Ken Wu

Every day during the COVID-19 outbreak, I go through the following scene:

• Open BBC News, read UK and world COVID-19 updates
• Open New York Times, read US and world COVID-19 updates 
• Open Boston Globe, read Boston COVID-19 updates (I live in Boston at the time of writing)

Then for my job as an editorial fellow at the New England Journal of Medicine (NEJM), I go through this:

• Open NEJM, scan through COVID-19 related submissions
• Open The Lancet, read COVID-19 publications
• Open JAMA, read COVID-19 publications

Then because I am a millennial and a developing “medtwitter” enthusiast, I do this:

• Open Twitter, descend into a bottomless pit of COVID-19 threads

I am sure most of you will do some combination of the above in any order depending on your preference and will find that information overload and fatigue quickly sets in. Making judgements about what you read is tricky, especially in a time when so much is unknown. Making that judgement is precisely what a team of editors do, both at medical journals and in newsrooms.

My last piece for PaediatricFOAM covered the type of information you should look out for in an article published during an outbreak like COVID-19. Using what I have learnt from my experiences at the NEJM, this piece will help guide you on how to interpret what you read and make your own judgements on each article that you come across.

What type of article are you reading?

This is an important decision and should be one of the first that you make. It will help frame whatever you are reading in a particular way. Below are some general categories, and the rest of this article will briefly cover each in detail.

• Opinion piece
• Informative piece
• Personal narrative piece

Is this something we now know, or are these someone’s thoughts?

Opinion piece

As the name suggests, this portrays the writer’s own opinion. Opinion pieces cover the majority of what you read, especially during periods of uncertainty like the COVID-19 outbreak. There are many quotations about opinions which vary in crassness; suffice to say everyone has an opinion.

Opinion pieces are found in general media and peer-reviewed journals. In journals, they are sometimes labelled as “perspectives” (NEJM), “viewpoint” (JAMA), “comment” (Lancet). Main things to consider when reading an opinion piece are: 

1. Who is writing it and are they the appropriate people?
2. What is their angle? 
3. What is their message?

If you are thinking about writing your own opinion piece, these are the same things that you should bear in mind as well.

For example, these are my thoughts on this perspective in the NEJM written by Bill Gates:

1. Being one of the richest people in the world who made his name in Microsoft might not be appropriate for commenting on a global pandemic, but being a philanthropist who funds medical research does.
2. He is looking at how a pandemic like COVID-19 can affect healthcare in a big-picture, global, systems-based view.
3. A general advocacy piece. He is essentially using his fame and influence to send a message.

Or this piece in the New Yorker written by Atul Gawande:

1. Being a surgeon and best-selling author on medicine makes him appropriate, but he lacks the in-depth knowledge of an infectious diseases or public health expert.
2. Analysis of infection control and healthcare worker protection using examples from Singapore and Hong Kong.
3. Protecting healthcare workers is more complex and nuanced than mass usage of personal protective equipment (PPE) for every healthcare worker.

Editorials are a particular type of opinion piece. In a medical journal, they are often commissioned by editors and the editorialist aims to highlight key points in data or other perspectives that readers may not have thought about.

For example, this editorial in the NEJM accompanied the lopinavir/ritonavir trial for COVID-19. Whereas the general takeaway of the trial is that lopinavir/ritonavir showed no benefit, the editorial stressed the difficulties of running a clinical trial as well as commending their efforts in a difficult circumstance.

Informative piece

This is classically known as “news”, which is self-explanatory. For medical journals, most people would call it a “research paper”. Because a lot of current research about COVID-19 are short reports, they are sometimes published as “research letters” most of which are peer-reviewed depending on the journal. One thing to bear in mind is that these are different from “letters to the editor” in which readers offer commentary on a research article and therefore act as an opinion piece.

Data are key, p-values are not

There are plenty of books and resources on how to read scientific papers. My own short takeaway from the NEJM editorial meetings is: data are key, p-values are not.

Personal narrative piece

If you read something and think “that’s me!” or something that sounds like a friend or colleague is debriefing to you at the end of a long day, the chances are it is a personal narrative piece (and probably begin with something like “I am an insert speciality doctor, and this is what I saw happen to patients with COVID”.

This is an example of a personal narrative piece about a doctor describing what it is like to live with and elderly relative and look after COVID-19 patients in the hospital.

These are stories written from a personal perspective. The writing is often in the first-person, and the style can be highly descriptive and emotive. Although the merit of evidence itself is weak because it is completely anecdotal, their influence is profound since people relate to and identify with personal stories.

People relate to and identify with personal stories

Last words

Jeffrey Drazen, the former editor-in-chief of the NEJM, once said to me that the NEJM aims to “turn what you think into what you know”. At the time of writing, we know very little about COVID-19. When you are reading anything on COVID-19 over the next few weeks and months, just consider: is this something we now know, or are these someone’s thoughts.

Ken Wu is a UK Paediatric trainee, and currently an editorial fellow at the New England Journal of Medicine.