Jonathan Lee is Senior Manager, Regional Publications, Growth and Emerging Markets at Takeda Pharmaceuticals and the Asia Pacific Trustee on the International Society for Medical Publication Professionals (ISMPP) Board of Trustees. The views expressed here are those of the interviewee and do not necessarily reflect those of Takeda Pharmaceuticals or ISMPP.

When developing a medical communications strategy, understanding the needs of colleagues from different geographic regions is key to ensuring plans are relevant and usable by all stakeholders. Effective publication planning therefore requires publication professionals to have an appreciation of cultural and linguistic diversity to recognise how to adapt and optimise engagement with publications teams and authors at a local level. Following his presentation at the 2023 Annual Meeting of ISMPP, The Publication Plan spoke with Jonathan Lee, Senior Manager, Regional Publications, Growth and Emerging Markets at Takeda Pharmaceuticals and current Asia Pacific Trustee for the ISMPP Board of Trustees to find out more about the role of publication professionals in regional publication planning.

You’re a big advocate for the importance of medical publication professionals in regional publication planning. Can you explain why this is such an important role; what are the potential benefits to industry-funded biomedical research in eg, Asia-Pacific (APAC) and Latin America (LATAM)?

“We’ve seen from many sources of research that our ethnic and geographic backgrounds can influence how we respond to certain treatments (eg, cancer treatments); however, efforts to better capture such diversity in current clinical trials will take time to be fully realised. A lack of sufficient ethnic/geographic diversity impacts the generalisability of clinical trial results to the under-represented groups in the general population. Additionally, healthcare systems can vary greatly across APAC and LATAM, so international treatment guidelines may not be fully applicable or implementable in some countries in these regions. This very often results in a lack of local/regional data and/or guidelines to support physicians with clinical decision-making relative to physicians in countries that tend to have good representation in clinical trials. A lack of resources in some countries in APAC and LATAM can also be a barrier to the conduct of clinical trials in these regions. This underlines the importance of having relevant local/regional real-world evidence to support clinical decision-making. But real-world evidence can be more challenging to publish than clinical trial data, given the differences in the nature of such studies.

This is where the importance of medical publication professionals comes in. Of course, we need people who can effectively design and execute such studies, but there is a saying that while a good publication cannot improve low-quality data, a low-quality publication can make great data look bad. Given the general lack of relevant local data, you can see how important it is to ensure that any data that are generated get published and disseminated in an effective manner across all regions. Think about the number of lives that could be impacted by the publication of important real-world evidence, like drug safety and effectiveness. This impact becomes even more pronounced in countries that may not use English as a first language (eg, many of the countries within Southeast Asia).

Therefore, it is critical that barriers to the publication of clinical data from regions like APAC and LATAM are removed or lowered. In order to implement such an initiative effectively, we need to have medical publication professionals who understand local and regional cultural and communication norms and who are well-versed with industry best practice. It’s not an easy combination to find.”

“We need to have medical publication professionals who understand local/regional cultural and communication norms and who are well-versed with industry best practice.”

You spoke at the 2023 ISMPP Annual Meeting and gave your insights into the role of publications professionals in the APAC region. What are some of the challenges to implementing global publication guidelines in a regional setting; how can publication professionals help to guide best practice?

“I think one of the biggest challenges is the assumption that all authors around the world are equally comfortable with sharing individual opinions, particularly differing opinions, in an open group setting. This does not always apply in cultures that favour group consensus and avoidance of confrontation over individual opinions and acceptance of open disagreement. Many countries in APAC (and other parts of the world) tend to have such consensus-seeking cultures. Some of these countries may also place more emphasis on hierarchy as a mark of respect, so open disagreement with a person who is considered senior to you is frowned upon.

Based on this you can then see how it may be challenging to collect individual inputs from a group of authors in an open forum in APAC. There is a tendency to wait for the most senior person to provide their thoughts first, before the rest of the group agrees as a mark of respect. Even if authors have differing opinions, they are unlikely to voice them.

A publication professional who understands this culture would know that soliciting individual opinions from such authors would be better done in an individual and personalised manner. Writing to or reaching out individually to authors would provide them with a safe space to express their opinions without fear of open disagreement with their colleagues. This individualised approach is even more important if the authors are not especially fluent in English. They may not be able to properly articulate their ideas in a language they do not regularly use and may also not want to appear foolish in front of their peers. Individually collected feedback could then be compiled and anonymised, so that all opinions can be reviewed without linking specific comments to individuals.

Separately, some cultures in APAC may favour face-to-face interactions or conversations over written responses – especially if you need to think in one language and then translate and articulate your thoughts in another language (consider the extra time required). While current practice and publication management systems rely on written documentation, authors in APAC may be more inclined to provide their thoughts through a conversation. Without a system that allows for documentation of such inputs, think about the amount of valuable clinical insights we may be missing because an author is unaccustomed to penning their thoughts or is unable to articulate them properly in English.”

“Think about the amount of valuable clinical insights we may be missing because an author is unaccustomed to penning their thoughts or is unable to articulate them properly in English.”

We’ve seen the Good Publication Practice (GPP) 2022 guidelines translated into Chinese and Japanese. Do you think translation of GPP and other guidelines such as EQUATOR checklists is sufficient or do the guidelines themselves need to be adapted on a region-by-region basis to account for different cultural norms?

“Translations are a good first step, but I think they need to be adapted on a region-by-region basis for the reasons I’ve described above. A translation is a literal interpretation of the original document that retains the cultural context of the language it was first written in. While it would be helpful to understand principles, the translated document may still struggle to communicate underlying concepts across cultures, so uptake of such guidelines may remain low. It’s analogous to global clinical treatment guidelines – can the recommended treatment sequencing still be implemented if some of the treatments are unavailable in your local healthcare system? This was one of the motivations for drafting the APAC adaptations of GPP3 and GPP 2022.

Adoption of guidelines by regional and local journals would also influence author receptiveness to guidelines. This would provide an additional avenue of encouragement and influence for authors to be familiar with and adhere to guidelines and best practice.”

You’re a co-author on the recent Asia-Pacific-adaptation of the GPP 2022 guidelines published in Curr Med Res Opin. How did you and your co-authors approach the task of producing this guidance? What were the most important updates in GPP 2022 from an APAC perspective?

“I’d like to first recognise the efforts of the authors of the APAC adaptation of GPP3, particularly Blair Hesp, who spearheaded the initiative. Development of the APAC adaptation of GPP3 was prompted by a need to provide clarity on how recommendations in GPP3 could be practically implemented within the context of the cultural and communication norms of the region. With the development of GPP 2022, which had several significant changes, it was only natural that these updated guidelines would need unpacking for the APAC region.

One of the more important updates was on how summaries of medical research written for non-specialist and lay audiences (ie, plain language summaries; PLS) can be utilised in the region. There is no doubt to the value that PLS bring to a publication in terms of improving accessibility to data, but not all regional/local journals are currently set up to accept such materials. Authors and audiences in APAC may also be less familiar with such content. Coupled with the smaller budgets that regional/local publication teams may have, decisions on the development of PLS need to be very targeted to ensure that the content will be accessible enough to readers and not buried in a supplementary file. As regional and local journals start to support the publication of PLS, clear guidelines on the development and review processes of such content will be instrumental in encouraging their development by authors.

“As regional and local journals start to support the publication of PLS, clear guidelines on the development and review processes of such content will be instrumental in encouraging their development by authors.”

Two other important updates were the commentary on the inclusion of patient authors and considerations for encore presentations at congresses. While the inclusion of patient authors is an important step towards a more holistic approach to biomedical research and drug development, the cultural landscape in APAC can add additional considerations. Physicians are often seen as senior figures to patients, so patients may be reluctant to share their opinions and physicians may perceive certain patient feedback as potentially undermining their expertise and therefore a source of embarrassment. There may also be situations where it would be culturally undesirable to be identified as being unwell – this may impact both the patient and their immediate and extended family.

On the topic of encores, there is a need for regional and local congresses to include clear guidance on their individual encore policies. Not all physicians may be able to attend international congresses, so encores provide an opportunity for them to still access important updates in biomedical research, more so if the encore is presented in a local language. Such increased access to data ultimately benefits patients who rely on their physicians to make important treatment decisions based on what they know.”

You also spoke at ISMPP about how the reliance on English as the default language of medical publications can be a participation barrier for non-native English speakers. What are some ways we can remove this barrier and what are the benefits if we can make participation easier?

“There are several things I can think of:

• Inclusion of English captions in videos will help to provide visual alternatives for people who may have challenges understanding and following various accents. The ability to provide real-time translations with artificial intelligence (AI), even if not completely accurate, would make presentations easier to follow.
• Provision of anonymised question posting platforms at congresses may encourage more questions from non-native English speakers. More so if there were options to post in your own language and then have it translated into English.
• AI-supported translations of publications may help non-English speakers access information that they would not normally have. AI-supported search algorithms could also help to better identify publications in various languages and make manuscripts more accessible through search engine optimisation.
• Having publication professionals and medical affairs representatives who are bilingual would allow for authors to provide input in the language they are most comfortable with. This would also allow their input to be accurately translated into English without losing any nuance and would go a long way to improving author engagement.
• Consideration of longer timelines by industry sponsors and journal editors to accommodate the need for face-to-face interactions and/or translations.

The benefit of lowering or removing these barriers is the improved sharing of ideas and information to support patient care. Imagine if a physician in APAC has a wealth of experience with treating patients in a particular setting that physicians from outside the region are trying to learn more about. But the APAC physician has never shared this experience because there is a challenge in communicating this in English. If communication in English was removed as a barrier, imagine how much more we might be able to do for patients with new-found access to previously untapped sources of knowledge!”

“The benefit of lowering or removing (participation barriers for non-native English speakers) is the improved sharing of ideas and information to support patient care.”

Is there a role for machine translation and/or generative AI tools to assist non-native English speakers with the publication process? What do you think could be done to encourage more biomedical research being published in multiple languages? Is mandatory multi-lingual publication of industry-funded biomedical research a goal to strive for?

“I’ve touched a little on this in the previous question. Building on that, I think it will be a practical question of how to balance the added time and resource costs of publishing in multiple languages versus the anticipated benefits. Idealistically, it’s a no-brainer if it benefits patients. Realistically, it would be challenging to mandate publishing in multiple languages if it is not financially viable.

Lancet Global Health has started supporting the publication of translated abstracts alongside the English version of accepted manuscripts, and I think this is a great step in the right direction. If the translated abstracts improve searchability of the manuscript in other languages, it will already start to make a positive difference in improving access to industry-funded biomedical research.”

“Lancet Global Health has started supporting the publication of translated abstracts… … If the translated abstracts improve searchability of the manuscript in other languages, it will already start to make a positive difference in improving access to industry-funded biomedical research.”

We’ve seen a continued focus on plain English language content in the biomedical publications community over recent years. Presumably, plain language content in languages other than English would be beneficial for non-native English-speaking patients, carers, and healthcare providers? Do you think there’s enough provision for this in the biomedical publishing industry?

“There is definitely a benefit to having plain language content in multiple languages. However, it comes back to the challenges of regional/local industry teams having smaller publication budgets to support the development of such content and the ability of regional/local journals and publishers to support publication of such content. I think we will need to watch how the global uptake and development of plain language content progresses further before the movement trickles down to regional teams and journals.”

Elsewhere at the 2023 ISMPP Annual Meeting, we heard how ISMPP’s geographic base continues to widen into new territories, with increasing numbers of Certified Medical Publication Professionals outside of North America and Europe. How else do you think ISMPP (and/or other professional societies involved in medical publishing) can evolve to increase the relevance of publications professionals in APAC and other regions?

“The biomedical publication landscape in APAC is a little different from that of North America and Europe. The major centres of industry-funded biomedical research reside in the large markets of Japan and China, while the major concentrations of medical writers reside in Singapore, India, Australia, and New Zealand.

We can all agree on the value of face-to-face interactions with publication professional peers, as seen with the record turnout we had for the 2023 ISMPP Annual Meeting, but the challenge in APAC is how to bridge the geographic space between the research centres and medical writers. Generally, smaller budgets for industry and agency teams in the region present major challenges for travel to regional congresses. For example, a congress held in Singapore (the geographic mid-point of the region) would still require a 5–7-hour flight from Australia, 7 hours from Japan, 5 hours from China, 4 hours from India, and 10 hours from New Zealand.

So, it remains a chicken-and-egg situation. Should the stakeholders (industry teams, agencies, and societies) make a concerted investment (potentially loss-making initially) to increase the relevance of publication professionals in the region now? Or should they wait until there is a critical mass of publication professionals in the region to support sustainable efforts?

I personally feel it should be the former, but I acknowledge the challenges with such an approach. Until then, there is a need to focus on grassroots initiatives to bring the publication professional community together and facilitate knowledge sharing. I know of such efforts in Australia, New Zealand, China, and Singapore, but these initiatives remain largely contained within each of those countries. The ISMPP Asia Pacific Education Committee has been working hard to develop and deliver regionally-relevant content, but the committee’s current capacity only allows for the roll out of webinars on a quarterly basis.

The region needs a platform that will enable experience sharing and interaction across countries (and languages), and professional societies will need to consider engagement and advocacy with regional/local publishers and journals to support a two-pronged approach to establishing the value of publication professionals.

As the value of real-world evidence continues to be recognised by health regulators, we should also ensure that publication professionals are leading the conversations on best practices for the publication of such data. This will be the game changer for the relevance of publication professionals in the region (and in other countries which may not be involved in clinical trials).

Until then, the challenge remains with publication professionals across the region to continue to drive education and awareness of good publication practice by demonstrating the value of well-developed publications and their dissemination to the relevant stakeholders.”

“As the value of real-world evidence continues to be recognised by health regulators, we should also ensure that publication professionals are leading the conversations on best practices for the publication of such data.”

What about other stakeholders involved in biomedical publishing for example journal publishers, funding institutions, and medical societies? What other initiatives would you like to see them implement to facilitate ethical and transparent regional publication practices?

“It is critical that the stakeholders listed recognise the value of ethical and transparent regional publication practices, so that authors will be more inclined to also adopt such practices. At the end of the day, we need authors to realise that good publication practice will help to improve the quality and acceptance of their publications. Only then will we see a significant shift in attitudes towards the relevance of publication professionals in the region.”

Jonathan can be contacted via LinkedIn.

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