Mailbag Friday: "Regime" or "Regimen"?

Today's Mailbag Friday question comes from Bob D., a doctor from Newton, Massachusetts. Bob asks: "What is up with the constant misuse of the word regime? It drives me crazy. It is like regimen never existed."

Medical professionals use the word regimen in a very specific way: to refer to "a systematic plan for therapy (often including diet)," as the Visual Thesaurus explains. Regime, on the other hand, commonly refers to a system of rule or government. Regimen and regime are what etymologists call "doublets": two words that have entered the language from the same source by different routes. Both come from Latin regimen, derived from the verb regere 'to direct,' but regime passed through an intermediary stage in Old French where it lost that final n.

In English, the two words have historically remained intertwined. Regimen entered the language first, but when regime made the scene in the 18th century as a learned borrowing from French, it wasn't restricted to government-related uses. In fact, the very first known use of regime in English, as recorded by the Oxford English Dictionary, was closer to the "plan for therapy" sense. It appeared in a letter from the Earl of Carlisle to George Selwyn on September 13, 1776:

You tell me you are better, though you have no appetite. You will certainly do well not to force it, and there is no doubt but by ease and exercise you will regain it. Régime is better than physic — pray be attentive to it.

Physic means "a purging medicine," so the Earl was telling his friend George that he better get with a good program of "ease and exercise" instead of trying to cure himself medicinally. The use of regime on its own, without a modifier like therapeutic or nutritional, sounds unusual to modern ears, but it's clear that the Earl wasn't talking about a system of government here.

Over the course of the late eighteenth and early nineteenth centuries, the word regime came to be used primarily in governmental contexts, but it continued to make inroads on the medical turf of regimen. Thus, a stroll through Google Books will find such phrases as "medicinal regime" in 1813 and "regime of exercise" in 1819. A bit later in the nineteenth century, we find references to "hygienic regime" in 1846 and "dietary regime" in 1864. In some cases, this was perhaps a conscious attempt to draw on the prestige of French: the 1864 quote, for instance, was from Annie Emma Armstrong Challice's French Authors at Home, which says of Honoré de Balzac, "The dietary régime, which poverty had prescribed for him...had reduced his body to a skeleton." Note the use of italics and diacritics for the word régime, which suggests it wasn't fully assimilated into English.

Regime never overtook regimen in the medical realm, but it did increasingly live side by side with it. Today, one can easily find legitimate medical texts referring to "chemotherapy regimes," "antibiotic regimes," "drug regimes," and so forth. Granted, in such contexts regimen continues to outpace regime by about two to one, but there doesn't seem to be a great stigma attached to regime in medicine, nutrition, and related fields.

Then again, stigma is in the eye of the beholder. Though the use of regime to mean regimen is recorded in most major American dictionaries (and the Visual Thesaurus) without comment, it does get treated as a solecism by some medical references. Edith Schwager's Medical English Usage and Abusage, for instance, makes a clear distinction:

REGIME, REGIMEN: These words are from the Latin regimen, a directing, guiding, or controlling. Regime, however, is usually confined to the idea of ruling or guiding (a country, for instance) for a specific time. A regimen is a systematic or planned guidance, as in a diet or medication regimen.

Stedman's Medical Dictionary is more blunt in its entry for regimen: "A program, including drugs, which regulates aspects of one's lifestyle for a hygienic or therapeutic purpose; a program of treatment; sometimes mistakenly called regime." On the other hand, the American Heritage Medical Dictionary doesn't have a problem with this sense of regime, and a 2004 article in the Journal of the American Association for Medical Transcription, after reviewing the history of regime, regimen, and regiment, concludes:

Anyone who confuses regimen and regiment betrays ignorance of an elementary verbal distinction. However, between regime and regimen no such distinction exists.

To sum up: if you're talking about a therapeutic plan, definitely stay away from regiment, which primarily refers to an army unit. If you use regime, you can be confident that you have a couple of centuries of accepted usage on your side. But if you want to make sure you don't set off anyone's pet-peeve alarms, stick with regimen.