Monday, 4 May 2015

Be Organised (Tips for Improving Your Medical Writing Part 3)

The third installment of bite-sized advice to help with your medical writing will concentrate on being organised in how you approach a writing task.

When you are asked to complete a medical writing task it may appear daunting to begin with, but in the words of William Faulkner who won the Nobel Prize for literature in 1949, "The man who removes a mountain begins by carrying away small stones."

In medical writing terms this means that your first steps towards achieving your goal must be to organise and plan your content.

Begin by capturing key points

Capturing key points and ideas can be achieved in a number of different ways including mind mapping, brain storming, concept maps and generating a random list.

Rearrange key points

Key points that are noted are then arranged into an organised list, rearranged, restructured and edited to create the skeleton of an outline or a framework.

Populate the outline

Within the outline or framework you present complete sentences, phrases or words together with supporting references.

To help develop the framework or outline

• Use headings and sub headings
• Often the first headings will include Introduction, Methods, Results and Discussion as the initial structure. This structure is referred to as an IMRaD structure
• It is important at this stage to group related themes together and by doing this other headings may become apparent

The framework can then be developed further into a first draft by continuing to populate with more detailed content under each heading.

As Benjamin Franklin said, “By failing to prepare, you are preparing to fail."

Sunday, 4 January 2015

Be Concise (Tips for Improving your Medical Writing Part 2).

Happy New Year.

To start 2015 I have prepared a new blog post with some more bite-sized advice to help improve your medical writing.

Be concise

What exactly do I mean when I say be concise? Putting it very simply:

• avoid things you don’t mean

• avoid more complexity than you need

CS Lewis summed this up nicely “Don't use words too big for the subject. Don't say "infinitely" when you mean "very"; otherwise you'll have no word left when you want to talk about something really infinite”

Avoid excess! Try to use as few words as possible and delete any words that are superfluous. Some examples are:

It would appear that…… becomes Apparently
In light of the fact that… becomes Because
It is this that… becomes This
It is often the case that… becomes Often

As a medical writer your job is not to inflate poor ideas or information, nor obscure weaknesses in the data you are presenting. By ensuring that your writing is clear and succinct you are not producing big words and complex nonsense to be used as camouflage to hide the data behind.


As a medical writer you are communicating complex ideas to different audiences.....the language is not there to impress and confuse your reader.

Sunday, 2 November 2014

Tips for Improving Your Medical Writing

Over the years I have taught courses on medical writing and in the next series of blog posts I will be sharing some bite-sized advice aimed at helping you improve your medical writing skills. I hope you find the information useful.

To start, a useful summary, and if you remember nothing else from this blog post, please try to follow this advice and you will surely be successful:

“Say all you have to say in the fewest possible words, or your reader will be sure to skip them; and in the plainest possible words or he will certainly misunderstand them”

John Ruskin (1819–1900)
Art critic, author, and poet

Be precise

In scientific and medical writing precision is the most important goal of language and can be broken into two parts

• choosing the right words
• choosing the correct level of detail

Choose the wrong word and you change the entire meaning for your reader and also cause confusion. Examples are:

affect : verb meaning to influence
principal: noun or adjective meaning most important
dose : quantity administered at one time
examine: patients, animals and slides are examined

effect : noun means result or when used as a verb verb to bring about
principle : noun meaning a law
dosage : regulated administration of doses
evaluate: conditions and diseases are evaluable

Singular or plural? Be sure you know your latin:

• phenomenon versus phenomena
• stratum versus strata
• criterion versus criteria

As Humpty Dumpty in Through the Looking Glass, by Lewis Carroll says “When I use a means just what I choose it to mean - neither more nor less.” So like Humpty Dumpty make sure that when you have chosen your words, that they are meaningful and precisely what you wanted to say.

Choosing the correct level of detail

When writing, have you chosen the correct level of detail to present to your reader and equally is it at a level that they will be receptive to?

This is very important because the precision of the information you present is also influenced by the level of detail you present. But to be successful, the writer must also choose an appropriate level of detail for the audience whilst carefully achieving a balance between general statements to establish a direction of thought and specific detail that gives evidence to support the direction.

The job of the medical writer is not to try to bamboozle the reader with unlimited facts and numbers as this will only succeed in alienating an audience. Remember, you are pointing your reader in the direction you want them to follow and then providing detailed information that will be of use to them.

More bite-sized advice will be provided in later blogs to help you:

Be concise
Be accurate and clear
Be correct
Be organised
Write for your target audience

Tuesday, 30 September 2014

How to Get Started in Medical Writing - Thinking Outside the Box

I have been a medical writer for the pharmaceutical industry since obtaining my first medical writing job with Wellcome in 1995. I was a postdoctoral scientist with no previous experience of writing for the pharmaceutical industry and during the interview my scientific knowledge and problem solving abilities were examined in more depth than my medical writing. Nowadays, people hoping to begin a career in medical writing with no previous “relevant experience” encounter many more challenges trying to obtain their first medical writing post.

Over the years I have received numerous enquiries from graduates hoping to start out in medical writing and asking for advice. They find themselves in a “Catch 22” situation because more and more advertised positions are asking for candidates with medical writing and/or pharmaceutical industry experience. The age-old conundrum is how to deal with this prerequisite when you cannot access a relevant job? My advice to anyone in this position is to try “thinking outside the box” either by capitalising on the strengths you already have, or by approaching the challenge from an altogether new angle.

For example, if the prospective employer requires up to one year of medical writing experience do not be disheartened. They may be quite willing to consider someone with suitable or related therapeutic area knowledge as this can also be an important aspect for some projects.

Some adverts may not specify a therapeutic area. Most companies advertise therapeutic area expertise on their websites and if your hoped-to-be employer has one always check it out. You never know, their expertise might match your own! But don't stop at the company website. Do they have a social media presence? If so you should be following them on twitter, facebook, LinkedIn etc and becoming familiar with the company ethos and any exciting news.

Don’t be afraid to call the employer to discuss the merits of your application and sell your therapeutic area knowledge to them. If you are a bench scientist, can you provide copies of your own scientific publications to support your writing abilities?

If the potential employer is asking for pharmaceutical industry as well as medical writing experience, can you gain this in another way? The Association of the British Pharmaceutical Industry (ABPI) is the trade association for around a hundred companies in the UK producing prescription medicines. Their website provides contact details for pharmaceutical companies and clinical research organisations, many of whom offer placements allowing suitably qualified candidates to gain that much needed pharmaceutical industry experience. If you are an undergraduate toying with the idea of becoming a medical writer try to arrange for a placement during your long summer break. Check out the ABPI website for useful information about careers in the pharmaceutical industry.

Think about other, perhaps temporary, writing-related jobs. By accessing writing support jobs like quality control of document content, you can be exposed to an element of proofreading and editing as well as familiarising yourself with the content of pharmaceutical industry documents. If you do manage to obtain one of these jobs or placements take advantage of any training opportunities that may arise and keep any certificates, or a list of the courses you attended. Be sure to add them to your CV to impress the next employer.

Consider short courses that can demonstrate your commitment to following this career path. Often run as one or two day training courses or workshops they can offer an insight into the pharmaceutical industry and medical writing in general.

The European Medical Writers Association (EMWA) runs a large number of training workshops at their regular Spring and Autumn conferences. These workshops cover many aspects of medical writing in more detail, including writing both manuscripts for publication and regulatory documents. More information can be obtained from their website (see: Medical writing vacancies submitted from companies based in the UK and the rest of Europe are also regularly posted on the EMWA website.

Attention to detail is often one of the necessary skills cited by an employer. The accuracy of document content is an important aspect of medical writing and the Society for Editors and Proofreaders(see: runs a one day “Introduction to Proofreading” course in London which is held at regular intervals throughout the year. The SfEP also run some on line courses at very reasonable cost. These courses will provide you with a flavour of editing and proofreading and could help impress your would-be employer.

Interested in finding out about becoming a medical writing for a medical communications company? Be sure to check out where you will find lots of useful information on this area of medical writing including webcasts and advice from other medical writers.

If you are in the process of applying for your first medical writing post please do not be discouraged by the requirement of “suitable experience.” From my own understanding there are not enough people to fill all the posts being advertised and like most chosen career paths, to make your aspiration a reality some forward planning and extra effort will pay enormous dividends.

Sunday, 31 August 2014

All You Ever Wanted to Know About Pandemics – and Then Some

The Viral Storm: The Dawn of a New Pandemic Age, by Nathan D. Wolfe
(ISBN-13: 978-1846142987)

A warning, for those with a nervous disposition this is not a book for you; if you have an obsessive compulsive nature and go around cleaning door handles after others have touched them, then this is also not the book for you.

Pandemic originates from the Greek pan meaning all and demos meaning people. Whether or not a disease is labelled as a pandemic is not related to how many people it manages to kill, but by how much it can spread. The ideal candidate has the ability to spread easily from person to person as well as harm and kill those it infects. The author defines pandemic as ‘a new infectious agent that has spread to individuals on all continents’ (except Antarctica) and tries to answer how and why pandemics start, and what can be done to prevent them.

Using the spread of HIV as the template for other potential pandemics, he attempts to explain how our evolution from small isolated hunter-gather communities into city-dwelling, high-density populations, who globe-trot around the world has allowed us to create the conditions for a viral ‘perfect storm’. Viral sequencing has enabled scientists to trace HIV evolution back to the late nineteenth or early twentieth century when it is presumed that a hybrid Simian immunodeficiency virus jumped from chimpanzees to humans via hunters catching and butchering infected animals. From this beginning, the virus remained unobserved and unrecognized in small isolated communities in Africa, 50 years before we had ever heard of it, and often following evolutionary ‘dead-end’ pathways. At some point, an HIV isolate obtained the necessary capacities to allow it to spread more easily and by capitalizing on our modern lifestyles involving urbanization and global travel it has spread into every corner of the world. In the way that HIV has gone global, are there other viruses waiting in the wings that will evolve in a similar way and are as yet undiscovered?

As I read the first part of the book, I found myself thinking ‘we’re doomed;’ however, we are left with some hope. The ability to stop pandemics is dependent on the dedication of the author, alongside that of several other teams of equally committed individuals across the globe. Self-styled as virus hunters, and reminiscent of storm chasers, Nathan Wolfe and his colleagues provide ‘listening posts’ at ‘hot spots’ around the globe with the objective of stopping potential pandemics in their tracks before they are able to take hold and spread. By harnessing modern, cutting-edge technology they are monitoring global ‘viral chatter.’ One eventual hope is that we will soon have the ability to recognize ‘early unusual clusters of health complaints that might signal the beginning of an epidemic,’ otherwise known as ‘digital epidemiology’.

Written in a very accessible style, the book makes a compelling read. As well as highlighting areas of modern-day medical virology relevant to halting the spread of a potential pandemic, it is an anthropological study of the interaction of people and viruses. The author examines our ancestry from a viral perspective and helps to explain the natural evolution of pandemics without bamboozling the reader with science. Well worth a read – but maybe not when you have flu-like symptoms or a cough.

This book review has been reproduced in full and was first published in Medical Writing in 2012 (volume 21 issue 1).

Sunday, 20 July 2014

A Futuristic Solution to a Medical Need

In recent years I have contributed book reviews to the EMWA journal. Most of these have been reviews of books related to medical writing but a few have been for works of fiction with medical or scientific relevance.

The book Never Let Me Go, by Kazuo Ishiguro made a big impression on me and a review I wrote was published in 2011 (TWS, volume 20, issue 4). The review is reproduced in full (spoiler alert if you read on...)

Some may be familiar with another book by this author ‘The Remains of the Day’ but the setting for this tale is very different from previous books by Kazuo Ishiguro. Set in England in the late 1990s, it is a country we know but don’t quite recognise as normal. The story is told by Kathy H, a carer reminiscing about her own life and those of friends from her much loved school Hailsham and we follow their exploits through school and beyond.

Initially we find out how the children coped with life at the school. Familiar scenes are depicted with undercurrents and a certain degree of strangeness. The children are boarders with assigned guardians and vie to have their art work selected to be viewed in the gallery. Earning tokens from the sales and exchanges that take place several times a year allows the children to make small purchases for themselves. When they become older and leave the school they move into “the Cottages” and come into contact with “veterans”. At this stage they are encouraged to attend seminars in preparation for the next part of their lives and rumours abound about what this will be.

At first, the story has the feel of an ordinary tale about young people growing up, however, as it progresses there is an undertone of things not being quite as they seem. It appears that the children know nothing about life outside and have no family or memories of life before the school. The words used in the book to describe roles the young adults are expected to undertake are words we would recognise from society today: carer, donor, completing, guardian, donations. However what becomes clear is that their meaning in the society depicted in this fictional world is entirely different from what we might expect in our own

One rumour the young people really believe is the ability to have a “deferral” if you can show you are in love; Kathy and her two close friends search desperately for a deferral. In doing so, they discover the truth about themselves. What emerges is that the children are clones designed to be used as living donors with their beloved Hailsham described as a failed experiment. They are told by one of the school founders:

“...How uncomfortable people were about your existence, their overwhelming concern was that their own children, their spouses, their parents, their friends, did not die from cancer, motor neurone disease, heart disease. So for a long time you were kept in the shadows, and people did their best not to think about you. And if they did they tried to convince themselves you weren’t really like us...”

“…we demonstrated to the world that if students were reared in humane, cultivated environments, it was possible for them to grow to be as sensitive and intelligent as any ordinary human being. Before that, all clones—or students, as we preferred to call you—existed only to supply medical science….”

In calm and pseudo-scientific terms an explanation is given as to how they came about “….when the great breakthroughs in science followed one after the other so rapidly, there wasn’t time to ask sensible questions. Suddenly there were all these new possibilities laid before us, all these new ways to cure so many incurable conditions…..people preferred to believe these organs appeared from nowhere, or at most in a kind of vacuum…”

Beyond the donation processes, where the living donor obtains “completion,” still more possibilities for harvesting useful parts are described. This is one scenario of how technology might advance to make organs and treatments for incurable disease more available to all who need it. I hope reality never imitates this fictional account.

I read this book when it was first released and I often find myself thinking back to the premise of the book and wondering if we will ever go that far. Some of the more disturbing stories that emerge about the trade in human organs can be regarded as urban myths but not all. One recent report that had wide coverage involved a teenager from China who was reported to have sold a kidney because he wanted to buy a new iPAD [1]. One thing is sure, that organ was sold on for a lot more than the cost of an iPAD.

Ask yourself: if necessary, how much would I be willing to pay for a kidney, a heart, or a liver and would I question where it had come from?

1. see

Sunday, 1 June 2014

Reading Round Your Therapeutic Area

Often when you accept a medical writing job you begin the task by researching the therapeutic area concerned. This can mean a quick update to remind you of any changes, or researching for several days to try to get a feel for a new disease area. I often employ an additional method, which is effective, does not involve delving into text books, or surfing the net, and feels much less like ‘work’. Perhaps you already use it?

A while ago I found myself writing a couple of hundred very detailed case narratives for Parkinson’s disease. For large phase III studies this can involve trawling through many hundreds of pages of listings to extract key data points to populate narratives. In this instance, considering the amount of information required by the client, each narrative was taking over three hours to write, contained masses of information about drugs with unknown names, and procedures that were not familiar to me.

Writing narratives can be a very laborious exercise, and unsurprisingly deal with many negative aspects associated with a disease area. For me, to keep the task invigorating it can help to put the disease in context, not just from a scientific perspective, but also from a patient perspective.

To help me understand Parkinson’s disease from a patient’s view I began to read ‘Lucky Man: A Memoir by Michael J. Fox’ In his autobiography he deals with his career and also the discovery that he had young onset Parkinson’s disease [1].

He describes the symptoms of the disease first hand, writing, “Every time my most recent dose of Sinemet would wear off the disease presented me with a concise history of my symptoms—first the tapping of the pinkie, then the dancing hand, and within fifteen minutes or so, the whole of my left arm would be tremoring. Tremoring, actually, is too subtle a word—the tremor would start my whole arm bouncing.” This kind of detailed description brought to life the ‘increase or worsening of tremor’ written in a listing as an adverse event.

Concomitant procedures undertaken during the course of the trial were also listed and in the book he describes having to undergo ‘thalamotomy’ providing a very detailed description of exactly what the procedure involved. This was no longer just a word written in a listing, and given a definition by a medical dictionary, but a complex procedure that patients underwent in an attempt to increase their quality of life.

In 1986 when I was investigating HIV-1 for my PhD, many new scientific discoveries were being made about a recently isolated virus. There were no licensed antiretroviral treatments and the outcome for those infected with the virus was considered dire. The media was full of extreme stories concerning HIV/AIDS and any celebrities reportedly dying from the disease. During this time I saw a performance of ‘Torch Song Trilogy’ by Harvey Fierstein [2] in a West End theatre. I remember I was incredibly moved by this seminal production which allowed the public examination of how AIDS had affected the gay community during the late seventies and early eighties in a more measured and productive fashion. It had absolutely no scientific content but what it did for me was place HIV-1 into a human context.

I know I am not alone in using personal accounts to help work through medical writing tasks. Last year I was asked to review oncology literature, a task I wanted to finish as quickly as possible. Another writer also assigned to the job approached the subject differently and began to read ‘Cancer: C: Because Cowards Get Cancer Too’ by John Diamond [3]. The author had been a journalist in the UK who recorded, in his newspaper column, his battle with throat cancer. This book recounts his life, his cancer and all the treatments he underwent and has very uplifting reviews on Amazon.

In the UK in recent months there has been much discussion around the outcome of the NICE review regarding availability of new dementia treatments. For those working in this therapeutic area who want to find out more about what this harrowing disease is like to live with on a day-to-day basis, John Bayley’s memoir would be a good place to start [4]. In this book he recounts the way normal life with his wife of 45 years slips further, and further away from him as the disease tightens its grip on her brain, ultimately destroying her ability to function as a person.

Interested in the moral issues science throws at us? Why not try reading the novel by Kazuo Ishiguro: ‘Never Let Me Go’. This book will leave you thinking about the moral dilemma of human cloning and all its implications [5]. Although not to be classed as a ‘light holiday read’ I thought it was an exceptional book.

Where ‘reading round your therapeutic area’ is written from a very personal perspective, Anne Hudson Jones has written a series of academic articles on the contribution of literary narrative to medical ethics. If you would like to examine the moral and ethical issues this poses in greater detail then accessing the articles would be a pertinent place to begin [6].

Perhaps you have used this ‘tactic’ in reading round your therapeutic area? Do you have any recommendations? If so please tell…or maybe I’m just a medical writer who needs to get out more!

1. Michael J. Fox. Lucky Man: A Memoir. 2003; Ebury Press; New Ed edition, UK.
2. Harvey Fierstein. Torch Song Trilogy. 1981; Gay Pr of New York, US.
3. John Diamond. C: Because Cowards Get Cancer Too. 1999; Vermilion; New Ed edition, UK.
4. John Bayley. Iris: A Memoir of Iris Murdoch. 2002; Abacus; New Ed edition, UK.
5. Kazuo Ishiguro. Never Let Me Go. 2006. Faber and Faber; New Ed edition, UK.
6. A Hudson Jones. Narrative based medicine: narrative in medical ethics. BMJ. 1999 January 23; 318(7178): 253–256. (accessed 30 May 2014:

Further reading:
A special issue of the The Lancet entitled ‘Medicine and Creativity’ published in December 2006 (vol 328) has an article by Anne Hudson Jones on the beneficial effects of writing about illness:
Jones AH. Essay Writing and healing. Lancet 2006;368:53- 54.

This posting is based on an article I first published in TWS, volume 16(2) 2007.