Good reminder on why to avoid jargon

Most professions have jargon, and while such technical language is useful and even necessary, it is overused. I propose that people should try, as much as possible, to use plain language, even when speaking to others in their discipline. It is important, especially in a world of specialization, to be able to communicate to a broad group of people about what you do and why it matters. 

I was reminded of this recently by a faculty member at work, who sent me an article by the Robert Wood Johnson Foundation called "A New Way to Talk about the Social Determinants of Health." Social determinants of health, or "SDOH" as they are often referred to on Twitter, is used by people in healthcare and public health to refer to how aspects of our lives like our education, income, or neighborhood, contribute to our health. It is usually thought of in contrast to the medical determinants--pharmaceuticals, surgeries, etc.-- of health or the biological determinants of health, like our genes. However, as Robert Wood Johnson's team director says in her introduction letter to the report, it is a term that does not "work on the ground." As she puts it, "For some [of our grantees] it was so patently obvious that it became a truism." 

I've always found social determinants of health clunky and unappealing, but I find myself using it not infrequently. Yet the problem is, as Robert Wood Johnson's report points out, it is not a frame that effectively persuades people that improving our schools or infrastructure can lead to improvements in health, as well as the more obvious benefits, like academic success and an easier time getting to work. A problem is that "SDOH" comes out of the perspective of someone with a strongly medical background. To someone whose training has mostly been focused on finding medical solutions to health problems, the idea of focusing on other factors is actually kind of novel. But for the rest of us, it actually may seem obvious, as Robert Wood Johnson's report suggests. What's more, the phrase has kind of an ominous mood because of the word "determinants." It makes it sound as if we are controlled by "social" factors, even though the whole idea of bringing attention to "SDOH" is to encourage people and policymakers to change aspects of our society not be determined by them. 

In any case, the Robert Wood Johnson report provides many more great, well-researched reasons why "social determinants of health" does not work in health messages and offers interesting ideas for what can work. For me, the lesson is when in doubt, do not use jargon. As a writer and communicator especially, I need to be vigilant to this and always search for what is clearer, more descriptive, and less jargon-laden.

Why I hate the word utilize, and how to avoid it

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Source: 20 words you should never use in a cover letter

While editing some web content for work the other day, I came across the word “utilize” – a word that makes me particularly upset. What you may ask is wrong with a mere word, one that is used in thousands if not millions of corporate emails per day, that is right at home in academic papers and engineering manuals?

For me, it’s larger than the word itself. Utilize is the perfect embodiment of what is wrong with professional writing today. Utilize signals not only that you may not know of what you’re speaking, but you’re insecure about it and feel the need to dress it up. If your goal is to engage people with what you’re writing, utilize will leave them cold.

Here’s my advice on how to avoid utilize and to engage more people with your writing:

  1. Don’t write from a place of insecurity. Believe what you’re writing, and admit uncertainty in your writing. If you can do this, you won’t feel compelled to dress up your prose with distracting four-dollar words.
  2. Do not trying to impress your audience, try to inform your audience. Your audience may have only the faintest idea about what you’re writing. Sprinkling in vague, dressed up words like “utilize,” “implement,” “impact,” “leverage,” and “interface,” will only lose their interest. I like to tell people who are struggling with professional writing–especially writing for the web–to imagine that they are talking about what they do to a friend at a party. When you’re talking with a friend, you try to select out the most interesting bits of information, you try to keep it fairly simple, and you try to get your friend to understand and even relate. You are trying to inform your friend not impress your friend. Even if you are kind of trying to impress your friend, you sure as heck aren’t using words like “utilize” to do it.
  3. Don’t feel an obligation to use a big or complicated word, especially when you are trying to replace a fairly non-descriptive verb. Although many of us learned in English class not to overuse verbs like “is,” “does,” “have,” “said,” and “use,” in professional writing, we often have to use these words. This is for a couple of reasons. Professional writing is not as florid as literary writing. And there are also many instances when one simply does not have enough detail or enough space to be descriptive. For example, if I’m writing that a government decided to expand a vaccination program, ideally I have enough detail to write something like the following:

The government has decided to expand their new vaccination program. To do this, they are building 55 more healthcare clinics across the country, hiring hundreds more nurses, and delivering flyers to citizens who live in rural areas to inform them about the clinics, and sending texts to people on their mobile phones.

However, I may not know this much detail about the program. So I might simply write: 

The government is expanding the vaccine program. 

I should however resist any urge to write: 

The government is implementing an expansion of the vaccine program.

Shudder. If you have a verb that offers little, it should be unobtrusive.

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Unfortunately, one of the major reasons why professional writing can be so bad, so filled with utilizations and implementations, is because people are sometimes trying to dissemble. They dress up what they’re saying because, as I alluded to above, they don’t know what they’re saying, but they feel they must look like they do know what they’re saying. That is of course one way to get through life, but it seems unsatisfying. My advice: don’t try to dress what you’re saying up in a suit if there’s no substance behind it. 

On God and the idea of righting wrongs

I believe in God. I won’t go into why at this point except to say that I don’t put much stock into the Bill Maher style analysis of whether God exists–the idea that you might as well believe in wizards, unicorns and lizard people if you believe in God–and I wonder what guides a person with his perspective through life if not a belief in higher ideals than what we see on Earth. For me, it’s that feeling that there is something greater than myself and my fellow comrades from which I derive my faith. 

I’m reminded of my belief in God when I have hungered for perceived wrongs to be righted. I think if God even had any influence, God would deny vindication. Why? Because I don’t believe we grow from being vindicated, from winning, from being right. I have had the greatest opportunity to grow when I was wrong, when I faced injustice, pain, and what some called losing. If God righted our wrongs, we wouldn’t have anything to work toward, or to grow from. I like to think this God wants us to work to become better people because that leads us to find that unparalleled ideal known as meaning. This is a God that, as one of my rabbis once said, is “all good” but not “all powerful.” God will not make the world just or right, God will however offer a light to guide you through darkness.

That was pretty deep for a Friday night. I’m going to go microwave a pupusa now. 

Reclaiming time

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-Juliet Schor, True Wealth

Why is this so hard? I am not entirely sure, but it is. We work a lot–that is one point Schor makes. I think about how good it feels when you are a master of your time, like on a Saturday when I finally clean out my refrigerator, go grocery shopping, cook a stew, go on a run, and do an errand I’ve been putting off for weeks. Reclaiming time is both something we must work on at an individual and societal level.

Self-actualization, defined, and why do people not feel entitled to it?

I have been thinking a lot lately about how to be a fully “actualized” human being. For a long time, I don’t think I felt entitled to self-actualization. It seemed overly introspective and indulgent. How can I be so focused on meeting my higher needs when some people are in circumstances that prevent them from meeting their basic needs like food and shelter?

For me the road to self-actualization has only been possible through in-person therapy. For a long time I felt guilty I was in therapy while people who “really needed it” were not. I was from a two-parent, comfortable home with no history of physical or sexual abuse. My assumption was that I was by default a healthy person and thus deserved no further self-examination even though I couldn’t help but do it. Then I began to realize this: it’s not going to matter to people whose basic needs aren’t being met what I choose to do to meet my own needs. And to the extent I can become a fuller and more emotionally healthy being, I am probably going to be a better contributor to society.

Sadly, in our culture, therapy and self-examination is often considered soft, self-indulgent, and neurotic. (The irony is that people who are spending time examining themselves are trying to free themselves of their neuroses). It’s Stuart Smalley’s “daily affirmations” and Woody Allen’s brain tumor hypochondria in Hannah and Her Sisters and the idea of “needing therapy” as a pejorative. Don’t get me wrong, I love Smalley, and Woody Allen can be funny, but they have painted a certain picture of the kinds of people who need therapy.

Back to actualization. What does it mean?

Self-actualization is a term coined by Abraham Maslow over 50 years ago referring to the goals of his most “emotionally healthy” clients. In his studies, he described the activities of those who had their basic needs gratified and were seeking a higher purpose in their lives. Maslow defined the qualities of their deeply human activities as including:
-keen sense of reality; aware of real situations
-see problems in terms of challenges and situations requiring solutions, -rather than see problems as personal complaints or excuses
-need for privacy and comfortable being alone
-reliant on own experiences and judgment; independent; not reliant on culture and environment to form opinions and views
-accepting others as they are and not trying to change people
-comfortable with oneself, despite any unconventional tendencies
-a few close intimate friends rather than many surface relationships
-sense of humor directed at oneself or the human condition
-spontaneous, creative, inventive, and original
-seek peak experiences that leave a lasting impression

— Jonathan Bartlett summarizing Abraham Maslow (of “Maslow’s hierarchy of needs”).

I am not there yet. Maybe I never will be. But the above list is incredibly inspiring. Self-actualization is about how to have a meaningful, below-the-surface life. It is about listening to that voice that asks is this it? and searching for something more even if you don’t and can’t and never will findit. (Because there is no it, is there…?)

It is interesting to me that that this journey gets scoffed off in our culture as self-indulgent. And that even uses of words such as “journey” and “affirmation” are seen as hokey. More to think about…

“I think social media sucks”

Following my social media detox post yesterday, I read this about a 19-year-old model named Essena O’Neill who very publicly quit social media and is now going through the photos she used to post and editing the captions to describe how she really felt that day–which is often pretty cruddy.

I gotta be honest: sometimes I wonder if I’m too sensitive to social media in part because I’m not a social media phenom. But after watching a couple of O’Neill’s videos, I can see that at least if you’re a person who values more than appearances, it probably isn’t going to be satisfying to focus a lot of effort to get validation on social media, even if you get a lot of likes and followers as she did. 

I don’t think the answer is total banishment. O’Neill is now using social media to spread her message about the emptiness of her old behaviors. There’s always a balance, and I’m not sure I’ve struck it yet, but I liked what my friend Flo had to say in response to my article: “When I use social media with moderation and intent, I feel it empowering me… But when I start using it to fill in a void, it creates a learned behavior that negatively impacts my ability to remain present in conversations, hangouts, etcetc.”

How scientists are fighting back against hidden biases in medical research

My article on scientists fighting back against hidden and misleading clinical trial research has been published on one of my favorite web magazines, the Pacific Standard/ pacificstand. Check it out.

And here is an excerpt:

Most of us who take a medication expect our doctor to prescribe it based on evidence. But it turns out that basic assumption is often incorrect.

In fact,many clinical trials of medical treatments—particularly negative ones—never make it to publication in academic journals, which doctors consult to make medical decisions and the media publicize in their health reporting.

[…]Even studies that are published may over-emphasize positive results—a kind of spin that we are conditioned to expect from politicians but not from clinical researchers. All of these practices—and many more variations of misleading—are known as publication bias, and they can seriously skew the evidence doctors and patients use to make health decisions.
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(Illustration: Jon Kalish)

Why we can’t always rely on medical research

An article I wrote called “Shining a Light on Hidden Medical Research: New Efforts Seek to End Publication Bias in Clinical  Trials” is now out on the 2x2 project run by Columbia University School of Public Health’s Department of Epidemiology (my former employer). Not only do I highlight the growing concerns around publication bias, but I talked to several sources who are working to tackle the problem.

It got promoted on Twitter by Dr. Ben Goldacre, one of the experts in this area and a crusader for medical transparency, and by Dr. Joseph Ross who does research on publication bias. I interviewed both of them for the article.

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(Illustration: Research being brushed under the rug, by Jon Kalish)

Here’s an excerpt:

Most of us who take a medication expect our doctor to prescribe it based on evidence. But it turns out that basic assumption is often incorrect.
In fact, many clinical trials of medical treatments—particularly negative ones—never make it to publication in academic journals, which doctors consult to make medical decisions and the media publicize in their health reporting. According to a 2014 systematic review in PLoS, more than half of trial results are not published, and those that are published are three times more likely to come out with positive rather than negative or null results.

…In recent years, a variety of governmental and nongovernmental groups are forming or stepping up efforts to bring transparency to medical research. What remains to be seen is whether these efforts can attack a problem that has persisted for decades.

The literature of creativity: "A genre of surpassing banality"

“What was really sick-making, though, was [Richard] Florida’s easy assumption that creativity was a thing our society valued. Our correspondent had been hearing this all his life, since his childhood in the creativity-worshipping 1970s. He had even believed it once, in the way other generations had believed in the beneficence of government or the blessings of Providence. And yet his creative friends, when considered as a group, were obviously on their way down, not up. The institutions that made their lives possible — chiefly newspapers, magazines, universities and record labels — were then entering a period of disastrous decline. The creative world as he knew it was not flowering, but dying.”

Thomas Frank in Salon

A public health perspective on gambling

I published “Gambling with America’s Health? The public health costs of legal gambling” on the Pacific Standard and the 2x2 project.

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(Image: Jon Kalish)

Here’s the nut of it,

A debate over the social and health costs of legal gambling has largely been sidelined even as availability has expanded dramatically in the last 25 years. This is not because of a lack of merit, say experts and activists, but because of the political power of the gambling industry. They allege that the industry has employed tactics in the same spirit as those of tobacco companies, which for many years misled consumers about the addictive properties of cigarettes and advertised to young people and other vulnerable consumers.

but read the whole thing.

Another way to look at addiction

I have been reading  and talking to many people for an article I’m writing about gambling addiction. I came across this, in the New York Times from 2005:

Q. I gamble as a social outlet. I’d much rather do something to reform society, which is in a mess at the moment…If a healthy environment gave addicts the release they seek in drugs, there would be no addicts.

A. Dr. Timothy Fong

Your comment taps into the idea that recovery from addictive disorders is a voluntarily maintained lifestyle characterized by sobriety, self-care and citizenship. The reality is that our current environment is one that promotes consumption, recreation and instant rewards, all of which are very reinforcing and compelling to the brain.

It would be interesting if we invested as much energy into making our society one that promotes health, instead of just looking to treat the psychiatric side effects of that so many of us experience as a result of the way our society is organized.

On convictions

As I have gotten older, I have found that some of my convictions have softened with a growing awareness I feel about all of the things that I do not know, in some cases, cannot know. I have been more comfortable saying those words: “I don’t know.” On the one hand, I worry that if I lose convictions, my life will feel tepid. It will feel like I am not really alive, or that I don’t really believe in anything. But on the other, I feel a bit of relief. Because losing some of my convictions has meant that I’m less exhausted by the disappointment I have felt when the world does not act the way I had wished it would.