editing process

People-First Language

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

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

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

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

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

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

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

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

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

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

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

 

Readability

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A common assumption about those of us who copy edit science papers is that we have a science background. Some of us do, but by no means all. After [mumble-number] years in the medical publishing field, I might feel like I “practically” went to medical school, but I did not. I could probably take out your gallbladder, though. Want to let me try?

Anyway, as long as you are a good reader, writer, thinker, and editor, and know your way around IMRAD, it is possible to edit a manuscript on a wholly unfamiliar topic. The authors are the content experts; the paper has (probably) been through peer review; and the copy editors have skills, coffee, and Google.

When a paper is excruciatingly hard to edit, it’s not usually because of the science but because of the writing. Some authors pile up jargon like hoarders collect cans of beans, as protection against the deadly apocalypse of someone being able to read their article without feeling squashed by the weight of all those words. Why settle for a teeny nothing word like “use” when “utilize” sounds so much more important? Why give us actual data when you can just talk about “trends” and “robustness”? Make sure you add a lot of “it has been shown that” and “the fact that.” And make sure you start every sentence in the Discussion section with “furthermore” or “moreover”!

Real talk from Nature: “You can always look up jargon, but with a poorly constructed sentence you’re on your own.” The best-case scenario between author and manuscript editor is a partnership—we don’t want to be on our own! We want to help explain complicated things in a simple way, and that often starts with authors picking the most direct words available.—Brenda Gregoline, ELS

Ding Dong: the Death Dagger Is Dead

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AMA Manual of Style, section 2.3.2, has an ominous subheading: “Death.” I’ve quoted it below:

Death. If an author of an article has died before the article goes to press or is posted online, a death dagger (†) should follow the author’s name in the byline, and one of the following footnotes should be inserted after the author affiliation footnote.

†Died November 17, 2005.

†Deceased.

Okay. That’s super-goth and all, but…why? Is that useful information for a reader? Does it serve any purpose other than a moment of recognition that life is fleeting, memento mori, etc?

Also, the life of a scholarly article is long—why single out the author who died during a relatively narrow window (from acceptance to publication)? We’re all going to die someday, including every byline author. (Sorry if you came to AMA Style Insider for happy feelings. Here is a picture of a puppy.)

At a recent stylebook committee meeting, we decided to kill the death dagger. (Get it?) If authors want to note that a coauthor is deceased, a note can be put into the acknowledgment section instead.

Interestingly, the dagger symbol is sometimes called an obelus. A variant on this symbol was probably used by Homeric scholar Zenodotus to critically mark lines in manuscripts that were of dubious attribution. The Oxford English Dictionary uses it to note that a word is obsolete. It seems a bit cruel to use the same typographical mark to denote a person as dead and to mark a word as obsolete—-but I suppose I can see the connection.—Brenda Gregoline, ELS

 

 

Raising (Rearing?) Hell

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Besides the dropping energy levels and unsightly wrinkles that daily remind me of my advancing age, I never expected an Associated Press style rule—beaten into me as a young reporter—to deliver the one-two punch that landed me squarely into the “old fogies” category.

I was editing a JAMA Viewpoint about a fairly modern question involving gender identity, hormone levels, and eligibility for women’s athletic events when my knee began to jerk at first sight of the descriptor “raised,” as it applies to how or where someone grew up.

As soon as I saw the word, I heard harsh tones in my head and felt the breeze of a wagging finger: “Corn and cattle are raised, people are reared!” So I dutifully changed “raised” to “reared” as the AP Stylebook commands. Soon, I sent the proof off for review by the senior editors and the authors.

As I had predicted, one of the medical editors deleted “reared” and inserted “raised.” I knew I was right about this! I was poised to cross off the edit when I thought, “Maybe I should look at a newer version of a stylebook, just to see if the rules have slackened over the decades.” (Our own AMA Manual of Style is silent on the matter.) My office was too cluttered to find the newest Associated Press Stylebook, so I turned to Google.

The first search result was titled “Grammar Gremlins: Is it ‘reared’ or ‘raised’?” I clicked—who says a pithy headline doesn’t draw in a reader?  Knoxville News Sentinel Columnist Don Ferguson, who by his photo looks older than me, offered his first sentence:

A recent Associated Press report about an accused terrorist said the man was “born and reared” in America.

He followed with,

Did this use of “reared” instead of “raised” say something about the age of the writer?

Oh my goodness! Who would have thought that old style rule would say more about me than my slowing gait? He noted that youngsters favor “raised.” He cited Garners Modern American Usage’s calculations that “born and raised” is used 8 times more often than “born and reared.”

As with most of often-confused words, he also noted that dictionaries say either is correct.

I dropped my pen and conceded the edit.—Beverly Stewart

 

 

 

Quiz Bowl: Sentence Structure

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

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

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

Highlight for answer:

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

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

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

Quiz Bowl: Editing and Proofreading Marks

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tr, swk, wf, lc.

No, the vowel keys haven’t fallen off my laptop keyboard. Those are just a few examples from this month’s quiz on editing and proofreading marks. Although most editing and proofreading are now performed electronically, corrections still sometimes need to be marked on printed manuscripts and typeset copy. Because of this, editors need to be able to identify and use correct editing and proofreading marks.

Although most editors are familiar with marks such as stet, for let it stand, and Au?, for author query, some of the other editing and proofreading marks can occasionally cause confusion. This month’s AMA Manual of Style quiz offers a sampling of these marks to test your knowledge.

Included in the quiz are the meanings of the vowelless list above: tr, swk, wf, lc.

Highlight for the meanings of these marks: tr, transpose; swk, set when known; wf, wrong font; lc, lowercase.

To test your knowledge of additional editing and proofreading marks, check out this month’s quiz at www.amamanualofstyle.com.—Laura King, MA, ELS

Quiz Bowl: Editing Prose

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You asked and we listened! This month’s style quiz once again gives users the chance to practice their editing skills in a more in-depth manner. Previous quizzes on prose editing, as well as editing figures and tables, aimed to fill this need, but you still want more. So, here you go.

This month’s quiz is a full paragraph that requires editing to eliminate usage and style errors. Below is the first sentence of the paragraph. See if you can identify the problems.

We report a young patient who presented with dysphagia caused by a right aortic arch, aberrant left subclavian artery, and associated Kommerell’s diverticulum.

Highlight for answer:  We describe a young patient who presented with dysphagia caused by a right aortic arch, aberrant left subclavian artery, and associated Kommerell diverticulum.

According to the AMA Manual of Style, both patients and cases are described; only cases are reported (§11.1, Correct and Preferred Usage of Common Words and Phrases, pp 381-405 in print). In addition, the nonpossessive form should be used for eponymous terms (§16.2, Nonpossessive Form, pp 778-780 in print).

If you’re interested in more practice, check out the full quiz, as well as the Prose Editing 1, Practice Editing Tables, and Figures quizzes, on the AMA Manual of Style website.

And if there are any other quizzes you want to see, just ask. We promise we’ll listen.—Laura King, MA, ELS

Quiz Bowl: Editorial Processing and Assessment

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

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

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

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

editor

peer reviewer

both the editor and peer reviewer

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

editor

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

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

Quiz Bowl: Author-Editor Relationship

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

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

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

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

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

c. Do not respond to the author.

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

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

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

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

 

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