That blunt statement is the start of the title of an editorial in the March/April issue of the National Medical Journal of India, "Not being clear about authorship is lying and damages the scientific record" by Charlotte England, Matt Hodgkinson and Pritpal Tamber. Yes, that's right, I'm published. Very exciting.

The online version isn't available yet; I'll see if I can get permission to reproduce the text here. I forgot to speak to Pritt about an 'Authors' addendum' when he submitted it, so the journal retains copyright and their permissions policy is that "The published manuscript may not be reproduced elsewhere, wholly or in part, without the prior written permission of the Journal".

I can, however, post an early version that I drafted with Charlotte, which formed the skeleton for the finished editorial. It bears little resemblance to the final version, so I'm in no danger of breaching copyright.

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Misattribution of authorship is corrupting the scientific and medical literature. Those who do not deserve to be included within the byline of research articles can be found listed despite this, the recipients of ‘gift’ authorship. The efforts of others go unrecognised by readers of articles since they have vanished to become ‘ghost’ authors. Why this abuse of the scientific record happens may be the same as why much corruption occurs – the opportunity for reward without effort, and the influence of money. Transparency can counter the temptation to misattribute authorship, but this requires the cooperation of journal editors, authors, and the authors’ institutions.

Authorship criteria

Authorship is intended to give credit to those who conducted the published work, as well as to highlight those who should take responsibility for the content of the published article. In order to make clear who deserves to be an author, criteria for authorship have been drafted, the most widely known being those of the International Committee of Medical Journal Editors (ICMJE). These classify an author as someone who has substantially contributed to a published study and suggest that authorship credit should be given when an individual meets each of three criteria: 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising critically for intellectual content; 3) final approval of the version to be published [1]. Many journals have since adopted these guidelines in their instructions for authors.

Policies on declaration of authorship often vary between journals. For example, the BMJ asks that authors explain their contribution in their own words [8], while JAMA has a checklist [9]. Research by the Croatian Medical Journal has shown that the structure of author contribution forms can significantly alter the number of contributions reported for each author, and therefore declared contributions should not always be taken at face value [Marusic et al., 2006].

Rising numbers of authors

Since the ICJME guidelines were first published in 1979, there has been a steady rise in the number of listed authors. The most significant aspect of this increase has been the inclusion of senior researchers such as department chairs or professors as either first or last authors [2]. This trend towards increasing numbers of authors is not exclusive to international journals such as the BMJ, as the Indian Journal of Pathology and Microbiology has also seen a 10-15% increase over two decades in the number of articles that have five or more authors [3]. However, this trend is not universal, since the number of authors of articles published in Indian Pediatrics has remained stable over the years [4]. It is not clear whether the increase in the number of authors can be attributed to an increase in the number of scientists being active in research or whether the inclusion of senior scientists as an author is due to the laboratory hierarchy, in other words whether a senior author has been ’gifted’ authorship solely due to their position.

Gift authorship

Honorary or gift authorship is known to frequently occur in biomedical publishing – one study in a French university suggested that up to 60% of senior researchers have received gift authorship by failing to meet all three of the ICJME criteria [5]. The prevalence of gift authorship has been seen to range from 0.5% of research papers in JAMA [6] to 39% of Cochrane systematic reviews [7]. Failure to meet ICJME criteria for authorship can be attributed to several possibilities. Due to the way in which the reviews are compiled, Cochrane authors may not be involved in the original draft or the ongoing revisions, thereby failing to meet all three criteria [7]. It is seen worldwide that the head of a department may insist on being listed as an author on any article issuing from their department, regardless of their own input [5], but in particular it has been acknowledged that authors listed on Indian research papers have a tendency to follow a traditional hierarchal order, where the most senior individual is listed first, followed in descending order by everyone else involved in the study [3]. The tendency to bow to authority has been criticised by Inder Verma, who has argued that “Science is best carried out in an irreverent environment, where the status quo is challenged, often at the risk of offending superiors. But the Indian scientific enterprise frowns on questioning authority and rewards obedience. Senior scientists are too often selected by seniority and rank, rather than their ability and achievements” [18].

Ghost authorship

Further issues arise with the concept of ghost authorship, where individuals do not receive acknowledgement of their contributions to a manuscript. This failure to disclose contributions is generally regarded as an unethical practice because of the potential conflicts of interest that may be present, such as resulting from the use of a professional medical writer by pharmaceutical or communication companies. The prevalence of ghost writing is not as great as that of gift authorship, with around 10% of manuscripts being written by ‘ghosts’ [7, 12]. However, there is a danger that pharmaceutical company-employed writers can ensure that the medical intervention in question is shown in the best possible light, and editors and readers will be unaware of the potential bias. There have even been reported cases where a medical communications company working on behalf of a pharmaceutical company will send potential “authors” a draft article, complete with a title page containing their name [13]. Provided the involvement of a professional writer in a manuscript is made as transparent as possible by acknowledging their contribution, their involvement can serve to improve the quality of articles [14]. The best way to deal with the potential issues surrounding the use of ghost writers is to ensure that not only is their involvement made plain, either within the byline if they meet the criteria for authorship, or in an acknowledgments section, but their competing interests, such as their employment by the sponsoring company, should also be stated. The present rapid growth in clinical trials in India run by foreign pharmaceutical companies makes this issue of increasing importance to Indian researchers [19].

Why authorship criteria matter

The reasons why authorship criteria should be adhered to and declared can be as mundane as making life easier for editors who are trying to find appropriate peer reviewers! Frequent gift authorship can make someone with little knowledge of a subject appear to be an expert, and lead to them being inappropriately invited to review. As has been discussed, ghost authors or unacknowledged contributors may have links to pharmaceutical companies, introducing a competing interest that will remain hidden. However, the issue of the ethics of authorship and contributorship is not only of interest to journal editors. Medical professionals have an obligation to behave ethically, and under the Medical Council of India Code of Ethics Regulations [15] they should “expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct”. The code specifically states in regard to signing professional certificates, reports and other documents that “Any registered practitioner who is shown to have signed or given under his name and authority any such certificate, notification, report or document of a similar character which is untrue, misleading or improper, is liable to have his name deleted from the Register”. Handing out a gift authorship or knowingly suppressing the involvement of a ghost could well fall within these regulations.

A further hazard of accepting undeserved authorship is highlighted by a case of fraud involving the University of California, San Diego. As Harold Sox and Drummond Rennie recount, “Slutsky had published 137 papers with 93 different coauthors when someone noticed anomalies in a few of his publications. The university's response was exemplary. [They] contacted Slutsky's coauthors and held them responsible for defending the integrity of every published paper”. They rightly conclude that “the guilty scientist's coauthors bear primary responsibility for publicly validating or retracting their joint publications” [10].

It is important that credit is given when credit is due because authors need to be accountable for the work they publish. This is especially important in cases where one of the authors is found to have produced fraudulent data, thereby affecting research that cites this data. Once there is suspicion that one research article contains fraudulent data, all other manuscripts from that group of authors need to be called into doubt [10, 11]. These matters are incredibly serious and co-authors should be involved in raising doubts about data as well as employers and journals. As an author, they should accept responsibility for that manuscript, even if their actions were not at fault.

Junior researchers who find themselves locked in a dispute over authorship can turn to the guidelines of the Committee on Publications ethics [17]. These guidelines advise that researchers start discussing authorship when they plan the research project. This is sage advice. The failure to agree authorship of a research project has previously seen researchers resort to legal action [16].

Conclusions

The corruption of the hard-won right to be recognised as an author of a scientific article can be countered by requiring authorship contribution declarations on all manuscripts, and requiring acknowledgment of anyone else who contributed. Despite the existence of journal policies on authorship, it is difficult for editors to enforce these policies. Editors do not have full knowledge of who contributed; only the authors and contributors can themselves say for sure. To avoid disputes, researchers should follow journal guidelines, and as COPE recommends collaborators should discuss authorship at the inception of a research project. As journals rely on authors’ institutions to arbitrate disputes between authors, institutions should have their own code of conduct for authorship, and be prepared to follow up on cases of authorship misconduct, be it gift or ghost authorship.

References

International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication. Updated February 2006 [http://www.icmje.org/#author]
Drenth JP: Multiple authorship: the contribution of senior authors. JAMA 1998 Jul 15;280(3):219-21.
Kakkar N: Authorship trends in the Indian Journal of Pathology and Microbiology: going the global way? J Clin Pathol 2004 Jun;57(6):670.
Sohi I, Kakkar N: Author numbers in Indian Pediatrics--going against the tide! Indian Pediatr 2004 Dec;41(12):1286-7.
Pignatelli B, Maisonneuve H, Chapuis F: Authorship ignorance: views of researchers in French clinical settings. J Med Ethics 2005, 31(10):578-81
Bates 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(1):86-8
Mowatt G, Shirran L, Grimshaw JM, Rennie D, Flanagin A, Yank V, MacLennan G, Gotzsche PC, Bero LA: Prevalence of honorary and ghost authorship in Cochrane reviews. JAMA 2002, 287(21):2769-71.
http://www.bmj.com/advice/article_submission.shtml#author
http://jama.ama-assn.org/cgi/data/295/1/103/DC1/1
Sox HC, Rennie D: Research misconduct, retraction, and cleansing the medical literature: lessons from the Poehlman case. Ann Intern Med 2006 Apr 18;144(8):609-13.
Flanagin A, Carey LA, Fontanarosa PB, Phillips SG, Pace BP, Lundberg GD, Rennie D: Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA 1998 Jul 15;280(3):222-4.
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Jacobs A, Carpenter J, Donnelly J, Klapproth JF, Gertel A, Hall G, Jones AH, Laing S, Lang T, Langdon-Neuner E, Wager L, Whittington R; European Medical Writers Association's Ghostwriting Task Force: The involvement of professional medical writers in medical publications: results of a Delphi study. Curr Med Res Opin 2005, 21(2):311-6
Jacobs A, Wager E: European Medical Writers Association (EMWA) guidelines on the role of medical writers in developing peer-reviewed publications. Curr Med Res Opin 2005, 21(2), 317–321 http://www.emwa.org/Mum/EMWAguidelines.pdf
Medical Council of India Code of Ethics Regulations, 2002 (Published in Part III, Section 4 of the Gazette of India, dated 6^th April,2002) http://www.mciindia.org/know/rules/ethics.htm
Abbott A: Dispute over first authorship lands researchers in dock. Nature 2002, 419(6902):4.
Tim Albert, Elizabeth Wager: How to handle authorship disputes: a guide for new researchers. COPE Report 2003. http://www.publicationethics.org.uk/reports/2003/2003pdf12.pdf
Verma I: Then and now. Nature 2005 Jul 28;436(7050):478-9. http://www.nature.com/nature/journal/v436/n7050/full/436478a.html
Srinivasan S, Loff B: Medical research in India. Lancet 2006 Jun 17;367(9527):1962-4.