In our tenth issue HOC editor David Woods editorialises about editorials, and offers some thoughts on overcoming writer’s block. Kevin Frick reviews a book on economic evaluation of healthcare programmes, and Clare Gurton provides some pointers for choosing a specific ad agency. Ruth Murray gives useful advice on making proofreading foolproof, and we have more abstract submission dates for the new year.

ISPOR in Europe

Rx Communications and Greenflint, our health economics modelling arm, attended the ISPOR 9th Annual European Congress on 28–31 October in Copenhagen, Denmark. The theme of the congress was “Asking Critical Questions”, covered in the plenary sessions as well as in the many issues panels and workshops. The opening plenary session discussed the use of health technology assessment in a policy-making and priority setting; the second dealt with evidence-based medicine.

Delegates enjoying a buffet as they listened to a string quartet at Monday evening’s
reception at the City Hall, hosted by Copenhagen City Council.

Look out for more in December’s issue.

What is an editorial?

by David Woods, HOC editor

During my eight year editorial tenure at the Canadian Medical Association Journal, I churned out some 200 articles, editorials, and reviews. One of the editorials was entitled ‘What is an editorial?’ In it, I noted that an editorial is a signed expression of opinion, and quoted an example from its then-editor, Dr. Arnold S. Relman, in the New England Journal of Medicine. Relman pointed out that an opinion piece represents purely and simply the views of its author, and that the Journal takes no ‘official’ position on any issue, nor are the opinions expressed in it those of the Massachusetts Medical Society, its owner. He went on to say that editorials are selected by the editors on the basis of originality, interest and readability.

I’m not sure I would have used the word signed, since the unbylined opinion pieces in The Economist are as pungent as you will find anywhere. But certainly a good editorial should be forceful without being shrill, and persuasive without beating the reader over the head.

So, if you plan to write an editorial, first do your research into the pros and cons of, say, government-sponsored versus private enterprise healthcare. Start with an attention grabbing lead paragraph, and possibly set up the arguments against your thesis. Then build a steadily stronger case for your thesis. At the end of the editorial, you might restate your case and offer a ‘what's next’ – a proposed course of action, say, based upon your proposition.

If you're submitting a one-off editorial to a publication dealing with your profession or speciality, make sure that you follow its guidelines for contributors. These might include preferred word count, style for references, and even warn against overuse of ‘in’ jargon or an over-sprinkling of acronyms. If you’re called upon to write regular articles for the same publication, be sure that your arguments are consistent – or make it very clear why you’ve changed your mind, as I did in paragraph 2 of this piece.

Writing editorials can be a wonderful release from the quotidian business of news items or research reports. They offer you a pulpit, a soap box from which to deliver your arguments... and a greater chance that you’ll invite response.

Methods for the economic evaluation of health care programmes – 3rd edition

Edited by Michael F. Drummond, Mark J. Sculpher, George W. Torrance, Bernie J. O’Brien, and Greg L. Stoddart.
Oxford University Press, 2005, $55/£29.50, 379 pages.
Reviewed by Kevin D. Frick

This book is an excellent addition to any collection on cost-effectiveness methods. It describes and gives usable examples of such methods.

The first edition was published in the mid-1980s; this third edition reflects new techniques, the many different recommendations for performing cost-effectiveness analyses, and recommendations for formatting descriptions of cost-effectiveness analysis results.

A key feature is the description of cost-effectiveness analyses conducted using either patient level data (such as analyses that are conducted alongside randomized trials) or decision analytic modelling. The authors highlight the strengths and weaknesses of both types of studies and make clear the challenges that an analyst will face in either type of study.

This book provides a balanced view of what economic evaluation may provide to enhance healthcare resource allocation.

"As a people we have become obsessed with health. There is something radically, fundamentally unhealthy about this."
Lewis Thomas, US author, biologist, physician, 1913–1993

The Gunning Fog Index: a useful tool for targeting an article to an audience

By Ruth B Murray

In the 1930s, psychologists began to research how our brains process written information. They found that the longer a sentence the more difficult it is for a reader's short-term memory to hold its meaning, so clearly shorter sentences improve comprehension. Readability formulas determine how difficult it is to read and understand a piece of writing.

Robert Gunning’s Fog Index (GFI) was one of the first efforts to quantify the readability. The number that results from the following calculation correlates to the grade level:

GFI = [(number of words / number of sentences) + number of ‘difficult words’] x 0.4

1. Count the words and sentences in a representative passage of about 100 words.
   
2. Divide the number of words by the number of sentences to give the average length of each sentence.
   
3. Count the number of words of three or more syllables that are not (a) proper nouns, (b) combinations of easy words, or (c) made three syllables by suffixes such as ‘ed’, ‘es’ or ‘ing’.
   
4. Add the average sentence length from step 2 and the number of ‘difficult’ words from step 3 and multiply by 0.4.

So the GFI in pulp novels is 8–10; that of tabloid newspapers is 10–12; while medical journals score 14–16. Not surprisingly, insurance policies score an daunting 18–20! Professional writing should score between 10 and 15. Below 10, and you are in danger of over-simplifying your message. Over 15, and your reader may struggle to understand.

Overcoming writer’s block

by David Woods

Asked if she liked writing, American author Dorothy Parker (1893–1967) replied that, no, she liked having written.

Any writer who has sat facing a blank computer screen and a fast approaching deadline will know what she meant. Just getting started – or restarted – that’s the challenge; and if you can’t, then you’ve come up against the dreaded writer’s block.

Experienced writers deal with this in different ways. For some, it’s trying to find a lead sentence or paragraph that will create a natural ‘trickle down’ to the rest of the story. This calls for meticulous preliminary work on the purpose and structure of your text. For those inclined to flight rather than fight, turn away from the screen and do something completely different. Go to the fridge, or go for a walk. But remember: only so much diversion and procrastination can ward off the looming deadline.

Another tactic is to write in different locations and at different times of the day (or night). Knowing when your level of creativity is higher or lower is helpful. Some well-known authors could write only in the early morning. W. Somerset Maugham, for example, jump started his work by thinking of the first two sentences he wanted to write while still in his morning bath. He then set himself a goal of 1,000 words a day, stopping for a martini at noon … and even though some critics have noted his carelessness, he never suffered from writer’s block. While of course Maugham predated computers and their blank screens, he was adamant that visual distractions were harmful to the writer, and he always sat down to write in front of a blank wall. Something to consider.

Flexibility and a degree of ruthlessness may also be helpful to the blocked. Prepare to jettison whole sections of the text that don’t seem to work.

Finally, don’t let writer’s block get you in a sweat. Relax. The more you worry, the harder it gets to think clearly.

The essentials of foolproof proofreading

by Ruth B Murray

Proofreading is the final stage of the editing process, focusing on surface errors such as misspellings and mistakes in grammar and punctuation, and should be done only after you’ve completed other editing revisions. Some proofreading pointers:

• Choose an environment that is quiet and free from distractions.
• Read the whole document for the ‘big picture’.
• Scan for visual style, word division and word spacing.
• Read the document several times.
• Proofread for only one type of error at a time.
• Don’t rely on spell or grammar checkers.
• Read very slowly; read out loud and read one word at a time.
• Read what is actually on the page, not what you think is there.
• Re-read, focusing on the types of errors you often make.
• Circle each punctuation mark and look at each one separately.

It is rare to find a piece of writing that is completely error-free. Professional editors proofread as many as ten times. Publishing houses hire teams to read in pairs, out loud, and errors can still occur. The important thing is to make the process systematic and focused so that you catch as many errors as possible in the least amount of time.

Abstract submission deadlines

Please note that dates were correct at time of sending this email; HOC cannot be responsible for any amendments.

By Clare Gurton

Once you have made a shortlist of no more than five agencies, ask each of them to present themselves and/or ‘pitch’ for a particular project. This is your chance to pick the right agency for the job, based on what you see and what you hear.

It makes no sense to attempt to outwit an agency or withhold information at this stage. Be sure to tell each agency everything that you can and be as honest and straightforward as possible. Be clear about what you need and any time or budget limitations you have. If possible, provide a full written brief of the job/project; its aims and objectives and how you want the agency to work with you. Make sure you give each agency enough time to prepare fully before coming in to present; often this may include interrogating the brief, so you should make yourself available to do this.

Try to book enough time for each agency to present properly and, if possible, avoid seeing all agencies on the same day – this will give you time to reflect on each presentation. It will also avoid agencies tripping over one another as they come to your offices.

Before each presentation be clear about what you are looking for – what’s essential and what’s important – a check-list may help. During the presentation, ask questions and make sure you are satisfied with the answers and that you fully understand what is being proposed. Ask who you would be working with and how communications would be maintained – remember to be realistic about any personality clashes. It doesn’t matter how good an idea is if you feel you might have problems with the account executive or project manager.

After you’ve heard all the presentations, let things settle for a day or two before you make a decision. If you need to ask further questions, or need more information, ask the agency during this time. But make a final decision within a week while the prospective agencies’ presentations are still clear in your mind.

Another packed issue, including Ethics in publishing, How health economists can develop a global outlook to healthcare, Graphic utilisation for health economists and What are journal editors looking for?