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My freelance medical writing and editing work in 2013

When I first went freelance, there were two things that used to cause me great anxiety – not having an IT department to turn to if something went wrong with my pc, printer, broadband connection, etc, and not having enough work.

As I became more established and started to build a client list, I occasionally had the opposite problem – too much work (or rather not enough time to do all the jobs that I had been offered). And if not having enough work was worrying, turning down work for the first time went to another level of scariness!

In the 11 years that I’ve been working as a freelancer, I have learned that the next job will come along, and that it is better to turn work down than to take on a job that I can’t finish to the standard expected by the client (and myself) and in the time required. Feast and famine go with the freelance territory.

Last year was one of those years: feast from January to August followed by famine through the autumn – partly because two contracts were severely pared back, and partly (sadly) because one of my clients went bust. Happily, not only was the failed company bought by a former competitor, but my work also picked up again towards Christmas!

Here are my highlights.

Medical writing

My biggest area of work in 2013 was on training materials. These included modules on new drug classes, procedures or therapy areas for pharma company internal use or for company reps to use with healthcare professionals in the field, as well as a really interesting project that allowed regional sales teams to share their most successful promotional campaigns with similar teams in other countries. While most of the training materials that I wrote were interactive elearning courses, others will only appear in hard copy and one was in the form of a video.

I did a lot of PowerPoint work in 2013. Interestingly, these decks were split between those designed to support drugs at the point of launch, and those that supported products off- or coming off patent. I was also happy to do more work in an area that was new to me in 2012 – payer brochures. Not all of the intended audience for these will have a pharma/medical background, and so it is important to strike a balance with the tone and language used, in order to provide accessible information without patronising the reader.

I have a long-term relationship with a dermatology team in Germany via one of the agencies that I work with, and just at the end of 2013 two reviews that we have been working on for about 18 months – one narrative and one systematic – were submitted. Sadly one was rejected very quickly, but I believe that the other one is progressing to publication.  I also helped a couple of teams to turn the results of surveys of adherence to medication for diabetes and of attitudes to fungal nail disease into manuscripts during the year.

My biggest therapy areas in 2013 were diabetes, eczema and B-cell lymphomas. Diabetes and eczema are areas that I have written about for many years, but B-cell lymphomas were fairly new to me. I also wrote about schizophrenia and multiple sclerosis for the first time.

Editing and proofreading

I continue to proofread the London School of Hygiene and Tropical Medicine’s Community Eye Health Journal, which comes out quarterly. I was also acting editor for three issues of a business-to-business journal for the customers of a medical device company. The latter involved working in-house with the design team at the end of each publication cycle, which was very enjoyable. My slew of PowerPoint work extended to editing and proofreading slides – and I found myself wondering (not for the first time) why you can’t track changes in PowerPoint.

Miscellaneous

This is a new section for this year – inserted because there were two areas of work that accounted for quite a lot of my time in 2013, but which don’t really fall into the medical writing and editing categories.

A few years ago, I was very fortunate to receive formal Zinc training (see http://www.zinc-ahead.com/ for information about Zinc) while I was doing a long-term contract for one of my clients, and I subsequently added it to my freelance offering. This year saw a major spike in Zinc activity, though, and I logged hundreds of hours marking up references for Zinc and creating linked reference packs within Zinc for two existing clients and three new clients.

Two clients asked me to track the posters and plenaries that their clients’ competitors were presenting at international meetings. A lot of the work in this type of project is in deciding how best to display the information gathered.

Away from the keyboard

I was very pleased to be asked by Peter Llewellyn (of MedComms Networking) and Ryan Woodrow (Aspire Scientific) to take part in a series of workshops aimed at current and aspiring freelancers. These were incredibly informative and useful for making new contacts and sharing hints and tips, and I’m looking forward to the follow-up session this year.

I attended the International Society of Medical Publications Professionals (ISMPP)  European meeting in London in January 2012. I was only able to attend for one day, but, as always, it was time well spent for getting up to speed on issues affecting the medcomms industry and meeting new and existing contacts. One of things that I particularly like about ISMPP meetings is that they are well attended by pharma companies, and it is interesting to hear the industry viewpoint.

The European Medical Writers Association (EMWA) held its 2012 annual meeting in Manchester. I spent a very useful two days attending a symposium on writing for payers, various workshops and the freelance business forum. I also had a meeting with the editors of the ‘Out On Our Own’ section of EMWA’s journal (Medical Writing) to discuss a series of three articles that they had asked me to write on how I use social media in my business. The first two are already published (see http://wp.me/p15PpZ-2G and http://wp.me/p15PpZ-2S) and the third will be available soon.

The annual publication planning meeting in London in the autumn as always included a review of changes to the various codes that govern our business, including, of course the US Sunshine Act which had only recently been enacted then. We also had some lively presentations and discussions on changes to the academic publishing model. It was good to see more freelancers attending this (free) meeting – and other meetings organised by Medcomms Networking during the year.

Looking forward

Some of my new clients from last year have already re-commissioned me for this year, which is very heartening, and I have been talking to some potential new clients – some via the Freelance Workbook service and others who’ve found me via my website – about potential new projects. I’ve also been very pleased to do more work with some of my long-established clients.

A very exciting development for me this year is that I have agreed to mentor a student who is interested in making a career in medical writing when she graduates. That will start in the spring and in addition to providing advice on writing style and practice, we will be looking into employment opportunities for new first degree graduates – if you have any thoughts, do get in touch.

5th March, 2014

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Communicating on non-communicable diseases

Last week, the World Health Organization (WHO) held its annual World Health Assembly (#WHA65) in Geneva, Switzerland. I was particularly interested to read the outcomes of the session on the prevention and control of non-communicable diseases (NCDs) – cardiovascular disease (CVD), cancers, chronic respiratory diseases (eg asthma and chronic obstructive pulmonary disease [COPD]) and diabetes mellitus (especially type 2 diabetes [T2DM] – which took place on 22nd May 2012. Most medical writers will work on one or more of these conditions at some point during their career because of their high prevalence and their correspondingly high levels of interest to the pharmaceutical and medical devices industries.

The background to the session is interesting.

In 2009, the leaders of the International Diabetes Foundation (IDF), World Heart Federation and the International Union Against Cancer (UICC) came together at WHO’s 62nd World Health Assembly to launch a campaign for a UN summit on NCDs to address the demographic-shifting levels of deaths from NCDs in low- and middle-income countries.1 This group highlighted the futility of spending millions of dollars every year to save people from infectious diseases only to lose them at a relatively early age to NCDs, particularly when efficacious drugs to address these conditions are readily available and cheap. In 2010, this group of three founded the NCD Alliance (www.ncdalliance.org), bringing together a network of 880 member organisations in 170 countries to continue to advocate for action against NCDs.

The UN duly held a high level Global Assembly Meeting in September 2011, to which >30 heads of state and government and ≥100 other senior ministers and experts were invited and which upheld the NCD Alliance’s call for NCDs to be added to the development agenda. As a result, the UN charged WHO with setting up a global surveillance programme and making recommendations for voluntary global targets for reducing deaths due to NCDs before the end of 2012.2 Perhaps surprisingly (and underlining the seriousness with which the UN regards these goals), this is only the second health-related campaign promoted by the UN – the first being the campaign to control the spread of HIV/AIDS.

The statistics3 that prompted the UN to act are shocking. NCDs account for 57 million deaths annually (63% of all deaths). Approximately 16% of all deaths due to NCDs occur in the under-60s. A disproportionate number of these occur in developing nations, where widespread death and debilitation among adults of working age could retard industrial development and where in any case the loss of a wage earner throws families back into poverty from where they are more susceptible to the effects of NCDs. Worse, WHO estimates that the proportion of deaths attributable to NCDs will increase by 17% worldwide in the next decade. The key messages to take from this are that NCDs are not conditions only associated with the developed world and not only associated with aging.

The burden of caring for people with NCDs is no less daunting. One in three people has raised blood pressure (a risk factor for CVD), rising to almost one in two in Africa, and one in ten people has diabetes mellitus.4 Moreover, in every region of the world the prevalence of obesity – which is a risk factor in T2DM, CVD and some cancers – doubled between 1980 and 2008.3 Today, half a billion people (12% of the world’s population) are considered obese. Worryingly, it is thought that there are hundreds of millions of people worldwide who are unaware that they have a NCD and whose first contact with the health service will only come when they develop complications associated with advanced disease. No wonder, then, that Margaret Chan – Director-General of WHO – referred to NCDs as ‘the diseases that break the bank’ at last week’s meeting.

It is generally recognised that the slowly progressive nature of most NCDs requires a quite different mindset at government/NGO level to that necessary for promoting control of infectious disease outbreaks. The NCD programme must be goal orientated and focussed on prevention (ie reducing exposure to risk factors such as tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity) and universal access to treatment.1  WHO has announced its aim to work with its existing stakeholders in the education, agriculture, sports, transport, communications, urban planning, industry, employment and finance sectors, in addition to the health sector, to develop a global framework for the prevention and control of NCDs.5

De Maeseneer et al, in their commentary on the aims of the NCD Alliance, agree that a fundamentally different approach is required for preventing and controlling NCDs but disagree that the vertical, disease-orientated approach advocated by the Alliance is the best way to approach the problem.6 They note that altering patient perceptions and behaviours are key aims in preventing and treating NCDs and that this process requires more than just access to medicines. They believe that it is necessary to empower patients, reduce barriers to healthy lifestyles and care that reflects the needs of individual patients and that this is best achieved by global investment in local primary healthcare.

And the outcome of the session at the WHA65? A target to reduce premature deaths due to NCDs by 25% by 2025 – this is a massive target (and an incredible achievement for the NCD Alliance).

Speaking personally, though, I was struck by the lack of any reference to the need for innovation in the approach to the prevention and control of NCDs. We know what the causes are, we know how to prevent NCDs and, as the Alliance has pointed out, medicines are available – but still their prevalence is increasing in countries with well-funded healthcare services and in countries without.

De Maeseneer et al, whose paper was published before WHO assembly, say that: ‘We must fundamentally rethink the way that we address complexity in health problems, in both developed and developing countries.’ And I agree with them.

References

1. IDF, UICC, International Heart Federation. Time to act: The global emergency of non-communicable diseases (2009). Available at: http://www.world-heart-federation.org/fileadmin/user_upload/documents/Publications/Time%20to%20Act%20-%20High%20Res.pdf

2. UN News Center. UN launches global campaign to curb death toll from non-communicable diseases (19 September 2011). Available at: http://www.un.org/apps/news/story.asp?NewsID=39600&Cr=non+communicable+diseases

3. World Health Organization. World health statistics 2010 (2011). Available at: http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf

4. World Health Organization. World health statistics 2012 (May 2012). Available at: http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Brochure.pdf

5. World Health Organization. Sixty-fifth World Health Assembly: daily notes on proceedings. (Tuesday 22nd May, 2012). Available at: http://www.who.int/mediacentre/events/2012/wha65/journal/en/index4.html

6. De Maeseneer J, Roberts RG, Demarzo M et al. Tackling NCDs: a different approach is needed. Lancet 2012;379:1860–1. (Free registration.)

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