I have a love-hate relationship with technology. I admire the way old-order groups such as the Amish or Mennonites restrict the use of new technologies until their societal effects have been carefully considered and analysed. Yet, rapid uptake of new technology is essential for me to work from a home office, access medical articles when I cannot get to a medical library, and travel for business meetings while still being (at least somewhat) productive.
There is a big push now to use electronic medical records, but how will this work in a medical setting, especially psychiatry? The idea of pouring out my heart and soul to a psychiatrist is intimidating on its own, let alone imagining him or her tapping away on a keyboard as I explain my deepest insecurities.
And yet, when it comes right down to it, patients don’t seem to mind the use of a computer in the doctor’s office/surgery. Am I being oversensitive?
It may be that most patients, when speaking with their physicians, are probably too focused on their own concerns and being able to vocalize them clearly to be worried about the etiquette or awkwardness of computer use.
Kate Casano describes the results of a study among psychiatric patients whose physicians began to incorporate electronic health records into the physician-patient encounter. The results are surprisingly… dispassionate. And as the study authors point out, attention to communication style, interpersonal manner, and computer proficiency are probably bigger players in how well technology is incorporated into such a sensitive setting. Click here to view her article.
By David Woods, PhD
There’s been much rattling of chains lately on the subject of ghost writing in medical journals. The British Medical Journal has reported that studies presented at the recent Sixth Annual Congress on Peer Review and Biomedical Publication in Vancouver showed that almost 8% of articles in high impact journals are ghost written.
In one study, Professor Lisa Bero of the Institute of Health Policy Studies in San Francisco said that while many journals have policies proscribing ghost writing, many weren’t explicit enough to capture ghosts. ‘We need to hit authors hard with explicit questions. Was this ghost written? Were you or anyone paid to write this article? And this has to be done universally so this sort of stuff doesn’t get through.’
While the full extent of ghostwriting is still unclear, presenters at the Vancouver conference felt that it is probably underestimated. What is clear, though, is that the concept is widely misunderstood. While such organizations as the World Association of Medical Editors, the International Society of Medical Journal Editors, the American Medical Writers Association (AMWA), the European Medical Writers Association, and the International Society for Medical Publication Professionals (ISMPP) have all weighed in on the topic, some misconceptions still prevail.
In its Code of Ethics, ISMPP tries to dispel some of these by stating that when preparing or developing publications its members should “avoid and discourage the practice of ghost writing (i.e., circumstances where the contributions of professional medical writers are not identified or acknowledged).” Some of these organizations’ codes state that “unethical ghost writing should be clearly defined and avoided, with all involved parties aware of what is and is not acceptable.” And: “To prevent some instances of ghost authorship, editors should make it clear in their instructions to authors that medical writers can be legitimate contributors and that their roles and affiliations should be described in the manuscript.”
The AMWA guidelines even suggest, where writing and communications agencies are involved, the following wording: “The authors gratefully acknowledge the assistance of A. Brown of Brown Writing and Editing Services, in drafting and editing the manuscript. This study was funded by XYZ Pharmaceuticals, Inc.”
That this issue has reached the public media and yet is still in need of clarifying is exemplified by a recent editorial in the Financial Times. It read, in part: “Using professional medical writers and editors to improve clarity in manuscripts is acceptable and even desirable. Ghost writing, which conceals underlying authorship, influence, and financial support, is wrong. All those involved in an article should be cited; those without any significant input should not be mentioned as authors at all.”
And recently-appointed editor of the Philadelphia-based Annals of Internal Medicine, Christine Laine, MD, was quoted in a recent article in the Philadelphia Inquirer as saying she wants medical research centers to forbid ghostwriting. However, she also said, “We don’t think the writing assistance per se is bad. It’s when it’s not disclosed that it’s a problem.”
But Arthur Caplan, PhD, director of the University of Pennsylvania’s Center for Biomedical Ethics, says it’s not just about disclosure; it’s about having an appropriate relationship with the editor. The author has to put together the concept and take responsibility for the draft; then others help the author, with appropriate credit; after that, there’s what he calls an exposition phase – editing, grammar, re-write. The important thing, says Caplan, is that this phase should certainly not involve spinning or massaging what’s being written. There’s confusion over what constitutes a ghost, he believes. A benign ghost can help you improve the manuscript; an evil ghost is one whose role is not acknowledged and who may be manipulating the data.
As both a medical writer and editor of long standing, I’ve observed that most editors are kindly and lovable – but also fairly compulsive – souls who want their handiwork to be impeccable. Writers, on the other hand, scarred by editors’ rejections and machete-wielding cuts, may be a bit diffident. And so I say to editors: welcome the involvement and cooperation of writers and give them credit for it; and to writers: jump in as early as seems appropriate, keeping in mind the Financial Times assertion that what you do is acceptable and desirable. But also be true to your professional sense of what’s right. It won’t be easy to exorcise these ghosts; maybe we should start by excising the word ‘ghostwriting’ from medical writing, and just follow the codes of ethics.
Dr. Woods is CEO of BioscriptUS (www.bioscriptUS.com). He is also the former editor of Health Outcomes Communicator.
It seems like there is a new social networking site every week. Just when I’ve mastered Facebook, everyone is talking about Twitter. It’s tough to keep up with it all. As a friend so aptly expressed, ‘This interweb twitblog thingy is confusing.’
It may be generational. I’m 43; my nieces and nephews introduced me to Facebook. Because I am a long-distance aunt, I loved being able to learn about their lives and watch them grow up via Facebook…until my nephew said I was ‘Facebook stalking.’ (I later learned that this slang does not necessarily imply stalking in the literal sense, but rather keeping up with friends’ activities by reading their Facebook pages.)
I enjoy getting in touch with old friends from high school and college. But I also have ‘friend’ requests from people I knew but with whom I didn’t associate in high school. They were not a part of my life then; why should I share my vacation photos with them now? How does one politely decline a friend request? And what if a colleague wants to ‘friend’ you? Do they need to see your current relationship status, or the silly comment you made about a friend’s party?
This week, Julie Stauffer brings us the first in her three-part series on etiquette for social networking media, starting us off with Facebook and LinkedIn. Forthcoming articles will discuss Twitter, blogging, and, yes, email (some people still need reminders).
HOC has Facebook, LinkedIn, and Twitter profiles, and we invite you to visit them. We’d even be happy to ‘friend’ you, link to you, or send you a tweet. And we hope these articles provide you with a little insight into navigating this brave new ‘interweb twitblog thingy.’
While economics is the main ingredient in most healthcare decisions today, health economics still has many pharmacologists, clinicians, physicians and marketing personnel left confused and appalled that quality of life is equated with money. This is primarily because the audience is fearful of the sheer science behind health economics. And so the need to understand health economics is essential for healthcare professionals.
Economic evaluation in healthcare is rapidly evolving and, as a consequence, so is the associated literature and terminology. The problem that health economists face is that communicating the economics of healthcare is often lost in science and the message is obscured. Ironically, the end result of health economics research is often not intended for the health economist but for payers, drug representatives and healthcare providers.
The onus is on health economists to communicate their messages well. But equally important as the message is the way the messages should be communicated to their specific audience because audiences respond differently to different channels and methods.
Whether it’s reimbursement submissions, value dossiers or internal papers and presentations, communicating health economics needs to be effective, concise and in a form that the audience can understand and digest. That doesn’t mean to say it shouldn’t be attractive, interactive and user-friendly.
The Wall Street Journal published an editorial last month titled “The Lancet’s Political Hit.” It described how that venerable medical journal had published a study exaggerating the number of casualties (by an estimated tenfold) in the Iraq war. It turned out that the study was funded by billionaire George Soros, a famous critic of that war. Moreover, Lancet editor Dr. Richard Horton, according to the WSJ, had said, before rushing the study into print in time for the 2006 US elections, that “this axis of Anglo-American imperialism extends its influence through war and conflict, gathering power and wealth as it goes.”
When even the ‘best’ scientific journals conflate science with politics they not only do themselves an injustice and harm their own credibility; they also do a disservice to readers and researchers who trust them.
This ‘fudging’ of science with political partisanship was also the case when in 1999 the Journal of the American Medical Association fired its editor Dr. George Lundberg for injecting JAMA into a major political debate. The AMA accused Lundberg of having “threatened the historic tradition and integrity of JAMA by inappropriately and inexcusably injecting the journal into a major political debate (President Clinton’s impeachment trial that had nothing to do with science or medicine).”
This was the case, as well, when the Canadian Medical Association journal ousted its editor Dr. John Hoey for a partisan swipe against a newly-installed Canadian health minister, Tony Clement, suggesting that he would favour privatising Canada’s cherished government-run healthcare system.
In his book “The Trouble with Medical Journals” Dr Richard Smith, former editor of the British Medical Journal, notes that “the two main pressures on medical editors come from politics and from business” – the latter having to do with not offending advertisers. Part of the problem, Smith wrote, “is that the selection of medical journal editors is more opaque than the selection of a pope.” Most editors of the world’s 10,000 or so medical journals have no training in editorship. But editing, he says, is becoming ever more complex and the journals are the main route to the research that underpins medicine; if the process is poor, he says, “there’s something rotten at the root.” Smith argues that it might be preferable to hire professional journalistic editors than academic physicians, some of whom, it seems, see their scientific journals as vehicles for promoting their political views.
But there are other reasons for scepticism about research articles. Dr John Ioannidis, an epidemiologist and researcher at Tufts University, believes that many studies may be flawed by sloppy analysis, which stems, he says, from poor study design or self-serving data analysis. It can be difficult to distinguish error from fraud, sloppiness from deception, eagerness from greed, or, increasingly, scientific conviction from partisan passion. The hotter the field of research the more likely its published findings should be viewed sceptically, he says.
As physician and humorist Michael O’Donnell puts it in “A Sceptic’s Medical Dictionary”: “Scientific Paper – Piece of prose that serves many purposes save that for which it claims to exist – the passing on of information… [and which] often serves the needs of its authors above the needs of its readers.”
So don’t let your sceptic’s guard down when trawling the biomedical literature. After all, scepticism is, as the American philosopher John Dewey put it, the mark of the educated mind.
A pair of economists, Charles Jones of the University of California at Berkeley and Robert Hall of Stanford University, predict that the share of income devoted to healthcare in the US will almost double to 30% by 2050.
While some of that increase has to do with an aging population and ever more sophisticated technology, much of it has to do with waste, duplication, defensive medicine brought on by possible litigation… and by general inefficiency and antiquated ways of connecting and communicating.
One much-touted solution to all this is for healthcare to embrace technology in much the same way as have the insurance and airline industries. In fact, that quintessential techie, Bill Gates, noted in the Wall Street Journal recently that the central issue is the fragmented nature of the way health information is created and collected.
Few industries, he said, are as information dependent and data rich as healthcare: every visit to a physician, every test and measurement and procedure generates more information; yet every clinic, hospital department, and doctor’s office has its own systems for storing that information and most of them don’t talk to one another.
Gates went on to say that his company, Microsoft, envisions a comprehensive internet-based system that enables healthcare providers to automatically deliver personal health data to each patient in the form they can understand and use.
But it won’t be easy.
Healthcare is an immensely fragmented enterprise with often competing and sometimes counterproductive fiefdoms. Nonetheless, Microsoft’s software powers more than 90% of all personal computers… something that Bill Gates sees as having the potential to attract huge audiences for health-related information, advertising, and services.
And Google is not far behind in this desire to “wire” healthcare, and put the patient at the centre of healthcare delivery, creating a more collaborative partnership rather than a top-down, ex-cathedra approach. In fact, Google Health’s welcome page reads: “At Google, we feel patients should be in charge of their health information, and they should be able to grant their healthcare providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”
At a time when all the candidates for the presidency of the United States are putting forth differing views of how America’s broken healthcare system can be fixed, wiring it is surely something they can all agree upon. Even the man about to leave the presidency has jumped on this particular issue. In his 2006 State of the Union address, George W. Bush called upon the healthcare community to “make wider use of electronic records and other health information technology.”
It’s an idea whose time has definitely come.
By Kevin Frick (email@example.com)
Many economists think their profession has something to say about almost everything. This is because nearly everything can be thought of in terms of incentives and constraints.
The list is endless: decisions to marry or have a partner, the number of children people have, parenting styles, attendance at religious services, the way people choose to die. Many of these issues come under the headings of lifestyle and demographics.
Should economists have a say in these areas, since they are not always immediately obviously about economics?
A more important question is how much say should economists have about these issues and where should we have that say – particularly outside our own professional journals?
The opportunities for comment are almost limitless – letters to the editor in the popular press, speaking invitations, manuscripts in non-economics professional journals, and even casual conversations with our friends, neighbours, and colleagues.
However, on the question of how much say, we as economists should not get carried away with our sense of unique insights. That would be one way to lose all influence and the ability to affect areas outside our own usual domains.
Non-economists (and perhaps even some economists) could find an overbearing sense of “we know best about everything” to be off-putting. Many other professions use the same outcomes and even many of the same things that we refer to as incentives and constraints as predictors of behaviour.
We should be careful to make clear arguments about the particular insights that economics adds and not overstate what economics can predict. We should be equally clear about what economics does not predict or explain well.
But we should take every opportunity made available to us to make known what economists have to offer. We should use the power of persuasion to make our case about the particular insights that we add to the discussion. However, we should remember that without some humility about how our arguments fit (or fail to fit) into the bigger picture, those opportunities are likely to fall on deaf ears.
By Mary Gabb (firstname.lastname@example.org)
Attending national or international scientific conferences is a must for any researchers hoping to stay current in their research area and to network with colleagues. With ever-tightening budgets, however, you may need to be more selective about which conferences to attend. Don’t just flip a coin – think hard about what you want to get out of the event.
There are several factors to consider when evaluating a scientific conference. Of course, the essential one is content. Look at the list of topics covered not only in the scientific sessions but also the keynote addresses, and note the speakers and their affiliations. Have you heard of them? Are they from well-known institutions or organisations? You might also consider asking colleagues for their recommendations.
Another important learning opportunity at a conference is the workshops, typically offered in the one or two days preceding the conference. Are there any workshops of interest?
Will the meeting abstracts, presentation slides, or posters be available in an enduring material (eg, a CD-ROM) after the meeting?
In a perfect world, we’d like to see a formal “meetings critic” who attends conferences and provides a formal review not only of the conference organisation and management but also the individual speakers, similar to the book reviews by readers on Amazon.com.
Until then, it is up to each of us to vote with our feet and carefully consider how we spend our travel budgets.
In the current pharmaceutical environment your work is of paramount importance. However, if it’s communicated poorly, and those who need it can’t use it, what value does it really have?
Health economics and outcomes research are vital in product development, subsequent approval, marketing and eventual market share. Demonstrating the economic value of the product alongside its efficacy and safety has become one of the fundamental concerns of pharmaceutical companies. As a health economist or outcomes researcher, your findings need to be accessible so they can benefit a wider audience. Perhaps most of your previous research has been published in highly technical health economics journals; now, however, you are faced with making these complex concepts and outcomes readily understood by people who don’t share your knowledge or mindset.
A simple checklist can help you make your research publications more accessible, and will enhance the chances of your manuscripts being published and understood by a clinical audience.
If it is aimed at a health economist audience, by all means explain and expand on the methodology: after all, this is the forum for technical discussion that gives you the chance to demonstrate the validity of your techniques. However, if your audience is made up of payers, remember that many of these people will not be trained in health economics. Thus, you should place your research in the context of the healthcare authorities who will be making decisions based on your information.
If your audience is composed of clinicians, remember that these people want to understand how your work will affect their clinical practice. If you’re aiming at a primary care audience – for example GPs or nurses – make sure you explain how patient care should, or could, be improved by your findings.
You might wish to make a brief note of the key topics or issues that specifically interest your target audience, and make sure your writing addresses these topics.
Always make sure that your data sources are clearly defined and that you have made it obvious why they have been selected for use. Explain any assumptions that have been made, and include a sensitivity analysis to show that your results are robust even when the assumptions alter. In your discussions, put your findings in the context of current care , practices, cost and cost-effectiveness; above all ensure that your conclusions are made in the context of your target audience.
If possible, leave out detailed explanations about health economics methodology that might cloud the issue or confuse the reader, ultimately detracting from your key messages. It is often preferable to write an initial methodology manuscript and direct this to a health economics journal if your work requires validation by your peers or is particularly complex . You can then always reference the methodology article in the one destined for the clinical audience.
You should look at your manuscript with fresh eyes, from the perspective of the journal editor and the journal’s readership. Use the printable checklist on our website to make sure you have thought of everything.
Honing a publication to the needs of a specific audience is not about ‘dumbing down’ or making it so simple that all scientific value is lost; it is about using appropriate language and concepts, so your readers can understand, appreciate and ultimately put your findings into practice.
We hope these few pointers will help you think about your work from the perspective of your audience and therefore help you communicate it more effectively, but if you would like to speak to someone about your specific needs please feel free to contact us for a chat.