A fourth category, the ghostwriter, may follow one of several scenarios. In one, an organization or individual who has had a major influence on a paper may decline to be listed as an author to hide a potential conflict of interest. In the worst case, the employees of an organization do the work, write the paper, and reimburse an “independent” investigator who is willing to be listed as the author. In a second scenario, an author may be hired to write all or part of a manuscript but is not listed as an author or acknowledged in the manuscript. As noted by Woolley,5 using a ghostwriter is distinct from using a medical writer or technical editor to improve the readability of a manuscript. Using a medical writer or technical editor who is noted in the Acknowledgment section can even be recommended, especially when the authors’ native language is not English.