Writing style: what's in a title?
Authors: A. Anstey
Journal: British Journal of Dermatology (2014)

I sometimes struggle to understand titles of dermatology research papers. Is it possible that some authors are failing to distil the essence of their skin research into terms that are informative and can be easily understood by the generalist? Submitting authors might improve their chances of publication success if they spent a lot more time on their title, thinking how best to communicate what follows in their paper. After all, the title of an academic paper is important, representing an opportunity by the authors to attract readers to their research. With access to most academic content now determined by tables of contents and search engines, titles may be the only chance authors have to announce 'read this, it's important and will improve patient care'. Furthermore, research carried out on the impact of article titles on citation hits reveals that the words chosen for titles influence the citation rate for the article.1 The crucial importance of the title and abstract has been summed up by Eva (2013) as follows: 'I say with absolute confidence that the shortest components of most academic work are the most important because if you do not write an effective title and abstract, there is little reason to invest in writing the rest of your paper.' Eva goes on, 'The title and abstract serve as the trailer to the movie that is the article itself. First, they strongly influence whether or not potential readers find the paper. Next, they govern the accuracy of the inferences readers will draw about the paper and determine whether or not attention is captured to the point that they even take the time to download and read the full article. Each of these factors is a fundamental determinant of the paper's impact.'2 Analysis of titles of articles published in dermatology journals in 2007 revealed that most did not report the study design that had been used in the study.3 Reporting of randomized controlled trials has improved following widespread adoption by journals of the 2010 Consolidated Standards of Reporting Trials (CONSORT) statement;4 this includes a requirement for the title to include identification of the study as a randomized trial. Similarly, for observational studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement5 requires authors to identify the study design of cohort, case–control and cross-sectional studies in the title. However, for nonrandomized controlled trials and nonobservational studies, clinical academics in dermatology still seem to believe that their serious science demands a serious title. But how to do this without being dull, technical or opaque? Convention dictates that the title of dermatology scientific research papers should not be frivolous for fear of implying a lack of scholarship, complexity or deep thought. Thus, a tension exists between an academic title that may threaten the potential reader with dullness, and a journalistic title that grabs the reader's attention but may lead to a paper that is lightweight and lacking in substance. How can authors reconcile these two conflicting styles? The AMA Manual of Style advises that phrases such as 'role of', 'effects of', 'treatment of', 'use of' and 'report of a case of' can often be omitted from titles. It continues, 'Declarative sentences are frequently used as titles of news stories and opinion pieces. However, sentences in scientific article titles tend to over-emphasize a conclusion and are best avoided.' It then provides a number of useful tips for authors to consider when creating titles for their research articles: 'Questions are generally more appropriate for titles of editorials, commentaries, and opinion pieces,' and, 'Randomized controlled trials should be identified in the title or subtitle, because this alerts readers to the level of evidence and the study design and is helpful for researchers performing a meta-analysis.' Other aspects of study design or methods may be included in the title or subtitle; for example: 'Incidence of multiple primary melanoma: two-year results from a population-based study.' The Manual concludes by advising on use of the following in titles: quotation marks (double not single); numbers (usually spelled out, not given as digits); drug names (generic or nonproprietary name); genus and species (expanded and italicized); abbreviations (best avoided); capitalization (the first letter of each major word); and names of cities, countries, states and provinces (again, best avoided if possible). How do medical publications fare when their titles are compared with titles from other academic disciplines? Research carried out by Sword7 on stylish academic writing placed medical publications at the bottom of ten disciplines assessed (medicine, evolutionary biology, computer science, higher education, psychology, anthropology, law, philosophy, history, literary studies) in terms of having an engaging title. Furthermore, this study also showed that medical publications came bottom in terms of having an engaging opening. This was just a sample, and did not include dermatology publications, so should not be taken to heart. Nevertheless, if the title and introduction of a paper fail to engage the reader, what are the chances that the paper will be read? As Sword states, 'Like a hat on a head or the front door to a house, the title of an academic article offers a powerful first impression.'7 Both Sword and Eva advise that the simplest way to create titles that are both engaging and informative is to join together two disparate phrases: one catchy, the other descriptive.2, 7 However, authors should not lose sight of the need for titles to include key information, or risk failing to attract the desired audience to their research work. For example, research on titles in medical education highlights the fact that important informative elements are often missing.8 Why would authors omit essential information from the titles of their papers? Some authors may try to tantalize their audience with an indicative title that describes only the purpose of the study.9 Others may opt for an informative title that includes an active verb and reflects the conclusion of the study.10 Ideally, titles should incorporate elements of both, avoiding excessive emphasis on the conclusion (after all, it is just one study), and attracting readers by highlighting the scope and purpose and methods of study. This has the desired result of attracting an audience, but leaves it to the reader to make their own judgement about the merits and significance of the study. In conclusion, the best titles of academic papers are created with care and craft. Medicine has many shining examples of titles that do justice to the science described in the paper. These include Watson and Crick's paper in Nature describing the molecular structure of DNA,11 and Alexander Fleming's report on the antibacterial effects of the Penicillium mold.12 The titles of these two papers were concise, specific and informative, and would pass muster with the contemporary AMA Manual of Style. Both articles were landmark papers in the history of medicine, yet one was immediately recognized as such while the other was initially overlooked. In contrast to Watson and Crick, Fleming had failed to grasp the significance of his serendipitous discovery. Despite choosing a title that was informative, Fleming was so matter of fact and downbeat about his discovery that his paper soon slipped into obscurity. Modern search engines would prevent a repeat of such an oversight, as long as the title contained sufficient relevant content. Thus, when faced with the dilemma to attract or to inform readers, authors should not lose sight of the need for their titles to be scholarly examples of communication that are factual, informative and can be easily understood, even by the nonspecialist.13 Thank you to Julie Browne for peer reviewing this editorial.