Patient Privacy

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Sometimes before I go to bed, I like to check in on one of my favorite YouTubers, Dr Pimple Popper (the nom de internet of dermatologist Sandra Lee), who posts videos of dermatologic procedures and skin care treatments. I particularly enjoy watching videos of dilated pore extractions, and I don’t mind watching lipoma extractions either (although I do sometimes fast-forward through the excisions). I know these types of videos can get viewers’ stomachs churning a bit, but I think it’s no worse than various photographs in medical journals I have worked at over the years. And because of my occupation, I do wonder about patient privacy and anonymity.

Patients featured on this YouTube channel may have a cyst near their eye or ask for blackheads to be removed from their cheek, and their faces are clearly visible. In many videos, Dr Lee chats with her patients, and although she sometimes edits out personal details, some of it stays. Dr Lee says that patients do sign consent forms before videos are published.

Similarly, when manuscript editors of medical journals encounter photographs of patients, we must review whether the photograph might intrude on patient privacy. Authors must obtain written permission from patients (or their legally authorized representatives) for any descriptions, photographs, or videos of patients or identifiable body parts and indicate that such consent was obtained in the Methods or Acknowledgment section. When I started in this field as an editorial assistant, I processed a manuscript that described a skin lesion on a patient’s back. In an accompanying photograph, the patient’s distinctive tattoo was visible, and I needed to ask the author to either obtain patient consent or have the photograph cropped because the patient (as well as anyone who knew he had that tattoo) would be able to identify himself. Results of imaging studies and photos of laboratory slides may also have identifying information that should be removed.

Protecting patient privacy also extends to what is in the text of an article. When editing case descriptions, case reports, and personal essays, nonessential identifying data (eg, sex, specific ages, race/ethnicity, occupation) should generally be removed unless the author has permission or the information is clinically or scientifically relevant and important. Authors and editors should not falsify or fictionalize details; doing so may introduce false or inaccurate data.

Read more about patient’s rights to privacy and anonymity in section 5.8.2 of the AMA Manual of Style.—Iris Y. Lo

Offensive Words and Apologetic Quotation Marks: Sorry Not Sorry

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News organizations everywhere had an important editorial decision to make in early January 2018 when President Trump categorized certain countries in a defamatory manner during a closed-door discussion about immigration in the Oval Office with Senators Dick Durbin and Lindsay Graham, among others.

  • “Trump decries immigrants from ‘shithole countries’ coming to US” (CNN headline)
  • “Trump derides protections for immigrants from ‘shithole’ countries” (Washington Post headline)
  • “‘Fox & Friends’ host called for Trump to clarify ‘s—hole’ comment shortly before denial” (The Hill headline)

In scientific reporting, as in politics and life, things sometimes get ugly, and when they do, we turn to apologetic quotation marks. In the examples above, the term shithole is a part of the story; without using the offensive term, the story’s meaning is lost. It’s interesting that these 3 examples apply the apologetic quotation marks in 3 different ways. The first example includes “countries” within the quotation marks, which is not necessary. The Washington Post example gets it right. And the example from The Hill is not fooling anyone. If you’re going to include it, include it. Crossing out a few letters in the offensive term is the literary equivalent to putting black bars over a patient’s eyes to make the patient “unidentifiable.” (←ironic use of apologetic quotation marks.) 

This is not a picture of my cat:

This is not an offensive word:

S—HOLE

You get the point.

The revised edition of the AMA Manual of Style will provide expanded guidance in the “Apologetic Quotation Marks” section of the Punctuation chapter, which currently only states that apologetic quotation marks are “sometimes used around words for special effect or to indicate irony.” Additional guidance will note that in some instances, the use of a potentially offensive term might be unavoidable if it is a direct quotation that is important to an article (eg, in a news story). In such cases, the offensive term may be published within quotation marks. The New York Times occasionally opens up its policy on including offensive terms in print. Ultimately, whether or not to include offensive language in an article is an editorial decision that comes down to how the term relates to the meaning of a story.—Lauren Fischer

   



Looking Forward to the 11th Edition

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At the most recent annual conference of the American Medical Writers Association, we received a sneak peek at some of the changes to come with the AMA Manual of Style 11th edition. AMA Manual of Style Committee Members Cheryl Iverson, Stacy Christiansen, and Annette Flanagin gave an overview of some highlights, including changes to the way references are styled, updates taking into account the growing presence of social media, and changes to nomenclature. Other topics included updates to corrections processes, clarification of authorship guidelines, and data sharing rules.

In this post, I thought I’d share some of the changes that I’m most excited about as an editor, many of which promise to make the editing process easier and more intuitive. Several new guidelines for styling references caught my attention. For example, electronic references in the current edition mirror traditional references with the addition of a URL in the middle of the reference and a date accessed at the end. The new edition will put URLs at the end of a reference, similar to how DOIs currently appear. Another welcome change is the omission of publisher locations from references to books and reports, which seems sensible given the multinational nature of publishing and the increasing move toward digital formats.

An update to the style of tables and figures was also covered in the presentation. Starting with the 11th edition, column heads in tables and axis labels in graphs will appear in sentence case capitalization rather than title case. Table and figure headings and labels in scientific publishing often contain a great deal of text, making it all the more important to display that text in a way that’s as easy as possible for readers to parse. In addition to saving space, the use of sentence case capitalization throughout figures and tables will make these elements appear more standardized and easier to read.

The new edition also makes some helpful distinctions between AMA style preference and alternatives considered acceptable. For example, it is now acceptable to use of “they” as a singular pronoun. In addition to circumstances in which “they” is a person’s preferred pronoun, this construction can also be helpful in preserving patient confidentiality (eg, avoiding the disclosure of patients’ sex in a small sample size to preserve anonymity).

Many other exciting changes are anticipated with the upcoming 11th edition. Stay tuned for more!—Heather Green

 

 

Words for the Road

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Maybe, like me, you’ve got a lengthy commute to work, either by train or by car. Maybe, also like me, you’ll be road tripping for the holidays and need a way to pass the time. So probably (wait for it…like me!), you are already filling your phone with podcasts in preparation.

Among your daily news briefs, true-crime series, and Stuff You Should Know, consider adding these grammar and language podcasts if you want to brush up on your word nerdiness while you’re on the go.

Grammar Girl: It’s a top podcast among editors and writers, and one you probably already subscribe to. Mignon Fogarty has been bringing Quick and Dirty Tips on grammar and usage to the masses for more than a decade in the form of her website, books, and podcast. With more than 600 podcasts (!) in her library, even if you’ve heard them all, there’s always a topic you can revisit.

Lexicon Valley: This podcast from Slate has also been around for a number of years, and its current host, linguist John McWhorter, explores grammar, of course, but also topics such as etymology and dialect. I particularly like his take on subjects because he frames them in historical context, mixes in relevance to current social issues, and recognizes that, like society, the English language is ever changing.

The World in Words: Packaged in the familiar part reporting, part storytelling format of many popular public radio programs, this podcast from Public Radio International tells stories of language of all types and how it affects those who use it. You’ll hear a wide variety of intriguing topics, including bilingualism, rhetoric in politics, and even how animals communicate.

Bonus audiobook:

Word by Word: The Secret Life of Dictionaries: If you’ve ever obsessed over the meaning and definition behind words, you’ll probably see bits of yourself in Kory Stamper’s book about her life as lexicographer. Plus, you’ll get a peek behind the doors at Merriam-Webster and find out just how words and their definitions make it to the page.

What language podcasts or audiobooks keep you both entertained and informed on long trips?—Jamie Scott

Transitions of Note, As Such

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I come to praise the lowly transition, the chemical drain opener of scientific writing. A transition unclogs copy. Just pour it in and it works.

In our daily responsibilities, time does not always allow for an examination of language functionality at that level of detail.  More pressing concerns prevail.

In processing a manuscript into final article form for JAMA Network journals, an editor applies several rounds of detailed attention to the information. The process involves many musts. The title must not be declarative or give away the conclusion. The abstract must be complete. The type of study must be specified. The results section must include appropriate data. The methods section must identify ethical or institutional review board approval or waiver as well as informed patient consent. The statistical analysis section must specify the statistical tests used and not present P values alone without comparative data. Figure and table elements must be complete. Abbreviations must be tracked for consistent use. The discussion must include a paragraph about the limitations of the study type. The conclusions must not be overstated or absolute.

Along with including these musts, the copy must follow JAMA Network style conventions, from the picayune (no period after “vs”) to the consequential (wording presents patient first: patients with diabetes instead of diabetics). The end matter also has to follow the author contribution, conflicts of interest disclosures, and identification of funding requirements.

The introduction, methods, results, and discussion format for scientific articles lead readers from section to section. Within those sections, subheads guide readers from one major topic to another.

What about finer divisions of thought than can be accommodated by subheads? In the dash to process 3000 words according to scientific format and AMA style directives, something often gets lost in the shuffle: the utility of the transitions used to move the reader within and between paragraphs of a subsection. One could argue that if transitions go unnoticed then they have done their job. Readers have gone from point A to point B, and no one has gotten hurt.

There is no must for transitions, but the AMA Manual of Style lists 6 functions of a transition with standard examples that perform those functions.

When I review a proof after the list of musts has been confirmed, I am sometimes startled that a conjunction or transition at the paragraph level appears several times in rapid succession. Three uses of of note occur at the end of the discussion section. Four occurrences of as such appear as an opening phrase. Even that being said has slipped by although no one is actually talking. A couple of buts might more properly be ands. Suddenly I am surrounded by however, furthermore, in addition or additionally, and therefore. A little CTRL + 4 action shows 7 however, 4 furthermore, and a walloping 9 additionally uses all within a 9-page original investigation.

Gliding across all-purpose transitions is quite easy as one goes about identifying and focusing on the musts. An all-purpose transition works because it is a transition regardless of whether it functions specifically.  When faced with rapid-succession infelicities, I strike them, perhaps keeping the first. Items of note are apparent from their inclusion. As such in most cases has no actual antecedent. A congenial and from a misbegotten but adds to readability. A quick note to the author usually begets a response ranging from “ok thanks” to something a little more effusive but not overboard.

We have become accustomed to reading right past transitions perhaps because we are not striving for literary awards. No one throws a parade to celebrate a sentence whose dispatched as such has hit the bricks.

Why note how transitions are used? I’m not advocating parades, which would eat significant processing time. Accurate transition use is part of a standard of completeness. Every movement toward specificity is worthwhile to give readers a clearer view of the author’s point. With this in mind, every transition, as such, is of note.—Timothy Gray

What’s the Magic Word?

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At the beginning of this year, I had the opportunity to escape the slowing thawing tundra of Chicago to attend the 2018 Council of Science Editors Annual Meeting in sunny, Spanish moss–scented New Orleans. In between trips on the streetcar (where I resisted yelling “STELLA!!!” out the window at French Quarter passersby) and consuming half of the Western Hemisphere’s stock of powdered sugar on a plate of beignets, I—along with several women from JAMA Network (#squadgoals)—took in panels on several pressing topics in the scientific publishing community, such preprint servers, image manipulation, diversity in publication staffing, social media, and data sharing.

One of the most highly anticipated discussions was the last panel on the last day, and although conference fatigue was beginning to set in, we sipped our Diet Cokes with determination to soldier through and gain insight from “The Copy Editor–Author Relationship: A Delicate Balance.”

The panel was led by Peter Olson, Senior Copyediting Coordinator at Sheridan Press, and Jessica LaPointe, Managing Copy Editor at the American Meteorological Society. Mr Olson was the first to present and spoke on the “Anatomy of an Author Query.” He highlighted the symbiotic relationship between copy editors and authors and the various challenges that are involved in the editorial process, including tight deadlines, busy schedules, the differing interpretation of editing comments, and the need to convey complex concepts in a way that maximizes the author’s experience and answers the questions of what, when, and why. He offered 4 central tenets for copy and manuscript editors to follow when querying authors:

  1. Be clear. When queries are unclear it can confuse and/or annoy the author, and you may get an equally unclear response. You can’t assume that the author has a perspective on the comment’s meaning or on the ins and outs of your publication’s editorial process or style guide. Instead of simply asking if edits are okay, provide a brief rationale for the change being suggested and indicate if something is a journal/style requirement. When asking the author to clarify something in the text, articulate what is unclear and, if possible, suggest an edit.
  2. Be concise. If your queries are concisely worded then it saves the author time in reading and understanding them, which can make them happier with the editorial process in general. Try to imagine the author’s perspective when creating queries and consider consolidating comments into 1 query (eg, “Please approve all edits in the sentence beginning…” or “Please provide corresponding data for all P values in this paragraph”). Formulating and using standardized queries for comments that you find yourself frequently making in manuscripts can also help save time for you and the author.
  3. Be accurate. Make sure that the way you have phrased your query reflects the edits that need to be made. Although there are no doubt highly trained PhDs and statisticians among us, many manuscript editors (present company included) do not come from a scientific background, and on occasion it may be appropriate to indicate that you are unclear of the subject matter of the sentence. For example, it is better to point out a perceived inconsistency than to just make a change in cases in which the same abbreviation is used to mean 2 different things, or if a sentence has multiple subjects and it unclear to which one data are referring.
  4. Be professional. Avoid language that is informal, flippant, curt, contentious, critical, or hostile, as well as casual abbreviations and exclamation points. Instead of making an open-ended comment like “Can we be more specific here?” specify what needs to be explained. Comments like “This reference needs to be sourced” provide a directive but are not helpful in indicating what information is needed. With authors you sometimes get more with sugar than with spice, so please be sure to actually use the word please and ask them for the exact thing that you need for them to do. As my mother used to say when I pleaded for a Fruit Roll-Up or the chance to watch Bill Nye the Science Guy, “What’s the magic word?”

Ms LaPointe was up next with her presentation on “Maintaining the Delicate Balance.” She stressed the importance of using a light touch to balance editing for clarity with changing meaning and taking your time during editing to potentially lessen the number of queries you need to make. Additionally, she focused on how to work successfully with international authors and presented a series of myths on the challenges that dynamic presents:

Myth 1: Papers from Asia present particular challenges. These authors actually usually write very clearly, utilize effective editing services before submitting articles, and consult with English-speaking colleagues extensively during the writing process.

Myth 2: An extensive English-language education eliminates problems. Authors who are very familiar with English, such as European authors, may have more confidence in than ability with the language and may be reluctant to use US English.

Myth 3: Copy editors prefer editing for English speakers. I think that we can all attest that courteous, cooperative authors are the best authors, no matter where they come from!

Ms LaPointe finished her presentation with a reminder that frankly, English is hard (even for native speakers!), and pointed out some common errors to look for when working with international authors, including preposition confusion (on words such as associated, accompanied, based, center, dissimilar, identical, off, and trade), plural vs singular, disconnected sentences, word choice, the confusion of “eg” and “ie,” and the incorrect use of “et al.”

We all know that maintaining the delicate balance between applying style rules and accommodating author satisfaction can sometimes feel like being stuck in a hamster wheel, but hopefully some of these tips will prove helpful for your editorial process and professional interactions. Just remember the magic word, and if all else fails (and you don’t happen to work on a cardiology publication), you can always treat yourself to the best cure-all for all author woes—a heaping plate of beignets piled with powdered sugar.—Amanda Ehrhardt

What’s in a (Drug) Name?

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I’ve recently joined the JAMA Network after a brief career in pharmaceutical editing, where I’ve read everything from the easy-to-digest pamphlets that come with your prescription to the headache-inducing instructions chemists follow when testing that a drug meets its quality compliance requirements.

One of these jobs required the terrifying task that editors, after editing an assignment, would sit together and read aloud entire monographs and articles to confirm all changes.

Real talk: I love editing because I get to read alone all day. I avoid public speaking whenever possible. Mustering the courage to read aloud in front of other people for hours on end—let alone pronounce words I’d never seen before—really revved the ol’ anxiety engine.

After countless sessions of tripping over impossible-to-say generic (or nonproprietary) drug names, I finally decided to do some research on my multisyllabic angst inducers.

Enter the United States Adopted Names (USAN) Council, a team composed of representatives from the American Medical Association, the United States Pharmacopeia, and the American Pharmacists Association, as well as a US Food and Drug Administration liaison and 1 member-at-large. This team “is responsible for selecting simple, informative, and unique nonproprietary (generic) drug names,” according to its website.

“Simple,” they say?

But, in fact, the names are not as daunting as I once thought and are often broken down into a general pattern. Again, from the USAN Council website:

Prefix: Means nothing; differentiates drug from others in class

(See? Nothing to be scared of here.)

Infix: Used occasionally; further subclassifies

Stem: Indicates place in nomenclature scheme; drugs with the same stem are related

(The stem is considered the pharmacologic family name and can be broken into further subgroups.)

 An example:

Cobimetinib

Prefix: co-

Infix: -bi-

Stem: -tinib (meaning: tyrosine kinase inhibitors [anticancer drug])

Stem subgroup: -metinib (meaning: MEK inhibitor [anticancer drug specifically to treat melanoma])

It also helps that the USAN Council strives to place any new drug into already existing families, so once you’ve seen several drugs in that family, pronouncing their siblings should be a breeze.

Next up for me: Conquering my Dorland’s Illustrated Medical Dictionary. Wish me luck!—Jamie Scott

 

 

Pop Quiz, Hotshot

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What’s the most important quality to have as a manuscript editor?

A few obvious traits come to mind, like attention to detail and command of the language and style.

When I was hired a few years ago, I wasn’t worried about developing those skills because I figured they would all get better with time and experience. My biggest worry—and what I thought was the most important quality—was speed.

I had 2 types of speed in mind. I wasn’t as worried about speed of editing for style because I knew I just needed to keep working with the style guide. After enough repetitions, of course I wouldn’t need to refer to the book as frequently, and the recognition of a style point would become recall of the answer.

No, I was most anxious about speed of reading. Obviously, reading comprehension was the key, but I even Googled how to strengthen eye muscles to prevent fatigue. Manuscript editing is sort of professional reading, so I thought the best editors should be the best readers.

I don’t know when exactly my anxiety went away. I don’t think it was just the repeated advice from my manager and coworkers—I heard that for months without it truly sinking in. But eventually, I stopped thinking about it, started focusing on other aspects to improve, and fell into a steady editing pace.

The change in thinking has been good for my sanity, but I’m not convinced my original idea is entirely wrong. Reading speed isn’t as important for me as I once feared, but I still wonder where speed ranks in the list of necessary qualities for an editor.

Freelancers, proofreaders, and managers: how important is reading speed in your job? Leave us a comment!—Kevin Brown

AMA Style in the Wild

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For many years, my best friend Conchita (not her real name—but she’ll appreciate this reference) and I lived accidentally parallel lives. We were band geeks together, shined in the back row of the chorus during high school musicals, and scrambled to compose an extremely derivative opera (a recording of which I’m pretty sure still exists, unfortunately) to satisfy a creative writing assignment in physics class. But whereas I dreaded said physics class with the fire of a thousand burning suns, Connie excelled in all things scientific. It was no surprise to me when she earned her Masters in Public Health, but it was a surprise when we both ended up in careers relating to the medical field. What was especially enjoyable was that the idle chit-chat usually reserved for whichever high school classmate had just had a baby could now be applied to hyperspecific work-related things, including our beloved AMA style.

Although initially I seized on our collective use of AMA style to complain about authors who had only used abbreviations 4 times, I became interested in learning how she used it in her corner, as I had previously assumed that AMA style was the domain of journal manuscript editors. So I gathered some questions together and polled both Connie and Edgar (name also changed), a former colleague of my fellow blogger Iris, to ask how they used AMA style in different areas of medical communications.

Edgar is an editor for a global advertising company whose clients provide products such as pharmaceuticals, medical devices, and guides relating to health and wellness. The writers and account managers creating their copy are required to be familiar with AMA style, and the style guide for each account has a template of “[X drug] uses AMA style with the following exceptions.” These exceptions usually come in the form of client preferences for the text and layout, which leaves Edgar with the challenge of how to be the resident style stickler while keeping the client’s dictates in mind. Ultimately, while a client’s spatial limitations may not allow for the correct number of thin spaces between P values, “no client style guide can match the AMA for depth and breadth” and it is an important organizing tool.   The final product represents a mix of both AMA style and client preferences, but, as Edgar puts it, “One veteran editor told me years ago, rather cheekily, ‘Not even AMA uses AMA style.’ … What he was getting at was that it’s a great tool to be adapted rather than followed in strict orthodoxy.”

In Connie’s previous role in the editorial services group of a medical communications agency, “The AMA Manual of Style was THE BIBLE. Past colleagues achieved mythical status for their ability to recall which section of the AMA manual housed the elusive answer to the day’s grammatical conundrum.” (As you can see, Connie also excelled in English class.) She now works for a pharmaceutical company in their labeling and product packaging divisions, which comes with its own set of complicated rules. The documents she works on (such as a product insert for a specific drug) are not organized with any one editorial style in mind, but rather in terms of their audience (eg, patients vs prescribers). Because these documents are written by multiple authors and pass through many hands before Connie sees them, the text can sometimes represent a hodgepodge of styles. However, because the text is also regulated by the FDA and any changes beyond simple typos would be subject to review by medical, legal, and regulatory teams, these inconsistencies often remain intact. In the rare opportunity when Connie is allowed to make edits on small items, she uses AMA style as a guide on things like italicization, reference lists, and capitalization to make her process more straightforward and efficient.

So my takeaway from these conversations is that while nobody will probably ever apply AMA style as strictly as manuscript editors do (and if we’re honest with ourselves, we probably take some proud satisfaction in that!), AMA style is a useful and important fall-back in other areas of medical communications because of its consistency, specificity, and efficiency. But for your sake, I promise that Connie and I won’t compose an opera about it.—Amanda Ehrhardt

Grammar Myths

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A Grammar Girl podcast from March 2018 in celebration of National Grammar Day detailed 10 common grammar myths. Some are plainly incorrect, some are overgeneralizations, and some are points of disagreement between different stylebooks. Even good writers (and editors) get it wrong sometimes!

I’ve seen authors use the term “run-on sentence” to describe a sentence that, while grammatically correct, may have overstayed its welcome. Medical articles are full of long sentences: when adding a word, a clause, or parenthetical numerical values makes the meaning clearer or renders a statement more scientifically accurate, we’ll do it! As Grammar Girl points out, “In a run-on sentence, independent clauses are squished together without the help of punctuation or a conjunction. If you write ‘I am short he is tall,’ as one sentence without a semicolon, colon, or dash between the two independent clauses, it’s a run-on sentence even though it has only six words.”

Use of the passive voice (GG’s myth No. 6) falls under the category of overgeneralizations. The active voice is often your best bet. According to the AMA Manual of Style, “In general, authors should use the active voice, except in instances in which the actor is unknown or the interest focuses on what is acted on.” When I first started working in the field of medical editing and my manager advised me to avoid the use of the first person in abstracts even if it meant rewording to use the passive instead of the active voice, it blew my mind a little. I certainly understood when a perplexed author took me to task for edits that changed the wording of a sentence in his abstract from active to passive. (I also learned the value of a comment specifying why I’ve made a change when it’s something that might not be obvious to an author.)

To further confuse things, different style guides have different rules, and when the guides disagree, a variation can seem like a mistake. Myth No. 7 deals with possessives and the apostrophe-s. AMA style is to omit the final s in the possessive form of a name that ends with s, using only an apostrophe. However, even editors sometimes have the admonitions of long-ago English teachers stuck in their heads. In college I learned that an ‘s was always added, except for classical or biblical names. So the phrase, “Harold E. Varmus’ discovery of retroviral oncogenes,” for example, sets off alarm bells in my head. Yet per AMA style, it’s absolutely correct.

My favorite of Grammar Girl’s myths was No. 3: “It’s incorrect to answer the question ‘How are you?’ with the statement ‘I’m good.’” When someone asks me how I am, and I say “good,” and when I ask them how they are in return they say “I’m WELL,” it feels like a citizen’s arrest, and I don’t love it. But I’ve always thought these scoldilockses were technically correct because the verb am should be modified by an adverb, well. Not so! GG points out that “‘good’ isn’t modifying ‘am’ in the sentence ‘I am good.’ Instead, ‘good’ is acting as the subject complement and modifying the pronoun ‘I.’” This one was news to me—turns out even editors fall prey to grammar myths sometimes!—Heather Green