key: cord-0036901-k78kauxs
authors: Taylor, Robert B.
title: A Writer’s Attic
date: 2015-05-23
journal: What Every Medical Writer Needs to Know
DOI: 10.1007/978-3-319-20264-8_10
sha: cc0645d4a9c5c07596408d0a60d680eae7098b08
doc_id: 36901
cord_uid: k78kauxs

This chapter presents a miscellany of facts about writing: America’s first and oldest medical journal; the most remarkable feat of medical writing in more or less modern times; and the change in focus in medical journals. The chapter describes “authorisms,” neosyndromes, and classic gaffes in the medical literature. There is advice about what to think about when invited to edit a clinical reference book. There are also tales of retracted scientific articles and fake medical journals, and advice for aspiring medical writers, including books and websites to consult.

The change has been subtle, and I had not noticed the shift in emphasis until I read the article by cardiologist Wes Fisher appearing on the website Kevinmd.com/blog. The title of Fisher's article tells it all: "Medical Journals Are Shifting From Science to Politics" [ 10 ] .

The author uses as his example the NEJM, considered by the New York Times to be the "most prestigious" of all medical journals [ 11 ] . He compares articles from his latest issue of the NEJM to those printed a decade before, fi nding a remarkable shift from an emphasis on scientifi c discoveries to a focus on sociopolitical topics.

This prompted me to look at the Table of Contents of my recent issues of NEJM and the Journal of the American Medical Association (JAMA). I found some purely scientifi c reports on the transfusion threshold in septic shock (NEJM), glycemic control in type I diabetes (NEJM), and comparative weight loss among named diet programs (JAMA), all containing information important to me as a generalist physician. [ 7 ] But in my same journals I encountered articles on calorie labeling in restaurants, barriers to physician reimbursement, life insurers having access to genetic results, diversity in medical education, hospital relationships with direct-to-consumer screening companies, government regulation of portion size, the blockade of Medicaid, and the inevitable debates about the Affordable Care Act.

Why the change? Certainly the shifting focus refl ects the increasing impact of economics and regulations on the process and outcome of health care. Any health care system is profoundly infl uenced by what doctors and other professionals are allowed to do and how they are paid for doing it. On all of these issues and more, the sociopolitical articles in our most infl uential "scientifi c" journals inevitably refl ect a viewpoint. That is what op-ed articles do. But who determines what is published and the viewpoint refl ected?

And, for those involved in treating actual sick patients, every political opinion article printed means another clinical trial report not published and read by those in practice. For medical writers, it is one more op-ed piece and one less research report.

In the Introduction to this chapter I alerted you that it represented a potpourri. Hence I am going to shift from history and politics to a lighter topic: made-up words.

An "authorism" is a new word created, and sometimes championed, by an author. Authorisms are invented words that catch on because they seem to fi ll a need. Otherwise they don't survive. Perhaps I am being restrictive, but I don't consider a new word an authorism unless the creator of the term can be identifi ed.

The word authorism seems itself, to be an authorism, the brainchild of Paul Dickson, who describes a number of such neologisms in his 2014 book appropriately titled Authorisms: Words Wrought by Writers [ 12 ] . One of the best known of these is the word "serendipity," fi rst used by Horace Walpole in a 1754 letter to his friend Horace Mann, alluding to the Persian folk tale of "The Three Princes of Serendip" (now called Sri Lanka). The princely trio had the facility of repeatedly making chance but happy discoveries. Dickson goes on to describe the words "pandemonium" (John Milton), "chortle" (Lewis Carroll), and "butterfi ngers" (Charles Dickens) as authorisms. My favorite: American scholar H.L. Menken, aka "the sage of Baltimore," created the term ecdysiast, based on the word "ecdysis," i.e., the process of shedding old skin, molting. This new word was his gift to famous striptease artist Gypsy Rose Lee (immortalized in the movie Gypsy ), who sought a more elegant term to describe her role on stage [ 13 ] . The creation of the verb "neologize" has been attributed to President Thomas Jefferson, along with some 100 other words such as "pedicure" and "indecipherable" [ 14 ] .

• Ambidextrous and others : In the seventeenth century, Sir Thomas Browne, author of Religio Medici (The Religion of a Physician), introduced dozens of new terms, many of them part of our current medical vocabulary. Among them are the words ambidextrous, ascetic, locomotion, prostate, and suicide [ 15 , 16 ] . • Vaccinate : In 1796 Edward Jenner was the fi rst to use the word "vaccinate," a very reasonable term considering that the material he used to protect humans from smallpox came from a cow ( vacca in Latin). • Streptococcus and Staphylococcus : In the mid-nineteenth century, the word " Streptococcus " was coined by Viennese physician Albert Theodor Billroth, based on Latin and Greek roots and describing bacteria seen in "chains." Billroth's name is part of the today's surgical lexicon, used to describe a gastric reconstruction procedure (see Fig. 10 .3 ). About this same time, Scottish surgeon and scientist Alexander Ogston gave us a new word, " Staphylococcus ," coming from similar roots, and identifying bacteria seen occurring in clusters under the microscope [ 16 ] . • Phantom limb : The phenomenon of perceiving sensation, sometimes including pain, following amputation of a limb had been known as early as the time of Ambroise Paré in the sixteenth century, but it was not until 1871 that American physician and writer Silas Weir Mitchell created the authorism "phantom limb" [ 18 ] . • Anesthesia : William T.G. Morton introduced us to ether insensitivity to pain, but Oliver Wendell Holmes, Sr. gave us the word "anesthesia" [ 19 ] . Billroth, considered by some to be the father of modern abdominal surgery [ 17 ] • [ 22 ] . A current Google search of the word "diabesity" yielded several dozen sites; Kaufman's neologism seems to have "stuck." • Singularity : Also in 2005, futurist author Ray Kurzweil coined the term "singularity" to describe the time when humans and computers will merge as one through the addition of technological advances, such as tiny nanobots, to our brain function [ 23 ] . • iPatient : In 2008, American physician Abraham Verghese gave us the freshly minted word "iPatient," to describe the virtual patient discussed by students and residents while viewing online laboratory reports "in the bunker while the real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer" [ 24 ] .

Not all attempts at medial authorism are successful. Some are proposed, but never really catch the fancy of the medical writing community. Consider the following:

• Balneation and others : Sir Thomas Browne, mentioned above, proposed some words that aren't often encountered today: "balneation" (bathing), "moratin" (a delay), and "pistillation" (to grind with a pestle) [ 15 ] . • Homogenic : In Chap. 8 , I told of British physician-author Havelock Ellis who wrote on homosexuality, but deplored the term, preferring the word "homogenic." Today we sometimes use the word "homophobic," but "homogenic" today has another meaning entirely. It is used in genetics to mean "having only one alternative form, or one allele, of a gene or genes" [ 25 ] . • Journalology : The term "journalology" is the brainchild of former British Medical Journal editor Stephen Lock [ 26 ] . The word describes the use of biometrics to evaluate journals, and has to do with the impact factor, described in Chap. 3 . The word "journalology", however, has no entry in Dictionary.com, and I can't say I have ever heard it used in conversation. • Neosyndrome : Just below, I use this term. I just made it up. Time will tell if anyone uses the word again.

This, the word "neosyndrome," is a neologism, an authorism I created just for fun. I could not fi nd it in any dictionary, my MS Word Spellchecker rejects it, and a Google search comes up empty. It designates a newly described syndrome, which may be a recently recognized constellation of symptoms and signs, or perhaps a descriptive title for a behavioral or physical manifestation we all know. Some neosyndrome names involve place names, or activities, or even the names of patients. Some involve irony and wicked wit.

• Little League pitcher's elbow and more : Among the diseases named for activities are "little pitcher's elbow," "silo-fi ller disease," "gamekeeper thumb," "tennis elbow," and "welder's conjunctivitis." "Saturday night paralysis" occurs when an alcohol sedated individual sleeps with an arm over the armrest of a chair or the back of a park bench, sustaining a radial nerve palsy. When garment workers return after a weekend to a factory with the air laden with cotton dust, they may suffer "Monday morning asthma." Then there is the "Sleeping Beauty syndrome" (a pathologic sleep disturbance). Sometime, somewhere, someone thought up all these descriptors. All were once freshly described neosyndromes. In the "Alice in Wonderland" syndrome, the patient experiences distorted perceptions of body images [ 29 ] • The Ulysses syndrome : We have an entire universe of iatrogenic syndromes caused by therapeutic misadventures. The Ulysses syndrome, fi rst described by Rang in 1972, is different. It is a side effect of investigation, and also might be identifi ed as the "laboratory error syndrome" or the "top/bottom of the bell curve syndrome." The non-disease begins with the discovery of an unanticipated abnormality on a laboratory panel or roentgenogram. This prompts a return visit to the doctor, who dispatches the healthy patient on an odyssey of unnecessary testing, imaging, and perhaps scoping. The most serious risk of being the victim of the Ulysses syndrome is not the wasted time and money, but the very real possibility that the investigation might culminate in needless therapy or even invasive surgery [ 30 ] . • Legionnaires' disease : Legionnaires' disease was so named because the index cases were American Legion members all staying in the Bellevue-Stratford Hotel on Broad Street in Philadelphia in July 1976. The disease, of course, has no other connection with this respected veteran's organization, and I suspect its members wish the new disease had been named something else, perhaps the Bellevue-Stratford disease. But it may be too late to call it Philadelphia disease. • Kabuki syndrome : "Kabuki syndrome," described by Kuroki in 1981, takes its name from the facial similarity of patients to the makeup of actors in traditional Japanese Kabuki Theater. Those affl icted have large ears, elongated palpebral fi ssures, a depressed tip of the nose, skeletal abnormalities, and mental retardation [ 31 ] . • SARS : In 2003, we witnessed the emergence of severe acute respiratory syndrome (SARS), which began in China, and, thanks to the miracle of modern air travel, eventually killed 775 persons in 37 countries. The name given hastily to the manifestations-severe acute respiratory syndrome-was not especially inventive, or even descriptive of the geographic or other locus of origin. In April 2014 the USA recognized its fi rst case of another acute pulmonary disease, named the Middle Eastern respiratory syndrome (MERS) [ 32 ] . The infected individual had recently returned home to Munster, Indiana, from Saudi Arabia. Both SARS and MERS are neosyndromes, as was the acquired immunodefi ciency syndrome (AIDS) in the 1980s. • Borrelia miyamotoi disease : Lyme disease, caused by Borrelia burgdorferi , is named for Lyme, Connecticut, where a cluster of cases occurred in 1975. Now we have a new disease, caused by a cousin of B. burgdorferi named B. miyamotoi , detected fi rst in Connecticut and subsequently found to be spread by all the same tick species that are the vectors for Lyme disease [ 33 ] . " Borrelia miyamotoi disease" is much too cumbersome a title for continued use, and so this new disease is a naming opportunity for someone. • Philadelphia syndrome : In searching for neosyndromes, I came to the 2013 description of a mystery ailment affecting chiefl y young women in the Philadelphia area, characterized by sudden personality changes, uncontrolled movements, and seizures. Physicians report, "It is like your brain is on fi re" [ 34 ] . Will this entity, in time, come to be known as "Philadelphia syndrome?"

• PCHD : In the wicked wit category is "political correctness hyperactivity disorder (PCHD)," a neosyndrome concept promulgated by Martin in a letter to the editor in the Wall Street Journal describing America's current state of political affairs [ 35 ] . The author writes, "What we have before us is a postmodern magisterium of secular doctrine, affected with political correctness hyperactivity disorder (PCHD) and fueled by a utopian ambition that see no limits to its quest for power in the guise of public service."

In Chap. 5 I described predatory publishers soliciting manuscripts for open-access journals whose chief goal was to extract publication fees from authors of scientifi c papers. There is a related online scheme to rob you of something more valuable than a few dollars-your reputation in the scientifi c community. What they want is your good name. Recently I also received an "out-of-the-blue," e-mail request to edit an ebook titled Current Developments in Stroke . This would seem to be a great honor. Finally someone recognizes my many valued contributions to the medical literature. Even though my "plate" is full, who could refuse such an opportunity? I would receive a 5 % royalty on sales, and all I would have to do is to "solicit chapter contributions from active, eminent scientists, largely from developed countries, with a focus on an important theme of current interest" [ 36 ] . I would then presumably correct all errors, arrange the chapters in an orderly folder on my computer, and send them on to the publisher. Did I mention that this proposal describes not a single work, but an entire ebook series?

My fi rst hint of something amiss was the topic proposed. I have written more that 30 medical books and some 200 published papers, including a few articles on the topic of migraine headache. But I am certainly not an expert on stroke, nor am I a "scientist." Thus, despite my editing experience, I seemed an odd choice to edit a work on stroke.

Then there was the publisher, which I will not name here. A quick Google check revealed that this publisher has its home offi ces in Sharjah, one of the emirates of the United Arab Emirates, and that it publishes more than 100 "scientifi c" journals and offers a number of free-to-view online publications. Perhaps nothing too alarming so far. But the publisher has its critics. A Wikipedia search on June 1, 2014, cites reports of this same publisher "spamming scientists to become a member of the editorial boards of its journals," and having "exploited the Open Access model for its own fi nancial motives and fl ooded scholarly communication with a fl urry of low quality and questionable research" [ 37 ] . I did not reply to the publisher's invitation and I advise even the most desperately aspiring medical writer to do the same. Don't say no (and thus confi rm your e-mail address for them); just delete the message. Sad to say, there are some-just a fewless than honorable individuals in medical publishing, and the medical writer must always exercise due diligence with any offer, especially if it seems just a little too appealing. And maybe slightly off the mark.

This offer is quite different from the one described just above, and it merits careful consideration, even if your eventual decision is to pass on the opportunity.

Over the past 40 years, I have edited some 15 multi-author medical reference books, 6 of them containing more than 1000 pages. I have coaxed and threatened authors. I have heard every tardiness excuse you can imagine-including one manuscript washed away in a fl ood. One author fl agrantly lied to me for months, "My chapter is almost done; I'll have it to you next week." It never arrived. At manuscript submission time, another author exclaimed, "You weren't really serious about deadlines, were you?" I have suffered warring coauthors, and have had authors whose lives fell apart or even, unfortunately, died during manuscript preparation. I have done some very heavy editing on poorly written chapters, and not all authors were thrilled with my changes. Being the editor of a multi-author book is not for the faint of heart.

On the other hand, medicine needs courageous individuals willing to compile multi-author works. Every specialty needs a few of these. Today, with electronic manuscript preparation, submission, editing, proofreading, and even online revising when errors are found following publication, things are much easier than in the past. No more manuscripts "lost in the mail" or washed away in fl oods. And there are few things as thrilling as seeing your own multi-author work come together and be published. Now, if only authors could just get their contributions in on time.

If you decide to become a volume editor of a reference work, here are Dr. Taylor's ten rules to guide you to a timely, rewarding conclusion [ 38 ] :

• Personal planning : Organize your personal schedule as you plan the project. An edited book in not a steady effort. There are three very time-intensive phases; in between there are quiet times. The busy stages are (1) author recruitment, (2) manuscript editing, and (3) proofreading of book pages. These will not be good times to book a month-long ocean cruise.

• Author selection : Choose the author for each chapter with care. Match each author with a topic that he or she wants to "claim" in the literature. Even if you, the editor, are not well known, the prospective author will often agree to write the chapter, because that person knows that a refusal means you will offer the topic to someone else. • Recruiting authors : Be fi rm in recruiting only authors committed to the project.

An eager assistant professor may, in the end, be a better choice than the already over-committed senior faculty member. In the end, a late contributor responsible for a "must-have" chapter can delay the entire project. Early warning signs of potential tardiness in manuscript delivery are initial hesitation about the project, a long discussion about the many projects your possible author already has committed to do, and early attempts to negotiate a later deadline for manuscript submission. If you sense any of these "red fl ags," it might be best to go on to someone else. Reference list at the end of the chapter, which can run to several manuscript pages? • Overwriting : Beware of authors' tendency to write too many pages, even in spite of instructions any high school student could understand. It is hard to believe, but most authors tend to overwrite. Adding a few pages to the desired chapter length might not seem to be important, that is, until 50 or 80 or 100 authors all exceed page allocations, and the fi nal book becomes a heavy tome. This has happened to me, as I described in Chap. 7 .

wishes about other things that may fi nd their way into manuscripts: Do you want footnotes, or should all material be presented in the text? Would an Appendix to the chapter be acceptable? Will it be okay if authors thank their administrative assistants, spouses, or mentors? • Reminders : Remind all authors monthly of the project. A real danger is that contributors forget about their chapters. After all, you gave the author a 6-month deadline, and so a natural tendency is to delay writing, focusing on more urgent issues such as teaching or seeing patients. Then, in a few months, the chapter you are counting on has become hazy in the author's memory. The way to avoid this is to send monthly reminders to all contributors. I tend to vary these: e-mails 1 month, postcards the next, letters the next, and so forth. • Following through : After the edited work is published, be sure to thank your authors and confi rm that each has received the promised copy of the book. If you promised authors a small fraction of the book's royalties (a practice which I do not advise), be sure this pittance is received. Fractional royalties due contributors represent tiny payments; but there will be many of them, and the publisher's accounting department hates this practice. Nevertheless, if you made such a promise, be sure the publisher follows through. • Looking to the future : Following publication, keep in touch with those who wrote for you, perhaps sending them copies of the book's glowing reviews. After all, you may want these authors to update their chapters in a few years or contribute to your next edited book.

In Chap. 4 , I described the Dizzy Awards, some slightly confusing contributions to the medical literature, and also the typographical, grammatical, and omission errors that somehow emerged in print. Here is another group of literary misadventures, some I consider to be more entertaining than simple obfuscation or misprints. These typically are wrong-headed misstatements and even ill-fated predictions. Wise medical writers keep in mind that what goes into print today may sound ridiculous when read back to you a few decades in the future. Pierre Pachet was Professor of Physiology at Toulouse University in France and highly respected in his day. In 1872, however, he declared [ 39 ] : "Louis Pasteur's theory of germs is ridiculous fi ction." Benjamin Rush, sometimes called the "American Sydenham," was professor of chemistry at the Philadelphia Medical School, later to become the University of Pennsylvania Medical School. He wrote America's fi rst chemistry book. Rush was an American patriot who signed the Declaration of Independence and served as Surgeon General of the Continental Army. But in 1796, he declared [ 40 ] : "I have formerly said there is but one fever in the world. Be not startled, Gentlemen, follow me and I will say there is but one disease in the world. The proximate cause of disease is irregular convulsive … action in the [vascular] system affected." JAMA has an engaging column titled "JAMA Revisited," transcribing verbatim articles published in the distant past. (I would enjoy the column even more if the original authors were identifi ed more often.) My small criticism notwithstanding, I read it regularly and was amused by an article on bicycles, published in the August 15, 1896, issue of JAMA [ 41 ] : "The esthetics and morality of bicycling do not come within the professional ken of the physician. A costume and posture which make ninety women in a hundred absurd spectacles will not long be popular with the thousands and tens of thousands of that fair sex as today … It is enough for us to declare that a woman, especially an adolescent girl, can not be suspended on the summit of a wedge without injury to the structures above, and the deformation of the pelvis; and that the bruising of the fl esh, which some riders unwillingly admit, and the craving for stimulants after a fatiguing ride, ought to restrain the prevailing indiscriminate and intemperate use of the vehicle."

What Are Some Classic Gaffes in the Medical Literature?

One of my favorite medical writers is Félix Martí-Ibáñez, medical writer and professor of the History of Medicine at the New York Medical College. Despite the erudition exhibited in his many works, including two quotations found in Chap. 9 , in 1958 Martí-Ibáñez made the following prediction [ 42 ] :

"The profound change that is taking place in the natural history of infections warrants the prophecy that by the year 2000 the diseases caused by bacteria, protozoa, and perhaps viruses will be considered by the medical student as exotic curiosities of mere historical interest, as is the case today with tertiary syphilis, gout, and smallpox."

Baby and Child Care , the book by Benjamin Spock, infl uenced how many of us were raised. At the time of the early editions, Spock and the world of medicine were not yet aware of the sudden infant death syndrome (SIDS). Thus, in the 1958 edition of his book, Spock was simply being logical when he advised that infants not sleep while placed on their backs: "If (an infant) vomits, he is more likely to choke on the vomitus" [ 43 ] .

In 1988, a molecular biology professor at University of California, Berkeley, is reported to have described the human immunodefi ciency virus (HIV) as "a pussycat" [ 39 ] .

In Chap. 7 , I described the fi asco of Andrew Wakefi eld's article, subsequently retracted, attempting to link childhood immunizations to developmental disorders. There have been many other retractions:

The International Journal of Cardiology has retracted a review article on pulsus paradoxus by Abu-Hilal et al. because "the authors have plagiarized part of a paper that had already appeared in History of Medicine Online " [ 44 ] . I followed the link to the 2006 victimized paper, a nice article by Woo et al. titled "Remarkable Physicians Associated With Pulsus Paradoxus, The Classic Sign-Richard Lower and Adolf Kussmaul" [ 45 ] .

In July 2014, Nature issued a retraction of two papers it had published earlier in the year by Haruko Obokata et al. in Japan. The papers described an amazing breakthrough: creating embryonic-like stem cells from bodily cells by subjecting them to stress. Perhaps a little too amazing. The report of the retraction states, "The retractions-agreed to by all of the co-authors-come at the end of a whirlwind 5 months during which various errors were spotted in the papers, attempts to replicate the experiments failed, the lead author was found guilty of misconduct, and the centre where she is employed was threatened with dismantlement" [ 46 ] . Steen et al. report a study of 2047 retracted scientifi c articles, which I fi nd a very large number of discredited reports. They looked at the time to retraction from the date the article was published, fi nding that the more recently published articles are being retracted quicker, although the average retraction time for articles published after 2002 was still 23.82 months. (It seems Nature , as described above, acted with lightening speed.) Of interest was the fi nding that from 1993 to 2012, singleretraction authors wrote 63.1 % of retracted papers. In contrast, from 1972 to 1992, authors with a single retraction wrote 46.0 % of retracted papers, suggesting that during that earlier time there were more authors with multiple retractions. Steen et al. also note: "The fi rst article retracted for plagiarism was published in 1979 and the fi rst for duplicate publication in 1990, showing that articles are now retracted for reasons not cited in the past" [ 47 ] .

Yes, there have, in fact, been six fake medical journals. And that is just the ones we learned about. Here I am not writing about the open-access, "scan and spam," online predatory publications described in Chap. 5 . By "fake scientifi c journals" I mean bogus, false, phony publications with a nefarious purpose, an intent even more egregious than convincing authors to pay for meaningless "publication" of their work. The goal for the fake journals was to introduce biased reports about pharmaceutical products into the literature. The hoax was perpetrated by an alliance of pharmaceutical companies and a cooperative journal publisher. Here is the story, and to be sure I am on sound legal ground, I am going to quote my sources liberally.

In 2009, Grant reported: "Scientifi c publishing giant Elsevier put out a total of six publications between 2000 and 2005 that were sponsored by unnamed pharmaceutical companies and looked like peer reviewed medical journals, but did not disclose sponsorship, the company has admitted" [ 48 ] . The author of the article goes on to describe one of the "journals": "The allegations involve the Australasian Journal of Bone and Joint Medicine , a publication paid for by pharmaceutical company Merck that amounted to a compendium of reprinted scientifi c articles and one-source reviews, most of which presented data favorable to Merck's products" [ 48 ] .

In confi rmation of the report by Grant, Huag, writing in the New England Journal of Medicine in 2013, told readers: "Until recently, 'international, scientifi c, peerreviewed journal' has had a fairly specifi c meaning to the scientifi c community and to society at large: it has meant a journal that checks submitted papers for scientifi c quality, but also for relevance and interest to its readers, and also ensures that it contains new fi ndings that may advance science. These features render a journal trustworthy and worthy of readers' time and money. Many observers were therefore understandably disturbed when the journal publisher Elsevier admitted in 2009 that it had published six 'fake journals' funded by pharmaceutical companies-in Elsevier's own words, 'sponsored article compilation publications … that were made to look like journals and lacked disclosure.' The company had intentionally exploited the word 'journal' to give the impression that these publications were honest and reliable" [ 49 ] .

I was prompted to consider this question by the words of nineteenth-century French physiologist Claude Bernard: "I feel convinced that there will come a day when physiologists, poets and philosophers will all speak the same language" [ 50 ] (see Fig. 10 .5 ). Bernard, a pioneer of the scientifi c method and blinded experiments, promoted the concept of the milieu intérieur , what we now call homeostasis [ 52 ] . Before becoming a renowned scientist, however, he was an aspiring playwright, which may help explain his dream of universal interdisciplinary communication [ 53 ] .

A century later, in his poem Asphodel, That Greeny Flower , William Carlos Williams wrote [ 54 ] : "It is diffi cult/to get the news from poems/yet men die miserably every day/for lack/of what is found there." What can we make of this? Williams, I believe, was not saying that a lack of what is found in poetry causes men to die , but rather that their deaths are sometimes unnecessarily miserable for want of the imagery, joy, and even the cadence of poems. And perhaps also, by inference, a paucity of philosophical refl ection. In my opinion, he was writing about the quality of life at the time of dying, and how it can be enhanced by metaphor, simile, allusion, and nuance of language and thought. [ 51 ] But, to return to Bernard, will we ever all speak the same language? I have written earlier in this book about the risks of creative prose in research reports. And isn't scientifi c language comprised largely of words that are polysyllabic, arcane, and derived from archaic Greek and Latin sources? These don't sound like the words of poets and philosophers. Or do they?

Poets speak of metre, caesura, iambic pentameter, alliteration, and (one of my favorite words) onomatopoeia. Philosophers speak of metaphysics and existentialism. Are these words any less inscrutable than words such as etiology, endothelial, musculoskeletal, prognosis, and other terms physicians use in their work and writings?

Ralph Waldo Emerson once called the poet "the true and only doctor," going on to explain about the poet: "He knows and tells; he is the only teller of news, for he was present and privy to the appearance which he describes. He is a beholder of ideas, and an utterer of the necessary and causal" [ 55 ] . But can the physician also have the heart of a poet? We seem to acknowledge this possibility by the inclusion of poetry and philosophy in many medical journals, and even on the program in some medical conferences.

Today many-perhaps most-medical schools offer courses that integrate medicine with literature and the humanities in general. In 1988, Calman et al. described one early course involving poems, plays, and books with both medical and nonmedical themes [ 56 ] . In 2015, Stanford School of Medicine described their Arts, Humanities, and Medicine Program, offering "medical students, faculty, staff, and community members to explore the intersections between creative expression, humanities based critical inquiry, and value-driven social science with medicine and biosciences at Stanford" [ 57 ] . Now if we can only bring our diverse languages a little closer together.

Books will evolve. In the beginning they were hand-written, and later some were copied by scribes. Next came the printing press, with hand-set type. Production of books-actual paper books-became easier when everything "went digital," allowing many bound books now to be produced on demand; an order generates a printed book. Many books are currently read on Kindle and similar text readers. In fact, this book you are reading is available in print and also as an ebook. The future will bring new innovations. Maybe we will read books on our television sets, just as many of us now read the morning paper over breakfast. But whatever happens, the basic product will involve words that begin in the mind of an author and that, by some means, are organized into sentences, paragraphs, and completed works.

There are plenty of basic "how-to" books about medical writing, including one of mine (see below). Just search Google or Amazon. Among the many possibilities I have some favorites. Here I present seven diverse sources that may help someone considering medical writing as a serious endeavor. In the Appendix, there is also a list of books about language, sayings, writings, and the lore of medicine.

The leading professional association of American medical writers, the American Medical Writers Association (AMWA), offers an informative website for aspiring medical writers. It is aimed at the person considering medical writing as a profession, rather than a health care professional contributing to the medical and scientifi c literature. But the topics discussed are, for the most part, important to all who consider themselves medical writers. These include types of medical writers, opportunities in medical writing, characteristics of successful medical writers, and resources available [ 58 ] .

Pories and coauthors have given us a useful guide to writing in general, with a focus on down-to-earth, practical issues. They begin with a fundamental truism in writing: "The fi rst step in any written scholarship is conceptualizing the scholarly project and establishing the importance of the topic." They go on to describe the literature search process, electronic resources, defi ning the scope of the project, establishing a timeline, selecting a target journal, and tips on how to submit your work for review [ 59 ] .

If I had been writing Sharma's title, I would not have included the question mark. But that minor criticism aside, I found this to be a comprehensive and readable overview of medical writing, which the author defi nes as "writing scientifi c documents of different types which include regulatory and research-related documents, disease or drug-related educational and promotional literature, publication articles like journal manuscripts and abstracts, content for healthcare websites, health-related magazines or news articles." In the article, he discusses types of medical writing, domain knowledge, steps in writing scientifi c documents, and available resources for medical writers [ 60 ] .

When I interview medical school applicants, I like to confi rm that they understand the life that lies ahead. Not just the supposed glamour, but the long hours, hard work, and occasional disappointments. Ryan Woodrow, the author of this slide program, is a writer for a medical communications company who tells how he got into medical writing, the typical qualifi cations of medical writers, and how to fi nd the job that is right for you. He ends the presentation with: "Each day I am writing or communicating about something different, and in doing so I am learning something new. Who needs more than that?" [ 61 ] .

The International Committee of Medical Journal Editors (ICMJE) "developed these recommendations to review best practice and ethical standards in the conduct and reporting of research and other material published in medical journals, and to help authors, editors, and others involved in peer review and biomedical publishing create and distribute accurate, clear, unbiased medical journal articles" [ 62 ] . The ICMJE recommendations are widely followed by journals, and any paper submitted that does not adhere to the advice given faces an uphill battle. Every medical writer aspiring to publication in a refereed scientifi c journal should be familiar with these recommendations.

Yes, this is my book. No list of recommended writing sources would be complete without listing a basic book in the fi eld. Although written chiefl y for an audience in academia, the book covers fundamental writing concepts such as idea development, article structure, technical issues in medical writing, and what's special about medical writing. There are also chapters on how to write a research protocol and how to write a grant proposal [ 38 ] .

The book is a collection of addresses that Sir William Osler "delivered at sundry times and diverse places in the course of a busy life" [ 63 ] . The fl agship address, for which the book is named, is "Aequanimitas," the word meaning "imperturbability," described as "coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril …." It was the Valedictory Address to the University of Pennsylvania on May 1, 1889. Other addresses presented in the book include Osler's thoughts on "Teacher and Student," "Books and Men," and "The Hospital as a College" [ 63 ] . I include Osler's book, which saw its fi rst edition printed more than a century ago, as an example of what medical writing can be.

Keep your eye on ReadCube, created by Labtiva, a software program that provides users an economically realistic way to view individual scientifi c papers, rather than subscribing to the entire journal or wait for an interlibrary loan. The Nature Publishing Group (publishers of Nature ), Springer, Elsevier, and other leading publishing houses have announced participation [ 64 ] . The program, at least at this writing, allows a reader to view the article, but not to print, copy, or share the content-a model that Weintraub compares to the iTunes sales approach [ 65 ] . The ReadCube prototype can be a useful fi rst step in combating the access-to-publishedreports problem that scientists regularly encounter. Stay tuned.

1. Read every day, both to learn facts and also to study the writing style of successful authors. 2. Write every day, even if you think what you wrote today is not your best work.

You can improve it tomorrow. 3. Marry someone or fi nd a partner who likes your writing-both the product and also your doing it. 4. Edit your own work ruthlessly. Eliminate excess verbiage and strive for prose that is clean and clear. 5. Have fun writing. It can really be a great joy. 6. Don't worry about critical reviews; you know your work is good, even if it could be better. 7. Never give up. There is someone out there waiting to read your work.

The Medical Repository-the fi rst U.S. medical journal (1797-1824)

This work is in the public domain in the United States, and those countries with a copyright term of life of the author plus 100 years or less

About NEJM: past and present

Highlights from the Bernard Becker Medical Library Collection

A history of William Osler's the principles and practice of medicine. Montreal: McGill University Osler Library studies in the history of medicine

The principles and practice of medicine Wellcome L0028674.jpg. This fi le comes from Wellcome Images, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom

The principles and practice of medicine

Can I use a book title that's been used before? The Writers' Dig

Medical journals are shifting from science to politics

A journal stands out in prestige and longevity. The New York Times/Science

Authorisms: words wrought by writers

The American language: an inquiry into the development of English in the United States

Words from the White House

Sir Thomas Browne and the Oxford English dictionary

This image is in the public domain because its copyright has expired

Phantom limbs. Lippincott's Mag. 1871

Isaac Asimov's book of facts

Urinary albumin excretion and diabetes mellitus

The house of God

Diabesity: the obesity-diabetes epidemic that threatens America-and what we must do to stop it

The singularity is near

Culture shock-patient as icon, icon as patient

Journalology: are the quotes needed? CBE Views

Christmas disease: a condition previously mistaken for hemophilia

The syndrome of Alice in Wonderland

Alice par John Tenniel 11.png. This image is in the public domain because its copyright has expired

The Ulysses syndrome

A new malformation syndrome of long palpebral fi ssures, large ears, depressed nasal tip, and skeletal abnormalities associated with postnatal dwarfi sm and mental retardation

MERS shows that the next pandemic is only a plane fl ight away. Time

Human Borrelia miyamotoi infection in the United States

Mystery disease discovered locally, strikes mainly young women

Personal Email message from publisher

Wikipedia report

Medical writing: a guide for clinicians, educators, and researchers

15 extremely embarrassing science predictions

The medical world of the eighteenth century

Bicycling-pro and con

molds and history

Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to

RETRACTED: pulsus paradoxus; historical and clinical perspectives

Remarkable physicians associated with pulsus paradoxus, the classic sign-Richard Lower and Adolf Kussmaul

Papers on "stress-induced" stem cells are retracted

Why has the number of scientifi c retractions increased?

Elsevier published 6 fake journals

The downside of open-access publishing

Quoted in: Cousins N. The physician in literature

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Lectures on the phenomena common to animals and plants

Asphodel, that greeny fl ower and other love poems

The poet

Literature and medicine: a short course for medical students

Medicine and the Muse: medical humanities and the arts

Toolkit for new medical writers

A writer's toolkit

How to become a competent medical writer?

Been there, done it, got the t-shirt. The life of a medical writer

Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals

New York: Blakiston; 1932. 64. Lighten our darkness. The Economist

A plan to open up science journals. The Boston Globe