The Pricing Saga

I’ve been a full-time freelance writer/editor for a few years now, and a part-timer for a decade before that. Feels like I should have the pricing issues worked out, right? Nope. At the moment it feels as if I have hit a wall – pricing is tied to the growth of my business, and as a single editor, I have a finite amount of time. I have to make every hour count. So if I am going to have an income that increases with the cost of living, I have three options: bring in other editors who can take on the overflow; raise my hourly rate; or start using project-based fees.  I now recognize the need to address this issue or watch my income stall (or worse, watch my business wither away). Here is the argument that rages in my head:

1) The question of branding

There’s a great pair of posts over on An American Editor that discusses the pros and cons of staying a “solopreneur” or becoming part of a group of editors. I know this depends on the kind of editing you do, so I’m still working through this. Up to this point, I have been selling myself and my skills as my brand. Should I expand my brand to include other editors and their skills? But the bigger obstacle is administrative. I can’t even fathom how I would handle my projects plus management of other editors’ projects and payments. I would definitely need to hire some kind of virtual assistant, and then there goes any extra income I would have gained by becoming a multi-editor company.

2) The pitfalls of project-based pricing

I have this mental block against project-based pricing, particularly for editing jobs. I find it incredibly difficult to anticipate the scope of editing projects, and usually end up underselling myself. For those clients who have insisted on a project-based fee, I have run into two issues. The first is that my estimate is taken as the project fee, with no room to increase fees should the scope of work change. In response, I have started to produce incredibly detailed scopes of work for these projects so that I can give myself some leeway to renegotiate (and something to fall back on when the client starts asking for more than what the fee covers), but it has been a bit of a learning process. I also have to remind myself to stipulate that a portion of the project fee will be paid midway through the project, or with the first deliverable, or whatever. Otherwise my cash flow gets seriously messed up.

3) The icky-ness of raising rates

I am probably justified in raising my rates, which haven’t really changed for – I am embarrassed to admit – 8 years. The first time I tried to raise my rates, I met with so much push back that it put me off trying again for quite some time. In fact, it resulted in this particular client hiring me at the new rate but telling me to limit the time I worked on the project (so that the final fee was about the same). Ugh. Really? I am going to take your project, work on it for X amount of hours, and then, no matter what state the project might be in, stop working and send it back to you? Really? At the risk of losing a pretty regular client, I tried to work faster to get everything done in the stipulated time frame–showing the client they get what they pay for–but I am always anxious that working faster also means producing poorer quality work. Which is definitely NOT a precedent I’d like to set.

The most recent experience involved me butting heads with client’s HR and the “company policy” that could not be changed no matter how valuable my services might be, so sorry. Again, I backed off because the project was a pretty big one and I didn’t want to  miss out and wonder where I was going to make up the income.

Now, I realize that this is no way to run a business, particularly now that this business is my sole source of income. I hate rocking the boat, but I know that when I fail to negotiate, I may be perceived as an amateur who doesn’t even recognize her own value. The business side of freelancing is really doing my head in.

To raise my rates, I think the easiest way is to go back and look at all of my service agreements, find the ones with rates that need to be changed, and for those that are about to expire, renew at the higher rates. I just have to be confident that I will find new clients who will accept my rates, knowing that they are getting a quality service.

For the project-based fees, I need to write out exactly what the fee includes, and if the fee is low, then the scope of work will need to be smaller. I need to make sure that my time is spent wisely, and that my effective hourly rate doesn’t shrink down to ridiculous.

So there is the glimpse of the pricing chaos in my head. I really know what I need to do, I just need the confidence to be the savvy business woman who can do it.

On niches and boundaries

2012 will be my first year as a completely independent freelance biomedical writer and editor. My freelance business has been through the various stages of hobby to side work to part time job to full time job, and this will be the first year that it represents all of my income. No pressure, right? When I first decided to make the final leap to full-time freelance last summer, I was understandably anxious about income and whether I could make this work without leaving me and my family eating macaroni and cheese every night. So I took any biomedical writing/editing projects I could find, regardless of whether they were proofreading, editing, or writing; regardless of the client: academic, agency, or not-for-profit; and regardless of the topic. I soon came to appreciate two things: (1) I am not “built” for all projects and (2) my time is limited and therefore precious.

What do I mean by being “built” for certain projects? I am one of many professional biomedical writers and editors. But my education, background, and experience make me unique. The question is, what kinds of projects, clients, and topics best suit me so that I am spending my freelance time in the best possible way? By taking any projects because I felt I had to in order to stay solvent, I was getting frustrated with the jobs I could do easily but that paid too little and also frustrated with jobs that were outside my comfort zone that made me struggle and feel I was wasting time. 

There are only so many hours I can work in a week, and so I needed to find those jobs I was best trained for in order to make the most of my time. I first had to admit that there were boundaries – a difficult thing to do because it felt like closing doors and because I never want to admit that I can’t do something. But it really wasn’t about saying I wasn’t able, it was more about saying that I have to choose the best projects that fit my particular skill set. I’m sure that I needed to go through that first anxious period of accepting every job, no matter how small or out of my niche, to learn this lesson.

The other important thing I came to realize is that while taking jobs that were outside my comfort zone could be personally frustrating, it is also not good business practice. Just like me, clients are looking for the best fit for their projects so they get their money’s worth. Accepting a job for which I am not a good fit may not lead to the best outcomes – for me or the client. It is far better to learn as much information about the project up front, evaluate the project through the lens of my ability and training and schedule, and then turn it down if the project just doesn’t fit. Better that than struggling and getting frustrated and, perhaps worst of all, running the risk of letting down the client and damaging my reputation.

So now I understand my boundaries – what’s my niche? I’ve discussed this in other posts, but I’ve come to realize that biomedical grant writing/editing and manuscript editing for academic clients is where I shine. My background in research, my experience in healthcare communications, and even my stint in healthcare advertising, have come together to give me a 30,000-foot view, an objective eye, and an appreciation for the funding agency’s perspective.

I admit, I still take jobs that aren’t grants or manuscripts but that are still within my comfort zone. But grants and manuscripts now make up the bulk of my projects. As much as I hate the idea that I might be limiting myself, that I am capable of much more, I have to accept that I am one person, and physically unable to do everything. (I have to sleep at least a few hours a night!)

So those are my thoughts on niches and boundaries – now, back to work!

Thoughts on Growth

I wished I could have made it to 50 posts before the end of the year, but alas. In any case, I thought I’d do one more, before I plunge back into grant editing for the February NIH cycle.

I was thinking about growth today – my professional growth as an individual writer and the growth of my freelance business – and where I want to go with this in the next 5 years. Professionally, I will never stop looking out for opportunities to learn new things, and will likely continue taking workshops through AMWA and other groups. This coming year, I’m planning on attending the NIH Regional Seminar on grants in Indianapolis, and I’m considering taking a similar workshop from the NSF and a local course specifically for SBIR/STTR grants. I’m a career student, I suppose! I also joined NORDP, and will continue my memberships in AMWA, CSE, BELS, and EFA – these are all amazing resources for keeping up with what’s going on in the field, finding new business leads, and networking.

Business-wise, I’ve just had to decide I need to reign it in with the growth. At this point in my career, I’m not interested in expanding my business to include other writers, so I continue to be incredibly busy just doing the writing and billing, with very little time for doing things that would grow my business – marketing, blogging more regularly, etc. I definitely would love more time to check in with my LinkedIn groups, participate in Twitter conversations, and read others’ blogs.

But when I’m busy, I’m really busy, and I have to be careful that busy doesn’t turn into overwhelmed and exhausted, and definitely not into burned out. One thing I hope to be able to do in the next 5 years is to hire an assistant to help with the administrative stuff – that would be an enormous help. Whether or not to grow my business further is something that will just have to wait. I’m not quite there yet. In the meantime, I am keeping close track of the careers of a few of my successful colleagues and watching how they are expanding their businesses.

But reigned-in growth doesn’t mean no growth at all. I have done pretty well within the grantwriting/editing niche this year, and I’m looking to expand on that to include NSF (biological sciences directorate) and NIH small business and technology grant mechanisms. Which is why I’m considering taking the workshops that are being offered this year in the Chicago area.

So that’s where I’m at as we enter 2012. Next year, I’m going to focus on settling into the freelance life a little more (can we say sensible scheduling?!), continue pursuing grantwriting as my market niche, and basically stay the course.

I hope everyone has a fantastic new year! See you on the other side…

Branding and Passive Marketing for Freelance Medical Writers

I attended a session at the AMWA annual meeting today on marketing for independent healthcare communicators (a fancy way of saying freelance medical writers). Deborah Gordon (GordonSquared) and Brian Bass (The Accidental Medical Writer) gave two fantastic talks about the importance of branding your freelance medical writing/editing business and the power of passive marketing. Deborah stressed the importance of branding your freelance business in a way that reflects who you are and what you stand for. Brian talked about building your reputation, then delivering on your marketing promises and gently reminding your clients about the value you bring.

I’ve often written about how trust is an essential part of my freelance medical writing business. I work with individual basic and clinical researchers who must trust me enough to hand over their data or their “next big idea” so that I can help them communicate it clearly – to journal peer-reviewers, to the NIH, etc. So to get new clients, I have to be able to assure them of my trustworthiness and my capabilities at the start. This is even more difficult because I work remotely, and usually am unable to meet face-to-face before a project starts.

So it became essential for me to develop a brand for my company, one that reflects not only trustworthiness, but also professionalism, experience, thoughtfulness, dedication, and attention to detail. I decided to rely on online marketing rather than direct mail or other print tactics, and I turned to a professional designer to develop my logo and website, and I did a lot of research of other medical writers’ websites to figure out what I wanted to say and the best way to say it. But my company website could only do so much to communicate a concept like trustworthiness (unless the color blue has a calming effect or something), so I also started a blog as a way to showcase how I think, what I think, and hopefully give potential clients a better idea of who I am and why they might trust me with their research.

So as Deborah was giving her talk on branding, I found myself nodding a lot (no, not nodding off, just nodding in agreement!). By creating a brand and then getting it out there through my website, my blog, Twitter, Facebook, LinkedIn, and even my AMWA freelance listing, I have been able to bring in new business, and do it fairly passively. In the past year, I’ve landed 3 clients who have found me through my blog because they liked what I had to say about one topic or another and many more people who contacted me because they liked my website. Even better, more than a few people here at AMWA blurted out “Oh, the Tobin touch” after I told them my last name. Which means that creating and cultivating my brand seems to be paying off.

Brian also introduced me to the idea of relationship marketing, which again had me nodding. Relationship marketing involves building your reputation and getting your name out there, marketing yourself whenever you can—though not with a hard sell, but with passive marketing. For example, each time Brian gives a talk for AMWA, he builds his reputation because his name is being seen and associated with a respectable group. Same goes for posts on LinkedIn or articles in the AMWA Journal. He may not be gaining clients directly, but when more people recognize his name, they may be more likely to remember him when they or someone they know is looking for a medical writer. You never know where opportunities will come from, and somewhere down the line, your name might get passed on to the right person. Keeping your name and brand visible and your reputation intact are critical to generating new freelance business.

But just building a brand and a reputation for your business and getting exposure is not the end of relationship marketing. You absolutely must deliver on what you have promised with your marketing. For me, I know I have delivered on my marketing promise if my clients feel that they were able to trust me with their data, that I understand their point of view and what they are trying to say, and that I helped them convey their thoughts clearly.

Another great piece of advice that Brian gave was that we should remind clients after the project is over about the value that we as medical writers brought to them. Brian wants his clients to look at his invoice and say, “Look how easy Brian made my life, he’s worth every penny.” Reminding your clients of your value doesn’t need to be overt; he suggested that in the cover letters you send with your invoices, you should add a short note reinforcing how you contributed and that you are looking forward to the next project. He also stressed the importance of helping your clients—in whatever way you can—and following up with emails, checking in often to see if you can help, and sending holiday cards to each of your contacts. By cultivating relationships with individuals, not companies, you are more likely to expand your business as individuals move from company to company. But above all, deliver on the promise of your relationship and prove your value.

A lot of great advice from some of the best in the medical writing freelance world…now go forth and brand thyself!

On the importance of definitions

I just received a link from a colleague on an AMWA listserv to an article in PLoS on one medical writer’s experience with ghostwriting. It got me all worked up, so I thought I’d share. First, let me make it clear that I completely agree that there is a problem, called ghostwriting, in which medical writers are asked to write a manuscript—based on someone else’s research, with very little transparency or author contact, and no acknowledgement of their contribution as either an author or in the acknowledgements section—for publication in the peer-reviewed biomedical literature. These medical writers might be freelancers or work directly for a publications planning or healthcare communications company, which is in turn hired by a pharmaceutical company. There are financial interests all over the place in this arrangement, no doubt about it, and that’s why it’s such a hot-button issue. Was the author of the PLoS article a ghostwriter? Sounds like it. Was she right to take a stand and question the ethics of what she was being asked to do? Absolutely.

So why did the PLoS article make me upset? Nutshell: It introduces confusion about medical writers, types of medical writing, and the types of companies that utilize medical writers and for what purpose. I’ll give the author the benefit of the doubt–something obviously got lost in translation as the article was repurposed from a presentation at a conference at the University of Toronto.

That said, the article would have benefited from some concrete definitions and descriptions of what kinds of medical writing are done at each of type of company mentioned: medical education companies, publication planning companies, healthcare communications agencies, and pharmaceutical advertising agencies. All of these entities work in some capacity with the pharmaceutical industry and either indirectly or directly with physician authors (thought leaders). But not all of these companies, or the medical writers they hire, ghostwrite manuscripts for physician authors to be submitted to peer-reviewed journals.

On first read, I came away asking, why was the med ed company part of an ad agency, and if it was, why were they doing pub planning? These seemed like some pretty big ethical red flags, but that issue was not explained to readers.

But then I re-read it several times, particularly the part about why she stopped. It wasn’t because of ghostwriting. It was because of the marketing doublespeak she was being asked to insert in her pieces, some of which were manuscripts. Lack of access to physician authors to confirm content and wordsmithing to fit a marketing plan are definitely ethical issues, and she was right to take a stand, particularly if she was working in a med ed company, which is supposed to produce content independent of the pharma company. (Again, those distinctions were not discussed.) Instead, issues about wordsmithing at a med ed company were presented in an article about ghostwriting. I am going to go ahead and assume that readers of this article are now really confused about what medical writing is.

The author ends with the suggestion that med ed companies be eliminated to remove the middleman, and that centers for guest authors be used to help researchers prepare manuscripts. That last part is a great idea, but all I read was “med ed companies are the middlemen between pharma and physician.” Again, definitions that distinguish between med ed, pub planning, healthcare comm, and pharmaceutical ad agencies would have been helpful here.

While the article had many valid points, and I recognized some of the unethical wordsmithing issues from my experience in med ed and healthcare communications, I came away confused about the ghostwriting issue and what those pesky medical writers are really up to. Which is why I got upset. Done.

On becoming an expert

I had a great afternoon and evening with my fellow Chicago-area AMWA colleagues last week. We don’t meet often, and probably recognize each other more by our listserv postings than by sight. Naturally, we all must introduce ourselves, share our backgrounds, and add our two cents on a particular topic within the biz. I’m not sure when this happened, and I don’t particularly see myself as one, but somewhere along the way, I became an expert. I was actually asked for my opinion more than once about my work, my business, and current controversies and topics within our field. But I’m still learning! How can I be an expert?

Maybe it’s my accumulated writing experience, in academic writing, continuing med ed, healthcare comm, and now as a freelance business owner?But experience doesn’t necessarily make me an expert. Experience makes me a veteran–what makes an expert is the ability to learn from past/present experience, apply new knowledge, and continue to seek out new experiences.

And expertise is relative, isn’t it? There are certainly more expert-y experts than I (I was sitting next to one at dinner), and I might be considered an expert in certain areas and a complete novice in others. I lie somewhere on the continuum for any number of skills within medical writing and editing. And anyway, can someone become the absolute expert of anything? Isn’t there always room for improvement? I think so.

Which brings me back to the idea of my very first post – time debting (Happy blogiversary to me!). Really, it’s investing in myself and my development as a professional medical writer/editor, beyond the experience of writing and editing that I get paid to do. There are always areas where I need improvement, and it is essential that I stay plugged into the conversations and topics of the day within my field. In a nutshell: my professional development is as important as my background and experience. No matter how many years of experience I have within medical writing/editing, there will always be a need to continue learning, hone my skills, and accumulate and apply new knowledge.

So, even though it’s non-billable, I try to spend at least an hour a day keeping up with the latest news and topics in medical writing and interacting with my peers online. There are many free resources online, but I will pay for certain types of continuing education as long as I can justify the expense with some tangible benefit to me as a writer/editor or business owner. Here are a few of the resources I tap into:

LinkedIn groups – Sometimes there are really good discussions (though you might have to wade through some spammy posts), and they are a great place to hear about new topics and ask your colleagues for advice or opinions. You can sign up for the once-a-week digest, rather than getting your inbox inundated with updates all day long.

Twitter – Even if you just lurk, you can still learn a lot. (Though I highly recommend tweeting as well.) I (and the accounts I follow) use Twitter to share interesting articles and resources, and I tend to post about my love of science maps and art.

AMWA listservs – These are truly invaluable resources for AMWA members. Enough said.

Blogs – I read a few blogs posts a day, and follow blogs from researchers, doctors, other bioscience and medical writers and editors, journals, and professional associations. The posts usually lead me to other interesting blogs, articles, or links that I can share with my peers.

Journals – specifically, the AMWA Journal and Science Editor from the Council of Science Editors.

Meetings – AMWA of course. I can’t say enough about how much you can absorb by attending the annual meeting. There are also other meetings out there, both national and regional, where you can meet and learn from your professional peers.

Training – this fall, I am taking a grantwriting course at Northwestern, and next spring, I’m planning to attend the NIH Regional seminar.

The Multidisciplinarity of Freelance Medical/Science Writing

It was meant to be a funny status update–I mentioned on Facebook yesterday that I was spending my Saturday brushing up on neuroscience. As most people do, right? Then one of my fellow medical writers said something like, “Well, that’s part of our line of work, right?” It got me thinking that not only is freelance writing, of any sort, something that is done at all hours of the day and night, but medical/science writing is also a career that asks you to learn something new every day. At the moment, between my day job at the healthcare comm agency and my freelance business, I am writing about cardiovascular imaging, bronchoconstrictive disease, chronic kidney disease, oncofertility, neurobiology of memory, network and Web science, personalized medicine, primary care delivery, and health care policy. And writing about these things isn’t cursory. I need to understand the science, the medicine, the hypotheses, the theories, the applications, the implications, and the connections with other areas. It’s almost inevitable that each topic area ends up being seen not as independent but as interconnected: how will personalized medicine be applied to oncofertility? How can the Web inform health care policy? I am asked to apply all the segments of Bloom’s Taxonomy to each one and in combination.

And I think that’s why I continue to work all hours as a freelance writer. I absolutely love how it challenges me to learn something new, make new connections (and synapses), work in a truly multidisciplinary way, and then write coherently so that I can share that knowledge with various audiences. I don’t think I would be able to keep up my crazy schedule–brushing up on neuroscience while the kids are eating cereal and watching Caillou, or editing grants at 3AM–if I didn’t love it.

I also think this is why I am so entranced with maps of science – particularly this one – because they illustrate just how interconnected all areas of research are. It’s nice to think that my synapses may one day be connected in the same way…

Start at the End

Just a quick post on time management and deadlines. Used to be, when I did this freelancing medical writing thing on the side, I’d have one project at a time. I’d finish it, and if I had another project waiting, well, that was a bonus. I’d move onto that one, finish it, etc., etc. Now that the “on the side” has turned into a full-fledged medical writing business, this approach just won’t cut it. More often than not, I have multiple projects on my calendar, with overlapping deliverable milestones and due dates.

I just finished reading The Accidental Medical Writer by Cyndy Kryder and Brian Bass, and on the topic of deadlines, there is only one thing to say: Don’t miss them. Ever. I wholeheartedly agree. There is nothing worse than being late on a deadline. It’s a reputation killer.

How do I avoid this? I start at the end…I set reasonable deadlines. And the only way to do that is to make sure I know everything I can about the project up front – the scope, the deliverables, the client expectations. And I never promise a deadline until I’ve completely evaluated everything in the context of my schedule.

What happens if I do mess up and overpromise? I put on a pot of coffee and work all night, that’s what. I will not let myself miss a deadline.

That said, I do have some long-time clients who would understand if I contacted them ahead of the deadline to negotiate an extension. But the key here is “ahead of the deadline” — no one wants a call the night before to find out I’ve dropped the ball. But I try to avoid these calls altogether. If they don’t kill your reputation outright, they will erode it over time.

So, time management. I have a pocketbook calendar that I carry around with me everywhere – oldskool, I know, but I haven’t got one of them fancy smartphones yet. And then I have a plain old Excel calendar on my office computer, where  I can keep track of all my overlapping projects and deadlines and set a month’s worth of priorities. Nothing fancy. But without it, I’d be toast. Or someone would find me under a pile of Post-It notes muttering about dates and numbers.

Everyone does it differently, but the key for me is to know my deadlines, see how they fall out on the calendar, and then set (and re-set) my priorities so that I don’t miss any deadlines. I’ve had to move away from the one project-one deadline model to one that is more flexible and can accommodate shifting priorities, which happens almost daily as new projects are added to my calendar.

It’s all very exciting–and maybe a little scary–for someone who does well with a little more structure and predictability in her schedule, but I’ve learned to adapt and make the most of the freelance rollercoaster.

Back, and then forward

I suppose now is the time of year when I should look back at what I have accomplished and determine what worked, what didn’t, and what I could do differently next year. Unfortunately, I tend to over think everything, so I do this constantly (and obsessively), rather than limiting it to the end of the year. But I’ll go ahead and list some things I have learned…

Things that didn’t work:

Cash flow. This has got to be the most nerve-wracking part of being a freelancer. I just cannot seem get the hang of it. I thought I gave up my need to control things once I had kids, but this is a lack of control even beyond that. I am hoping that I can just learn to go with it next year, rather than harass the mailman daily about whether I got any checks. This is a tough lesson that I’m just going to have to learn if I want to continue with my freelance business.

Going after jobs with low hourly rates just to keep busy. I really don’t need any help in the “busy” department, and so I found that when I took these jobs, my attitude ended up in the toilet because I felt (rightly) that I wasn’t getting paid for the effort I put in. I had to let go of the notion that if I wasn’t actually working on a project I must be wasting time, when in reality, I was catching up on the business side, prospecting, replying to ads, researching, professional development, etc. I’m a much saner person for having realized this and for no longer taking on jobs with unacceptably low rates.

Time management and scheduling. My skills in this department are definitely lacking, and this is somewhat related to the previous issues. Scheduling is yet another thing I can’t completely control as a freelancer, but there are a few things I can do to spread projects out more evenly. Saying no to the low paying clients–or not going after those jobs in the first place–helped a lot. Another thing is setting reasonable deadlines and letting clients know that there is actually a queue – and that I’m not able to work on a job immediately. There’s no harm in asking for a later deadline, but there IS harm in having to extend deadlines. Best to acknowledge how busy I am up front and set deadlines I can actually make, rather than having to sheepishly call a client to ask for more time.

Things that worked:

Getting involved with AMWA. I went to my first national conference this year, as well as a chapter meeting and a freelance group meeting. All were incredibly rewarding experiences that validated my aspirations to become a freelance medical writer. I’m well on my way to the essential skills certificate, and the advanced workshops I took at the national meeting were fantastic; the grantwriting workshop in particular lit a fire under me to expand that side of my business. Above all, I met some great people who succeeded in drawing me out of my shell to talk shop. The most important lesson I learned from my colleagues: each of us has a unique background and training, and finding and promoting my niche within the medical writing field is going to be crucial. One day, I hope that I will be able to give back to AMWA – maybe even become a workshop leader – but right now, my capacity to volunteer is limited. In any case, I recommend to anyone thinking of a career in medical writing: get involved with AMWA. Period.

Taking the BELS exam. This was the first thing I did in the category of professional development this year. I wrote a post about it, and how it really served as another form of validation that a career in medical writing and editing was for me.

Plugging in. I launched my company Web site late last year, but really hadn’t done much to promote myself otherwise. I work part-time in healthcare advertising, and I started thinking about how to advertise my services. But because what I do requires a level of trust on the part of my clients–they are giving me their hard-earned data, manuscripts, and grants and asking for my help–word-of-mouth and networking are really the only two pathways to new clients. Any potential clients visiting my Web site would understand what I offer, but they really wouldn’t know me from any other writing service. Further, there is no metric to measure my effectiveness as a medical writer/editor, and so testimonials are key.

So, I started a blog as an extension of my company Web site so that potential clients could read my writing and see where I am coming from, what’s important to me, and my personal approach to what I do. I also set up a Twitter account (@thetobintouch) so that I could tap into the professional narrative and learn about the issues out there (open-access publishing, ghostwriting, science blogging vs journalism, and credentialing were pretty hot this year) and then share those issues–and my thoughts on them–through my blog. Keeping up the blog and scanning Twitter are time-intensive, but I feel it’s a worthy investment, not only for promoting my business and attracting new clients, but also for keeping up with my own professional development through interaction with peers and thought-leaders within the larger science and medical communications field.

Another plus for the blog: it gives me an outlet for all that constant self-assessment and business analysis – gets it out of my head and onto the page. Very therapeutic.

Things to do in 2011:

Update the company Web site. I’ve been looking at other writing and editing companies’ Web sites and gathering ideas for updating mine. In particular, I want to put some client testimonials up and maybe develop a flowchart showing the administrative and process steps for writing and editing projects. Also, a different head shot. I don’t look so tired these days!

Get my grantsmanship on. This is a big one for me. I’ve been helping out on more and more grants lately–NIH, NSF, NEH, and private–and I want to add grantwriting as an official part of my skill set. I’ve really focused on this part of my professional development in the last couple months, attending Web seminars and the AMWA workshop, and doing a lot of recommended reading.

Finish my AMWA essential skills certificate. Thanks to the self-study modules, I’ve been able to finish 4 of the 8 credits (medical terminology, statistics, sentence structure, and punctuation) – and I am working on 2 more now (grammar). I’ll be buying the next self-study module on ethics in 2011, and I’ll then I’ll have just one more credit to go. I’ve only been asked by one potential client if I have an AMWA certificate, but based on what I have been seeing on Twitter and LinkedIn, recognition of the AMWA educational program is growing. It certainly can’t hurt to have a certificate, in my opinion, and although the workshops have been humbling, they’ve been an excellent review of the basics.

So that’s it for 2010, I think. I hope everyone has a great holiday and great things happen for all of you in 2011! See you on the other side.

In which I defend my chosen profession from wily ghosts

Ah, ghostwriting. Yes, I believe I will step into the fray, thanks very much. Here goes nothing…

At AMWA’s annual meeting last month, the Keynote Address was given by William L. Lanier, MD, editor-in-chief of Mayo Clinic Proceedings, on the topic of preserving the integrity of medical literature. His talk focused on the role of the pharmaceutical and medical device industries (referred to broadly as “industry”) and their influence on the publication of clinical research. Thankfully, Dr. Lanier did not veer to one extreme opinion or the other on this controversial topic, neither defending the need for pharmaceutical companies to profit from their investment in R&D nor advocating a need to purify the medical literature of the taint of industry bias. Rather, he acknowledged the incredible impact that industry has had on medical science, the practice of medicine, and patient care, while also admitting that there are some who would try to hijack the peer-reviewed literature for their own gain, as evidenced by the HRT publication planning “scandal” that was revealed a few months back, and many others that have come to light since.

Once the floodlight was trained on the practice of publication planning and the use of ghostwriters by industry, there have been more than a few articles that have “exposed” these sinister practices and provided profiles of people involved. One particular story in The Atlantic profiled a medical ghostwriter, “David,” who has a background in life sciences research and ended up leaving academia to work at a communications company (sorta like me–maybe that’s why the article irked me so much). David described the type of industry-dictated spin that he was asked to put on his ghostwritten abstracts and journal articles as a source of personal humiliation and a true moral dilemma. He described the profession of medical writing and his fellow medical writers as sad, and the author of The Atlantic piece summed up this way:

Medical writing has little glamour, and whatever moral purpose it might once have carried has been rubbed away by the constant friction with commerce. If you are a true believer in the glory of the market, the work might be invigorating, and the long hours a mark of pride. But if you are a lapsed biologist, raised in the church of science but compelled to leave, it is apparently a source of nagging resentment. Says David, who for all his protests has yet to give up his job, “What a wretched epitaph to a life this would be.”

So…I had a pretty visceral reaction to this article. It really boiled down to the fact that not all medical writing is ghostwriting. To characterize the profession of medical writing as having no moral purpose, with the only source of pride being in furthering the profits of industry, is simply incorrect. Medical ghostwriting? Yes, absolutely. Medical writing? No. There are many, many kinds of medical writers, working for many, many clients who are not even connected to industry. Once I calmed down, I actually found it rather sad that “David,” who is portrayed as resentful and plagued by moral and ethical crises, has not learned that what he does–which is truly medical ghostwriting, with no acknowledgement that he is the actual author of the work AND with named authors who did not contribute–is not the only type of writing that is done by professional medical writers. I hope for his conscience’s sake that he is able to extract himself from his situation and find other ways to use his skills – it really would be a wretched epitaph if he never does.

The article also made me realize how little people understand that there are established ethics for medical writing. AMWA brought together a task force in 2002 to develop a code of ethics for medical writers and to delineate requirements for acknowledging the contributions of medical writers. As a result of their work, the task force published the AMWA Position Statement on the Contributions of Medical Writers to Scientific Publications, which can be found here. There is a fantastic FAQ on ethics in medical writing here, which includes these definitions:

“Ghost authoring” refers to making substantial contributions without being identified as an author. “Guest authoring” refers to being named as an author without having made substantial contributions. “Ghostwriting” refers to assisting in presenting the author’s work without being acknowledged. The term “ghostwriting” is often used to encompass all three of these practices.

What is “substantial contribution?” AMWA quotes the AMA Manual of Style on that one:

“A substantial contribution is an important intellectual contribution, without which the work, or an important part of the work, could not have been completed or the manuscript could not have been written and submitted for publication.”

So, back to our David. David is absolutely right in feeling that his work as a medical ghostwriter is morally perilous. In his current position, he is engaging in ghostwriting and ghost authoring, and the physicians being paid to put their name on his work are guest authoring (at best).

Medical journal editors are in agreement with AMWA and the general public in the recognition that ghostwriting needs to be rooted out and medical writers acknowledged for their contributions. Many, if not most, journals have accepted the International Committee of Medical Journal Editors (ICJME) Uniform Requirements, found here, which echo the same requirements for substantial contributions from named authors. But the journal editors can only do so much – in his AMWA Keynote Address, Dr. Lanier stated that medical writers need to remind their employers and industry clients about the ethical policies of the medical  journals to which they are submitting their manuscripts, and the consequences of being identified as a sponsor of ghostwritten articles. David should be listed as an author. Period. Easier said than done, I know. But that’s the issue.

What about acknowledging medical writers (and editors) who have not made substantial contributions to qualify as a named author? For example, I often help prepare manuscripts based on clinical study reports (CSRs), which involves formatting and rearranging information from the CSR into a journal article format and making sure it meets CONSORT requirements.

The discussion section might be the one place where I do a little more writing, and the place where a client might want some spin introduced. But even then, the CONSORT statement gives medical writers an ethical leg to stand on, by recommending a structured approach to the discussion section, as outlined by the Annals of Internal Medicine:

…Annals of Internal Medicine recommends that authors structure the discussion section by presenting (1) a brief synopsis of the key findings, (2) consideration of possible mechanisms and explanations, (3) comparison with relevant findings from other published studies (whenever possible including a systematic review combining the results of the current study with the results of all previous relevant studies), (4) limitations of the present study (and methods used to minimise and compensate for those limitations), and (5) a brief section that summarises the clinical and research implications of the work, as appropriate.

Preparing a manuscript from a CSR is not ghostwriting, in my opinion, but it does warrant some kind of acknowledgement. This is what the ICJME says:

All contributors who do not meet the criteria for authorship should be listed in an acknowledgments section. Examples of those who might be acknowledged include a person who provided purely technical help, writing assistance, or a department chairperson who provided only general support.

So the demarcation for authorship vs. acknowledgement is substantial contribution vs. writing assistance.

I will sum up this lengthy post by saying that I was heartened by Dr. Lanier’s keynote address at AMWA in that it did not vilify industry or industry-sponsored research, but still acknowledged the need for transparency regarding industry involvement in publications of the research in the peer-reviewed medical literature. There must be a concerted effort among journal editors and professional medical writers to increase awareness of the ethical standards established by both groups regarding authorship and acknowledgement. Otherwise all medical writers run the risk of being mis-labeled as ghostwriters, like our sad friend David.

P.S. As a professional medical writer, I stipulate up front, in the service agreement, how my contribution will be acknowledged in the final article. Many times, the client is completely unaware of ICJME requirements or the policies of specific journals on authorship and they appreciate that I have brought the issue to their attention.