Writing well is important: The value of a science-based approach

The Reader's Brain How Neuroscience Can Make You a Abetter Wrtier

No matter what initially drew you to medicine, you most likely failed to picture yourself spending a hefty portion of your time writing. But, if you entered academic medicine, writing ends up occupying a significant amount of your time. Universities require us to bring in a stream of funding, which requires us to write grant proposals. In the US, only one of every seven proposals researchers write receive funding—and this statistic excludes the highly competitive and prestigious R01 awards offered by the National Institutes of Health (NIH). In addition, to first obtain funding, researchers usually need at least one publication as evidence of expertise in the area their proposal targets. Once you obtain funding, you face still greater pressure to produce a stream of publications that demonstrate you’re making progress in achieving your grant’s specific aims. Moreover, most universities tie job offers and promotions to your publications and papers you present at meetings. In short, in academic medicine, writing is inescapable—and integral to your success.

However, few researchers or clinicians understand the advantages of writing well in a now-competitive environment. A well-written proposal or manuscript increases your odds in receiving funding or getting published. Why? Three of the top seven reasons why journal reviewers and editors reject manuscripts include poor focus, organization, and writing (1). In addition, poor writing ranks fourth in the ten most common reasons why Respiratory Care rejects papers (2). Writing also figured in the top reasons why reviewers rejected manuscripts for a conference, slated for subsequent publication in Academic Medicine (3).

In addition, academic medicine often requires writers to generate reader-friendly lay summaries or recommendations for practice that the general public understands. UK-based journals, including The Lancet-, BMJ­-, and Nature-affiliated journals, place particular emphasis on writing articles comprehensible to a general audience, not just subject-matter experts. In the US, the NIH favors research proposals that contain some outreach to the general public. In NIH-funded Clinical and Translational Science Institutes, including the one in which I teach at the University of Florida, we include in our courses for fellows and faculty instruction on reaching lay readers and writing reader-friendly prose.

All these demands bring us to the nub of a rather vexing problem. The handful of publications on writing in medicine contain advice on tackling the rhetorical and content challenges of each section of a proposal or manuscript. A few others have bravely struck out into territory normally claimed by English studies faculty—the components of readable sentences. However, neither approach tells, say, a gastroenterologist how she can identify a problematic sentence or avoid burying important data. The how-to-get-published advice helps you dodge common errors in study design, data analysis and reporting, and the handling of introductions and discussions (1, 4, 5). Other resources included now-dead URLs featuring writing advice on avoiding passive voice and wordiness. But, while most researchers might grasp why passive voice is something to be avoided along with verbosity, few of us know how to recognize when we use either—let alone how to avoid using them.

The first brave foray into giving researchers advice on writing well in academic medicine appeared in Gopen and Swan’s 1990 article on scientific writing (6). Their work tackled examples of academic prose, used linguistics to examine the challenges poor writing throws at its readers, and offered guidance on handling sentence-level challenges. That article represented a quiet milestone on the science of writing, which should have begun a decades-long series of studies on psycholinguistics and its valuable insights into how writers need to write to accommodate the challenges words and sentences pose to our readers’ brains. Instead, however, to use Hamlet’s dying words, the rest is silence.

This silence is particularly ironic, given our growing knowledge of how the reading brain processes written language. Gopen and Swan’s work focused on how words, sentence structure, and connections between sentences impact writing. Their 1990 article used dramatic “before” and “after” versions of scientific writing to demonstrate how to make easily readable even the most complex information. In addition, they established a valuable precedent in recognizing that, as researchers, we are data-driven. Provide a researcher or clinician with data-driven methods for improving their writing, and you’re speaking to us via a conduit we understand.

I spent nearly two decades using research on reading drawn from psycholinguistics and neuroscience to understand reading in multimedia documents before I realized its value to creating a methodology in creating principles for writing. In English studies, every book on writing seeks to be the last word on the subject. In science, you realize that your research can only begin or add to conversations on your subject. My book, The reader’s brain: How neuroscience can make you a better writer uses empirical data to begin a much-needed conversation and research on the connection between writing and the reading brain. One student claimed these methods enabled her to become a full professor and dean within a decade of taking my course via her hefty list of grants and peer-reviewed publications. I hope others in medicine find it as useful—and that considerable conversation and debate ensue.

–Yellowlees Douglas

  1. D.W., Byrne. (1998). Publishing your medical research paper. What they don’t

teach in medical school. Baltimore: Lippincott Williams & Wilkins.

  1. Pierson, David J. (2004). The top 10 reasons why manuscripts are not accepted for publication. Respiratory care, 49(10), 1246-1252. PMid:15447812
  2. Bordage, Georges. (2001). Reasons reviewers reject and accept manuscripts: the strengths and weaknesses in medical education reports. Academic Medicine, 76(9), 889-896. PMid:11553504
  3. Provenzale, James M. (2007). Ten principles to improve the likelihood of publication of a scientific manuscript. American Journal of Roentgenology, 188(5), 1179-1182. PMid:17449755
  4. Browner, Warren S. (1998). Publishing and presenting clinical research. Baltimore: Lippincott Williams & Wilkins.
  5. Gopen, George D, & Swan, Judith A. (1990). The science of scientific writing. American Scientist, 550-558.

Sociology, Stigma and Innovation – Sam Rowlands on editing a book about abortion

Abortion Care Cover

After last month’s article about the journey of a medical book from an author’s perspective, this month we hear from Sam Rowlands, editor of Abortion Care, about editing a book which boasts more than 40 contributors – and which is about a particularly emotive topic…

There aren’t many medical books dedicated to abortion care. I felt there was a gap in the market for a smaller book that could be easily carried around. I wanted to produce a book that had all the conventional ingredients such as the methods of abortion, complications and so on but also looked at abortion from a wider perspective.

I drew up a list of around 30 chapters and identified potential authors for each. Cambridge were keen for the book to have international appeal so I endeavoured to select recognised specialists from around the world. I am fortunate to have met many of these personally through my career in sexual and reproductive health but still I was delighted (and surprised) that most of the colleagues I chose readily agreed despite their very busy schedules. I was then intrigued by how many chapter authors (15) asked to collaborate with their selected colleagues. This has resulted in an even richer authorship.

I had originally thought I might ask a couple of collaborators to co-edit with me but on reflection decided to edit the book on my own. The advantage of this was that I could be in control and do things my way, especially as I had by now a clear view of how the book would look. The downside was that when more than 20 chapter manuscripts arrived in a rather short space of time, I felt a bit overwhelmed! The lead chapter authors are all authorities in their fields. Some are academics and some are skilled practical clinicians, some both. Some are neither of these, just incredibly knowledgeable and wise. All authors developed their chapters in their own way; I encouraged them but tried not to steer them in any particular direction.

Although the book is mainly for readers with a medical bent, I have tried to include chapters to stretch their minds on topics that they might not necessarily otherwise tackle. Sociological topics are included but the authors of these were banned from using inaccessible terminology! There are two chapters with an epidemiological flavour which are not too daunting even to the numerically-challenged. There are two chapters written by lawyers which really flow, despite references to statute and case law.

Although the book is about a controversial subject and is bound to be serious in most of its content it is written in language that I hope is accessible and uses a lighter touch at times, for example a quote from Monty Python in the ethics chapter. The historical chapter provides a wonderful backdrop, painting a vivid picture of days gone by with some poignant examples of tragic cases. Stigma is a theme that runs through the book. Half a chapter is dedicated to this but reference is also made elsewhere, particularly in the chapter on staff. Although we all know that abortion is stigmatised, it’s only quite recently that it’s been written about and even measured.

I tried to include some innovations in the book and two chapters come up trumps in this respect. One covers abortion care provided by personnel other than doctors, showing that all the evidence points to this being not only safe but actually preferred by many women. The other looks to the future and shows how telemedicine can be applied to facilitate communication and treatment when the clinician and the woman are not in the same place, which has potential to improve access in more rural areas or in those parts of the world with restrictive regimes.

I’ve found it very rewarding to head up this project but don’t claim it is perfect. I invite anyone to make suggestions for a second edition.

Sam Rowlands MBBS, MD, LLM, FRCGP, FFSRH, Clinical Lead in Community Sexual and Reproductive Health, Dorset HealthCare and Visiting Professor, School of Health & Social Care, Bournemouth University

Sam Rowlands is the editor of Abortion Care (out now).

International Ear Care day 2014

The International Ear Care day was the outcome of the Beijing Declaration made during the 1st International Conference on Prevention and Rehabilitation of Hearing Loss in 2007. The date ‘3 March’ was selected due to the similarity of the figures 3.3 with the shape of our ears. The day is observed with a designated theme, decided by WHO in collaboration with its partners, collaborating centres and experts. The ‘day’ provides a unique opportunity to work together to draw the attention of media, policy-makers, administrators, health professionals and the general public towards the cause of hearing loss. By observing this day, we can all help create a global movement, which will compel others to give ear and hearing care the attention it deserves and to persons with hearing loss, their due respect.

The 2014 theme is Ear care can avoid hearing loss. At least half of all cases of hearing loss are avoidable through primary prevention, including healthy ear care practices.

Dr Shelly Chadha, Technical Officer, Prevention of Blindness and Deafness, World Health Organization, Geneva, commented, “In order to raise the profile of ear and hearing care on the global health agenda, all of us: ear and hearing care professionals; nongovernmental organizations; collaborating centres; persons with hearing loss and their caregivers, must be a part of this movement. As members of the health profession, we dedicate ourselves every day to caring for our patients and their wellbeing. By devoting one day to the public health aspect of our chosen field, we can reach many more and be a part of a worldwide effort to raise awareness and resources for ear and hearing care.”

In 2012, WHO released estimates which suggest that 360 million persons across the world live with disabling hearing loss. Amongst persons above 65 years of age, one out of three is reported to have hearing loss, yet less than 3% of persons receive the hearing aids they require.

Despite the fact that two thirds of people with hearing loss live in developing countries, services for hearing care remain elusive where they are most needed. The number of ENT surgeons per million ranges from 0 to 4 in low-income countries as compared to 9-178 in high-income countries. In 18 countries of sub-Saharan Africa, there is an average of less than 1 ENT surgeon per 100 000 persons. Moreover, the current global health priorities for developing countries have yet to pay attention to hearing loss. The overall low level of awareness about ear diseases and hearing loss at all levels within the society adds to the growing burden.

This blog post is based on the Editorial that Dr Chadha wrote for the March issue of The Journal of Laryngology & Otology, the full article can be read free of charge here.

Find out more about the WHO International Ear Care Day here.

Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog

Health Professionals Who Participate in Force-feeding Prisoners on Hunger Strike at Guantanamo Bay Should Lose Professional Licenses

Force-feeding Violates Medical Ethics and Amounts to Torture

Physicians and other licensed health professionals are force-feeding hunger strikers held prisoner at the US Naval Base at Guantanamo Bay (GTMO), Cuba. These health professionals are violating the medical ethics they swore to uphold and are complicit in torture, according to the authors of an article published in Prehospital and Disaster Medicine. Dr. Jennifer Leaning, Director of the FXB Center for Health and Human Rights at Harvard University, and her Harvard colleagues, Sarah Dougherty, Dr. Gregg Greenough, and Dr. Frederick Burkle, urge the licenses of health professionals who participate in force-feeding be revoked. Leaning and her co-authors also call for the medical profession to demand changes in military medical management protocols and stronger protections for military health professionals who protest unethical orders.

Historically, the treatment of hunger strikers has been difficult for health professionals, particularly those employed in institutional settings, because the practice raises profound clinical, ethical, moral, humanitarian and legal questions.

Leaning and her co-authors note that hunger strikes are political acts, not medical conditions. Hunger strikers refuse food on a voluntary, informed basis and without suicidal intent. At GTMO and elsewhere, force-feeding involves the use of force and physical restraints to immobilize hunger strikers without their consent and against their express wishes—actions which constitute battery and violate basic human dignity. The US Department of Defense (DoD) force-feeding policy and protocols are a “gross violation” of US and international ethical standards prohibiting force-feeding of hunger strikers.

The DoD has also ratified the practice through a longstanding policy of vetting health professionals assigned to GTMO. Military health care providers have the same medical ethics obligations as civilian providers, but as military personnel are also required to obey lawful orders. Because force-feeding has been found lawful under US civilian and military law, military health professionals at GTMO ordered to force-feed hunger strikers must choose between upholding medical ethics and obeying the law.

“Given the failure of civilian and military law to end force-feeding, the medical profession must exert policy and regulatory pressure to bring DoD policy and operations into compliance with established ethical standards,” says Jennifer Leaning. “We join those medical and ethical authorities who have called for investigations into the force-feeding at GTMO and for sanctions where appropriate. This paper is the first in the medical literature to review the history of exhausting attempts at remedy through US law and presents the tight argument for why only the US medical profession can adequately uphold professional standards of medical ethics through its licensing power. When the law has become deferential to the claims of civilian and military institutions, our only ethical bastion as physicians and health care providers is the national and international guild we have built and belong to. The professional battle to uphold principles of medical ethics and human rights has often in the past proved grossly feeble against prevailing institutional pressures. We turn away from this instance at our collective peril.”

“Political events and actions are increasingly forcing physicians and other health care professionals to choose between medical ethics and US law,” says Dr. Samuel J. Stratton, Editor-in-Chief of Prehospital and Disaster Medicine. “In both military and civilian contexts, the issues surrounding force-feeding are complex and contentious, and should be subject to rigorous examination and debate. Prehospital and Disaster Medicine intends to publish additional papers adding to the debate on how health professionals should navigate this important ethical dilemma.”


The paper “Hunger Strikers: Ethical and Legal Dimensions of Medical Complicity in Torture at Guantanamo Bay” can be viewed free of charge for a limited time here.

A companion paper, providing historical perspective from the emergency management of refugee camp asylum seekers, can also be viewed free of charge for a limited time here.


via Ethics and force-feeding prisoners on hunger strike « Medicine « Cambridge Journals Blog.

Young people and substance misuse

Blog Post by Professor Hamid Ghodse, Dept of Addictive Behaviour & Psychological Medicine, St George’s Hospital Medical School, University of London

The young people of today live in a world that it is complex, providing them both with tremendous opportunities as well as challenges, with many benefits as well as many risks.  The influence of their peers and their surroundings upon them and their behaviour, their life style and their health is greater than ever before. Peer influences are no longer solely emanating from school or the neighbourhood but can come from thousands of miles away. Indeed, adolescents’ ideals and role models may be in another continent, and their problems may start from under the same roof or from a long distance away.  Read more of this post

A Meeting of Minds – Cambridge Clinical Neuroscience and Mental Health Symposium

Blog Post by Jenny Ridge, Academic & Professional Marketing, Medicine

neuroscience logoThe Cambridge Clinical Neuroscience and Mental Health Symposium starts today, with Press authors ready to speak on the most up-to-date research.

Organised by Cambridge Neuroscience, whose mission is to increase our fundamental understanding of brain function and enhance quality of life, the Symposium is a highly significant event for all neuroscientists. The Symposium connects the varied and vast areas of neuroscience research and teaching that takes place across the University of Cambridge and affiliated institutions and is vital to furthering the aims of Cambridge Neuroscience.

Read more of this post

World Heart Day – The Battle Against Heart Disease

Blog Post by Nisha Doshi, Editorial, Cambridge University Press

According to the World Health Organization, cardiovascular diseases claim 17.5 million lives per year, representing about 30% of global deaths. To raise awareness about heart disease and stroke, and the associated risk factors such as tobacco, physical inactivity and unhealthy diets, Sunday 27th September 2009 is World Heart Day.

This year’s World Heart Day theme is ‘Work With Heart’ and is aimed to encourage healthier habits within the work place: the World Heart Federation states that almost half of those who die from chronic diseases such as heart attacks and stroke are of working age, while employees engaged in physical activity have greater enjoyment of their work, increased concentration and mental alertness, and better rapport with colleagues. Activities across the world include: radio programmes and an organised walk in Ghana; sporting events, presentations, guided walks and a concert in Slovenia; an orchestral performance, body building, Nordic walking and theme dancing in China; and running events and the launch of teaching centres in Uruguay.

Read more of this post

%d bloggers like this: