Letter: Rise of the Machines: The Promise and Peril of AI in Medical Literature

Abstract

To the Editor: Below, two versions of this letter are presented: one authored by AI and the other by a human researcher. The human voice should exhibit deeper critical engagement, while AI excels at coherence and speed. If the two seem indistinguishable, the human contribution must emphasize originality of insight, lived expertise, and accountability. Can you tell which is which? Which would you trust to guide clinical practice? Let us know through completing the accompanying survey (Figure). The answer reveals not just the limits of machines but what we must vigilantly preserve in human authorship. - Version 1 Version 2 Medical writing aims to distill complicated scientific observations into a digestible narrative for the purpose of knowledge dissemination. The evolution of AI use in medical writing has far outpaced our ability to police it, leading to questions regarding its role and the ethics surrounding it. We now find ourselves at a crossroads.AI use drastically reduces the time needed for manuscript drafting, including outlining, reference collection, writing, and formatting.1 Further editing can afford the authors an opportunity to add their own linguistic flavor. For non-native English-speaking authors, this technology provides a means to overcome language barriers and levels the playing field.2 This technology comes with concerns; AI is prone to hallucinations, factual inaccuracies, incorrect references, and simplification of complex research.3 It requires effort to alter the tone to match that of an experienced neurosurgeon-scientist. It lacks deep insight, unique neuroscience vernacular, and clinical relevance. AI leans on existing literature for its output, so with increased utilization, each subsequent article is written with a higher percentage of AI-produced input. With cumulative use, the unchecked errors and artificial writing produced by AI have the potential to be compounded over time. Is the potential of contributing false information to literature worth the risk?It is evident that AI in medical writing is here to stay and will undoubtedly improve over time. Regarding concerns of ghost authorship, when AI is used and “reviewing of the work critically for important intellectual content” is upheld, ethical guidelines for authorship based on current definitions are satisfied. But if we allow its use to be unconstrained, do we accept that human creativity can be removed from scientific writing altogether and redistribute our research efforts to other parts of the process?For most involved in scientific writing, the emerging use of AI elicits both anxiety and excitement. There is great potential to maximize scientific productivity, but if exploited without adequate oversight, it could result in peril to the field and the reputation of physicians.It is becoming more apparent that simple “acknowledgement of AI assistance” during the submission process is no longer a sufficient ethical checkpoint as its use in medical writing has a vast range. As this technology evolves, neurosurgery must be at the forefront of defining the guardrails that ensure its proper and ethical use. In recent years, artificial intelligence has quietly entered the domain of medical authorship, reshaping how clinicians and researchers draft narratives, reviews, and guidelines. An international review noted how AI tools streamline literature synthesis and draft creation but stressed the indispensable role of human expertise in ensuring contextual accuracy and clinical nuance.4 Thus, the current moment invites a critical appraisal: AI is neither miracle nor menace, but a provocation to re-examine the nature of authorship in medicine.AI can reduce workload. For example, AI-assisted reviews in musculoskeletal research showed dramatic time savings, though requiring meticulous fact-checking.5 Specialized models like “LEADS” improved recall and reduced screening time by >20% in literature mining tasks.6 Beyond efficiency, AI also helps non-native English writers produce clearer manuscripts and handles references rigorously.2 These gains signify not replacement of the medical author, but augmentation, freeing human intellect to focus on interpretation, clinical judgment, and ethical considerations.Despite its promise, AI presents hazards. In one comparative study, AI-only drafts contained up to 70% inaccurate references and required extensive editorial correction.5,7 AI systems also risk perpetuating bias hidden within training data, particularly concerning given known healthcare disparities.2 Moreover, the ease of generating polished text raises questions about ghost authorship and plagiarism: AI-generated content has passed editors undetected, which obscures accountability.8 These issues reinforce that AI, without vigilant oversight, can undermine accuracy, equity, and authorship integrity.To harness benefits without succumbing to pitfalls, guardrails are essential. Guidelines from the ICMJE (January 2024) require disclosure of AI assistance and insist that authors remain responsible for content.9 Ethical frameworks emphasize transparency, traceability, and algorithmic auditing to protect confidentiality and guard against bias. Some journals have barred AI from peer review to preserve human judgement.10 Implementing such measures requires publisher commitment and author accountability throughout the writing pipeline.Ethically sound use of AI in medical writing begins with the principle that human authors hold ultimate responsibility. Best practices include using AI for drafting, not interpretation; verifying citations and content; disclosing AI use transparently; and applying audits to detect bias. Equally, maintaining authorship standards, crediting only those who shaped intellectual content, is critical. In sum, AI should be understood not as an author, but as a tool whose responsible deployment demands vigilance, clinical wisdom, and moral clarity. FIGURE.: QR code linking to the readers' poll. Scan this code to participate in a survey querying which letter was written by a human vs AI; vote proportions will be shared 6 months later using the hashtag #neurosurgery_journal on X (formerly Twitter) at @alex_spiotta.

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