It’s incredible how you can often be engaged in something completely removed from work and then you encounter something out-of-the-blue and brilliant that immediately brings you back.

Colin Thubron’s ‘In Siberia’ is one such case. On his travels through Siberia, he describes meeting a doctor in a remote town who is struggling to translate into Russian leaflets from medicine packs he has received from a company in Mumbai. He provides this translation so that he can communicate more effectively with his patients when he prescribes these medicines.

This doctor appeals to Thubron to help him explain the English of the package leaflet in a more understandable, accessible style, upon which he can base his translation into Russian. This is a task that Thubron is unable to do, describing the exchange as follows:

“I unfolded a leaflet of smudged directions… ‘Metoclopramide has an antidopaminergic effect in the hypothalamus and thereby raises the threshold for vomiting at the chemo-receptor trigger zone. Its effects on the GI tract are thought to result from the blocking of dopaminergic receptors, potentiation of cholinergic effect.’

- I said bleakly: ‘I don’t think I can do this’

- ‘But, Nikolai, you’re English!’

- I know, but this leaflet has a language of its own.”

This took place in the late 1990s and is a tiny snapshot of post-Soviet chaos. Receiving medicines with original labelling was commonplace in Russia, particularly in the immediate post-Soviet years and prior to the Russian labelling and packaging legislation coming into force in 2010.

In terms of the quality of written medicines information worldwide, I do not think a great deal has changed. If it has improved, then it is only marginally so. This impression of mine, possibly subjective, even extends to regions such as the EU, where User Testing of Package Leaflets has been mandatory for almost 15 years. In 2019, I still encounter tested, approved leaflets that are not too different from the one described by Thubron.

Another example came when I recently read Robert MacFarlane’s Underland. He wrote in some detail about a subject that has been of interest to me for over 10 years: nuclear semiotics.

However, before I write more about this, I would like to go on a tangent. MacFarlane talks about issues that I had already read elsewhere this year, namely the shocking re-emergence of long-buried virus strains in the melting Arctic due to climate change. In 2016, 23 nomadic people in the Yamal Peninsula in northern Russia were infected by spores from anthrax released from thawing reindeer carcasses that had died 70 years earlier and one child died from this. In 1997, live Spanish Flu fragments were recovered from the lungs of a woman who had been buried in frozen ground in Alaska.

In 2015, a giant virus from mammoth carcasses was discovered in the Siberian ice. This virus is so massive that is forcing a rethink amongst scientists about how life itself should be classified. Russian scientists believe that smallpox could soon be released from mass graves in the Siberian tundra. In Greenland, the US buried large quantities of biological, chemical and radioactive waste deep in the Greenland ice near Thule. There are fears that the melting ice could expose this sludge and cause untold ecological damage. Scary stuff!

This brings me back to nuclear semiotics. How do we, at the beginning of the 21st century, make permanent messages for future generations, thousands and tens of thousands of years hence, about the dangers of radioactive sites? Do we just stick up a sign with a skull-and-crossbones or a radioactivity pictogram and hope for the best?

Within the discipline of nuclear semiotics, there is an assumption that our current languages will have either gone extinct, diverged to the point of unintelligibility (‘languages have their own half-life’, says MacFarlane) or there has been some kind of discontinuity or rupture between our civilizations now and those far in the future.

After all, there are writing systems from civilizations from less than a couple of thousand years ago, such as Olmec in Mexico, that we are unable to decipher. And what sense do we in the 21st century make of Paleolithic cave paintings, such as those in Lascaux?

We do not know for certain what they mean, because there has been a lack of continuity between contemporary cultures and those which produced these paintings [1]. Yet, we are talking about the same kind of distance in time: between the Upper Paleolithic period and now and between now and the timeframe that we need to be warning future generations about keeping away from toxic sites.

In other words, tens of thousands of years. Those engaged in nuclear semiotics ponder how to communicate this to future civilizations, whether written in pictogram form or otherwise (music, voice, specific vegetation used semiotically have all been proposed). It is a fascinating area of research.

Poorly written Package Leaflets and nuclear semiotics: two extremes of written health communication. One is routine and commonplace, the other urgent and desperate. Nuclear semiotics is arguably the most extreme form of written health communication.

These are both appropriate illustrations of the scope of this section of the blog. It aims to provide ongoing, detailed analysis of the quality of written health information. We provide a view of written information designed for patients in the clinical phase, the marketed product, medical devices, electronic information, pictograms, health promotion, and consumer health campaigns from around the world.

We draw upon our direct experience of working globally in multiple disciplines, including cognitive information design, health care professional-patient communication, psychology, sociolinguistics, medical sociology, and so on. The aim of this is to educate about how written information is provided across the world and highlight instances of best practice.

Watch this space!

By Mark Gibson, Health Communication Specialist

2nd August 2019, United Kingdom

Sources:

Colin Thubron, In Siberia, Penguin, 2000, page 136.

Robert MacFarlane, Underland. A deep time journey, Penguin Random House, London, 2019

Swain F, A treasure map of the Arctic, New Scientist, 2nd February 2019

Bryson B, Down Under, Transworld Publishers, London, 2000

[1] For some cultures, there has been continuity from the distant past and present. In a recent article, we have already written about the North Sentinelese. About indigenous Australian cultures, Bryson writes: “It is a fact little noted that the Aborigines have the oldest continuously maintained culture on earth, and their art goes back to the very roots of it. Imagine if there were some people in France who could take you to the caves at Lascaux and explain in detail the significance of the paintings – why this bison is bolting from the herd, what these three wavy lines mean – because it is as fresh and sensible to them as if it were done yesterday. Well, Aborigines can do that. It is an unparalleled human achievement, scarcely appreciated.” Bryson (2000: 144)

Written Health Information