What is an appropriate title for a letter to the editor?

The title of a paper or a letter to the editor is important. It conveys a specific message from the author. The BCMJ follows a specific convention of titling a letter to the editor in response to a published article: “Re: the title of the original article.” That is certainly appropriate if the letter presents additional information for the paper.

Recently a news article in the BCMJ reported “Daily ibuprofen may prevent Alzheimer disease” (2018;60:191). It was followed by a letter raising the concern that FDA had strengthened the label warning that (non-aspirin) NSAIDs can increase the risk of heart attack, stroke, and death.[1] The letter suggests that caution should be exercised not to jump into action by taking daily ibuprofen to prevent Alzheimer disease.

The letter followed the standard format, with the title “Re: Daily ibuprofen may prevent Alzheimer disease.” But readers who skimmed the title without reading the letter itself may erroneously have thought it was a reinforcement of the message. Since the letter gives a different message—a message of caution—it may have been more appropriate to title it as “Potential serious adverse reaction of ibuprofen used in prevention of Alzheimer disease.”

In other journals, for example the CMAJ, the title of the letter to the editor in response to an article is provided by the author of the letter. It is also important to note the letter may only address a certain part of the paper with the title noting that. An example is a recent article that appeared in the humanities section of the CMAJ by a Saudi physician sharing his experience just prior to medical training in Canada (“The Saudi resident and Tillsonburg”).[2] It is a humorous article similar to some of the editorials by our BCMJ editor Dr Richardson. A letter to the editor in response to the article addressed only one specific area of this article, with the author of the letter expressing his own interesting encounter (“A tailor made suit for interview/oral examination”).[3] That letter did not address the whole article, but a parallel situation.

Another article in the CMAJ outlined the interwoven history of mercury poisoning in Ontario and Japan.[4] A letter in response to this article pointed out that there is an ongoing problem with mercury poisoning in that specific Indigenous community in Ontario from an unknown source and, therefore, the history is not completed.[5] The title of this letter brings out a specific and important message.

The Editorial Board of the BCMJ may want to consider using the title of a letter provided by the author if they are addressing a specific area of an article they are responding to. Of course, the Editorial Board may still reserve the right to have the format of “Re:” followed by the title of the original paper, or to provide a different shortened title.
—H.C. George Wong, MD

This letter was submitted in response to “Daily ibuprofen may prevent Alzheimer disease.”

Thank you for your thoughtful letter. The Editorial Board’s role in the disposition of letters is to accept, decline, or, on occasion, request revisions (usually for length). Once a letter is accepted, it is handed off to our editorial staff who execute all subsequent aspects of publishing. The naming formula for letters has been handed down through the generations and may date back as far as 1959, to issue 1, volume 1. The naming convention you accurately describe is intended to allow readers to trace back to the source of the conversation, and while we are reluctant to bow to the skimmers, we agree that sometimes the format could be misleading, and, in all honesty, we know everyone is a skimmer sometimes. In future you will see letters titled to better reflect their subject rather than their source.


1.     Wong HCG. Re: Daily ibuprofen may prevent Alzheimer disease. BCMJ 2018;50:19.

2.     AlAmeel T. The Saudi resident and Tillsonburg. CMAJ 2019;191:E 287-288.

3.     Wong, HCG. Re: A tailor made suit for interview/oral examination. CMAJ 2019 Mar 11;191. Accessed 4 June 2019. www.cmaj.ca/content/191/10/E287/tab-e-letters.

4.     Mosa A, Duffin J. The interwoven history of mercury poisoning in Ontario and Japan. CMAJ 2017;189;E213-215.

5.     Wong HCG. Mercury poisoning in the Grassy Narrows First Nation: History not completed. CMAJ 2017;189:E784.

H.C. George Wong, MD, FRCPC. What is an appropriate title for a letter to the editor?. BCMJ, Vol. 61, No. 6, July, August, 2019, Page(s) 237 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

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