Discard the Rest

For several years, I have had a healthy curiosity with minimalism. I’ve listened to TED talks and watched documentaries about the topic and pared down my items accordingly. Last year, I read The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing by Marie Kondo. The author describes a process in which you go through every item you own, keep only what sparks joy or is necessary, and discard the rest. Once you have tidied up your belongings, your mind is free to tackle other issues. This process resonated with me, perhaps because it seemed quite similar to my approach to medical editing.

Part of our job as editors is to remove redundancy in manuscripts—to tidy it up, if you will. We go through a manuscript word for word and carefully discard what phrases or words that do not serve the science (with the author’s approval, of course). Omitting unnecessary words can improve readability. In making an author’s work clearer and more concise, readers are able to tackle other issues, such as responding to the research or designing their own studies. Moreover, scientific writing should be as precise as possible to avoid misinterpretation. Below are some tips, adapted from AMA Manual of Style 11.1.

Some common redundancies that can typically be avoided (redundant words are italicized):

  • first initiated
  • skin rash
  • herein we describe
  • past history
  • period of time, time period, point in time
  • whether or not [unless the intent is to give equal emphasis to the alternative]
  • younger [older] than 50 years of age

Here are some common words and phrases that can usually be omitted without affecting meaning:

  • as already stated
  • it goes without saying
  • it is important [interesting] to note
  • it was demonstrated that
  • take steps to

And here are some expressions to avoid and what to use instead:

Avoid Better
in terms of in, of, for
an increased [decreased] number of more [fewer]
as the result of because of
during the time that while
in close proximity to near
in regard to, with regard to about, regarding
the majority of most
have an effect [impact] on affect

When editing and reducing redundancy, a balance must be struck. Deleting or rewriting too much may lead to accidentally altering the author’s intended meaning, which could adversely affect the author-editor relationship or perhaps even result in a correction after publication. I have been tempted to rewrite sentences, but I have to remind myself that this is the author’s work, not mine. Our responsibility as manuscript editors is to make a research paper as readable as possible so the science is the main focus.—Iris Y. Lo

People-First Language

In the new Netflix series Atypical, a father attends a support group meeting for parents of children with autism. As he begins to describe how well his son has been doing lately as an “autistic person,” he is gently interrupted by the support group leader.  She stresses the importance of him using “people-first” language, that his son is not an autistic person, but rather a person with autism. When she intercedes again to remind him that his son can’t get “better” from autism, he stares at her blankly while his wife (who is more well-versed in the appropriate vocabulary) interjects with an explanation of their son’s recent progress using replacement behaviors.

The scene is played to parodic effect—the support group leader comes across as a pretentious pedant who pays more sensitivity to correct language use than to an exasperated father who is struggling to connect with his son. The insistence on using people-first language is seen as a distraction from what is really being communicated, and I couldn’t help but be reminded of similar reactions from authors over this same issue. How many times as a manuscript editor have I rolled my eyes when I’ve seen the phrase “the patient was diagnosed with” and known I’d have to significantly restructure the sentence? How many authors have been annoyed with the sea of red strikethroughs they encounter because their article is filled with “autistic patients” or “diabetics ” or “the disabled”?

But yet, whenever I explain to authors that AMA style is strict about not defining patients by their illnesses or survivors by their experiences, they get it. “Oh yeah,” they say, “that makes sense.” They understand that it’s important for patients to have autonomy and a sense of personhood, that it’s important to recognize that behind the data are human beings who trying to live their lives while facing all sorts of experiences, of which illness may only be one.

There has been considerable pushback from politicians, corporate leaders, and even comedians against what is seen as a culture of “political correctness,” with people bemoaning that there is a social imperative to use what they see as arbitrary substitutions for words that are considered insensitive or offensive. But what good word nerds know (and manuscript editors take that title with pride) is that words and the way we choose to use them are symbolic and communicate more than their definitions.  And that is why AMA style is committed to using its reputation as an industry standard to set a tone of inclusion and sensitivity for medical discourse, a tone that states that these values are not only accepted but required.—Amanda Ehrhardt

The Use of Cause-and-Effect Language in the JAMA Network Journals

As a manuscript editor and freelance manuscript editing coordinator for the JAMA specialty journals, I am constantly having to edit out cause-and-effect language from observational studies that are not randomized clinical trials. According to the AMA Manual of Style, the word effect, as a verb, means to bring about a change; as a noun, it means result.

A randomized clinical trial is one of the few types of studies that are designed to assess the efficacy of a treatment or intervention (and thus allowed to use cause-and-effect language) because the participants are treated in controlled, standardized, and highly monitored settings.

Whenever I come across a study in which the authors are trying to determine, for example, whether the use of a certain type of drug will reduce the risk of some complication following a certain type of surgery, I need to verify whether the study is a randomized clinical trial or a report of a controlled laboratory experiment. If it isn’t, and is a report of an observational study (such as a cohort, cross-sectional, case-control, or case series study, or a meta-analysis), then all cause-and-effect language must be replaced. But by what?

Generally, association may be a useful replacement for effect. The AMA Manual of Style defines association as a “statistically significant relationship between 2 variables in which one does not necessarily cause the other. When 2 variables are measured simultaneously, association rather than causation generally is all that can be assessed.” So instead of saying the “effect of this on that,” rephrase as the “association of this with that” or the “association between this and that.”

Sometimes, however, the authors don’t agree and want me to change it back, in which case I calmly let the authors know that it is AMA style to allow cause-and-effect language only for randomized clinical trials and controlled laboratory experiments and that, perhaps in the “Discussion” section of their manuscript, they can try to make arguments to support that the association might be causal. However, to quote from one of our scientific editors, “the expression and ultimate interpretation of the findings can’t be causal.”

The use of cause-and-effect language is quite common in everyday speech, and so it is easy for most people to assume that if one event comes before another, then the first is the cause of the second. In the JAMA Network journals, findings that rely on this type of logic had to have been rigorously tested in a randomized clinical trial.—Paul Ruich

 

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

Quiz Bowl: Sentence Structure

One of the challenges for medical editors is to synthesize a great deal of information into clear, readable prose. To accomplish this task, we often have to wade through a murky bog of confusing comparisons, run-on sentences, or large amounts of data. We must tread lightly so as not to distort the meaning of the text or the accuracy of the data, but tread we must.

This month’s style quiz gives users the opportunity to practice their editing skills in a more substantive manner. The quiz provides 6 examples of convoluted text that require a fine editorial hand. The following is one example from the quiz:

Adolescent participants (aged 13-17 years) were recruited from 9 pediatric and family medicine clinics located in 3 urban areas in Washington State in the Group Health system from April 1, 2010, through March 31, 2011, that were selected because of their greater patient diversity and higher number of adolescent patients.

Highlight for answer:

Adolescent participants (aged 13-17 years) were recruited from 9 pediatric and family medicine clinics in the Group Health system from April 1, 2010, through March 31, 2011. Clinics located in 3 urban areas in Washington State were selected for their greater patient diversity and higher number of adolescent patients.

Obviously, there are numerous ways to edit the original sentence. We provide just one example of many. Perhaps you found an even better way; if so, leave us a comment.

If you’re interested in more practice, check out the full quiz on the AMA Manual of Style website.—Laura King, MA, ELS

Quiz Bowl: Editorial Processing and Assessment

So, what happens to my manuscript once it has been submitted for publication? Who reads it? Who decides its fate? If it is accepted, what happens next? Help!

Many authors are perplexed by the editorial processing and assessment stages of the publication process. Sometimes it seems as if manuscripts are submitted for publication only to disappear into a sinkhole of unpublished data. Never fear, diligent authors. This month’s AMA Manual of Style quiz covers the procedures involved in editorial assessment and processing.

Here’s an example to test your knowledge of this often puzzling process.

Who on the editorial team makes decisions regarding rejection, revision, and acceptance of manuscripts?

editor

peer reviewer

both the editor and peer reviewer

So, what do you think? (Use your mouse to highlight the text box.)

editor

That one wasn’t too hard. The editor is the head honcho after all, although input from the peer reviewers is invaluable.

If you’re interested in learning more about how manuscripts are processed and assessed, check out this month’s quiz at www.amamanualofstyle.com.—Laura King, MA, ELS

Quiz Bowl: Author-Editor Relationship

There have been some famous, even notorious, author-editor relationships: Charles Dickens and Edward Bulwer-Lytton, Ted Hughes and Sylvia Plath, Raymond Carver and Gordon Lish. This month’s quiz takes us on a tour of some of these fruitful and fractious relationships as a means of exploring effective ways for editors to handle issues with authors. The following is an example from this month’s quiz.

Vladimir Nabokov, author of Lolita, notoriously and wittily disdained editors. In a 1967 interview in The Paris Review, he said, “By ‘editor’ I suppose you mean proofreader. Among these I have known limpid creatures of limitless tact and tenderness who would discuss with me a semicolon as if it were a point of honor—which, indeed, a point of art often is. But I have also come across a few pompous avuncular brutes who would attempt to “make suggestions” which I countered with a thunderous ‘stet!’”1

What is the best way for editors to communicate with authors who balk at the suggestions made to improve the manuscript?

a. E-mail the author to tell him/her that all the edits are based on the AMA Manual of Style and therefore not subject to change.

b. Telephone the author to discuss the edits, iterating the rationale and providing resource support for the changes.

c. Do not respond to the author.

d. Eliminate all the edits and publish the paper as the author originally submitted it.

What would you do? Here’s our advice (use your mouse to highlight the text box):

Telephone the author to discuss the edits, iterating the rationale and providing resource support for the changes.

Usually, an author’s insistence to overrule all editorial changes is a knee-jerk reaction to extensive editing. Most authors are aware of the editing process, although some need to be guided gently through it. Communicating with the author and explaining the reason for the changes (as well as providing resource support when necessary) can often defuse a volatile situation.—Laura King, MA, ELS

 

  1. Gold H, interviewer. Vladimir Nabokov, The Art of Fiction No. 40. The Paris Review. http://www.theparisreview.org/interviews/4310/the-art-of-fiction-no-40-vladimir-nabokov. Accessed February 8, 2013.

Quiz Bowl: Intellectual Property

Whenever I see the words intellectual property, I think of David Letterman. Remember when he left NBC for CBS, thus inciting an intellectual property firestorm? NBC claimed intellectual property rights on much of Letterman’s material, including Stupid Pet Tricks and the Top 10 List. The controversy even caused the fictional demise of Larry “Bud” Melman (also considered the intellectual property of NBC), although the actor who played the character of Larry “Bud” Melman (Calvert DeForest) continued with Letterman at CBS until he retired in 2002. Much comic fodder was made of this intellectual property brouhaha, mostly by Letterman himself. However, in publishing circles, intellectual property is serious business.

So, what exactly is intellectual property? The AMA Manual of Style writes,

Intellectual property is a legal term for that which results from the creative efforts of the mind (intellectual) and that which can be owned, possessed, and subject to competing claims (property). Three legal doctrines governing intellectual property are relevant for authors, editors, and publishers in biomedical publishing: copyright (the law protecting authorship and publication), patent (the law protecting invention and technology), and trademark (the law protecting words and symbols used to identify goods and services in the marketplace).

This month’s AMA Manual of Style quiz offers multiple-choice questions on intellectual property. Test your knowledge by responding to the following question from this month’s quiz:

A scientist develops data while working at Harvard University. He then moves to Stanford University, where he publishes an article using the original data in JAMA. Who owns the data?

  1. Harvard University
  2. Stanford University
  3. Scientist
  4. JAMA

What do you think? Do the data belong to the scientist, one of the academic institutions, or the publishing journal? Use your mouse to highlight the text box for the answer:

Harvard University

In scientific research, 3 primary arenas exist for ownership of data: the government, the commercial sector, and academic or private institutions or foundations. Although an infrequent occurrence, when data are developed by a scientist without a relationship to a government agency, a commercial entity, or an academic institution, the data are owned by that scientist. Any information produced by an office or employee of the a government agency in the course of his or her employment is owned by the government. Data produced by employees in the commercial sector (eg, a pharmaceutical, device, or biotechnology company, health insurance company, or for-profit hospital or managed care organization) are most often governed by the legal relationship between the employee and the commercial employer, granting all rights of data ownership and control to the employer. According to guidelines established by Harvard University in 1988 and subsequently adopted by other US academic institutions, data developed by employees of academic institutions are owned by the institutions (§5.6.1, Ownership and Control of Data, pp 179-183 in print).

So, when Letterman packed his bags and moved to CBS, he was legally required to leave some of his property behind because it was owned by NBC. Similarly, when authors leave their academic institutions, they are usually required to relinquish the results of the work they performed during their employment.—Laura King, MA, ELS

Jarring Jargon

Theodore M. Bernstein, in The Careful Writer: A Modern Guide to English Usage, describes jargon as “meaningless, unintelligible speech,” which is how some people might describe their last conversation with their physician. In science and medicine, many barriers to clear communication exist, with jargon being one of them. In fact, it’s so difficult for physicians and patients to communicate clearly that a federal program has been created to promote simplified health-related language nationwide. The Health Literacy Action Plan is a “national action plan to improve health literacy.” The entire action plan is 73 pages (which is probably their first mistake) and it highlights the fact that we have a problem.

As editors, we know that jargon is to be avoided in medical literature. While jargon may evolve for the most innocuous of reasons, it is a vocabulary specific to a profession that sometimes is esoteric or pretentious and that can be confusing to those not familiar with it (sometimes to those familiar with it as well). “Inside talk” can be just that by design—it keeps outsiders out. Therein lies the source of the negative feelings about jargon.

In addition to being exclusive, some jargon is offensive and unprofessional. Have you ever seen an FLK? Probably. That’d be a funny-looking kid. “We bagged her in the ER” sounds ominous; what it means is that a patient was given ventilatory assistance with a bag-valve-mask prior to intubation in the emergency department. Hopefully the emergency department physician didn’t describe the patient as a GOMER. This means “get out of my emergency room” and could refer to, for instance, an elderly patient who is demented or unconscious and near death and who perhaps should die peacefully rather than occupy emergency department resources. In this example, jargon diminishes the complexity of a situation that should be dealt with in a more thoughtful way. As Bernstein writes, “All the words that describe the kinds of specialized language that fall within this classification [of inside talk] have connotations that range from faintly to strongly disparaging.”

Jargon also sometimes violates rules of grammar, eg, turning nouns into verbs, “The doctor scoped the patient,” or creating back-formations, like “The patient’s extremities were cyanosed,” instead of “The patient’s extremities showed signs of cyanosis.” Jargon can sometimes appear to depersonalize, by defining a person in terms of a disease. A “bypassed patient” may be one who has undergone coronary artery bypass graft surgery rather than one who has been overlooked. Sometimes, patients might be referred to by their organs, such as “the lung in room 502” instead of “the patient in room 502 with lung disease.”

The AMA Manual of Style lists examples of jargon to avoid in section 11.4, Jargon. Some other examples that we’ve collected over the years are listed here:

* Collodion baby is better phrased as collodion baby phenotype or “the infant had a collodion membrane at birth.”

* Surgeons perform operations or surgical procedures, not surgeries.

* Rather than say a patient has a complaint, describe the patient’s primary concern.

* Do not use shorthand (eg, exam for examination, preemie for premature infant, prepped for prepared).

* Euphemisms sometimes are not clear and should be avoided: “The patient died” is preferred to “The patient succumbed or expired”; the same holds true for killed vs sacrificed (in discussion of animal subjects).

* Patients aren’t “put on” medication, they’re treated with medication. Also, patients aren’t “placed on” ventilators, they’re given ventilatory assistance.

Certainly jargon does have its place. It is specialized, and those in the same field can use it to communicate precisely and quickly. However, when it comes to medical and scientific publications, jargon is best avoided. Bernstein ends his entry on “inside talk” with the following: “It must never be forgotten that the function of writing is communication.” Clear enough.—Lauren Fischer

Go, Embargo, Go

So what’s an embargo, anyway? There’s the economic trade kind, but let’s stick to the news kind (much more relevant for AMA Style Insider readers). I spoke with Jann Ingmire, the JAMA and Archives Journals media relations guru, and she explained that embargoes exist primarily to give reporters the opportunity to cover a story in a more thorough way.

Here’s how they work: Embargoed material is released to members of the press prior to being released to the public, usually a few days early. This gives reporters time to do research, conduct interviews, and write a really great piece. When the embargo lifts, journalists are already prepared to report on newly published scientific studies.

Most of the time, the system works, but occasionally, an embargo is broken. Ms. Ingmire said she tries to give reporters the benefit of the doubt because, usually, it’s simple human error. Sometimes, though, the embargo break is flagrant. When this happens, reporters are sanctioned and stop receiving embargoed material.

Embargoes make it possible for everyone—from the independent blogger to the major media outlet—to have the same opportunity to gather a story. If you want to learn more, read embargowatch.wordpress.com, a blog that chronicles how embargoes affect news coverage.—Lauren Fischer