The business of medical writing is competitive, but can it be cooperative? Is it time for agencies, which provide professional and ethical publication support to authors, to cooperate for the greater good of the medical publication profession? Formal collaborations have occurred among competitors in the biopharmaceutical and the contract research organisation sectors but rarely among competitors in the medical communications sector. In holding the inaugural Agency Executive Forum, sponsored by the International Society for Medical Publication Professionals (ISMPP), representatives of nine large international agencies met to rectify this situation. We identified a number of areas where we might cooperate, including proposing best-practices for working with freelance medical writers and for responding to procurement-driven requests for information. We are actively looking to cooperate with other groups, such as EMWA, to help ensure outputs that are valuable to the relevant stakeholders.