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From the Gospel According to Saint Matthew

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Parable: From the Gospel According to Saint Matthew
Mauricio Goihman-Yahr MD PhD
Dermatology Online Journal 15 (3): 14

Professor (E) of Dermatology and Immunology, Vargas School of Medicine, Central University of Venezuela, Caracas, Venezuela.

Disclaimer: The contents of this paper represent the writer's own opinion but do not and do not intend to represent those of the Central University of Venezuela.

"Swear not at all; …But let your communication be, 'Yea,' yea; 'Nay', nay; for whatsoever is more than these cometh of evil."

The direct meaning of these statements is that oaths are completely undesirable. An honorable person would speak the truth with no need of reinforcements. In addition, oaths are part of primitive superstitious beliefs; an oath compels a god to punish an oath-breaker.

The quoted verse also declares a need for clear, concise, unequivocal words. A 'yea' is simply a 'yea,' not a suggested possibility that might approach the truth. A 'nay' is a 'nay,' not a weak statement that does not directly imply approval. Clear, straightforward speech or written words are the basis for scientific (and medical) thought and publication. A good manuscript or book conveys a clear opinion based on experimental results or known facts, defines what is true, what is likely, and what is false or unlikely to the best of the knowledge of the authors. The reader is able to receive and understand this information without recourse to transmutation of words or meanings.

Three simple examples can clarify my point. Some words or concepts highlight prejudices that our society perceives to be shameful, but recognizes are still present. Euphemisms may be employed; in general, I dislike them, but concede that they have a place. However, in medicine and science, one must make sure that the terms used convey a clear and correct meaning. Many books and papers refer to Ethnic Skin. We all understand that certain characteristics of the skin, including color, shape and distribution of hair, the amount of melanin, the presence of melanocytes in the mucosae, differ between races and ethnic groups. An author may legitimately write about variations in physiology, anatomy, biochemistry and ultra-structure of skin in diverse ethnic groups. Unfortunately, this is not what is usually meant by ethnic skin. What is meant, is skin that is not white. This use of the word ethnic for this purpose has two unwanted implications: 1) whites would not belong to an ethnic group or 2) white skin would somehow be considered the standard. The use of the term, skin of color is only slightly better, but does indicate that one is generally referring to patients that have significant pigmentation. We must strive to make our meanings clear and unambiguous in ways that allow useful comparisons for the benefit of all our diverse patients.

A second example is the confusing and misleading language employed to allow the trade of medications and products that are promoted as useful for the treatment of conditions as diverse as prostate hyperplasia, arthritis, alopecia coronary disease, and actinic damage to the skin. Although they are not labeled as medications, the public is persuaded to believe that they are just as efficacious. Medications are extensively tested, need a formal approval for their marketing, and must show efficacy. The governmental application of black boxes or withdrawal of a drug from the markets are ever present possibilities. This is all as it should be, but why should a misleading label of "dietary supplement" or "vitamin" protect products from necessary controls?

A third example is the disgraceful and increasingly common use of the word may as a technique in papers that are written to attempt to solve a therapeutic query. A compound (X) is tested to determine whether X is active against psoriasis. A complex double blind protocol is carried out and authors conclude that X may be effective in the treatment of the disease. This is total nonsense. Authors supposed beforehand that X may be effective. If not, there would be no point in spending all the money, time, and effort needed to carry out the study. In addition, there would be no ethical justification to put patients under treatment with a substance that would not have a chance to be of benefit. What readers and patients need is to know whether X is shown to be active or not.

To go back to the beginning of this parable; let 'yea' be yea and let 'nay' be nay.

© 2009 Dermatology Online Journal