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Absence of timely treatment of arthritis can worsen the symptoms of the disease.

According to Grammarly, the article 'an' or 'the' ought to be used at the start of the above sentence.

The noun phrase Absence seems to be missing a determiner before it. Consider adding an article.

Is this absolutely necessary?

I remember noticing quite a few contexts which use this style of writing: dropping articles at the beginning of the sentence (alas, I cannot remember where). What is an expert's take on this?

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    I guess, here we are referring to "absence" in general not a specific absence. So, i think we don't use "the". And it is uncountable noun in this case, so we don't use "an" also. – Omkar Reddy Sep 22 '16 at 11:41
  • @Ganesh.R That would be my preference too. But I'd like to be sure about its nuances to confirm. – Ébe Isaac Sep 22 '16 at 11:44
  • This sounds like an excerpt from a formal text. In formal writing, especially writing that is giving orders or explanation, it is common to omit articles that should normally be included when the article is not completely necessary to understanding the meaning. I cannot come up with rules for this but it is very common in legal and medical documents. – G-Cam Sep 22 '16 at 13:28
  • Remarks about article usage, in particular, are often determined by the greater context. Can you supply more context than a single sentence? Also can you provide a link to where we can look at this sentence? You should always provide a link to something you are quoting. – Alan Carmack Sep 24 '16 at 9:12
  • @AlanCarmack: Actually, it is my own sentence. – Ébe Isaac Sep 24 '16 at 9:15
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Short answer: no, it is not the case that a determiner "must" be part of the phrase that begins the sentence you ask about—although, depending on the context, there are times when a determiner will be expected and the sentence would seem strange without one. Without more such context, we can't tell.


The automated program Grammarly is saying a determiner "seems to missing" from your sentence. This is the programmer's way of saying that our software cannot actually correct the grammar of human language.

One of the reasons it can't is because the use of determiners (of which articles are a subset) are largely dependent on the discourse context in which an individual sentences occurs, as well as the speaker's or writer's intention in choosing to include a determiner or not. And since Grammarly cannot possibly take into account speaker's intention (and I seriously doubt it can take discourse context into account either), its advice is pretty much useless for this sentence.

But human proofreaders of your sentence may not be able to offer any better advice, and for the same reasons given above. The usage of determiners, perhaps especially articles, is highly context dependent. It's virtually impossible to tell which article should be (or even might used) in any given sentence, without knowing something about the speaker's intent and discourse within which the sentence occurs.

You stated in a comment that this is your own sentence, that is, that you yourself wrote this sentence. Since determination about determiners is so often dependent on context, if you provided more, we humans could probably do a better job of saying whether you need one in the sentence you wrote.

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Your question affords an opportunity to illustrate the frequently optional nature of article usage in English, and to point out that the search for a dependable and universally applicable "rule" governing the usage of the articles in English is, sadly for the learner, a "fool's errand."

The example sentence you present could actually be written without any articles at all!

Absence of timely treatment of arthritis can worsen symptoms of disease.

As ungainly as this sentence is, it would not be out of place in any issue of Science, Nature, or The Lancet. It is a commonplace in technical and scientific writing to dispense with the articles; this is a matter of style, but there is an underlying purpose which deserves explication, especially to the interested student of English.

In medical literature particularly, the objective seems to be to use the articles only when omitting them creates an irresolvable ambiguity. One reason for this may be the simple desire to reduce the number of words in a given piece of writing. Medical students are required to read an enormous number of words, and reducing that number even by a small percentage provides a tangible benefit. For example, in a favorable review of An American Text-Book of Surgery, (1899), The Medical World, Volume 18, page 110 tells us:

Conciseness is gained by the omission of such articles as "a," "an," and "the," except where necessary.

Another plausible explanation of this phenomenon is that in medicine (and in the sciences generally) many of the nouns are mass nouns: hospital, pain, disease, medicine, treatment, diagnosis, etc., appear frequently as uncountable, e.g.:

In hospital, pain and disease not amenable to treatment and diagnosis are encountered...

Whatever the reason, English technical and scientific writing is littered with nouns unaccompanied by articles. If you are a student of English whose sights are set on a career in medicine, engineering, political science, etc., you should be prepared to see and hear many such usages.

  • I wonder if you have a reference more modern (closer to the 21st century) that supports your statement "a commonplace in technical and scientific writing to dispense with the articles; this is a matter of style." – Alan Carmack Sep 24 '16 at 9:19
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    @AlanCarmack If compelled to, I might be able to find a more contemporary similar reference, but anyone who reads Science every week knows that articles are, if not rarae aves in scientific writing, at leaat sparingly used. I'll add a few "in my opinions" to lessen the authoritative tone. How'll that be? – P. E. Dant Sep 24 '16 at 9:34

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