4. Making Clear the Risk of Testosterone

This blog post looks at an excerpt from an article published in the New England Journal of Medicine. (1) We underlined the long words.

The generalizability of these results is limited, however, because we excluded men with a high risk of prostate cancer and men with moderately severe urinary tract symptoms. Furthermore, the sample size was inadequate to assess reliably the effect of testosterone on the risk of these conditions. (WSEG = 46/23.0/23.4/15.6)

The WSEG score shows: this 46-word excerpt has an average sentence length of 23.0. Its reading ease score is 23.4 and grade level, 15.6.  To us, this looks like garden-variety medical writing. We understand it, but it isn’t as clear as it might be.

Revising to improve reading ease

How might we revise to improve reading ease? For one thing, we would expect a text written in plain English to use sentences closer to 15 words average, and 25 words at most. The first sentence is 27 words long; we can easily split it in two. 

This excerpt also uses more long words than it needs to. Nine of the 45 words, or 20%, have three syllables or more (9/46 = 20%). We can also replace some of the long words with shorter ones. In the excerpt, we underlined the long words and bolded the essential scientific terms. The table below shows our thoughts on replacing long words with shorter ones.

Trying to replace long words with shorter words

Long words	Shorter words that mean about the same thing
generalizability	general, generalize, can generalize
however	but, although
furthermore	too, also, and
inadequate	not enough, too small, too few, not robust
reliably	rely, reliable, repeatable, precise, accurate
conditions	illness, problem, disease

Precise vs. Accurate

As we looked for shorter words, it led us to ask, What does assess reliably mean here? The definition of assess is to estimate or judge the value, character, etc., of; evaluate (e.g., to assess one's efforts.)(2) In this context, the word assess alone implies a sound assessment. Therefore, the phrase assess reliably seems redundant.  

Does it mean the assessment is precise, accurate or both? Precise means repeated measurements show the same results. Accurate means measurements come close to the true value. (3)
​
Since we weren’t sure what the excerpt was trying to say, we left out the word reliably.

Our Revision

Here is our attempt to revise to improve reading ease.

Original	Revised
The generalizability of these results is limited, however, because we excluded men with a high risk of prostate cancer and men with moderately severe urinary tract symptoms. Furthermore, the sample size was inadequate to assess reliably the effect of testosterone on the risk of these conditions. ​(WSEG = 46/23.0/23.4/15.6)	But we can’t generalize much from these results. Why? Since we left out men with a high risk of prostate cancer or moderately severe urinary tract symptoms. The sample size was also too small to judge how testosterone affects the risk of these conditions. ​(WSEG= 44/11.0/68.7/6.4)

We reduced long words to just 13% (6/45 = 13%). Is this the best revision? Perhaps you can think of something better. The point is: when you try, you can often improve reading ease a lot.

How much does reading ease change?

The chart below shows before and after WSEG scores.

WSEG	Meaning	Original	Revised	Change
W	Total words	46	44	-2
S	Average sentence length	23.0	11.0	-12.0
E	Flesch Reading ease	23.4	68.7	40.4
G	Flesch-Kincaid grade level	15.6	6.4	- 9.2

These data show a reader would find the revision much easier to read. If the whole article were revised in plain English, it could reach a much wider audience.

Conclusion

In this blog post, we looked at an excerpt that used long sentences and long words —two classic symptoms of medicus incomprehensibilis. We revised to fix these issues. We talk more about reading ease in Chapters 1 and 2 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, 2017).

​This blog post is fourth in a series on the Symptoms of Medicus Incomprehensibilis.

----
(1) Snyder P, et al., “Effects of Testosterone Treatment in Older Men,” NEJM 374, no. 7 (2016): 622.
(2) Dictionary.com, s.v. “Assess," http://www.dictionary.com/browse/assess?s=t.
(3) Wikipedia, s.v. “Accuracy and precision,” https://en.wikipedia.org/wiki/Accuracy_and_precision (accessed 1/23/17).