Scientific and medical publications are the pulse of the clinical world and play a key role in disseminating data to healthcare providers, scientists, and researchers. However, the process of publishing is hampered by the lack of harmonisation in structure, format, and style of manuscripts across journals. The authors/writers are challenged by this variability, which dilutes their ability to focus on science and medicine. The key challenges of structure, format, and style, including word count, referencing, and citation, are discussed here. We also provide a framework for a possible solution. We urge key stakeholders to come together and harmonise the for mat - ting and technical requirements of scientific and medical publications with consensus from pharmaceutical industry, academics, publishers, and relevant organisations with expertise in medical writing and publication planning. It would take considerable effort from all stakeholders, but the end result of harmonised specifications represents a “blue sky” that is worth striving toward.