This is the most extended revision of a book that first appeared nearly 25 years ago. For the second edition, we included more examples and exercises, and a new chapter on that much abused diagram, the graph. For the third, there were new words, new examples and fresh exercises. There are over 100 new abused words in this fourth edition. Many of the exercises from previous editions are now included as examples in the text, and there are new exercises. The introductory chapter attempting to explain the reasons for poor medical writing has been shortened. We do not think that the attitudes of medical writers to the way they write have altered, but it is better to present solutions than to be too introspective about problems.

Sadly, my co-author, Martin Edwards, died during the production of the third edition; I am joined for this fourth edition by Elise Langdon-Neuner, an experienced copy-editor. She has looked at the text with writers of English as an additional language (EAL), also known as writers of English as a foreign language (EFL) and non-native speakers (NNS), in mind, so they are catered for more directly than in previous editions. In 1960 just under half of all articles now listed by PubMed® were published in English. In 1991, the year of the first edition, there were nearly four times as many articles published, with over 80% in English. By 2012, this had risen to nine times, and 94% were published in English. (At March 2014, this was 95% for articles published in 2013.) Most medical articles are now written by writers whose first language is not English. We give pointers to errors made by EAL writers both with their words and with their sentence construction, which will be helpful not only to them, but to their English native language co-writers trying to correct the errors.