English has gradually become the lingua franca of medical publications and conferences across Europe, with scholars from "smaller" languages opting for English because of the greater scientific impact and prestige associated with a wide international audience; at the same time, however, this transition has disrupted well-established textual traditions, hybridising local written and spoken practices. The case of Italian medical journals is especially enlightening, as shown by entries in PubMed (U.S. National Library of Medicine) over the last two decades. The rhetorical implications of this shift are investigated in a sample of medical editorials consisting of Italian texts, NNS English texts from Italian journals, and NS English texts from Anglo-American journals. Cross-linguistic variation in the genre appears to be particularly noticeable in the wording of opening and closing sentences and in the frequency/referent of first-person markers. The analysis of such features suggests that insecurity and decontextualisation are experienced by Italian editors writing in English and that the structural demands placed on NS English texts are more stringent than those placed on their NNS and Italian counterparts. In a way, NNS editorials may thus be seen as intertexts mediating between two different NS models.