Efficacy

Efficacy (pronounced ef-i-kuh-see)

(1) A capacity for producing a desired result or effect; effectiveness; an ability to produce a desired effect under ideal testing conditions.

(2) The quality of being successful in producing an intended result; effectiveness; a measure of the degree of ability to produce a desired effect.

1520-1530: From the Old French efficace (quality of being effectual, producing the desired effect), from the Late Latin efficācia (efficacy), from efficāx (powerful, effectual, efficient), genitive efficacis (powerful, effective), from stem of efficere (work out, accomplish).  In eleventh century English, in much the same sense was efficace from the Old French eficace from the same Latin root efficācia; there was also the early fifteenth century efficacite from the Latin efficacitatem.  The sixteenth century adjective efficacious (certain to have the desired effect) was often used of medicines (presumably a favorite of apothecaries), the construct being the Latin efficaci-, stem of efficax from the stem of efficere (work out, accomplish)  + -ous.  The –ous suffix was from the Middle English -ous, from the Old French –ous & -eux, from the Latin -ōsus (full, full of); a doublet of -ose in an unstressed position.  It was used to form adjectives from nouns, to denote possession or presence of a quality in any degree, commonly in abundance.  In chemistry, it has a specific technical application, used in the nomenclature to name chemical compounds in which a specified chemical element has a lower oxidation number than in the equivalent compound whose name ends in the suffix -ic.  For example, sulphuric acid (H₂SO₄) has more oxygen atoms per molecule than sulphurous acid (H₂SO₃).  The noun inefficacy (want of force or virtue to produce the desired effect) dates from the 1610s, from the Late Latin inefficacia, from inefficacem (nominative inefficax), the construct being in- (not, opposite of) + efficax.

The most familiar related form in modern use is efficacious but in general use this is often used in a more nuanced way than the pass/fail dichotomy of "efficacy" familiar in medical trials.  In general use, efficacious is a "spectrum word" which describes degrees of the ameliorative effects of treatments although while the comparative is "more efficacious", a more common form is "quite efficacious"; the superlative "most efficacious" appears to be popular among the small subset of the population who use efficacious at all.  Efficacy, efficacity & efficaciousness are nouns, effectuate is a verb, effectual & efficacious are adjectives and efficaciously is an adverb; the noun plural is efficacies.

Clinical trials in the pharmaceutical industry

In the development of vaccines (and medicinal drugs in general), efficacy trials (sometimes called phase III or explanatory trials) determine the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, under the most favorable conditions, which is with the subjects housed in a hospital equipped to handle intensive care patients.  Conducted on human subjects if tests on animals proved satisfactory, it’s a purely clinical exercise, practiced since 1915 and can be done as a double-blind, randomized study if no safety concerns exist.  One potentially distorting aspect of both efficacy and (particularly) safety trials is a historic bias towards healthy young males as the subjects.  The antonym of the adjective efficacious is inefficacious but the word is rarely used when drug trials produce unsatisfactory results: the punchier "failed" is almost always used.  Under normal circumstances, the testing process can take many years, the industry usually referring to trials as phases:

Phase I: Safety Trial

Phase I trials are done to test a new biomedical intervention for the first time in a small group of people (typically 20-100) to evaluate safety.  Essentially, this determines the safe dosage range and identifies side effects.

Phase II: Efficacy Trial

Phase II trials are done to study an intervention in a larger group of people (several hundred or more depending on the product) to determine efficacy (ie whether it works as intended) and further to evaluate safety.

Phase III: Clinical Study

Phase III studies are done to study the efficacy of an intervention in large groups of trial participants (often thousands) by comparing the intervention to other standard or experimental interventions (or to non-interventional standard care).  Phase III studies are also used to monitor adverse effects and to collect information that will allow the intervention to be used safely.

Phase IV: Efficiency Study

Phase IV studies are done after the drug has been released and is being prescribed.  These studies are designed to monitor the effectiveness of the approved intervention in the general population and to collect information about any adverse effects associated with widespread use over longer periods of time.  They may also be used to investigate the potential use of the intervention in a different condition, or in combination with other therapies.

Proven efficacy: Adderall.

Adderall and Mydayis are trade names for a combination drug called mixed amphetamine salts (a mix of four salts of amphetamine).  In all Western jurisdictions  Belonging to a class of drugs known as stimulants, Adderall is a prescription medication and it contains two active ingredients: the amphetamines and dextroamphetamine.  As a prescribed medicine, primarily Adderall is used in the treatment of attention deficit hyperactivity disorder (ADHD), a neurobehavioral disorder characterized by symptoms such as inattention, hyperactivity, and impulsivity.  Adderall works by increasing the levels of certain neurotransmitters (most critically dopamine and norepinephrine) in the brain, these both mechanisms which play some role in regulating attention, focus, and impulse control.  Beyond ADHD, Adderall is sometimes prescribed off-label for the treatment of narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and sudden, unpredictable episodes of sleep.

Adderall also has something of a cult following among those who seek to experience some of its more desirable side-effects.  Like many of the earlier amphetamines (most famously Tenuate Dospan (diethylpropion or amfepramone) an appetite suppressant of legendary efficacy), Adderall can assist in weight-loss and can safely be used for this by most people but because of its potential for dependence, it should be taken (for whatever purpose) only under clinical supervision.  For those prescribed Adderall, in some circumstances, it may continue to be taken (at the prescribed level) even if one is in a substance rehabilitation facility as was the case in 2013 when Lindsay Lohan completed a 48-hour drug detox at the Betty Ford Clinic in Indio, California.  Ms Lohan was prescribed Adderall after being diagnosed with ADHD but the standard protocol used by rehab clinics is that doctors routinely re-evaluate (1) the ADHA diagnosis and (2) the efficacy of the treatment regime.  Depending on their findings, doctors can prescribe alternative drugs or cease drug intervention entirely.  Ms Lohan was quoted as saying she’d been using Adderall "for years" and that she cannot function without it and her choice of rehab facility was once which would permit both smoking (tobacco) and the use of Adderall.

As she earlier explained it: “I have severe ADD. I can’t stand still.  So, I take Adderall for that; it calms me.”  Ms Lohan further noted she was not unaware there were those who took Adderall for its side-effects, notably weight loss or the ability to function effectively for extended durations without needing to sleep but that she wasn’t someone who needed to regulate her weight and that her sleeping patterns were normal.  However, the cult if anything is growing and in the US shortages of Adderall were reported (not for the first time) in late 2022.  The US Food and Drug Administration (FDA) responded by issuing a statement noting that while there was nothing unusual about episodic shortages of generic drugs at any given time because the profit margins are low and production is sometimes restricted to avoid a sacrifice in the opportunity cost vis-a-vis higher margin products, Adderall was “a special case because it is a controlled substance and the amount available for prescription is controlled by the Drug Enforcement Administration (DEA).”  The FDA added that because there had been “a tremendous increase in prescribing” because of virtual medicine (e-consultations) and a general trend towards over-prescribing and over-diagnosing, the periodic shortages were likely to continue.  THE FDA’s conclusion was that “if only those who needed these drugs got them, there probably wouldn't be a [stimulant medication] shortage” but the diagnosis of ADHD continues to grow and the desire for rapid weight-loss solutions remains strong.

Virtual

Virtual (pronounced vur-choo-uhl)

(1) Being as specified in power, force, or effect, though not actually or expressly such; having the essence or effect but not the appearance or form.

(2) In optics, of an image (such as one in a looking glass), formed by the apparent convergence of rays that are prolonged geometrically, but not actually (as opposed to a real image).

(3) Being a focus of a system forming such images.

(4) In mechanics, pertaining to a theoretical infinitesimal velocity in a mechanical system that does not violate the system's constraints (applied also to other physical quantities); resulting from such a velocity.

(5) In physics, pertaining to a theoretical quality of something which would produce an observable effect if counteracting factors such as friction are disregarded (used often of the behavior of water if a factor such as friction were to be disregarded.

(6) In physics, designating or relating to a particle exchanged between other particles that are interacting by a field of force (such as a “virtual photon” and used also in the context of an “exchange force”).

(7) In digital technology, real, but existing, seen, or happening online or on a digital screen, rather than in person or in the physical world (actually an adaptation of an earlier use referring to political representation).

(8) In particle physics, pertaining to particles in temporary existence due to the Heisenberg uncertainty principle.

(9) In quantum mechanics, of a quantum state: having an intermediate, short-lived, and unobservable nature.

(10) In computing (of data storage media, operating systems, et al) simulated or extended by software, sometimes temporarily, in such a way as to function and appear to the user as a physical entity.

(11) In computing, of a class member (in object-oriented programming), capable of being overridden with a different implementation in a subclass.

(12) Relating or belonging to virtual reality (once often used as “the virtual environment” and now sometimes clipped to “the virtual”) in which with the use of headsets or masks, experiences to some degree emulating perceptions of reality can be produced with users sometimes able to interact with and change the environment.

(13) Capable of producing an effect through inherent power or virtue (archaic and now rare, even as a poetic device).

(14) Virtuous (obsolete).

(15) In botany, (literally, also figuratively), of a plant or other thing: having strong healing powers; a plant with virtuous qualities (obsolete).

(16) Having efficacy or power due to some natural qualities; having the power of acting without the agency of some material or measurable thing; possessing invisible efficacy; producing, or able to produce, some result; effective, efficacious.

1350–1400: From the Middle English virtual & virtual (there were other spellings, many seemingly ad hoc, something far from unusual), from the Old French virtual & vertüelle (persisting in Modern French as virtuel), from their etymon Medieval Latin virtuālis, the construct being the Classical Latin virtū(s) (of or pertaining to potency or power; having power to produce an effect, potent; morally virtuous (and ultimately the source of the modern English “virtue” from the Latin virtūs (virtue)) + -ālis.  The Latin virtūs was from vir (adult male, man), ultimately from the primitive Indo-European wihrós (man) (the construct of which may have been weyh- (to chase, hunt, pursue) + -tūs (the suffix forming collective or abstract nouns)).  The –alis suffix was from the primitive Indo-European -li-, which later dissimilated into an early version of –āris and there may be some relationship with hel- (to grow); -ālis (neuter -āle) was the third-declension two-termination suffix and was suffixed to (1) nouns or numerals creating adjectives of relationship and (2) adjectives creating adjectives with an intensified meaning.  The suffix -ālis was added (usually, but not exclusively) to a noun or numeral to form an adjective of relationship to that noun. When suffixed to an existing adjective, the effect was to intensify the adjectival meaning, and often to narrow the semantic field.  If the root word ends in -l or -lis, -āris is generally used instead although because of parallel or subsequent evolutions, both have sometimes been applied (eg līneālis & līneāris).  The alternative spellings vertual, virtuall and vertuall are all obsolete.  Virtual is a noun & adjective, virtualism, virtualist, virtualism, virtualness, virtualization (also as virtualisation) & virtuality are nouns, virtualize (also as virtualise) is a verb and virtually is an adverb; the noun plural is virtuals.  The non virtualosity is non-standard.

The special use in physics (pertaining to a theoretical infinitesimal velocity in a mechanical system that does not violate the system’s constraints) came into English directly from the French.  The noun use is derived from the original adjective.  Virtual is commonly used in the sense of being synonymous with “de facto”, something which can now be misleading because “virtue” has become so associated with the modern use related to computing.  In the military matters it has been used as “a virtual victory” to refer to what would by conventional analysis be thought a defeat, the rationale being the political or economic costs imposed on the “winner” were such that the victory was effectively pyrrhic.  It was an alternative to the concept of “tactical defeat; strategic victory” which probably was a little too abstract for some.

"Virtual art galleries" range from portals which enable works to be viewed on any connected device to actual galleries where physical works are displayed on screens or in some 3D form, either as copies or with a real-time connection to the original.   

In computing, although “virtual reality” is the best known use, the word has for some time been used variously.  “Virtual memory” (which nerds insist should be called “virtual addressing” is a software implementation which enables an application to use more physical memory than actually exists.  The idea dates from the days of the early mainframes when the distinction between memory and storage space often wasn’t as explicit as it would later become and it became popular in smaller systems (most obviously PCs) where at a time when the unit cost of RAM (random access memory) hardware was significantly higher than the default storage media of the HDD (hard disk drive).  Behaving as static electricity does, RAM was many orders of magnitude faster than the I/O (input/output) possible on hard disks but allocating a portion of free disk space to emulate RAM (hence the idea “virtual memory”) did make possible many things which would not run were a system able to work only with the installed physical RAM and rapidly it became a mainstream technique.

There’s also the VPN (virtual private network), a technology which creates a secure and encrypted connection over a public network (typically the Internet) and use is common to provide remote access to a private network or to establish a secure tunnel between two networks using the internet for transport.  The advantage of VPNs is they should ensure data integrity and confidentiality, the two (or multi) node authentication requirement making security breaches not impossible but less likely.  Widely used by corporations, VPNs are best known as the way traditionally used to evade surveillance and censorship in certain jurisdictions as diverse as the PRC (People’s Republic of China), the Islamic Republic of Iran and the UK although this is something of an arms race, the authorities with varying degrees of enthusiasm working out way to defeat the work-arounds.  VPNs often use an IP tunnel which is a related concepts but the IP tunnel is a technique used to encapsulate one type of network packet within another type of network packet to transport it over a network that wouldn't normally support the type of packet being transported.  IP tunnels are particularly useful in connecting networks using different protocols and (despite the name), the utility lies in them being able to transport just about any type of network traffic (not just IP).  A modular technology, not all IP tunnels natively provide authentication & encryption but most support “bolt-ons” which can add either or both.  So, while all VPNs use some form of tunnelling (however abstracted), not all tunnels are VPNs.

Microsoft really wanted you to keep their Java Virtual Machine.

Then there are “virtual machines”.  In personal computing, the machine came quickly to be thought of as a box to which a monitor and keyboard was attached and originally it did one thing at a time; it might be able to do many things but not simultaneously.  That situation didn’t long last but the idea of the connection between one function and one machine was carried over to the notion of the “virtual machine” which was software existing on one machine but behaving functionally like another.  This could include even a full-blown installation of the operating systems of several servers running on specialized software (sometimes in conjunction with hardware components) on a singles server.  What made this approach practical was that it is not unusual for a server to be under-utilized for most of its life (critically components often recording 2-3% utilization for extended periods, thus the attraction of using one physical server rather than several.  Obviously, the economic case was also compelling, the cost savings of having one server rather than a number multiplied by reductions in electricity use, cooling needs, insurance premiums and the rent of space.  There was also trickery, Microsoft’s JVM (Java Virtual Machine) an attempt to avoid having to pay licensing fees to Sun Microsystems (later absorbed by Oracle) for the use of a Java implementation.  The users mostly indifferent but while the hardware was fooled, the judges were not and the JVM was eventually declared an outlaw.

Operating a computer remotely (there are few ways to do this) rather than physically being present is sometimes called “virtual” although “remote” seems to have been become more fashionable (the form “telecommuting” used as early as 1968 is as archaic as the copper-pair analogue telephone lines over which it was implemented although “telemedicine” seems to have survived, possibly because in many places voice using an actual telephone remains a part).  In modern use (and the idea of virtual as “not physically existing but made to appear by software” was used as early as 1959), there are all sorts of “virtuals” (virtual personal trainers, virtual assistants et al), the idea in each case is that the functionality offered by the “real version” of whatever is, in whole or in part, emulated but the “virtual version”, the latter at one time also referred to as a “cyberreal”, another word from the industry which never came into vogue.  “Virtual keyboards” are probably the most common virtual device used around the world, now the smartphone standard, the demise of the earlier physical devices apparently regretted only by those with warm memories of their Blackberries.  Virtual keyboards do appear elsewhere and they work, although obviously offer nothing like the tactile pleasure of an IBM Model M (available from ClickyKeyboards.com).  The idea of “a virtual presence” is probably thought something very modern and associated with the arrival of computing but it has history.  In 1766, in the midst of the fractious arguments about the UK’s reaction to the increasing objections heard from the American colonies about “taxation without representation” and related matters (such as the soon to be infamous Stamp Act), William Pitt (1708-1778 (Pitt the Elder and later Lord Chatham); UK prime-minister 1766-1768) delivered a speech in the House of Commons.  Aware his country’s government was conducting a policy as inept as that the US would 200 years on enact in Indochina, his words were prescient but ignored.  Included was his assertion the idea of “…virtual representation of America in this house is the most contemptible idea that ever entered into the head of man and it does not deserve serious refutation.”  However, refute quite seriously just about everything his government was doing he did.  Pitt’s use of the word in this adjectival sense was no outlier, the meaning “being something in essence or effect, though not actually or in fact” dating from the mid-fifteenth century, an evolution of the sense of a few decades earlier when it was used to mean “capable of producing a certain effect”.  The adverb virtually was also an early fifteenth century form in the sense of “as far as essential qualities or facts are concerned while the meaning “in effect, as good as” emerged by the early seventeenth.

Lindsay Lohan's 2021 predictions of the US$ value of Bitcoin (BTC) & Ethereum (ETH).  By April 2024 the trend was still upward so the US$100,000 BTC may happen.  

In general use, the terms “cybercurrency”, “cryptocurrency” & “virtual currency” tend to be used interchangeably and probably that has no practical consequences, all describing electronic (digital) “currencies” which typically are decentralized, the main point of differentiation being that cryptocurrencies claim to be based on cryptographic principles and usually limited in the volume of their issue (although the decimal point makes this later point of little practical significance)  Whether they should be regarded as currencies is a sterile argument because simultaneously they are more and less, being essentially a form of gambling but for certain transactions (such as illicit drugs traded on various platforms), they are the preferred currency and in many jurisdictions they remain fully convertible and it’s telling the values are expressed almost always in US$, “cross-rates” (ie against other cryptocurrencies) rarely quoted.  However, to be pedantic, a “virtual currency” is really any not issued by a central government or authority (in the last one or two centuries-odd usually a national or central bank) and they can include in-game currencies, reward points and, of course, crybercurrencies.  The distinguishing feature of a cryptocurrency is the cryptotography.

Although the term is not widely used, in Christianity, "virtuality" was the view that contrary to the Roman Catholic doctrine of transubstantiation, the bread & wine central to Holy Communion do not literally transform into flesh and blood but are the medium or mechanism through which the spiritual or immaterial essence of the flesh and blood of Jesus Christ are received.  Within the Church, those who espoused or adhered to the heresy of virtuality were condemned as "virtualists.  In philosophy, the concept of virtuality probably sounds something simple to students but of course academic philosophy has a “marginal propensity to confuse”, the important distinction being “virtual” is not opposed to “real” but instead to “actual”, “real” being opposed to “possible”.

Phlebotomy

Phlebotomy (pronounced fluh-bot-uh-mee)

(1) The act or practice of opening a vein for letting or drawing blood as a therapeutic or diagnostic measure; the historic practice of bleeding (the letting of blood).

(2) Any surgical incision into a vein (also known as venipuncture & (less commonly) venesection).  It shouldn’t be confused with a phlebectomy (the surgical removal of a vein).

1350–1400: From the earlier flebotomye & phlebothomy, from the Middle French flebotomie, from the Old French flebothomie (which exists in Modern French as phlébotomie), from the Late Latin phlebotomia, from the Ancient Greek φλεβοτόμος (phlebotómos) (that opens a vein), from φλέψ (phléps) (vein) of uncertain origin.  The construct of the Greek was phléps (genitive phlebos) + tomē (a cutting), from the primitive Indo-European root tem- (to cut).  It replaced the Middle English fleobotomie, from the Medieval Latin fleobotomia, a variant of phlebotomia.  The noble profession had long been recognized but the job first gained the designation phlebotomist (one who practices phlebotomy, a blood-letter) in the 1650s (phlebotomizer never existed). The earlier noun and verb in English were the early fifteenth century fleobotomier & fleobotomien.  The instrument used by a phlebotomist (and this in the pre-anesthetic age) was the fleam (sharp instrument for opening veins in bloodletting), from the late Old English, the from Old French flieme (which exists in Modern French as flamme), from the Medieval Latin fletoma, from the Late Latin flebotomus, from the Ancient Greek phlebotomos (a lancet).  Phlebotomy, phlebotomization & phlebotomist are nouns, phlebotomize is a verb and phlebotomic & phlebotomical are adjectives; the noun plural is phlebotomies.

Phlebotomy describes the process of making a puncture in a vein cannula for the purpose of drawing blood.  In modern medicine the preferred term is venipuncture (used also for therapy) although the title phlebotomist continues to be used for those who specialize in the task.  One of the most frequently performed procedures in clinical practice, it’s commonly undertaken also by doctors, nurses and other medical staff.  Although the origins of phlebotomy lie in the ancient tradition of blood letting, it’s now most associated with (1) the taking of blood samples for testing by pathologists and (2) those carried out as “therapeutic phlebotomies” as part of the treatment regimen for certain disorders of the blood.  The inner elbow is the most often used site but in therapeutic medicine or in cases where the veins in the arms are not suitable, other locations can be used.

Bleeding the foot (circa 1840), oil on canvas following Honoré Daumier (1808-1879).

The Greek physician Hippocrates of Kos (460-375 BC) is regarded as one of the founders of medicine as a science rather than an appeal to the gods and the Hippocratic Oath which still underpins the ethics of Western medicine is based on his teachings.  His influence thus endures but one of his most famous theories which persisted for decades resulted in much lost blood for no known benefit and an unknown number of deaths.  Drawing from the notion of earlier philosophers that the basis of the universe was air, earth, water & fire, the theory was that there were four “humors” which had to be maintained in perfect balance to ensure health in body & mind, the four being flegmat (phlegm), sanguin (blood), coleric (yellow bile) & melanc (black bile) which were the source of the four personality types, the phlegmatic, the sanguine, the choleric & the melancholic.  Had Hippocrates and his successors left the humors in the realm of the speculative, it would now be thought some amusing fragment from Antiquity but unfortunately surgical intervention was designed to ensure balance was maintained and the mechanism of choice was bloodletting to “remove excess liquids”.

George Washington in his last illness, attended by Doctors Craik and Brown (circa 1800) engraving by unknown artist, Collection of The New-York Historical Society.

Apparently, bloodletting was practiced by the ancient Egyptians some 3000 years ago and it’s not impossible it was among the medical (or even religious) practices of older cultures and From there it’s known to have spread to the Middle East, Rome, Greece and West & South Asia, physicians and others spilling blood in the quest to heal and the evidence suggests it was advocated for just about any symptom.  The very idea probably sounds medieval but in the West that really was the nature of so much medicine until the nineteenth century and even well into the twentieth, there were still some reasonably orthodox physicians advocating its efficacy.  Still, in fairness to Hippocrates, he was a pioneer in what would now be called “holistic health management” which involved taking exercise, eating a balanced diet and involving the mind in art & literature.  He was an influencer in his time.  All the humors were of course good but only in balance so there could be too much of a good thing.  When there was too much, what was in excess had to go and apart from bloodletting, there was purging, catharsis & diuresis, none of which sound like fun.  Bloodletting however was the one which really caught on and was for centuries a fixture in the surgeon’s bag.

Blood self-letting: Lindsay Lohan as Carrie from the eponymous film, Halloweeen party, Foxwoods Resort & Casino, Connecticut, October 2013.

Actually, as the profession evolved, the surgeons emerged from the barber shops where they would pull teeth too.  The formal discipline of the physician did evolve but they restricted themselves to providing the diagnosis and writing scripts from which the apothecary would mix his potions and pills, some of which proved more lethal than bloodletting.  The bloodletting technique involved draining blood from a large vein or artery (the most productive soon found to be the median cubital at the elbow) but if a certain part of the body was identified as being out-of-balance, there would be the cut.  The mechanisms to induce blood loss included cupping, leeching & scarification and with the leeches, they were actually onto something, the thirsty creatures still used today in aspects of wound repair and infection control, able often to achieve better results more quickly than any other method.  Leeches have demonstrated extraordinary success in handing the restoration of blood flow after microsurgery and reimplantation and works because the little parasites generate substances like fibrinase, vasodilators, anticoagulants & hyaluronidase, releasing them into the would area where they assist the healing process by providing an unrestricted blood flow.  Of course the leeches don't always effect a cure.   When in 1953 doctors were summoned to examine a barely conscious Comrade Stalin (1878-1953; Soviet leader 1924-1953), after their tests they diagnosed a hemorrhagic stroke involving the left middle cerebral artery.  In an attempt to lower his blood pressure, two separate applications of eight leeches each were applied over 48 hours but it was to no avail.  Had he lived he might have has the leeches shot but they probably lived to be of further service.

A Surgeon Letting Blood from a Woman's Arm, and a Physician Examining a Urine-flask (in some descriptions named Barber-Surgeon Bleeding a Patient), eighteenth century oil on canvas, attributed to school of Jan Josef Horemans (Flemish; 1682-1752); Previously attributed to Richard Brakenburg (Dutch; 1650-1702); Previously attributed to the Flemish School,

Scarification was a scraping of the skin and if the circumstances demanded more, leeches could be added.  Cupping used dome-shaped cups placed on the skin to create blisters through suction and once in place, suction was achieved through the application of heat.  However it was done it could be a messy, bloody business and in the twelfth century the Church banned the practice, calling it “abhorrent” and that had the effect of depriving priests and monks of a nice, regular source of income which wasn’t popular.  However, especially in remote villages far from the bishop’s gaze, the friars continued to wield their blades and harvest their leeches, the business of bloodletting now underground.  In the big towns and cities though the barbers added bloodletting to their business model and it’s tempting to wonder whether package deals were offered, bundling a blooding with a tooth pulling or a haircut & shave.  From here it was a short step to getting into the amputations, a not uncommon feature of life before there were antibiotics and to advertise their services, the barber-surgeons would hang out white rags smeared in places with blood, the origin of the red and white striped poles some barbers still display.  To this day the distinctions between surgeons and physicians remains and in England the Royal College of Physicians (the RCP, a kind of trade union) was founded by royal charter in 1518.  By the fourteenth century there were already demarcation disputes between the barber surgeons and the increasingly gentrified surgeons and a number of competing guilds and colleges were created, sometimes merging, sometimes breaking into factions until 1800 when the Royal College of Surgeons (RCS) was brought into existence.  It's said there was a time when fellows of the RCP & RCS, when speaking of each-other, would only ever make reference to "the other college", the name of the institution never passing their lips. 

Bloodletting tools: Late eighteenth century brass and iron “5-fingered” fleam.

Unfortunately, while doubtlessly lobbying to ensure the fees of their members remained high, the colleges did little to advance science and the byword among the population remained: “One thing's for sure: if illness didn't kill you, doctors would”.  It was the researchers of the nineteenth century, who first suggested and then proved germ theory, who sounded the death knell for most bloodletting, what was visible through their microscopes rendering the paradigm of the four humors obsolete.  By the twentieth century it was but a superstition.

Pellucid

Pellucid (pronounced puh-loo-sid)

(1) Allowing the maximum passage of light, as glass; transparent; translucent; non-opaque.

(2) Clear; limpid.

(3) In fashion, a see through fabric or a garment made of such (used loosely also of many which are semi-opaque and thus technically subpellucid).

(4) Easily recognized or seen through; apparent, obvious (archaic).

(5) By extension, of music or some other sound: not discordant or harsh; clear and pure-sounding (technical use only in composition, academic study or criticism).

(6) Figuratively, clear in meaning, expression, or style; not obscure.

(7) Figuratively, of a person, able to think and understand clearly; not confused, perspicacious (now rare).

(8) In anatomy, as "zona pellucida" (the plural: zonae pellucidae or zonæ pellucidæ), a glycoprotein membrane surrounding the plasma membrane of an oocyte.

1610-1620: A learned borrowing from the Latin pellūcidus, a variant of perlūcidus (transparent, pellucid; very bright, radiant; very understandable), from perlūcēre (to shine through), the construct being per- (as a prefix, “through; throughout; completely, thoroughly”), from the primitive Indo-European root per- (forward, hence “through”) + lūcēre or lūcidus (clear; full of light, bright, shining (and figuratively “easily understood, clear, lucid”)), from lūceō (to shine; to become visible, show through (and figuratively “to be apparent, conspicuous, or evident”)).  The construct of the Latin lucidus was understood as lux (light), ultimately from the primitive Indo-European lewk- (bright; to see; to shine) + -idus (the suffix forming adjectives conveying the sense “tending towards”).  The construct in English may thus be understood as pe(r) +-l- + lucid (see through).  The (now rare) noun was derived from the adjective.  In technical use, the preferred word to convey the idea of “somewhat pellucid; tending toward pellucidness” appears to be subpellucid (along with the derived subpellucidly & subpellucidness, all sometimes hyphenated) rather than semi-pellucid, quasi-pellucid, or other possibilities.  The comparative is “more pellucid” and the superlative “most pellucid”).  Pellucid is a noun & adjective, pellucidness & pellucidity are nouns and pellucidly is an adverb; the noun plural is pellucids.  Pellucid and its derivatives are good words and should be used, just not by lawyers.

The pellucid water of Flathead Lake, Montana USA.

“These wells were filled with water, and with a blue light, celestial in its loveliness,—a light ethereal and pellucid.” (Over the Rocky Mountains to Alaska (1914) by Charles Warren Stoddard (1843-1909)).  In literary and poetic use, one will sometimes find “pellucid waters” but the word seem too obscure for advertizing copy-writers who, seeking pellucidity, prefer “crystal clear” although the once uncommon “azure” seems to have become sufficient familiar for the bays of the Mediterranean or Caribbean to be called “azure blue waters”.

Lindsay Lohan in swimsuit with subpellucid V-cut panel; clutch purse by Chanel and wearing Lanvin Classic Garnet ballet flats, Los Angeles, August 2012.

Although there are a few which are designed to be eye-catching, the extensive use the industry makes of pellucid (see-through) fabrics mostly is barely noticed because typically the application is either (1) only subpellucid, (2) covering non-sexualized body-parts such as arms or (3) as an overlay designed to highlight or subtly alter the color or texture of the fabric with which what lies beneath is made.  One intriguing tradition exploiting a fabric’s quality of pellucidly which has endured despite the unpromising origin is the bride’s wedding veil.  Historically, the idea of the veil was to conceal the bride’s appearance from the groom until the priest had pronounced the couple man & wife, thereby having joined together in the name of God what “let no man tear asunder”.  The functional advantage was as a precaution against a groom finding grounds for rejecting his betrothed in those once not uncommon cases where the ceremony was the first time the two had met, the arrangements having been hammered out by the often distant families, sometimes years in advance.  The point at which the bride was unveiled and the priest spoke the words: “You may now kiss the bride” which, in the cases of arranged marriages, actually meant: “You’re stuck with her mate; good luck.”  Even in times gone by however, most brides and grooms were well known to each other (“known” sometimes in the Biblical sense, thus the need for sometimes hastily arranged marriages) but the veil became a popular part of a bride’s ensemble and still they’re sometimes used.

In most parts of the English-speaking world, in recent decades there have been attempts to ensue “plain English” is used in legislation and legal documents.  It’s an admirable goal for many reasons but perhaps the most obvious is a contribution to increased compliance with laws, simply because pellucidness in wording would decrease the risk of unintentional breaches of law and legal obligations, at least some of which are the consequences of misunderstanding; as an example, a word like pellucid should not appear in legal documents because it is little-known and rare.  Using sentences plain in meaning and unambiguous even to those without legal training improves communication which increases information, thereby reducing the need for interpreters (lawyers), thereby decreasing the costs associated with the administration and application of legislation and other legal documents.  Those fond of conspiracy theories like to find in the difficult language a sort of job-creation programme for lawyers but it was really a product of the power of precedent, the phrases and terms of law, many still in their original Latin, having gained a certainty of meaning and thus maintained for generation after generation.  Language itself also had some inertia, the idea of a “legal style” of writing soon entrenched as “correct” and maintained by law schools and practitioners.

Lindsay Lohan and her lawyer in Court, Los Angeles, December 2011.

The matter for a long had attracted the interest of reformers in the law and parliaments but began to coalesce as a movement in the post-war years and this may at least have been influenced by the extent to which the increasing volume of laws passed by modern states were starting to intrude on the lives of more citizens, most of whom historically had little direct contact with legislation unless they came to the attention of the police.  In 1950, when sitting as a Lord of Appeal, the English judge Lord Radcliffe (1899–1977) observed what as early as 1913 had come to be called “legalese” had become: “…a sort of hieratic language… by which the priests incant the commandments.  I seem to see the ordinary citizen today standing before the law like the laity in a medieval church: at the far end the lights glow, the priestly figures move to and fro, but it is in an unknown tongue that the great mysteries of right and wrong are proclaimed.”  He concluded by asking: “...what willing allegiance can a man owe to a canon of obligation which is not even conceived in such a form as to be understood?”

It was a reasonable question, even if phrased in a way many would find as arcane as the object of his Lordship’s critique it wasn’t until the 1970s that law reform commissions and others began to circulate discussion papers and proposals  The rationale was encapsulated in one fragment in the decision handed down by Lord Donaldson (1920–2005; Master of the Rolls 1982-1992) in Merkur Island Shipping Corp v Laughton [1983]1 All ER 334: “The efficacy and maintenance of the rule of law, which is the foundation of any parliamentary democracy, has at least two prerequisites.  First people must understand that it is in their interests, as well as in that of the community as a whole, that they should live their lives in accordance with the rules and all the rules.  Second they must know what those rules are.”  In the 1990s, reform of language began to happen at scale and there was in this an element of technological determinism, the digitization of legislation and codes meaning texts ancient and modern began to appear on the screens of word processors, making modernization a simpler process.

Blip

Blip (pronounced blip)

(1) A spot of light on a radar screen indicating the position of a plane, submarine, or other object (also as pip); any similar use on other electronic equipment such as an oscilloscope.

(2) By adoption from the use in radar (and applied very loosely), any small spot of light on a display screen.

(3) In any tracked metric (typically revenue, sales etc), a brief and usually unexpected.

(4) In general use, an aberration, something unexpected and (usually) fleeting (often in the expression “blip on the radar”).

(5) In electronic transmissions (audible signals), a pip or bleep (also both onomatopoeic of short, single-pitch sounds).

(6) By extension, any low level, repetitive sound (rare).

(7) In the slang of software developers, a minor bug or glitch (retrospectively dubbed blips if promptly fixed (or re-labeled as “a feature”)).

(8) A specific data object (individual message or document) in the now defunct Google Wave software framework.

(9) In informal use, to move or proceed in short, irregular movements.

(10) In automotive use, briefly to apply the throttle when downshifting, to permit smoother gear-changing (the origin in the days of pre-synchromesh gearboxes, especially when straight-cut gears were used) and still used in competition to optimize performance but most instances by drivers of road cars are mere affectations (used as noun & verb).

(11) In informal use, abruptly to change a state (light to dark; on to off etc), sometimes implying motion.

(12) In broadcast media (and sometimes used on-line), to replace offensive or controversial words with a tone which renders them inaudible (a synonym of “bleep”, both words used in this contexts as nouns (a bleep) and verbs (to bleep out).  In live radio & TV, a junior producer or assistant was usually the designated “blipper” or “bleeper”.

1894: An onomatopoeic creation of sound symbolism, the speculation being it may have been based on the notion of “blink” (suggesting brevity) with the -p added to bli- as symbolic of an abrupt end, the original idea to capture the experience of a “popping sound”.  The use describing the sight and sound generated by radar equipment was first documented in 1945 but may have been in use earlier, the public dissemination of information about the technology restricted until the end of World War II (1939-1945).  The verbs (blipped & blipping) came into use in 1924 & 1925 respectively while the first documented use of the noun blipper dates from 1966 although “bleeper” appeared some fifteen year earlier and the role was acknowledge as early as the 1930s.  Blip is a noun & verb, blipped & blipping are verbs and blippy, blippier & blippiest are adjectives; the noun plural is blips.

The blipster

One unrelated modern portmanteau noun was blipster, the construct a blend of b(lack) + (h)ipster, used to refer to African-Americans (and presumably certain other peoples of color (PoC)) who have adopted the visual clues of hipster culture.  Whether the numbers of blipsters represent the sort of critical mass usually associated with the recognition of sub-cultures isn’t clear but as in medicine where a novel condition does not need to be widely distributed (something suffered even by a single patient can be defined and named as a syndrome), the coining of blipster could have been inspired by seeing just one individual who conformed to being (1) African American and (2) appearing in some ways to conform to the accepted parameters of hipsterism.  Labeling theory contains reservations about this approach but for etymologists it’s fine although there is always the risk of a gaboso (generalized observation based on single observation).  Predictably, there is debate about what constitutes authentic blipsterism because there are objections by some activists to PoCs either emulating sub-cultures identified as “white” or taking self-defining interest in aspects of that culture (such as those associated with hipsterism).  What seems to be acceptable is a stylistic fusion as long as the fashions are uniquely identifiable as linkable with traditional (ie modern, urban) African-American culture and the cultural content includes only black poets, hip-hop artists etc.

The Blipvert

The construct of blipvert (also historically blip-vert) was blip + vert.  Vert in this context was a clipping of advertisement (from the Middle French advertissement (statement calling attention)), the construct being advertise +‎ -ment.  The -ment suffix was from the Middle English -ment, from the Late Latin -amentum, from -mentum which came via Old French -ment.  It was used to form nouns from verbs, the nouns having the sense of "the action or result of what is denoted by the verb".  The suffix is most often attached to the stem without change, except when the stem ends in -dge, where the -e is sometimes dropped (abridgment, acknowledgment, judgment, lodgment et al), with the forms without -e preferred in American English.  The most widely known example of the spelling variation is probably judgment vs judgement.  In modern use, judgement is said to be a "free variation" word where either spelling is considered acceptable as long as use is consistent.  Like enquiry vs inquiry, this can be a handy where a convention of use can be structured to impart great clarity: judgment used when referring to judicial rulings and judgement for all other purposes although the approach is not without disadvantage given one might write of the judgement a judge exercised before delivering their judgment.  To those not aware of the convention, it could look just like a typo.

As both word and abbreviation “vert” has a number of historic meanings.  One form was from the Middle English vert, from Old French vert, from Vulgar Latin virdis (green; young, fresh, lively, youthful) (syncopated from Classical Latin viridis)  In now archaic use it meant (1) green undergrowth or other vegetation growing in a forest, as a potential cover for deer and (2) in feudal law a right granted to fell trees or cut shrubs in a forest.  The surviving use is in heraldry where it describes a shade of green, represented in engraving by diagonal parallel lines 45 degrees counter-clockwise.  As an abbreviation, it's used of vertebrate, vertex & vertical and as a clipping of convertible, used almost exclusively by members of the Chevrolet Corvette cult in the alliterative phrase "Vette vert", a double clipping from (Cor)vette (con)vert(ible).

Vette vert: 1967 Chevrolet Corvette L88 convertible which sold at auction in 2013 at Mecum Dallas for US$3,424,000, a bit short of the L88 coupé which the next year realized US$3,850,000 at Barrett-Jackson Scottsdale; that remains the record price paid for a Corvette at auction.  The L88 used a 427 cubic inch (7.0 litre) V8 with a single four barrel carburetor, tuned to produce between 540-560 (gross) horsepower although for official purposes it was rated at 430, slightly less than the advertised output of the L71 427 which, with three two barrel carburettors was the most powerful version recommended for “street” use.  The L88 was essentially a race-ready power-plant, civilized only to the extent cars which used it could be registered for road use but, demanding high-octane fuel available only in a limited number of locations and not offered with creature comforts like air-conditioning, it really was meant only for race tracks or drag strips.  For technical reasons, L71 buyers couldn’t order air-conditioning either but were at least allowed to have a radio, something the noise generated by the L88 would anyway have rendered mostly redundant.

When humans emulated CGI: Max Headroom, 1986, background by Amiga 1000.

A blipvert is a very brief advertisement (a duration of one second or less now the accepted definition although originally they could three times as long).  The concept first attracted widespread attention in the 1980s when it was an element in the popular television show Max Headroom, a production interesting for a number of reasons as well as introducing “blipvert” to a wide audience.  In Max Headroom, blipverts were understood as high-intensity television commercials which differed from the familiar form in that instead of being 20, 30 or 60 seconds long, they lasted but three, the line being they were a cynical device to discourage viewers from switching channels (“channel surfing” not then a term in general use).  The character Max Headroom (actually an actor made up to emulate something rendered with CGI (computer generated imagery)) was said to be pure software which had attained (or retained from the downloaded “copy” of the mind taken from a man killed after running into a “Max Headroom” warning sign in a car park) some form of consciousness and had decided to remain active within the television station’s computer network.  In this, the TV show followed a popular trope from science fiction, one which now underpins many of the warnings (not all by conspiracy theorists) about the implications of AI (artificial intelligence).  Although a creation of prosthetics rather than anything digital, the technique was made convincing by using a background generated on an Amiga 1000 (1985), a modest machine by today’s standards but a revelation at the time because not only was the graphics handling much better than on many more expensive workstations but even by 1990, despite what IBM and Microsoft were telling us, running multi-tasking software was a better experience on any Amiga than trying it on a PS/2 running OS/2.

On television, the stand-alone blipvert never became a mainstream advertising form because (1) it was difficult, (2) as devices to stimulate demand in most cases they appeared not to work and (3) the networks anyway discouraged it but the idea was immensely influential as an element in longer advertisements and found another home in the emerging genre of the music video, the technique perfected by the early 1990s; it was these uses which saw the accepted duration reduced from three seconds to one.  To the MTV generation (and their descendents on YouTube and TikTok), three seconds became a long time and prolonged exposure to the technique presumably improved the ability of those viewers to interpret such messages although that may have been as the cost of reducing the attention span.  Both those propositions are substantially unproven although it does seem clear the “video content generations” do have a greater ability to decode and interpret imagery which is separate for any explanatory text.  That is of course stating the obvious; someone who reads much tends to become better at interpreting words than those who read little.  Still, the blipvert has survived, the advertising industry finding them especially effective if used as a “trigger” to reference a memory created by something earlier presented in some form and those who find them distasteful because they’re so often loud and brash just don’t get it; that’s the best way they’re effective.

Alex (Malcolm McDowell (b 1943)) being re-sensitised (blipvert by blipvert) in Stanley Kubrick's (1928-1999) file adaptation of A Clockwork Orange (1971).

The concept of the blipvert is sometimes attributed to US science fiction (SF) writer Joe Haldeman (b 1943) who described something close to the technique in his novel Mindbridge (1976) and it’s clearly (albeit in longer form) used in the deprogramming sessions in Anthony Burgess’s A Clockwork Orange (1962) but use predates both books.  In 1948, encouraged by their success in countering the Partito Comunista d'Italia (PCd'I; the Communist Party of Italy) in elections in the new Italian republic (the success achieved with a mix of bribery, propaganda, disinformation and some of the other tricks of electoral interference to which US politicians now so object when aimed at US polls), the newly formed US Central Intelligence Agency (CIA) turned their attentions to France where the perception of threat was even greater because the infiltration of the press, trade unions, universities, the military and many other organs of state was rife.  The US was well-placed to run effective propaganda campaigns because, uniquely in devastated, impoverished Europe, it could distribute the cubic money required to buy advertising space & airtime, employ cooperative journalists, trade union leaders & professors and even supply scarce commodities like newsprint and ink.  To try to avoid accusations of anything nefarious (and such suggestions were loud, frequent and often not without foundation) much of the activity was conducted as part of Marshall Plan Aid, the post-war recovery scheme with which the US revived post-war European economies with an injection of (what would in 2024 US$ terms) be something like US$182 billion.  As well as extensively publicizing the benefits of non-communist life compared with the lot of those behind the iron curtain, the CIA published books and other pieces by defectors from the Soviet Union.  One novelty of what quickly became an Anglo-American psychological operation (the British Political Warfare Executive (PWE) having honed successful techniques during wartime) was the use of 2-3 second blipverts spliced into film material supplied under the Marshall Plan.  The British were well aware the French were especially protective of what appeared in cinemas and would react unfavourably to blatant propaganda while they might treat something similar in print with little more than a superior, cynical smile.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

The blipvert is sometimes grouped with subliminal advertising and that’s convenient but they’re different both in practice and definitionally and the rule of thumb can be expressed as (1) if it can (briefly) be seen it’s a blipvert and (2) if it can’t be seen it’s subliminal.  No doubt media studies academics (of which there seem now to be many) could punch holes in that and cite a dozen or more exceptions but as a definition it at least hints in the right direction.  What subliminal advertising involves is the presentation of understandable information (which can be images, sound or text) at a level below the conscious awareness of the viewer, the idea being (unlike the confrontational blipvert) to bypass conscious perception.  The extent to which subliminal messaging is an effective way to influence consumer behaviour is debated (as is the notion of whether it’s manipulative and unethical) but the continued use of the technique in political campaigns does suggest that in that specialized field of consumer behaviour, there must be many convinced of the efficacy.  Certainly it appears to work although the less subtle forms are quickly deconstructed and critiqued, such as the sudden adoption in sports, almost as soon as tobacco advertising was banned, of color schemes triggering memories of cigarette packets.

A Marlboro Man lights up.  The "Marlboro 100s" in the gold & white pack were so-named because each stick was 100 mm (4 inch) long.

After some years of prevarication, in 2005 the European Union (EU) banned tobacco advertising “in the print media, on radio and over the internet” at the same prohibiting “tobacco sponsorship of cross-border cultural and sporting events”.  Making unlawful the promotion of a known carcinogen responsible over a lifetime of use for shortening lifespan (on average) by just under a decade sounds now uncontroversial but at the time it had been bitterly contested by industry.  Of interest to some was that despite the introduction of the laws being known for some two years, only couple of months earlier, Ferrari had signed a fifteen year, billion dollar sponsorship deal with Philip Morris, best known for their Marlboro cigarette and “Marlboro Man” advertising campaign which featured a variety of men photographed in outdoor settings, five of whom ultimately died of smoking-related diseases.

Variations on a theme of red & white.  Ferrari Formula One cars: F2007 (2007) in Marlboro livery (left), F10 (2010) with "bar code" (centre) and F14 (2014) in post bar-code scheme.

Ferrari’s lawyers took their fine-toothed legal combs to the problem and came up with a way to outsmart the eurocrats.  The Formula One (F1) cars Scuderia Ferrari ran began to appear in what had become the traditional red & white livery (the same combination used on Marlboro’s signature packets) but in the space where once had been displayed the Marlboro logo, there was instead a stylized “bar code”.  In response to a number of accusations (including many by those in the medical community) that the team was guilty of “backdoor advertising” of cigarettes, in 2008 a statement on the company website said it was “baffled”:

"Today and in recent weeks, articles have been published relating to the partnership contract between Scuderia Ferrari and Philip Morris International, questioning its legality.  These reports are based on two suppositions: that part of the graphics featured on the Formula 1 cars are reminiscent of the Marlboro logo and even that the red colour which is a traditional feature of our cars is a form of tobacco publicity.  Neither of these arguments have any scientific basis, as they rely on some alleged studies which have never been published in academic journals. But more importantly, they do not correspond to the truth.  "The so-called barcode is an integral part of the livery of the car and of all images coordinated by the Scuderia, as can be seen from the fact it is modified every year and, occasionally even during the season. Furthermore, if it was a case of advertising branding, Philip Morris would have to own a legal copyright on it.  "The partnership between Ferrari and Philip Morris is now only exploited in certain initiatives, such as factory visits, meetings with the drivers, merchandising products, all carried out fully within the laws of the various countries where these activities take place. There has been no logo or branding on the race cars since 2007, even in countries where local laws would still have permitted it.  The premise that simply looking at a red Ferrari can be a more effective means of publicity than a cigarette advertisement seems incredible: how should one assess the choice made by other Formula 1 teams to race a car with a predominantly red livery or to link the image of a driver to a sports car of the same colour? Maybe these companies also want to advertise smoking!  It should be pointed out that red has been the recognised colour for Italian racing cars since the very beginning of motor sport, at the start of the twentieth century: if there is an immediate association to be made, it is with our company rather than with our partner.”

When red & white was just the way Scuderia Ferrari painted their race cars: The lovely, delicate lines of the 1961 Ferrari Typo 156 (“sharknose”), built for Formula One's “voiturette” (1.5 litre) era (1961-1965), Richie Ginther (1930–1989), XXIII Grosser Preis von Deutschland (German Grand Prix), Nürburgring Nordschleife, August 1961.

The suggestion was of course that this was subliminal marketing (actually unlawful in the EU since the late 1950s) the mechanics being that Ferrari knew this would attract controversy and the story was that at speed, when the bar code was blurred, it resembled the Marlboro logo; racing cars do go fast but no evidence was ever produced to demonstrate the phenomenon happened in real world conditions, either when viewed at the tracks or in televised coverage.  It was possible using software to create a blurred version of the shape and there was a vague resemblance to the logo but that wasn’t the point, as a piece of subliminal marketing it worked because viewers had been told the bar code would in certain circumstances transform into a logo and even though it never did, the job was done because Marlboro was on the mind of many and doubtlessly more often than ever during the years when the logo actually appeared.  So, job done and done well, midway in the 2010 season, Ferrari dropped the “bar code”, issuing a press release: “By this we want to put an end to this ridiculous story and concentrate on more important things than on such groundless allegations.”