The Arrogance of the English Language in Medical Communications

Milton Packer ponders the awesome power of linguistic imperialism

by Milton Packer MD

Two weeks ago, the European Society of Cardiology held its annual meeting in Munich. Attended by more than 33,000 physicians from more than 100 countries, the ESC Congress is widely recognized as the international congress for cardiovascular science.

The ESC takes its goal of inclusiveness and diversity very seriously. Many speakers are young investigators from small nations, who typically might not have a chance to address an international audience. The ESC provides them an opportunity to share their ideas.

Yet, all of the communications at the ESC were in English, even though native Anglophones probably represented only about 10% of the attendees. Decades ago, the ESC adopted English as its lingua franca. All of its meetings and all of its journals and other communications are in English -- actually, in British English, not American English (but this is a minor point!).

Speakers are required not only to present in English, but to field questions in English. Many non-native English speakers probably need to translate questions from the audience inside their brains into their native tongues, develop an answer, and then translate the answers back into English. Although each speaker performed the task seamlessly, I am sure it was not easy.

Even extremely proficient non-native English speakers face disadvantages. The ESC asked me to debate someone whose native language was Dutch. My opponent was totally and effortlessly fluent in English. Yet, during a competitive debate, there is no doubt that persuasive arguments are easier to deliver if you are speaking in your native tongue.

The ESC is not the only international organization that has adopted English. Every international meeting that I have attended in the last decade has been conducted in English, regardless of its location or participants. Business meetings that are attended by participants from Germany, France, Spain, and Italy are conducted in English, even if not a single attendee hails from an Anglophone country. The medical literature is dominated by journals printed in English, and systematic reviews of medical topics are considered adequate even if they restrict their survey only to articles written in English.

It was not always this way.

In the 1970s and 1980s, the meetings that I attended in Europe were characteristically equipped with simultaneous translations. Each person in the audience was given headphones and could listen to my words in their native language, delivered by a translator, who was listening and translating at the same time.

Simultaneous translation was a remarkable feat. I only encountered difficulties with it when telling a joke. All too often, the translator did not fully understand the idiomatic and cultural nuances of humor at play. Even if the joke elicited its intended response, the process of delivering it was still challenging. Imagine telling a joke, getting no immediate response, and continuing with your talk -- only to hear the audience laugh when you have already started the next part of your presentation -- simply because the delayed translation had finally kicked in. For anyone who is sensitive to comedic timing, it is an eerie experience.

But hardly anyone uses simultaneous translation at scientific and medical meetings anymore. If I am giving a talk in Italy, I might be introduced to the audience in Italian. But I will present in English, and no one will be wearing headphones.

How did English achieve this privileged status -- especially over the past 40 years?

The dominance of English can be explained in two ways. First, English is now a required secondary language in most countries throughout the world. The current generation of physicians grew up with an intimate knowledge of English. At the same time, many speakers from Anglophone countries are linguistically lazy, being reluctant to become fluent (or even try to communicate) in any other language. Sadly, many American tourists arrogantly assume that everyone in a major European city speaks English (or should!).

In the past, English was not the language of medical or scientific communication. In the 16th and 17th centuries, scientific works (including those carried out by Englishmen) were never presented for the first time in English. In 1600, the English physician William Gilbert published his seminal work on magnetism in Latin. In 1628, William Harvey published his work on the circulation of the blood in Latin, although it carried a dedication to King Charles I of England. The English physicians Francis Glisson and William Briggs published their seminal work on the liver and the eye, respectively, in Latin (in 1654 and 1685). In 1687, Isaac Newton published the first edition of his Principia in Latin.

However, as the British imperialism spread, the rules changed. A pivotal event occurred in 1685, when Govert Bidloo, a famed Dutch anatomist, published his landmark atlas. In one of the greatest acts of plagiarism in the history of medicine, in 1698, William Cowper (a leading English physician) usurped his anatomical plates and appended English text, without ever acknowledging Bidloo. The plagiarism caused a horrific uproar within the European medical community. Yet, despite overwhelming evidence of intellectual theft, Cowper never apologized -- and never paid a reputational price for his arrogance. For the first time, someone who wrote in English no longer needed to acknowledge the existence of -- let alone their debt to -- someone who wrote in a different language.

The linguistic arrogance of Anglophones grew outrageously over the next 300 years, fostered by the vast expansion of the British Empire. That arrogance exploded following the American victories in World War II, and the dominance of British and American popular culture in the post-war era. When the European Heart Journal (the ESC's official journal) was launched in 1980, its official language was English, even though it was positioned initially as the Continental alternative to the British Heart Journal.

Physicians throughout the world will tell you that they do not mind communicating in English. At an international meeting, a physician from Spain truly prefers to give her talk in English than in German or French. As a result, those of us who hail from native English-speaking countries have enjoyed an enormous -- but wholly undeserved -- privilege. And we take it for granted every single day.

I must admit that I am particularly sensitive to this issue. English was not my first language, and in their zeal for assimilation, my parents forbid me to speak any language other than English at home. Decades later, when traveling, my efforts to speak the local tongue are woefully inadequate.

Linguistic imperialism is an overwhelming force.

Packer recently consulted for Actavis, Akcea, Amgen, AstraZeneca, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Novo Nordisk, Pfizer, Sanofi, Synthetic Biologics, and Takeda. He chairs the EMPEROR Executive Committee for trials of empagliflozin for the treatment of heart failure. He was previously the co-PI of the PARADIGM-HF trial and serves on the Steering Committee of the PARAGON-HF trial, but has no financial relationship with Novartis.



Milton- This topic has been covered extensively by scholars of Nursing, Anthropology, History, linguistics, social justice and Sociology for years. This is not NEWS!

Milton- This topic has been covered extensively by scholars of Nursing, Anthropology, History, linguistics, social justice and Sociology for years. This is not NEWS!

Arrogance? Nonsense. For medicine there should be a universal language and English is as good (or even better) than many. One, everybody learns it in school. Second to properly discuss medicine one language eliminates confusion & puts us on a common ground. I like universal translators but my guess is it is too expensive.

As usual, I find your articles very interesting and timely! Thanks! I am 55 and have always believed that you should speak the language fluently for whatever country you live in (their native language) So, if I choose to move to Mexico, I should know and expect to speak Spanish. If I am only visiting a country with a different native language, I don't think I should have to speak their language fluently as long as I can get by ie. have ability to seek translation. I would not presume to speak my native English in a country with a different native language and be understood by most if not any people there. I would indeed take a translator with me or meet one or whatever. I have never attended an a medical or pharmacy meeting outside the USA! That would be terrific but I would expect to have to have a translator with me depending on the native language (I can get by with French!) The ESC conference is one I'd like to someday attend as I specialize in anticoagulation as a Pharmacist. I am blessed to be able to attend the every other year Anticoagulation Forum's National Conference held in a different city each time (Ft. Lauderdale, FL April 2019), where medical folks from around the globe congregate and it is totally in English. If it were held in a different country with a different native language, I personally would expect for it to be spoken in that language and I would need a translating computer or something!
Also, I wanted to mention that people I've known over the years from the USA who have lived in Europe (so, no other continent) have learned that native language but those kids in European countries have always learned English as a second language.
Thank you again for this info and a wake up call to this topic!

But the ESC (European Society of Cardiology) chose to make English their preferred language. How is English then blamed for being arrogant? The Europeans decided to do that freely. Probably they have more respect for English than the author does. Europeans recognize how great a history the English language has.

I thank all those who have posted comments. I expected my post to trigger a response — and it has!

In particular, I would like to respond to the anonymous post, suggesting that Europeans recognize "how great a history the English language has".

Really? Does it mean that Italian does not have a great history, even though it was the language used by Galileo in proposing his heliocentric solar system? Does it mean that German does not have a great history, even though it was the language Einstein used to propose his theory of relativity? Does it mean that French does not have a great history, even though it was the language that Descartes used in his landmark work on scientific reasoning?

This response represents the embodiment of linguistic arrogance. The current dominance of English is not due to its great history, but the result of political and social factors that have little to do with the "importance" of the language. The decision to adopt English by the ESC was a matter of expediency, not respect. To think otherwise is to ignore history and reality.


Wrong, wrong, wrong. What is described is not "linguistic imperialism." As Rick Steves, the travel guru, has explained, if someone from Greece wants to talk to someone from Norway while they are in Poland, they will communicate in English. The fact that English is the second language throughout much of the world has brought people together in a way that was unimaginable not long ago.

It is really important to understand how we arrived where we are.

English is the lingua franca for many transactions and communications. It is a very appropriate choice and a very useful one. But the choice of English is a matter of convenience. The selection of English in communication is not based on its unique "greatness".

It would be unfortunate if native English speakers believed that English has become dominant because it is "great". Its current dominance is a very recent historical phenomenon. To think of English as being convenient is sensible. To think that English has become dominant because it is "great" is arrogance.


If you really want to engender a meaningful discussion about language, please spend 14 minutes of your time watching this talk.
Bemoaning the facts as they exist isn’t a useful endeavor - learning to appreciate other subtle differences is enriching

Boroditsky has given this talk in other venues - which can be easily googled

I am aware of Boroditsky's great work. She argues convincingly that the choice of language shapes our thought processes. Hence, there are important consequences to any language that is positioned as the lingua franca.

I am not denying the current dominance of English or the desirability of having a common vehicle for communications. However, I am making the point that this dominance provides native English speakers with a privilege, which we should not ignore. The choice of English as the current lingua franca has consequences, as Boroditsky so eloquently describes.


Milton, If you feel a de facto language for communication is "linguistic arrogance". What did you expound it usurped except delayed translation? If that kind of improvement is arrogance, sign me up for more.

Might you be projecting the childhood regret of not learning one's native language. Applying this to the whole of a working system and searching for validation.

Dr Packer,
I have usually enjoyed your essays but this was not one of them. It betrays a liberal bent - nothing wrong with that except when you go all-crazy to allow "equal participation" and "fairness", excuse me for using your concept, to those who seek an "undeserved privilege". To put it mildly, I will probably NEVER ever want to listen to someone deliver a medical, let alone legal, discourse in Albanian, no matter how important the subject is -- so English it is. I ACCEPT ENGLISH AS THE LINGUA FRANCA. :) Evidently, so do many others.

I do not even hear the Russians or French complaining, and you know how much they (non-sensibly) cry over linguistic intrusions. French is not even the diplomatic language it once was and Russian is hardly used in scientific conferences. The reasons are pretty obvious and you seem to be the only voice bemoaning the dominance of English.
Accept it, grow, and move on. It really is not an issue because I don't really see an alternative that would please everyone.
At this point, I can't think of another language that could supplant English because there just is not another cultural or scientific force propagating it.

O. Land, MBA, JD

I understand the author's point - English is pervasive. But, in a real sense, English has become the new Latin.
In the centuries leading to the 1600s Latin was universally used in scholarly articles, yet there was and is no Latin Outrage.
And yes, I am an American, and yes, I am woefully lacking in other language skills - but I promise to try harder.

Hi Milton, the use of the english language as a method of medical communication is to be applauded.(as in so many other areas of our lives) & not undermined by such an arrogant point of view. The conclusion reached by most modern educated persons is that the use of one easily understood language is one of the greatest achievements of our time ie a practically a universal language. If you have a problem calling it english call it the new Esperanto if that make you happy. You seem to be a very balance person but with a chip on both shoulders where this is concerned. On one shoulder lies the arrogance of the english language & on the other the linguistic arrogance of the Anglophones.
Already with Brexit in sight the French & Germans are starting to assert their own "linguistic arrogance" & I assume that is OK even tho' most people with no working knowledge of these languages have no interest in learning them never mind understanding technical interpretations of them while there is already a viable alternative. Why you want everyone to revert back to a tribal mentality defies logic.
Arrogance is not the word I would associate with the english language. I suggest the word confidence is more appropriate. "Confidence means feeling sure of yourself and your abilities — not in an arrogant way, but in a realistic, secure way. Confidence isn't about feeling superior to others" - the words borrowed from somewhere on google (just to show the importance of a universal language

Ray Carthy

 Beside the fact that English speaking countries are politically, economically, and yes, scientifically, dominant in the world at the present time, and beside the fact that English is one of the most widespread languages presently in use, it is tremendously flexible. It is derived from Latin, Anglo-Saxon, Nordic and many other sources. It often has multiple origin words to express the same concept and is particularly good to use for forming the compound words so useful in science.

Yes, those of us native English speakers are fortunate in this regard but there's no reason to feel guilty about it. That's silly.

Anthony Perry, MD

The world has indeed elected to create a universal communication language not only in healthcare but in other aspects as well
ALl pilot to tower and the like communication must be made in English. That means every pilot regardless of the airspace he/she is flying in must communicate in English. Same goes for most business communications in science-related issues. I have been to many simple committee meetings between companies who neither were Anglophilic but at the meetings, they both spoke English to each other
It is FAR more important to select a common language to communicate to prevent misunderstandings then which one is packed/chosen. I agree the US and UK populations are the most last lazy to learn other languages but never the less pick we all must and English seemed the most common of all the options
Heck I guess we could have chosen one of the hundreds of Chinese dialects or one of the dozens of Philopino ones or even chosen Yiddish to accommodate a wide spectrum of Europeans in one swoop (all be it pre-1942 Europeans only) but Royal English is a better option
LOVE your work my friend and thank you for identifying great areas of our industry that need atleast some light pointed on them so everyone sees that someone is nothing
Dr Dave (H+N Surgical Oncology)

Wow--these comments really prove your point. However, why was I told growing up in the '60s that if I wanted to become a science major I should study French or German because so much of the scientific literature was in those languages?

Steven Bornfeld, DDS

Dr. Milton Packer, what was your first language?

Anna Zayachkowsky

Again, I thank the thousands who read my posts every week, and in particular, I thank those who take time to post comments.

I would be delighted to answer Anna's question. My parents were one of the very few who survived the liquidation of the Vilna Ghetto in 1943; they emigrated to the United States in 1947. They spoke four languages, but their emotional favorite was English, since they considered it to represent the language of their liberation. The language spoken in my home was Yiddish (my first language), but in short order, I was forbidden to speak it, since my parents prized assimilation to the United States so much.

On the eve of World War II, there were 11-13 million people who spoke Yiddish as their primary language. Currently, in the US, the number of people who speak Yiddish at home is about 200,000. Given my parents' decision to discourage my own use of Yiddish early in my life, I can understand (but cannot speak) the language.


My parents (first generation American) spoke Yiddish at the dinner table occasionally--a sure sign they wanted to hide something from us kids. We eventually picked up enough to get the general gist.

Steven Bornfeld, DDS

I refuse to adopt the Liberal guilt mindset. English as a language is well adapted to ise as a scientific language and is continually growing to encompass new challenges. Other languages do the same with various degrees of success. Can you imagine the Mandarin characters for Lactate Dehydrogenase... I can, because I looked it up... It is LDH.
Please dont pretend there is a problem because of western imperialism. It is a paper tiger.

david chorley


Milt-- as a Cardiologist and former Medical Resident at Mount Sinai during some of your great years there, I am pleased that you are continuing to provide thoughtful discussion and deep insight to a large audience.

On this one, I don't think arrogance the proper descriptor. You surprisingly omit the tremendous strides in the STEM and Business that America has made since WWII; this surely correlates & has promoted the world dominance of English, as the planet has been transformed by the Computer Science and Engineering brilliance and innovation from MIT, Stanford, Silicon Valley , and other (predominantly US) Institutions since the 1940s. Arcane terminology and the need to get things done expediently could only be done in English, by the home inventor (America).

For example, ENIAC was the first large scale Main Frame Computer in the mid-1940s, an invention at UPENN. The Manhattan project arguably saved the Free world, a creation of US Physicists in New Mexico, at the same time. After the war, the invention of the Transistor, ultrasound technology, and the wide spread use of Micro-processors by US engineers at MIT and Northern California sites, was the basis for like .....almost EVERYTHING we have today.

From a Business perspective, decades of world Trade starts here and ends here in the US; Russia and China were Communist and not even really doing business until 1991 (Russia) and 2000 (China was brokered into the WTO by the US) . Our European allies are bright, great, and wonderful, but their individual populations and GDPs are, of course, not at all comparable to ours to make their mark in Business on our level

I think, overall, that this explains things more accurately, in my opinion

Robert Labarre

While I understand the commentary and intent of Dr. Packer's editorial, I must say that like anything which which has the inherent nature for progression and advancement, such as technology, mechanics, space travel or medicine, there must be a common platform for which experimentation, ideas, and concepts can grow. Can you imagine in this rudimentary example that a USB port (which means "Universal Serial Bus", by the way, "Universal" being the operative word), was a different size for each computer manufacturer? Firstly it would not be called a USB port, as it would not be "universal" any longer. (In reality, I shouldn't say that, we could call it an "Unlike Serial Bus").
We then would be individualized to the USB size we had on our own computers, thus we would not be able to provide a slide deck, music, TV show, photos or even important medical information to our friends, relatives or colleagues, who owned a computer with an unlike USB port. In medicine then, how would we transfer knowledge quickly from our friends who operate in a different language, who have ground breaking information they would like to share? Accept it in their language, send it out to translation and wait for the results, like a lab test? Can you imagine the pace of medicine at that rate? In medicine, without a universal language as a foundation for our communications, our advancements would suffer. Multi Country research would take longer, and like Dr. Packer mentioned about a joke not landing on a foreign speaking audience, our ability to connect with our colleagues, who we rely on for the advancement of the world of medicine at large, may not land either. I don't think we have to feel that there is an "arrogance" attached to the use of a universal language, I would see it as a practicality.

R. Rotex, MD

Arrogance is when someone thinks science and medicine were the fields that pushed English. It was ENTERTAINMENT. Television in Sweden is full of American programs in English with Swedish subtitles. Movies from Hollywood were not dubbed into every native language because that was expensive. People listened to the Beatles singing in English and newspapers, magazines, and yes, scientific journals were published in English. Finally, the military and aerospace industries mandated English to facilitate safety during transportation and international commerce. We and the Pope were the last to abandon Latin.

dominick zito

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