What's behind this?

Shannon Brownlee is perhaps a smarter and more reasonable version of Kevin Trudeau. Trudeau has made millions as the sultan of snake oil. He claims that doctors and the pharmaceutical industry are evil. Brownlee believes that medicine and treatment are good when administered sufficiently and necessarily. But she knows there are problems with the system. We all know that.

She was just on Book TV talking about her book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.

It was an interesting presentation. I wish I had started watching from the beginning. And I wish had been paying closer attention when one fellow in the crowd asked her a question (I think it was about managed care) and he relied on the premise that some part of the system "has always been behind the progressive 8-ball."

[Update: As Casey points out in his comment the program is now available. It must take some time before the video is posted on the C-SPAN website. I had looked at that page. Here's the full quote from the question (~45:50 into the video):

"Two topics: medical assistance in Maryland, and mental health. Medical assistance in Maryland has always been behind the progressive 8-ball. Have you done any looking into programs in other states...? What have you seen in other states that makes medical assistance models look good?"

And by medical assistance he means programs like Medicaid.]

I think he was trying to accomplish more than this image is accustomed to.

It makes sense that by saying its behind the 8-ball he means the system is in trouble. It finds itself stymied while facing an important task. Some people will throw in the word "proverbial" to make sure that we dense listeners catch the metaphorical intention.

They're playing snooker ol' boy?
No no. It's a proverbial 8-ball ol' chap
Ah. But of course!

Well since he was arguing for the importance of change I'm guessing that he meant the health care system is lagging in its response to the need for improvement and evolution. So the system is behind in its task of progress. And it's a tough situation. But instead of a proverbial 8-ball this is a progressive 8-ball.

So here we find it behind_blocked and behind_lagging.

So this blend seems to be functioning on the idea that "the 8-ball" is both a hindrance to progress and the model of progress. Awesome.

This looks like a wonderful instance of several necessary influences interacting at the right time to create this phrase. The standard term --proverbial-- being close enough to another word --progressive-- so that because of an implication of the argument (we need progress) an idiomatic blending occurs maybe even influenced by several other 'behind the X' phrases taken to be sports/gaming idioms even if they're not all from the world of sports.

Behind in the count
Behind the curve
Behind in points

And I've found a few sites that use the phrase "behind the curve ball" meaning running late or in a difficult situation. see here see here.

Apparently some people do see "behind the curve" as a baseball image.

(BTW: Within a span of only a few minutes I heard Brownlee use Isis formation a couple of times. Loverly.)

Don't breathe the water

An AP story about a brain eating amoeba is making the rounds. Why? because there's been a recent spike in the number of cases reported. Infection is around ninety-seven percent fatal--only three survivors ever reported. It crawls up your nose and follows the olfactory nerve to your brain causing headaches and hallucinations and finally death.

Sounds pretty scary. And the spike this year was enormous. In 2007 Primary Amoebic Meningoencephalitis was reported to have caused about two-hundred percent more deaths than the yearly average from 1995 to 2004. The amoeba-- Naegleria fowleri --thrives in warm stagnant water. So global warming is expected to make it worse.

I've borrowed some of the language and some of the statistical rhetoric from all the stories I've seen. Brain-eating is a favorite in these stories. It's up there with flesh-eating in its impact. Maybe better. It's a lot better than infection. It sounds a lot scarier and more deliberate on the part of those ravenous brain eating mini-monsters.

And the statistics: In the story I linked to above Chris Kahn writes "The spike in cases has health officials concerned." Infections are exceedingly rare. So a spike is a complicated phenomenon. From 1995 to 2004 there were 23 reported cases. That's just over 2 per year. 2007 saw 6 deaths. About four more than the average. But is that a spike? Snooping around the CDC website I found that there were 6 cases in 2002 as well. Two each in Texas Arizona and Florida.

I've not been able to find the numbers for year to year cases tho I'm quite sure that they would make 2007's "spike" look less alarming.

But then how would the story make it into all the newspapers and TV newscasts?

_

The wrong typo disorder

Picking on spelling errors is not the high road for a linguist. We usually let people like Richard Lederer and Lynne Truss and George Bernard Shaw fling that mud 'cause we get dirty and they like it.

But we need to get a little dirt under our fingernails every once in a while right? Sometimes that's how the important work gets done. And sometimes the pigs are right; it can be fun. And sometimes its a genuine question of the intended meaning of a phrase.

So...The NFL has become a lot more strict regarding concussions. Some players have been put back into games without fully recovering from brain injuries and something has to change.

The new policy apparently wants to raise the standard of mental functioning necessary for permission to suit-up.

The guidelines include prohibiting any player who has lost conciseness from returning to a game or practice. It outlines the symptoms, which include confusion; problems with immediate recall; disorientation and blurred vision and says that a player should have no concussion symptoms and normal neurological test results before returning to play. [emphasis added]

So I guess when an athlete is hit in the head they ask him to state his name, give his age, and defend capitalism in fewer than 25 words.

Read the story here. Looking for this form on Google^TM I got these results.

[Update:
Via ADS-L Ben Zimmer reminds me of the Cupertino effect "wherein an automatic spellchecker miscorrects an error. MS Word gives "conciseness" as the first alternative for various plausible misspellings of "consciousness", such as "conscisness", "conscesness", "conshisness", "concisness" and "concusness". (I like the last one as a possibility, since the error could have been influenced by the frequent use of
"concussion" in the article.)"

He also provides links to two Language Log posts on the issue.
]

Knees and ankles...I mean niece and uncle

My 9-year-old niece just told me that she sprained her ankle. "Yes. You told me" I said. "Did you still sprain it?" I asked (playing around with the telic sense of the word--she didn't catch that and it wasn't that funny anyway).

"How long ago did you sprain it?" I asked.

"Two days ago" she said. Then she corrected herself. "Well...one and a half day ago."

"One and a half day ago?" I asked thinking she had misspoken.

"Yes" she assured me. "One and a half day ago."

I can name that drug with three connotations

Daniel's suggestion of Ameliozene is good (comments of last post). These drug brands can be just that transparent in their implications.

Some notable drug brand names (assume a little ® after each):

Abilify: This antipsychotic drug has a nice 'verbing' name. To make able or to give ability is to abilify right?

Acarbose: Of course diabetics want to neutralize or decarbify all those sugars. They're not carbs. They're Acarbs.

Actron: Not only will you ease your suffering from osteoarthritis, you'll be strong like a robot!

Alavert: Avert is not only appropriate for someone hoping to avoid allergies--vert is also a popular syllable with that upright connotation.

Bactroban: This medication for bacterial skin disease has a negative sense. The name introduces itself as half bacteria for goodness sake.

Celexa: Half of the Citalopram molecule was useless and caused side effects. So they refined it and used only the good half to make Lexapro (Escitalopram). It's like Celexa finally made it to "the show."

Eulexin: These brands love that 'X'.

Flomax: Your enlarged prostate is keeping the flow to a minimum. Well take it to the max. (See this SNL ad for Urigrow. A disgusting parody that's very funny.)

Januvia: For some reason J is not a popular initial letter.

Miltown: Feeling anxious. Come on down to Miltown. More Chillin' when you're illin'

Provigil: Pro is a popular drug brand name morpheme. What sufferer from narcolepsy doesn't wish to be capable of a vigil?

Proscar: Either a racing circuit or a lobby in favor of the cicatrix or a bad name for a medication for an enlarged prostate.

Wigraine: Suffering from migraine? Wigraine? Because you deserve relief.

Wytensin: Why so tense? Wytensin. (You know they thought of that.)

Zanamivir: It's intended to curtail the flu virus. It sounds like the master of the pan flute. Wait. Zanamivir... respiration... flu... playing the flute... pan flute master Zamfir...

Zyban: We don't want any more Zys Dammit!

So I suggest we call this new drug Extasty (PRO) and make it in the shape of a little candy heart stamped with the message "Say Yes to Me!"

Ask your doctor about

We call on Thursday to beg them to let us take the not-yet-approved-for-use-by-humans drug. It's name so far is APD791. "This is the first study in which APD791 will be given to humans." Here's the word on the street about it:

APD791 is a selective inverse agonist of the 5-HT2A serotonin receptor. By selectively inhibiting the activation of 5-HT2A serotonin receptors found on platelets and vascular smooth muscle, Arena believes that APD791 may reduce the risk of arterial thrombosis and conditions such as acute coronary syndrome, heart attack and stroke.

Sweeeet.

If we are among the chosen few we will be the first humans to take this. Fortunately that means that our dosage will be low: 1mg one time. The plan is to increase the dosage (in later studies) as high as 160mg.

But the fun has already begun. Today we showed up and signed on all the dotted lines agreeing to risk the following:

nausea, abdominal pain, rash, headache, dry mouth, dizziness, drowsiness, common cold symptoms, and nausea.

Other side effects also include nausea and sometimes feelings of nausea. And those are just the "common" side effects of similar drugs. Of course the list continues:

hepatitis, kidney stones, heart attack, low blood pressure, abnormal heart beat, bleeding from the stomach, nose bleed etc.

Okay--they list heart attack third. As if they had to ease up to it then taper back down. Why bother listing anything else?

"What might go wrong?"
"Oh there are several possibilities. Your heart might stop beating."
"Hmmm...tell me more before I decide."
"Well you might have trouble sleeping."
"Wow that sounds serious. Anything else?"
"Dry mouth..."
"Whoah! Get me outta here!"

Among the "side effects" listed are "abnormal laboratory test results." This is the type of warning that could be nothing or it could be horrific.

Scenario 1:

"Your results are back and I'm a little concerned about some abnormalities."
"Oh No! What is it?"
"Well your cholesterol is surprisingly good for someone with your diet and you seem to have antibodies making you immune to to every disease known to man."
"Hmmm...That's odd."

Scenario 2:

"Your results are back and I'm a little concerned about some abnormalities."
"Oh No! What is it?"
"Well we can't find your blood and it says your soul is dead."
"I have crossed oceans of time to find you."

But the name needs work. APD791 just doesn't have the right connotations of health vigor and longevity that it needs in order to sell. How about a little game of fill in the blank hinted at by the title post:

Ask your doctor about ___________.

I'm going to think about this for a few hours before posting again tonight.

Medical mass nouns

I remember a commercial for a migraine drug from several years ago. I can't remember the drug or the exact wording, but I'll pretend that it was Zomig® (there were a lot of commercials for it back then) and I'll craft a fake pitch:

If you suffer from migraine you should ask your doctor about Zomig®. Zomig®: before migraine controls your day.

That was not the exact wording of the commercial. I only remember the noun form for "migraine."

There was a commercial for Actonel® on television recently that had the tagline:

"Keep fighting fracture with Actonel" (Does the "®" belong in a quote?)

Notice the similarity? The two ailments in the commercial are used as mass nouns instead of count nouns. As these are the only two times I've noticed this I'm not sure if it's a trend. But there must be a reason for these two wording decisions. What could it be?

Migraine and fracture are usually used as count nouns. Sufferers of the former that I've talked to would say "I suffer from migraines" or "I had a terrible migraine yesterday." And I would likely ask "How often do you get them?" or "How bad are they?" Someone with a broken bone would say "I suffered a fracture" or "the x-ray revealed several fractures in my tibia." Notice that the singular of each gets the indefinite article, and the plural of each is...well possible.

There are some conditions that don't get either. No one would likely say "I have a cancer" or "I recovered from two cancers."

Mass nouns can take the definite article (like "the water" or "the air") so mass noun illnesses can as well. This is not in every use. To say "the water is cold" or "the air is dry" refers to a limited portion of water or air. The portion is not always known and the boundaries are not always clear, but there is an implied relevant mass of the air or water that is being described. The same is true for an illness like cancer. That memorable line from The Royal Tenenbaums "He has the cancer" is not standard English unless you're talking about an oncologist holding the bowl after a successful surgery. Of course there are some health conditions that would take the definite article with this "X has the Y" usage: he has the flu, she has the measles, he has the delirium tremens, and about 150 years ago you might have said she has the fever. But you still wouldn't say anyone had "one flu" or "a flu." Fever has switched and now is often (usually?) used as a count known.

So why are a fracture and a migraine more likely to be counted? Is it because they are relatively finite in space or time. Many people will suffer more than one broken bone and those who suffer from migraines know that the pounding and pressure will unfortunately return. But we can see where a fracture is. We know that a migraine will soon abate. (I experienced a migraine headache that lasted a week. Twice. My sympathies to all who suffer them more often.)

When everyone in the office succumbs to the effects of the rhino-virus we don't usually say that "the cold was everywhere." We say that everyone "caught colds" or "a cold." We ask how many colds there were, not "cases of the cold" as we would with the flu.

But I'm getting away from my earlier question. Why would drug companies advertise some count nouns as mass nouns? Does it make the condition sound more serious? My theory is that mass nouns in illnesses sound like a well studied, carefully analysed, scientifically defined and assessed condition. And it sounds just a little more serious. The drug company then sounds like it has a handle on the condition and it has the tools to help those who suffer from it. And perhaps, just perhaps, it's a hint at the chronic nature of the condition -- something that will encourage even a mild sufferer to seek help.