Beyond the Manuscript: The Editorial Responsibility in a Complex World

I was troubled by an interview with a researcher involved in the development of voice editing technology. This innovation has the potential to manipulate video content, allowing individuals to be represented in ways that contradict their actual speech. When questioned about the implications of such technology, the researcher’s response was dismissive: “I’m a researcher. My role is to extend what’s possible. I’m not concerned with its implications.” 

It is paramount that researchers approach their findings with a sense of responsibility, considering the wider impacts of their work rather than pursuing technological advancement in isolation. This expectation can, however, be challenging for individual scholars or teams focused on specific areas of expertise. My experience as an editorial fellow at Annals of Internal Medicine has underscored the crucial role that journals and editorial teams play in addressing the broader implications of research disseminated through publication. 

Published in the spring of 2025, "Insurer-Level Estimates of Revenue From Differential Coding in Medicare Advantage" illustrates the power of a well-structured editorial review process in facilitating constructive dialogue surrounding contentious research findings (1). This study examined the discrepancies between Medicare Advantage (MA) and traditional Medicare plans, specifically on how patients’ risk scores, derived from their diagnoses, determine the estimated revenue allocated to various private insurers offering MA plans. 

The authors conducted an analysis of differential coding intensity—measuring the thoroughness of diagnosis documentation in MA plans compared with traditional Medicare plans—from 2015 to 2020 across major private insurers. UnitedHealthcare emerged as the insurer with the most significant increase in revenue, averaging $13.9 billion—approximately $1,863 per beneficiary. This figure starkly contrasts with the second-highest estimate of $6.3 billion (averaging $1,274) from Humana’s MA plans, with other insurers having lower estimates. 

During an editorial meeting convened shortly after the tragic murder of Brian Thompson, the manuscript was reviewed. As we discussed the findings and corresponding figures, our dialogue shifted toward the messaging surrounding the work. At first glance, the inference that UnitedHealthcare was generating disproportionately higher revenue compared with other insurers following the establishment of MA plans appears valid. Yet, the fundamental inquiry among editors was: “How can we contextualize these findings to foster a constructive societal dialogue rather than fuel further rage against insurance companies?” It is essential to recognize that these conclusions could be misinterpreted or exploited in ways that the authors might not have anticipated, inciting violent hostility toward insurers. Consequently, the framing of the narrative takes on critical importance—arguably as vital as the presentation of the data itself. 

Therefore, researchers and editors share a collective responsibility in the arena of messaging. I strongly encourage readers to read both the discussion and the accompanying editorial (2), which emphasize potential solutions. In today’s intricate landscape, initial reactions may often be charged with emotion or political implications—a natural consequence of human behavior. Nonetheless, we owe it to ourselves and society to pursue responses that are both thoughtful and enlightened. I extend my gratitude to Annals of Internal Medicine for its commitment to navigating these complex issues that profoundly affect modern health care. 

References

1. Kronick R, Chua FM, Krauss R, et al. Insurer-level estimates of revenue from differential coding in Medicare Advantage. Ann Intern Med. 2025;178:655-662. [PMID: 40194284] doi:10.7326/ANNALS-24-01345 
2. McWilliams JM. Risk adjustment in Medicare Advantage needs fixing—there's just one catch. Ann Intern Med. 2025;178:739-740. [PMID: 40194285] doi:10.7326/ANNALS-25-00549

Jeffrey Wagner, MD, MCR

Jeff is a native of San Francisco who completed both medical school and a master's degree in clinical research at Oregon Health & Science University in Portland, Oregon, where he met his now wife. He completed residency training at Kaiser San Francisco Hospital, serving as chief resident. In July 2023, Jeff joined the Advanced Clinical Scholars Program at the University of Colorado Anschutz Medical Campus. For the 2024–2025 academic year, he served as an editorial fellow at Annals of Internal Medicine, and starting in 2025, he will be an associate editor for the Journal of General Internal Medicine. For correspondence, he can be contacted by e-mail (jeffrey.wagner@cuanschutz.edu).