ethics

Can JAMA Network Authors Use Generative Artificial Intelligence to Create Content?

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Jennifer Sakhnovsky, MA, JAMA Network

The short answer is yes, but with a caveat: transparency is key. It is no secret that generative artificial intelligence (AI) models can create various types of content, including text, images, audio, and video. However, people’s feelings about using these tools in scientific research are mixed, with some academics showing concern and others embracing the new technology.

Regardless of personal opinion, people are using these tools—a 2023 Nature survey of more than 1600 scientists reported that nearly 30% reported using generative AI tools to assist with writing manuscripts.1 As 2023 began, many research articles already listed the generative AI tool ChatGPT as an author.2 By October of the same year, 87 of the 100 highest-ranked scientific journals saw the need to publish online guidance for authors on generative AI use for content creation at their publications.3

JAMA and the specialty journals in the JAMA Network were among those that provided online guidance, encouraging authors, reviewers, and editors to be transparent, responsible, and follow AI best practices in medical and scientific publishing. Importantly, the guidelines noted that “nonhuman artificial intelligence, language models, machine learning, or similar technologies do not qualify for authorship.”4 More information on ethical and legal considerations can be found in chapter 5.1.12 of the AMA Manual of Style.

If authors choose to use AI tools to create content or assist with manuscript creation, they must disclose such use in the Methods or Acknowledgements section of the article. The following example, found in chapter 3.15.13 of the AMA Manual of Style, can be used as an acknowledgment for an article that uses generative AI:

“The authors acknowledge using ChatGPT (GPT-3.5, OpenAI) for text editing to improve the fluency of the English language in the preparation of this manuscript on September 15, 2023. The authors affirm that the original intent and meaning of the content remain unaltered during editing and that ChatGPT had no involvement in shaping the intellectual content of this work. The authors assume full responsibility for upholding the integrity of the content presented in this manuscript.“

As presented in this example, the following information must be included in the disclosure of AI use for content generation:

  • Name of the AI software platform, program, or tool;
  • Version and extension numbers;
  • Manufacturer;
  • Date(s) of use; and
  • A brief description of how the AI was used and on what portions of the manuscript or content.

In addition to the above considerations, authors should provide the following additional information if AI was used in the study:

  • Prompt(s) used, their sequence, and any revisions;
  • Institutional review board/ethics review, approval, waiver, or exemption;
  • Methods or analyses included to address and manage AI-related bias and inaccuracy of AI-generated content; and
  • Adherence to a relevant reporting guideline if followed.

These guidelines emphasize accountability and human oversight when AI is used in medical publishing. To assist authors with adhering to new policies regarding AI, the JAMA Network’s automated manuscript submission system asks all authors whether AI was used for content creation.5 If AI tools were used to generate creative content (noncreative content, such as basic grammar and spelling checks, does not need to be disclosed), authors must provide specific information about their use and take responsibility for the integrity of the AI tools’ outputs.

JAMA Network authors are also asked to be aware of inputting identifiable patient information into an AI model, as well as potential copyright and intellectual property concerns. Limitations of AI tools should be included in an article’s Discussion section, including potential inaccuracies or biases, and, ideally, how these have been managed by the authors.

The JAMA Network also encourages authors to consult relevant EQUATOR guidelines (https://www.equator-network.org) depending on the type of study and AI use,4 including the following:

  • Reporting guidelines for clinical trial reports for interventions involving artificial intelligence (CONSORT-AI);
  • Guidelines for clinical trial protocols for interventions involving artificial intelligence (SPIRIT-AI);
  • Minimum information about clinical artificial intelligence modeling (MI-CLAIM);
  • Checklist for Artificial Intelligence in Medical Imaging (CLAIM);
  • MINimum Information for Medical AI Reporting (MINIMAR) for developing reporting standards for AI in health care; and
  • Updated guidance for reporting clinical prediction models that use regression or machine learning methods (TRIPOD-AI).

At the time of writing this blog post, several reporting guidelines are under development by the EQUATOR Network, including the following:

As AI tools continue to gain momentum and develop rapidly, editorial leaders of scientific journals are wise to guide the responsible use of such tools. This guidance may—and likely will—evolve over time. Like other publishers, the JAMA Network has moved expediently to publish AI usage guidelines. As is true for the journal’s other style rules, authors who publish in JAMA and the JAMA Network specialty journals will be guided to follow these guidelines into the future.

References

  1. Van Noorden R, Perkel JM. AI and science: what 1,600 researchers think. Nature. 2023;621(7980):672-675. doi:10.1038/d41586-023-02980-0
  2. Mazzoleni S, Ambrosino N. How artificial intelligence is changing scientific publishing—unrequested advice for young researchers II. Pulmonology. 2024;30(5):413-415. doi:10.1016/j.pulmoe.2024.04.011
  3. Ganjavi C, Eppler MB, Pekcan A, et al. Publishers’ and journals’ instructions to authors on use of generative artificial intelligence in academic and scientific publishing: bibliometric analysis. BMJ. 2024;384:e077192. doi:10.1136/bmj-2023-077192
  4. Flanagin A, Bibbins-Domingo K, Berkwits M, Christiansen SL. Nonhuman “authors” and implications for the integrity of scientific publication and medical knowledge. JAMA. 2023;329(8):637-639. doi: 10.1001/jama.2023.1344
  5. Flanagin A, Kendall-Taylor J, Bibbins-Domingo K. Guidance for authors, peer reviewers, and editors on use of AI, language models, and chatbots. JAMA. 2023;330(8):702-703. doi:10.1001/jama.2023.12500

November 27, 2024

Language to Discuss Suicide

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Miriam Cintron, BA, JAMA

Although often regularly used in the past, the term committed suicide may imply that the act of suicide is criminal or morally wrong.1

Likewise, referring to a suicide attempt as a “success” or “failure” implies that “the person who died by suicide has accomplished or not accomplished (a failure) the act of suicide”1 or that death was a favorable outcome.2

Factual and judgment-free language is preferred.1 Language that is careful not to stigmatize suicide, suicidal behavior, or mental health issues3 should always be used. For that reason, terms such as died by suicide or suicide attempt should be used. Such terms contribute to destigmatizing suicide.2

The term suicide should also not be used out of context (eg, “political suicide”) because this may desensitize readers to the term2 or seem insensitive.

Person-first language, which aligns with existing AMA Manual of Style guidelines (chapter 11.12.6), should be used (eg, “person who attempted suicide” instead of “suicide attempter” or “person with suicidal ideation” instead of “suicidal person”).

Avoid:

  • Committed or completed suicide
  • Unsuccessful or successful suicide attempt
  • Failed suicide attempt
  • Suicide epidemic
  • Killed themself
  • Took their own life
  • Ended their life

Preferred:

  • Died by suicide
  • Death by suicide
  • Suicide death
  • Suicide attempt
  • Fatal suicide behavior
  • Person with suicidal ideation

The term “intentional self-harm” should not be used interchangeably with “suicide attempts.”

References

  1. Suicide Prevention Alliance. Changing how we view suicide prevention: suicide language. Accessed March 11, 2024. https://www.suicidepreventionalliance.org/about-suicide/suicide-language/
  2. World Health Organization. Preventing suicide: a resource for media professionals: update 2023. Accessed March 11, 2024. https://iris.who.int/bitstream/handle/10665/372691/9789240076846-eng.pdf
  3. International Association for Suicide Prevention. The language of suicide. Accessed March 11, 2024. https://www.iasp.info/languageguidelines/

May 31, 2024

New Abbreviations for Liver Diseases

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Timothy Gray, PhD, JAMA Network

The designation “nonalcoholic fatty liver disease (NAFLD)” is no longer accepted across JAMA and the JAMA Network journals, except to reflect the language used in data collection for a study (or search terms for a review).

The directive is based on the recommendations of the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, as well as the Latin American Association for the Study of the Liver.

In collaboration with hepatologists, gastroenterologists, pediatricians, endocrinologists, hepatopathologists, public health and obesity experts, colleagues from industry, regulatory agencies, and patient advocacy organizations, a consensus was developed via the Delphi process for a change in nomenclature.1

The term chosen to replace NAFLD is “metabolic dysfunction–associated steatotic liver disease (MASLD).” In the previous designation, the term nonalcoholic may have been confusing for patients and physicians. The word fatty also has stigmatizing and negative connotations.

The same committee process resulted in another designation change that will be implemented across JAMA and the JAMA Network journals. The designation “nonalcoholic steatohepatitis (NASH)” is now called “metabolic dysfunction–associated steatohepatitis (MASH)” to avoid trivializing the diseases or confusing patients with the possible connotations of the term nonalcoholic.2

It is hoped that these updates will clarify what the diseases are instead of what they are not.

The AMA Manual of Style has added these abbreviations and expansions to the list of clinical terms in chapter 13.11.

References

  1. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78:1966-1986.
  2. Eskridge W, Cryer DR, Schattenberg JM, et al. Metabolic dysfunction–associated steatotic liver disease and metabolic dysfunction–associated steatohepatitis: the patient and physician perspective. J Clin Med. 2023;12(19):6216.

May 24, 2024.

New Mpox Name for Monkeypox Disease

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Stacy L. Christiansen, MA, Managing Editor, JAMA

The recent outbreak of monkeypox disease (caused by the monkeypox virus), like COVID-19 and other pathogens before it, raised concern about disease names, particularly those that could negatively affect particular nations, populations, or animals.

The naming of diseases (and in this case, renaming) falls to the World Health Organization (WHO). After reports from individuals and countries raised concerns about the term “monkeypox” being racist or stigmatizing, the WHO met with concerned parties and invited public comment to rename the disease.1

The result is “mpox.”

The AMA Manual of Style will add the term “mpox” to the viruses section in the Nomenclature chapter (14.14) as well as information about the renamed clade I and clade II (formerly Central African and West African, respectively).2

We recommend dual reporting, such as mpox (monkeypox), at first mention to ease adoption of the new terminology. Other organizations, such as the Centers for Disease Control and Prevention3 and AP Stylebook,4 have also announced their adoption of the updated terminology.

The monkeypox virus name has not yet been changed. The International Committee on the Taxonomy of Viruses is responsible for that terminology,1 and when new nomenclature is announced we will update the Manual accordingly.

References

  1. World Health Organization. WHO recommends new name for monkeypox disease. Accessed December 1, 2022. https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease
  2. World Helath Organization. Monkeypox: experts give virus variants new names. Accessed December 1, 2022. https://www.who.int/news/item/12-08-2022-monkeypox–experts-give-virus-variants-new-names
  3. US Centers for Disease Control and Prevention. Monkeypox. Updated November 30, 2022. Accessed December 1, 2022. https://www.cdc.gov/poxvirus/monkeypox/index.html
  4. The Associated Press. mpox. AP Stylebook. November 30, 2022. Accessed December 1, 2022. https://www.apstylebook.com/ap_stylebook/mpox

Pregnancy Language Update

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Iris Y. Lo, BA, JAMA Network

The AMA Manual of Style will soon offer guidance on inclusive language when referring to people who are pregnant or people with the capacity for pregnancy.

This wording has more general use and can include individuals who were assigned female at birth, transgender men, nonbinary individuals, gender-nonconforming individuals, and gender-fluid individuals–basically anyone who is physically able to become pregnant.

This language should be used when study investigators have not explicitly asked participants to self-identify their gender. In studies in which participants have all identified as women, it is appropriate to use terms like pregnant women.

However, if study participants have not completley self-reported their gender as women, terms such as pregnant participants, pregnant individuals, and pregnant patients are more accurate. In these cases, birthing parent rather than mother is a more accurate term and should be used for the same reasons.

The JAMA Network has internally started to follow this guidance, joining many other scientific journals, such as Nature, and medical associations and societies, such as the Society for Maternal-Fetal Medicine. The US Preventive Services Task Force also uses this type of language.

Style vs Substance—Is There Room for Both?

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Peter J. Olson, ELS, JAMA Network

There’s a scene in the film Pirates of the Caribbean: The Curse of the Black Pearl in which the heroine, Elizabeth, is taken captive by the infamous Captain Barbosa aboard his ship. In an attempt to negotiate her release, she invokes the Pirates Code, a set of rules to which she knows Barbosa is beholden. Barbosa initially appears to comply, then abruptly reneges. When Elizabeth protests his disregard for the Code, Barbosa defends his decision with a snide retort:

“The Code is more what you’d call guidelines than actual rules.”

His deviousness aside, the Captain has a point. As humans, we have an innate tendency to create rules with the intent of establishing order and certainty, yet those rules are occasionally subject to exceptions, inapplicability, and multiple interpretations. Try as we might, it’s virtually impossible to anticipate every possible scenario and account for it, which means there will be times when the rules we make for ourselves simply do not apply—and editorial style rules are no exception.

The question is: does style always supersede substance?

The AMA Manual of Style is a renowned and authoritative reference manual, and for good reason. It’s a meticulously crafted, oft-updated repository of linguistic and stylistic information steeped in authentic medical language and policy, and the guidance within its pages is critical to physicians, authors, and editors alike.

In that sense, the argument could be made that when it comes to the AMA Manual, style is substance. However, as editors, we at times find ourselves in scenarios in which adhering to a particular style point is akin to the proverbial placement of a square peg in a round hole. The gadget doesn’t quite fit into the device, and the results can be ugly. It’s those circumstances in which the absence of a peg may be preferable to the sight of a horribly splintered one.

What’s more, rules are almost always subject to change, and depending on the impetus behind an amendment, it can take the purveyors of a style manual weeks, months, even years to discuss and formulate a responsible and sustainable update before disseminating it to the manual’s users.

Take the topic of race and ethnicity language (Chapter 11.12.3), which continues to evolve at an unprecedentedly rapid pace—enough so that the requisite section in the AMA Manual was updated less than a year after the release of the 11th edition.1 Language and terms that may have been deemed acceptable just months previously may shift suddenly, and the intuitive and attentive editor may need to set aside current style guidelines to align with cultural and/or societal trends.

That said, style deviations should be made only after careful consideration of the potential ramifications, especially those involving reader perception. In other words: if you’re going to deviate from style, you’d better have a really good explanation ready.

Authors are often quick to point out style infractions in previously published material, either to defend their own infringements or to object to style-adherent edits (“If this author got to do it, why can’t I?”), and trivial or inexplicable noncompliance can undermine the authority of your style manual as well as your publication. If you can’t justify a style detour that goes beyond “I just thought it sounded better that way,” you probably shouldn’t take it.

Fictional though he may be, I expect that Captain Barbosa fully honors the Pirates Code—he is a pirate, after all. Yet even he knows to adapt the rules when necessary to achieve his goals. This is not to suggest that editors should swashbuckle their way through a manuscript, playing fast and loose with the style rules they’ve sworn to uphold. Those rules are there for a reason, and they wouldn’t exist if they didn’t almost always apply.

However, absolutism is fraught with its own perils, and the astute editor must be mindful of those rare situations in which a rule may need to be bent—or perhaps broken—for the greater good. And although there’s no single, comprehensive answer to the question of whether and when to sacrifice style for substance, if preserving the integrity of a publication is given precedence, the answers will at least be easier to identify.

Reference

  1. Frey T, Young RK. Race and ethnicity. In: Christiansen SL, Iverson C, Flanagin A, et al, eds. AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:545-547.

Hawaiian Diacritics

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Miriam Cintron, BA, JAMA Network

https://decolonialatlas.wordpress.com/2015/06/03/the-hawaiian-islands/

The islands of Hawaiʻi and its people have a culture rich in history, traditions, and the Native Hawaiian language.

Sadly, use of the Native Hawaiian language began to decline in 1896, when it was banned from schools just 3 years after the Hawaiian monarchy was overthrown.1 Without being taught in schools, the Native Hawaiian language became dangerously close to being completely forgotten. By the early 1980s, fewer than 50 children spoke the language.2

A resurgence in cultural pride and identity in the 1970s led to the resurgence of many Native Hawaiian cultural traditions, including the language.

With this in mind, the AMA Manual of Style strives to be accurate, fair, and respectful in reflecting the identities of individuals and groups. The Manual is adding 2 diacritical marks used in Native Hawaiian to the Accent Marks (Diacritics) section (chapter 12.2).

The okina (ʻ) is a glottal stop and the kahakō is a macron (ā) that lengthens and adds stress to the marked vowel.

The marks are used throughout the language, including in many of the names of the main Hawaiian islands (eg, Hawaiʻi, Kahoʻolawe, Kauaʻi, Lānaʻi, Molokaʻi, Niʻihau, and Oʻahu).

Note that Hawaiʻi has 2 official languages according to the state constitution: English and Hawaiian.3 “Hawaiian” is considered an English word, so it doesn’t take the okina.

  1. Hawaii State Department of Education. History of Hawaiian education. Accessed January 19, 2022. https://www.hawaiipublicschools.org/TeachingAndLearning/StudentLearning/HawaiianEducation/Pages/History-of-the-Hawaiian-Education-program.aspx
  2. The Hawaiian Islands. The Hawaiian language. Accessed January 19, 2022. https://www.gohawaii.com/hawaiian-culture/hawaiian-language-guide
  3. The Constitution of the State of Hawaii. Article XV. Accessed January 22, 2022. https://lrb.hawaii.gov/constitution#articlexv

Updated Guidance on Reporting Race and Ethnicity: Let’s Start With the Why

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Kim Penelton Campbell, BS, JAMA Network

I have used many adjectives to describe myself, but I’ve never referred to myself as other. When teachers called my name during morning attendance, I responded by saying “Here.” I never said, “Invisible.”

In medical literature, the failure to fairly and respectfully recognize and include individuals of all races and ethnicities can severely adversely affect patients’ lives and the quality of care they receive. It can misinform clinicians. It can compromise the credibility of a journal.

This means that race and ethnicity data should be reported in a way that encourages fairness, equity, consistency, and clarity in medical and science journals.1

Changing the b in Black and the w in White to uppercase lettering when describing race is not about mere political correctness—these changes are part of a conscientious movement toward equitable delivery of health care services to all people.

The objective of this post is to emphasize that updated guidance about the reporting of race and ethnicity is important, not because the AMA Manual of Style says so, but because inattentiveness to these changes can contribute to unconscious bias and ultimately affect how patients are treated or unintentionally mistreated.

Bias, when unintentional, is not mitigated—it remains bias all the same. Unintentional bias can occur simply because the writer or editor is removed from the patient’s life experience. When the writer or editor is unaware, they may not recognize how insensitive wording can affect the reader.

Example: “Adherence to the prescribed medication was higher among White patients than among Blacks.”

Consequence: Does this mean that if you are White you are a patient but if you are Black you are nothing? What is a Black?

When a person is called a Black instead of a Black patient or a patient who is Black, the wording detracts from that person’s humanity.

Likewise, use of lowercase lettering for Black and White, as well as referring to people as minorities instead of as members of a racial or ethnic minority group, also diminishes their humanity. Stating race or ethnicity in noun form can be interpreted pejoratively and is akin to labeling patients by their disease (eg, the blind, schizophrenics, epileptics) instead of putting the individual first (eg, a person with schizophrenia).2 Other things that can be interpreted pejoratively and should be avoided are using the term mixed race, which can carry negative connotations, instead of multiracial or multiethnic, merging race and ethnicity with a virgule (ie, race/ethnicity) rather than recognizing the numerous subcategories within race and ethnicity with the term race and ethnicity, and using abbreviations for racial and ethnic terms. Although the writer or manuscript editor may not have intended to negatively portray a group of people, the potential effect on readers remains unchanged.

  • To potential authors, the absence of a single word can indicate that a journal is insensitive to the health care needs of a population of patients.
  • To clinicians with the same racial or ethnic background as the one negatively represented, this can promote the inference that the journal has no diversity on its editorial board or staff.
  • To a practicing physician, this language can translate to offensive or insensitive communication when speaking with a patient or a patient’s family member.
  • To a patient, this wording can indicate that the medical community views individuals from their racial or ethnic group as nonpersons—unseen, unconsidered, and uncared for.
  • For all of these individuals, this can deepen a sense of mistrust.

Language that excludes a racial or ethnic group can subtly influence a medical trainee to “unsee” the humanity in people who are from a different background. If their research and educational sources are written or edited without intercultural competence, the medical trainee may unintentionally miscommunicate or make incorrect assumptions about patients from other backgrounds. This breach can interfere with a clinician’s understanding of the patient and, in response, impede the patient’s trust in the clinician.

Among some patients from communities that have been medically underserved or ignored, information about medical mistreatment can transcend generations. Past miscommunication can lead to mistrust, which can then lead to fear.

A family may never forget that Grandma never came home from the hospital and that no clinician took the time to explain why. Although this family was made to feel invisible because of miscommunication, it is quite possible that the clinician intended no disrespect and had no knowledge of how the family was affected. A patient with a historic burden of oppression can potentially interpret disrespectful communication as an initial step down the road to medical abuse.

My godfather once expressed such fear. He was Black, the clinicians were White, and he had grown up in Mississippi during the 1940s. Although I asked, he refused to ever repeat details of what was said by these physicians many years ago. But decades later, when I was a teenager and a novice driver, my godmother phoned and urgently asked that I come to their home immediately to rush him to our local VA hospital.

On my arrival, she exclaimed, “I think he had a heart attack while gardening in the back yard!” I said, “I’ll call 911. The ambulance will get him there faster.” Then, she stopped me. She pleaded that I drive him there myself. As I rushed to his aid, she continued by telling me that he would die of fear if an ambulance came to their home. She told me that I must speak for him when we arrived, remain by his side, and do everything in my power to keep him calm.

He cried like a baby during the entire ride. He was afraid. He was humiliated about expressing fear in my presence. I did not know what to say. I just kept driving. My heart was broken.

This brief story is an example of deep-seated fear that some Black people experience in a health care setting, a fear that can only begin to be abated with a conscientious effort to ensure that language humanizes Black patients and patients from all racial and ethnic backgrounds.

How does one address suboptimal reporting on race and ethnicity?

  • First, follow the guidelines.
  • Second, write and edit with a raised antenna. Look for what is unsaid in addition to what is written on the page.
  • Try to interpret as if you are a person from a racial or ethnic group unlike your own. Think about how you would you feel as the subject or nonsubject of the article.
  • Consider how wording can be misinterpreted.
  • Consider how inattentiveness to detail can affect the health, safety, or life of someone who is misrepresented.
  • Edit responsibly, but without fear of respectfully questioning the author.

Remember: no one is invisible, and no one is other.

“Not everything that is faced can be changed, but nothing can be changed unless it is faced.”3

James Baldwin

References

  1. Flanagin A, Frey T, Christiansen SL; AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304
  2. Christiansen SL, Iverson C, Flanagin A, et al, eds. Correct and preferred usage. In: AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:547-548.
  3. Baldwin J. As much truth as one can bear. New York Times. January 14, 1962: Book review 1, 38. https://www.nytimes.com/1962/01/14/archives/as-much-truth-as-one-can-bear-to-speak-out-about-the-world-as-it-is.html

Mxed Messages

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H Ford, they/them/theirs, Manuscript Editor, JAMA Network

There is a particular type of online pedant whose view of the English language has the effect of invalidating strangers’ sexual and gender identities. Much physical and digital ink has been spilled discussing the validity of the singular “they” when referring to a single gender-unknown subject of discussion and as an intentional personal pronoun.

I will not relitigate this issue here, but it should suffice that the AMA Manual of Style (sections 11.12.2 and 7.2.3.2, specifically) concurs with the Chicago Manual of Style, the AP Stylebook, and historical use (eg, Shakespeare and Emily Dickinson) in permitting the singular they.

Now with that said, let’s talk about respecting our queer friends, family, colleagues, and authors by using the honorific Mx! According to Merriam-Webster, the first use of the gender-neutral honorific Mx was in the 1970s, but its widespread use has only gained momentum within the past 5 to 10 years.

It can be helpful to compare Mx with Ms, another relatively recently developed honorific. Although the very first publication of the honorific Ms was in a 1901 article and was likely more focused on expediency of the address than the linguistic and sociopolitical ramifications of defining a woman by her social status, most people’s understanding of Ms is rooted in Gloria Steinem’s eponymous magazine (https://www.nytimes.com/2009/10/25/magazine/25FOB-onlanguage-t.html).

Mx is an honorific that affords the same respect to nonbinary and gender-nonconforming people that has traditionally been given to gender-conforming individuals who do not hold advanced degrees. As awareness grows of the existence of gender identities outside the male/female binary, more people every day feel comfortable publicly identifying as nonbinary, genderqueer, and agender.

The widespread use of Mx signals acknowledgment of and respect toward these individuals. Yet there is a broader application of the honorific Mx that we haven’t fully considered, one that is as practical as it is gender inclusive. Just as the title Ms allowed us to ask why a woman’s marital status affected how she was addressed, Mx should allow us to ask why a person’s gender should matter to any respectful form of address.

For these reasons, JAMA Network now offers Mx as a salutation for submissions to all of its journals!

As editors and writers, we occupy a unique position in the process of the legitimization of nascent linguistic terms. Let’s use that power for good!

Social Media: Dos and Don’ts

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Eman Hassaballa Aly, Social Media Manager; Reuben Rios, Social Media Coordinator; Deanna Bellandi, MPH, Manager, Media Relations (JAMA Network)

“All we want are the facts.”

Sgt Joe Friday, Dragnet

Social media is an important tool for promoting content published in JAMA and the JAMA Network family of journals to the research community, physicians and other health professionals, and lay audiences. Doing that means following a set of guidelines meant to ensure accurate and responsible social media posts.

JAMA Network Social Media Guidelines

  • Content published in social media sites is subject to the same norms, standards, and regulations as is all other published content.1
  • Be respectful.2
  • Use proper grammar, spelling, and capitalization.3
  • Abbreviations may be used provided they can be easily understood in context.
  • Avoid texting jargon, such as “U” for “you” or “L8” for “late.”3
  • Do not use sarcasm, irony, satire, or absurdities.4
  • Reflect diversity.4
  • Use language that is nondiscriminatory.5
  • Do not include negative comments directed at any person, group, or institution.
  • Do not use offensive content (including, but not limited to, racist, sexist, ageist, anti-LGBTQ, and antireligious.)6
  • Do not include sexually suggestive images or video (eg, genitalia, breasts, buttocks) or those that portray sexual assault/abuse.
  • Do not use language, images, or other content that reinforces stereotypes.5
  • Use individuals’ preferred pronouns when known; inclusive pronouns (they/them) are acceptable.4,5
  • When reporting the results of a study or describing a specific journal article, replace personal pronouns (I and we found) with reference to the study or the article type (eg, Viewpoint, Review).
  • When mentioning people/Twitter handles, do not editorialize or designate appellations (eg, do not say, “The great [@Twitter handle] discusses…”).
  • Do not use profanity or vulgarity.2,6
  • Do not include emojis based on gender or race.4
  • Do not include identifiable patient content without permission.1
  • Do not share confidential information.7
  • Do not share information that is embargoed or before publication date and time.
  • Do not include quotes, images, photos, or video from other social networking sites or third-party publications without permission and attribution to the source.8
  • Do not share others’ social media posts that do not follow these guidelines.
  • Correct posts with errors transparently and as soon as possible. For example, add a new post clarifying the correction, and include the word “correction.”

Posts that do not follow these guidelines may be removed.

Tweet Formatting

  • The basic format of a tweet consists of text, links, and hashtags handles with optional attached video and images (up to 4 images per tweet).
  • Length: the maximum length for JAMA Network tweets is 257 characters. Twitter limits to 280 characters, but because JAMA Network always includes a link, 23 characters are reserved for the link.
  • Hashtags should be limited to 3 per tweet.
  • Twitter handles should be included if there is room. Handles should be limited to authors and institutions directly related to the content of the tweet.
    • Example: Tweet text (including relevant @mentions and #hashtags), Link, Other @mentions (if not directly mentioned in the tweet), Other hashtags (if any, and if space permits).

References

  1. Christiansen C, Iverson C, Flanagin A, et al. 5.9.5. Social Media and 5.11.19 Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-5-div2-230
  2. Grossmont-Cuyamaca Community College District. Social Media Guidelines. Accessed April 2, 2021. https://www.gcccd.edu/marketing-communications/social-media-guidelines.html
  3. Christiansen C, Iverson C, Flanagin A, et al. 7.11. Grammar in Social Media. In AMA Manual of Style: A Guide for Authors and Editors. Accessed March 24, 2021. https://www.amamanualofstyle.com/view/10.1093/jama/9780190246556.001.0001/med-9780190246556-chapter-7-div1-138
  4. Sehl K. How to Create Effective Social Media Guidelines for Your Business. Hootsuite. Blog. February 3, 2020. Accessed April 2, 2021. https://blog.hootsuite.com/social-media-guidelines/
  5. United Nations. Guidelines for gender-inclusive language in English. Accessed April 2, 2021. https://www.un.org/en/gender-inclusive-language/guidelines.shtml
  6. CollegeGrad. 10 Things You Should Never Post on Social Media. Accessed April 2, 2021. https://collegegrad.com/blog/10-things-you-should-never-post-on-social-media
  7. Storey V. Social Media Guidelines or Policy?  Social Media Today. May 17, 2011. Accessed April 2, 2021. https://www.socialmediatoday.com/news/social-media-guidelines-or-policy/475646/
  8. Associated Press. Social Media Guidelines for AP Employees. Revised May 2013. Accessed March 24, 2021.  https://www.ap.org/assets/documents/social-media-guidelines_tcm28-9832.pdf