An instructor for the Medical Writing and Editing certificate discusses the importance of statistical literacy for medical writers and the chain of events that led him to write the fundamental textbook in the field.
Medical writing, as we know it today, is still a relatively new field, notes Tom Lang, who has taught Interpreting & Reporting Biostatistics for the University’s Medical Writing and Editing certificate program since it began in 1999. Lang points out that, although medical writing is often defined as writing about medicine, as a subset of technical writing, it differs greatly from literary and journalistic writing in its purpose, form, and evaluation.
“The purpose of medical writing is not to get as many clicks as possible,” he says. “Nor does it need to tell an interesting story or have a unique voice. It’s functional writing designed to help people act by communicating complex science using words, tables, graphs, and images as clearly and concisely as possible.”
A Boundary Spanner at the Forefront of the Profession
Since beginning his career as a medical writer, Lang has been at the forefront of developments in the field and in advancing the profession. After starting as a technical writer at Lawrence Livermore Laboratory, where he was trained by some of the pioneers in the emerging field of technical writing, he went on to take his first steps into medical writing as the co-author of a college text on personal health.
“With an undergraduate degree in the social sciences, I’ve always been a boundary spanner,” Lang says. “I loved applying anthropology to economics and political science to sociology. So, I was a natural fit for writing about personal health because it drew on such a wide variety of disciplines.”
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Biostatistical Reporting and the Need for Guidelines
As manager of medical editing services at the Cleveland Clinic in the 1990s, he and his staff edited a broad range of documents reporting basic and clinical research. Early on, however, he encountered an article that presented the results of the same statistical test in two different ways.
“Inconsistencies are the things you look for as an editor to do the job well,” Lang says. “So I went to the publication style guides for answers, but none had guidelines for reporting statistics. The lack of guidelines or requirements seemed strange, given how important statistics are to conducting and reporting research.”
Additionally, the primary books on preparing scientific articles available in the early 90s said nothing about statistical reporting, which only made Lang more curious to find an answer. He turned next to the medical literature where, along with a few relevant short articles and letters to the editor on statistical reporting, he started finding articles by an Oxford statistician named Doug Altman, who was studying statistical errors in the medical literature.
The Foundational Text on Statistical Reporting in Medicine
With Altman’s work as inspiration, Lang began writing a manuscript that focused on how to report statistical results in the biomedical literature. From a review of some 350 studies on statistical and methodological flaws, he created the first comprehensive set of guidelines for reporting statistics in medicine.
That work turned into How to Report Statistics in Medicine: Annotated Guidelines for Authors, Editors, and Reviewers. Now in its second edition, the book has been a best seller for the publisher, the American College of Physicians, throughout its publication twenty-two years ago. It has also been translated into Chinese, Japanese, and Russian.
“Shortly after the book was published, I was contacted by the University of Chicago to teach a class on reporting biostatistics for their new medical editing certificate program,” Lang adds. “Drawing on the information presented in my book, I designed an intensive three-day curriculum to introduce students to the statistical analyses they’ll need to understand and report about 80% of the clinical literature. Although there are thousands of tests, only about two dozen are common, so it’s not hard to bring students up to speed.”
The Importance of Statistical Literacy for Medical Writers
In this core course of the Medical Writing and Editing program, students develop a conceptual understanding of the most common statistical tests and procedures used in biomedical and epidemiological research. Lectures and readings address what type of statistics to expect in a given research article, how to interpret their meaning in the article, and how to identify errors and omissions. Assignments focus on the complete and proper reporting of research activities, data, and statistical analyses.
Lang emphasizes that the course is not a typical course on statistics taught by and for statisticians. There is no calculating of statistics or designing of research involved. The course is designed and taught by a medical writer for medical writers.
“Evidence-based medicine is literature-based medicine, and medical writers and editors help prepare that literature,” he says. “I teach students what they need to know to apply the reporting standards of evidence-based medicine. These are the skills that help advance medicine and the profession of medical writing.”
“As professional writers and editors,” he adds, “we need to persuade people that we are not just people who like to write but that our knowledge, skills, and experience make us expert writers and allow us to communicate far more effectively than can writers without advanced training. Becoming ‘statistically’ literate greatly improves the value of our services and the image of our profession.”
