frequently asked questions

Questions From Users of the Manual

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Q: If a product name appears in all caps in a company’s product literature (with or without a trademark symbol or registered symbol), must the editor retain the all caps in a journal article? Companies use caps for graphic impact or emphasis, but caps can be distracting and can make the text difficult to read. Would it be acceptable to substitute only an initial cap for an all-cap product name, particularly if the product is the main subject of the manuscript and occurs frequently?

A: Our journals do not require use of the trademark symbol (™) or the registered symbol (®) as the use of the initial cap frequently used on proprietary names indicates the proprietary nature of the name (see 5.6.16, Legal and Ethical Considerations, Intellectual Property:  Ownership Access, Rights, and Management, Trademark). There are exceptions to the use of the initial cap (eg, pHisoHex; see section 10.8, “Intercapped” Compounds) and in these cases, as in all others, we advise using the name according to the presentation of the legal trademark. To avoid a plethora of caps—which certainly can be distracting—we would suggest varying the way in which the product is referred to (eg, “this product,” “it”) as long as the meaning remains clear.

Q: Your manual indicates that references should be numbered consecutively with arabic numerals in the order in which they are cited in the text. But what about the distinction between references cited in a range and references cited individually? If an author cites references 1 through 5, does this count as only the citation of reference 1, as the first number in the range, or does it count as citation of all 5 references included in the range?

A: It matters not if the references are cited as part of a range or cited individually. Even if a reference is cited as part of a range, when any one of those references is cited later, it retains the same reference number.  This is not specifically stated in the Manual and, perhaps wrongly, we assumed that it would be understood. Thank you for allowing us to clarify this point.

Q: Convention seems to be to use the leading zero in P values, but why is this necessary since P cannot be greater than 1?

A: JAMA and the Archives Journals do not use a zero to the left of the decimal point, since statistically it is not possible to prove or disprove the null hypothesis completely when only a sample of the population is tested (P cannot equal 1 or 0, except by rounding). If convention dictates otherwise, we are unconventional!

Q: I have been unable to find specific rules on the use of nonbreaking hyphens and spaces. Do you have any suggestions for the correct and preferred use of nonbreaking hyphens and spaces?

A: You are right. We do not have any section devoted to this. However, there is information about line breaks scattered throughout the Manual. For example:

  • On page 29 (section 1.20.4), there is information on how to break an e-mail address. The same guidelines apply to breaking URLs.
  • On page 646 (section 15.6.4), there is information on breaking long karyotypes.
  • On page 910 (section 21.5), there is information on breaking long formulas.

There may be other instances like this scattered throughout the Manual where specific guidance is needed. However, individual publishers or clients may have their own preferences that require attention when editing material for their publications.

Q: I am working on a manuscript in which one of the authors has listed the degree MAS (Master of Advanced Studies). This abbreviation is not included in the Manual. Is it acceptable?

A:  This is a perfectly acceptable abbreviation. We simply did not have space to list all possible degrees and their abbreviations in the Manual and attempted to list some of the more common ones.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: What do you recommend regarding the necessity of including state names (or province names or country names) with the names of certain well-known cities?

A: We used to have a list of cities that could stand without a state (or province or country), but we discontinued that with the ninth edition and recommend that a state or country name be included with all cities.  (What is well known to one may not be well known to another.)  For details and exceptions, see section 14.5.

Q: Do you recommend using “eg” or “e.g.”? Since this represents the shortening of 2 words, I believe “e.g.” would be correct.

A: We recommend using “eg,” closed up, with no periods. See the list of Clinical, Technical, and Other Common Terms in section 14.11. It is true that this abbreviation represents 2 words, but within the list in section 14.11 you will note that most of the abbreviations included represent at least 2 words and yet they are joined without periods. This is a fairly common practice.

Q: I can’t find anything in the Manual about “normal saline,” but I seem to remember that this term was not preferred. Help.

A: Your memory is good.  In the ninth edition of the Manual (section 15.11), we did  indicate a preference for isotonic sodium chloride solution over normal saline. However, in the current edition we dropped that preference and consider normal saline acceptable, so there is no need to change it. If an author uses isotonic sodium chloride solution, however, that too may stand.  Both terms are acceptable.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q: I am a medical writer (and writer, in general) and have always questioned the use of the lowercase “b” in the word “blacks.”  The “w” in “Whites” is normally capitalized when talking about that population.  Although this question is not limited to the AMA Manual of Style, how might I go about getting it changed so that the “b” in “blacks” is also capitalized, for consistency?

A: You will have noticed that in section 11.10.2 of the manual we do not use intial caps on either “white” or “black.”  Webster’s 11th seems to follow this policy also, as you will find definitions related to both races presented without initial caps. I also checked the Chicago Manual and, in section 8.39, they indicate a similar policy. “Common designation of ethnic groups by color are usually lowercased unless a particular publisher or author prefers otherwise.” So, there does seem to be consensus among this small sampling, but it is in the direction of using initial lowercase letters rather than initial caps for these terms.

Q: Are there courses that teach proper use of the AMA Manual of Style?

A: I know of one such course. It is the Medical Writing and Editing Certificate Program that is offered by the University of Chicago Graham School. See https://grahamschool.uchicago.edu/php/medicalwritingandediting/.

Q: I have been working as an APA style editor for nearly 3 years.  I would like to be able to work as an AMA style editor.  I need to learn the AMA style.  Which version of the manual do you recommend?  Is this manual available online?

A: You can visit the AMA Manual of Style Online site (www.amamanualofstyle.com) and you can see that you can purchase a book, an online subscription, or a “bundle” of both. You can also subscribe to the blog and sign up for tweets at no charge. Good luck to you!

Q: Does AMA have a preference for “versus” vs “vs”? If so, can you include the rationale behind the choice?

A: Yes, we prefer “vs” as an abbreviation for “versus” (except in the names of legal cases, where we use the conventional “v”). See the list of abbreviations (14.11) re our preference for how to abbreviate “versus” and also note that we do not require this abbreviation ever to be expanded.  Note too that the use of the lowercase italic “vee” is preferred in legal cases, per convention.  As to our rationale, we have been doing this for so long it is hard to recall exactly.  I suspect it was a combination of “vs” taking up less space than “versus” and being well recognized and understood by all/most.

Q: Is it 0.9 second or 0.9 seconds? The AMA Manual of Style doesn’t seem to address this particular question.

A: This question originally arose on the AMWA Editing-Writing Listserv. There was much good discussion and various sources were cited. After considering all the comments and polling our own staff, we come down on the side of Words Into Type and Edie Schwager’s Medical English Usage and Abusage (for print usage:  prefer the singular).  But when spoken, we prefer the advice of the Chicago Manual (section 10.68)—in general, prefer the plural.—Cheryl Iverson, MA

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Q: I thought AMA supported putting no space following a symbol such as > (eg, age <18) if, in the expression, the symbol is acting more as a modifier, not as an operator (eg, 3 < 4), in which case the symbol would have a space (AMA specifies a thin space).  If I’m mistaken, I need to make a mental adjustment.

A:  This is addressed in section 21.10.  We recommend thin spaces with such symbols as greater than, less than, equals, etc.  So, a small mental adjustment might be needed as we make no distinction between the 2 uses you describe.

Q: Is it true that AMA style no longer requires an expansion of CI (confidence interval) at first mention?

A: Yes, it’s true.  As of July 27, 2011, as announced on Twitter, we are no longer requiring that CI be expanded at first mention.  This is posted on the style manual Web site in “Updates to the Manual” and soon will have a special icon within the text to indicate that this material has been updated.

Q: Does AMA have a preferred format for telephone numbers?  How about international numbers?

A:   The manual does not address this question specifically (and perhaps it should).  However, if you look in section 25.11, you will see many examples (both from the United States and elsewhere) for presentation of telephone numbers.—Cheryl Iverson, MA

 

Jarring Jargon

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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

Questions From Users of the Manual

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Q: I’m not sure when I should use “rheumatologic” vs “rheumatological.”  Is there a subtle difference I don’t know about?

A: The use of “-ic” vs “-ical” is addressed in the Manual on page 396 in the Correct and Preferred Usage chapter.  You’ll note that there are a few instances in which the choice of ending does make a difference in meaning.  With “rheumatologic” vs “rheumatological” I do not believe there is such a difference in meaning and we would be more likely to choose the “-ic” ending for the rationale described on page 396.

Q: I’ve always followed Edie Schwager’s advice in Medical English Usage and Abusage (p 153):

If you remember to prevent, you’ll never choose the obsolete “preventative” instead of “preventive.”  The noun is prevention, not “preventation.”

Do you agree?

A: We agree with Edie.  We also prefer preventive.  Webster’s 11th edition shows the 2 words as equal in meaning but shows a preference for preventive as well.  Consensus!

Q: In section 3.15.3 of the Manual, the words “Web site” are used in examples 1 through 3 and 6, but are not used in examples 4 and 5.  What is the rationale for these differences?

A: This is an excellent question and points out an inconsistency that should be corrected.  I would include “Web site” in examples 4 and 5 as well.  In our next edition, I think we will need to consider if the inclusion of “Web site” is necessary or helpful.  In the current edition, we decided to drop the inclusion of “Available from:” before the URL as we thought that URLs were now well enough known that they did not need this extra identifier.  Perhaps this will also become the case with “Web site.”

Q: When an author’s surname includes 2 names not joined by a hyphen, which name should be included in the reference citation?

A: To assist in answering this question, I consulted Lou Knecht, Deputy Chief, Bibliographic Services Division, at the National Library of Medicine (NLM).  She said that the surname is determined by the preference of the author and she stressed the important role played by the author in presenting this information clearly to the publisher. Publishers also play an important role in clarifying the surname, for example, by using some  typographic device (eg, boldface on the author’s surname in the byline or in the table of contents) to make clear which is the surname.  She notes, “If the journal does not use some sort of surname indicator technique, then both the journal and NLM are left to make their best guesses.  And we frequently guess wrong.”   If NLM is contacted by an author to correct an incorrect surname (ie, the name is presented in direct order in the text and you cannot tell what the surname is), they will gladly do this.  They also monitor authors’ preferences for surname, so once NLM is contacted the first time about an incorrect surname, they enter the complicated surname into a table for the future.  If, however, the surname is published incorrectly, this requires an erratum.—Cheryl Iverson, MA

Questions From Users of the Manual

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Q:   If one has a list of laboratory values, does one have to keep repeating the units of measure, eg, albumin levels of 3.8 g/dL, 3.9 g/dL, and 4.0 g/dL, or is once enough, eg, albumin levels of 3.8, 3.9, and 4.0 g/dL.

A:  No, the unit of measure does not have to be repeated:  albumin levels of 3.8, 3.9, and 4.0 g/dL is fine.  The exception to this is for units of measure that are set closed up to the number or value that they follow, such as the degree sign or the percent sign.  In these cases, the unit of measure should be repeated:  38%, 45%, and 53%.

Q:   What abbreviation does JAMA/Archives prefer for adjusted odds ratio?

A:   We prefer AOR.

Q:   Is “data on file” acceptable in a bibliography or in parentheses in the text?  I don’t see this in the Manual.

A:   The phrase “data on file” is a little vague.  What a reader who’s interested in more information might really want to know is how the author of the manuscript saw the data (and how, perhaps, the interested reader might be able to see it too).  Something more granular about how the author came upon the information would be more helpful.  For example, did the author learn about the information through a personal communication (and is that personal communication the “data on file”?)?  If so, see 3.13.9 in the Manual for how to style this as an in-text references.  Is the “data on file” an internal memo at an institution and, if so, does it have a document number that could be listed in the reference list?

Q:   Would you hyphenate “quality of life” when it’s used as a noun as well as when it’s used as an adjective?

A:   We usually hyphenate as an adjective and not as a noun.—Cheryl Iverson, MA

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Q:    If a person has multiple advanced degrees, should the medical degree always be listed first, eg, MD, PhD?

A:   We would advise following the author’s preference as far as the order in which degrees are listed.

Q:   I know that journal names are typically italicized in their expanded form, eg, Journal of the American Medical Association. Should the abbreviation also be italic, eg, JAMA?

A:   Yes. The same policy applies to book titles and their expansions. See, for example, International Classification of Diseases, Ninth Revision and ICD-9 in the list in 14.11.

Q:   On page 500, in the list of journal abbreviations, is there a reason that the journal Transplantation is spelled out in full as Transplantation and yet other journals whose titles include that word abbreviate it as Transplant?

A:    Yes, there is a reason. See the sentence on page 479 advising that “Single-word journal titles are not abbreviated.”

Q:    The AMA Manual of Style says that tables should be able to stand independently and not require explanation from the text. Could you clarify “stand independently”? Our publication has taken this rule to an extreme, often adding lengthy definitions of terms already provided in the text. One recent example added 15 footnotes to a single table!

A:   As with so many things editorial, this requires judgment.  We were thinking about things like this:

  • Expansion of any abbreviations, given in the text, provided again in a single footnote to the table.
  • Explanation of things that might not be apparent from the tables (eg, what the various groups are if they are only identified as “group 1, group 2, etc” in the table).
  • Explanation of how to convert units from conventional to SI (or the reverse), if this is important in your publication/to your audience.
  • Explanation of some statistical method that would likely not be familiar to your readers without some information—the bare bones, not a lengthy explanation. If a lengthy explanation is necesssary, simply refer the reader to the relevant section or subsection of the text.
  • Explanation of a phrase used for shorthand in a table stub or column head that might not be clear if all you were looking at was the table (eg, if a column head is “Unstable Vital Signs,” explain in a footnote the specific items and values that this refers to).

It truly is a question of judgment and I suspect that 15 footnotes in a single table is taking it too far.—Cheryl Iverson, MA

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Q:    When a bulleted list is introduced by a brief comment, eg, “The principal signs and symptoms of rheumatoid arthritis are as follows,” and all of the items in the bulleted list are from the same source, does a citation need to be placed at the end of each bulleted item or is it sufficient to place the citation at the end of the brief introductory comment?

A:    We would recommend placing the citation within the text that introduces the bulleted list if all the items in the list came from the same source.  If the items came from multiple sources, then placing the appropriate citation at the end of each item would be necessary.

Q:    In this example, would you hyphenate “well child”?

  • He was taken for a well-child [or well child] checkup.

A:    Yes, we would hyphenate in this case.

Q:    The Manual says nothing about how to treat reference citations in the abstract.  Should such citations simply be deleted from the abstract and from the reference list or should complete bibliographic details about the reference be inserted in the abstract parenthetically?

A:    You are quite right that the Manual does not mention how to treat references in the abstract as we never include reference citations (either as superscript numbers or within parentheses in the text) in the abstract (see 2.3, fourth bullet, re not citing references in an abstract).  If an author has included references in an abstract, it doesn’t seem advisable to delete the references altogether.  Discuss with the author trying to include the references early on in the manuscript itself.  It seems unlikely that an author would consider a reference important enough to include in the abstract and then not cite it in the text.

Q:   I don’t see anything in the Manual about how to style “e-mail,” ie, with or without a hyphen.  Help, please.

A:   Although the Manual doesn’t specifically address this point, it does include guidance on capping (see 10.7) and, in that section, it’s clear that the Manual recommends a hyphen in “e-mail.”  If you use the Manual online, for questions like this the “quick search” box is invaluable.  Just type the term you are looking for into the search box and the results should guide you.  If you had begun with “email,” you would have gotten no results, which would—I hope—have tipped you off to try “e-mail,” which produces 3 pages of results.—Cheryl Iverson, MA

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Q:  Do you recommend end point or endpoint?  I have folks dying on their grammatical swords over this and thought you might have an opinion.

A:  We follow Dorland’s and use end point.  Replying quickly so as little blood as possible is shed.

Q:  I failed to find guidance in the Manual on correct use of the apostrophe with plural compound nouns, eg, the possessive of mothers-in-law.  What would you advise?

A:  You are quite right that we don’t include any examples that address this specifically and it would be helpful to do so.  (A thought for the next edition—or an annotation for section 8.7.3 if you are an online subscriber.)  I would recommend mothers-in-law’s, as in mothers-in-law’s first meeting.  The Chicago Manual of Style also recommends this (section 7.23):  my sons-in-law’s addresses.

Q:  Where is the style going on the treatment of Web site?  We use Web site but are seeing it more and more frequently as website, or web site, or Website.

A:  JAMA and the Archives Journals are still sticking with Web site, but the new edition of the Chicago Manual of Style is recommending website.  So, it appears that things are, indeed, shifting but we have not shifted yet!

Q:  We’re having a debate about the order of footnotes in a table.  Are they ordered left to right, top to bottom?  Or are they ordered by where they fall in terms of the table components (eg, title, column heading, row heading, field) and then left to right, top to bottom?

A:  There’s a great example in the Manual on on page 93 (Table 10).  In that table, which has a raft of footnotes, you’ll see that the order is basically from top to bottom and, within that, from left to right…as we expect readers would move through a table as they were reading it.  That said, there is nothing sacred about this and a publication could certainly establish a different policy (eg, with the table body, priority could be given to footnotes attached to table stubs, so that if you had footnotes a and b in stubs high up in the table and then footnotes c, d, and e in rows below this but NOT in the table stubs, and then footnote f in a later stub, you might decide to make the stub footnotes a through c [renaming f to c] and then the footnotes within the body of the table d through f. )—Cheryl Iverson, MA