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.