Controlling terminology and market assumptions
A source text carries terms it has not defined and assumptions about markets it has not named, and once the document is handed over both become somebody else's decision. A euphemism such as safe can be kept or replaced with what it stands for. Some terms are the writer's to choose, and some are fixed by law or by collocation. A maintained term base settles a choice once rather than leaving it to each language team. References bound to one market need flagging for a local decision rather than a translation. An English term already in use in the target language can still be worth translating.
Euphemisms
Whether to keep a euphemism the original text uses is a frequent dilemma in medical translation, and not a simple one, because euphemisms are highly influenced by culture and culture is transferred through language and not only through words. A euphemism is the substitution of a mild or indirect expression for one thought offensive or blunt, and also the expression so substituted. Collins Dictionary adds that the expressions replaced are especially those concerned with religion, sex, death or excreta, as departed replaces dead, and the Spanish academy's dictionary defines a euphemism as the gentle or decorous expression of ideas whose direct expression would be harsh. In every scientific or specialist jargon and language some words are, by implicit or explicit agreement among speakers, not spoken or written, and these taboo words are substituted, not always voluntarily, with other words that form euphemisms. In the view of two medical translators, the label politically correct is too vague to be useful, and the terms it is applied to, such as differently-abled people for disabled people, are actually euphemisms.
Safe and safety, alone and in compounds such as safety evaluation, safe procedure and safety data, appear increasingly often, as many medical writers and translators may have noticed, in texts pharmaceutical companies write for investigators, such as protocols and investigator's brochures, for health authorities, such as the summary of product characteristics, and for trial participants and patients. Both are euphemisms, and the first sense Merriam-Webster gives for safe is not able or likely to be hurt or harmed in any way. The two translators hold that the health authorities that regulate medicines, such as the Food and Drug Administration, the European Medicines Agency and the Spanish Agency of Medicines and Medical Devices, should forbid both terms in texts addressed to trial subjects, investigators, patients, the media and their own staff, because their meaning is at best vague and inaccurate and at worst deceptive.
Seguro and seguridad appear too often in Spanish texts, in originals and translations from English alike, mainly because translation is done mechanically and uncritically or, at worst, in what some call Spanglish when the content is medical, one of the bad influences of science having a universal vehicular language. In the two translators' view, writers and translators should ideally follow the equivalents in Fernando A Navarro's critical dictionary of doubts in English–Spanish medical translation, although many compounds are so established through usage that changing them risks readers no longer knowing what is meant. Examples of such compounds, with the equivalents the dictionary gives for them, are:
- safe drug: medicamento inocuo or sin efectos adversos importantes
- food safety: inocuidad de los alimentos
- preclinical safety: toxicidad en animales or en voluntarios sanos
- safety event: efecto secundario or reacción adversa
- safety profile: toxicidad del medicamento or tolerabilidad del medicamento
- safety evaluation or assessment: evaluación de la toxicidad or de la tolerabilidad
- safety studies: estudios de toxicidad
Safe and safety are used much less in Spanish than in English, except in texts translated from it, so writers and translators need to look for more accurate and idiomatic equivalents, and the best equivalent of safe is not always seguro. The two translators prefer este producto es apto para diabéticos to es seguro para diabéticos, and el procedimiento conlleva cierto riesgo to el procedimiento no es seguro.
Potential risk, with its synonyms potential threat and potential danger, is a subtle euphemism and so hard to detect: potential softens the clearly negative meaning of a noun that already contains the idea of possibility or probability. Something may constitute a risk whatever the outcome of one occasion: a person driving while drunk may usually arrive safely, which does not mean that drink-driving entails no risk. In Spanish, there may be a potential risk of… becomes the equally uncritical calque puede existir el riesgo potencial de…, which often appears in Spanish originals too. Plain riesgo is better, and posible riesgo is better than the calque riesgo potencial where an author insists on keeping the modifier. Potential is generally best left untranslated where it modifies nouns such as risk and threat, and potentially can mostly be omitted, becoming posiblemente rather than potencialmente where it is kept. An unnecessary may is dropped too, so a drug that may cause rash in about 34% of patients is said in Spanish to cause it. Authors and translators should avoid such imprecise terminology when writing English as well. The stiff tiene el potencial de causar… is to be avoided too, because puede causar is enough or the wording can be dropped: selective serotonin reuptake inhibitors that have the potential to cause erectile dysfunction become inhibitors that cause it, and at high doses a drug puede producir nausea, vomiting and diarrhoea rather than tiene el potencial de producir them. The adjective posible before the noun is far more frequent in Spanish than the anglicism potencial after it, and only the first is idiomatic: posibles efectos secundarios, not efectos secundarios potenciales.
Fixed terms and consistent terminology
Not every term is the writer's to choose, because health authorities sometimes impose a wording by law, and the translator or writer can then do nothing about it. In 2015 the imposed Spanish terms, found for example in Real Decreto 223/2004 on clinical trials with medicines, included comité ético where comité de ética is correct because ético is an adjective, consentimiento informado although a person and not a consent can be informed, and acontecimiento adverso for adverse event although acontecimiento means a happening rather than an outcome. Many other compound terms are neither collocations nor legally required, and there translators and writers may vary the standard wording. For such terms built on safe and safety, Navarro's dictionary gives:
- safe blood: sangre que no está contaminada, ni infectada
- safe disposal: evacuación higiénica
- safe food: alimento salubre
- safe maternity: maternidad sin riesgo
- safe sex: relaciones sexuales sin riesgo or con protección
- safe water: agua salubre
- drug safety monitoring: farmacovigilancia
Hypertension and high blood pressure, like myocardial infarction and heart attack, name one concept in a technical and a lay register, and both are correct: the problem is variation between them in one document. Where the reason for a switch is not stated, whether a change of audience between a technical and a patient-facing section, approved terminology or mere variety of wording, each language team has to decide for itself, and inconsistent terminology, disagreement between reviewers and extra rounds of revision follow in every language. Writers should use and maintain a term base, keep one preferred term for each concept unless a variation is intentional, define when lay and technical terms are used, treat approved terms as part of authoring rather than of quality assurance at the end, expand acronyms at first use and not give one acronym to different concepts.
Market-bound references
A source carries regulatory, cultural and healthcare-system assumptions that affect its terminology. Approved claims, named comparators that may not be marketed elsewhere, prescription or over-the-counter status and indication wording can all differ between markets, so a claim compliant in one region may need review before it is used in another. References to a healthcare system or a culture, such as co-payments, general practitioners, the emergency room, dosing in teaspoons, date and decimal formats, risk and numeracy, local contact points and care pathways, may each need translation, localisation, or input from the medical or regulatory team. The writer is not expected to solve every market-specific issue, but can flag what is likely to be local rather than write the source and expect it to work everywhere. Such a reference need not be left out where it makes sense for the market the content is developed for, but it should not go in without being flagged.
Writers should know which parts must stay unchanged, such as safety information, approved claims and validated wording, and which can change, such as examples, tone and calls to action. They should flag market-specific references, so that the local assumptions the content carries at the writing stage are not lost in the translated material. Items they identify as purely regional or local should be avoided where they can be.
Content accepted in one market can be unacceptable in another: directing patients to a website to find out more about a device or a medicine is very common in the United States and is not accepted in some EU countries, where it could be seen as direct marketing. An instruction telling patients with low blood sugar to eat jelly beans would not be accepted in Norway, which does not have jelly beans and recommends that such patients eat complex carbohydrates rather than sugars.
In 2024 one company's translation department often received documentation meant for a global audience with imperial measurements only, such as inches and feet. In the EU there is at least the recognition that many places use metric, and both units should be given. Source documents can also arrive with data problems, missing SI values and ambiguous text that leads to translation errors.
A language shared with another market still calls for an extra language check on every document, as a sign advertising flip-flops in Darwin, in English shared with Australia, is a reminder.
Borrowed English terms
Itangliano is Italian strongly influenced by English, above all through English words used without adaptation, and the word was first used in the 1970s, when Italian business language began using English words untranslated. Italians have taken English words into their common vocabulary so far that Itanglish is well known among linguists. The absence of norms forcing the standardisation of new terms, together with the belief that a language regulates itself, lets media and advertising agencies unduly influence how Italian develops. In the view of an Italian translator and an Italian biostatistician, statistics is the scientific field where Itanglish has gone furthest.
They do not want a pure Italian free of foreign borrowings, since interchange between languages is a natural consequence of globalisation, but they object to the "refined ignorance" that pads conversation with words from a language the speaker barely speaks, and hold that the globalisation of language need not mean complete and unavoidable anglicisation. Pushing out the foreign expressions already in the vernacular would be largely pointless, but widely used technical expressions should be translated, not to counter globalisation but to preserve the language as the most important vehicle of local culture, identity and history.
Not everyone agrees about the effect of dominant languages on other languages and on language loss. Some may argue that it is all part of linguistic evolution and not a matter of international concern, since languages evolve according to their usefulness and consolidate according to their ability to communicate globally without the burden of translation. Against this, the rapid loss of technical Italian words in daily use correlates, in their view, with a decrease in the richness of human expression and endangers the future of a linguistic identity.
Translators are responsible for the correctness of the terms they use and for translating new concepts properly into their own language. Translation is one of the most powerful means of communication between cultures, yet different identities and cultures need attention if they are to be preserved. Experienced translators are fully aware of this threat to their language, and new professionals need to be particularly careful. In February 2015 the Accademia della Crusca, the most authoritative body representing the Italian language, signed a petition to save it, and according to a study then recent, the use of English terms had increased by 773% over the previous eight years.
A list of proposed Italian equivalents for English biostatistical terms was drawn from almost 200 frequently used terms that may cause problems in translation into Italian, taking the most frequently recurring ones that also recur in English-to-Italian texts. It pairs each English term with a proposed Italian translation and, for most, with the familiar rendering to avoid:
- attrition bias: errore di esclusione, not attrition bias
- bias: errore sistematico, not bias sistematico
- censoring: censura
- cross-over design: disegno incrociato, not disegno cross-over
- dropout: abbandono, not dropout
- dummy variable: variabile binaria, not variabile dummy
- hazard ratio: rapporto tra rischi, not hazard ratio
- intention-to-treat analysis: analisi secondo l'intenzione al trattamento, not analisi intention to treat
- interquartile range: ampiezza inter-quartile, not range interquartile
- odds ratio: rapporto delle proporzioni, not odds ratio
- outlier: valore anomalo, not outlier
- per-protocol analysis: analisi secondo protocollo, not analisi per protocol
- range: ampiezza, not range
- recall bias: errore da rievocazione or errore di memoria, not recall bias
- risk ratio or relative risk: rischio relativo, not risk ratio
- scatter plot: grafico a dispersione, not scatterplot
- statistical analysis plan: piano dell'analisi statistica, not statistical analysis plan
Glossaries such as this are extremely useful tools for medical translators, and the list was offered as a starting point for further ones. Its translations are proposals, offered also to provoke debate and hear readers' opinions.