20 December 1999 Rev. 20 March 2000
4,800 words

Medscape and CBS spawn HealthWatch,
"Advanced" consumer stories 900 words/$500+
Meeting coverage but no expenses

Update: On 12 November 2001, Medscape and CBS split up. The site is now Medscape Health for Consumers again.

NEW YORK-- Medscape , the world's most popular commercial medical web site, has finally developed a separate consumer site, and they're looking for writers. And the pay is good "by web standards," they say. The new site is called CBS HealthWatch by Medscape , and 2 editors told the Editorial Freelancers Association about the kind of writing they're looking for, at a meeting of the EFA Medical Affinity Group here on 11 November 1999.

The starting pay is in the low range, but good writers get more, sidebars pay more, and writers who have put together a package of 4 or 5 stories from a meeting say that they are very satisfied--one writer made $3,000 for 2 weeks' work, although she had to pay her own conference expenses out of that.

But some writers had problems. The editors, they say, are very smart, very busy, and very hard to reach for guidance. The writers didn't understand what kind of story they were supposed to write. They wrote a meeting report, but CBS HealthWatch wanted a consumer story, with comments from other sources, that only mentions the meeting--so why travel? Sometimes they wrote the story, got paid, and waited weeks to see it on the website. Or they wrote the story, and waited for it to appear on the website before they got paid. Lots of people are happy writing for CBS Medscape, but it's important to specify clearly in writing what kind of story the editor wants, and whether they're paying you on acceptance or on publication.

CBS HealthWatch starts at $450 for a 900-word story, and pays $700 to writers who understand the site's style well enough that their copy can go on the web with minimal editing, said Glynna Prentice , Project Director, Editorial, Consumer Division . A sidebar might get another $100-150. You should interview 2 doctors and, if appropriate, a patient. The information must be current and stories are typically based on a presentation at a medical conference. Stories are reviewed by Harvard Medical School faculty, an unhurried, scholarly process that gives writers a longer deadline than most print publications. The Harvard reviewers believe in evidence-based medicine, and demand authoritative sources for statistics. If you cite a published source, it should be a primary source, or at least the web site of a reliable organization. Prentice gave a list of topics that she was particularly interested in covering, and said that CBS HealthWatch will cover important health issues, like aging, minorities, and disabilities, that other publications ignore. They prefer you to contact them initially by email, at <consumer_content@mail.medscape.com>.

Contract improved

An indemnification provision in the contract, which many writers refused to sign, "is now out," said Prentice. They do have a kill fee, but, she said, it has only been invoked in 4 of 200 articles. They buy all rights, but once you've collected the information, it should be easy for you to rewrite the content into a different story for another publication, she said--but it should be a different story, not merely the same story with a few new paragraphs.

CBS HealthWatch covers conferences together with Medscape, and that's one of the best ways to write for CBS HealthWatch, since the Medscape doctors can help you figure out the conference, said Carla Cantor , Project Manager, Consumer Editorial.

But CBS HealthWatch doesn't pay travel expenses, said Cantor apologetically. They try to use local writers, or writers who are covering the conference for somebody else. This can present conflict of interest problems, especially when a writer's expenses are paid by a pharmaceutical company (which you must disclose). You can write for CBS HealthWatch about other presentations at the meeting, but not about the products of the company that sends you, said Cantor.

CBS HealthWatch requires a certain "voice" or writing style, they said. The Internet requires an intimate style, often addressing the consumer--not the "patient"--as "you."

(For a good business description of Medscape as of 4 May 1999, see Medscape's Form S-1 which they filed with the Securities and Exchange Commission in a cancelled attempt to go public.)

Simplified Medline

Like America On-Line, CBS HealthWatch is trying to offer easy, simplified versions of difficult, complicated Internet services like Medline and Internet relay chat, together with some popular interactive functions.

The opening screen is 3 columns, with the middle column dedicated to features and news (usually Reuters). On the left is a chapter-like list of 22 "Channels" of major categories, such as cancer, "heart health," and women's health, each of which links to a separate page or "condition area." There is also a list of about 800 keywords, which looks like a simplified Medline thesaurus. There is also a free-text search (which cannot however search by author or date). The search returns a title list of documents, 10 titles per screen, sometimes for 20 screens. A colored bullet indicates the difficulty of the article. After you've found the document, you can bookmark it and place it on your "Bookshelf."

3 levels of detail

"We have 3 levels of information on the new site," said Prentice. The consumer is offered basic information, advanced information on the CBS HealthWatch site, and professional-level articles on the Medscape site, designated, "What your doctor is reading."

  1. There is basic-level information, "which at this point we get mostly from third-party providers," said Prentice. Thousands of documents have been gathered from vendors, such as the American Institute for Preventive Medicine , the more detailed and Harvard-based Nidus Information Services, Inc. and government sources like the National Cancer Institute. Breaking news is provided by Reuters, but Reuters stories are only on the site for 1 week.

    Nidus pages are similar in style and content to the Merck Manual Home Edition . (A good way to evaluate a medical web site is with the Merck at your side. Is the information you get with a $2,000 computer as good as the information you get from an $8 paperback? Is the content as complete, and is it as easy to read? Is the information as easy to find, and is it more up to date? For a critique of patient information literature, see "Education and debate. Sharing decisions with patients: is the information good enough?" BMJ 30 January 1999;318:318-322 .)

    In my reading, the vendors are serviceable but bland. They provide content to managed care companies, government agencies and corporations, for newsletters and patient handouts. They are therefore unlikely to write anything that will offend managed care companies, government agencies and corporations. There is little on abortion. One big controversy in patient materials is: Do you tell patients the bad news, or do you tell them to "talk to your doctor"? Referring patients to "your doctor" is often inadequate, because doctors are often unwilling to break bad news ("Lisa's Stories," Daniel Rayson, JAMA 282(17) 3 November 1999 ). The Merck Manual entry on pancreatic cancer gives the dismal survival rates. The NIH PDQ entry doesn't.

  2. "At the upper end," said Prentice, "on the expert level, are the articles that we can pull off from the Medscape professional web site, for consumers that feel that they're up to reading things that are designed for professionals."

  3. "The middle section, our advanced-level articles, are where our freelancers come in because we are creating them as original content," said Prentice. "And we're turning not so much to physicians as to really experienced writers and journalists who are used to dealing with the public," and who "preferably" have some background in health care.

22 channels

Prentice is in the process of creating content not only for those 22 condition areas "but for areas that we will be rolling out in the coming months." She distributed a list (below) of topics on which she is looking for stories. "You can always make pitches on other things."

If you have written about those topics, like public policy, managed care, breast cancer, or women's health and men's health, "it puts you in a good position to send us story ideas," said Prentice.

Women's health includes topics like pregnancy, parenting and child care, menopause, osteoporosis, hormone replacement therapy, breast and ovarian cancer. Men's health includes prostate cancer, impotence and lighter topics like sports medicine.

"Those are some areas that are frequently unrepresented" in other sites and publications, and "we want to make sure on our site they are not," said Prentice. Older readers, for example, are often ignored by magazines. But CBS HealthWatch is interested in seniors, in multi-ethnic minority issues, and in the disabled.

"I've done 6 stories so far" for CBS HealthWatch, said Wendy Meyeroff, chair of the Medical Affinity group. "Glynna has been my editor, and I've found her very open to ideas that I can't get past people at other consumer publications. They say, 'We want something new,' and what they mean by 'something new' is, 'What everybody else is doing.'" For example, she did a piece on anorexia in senior citizens, "which is something I could not sell on the consumer side anyplace else."

"I like to think that we're the place you can come with ideas that other places won't take," said Prentice.

Flexible deadlines

After the writer finishes a story, it is edited, and sent for review by a faculty member at Harvard Medical School. That can take a while, so the deadlines are more flexible than you would get on a magazine.

"At some point it will be a featured article, the equivalent of a front page article, in a premier spot either on one of the health channel pages or on the home page," said Prentice. Then it goes into the archives.

"Shoot for 900 words," with a 1,200-word absolute maximum, said Prentice. "Our stories are rather longer than many web sites."

There is no space constraint on a web site, but there is an "attention-span constraint," said Prentice.

The advanced level articles are written for "The woman who has been diagnosed with breast cancer," said Prentice. "She knows what it is, now what does she do? What are the latest drugs? What's the latest thinking on treatment?"

Stories can be tailored to specific risk groups, said Prentice. Suppose you have diabetes, and you are a 40-year-old African-American male who is 40 pounds overweight. "What do you need to know?" Well, prostate cancer is also a big risk in that group, she noted.

"But we're also interested in some of the more thought-provoking things," said Prentice. "Genetic diagnosis. What's the new technology and what are the implications?"

"We do like to develop relationships with writers, so that we're not speaking with new voices over the telephone every week," said Prentice.

"There could be a fairly steady stream of work," said Prentice. They might need 1 article this week, and 2 or 3 next month.

Topic areas

"Medscape made a reputation for itself on the professional side because they provide next-day turnaround of conference sessions," said Prentice. "They take a considerable staff to conferences, cover particular sessions, work with authors, and on the next day will have reports out of specific sessions on the conference."

Cantor is one of the editors responsible for that conference coverage.

The topic areas are divided among editors, explained Cantor. She handles mental health, pregnancy, menopause, child health and parenting, hepatitis C and diabetes.

"I was a freelance for 10 years before I went back to work full time 4 years ago, so I do understand the freelance world," said Cantor. "I wrote for newspapers, magazines, and wrote a book [ Phantom Illness: Recognizing, Understanding, and Overcoming Hypochondria, Houghton Mifflin ]."

CBS HealthWatch's voice

One of their big discussions was, "What kind of voice would CBS HealthWatch have?" said Cantor. "There is room for a variety of voices on the site, because the people in charge really appreciate writers. While there is a need for stories about signs and symptoms and prevention, we also are able to try out some really different types of stories."

There are first-person stories in the "I" voice. For example, a writer's mother was dying of emphysema. "They set up a hospice in a hospital, moved in some of her things, and that was her last week," recalled Cantor. "It started as a first-person and ended as a service piece." Another writer described how she nursed her boyfriend through brain cancer. "But not everything is that morbid," she added.

The style should be "less formal without being slangy," said Prentice, "without being inappropriate for a serious site."

"I was one of the strong proponents of the 'you' voice," said Prentice. "For the Internet, it's that level of intimacy" that you want.

"We really wanted that sense of intimacy," said Cantor, but the "you" didn't work all the time.

Prentice described the tone in her style sheet as "intellectually rigorous," "compassionate," and "thought-provoking."

"We do want intellectually rigorous thinking," said Prentice, because their readers are people who are looking beyond the basics.

It must be compassionate, said Prentice. "Even if you're talking about the latest gee-whiz technology, at the end of the day its a person or family that's having to make a potentially very difficult and life-altering health decision." A story about diagnosing the breast cancer gene must remember that there is a woman who will get the results at the end. You have to remember the social context. What's the consequence of a false positive mammogram?

"When you have such a short space," said Cantor, "it takes a talented writer to inject himself or herself into a piece to give it a tone."

Working with Medscape

Medscape's original purpose was next-day meeting coverage, and CBS HealthWatch can take advantage of it.

Medscape has developed a "relationship" with physician authors, said Cantor, "doctors who are tops in their field," who are commissioned to write a section summary, which can be read by the doctors who are attending the meeting, and can't make a session, or doctors who can't make it to the meeting at all, she said. "There is a doctor in the Sinai desert who thrives on these things."

The Medscape program directors who take care of particular areas are "pretty remarkable people," with real expertise, said Cantor. The program director who handles diabetes, for example, has a PhD and was a pharmacist for 4 years.

"I came back from the diabetes conference in June with 10 stories," said Cantor. "Working with the program director, I was able to zero into what's important."

The stories have different voices. "I was able to do fun pieces along with serious pieces," said Cantor. One fun story was about a group of teenage diabetic girls who have pumps implanted. They call themselves "The Pump Girls," she said. "They've become the teenage mascots of type I diabetes. They have a CD-ROM out now, they sing and take tours." ( "The Pump Girls Deliver Music With a Message" and "Heading Off Type I Diabetes in Children at Risk" . Other stories by Cantor, in case you want to get an idea of her style, are: "AIDS Never Leaves Body, Researchers Fear" ; "Children Who Kill Children: What Can Be Done?" ; "Keeping Track of Your Kids on the Information Superhighway" ; "Making the Internet Safe for Children: Creating a Global System" .)

The consumer side has a much easier schedule at the conference than the professionals, added Cantor.

Reviewed by Harvard

"The nice thing we can provide for you is, we're not breaking news," said Cantor. "The vetting process makes it really impossible for this part of our editorial process to be very timely."

CBS HealthWatch vets everything through faculty members at Harvard Medical School, through a relationship with Beth Israel Deaconess in Boston, MA.

The reviewers need citations for your sources, said Cantor. You have to provide the urls of the web sites you used, and the phone numbers of people you called.

Conference coverage

"We like it in as soon as possible," said Cantor, "ideally" 1 story a week, and 3-4 stories in a month.

"A session does not mean an article," said Cantor. For the American College of Rheumatology 1999 Annual Scientific Meeting in Boston, 13-17 November, "my schedule is 8 pages, we have 4 writers, and we hope to get 3 or 4 stories out of all the sessions they go to."

"We meet in the press room," said Cantor. "We can talk and re-evaluate things." The rheumatology conference will be exciting because "I'm going with someone who's doing it for professional, not next day, but as a treatment update, and I've talked to this person about bringing my writers into their workroom." Medscape authors are prominent people in the field of rheumatology, and "my writers will be able to interview their physician authors."

"So I'd love to get an email about which conferences you're planning to attend," said Cantor.

$450 to $700 an article

"The pay is a moving scale," said Prentice, with features paying "in the area of $450 to $700." If you have a sidebar that "really makes sense," she'll pay another $100 or $150.

"When we're first working with a writer we start on the lower end," said Prentice. "In my experience a clip that has already appeared in a publication does not give me a good idea of what I'm likely to see in terms of a raw manuscript," she said. "So I like to see the original work from the writer to see how you think, how do you write.

"Is it the tone we're looking for?" Prentice asked. "How much editing is it going to take?"

"The bottom line," said Prentice, "is how much work is it going to take on my end? The closer it approximates what we will want to put up on the site, the more I can pay you."

That's about 50 to 80 cents a word. "For those of you used to $1/word in print, it may seem low," said Prentice. "By web standards that's pretty high."

(According to my sources, Reuters pays $100/story, $300/day; MSNBC $0.75-1.00/word, Medcast $300-350/500-600 words; WebMD pays a complicated rate which works out to $300-550 or more for 6-700 words, with additional fees for writing both a consumer and physician version; PSL-Doctor's Guide $100/200 words; HealthScout $100/750 words and maybe more ; and The Lancet $0.50/word for shorts of about 200 words. Medical Tribune pays $300/750 words--but many writers report problems getting paid, and the ASJA has just put MT on the "Warning List." Many medical tabloids pay $300 for 800-word stories, but some, like the Nature magazines, go to $1/word or more.)

"We get all rights," said Prentice. "That is following the tendency on the web these days. Part of it comes down to the way this industry works."

"There's no copyright on ideas," Prentice noted. "If you've done a 2,000-word magazine article on an idea that we can use, it seems to me it's very easy for you to turn that into a 900-word, and you have the basis for an article that we can use," she said. "Provided it's up to date."

All rights

2 days earlier, Jonathan Tasini, president of the National Writers Union, had addressed the EFA, and recommended that writers turn down all-rights contracts, unbundle the rights and negotiate for each right separately. But that would be impossible for CBS HealthWatch, said Prentice. (Many Union members concede that it is sometimes an impossible negotiating position. Even members of the NWU advisory board, for example Todd Gitlin, write for the New York Times, even though the Times demands all-rights contracts.)

"We do not have the staff to monitor many, many varieties of contracts with respect to secondary works," said Prentice. "And I've looked at a number of contracts for other web sites, and the ones I looked at were pretty much all rights."

The original contract bought rights for 2 years, said Prentice, but the lawyers said that monitoring the 2-year timeline would be "a nightmare." Furthermore, CBS HealthWatch wants to keep the articles in their archives. If a consumer puts an article on her bookshelf, the rights expire, and the consumer wants to look at it again, the consumer would find the article gone.

Better indemnification clause

Several writers had refused to sign the CBS HealthWatch contract because of an earlier indemnity clause and a kill fee provision. According to the complaints, the old contract required the writer to pay for the company's legal fees if they were sued--regardless of whether the court finally decided the suit had merit. This means that a writer could get stuck with enormous legal fees even defending a nuisance suit.

"It has been resolved," said Prentice. The objectionable provision "is now out," and the writers who had objected have now signed.

Under the new contract, you as the writer affirm that you hold the rights to the material that is being sold to CBS HealthWatch, and that to the best of your knowledge it is accurate, and conforms to the generally accepted standards of journalism. It requires you to disclose payments or conflicts of interest--which would rule out placement. (Prentice didn't want the contract or indemnity language to be disclosed publicly.)

Kill fee

"We do provide a kill fee of 25%," said Prentice. "We have applied it about 4 times out of about 200 articles." (But writers frequently complained that they had articles killed, so you should clearly describe the assignment in writing to make sure everybody understand and agrees on what you're supposed to do.)

The writer provides a manuscript and 1 rewrite, said Prentice. "I feel that part of our obligation in working with a writer is to talk about the angle we want, and to make that clear," she said. "And we are available if necessary if the writer has questions."

"If after that the quality of the story does not match, or the angle of the story is not there and we don't get it in a rewrite, I have no compunction" about giving a kill fee, said Prentice.

"I've never killed an article," said Cantor.

Interview 2 docs and a patient

"We want stories to be thought-provoking," said Prentice. "We don't want them to be shallow" in their research. "We prefer at least 2 physician sources," and an interview with at least 1 patient when appropriate.

These are not next-day conference reports, noted Cantor. "These are features," she said. "We've had a little trouble with a session where somebody's just quoting one person. My feeling now is, let's interview somebody else, let's see if we can find a patient, and let the conference be the seed."

(The Reuters stories, in contrast, are next-day stories, and usually one-source stories.)

"Harvard is asking us for reference information and sources at the end," said Prentice. Andrew Weil's web site "will be suspect," she noted. The New York Times is not an acceptable source for a clinical issue (although it is a good source for non-clinical news). "We want the primary source from the medical journal."

You can use standard medical textbooks for background, "but for a good percentage of the advanced level articles, we are moving beyond that, because you're looking at a new angle," which is probably coming out of a new study, said Prentice. You can just call the doctor directly.

"We have gotten a very few manuscripts" from people who gave links for the reader in their stories, said Prentice.

The style sheet describes the computer formatting. Writers usually send in stories as Word for Windows file attachments, without "Smart Quotes". With a high volume of stories, it's difficult to copy text from email and format it, Cantor explained.

Statistics and credibility

"Harvard has some trouble lately trying to verify statistics," said Prentice. If you want statistics on, say, teen suicide, "please go to the National Institute of Mental Health, [or] the Centers for Disease Control," rather than, say, a self-help site, she said. "We all know what the really reputable organizations are."

Accuracy, completeness and journalistic standards are "big issues for us," said Prentice. For the New York Times, the assumption that they will separate advertising and news, and that their basic information is accurate, "is a given." On the Internet, "it's not a given." That reputation is what "we are working very hard to establish." A source, and story, should have the level of accuracy that you would expect for the New York Times science section, "or maybe a little more."

"The conference model has really worked well for us, because you meet the people who are tops in the field," added Cantor.

Conflict of interest

Often, a pharmaceutical or medical device company will send a writer to a conference, to cover a presentation on their product. The company wants the writer to place stories on that product in medical and consumer magazines. Some magazines accept stories like that, others don't. Some writers disclose the arrangement, others don't.

Suppose, said one writer, a drug company sends me to a conference. I call editors before I go, explain the arrangements, and ask them if they need coverage, on the product or anything else. "I write a sound story, a balanced story," which talks about the benefits and downside of the drug, and I interview people on the opposite side. I would tell you up front that the company is sending me. "That's the only way I can get to Portugal," she said.

"I would rather hear who's sending you, why they're sending you--and steer clear of them in terms of what you do for us," said Cantor. "There are so many other articles that could be developed, that wouldn't conflict."

"When I cover conferences I'm usually sent by a publication," said another writer. "Is it not in conflict if I write for you and for them?"

"I think it falls into your camp," said Prentice. "From our point of view, if you are going to be at a conference because you're doing a story for another publication, and you make a pitch to us, and it's something we're interested in, I'm happy to take it."

Not breaking news

"If it's something we don't have and it's an angle that would be interesting to our readers," it doesn't have to be breaking news, said Prentice. Back in June, there were some reports on the use of CAT scans and their ability to detect lung cancer tumors much earlier. The Lancet "The question for us is, Is that going to be the new baseline measure for detecting lung cancer?" That is tied to a news event, "but that's an article that's equally good right now. We could have commissioned that in June, we could commission that now."

Basic articles are already covered. "But that doesn't mean you can't write a more basic kind of article," said Cantor. For example, does antibiotics in animal feed produce antibiotic-resistant bacteria that infect humans? Before they put up an article like that, "We need a really basic article on how to protect yourself from food poisoning." So they did a story on 12 ways you can keep yourself from getting sick on food.

Alternative meets evidence-based medicine

"Medscape was very conservative about getting into alternative medicine because of its [medical doctor] audience, and it was a big deal for us to create an alternative medicine area," said Cantor. "Because we're part of the same company, we may be a tad more conservative than another site--perhaps Dr. Weil. We're not going to publish an article because one study found something."

"All of the major people on Medscape are very much proponents of evidence-based medicine," added Prentice. "Having said that, we really felt that in this day and age, particularly the way consumers are thinking, you can't launch a consumer health site and not cover alternative medicine."

This was resolved by doing it "in a way that is acceptable within the Medscape standard of accuracy of information," said Prentice. "You do have to look very carefully at the evidence for each of these alternative medicine practices," she said. "What are the studies?"

"I definitely did not want to have an alternative medicine section just to be slamming it," said Prentice, "because in fact most of the people on the editorial staff are very pro-alternative, just on a personal basis."

"It's very hot among writers, it's very hot among consumers," said Prentice. "Just remember that in writing for CBS HealthWatch you are writing by Medscape standards, and it will be vetted by Harvard. Remember that you're going to be well-balanced, that you have to be providing the evidence on it. One study is not enough."

--Norman Bauman


Topics on which CBS HealthWatch is looking for stories