We need to talk about drug-resistant infections

Do you know what “antimicrobial resistance” is?

Most people don’t. That’s one of the findings from a series of focus groups and interviews commissioned by the Wellcome Trust (where I work).

First of all, “antimicrobial”. A lot of people have never come across this word. Antimicrobials are a family of drugs that kill microorganisms. It’s a broad über-category spanning several types of drug – including antibiotics, which pretty much everyone has heard of.

You probably have a rough idea what antibiotics are, even if you don’t know the exact definition: they treat infections that are caused by bacteria. Other types of antimicrobial drug treat infections that are caused by viruses or by fungi.

So, based on that, what’s antimicrobial resistance?

This still flummoxed the people in the focus groups. They hadn’t heard the phrase, but some of them thought they could work out what it meant: it’s when a person who has taken antimicrobial drugs for a while develops a resistance to them.

It sounds logical. It’s also dangerously wrong.

Scientists and health policy makers use “antimicrobial resistance” to mean that the microbes develop a resistance to the drugs.

This is the sort of confusion that happens when you carelessly use an abstract noun like “resistance” – whose resistance to what? It’s especially confusing when you couple it with a scientific word that most people don’t know.

A better term, the research suggested, would be “drug-resistant infections”. This clearly says who is resistant to what.

People need to understand this. Not because science is cool, but because people’s behaviour contributes to the growth of infections that are immune to our best drugs. For instance, as my colleague Kate Arkless Gray says, “if people think that they will develop a resistance to antibiotics, they may be less likely to finish the full course, when in fact not finishing the course could increase the rate at which resistance develops”.

We must talk to people in a language they understand. It can be hard to appreciate how little specialist language really seeps into public awareness, but it’s essential to make the effort to understand your audience.

And that’s why we need to talk about drug-resistant infections.

Synonymous with correct usage

One of the common mistakes I come across when I’m editing involves the word synonymous. You can see it in sentences like this:

Roger Federer is synonymous with great tennis.

Does that seem OK to you? If so, I’m afraid you’ve fallen prey to a confusion that affects many people. But it’s easy to explain.

A synonym is a word having the same meaning as another. It originally comes from the Greek syn (meaning same) and onyma (meaning name). Based on this, the adjective synonymous is defined as “having the same meaning”.

So big is synonymous with large and field is synonymous with meadow – but Roger Federer is not synonymous with great tennis. The man is associated with the game, sure, but the two terms don’t mean the same thing – otherwise people would talk about Serena Williams playing some really Roger Federer. And that’s obvious nonsense!

For centuries, people used synonymous without any difficulty, but recently some have started to extend its use, blurring the true meaning. This misuse is now widespread, but careful writers still avoid it – and so should you. If you use synonymous in this loose modern way, you risk not just confusing your audience but also degrading the word so much that it becomes unusable.

This would impoverish the English language and make it harder for us all to communicate. But it’s not too late to avert this, if we just make the small effort to use synonymous only in its original, logical, correct sense.

Fowler’s Dictionary of Modern English Usage (4th edition) – by Jeremy Butterfield

“Is that good English?”

Century after century, people ask this and publishers sell books to answer them. A lot of these books are terrible but some are linguistic treasure troves. A lot of them sink without trace but some endure for decades.

This is one of the good ones.

A brief history of Fowler

One of the biggest names in usage guidance over the last 100 years, especially in Britain, has been Fowler.

Henry Fowler published his Dictionary of Modern English Usage in 1926. It contained a lot more learning, insight and modesty than many of today’s usage guides, but it was fundamentally a book of Fowler’s opinions. These opinions, shaped by his lexicographical work, were sometimes wise, sometimes idiosyncratic. His writing style was sometimes witty, sometimes obscure. It was a hugely influential book, which is why its successors still bear the Fowler name.

In 1965, Ernest Gowers edited the second edition. There were cuts and additions and polishes, but it was essentially an update, and the bulk of the book stayed the same.

The third edition came in 1996, edited by Robert Burchfield. This was a near-total rewrite, although there were still plenty of traces of Fowler. It marked a shift in approach towards greater objectivity and more systematic analysis. Burchfield had built up a database of language use far exceeding Fowler’s more hotchpotch collection, and he used it to inform his judgements. That said, he wasn’t shy with his opinions.

Now, in 2015, we have the fourth edition, edited by Jeremy Butterfield. It’s an update of Burchfield’s version, but a pretty substantial one. There are over 250 new entries and many of the others have been partly or mostly rewritten. Butterfield again improves the standard of evidence by using the immense resources of the Oxford English Corpus – a database holding 2.5 billion words of 21st-century usage from all sorts of sources. And while his own opinions still figure, they play a smaller role than Burchfield’s did.

They know not what they do

One of my more exciting hobbies is checking whether prescriptivists follow their own advice. Often, they don’t. For instance, a stunningly high proportion of people who criticise the passive voice use the passive voice themselves, even as they’re criticising it.

I’ve seen four of these in the last week or so (most if not all via Oliver Kamm).

First, in an article on LinkedIn, Bernard Marr writes:

While there’s nothing absolutely wrong about passive voice, it’s considered weak writing.

I’ve underlined Marr’s use of the passive voice. And I don’t think it’s weak – and nor are the other nine uses of the passive in that article.

Second, in a blog post, Nigel Dudley writes:

Organisations use the passive in their statements, particularly when they have been criticised and want to dodge responsibility.

True, the passive voice can be used to avoid mentioning who was responsible for something. But here, there’s nothing evasive about Dudley’s use of it. He’s talking in general, not about any particular instance of criticism. It’s a perfectly good turn of phrase.

He says that we should “doubt the integrity of those who use the passive a lot” – but I disagree, because he’s clearly sincere even though he uses the passive another six times in the post.

Third, and more shockingly, the Economist Style Guide’s entry on “passive” says:

Be direct. Use the active tense. A hit B describes the event more concisely than B was hit by A

Talking about the “active tense” or the “passive tense” is a howler: they’re voices, not tenses. Either can be used in any tense:

• A is hitting B; B is being hit by A
• A will hit B; B will be hit by A
• A had hit B; B had been hit by A

And while this entry doesn’t use the passive itself, the two immediately below it do:

Peer (as a noun) is one of those words beloved of sociologists and eagerly co-opted by journalists who want to make their prose seem more authoritative.

Per capita is the Latin for by heads; it is a term used by lawyers when distributing an inheritance among individuals…

The “per capita” example could have been written in the active with a tiny gain in concision (“…it is a term lawyers use when…”). But the “peer” one would have been awkward and in fact longer (“words beloved of sociologists and which journalists eagerly co-opt when they want…”).

Many other entries on the P page of the Economist guide use the passive – and use it well.

Fourth, and most spectacularly, Toby Young writes in the Spectator:

On the contrary, nearly all of Gove’s rules can be traced to George Orwell’s ‘Politics and the English Language’, an essay that’s generally regarded as the best guide to writing good English that has ever been produced. To give just one example, Orwell’s fourth rule is ‘Never use the passive where you can use the active’. Kamm singles this out for condemnation in his Times article, apparently unaware that it was first set out by the finest prose stylist of the 20th century.

There’s one final reason why it was sensible of Gove to set out these rudimentary principles. I’m absolutely certain that for every Oliver Kamm who bridles whenever these old–fashioned rules are observed, there are 10,000 Toby Youngs who feel almost physically assaulted when they’re ignored.

Part of the beauty of this self-blindness is that Orwell’s essay also used the passive voice extensively, including in his complaint that “the passive voice is wherever possible used in preference to the active”. So Young is truly a disciple of his hero.

(Other professional writers who condemn the passive while using it include Stephen King and Simon Heffer.)

So, what’s the moral of all this?

I am shallow and I can’t deny a certain cheap ‘Gotcha!’ satisfaction in spotting examples like these. But I’m not faulting these writers’ uses of the passive: this rule-breaking prose is mostly well-written, and there’s something to learn from that fact.

Young, in particular, knows how to put sentences and paragraphs together. But he apparently doesn’t know how he does it. He thinks certain grammatical rules make him “feel almost physically assaulted when they’re ignored”. But that passive construction, and the others, didn’t make him feel assaulted. He wrote them, probably read them over once or twice, and thought they were fine. And on that point, at least, he was right.

The passive voice is an essential tool in every good writer’s repertoire. Oliver Kamm, in the Times, gives a superb example of Orwell using it in his essay:

Orwell describes the reality of the anodyne term pacification: “Defenceless villages are bombarded from the air, the inhabitants driven out into the countryside, the cattle machine-gunned, the huts set on fire with incendiary bullets…” – passive clauses, every one. It’s powerful writing because Orwell ignores his own advice.

I’ve written plenty about the passive voice before. In summary, it can indeed be stuffy, verbose and evasive – but it can also be useful for shifting focus and improving flow.

But today I’m making a point about the psychology of prescriptivism (or what Joseph Williams called “the phenomenology of error”).

When people insist that a certain use of language is bad or wrong but use it themselves, even while doing the insisting, something is amiss. Their beliefs about language have become unmoored from their use of language.

They have heard that the passive voice (or adverbs, or split infinitives, or fused participles, or singular “they”, or “who” as object, or whatever) is bad. They have seen a few examples of it being used to bad effect. This has convinced them that it is bad, and so they’ve started to preach the rule against it themselves.

But they haven’t thought enough about possible good uses of the passive (or whatever). And because they don’t realise that the human mind is far from transparent to itself, it doesn’t occur to them that their proud, firm belief isn’t reflected in their own fluent, natural behaviour. They don’t notice how useful they find the thing that they condemn.

They understand how to use language. That understanding runs deep – deeper than the conscious belief they’ve adopted – and it is what keeps them good writers even as they become bad writing advisers.

There is no surer sign of a bogus rule than that it cannot take root in its own evangelists’ minds.