Rebuilding a 28-output publication plan after a 35% budget cut

Criteria first, outputs second. Rank each proposed output on four questions: (1) Does it fill an evidence gap that affects a real clinical or coverage decision? (2) Is the underlying analysis pre-specified and defensible? (3) Is there an audience that will act on it? (4) Is it the only route to that audience? Impact factor is not a criterion at this stage; it tempts teams to protect prestige outputs and cut the payer work that changes access.

Protect. The paediatric PK study - it is a regulatory commitment, non-negotiable. A payer-facing exacerbation analysis in comorbid heart failure, because a national formulary committee has publicly named the gap and the cost of leaving it unanswered is access. The core primary and key secondary publications. Two or three of the post hoc analyses with genuine clinical decision value, chosen on pre-specification and effect size, not on message fit. At least one plain-language summary and one nursing/respiratory therapist-facing output, because that audience currently has nothing.

Defer. Subgroup manuscripts that restate a known effect in a smaller population; resubmit if an external trigger appears. Additional congress abstracts that duplicate a manuscript already in press.

Drop or consolidate. Several of the 11 post hoc analyses are likely message-support pieces with overlapping content; consolidate into two or three analyses with a clear clinical question. Sponsor-commissioned narrative reviews are the lowest-value item in most plans and should be cut first - they add little and are the hardest to defend in an audit.

Be explicit about the trade-off. Say in the plan what is not being done and why. A cut plan that hides its omissions will be relitigated every quarter.

Separate the decision from the negotiation. Publish the criteria and the scoring in advance, then score every output against them before the meeting. If the conversation starts with a list of eleven, it becomes a bargaining session rather than a portfolio decision.

Engagement sequence.

1. Brief medical affairs, market access and commercial separately, with the same criteria and the same data.
2. Ask commercial to state, for each post hoc analysis, the specific decision it would change and for which audience. Analyses that cannot answer that question fail criterion 1 and drop out without an argument about ownership.
3. Run a scoring workshop chaired by medical affairs, not by publications and not by commercial.
4. Take the scored portfolio to the publication steering committee for sign-off.

Governance point. The steering committee, not the commercial function, owns the final plan. Document that commercial provided input and that the committee decided. This matters later if a deferred analysis is requested again mid-year.

Guardrails to write into the plan. No output is added mid-cycle without going through the same criteria and the same committee. Changes of authorship, journal or timing are logged. A standing item reviews deferred items against new evidence triggers.

Handle the objection honestly. Commercial is not wrong that post hoc analyses can support differentiation; the issue is that eleven of them, in a 35%-cut world, crowd out work that answers a payer's published question. Frame the choice in access terms and the conversation usually moves.

Paediatric PK study (n=40). Small N does not make it optional. It is a regulator-required commitment, so it must be resourced, timelined and tracked as a compliance item rather than treated as a discretionary publication. Plan realistically: a small PK study is unlikely to land in a high-impact journal, and that is fine - the goal is a complete, accessible, indexed report with the full dataset and limitations. Consider a dedicated journal, and pair it with registry or regulatory disclosure so the data are not dependent on one submission. Do not allow the small sample to be used as an argument for deferral.

Nursing and respiratory therapist audience. This is a genuine evidence-translation gap, not a marketing add-on. Two or three reviews for pulmonologists do not serve a nurse managing inhaler technique and adherence. Practical options: a structured, referenced review in a respiratory nursing journal; a short practical summary with a clear methods note; and a congress presence at a nursing or allied health meeting. Keep them evidence-based and free of promotional framing - patient-facing and nursing materials are scrutinised closely and are where over-claiming most often occurs.

Budget logic. These outputs are cheap relative to a post hoc manuscript and reach an audience no one else is serving. That combination is exactly what a constrained plan should buy.

Plain-language summary. Produce at least one, tied to the main results publication, and record where it is disseminated. Transparency expectations increasingly assume a lay summary exists; budgets that cut it are cutting the cheapest item in the plan.