22 May 1998
1,470 words

Writing about cancer:
Explaining work of busy researchers
to worried laymen;
Online becoming more important

NEW YORK--Since 1992, the number of publications produced by the Public Affairs Department at Memorial Sloan-Kettering Cancer Center has dramatically increased, while the staff has remained constant. One means of dealing with the extra workload is to hire more freelancers, said Rosie Foster, Senior Editor in Memorial Sloan-Kettering's Department of Public Affairs.

It's not a job for beginners, Foster told a meeting of the Editorial Freelancers Association here on 21 May 1998.

To interview the world's leading--and busiest--physicians and researchers, you'll need to do your homework first. "We need people who are really sharp and 'get it' quickly," said Foster. You have to understand the project and MSKCC's mission.

To write for an audience of cancer patients, you need a "comfortable tone that is not too patronizing," said Foster.

Read NEJM, sometimes "play dumb"

The physicians and researchers at MSKCC "don't have a lot of time," said Foster. "They don't just treat patients." They teach fellows. Most of them do research, too. Surgeons usually start their days at 6:00 or 6:30am. Many physicians put in 10 to 12 hour days--some even more.

"You have to be able to come in and have specific questions ready," said Foster. "You can't just come in to a prostate cancer specialist and say, 'What's going on in prostate cancer?' You need to structure your interview first."

"Some of my best interviews," said Foster, "have occurred when I read something in a journal like the New England Journal of Medicine first, and then mentioned it to the doctor. They appreciate your being up on the news."

Another interviewing skill is finding the right level to use in speaking to the doctors. When Foster first started in medical writing, she would tell the doctor, "I have a biology degree, so feel free to speak to me in technical terms."

"Big mistake," said Foster. They would give her a technical discussion, with details that never made it to the final patient material anyway, and she would simply have more work translating it into layman's terms.

"Most doctors are very good at speaking to patients," said Foster. "But sometimes you need to 'play dumb' to get them to speak to you in terms that a lay person would understand." This is an especially useful technique to use when speaking to laboratory researchers.

Reports, newsletters, web site

With a staff of 20, the MSKCC public affairs department is large for a hospital, said Foster. Like Gaul, it's divided into 3 parts.

The highly-regarded media group deals with outside reporters.

The special events group organizes meetings and special occasions such as the annual academic convocation.

The publications group--Foster's group--puts out brochures, and sometimes uses freelancers for one-time projects, "especially those that come up when we are already swamped." For example, MSKCC opened its International Center, on First Ave. and 74th St., in July 1997 to accommodate patients from abroad who come to Memorial Sloan-Kettering for care. Many of them are business people, who have to continue working during treatment, so the International Center features high-tech business facilities. A well-illustrated and beautifully printed brochure describing the Center was written by a freelancer who worked closely with an outside designer, said Foster.

The one new job position created at MSKCC since Foster began working there was a web writer/editor, said Foster. She urged writers to visit Memorial Sloan-Kettering's web site , which gets more than 2,000 visitors every weekday. In addition to information about the institution's facilities and services, the site features basic information for patients about cancer in general and treatment profiles of several specific cancers. "The cancer overviews are our most heavily accessed pages on the site," she said. Freelancers have been hired to write some of them.

MSKCC's 1997 annual report profiles doctors, their research, and their patients, in a style appropriate to an institution that positions itself as providing "The best cancer care. Anywhere." The report is done in-house, said Foster, and sent out for review to "an editor who works at a financial magazine and puts a stylistic spin on the writing."

The MSKCC Research and Educational Programs report is a massive compilation, produced every 3 years, of summaries submitted by some 80 basic science laboratories describing their work. A "meticulous" outside copy editor works on the summaries for consistency in style and length, including the bibliographic citations. Another big copy-editing job is the Physician Referral Guide and Media Resource Guide, a biographical directory of Memorial Sloan-Kettering's physicians and researchers.

"Center News" is a bimonthly newsletter sent to readers outside MSKCC. Although it is most often produced in-house, occasional staff changes sometimes produce opportunities for freelancers. "MSK Life" is an internal employee newsletter produced by the institution's Human Resources Department, and sometimes uses freelancers for occasional articles.

The "ideal" freelancer

The ideal freelancer, said Foster, has a science degree, an understanding of basic biology, a journalism background, excellent interviewing and reporting skills, the ability to translate a complex subject for a lay audience, attention to details, an obsession with middle initials, and a proven track record in medical and health care writing. Membership in the American Medical Writers Association or the National Association of Science Writers is a good credential. The work arrangements are "flexible," she said. Some freelancers prefer to work at home, some freelancers use MSKCC resources like the library.

There is no set pay rate, she said; fees vary depending on the project. "But we pay competitively and we pay on time," Foster added.

Working in any large academic hospital requires "diplomacy," said Foster. "You have to be able to feel out the doctor or researcher you're interviewing and set the appropriate tone," she said. You also have to accept the politics of writing for a big institution. "Sometimes we'll make an edit and we don't always have time to explain why we need to do that, due to some knowledge we may have of our organization," she added. "And you'll just need to accept that."

Deadlines are absolute. "A lot of our publications are timed for our Board meetings," said Foster. "So we have no flexibility with the deadline." A responsible and mature attitude is also a must.

The newsletters, and the web site, require a tight writing style. You have to get to the point quickly, usually in 500 to 700 words for a Center News article. On a web page, people will only scroll down a page or two. "We need the writing to be really quick and snappy," said Foster. It helps to know that you can write a short web page, for example, and link to more detail on a second page. It helps to know the basics of HTML, like bold and italics codes, but it's not essential.

Freelancers interested in writing for Memorial Sloan-Kettering should send Foster a "well-crafted cover letter explaining why we think we should consider you," a resume, and no more than 3 medical or health care clips.

Interactive media

The second presentation at the EFA meeting was by Jonathan Pace, Executive Director, Phase Five Communications Inc., a division of Grey Healthcare Group, Inc. Although Pace looks like he's 25 years old, he's actually had 25 years experience in interactive media, starting with some of the first medical lectures with interactive keypads. A recent project was a pharmacy-based computer kiosk that analyzes the reasons a smoker might be motivated to quit. This tailored behavior modification program supplies a printout that outlines a customized smoking cessation plan. Pace is posting the notes from his Powerpoint presentation at next Wednesday.

Pace demonstrated a program, Protoge, which his company created for Schering International. Schering gives Protege to its independent investigators to generate protocols for open, single-center oncology drug studies. From a CD-ROM, the investigator can select the cancers for study from a pick list, describe the cancers from National Cancer Institute PDQ reviews, select in- depth drug information a drop-down list, and finally generate an investigatory protocol the way a lawyer generates a will. A nurse in Rochester, NY who writes oncology trial protocols full-time told Pace that the program saves 65-85% of the time it used to take to generate a document for Internal Review Board submission. Other programs are used in patient education, physician education, and pharmaceutical sales training.

In an interactive job like this, the writer should learn as much as possible about what other people on the project are doing, and try to assume some of the responsibility for organizing the project, said Pace. "Once you have insinuated yourself into the program, beyond writing copy, nobody is going to want to get rid of you."

--Norman Bauman