Friday, November 12, 2010

The Delicate Balance

by Faith Reidenbach

So many guidelines have been issued about best practices in publishing medical journal articles, “it seems like more people are talking than listening,” William L. Lanier, MD said in AMWA's keynote address Thursday. “We are exhausting our energy in areas that are not productive.”

Dr. Lanier is Professor of Anesthesiology at Mayo Clinic in Rochester, MN and has been editor-in-chief of Mayo Clinic Proceedings since 1999. He offered a journal editor’s perspective on “the delicate balance” of the various stakeholders in medical publishing: pharmaceutical and medical device companies, investigators/authors, medical writers and authors’ editors, and journal editors.

Likening the current situation to Cold War, when the United States and Soviet Union built ever-increasing stockpiles of submarines and nuclear weapons, Dr. Lanier called for détente--an easing of tensions — between these groups. “If we don’t fix our problems, other people will fix them for us,” he said, referring to the National Institutes of Health and several other federal agencies that have an interest in seeing that medical journals are of high integrity. What’s needed, he said, is “guidelines centralization, simplification, and compliance.” His list of organizations that have attempted to improve the indexed medical literature filled an entire slide: ACRE, AMWA, CSE, ICMJE, IOM, ISMPP, MPIP, NIH, PhRMA, PRC, and WAME.

Dr. Lanier listed what he sees as the potential strengths and weaknesses of each group of stakeholders. Medical communicators’ strengths, he said, are experience in formulating communications that are accurate, clear, and concise; familiarity with the rules of style and formatting at numerous journals; appreciation of the use of accurate, informative figures and tables; and ability to safeguard authors against committing errors of omission or commission.

Weaknesses of medical writers and authors’ editors, Dr. Lanier said, can include misinterpreting the roles of industry and investigators/authors, buying in to the myth that physicians and scientists are too busy to conduct their own work, being eager to initiate manuscripts on behalf of nominal “authors,” and engaging in ghostwriting and ghost authorship. The latter practices are “not acceptable,” he said flatly, and he rejects ghosted manuscripts whenever he can spot them. That’s not as hard as it might seem, he said, because “the medical community has a collective knowledge and memory that astounds me.” Within each specialty or subspecialty, physicians come to know the people who publish — how they write and even what they cite.

When an audience member protested that ghostwritten scientific literature is as innocuous as other types of ghostwritten material, such as political speeches, Dr. Lanier responded emphatically, “I could not disagree more.” A politician, he said, is surrounded by people who are thoroughly acquainted with his or her positions, which are stated in pretty much the same terms in dozens or hundreds of speeches. Moreover, speeches deal in broad strokes and the bottom line. In contrast, the importance of a scientific paper lies in “the fine print” — the nuance — and it is investigators who can understand and employ that nuance when communicating.

A more detailed report on the keynote speech will appear in the March issue of the AMWA Journal.

[Post corrected. Speech was not recorded.]

Related links
AMWA Code of Ethics
AMWA Position Statement on the Contribution of Medical Writers to Scientific Publications

Lanier WL. Bidirectional Conflicts of Interest Involving Industry and Medical Journals: Who Will Champion Integrity? Mayo Clin Proc. 2009 Sep;84(9):771-5

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