Questions From Users of the Manual


Q: A colleague is adamant about citing page numbers even if the reference is used more than once in a paragraph. Is this necessary?

A: There is a little advice on citing page numbers in the manual, just above section 3.7.

If the author wishes to cite different page numbers from a single reference source at different places in the text, the page numbers are included in the superscript citation and the source appears only once in the list of references.  Note that the superscript may include more than 1 page number, citation of more than 1 reference, or both, and that all spaces are closed up.

Example: These pages showed no sign of proactive sphincteric adduction.3(p21),9

You’ll notice that it’s not mandatory and our style includes, “If the author wishes.”  Page number citation can be helpful to the diligent reader who wants to go to the source cited and find the exact mention of the quoted material.—Cheryl Iverson, MA

Quiz Yourself

Do you know the difference between the terms multivariable and multivariate? One term refers to multiple predictors (independent variables) for a single outcome (dependent variable), and the other term refers to 1 or more independent variables for multiple outcomes? Which is which?


Multivariable refers to multiple predictors (independent variables) for a single outcome (dependent variable). Multivariate refers to 1 or more independent variables for multiple outcomes. Therefore, analyses can be described as multivariable, to indicate the number of predictors, or as multivariate, to indicate the type of outcome.—Laura King, ELS

The Percolating Proofreader

(Editor’s Note: We are a little late posting this update from the bold, fresh-roasted David—but it’s still January and still legit to think about the new year. And it’s always legit to think about commas!—Brenda Gregoline, ELS)

I’ve been percolating through a sieve called December and am ready to be poured into a new year. When I imagine myself as dark liquid I also imagine I’m filling one of my favorite cups to the brim, usually a small tapered one with a pecking hen, though my foursquare Yosemite one sporting a cute raccoon and all-caps DAVID is a real winner too. But this is different: 2016 is no cup I’ve known, no mug, no chalice, no shattered past or graspable present. December 31 is intent on pouring me into a vat of pure future, of which the only knowledge I have is really a bag of assumptions, such as that the Chicago River will continue to flow backwards and the world will not end. A recent year had the distinction, until it was over, of being a candidate for the year it all ended, something no cool person took seriously but the less smug secretly pondered. Was that 2012? I should know; I was there. There was a movie about it, so let’s look it up: yes, 2012 is the movie, and other sources specify the date as December 21. Unless I’m oblivious, the world didn’t end then, but I do recall it beginning when, either that day or the day before, a person actually asked me if I thought it would end. She asked cautiously, sincerely, a human comma breaking the flow of unthinking acceptance that an unpunctuated worldview promotes. That was 3 years ago now, and I think not one of the 1000+ days since has passed without a moment of appreciation for that strategically placed comma.

Now what do you suppose I said when asked if I thought the world would end later that day or the next day, depending on which day the question was posed, which I’m irked not to be remembering, especially since I’ve already said the current world began at that moment, which makes that moment momentous, to say the least? I dug into myself and excavated an honest answer, which is that I thought it wouldn’t end because it hadn’t ended yet and I’m used to continuance, believing in it not as a matter of faith but as a matter of habit, expecting the sun to rise each morning because I don’t trust it to do anything else. As I spoke I realized that, in my own dim way, I was being as smoothly uncritical as the snarksters who, subtext curling lasciviously around the scientific method, dismissed the whole Mayan calendar thing as the kibble of bozos. I too was riding a wave of unpunctuated assumptions, though on a sea of dork instead of a sea of cool. The earnest question was dry land where there had been none, a bit of Moby-Dick calling into question the efficacy of sailors. Had it not been posed, the world would have continued without the slightest hesitation, but the human comma created a pause in which thought struggled to find itself and, failing somewhat, has been continuing the struggle through each of these past 1000+ days.

You might suggest that my human comma was more of a question mark, but you’d be literalizing my friend based on the type of sentence she uttered rather than the form her sentence imposed. A semicolon possibly; maybe even a period, given that she stopped the world cold and started it up again in a different water park. But a human question mark? I think not. She, or he, or whatever she or he really is–we’re all on a continuum, you know, but not an unpunctuated one, not (for me, anyway) since December 20 or 21, 2012– tossed a silken boomerang into the assumption stream and now, though I have no idea what lies ahead, or beneath, as I begin to tumble into whatever 2016 is or isn’t, I do find one sustaining idea limning the boomerang’s surface, that punctuation exists not to separate but to illuminate, to gently render intelligible the formless murk through which we pilot our masked faces and ringed tails.—David Antos


Questions From Users of the Manual

Q: Is it correct to leave “post” as a separate word in the following sentence? “These activities must take place from prelaunch to post launch.”

A: In section 8.3.1 (“When Not to Use Hyphens”), you’ll see the following:

Note that when post is used as a combining adjectival form, as in postmortem examination, it is set closed up. When it is used as an adverb, as in post hoc testing, it is set as 2 separate words.

So in your example, you would not close up “post launch.” However, the meaning of this sentence is ambiguous to me.  I would suggest rephrasing it to avoid an awkward construction and to clarify exactly what interval you are talking about. How about “These activities must take place both before and after launch.”?—Cheryl Iverson, MA

Quiz Yourself

Edit the following sentence for correct usage of anatomy terms:


The investigators examined catheter-induced lesions of the right heart.


Highlight for the answer:
The investigators examined catheter-induced lesions of the right side of the heart.

Editor’s Note: Authors often err in referring to anatomical regions or structures as the “right heart,” “left chest,” “left neck,” and “right brain.” Generally these terms can be corrected by inserting a phrase such as “part of the” or “side of the” (§11.6, Anatomy, p 410 in print).—Laura King, ELS

The Percolating Proofreader

Editor’s Note: Here begins an occasional series by one of The JAMA Network’s favorite overcaffeinated proofreaders, David Antos. He has a deep affection for parts of speech, punctuation, and widows and orphans. (See what I did there?)

Twice in the past week I’ve done the unthinkable, which, however, I found my mind was eventually willing to grasp, as if the unthinkable could be thought through without losing its privileged status of noble ignorance. Less like a raccoon’s grasping a crayfish than a raccoon’s washing pastry till it dissolves, my mind was the beneficiary of an organic shampooing so dense and luxurious that I got a little smarter right there in the shower. No blinding insight in my trickle-down acuity, but a soft perception that there was meaning to be had in twice forgetting to close a parenthetical expression, which is the horror I’d committed.

Do you call parens open/close or opening/closing? Or left/right? I tend toward overexpression, so you can imagine I favor the suffix, but, to keep this clean and tidy, like my hair, let’s do open/close, even though “close” reminds me of “clothes,” which I was bereft of in the shower though in polite society am usually not. Which is the point my shampooed mind was shoring into, that society becomes impolite when punctuation falters. In 2 emails I’d sent that week I’d properly initiated a parenthetical expression that, when gotten to the end of, nakedly submitted itself to the rest of the sentence without so much as a stitch of close. Well, actually, the 2nd email contained a couple bracketed morsels at its conclusion, and the close paren was likely forgotten in the heat of bracketing. No excuse that, but a circumstance lending a ray of thought to the unthinkable. I’d also preemptively included in each of those emails the assertion that, in the interests of sending them in a timely fashion, I was not going back to proofread before hitting the button of no return. I had my out, yet when, after sending, I did proofread, I felt guilt, shame, inner filth, as if I were Michelangelo’s socks when he finally crept down the Sistine Chapel’s ladder. I’d poured my soul into words and left out the close parens, rendering that soul holier than the aforementioned socks. And not in a good way.

Later, I washed my hair and, as a person does when feeling hair and contemplating sin, reflected on the week that was and the week that will never be. I thought of the close parens that were not allowed to see the light of another’s eyes and of the violent omissions recounted in the week’s headlines, and it began not to seem out of place to think that faulty punctuation is at the heart of a world gone wrong. Not that a sloppy email is to blame for unthinkable atrocities, but the sense of purpose, order, and unblinking inclusion punctuation provides mirrors the sense of moral rectitude we only occasionally achieve in our dealings with each other. Punctuation is never evil, just misplaced or missing, and as I stepped out of the shower I cheerfully anticipated my next trip on public transportation, for I would no longer regard the other commuters as merely people but as pieces of punctuation, possibly shoveled into a seat of crumbs or wedged pielike into each other, but innately good, even angelic. —David Antos

Why Not Say It Clearly: The JAMA Network Editors on Correct Usage

The second edition of Why Not Say It Clearly? A Guide to Expository Writing by Lester S. King, MD, was published in 1991 (first edition in 1978).

Dr King was a charmingly irascible but fascinating and classically trained scholar who was a senior editor at JAMA for more than 25 years. A coauthor of the AMA Manual of Style (eighth edition), he was an accomplished raconteur and humorist as well as a prolific writer, particularly concerning language and usage.  He was professor of pathology and professorial lecturer of history of medicine at the University of Chicago.

Why Not Say It Clearly remains an enduring editorial classic on writing and usage and is the inspiration for this expansion of the AMA Style Insider:  The JAMA Network Editors on Correct Usage.  Feedback welcome!—Roxanne K. Young, ELS

Internet, Computer Terms, and References to Social Media

The JAMA Network editors prefer the following capitalization and punctuation styles for e- and i-entities, computer terms, and references to and in social media and networks.  Also check commercial websites for trademarked terms and conditions of their use.

app, application

cell phone

e-cigarette (E-cigarette at the beginning of a sentence or in a title, subtitle, or heading)

e-commerce (see e-cigarette)

e-learning (see e-cigarette)



e-terms (see e-cigarette)

email (Email at the beginning of a sentence or in a title, subtitle, or heading)

Follow (as on Facebook; also capitalize Junk folder, Option key, Edit menu, and other computer key and menu names)

Google (google as verb)



iPod, iPad, iPhone, etc (trademarks)




online (as both adjective and adverb)


Skype (skype as verb)


text, texted, texting

Tweet, Tweeting, Twitter, Twittering (despite the official logo being lowercase; a trademark)

webinar, website (World Wide Web, web-based literature search)

Wiki, Wikipedia

Quiz Yourself

Edit the following sentence to eliminate jargon:

A 78-year-old woman with a congenital heart and a history of high blood pressure and heart attack was admitted to the hospital and prepped for surgery.

Highlight for the answer:

A 78-year-old woman with congenital heart disease and a history of high blood pressure and myocardial infarction was admitted to the hospital and prepared for surgery.

Editor’s Note: A heart is not congenital; the preferred terminology is congenital heart disease or congenital cardiac anomaly. Myocardial infarction, not heart attack, is the preferred term. Patients are prepared, not prepped, for surgery (§11.4, Jargon, pp 408-410 in print). Some of these terms may be acceptable for certain types of writing; peer-reviewed medical journals generally avoid them.—Laura King, ELS

Quiz Yourself

Correct the grammar error in the following sentence:

We performed a quantitative overview of randomized trials which tested β-blockers in myocardial infarction, heart failure, and hypertension.

Highlight for the answer:

We performed a quantitative overview of randomized trials that tested β-blockers in myocardial infarction, heart failure, and hypertension.

Incorrect use of relative pronoun (which vs that) (§7.2.2, Relative Pronouns, pp 317-319 in print). That introduces a phrase that is essential to the meaning of the sentence, and which introduces a phrase that adds more information but is not essential to the meaning. Which should always be preceded by a comma. Another example: “He visited the new hospital, which had been built last year” is correct. However, if there were 2 hospitals and only 1 had been built last year, the sentence would read, “He visited the new hospital that had been built last year.”—Laura King, ELS

Questions From Users of the Manual

Q: What guidance can you offer as to the inclusion of white space in a publication? My company prefers that level 1 headings begin on a new page, but if the text beneath the heading is only a single paragraph, wouldn’t it be preferable for that heading and its text to share the page with the preceding or the subsequent heading and text?

A: This is really an individual decision for each publisher/publication. Especially in the days of print-only publications, many journal editors tried to optimize the use of every page as each journal had a page budget per issue/per year. In some of the JAMA Network specialty journals. for instance, the journal editors specifically developed short items that could be placed, as space allowed, at the ends of articles that ended with at least half a page of white space…thereby using every bit of space that they could to provide interesting and educational information to their readers. White space was never (to my knowledge) used within an article in the way you are describing.

In the JAMA Network journals, there is no page break before the major headings in an article (eg, Methods, Results, Discussion). This would indeed create a lot of white space. In books, on the other hand, this is fairly customary…you do see that each chapter begins on a new page.

In conclusion, to start each major part of a journal article on a new page would create a very odd-looking journal with lots of white space scattered willy-nilly throughout. Perhaps the desire to emphasize each major part of an article could be accomplished with some other design consideration (eg, style of headings).—Cheryl Iverson, MA