that tends to be the difficult ones.”

Rumsfeld, was effectively warning that in any situation there can be known knowns and unknown unknowns, with the latter potentially being the most dangerous as they represent "things that we don't know we don't know." Interestingly, what appears to be missing from his list is the unknown knowns, the things we know, but we aren’t necessarily aware of. In the case of the English language, this understanding can make the difference between whether (or not) you will be recognised as a native English speaker (or writer). In many cases, a ‘native’ may not even remember learning this knack, and yet they will use it every day. This represents a medical writing superpower in a world hungry for native English-speaking authors.

Ordering adjectives

Believe it or not, the superpower is little more than knowing about the correct order in which to use adjectives when we write. The skill is described beautifully in the 2013 book ‘The Elements of Eloquence: How to Turn the Perfect English Phrase,’ by Mark Forsyth [1]. The book, which explains classical rhetoric, dedicates chapters to rhetorical figures with illustrating examples, particularly in the works of William Shakespeare. Regarding adjectives, Forsyth states:

“…adjectives in English absolutely have to be in this order: opinion-size-age-shape-colour-origin-material-purpose Noun. So, you can have a lovely little old rectangular green French silver whittling knife. But if you mess with that word order in the slightest, you’ll sound like a maniac. It’s an odd thing that every English speaker uses that list, but almost none of us could write it out.”

In other words, the order of adjectives has to be: opinion-size age-shape-colour-origin-material-purpose. Change this order in any way and you give away your non-English roots. And yet, most English people would not be able to tell what they are doing.

Whereas most English speakers have little interest in the practice of correct grammar, French and German speakers are a lot more interested in the mechanics of their languages – they'll argue about grammar and go and get Le Bon Usage to settle a dispute [2]. Nevertheless, there are a lot of rules like this that we don't know. We're lucky that, as native speakers, we can just open our mouths and it comes out. Whether it's the odd rules about the order of adjectives or ablaut reduplication, or the bits of etymology that are utterly obvious once you point them out. As Mark Forsyth says "there’s a reason there may be little green men on Mars, but there certainly aren’t green little men” [1]. As with any rule, there are always exceptions, but these are simply obeying another commonly unknown rule of English usage – that of ablaut reduplication.

Criss-crossing

There may not be that many opportunities to demonstrate your understanding of ablaut reduplication in your scientific writing, but it is certainly a sacred rule of language that immediately identifies non-native speakers when not followed. Why this should be is a subject of endless debate among linguists. Whether it’s something to do with the movement of our tongues or an ancient language of the Caucasus, native speakers follow the rule religiously even if they don’t know they know it. You would immediately balk at writing ‘zag-zig’ or ‘cross-criss.’ Effectively, reduplication in linguistics is when you repeat a word, sometimes with an altered consonant (i.e., nitty-gritty), and sometimes with an altered vowel (i.e., clip-clop or ding-dong). When talking vowels, if there are two words then the first uses the letter ‘i’ and the second is either ‘a’ or ‘o’ (i.e., tip top, chit-chat or tick-tock). If there are three words then the order must go ‘i’, ‘a’, ‘o’ (i.e., bish-bash-bosh).

Getting tense

Even experienced and accomplished native English speaking medical writers are adept at employing the many tenses available tenses available to them – though almost certainly not all of them will be able to name the rules they are following. Depending on how you name them there are about 20 – believe it or not. For example, understanding how to deploy the pluperfect progressive passive for an extended state of action that happened (to you) prior to another action in the past is, sounds complex. But you might happily say “I realised I’d been being watched.” These twists in how to create a flowing narrative in your writing can be daunting for those learning English. You could try explaining how English don’t usually use the present tense for things that are happening in the present. For example, “I tie my shoelaces” doesn’t mean that you’re doing it right now, it just means that this is something that you do. In contrast, we use the present progressive “I’m tying my shoelaces” when describing things we are currently doing. English gets particularly tricky when using the future present tense and even trickier when you learn that there are also exceptions, like the verb ‘to think’ used as an auxiliary. In such cases a native speaker might say “I think you’re right” whereas a non-native speaker might use the phrase “I am thinking that you are right”. It can take a lifetime of immersion learning to reach this level of expertise.

Clearly, English is a complicated language, and even native speakers often have no idea of its strangeness. A few examples are summarised here – don’t even get me started phrasal verbs and how they too can be a nightmare for would-be English speakers. Whatever the extent of your understanding, it makes a good case for using native English-speaking writers (like we have at Niche) when preparing your regulatory documents.

References

1. The Elements of Eloquence: Secrets of the perfect turn of phrase. Mark Forsyth Oct 07, 2014 (ISBN 9780425276181)
2. Le bon usage. Grammaire francaise, 16e edition 16 by Goosse, Andre, Grevisse, Maurice (ISBN: 9782807300699)