The 14th Annual Meeting of the International Society for Medical Publication Professionals (ISMPP) took place over three days (30 April–2 May) in National Harbor, MD, USA, and attracted a record-breaking number of visitors — over 600 attendees.

The theme of this year’s meeting, ‘From Publication to Practice: Advancing Science Through Effective Communication’, focused on the evolving role of the publication professional, the importance of effective communication, and emerging trends within the medical publications industry. These topics were explored through keynote addresses, lively panel discussions, and interactive roundtables. As in previous years, members were also given the opportunity to share their own research via oral and poster sessions. The meeting was attended by both highly experienced professionals and relative newcomers to the industry. The meeting also saw Chris Winchester (Oxford PharmaGenesis) begin his post as the new Chair of ISMPP Board of Trustees.

A summary of the second half of the meeting (Tuesday afternoon and Wednesday) is provided below for those who could not attend, and as a timely reminder of the highlights for those who did. Many of the presented slides and posters are available to ISMPP members here. A summary of the first half of the meeting can be found here.

Is pharmaceutical industry research posted as preprints?

Tuesday afternoon started with the member oral presentations, the first of which was delivered by Heather Lang (Oxford PharmaGenesis) and described her team’s research on preprints. Preprints have been the subject of much debate within the medical field in recent years and were a key topic at the meeting. Lang’s research addressed the following questions:

• Is the pharmaceutical industry posting research as preprints and, if so, what kind of research is being posted?
• Are comments on the research being posted and do authors respond to such comments?
• Have preprints been fully published and in what timeframe?

Findings showed that:

• Only around 1% of preprints on bioRxiv (an online platform for the distribution of preprints in life sciences), reported industry-authored research. Most of this was basic science; bioinformatics, genomics and genetics were the most common.
• Two-thirds of preprints were not revised on the system once posted.
• Two-thirds of the preprints from pharmaceutical companies (posted up until the end of 2016) had been published in full.

Lang acknowledged that the pharmaceutical industry could share work more rapidly using preprints than with traditional peer-reviewed publications, but stressed that education around preprints is needed. She concluded by suggesting that the industry evaluates the appropriateness of preprints for different types of research, runs pilots to explore preprint services, and develops and shares policies regarding the appropriate use of preprints.

Attention analysis simulation of scientific posters aligns authors’ intent with viewers’ focus

The second member oral presentation was given by Steve Palmisano (MedThink SciCom). This team’s research involved the use of machine learning algorithms to simulate audience visual attention via eye-tracking movements. The approach was used to evaluate the effectiveness of 16 scientific posters from a recent ISMPP annual meeting. Results showed that headlines should be kept short, especially when used on a coloured background. Graphic elements that lead the eye worked well, as did clear figures free from unnecessary elements. Use of callout boxes and displaying key results within figures were also found to be effective.

Examples of less effective posters included those that resulted in very long eye movements between areas of focus, those which drew the reader’s attention to the wrong area, and those which featured callout boxes with too much copy. Palmisano advised placing QR/VR codes strategically, when used, within the headline or conclusions box for example.

Palmisano summarised that an effective poster should draw the reader’s attention to the most important elements, enable an efficient scan path pattern that is appropriate for learning, and be visually attractive.

Publishers panel: simplifying and streamlining – working together to improve the quality of medical publications

The focus of this session, featuring representatives from major publishers, was practical advice and insights into improvements in the publishing process. Terry Materese (Elsevier) moderated the session and was joined by Chris Baumle (Elsevier), Jan Seal-Roberts (Adis, Springer Healthcare Ltd) and Caroline Halford (Adis, Springer Healthcare Ltd).

The key discussion points and take-away messages are summarised below; many of the themes that emerged aligned with focus topics for this year’s meeting.

Authorship and peer review

• Author transparency and acknowledgement of author contributions is critical; the use of systems such as CRediT should be encouraged – as discussed during Monica Bradford’s talk earlier in the day).
• A blockchain initiative is currently being trialled by Springer Nature to support the peer review process. The aim of the initiative is to create a platform where all review activity is deposited in a blockchain owned by the initiative (currently Springer Nature, Digital Science, and ORCiD), with the advantage that every deposit will be verifiable and auditable, thereby increasing transparency and reducing risk of manipulation.
• Elsevier has developed a Reviewer Recognition programme whereby peer review is a measurable research output for which credit is given. Both Springer Nature and Adis journals reward reviewers by waiving the article processing charge if they submit articles to one of their journals.

Preprints and data sharing

• A number of preprint services are now available, including bioRxiv (covered in the keynote presentation earlier in the day). Elsevier supports preprints and allows authors to share their preprints at any time on arXiv or RePEc. Other publishers, including Springer Nature, are also starting to take this approach. With the increased popularity of preprint services it will be important to update anti-plagiarism software such as iThenticate, so that preprints are not classified as plagiarism.
• Elsevier and Springer Nature have data sharing policies in place regarding the deposit of research data in relevant repositories and the subsequent citation/linking of the dataset in the article. Data in Brief (Elsevier) provides researchers with an avenue through which they can share and reuse datasets by publishing data articles.

Other themes

• Elsevier offer an Article Transfer Service whereby, if an article is deemed unsuitable for publication in a chosen journal, the editor may suggest submission to an alternative journal. The transfer can happen in minutes, negates the need for reformatting, and reduces reviewer time/burden as previous reviewer comments are pulled through. Springer Nature offers a similar process (Transfer Desk).
• The use of social media is encouraged by Elsevier and Springer Nature; both publishing houses provide guidance for authors and editors.
• Readership can be boosted by article enrichments including plain language summaries, audio slides, graphical abstracts, video abstracts and video articles.

The presentation concluded with a busy question and answer session in which the panellists informed delegates that video articles/abstracts do not have to be ‘polished’, article enrichment items adopt the same copyright as the main article, preprints remain available indefinitely, and that articles with digital features are downloaded more often than those without.

Successful integration of enhanced digital technology into scientific congresses

There are an increasing number of options available for enhancing the content of congress posters and presentations. In this session, John (Zeke) Czekanski (Fishawack US), Kimberly Della Penna (Merck) and Travis Hicks (American Society of Oncology [ASCO]) described the digital tools currently being utilised at meetings, future trends, and the pros and cons of these options in practice.

Czekanski began by providing a snapshot of current experience with digital tools and formats, based on a survey of ISMPP members and client service teams. Results revealed that most respondents had utilised various types of enhanced technology, including digital posters, virtual/augmented reality, meeting apps and QR codes. Although most considered these digital offerings to be beneficial to the end user, their value was not typically measured, suggesting that there was scope to better understand the benefits of these formats.

Della Penna summarised available technologies that offer improvements on traditional presentation types. These include the use of QR codes in oral presentations or posters, which link the user to the presentation slides, e-poster, or additional content. Unlike paper posters, e-posters can easily be made available after presentation at a congress. Videos, animation or audio commentary can be embedded within e-posters to provide greater understanding of the work, but can be expensive to develop and require advanced planning.

Hicks described ASCO’s approach to digital meeting tools. At the 2017 annual meeting, almost 3,500 e-posters and videos were accessible via the ASCO Meeting Library at digital kiosks during the congress and online afterwards. Despite the flexibility and portability offered by digitally presented content, ASCO continues to offer physical versions of posters as many attendees prefer this approach. Hicks concluded that the decision on how to consume congress material should be left to the attendee and that no single approach should be forced as it would be met with resistance.

Following this presentation, delegates had the opportunity to attend one of three parallel sessions, two of which are summarised below. The third session provided an overview of the ISMPP Certified Medical Publication Professional (CMPP™) programme; more details of which can be found here.

Incorporating value into planning for early development compounds: the impact of market access trends

Emerging trends in market access and the implications for publication planners was the topic of this comprehensive presentation by Shana Traina (Janssen) and Kimberly Dittmar (Cello Health Communications). Coined the fourth ‘hurdle’ in drug development (after safety, efficacy and quality), market access is driven by many factors, as well as by payer questions regarding the value and budget impact of a drug. These include: therapeutic effectiveness, quality of evidence, perceived medical need, medical appropriateness, cost effectiveness, potential for underuse of overuse, and political expediency.

The value and budget impact of a therapy are usually assessed by governments using health technology assessments. When there are insufficient data to support value, access to a drug can be severely restricted based on clinical (eg limited to patient subgroups) and economic (eg managed entry agreement) considerations. The presentation continued with a review of the International Society for Pharmacoeconomics and Outcomes Research ’s top 10 trends in health economics and outcomes research (HEOR) and their potential impact on market access.

In the next part of the session, a case study illustrated how market access considerations (eg disease burden, clinical management, payer perspectives) can influence the scientific platform and publication plan. The example highlighted the benefits of incorporating value measures, market access factors, and HEOR data generation and dissemination plans early in the clinical development programme. The presentation concluded with a call to action — to engage HEOR stakeholders early in the drug development and publication planning processes.

Permission granted? The ins and outs of global copyrights

In this session, moderated by Sharon Suntag (IQVIA), Liz Bilodeau and Stephen Garfield (both from Copyright Clearance Center [CCC]) delved into the complex topic of copyright laws and permissions, and how the principles differ globally.

Bilodeau introduced the CCC, the basic principles of copyright, and walked delegates through Code § 106 – Exclusive rights in copyrighted works — the US guidance that covers copyright related to reproduction, distribution, derivative works and other aspects of reusing content. There are no defined international copyright laws; laws vary from country to country, and permission to use copyrighted work often excludes reuse in other countries and languages.

Exploring the complexities of global copyright in more detail, Garfield outlined how intellectual property and content sharing are guided by various policies and laws:

• treaties and agreements: eg BERNE, other treaties administered by the World Intellectual Property Organization, and TRIPS
• national laws: the two broad approaches are termed ‘continental’ in which personal rights reside with the author and are not transferred, and ‘Anglo American’ in which an economic approach to copyright and set arrangements between society and content creators is adopted
• licenses: various models exist in different countries, including statutory licenses (eg as in Germany), blanket mandates (UK, Canada), and voluntary licenses (US). Collective licensing models also exist; in these models reproductive rights organisations, such as the CCC, license the use of content from many rights holders, collect royalties, and distribute them to the rights holders
• individual company policies.

Garfield continued by discussing considerations related to open access, creative commons licenses, and the importance of obtaining permission to reuse or repurpose content. Key takeaways from the presentations are for organisations to appoint a copyright expert, create/update and communicate copyright policies, and provide effective licensing solutions for employees. Additional resources around copyright and permissions are also accessible on the CCC website.

Following the parallel sessions, delegates could attend one of 10 roundtable discussions, which afforded the opportunity to have an in-depth conversation on their chosen topic in a smaller group setting. Day 2 concluded with the annual evening networking session.

Increasing speed, efficiency and transparency in medical publishing through open access

Day 3 of the meeting began with opening remarks by Chris Winchester (Oxford PharmaGenesis and new Chair of ISMPP Board of Trustees).

The proportion of articles published open access is increasing. In this panel discussion, Valerie Philippon (Shire), David Sampson (ASCO), Maria Alu (Columbia University Medical Center) and Moderator, LaVerne Mooney (Pfizer) shared their experiences with open access from a pharma and non-pharma perspective.

Mooney began by giving an overview of open access, the current options available and the advantages it can bring; including speed of dissemination, accessibility to research and increased transparency. A poll revealed that most of the audience considered that an article being free to read was enough to qualify it as open access, whereas others considered the ability to re-use the article either non-commercially or without restrictions was important; most considered an article processing fee of less than $3000 a reasonable price for publishing open access. While governmental and charitable research funders increasingly mandate open access publishing, it is pharma that funds over half of all medical research.

To date, Shire is the only pharmaceutical company that has introduced a mandatory open access policy. Philippon discussed the impact of this policy, which was introduced in January this year, and has seen an increase from 75% to 100% of articles reporting Shire-funded research being published open access. This has resulted in an increase in expenditure on publications, but this was considered reasonable compared with other methods of disseminating clinical data (eg cost of travelling to and presenting at conferences).

Alu described her experience at Columbia University which, having implemented its open access policy in 2011, has led the way by mandating all faculty members make their research articles freely available. Alu described some of the real and perceived barriers to open access that she has encountered, such as the perception that fully open access journals are lower tier than society-led journals, which are often the first point of call for many authors.

During questions from the audience, Sampson was asked why the Journal of Clinical Oncology (J Clin Oncol; Official Journal of ASCO) did not offer open access for industry-funded research. Sampson stated that this was in part due to concerns over the re-use of content for commercial purposes. He continued to say that J Clin Oncol may in future offer open access with non-commercial use options for these articles and the journal is currently reviewing its policy. In response to a comment about the low acceptance rate for J Clin Oncol, Sampson directed the audience to potential alternatives, including the new sister journals, JCO Precision Oncology and JCO Cancer Informatics.

Member oral presentation: patient lay summaries in biomedical journals: what and how much is currently available?

Ramji Narayanan (SIRO Clinpharm Pvt. Ltd) presented findings from his study that investigated the current usage of patient lay summaries, or plain language summaries (PLS), by biomedical journals. PLS are intended to communicate vital research using simplified language, without jargon or technical terminologies, aimed towards a non-expert audience.

The study found that 44 biomedical journals currently publish PLS. These were often not mandatory and word count restrictions ranged from a single summary sentence up to 700 words; the most common was 250 words. Guidelines for writing PLS were often not given and in some cases the journal’s editorial team provided the PLS. Analysis of readability using online tests revealed that many summaries were pitched at too high a level, suggesting more patient-friendly language was still needed. Six of the journals that published PLS encouraged authors to involve patients in the writing or reviewing of the summaries, while one journal mandated patient involvement.

Narayanan concluded that there was a need to streamline PLS reporting practices among journals and maintain a consistent style and reading level. He suggested the Plain Language Expectations for Authors of Cochrane Summaries could be adapted for this purpose.

Following the oral presentation, delegates could attend one of three parallel sessions or a guided poster tour; the parallel sessions are summarised below.

“Mind the gap”— life cycle management and HEOR integration

Kristen Quinn (Peloton Advantage) and Ilia Ferrusi (Novartis Oncology) discussed how gap analysis can be used throughout the life cycle of a product and the benefits of incorporating HEOR and real world evidence.

Quinn began by differentiating gap analysis, which evaluates deficiencies in specified topics, from other similar types of research such as situation or competitor analysis. Quinn gave examples of how gap analysis can be used to answer different questions throughout a product life cycle. For example, during early stages of clinical development a gap analysis may assess the unmet needs of existing management strategies, whereas closer to product launch, there may be specific questions pertaining to patient subgroups that can be answered. Quinn recommended that analyses are routinely repeated so that new and evolving data can be used to fill existing gaps and to identify new ones. Quinn emphasised the importance of fully understanding the research question to ensure the most appropriate analysis is carried out, using quality source data, and ensuring results and their implications are communicated effectively to the client/team.

Ferrusi described how traditionally HEOR might be carried during the latter stages of a product’s life cycle to determine, for example, its relative value as an intervention. Increasingly, however, HEOR is being incorporated earlier in product development to establish unmet needs from an economic perspective, such as the cost-effectiveness of existing therapies or the economic burden of disease management. Ferrusi discussed how integrating this type of evidence into gap analysis can inform HEOR strategy and evidence-generation plans and identify opportunities for differentiation. She concluded by summarising tools that are currently available to assess the quality of HEOR and real world evidence, with a reminder to utilise non-traditional or ‘grey literature,’ in addition to traditional publications.

Lay summaries for biomedical journals

Clinical trial lay summaries will soon become a legal requirement in the EU. Although the same is not true for lay summaries published in biomedical journals, their adoption should be encouraged. In this session Jan Seal-Roberts (Adis, Springer Healthcare Ltd) and Tom Rees (Oxford PharmaGenesis) provided practical guidance on the development of lay summaries and discussed potential trends from a publisher’s perspective.

Lay summaries for peer reviewed publications facilitate readability and understanding of a research article by non-expert readers such as patients, caregivers, tax-payers, non-specialist clinicians, and by ‘time-poor’ specialists. Many patients and caregivers are familiar with scientific publications but with abstracts becoming more difficult to read, there is a growing need for publication-specific lay summaries. After the main differences between publication lay summaries and clinical trial lay summaries were presented (eg rationale, scope, endpoints included, format/style and reading age), the presentation focused on the increasing uptake of publication lay summaries.

Several journals now accept or require lay summaries, including PLOS Medicine, PNAS and Annals of the Rheumatic Diseases. Moreover, all Adis articles can be accompanied by a lay summary, which is peer reviewed. The British Journal of Dermatology now publishes a plain language summary for every accepted paper. Seal-Roberts and Rees emphasised the importance of lay summaries being made open access so that patients can find them. However, although this is the case for some journals, eg British Journal of Dermatology and those published by Adis, lay summaries are not always free accessible. It was noted that a number of non-journal opportunities for lay summaries also exist, including KUDOS, scienceOPEN, The Conversation, ATLAS of science and figshare.

Some best practice tips for developing a publication lay summary were recommended:

• focus on the significance of the research
• consider the use of infographics or visual abstracts
• use available tools to check the readability score
• consider using peers and lay readers to provide objective feedback.

Seal-Roberts and Rees concluded that publication lay summaries complement those mandated for clinical trials and have the potential to boost the impact of published research to a wider audience.

Posters of the future

In this highly engaging and interactive session facilitated by Eline Hanekamp, Niina Nuottamo, Hester van Lier and Shanthi Voorn (all from Excerpta Medica), delegates were split into groups and tasked with developing a poster. Delegates were informed that the poster must include the traditional Introduction, Methods, Results and Conclusions sections, but should be designed in a non-conventional style (eg be highly visual, interactive, employ infographics or augmented reality, have increased white space, or adopt the inverse pyramid approach to the flow of information).

After each group developed their poster all delegates reviewed all posters and discussed what made each poster effective. Examples of best practice included:

• minimal use of words
• increased focus on the results
• placing the results first or more prominently on the poster
• having a good balance of figures versus text
• having a highly visual conclusions section
• including a patient lay summary
• including QR codes linking to different versions of the poster tailored to specific audiences (eg clinicians, patients, payers).

The facilitators concluded that posters are an effective communication tool. They suggested that putting some of the discussed approaches into practice would lead to a highly engaging and impactful poster that stands out from the crowd.

News you can use

In this rapid-fire session, delegates heard updates on a number of hot topics in medical publishing, as summarised below.

Does pharma publish clinical trial data? What’s NCT number got to do with it – LaVerne Mooney (Pfizer)

Mooney reminded delegates that publications and press articles have, in the past, reported that <50% of studies do not get published, although recent analyses have shown these rates have improved. A factor that can hinder such analyses is matching a publication to its ClinicalTrials.gov record. Mooney recommended that the clinical trial registration number is included in the abstract of all submitted/published articles and, if it is not, authors should contact PubMed or the publisher to get abstracts updated/or corrected.

Right to Try bill – Juliana Clark (Amgen and Outgoing Chair of ISMPP Board of Trustees)

This US bill, which controversially allows terminally ill patients to receive investigational drugs not yet approved by the FDA, was passed by the House of Representatives on 21 March 2018. Commenting on the potential impact for medical publication professionals, Clark noted that trial recruitment may slow down, however, the bill could also result in additional relevant publications of case reports.

Patient engagement update: GRIPP2 guidelines (patients as manuscript reviewers) – Jan Seal-Roberts (Adis, Springer Healthcare Ltd)

Seal-Roberts provided an overview of GRIPP2 (Guidance for Reporting Involvement of Patients and the Public); guidance that aims to improve the quality, transparency and consistency of patient and public involvement in health and social research. Research is ongoing to assess the extent of patient and public involvement in research and medical publications. For example, a 5-year randomised controlled trial that will assess whether the lay public can enhance the peer review of journal articles.

GAPP announcement – Jackie Marchington (Caudex)

As of 2 May 2018, and after 6 years of service, the Global Alliance of Publication Professionals (GAPP), is stepping down and handing back responsibility to professional bodies, including ISMPP and the American and European Medical Writers Associations (AMWA and EMWA). The GAPP website and email address will be maintained for another ~1 year. The full press release is here.

Keynote address: the truth about doctors

In the final keynote of the meeting, a thought-provoking presentation by Hilary Gentile (McCann Health) looked at the current perceptions and roles of doctors as healthcare providers. She began by summarising some of the recent trends in the healthcare space. For example, with ~80% of the world’s health data reportedly generated in the last 2 years, doctors have been overwhelmed by information. The increased volume and access to such information also means that patients are much better informed. Additionally, time and cost pressures within health services mean doctors spend very little time with patients (2.3 minutes per patient visit for community doctors in the US) and more time on paperwork.

Gentile reported results from the ‘Truth about Doctors’ study undertaken by McCann Health. This survey of nearly 2,000 physicians from 16 countries aimed to understand the views of doctors on the “expectations and reality” of their roles. There were some surprising findings! Thirty-four per cent of survey respondents thought they could have become doctors without any training, while 53% of 18–34 year olds believed that technology could eliminate the need for doctors in the future. Doctors reported that they entered the profession to make a difference, but many felt a great sense of frustration with the current practice of medicine. This discontent is not without consequences: 66% of doctors had trouble sleeping and 58% reported marital problems.

The study showed there is a disconnect between doctors’ expectations and the reality of doctoring – but what are the solutions? Some of the insights offered by Gentile included:

• embrace and better harness the wealth of available information
• humanise new technologies to advance the doctor–patient shared care paradigm
• focus on all healthcare professional roles, not just doctors, and create new multi-stakeholder pathways to care
• empower doctors to regain mastery in patient care.

Gentile concluded that, with 80% of doctors in the survey stating they’d take the same career pathway again, the good news is the profession is unlikely to become extinct! However, the role of doctors in the provision of healthcare will almost certainly change.

Closing the meeting, Al Weigel (ISMPP President & CEO) thanked the programme, abstract and global workshop committees for their contributions, and the meeting sponsors and exhibitors. He concluded by informing delegates that an ‘ISMPP University’ webinar of the meeting highlights will be held in June, and by reminding delegates of the upcoming ISMPP West (11–12 October 2018), ISMPP EU (22–23 January 2019) and Annual (15–17 April 2019) meetings.

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By Aspire Scientific, an independent medical writing agency led by experienced editorial team members, and supported by MSc and/or PhD-educated writers

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