What I do

I have been meaning to do this post for a while, but finally got down to it after reading an excellent post describing substantive editing, and another post on the importance of building off your unique set of skills and background. For some reason, I’ve often struggled to describe exactly what I do, beyond saying I am a biomedical editor. There’s nothing wrong with that, it just fails to capture the nuance. I could get really philosophical about what it means to be an editor, but Rich Adin over at An American Editor has done a far better job at this than I ever could, so I will direct you to his excellent posts here and here. His characterization of the twin pillars of editing–mechanics and thinking–really struck me.

So back to my purpose. How do I describe what I do? Of course, what I do differs based on my client, so I will focus on what I feel I do best – scientific grant and manuscript editing. There are really several different levels of editing going on here.

1) Basic editing: Checking spelling and grammar, fixing awkward sentence structures, simplifying the language, and checking verb tenses and parallelism. This is a part of the “mechanics” pillar of editing.

2) Substantive editing: checking the flow and logic. How is the story being told? Is it clear what has been done and what needs to be done? It is clear what hypothesis is being tested and why? Are the right headers being used to help the reader through the document? Obviously this is part of the “thinking” pillar.

My goal here is to make the paper or grant proposal something that the reader wants to read, that the reader actually enjoys reading, rather than just skimming the abstract and figure legends. As a graduate student, I read many, many, many papers, but there were only a few that sucked me in because they were just written so well. There was a clear explanation up front about why the research was being done, each experiment in the results section flowed logically into the next, and the discussion put all the data in perspective, in the context of what is already known. I almost felt like I could see the authors at the bench, working through the data, designing the next experiment. Those are the papers I want my clients to publish. The same thing goes for grants – if anything is confusing or convoluted, the grant reviewer is going to pass it over. I edit grant proposals so that they are as clear and logical as possible, so that the reviewer immediately understands and appreciates the problem that needs to be solved, sees that the proposed aims will answer a clear set of relevant questions, and agrees that the methods used and people involved are up to the challenge.

3) Content editing: Another one for the “thinking” pillar. This is where my unique background fits in, where I can look at the experiments and the results and think about what conclusions are being drawn and whether they are being communicated accurately. Is the experimental design sound? What are the caveats? Are the statistics appropriate? Are the proposed experiments going to test the stated hypothesis? Have the data proven or disproven the stated hypothesis?  How do the data compare to what’s been done before? What are the implications for future basic or translational research? For research grants, I also draw on my background in promotional writing – will the science as presented convince the reviewer that this is a worthy problem (or gap in knowledge) to tackle and that the proposed experiments will provide the data needed to solve the problem?

4) Formatting: This also falls under mechanics – it’s making sure that the manuscript follows the journal’s editorial rules, and that the grant proposal follows the structure stipulated in the funding announcement. There are a ton of rules and regulations for preparing federal grants, and even more embedded in specific funding announcements.

So that is what I do…and now I can just direct friends and family here when they ask (hi mom!).

Descriptive vs. Experimental Research

Because I have this handy soapbox, I’m gonna use it. Here’s the thing. There is descriptive research and there is experimental research. Descriptive research on its own is not enough. You’ve got to get in there, change something, and see what happens. Just reporting on what you see under the microscope or on a blot is NOT hypothesis-driven science. Descriptive science is a starting point, it sets the baseline, the control state, what is known. Experimental research tests a hypothesis, which means altering a variable in the known system and seeing what happens – the result will lead you to reject or fail to reject either prove or disprove your hypothesis. Of course you’ll repeat the experiment in exactly the same way several times so you can be confident your results are statistically true. But then you’ll need to try changing something else, repeat, repeat, repeat, and so on.

In a research grant proposal (and I’m coming from the NIH perspective here), each aim should independently test your central hypothesis from different angles. Angles meaning using different methods or combinations of methods, or working at different levels (biochemical, molecular, cellular, tissue, organism, ecosystem, etc). What you learn in each aim will come together to shed light on the system you are studying.

Now, one of those angles might be descriptive, but I would argue that a purely descriptive aim is going to be your weakest aim. Devoting an entire aim to descriptive science breaks two rules in scientific grantwriting – descriptive science is not able to test your central hypothesis, and your aims must not depend on each other. (Because if one aim fails, there goes the entire proposal, and no agency will be interested in funding something so risky.) Any aim that is descriptive will be dependent on what you find in the other two aims.

The same descriptive vs. experimental idea applies to journal articles too. If your article is just descriptive, you’ve got half a manuscript. Sorry, but it’s true. The best, most compelling, field-advancing, paradigm-shifting articles are those that have a clear hypothesis, describe what is known (from descriptive science), and then describe a logical progression of changes made to the known and what happened. I know you’ve heard this before, but the best paper tells a story, leads the reader into the known system and the hypothesis, and then through each question, discovery, question, discovery, until the Discussion section brings the reader back around and gives some context. I know, some journals will accept purely descriptive articles, but in my experience, those are the smaller, second-tier journals. Not the Cells, Sciences, Natures, etc.

It’s getting more and more competitive out there – for research grant funding and publishing articles. So get in there. Get your hands dirty. Know your system then change it and see what happens.  Then change it again and see what happens. And if you need help telling your story, getting other people to understand exactly what it is you’re doing, I’ve got your back.

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.

Write Young Grasshopper! Write.

I know I said my next post was going to be about marketing and writing, but I got sidetracked (things get busier as the school year begins) and then a few recent blog posts got me thinking back to my own experience with writing while in graduate school.

In this post, Dr. O explains why grad students shouldn’t feel like they need permission to write their dissertation (or to write in general, in fact):

“On the contrary, grad students should be continually writing throughout their thesis work, one results section at a time. For papers, if possible. If not, then for practice. Writing is an art, and it takes lots of practice. You understand your data and results better when you have time to write and reflect on them. Speaking on those results is important too, but unless you can convey your message on paper, you’re doomed.”

This advice was seconded here:

“Grad students, [writing]’s a great habit to get into RIGHT NOW–write a bit every day (or every week, if you’re like me and prefer to vomit papers up in  larger chunks)–just get into the habit of doing it regularly and you’ll be way ahead of the game when it comes to your thesis or dissertation.”

I wish I had received advice like this a little earlier in my grad school training, maybe even in year one. It actually took me a few years to cop on that one paper equals one chapter of my dissertation (I know, duh!).

So I’ll throw in my two cents here – I recommend that first-year grad students be required to write up what they accomplished after each lab rotation (even if it was very little), as if it were going to be submitted to a journal. I ended up developing my writing chops despite being clueless about how crucial writing and communication skills really are to being a successful scientist, because I actively sought out opportunities to write for my own reasons. But I don’t think this is true for most grad students, who are already completely overwhelmed with their experiments, lab meetings, journal clubs, departmental seminars, conferences, abstract submissions, self-doubt, sleeplessness, etc, etc, to be worried with whether or not they can or need to practice writing. For the grad students I knew, writing the paper often seemed like an afterthought at best, and at worst, like drudgery and punishment that required time away from the bench. So I think Dr. O has it right – writing should be happening all the time, not shoved aside until it absolutely must be done to meet an abstract deadline or submit a paper. More than that, I think all graduate students would benefit from formal training in manuscript writing and grantsmanship. Just a single quarter’s worth, one class.

Expanding on this theme in another post, Dr. O lamented the fact that grad student training tends to be a little light in the grantsmanship department. She went on to explain why grant writing seems like (is) such a Herculean task and why putting it off to the last minute is not a wise strategy.

When I joined the lab, my research project R01 funding had just been renewed for another 5 years, so I was able to pretty much keep my nose to the bench, and produce data, abstracts, and papers…until around my 4th year when it was time to start working on the competitive renewal. Wait…wha? I look back and picture myself coming up for air and then looking around to find myself on Mars. I had to learn pretty quickly about what goes into a grant submission. Blood, sweat, and a lot of tears, as it turned out. And I think some brain cells were sacrificed as well.

So I’ll add another three cents to make it an even nickel – immediately upon joining their thesis lab, grad students should be handed a copy of the grant(s) that is funding their research. It should be required reading. Students should have an understanding of where their research fits into the aims of the grant, how their data will support future grant applications and inform the direction of the next 5 years of research, as well as how the grant fits into the overall research goals of the lab. (In defense of my advisor, she excelled at sharing her vision with us in yearly State-of-the-Lab addresses.) While reading the grant will help grad students appreciate what grant writing entails, I would further suggest that every graduate student, whether or not they intend to pursue a career in academia, needs to help prepare a grant submission before they are allowed to graduate. (Sorry guys, it’s for your own good, I promise.)

In my post-graduate career as a freelance academic writer and editor, I have had plenty of experience preparing and consulting on grant applications. But I think I would have benefited from more formal training in writing and grantsmanship when l was a grad student.

How Do You Solve a Problem Like Peer Review?

The August issue of The Scientist features several articles that discuss the problems with the current anonymous peer-review system of scientific research papers—many of which have become even more obvious as the Web gains popularity as an alternative for rapid publication and access to manuscripts.

In I Hate Your Paper, Jef Akst identified 3 specific problems with the traditional peer-review process, and then presented some alternative strategies that are being tested by various journal editors. I’ve summarized the ideas discussed in the article here:

In Peer Review and the Age of Aquarius, Sarah Greene suggests that increased use of the Web by journal publishers, authors, and readers has accelerated change in the traditional manuscript review processes. First, the journal impact factor, which is based on the number of times articles from the journal have been cited, has been rendered nearly meaningless by the rise of open-access publishing on the Web. In the Internet age, the impact of individual articles might be more appropriately measured in terms of page hits or downloads. The Web has also introduced the concept of post-publication peer review, in which an article is published on the Web first and then undergoes open peer-review, with reviewers’ identities and comments published alongside the article.

What does all this mean for the manuscript editor? One commenter on my previous post lamented that the rapid pace of online article submission and publication will mean that more articles will appear online without the benefit of a final review by an editor. I certainly hope that the value of a manuscript editor—either prior to submission for review (the author’s editor) or prior to publication (the copyeditor)—will not be overlooked as review methods are overhauled in the name of speed and efficiency.  When the science is eventually lost in sloppy grammar and spelling mistakes, perhaps the pendulum will swing back the other way, and the process will slow down a bit to accommodate a round or two of careful editing.

Journal Access as Part of the ROI Calculation

A recent news article from Science Insider described the results of a study showing that by making access to journal articles from publically funded research (eg, NSF, NIH, etc), the return on investment for the funding agencies would increase substantially.

A proposal in Congress would extend the policy to 11 more research agencies and shorten NIH’s 12-month delay to 6 months. Supporters say taxpayers should have free access to the results of research they paid for; publishers worry that they will be put out of business.

I am of two minds on this. As a medical writer, having access to journal articles for my own research purposes would be invaluable and highly appreciated. But as a freelance copy editor for journal publishers, I also wonder what the economic impact of this policy on the journal publishers would actually be. How much revenue is generated from library subscriptions? How often is an article downloaded within the first 6 or 12 months of publication? The New England Journal of Medicine, Circulation, Endocrinology, and several other journals already make their content freely available after 12 months. What impact has that policy had on their bottom line?

Of course, the journal publishers are in an uproar, but I think I’m leaning toward open access after a set time point. With news breaking as quickly as it does, those who need or want the article as soon as it comes out will pay for it, simply because they must cite the most recent data.