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The ethics of bylines: Would the real authors please stand up?

2005; Elsevier BV; Volume: 42; Issue: 4 Linguagem: Inglês

10.1016/j.jvs.2005.06.026

1097-6809

James W. Jones, Lawrence B. McCullough, Bruce W. Richman,

Academic Writing and Publishing

What rage for fame attends both great and small!Better be damn’d, than not be named at all.John Wolcot, 1793 (Lyric Odes to the Royal Academicians, Number IX) A young faculty member in an academic surgical department has completed a manuscript for submission to a professional journal with a high impact score. The concept, involving outcome comparison of two techniques for placement of vascular stents, was entirely his own. He prepared the Institutional Review Board submission, collected the data, and wrote the first draft of the resultant paper. A senior faculty member made periodic helpful suggestions throughout the design and data-gathering phases and offered sensible editorial advice after reading the manuscript. A departmental statistician ran the data. The mentor and the statistician suggested that the principal investigator add some faculty colleagues to the by-line of the journal submission, pointing out that this time-honored practice would likely result in his own inclusion as an author on their subsequent publications, thereby thickening his curriculum vitae and hastening his eligibility for faculty promotion and tenure. One of the faculty members suggested for honorary authorship publishes widely, and it’s pointed out to the young investigator that this man’s prominence may very well improve the paper’s chances of acceptance by the journal. The other man recommended for inclusion as an author has not had a single article appear in the literature for years but performed the surgery on about half the patients used for one of his comparison groups. Neither the statistician nor either of the people recommended as “honorary” coauthors have read the manuscript. What should the young investigator do? ACite as authors only himself and the senior faculty member who advised him.BInclude as authors the senior adviser and the statistician.CInclude the adviser, the surgeon who operated on the study patients, and the widely-published faculty member.DList only himself as the paper’s author.EInclude as authors the adviser, the statistician, and both recommended faculty. There’s very little confusion about who wrote such complex works of individual imagination as The Canterbury Tales, Paradise Lost, or Ulysses, but even the most mundane medical research projects require a division of responsibilities within a group, and that’s where trouble begins. Someone in every group inevitably does a lot, someone else does less, and in the confusion, there has arisen in medical research a tradition of those who do nothing. The inclusion on publication bylines of colleagues who have done little or no work in the conceptualization or development of a scientific project has been called “gift authorship,” “guest authorship,” “honorary authorship,” “gratuitous authorship,” and more. The fact that the practice has drawn so many appellations, and that all of us know exactly what each of them means, is evidence enough of how widespread and deeply institutionalized it is within the medical profession. The additional fact that none of these terms is inherently pejorative, that none of them evokes any of the language’s other standard vernacular mechanisms for expressing contempt, is further evidence of the practice’s tacit acceptance among almost all of us. Objective and accurate publications, carefully written by knowledgeable and responsible investigators and thinkers, are how the medical profession expands and distributes its most important information. The process relies entirely for its authority upon the personal integrity of the participants, a confidence that physicians and scientists will practice medicine and conduct research consistent with standards of intellectual and moral excellence.1McCullough L. Jones J. Brody B. Principles and practice of surgical ethics.in: McCullough L. Jones J. Brody B. Surgical ethics. Oxford University Press, New York1998: 3-14Google Scholar The falsification of research results in exchange for fame, promotion, or money is a considerable affront to the profession and its processes because it sends colleagues down dead-end paths and ultimately imperils the health and lives of patients and research subjects whom the medical profession exists to protect. But does a little fudging on a paper’s byline, some generosity in the distribution of credit for authorship, really sink to the level of data falsification? Or is it ultimately a victimless crime, and one that greases the wheels of the academic medicine business, builds working alliances, lends prestige, settles small debts, and stimulates future cooperation? The prevalence of gratuitous authorship in medical publications has been closely studied, and it is breathtakingly high, ranging on individual papers from 48%2Mowatt G. Shirran L. Grimshaw J.M. Rennie D. Flanagin A. Yank V. et al.Prevalence of honorary and ghost authorship in Cochrane reviews.JAMA. 2002; 287: 2769-2771Crossref PubMed Scopus (155) Google Scholar to 60%,3Bates T. Anic A. Marusic M. Marusic A. Authorship criteria and disclosure of contributions comparison of 3 general medical journals with different author contribution forms.JAMA. 2004; 292: 86-88Crossref PubMed Scopus (143) Google Scholar dependent upon the type of article and the particular journal. The gift of a coauthorship on a paper published in one of the most prestigious of the refereed journals is, expectably, more dearly prized than one in an obscure throwaway, and there’s been a historic tendency for extraordinary lists of authors to pile up on papers appearing in those well-known journals; all have given their prospective contributors stern admonitions. Department chairs and division chiefs have shown a marked proclivity for attaching their names to papers they had no role in producing, usually in the last, or senior author, position. There appears to be a saturation phenomenon at work here, as chairs with more than 10 years’ tenure appear in the senior author position significantly less often than the ones still getting accustomed to the thin air of medical aristocracy.4Shulkin D.J. Goin J.E. Rennie D. Patterns of authorship among chairmen of departments of medicine.Acad Med. 1993; 68: 688-692Crossref PubMed Scopus (26) Google Scholar At the lower rungs of academic departments, faculty may pass honorary authorships around among themselves to help one another with organizational pressures to publish, with expectations of appreciation or future considerations, or to insure that referral sources remain obligated. Coauthorship is often the currency offered in exchange for essential functional help like provision of tissue samples or a special lab test. These may seem like fairly good reasons, given the realities of academic medicine, to give or receive a gratuitous addition to an authorship list, but it actually violates standards to which we hold others who function all around us. If we piously issue failing grades or even expel from the institution those of our students found plagiarizing the course work they submit, how can we wink gleefully when we mirror the practice by representing someone else’s work as our own? Our deception is, in fact, quite a bit more consequential than that of a plagiarizing student, because it is not done in the context of a training exercise, a trial run, but as an actual contribution to the professional literature, intended to guide other professionals in their clinical work or direct their future scientific studies. But still, who’s hurt by this? It’s been going on practically everywhere in medicine for years, and no one seems to have really been injured, right? The primary reason for gift authorship is just the cultivation of pride. The principal author offers inclusion in an article’s byline to a colleague as an appeal to pride, and it is accepted accordingly. Surgery is filled with hard-charging, type-A personalities with a well-developed sense of self-esteem, and most of us like to see our names in print, the more the better. But after we gaze lovingly at our names neatly printed on gleaming, heavy-stock paper at the top of a page in the Journal of Vascular Surgery, we add that article to our curriculum vitae, where it serves forever after as evidence of our merit. If we send the vitae to another medical school in search of a more favorable faculty position, a higher rank, a better salary, or a bigger lab, we’re using that unearned citation to misrepresent ourselves to others in the interest of material gain. If we submit it to a national institute to prove our worthiness for a competitive grant that will advance our careers, we’ve done much the same. When our credentials are reviewed by our own tenure and promotions committees, or when we bask in an introduction from the podium at a national meeting as the author of 200 publications when we really worked on only about 75, we have in fact stolen something and diminished the general integrity of our profession. The practice of deception always erodes professional integrity. In the case of gift authorship, it does so by asserting authority for people who have no authority, and by courting a misplacement of trust, the most valuable single commodity that we have to sell in the medical profession. The crime is not victimless. The donor of the “gift” is no less at fault than the recipient. If a primary author adds an unproductive but well-known colleague to the byline in hopes of positively influencing the journal’s reviewers, he is misrepresenting the work and offering it on something other than its merits. If he adds the names of other faculty members with scientific influence in his department to curry their favor and perhaps cut a few corners on the path to promotion and tenure, he is equally to blame. He may be overwhelmed by the tyranny of a department executive elbowing himself into an unearned slot on the byline, but he should not be forthcoming with an offer for purposes of ingratiating himself. The principal author who rewards a clinical referral source with gift authorship on a scientific paper might just reveal that maybe he isn’t the kind of person who should be trusted with another doctor’s patients after all. NIH guidelines suggest that, “Those persons designated as authors should make a significant contribution to the conceptualization, design, execution, and/or interpretation of the study, and be willing to accept responsibility for the study.”5Benos D.J. Fabres J. Farmer J. Gutierrez J.P. Hennessy K. Kosek D. et al.Ethics and scientific publication.Adv Physiol Educ. 2005; 29: 59-74Crossref PubMed Scopus (90) Google Scholar Coauthors should work as a team from inception of the project until completion of the manuscript for submission. The International Committee of Medical Journal Editors is only slightly less demanding in its standards for authorship of professional publications. They propose that “Authorship credit should be based on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Authors should meet … all 3 conditions.”6International Committee of Medical Journal EditorsUniform requirements for manuscripts submitted to biomedical journals. 2004Google Scholar At a minimum, each coauthor of a published article should be able to explain the article in detail and defend it against critics.7Johnson C. Questioning the importance of authorship.J Manipulative Physiol Ther. 2005; 28: 149-150Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Option C is the wrong choice for several reasons. It assigns two coauthors who don’t meet the minimum criteria for that designation. Its use suggests that the young principal author is courting favor and a subsequent quid pro quo from an uninvolved senior colleague, misleading the journal about this respected investigator’s role in the research, and inappropriately characterizing the routine clinical work of a colleague with no intellectual involvement in the study. The functional contributions of the operating surgeon might be properly mentioned in an acknowledgements section at the conclusion of the published article. Option E should be similarly eliminated. It and Option B both become further disqualified by the presence of the statistician, who was absent until the end of the study and has neither read nor can explain the manuscript. Coauthorship would have been a legitimate consideration had the statistician been closely involved in designing the study methodology and substantially influencing how the data should be conceptualized, organized, and evaluated to best determine whether the study hypothesis had been substantiated. As described in this case, that has not happened; the statistician’s duties have been effectively limited to loading a computer program and mechanically running data through it. Recognition of her contribution should also properly appear in the article’s acknowledgements section. Our young faculty member conceived of, effectively implemented, and substantially described the research project, clearly meeting all the criteria for authorship, and specifically primary authorship, of the resultant publication. Option D, sole authorship, is not his correct choice, however. Option A is. He did not, and likely could not, have completed the project as well as he did alone and without the guidance, from beginning to end, of his experienced mentor. Having significantly contributed to the study design, data-gathering methods, and preparation of the manuscript for journal submission, the senior faculty member has met all the legitimate criteria for coauthorship, despite having offered some bad advice about adding some “honorary” authors. His contribution should be so-noted with an author’s citation in the second position. Principal investigators can sometimes lose sight of how valuable the listening, encouragement, and editorializing of a colleague can be in patting a scientific project into shape and bringing it to fruition. Recognizing the mentor as the paper’s second author is ethically sound, not only because his contributions have been genuine, but because none of the principal investigator’s motivations for doing so are deceptive, irrelevant to the scientific project, or intending toward secondary gain, the fallibilities that commonly distort the process of assigning multiple authorship in medical publication. Failure to acknowledge the mentor’s efforts with authorship would assign him a “ghost authorship,” the ethical equivalent of “gratuitous authorship.” If the most exacting of the NIH guidelines were to be honored, the bylines of our professional publications would almost certainly become substantially shorter. The requirement that coauthors contribute directly to development of a study’s intellectual concept, participate in writing the manuscript, and understand and approve its final content would not only eliminate the people who did nothing, it would also disqualify from authorship the functionaries who expected more than they were entitled to for their small contributions. And principal investigators would be constrained from distributing authorship as coin-of-the realm for all sorts of reasons other than specifying who is responsible for a particular scientific publication. These seem to us to be pretty good ideas.