





































       V37 N4 / 2022 

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

AMWAJournal.org     6

ABSTRACT 
Key thought leaders discuss their views of the evolution 

of medical communication focusing on their grand 

visions for medical communicators, what we learned from 

the pandemic, and what will be required in the future. 

Topics touch on the impact of developing technology, 

communicating with the public, managing social media, 

standardizing education requirements, and preparing the 

next generation of medical communicators.

INTRODUCTION
In this contribution to “crystal ball” musings, diverse 

thought leaders chimed in on their visions of medical com-

munication and medical writing in 10, 15, and 20 years.

 Three seasoned professionals from different areas of 

medical communication provided commentary: 

• Ms Joan Affleck, Associate Vice President-Medical 

Writing, Merck & Co., Inc

• Dikran Toroser, PhD, CMPP, Senior Director, 

Publications, Merck & Co., Inc

• Genevieve Walker, PhD, Freelance Medical Writer, 

Bridge Health Communications

 The moderator’s (Dr Suzanne DeVandry) prompt is  

provided for each topic, followed by the responses of panel 

participants. Each perspective offers insights on some of the 

vital questions of our day.

What is the grand vision for medical communicators? 
How do we become the people who can help humans 
around the globe understand what they need to do to be 
healthy and how to meet the challenges when certain 
life-changing events occur? 

Genevieve Walker: My grand vision for medical commu-

nicators is that we continue to be facilitators in getting 

health and science information to the people who need it. 

Regulatory bodies. The FDA. Members of the public. The 

“worried well”—people who aren’t sick but who really crave 

health information. 

 We should facilitate getting it to these audiences clearly, 

with as few frills as possible, and with as much need to 

know as possible. 

Joan Affleck: Some factors need to be brought into consid-

eration. We hear a lot about digitization in the press, and 

some people view digitization as the prioritization of data 

over words and messages.

 That’s actually a piece of misinformation. Data support 

the messages. And we need the messages. If we learned 

nothing else from the pandemic, it was that too often people 

don’t understand the messages, and sometimes the mes-

sages aren’t clear. 

 It should be a real reminder to us that when we start 

thinking about prioritizing data, it means the messages are 

even more important. We need to be able to explain what 

those data say, how to interpret them. This will become 

more and more important—the creation and curation of 

messages. I think it is vital to the work of medical communi-

cators today. 

Dikran Toroser: Medical communicators are going to be 

the gatekeepers to make sure that our stuff is stamped with 

dependable, peer-reviewed credibility. The speed at which 

communications have been produced … the speed at which 

things have reached the literature … the involvement of 

medical writers … the type of work that medical writers have 

been asked to do … the type of output in which medical 

writers are involved … all the changes are just staggering. 

And all of this is happening right now.

 As medical communicators, we have to keep on top 

of this, because we hold the gate—the gate where authors 

Speakers
Joan Affleck, MBA  / Associate Vice President-Medical Writing, Merck & Co., Inc, Rahway, NJ
Dikran Toroser, PhD, CMPP / Senior Director, Publications, Merck & Co., Inc, Rahway, NJ
Genevieve Walker, PhD / Freelance Medical Writer, Bridge Health Communications, Portland, OR

The Evolution of Medical Communication

THEME ARTICLE

Suzanne DeVandry, PhD, RN / Executive Director, Medical Writing, Merck & Co., Inc, Rahway, NJ

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AMWAJournal.org     7The Evolution of Medical Communication

are involved with what is done ethically, with who gets the 

data. We are at the center of most things. So I think these are 

exciting times.

How do you see the evolution of medical communica-
tions through the next 10 to 20 years?

Joan Affleck: I’ve been thinking about this a lot actually. 

It’s one of my preoccupations. When I think of medical 

writing 15 to 20 years from now, for me, that means any-

body who is 55 years [old] or younger in medical commu-

nication has a major stake in this conversation and should 

be participating in it. I feel we’re missing those voices.  

One of the things I think about is how to bring them into 

the conversation.

 I am not planning to be working as a head of medical 

writing at Merck in 20 years. I may be doing something else, 

but I’m not going to be head of medical writing at Merck. I 

want someone else to do that job, and I want somebody else 

to be shaping the profession.

Genevieve Walker: Patient engagement has really skyrock-

eted since I entered medicine in 1990. We have much more 

available for patients to access. We have much greater 

need and a drive for people to be involved in their own 

health and health care, be it changes in insurance, clinical 

care, regulations, or whatever else.

 People have a lot more responsibility and a lot more 

options than they once did. So I think that my sector of 

medical care—health education, patient education—is a 

growing part of the field. 

Dikran Toroser: In the last few years, work in day-to-day 

jobs as well as the final output has become more electronic. 

The job has become pretty much paperless. During the pan-

demic, a lot of companies got caught unaware. Forms for 

clinical trials used to be paper … and suddenly, you couldn’t 

get from A to B. 

 Everything is searchable at a speed we had no aware-

ness of a couple of years ago. I can find things in a database 

within minutes, look up congresses, find abstract require-

ments, touch base with medical communicators. So that’s 

been a major development. 

 We’ll be software dependent. It’s going to be a long time 

before a Clinical Study Report will be written by a machine. 

We’ll always need people, but things are going to get much 

faster because some of the routine aspects of our work will 

be handled by artificial intelligence. 

Genevieve Walker: There was a time 10 or 15 years ago 

when we were concerned that medical communication 

would be outsourced to large content mills. But because 

medical communication is pretty high touch and the lan-

guage is usually quite high level, it requires very careful 

handling. The outsourcing didn’t happen the way that we 

thought it would.

 My concern now is that we keep that hands-on high 

touch. Let’s respect that very careful and compassionate 

way of working with the words around medicine and health 

while we are separated. In a big medical writing depart-

ment, say at Merck or at the University of Texas, people may 

have worked together in an office for many, many years. 

There is a give and take, a flow, that goes on when humans 

are together. 

 That may not be very visionary. On the other hand, it 

might be all that we need.

What has the pandemic taught us? What things have  
happened or what things have we learned from the  
pandemic that we will want to continue to move forward 
and develop? 

Genevieve Walker: We have a couple of things going on 

with science medicine and the public that became very 

clear in the pandemic. 

 We have folks who are able to do their own research, who 

understand a concept like risk or a concept like relative risk. 

Then we have a vast number of people who have no idea 

what that means, who have no way to calculate their own risk.

 We have people talking about disease and health care 

who are in no way related to disease and health care and 

really should not speak about it. It causes a lot of frustration. 

The pandemic highlighted that science can be politicized to 

serve the ends of almost anyone.

 So one lesson I see is the repeated lesson. Science is 

hard to understand in patient education. The lesson for us 

is to present information simply. Not dumbing it down. 

Simplifying it: Clear. Short. Usable. Do this, not that. And 

communicating to people that you have rights, and you 

have some responsibility for yourself—those are important 

lessons for good or for ill that came out of the pandemic.

Joan Affleck: You know, the veil was pulled back, and we 

could see that most people in this country, in the United 

States, do not have a high level of health literacy or numer-

acy, and I’d be willing to bet that the competency is not that 

much better around the world. Maybe in a few countries it 

is, but in general that literacy and numeracy are poor. 

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AMWAJournal.org     8The Evolution of Medical Communication

 So we’re going to have to think about real ways to be 

able to test information to know whether it’s comprehensi-

ble to people and to figure out new ways of delivering that 

information. We just can’t go on the way we’ve been doing 

things in the past. What we were doing before is not going to 

get us to where we want to be in the future.

Dikran Toroser: Because of the pandemic, the format 

of communication really morphed into various types of 

media—voice, video, and others. There's a lot more output 

and it's going to be available whether we like it or not, in lots 

of venues. It's not just going to be in PubMed. It's also going 

to be leaked out in social media.

 Some of the [other] changes from the pandemic will 

stick. For example, I don’t think we’re going to be in the 

office 5 days a week anymore. We’re wiser about how inef-

ficient that is. At the same time, I don’t think we’re going to 

be remote 100% of the time. We just lose so much by being 

remote all the time. 

 And we need things like our congresses, where the med-

ical communicator interacts with stakeholders, rubs shoul-

ders with people doing analysis … you know, being there at 

the inception of the concept. That stuff I think has to happen 

face to face.

What is the role of education and certification in estab-
lishing a consistent quality of practice in medical  
communication?

Joan Affleck: This whole question of the competency of pro-

fessionals and the quality of our work keeps me up at night. 

How do we continue to show the value of what we do? How 

do we convince others that ours is a special skill set?

 Are we going to look at academic education, apprentice-

ships, certification, continuing education requirements? 

These are some of the standard professional benchmarks. 

Or we could go to some totally new paradigm. The point is 

that we have to do something.

 Again, this is where we need the voices of people who 

are mid-career to help steer the profession into the future.  

I challenge people under age 55 to step up and get involved.  

If you don’t know how, call me. We’ll talk about it.

Dikran Toroser: You’ve got to be familiar with your guide-

lines. I’m a CMPP-certified medical publication profes-

sional. I took the exam to be CMPP qualified, and I attend 

the meetings and have peer review. 

 Many of us are actually editors for journals. I interact 

with a number of clinical journals, and peer review is not 

just off the top of your head. Training will be required to 

make sure that you look at things in a nonbiased manner, 

that you view things appropriately. There’s a lot of training 

to keep up with the field, and it’s expected. 

 My recommendation is for new aspiring medical com-

municators to get in with the local AMWA chapter. I’m in 

Boston, and the Northeast chapter is brilliant. You have to 

make contact with people. That’s the way it works.

Genevieve Walker: I don’t feel there should be one stan-

dard for every type of medical communication. 

 I know that AMWA has made great strides in developing 

a medical writer certified designation with a test. However, 

what if we had a certification process that really reflected 

the differences among types of medical communications?  

I think it’s really important, because folks who are generally 

good at regulatory writing often can’t do writing for patient 

education and the public. Those are different skill sets, dif-

ferent mindsets. They’re different backgrounds, and maybe 

even different imaginations.

 I would love to see education and certification going 

more in a direction that mirrored what we do to certify phy-

sicians, where you pass a board exam in your specialty or 

related specialty. I think it would be preferable to have sepa-

rate certifications. 

What do the medical communicators of the future need  
to be successful? 

Dikran Toroser: Cultural awareness. Many of our compa-

nies are global, but suddenly the medical writer is having  

to interact with someone in China, someone in Japan. There 

are cultural differences. There are certain ways to behave if 

you actually want to get done what you need to be done.

 So cultural awareness is number one. Number two is that 

you can’t drop basic things like grammar. Grammar is always 

This whole question of the competency of professionals and the quality of 
our work keeps me up at night. How do we continue to show the value of 
what we do? How do we convince others that ours is a special skill set?

—Joan Affleck

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AMWAJournal.org     9The Evolution of Medical Communication

important. Finally, you need a simple awareness of what to  

do if you’re contacted by a predatory journal. You need to 

recognize it. You need to recognize the URL address. If it’s 

from somewhere that’s suspicious, you need to warn your 

authors.

 So, it’s a diversity of skills. 

Joan Affleck: Unfortunately, today we do a lot of templated  

work – agencies give us templates to fill in. Our future 

depends on having people who think a lot more freely out-

side of a template, beyond just plugging in information here 

and there. We want people who understand that.

 Medical communication is at the intersection of data 

and messages, all the way from the protocol throughout the 

life cycle. Our work requires multiple points of view, and 

medical communicators really need to be thinking of the 

role holistically.

 Medical communicators need to be at the right tables, 

whatever those right tables are talking about. We need to 

be educated about the capabilities and limitations of our 

profession and be forward-thinking in terms of what we’re 

going to need to help design programs, platforms and sys-

tems, their interoperability. 

 A big question is how do we control information, the 

way reputable newspapers and journals manage it? How do 

we lock down what the real message is? How do we win that 

credibility with the public? I don’t know the answer to that, 

but it’s a problem for us.

 I think in regulatory medical writing we’ve had a small 

lens. We’ve been thinking our work is just for this company, 

not anything bigger. We need to blow that attitude apart.  

We need to acknowledge that we are a crucial part of a global 

public health network, and we need to participate in that.

Genevieve Walker: We are here to communicate. We are 

here to be great conduits and interpreters, not to promote 

specific findings or points of view. I actively discourage 

people from believing what they read on Twitter, Facebook, 

etc. As we’ve seen, those platforms aren’t channels of com-

munication per se. They have agendas behind them, no 

matter whose it may be. There are lots of channels, and each 

one is a business. Somebody’s making money, and they’re 

making money off you. 

 So I think we need to refresh people’s memories. There’s 

quality. And then there are junk sources of information. We 

need to be pretty clear about that. That would be a good 

stand for medical communicators to take.

 Success is easier with an attitude of service, an eager-

ness to learn, and a spirit of willingness. We have an  

enterprise centered on the patient—centered on the person 

who needs information. 

 And we are all in service of something greater, which is 

access to health.

Suzanne DeVandry: Thank you to our panelists for shar-

ing your thoughts and vision of the evolving field of medi-

cal communication. In response to our questions, we heard 

several common themes about the benefits and challenges 

of working in a virtual environment, the need to extend the 

vision of medical communication to include global health 

literacy, the urgency of building trust with patients and pro-

viders, learning from the pandemic how information may 

be used and misused, and preparing the next generation of 

medical communicators.

 Other questions still remain: How do the various spe-

cialties of medical communicators best work together to 

optimize information dissemination? How do we manage 

and improve the flow of information in the public sphere to 

ensure accuracy? What can we, as medical communicators, 

do to elevate global health literacy and positively impact 

global health? How do we overcome negative societal per-

ceptions and gain the trust of the patients we serve?

 The answers to these questions and others will shape the 

evolution of medical communication.

The authors would like to acknowledge and thank Charles 
McNair, who contributed to the initial draft of this article.

Author declaration and disclosures: The authors note no  
commercial associations that may pose a conflict of interest in 
relation to this article.

Author contact: suzanne_devandry@merck.com

BIOSUMMARIES
Joan Affleck is an Associate Vice President at Merck & Co., 

Inc, where she leads the Medical Writing Department. 

Throughout her 20 years in the pharmaceutical industry, her 

work has focused on solving information management chal-

lenges by learning from a variety of industries and devel-

oping novel approaches. Following university studies in 

science and literature, Joan moved to Paris to edit a peer-re-

viewed international medical journal. After several years 

in publications, she shifted to the pharmaceutical indus-

try. She has created and developed medical writing teams 

in North and South America, Europe, and Asia. Joan holds 

an MBA from Columbia University, where she is a Lang 

Center Innovation Fellow and guest lecturer at Colombia 

Business School. She has served as an advisor to the 

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AMWAJournal.org     10The Evolution of Medical Communication

Healthcare Businesswomen’s Association and TransCelerate 

BioPharma Inc and is a member of the University of Virginia 

Darden School of Business Leadership Communication 

Council. In 2020, she received the President’s Award from 

the American Medical Writers Association. Find Ms Affleck 

at Merck Sharp & Dohme, LLC, at joan.affleck@merck.com.

Dikran Toroser is a Senior Director of Project Management 

in Global Scientific and Medical Publications at Merck 

Sharp & Dohme, LLC. He has a PhD in Biochemistry from 

Newcastle upon Tyne (UK). He did his post-doc at the 

Cambridge lab (UK) on genetics and then moved to the US 

to work as a senior biochemist/researcher for the USDA. 

Dikran has been in publications since 2004, working at large 

pharmaceutical companies as Publications Lead and most 

recently at Amgen and also Takeda as a Publications Group 

Lead. Dikran has an extensive background in publication 

planning as well as medical writing. Dikran is active in pro-

fessional organizations (AMWA, ISMPP, ACSE) and is an 

author on guidelines for the publications profession (eg, 

AMWA/EMWA/ISMPP Joint Position Statement and “GPP4” 

[“GPP 2022”], the latest Good Publication Practice guide-

lines for industry that was published in September 2022). He 

is one of the founding faculty for the UC San Diego medical 

writing certificate and is a consulting director for the course. 

Find Dr Toroser at Merck Sharp & Dohme, LLC, at dikran.

toroser@merck.com.

Genevieve Walker writes and edits patient education and 

consumer health materials in plain language. A medical 

communicator since 2002, she is a past president of the 

Northwest AMWA chapter, a new current member of the 

Southwest chapter, and the leader of the AMWA credit 

workshop Writing and Designing Materials for Patient 

Education. Dr Walker is also an instructor in the University 

of Chicago’s Graham School Medical Writing & Editing 

Certificate program. Dr Walker holds a PhD in English from 

the University of Oregon. She has studied the principles 

of health literacy, readability, user-friendly design, and 

plain language since the mid-2000s. Her background 

includes courses in adult instruction and linguistics. Find 

Dr Walker at Bridge Health Communications at genevieve@

bridgehealthcomm.com. To see her work, please visit www.

bridgehealthcomm.com.

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