editing process

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

Ode to the Style Manual

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(A poem from a hardcore user of the AMA Manual.) (No, not the cat.)

I study the Manual each day and each night

Coming away with equal questions and answers

Seeking all ways to be right

Are you a temporary compound, both sides with a tall, proud face
or are you with us permanently but deserve only lower case.

Are you a word just colloquial–or maybe even worse–

The ever-intrusive –ology (ie, completely perverse)

Have you been with us 5 times or more

Making a point so precise and succinct

Or are you here fewer times but wind up using more ink

It’s often exhausting, I must admit

I feel like I’m chasing elusive catnip

Each time I move close to the intoxicating scent

I discover new Elements that were recently sent

They arrive in my inbox with regular speed

And though I accept them, I must concede

I’d rather they land in another box I need

I give up and lay (or lie?) down

Staring off into space

Who knew that reading required such mental pace

But eventually I notice the pillow I chose

The source of all I have said

Provides a solid foundation from which to function

Indeed, a good place for my head

Finally

I must admit to own

The penultimate of nerdity

In my discomfort with the structure of

A poem on editing’s absurdity—Donna J. Thordsen

Cheat Sheet for Abbreviations Style

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Abbreviations are a convenience, a time saver, a space saver, and a way of avoiding the possibility of misspelling words. However, a price can be paid for their use. Abbreviations are sometimes not understood. They can be misread, or are interpreted incorrectly. … The person who uses an abbreviation must take responsibility for making sure that it is properly interpreted.—Neil M. Davis1

Abbreviations are used widely in medical articles, and great care should be taken to provide expansions that define these abbreviations. The AMA Manual of Style includes a straightforward rule regarding the use of abbreviations: Define abbreviations at first mention by providing the expanded term first, followed by the abbreviation in parentheses, and the abbreviation is used thereafter.

But for every rule, there are exceptions.

Some Exceptions:

• Avoid creating abbreviations for terms that are easy to spell out and do not take up a lot of space. For example, it is not advisable to abbreviate “catheter ablation” as “CA” or “immune response” as “IR.” Also, avoid using too many abbreviations in any one article.

• If a term is better known as an abbreviation, provide the abbreviation first with the definition following in parentheses. “The TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling) staining assay was carried out using an apoptosis detection kit.”

• It is inelegant to begin sentences with abbreviations, unless the expansion is so unwieldy that using the abbreviation makes sense. The previous example, TUNEL, also works here. Rather than begin a sentence with the cumbersome expansion, it is acceptable to begin the sentence with the abbreviation TUNEL.

• Abbreviations should not be introduced in headings. If an abbreviation is being used for the first time in a heading, expand the abbreviation in the heading; then, at first mention in the running text after the heading, expand the abbreviation again, with the abbreviation following in parentheses. Use the abbreviation thereafter.

• Some very common abbreviations do not require expanding at first mention, such as AIDS, TNM, UV, and CD-ROM. A complete list of these abbreviations is provided in section 14.11, with those that do not require expansion denoted by an asterisk.

• The efficiency of using an abbreviation is lost if the abbreviation is used only one time, so as a rule of thumb, introduce an abbreviation only if it is used at least 2 or 3 times.

Items of Note:

• Tables, figures, and abstracts are treated as separate items from the text, so abbreviated terms must be reexpanded in each of these items.

• Use the appropriate article (a or an) before an abbreviation according to the sound following the article (eg, a UN resolution, an HMO plan).

• Use a lowercase s (and no apostrophe) when making abbreviations plural (eg, NSAIDs).—Lauren B. Fischer

1. Davis NM. MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety. 13th ed. Warminster, PA: Neil M Davis Associates; 2007:1.

Masterful, Masterly

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Writers are often taught that masterful and masterly mean different things and to ensure that they are used correctly. Masterful, so such thinking goes, is taken to mean “suggestive of a domineering nature,” or “inclined and [usually] competent to act as master,”1 whereas masterly is used to denote “having the power and skill of a master.”1

However, the use of masterful to mean “skillful” is now widespread; as Bernstein, clearly a proponent of maintaining the distinction, pithily puts it, “masterly is never misused; masterful often is….”2 Moreover, it seems that the distinction has not always been observed. Whereas masterful has been used in the sense of “domineering” since the 1330s,3 it also was used to mean “skillful” as early as 1613.3 And whereas masterly was used in the sense of “skillful” since the mid 1600s,3 it also was used to mean “domineering” as early as the 1530s,3 although that use has been obsolete since the late 18th century.3

In short, both words have been used to indicate “skillful” since roughly the time of King James I of England. However, the idea that writers should distinguish between them is comparatively new1—and such a late addition of a distinction is the reverse of the more common case, in which a distinction between words ceases to hold sway as the language evolves.

The origin of the distinction? Merriam-Websters posits that it was “excogitated by a 20th century pundit”1—this “pundit” apparently none other than Henry Watson Fowler, editor of The Pocket Oxford Dictionary, coeditor of The Concise Oxford Dictionary and The King’s English, and author of A Dictionary of Modern English Usage.4 In the latter work, Fowler established a distinction between masterful and masterly that was taken up by authorities such as Bernstein2 and that continues to be trumpeted to this day.5 Fowler’s reason for introducing the distinction? Masterly has only 1 sense (at least since its use to mean “domineering” became obsolete), so masterful should be limited to a single sense as well.1

However, some also have argued for the use of masterful in place of masterly in adverbial constructions, pointing out that although masterly is properly used as an adverb as well as an adjective, its use as an adverb seems awkward, even incorrect; eg, “He paints masterly.”2 Moreover, masterly, like many words ending in “y,” is what Bernstein (who nevertheless advocates distinguishing between the words) calls a “reluctant” adverb—ie, a word that resists serving as or being turned into an adverb.6 To make matters worse, masterly takes another adverbial form, the admittedly horrid masterlily.

Where does this leave the conscientious writer? Like Fowler, several modern authorities deem the distinction a valuable one5 and often advocate recasting a sentence to allow a more mellifluous use of a reluctant adverb5,6: hence, the sentence “Its wooden gables… showed how masterly they had been carved of old”3 might be recast as “Its wooden gables… showed the masterly manner in which they had been carved of old,” or similar. “A retreat of this kind,” Bernstein maintains, “is better than clumsy bravado.”6

At least one like-minded authority, however, has conceded that the battle to maintain the distinction—whatever its merits—has likely been lost.5 The prevalence of masterful in everyday usage confirms that opinion, receiving further support from the fact that the words have developed in roughly parallel fashion over time.3 Merriam-Websters concurs, maintaining that masterful used in the sense of “skillful” “has continued in reputable use all along; it cannot rationally be called an error.”1 Moreover, it has been suggested that using masterful in its original sense might even confuse readers now accustomed to the use of masterful to mean “skillful.”7

The bottom line:

● Using masterful in place of masterly to mean “skillful”? You’re in good company, and that usage has a long history. However:

● Set on maintaining a distinction between masterful and masterly? You can’t go wrong there, either. True enough, some readers might be confused by the use of masterful in its original sense—but since when do writers shrink from using words correctly to avoid confusion?—Phil Sefton, ELS

1. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003:764.

2. Masterful, masterly. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:269.

3. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:1045.

4. Sheidlower J. Elegant variation and all that. The Atlantic Online Web site. http://www.theatlantic.com/past/docs/issues/96dec/fowler/fowler.htm. December 1996. Accessed September 16, 2011.

5. Masterful, masterly. Good English Rules! Web site. http://www.goodenglishrules.com/masterful_masterly.htm. Accessed September 16, 2011.

6. Adverbs, reluctant. In: Bernstein TM. The Careful Writer: A Modern Guide to English Usage. New York, NY: Athaneum; 1985:27.

7. Masterful vs. masterly. Grammarist Web site. http://www.grammarist.com/usage/masterful-masterly/. Accessed September 16, 2011.

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

Ventilate or Ventilation

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“The patient was ventilated.”

“We decided to ventilate the patient.”

Such statements are commonly overheard in critical care units and other areas when clinicians discuss the care of a patient experiencing insufficient or absent respiration. Both statements use forms of ventilate in ways that—because they appear in this sense in the latest edition of Merriam-Webster’s Collegiate Dictionary—are correct and so may be used in medical journals. However, writers and editors have a valuable opportunity to ensure the continuing precision of the language through careful use of such terms and their variants, referred to as back-formations.

As discussed in the 10th edition of the AMA Manual of Style, “Back-formation is the creation of a new word in the mistaken belief that is was the source of an existing word” (see §11.3, Back-formations, in the AMA Manual of Style, p 407 in print). Back-formations are formed by the removal of a suffix (either a derivational suffix such as -ion or an inflectional suffix such as the plural -s) from a word that actually appeared first, changing its part of speech and forming a new word. Thus, the verb ventilate when used in the clinical sense may well be such a form, as suggested by its appearance in common use slightly later than the appearance of the noun ventilation (early 1900s vs 1890s, respectively).1 Interestingly, however, users of the English language had been busily back-forming for some time before that: ventilate as used in the closely related sense of exposing the blood to air, now obsolete or nearly so apart from its use in the study of physiology, likely also represents a back-formation that appeared some 50 years after ventilation as used in this sense (1660s vs early 1600s, respectively).2

Back-formation plays a valuable role in language evolution, producing neologisms that often subsequently enter common use. However, coining verbs through back-formation can result in medical jargon (see §11.4, Jargon, in the AMA Manual of Style, pp 408-409 in print) that is vague, depersonalizing, and sometimes downright comical in the images it can evoke. Taking the case in point, for example, what does “the patient was ventilated” mean, exactly? Was the patient perforated? Fitted with louvers? Left outdoors?

While it is commonly understood that the use of ventilated in this sense in spoken English denotes the use of a mechanical ventilator or other means of artificial respiratory assistance (eg, use of a bag-valve-mask apparatus), it typically refers to the former. However, in written materials, the use of mechanical ventilation should be explicitly reported when appropriate. In addition, eschewing the use of assistance altogether is perhaps advisable, and certain constructions (eg, “was” or “on” constructions) should be avoided if they lead to ambiguity such as that noted above. For example, “the patient was ventilated” and “the patient was placed on a mechanical ventilator” should be rewritten to read “the patient underwent mechanical ventilation.” In some instances, it might also be helpful to report additional information to clarify whether the intervention was invasive (ie, required endotracheal intubation, nasotracheal intubation, or tracheostomy) or nonvasive (eg, used a mechanical, sealed-mask approach such as BPAP [bilevel positive airway pressure]).

Writers and editors of medical information, then, should be vigilant when using terms coined through back-formation. Such terms should not be used if they do not appear in a current dictionary of reference. Those that do—eg, ventilated—may be used, but writers and editors should take care to ensure that they are not used in ways that are vague, depersonalizing, or unintentionally comical. Ultimately, however, a bit of back-formation is not a bad thing—for example, edit is a back-formation coined from editor.3—Phil Sefton, ELS

1. Ventilate. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
2. Ventilation. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:2223.
3. Back-formation. In: Hoad TF, ed. The Concise Oxford Dictionary of English Etymology. Encyclopedia.com Web site. http://www.encyclopedia.com. Accessed August 5, 2011.

Abbreviation Nation

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Of the reference books I use while editing the Archives journals, my favorite by far is MEDical ABBREViations: 28,000 Conveniences at the Expense of Communication and Safety, 13th Edition, by Neil M. Davis. Not only does it have the most wonderfully snarky title I’ve ever seen on a reference book, but it is the Great Decoder, the book that allows me to make sense of the myriad abbreviations I run across in my daily work.

As much as we are a nation of people who speak largely in cliches and mixed metaphors (I will save my rant about the overused and incorrect “magic bullet” for another day), we are a nation of overabbreviators. The number of organizations that are known by their abbreviation are too many to quantify (NFL, AMA, NORAD). We put out APBs, send out CVs, take our OTC meds, surf our Macs and PCs, and occasionally go AWOL. But when you think about it, do these mean anything? A National Football League is a thing. An NFL is not. What about an AC? Is it an air conditioner? An alternating current? Atlantic City? Though sometimes context can tell us what an abbreviation means, just as often it cannot, and it’s my job to sort these out.

As someone who previously tried to argue that texting is a valid and efficient method of communicating, it may seem hypocritical for me to do a mental fist pump every time I read Mr Davis’ snappy title, but I do. It’s because for every abbreviation that I find easily in my AMA Manual of Style or my MED ABBREV, there are so many that I must ask authors about. This worries me, because I don’t think authors would put these in their articles if they weren’t  routinely used. And though they and their colleagues and most of the American medical community may know exactly what they mean, will readers in Zimbabwe, Thailand, or Argentina? Those readers may have their own set of metaphors, jargon, and abbreviations that makes perfect sense to them. Or they may be students who don’t come across them every day. What happens when we let them slide, or when a journal doesn’t have finicky, know-it-all editors to question them? I worry that it will make journals less accessible, and that it will make medical discourse less accessible. I hate the idea of a medical student somewhere in the world not being able to use one of our articles in his research because I didn’t feel like finding out what something means. And believe me, sometimes I don’t feel like it. But I know I must be persistent, as annoying as it feels to harass a busy professional about something that seems so trivial. And that medical student out there better appreciate it.—Roya Khatiblou, MA

Quiz Bowl: Statistical Terms

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What’s the difference between an α level and a β level? Do you know your y-axis from your x-axis from your z-axis? What term means the spread or dispersion of data? This month’s quiz, which subscribers can find at http://www.amamanualofstyle.com/, can help you learn the answers to these and other questions on statistical terms. On the basis of your understanding of section 20.9 of the AMA Manual of Style, select the correct answer from the choices listed in the following sample quiz question.

Which of the following terms means the correlation coefficient for bivariate analysis?
r
R
r2
R2

So, how did you do? Here’s the answer (use your mouse to highlight the blank line):

Which of the following terms means the correlation coefficient for bivariate analysis?
r

R is the correlation coefficient for multivariate analysis. r2 is the coefficient of determination for bivariate analysis. R2 is the coefficient to determination for multivariate analysis.

If you want to further test your knowledge of statistical terms, subscribe to the AMA Manual of Style online and take the full quiz. Stay tuned next month for another edition of Quiz Bowl.—Laura King, MA, ELS

Go, Embargo, Go

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

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

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

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

Dr Readability: Or How I Learned to Stop Worrying and Love the Pronoun

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In academic writing, the current modus operandi seems to be: the more words the better. Why say “children” when we can say “individuals of pediatric age”? Why “time” when “period of time” sounds so much more substantial? Strunk and White1 would surely disapprove. Extraneous verbiage may make one’s writing sound lofty and important, but it can muddle one’s message. Writers should not use circuitous, rhetorical language to persuade their readers. Strong, clear writing, without extra baggage, creates a confident tone and allows the reader to more easily understand a work’s significance.

Here are a few ways to clean up one’s writing for easier reading:

Use the pronoun. Use it.

Writers often repeat nouns instead of using pronouns, as writers fear that readers won’t understand what the writers are saying. Not horrible, but is there confusion over what they refers to in this revised sentence: “Writers often repeat nouns instead of using pronouns, as they fear that readers won’t understand what they are saying”? Repeating the same word or phrase creates reading fatigue, like listening to someone beat on a drum over and over. Trust that your reader has a longer attention span than the time it takes to read half a sentence and there will be no need to use the same nouns over and over and over…

Here’s an example: “Because many people use vitamin therapy, we must determine the efficacy of vitamin therapy compared with other treatments.”

How about this instead: “Because many people use vitamin therapy, we must determine its efficacy compared with that of other treatments.”

Use the verb.

Editors are in agreement that “to be” constructions are weak and should be replaced with the actual verb. I agree!

Substituting “to be” constructions with actual verbs makes writing stronger and more confident. Researchers often use the phrase, “Our findings are indicative of…” See the “to be” hidden in there? How about “Our findings indicate…”? Were “patients in receipt of the drug” or did they “receive the drug”? Were participants “in attendance” or did they “attend”? The meaning is the same, but the writing sounds a whole lot better with the true verb.

This goes hand in hand with the passive voice. We’re not saying that the passive voice is wrong necessarily, it’s just that it is believed by some people that it is not as strong as it could be. Rather, some people believe that the passive voice is weak. In general, the active voice should be used over the passive voice, especially in cases when the “actor” is present. For example, “Patients were monitored by resident physicians” should be changed to “Resident physicians monitored the patients.”

This is another way to say: Use the delete button.

Close your eyes. Pretend you have a word limit. Now, pretend you have to follow it. Would you rather cut 100 words from the “Results” section or 100 words throughout a manuscript that add nothing of substance substantial? See what I did there?

Here are a few substitutions that reduce wordiness:

–“combined with” instead of “in combination with”
–“important” instead of “of importance”
–“most” instead of “the majority of”
–“can” instead of “is able to”
–“affect” instead of “to have an effect on”

Eliminating exaggerations can also trim one’s writing. How often is quite, very, or rather necessary (or accurate)? Writers should also avoid superlatives like profoundly and significantly when describing a study’s results.

These tips will help eliminate excess verbiage and heighten readability while preserving meaning. What is there to be afraid of fear?—Laura Adamczyk

[author’s note: Some of these ideas came from lectures by Northwestern University professor Bill Savage, PhD.]
1. Strunk W Jr, White EB. The Elements of Style. 4th ed. New York, NY: Longman; 1999.