Intended for healthcare professionals

Letters New Scottish GP contract

New Scottish GP contract increases risk for remote and rural communities

BMJ 2018; 360 doi: (Published 19 February 2018) Cite this as: BMJ 2018;360:k762

Why does The BMJ so hate hyphens?

In the 1980s I wrote a basic science review for the BMJ on how receptors at cell surfaces signal1. It included many references to ‘receptor-activated’ and ‘receptor-stimulated’ events, and I was taken aback when these hyphenated phrases provoked an editorial demand that I either delete the hyphens or rephrase the text to avoid them. In my experience, no other journal had imposed such a prohibition.

Now my GP wife’s BMJ brings weekly news of medicine and the NHS into our house – and constantly reminds me that your style guide still proscribes most hyphens [“Minimal hyphenation – use hyphens only for words with non-, -like, -type, and for adjectival phrases that include a preposition (one-off event, run-in trial). Not using hyphens will help you to avoid noun clusters”.].

It still seems to me that this prohibition tends to produce sentences that are so dense and/or opaque that they must be re-read before sense emerges. Where, for example, might a hyphen-free sentence that starts “Through the patient facing ISABEL system . . . .” be going (7 May, 2016)? Wouldn’t ‘patient-facing’ or rephrasing have helped? In the same week the Minerva column, a BMJ segment that I assume is at least partly for non-expert readers, included: “The 151 participants in this university-based study comparing ICBT with internet-based behavioural stress management were self-referred.” Which was pretty clear, except that the printed version included none of the three hyphens included above. As a result, it demanded more careful reading (and re-rereading?) to become comprehensible. And in February this year (24 Feb, p. 322) a discussion of GP contracts includes “. . . . – designed from the urban based top, with a system centred focus on planning”. Do others, like me, find that such hyphen-deficient writing is confusing gibberish that takes some unravelling?

The ‘problems’ in these examples are not objectionable ‘noun clusters’. They are present and past participles used adjectivally. These help to abbreviate complex sentences; they rescue the sentences from being made more convoluted; and hyphenation improves their clarity by removing ambiguity.

After publishing in many journals, I remain baffled that The BMJ remains the only journal that is offended by the use of such simple, and I believe useful, hyphenated constructions as ‘receptor-activated’ and ‘hormone-stimulated’.

1. Michell, R.H. How do receptors at the cell surface send signals to the cell interior? Br Med J (Clin Res Ed) 1987; 295: 1320-1323.
2. Patients’ experiences of intensive care and other stories . . . BMJ 2016; 353: i2414

Prof Bob Michell
Emeritus Professor
School of Biosciences
University of Birmingham

Competing interests: No competing interests

23 April 2018
Bob Michell
Emeritus Professor
School of Biosciences, University of Birmingham, Birmingham B15 2TT, UK