6 May 1999 Rev. 8 August 1999
3,500 words

Med Trib on Web, into complementary med,
new editor trying to raise standards,
but freelancers aren't getting paid

NEW YORK--Down from its days of glory, Medical Tribune was sold from one publisher to another, each one ready to pull the plug until they passed it on to the next sucker. Now it's back in business, under an editorial director with 21 years in the trade press, a reasonable budget and a determination to raise the tabloid's standards.

"I'm betting my career on it," said Janice L. Zoeller, Medical Editorial Director of Medical Tribune, and Editor-in-Chief of American Druggist (which is not on the web), both owned by PressCorp, Inc., New York.

Zoeller spoke at a meeting of the Editorial Freelancers Association's Medical Writers and Editors group here on 6 May 1999.

(But after I sent this story to my email list, several freelancers complained that Medical Tribune owed them thousands of dollars, and hadn't paid for months, despite their repeated requests. In addition, one writer noted that the rates had been 50 cents a word before PressCorp took over, and were now down to 30-40 cents. On 18 March 2000, Zoeller told her writers that PressCorp was declaring bankruptcy, and was sold to Rogers Media, publisher of Medical Post of Canada, a division of the CN $2.8 billion Rogers Communications Inc. But the deal didn't go through, and Medical Tribune ceased publication.)

This story is written for freelancers who want to write for Medical Tribune or American Druggist and magazines like them.

In summary, Medical Tribune pays $250-300 for a 750-word news story based on 2 or more interviews. Medical Tribune gives a daily feed to the New York Times Syndicate, and publishes a bimonthly tabloid, in print and on the web, for the Nation's 200,000 doctors. So they cover everything in medicine of interest to laymen or physicians, from clinical stories like gene therapy reports from cancer society meetings, to social issues like domestic abuse--and complementary medicine. If you're at a press conference or medical meeting, or you've just written a hot story for a publication in a different market, or you understand a complicated subject that's suddenly in the news, it's easy to pick up another $300 by spinning off a news piece to Medical Tribune (perhaps with another interview or two) as medical writers have done for decades. Conversely, consumer magazine editors often assign a story to someone who has already covered it for Medical Tribune. Med Trib is--or will now be--written at the fairly high level of quality that's standard in writing for doctors. Zoeller is not afraid of controversy or offending advertisers (in a well-documented story). Reliable freelancers with a useful specialty can look forward to a long-term relationship.

American Druggist pays $900 for a 3,000 word story, with a similar density of interviews. They range from easy profiles of pharmacies and marketing techniques, to technical overviews of medication best left to Pharm.D.'s or very good medical writers.

Freelancing at American Druggist

American Druggist is known to pharmacists as "the magazine with a person on the cover," because the cover always has a head shot of a pharmacist. But the story isn't a profile of the person, said Zoeller. "The person is a stand-in for a larger trend." For example, the April cover features John Fegan, vice president of pharmacy at Stop & Shop Supermarket, and the story deals with the trend of supermarkets, with their pharmacy departments, marketing food on the basis of health and nutrition benefits.

American Druggist is mostly staff-written, but Zoeller has 4 to 6 freelance writers, mostly with specific expertise, she said. Some are pharmacists.

Zoeller assigns some stories, and freelancers propose others. In particular, Zoeller uses freelancers for the quarterly supplements, on HIV and diabetes, because it's easier to get freelance writers in the budget. While interviewing pharmacists for one story, you can get leads for other stories, she noted. You'll be interviewing them for a story on how pharmacists use the Internet, and they'll tell you in passing that they're suing Aetna.

The writer gets $900 for a 4-page story (about 3,000 words). The writer usually gets an outline and background material from Zoeller's files. For a story on attention deficit disorder, for example, the writer might interview several pharmacists to find out how they counsel patients.

Reliable freelancers

Zoeller has a "good relationship" with a Washington correspondent. She can call him up and run down the important stories, because he understands the needs of the magazine. "It has gotten better and better," she said. "That's the good thing about working with a person over a period of time."

One freelance writer called. "I thought she was calling to tell me she received the package," said Zoeller. "She was actually calling to tell me she did the first interview."

"We get swamped and need somebody reliable," said Zoeller. "We're hoping to find people who will be forthcoming as to what they can do and what they can't, and will let us know if they have problems." One writer recently fell through at the last minute, and two staffers had to write a long feature story in about 24 hours.

"It's hard to find reliable people," said Zoeller.

Some people don't know how to write objective news. One writer did a story on needle exchange programs for the quarterly HIV supplement. Instead of doing interviews, the writer wrote an opinion piece arguing that pharmacists should distribute needles to IV drug users. "We had to call pharmacists," said Zoeller. Most medical societies support needle exchange programs, and a National Institutes of Health consensus report recommended that pharmacists should sell needles to IV drug users. But when American Druggist finally interviewed pharmacists, they complained of IV drug users unsafely discarding old needles.

Zoeller gets stories in which the writer couldn't find anybody to interview, and just fakes it. "Fact-free copy," she calls it. "I'm a big stickler for facts," she said. "When did ibuprofen come on the market?"

Pharmacists understand the content better, but sometimes they don't understand journalism. Zoeller assigned a story to a pharmacist, and gave her a list of questions. The writer turned in a bland, boring story. Zoeller asked the writer whether she had asked any of those questions. The writer said, yes, she had, but the answers were too controversial, and she was afraid it would make trouble.

Copy editors--finally appreciated

Among Zoeller's improvements to Medical Tribune: restoring copy editors, who had been fired by former owners to cut costs. A previous publisher gave responsibility for proofreading and copy-editing to the section editors, who would make sure the location of Cornell Medical Center, for example, was changed from New York City to Ithaca, NY.

"Copy editors are the most undervalued people," said Zoeller. "Our readers don't have a lot of time, and we have to make the information as accessible as we can."

"We have a good copy editor who is going to be working on Medical Tribune," said Zoeller.

"I could use some help on American Druggist," said Zoeller. "There are so many little ways you can mess up." A story appeared in the April American Druggist under her byline with the headline, "Solutions to Workplace Issues Remain Illusive." They changed it in the blues, but it still wound up in print. "It ruined my day," she said.

Competitors are "garbage"

Zoeller is also running an ad in the Sunday New York Times for editors at Medical Tribune. (Here's the ad: "EDITORIAL/Wanted: writers for Medical Tribune, a daily health & medical consumer newswire distributed via the NY Times Syndicate & a bi-monthly physician newspaper. Applicant should be fluent in AP style, medical terminology & comfortable w/both lay & physician audiences. FAX to JK 212-686-5310")

She's also trying to fill a Senior Editor/Editor job at American Druggist, which is a "full-time job and then some."

Zoeller suggested that applicants for copy editor jobs mark up a page and send it to her. (She likes e-mail or regular mail, but said, "I'm going blind from faxes.")

"Most of our competitors are garbage," said Zoeller. "We never rely on single sources. We will tackle any subject, even if it would be offensive to our advertisers," although they would strive for balance.

A more controversial story needs more research, said Zoeller. One story about a chain that was raising the prices of generic drugs had to be shelved because "I didn't think we had enough facts to support the story."

A pharmaceutical company, for example, did a survey of pharmacy pricing, but wouldn't release the survey. American Druggist got a copy of the survey, and it turned out that they only questioned 10 pharmacists. "The fun part was calling them back" to confront them with the facts, said Zoeller.

"Stuff like that is so much fun and so motivating for my staff," said Zoeller. "Next month they won't mind writing about lice cures."

Medical Tribune's history

Zoeller has only been working on Medical Tribune for 4 months, so she didn't discuss its past. But the magazine has a long history (which is summarized here from the lore former editors and writers). According to old-timers, it was founded by Arthur Sackler, who made a fortune with advertising from magazines and medical ad agencies. Sackler contributed tens of millions of dollars to medical research and art galleries in the U.S. and Israel, supported liberal causes, hired blacklisted Herald Tribune writers, and appointed a distinguished editorial board.

Medical writers have much affection for Bill Ingram, the former editor, who enjoyed teaching newcomers and gave many of them their first job or freelance assignment.

Medical Tribune also faced charges (unresolved) of letting its advertisers influence news stories, in promoting branded drugs over generics, for example. But Ingram's managing editor Tom Watkins drew the line. A PR man once told him, "You know, our client is a big advertiser." Watkins replied, "Because you said that, I'm never going to mention your product in Medical Tribune again."

Ingram, a cigarette smoker, admitted that he gave Medical Tribune press credentials to Leonard Zahn, a tobacco industry PR man, who wanted to cover medical meetings as a journalist. Zahn used these credentials to get into press rooms, spy on reporters, and (Zahn claimed to his clients) influence stories, according to court documents disclosed by Zahn's long-time nemesis, David Zimmerman, publisher of the newsletter Probe.

In its heyday, Medical Tribune was probably the largest single source of physician-level medical news (and freelance work), especially after the Medical Tribune Group bought and finally pulled the plug on its main competitor, Medical World News.

Medical news formula

As former editors described it, the 2 publications, Medical Tribune and Medical World News, invented modern medical journalism: take a paper from the New England Journal of Medicine, or a presentation at a conference; rewrite the dense academic style into tight, bright, fun-to-read news format; call the investigator and read your story back ("for accuracy"), ask for additional comments; then call a respected independent expert, maybe from the editorial board, for response. They worked in the language of everyday English, and wrote for the lowest common denominator, "the GP from Kansas," as one editor (unfairly) described it. They hired reporters with the philosophy that a good reporter could pick up the medical specialty on the job.

The key was to have a network of doctors, who were respected by other doctors, whom you could call to respond and evaluate a new development. And the editors of those 2 publications knew who to call. ("Long distance? From New York? I'll get him immediately!")

When new drugs were coming out, advertising was flush, and everyone flew first class, ex-staffers recalled. Writers from Medical Tribune and Medical World News formed a network of people who edited and published an explosion of professional medical publications, and also consumer writing, in the same style. Watkins was later hired by Cable Network News in Atlanta at reportedly triple his New York salary.

The 2 publications also formed the base of a system of freelance writing. People would write a story for one publication, and resell it, with either no changes, or additional interviews, or a total rewrite, to another publication (sometimes under a pseudonym). With the Internet, and with syndication, however, this has become more difficult, since it's easier to step on your own publisher's toes.

This system was also vulnerable to exploitation by public relations firms trying to tout their drugs. It's easy for a pharmaceutical company to pay a freelancer $500 to write a story touting a new drug, and then place it in a few magazines.

It was a pretty good deal 30 years ago, when they were paying 25 cents a word, and an 800-word story could pay your rent for a month. It's wasn't such a good deal any more in the 90s, when they were paying 50 cents a word, about the same before inflation.

But competition grew, and drug company advertising strategies shifted more towards specialty magazines, direct-to-consumer advertising, sponsored symposia, and other media--such as billboards in the airports and on highways around medical meetings. Medical Tribune was sold to Axel Springer Verlag, and they fired Ingram.

Unpaid freelancers

Yes, gentle reader, I too suffered under the harsh rule of Axel Springer Verlag, and pen cannot tell the horrors. They plundered my payments and hacked my copy.

I remember writing a story about managing receivables in the small medical office. An office manager warned me that if you don't get paid in 90 days, you'll never get paid. A light went on. I hung up, checked my books and sure enough, Medical Tribune was past 90 days. (Bill Ingram used to pay immediately.)

My mother, a retired bookkeeper, told me of one employer who ordered her to write checks but not send them out. "His creditors would call me up and complain," my mother said. "I hated it. It was the worst job I ever had." That's what happened to me with Axel Springer's bookkeeper. They would say, "We just cut your check." But that doesn't mean they're going to *mail* it.

Editing horrors

But at least, eventually, I got the money. In these days of electronic archives, bad copy editing stays with you like a bad tattoo (or at least a bad haircut). I wrote about computers in small medical offices.

Original lead:

You get an off-hours call at home: "We have your patient unconscious here in the emergency room--do you know what her medications are?"

If you keep your charts on computer, you can give a good answer.

Dr. John Dulcey, a Sellersville, Pennsylvania, solo practitioner, calls his office computer on a modem line, then calls the ER back on a voice line, and so, he says, "I can respond to any questions in a reasonable fashion..."

As printed:

An intelligently thought-out mix of software and hardware can bring almost any practice into the computer age with lightening speed.

Dr. Mark Weitman, a family practitioner in St. Petersberg, Florida, uses a laptop....

I asked advice from one of the great copy editors from the Bill Ingram days, who said, "That's terrible. You really should complain about it." I complained, in a tactful, non-accusatory letter. Big mistake.

But I digress.

Saved by the Internet?

Just as it was entering another seemingly fatal dive, Medical Tribune got its most prestigious coup: affiliation with the New York Times Syndicate. It was a delight for freelancers but a money-losing operation at first. Prestige didn't mean anything to a spreadsheet in Berlin, compared to Axel Springer's more profitable operations, like Der Bild Zeitung.

Axel Springer became disenchanted, and tried to shut the news service down, but The Syndicate wouldn't let them out of the deal. A good thing, too, because soon after, the Internet went mass market, and generated a huge demand for health news. News for doctors was even more popular among laymen, and Medical Tribune appeared prominently on the search engines. Now that price-to-earnings ratios are less important, and now that recognizable brands are more important on the Internet, the name and tradition of Medical Tribune is worth something again.

One of Zoeller's goals is to better integrate the paper edition with the web site. "We're trying to position Medical Tribune as the on-ramp to the Internet," she said. "Our site is not big on content, but it's big on links." Stories are hyperlinked to original sources--an online journal article, or abstract, or government report. In the printed edition, the hyperlinks are printed in purple. Finally, Vannevar Bush's dream of a hyperlinked libary has been realized.

Links back to sources

For example, in the May 6 issue, a story reporting that women survive congestive heart failure better than men is linked to the abstract of the journal article in Circulation on which it was based, and also to the abstract of an article in the NEJM with a contrasting view.

A story on adenovirus gene therapy for cancer is linked to the site of the April American Association for Cancer Research meeting where it was reported. If you're interested in adenovirus gene therapy (as I am), the AACR meeting has over 50 abstracts on that subject, which you can browse on-line after completing a free registration. Or, if you happen to be writing about prostate cancer (as I am), you could browse through another 50 abstracts on that subject, which you (or at least I) wouldn't have thought of without that link on Medical Tribune. Contributing editor Linda Carroll apparently went to the AACR meeting and wrote 3 pretty good stories on cancer genes.

Bypassing passwords

Some linked articles are in abstract, but others are in full text. Many government reports are in full text, like the guidelines of the Agency for Health Care Policy and Research. There are some full text articles that are password-protected and only available to subscribers, said Zoeller, but if you use the full url of the article, you can often bypass the password.

Medical Tribune covers the Internet itself, and the MD CyberGuide reviews medical web sites, and recommends them on a scale of 1 to 4.

Freelancing at Medical Tribune

Medical Tribune comes out every 2 weeks, noted Zoeller. It's tough to beat the competition Reuters on news (although not so tough to beat them on accuracy), so they have to be more analytical.

Medical Tribune uses a "fair number of freelancers," said Zoeller. "We could use more and better quality writers."

Articles are about 750 words, and pay $250-300.

Medical Tribune covers not only clinical medicine sourced from meetings and journals; but also social, political and economic stories.

A non-clinical story in the 6 May issue, for example, is based on an American Journal of Public Health article reported that doctors in California often ignore the state law that requires them to report domestic violence to the police, even if the victim objects.

Traditionally, Medical Tribune's network of freelance medical writers would write stories for other publications, and send on a version to Medical Tribune. After writing a story for a specialty publication, they would write a short piece on what a primary practitioner needs to know about prostate cancer or glaucoma, for example. That's fine, said Zoeller. And if you're at a medical meeting, she'd be interested to know what's being reported there.

Placement never works

What about placement? Often, a freelance writer will work for a public relations agency, on behalf of a pharmaceutical company, and try to place a story on the client's drug in a trade magazine. Often, the story is legitimate and newsworthy, based on good research reported at a medical conference. This placement work can pay $700 or more a day--better than the writing. Some publications will print these stories, some won't. Zoeller's competitor, Retail Pharmacy News, will take placement, provided the writer discloses the situation.

Zoeller won't. Disclosure isn't an issue. "You can tell," she said. Once or twice, "I tried." They say that they'll write an objective, balanced story, get the other side, and mention the competition. "It never worked out."

"Some of our competitors let the sources read the articles" before publication, said Zoeller. "It drives me crazy." The stories "read like puff pieces." She may be willing to let sources read their own quotes, for accuracy, on a technical story, on a case-by-case basis, although it's "hardly ever" necessary.

Alternative/complementary medicine

Never afraid of controversy, Zoeller gives lots of coverage to complementary medicine, a term she prefers because she doesn't think it should be an alternative to traditional medicine. She thinks complementary medicine is "tremendously empowering," and more supportive than, for example, the NEJM.

"Why should we wait 10 years for double-blind studies?" Zoeller said. She ridiculed sham surgery for a control arm in tests of fetal cells as a treatment for Parkinson's.

In the diabetes supplement, the writer interviewed pharmacists who recommended vitamins to diabetics. The American Diabetes Association disagreed. So how do they handle it? Mention the ADA position in the story, said Zoeller, but don't make it an evenly balanced story. She didn't want a point-counterpoint on vitamins.

"Medical Tribune in the past has been very conservative," said Zoeller, "and I wanted to push the envelope a little bit."

--Norman Bauman