Supporting authors who write in English as an additional language
Researchers who write in English as an additional language publish in a language that is not their own, and the help that gets their work published reaches past correcting the English. It takes in why English is the language they publish in, how a second language is learned, what the support involves beyond the language, the gap in each author's writing and how to teach to it, how to tell an author what a text needs, what an AI language tool leaves them unable to check, and freelance editing for them.
Why English is the publication language
English is the lingua franca of scientific communication, and of medicine in particular. All scientists must speak and write English adequately if they want to present their data or communicate with other researchers. English has not always held that position: for centuries the Middle East was the centre of science and culture, and many manuscripts were written in Arabic and Persian, then the main languages of science. English emerged as the lingua franca of science and of medicine in the mid-twentieth century.
Scientific communication switched from mainly French and German to English: at the turn of the twentieth century at least 40% of the publications in the New England Journal of Medicine were in French, 10% in German and the remaining 50% in English, and students of science at the University of Sydney studied scientific French and German, whereas in 1981 fewer than 1% of that journal's publications were in French or German, and hardly any medical or science students studied those languages except as an elective. During the Second World War isolated national medical communities and single authors began to collaborate, and afterwards these scholarly exchanges gave way to substantial transnational research teams, with English as their language of international scientific communication. English became a means of gaining general professional recognition, and it allowed medical communities to participate in and adapt to modernisation. One morning in June 1957 the new undersea cable linked an elite group of American and British physicians for more than an hour: a joint meeting of the American Medical Association, in annual session in New York, and the Harvey Tercentenary Congress, convened in London, heard distinguished panellists on both sides of the Atlantic exchange information on cardiac surgery for the first time. By the 1980s the Science Citation Index had greatly stimulated citation, and studies of its data showed an increasing number of non-Anglophone investigators publishing in English in both their local and Anglo-Saxon journals. Scientists who expected to be read and cited had to publish in English, and by the early 1990s English was well and truly established as the lingua franca of scientific and medical communication.
With English as the universal language of international scientific and medical collaboration, specialists and researchers from all around the world can share their knowledge and experience more easily and with multilingual audiences; international scientific meetings provide a formal venue for transnational interaction, and online open access has brought groundbreaking science to the farthest corners of the world. The unique knowledge specialists gain from local experience with local techniques, traditions or medicines is valuable for finding solutions to the problems the medical world faces. Being able to communicate effectively in scientific English allows researchers to question the science on the table openly and to propose other valid ideas, and different ideas create an environment for debate.
By the end of the 1980s about 25,000 medical journals published some two million medical papers, and 15,000 of those journals, all Anglo-American, were considered serious. By 2000 over five million medical papers were published annually, and with the 500 or so journals in nursing and dentistry the figure is 10 million health-related peer-reviewed papers a year, over 80% of them written in English.
Many medical journals once published in national languages have switched to English, among them the Croatian Medical Journal, the Mexican Medical Journal, the Saratov Journal of Medical Scientific Research and many others in Latin America, Eastern and Western Europe, Asia and the Middle East; the same linguistic shift is frequent in other disciplines, in both the hard and the soft sciences, and English-medium journals on alternative and complementary medicine are also steadily increasing. Many journals in the Middle East are published in English to increase the chance of being read and accepted by the medical community and of being included in prestigious indexing systems such as MEDLINE.
In 2007, researchers in China were motivated to publish in English because English is the international language of science and because publication in English-language journals counted highly in the Chinese evaluation system. China then had 31 English-language biomedical journals, all with low impact factors, so publishing in English generally meant publishing outside China.
A 2014 white paper reported that nearly 70% of the publications in the Scopus database came from countries where English is not the native language, against an estimated 50% in 2006, and one medical writer expects that, as that share grows, working closely with authors whose first language is not English will become even more important.
Writing itself is a challenge for many researchers, and Charles Darwin once asserted that a naturalist's life would be a happy one if he had only to observe and never to write. In Middle Eastern societies, because of cultural issues, most people, including scholars, are talented at oral communication but have trouble with writing, and the need for medical researchers in the region to publish in English complicates the situation further.
Scientific English has in recent years been developing a style of its own, specific to medical and scientific research, with well-recognised norms of content and presentation now clearly defined in published guidelines such as those of the International Committee of Medical Journal Editors and the CONSORT statement. Its tone of voice is direct and factual, and authors increasingly employ simple sentence structures and a restricted vocabulary of common words that an international audience can understand. That is an advantage for non-native speakers of English, since a good paper in English needs no novelist's descriptive powers. Mastering the style is still important to be taken seriously on the international playing field, and many researchers drawn into the international spotlight are experts in their field but have not always had the appropriate training to use scientific English effectively.
A 2019 study of Taiwanese and Mexican researchers examined the linguistic burden placed on scientists who publish in English as a second, third or additional language, a form of linguistic injustice with real and measurable effects on individual writers.
How a second language is learned
On one account, cultural roots are probably not the main factor in how well someone learns English. By the theory of roots, Italian students at a language high school in Milan should have been very good at French and less proficient at German and English, but that is not always the case: one student there learned every language as soon as she heard its first words, while the others had to work hard at pronunciation. Humans are not born with speech but learn it by listening: a newborn can potentially speak any language in the world, and babbling, the attempt to repeat what is heard, activates the brain areas involved in language.
In the classical model, two areas of the left hemisphere organise language: Broca's area, in the inferior frontal gyrus, is involved in the ability to speak one or more languages, and Wernicke's area, in the posterior superior temporal lobe, in understanding them; the two are connected by the arcuate fasciculus, with language concepts dispersed around them. On this model, the more a speaker practises, the more Broca's area is stimulated and the better the speech, which might explain why someone can understand a language they cannot speak.
Newer models are more complex. A review of two dual-stream models, the Hickok-Poeppel and the Rauschecker-Scott, found that both argue for processing that starts in the auditory area and proceeds through Wernicke's area with sensorimotor integration of the information, and that they differ in whether the process is bilateral, involving both hemispheres, or possibly confined to the left dominant hemisphere. The ventral stream flows to the anterior and middle temporal lobe and is involved in speech recognition and the representation of lexical concepts; the dorsal stream is believed to carry out sensorimotor integration by mapping phonological information onto articulatory motor representations, through the premotor cortex, the inferior frontal gyrus and the parieto-temporal boundary region. The dual-stream models show that multiple parts of the brain are involved, not only Broca's and Wernicke's areas: learning a new language is a complex process that involves the whole brain and generates new connections.
A 2007 study used magnetic resonance imaging and diffusion tensor imaging on 65 native French speakers learning to understand the Hindi dental-retroflex contrast. Fast learners had a greater volume of white matter than grey matter and an asymmetry in the auditory cortex from more white matter on the left than on the right, and so more fibres, fibre tracts and connections between the left auditory cortex and the language regions than slow learners. A 2013 study found that white matter in children develops and stabilises at age 3 to 4, suggesting that teaching young children a new language may result in better-speaking adults. Someone who learns a language late in childhood or in adulthood has therefore passed the more favourable time for brain connections and the babbling phase, and goes straight to sentence production. The ability to learn a new language more easily than others thus depends on the anatomy of the brain and the possibility of generating new connections between its parts, and the sooner the auditory cortex is exposed to new words and sounds, the better they are learned.
In one medical writer's opinion, predicting from the amount of white matter in someone's brain whether they will be a good medical writer is a frightening scenario, because it leaves out creativity and motivation, and the willingness to communicate science and to deliver clearly messages that a lay audience may find difficult does not depend on white matter. By 2015/16 most countries in the European Community had introduced compulsory English teaching in school by the age of 6, probably because English is the lingua franca in many fields, and the same writer counts this a very good result compared with a few years earlier, when children started English later in childhood, though more could be done to let children benefit from learning a foreign language at the age of 3.
What the support involves beyond the language
As hard as academic writing may be, it has been argued to be harder for researchers whose first language is not English. Clinicians and scientists whose native language is not English may find it challenging to communicate the clinical relevance of their research effectively. For clinical researchers with little experience in academic publishing, or whose native language is not English, communicating their data clearly and effectively can be daunting, and many seek out professional medical writers to help prepare manuscripts for peer-reviewed journals. The role of a medical writer is therefore not only to assist with language issues but also to advise authors on the best way to present their results. To achieve publication, the clinical researcher and the medical writer must work as a team, and it is important that both understand what journal editors are looking for when they evaluate submitted manuscripts. Authors and the medical writers who work with them need to be aware of the structural and content requirements for their manuscript and of the ethical guidelines on how research is done and shared, and a writer's active involvement in and awareness of the publishing process ensures a well-written, ethically sound manuscript with a greater chance of acceptance.
A survey of researchers at Assistance Publique – Hôpitaux de Paris, the largest public health institution in Europe, with more than 9,000 articles a year in PubMed-referenced journals, was sent by email to 7,766 researchers between 28 May and 15 June 2015 and completed by 1,191 of them: 63% were under 45, 55% were women, 81% were physicians, 45% held a PhD, and 94% had published at least one article in the previous two years. Of the respondents, 76% felt they were not publishing enough, mainly because of lack of time to write (79%) or to submit (27%), limited skills in English (40%) or in writing (32%), and difficulty starting to write (35%).
Of the same respondents, 87% would accept technical support, especially English editing (79%), critical editing (63%), formatting (52%) and writing (41%), to save time (92%) and to increase submissions to high-impact-factor journals and acceptance (75%). Of the respondents, 79% would appreciate funding support for future publications, for English editing (56%), medical writing (21%) or publication fees (38%), and considered that it could be covered by the institution (73%) or by the added financial value their department had obtained from previous publications (56%). There appeared to be a lack of knowledge of the job of medical writers and a confusion between the jobs of translator and medical writer: English editing, critical editing, formatting and submitting, and writing were the main tasks for which support was needed, and medical writers fulfil all of them. A lack of funding and a poor writing culture could explain this situation.
Science writers for whom English is an additional language are often termed non-native speakers, a negative term that describes them by something they are not; the more positive term writers who have English as an additional language is longer, but brevity is not always most important.
Writing support has three main areas, education, translation and editing, and hybrid services that combine them are needed, on one editor's account, when manuscripts are far from publishable. The editors, translators and teachers who help authors who use English as an additional language to write and improve their research articles have been given the collective term language professional, inspired by IT professional, on the suggestion that a unifying label could help raise their profile, especially in research and academic settings. The typical medical writer role is presented as different from that of a language professional. One medical writer who translates and edits, and who also takes an author's ideas and helps to craft them into an appropriately presented text, often feels that it would have been quicker and easier to start from scratch.
An authors' editor is a person who reads through a draft critically and makes any linguistic, stylistic or contextual changes deemed necessary to ensure that the intended message is expressed logically, precisely, idiomatically and appropriately, without cultural interference that could distort the message. Research editors are rarely visible: they suggest simple solutions to complex linguistic problems, clarifying the text and strengthening the author's voice, and they appear in the acknowledgments for a quick thank you; an editor who has done the job properly is discreet and inconspicuous, invisible to the audience.
The everyday work of an authors' editor covers reference checks, plagiarism checks, pre-review (a type of pre-submission peer review), dialogue with authors and the ethical limitations of editors, and editing before submission, after a revision request or after a rejection each has its advantages and disadvantages. Authors' editors work as freelancers, as employees of editing service providers and for academic institutions, and they also edit document genres other than research manuscripts, such as social media content, press releases and dissertations.
An editor working with authors for whom English is not their first language needs to combine many skills, and the work frequently goes far beyond simply editing the paper: teaching authors how to build each section of a research paper, indicating flaws in how controls are presented, and pointing out every place in the text where a reference should be added to indicate the source of scientific evidence. One Brazilian scientific-communication company calls its editors multifunctional, being teachers, sometimes writers and very frequently translators, and holds that the role requires some knowledge of the field of the research paper. Explaining to prospective clients that it is neither a translation company nor a company that "reviews the English" has been an additional challenge for that company.
A multilingual medical writer with native or near-native English has a position with these authors that goes beyond editing and proofreading. Being able to communicate with the authors in their own language means the writer can easily discuss the project and understand the story the author wants to tell, and then translate those ideas into scientific English style. On a clinical study manuscript, once the text is clean in grammar and punctuation, the writer can focus on the key messages and work the text so that the story and logic flow smoothly and are in line with the data, check that the manuscript meets author and publication guidelines, and identify problems that may arise during peer review. Authors whose first language is not English are often so focused on getting their ideas onto paper and into English that they lose track of what they really wanted to say, and the reasoning and logic become lost behind stuck-together sentences and jumbled paragraphs, so the writer not only helps ensure that the English is correct and fit for purpose but, more importantly, helps the author arrange their ideas and information clearly in scientific English style.
Medical communications publications differ from clinical study manuscripts in having no clinical study report to work from. Their story is based on the current literature, but their key messages contain experience-based conclusions carrying practical, real-life knowledge that is becoming increasingly valuable because it complements or explains clinical research data, and the authors usually know what story needs to be told, having probably formulated it, told it and tested it with colleagues before arriving at a publishable conclusion. The multilingual writer works with the authors in their native language to plan the article structure and define the key recommendations or take-home messages, then builds the manuscript in scientific English style, bases the story on the published literature and fine-tunes the text with the authors, paying particular attention to the story the authors tell so that their ideas and reasoning are communicated correctly and not confused by an Anglo-Saxon way of thinking.
Training is another area for such writers: experienced native-speaking medical writers with knowledge of international scientific style can train authors whose first language is not English to write, speak and manipulate the language appropriately. Non-native researchers can often read and understand most technical language but cannot produce it themselves; their sentence structure and syntax often reflect their native language; some have a working knowledge of casual English but do not know how to speak or write in the professional manner publication requires; and others may communicate well in their area of expertise but be unable to manipulate their spoken or written language enough to deliver powerful messages. These authors require specific training that combines communication skills with appropriate language. Such writers are well placed to give these authors much more than correction of spelling and grammar: helped with their written and oral communication, authors get their message across clearly and move a step closer to their professional objectives.
Each author's specific gap and how to teach to it
A book published in Brazil shows that the main obstacles to a better publication record for researchers there are not the English language but a lack of clear understanding of the scientific discourse and of how research projects should be carried out.
In developing a cancer centre's training programme in scientific writing for its faculty, many of whom are non-native English speakers, the developers found that many faculty and postdoctoral fellows did not understand the structure of a scientific article and that most postdoctoral fellows did not know how to write the introduction and discussion sections. The programme's recommendation is to focus on structure instead of the fine points of English, and even participants with rudimentary English fluency benefited from it. A teacher of young faculty and PhD students at a Beijing health science centre found that many Chinese students tend to overstress the language barrier but underestimate the importance of the structure of a scientific article and of the logic in medical writing, and that many students in China are unaware of the style differences between English and Chinese writing. Asked how to inform international authors about the differences in writing styles between countries, the speakers of one session on teaching them recommended letting the authors know what editors of English publications expect and helping them become familiar with the way native English authors write.
In scientific-writing workshops for an AIDS vaccine initiative's African research partners, many researchers were eager to publish but faced what their trainer described as a "chasm between the data and the blank page". Others were better prepared to analyse data in a manner fit for publication but were stalled in drafting, and were eager to learn the mechanics of technical writing, such as how to link the introduction and discussion sections or how to present results using tables and illustrations.
In those workshops, the KISS principle (Keep It Short and Simple) was a favourite topic, but few respondents wanted to dwell on grammar and punctuation, even though the trainer viewed these as a critical skills gap and recommended that demonstrated proficiency in them be a prerequisite for attending future scientific-writing workshops.
Some authors writing in a language that is not their own find themselves so busy thinking about word order, conjugating verbs or finding the right word that they lose the meaning of what they are really trying to say, unable, as the English expression has it, to see the wood for the trees. A reporting checklist can then keep track of the ideas: writing one small phrase, or two or three where there is enough information, for each section gives the first step towards an outline, from which the first draft is built.
Developing the skills of researchers whose first language is not English can seem daunting given the wide spectrum of language difficulties many of them face. In designing an English-language workshop for PhD students at the University of Southern Denmark, its teachers' main challenges were deciding which aspects of written English grammar to cover and finding a relevant but easy starting point. University writing-lab websites offer useful explanations and exercises, but language difficulties can differ from person to person and from one group of non-native speakers to another, so the challenges a native Danish speaker faces writing in English may differ from those of a native Mandarin speaker. The workshop therefore focused on the problems common to most participants rather than on a predetermined set of grammar rules, and required each student to submit a one-page writing sample two weeks before the course. The most common problems in the samples were:
- subject-verb agreement (Danish does not distinguish between singular and plural verbs)
- adjective and adverb confusions
- lengthy, complex sentences, often including run-on sentences (subordinate clauses are more common in Danish than in English)
- faulty word order (small but important differences between Danish and English word order)
- misuse of that and which (different rules in Danish)
- unnecessary words or wordiness
The list may look different for students in other countries, but a common problem is likely to be texts that are disjointed or difficult to read. The course judged an understanding of English sentence structure essential to creating a clear text, and discussing the main sentence types also allowed a review of the main parts of an English sentence, such as nouns, verbs, adjectives and adverbs, before specific grammar points such as subject-verb agreement and wordiness. Throughout, the course used the students' own examples, which its teachers believe increased understanding and the likelihood that the students would remember the strategies and use them.
The most common English-as-second-language mistakes in science writing are the choice of tense, wordiness, passive writing, which versus that, the use of respectively, translating terms, the definite versus the indefinite article, transitional phrases, the positioning of adjectives and adverbs, and vague statements; the list is not exhaustive, and other issues may arise depending on the writer's experience and working field.
Journal editors and referees often highlight the use of the articles a, an and the as needing attention in submitted manuscripts. Many languages have no equivalent constructions and, in those that do, the articles are not necessarily used in the same way as in English. One editor deletes a lot of definite articles, usually because they are superfluous but sometimes because they are used wrongly: our aim was to establish the association between X and Y gave the impression that X and Y were known to be associated and that the study was designed to establish or confirm that knowledge, where the intended meaning was to clarify whether they were associated. As in Danish, Norwegian has only one form of the verb for is and are and for was and were, so subject-verb agreement is not an issue in these languages, and this causes some Scandinavian authors a lot of problems in English; one manuscript had subject-verb disagreement in almost every sentence, which is rare.
Asked by one editor what they find most challenging about writing, many researchers name writing concisely.
Metadiscourse is the set of linguistic cues that explicitly guide readers through a text and help them build understanding of its ideas, such as inconclusive and notable. A manual analysis of the 24 research-article abstracts published in 2013 in one cancer research journal, following Hyland's taxonomy, counted hedges such as suggest, code glosses such as specifically, frame markers such as aim, attitudinal markers such as exclusively, self-mention such as we, transition markers such as however and engagement markers such as overall: 212 transition markers (5%), 122 code glosses (2.9%), 79 attitudinal markers (1.9%), 45 engagement markers (1.1%), 38 hedges (0.9%), 20 frame markers (0.5%) and 4 self-mentions (0.01%). Its authors conclude that the results give insights into helping novice medical research writers achieve a professional tone by including conventional metadiscursive markers in their texts, and a conceptual framework teachers can use to help ESL students learn English for reporting medical research.
Many PhD students and researchers in non-native English-speaking countries need help with writing manuscripts for publication, and an alternative to editing their manuscripts year after year is to help them develop their own language skills, which should reduce the need for heavy editing caused by poor sentence construction and incorrect grammar. There is also a joy in being able to express oneself and share one's research and discoveries, even if the text is finally submitted to an editor for a polish. Not many people teach written English to non-native academics.
One workshop on critical reading of scientific papers asks participants to bring papers relevant to their own research, published by acknowledged authors in journals considered good in their field, and reads them with the intention to misunderstand anything that can be misunderstood, the way an editor reads a paper to be edited and the opposite of how young researchers are often told to read. To get a snapshot of a paper's content, terminology and target readers, the session starts with the journal title, article title, keywords, purpose statement and conclusion, and then analyses abstracts sentence by sentence.
A University of Helsinki course in English writing for research scientists, running since 1985, includes an exercise in which students reduce a 200-word Finnish Methods section by half, put its 14 passive-voice verbs into the active without we, and flip clauses to achieve end-focus, using the tool of the inanimate agent, as in the test served and data provided. The course's teacher also author-edits for professors and edits her students' post-course manuscripts, which become the journal articles of their compilation PhD theses, and she is later the sole editor of the summary of up to 100 pages that binds their four or five articles into a book. That editing shows her what to teach, such as punctuation and the avoidance of naïve, unintended plagiarism. By 2020 about a fifth of her classes came from abroad, their differing issues quickly recognisable: in her view Persian and Nepalese students are particularly good non-Indo-European writers, and Estonians write just like Finns.
Telling the author what the text needs
One medical writer and translator finds writing no more challenging than translating, and the reverse, but sometimes finds interacting with the author of a text that needs editing or translating challenging, because it is not always easy to explain to a physician that what they have written is ambiguous and needs clarification, grammatically incorrect, semantically incorrect, not coherent with other parts of the text, or does not respect the typographical rules of the language. Very often authors consider their texts their own creation and do not happily accept criticism, even constructive criticism, so the editor needs an appropriate way of communicating and references at hand to support the point, and with experience learns to approach such situations in the best way possible. Even experienced practitioners face such resistance.
Editors of English are typically met with expectations of a quick fix for documents that need more radical changes than the authors think. Language laundry is a typical description of what Norwegian researchers want from editors of English, and one job description an editor received was "just check my use of definite articles". The editor should convey how they work to improve readability and either adjust or gain acceptance for that approach, then identify and discuss illogical and ambiguous content, check grammatical issues where the writer's first language differs from English, and anything that deviates from clear, concise, consistent, well-formed prose focused on the research question. A good way of communicating effectively with authors is to give reasons for suggested changes and, ideally, to name the problems, such as non-parallelism or misplaced -ing forms. One editor who teaches manuscript writing to academic researchers with various language backgrounds, with the intention of reducing the need for editing, finds her ideal job is working with authors who have been through some of her training, so that she can communicate more effectively with them about the radical changes often needed to create a good paper.
An editor of English or a co-author who thinks a text should be 25% shorter should convey that carefully to the author, because the risk of offending is overwhelming.
Editing texts by authors writing in English as an additional language is similar to editing any texts, and one experienced editor stresses that the editor must be "respectful of the author's grammatical style and content" but "rigorous in making necessary corrections, revisions", and can show respect in the queries, with diplomatic questions such as "Do you agree with this wording?" and "Does this convey your intent?", while the edits improve the writing.
The same editor advises giving clients honest feedback: "Be objective and honest but polite." Offering honest suggestions can be difficult, but withholding them does not help the author, and in his experience clients "really want your help" and are not really offended by rewriting or by being told that something is incorrect and needs to be changed; he also compliments authors when compliments are due, so that they have confidence that their work is good: "Your paper is good, you did good research. Let's work together to try to get it published, to try to get it written better."
The same editor writes extensive notes for authors, framed diplomatically: "Here are my suggestions. You may reject them, but this is what I think will help your paper get accepted." The authors have generally been grateful for his guidance, and he concludes that with authors writing in English as an additional language the editor has a major educational role, not just a critical one.
What an AI language tool leaves unchecked
Authors are told to verify and validate what an AI tool produces, but an author who is not confident in their language skills and uses a tool for spelling or grammar may be unable to verify that it has communicated their thoughts accurately, since some nuances may not come across the way they were intended. In 2024 one publisher's editor acknowledged this as one of the difficulties, a case where that verification is very difficult.
On the same editor's account, disclosing the use of AI for language editing lets peer reviewers know that it has been used, so that a reviewer who finds a word or phrase awkward can recommend something better; it is not a total stopgap measure. Some journals also have in-house editors who read the manuscript, and knowing that AI was used lets the publication team take it into account.
Editing for these authors as a freelance
With the global expansion of medical communication, some medical writers look to expand their careers to editing medical communication written by authors whose first language is not English.
Much of the advice on editing a manuscript from title to references applies to editing any author's work. The tips one editor developed specifically for editing work by these authors are:
- Synchronize objectives, methods, results, discussion, and conclusions.
- State conclusions positively, concisely, unequivocally.
- Shorten! Shorten! Tighten! Tighten! Focus! Focus!
- Omit all unnecessary words.
Clients can be found through advertising in places such as the AMWA Freelance Directory, LinkedIn and overseas journals; through starting out by editing for one of the many international editing companies, which gives a beginning editor experience while requiring minimal administrative effort; and through making the business website translatable, which makes the services accessible to a wider audience. Existing clients still come first: "Nurture the clients you have. Write to them, contact them, thank them. Write and ask, 'Has your paper been accepted?'"
Editing the work of authors from non-English-speaking countries has its challenges but can also be rewarding, and a freelance editing career offers flexibility. The work is demanding, labour-intensive and time-consuming, and interpreting what the authors are trying to say can be complex, yet English language and usage are often not the most challenging issues: "It can be a far more difficult task to take a paper that needs work and reconstruct it in a logical, orderly, and systematic way according to the conventions of English-language medical journals."
Editors for these authors regularly receive papers in need of major revisions, and can either correct the punctuation and spelling or try to help the author fill the paper out; one editor has decided it is better to help, as with an abstract that had densely detailed methods and results but no introduction, rationale or conclusion, which became much more understandable once he added those and eliminated nonessential methods and results. Over his editing career he has increased the rewriting he does where it is clearly needed, and found that authors appreciate the improved quality of their papers.
That editor charges a standard rate of 10 cents per word rather than an hourly rate, because he thinks authors like the concreteness of a cost per word, and his advice is to charge as much as possible, "because it won't be big bucks at the most". Invoices should look professional and carry a logo, and a business email address, business mailing address and business bank account matter too; in his experience Asian clients are particularly interested in evidence that they are dealing with a professional service. Working for editing companies can be a way to get started and try the work: the company finds clients, collects fees and does the bookkeeping, and usually pays reliably and without haggling, but it may pay editors poorly and require revisions without remuneration. The rewards of the work include an appreciation of the quality of research done around the world, cordial relationships with authors from other countries and the gratification of educating young and inexperienced researchers.