{"id":69731,"date":"2016-12-29T11:54:52","date_gmt":"2016-12-29T16:54:52","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=69731"},"modified":"2016-12-30T06:26:45","modified_gmt":"2016-12-30T11:26:45","slug":"whodunit-theydunit","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/12\/29\/whodunit-theydunit\/","title":{"rendered":"whodunit? theydunit&#8230;"},"content":{"rendered":"\n<ul><sup> <\/p>\n<div><img decoding=\"async\" src=\"http:\/\/1boringoldman.com\/images\/strunk.jpg\" width=\"86\" vspace=\"5\" hspace=\"5\" border=\"0\" align=\"right\" \/><font color=\"#200020\"><a href=\"https:\/\/faculty.washington.edu\/heagerty\/Courses\/b572\/public\/StrunkWhite.pdf#page=11\" target=\"_blank\">Use the active voice<\/a>.<\/font><\/div>\n<div><font color=\"#200020\">T<\/font><font color=\"#200020\">he active voice is usually more direct and vigorous than the passive:<\/font><\/div>\n<div><strong><em><font color=\"#200020\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;I shall always remember my first visit to Boston.<\/font><\/em><\/strong><\/div>\n<div><font color=\"#200020\">This is much better than<\/font><\/div>\n<div><strong><em><font color=\"#200020\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;My first visit to Boston will always be remembered by me.<\/font><\/em><\/strong><\/div>\n<div><font color=\"#200020\">The latter sentence is less direct, less bold, and less concise. If the writer tries to make it more concise by omitting &quot;by me,&quot;<\/font><\/div>\n<div><strong><em><font color=\"#200020\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;My first visit to Boston will always be remembered,<\/font><\/em><\/strong><\/div>\n<div><font color=\"#200020\">it becomes indefinite: is it the writer, or some person undisclosed, or the world at large, that will always remember this visit?<\/font><\/div>\n<p><\/sup><\/ul>\n<p>    <\/p>\n<div class=\"small\" align=\"justify\">I come from a generation schooled in the ways of <font color=\"#200020\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/The_Elements_of_Style\" target=\"_blank\">Strunk and White<\/a>,<\/font> though the only suggestion I really remember is <em><font color=\"#200020\">Don&#8217;t use the passive voice<\/font><\/em> as my take-away [in case I forget, the grammar-checker in <font color=\"#200020\">Microsoft Word<\/font> is there to remind me]. As a kid, I could see that the active voice sounded better. But later, I saw that the passive voice was often used to obscure <em><font color=\"#200020\">agency &#8211;<\/font><\/em> a way of avoiding saying directly <em><font color=\"#200020\">whodunit?<\/font><\/em>.  So writing <em><font color=\"#200020\">&quot;The primary outcome variables were changed in the published version of Paxil Study 329&quot;<\/font><\/em> just isn&#8217;t the same as writing <em><font color=\"#200020\">&quot;Martin Keller and his coauthors changed the primary outcome variables  in the published version of Paxil Study 329.&quot;<\/font><\/em><\/div>\n<p class=\"small\" align=\"justify\"><img decoding=\"async\" src=\"http:\/\/1boringoldman.com\/images\/whodunit.gif\" hspace=\"5\" height=\"90\" border=\"0\" align=\"left\" \/>One encounters patients who appear to live their lives in the domain of the passive voice. Things just happen in the world. Things happen to them [usually bad or disappointing things], but there&#8217;s no agent causing them. And invariably, they leave out their own participation in the things that happen. This was once known as <em><font color=\"#200020\">the Fate Neurosis<\/font><\/em>. While it may keep them from blaming others, or keep them from shouldering blame themselves, it&#8217;s part of a long-suffering view of life that has a sticky persistence that maintains their dysphoria [and often drives their therapists and acquaintances to distraction]. One of the goals of their psychotherapy is to help them see their own part  in making things happen, even if it&#8217;s negative &#8211; to help them see a  world in which they are actors rather than victims of obscure forces  like fate, destiny, or bad luck. <em><font color=\"#200020\">Whodunit?<\/font><\/em> is of major importance in understanding anything that happens to these people [often times <em><font color=\"#200020\">theydunit<\/font><\/em>].  <\/p>\n<p class=\"small\" align=\"justify\">Oddly, my mind goes down this path when reading some of the language used to describe the various <a href=\"http:\/\/www.blackwellpublishing.com\/content\/BPL_Images\/Content_store\/Sample_chapter\/9781405132664\/9781405132664_4_003.pdf\" target=\"_blank\">sources of bias in Clinical Trial reporting<\/a>. There&#8217;s a long-suffering quality to the lamentations, as if we are victims of a maleficant&nbsp; universe. It&#8217;s in the language we use. <font color=\"#200020\"><em>Publication Bias <\/em><\/font><em><font color=\"#200020\">refers to trials with unfavorable outcomes that don&#8217;t get published<\/font><\/em>. That italicized phrase happens to be an example of the use of the passive voice in that the actor who didn&#8217;t publish the study is <em><font color=\"#200020\">missing in action<\/font><\/em> &#8211; literally. <em><font color=\"#200020\">Selective Reporting?<\/font><\/em> Somebody did the selecting. And so it goes. The culprit isn&#8217;t in the language. All these sheenanigans that have so garbled our Clinical Trial literature aren&#8217;t mistakes, or sloppiness, or something overlooked, or random acts of a perverse deity. They&#8217;re not coming from incompetent or poorly trained statisticians. <em><font color=\"#200020\">They&#8217;re the conscious, motivated acts of a person or persons who&#8217;ve got something very specific in mind.<\/font><\/em> And again, the important question is <em><font color=\"#200020\">whodunit<\/font><\/em>?<\/p>\n<p class=\"small\" align=\"justify\">We all know that these distorted trial reports are motivated actions. The goal is to exaggerate efficacy and downplay toxicity, to sell these drugs, but that knowledge doesn&#8217;t make it into our descriptive language or our policies. We routinely relate to them in the passive voice, but then wrack our brains trying to think up things that might <strong><em><font color=\"#200020\">respond to their happening<\/font><\/em><\/strong> rather than <strong><em><font color=\"#200020\">stopping people from doing them in the first place<\/font><\/em><\/strong>. We request minimal information and give industry a long time to provide it. Then we don&#8217;t levy fines when the required information doesn&#8217;t show up. We lament the things that are happening and rarely go after the agents except to extract inadequate fines long after the fact. Many say it won&#8217;t stop until we start sending people to prison, but that just hasn&#8217;t happened, in part because it&#8217;s so difficult to prosecute and often impossible to prove.<\/p>\n<p class=\"small\" align=\"justify\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/1boringoldman.com\/images\/whodunit-rev.gif\" width=\"74\" hspace=\"5\" height=\"90\" border=\"0\" align=\"right\" \/>Instead of chasing instances where various biases have colored&nbsp; the reported results after the fact, we could face the reality that distortion and non-compliance are the the expected response. The <em><font color=\"#200020\">a priori<\/font><\/em> protocol and declared outcome variables are unlikely to be available <em><font color=\"#200020\">a priori<\/font><\/em>. So we could say that <strong><font color=\"#990000\">no trial can begin until the outcome variables are posted in the registration section on ClinicalTrials.gov<\/font><\/strong>. Why not? They&#8217;re already available from the Institutional Review Board submission. Similarly, we could say <strong><font color=\"#990000\">no FDA review of an NDA will be initiated until the Results Database is publicly available filled out on ClinicalTrials.gov<\/font><\/strong> for all submitted trials. Why not? They&#8217;re being submitted to the FDA so they&#8217;re available. Why not submit them to the rest of us?<\/p>\n<div class=\"small\" align=\"justify\">So no more<em><strong><font color=\"#200020\"> it happened to us<\/font><\/strong><\/em>. We need to act on <em><strong><font color=\"#200020\">they do it<\/font><\/strong><\/em>. We already know <em><font color=\"#200020\">whodunit!<\/font><\/em>&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Use the active voice. The active voice is usually more direct and vigorous than the passive: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;I shall always remember my first visit to Boston. This is much better than &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;My first visit to Boston will always be remembered by me. The latter sentence is less direct, less bold, and less concise. If the writer [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-69731","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69731","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=69731"}],"version-history":[{"count":44,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69731\/revisions"}],"predecessor-version":[{"id":69799,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69731\/revisions\/69799"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=69731"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=69731"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=69731"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}