International Medical Writing: 

English for a Global Audience

By Lee Seaman and Tom Lang

With contributions by Raoul Breugelmans, Edward Barroga, and Mary Shibuya




Chapter 1. Clear, Concise, and Coherent: 3Cs English

Chapter 2. Shared Experience: A Key to Improving Clarity

Chapter 3. Writing Better in English: The 12 Edits

  1. Prefer shorter sentences.
  2. Keep the verb close to the subject.
  3. Avoid using empty words.
  4. Prefer the active voice and “subject-verb-object” sentence structure.
  5. Be careful when using the passive voice.
  6. Use nominalizations only when necessary.
  7. Be careful about using the passive voice and nominalizations in the same sentence.
  8. Make the units of a sentence parallel when possible.
  9. Use personal pronouns (“I” and “we”) where appropriate.
  10. Ensure that the meaning of all pronouns is clear.
  11. Use only a few common standard abbreviations.
  12. Use a “given-new” edit to connect your ideas and make your writing smoother.

Chapter 4. Examples and Explanations

Chapter 5. Advice for Publishing in English-Language Journals

Advice for Preparing Manuscripts

Advice for Submitting Manuscripts

Advice for Responding to Reviewers


About the Authors and Contributors


3Cs English Started with Study in Japan

日本での学びに基づく3Cs English

I began to study Japanese as a college student at Waseda University in Tokyo. There, I fell in love with the Japanese language and culture. But although most of my friends studied Japanese literature and philosophy, I studied science. I was fascinated by Japanese research, but I also found that a lot of that research was not presented well in English. As a result, most of the rest of the world did not have access to the valuable work that was being done in Japan.

After university, I studied Japanese further and began to do medical translation into English. Of course, I had to improve my Japanese, and soon I realized that my English writing skills were insufficient, too. So, I did a lot of studying, especially of medical writing, to make my translations as clear and understandable as possible.

Soon, I began to help Japanese authors with their English writing. I discovered that most of them thought in Japanese (usually complex and complicated Japanese) when they wrote in English. As a result, much of their English writing was complicated, and international readers couldn’t understand it. Sometimes the authors didn’t even understand their own English.

I began to teach them to write clear, simple English. Once they could understand their own writing more easily, their readers could understand it, too. That was the beginning of my thinking about 3Cs (Clear Concise Coherent) English as my goal for international medical writing. I wanted to write 3Cs English myself, and I wanted to teach that style of writing to my Japanese students.

The 3Cs relate to the text as a whole, not to vocabulary. Medical vocabulary is generally precise, clear, and widely understood by specialists around the world. As a result, we don’t need to fix vocabulary. However, English grammar should be as clear and simple as possible. Fortunately, you can use several grammar techniques to make your English sentences easier to understand. In this book, Tom and I identify 12 such techniques. We call them “edits” because they are editing techniques. We think that applying these 12 edits can help you to achieve the 3Cs. We believe that this practice will help you to 1) think more clearly about what you want to say and 2) say it in a form that is more likely to be understood by your reader. The result should be writing that is clearer, more concise, and more coherent.