Thursday Review: “Why Are Medical Journals So Dull?”

Writing in the British Medical Journal in 1958, some of Richard Asher’s ideas concerning “Why Are Medical Journals So Dull?” are certainly products of their times. Others, though, are still valid and instructive today.

All of his brief article is still edifying, though, partly because Asher is so clever and funny:

There are many causes of [journals’] dullness; some are curable and some incurable. I do not separate them: this is a short study of the pathology, not a dissertation on the prophylaxis and treatment, of the condition.

In an era of increasingly digital delivery, I’ll skip over Asher’s ideas on the difficult wrappers, drab covers, and uninteresting, black-and-white advertisements found in journals during his career.

His main point is that a lively contribution shines like a good deed in a naughty world. A journal article should present its ideas to the world by being interesting, and it’s possible to do this without going in for sensationalism, he writes.

A poor title dulls the clinical appetite, whereas a good title whets it. I have called this article “Why Are Medical Journals So Dull?” I do not claim this title is specially good, but it is better than “A Study of the Negativistic Psychomotor Reactions induced by Perusal of Verbalized Clinical Material.” Titles such as “A Trial of 4.4-Diethyl-hydro-balderdashic Acid in Acute Coryzal Infections” are far better changed to “A New Treatment for Colds.”

Style, Asher says, is largely a matter of taking trouble. Speaking about something akin to Balderdashic Acid again:

Here is a sentence from a medical journal: Experiments are described which demonstrate that in normal individuals the lowest concentration of which sucrose can be detected by means of gustation differs from the lowest concentration in which sucrose (in the amount employed) has to be ingested in order to produce a demonstrable decrease in olfactory acuity and a noteworthy conversion of sensations interpreted as a satiety associated with ingestion of food. All the author meant was: Experiments are described which show that normal people can taste sugar in water in quantities not strong enough to interfere with their sense of smell or take away their appetite.

I actually disagree with Asher that style is what matters most. From my point of view, what Asher calls presentation — that is, the way it is set out, the order in which the facts are put, and the way the diagrams or pictures are arranged, or what I would call “structure” is the most important thing to any communication.

As we’ve seen, in his article, Asher gives several how-to and how-not-to examples in parallel, and this section on “presentation” is no different. He starts with an account which is factual and accurate, but not especially interesting:

A man was crushed by a bombed building, injuring his diaphragm. He consequently developed a right diaphragmatic hernia which resulted in dyspepsia from visceral displacement. Surgical repair of the hernia relieved his symptoms.

This version, Asher says, has been tidied up so much that there was no interest left. The point of view of the teller has been zoomed out so far, that only broad details remain, which progress one after the other in a strict chronology. To make it more interesting, Asher variously describes presenting it “thematically”, or using the device of telling a story by starting in the present and darting to the past and back.

The uninteresting way of telling this story treats the revelation of its details as unimportant. What happened is only summarized, as if its characters had been lost to the aeons of time. It is much, much more interesting to reveal details of the story as they are presented to the doctors, etc., who are discovering them.

Here is the same case as I heard it described by the surgeon at a meeting of a clinical section. He operated on a man who had symptoms of duodenal ulcer, and to his chagrin was unable to deliver the duodenum. At length his exploring hands disappeared into a large hole in the right diaphragm, where he found much intestine. There was no duodenal ulcer. He then reviewed the chest x-ray film and found that the alleged thickened pleura was really hernia and that gas could be (and should have been) recognized in it. As soon as the man came round from the operation a fresh history was taken, and it was found that the pain was nothing like ulcer pain; it had no periodicity (it had been caused by the duodenum being stretched across the lumbar spine). Also, the history of the crush injury was elicited; until then it had not been discovered. The surgeon concluded: “The moral is that one ought to take a history before the operation rather than after it.”

I might go so far as so say that the first version of this story isn’t really a story: it might be a narrative, a list of events from beginning to end, but in the first version, there’s no opportunity to learn anything from the telling, there’s no way to empathize with the patient, or ask what a physician might have done differently.

So, one of the answers to “Why Are Medical Journals So Dull?” is fairly straightforward: too much “tidying”, not enough good stories.

Sources

The article reviewed: Asher, Richard. “Why Are Medical Journals so Dull?” British Medical Journal 2, no. 5094 (1958): 502–3.

Featured Image: Richard Asher, photograph provided by his family, used under a CC BY-SA 3.0 license, via Wikimedia Commons.