Anita Hegedűs
Faculty of General Medicine, University
of Pecs, Hungary
anita.hegedus@aok.pte.hu
Modality in English and Hungarian Drug Information
Leaflets
1. Introduction
Modality is defined as the grammaticalization
of speakers attitudes and opinions (Palmer 1993: 16). Modality is
an important linguistic function in biomedical communication; it could
be expressed to mark any of the following: possibility or the related
concept of permission, probability or the related concept of obligation,
certainty or the related concept of requirement (Steele et al. 1981:
21). Modality has two main classes: epistemic and deontic. Epistemic
modality is concerned with matters of knowledge, belief, or opinion
rather than fact (Llyons 1977: 793), while deontic modality relates
to the necessity or possibility of acts performed by agents, including
the speaker himself (Llyons 1977: 823). The present study will focus
on deontic modality. This device which makes it possible for the authors
of biomedical texts to tone down the strength of the statements and
also to include their opinion concerning the truth conditions can also
be found in a special type of biomedical communication, namely drug
information leaflets. Drug information leaflets are those sheets of
papers that are included in medicine boxes and bottles and provide information
about the purpose, the side effects, the dosage and the storage of the
drug they describe.
2. Modality in drug information leaflets
Genre is comprised
by a set of communicative events, which have a common communicative
purpose (Swales 1993: 58). The purpose of the genre of drug information
leaflets is giving useful pieces of information to drug takers on the
amount, way, expected side effects and hoped positive outcome of using
a particular medicine. On the other hand, these documents are also meant
to serve as a special means of self-defence used by "drug-dealers"
for preventing legal action taken against them by unsatisfied, disappointed,
or even damaged patients. The linguistic manifestations of these efforts
are the main focus of the present study and their interpretation and
classification are thought to be a useful contribution between the two
traditional partners: patients and drug manufacturers. A very curious
point of the investigations was a comparison between the samples of
this commonly used genre in the Hungarian and Anglo-Saxon backgrounds.
The initial hypothesis of the study was that both languages apply the
technique of modification, but Hungarian texts seem to state information
in a more explicit manner.
The method of investigation
was manual analysis of a corpus of fifteen drug information leaflets
in both language. A special selection criterion was the originality
of the texts in both language. The manual analysis
as a procedure was preferred to computerised
analysis for its more individualistic character and the opportunity
it provides for analysing narrower or wider contexts of each individual
target language item.
In the following sections
of this paper I will discuss how drug information leaflets provide information
about the way of taking the drug, the amount f taking the drug, side
effects and storage of the drug.
3. The results of the study
3.1.Providing information on the way of taking
the drug
Drug interactions caused by taking more
than one drug simultaneously can result in adverse effects. Each drug
information leaflet mentions that the drug it describes cannot be taken
together with certain other drugs. English drug information leaflets
investigated here normally name those other drugs and state that the
two drugs taken together can cause side effects, e.g. Do not take ergotamine
or dihydroergotamine tablets or use ergotamine inhalers for migraine,
while taking Erythroped A as this can cause serious side effects. The
usage of the auxiliary can (or may) expresses
deontic possibility and implies that it is not certain that serious
side effects will occur when taking the two drugs simultaneously, merely
there is a chance for their appearance. Thus, it seems to place the
patient into a position of false security, since the patient may think
that if the drug only sometimes causes side effects than he/she will
not be just the person to experience side effects. The majority of the
Hungarian drug information leaflets do not state explicitly what those
drugs are that should not be taken together with a particular drug,
only pass on this problem to the doctor, e.g.: Az egyidejűleg
szedni kivant egyeb gyogyszerekről a kezelőorvost tajekoztatni
kell. (=The consultant doctor must be informed about other drugs that
the patient wishes to take simultaneously with the drug.) Some of the
Hungarian texts forbid the patient to take the drug together with any
other drug, unless the doctor prescribes it (e.g. Kifejezett orvosi
előiras nelkul mas gyogyszerekkel egyutt alkalmazni nem szabad.
=It must not be applied together with other drugs without the explicit
prescription of the doctor), while none of the English texts do so.
Similarly, drug information
leaflets indicate that patients must not take the medicine if they are
allergic to an active ingredient. Each Hungarian text displays it in
a straightforward manner, e.g. Penicillin-tulerzekenyseg eseten nem
alkalmazhato (=It must not be applied in case of oversensitivity to
penicillin.), while in about half of the English texts we can find a
hedge which slightly modifies the information conveyed by the sentence,
e.g.Do not take Hytrin BPH if
you know that you are allergic to terazosin, any of the following
drugs alfuzosin, indoramin, prazosin, tamsulosin, doxazosin, or any
of the other ingredients contained in Hytrin BPH.In this way, patients should avoid taking the
drug only if they know that they are allergic to an ingredient, although
practically any ingredient of the medicine can cause allergic reactions,
the patient is not warned about it in a separate sentence. Hence, drug
information leaflets avert responsibility in case of patients who are
allergic to an ingredient of the medicine but are not aware of their
allergy, although they can experience severe allergic reactions.
Many drugs cannot be
taken if the patient suffers from a certain illness, e.g. liver problems
or renal failure. The investigation has revealed that several drug information
leaflets do not mention the problems caused if the patient takes the
drug when he/she has the illness mentioned in the leaflet or some of
the texts do not indicate that it can cause problems at all, but they
direct the patients to the doctor, e.g. If you suffer from a condition
called myasthenia gravis, which causes muscle weakness, consult your
doctor before taking erythromycin lactobionate. In this way, drug manufacturers
transfer responsibility to the doctor. Of course, doctors ask whether
the patient suffers from an illness, but patients may not be aware of
the importance of mentioning a certain condition because they do not
know that if they suffer from an illness other than that the drug was
prescribed for then they might not take the medicine. Among the Hungarian
drug information leaflets I have found two examples, where the illness,
in case of which it is not indicated to take the drug, is not overtly
mentioned, e.g.
Mikor nem szabad Nitromint aerosolt
hasznalnia? .
-
heveny szivinfarktus es szivelegtelenseg
bizonyos eseteiben;
-
szivizombetegseg es szivburokgyulladas
bizonyos eseteiben;
-
szivbillentyű-hibak bizonyos eseteiben;
(= When should you not use Nitromint
aerosol? .
-
in certain cases of cardiac infarction
and cardiac insufficiency;
-
in certain cases of myocardial disease
and pericarditis;
-
in certain cases of valvular disorder;
)
In this case the name of the disease
is modified by the expression in certain cases, thus some patients
suffering from pericarditis, for instance, can use the drug while others
cannot because due to the modifying expression patients suffering from
the diseases mentioned above do not learn whether or not they can take
the medicine. Here the purpose of the modifying expression is to avert
responsibility because drug manufacturers do not specify which patients
of the above diseases can take the drug. Drug manufacturers are protected
in those cases patients suffering from any of the above diseases develop
some unexpected symptom, because they have told that the drug must not
be used in certain cases of the disease.
3.2. Providing information on the amount of taking the drug
The drug information leaflets
investigated here, except for one, describe prescription drugs, i.e.
they are drugs that you can only get by prescription. The dosage of
the drug is determined by the doctor, but, nevertheless, drug information
leaflets still display a usual dosage, which is often followed by
the sentence The doctor can prescribe a different dosage. Drug information
leaflets use this sentence as a safeguard to avert responsibility in
case of an overdose. Overdose can lead to serious side effects, but
by entitling the doctor to prescribe a different dosage (by the use
of the modal auxiliaries can or may) they do not indicate the upper limit of the dosage. Thus,
patients damaged by a drug overdose cannot find any basis concerning
dosage in these drug information leaflets. If the doctor prescribes
a dosage different from the usual dosage in the leaflet and the patient
develops any adverse symptoms than drug manufacturers can avert responsibility
to the doctor although in most cases the problem does not stem from
the dosage.
3.3. Ways of rendering side effects
Each drug information leaflet indicates that
the drug can cause certain undesired effects called side effects. Modality
is used to predict the chances of occurrence for a certain side effect.
Most drug information leaflets use the modal verbs can or may (and their Hungarian equivalent in this sense, the
suffixes hat, -het) to inform the patient that it is possible
that a certain side effect appears. Mainly the English texts, but rarely
Hungarian texts also use an auxiliary expressing possibility together
with an adverb of frequency (e.g. rarely, sometimes) I introduce the
concept of double modality to refer to this technique- to express
that the likelihood of a certain side effect occurring is extremely
low: e.g. Very occasionally, dobutamine may cause a reduction in the
cells that help blood to clot.Double modality is applied to calm the patient,
implying that it is not likely that they will experience these side
effects, but drug manufacturers still mention these side effects in
drug information leaflets to protect themselves if these side effects
appear in patients. On the other hand, a list of side effects which
can although only sometimes- occur may frighten some of the patients.
Almost every drug information
leaflet mentions that other side effects can occur besides the ones
enumerated in the leaflet, e.g. Tell your doctor or pharmacist if you
or your child develop any of these problems or if you have any other
unexpected or unususal symptoms while taking Erythroped SF Suspensions.
This sentence suggests that, although in rare cases, the drug can practically
have any side effects, of which patients are not aware. By including
this sentence, drug manufacturers decline to take responsibility and
refuse to state explicitly the possible consequences of taking the drug.
In this way, they prevent legal action taken against them by patients
who have been damaged by the drug.
3.4. Ways of Providing Information about
the Storage of the Drug
The last rhetorical
step in each drug information leaflet is instructions concerning the
storage of the drug. The Hungarian texts investigated here express this
function with a modal verb denoting obligation or prohibition, or with
the imperative, e.g. A gyogyszert gyermekek elől gondosan el kell
zarni. Ne tarolja 30C feletti
hőmersekleten! (= The medicine must be closed from children.
Do not store it at a temperature above 30C!)
The imperative expresses deontic proposition, and it is neither stronger
nor weaker and neither less nor more polite than a modal verb expressing
obligation (Palmer 1993: 108). Here the drug information leaflet clearly
instructs the patient how to store the medicine. Half of the English
texts use the same devices as the Hungarian texts to formulate instructions
concerning the storage of the medicine, but some of the texts use a
modal verb that is weaker than the imperative (e.g. should): This medication
should not be used after the expiry date shown on the label. By using
the modal verb should the speaker does not exclude the possibility
that the event described by the verb will not occur (Palmer 1993: 100),
thus he/she does not take responsibility whether or not the patient
follows the instructions. Moreover, in some cases the English texts
apply the modal verb expressing future (will) to express this
function, e.g. It will be used before the expiry date. Your medicine
will be kept below 30C
away from light. The solution will be stored below 25C
and used within 24 hours. The modal verb expressing future predicts
that the event will occur and the patient will follow the instructions.
The modal verb will does not concern the speakers opinion or
attitude, but it is completely hearer-oriented (Palmer 1993: 103), thus
it is the patients responsibility to keep the instructions, it does
not express as clearly as a modal expressing obligation or the imperative
that the patient must follow the instructions so that the drug provide
the most beneficial effect. Rather, it expresses a habit that patients
in their interests- usually comply with the instructions provided by
the leaflets, thus, it is presupposed that patients will keep the instructions.
On the other hand, the imperative preferred by Hungarian drug information
leaflets does not contain an element of presupposition, but it simply
tells the patient what to do and what not to do, thus expressing a caring
attitude towards patients.
4. Conclusion
The following conclusions can be drawn
from the investigation:
-both languages resort to
the use of devices expressing modality to a large extent in drug information
leaflets;
-we can find examples in both languages
where more than one device is applied within the same structure, a technique
which I call "double-modality";
-with a few exceptions, Hungarian drug
information leaflets tend to provide information in a more straightforward
way, whereas the English texts investigated by the present study seem
to tone down and obscure information to a larger extent than their Hungarian
counterparts.
The main function of
modal devices in this genre is to change the truth conditions of the
information provided by texts representative of this genre by avoiding
explicitness and providing intentionally vague information. They resort
to modality either to change the patients attitude to the drug he or
she is taking (for instance, to calm or flurry the patient) or to decline
responsibility by refusing to state explicitly the possible consequences
of taking a particular drug. The differences between the way the two languages handle modality in drug information leaflets
may be explained by cultural differences, but further studies are needed
to confirm this.
References
Llyons, J. (1977) Semantics.
Cambridge: CUP.
Palmer, F.R.(1993)
Mood and Modality. Cambridge:CUP.
Steele, S., Akmajian, A., Demers,
R., Jelinek,E., Kitagawa,C., Oerle, R., and
Wasow, T. (1981) An Encyclopedia of AUX: a study in cross linguistic
equivalence. Cambridge, Mass. and London: MIT Press.
Swales, J. (1990). Genre Analysis: English in Academic and Research Settings. Cambridge:
CUP.
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