Walking Deadlines: An Undead Perspective on Managing Zombie Manuscripts

There is a deadly pathogen lurking in the shadowy corridors of medical publishing. We call it the Zombie Manuscript.

While the Good Publication Practice (GPP) guidelines introduced in 2005 and updated in 2009 (GPP2) were designed to exorcise the ghosts of unethical writing, they could not fully eliminate the shambling shells of poorly developed scientific papers [1][2]. For the uninitiated medical writer, getting entangles with a zombie manuscript can sap the life out of you. The vital signs are there for all to read, a title, an abstract, a methods section, but the soul is missing. The Investigator provides no valuable insights; the Sponsor assumes that their manuscript is alive (somewhere) and all is well.

From the unique perspective of the undead (who appreciate the value of a functioning brain), we argue that the core pathology of the zombie manuscript is vascular. Specifically, a blockage of the arteries of communication leads to tissue necrosis of the text. The behavioural warning signs of an impending zombie outbreak are there to see. Here are some prophylactic measures to keep your manuscript firmly among the living.

Aetiology and Pathogenesis: How a Manuscript Dies and Walks Again

The lifecycle of a zombie manuscript begins with a critical error: the failure to hold a proper kick-off meeting to discuss objectives and establish roles and responsibilities in an open setting. The GPP guidelines emphasise the importance of transparency and planning early in the development process [2]. Pulling the team together in the face of conflicting calendars is too much effort and might take time. The zombie manuscript is born when the contributors adopt an attitude along the lines of, "The writer doesn't need to speak with the whole team."

Without the light of collaborative scrutiny, the first draft ends up being produced in a vacuum. It is reviewed poorly as D1 is imply considered a rough draft. The Investigator irritatingly adds a handful of single-word edits; the Sponsor, assuming the Investigator has been thorough, adds two more. As noted in general publication ethics, a lack of detailed feedback often reflects a lack of engagement, which is a primary driver of editorial rejection [3]. The manuscript shambles forward, draft after draft, accumulating minor changes but lacking direction and structural integrity. The text often starts to ramble, no one tracks the sources used and the changes made at each step fail to get logged.

Eventually, at a late stage, the team realises the product is not what they ordered. It has become a monster! The messages have drifted from the clinical findings, and the target journal’s scope does not fit the emerging story. This late-stage realisation is the equivalent of realising your Frankenstein has the wrong head and heart).

The Undead’s Diagnostic Signs

As a medical writer, you need to tune into the situation (the low moans) to avoid fright scares. Your alarm bells should ring if you observe the following clinical signs of the undead:

• The Apathy Signal: There is little enthusiasm for a briefing meeting, and the team suggests you can write without speaking to them, suggesting that you perhaps approach contributors individually.
• The Invisibility Cloak: The Investigator explicitly states that recognition of the medical writer’s contribution (required by GPP3) is not wanted [4]. This suggests an attempt to hide the collaborative process.
• The Key Message Necrosis: Pressure is applied to include what might be considered marketing messages that are not directly supported by the study data. In our experience, this ‘drift’ from evidence is a hallmark of the zombie.

If these signs are present, your manuscript is seriously infected.

Prophylaxis and Treatment: Keeping Communications Open

In our fictional world, the undead crave brains. In the real world, zombie manuscripts crave clarity. To stop the shambling progression toward project failure and manuscript rejection, the medical writer must act decisively.

First, introduce (or revisit) a manuscript template – an example manuscript from the journal you want to submit to (target journal [5]) that looks something like what the team are trying to create. Using a template manuscript is a pragmatic way to reverse-engineer what a journal consistently accepts, but it only works if you’re copying structure and signals of quality, not someone else’s science. Here’s a grounded breakdown of what to look for when selecting a template, and what elements are worth mimicking. A strong template isn’t just from the same journal, it’s aligned on multiple dimensions:

Study and content fit

• Study design match (e.g., RCT, cohort, qualitative, systematic review)
• Methodological rigor level expected by the journal
• Clinical vs. mechanistic vs. translational focus
• Population similarity (size, demographics, setting)
• Disease/therapy proximity (same field or adjacent with similar stakes)

Journal fit signals

• Article type (original research, brief report, review, correspondence)
• Recency (ideally within last 3–5 years to reflect current editorial standards)
• Citation performance (often indicates resonance with readership)
• Funding/consortium patterns (multi-centre vs. single-site expectations)

Practical considerations

• Word count proximity to journal limits
• Complexity level of analyses (basic vs. advanced statistical modeling)
• Number of figures/tables typical for that article type
• Authorship size and affiliations (multi-institutional norms)

You also need to consider structural elements. These are the highest-value 'copyable' features, safe, expected, and often decisive.

Title and abstract

• Title format [6]
  • Declarative vs. descriptive vs. question-based
  • Inclusion of study design (“A randomised controlled trial”)
  • Length and punctuation patterns
• Abstract structure [7]
  • Structured headings (e.g., Background, Methods, Results, Conclusion)
  • Word count and level of detail
  • Balance of quantitative vs. narrative reporting

Manuscript architecture

• Section headings and ordering (strict IMRaD vs. variants)
• Paragraph density and flow within sections
• Use of subheadings in Methods/Results
• Consistency in section length proportions

(e.g., relatively short intro, heavy methods/results, focused discussion)

It is important to capture the right details for methods and depth of reporting. This is where many submissions fail—templates help calibrate expectations.

• Level of methodological detail: Enough for reproducibility, but not excessive
• Statistical reporting style: Confidence intervals vs. p-values vs. effect sizes; Reporting standards (CONSORT, STROBE, PRISMA, etc.)
• Order of information presentation: Population → intervention → outcomes → analysis
• Transparency signals: Trial registration, ethics approval, data availability statements

Results presentation factors to consider

• Narrative vs. tabular balance
• Sequence of results (primary → secondary → exploratory)
• Figure/table count and design style
• Redundancy avoidance (don’t repeat tables in text excessively)
• Statistical emphasis (what gets highlighted vs. backgrounded)

Discussion style and depth of consideration of your findings

This is one of the most journal-specific “fingerprints.”

• Opening move: Immediate summary of key findings vs. broader framing
• Depth of interpretation: Conservative vs. assertive claims
• Comparison with prior literature: Number and type of references used
• Handling of limitations: Placement (end vs. integrated) and level of candour
• Clinical or theoretical implications tone
• Ending style: Strong conclusion vs. cautious closing

Referencing patterns to follow

• Number of references (often tightly clustered by article type)
• Recency bias (how many are from last 5 years)
• Journal self-citation frequency
• Primary vs. review article balance
• Citation density per paragraph

Language and tone

• Formality level (highly technical vs. accessible clinical tone)
• Verb tense conventions (past for methods/results, present for interpretation)
• Use of hedging language (“may,” “suggests,” “is associated with”)
• Clarity vs. density trade-off
• Use of abbreviations and when they’re introduced

Visual and formatting conventions

• Figure styles (colour usage, labelling, statistical annotation)
• Table formatting norms
• Supplementary material usage
• Graphical abstracts or highlights (if required)

The final and perhaps most subtle but powerful characteristics to mimic are the editorial ‘acceptance signals.’ These include:

• Clear alignment between aims, methods, and conclusions
• Tight narrative cohesion (no drift between sections)
• Appropriate ambition level (not overselling modest findings)
• Relevance to journal readership
• Compliance with reporting guidelines and formatting rules

To avoid a complete horror movie manuscript ending it is important to remember things you must not do when taking the template manuscript approach

• Do not mimic conclusions without equivalent evidence
• Avoid copying niche stylistic quirks from a single paper
• Don’t overfit to one example—use 3–5 templates to find patterns
• Never replicate phrasing or structure too closely (plagiarism risk)

A practical workflow to follow when taking this approach

1. Select 3–5 high-performing articles from your target journal
2. Create a side-by-side comparison grid:
   • Word counts
   • Section lengths
   • Reference counts
   • Figures/tables
3. Identify common denominators (not outliers)
4. Build your manuscript to match those norm ranges, not exact replicas

Template manuscripts act as your ‘stake’; it forces specific project information into specific boxes, leaving little room for speculation and ambiguous wandering [2]. Second, document everything (retrospectively if there are no records from the project so far). GPP guidelines provide the framework for ethical publication, but the writer is responsible for enforcing these standards [2][4]. Plan a route to redemption, provide clear review timelines and document who is responsible for what. If an Investigator fails to engage, the written record protects the writer from blame when the project collapses.

Third, get the life-blood flowing. Open communication is the circulatory system of a manuscript. The writer must explicitly state to the team: “I am adhering to GPP3. Please explain the part you have a problem with following the guidelines” [4]. This forces your ‘undead’ team members to confront their responsibilities rather than lurking in the shadows. A 2009 editorial in The BMJ supporting GPP2 noted that transparent collaboration is the only way to exorcise the ghosts haunting professional medical communication [2]. We argue that this behaviour is equally true for zombies.

Conclusion

Zombie manuscripts are real. They are toxic and, like fish, they rot from the head down. They are the result of disengaged teams and closed communication loops. However, they are preventable (and rectifiable). By enforcing a rigid structure (templates), shining a light on the process (documentation), and forcing the lifeblood of open dialogue from the very first briefing session, the medical writer can redeem the undead.

Do not let your manuscript stagger toward a journal rejection. Keep the lines open; keep your manuscript alive.

References

1. Wager E, Field EA, Grossman L. Good publication practice for pharmaceutical companies. Curr Med Res Opin. 2003;19(3):149-54.
2. Gegeny T, Ross MF, Hamilton C, et al. Applause for the GPP2. BMJ. 2009;339:b4330.
3. Ali J. Manuscript rejection: The whys and wherefores. J Contemp Orthod. 2017;1(1):22-25.
4. International Society for Medical Publication Professionals (ISMPP). Good Publication Practice (GPP3) Guidelines for Company-Sponsored Biomedical Research. Ann Intern Med. 2015;163(6):461-464. doi:10.7326/M15-0288.
5. Niche Science & Technology Ltd. (2015). Ready! Aim! Fire!: An insider's Insight into Targeted Journal Selection.
6. Niche Science & Technology Ltd. (2017). Putting your best foot forward: An Insider's Insight into what makes a great title.
7. Niche Science & Technology Ltd. (2015). An Insider's Insight into Amazing Abstracts.