White paper: what is it and how can it be made insightful

If you have seen a white paper, you would have realized that it often looks like a journal article or manuscript. So then, what is a white paper, who publishes it, when, and why?

Well, technically it looks similar to a journal article, but there are major differences that are not obvious when you read the content. Journals have 2 types of articles that can be said to resemble a white paper- these are original research articles and narrative reviews. The latter resembles a white paper more closely. As we know, an original research article is based on a single study and cites similar other studies in the Introduction and Discussion sections. The author(s) of an original article are the ones who conducted the research. Whereas a narrative review is an article on a specific topic, which is completely written by referencing existing literature i.e., the authors are not presenting the outcomes of a study they have conducted. A white paper is similar. The key differences between a white paper and a published narrative review in a medical journal are:

1. The author of a narrative review is usually a known specialist in his/her field e.g., a KOL. The journal would ask for the credentials of the author(s). In fact, most leading journals do not even accept narrative reviews anymore or accept only those that they invite specific KOLs to write. However, a white paper can be written by anyone- an HCP or marketing/medical affairs personnel or anyone else. This is because a white paper will never be published in a journal but is distributed to anyone the writer(s) wants to share with.
2. A narrative review published in a scientific journal is peer reviewed and has more credibility. Since it is peer-reviewed, the author(s) need to balance arguments in favor as well as against the topic (unless there is absolutely no evidence for one of the two scenarios). The objective of the narrative review is to share medical knowledge with specialists from the same field. A white paper does not enjoy that kind of credibility in the scientific community because it is perceived more as a marketing tool, which in reality it is.
3. A narrative review can/might be cited by other publications in the future while a white paper is not acceptable as a citation.
4. Although there are no strict rules as such, white papers are usually shorter than manuscript articles (at least in the context of the healthcare industry). This might be because a very long white paper might not be completely read by the HCP since it does not enjoy the credibility a published article does.

In the context of the commercial healthcare industry, white papers are indeed marketing tools published by a healthcare company. It is usually to build awareness about the benefits of a product, feature, or new concept. Hence, most evidence likely to be presented is in favor of the messaging that the company wants to propagate. Of course, there is no requirement for a review by KOLs or any specialists since this is not a journal publication- although it might be a good idea to run it by some specialists in the field, if feasible. Usually, the author's name is not mentioned, and it can bear the company logo if the company desires to. How does it then differ from newsletters or brochures? Newsletters and brochures focus a lot on design and presentation as well, while the look of a white paper is very academic though it might have charts, tables, etc. as necessary.

Why then do companies resort to creating/sharing white papers? There is one single reason-marketing. Yet, good white papers can indeed earn respect from HCPs. In fact, once that respect is earned, HCPs might look forward to receiving your white papers and reading them as well. So how can one write a 'good' white paper? Here are some tips to follow:

1. Choose a topic that is relevant to current practice and will be of interest e.g. a white paper on the importance of regular monitoring of BP in hypertensive patients is unlikely to be of interest although it is relevant to practice- unless there is some information that is not commonly known. This leads us to point number 2.
2. The title of the paper- The title is the initial hook that will evince interest e.g. for the topic of regular monitoring of BP in hypertensive patients, maybe you are presenting evidence that monitoring should be at different intervals for different levels of hypertension (this is a hypothetical example).
3. After the title, there should be a short Introduction section providing the objective of the white paper and highlighting the uniqueness/ novelty of the content. The title and Introduction sections will decide whether the reader reads the white paper.
4. The content should be organized into various sections, each having its own heading. The source of the content should be published evidence in leading journals with a high impact factor and should be as recent as possible e.g., for writing a white paper in 2022, I would not look at literature published before 2018. In some cases, there might not be many recent publications- yet I would not select anything before 2015. In fact, if most of the evidence is old, I would mention it in the white paper.
5. While the objective of the white paper is marketing, in the case of the healthcare industry the readers will be HCPs- a highly knowledgeable audience, which knows much more than the writer(s). Hence, a good way to enhance credibility is also to present some evidence against the message you want to propagate but justify why you think the argument in favor of the message is stronger. e.g., studies that are against might have a small sample size or might have been conducted among specific ethnic groups, or might not be RCTs etc. By providing a balanced argument you earn credibility and respect from the HCPs.

Before releasing and distributing the white paper, it might a good idea to circulate it among colleagues in the team to get their feedback about the ease of understanding, the messaging they decipher from it, and whether there is some balance between for and against. Of course, the best would be pilot testing to get some feedback from HCPs before sharing it with a wider audience.

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