I’ve been a loyal ASCO member since the early 1970s (aka “back in the day”) and wanted to share a growing pet peeve. I thought of attacking an individual author, but my sense tells me the source of my annoyance is really now a cultural problem and one that can only be fixed at the editor level. With seemingly every drug name ending in “mab” and with oncogenes and other genomic matters becoming so critical, the specialty is necessarily more complex. But now our language usage has morphed into pseudosophistication and the needless confusion of commonplace terms.
In citing the following notations, I’m simply paging through the bold print of the May 25 issue of The ASCO Post.
- Noninferiority? Now we’re even labeling studies as “noninferiority trials.” What’s up with that? Why not just say it: Trastuzumab is just as good as___. Why do we have to go with the opaque “noninferior?” That seems to me very close to a double negative.
- Standard of care? Many articles refer to a “standard of care.” Physicians using the phrase are likely those who haven’t been sued (yet). We are writing in 2018, but the legal profession claimed this term decades ago, and it has a very clear meaning in a court of law. This front-page article suggests a trial “could shake up the standard of care.” Organizations like the American College of Physicians and the Centers for Medicare and Medicaid Services synonymously refer to “evidence-based medicine” or “best practice.” A plaintiff litigant might have to work to develop a theory based on those terms, but “sets a new standard of care”—a pretty bold assertion for a single medical report—serves the case up against the oncologist on a silver platter. Consider instead, “these superlative results need confirmation in other venues and seem to offer hope of improving current best practices.” Isn’t that more accurate?
- First-in-human? A “first-in-human seems like another neologism; I get what it means, but why make a new special pseudosophisticated term of it? It will get picked up and propagated.
- Meritorious claim? “Crizotinib could be considered the standard of care for….” That would be this investigator’s opinion, but without citation of corroborating evidence and other trials, is it a meritorious claim?
- Advertisement—An ad states, “FDA-Approved Based on Evidence.” That’s more like it—and this is an advertisement!
- ASCO Clinical Practice Guideline— Another high five; “guidelines” are much better than standards made up of whole cloth.
- “Weighing the cost and value” of a particular therapy—Excellent! Seemingly an uncommon consideration.
- On steroids? And then, in the same article, we put the immune system “on steroids.” There’s a common but colloquially used term, tossed out in a bold pullquote, making us at once wonder whether it’s metaphorical or part of a MOPP-type protocol.
- Naming clinical trials—The “PRECISION trial” promises outcome bias by its very name.
- Figurative vs literal—One can guess at what this headline means: “Florida Cancer Centers Awarded $1.36 Million to Minimize Disparities in Pancreatic Cancer.” But I was confused, not knowing that this cancer was so disparate. Indeed, we’re talking about the outcomes and care of patients who have pancreatic cancer, not the disease itself.
Well, thanks for reading this far and for all you do for patients with cancer. This litany of complaints is, I think, too representational. Although my points are all picky and minor, they do suggest an overabundance of torqued language that is creeping into common parlance, without an improvement of knowledge or clarity. ■
—Charles P. Duvall, MD, MACP
Hilton Head Island, South Carolina
DISCLOSURE: Dr. Duvall reported no conflicts of interest.
DISCLAIMER: Letters to the Editor represent the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
