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Faculty of General Medicine,
Modality in English and Hungarian Drug Information Leaflets
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.
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.
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.
3.4. Ways of Providing Information about the Storage of the Drug
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.
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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