Odds and Ends Again

Consolidate, Consolidate, Consolidate

Here is a passage from an article about hormone replacement therapy.

The best evidence for the risks and benefits of postmenopausal hormone use comes from the Women’s Health Initiative (WHI), a large randomized clinical trial of over 16,000 healthy women ages 50 through 79, in which half of the participants took hormones and the other half took a placebo pill (which does not contain any drug). The trial, sponsored by the National Institutes of Health (NIH), was halted early when, in July 2002, investigators reported that the overall risks of estrogen plus progestin, specifically Prempro™, outweighed the benefits. The WHI found that use of this estrogen plus progestin pill increases the risk of breast cancer, heart disease, stroke, and blood clots. The study also found that there were fewer cases of hip fractures and colon cancer among women using estrogen plus progestin than in those taking a placebo.

The author seems to be trying to get too much information into too little space. The problem is the reader feels as if she were just hit by a truck. Now did I get that license number or not? Consolidate means to bring together as a unit. Now if the writer takes the time to think what the actual intent of this paragraph is, he might come up with something like this.

A lot of what is known about the risks and benefits of hormone use comes from the Women’s Health Initiative (WHI). The WHI is a large clinical trial of over 16,000 healthy women between the ages of 50 and 79. Half of the women took hormones. The other half took a placebo. In July 2002, the trial was stopped early. That’s because the data showed the overall risks of estrogen plus progestin outweighed the benefits. Using the combined hormone pill increased the risk of:

· breast cancer
· heart disease
· stroke
· blood clots

On the other hand, women taking the pill had fewer cases of hip fractures and colon cancer.

The important question to ask is what does the reader want to know? And how can I make sure the reader can find it?

Need to know vs nice to know

When you work in the area of patient education, or investor education, or legal client education, or . . ., there is one very important distinction that a writer (or an editor) needs to make. That is the distinction between what the reader needs to know and what is nice to know. Too often, the writer has information he or she wants to share just because he or she has it. But unless that information advances the reader's ability to do what the reader needs to do, it can get in the way of the information the reader needs. Consider this passage from a question and answer article about dietary supplements.

What is a dietary supplement?

Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of "foods," not drugs, and requires that every supplement be labeled a dietary supplement.

Now I ask you, what is a dietary supplement? I'm not sure the following edit clearly answers the question yet, but it at least gets rid of the DSHEA, which really has nothing to do with what the reader needs to know.

A dietary supplement is something you take by mouth that gives you something your diet may be missing. That may be:

· vitamins
· minerals
· herbs
· other botanicals
· amino acids
· substances such as enzymes, organ tissues, glandulars, and metabolites

Supplements can also be extracts or concentrates. They may be found in many forms including:

· tablets
· capsules
· soft gels
· gel caps
· liquids
· powders

They can also be in other forms. For instance a supplement may come as a bar. But by law, the information on the label cannot represent the product as a conventional food. Nor can it call it the sole item of a meal or diet. By law, dietary supplements fall into a special category under the general umbrella of "foods" not drugs. And they must be labeled a dietary supplement.

The edit also got rid of some really distracting redundancies. But that's a different post.

On a personal note

I just finished two huge projects that have been going on for months. One started in May. The other in July. They couldn't have ended at a better time. My daughter and her husband are coming with their kids. That means I get to devote all my time this weekend to being the Grandpa.

More about location

Emphasis isn't the only reason to be concerned about where something goes in a sentence. Here's an example that illustrates how important location is. It comes from an article I was editing yesterday.

"Remember to drink plenty of water each day, to eat foods high in fiber, and to exercise to prevent constipation."

Technically there's nothing wrong with the sentence -- except the meaning is not clear. Are all three items in the series -- drinking water, eating, and exercising -- related to preventing constipation? Or is it just exercise that prevents it? The sentence could be read either way, and a reader most likely isn't going to stop to work it out. So even if two out of every three readers understand the sentence correctly, the writer is still going to leave one third of the audience in the dark. This problem can be avoided by moving "to prevent constipation" ahead of the series rather than at the end of it.

"To prevent constipation, you need to drink plenty of water each day, eat foods high in fiber, and exercise."

(The "remember to" didn't really add anything to the meaning of the sentence.) Now, preventing constipation has provided context for all three actions in the series, something that's best accomplished at the beginning of a sentence. If the context is left until the end, a reader needs to go back and apply it to what he or she has just read. The effect is like tripping over a crack in the sidewalk.

And the prize goes to

A few odds and ends this morning.

(1) Found this sentence yesterday in an article I'm editing:

Strattera is the first medication to receive an FDA indication for treatment of ADHD in adults.

I'm certain the source the writer consulted used the word "indication." The problem is the work the writer was doing is meant for a health consumer audience, not a medical or pharmaceutical audience. It's like the writer simply took the information in but didn't have time to digest it before spilling it back out. Had the writer taken the time to think about what the sentence meant in the day to day language of the audience she was writing for, then she would have at least used the word "approval."

But the problem with the sentence is actually more basic than that. The sentence appeared in a section about what medical treatment is used for adults with ADHD. Here's the sentence before the one in question:

If stimulant medications have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera), a non stimulant medication.

The real problem with the FDA sentence is that it doesn't add anything to the reader's understanding. Since the reader is not going to be writing prescriptions, then it doesn't matter that Strattera is the first -- or only -- medication approved for this use. What question the reader probably will have is, "What is a non stimulant medication, and how is it different than the other medications?" And that's because the real question the reader is going to have is, "How will this medication affect me?"

(2) Speaking of digesting....When I was a young (er, relatively young) teacher, I had a freshman composition class and we were studying the use of figurative language. One of the students asked me what a mixed metaphor is. I stumbled through an answer and searched my brain frantically to come up with an example.

That afternoon, I went to an American literature seminar, and the professor, for some reason, wanted to discuss the value of seminars in a graduate program.

One of the women in the seminar, who had actually passed her generals and was working on her dissertation, said:

Oh, I love seminars. To me they're just like this huge, delicious smorgasbord where I can pick and choose and try things on for size.

It took me a week to get rid of the image of her walking down the street wearing a wardrobe made out of mashed potatoes and caviar.

(3) I got an email this morning with the subject line, "I hate to edit the Word mechanic. That being said...". It came from my son :

From a recent post:
"There are two questions you here all the time in certain circles in places like Birmingham: "Who's your mother?"

I fixed it. Now I'll have to have a conversation with him about the use of internal quotation marks.