Elegant expressions from the New England Journal of Medicine and Nature

J. Patrick Barron
Professor, International Medical Communications Center
Tokyo Medical University

18 January 2006

This presentation introduced elegant and convenient phrases from the New England Journal of Medicine (NEJM) and Nature.

Beginning with the Introduction section of the NEJM, it was pointed out that one of the quickest ways of getting a good idea of the journal contents of an original research paper in the NEJM is to read the first and the last sentences of the Introduction and also of the Discussion. In the Introduction, the aim is to establish the gap. The first sentence generally gives a background statement indicating what is known about the given topic. The final sentence of the Introduction describes what the authors are trying to do in this paper. The first and last sentences of the Discussion also generally indicate what was found in the study. Thus, the main purpose of the Introduction is to establish the gap by indicating what is known, what is not known, and how the authors plan to bridge the gap.

Specific examples of tight writing were given in the handouts. For example, sentences establishing the purpose of the study included gUncertainty about morbidity and mortality, extent of benefit and predictors of benefit led us to conduct a randomized clinical trial.h Or, gThis observation, along with preclinical evidence of anti-xxx activity, provided the rationale for our open-label phase 2 study ofch, or gThere is a paucity of data addressing long-term survival and the quality of life of survivors of zzz.h


In the section concerning the Methods, the golden rule, enunciated by Strunk in 1919 was presented, i.e. gOmit needless wordsh. For example, in the statement gBetween December 1998 and April 2001, 163 patients with xxx were consecutively enrolled after their written informed consent had been obtained.h, tell us the period of time, and the number of patients, while the word gconsecutivelyh indicates that the authors did not pick and choose patients likely to produce the anticipated or desired results, but rather had enrolled all patients within that period who had the disease. It also tells us that the informed consent that was obtained was written. Another kind of statement, gAll patients provided written informed consent, and the study was approved by the institutional review board at each center.h, indicates that the hospital or the health care center had an institutional review board and they approved the study. To take this one level higher in terms of ethical considerations, consider the sentence gThe study and written consent forms were approved by the Ethics Committee of YY.h This indicates that not only the study but also the informed consent forms were also reviewed and approved by the IRB.


In the Results section, some examples of defensive writing such as gTable 1 shows the characteristics of the participants. These characteristics differ from population averages but parallel the profile of persons receiving medical care.h This protects the authors from potential criticism by a reviewer that the patient group differed from the general population profile. Examples of gwiggle roomh were given, one of which was gGastrointestinal events were typically mild to moderate and were manageable with routine support.h This does not say that all of the adverse events were mild to moderate, nor that all were manageable with routine support. However, it does suggest that a large majority were mild to moderate, and were manageable with routine support.

Concerning the Discussion, the ability to write with an idea of what kind of criticisms the reviewer might express (see gwiggle roomh above) was discussed and examples such as gWe recognize the pitfalls of subgroup analyses, but we believe that the heterogeneity of the patients and outcomes, and the considered approach we used, make our findings clinically and statistically valid.h This would preempt a criticism that there was too much division into subgroups.

Similar examples from Nature were presented. A simple statement of the purpose of the study, such as gThe critical importance of excess salt intake in the pathogenesis of hypertension is widely recognized, but the mechanism by which excess salt intake elevates blood pressure has puzzled researchers.h, presents the problem as a kind of challenge to the reader.

It is also possible to try to arouse interest of the reader, such as gHistorically, the ABO compatibility between the donor and the recipient has been required for a successful organ transplantation.h This sentence will make the reader think the authors may be suggesting that now things may have changed.

In total, 50 slides based on the NEJM material and 30 from Nature material were presented in the format I often use, which is to give all participants a handout concerning the text of the slides presented, with blanks to be filled out by referring to the slides shown, so that the participants can write in the blank portion. At the end of the lecture, the participants have the text of my slides in their possession.

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