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©2022 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     11

The John P. McGovern Award is named in honor of John P. 

McGovern and is presented to a member or nonmember of 

AMWA to recognize a preeminent contribution to any of the 

various modes of medical communication. The McGovern 

Award is presented during AMWA’s Medical Writing & 

Communication Conference.

Hello, AMWA attendees. I’m Stacy Christiansen, and I am 

incredibly humbled to be talking to you as the 2021 John P. 

McGovern Award winner. Looking through the list of previ-

ous winners leaves me a little starstruck; I am in incredibly 

good company.

 I have been very fortunate to spend my medical commu-

nication career at one organization, the American Medical 

Association (AMA). I was hired in the last century (but very, 

very late in the last century) as a copy editor for the specialty 

journals published by the AMA. Their names at the time were 

Archives of Dermatology, Archives of Internal Medicine, and a 

handful of others. They have been successfully rebranded as 

JAMA Dermatology, JAMA Internal Medicine, etc.

 After a few incredibly instructive years as a copy editor, 

I had the opportunity to move over to the flagship journal, 

JAMA. One of the main differences with JAMA was applying 

all of the skills and knowledge I had gained, but faster. I was 

up for the challenge and the rest is history. I moved from 

copy editing manager to managing editor of JAMA.

 I’ve also been a member of the committee that produces 

the AMA Manual of Style since 2002. I worked on the 10th 

edition, and then became the co-chair for the eleventh, just 

published last year.

 Before I dive in, I just want to take a brief minute to give 

thanks where it’s due—to acknowledge the people who have 

mentored me, educated me, and supported me along the 

way. The person who fills all of these roles is JAMA Network 

Executive Managing Editor Annette Flanagin, who, by the 

way, won this award in 2009. Annette is a manager, educa-

tor, problem-solver, and cheerleader all in one, and she has 

set the bar high at JAMA, but is always willing to give me a 

boost to reach it.

 Another McGovern award winner has also been a huge 

influence on me, and that’s Cheryl Iverson, the previous 

chair of the AMA Manual of Style committee. She won the 

award back in 2004. Cheryl is one of the most 

upbeat, can-do people I have ever met, and 

her support and encouragement helped me 

believe I could wrangle this stylebook, no 

problem.

 There are a host of others who have 

been instrumental, including all sorts of 

folks at JAMA, from editors in chief to all of 

the amazing manuscript editors, systems 

administrators, editorial assistants, and pro-

duction staff. Also, AMWA and Council of Science Editors 

(CSE) colleagues, a number of people at Oxford University 

Press, and even authors, readers, and tweeters who share 

their experience and feedback. I owe a debt of gratitude to a 

host of individuals for helping me along this path.

 So, in thinking about this talk, I settled on Style and 

Substance as the title, because that’s one phrase I feel sums 

up a lot of our work in medical communication. And then, I 

struggled with a subtitle.

 My first idea was “But What Do You DO?” I’m sure I’m 

not alone in this scenario. You’re at a gathering with people 

you’re meeting for the first time, and they inevitably ask 

what you do for a living. And you reply, “medical writer,” 

or worse, “medical editor.” Medical writer at least is sort of 

clear: you write about medical stuff. But medical editor? 

One well-meaning older man asked if that meant I was a 

secretary—his word. Other times I’ve been met with a blank 

stare and the question, “Yeah, but what do you DO?”

 So, I thought about that. What do we do? My personal 

philosophy can be summed up as ACC. That’s an acronym 

I coined for accuracy, clarity, and consistency. As an editor, 

those are the paramount goals of anything I work on, from 

Stacy L. Christiansen, MA / Managing Editor, JAMA, and Chair, AMA Manual of Style 
Committee, Chicago, IL

2021 John P. McGovern Award Address
Style and Substance 

CONFERENCE

http://www.amwajournal.org


AMWAJournal.org     12Style and Substance

a brief news item to a large groundbreaking clinical trial. A 

good editor should be behind the scenes helping an author 

ensure that the science is communicated accurately, clearly, 

and consistently.

 There are varying perspectives about what editors actu-

ally do, from people who aren’t sure, to those who are as 

invested in the product as editors are—namely writers—

and, of course,  the “track changes” reality.

 There have been some attempts to place value on edi-

torial work, such as a comparison of unedited papers with 

final publication. In this study from 2015,1 readers were 

asked to read 4 articles in their unedited and edited ver-

sions. While these articles were principally news stories and 

not trial reports, I think the findings are relatable. Readers 

preferred the edited versions, and felt the quality was worth 

the cost.

 Two papers published in 2007 in Learned Publishing 

also investigated the changes between author manuscripts 

and final published versions.2,3 In the first study, a review of 

189 articles published in science, technology, engineering, 

and mathematics journals or humanities publications com-

pared the author’s version with the final article. A substan-

tial amount of edits worked to correct citation errors, a third 

of the edits fixed grammatical or stylistic problems, and 

nearly 14% of the edits queried missing data. The authors 

concluded that editing contributes substantially to the accu-

racy of the paper and is therefore an important function for 

the integrity of the article of record.2

 The second paper in Learned Publishing was by 

Goodman and colleagues, and it compared self-archived 

manuscripts with the published versions. This study looked 

at 24 papers in biochemistry or social sciences, and the 

results were similar to the first study. In general, the edit-

ing helped improve the readability of the paper, although 

no errors were serious enough to invalidate significant data, 

conclusions, or the overall validity of the findings, and none 

of them would warrant a correction or a retraction.3

 A slightly older study was 

presented at the Peer Review 

Congress in 2001.4 

 This was a systematic 

review of the literature on 

technical editing, which has 

been posited to improve accu-

racy and clarity—2 of my ACC 

words. The authors found 11 studies of technical editing that 

concluded that editing improves readability, may improve 

quality, and increases the accuracy of references and quota-

tions. It also elevates the accuracy of abstracts.4

 There have been some other efforts to validate the con-

tributions of communication professionals, but I have yet to 

see any study that says, “nah, don’t bother.”

 As I mentioned earlier, I was hired at the turn of the cen-

tury, and we still did a lot of things on paper. We were just 

learning how to edit in Microsoft Word, and some of us 

learned to write custom scripts. My first script removed the 0 

before the decimal point in P values. I am still super proud of 

that very basic script that no one uses.

 Among editorial staff, there was some general fear 

as technology evolved that editors might be replaced. 

Spellcheck and grammar checking in Word were the first 

software-based features that took on some of an editor’s 

responsibilities, followed by more sophisticated programs 

such as software that autocorrects errors, or that fixes termi-

nology based on preselected rules (for example, changing 

British spelling to US spelling).

 Technology can be incredibly helpful to improve quality 

by spotting errors, but we’ve all had a good laugh over auto-

correct or spell Czech. I get really tired of spellcheck’s shirt; 

that process can go to he’ll. I realize that correct spelling is 

impotent, but sometimes the corrected words aren’t write.

 And sometimes it’s not individual words but sentence 

construction that editors need to fix. For example:

The patient has chest pain 

when lying on her right 

side for over a year.

The patient lives at home with his 

mother, father, and pet turtle, who is 

presently enrolled in daycare.

 

 Editors work to preserve the credibility of a paper and 

of a journal or other publication as a whole. While I know 

we’ve all had a good chuckle about menu gaffes and not 

worried too much about how the food would be, the same is 

not true of more serious communication.

 As the patient, if you were provided a document 

intended to address your concerns about a new medication 

or a diagnosis, what would your confidence be if it were rid-

dled with errors? We might assume anyone or any company 

that did not take the time to do something as straightfor-

ward as proofreading might not have done the necessary 

quality checks on the product or information itself.

The Ninth International 
Congress on Peer Review 
and Scientific Publication 
is set to meet in September 
2022. Get your research 
done! Abstracts can be  
submitted now.

http://www.amwajournal.org


AMWAJournal.org     13Style and Substance

 And although technology might be able to assist with 

some functions of a writer or editor’s job, it simply will never 

replace the judgment a human brings to the work. There is 

nothing misspelled or grammatically wrong with the sen-

tence, “This medication is for diabetics.” But a well-trained 

writer or editor will tell you that it’s best to use patient-first 

language to avoid labeling people with a disease or a con-

dition. Microsoft Word would pass over that sentence with 

nary a red squiggly line, but the editor would recast it as 

“This medication is for patients with diabetes.”

 The same is true for language addressing people’s sex 

or gender, age, socioeconomic status, race and ethnicity, or 

disabilities. Writers and editors are in tune with inclusive 

language in a way that even the most sophisticated software 

cannot replicate, so clearly human editors are important. 

And as advanced as technology becomes, medical writers 

and editors will always be needed if the desired result is 

clear, accurate, and valid content.

 Editors’ work with references is particularly important—

ensuring that references are cited, are associated with the 

right content in the text, and are complete enough that they 

can link to the original source, allowing readers to access 

the primary information. Knowing when citations are 

needed, which citations are appropriate vis-à-vis the refer-

ence list, and ensuring citation accuracy really rely on well-

trained medical writers and editors.

 I realize some of you are saying, “Stacy, you’re preaching 

to the choir.” And I know that, but it doesn’t hurt to hear evi-

dence to validate our work. Consider this your affirmation. 

Your work matters tremendously in helping communicate  

science clearly and accurately, with the ultimate goal of 

advancing science and helping patients.

 You may remember that I mentioned earlier that I was 

toying with several subtitles for this talk. My second idea was 

along the lines of “Who Cares About Style?” or “Why Is It 

Important to Use a Stylebook?” Although we all carry knowl-

edge in our heads, it’s much more efficient and consistent 

to share it. With the pace of information sharing continually 

accelerating, it’s inefficient to have to ask around if something 

is hyphenated. And of course, depending on who you ask or 

where you look, you might get different answers. Having one 

place to look up guidance will help establish consistent  

decision-making.

 I would never ask anyone to read the AMA Manual of 

Style cover to cover—or any stylebook for that matter—

unless you can’t fall asleep. A stylebook is a reference tool, 

like the dictionary. 

 Now, there are definitely sections of a style manual that 

lend themselves to narrative, and perhaps certain chapters 

should be must-reads, like those that provide the history of 

certain policies to give you some context. But essentially, a 

stylebook is a resource for consultation and guidance.

 So why should you use a stylebook? Because they pro-

vide guidance on how to handle small details, substantive 

issues, and even major problems. For example, you may 

not remember the rule for using en dashes with compound 

terms. Where does the hyphen go? When do you really need 

to use the en dash? Give me some examples! A style manual 

is happy to oblige.

 Same thing with comma use. Most style guides will 

share a preference for using the serial comma or not, and 

it’s important to use (or not use) it consistently. Following 

one main guide or adopting a house style on this point will 

ensure that all content is in agreement.

 Another guidance point a manual will assist with is what 

is capitalized in a title, especially if you don’t encounter 

terms such as in situ or mendelian very often.

 Stylebooks also provide guidance on substantive issues 

such as data display, for example, the basic formatting of 

what should be included in a survival curve. The exam-

ple here provides the general expectations for formatting, 

like using a nonbreaking scale starting at 0, or, alterna-

tively, at 100. The guide also explains what elements need 

to be included to interpret the figure, such as the number of 

patients in follow-up and plotting the progression of time  

on the x-axis.

 Other substantive guidance a manual will offer might 

involve language use, in this case guidance on inclusive 

language. Stylebook authors will have done their  

A collection of commonly used manuals.

http://www.amwajournal.org


AMWAJournal.org     14Style and Substance

homework on wording to be used in certain disciplines or 

in certain situations. In the examples here, there are spe-

cific recommendations for how to report on race and eth-

nicity, as well as disabilities and diseases. Note the theme 

here, which is asking authors and editors to use person- 

first language.

 Finally, a style guide should also provide guidance on 

major issues, for example in medical articles what to do 

when an identifiable image of a patient is included with a 

document for publication. You can see here the manual pro-

vides a list of options for how to legally and ethically handle 

this situation.

 Another major issue that might arise in a writer or edi-

tor’s work is dealing with authorship issues. A style manual 

will likely offer guidance on how to navigate authorship, or 

at least suggest resources for assistance. 

 This can be very helpful for writers or editors because it 

provides an authoritative guidance to cite. I can’t tell you how 

many times I’ve copied and pasted from the AMA Manual 

online to help explain what our policy is, or why it is.

 Stylebooks usually also offer guidance on how to orga-

nize information, which helps readers digest the informa-

tion. For example, readers expect an abstract in a clinical 

trial report, and some even expect that they can skip read-

ing the whole thing, just reading the last paragraph (the 

conclusions). When the document is organized, ideas flow 

logically, tables and figures present data efficiently and in a 

logical order, and readers can skim the paper but still find 

what they’re looking for, and come away with at least a basic 

understanding of the study.

 You don’t have to use the AMA Manual—although it 

would be great if you did! The important thing is to have a 

resource available that will provide guidance in your work, 

whether it’s a question on comma use, or help with serious 

issues like conflicts of interest or handling retractions.

 These are the tools medical writers and editors need to 

practice their craft: reference tools; software programs for 

word processing, data display, and reference management; 

and most importantly, your brains, skills, and experience. 

The end result is a well-equipped communicator whose 

work helps the science shine.

 Remember, ACC (accuracy, clarity, and consistency) 

never go out of style.

 Thank you, everyone, for your time and attention, and 

thank you, colleagues, for the McGovern Award.

Acknowledgment 
I thank Jodie Rothschild, Principal Medical Writer at 

Rothschild Medical Communications, for her help in bring-

ing the transcript to the page.

Author declaration and disclosures: The author notes that she is 
employed by the American Medical Association, which publishes 
the AMA Manual of Style. No other disclosures were reported.

http://www.amwajournal.org


AMWAJournal.org     15Style and Substance

Author contact: stacy.christiansen@jamanetwork.org

References
1.  Vultee F. Audience perceptions of editing quality. Digit Journal. 

2015;3(6):832-849. https://doi.org/10.1080/21670811.2014.995938
2.  Wates E, Campbell R. Author’s version vs. publisher’s version:  

an analysis of the copy-editing function. Learn Publ. 2007; 
20(2):121-129. https://doi.org/10.1087/174148507X185090

3.  Goodman D, Dowson S, Yaremchuk J. Open access and accuracy: 
author-archived manuscripts vs. published articles.  
Learn Publ. 2007;20(3):203-215. https://doi.org/10.1087/

  095315107X204012
4.  Wager E, Middleton P. Effects of technical editing in  

biomedical journals: a systematic review. JAMA. 2002;287(21): 
2821-2824. https://doi.org/10.1001/jama.287.21.2821

SCREENS FROM THE 
 VIRTUAL CONFERENCE #AMWA2021

The 2021 Alvarez Award address 
by recipient Harriet A. Washington 
will be published in a future issue 
of AMWA Journal.

http://www.amwajournal.org
https://doi.org/10.1080/21670811.2014.995938
https://doi.org/10.1087/174148507X185090
https://doi.org/10.1087/095315107X204012
https://doi.org/10.1087/095315107X204012
https://doi.org/10.1001/jama.287.21.2821



