Updates to Our Style Guide for the Sartorially Challenged

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio

Every so often, the crackerjack editorial team of ASH Clinical News gets together and discusses style.

No, not of the sartorial variety, particularly as mine tends toward chinos, a shirt with a non-asphyxiating collar, and comfortable shoes – matching colors and patterns be damned. This is a combination I like to call “hematologist fashion backwards,” or a “smear” of style.

I refer instead to style of the writing variety. We have evolved over the past few years in an effort to improve our readability, particularly with respect to clarity of text, and to respond to trends we see in medical journals and other magazines, along with the lay press. We also strive for neutrality in reporting and try not to be taken in by the subtle vaunting of scientific findings that creep ever-so-insidiously into even the most prestigious journals.

Here are some examples. As always, we welcome your input into how we can better present you with hematology news – and, indeed, some of these changes have resulted from your suggestions! Feel free to email us at ACNEditor@hematology.org.

Conflicts of Interest

We now provide information regarding authors’ conflicts of interest at the end of each article about a scientific publication and note whether “editorial assistance” was provided by the study sponsor in writing the manuscript. This gives readers additional information to place research findings in the context of what may or may not be subtle influences on the study’s results or interpretations. The details about conflicts may not be comprehensive, though, as we rely on what a journal reports as a conflict, which itself may rely on what authors report as their conflicts. Authors may not always be forthcoming with complete information. I have occasionally reviewed manuscripts for journals, for example, that are written largely by pharmaceutical company employees and that support use of that company’s drug, yet the authors did not disclose their employment by the company as a conflict. Caveat emptor, as my son the Latin scholar might say, and don’t be afraid to check out the Physician Payments Sunshine Act website yourself if you have doubts.

A New Standard of Care

Speaking of conflicts of interest, the most common one that, ironically, never requires a disclosure is the relationship between a manuscript reporting positive study results and the betterment of one’s career. Success, particularly in academics, is often predicated on self-promotion. In science, though, the data should speak for itself. (Nota bene: grammatical error is deliberate, as data should take a plural.) Frequently, we see phrases in journal articles that claim a given finding is “practice-changing” or represents “a new standard of care.”

However, a change in practice or new standard is defined functionally – one actually has to observe patterns of adoption of a paradigm over a period of time, and not when research is first published, to make such claims. We will continue to present just the facts of research, try to place them in context, and leave the editorials to … well … our editors.

Email News Content

Here’s a fun fact you may not realize about magazines, journals, and newspapers: The size of an issue depends on the number of advertisements sold. It isn’t as if we decide, “It’s December, I’m in the mood for an issue with 140 pages! But let’s keep it small in February because, after all, who likes February?” Advertising content is restricted to no more than 75 percent of more than half the issues published during any 12-month period to qualify for periodical mailing status. Advertising revenue also offsets the costs of printing, and our issue sizes increase or decrease to maintain at least a 50:50 ratio of editorial to maintain our editorial standards.

We augment this with our online content. While we believe our website is a great venue for stories originating from places like regulatory agencies, the Hill, or cross-discipline articles, we recognized that we could not turn the same critical eye to reports of scientific findings as we do to reports on journal articles in our print edition. Consequently, we have largely eliminated coverage of study results from the “Online Exclusives” emails you receive from us.

Simple Statistics

There is an old joke among epidemiologists.

One epidemiologist encounters another at an epidemiology meeting.

The first says to the second: “Oh, it’s so nice to see you! How’s your family doing?”

The second replies: “Well, compared with what?”

I know, you’re probably laughing on the inside, right? Statements such as “greater response,” “fewer toxicities,” and “higher rates” riddle scientific abstracts and manuscripts, but without supporting statistics or comparison groups, they are no more than hollow words. Recognizing the sophistication of our readership (many of whom are used to reading primary scientific articles), we provide measures of comparisons (e.g., p values) when available, and have put such phrases in context when formal analyses are lacking (e.g., “numerically higher” or “no p value provided”).

How I Treat In Brief

Guilty pleasure confessions: I am a total fan of the Game of Thrones books and HBO series (and if I had to choose one person alive or dead, real or fictional, with whom to have dinner, it would be Tyrion “The Imp” Lannister, a flagon of Dornish wine included with the meal). I also love the “How I Treat” series in Blood. It’s great content, with just the right mix of data-driven guidance and practical recommendations when data are lacking (Nota bene: No nota bene is needed in this case). Bob Löwenberg, MD, PhD, and Nancy Berliner, MD, the editor-in-chief and deputy editor, respectively, of Blood, graciously supported our extracting some of these choice pieces in a précis every other month in ASH Clinical News. These are capsule summaries, and online we provide links to the full treatment in Blood, which we encourage you to visit.

I suspect that Tyrion, as hand to Queen Daenerys Targaryen, mother of dragons, rightful heir to the Iron Throne, is also a frequent purveyor of Blood, and of ASH Clinical News. They’re the most widely read publications in all of Westeros, with 83 percent of the literate population reporting perusing them, compared with 21 percent who read scrolls or “scraps of parchment delivered by ravens” (p<0.01).

Mikkael Sekeres, MD, MS