Why Not Say It Clearly: The JAMA Network Editors on Correct Usage

The second edition of Why Not Say It Clearly? A Guide to Expository Writing by Lester S. King, MD, was published in 1991 (first edition in 1978).

Dr King was a charmingly irascible but fascinating and classically trained scholar who was a senior editor at JAMA for more than 25 years. A coauthor of the AMA Manual of Style (eighth edition), he was an accomplished raconteur and humorist as well as a prolific writer, particularly concerning language and usage.  He was professor of pathology and professorial lecturer of history of medicine at the University of Chicago.

Why Not Say It Clearly remains an enduring editorial classic on writing and usage and is the inspiration for this expansion of the AMA Style Insider:  The JAMA Network Editors on Correct Usage.  Feedback welcome!—Roxanne K. Young, ELS

Internet, Computer Terms, and References to Social Media

The JAMA Network editors prefer the following capitalization and punctuation styles for e- and i-entities, computer terms, and references to and in social media and networks.  Also check commercial websites for trademarked terms and conditions of their use.

app, application

cell phone

e-cigarette (E-cigarette at the beginning of a sentence or in a title, subtitle, or heading)

e-commerce (see e-cigarette)

e-learning (see e-cigarette)



e-terms (see e-cigarette)

email (Email at the beginning of a sentence or in a title, subtitle, or heading)

Follow (as on Facebook; also capitalize Junk folder, Option key, Edit menu, and other computer key and menu names)

Google (google as verb)



iPod, iPad, iPhone, etc (trademarks)




online (as both adjective and adverb)


Skype (skype as verb)


text, texted, texting

Tweet, Tweeting, Twitter, Twittering (despite the official logo being lowercase; a trademark)

webinar, website (World Wide Web, web-based literature search)

Wiki, Wikipedia

Quiz Yourself

Edit the following sentence to eliminate jargon:

A 78-year-old woman with a congenital heart and a history of high blood pressure and heart attack was admitted to the hospital and prepped for surgery.

Highlight for the answer:

A 78-year-old woman with congenital heart disease and a history of high blood pressure and myocardial infarction was admitted to the hospital and prepared for surgery.

Editor’s Note: A heart is not congenital; the preferred terminology is congenital heart disease or congenital cardiac anomaly. Myocardial infarction, not heart attack, is the preferred term. Patients are prepared, not prepped, for surgery (§11.4, Jargon, pp 408-410 in print). Some of these terms may be acceptable for certain types of writing; peer-reviewed medical journals generally avoid them.—Laura King, ELS

Quiz Yourself

Correct the grammar error in the following sentence:

We performed a quantitative overview of randomized trials which tested β-blockers in myocardial infarction, heart failure, and hypertension.

Highlight for the answer:

We performed a quantitative overview of randomized trials that tested β-blockers in myocardial infarction, heart failure, and hypertension.

Incorrect use of relative pronoun (which vs that) (§7.2.2, Relative Pronouns, pp 317-319 in print). That introduces a phrase that is essential to the meaning of the sentence, and which introduces a phrase that adds more information but is not essential to the meaning. Which should always be preceded by a comma. Another example: “He visited the new hospital, which had been built last year” is correct. However, if there were 2 hospitals and only 1 had been built last year, the sentence would read, “He visited the new hospital that had been built last year.”—Laura King, ELS

Questions From Users of the Manual

Q: What guidance can you offer as to the inclusion of white space in a publication? My company prefers that level 1 headings begin on a new page, but if the text beneath the heading is only a single paragraph, wouldn’t it be preferable for that heading and its text to share the page with the preceding or the subsequent heading and text?

A: This is really an individual decision for each publisher/publication. Especially in the days of print-only publications, many journal editors tried to optimize the use of every page as each journal had a page budget per issue/per year. In some of the JAMA Network specialty journals. for instance, the journal editors specifically developed short items that could be placed, as space allowed, at the ends of articles that ended with at least half a page of white space…thereby using every bit of space that they could to provide interesting and educational information to their readers. White space was never (to my knowledge) used within an article in the way you are describing.

In the JAMA Network journals, there is no page break before the major headings in an article (eg, Methods, Results, Discussion). This would indeed create a lot of white space. In books, on the other hand, this is fairly customary…you do see that each chapter begins on a new page.

In conclusion, to start each major part of a journal article on a new page would create a very odd-looking journal with lots of white space scattered willy-nilly throughout. Perhaps the desire to emphasize each major part of an article could be accomplished with some other design consideration (eg, style of headings).—Cheryl Iverson, MA

Questions From Users of the Manual

Q: I would like to know how to reference a Kindle book.

A: This question was addressed on this very blog on May 7, 2012. We love questions, though, so feel free to send them in as well as using the search box on the top right corner of the blog home page. Also, we are working now on revising the manual for the next edition and we will be including lots more examples of online reference styles.


Q: How should an “e-pub ahead of print” reference be cited in the reference list?

A: There are a few examples in the current manual, but we plan to include many more examples of citing electronic documents in the next edition—and we are deep in discussions (some might say “arguments”) about a style change, so stay tuned!  See 3.15.1, examples 14 through 17. Note, however, that we have now dropped the words “ahead of print” in the phrase that appears in brackets.   Here is an example from JAMA Pediatrics:

Keren R, Shah SS, Srivastava R, et al. Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children [published online December 15, 2014].  JAMA Pediatr.  doi:10.1001/jamapediatrics.2014.2822.

Q: How would I introduce an abbreviation that first appears in a compound word? For example, if my first use of traumatic brain injury was in TBI-related complications?

A: I would recommend the following: traumatic brain injury (TBI)–related injuries. (That’s an en-dash before related.)—Cheryl Iverson, MA

Ex Libris: Between You & Me

In the tradition of Eats, Shoots & Leaves and Woe Is I comes Between You & Me: Confessions of a Comma Queen by Mary Norris. Norris is a veteran of The New Yorker copy department, having worked there since 1978. With her vast editorial experience, she certainly knows her who from her whom and her I from her me. However, books on usage that aim to be more novel than manual require a style similar to, say, Tina Fey rather than Strunk and White.

Between You & Me is part memoir, part history text, and part usage manual. Where Norris succeeds the most is in sharing her vast knowledge on the history of language. In the chapter entitled “The Problem of Heesh,” Norris details previous attempts at developing gender-neutral language. Who knew that in 1850 the words ne, nis, and nim were proposed to replace he/she, his/her, and him/her? Or that ip and ips were offered in 1884, ha, hez, and hem in 1927, shi, shis, and shim in 1934, and himorher in 1935? In the chapter on commas, we learn that the comma was “refined” by printer Aldo Manuzio in Venice in 1490. In the chapter on apostrophe, we learn that the word goes back to Greek drama and derives from “a rhetorical device in which the actor turns from the action and addresses someone or something who is not there.”

Norris also uses examples from classical literature to illustrate her points on usage. She discusses Charles Dickens’ style of punctuating by ear, which today seems not only overdone but also incorrect: “We know that Dickens got paid by the word (writers still do), a fact that is often used to explain his prodigious output, but I think he might have collected a bonus for punctuation.” She addresses the history of the hyphen in Herman Melville’s Moby-Dick: “The holiest hyphen in literature is the hyphen in Moby-Dick.” She examines Emily Dickinson’s use of the hyphen, Henry James’ fondness for semicolons, and Gertrude Stein’s love of the apostrophe. All these literary details make for entertaining reading. Less effective are the stories from Norris’ personal life. She begins with her own history of working as a “key girl” at a public pool in Cleveland when she was 15 years old. She ends with a story about speaking at the funeral of her New Yorker colleague Lu Burke. Her stories are fine, but there’s nothing particularly compelling, revealing, or funny about them.

Between You & Me is enjoyable for anyone interested in spending some time contemplating spelling, punctuation, and general usage issues. Although Norris’ personal stories do not serve the book as well as her exploration of the history of language and the usage styles of famous literary figures, Between You & Me is a worthwhile read. Hey, we can’t all be Tina Fey, but there’s a lot to be said for Strunk and White.—Laura King, MA, ELS

Steal This Article

Today we shine a light on a fascinating blog on plagiarism and scientific misconduct, Copy, Shake, and Paste (dig that serial comma!), written by Debora Weber-Wulff. Do any of you work with plagiarism-detecting software? Leave us a comment on your experiences.

Also check out her sadly hilarious entry about fake editorial board members. Brenda Gregoline, ELS



Quiz Bowl: Ophthalmology Terms

Do you know the difference between disk and disc? What about vision and visual acuity? Or conjunctival hyperemia and conjunctival injection? That’s right, this month we’re talking about ophthalmology!

The AMA Manual of Style has an informative section on ophthalmology terms (§15.13). The section defines terms commonly used in radiology literature and offers instruction on how to use these terms correctly. Some of the terms addressed in the section are fovea, macula, lid, and orbit, as well as several acuity terms.

See if you can identify the problem(s) in the following sentence from this month’s quiz:

At initial presentation, her best-corrected visual acuity was 20/30 in each eye. Five weeks later, while taking 40 mg of prednisone, she reported no improvement in her vision, and her best-corrected visual acuity remained at 20/30 OU.

Highlight for the answer:

At initial presentation, her best-corrected visual acuity was 20/30 OU. Five weeks later, while taking 40 mg of prednisone, she reported no improvement in her vision, and her best-corrected visual acuity remained at 20/30 OU.

The abbreviations OD (right eye), OS (left eye), and OU (each eye) may be used without expansion only with numbers, eg, 20/25 OU, or descriptive assessments of acuity. Note that OU does not mean both eyes, although it is often used incorrectly to imply a vision measurement (eg, visual acuity or visual field) with both eyes at the same time (§15.13, Ophthalmology Terms, pp 736-739 in print).

That’s just a glimpse of what we have to offer in this month’s quiz on ophthalmology terms. If you’re a subscriber, check out the complete quiz at www.amamanualofstyle.com.—Laura King, MA, ELS


Questions From Users of the Manual

Q: I am putting together an annotated bibliography for a manuscript. What is the correct order recommended by the AMA Manual of Style for citing multiple articles by the same author? Is it by date of publication or article title?

A: The JAMA Network journals do not use a name-date style of reference citation. Instead they use a superscript reference citation system. If you look in the 10th edition of the Manual of Style, section 3.6 (Citation), you will see further information on this. So, it matters not the date of publication or the article title. What is key is the order in which the reference is cited in the paper, eg, the first reference to be cited would be reference 1, the second would be reference 2. (And if reference 1 is cited again later in the paper, it would still remain reference 1.)

Q: What do you tell authors who object to the house style your publications follow by saying that “Everybody does X [rather than what you recommend].”?

A: When people respond like this, I find that it’s helpful to look at what a few key style manuals or journals in the field (based on their Instructions for Authors) do in areas in which people have complaints or concerns. If you can put together a little chart (nothing fancy) showing that indeed maybe it is not EVERYBODY who does X, real data can sometimes calm the fevered brow. And sometimes you may find that indeed most others do have a different policy than what your house style recommends. Then it may be time to reconsider your policy. Sometimes this is how style policies change, and that can be a good thing. We learn from our authors just as we hope they learn from us.—Cheryl Iverson, MA