not approvable letter

not approvable letter


An official communication from FDA (US Food and Drug Administration) informing a sponsor of a drug or device marketing application that the important deficiencies described in the letter preclude approval of the drug or device unless corrected. 

Synonym Non approvable letter 




This is the first completely new medical dictionary to come to the market in 75 years*. 

*The Tabers Medical Dictionary, which was first published in 1940. It seems best to discount John Wiley and Sons’ International Dictionary of Medicine and Biology published in 1986, as it lasted but one edition.

It is the ONLY medical dictionary written entirely by a medically trained doctor and board-certified specialist. It is the first such work deployed as a database*. 

*Databases allow users instant access to the information contained in the dataset. It is virtually impossible to access targeted information from the electronic versions of the venerated  (Dorland’s Medical Dictionary, Stedman’s Medical Dictionary and Taber’s Medical Dictionary), precisely because they’re text-based. To access information from text-based information, a computer has the daunting task of sifting through ALL the information in the data set, a problem that doesn’t occur with relational database searches.

In reviewing the electronic version of the Dorland’s Medical Dictionary on, reader Dominique Johnson said, Massive amount of data without proper indexing. I thought that having it in Kindle would allow me to just type in a term in the “find” field and let the device find the entry, but that takes way longer than when I open the physical copy myself.

The Concise Dictionary of Medicine and a handful of other text-based eBooks I’ve written over the last few decades have the above-noted indexing issue. These works are still available on various eBook stores (iTunes, Kindle, Nook, etc) for those who like the text format and want them on their iPads, tablets, etc. However, the database format is the future of medical lexicography and as I go online with the database version of each, the text-based version of a particular product will be retired. The eBook British Medical Abbreviations and Acronyms is the first on the chopping block and should be off the eBookstores by 1 July 2016. That product has about 6000 medical abbreviations and acronyms (A&As) that focus on A&As used in British medical practice. I’ve just finished a larger work, Medical A&As, that translate some 18,000 medical A&As used by all healthcare providers, not just those in the UK. The entire A&A database will soon be available for searching. Those interested in having the A&A database on their iPads, tablets, iOS and android devices can download letters A to R for free or the entire database for a nominal fee ($4.99). 

I began collecting new medical terms as a hobby in 1984 during my residency in pathology at LIJ, now part of the massive North Shore-LIJ Health System on Long Island, premised on my belief that the standard medical dictionaries were losing touch with the spoken and working language of medicine.

You’ll find my musings on medical lexicography on:

A New Major Medical Dictionary

I went live with this website in May, 2012 and blogged 5 terms/day until I reached about 5000 entries. Most of those blogged entries have been converted to separate pages for ease of searching. These terms derive from a growing database that now has 190,389 entries*.

*To put that number in perspective, the Dorland’s Medical Dictionary has less than 124,000 entries.

As above noted, I’ll be making parts of the database available as iOS/Android products. The first product, Medical Abbreviations & Acronyms, is finished and, once it’s been formatted, will be available as a downloadable app. A truncated portion (up to letter “R”) will be available as a free download so users can extensively test drive the app before buying the full version.

Parenthetically, the material on this website ( will migrate to by year’s end. I hope you like the format. 

Most of the blogged terms fall into one of 3 categories:

• Popular terms–e.g., champagne bottle leg, Michael Jackson syndrome(s), Mickey Mouse sign(s), bubble pattern, Sutton’s law, etc.

I’ve tried to include something for everyone, in particular as relates to the cultural savvy that doctors are expected to have vis-à-vis music, literature, the arts and the world in general. Even if you’re not in health care, the material is “edutaining”, occasionally droll…

• New biomedical terms–e.g., from genomics and molecular biology, evidence-based medicine, informatics, managed care, sport medicine, etc

• Old terms due for burial with comments on usage

I encourage the reader to look over the nearly 5000 terms now found on this website.*

*To improve the user experience, and for search engine optimisation, parts of this website have been reworked thanks to database guru and webmaster, Kent Hummel. 

Format of entries Whilst I believe the format is self-explanatory, I am biased and may be assuming too much. The following few lines are meant to explain the elements found in most of the terms blogged on this website.

Entry name bailout

•  Area of interest SURGERY

•  Definition The immediate closure…

•  Synonyms Bailout procedure, damage control  


A lexicon written in the 21st century can’t, given the diverse sources from which it derives, completely escape tongue-in-cheek humour or outright comedy.

I tried to confine the jocularity to the illustrations so as to not diminish the value of the work. For most terms, the illustration is on point. For others, I took liberties, such as those taken for genes–e.g., HOMER2, which got a mugshot of Homer Simpson and HIP2, which got an illustration from hipster artist Josh Agle.

Small minds, as they say, easily amused…

If you have a new term that you feel has gotten short shrift in a medical dictionary, shoot me an email at and I’ll add it if I agree. And feel free to back-link to this website.

The reader will note that the spelling follows that extant on the other side of the pond. Unless they change the name of the language we speak to American, orthographic principles should follow received pronunciation (Queen’s English).