Editorials and commentary

An editorial develops an opinion through a reasoned argument, interpreting research, introducing a publication or offering a distinctive professional viewpoint.

Forms and purposes

Editorials usually express the opinion of an editor, publisher or designated authority; an opinion-editorial is also called an op-ed. ¹ They are generally short, can draw on experience and intuition without a major research effort, and are less often available to beginning writers. ¹

An editorial may introduce an issue and explain its contents, accompany a research paper or offer insight into a practical or health-policy concern. ^{2, 3, 4} A claim that much of the scientific literature might be untrue illustrates how a provocative editorial can depend on its author’s highly respected qualifications for credibility. ⁵ A journal may commission a controversial viewpoint while disclaiming that it represents the journal or publisher. ⁴

Two main occasions are a preface to a journal, book or report and a commentary on a published study, usually a new clinical trial. ⁶ The approach can be:

• Supportive: praise a trial, author or topic.
• Critical: criticise a trial, disease recognition or treatment.
• Explanatory or educational: clarify a complex or controversial issue.
• Persuasive: examine facts and figures to produce a solution.

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Several approaches may be combined, but one should predominate. ⁶ Advice on forcefulness differs: 2007 guidance called for all editorials to be hard-hitting, provocative and often controversial, yet its preface example primarily introduced a subject rather than provoking; a 2018 definition instead called for expressing an opinion without being opinionated. ^{7, 8, 9, 10}

Assignment and expertise

Editorials may be invited or volunteered; invitations can concern a particular study or leave the topic open, with open invitations usually going to prominent experts or editorial-board members. ¹ A clinician can offer commentary on accepted research through a well-written letter accompanied by a curriculum vitae, which together help the editor judge whether to invite a contribution. ³ A proposed opinion piece should be exceptionally well written and concern a subject the author knows particularly well. ¹

Before accepting:

• Decide whether the main focus will be supportive, critical, explanatory or persuasive.
• Check whether knowledge and experience are sufficient to choose that focus after reading the accompanying manuscript.
• Tell the editor promptly if the subject lies beyond that expertise, allowing another author to be found.

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Scientific editorials can have lasting effects on a study’s reception and can create enduring personal disagreements, unlike the often shorter-lived influence of a widely read newspaper editorial. ⁷ A two-point reminder is:

• Recognise the different effects of editorials for general and scientific audiences.
• Engage readers with a forceful, provocative and often controversial argument, understandable explanations and a fresh perspective.

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Author selection and control

Expert authors are commonly chosen from recognised leaders, sometimes of international repute; eminent authors may lend credibility but can also deliver strongly favourable or dismissive judgments. ¹² Searches, consensus-statement authorship and publication counts give an incomplete picture: read candidates’ editorials and recent reviews and seek colleagues’ experience of their judgment, practical insight and originality. ¹² Editors may deliberately invite controversy, and an editorial’s content remains partly unpredictable. ¹²

If staff or a medical writer drafts the text, the drafter should first establish the named author’s views, potentially through a recorded discussion, and agree a short outline before preparing the draft. ¹² The named author must then review, rewrite or edit and approve an article expressing their own views, with full control and no pressure to change opinions to suit others. ¹² Journal policies on this practice must be followed, and writers should know the relevant EMWA and WAME ethical guidance. ¹²

Preparation and structure

A preparation checklist is:

1. Obtain specifications for word count, reference count, layout and deadline, and read the material the editorial addresses.
2. Choose an angle from knowledge and opinions, aiming for objectivity.
3. Gather supporting and contrary published evidence.
4. Plan the structure.
5. Write.

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There is no single best structure: an editorial expresses an individual’s fact-based opinion and experience, so authors on the same topic may reasonably write differently. ¹⁴ The argument can follow this sequence:

1. Present the problem, directly in the opening sentence or paragraph or through a relevant vignette.
2. Signal early where the argument is heading.
3. Support the position with evidence, choosing references carefully so the piece does not become a review article.
4. Describe personal insight, preferably with an anecdote making the general point concrete.
5. Present counterevidence respectfully and without bias, then explain why it is unconvincing.
6. Summarise the conclusion, usually in one closing paragraph linked to the opening, with implications for practice or society if appropriate.
7. Give a short reference list.
8. Use headings where helpful, particularly for a long editorial.
9. Avoid overused expressions such as “paradigm shift”, “call to action”, “dramatically increased” and forms of “impact”.

¹⁰

An introductory brief for a schizophrenia review used five steps:

1. State the disease burden in the UK and worldwide in one or two sentences.
2. Look back at least ten years at developments in management.
3. Acknowledge progress and achievements.
4. Analyse remaining challenges and the leading roles of general practitioners and hospital doctors.
5. Look roughly ten years ahead, setting realistic but challenging goals and potentially positive forecasts for patients and professionals.

¹⁵

A hypothetical trial-commentary example instead moved through unanswered questions, reasons for prescribing practice, which patients benefit, how benefit is assessed, and appraisal of the trial design and credibility of its results. ^{9, 16}

The structure should also pass three checks:

• Choose it according to the author’s views and opinions.
• Write out the plan.
• Check that it expresses those views cogently, logically and accessibly.

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Writing the draft

Ten writing hints are:

1. Choose a title that attracts attention.
2. Be concise, beginning with an overview and narrowing into detail.
3. Keep one main idea per paragraph.
4. Use short, familiar words where possible, avoiding nonstandard English and needless terminology, particularly for readers using English as a second language.
5. Avoid abbreviations where possible; define those used and do not overuse them, while allowing familiar abbreviations for repeatedly used long condition names.
6. Choose a relevant topic or explain why readers should care.
7. Remove obvious statements that add nothing.
8. Remove repetition and redundant wording; testing a word’s opposite can reveal redundancy.
9. Make the content interesting and well presented to reach the widest possible readership.
10. Close with a call for action, which can form part of a take-home message giving new knowledge or a different perspective and provoking discussion, even if readers disagree.

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Two final principles are:

• Support radical arguments with adequate facts without making the piece dull and unoriginal.
• Keep it short, punchy and interesting, based on a defensible position.

^{19, 20}

A critique of package inserts declared dissatisfaction and proposed improvements at the outset, separated its physician, consumer and medical-writer perspectives, and limited its criticism by assigning no single party blame and keeping the focus on writing and design. ^{21, 22, 23}

Responsibilities and review

An editorial’s attractions can include engaging titles and content and increased journal impact factors, while potential drawbacks include absent peer review, publication bias, editorial conflicts of interest and excessive self-citation. ²⁴

Access and freedom carry corresponding duties:

Privilege	Responsibility
Seeing trial data and interpretation before publication, like a peer reviewer	Make no other personal or professional use of data, arguments or interpretations before publication without the authors’ specific permission.
Choosing supporting facts and references	Select references fairly and use reputable sources for facts and figures.
Greater freedom to express ideas and opinions	Weigh the facts and present more than one side.
Influencing reception of the paper	Keep an open mind and represent a fair, balanced and substantiated view.

^{25, 26}

Final checks are:

1. Meet author guidelines for word and reference counts and format.
2. Check spelling, grammar and abbreviation definitions.
3. Reread for audience-appropriate tone, readability and logical expression of the opinion.
4. Reduce excessive jargon and abbreviations that limit accessibility.
5. Check whether the editorial is thought-provoking, original and persuasive.
6. Verify citation accuracy and that references support the intended argument.
7. Declare conflicts of interest.

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