Welcome the 11th Edition of the AMA Manual of Style!

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We are pleased to announce the 11th edition of the AMA Manual of Style, now live at https://www.amamanualofstyle.com/ and shipping in hardcover in a few days.

The manual has been thoroughly updated, including comprehensive guidance on reference citations (including how to cite journal articles, books, reports, websites, databases, social media, and more), an expanded chapter on data display (for the first time in full color), a completely up-to-date chapter on ethical and legal issues (covering everything from authorship and open access to corrections and intellectual property), and updated guidance on usage (from patient-first language and terms to avoid to preferred spelling and standards for sociodemographic descriptors).

The section on nomenclature has undergone thorough review and updating, covering many topics from genetics and organisms to drugs and radiology.

The statistics and study design chapter has been extensively expanded, with more examples of usage and terms that link to a related glossary.

Chapters on grammar, punctuation, abbreviations, capitalization, manuscript preparation, and editing feature refreshed examples and new entries (such as allowance of the “singular they”).

The nearly 1200-page book is enriched by a variety of online features. For example, regular updates to address changes in style or policies will be featured in the Updates section. Any corrections will be made online so that you are always looking at the latest guidelines as you use the manual.

New quizzes will be posted to help new or continuing users learn to master the finer points of AMA style, and the units of measure calculator offers easy conversions between the SI system and conventional units, as well as the metric system.

We welcome questions and comments on the manual: write to stylemanual@jamanetwork.org or find us on Twitter (@AMAManual). We look forward to engaging with you. –Stacy Christiansen, for the AMA Manual of Style Committee

Does Freelancing Pay?

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In addition to my duties as a manuscript editor, I pick up freelance editing assignments when I can. At JAMA Network, I am part of a team of many talented editors and proofreaders who collaborate throughout the editing process, but when freelancing, I am often the only line of defense between clients and catastrophe.

Writing and editing, including in the medical sphere, are largely independent work and conducive to freelancing. But they can also be lonely jobs. Who do you bounce ideas off of when you have a tricky question? Where’s IT when your internet goes down? And how do you know if you are charging your clients enough to cover the overhead costs of your freelance business?

That last question is why I was one of more than 1400 medical communicators who participated in the American Medical Writers Association’s 2019 Medical Communication Compensation Survey.

Following a similar structure as the last edition of the survey (published in 2015), the results are broken up into categories for full-time employees and freelancers. Full time was defined as working 32 or more billable hours per week.

Of full-time employees, almost half (46%) reported having a PhD or advanced degree and more than 10 years of experience (42%). The most common employers were pharmaceutical companies (20%), clinical research organizations (14%), medical communications companies (14%), biotechnology companies (9%), medical device companies (8%), health care organizations (7%), and medical schools or universities (7%).

Writers reported a median annual income of $107 000, while editors reported $80 560. The most commonly reported benefits for those employed full time included health insurance (93%), retirement savings plans (85%), life and/or disability insurance (82%), professional development (64%), pretax spending programs (63%), and an annual bonus (60%).

By contrast, of full-time freelance medical communicators, 38% reported having a PhD or other advanced degree, but 72% reported more than 10 years of experience.

There was some overlap with what the first group of employees reported; for freelancers, the most common clients included pharmaceutical companies (21%), medical communications companies (19%), medical education companies (9%), biotechnology companies (8%), medical marketing agencies (6%), medical device companies (5%), and health care organizations (5%).

Full-time writers reported a median annual income of $151 000, while editors reported $77 500. As with the first group of employees, the results note that salaries tend to increase with years worked in the industry.

Because freelancers generally do not receive the same benefits as employees, they tend to charge higher rates to cover expenses (respondents reported an average hourly rate of $116 for writing and $97 for editing). In this survey, respondents reported their most common recurring expenses as professional membership dues, costs of a tax accountant, health insurance, office supplies, and professional development.

The 2019 survey also reported that 55% of all respondents work remotely on a regular basis and of these, 48% only work remotely. This is an industry trend that continues to grow through the use of technology and continued research showing the benefits of remote work.

Organizations, such as the American Medical Writers Association, Council of Science Editors, and Board of Editors in Life Sciences, are valuable in connecting medical communicators with resources and information, especially freelancers or remote workers in need of a network. Sharing data is the core of our careers after all.–Jamie Scott

Breaking It Down

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When you pick up a book you haven’t yet read, do you immediately turn to page 1 and begin reading? Or, do you check out the front cover design to see if the book looks interesting? What about the back cover?

Most stories are broken down in many ways to hook the audience. It’s fairly standard that a book has a promotional blurb on the front cover, a tagline, a 1-sentence summary on the back, a slightly longer summary on the back, and, yes, more promotional blurbs on the back and inside the front cover. Perhaps you learned of the book through a social media post or through a review. What grabs your attention may not grab someone else’s, so breaking a story down in various ways makes it appeal to a larger audience.

The same can be done with scientific research articles. The main text typically follows the IMRAD format (introduction, methods, results, and discussion) to clearly and fully tell the story. The authors detail why they performed the research, how they did it and among whom, what they found, and what it means.

That story is condensed into an abstract, a brief summary that allows readers to determine whether they may find the full article interesting or useful. Should an abstract be too long or technical to pull a reader in, an article can have an even briefer key points section. This could be a bulleted list of important findings or, as in the JAMA Network journals, a list of the question, findings, and meaning of the research.

For social media, perhaps a single summary sentence is needed to fit the constraints of a character limit. For readers who prefer a more visual summary, especially through social media, a visual abstract can be useful. These are eye-catching depictions of the research, often using icons and very brief wording.

Twitter, JAMA (JAMA_current), January 17, 2020.

Medical editors may be tasked with reviewing, editing, or even writing some of these pieces. In doing so, a few tips might be helpful.

First, make sure the shorter piece is consistent with the main article. Numbers should match and any data in the shorter piece should be included in the main article.

Second, make sure the trimmed text doesn’t overstate the study’s results. For example, “This study suggests that X is associated with Y” is different from “X affects Y.”

Third, make sure the most important information is emphasized: “This [study type] examines [primary outcome] in [population].”

Fourth, remember the audience. The short items should be able to draw someone in to read the more technical information in the main article.

A journal article may be the culmination of an investigator’s life’s work or the end of a trial that has cost millions of dollars, which may make an article’s 1-sentence blurb seem measly. However, a patient may search social media to find information on a rare disease, and a post could bring the patient to the full article. A physician may scan key points to see if an article looks interesting enough to read fully. A student could review abstracts to find articles that are helpful for a research project. An investigator might use the full article to replicate the study or as a springboard for further research.

Each breakdown serves a purpose, promoting the right information to the right audience.–Shannon Sparenga

ME Without the MD

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One of the occupational hazards of being a medical editor is the inevitability of occasionally working on a highly technical, highly detailed manuscript on a topic about which you know nothing. You don’t need to have a medical degree to be a medical editor, but how do you edit a paper when you’re not sure whether the item under discussion should treated as a plural, or even as a noun?

Of course, an excellent place to start is the AMA Manual of Style, which can provide a general overview sufficient to navigate the complexities of many topics.

For example, you don’t need to know much about respiratory physiology as long as you remember to check section 15.16 (Pulmonary, Respiratory, and Blood Gas Terminology). You’ll be sprinkling cryptoglyphs like V̇, Pb, and v̅ in no time!

You also don’t need to know how to conduct an F test to know that when you see an F score, it should also include the numerator and denominator of the degrees of freedom in subscript (section 20.9, Glossary of Statistical Terms).

In addition to the searchable AMA Manual of Style, the modern age has also bestowed the gift of internet search engines to help decrypt topics of which you may have no knowledge (and had never previously needed knowledge of, for that matter). If you find yourself looking at a topic you’ve never heard of and the Manual doesn’t cover it, a few minutes perusing sites such as Google, PubMed, and Wikipedia can give you tentative grounds on which to make your stand.

But sometimes even all the treasures of the internet and your trusty AMA Manual of Style combined can’t help and you’re adrift on a sea of statistics, biochemistry, gene expression, or whatever your topical Achilles heel may be.

In such cases, it can be useful to think of a sentence like a math equation—you don’t need to know what the subject means, but if you can look at a sentence and know where the subject is, where the object is, and what kind of verb tense you need, you’re more than halfway there.

And, as always, you can and should rely on the author to clarify and correct as needed. The ultimate goal of your work is to improve the author’s work, and that can only be truly accomplished through teamwork.–Rebecca Palmer

A Blueprint for Science Editing

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As a high school student, I stumbled across A Blueprint for Teen-Age Living in a recessed shelf of the library. The book was older than I was with a spine unbroken. Despite these red flags, I believed this William C. Menninger author might have some wisdom for the ages.

The breezy illustrations failed to track against the daily dramas unfolding around me in those years, and its advice did not seem to be applicable to peers. No one else was consulting a book on how to behave. One of the 7 signs of maturity was the ability “to deal constructively with reality.” Real life never arranges itself as in a guide to behavior, so to deal with reality, I began to disregard the Blueprint advice. Let’s just say that A Blueprint did not open any doors.

Happily, as a manuscript editor, I have access to guidebooks that not only open doors but also resolve questions. With the impending arrival of the AMA Manual of Style 11th edition comes the opportunity to take a brief peek at the first edition, which is of about the same vintage as that guide for teenagers.

A reasonable facsimile.

The typeface on the cover is, like the illustrations in A Blueprint, deceptively breezy. The book gets down to business. Even a quick look shows that the book arranged itself according to the real life of an editor. Written by director John H. Talbott, MD, for the Scientific Publications Division, this 70-page Style Book was produced in 1962 for an in-house audience. Stapled with a green cover, it has the look and weight of a fundraising cookbook from church. The Foreword (spelled “Foreward,” a potential mash-up of “foreword” and “forward”) indicates that numerous blank spaces appear on pages for additions the user may wish to enter. How thoughtful, but the version in hand must be a facsimile edition because all pages are jam-packed with scant space for additions.

The Style Book consists of 25 sections, mostly about the conventions of punctuation, with excursions into italics, laboratory values presented as cc instead of mL, drug names, and proofreader’s marks (perhaps the most constant of all sections). The Style Book shouts. CORRECT USAGE. INTERROGATION MARKS. FOOTNOTES. What became of the cover’s breeziness? The CORRECT USAGE section 9 lists “lipid: noun” and “lipoid: adjective,” and “mucous: adjective” and “mucus: noun.” These distinctions have evaporated over the years. In contrast, Section 9.16 advises for “over”: “‘more than’ preferred when numbers are used,” which appears to be an eternal directive.

The current manual directs us not to use a colon if a sentence is continuous without it. No such ruling appears in the first edition, which mentions colons as an indication of an explanation or enumeration to follow, as an introduction to a formal direct quotation, or to separate numbers in time of day, biblical references, and parts of numeric ratios. The book does use colons even when the sentence would be continuous without. In at least one place, the verb “are” is followed by a colon then its predicate nominative string.

One change that won’t surprise those of us in house is the guidance about numbers. NUMBERS 16.00 indicates “In the text all numbers from one through ten should be spelled out.” Current style is to use numbers, which still surprises many authors who return proofs with the instruction to spell out numbers. Another minor change is in capitalization after a colon. CAPITALIZATION 4.00 directs that the first word after a colon in a reference gets capitalized. Now the opposite is true.

In current Common Usage, “utilized” is not preferred because “use” is concise. The Style Book has plentiful examples of “used,” but “utilized “makes at least 1 surreptitious appearance.

It may sound odd to personify a book, but the Style Book has become surer of itself in the last 58 years. I believe it must have gone through the 7 signs of maturity. The original Foreword claims that “Few of the rules contained in this book are inviolable” and that the book “is not to be static,” modest claims presented with a certain authority, not to mention an admirable realism. The current Foreword focuses on the need for communicative writing and the manual’s standing as a more extensive and comprehensive manual than earlier editions.

The upcoming Foreword characterizes the manual as indispensable for medical journalism and communication, which embodies being “not static.” The new manual is 17 times the size of the 1962 edition, whose Foreword also presented the optimistic expectation of a new edition every year. Unlike A Blueprint, the community of users was accurately assessed. I imagine that even in 1962, people who consulted the Style Book felt like part of a community centered around this makeshift blueprint for science editing. Now the community of users extends around the globe. The AMA Manual of Style also opens doors, not just for editors but also for conversations between editors and authors.–Timothy Gray

The Devil’s in the (Formatting) Details

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When I was completing my thesis during graduate school, one of my most frustrated moments came right at the end of the process while preparing my final manuscript for submission. The school required thesis manuscripts to have a uniform title page, with all the information sized and spaced just so. They provided a template to work from, but somehow, when I converted my finished file to a PDF, one of the signature lines for my advisor’s name kept coming out a fraction of a centimeter too short.

This seemingly simple issue—which ultimately turned out to be a problem with an outdated PDF viewer on an administrative assistant’s computer—required multiple rounds of emails between myself, my department head, and the graduate school office, and at one point led to me crouching over a physical copy of the page with a ruler the day before the final deadline, begging the thesis gods for mercy.

I understood the need for a correctly formatted title page, but it was frustrating having to spend so much time on such a small problem after pouring months of hard work into my thesis. So when a recent study by LeBlanc et al in PLOS One found that authors of research articles reported spending a median 14 hours on formatting their manuscript for publication in a peer-reviewed journal, I was surprised, but not without sympathy.

As an editor, I’m often communicating with authors to resolve relatively small questions about style and format: is the header in this table really meant to cover both of these columns? This figure looks good, but can you resend it in a different file format? When you gave this value as 48.5% in the Methods but 48.45% in the Table, was it inconsistent rounding, or is this a different result?

The Instructions for Authors for JAMA Network’s journals (not to mention the AMA Manual of Style) offer guidance on many of these formatting points, from how to format tables and figures to how to present numbers for certain types of data. It may feel overwhelming or frustrating to authors on top of all the work required to write up their study to have to go through all those seemingly small details before their article has even been accepted. But there is a reason these formatting instructions are given to authors before submission.

Chapter 2 of the AMA Manual of Style focuses on manuscript preparation, and the chapter’s introduction makes the point that properly preparing a manuscript according to journal requirements “may enhance the chances of acceptance and expedite publication.” Just like decent grammar and correct spelling allow a reader to focus on a writer’s message without distraction, a cleanly formatted article makes it easier for editors and reviewers to focus on the content of the work and more quickly ensure that certain required elements are present.

And, of course, formatting requirements are ultimately set with the scientific content in mind, with the goal of ensuring all methods, data, and findings are presented clearly, correctly, and unambiguously. For authors wanting to better understand what goes into a properly formatted article (and for some insight into the why behind certain style and formatting requirements), chapter 2 of the style manual is a valuable reference.

The PLOS One article by LeBlanc et al recently made the rounds in some of the online editing circles I follow, and one commonly raised question was how much unnecessary time authors may be spending following out-of-date instructions. With most publications now having their instructions and submission processes moved online—making them able to update their guidelines more efficiently—I wouldn’t imagine this to be a common risk. For example, the JAMA Network journals have their Instructions for Authors updated regularly to reflect any changes in style or procedure and to correct any inconsistencies that may pop up. There’s a “Last Updated” date posted at the bottom of the instructions page so authors can be sure they’re working with the most recent version.

I would also encourage authors to remember that if they do have a question about formatting or something in the instructions for authors, they can feel welcome to email that question to the journal. Someone in the journal office may be able to provide guidance that will help clarify the process. It’s also possible that a question may lead to the correction of an inconsistency in the instructions, which can make things that much easier for other authors down the road.

And as a final tip, to speak from personal experience: it never hurts to make sure your PDF viewer and other programs are all updated.–Kirby Snell

Resources for References

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Sometimes editing requires a little detective work, especially when the manuscript you’re working on has several incomplete references. You could query the author for the missing information, but with minimal time and effort, you may be able to the find the information you need using 2 free resources: PubMed and Worldcat. Both of these resources have extensive features, and editors can use the basic search interface to find missing reference information.

PubMed is an essential resource for medical editing—I use it nearly every day. If you need to fact-check data from a published journal article or online book, find an abstract for background information on a study cohort, or search for a missing volume or issue number for a journal reference, PubMed is the tool for the job. Let’s use it to find the missing volume and last page of the article in this reference:

Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA: a Cancer Journal for Clinicians. 2018;_(5):356.

We’ll start by typing in the author names in the PubMed search field and hitting enter.

Let’s see what we get!

Voila! Now we have the complete reference, and we can even update the journal title. As an added bonus, the full-text article is available with a click of a button on this page. If I need to do any fact-checking, I can access the article directly from PubMed.

That was quick and easy, but PubMed doesn’t index print books. No problem! Worldcat, the world’s largest library catalog, is another free resource that editors can use to find missing publication information. Worldcat allows you to search the collections of libraries around the world; it’s a great resource for materials published in languages other than English. I primarily use it to find chapter titles and publication information for print books. Let’s give it a try with this incomplete reference:

Erinnerungen, Träume, Gedanken von C.G. Jung 1961; Carl Gustav Jung and Aniela Jaffé.

Although I’m almost certain that this is a reference for a book, I’m going to select the “Everything” tab in the Worldcat search field to capture all of the potential results.

This yields 130 results, but in this case, the first result is a close match for the title and authors. The year doesn’t match the information in the incomplete reference, but if we click the “View all editions” link underneath the reference, we can narrow the results even further.

This is what we get:

This looks like a good match! The title and authors match those listed in the incomplete reference. The year doesn’t quite match, but it’s close. I can now ask the author to confirm the complete reference.

Searching for complete publication information for journal articles and books is quick and simple with PubMed and Worldcat. Although these free databases offer many more features, I use the basic search feature most often. Give them a try, and, of course, always check with the author to confirm that the information that you have is correct.–Juliet Orellana

102 Things Journal Publishers Do

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I recently came across an interesting post on The Scholarly Kitchen titled Focusing on Value — 102 Things Journal Publishers Do. Originally posted in 2012, it’s been updated every couple years as journal publishing changes and becomes more complex. Working at JAMA Network, I’ve been amazed at the breadth of skills needed to publish our array of journals. As a copyeditor, I only experience a narrow part of the publishing process, so I appreciate the overview and seeing how all the pieces fit together.-Heather Green

How Many Is They?

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Since I’ve been a manuscript editor, JAMA Network journals have published a few articles about health care for transgender patients. I’ve had the good luck to edit a few—they are always interesting—but this week, I realized that there is a grammatical issue in editing these articles that I have never heard fully addressed.

The issue is not what pronouns to use for transgender individuals—that question is well-known. Because the English language uses gendered pronouns, people who change their gender expression or whose gender isn’t accurately defined by labels are faced with several choices: should they go by she, he, a singular they, or a neologism, such as xe?

The news media has addressed this, including The New York Times articles in 2016 and 2017, with another written by transgender English professor Jennifer Finney Boylan in 2018. These articles often make the same points: that people can get confused by this transformation of language, but that people who want to use pronouns that reflect a gender different from their assigned sex should have their wishes respected. This squares with the approach used in JAMA Network journals.

But it also raises a question rarely addressed: what about verb conjugation? In the present tense, English applies a letter s to the third-person singular (he, she, or it runs) but not to the first-person singular, first-person plural, second-person singular, and third-person plural (I, we, you, and they run). So, if an article uses a singular they, should it be conjugated like the third-person plural (run) or like the third-person singular (runs)?

While editing, I have realized that the default method of using the singular they along with someone’s name (or a descriptor, such as the patient) involves flip-flopping between singular and plural verb conjugations (eg, “The patient is receiving gender-affirming treatment, and they are pleased with the outcome thus far”). A consistent use of the singular they would seem to require using third-person singular conjugations throughout (“The patient is receiving treatment…. They is pleased…”) or plural conjugations throughout (“The patient are receiving treatment…. They are pleased….”). Is either approach correct?

The public discourse on pronouns has not provided much insight. It has prompted the argument that we all use forms of singular they-series pronouns in casual language, in sentences such as “If someone wants gender-affirming treatment, that is their choice” or “Give them an injection.”

But that is distinct from the current issue. In these usages, the pronoun is usually objective (them) or possessive (their or theirs), and the verb is conjugated in the third-person singular alongside another subject. (In the example sentences, these are “someone” and “that,” and in the command, an unspoken “you.”) When the singular they is placed immediately before the verb, the question of conjugation instantly reappears.

Weighing “they run” vs “they runs,” I looked for guidance in the AMA Manual of Style. It offered a few relevant thoughts: “In an effort to avoid both sex-specific pronouns and awkward sentence structure, some writers use plural pronouns with singular indefinite antecedents… Editors of JAMA and the Archives Journals prefer that agreement in number be maintained in formal scientific writing.”

But that seemed short of clear instructions. Still uncertain if constructions like “they is pleased” would please anyone, I reached out to Jennifer Finney Boylan, the New York Times contributor whose article on pronouns was published in 2018.

A quick email to her university address got an equally quick response. “I’m not certain about this,” she wrote. “I want to endorse ‘they is’ because the non-specific pronoun is still referring to a singular individual. On the other hand, ‘they are’ sounds better to my old, English professor ears.”

That seemed similar to how our society is handling the matter. On her authority, I decided to stick with conjugations that shift from singular to plural and let the matter rest until a thoughtful body of grammarians, popular opinion, and perhaps the next edition of the New York Times’ article series on pronouns weigh in with a definitive answer to conjugating verbs after a singular they.—M. Sophia Newman