So, my fiance is in medical school and we have been looking

Question

So, my fiance is in medical school and we have been looking at a sentence from one of her textbooks. The sentence is just below. I put some of my own thoughts after the sentence. Patients with a previous diagnosis of cancer should be presumed to have back pain secondary to malignancy until proved otherwise. My initial thought was that this sentence contains the conditional statement, "should be...until". Then I realized "until" is also a preposition, and if it functions as one it should have a noun included (not assumed). Finally, I wonder if "proved otherwise" is an idiom. Which is right, and why?

: My second issue with this sentence is that it is written in the passive voice. I am unsure this is optimal, but it probably doesnt make the sentence wrong.

esledge · Answer

I suspect that one needs some medical knowledge to evaluate the correct grammar for this sentence!

What is the intended meaning?
(1) If someone has a previous diagnosis of cancer, then develops back pain, assume it is just simple back pain until you can prove it is something worse (i.e. malignancy)?

(2) If someone has a previous diagnosis of cancer, then we should assume that they will have back pain if a malignancy develops?

I suspect that "secondary to" has some idiomatic usage unique to the medical community.

Until can also be a conjunction, i.e. when followed by some event:
He studied until the test began.
They danced until the neighbors complained.

Correct. Passive voice is acceptable, even if the "actor" is never named. For example:

The famous painting was stolen from the museum last night. (By someone...maybe we don't know whom...)
The dish should be served immediately being removed from the oven. (By the chef? By your mom? Maybe it doesn't matter...)

Gogoplata · Answer

Thanks so much for the informative response esledge

I have asked a medical professional what the meaning of the statement is, and this is what I was told: If someone is diagnosed with cancer, then has back pain, assume the pain is due to a malignancy (probably a tumor in their back), until proved otherwise. Good job on noticing "secondary to." I was told this is medical jargon interchangable with "due to." Is the sentence a conditional statement, is "until" used as a conjuction, or is "until" used as a preposition? I know it really doesnt matter (in terms of the sentence meaning), but I am trying to learn grammer and need to understand the function here. Thanks so much

esledge · Answer

I didn't expect to learn something about medicine today; that's nice to know! I relied on this (https://dictionary.reference.com/browse/until) for info on "until." From what I can tell, if until is followed by a noun, it is a preposition. If followed by a clause, until is a conjunction.

So, my fiance is in medical school and we have been looking

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