T H E   N I H    C A T A L Y S T      M A R C H  –   A P R I L   2000


by Celia Hooper

No sooner do we get by Y2K and along comes another challenge. Ready or not, it’s time to grapple with Vice President Al Gore’s Plain Language Initiative. According to the June 1, 1998, Presidential Memorandum on Plain Language, all government agencies must use plain language in new customer service documents as of October 1, 1998. By January 1, 1999, all the rules published in the Federal Register should be written in plain language. And by January 1, 2002, every piece of writing that explains "how to obtain a benefit or service or how to comply with a requirement you administer or enforce" must be in plain language.

Karen O’Steen, who heads the Executive Secretariat (ES) in the Office of the Director, will be heading NIH’s Plain Language efforts. O’Steen says the initiative will be good for NIH. "Plain language is a requirement that makes sense. The ultimate goal of NIH research," she observes, "is to improve people’s health, and that won’t happen unless we communicate clearly our research results to our "customers"—the public, our grantees, physicians, the Congress, and others."

Ruth Kirschstein, NIH acting director, sees the initiative as a bread-and-butter issue. "Surveys have shown that the American people support biomedical research—even when they do not know what it is. It is the responsibility of all of us at NIH to explain what we do and why it is important in ‘plain language’ so that we continue to have the trust and support, through taxpayers’ dollars, to add knowledge that will improve the health of the public."

What has to be written in plain language at NIH?

NIH doesn’t do much administering or enforcing of requirements, but that doesn’t get us off the hook. Thinking of writings generated by NIH research and the kinds of things I myself write or receive from colleagues at NIH, numerous examples presented themselves to me, such as:

Fact sheets

Patient consent documents

Web pages

Letters to potential trainees

Requests and instructions for extramural grant proposals

Responses to colleagues requesting a cell line

If you consider that other NIH staff are the "customers" for administrative memos, the writing we do for other NIHers could probably benefit from plain language handling, including:

Memos on how to use a purchase card

The charge to a committee

Directions to the lab picnic

Arguably, even research descriptions in annual reports–although they are aimed at a technical audience–could benefit from plain language principles. These reports communicate the knowledge NIH has gleaned with taxpayer dollars and, as President Bill Clinton’s directive says, "By using plain language, we send a clear message about what the Government is doing."

Why should I use plain language?

It is required for all executive-branch agencies, but there are plenty of other good reasons to use plain language, say the experts in the ES, who are charged with getting NIH to write right. Dale Johnson, ES deputy director, told the first meeting of NIH’s Plain Language Coordinating Committee (PLCC) that plain language:

Gets the message across quicker and better

Increases reader understanding and compliance

Cuts staff writing, editing, and rewriting work

Saves time and money

Nancy Miller, the plain language guru for OD’s Office of Science Policy, says plain language can even improve public health. She cites an August 18, 1999, article in JAMA that shows that an easy-to-understand brochure increased the rate of pneumococcal vaccination.

Alison Wichman of the Office of Human Subjects Research is developing an online tutorial for writing clear patient consent documents. Wichman points to research showing that patients at all educational levels understand consent forms better if they are written in plain language (D.R. Young, D.T. Hooker, and F.E. Freeberg. "Informed Consent Documents: Increasing Comprehension by Reducing Reading Level," IRB Rev Hum Subj Res 12(3):1–5, 1990).

Jon Holmes, a contractor who teaches bureaucrats how to use plain language, says the advent of electronic communications has increased the importance of efficient writing. He says studies show that reader speed and comprehension of e-mail is about half that for print documents. Unfortunately, the average time a reader will devote to understanding an electronic document is shorter, not longer.

How do I write in plain language?

Strategy: The key to plain writing is identifying with the audience, says Johnson. Holmes’ course emphasizes "reader-centered writing." Patrick Boyd, a senior regulatory analyst at the Bureau of Land Management (BLM) who volunteered to teach the PLCC how to use plain language, says the focus should be on what the reader needs to know, rather than what the writer wants to say.

Taking a reader-centered approach means crafting documents that are concise, to the point, unambiguous, and organized so that readers can quickly find what they want to know. Clinton’s memo says that plain language documents have logical organization, easy to read design features, and use:

Common, everyday words, except for necessary technical terms

"You" and other pronouns

The active voice

Short sentences

Holmes recommends taking a few minutes before you start writing to analyze your audience and define the purpose of the document. Key questions include:

What should the reader get from this?

Who is my reader?

The answers to these questions should dictate what you say and how you say it.

Organization: Boyd uses a BLM document, written before the days of plain language, to demonstrate that good writing starts with good organization. Although the point of the BLM brochure is ostensibly to tell citizens how to appeal BLM actions, the table of contents yields no clue where to begin. A better approach is to identify the key information potential readers will seek from a document and organize it around those points, usually starting with the most important point. Holmes calls this "putting the bottom line on top."

To focus on what the reader needs to know, Boyd often recommends question-and-answer format for documents. Within the document, bulleted lists and brief, informative headlines and subheads help readers locate information more quickly. In his spiel to the PLCC, Boyd showed that tables can give readers massive amounts of detail quickly, sometimes sparing them many paragraphs of dense prose.

Other tricks that enhance the visibility of information also improve readability. These include using:

Double columns Lists
Informative headings Indenting
Margin notes Charts
Boldface and Italics to emphasize key concepts Short paragraphs

In general, shorter is better—shorter words, sentences, paragraphs (aim for four to six lines, with just one topic per paragraph), and documents. But Boyd does not recommend getting rid of all the white space in a document to shorten it. Space around and between the sections of a document actually makes it more readable, he says.

Clear Sentences: The basic building block of plain writing is the clear sentence. In addition to keeping sentences short—an average of 15 to 20 words is good—you should strive for clarity, says Johnson. "Write not just to be understood, but to avoid misunderstanding," she advises.

In addition, plain sentences:

Use short, familiar words wherever possible

Are streamlined with no extra words

Have active rather than passive construction (see box)

Feature strong, specific verbs and the simplest verb tense possible

Are varied in structure and length

Avoid negative constructions (see box)

Refer to the reader as "you" and the writer or agency as "we"

Where can I get help?

Help abounds. On the Internet, the National Partnership for Reinventing Government’s "Plain Language Action Network" is an excellent aid:


The site includes links to Canada’s Plain Train–online plain language training–and other resources.

NIH’s local plain language initiative has established a website that includes the presidential and NIH Plain Language memos:


The NIH Training Center offers plain language training:

(see Communications Skills)

Some training is available through the USDA and various contractors. Your IC’s PLCC member or the ES office may be able to refer you to these and other trainers. Some institutes may arrange and require plain language classes for their staff.

What’s the plain language plan for NIH?

NIH is taking a velvet-gloved approach to implementing the Plain Language Initiative. "We know that if we tried to force this down people’s throats at NIH, it wouldn’t work," O’Steen says. After assembling the PLCC, O’Steen divided the large group into three committees: Training, Media, and Evaluation and Awards. Now it is up to PLCC members to use the bully pulpit and some centralized efforts by the three committees to induce, cajole, or harangue NIHers to write right.

One inducement O’Steen and the Evaluation committee are planning is awards for Plain Language achievements. ES’s Geri Lipov says her office wants NIHers to send them good examples of plain language communications. Lipov especially wants "Before and After" examples showing how a document was improved through plain language. Her office will consider submissions for Gore’s "No Gobbledygook" awards as well as NIH awards.

PLCC members—some clearly passionate about good writing—are divided on how tough it will be to get NIH writing plainly. At a recent meeting of the PLCC, Katherine Kaplan, plain language representative for NCRR was optimistic: "What we’re asking people to do is just write a good sentence. What’s the big deal?" NHLBI’s Nancy Eng was less certain. "It’s not that easy. Not everyone is a born writer."

O’Steen says she agrees with William Zinnser, author of "On Writing Well," who acknowledges that good, clear writing is one of the most difficult things a person can do. But she is confident that NIH will rise to the task. "As a result of this initiative, I expect NIH’s communications—in the broadest sense of that term—to be as outstanding as our biomedical research."


Quick Tips To Put It Plainly

Gear your writing to the audience: Aim for junior high school level for public information; higher reading levels are okay for technical documents. You can quickly get a crude estimate of the grade level of your writing by using the scales built into popular word-processing programs. (In Word, select text to be rated, then "Grammar" from the "Tools" menu. You must first have checked "Show Readability Statistics" under "Tools Preferences." For WordPerfect, look in "Grammatik.") Example: The grade level of the writing in this article is about 9.

Use the active voice: Active sentences are clearer, more precise, and engage the reader. Make sentences active by starting with the subject that performs the action of the verb. Use "we." Example: Active: "We modified the technique…" Passive: "The technique was modified…"

Keep it short and simple: Common, everyday words and shorter sentences are more understandable. Where possible, and especially in public documents, avoid jargon. Sentences should average 15 to 20 words.

Use personal pronouns: "You" and other pronouns engage readers. Examples: "You may apply on the web." "I will send the cells to you."

Pick positives: Negatives can confound meaning. Example: Positive: "The result had consequences." Negative: "The result was not inconsequential."

So Accordingly
Allow Afford an opportunity to
To In order to
Use Utilize
And, depending on the context, scientific terminology can sometimes be simplified
Iron deficiency anemia Hypochromic microlytic anemia
Cancer Neoplasia
Heart attack Myocardial infarction


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