Are Zombies Creeping into your Plain Language Content?

Technical content in medical and legal professions is crawling with zombies that can suck the lifeblood out of any well intended communication. Nominalizations - also referred to as zombie nouns(1) - feed upon lively verbs or adjectives and their feast can turn any message into a lifeless, word-infested reading experience for people who are not industry professionals or peers.

How do you Check if your Content is Infected?

Zombie nouns or nominalisations are verbs or adjectives that have been given a suffix and used as nouns. The linguistic term for such additions are morphemes which are defined as small language units that cannot be divided further, for example -ment, -ion, -ance, -ly, -ness, -ity, -edge, -ing, and -ship.

Extensive use of nominalisations is standard within certain professional writing traditions, for example in regulatory medical writing where objective and unbiased communication is key to presenting scientific research results. Or, in the legal profession where nominalizations serve to formalise content, as we see in recital (13) of the European Clinical Trial Regulation: “The assessment of the application for a clinical trial should address in particular the anticipated therapeutic and public health benefits (relevance) and the risk and inconvenience for the subject. In respect of the relevance, various aspects should be taken into account, including whether the clinical trial has been recommended or imposed by regulatory authorities in charge of the assessment of medicinal products and the authorisation of their placing on the market and whether surrogate end-points, when they are used, are justified.”

By turning perfectly sound verbs, such as “assess”, “apply” and “include”, into zombie nouns, a passive voice is created in the text where the actor (subject) of the sentence is left lingering on the page. As a result, the reader will need to store large chunks of text in memory to eventually discover who the subject or the “doer” is. This is problematic when you wish to deliver a message to a reader who is not familiar with legal jargon and has an average literacy level of the general population(3).

Bring Life Back to your Plain Language Content

The use of nominalisations is not wrong it itself and they can be fit for some situations. For example if you present a statement where you are more interested in the concept than the actor or subject of the sentence. Example: “The distribution of the study materials was completed before Halloween”. But when you author or re-author technical content to a plain language audience, such as the general public or clinical study volunteers, it is not recommended to embalm your text in too many heavy noun phrases. Zombie nouns have the disadvantage that they trigger more words and you risk cooking exactly what you aim to avoid; alphabet soup!

If we replace the zombies (in bold) in the examples below with their verbs or adjectives, we can re-author the sentences into a more lively communication which is easier to digest for the reader.

"An agreement was made between the sponsor and the vender to provide information to patients with the purpose of increasing awareness of the safety assessments carried out regularly during the study."

"The sponsor and the vendor agreed to inform patients and make them more aware of how safety would be assessed on a regular basis during the study."

"The regulatory authority found GMP compliance issues during the sponsor inspection that would lead to impairment of the validity of the study results."

"The regulatory authority inspected the sponsor and found that the sponsor had not complied with GMP which would make the study results invalid."

In our re-authoring process, we have removed the suffix from the noun phrases in our examples (-ment from agreement) and replaced them with active verbs (agree).

The Language Gap and How To Close it

Plain language writing is distinct from academic or scientific writing styles. When you author content in plain language, you should assume that your reader has no prior knowledge of your technical content. Everything should be in full view, and the reader needs no help in seeing or understanding anything(2). This is especially important for one-way communication where the written content is stand-alone and not aided by dialogue or other means of communication.

Scientists and academics have been schooled in a specific writing style which is perfectly understandable amongst peers of their communities but very far from the simple conversational language which is the aim of most plain language information. Therefore, they may struggle to present their content to an outside reader in clear language.

Steven Pinker describes this language gap as the curse of knowledge: “The problem is that as we become proficient at our job or hobby we come to use these catchwords so often that they flow out of our fingers automatically, and we forget that our readers may not be members of the clubhouse in which we learned them”(2).

So, what then is the recipe for success? Well, you may consider asking an expert for help. Or rather, two experts. Your most important expert will always be your intended audience so if you are preparing information for the general public or for patients, you can test your content with a representative of these audiences. I would also argue that you should involve a language professional in your communication process who can help you identify and rectify language aspects of your content. Style guides and templates can be helpful as well and save you a lot of time.

Sources:

1. Sword, Helen, "Zombie nouns", New York Times, Jul 23, 2021

2. Pinker, Steven, "The Sense of Style", Penguin, 2015

3. Across Europe the average proficiency level is 2 -3 as defined in the International Adult Literacy Survey (IALS). A proficiency level of 2 is defined as being able to identify words and numbers in a context and being able to respond with simple information e.g. being able to fill in a form. A proficiency level of 3 is defined as being able to identify, understand, synthesize and respond to information, be able to match given information which corresponds to a question. This level corresponds roughly with high school completion levels.