Keynote Address: Can Fictional Television Make a Difference in Public Health Education?

Dr. Neal Baer receives the John P. McGovern Medal from Melanie Ross, AMWA past president, as  Barbara Snyder, current president, looks on. The award recognizes preeminent contribution to medical communication.

by Whitney Smalley-Freed

“People don’t get moved and inspired by data,” Dr. Neal Baer, writer for ER, Law and Order SVU, and A Gifted Man, explained to the large audience attending his keynote address on Thursday morning. Dr. Baer told attendees, “reporting on evidenced-based medicine is not enough,” you need the data, but you also need a story to get people to be passionate about a health care topic.  Public story telling draws from our personal experience and lives to tell a story to the public.

Using video clips from Law and Order SVU, Dr. Baer demonstrated how the private stories of patients and clinical data can be turned into public stories that can teach health information to the general population. The first episode addressed the issues raised by a study published in the journal Science showing that children who witness gun violence are more likely to commit gun violence and related it to the child catching an infectious disease. Another episode delved into whether parents have the right to decide not to vaccinate their children and how this could be detrimental to the health of other children.

“Did my show make a difference?” Dr. Baer questioned. A study on an episode of ER depicting a patient diagnosed with cervical cancer caused by HPV indicated that only 19% of viewers knew that HPV could cause cervical cancer before watching the episode but 60% were aware of this after watching the episode.

Dr. Baer explained how BubbleTweets could be used to tie video clips to news articles and actionable steps for addressing health care topics raised by TV dramas. Social media can be used to further the knowledge of seeds planted by television.

During the question and answer session, Dr. Baer stressed the responsibility that television shows have to present health topics accurately since a large portion of the population accepts them as fact. When asked “who is your peer-review,” Dr. Baer explained the review and oversight committees involved in all of his shows.

Dr. Baer suggested that medical writers have the responsibility to start discussions and raise issues that can help establish ethical boundaries for medical frontiers.

Dr. Baer’s charge to AMWA members, “take your own stories…and make them public.” Find stories that move your audience to action.

Should the Skull Be an Inviolable Zone of Privacy?

Keynote Speaker Focuses on Bioethics

by Faith Reidenbach

“We are becoming cyborgs,” one of the founders of neuroethics, Dr. Paul Root Wolpe, told the large audience assembled for his keynote address on Thursday morning. He wasn’t playing on the fact that AMWA’s conference falls near Halloween this year. As an increasing number of people use artificial organs to survive, prosthetic limbs to move, or brain waves to communicate, we are becoming “semicreated creatures,” Dr. Wolpe said, and the accelerating pace of these advances “may induce a phase change beyond which we can predict nothing.”

By juxtaposing photos, Dr. Wolpe demonstrated that a real-life woman who has a brain implant for a neurologic disorder looks remarkably like Star Trek Captain Jean-Luc Picard after he was assimilated by The Borg. And just as Picard discovered when he battled the Borg Queen, “our last great freedom”—the freedom not to reveal the contents of our minds—may someday be in jeopardy. Using functional MRI, scientists at Carnegie Mellon University have taken a baby step toward mind reading:  they have shown that they can identify the unique brain activation patterns generated when a person thinks of any one of dozens of nouns. Later, with about 75% accuracy, they determined what noun a person was thinking of, even nouns their computer model had not encountered.

Dr. Wolpe explained that according to other studies, brain imaging can distinguish traits, such as extroversion versus introversion; whether a person has racist attitudes; what languages a prisoner of war can read; a person’s intentions on a very simple level—the intention to add or subtract; and whether a person is more likely than average to engage in violent behavior.

“Should the skull be an inviolable zone of privacy?” he asked. The emerging field of what he calls neuroprivacy exemplifies that ethics is much more than an inquiry into right and wrong. “Ethical consensus is a social, evolving process in which the media plays a primary role.”

Dr. Wolpe also discussed “cosmetic” neurology. Reporting that 20% of scientists acknowledge using a psychostimulant such as Ritalin, Adderall, or modafinil, he posed the question of whether use of this drug class should be required of professionals such as pilots and surgeons. Other examples of cosmetic neurology are the use of propranolol for memory suppression, research by Nobel Laureate Eric Kantel on memory enhancers, and, much more questionably, the use of oxytocin spray as a “trust inducer.” What are the ethical implications of spraying Liquid Trust on flowers given to a girlfriend?

Turning to the hot-button issue of prenatal genetic testing, Dr. Wolpe said he is not opposed, but that scientists should own up to the fact that “it’s eugenics” and talk about how to manage the consequences of the testing. For example, he pointed out, a disease such as cystic fibrosis might be cured by the time a child with the CFTR gene reaches reproductive age; should a fetus with the gene necessarily be aborted?

Medicine will become a “risk management system,” he predicted, with individuals receiving long printouts of their genetic profiles. Not all parts of the profiles will relate to disease; for example, some scientists believe there are genetic markers for criminal behavior. “What do we do with that information?”

In all of these areas, “the science is running way ahead of the ethics,” Dr. Wolpe said. The goal should not be to hurry to arrive at cut-and-dried decisions; rather, what’s needed are “robust ethical conversation with people representing different points of view.”

Dr. Wolpe encouraged listeners to visit the home page of the Center for Ethics at Emory University, which he currently directs. At Emory he is the Asa Griggs Candler Professor of Bioethics; Raymond Schinazi Distinguished Research Professor of Jewish Bioethics; and professor of medicine, pediatrics, psychiatry, neuroscience and biological behavior, and sociology. Dr. Wolpe also serves as the senior bioethicist at NASA (National Aeronautics and Space Administration). He is co-editor of the American Journal of Bioethics (AJOB) and editor-in-chief of AJOB‒Neuroscience. He sits on the editorial boards of more than a dozen professional journals in medicine and ethics. Dr. Wolpe is a past president of the American Society for Bioethics and Humanities, a fellow of the Hastings Center, and a fellow of the College of Physicians of Philadelphia, the country’s oldest medical society.

Related Links
Dr. Wolpe's Web page
Dr. Wolpe on "60 Minutes"

2009-10 AMWA President Thomas Gegeny with keynote speaker Dr. William Lanier and Dr. Thomas Stossel, McGovern Award recipient. (Photo by C. Jackson)

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

Missed the keynote speech? Listen online

Missed the inspiring keynote speech from Karen Woolley at this year's AMWA conference? You can now hear it online. This is a resource available for AMWA members only. Follow the link from AMWA's home page.

Read our posts about the speech here, here, and here.

And so it begins

Luncheon discussions at AMWA often fall into 1 of 3 categories: light conversation (work and AMWA-focused), polite or strained small talk, or subtle angling for job leads or freelance work. Things were different today at my table, because for part of the time, the discussion concerned yesterday's keynote. It wasn't a debate -- yet. A veteran member I admire expressed strong views, some of which I agree with and some of which I don't (so far). As an organization we need LOTS more talk about the points Karen Woolley raised, and (as Admired Woman pointed out) we can't concentrate just on ghostwriting.

--Faith Reidenbach

A visionary keynote address

Dr. Karen Woolley is the first AMWA keynote speaker in my experience who is one of us--a medical writer. And what a medical writer she is! In addition to running a large medical writing firm based in Australia, she is internationally engaged in advancing our profession through teaching, research, and advocacy for higher educational and ethical standards.

In her talk Thursday, Karen outlined 3 major problems facing medical writers, especially those of us who work on journal manuscripts:

• Lack of evidence that we add value to our projects and are ethical
• Lack of a truly international approach to training
• Isolation from other stakeholders, particularly journal editors

For each problem, she suggested actions that the profession can take and actions that individual members can take.

To address the first problem, Karen urged members to compete for the new award AMWA created for original research by AMWA members. The research must explore the value added by medical writers and editors and must be published in a peer-reviewed journal indexed by PubMed. The winner will receive a $2000 honorarium. (For more information, look under "What's New?" on the AMWA home page.) Aside from competing for that award and the new student research award, individuals can help by learning the rules of medical publishing, especially the AMWA Position Statement, Good Publication Practice for Pharmaceutical Companies (soon to be updated), and the Uniform Requirements for Manuscripts.

Even more emphatically, Karen called on us to reject ghostwriting assignments, because short-term financial gain for individuals is creating long-term professional pain for everyone in the profession. “That has got to stop,” she said. She urged us to use the PLoS Medicine checklist to document the specifics of our collaborations with authors.

As part of formal research, Karen and colleagues have investigated manuscript retraction rates to identify contributing factors. They presented some of this research at last month’s 6th International Congress on Peer Review and Biomedical Publication. One critical issue, Karen believes, is lack of training in medical writing. Effective training needs to be available globally, given that clinical trials are booming in sites such as China and India.

Confessions of an amateur photographer

I have tried to snap a few pictures around the AMWA conference to liven up the blog. The results have not been very satisfactory. I would say, I know better than to quit my day job, but that would be such a cliche that I couldn't possibly inflict such a thing on an audience of writers and editors.

I tried to grab a quick shot of the standing ovation that greeted Karen Woolley at the end of her keynote speech. Alas, the shutter finally closed just as everyone had taken their seats. And for the record, to the best of my knowledge, Karen Woolley (left) and Sue Hudson, AMWA's immediate past president, were not praying when this picture was taken at the end of Woolley's speech.

--Victoria White

R-E-S-P-E-C-T

Karen Woolley delivered an impressive keynote speech titled "Getting Respect--Two Steps Forward and?" She addressed head-on the challenges of banishing the practice of ghostwriting in medical communication and the critical importance of ethics in medical writing and editing.

Woolley is the CEO of ProScribe Communications, and an adjunct associate professor at the University of Queensland, University of the Sunshine Coast, Australia.

The blog will have more on the speech later. Full coverage will be available in the AMWA Journal. The speech was audiotaped and will be posted at a later date in the members-only section of the AMWA web site.

Articles referenced by Woolley in her talk:

Gøtzsche, PC et al. What Should Be Done To Tackle Ghostwriting in the Medical Literature? [Authors include Karen Woolley and Cindy Hamilton, 2008-09 AMWA president.]

Woolley, KL. Goodbye Ghostwriters! How To Work Ethically and Efficiently With Professional Medical Writers.^*