How I edit

In the late 1950s my medical career and my literary life began to merge in pleasing ways -- pleasing to me as a writer, pleasing to readers who fed back to me the fact that the stuff I wrote was easy and even enjoyable to read and was educationally useful. I began to feel that I was doing what I was meant to do with my life. I consciously set about sharpening the skills I was developing. Medical journals were not only hospitable to the stuff I was writing; their editors began to ask me to pass judgement on other people's articles: I became a peer reviewer. That further transformed my life, bringing me into closer contact with the complex problems of scientific editing. I had a mission in life. I began mobilizing my professional expertise and my literary skills to the same worthwhile end.

The next step plunged me into the wonderful world of editing. At the University of Edinburgh, two senior staff members, Reg Pasmore, a physiologist, and Jim Robson, an internal medicine specialist, invited me to edit the 'community medicine' section of the massive multi-volume Companion to Medical Studies they were compiling. This covered everything a medical student needed to know: the basic preclinical subjects, anatomy, biochemistry and physiology, the bridging disciplines, pathology, microbiology, immunology, pharmacology, the clinical sciences, medicine, surgery, obstetrics and gynaecology, psychiatry, and my specialty, community medicine, or public health.  At first I innocently thought my task as a medical editor was to improve the prose in the texts that authors sent to the textbook I was editing: to tighten, clarify the language. I was taken gently in hand by the two editors in chief, who explained my role and responsibilities to me. 

'Literary' editing was part of the task but it mattered less than factual correctness. First and foremost, was the text scientifically accurate, truthful, valid? Scientific writing covers a wide spectrum. Almost all scientific writers aim to present the truth as they understand it. They may grasp only part of the truth, may use inappropriate statistical tests to demonstrate that their findings are true, or - rarely - may seek to deliberately deceive readers. The most important quality required of a good editor is possession of a built-in crap-detector. At the far extreme of bad medical science writing is scientific fraud. It is rare but its impact can be devastating because it can do great harm. A scoundrel fabricated false evidence purporting to show that the measles, mumps and rubella (MMR) vaccine caused autism. His motive was that he had a financial interest in a company that made a competing vaccine. The fraud was soon exposed, but many otherwise intelligent young parents continue to resist getting their infants immunized against measles, mumps and rubella, and often by extension other preventable infectious diseases because publication of the fraudulent paper in a prestigious medical journal left a permanent memory stain on the vitally important public health procedure of immunizing infants against infectious diseases. Gross fabrication and deliberate fraud are rare but minor examples are common. That is why possession of an effective crap-detector is such an important quality of all editors  of scientific books and journals. I'll say more about this in a future post.

Other skills are required when editing scientific books. How and where does the text I am editing fit into the big picture, the entire discipline? Is it concordant or discordant with other parts of the book, other aspects of the body of knowledge in that domain? Are all chapters at the same intellectual and professional level? (Once I had the troublesome task of telling an eminent specialist that his contribution might have been OK in the New York Times Sunday magazine but was below the level required by advanced postgraduates aiming to enter that specialty).  Other things editors must detect include plagiarism, including self-plagiarism, i.e. publishing the same chapter in two or more different books. Rather often I sought second and third opinions, inviting other experts to review the MSS submitted by the expert who'd been invited to write the chapter. This is part of the peer review process which is so valued by scientific editors. I discovered that I had a talent for medical editing. 

A problem arises in domains of biomedical science where uncertainty persists, for instance about which theory of causation best fits the facts, for example in coronary heart disease; or which treatment regimen is the most likely to control a potentially lethal disease such as breast cancer. In those situations the best approach is to present summaries of each point of view - with supporting factual evidence of course.  Pasmore and Robson were fortunate to have in Edinburgh an eminent authority on radiotherapy and an eminent breast surgeon: they were able to offer chapters by both in the Companion to Medical Studies, and leave it to readers to decide. I learnt a great deal from Reg Pasmore and Jim Robson about the art and expertise of editing. The search committee seeking an editor in chief for the massive US reference textbook of public health and preventive medicine evidently had me in the cross-hairs and might have consulted with Reg Pasmore or Jim Robson.  Perhaps that's why I, a non-American, was invited to be editor in chief of this fat volume now eponymously known as 'Maxcy-Rosenau-Last' Public Health and Preventive Medicine. 

My successful completion of that task established my reputation, and led to other editing tasks, some even more challenging. I edited the Canadian Journal of Public Health for 11 years, Annals of the Royal College of Physicians and Surgeons of Canada for 9 years, networked with editors of other medical journals and learnt a great deal about the unique problems they faced. I got deeply immersed in compiling and editing technical dictionaries, starting with the Dictionary of Epidemiology, which was in many ways the most enjoyable professional work I ever took on. I was co-editor of several other technical reference books, ranging from Stedman's Medical Dictionary and the Oxford Dictionary of American English, to several encyclopedias, notably the MacMillan Encyclopedia of Public Health. All these tasks, some of them pretty large, occupied the first 12-15 years after I officially retired from the active staff of the University of Ottawa. I am among the most fortunate of people, to have had the opportunity to do such enjoyable and worthwhile jobs over such a long period of my professional life.