JMS Pearce M.D.
When Prime Minister, David Cameron recently thought that LOL meant lots of love, not laugh out loud, he appeared out of touch. [The Guardian, May 11, 2012] He illustrated the difficulties that acronyms can cause.
But acronyms are not new. The Romans used SPQR to abbreviate Senatus populusque Romanus, isinscribed on Rome’s Arch of Titus (fig 1).1
|SPQR (senatus populusque Romanus): an early initialism|
The first book-length collections of English initialisms may have been Courtenay's 3,000-item, 53-page pamphlet2 published in 1855, it included abbreviations such as Brit. and chron. TWW’s general English collection (1873)3 is one of the few abbreviations dictionaries where entries are given citations. Next came Fallows’ handbook (1883)4 and the anonymous Dictionary of Abbreviations(1886).5
The frequent and habitual practice of writing acronyms is surprisingly recent, appearing insidiously during the First World War (WW1), when for example, AWOL (absent without official leave) appeared: although it was earlier recorded in Report - National Home for Disabled Volunteer Soldiers in Misc. Documents House of Representatives 1894-5. Others followed to be quickly embedded in contemporary written and spoken language. Familiar examples are: LASER (Light Amplification by Stimulated Emission of Radiation), and RADAR (Radio Detecting And Ranging).
Acronym is derived from a combination of the Greek words akros — highest or foremost, and onyma — forming nouns denoting certain semantic terms. At first, attractive to both editors and publishers of journals and books, their appeal was probably one of brevity. Although they commonly refer to any phrase abbreviated by the initial letters of each word or syllable (in capitals), the strict definition of acronym is an abbreviation formed from the initial letters of other words and pronounced as a word, which perhaps makes them easy to remember, such as AIDS, NATO, or SCUBA. Equally common are initialisms, which by contrast, are a group of initial letters used as an abbreviation for a name or expression, each letter being pronounced separately. (OED) Examples are NHS (National Health Service), and FDA (Food and Drug Administration). But, both acronyms and initialisms can when overused deface the written page with an unsightly alphabet soup.
But acronym use, like Topsy, (in Harriet Beecher Stowe’s Uncle Tom's Cabin) just ‘grow’d.’ In radiology, psychology, and cardiology inter alia, they have become epidemic. In the acronymous cardiology trials, between 1992 and 2002, they increased from 250 to nearly 4,200.6 The coined words acronymania and acronymophilia (‘a sinister scourge of modern medicine’7 ) disclose reactions to this expansion—not always popular.
It is arguable whether acronyms speed up reading time and understanding and by saving space shorten scientific papers and books. But many do maintain that acronyms can be useful as one of several types of abbreviation designed to shorten lengthy tracts. However, if overused the unfortunate reader is faced with a text littered with these capitalised interruptions, whose meaning is often obscure. If they are new to our reader, as he struggles through the text, he will often have forgotten their meaning and significance and then has to go back seeking the first explicit mention. This seldom appeases his annoyance. Many pass into casual conversation perhaps to show off arcane knowledge or wit, but may cause an irritating sense of ignorance or inferiority in those unenlightened by mercurial technobabble.
Commercial, Scientific, and Medical journals notably became hotbeds of excessive use. The New England Journal of Medicine (NEJM) editors showed unease with abbreviations and acronyms as long ago as 1966:
Anything that hinders communication of ideas defeats the purpose for which a medical article has been written. The failure in communication may be due to any one of a number of flaws… Ambiguous symbols and abbreviations that defy comprehension… Authors should be encouraged to realize that their mission is to reach a large readership by a clear and simple presentation of their investigative result.8
In 1989 a letter to the New England Journal of Medicine, Mann complained:
There is a recent trend (RT) in the medical literature (ML) to abbreviate previously unabbreviated phrases for the sake of efficiency (PUPSAE). Although it makes good sense (GS), the frequency with which it is used can tax the inexperienced reader (IR). Sometimes repetition can actually be beneficial (RCABB) by allowing the reader to retain words that he does not constantly have to refer back to (WOHCREBT). I would like to suggest to the Editor (ED) that for the IR who doesn’t wish to have PUPSAE, he have the GS to change the ML so that RCABB and he can eliminate WOHCREBT.9
Ambiguity is an important hazard of the indiscriminate use of acronyms. Authors commonly fail to define the acronyms/initialisms that they use.10 CT may mean coronary thrombosis, cerebral tumour, or computerized tomography. MI may mean mitral incompetence or myocardial infarction. Similarly, ALS stands for amyotrophic lateral sclerosis, but it also stands for afferent loop syndrome, and antilymphocyte serum. IC can mean intensive care, internal carotid, and immune complex.
Another issue is that acronyms can impede a successful subject MEDLINE search ((Medical Literature Analysis and Retrieval System Online) if they are not mapped to appropriate MeSH (Medical Subject Headings) terms.11 For example, Glasgow Coma Scale is not listed among the MeSH choices for the abbreviation GCS. Many journals sensibly instruct authors not to use abbreviations in the title or abstract. Complex systems for retrieving and recognizing acronyms and their definitions, has spawned its own literature.12
Acronyms also foster tautology. In particular, we may be justly irritated when asked for our PIN number (Personal identification number), rather than just our PIN, or for the ISBN number (International Standard Book Number).
Yet acronyms and initialisms, many which flood into conversation as well as writing, can be witty or amusing and usually inoffensive: BOGOFF for Buy One Get One For Free; 2BC/2 for Too Bloody Clever by Half; DIMWIT for Don't Interrupt Me While I'm Talking; KISS for Keep It Simple Stupid; and the well known diagnoses: GOK meaning God Only Knows, and PO standing for Plumbitis Oscillans [swinging the lead].
Acronyms have a justifiable function. They form part of the wider concept of jargon: intelligible to those with specialised knowledge in a particular field; and if carefully confined to this informed readership they save unnecessary repetition of words and tediously long phrases. For instance, radiologists will be instantly familiar with magnetic resonance imaging (MRI) sequences, such as STIR (Short Tau Inversion recovery), Fluid-attenuated inversion recovery (FLAIR), TSE (Turbo Spin Echo), Echo Planar Imaging (EPI). But such abbreviations will confuse most of us not intimately involved in this technology. This proliferation prompted the editor of the American Journal of Radiology to observe:
…abbreviations have come to be accepted by editors and readers as a necessary evil. Not so. We are not obligated to use abbreviations. The AJR therefore is adopting a policy to remove any and all abbreviations when they interfere with readability and potentially impair the reader’s comprehension. 13
By contrast, most doctors will readily understand OA — osteoarthritis, TB — tuberculosis, ECG — electrocardiogram, which have become absorbed into Common English Usage.
To the discomfit of perplexed readers, many editors and authors still allow the profligate use of acronyms and seem to have no qualms in ignoring the established rules of syntax that discourage excessive abbreviation. They seem to believe that like texting and messaging they serve to shorten text or facilitate the transfer of information.14 However, The International Committee of Medical Journal Editor’s guidelines advise, “Use only standard abbreviations; use of nonstandard abbreviations can be confusing to readers….” 15
Acronyms are plainly here to stay. But we can conclude that it is all a matter of good taste and sensible balance. The trouble with acronyms, like jargon and buzzwords, is that they resemble a club that seemingly is forever trying to have you removed as a member.16 Nonstandard acronyms, those not in general use, hamper good scientific writing that complies with established rules of grammar,14 which facilitate understanding. Texts and journals should keep them to a minimum. The practice of excessive usage degrades both the English language and medical texts by impairing their quality, intelligibility and value, thereby frustrating readers and lessening their understanding.
Sufferers from acronymophilia need to be treated with sympathy and understanding, and offered tender loving care, not TLC. However, peer review may not be sufficient to expunge the acronym from consciousness. As an alternative to exorcism, acronymophiliacs should be encouraged to join AA (Acronymophiliacs Anonymous).7
Do writers and publishers really want to alienate the people they would really like to influence?
- Cannon G. Abbreviations and Acronyms in English Word-Formation. American Speech . Duke University Press 1989;64, No. 2: 99-127.:
- Courtenay,EdwardS.C.1855.Dictionary of Abbreviations. L.ondon: Groombridge and Sons.
- T.W.W. 500 Abbreviations made intelligible. Containing an explanation of the initial letters commonly used to denote titles, orders, etc. London: Routledge. 1873.
- Fallows, S. 1883. Handbookof Abbreviations and Contractions. Chicago: Stan- dard.
- Dictionary of Abbreviations. 1886. London: Griffith, Farran, Okeden & Welsh.
- Cheng TO, Julian D. Acronyms of cardiologic trials—2002. Int J Cardiol 2003;91:261–351
- Isaacs D, Fitzgerald D. Acronymophilia: an update. Arch Dis Child 2000;83:517-8.
- O’Leary R. Technic of medical communication. N Engl J Med 1966;274:940–944.
- Mann SG. Abbreviations in the medical literature [letter]. N Engl J Med 1989;320(17):1152.
- Fred HL, . Cheng TO Acronymesis The Exploding Misuse of Acronyms. Tex Heart Inst J. 2003;30:255-7.
- Federiuk CS. The Effect Of Abbreviations On Medline Searching. Academic Emergency Medicine 1999; 6:292 – 296
- Taghva, K. and Gilbreth, J. Recognizing acronyms and their definitions, International journal on Document Analysis and Recognition, 1999: 191-198.
- Rogers LF. From The Editor’s Notebook: ABBREVs. (abbreviations). AJR Am J Roentgenol 1997;169:1481.
- Berlin L. TAC: AOITROMJA? (The Acronym Conundrum: Advancing or Impeding the Readability of Medical Journal Articles?) Radiology. 2013;266(2):383-7.
- International Committee of Medical Journal. Uniform requirements for manuscripts submitted to biomedical journals: manuscript preparation and submission—preparing a manuscript for submission to a biomedical journal. http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html#k
- Bowen Charles. Deciphering Acronyms and Abbreviations. http://www.editorandpublisher.com/PrintArticle/Deciphering-Acronyms-and-Abbreviations. Posted: 10/29/2002.
MD, FRCP (London) is emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England. All correspondence to: 304 Beverley Road, Anlaby, East Yorkshire, HU10 7BG, England, or to my email address [jms[dot]pearce[at]me.com].