Preventive or Preventative

Mark B. Johnson, Am J Prev Med

The word “preventative” is commonly and erroneously used in place of “preventive” when referring to the medical specialty, preventive medicine. This has led to confusion in both the lay and medical communities. Preventive medicine is a science-based specialty within organized medicine, whereas “preventative medicine” often refers to the use of unscientific or unproven medical activities. This commentary describes the problem and some of the untoward effects of this confusion and suggests a remedy for the use of these words in the medical literature.

“What’s in a name? That which we call a rose, By any other name would smell as sweet.”—William Shakespeare, Romeo and Juliet (II, ii, 1–2)

Shakespeare was wrong. Names do matter. Names and titles have a tendency to become a part of who we think we are. Most people probably overvalue their own name, but some names really do have monetary value. Federal Express paid over $12 million for the naming rights of the venues where the Washington Redskins and the Memphis Grizzlies play their home games. Reliant Energy paid $10 million to name the new sports venue in Houston TX, Reliant Stadium.

Some people just wouldn’t be the same with a different name. Cher would never have made it as Cheryl. Elvis would not have become a sex symbol if his name had been Ernie.

Although lacking the romance of Romeo and Juliet, the perceived value of FedEx and Reliant Energy, or the sex appeal of Elvis, the name about which I am concerned is that of my medical specialty, preventive medicine. Although this specialty was established more than 50 years ago and is a member of the American Board of Medical Specialties (ABMS), my colleagues and I have long had to put up with the erroneous appellation “preventATive medicine.” We see it in medical journals, newspaper articles, and pharmaceutical advertisements. We have found it on our stationery, our checks, and our business cards. I, for one, am finally fed up!

Literary purists and Scrabble® lovers are correct when they point out that the word preventative is found in many dictionaries. Both of the words have been used since the mid-17th century, although preventive clearly preceded preventative. In modern dictionaries, though, even when the word preventative is found, it usually is identified as being a distorted or obsolete form of preventive. In his book, Modern English Usage,¹ the esteemed English grammarian H.W. Fowler stated that preventative was a “needless lengthening,” and declared that preventive was the proper form. Unfortunately, few people seem to have heard of Fowler, or don’t seem to value his opinion.

In an attempt to determine modern usage, I did an Internet (Google) search, and found 36.5 million references to preventive medicine, and fewer than 6.7 million references to preventative medicine. And yet it still seems to me that preventative is taking over. Perhaps I’m just too sensitive.

There are, however, some interesting differences in how the two words appear to be used on the Internet. The preventative medicine sites almost all fall into one of four categories: (1) sites that obviously mean preventive medicine, but the words have been misspelled or mistakenly interchanged, (2) sites that promote alternative or nonscientific modalities or treatments, (3) sites that are based in the United Kingdom or one of its Commonwealth members, and (4) sites dealing with veterinary preventive medicine. My favorite, which is hard to categorize, is a site with an article entitled, “Sport Preventative Medicine for Depression,” found on the Beer League Hockey’s website.²

Examples from the first category, obvious misspellings or misuses, included some rather impressive institutions. The website of the National Library of Medicine, National Institutes of Health, attributed a collection from the Gorgas Memorial Institute of Tropical and Preventive Medicine to having been created by the Gorgas Memorial Institute of Tropical and Preventative Medicine.³ Rush University’s Department of Preventive Medicine website search banner welcomes one to the Department of Preventative Medicine (www.rushu.rush.edu/prevent), and a web-page reference to Columbia University’s Social and Preventive Medicine course is displayed as “social-preventative-medicine.”

It is the second category, however, that is the most challenging for my preventive medicine colleagues and me. The specialty of preventive medicine works closely with the fields of nutrition, exercise physiology, and behavioral medicine, and uses many of the scientific research findings from the wholistic (spelled purposefully with a “w”) approach to health care. Unfortunately, these are fields that have also been used effectively by those who do not appreciate science- and evidence-based medicine. In this age of kinder and gentler political correctness, we no longer label anyone as a quack, but the health information and advice found on many sites promoting preventative medicine is alarming and can be downright dangerous.

Having one’s friends, medical colleagues, and patients fail to clearly differentiate between the evidence-based specialty of preventive medicine and that claimed by the purveyors of preventative medicine is problematic, and can be rather disconcerting. At a high school reunion, I was chatting with a friendly classmate. He had finished 1 year of college as a music major, and then dropped out and become a bartender. On the side, to augment his income, he sold vitamins and nutritional supplements. When he asked what I was now doing, I told him I was practicing preventive medicine. “Oh,” he excitedly replied, “so am I!”

To bring some order to the use of these words, at least in the scientific medical literature, I would like to make a suggestion that I hope will help to alleviate some of the confusion. My proposal is that the word preventive be used exclusively as an adjective, and the word preventative be used only as a noun. Thus such terms as preventive medicine, preventive cardiology, preventive maintenance, and preventive war, would be grammatically, if not necessarily politically, correct. So, too, would such statements as, “This immunization is a preventative for polio,” or, “Sunscreen may be a preventative to keep one from getting skin cancer.” We may not be able to get the rest of the world to conform, but we could at least bring some uniformity to the American medical literature and some peace to those of us who use preventatives in the practice of preventive medicine. My secondary proposal would be to just kill the use of the word preventative.

I am sure there are those who feel this is much ado about nothing. They feel I am obviously being much too sensitive. Perhaps I am, but names and titles have a way of becoming more than just mere symbols to those who own them. I have seen shrinks, and orthopods, and gas passers, and various sawbones get quite upset if they felt their specialties were not being shown the respect that was obviously their due. I am also pretty sure that before I started calling him a certified public accountant, my personal bean counter always over-estimated what I owed in taxes. I have paid dearly in gaining my understanding that some roses truly do smell sweeter than others.