Fortunately, the process required for ethical manuscript preparation aligns well with the process used for efficient manuscript preparation. Professional medical writers will, ideally, follow a standard operating procedure (SOP) that facilitates ethical and efficient manuscript preparation. Manuscript SOPs may vary among writers, but every writer’s SOP should require that authors and writers work collaboratively throughout the process. The SOP should clarify that authors are responsible for identifying the key messages and data to be presented in the manuscript. The SOP may then recommend that the writer develop a comprehensive structural outline based on the author-identified messages and data. The outline should be reviewed, edited (as necessary), and agreed to by the authors. The SOP may then clarify that the writer prepares the first, full-text version of the manuscript only after the key messages, data, and the scope and sequence of content have been author approved. An experienced medical writer will be able to efficiently convert the approved outline into a submission-ready manuscript. The writer, rather than the authors, can perform many of the time-intensive tasks in manuscript preparation. These tasks include the following: drafting text that is clear, concise, credible, and grammatically correct; preparing figures and tables; tracking and incorporating author feedback; ensuring the manuscript meets the requirements of the journal (eg, word count, formatting); and finalizing the multiple text and graphics documents usually required for on-line submission. The SOP should mandate that authors retain responsibility for approving the final version of the manuscript and submitting it to the journal. A professional medical writer can help authors efficiently address the issues (eg, problems with writing style, graphics, formatting) that have been previously identified as persistent problems in manuscripts submitted to CHEST,16 and help ensure that manuscripts are prepared ethically.