275
EDITORIALS
Trimming hedges It seems that most contributors to medical journals find it extremely difficult to be certain which of their conclusions have been proven and which not, or so one must assume. Not surprisingly, they resort to "hedges"-words or phrases used to denote lack of assertiveness. Let us consider the what, when, and why of hedging. The original definition of hedging was words "whose job is to make things more or less
fuzzy"; Salager-Meyerl suggests that they are "linguistic cues of bias" and "politeness devices". Omnipresent in both speech and writing, hedges emerge unconsidered and pass unnoticed.
Students of linguistics recognise five categories of hedging device, illustrated by the first sentence of this editorial. "It seems [shield] that most [approximator] contributors to medical journals find it extremely
difficult [emotionally charged intensifier] to be certain which of their conclusions have been proven and which not [passive voice], or so one must assume [(paradoxical) expression of author’s personal doubt]." Shields include modal verbs-it may be, semi-auxiliaries-it appears, probability adverbs-likely, and epistemic verbs-it suggests. In combination they form compound hedges, loathed by editors and readers alike-it seems reasonable to assume that... [triple can barely hedge]. Enough, you cry. Readers who can the subtleties will still grasp linguistic recognise the species. The passive voice is easy to discern and often criticised: Gould2 is only one of many to bemoan "the relentless passive voice of conventional scientific prose [which] imparts no charm or grace of
hedge].Enough, you cry.Readers who barely
composition ...". Approximators, intensifiers, and the expression of personal doubt need no explanation. In a study of hedging in English language medical journals, Salager-Meyerl analysed which types of medical text use which categories of hedge. She defmed four fundamental medical text-types; research papers, case-reports, reviews, and editorials. Her analysis reveals that hedges are widely used but the pattern varies with the text-type studied. "Shields are the hedging technique par excellence of editorials and reviews, whereas the passive voice is the hedging marker of research papers and case-reports ..." Other categories of hedge are less often used. Quotation marks as hedges are not discussed. Are hedges necessarily bad? They allow the introduction of new scientific data and conclusions in a manner that is tentative, understated, or imprecise. In a real sense theories, practice policies, and data collections belong to their originators and proponents, and are invested with money, status, power, and the researcher’s self-esteem. The author who reports original research is a threat to any colleague who shares an interest in the topic under study. He or she will not wish to be buried under the rubble if further research demolishes the conclusions reached and will therefore adopt a cautious, modest, and diplomatic manner. At the same time, the author will want to make some general claims on the basis of specific data. An example from the summary of a recent Lancet paper goes as follows: "TCHT [traditional Chinese herbal therapy] seems to benefit patients with atopic dermatitis."3 The authors needed the shield of "seems" only because they chose not to say "TCHT benefited the patients studied here"; the latter version makes no explicit general claim. Quite properly the authors want credit for establishing the value of this novel therapy and its introduction into western medical practice. Time may prove them wrong; hence the generalised conclusion with protective shield. Salager-Meyer argues that hedging is an essential skill in medical writing and serves a valid purpose. She adds that "hedging is not a problem ... but rather a resource used to express scientific uncertainty". However, there is a cultural difficulty with hedging. English is the language of scientific writing. Those for whom English is a second language are at a disadvantage, since for them hedging devices are puzzling and confusing. Salager-Meyer suggests helfpul teaching exercises for students who are non-native speakers of English. They can be given actual papers, of various text-types, and invited to rate them according to degree and category of hedge, and can be asked to remove hedges from text, or to insert hedges into an unhedged text. By now you can guess what the editors of internationally distributed journals want you to do as contribution. You have assembled your Vancouver-style reference list; you have structured your results and discussions; you have taken special you prepare
a
276
care over
the
abstract/summary, which is all many of
your colleagues will read and which it is easy to construct badly.4 Now underline your hedges and rewrite the paper without them, paying special attention to shields and the passive voice. Finally, replace the hedges you think are essential. Your rhetorical caution is now deliberate and purposeful, not defensive and ill-considered. Hand the final draft to a willing medical student or colleague whose first language is not English. Note carefully any source of confusion. Rewrite and post. F. A genre-based and text-type analysis of hedging in written medical English discourse (1980-1990). INTERFACE: J Appl Linguistics 1991; 6: 33-54. 2. Gould SJ. How does a panda fit? In: An urchin in the storm. London: Collins Harvill, 1988: 20. 3. Sheehan MP, Rustin MHA, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992; 340: 13-17. 4. Salager-Meyer F. Discoursal flaws in medical English abstract: a genre analysis per research- and text-type. Text 1990; 10: 365-84. 1.
Salager-Meyer
Stapled
anastomoses and colon
cancer recurrence
A report by Akyol and colleagues1 suggested that the use of stapled anastomoses in colorectal cancer surgery lessened recurrence rates and cancer-related mortality by up to 50%. At first glance these figures are surprising since previous surveys showed that local recurrence rates with stapled anastomoses are either higher than2,3or similar to4-6 those with sutured anastomoses. However, many of the earlier reports were of small, unrandomised, or retrospective series. Akyol et al studied 294 patients who had undergone ostensibly curative colorectal cancer resections; sutured and stapled anastomoses had been considered equally feasible at operation. Unlike previous researchers, they randomised only after the resection had been completed; this approach presumably equalised the possibility of tumour clearance in the two subgroups. Individual surgeons contributed a similar number of sutured and stapled anastomoses to distribute evenly the influence of surgeon variability on local recurrence rates.4 By the end of the second year after surgery, overall tumour recurrence was 29-4% in the sutured group and 19-1% in the stapled a reduction of 42% (95% CI group (p
EDITORIALS
Trimming hedges It seems that most contributors to medical journals find it extremely difficult to be certain which of their conclusions have been proven and which not, or so one must assume. Not surprisingly, they resort to "hedges"-words or phrases used to denote lack of assertiveness. Let us consider the what, when, and why of hedging. The original definition of hedging was words "whose job is to make things more or less
fuzzy"; Salager-Meyerl suggests that they are "linguistic cues of bias" and "politeness devices". Omnipresent in both speech and writing, hedges emerge unconsidered and pass unnoticed.
Students of linguistics recognise five categories of hedging device, illustrated by the first sentence of this editorial. "It seems [shield] that most [approximator] contributors to medical journals find it extremely
difficult [emotionally charged intensifier] to be certain which of their conclusions have been proven and which not [passive voice], or so one must assume [(paradoxical) expression of author’s personal doubt]." Shields include modal verbs-it may be, semi-auxiliaries-it appears, probability adverbs-likely, and epistemic verbs-it suggests. In combination they form compound hedges, loathed by editors and readers alike-it seems reasonable to assume that... [triple can barely hedge]. Enough, you cry. Readers who can the subtleties will still grasp linguistic recognise the species. The passive voice is easy to discern and often criticised: Gould2 is only one of many to bemoan "the relentless passive voice of conventional scientific prose [which] imparts no charm or grace of
hedge].Enough, you cry.Readers who barely
composition ...". Approximators, intensifiers, and the expression of personal doubt need no explanation. In a study of hedging in English language medical journals, Salager-Meyerl analysed which types of medical text use which categories of hedge. She defmed four fundamental medical text-types; research papers, case-reports, reviews, and editorials. Her analysis reveals that hedges are widely used but the pattern varies with the text-type studied. "Shields are the hedging technique par excellence of editorials and reviews, whereas the passive voice is the hedging marker of research papers and case-reports ..." Other categories of hedge are less often used. Quotation marks as hedges are not discussed. Are hedges necessarily bad? They allow the introduction of new scientific data and conclusions in a manner that is tentative, understated, or imprecise. In a real sense theories, practice policies, and data collections belong to their originators and proponents, and are invested with money, status, power, and the researcher’s self-esteem. The author who reports original research is a threat to any colleague who shares an interest in the topic under study. He or she will not wish to be buried under the rubble if further research demolishes the conclusions reached and will therefore adopt a cautious, modest, and diplomatic manner. At the same time, the author will want to make some general claims on the basis of specific data. An example from the summary of a recent Lancet paper goes as follows: "TCHT [traditional Chinese herbal therapy] seems to benefit patients with atopic dermatitis."3 The authors needed the shield of "seems" only because they chose not to say "TCHT benefited the patients studied here"; the latter version makes no explicit general claim. Quite properly the authors want credit for establishing the value of this novel therapy and its introduction into western medical practice. Time may prove them wrong; hence the generalised conclusion with protective shield. Salager-Meyer argues that hedging is an essential skill in medical writing and serves a valid purpose. She adds that "hedging is not a problem ... but rather a resource used to express scientific uncertainty". However, there is a cultural difficulty with hedging. English is the language of scientific writing. Those for whom English is a second language are at a disadvantage, since for them hedging devices are puzzling and confusing. Salager-Meyer suggests helfpul teaching exercises for students who are non-native speakers of English. They can be given actual papers, of various text-types, and invited to rate them according to degree and category of hedge, and can be asked to remove hedges from text, or to insert hedges into an unhedged text. By now you can guess what the editors of internationally distributed journals want you to do as contribution. You have assembled your Vancouver-style reference list; you have structured your results and discussions; you have taken special you prepare
a
276
care over
the
abstract/summary, which is all many of
your colleagues will read and which it is easy to construct badly.4 Now underline your hedges and rewrite the paper without them, paying special attention to shields and the passive voice. Finally, replace the hedges you think are essential. Your rhetorical caution is now deliberate and purposeful, not defensive and ill-considered. Hand the final draft to a willing medical student or colleague whose first language is not English. Note carefully any source of confusion. Rewrite and post. F. A genre-based and text-type analysis of hedging in written medical English discourse (1980-1990). INTERFACE: J Appl Linguistics 1991; 6: 33-54. 2. Gould SJ. How does a panda fit? In: An urchin in the storm. London: Collins Harvill, 1988: 20. 3. Sheehan MP, Rustin MHA, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992; 340: 13-17. 4. Salager-Meyer F. Discoursal flaws in medical English abstract: a genre analysis per research- and text-type. Text 1990; 10: 365-84. 1.
Salager-Meyer
Stapled
anastomoses and colon
cancer recurrence
A report by Akyol and colleagues1 suggested that the use of stapled anastomoses in colorectal cancer surgery lessened recurrence rates and cancer-related mortality by up to 50%. At first glance these figures are surprising since previous surveys showed that local recurrence rates with stapled anastomoses are either higher than2,3or similar to4-6 those with sutured anastomoses. However, many of the earlier reports were of small, unrandomised, or retrospective series. Akyol et al studied 294 patients who had undergone ostensibly curative colorectal cancer resections; sutured and stapled anastomoses had been considered equally feasible at operation. Unlike previous researchers, they randomised only after the resection had been completed; this approach presumably equalised the possibility of tumour clearance in the two subgroups. Individual surgeons contributed a similar number of sutured and stapled anastomoses to distribute evenly the influence of surgeon variability on local recurrence rates.4 By the end of the second year after surgery, overall tumour recurrence was 29-4% in the sutured group and 19-1% in the stapled a reduction of 42% (95% CI group (p
