Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 46, Num. 3, 2000, pp. 205-210

Journal of Postgraduate Medicine, Vol. 46, No. 3, July-September, 2000, pp. 205-210

Ethics Forum

Authorship: Rules, Rights, Responsibilities and Recommendations

Sahu DR, Abraham P*

Consulting Paediatrician, Mumbai and Department of Gastroenterology*, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400 012, India
Address for correspondence: D. R. Sahu, MD, 12, Manisha Plaza, M N Road, Kurla (W), Mumbai - 400 070, India E-mail: dksahu@vsnl.com

Code Number: jp00072

There was a time when people preferred writing anonymously, there was a time when nobody objected to someone having published the same article at eight different places, there was a time when most of the manuscripts were written single handedly.¹ Times have changed. Now, more and more people want to be associated with a manuscript, publishing the same manuscript more than once is considered unethical, and multi-authored articles are the norm. Newer issues like contributorship, conflicts of interest, corporate authorships, etc. have come into the picture.

Several prominent cases of research misconduct provoked a discussion on issues related to authorship and led to formation of guidelines on authorship issues. The guidelines formed by the International Committee of Medical Journal Editors (ICMJE) constituted one such framework. However, the lack of a consensus on all the issues and unfamiliarity with the guidelines amongst the author community and the administrators^2-6 has led to continued authorship disputes and violation of the guidelines. The disputes and discussion have added newer terminologies to the dictionary_ gift or honorary authorship, pseudo-authorship⁷, surprise authorship⁸, ghost authorship, polyauthoritis giftosa⁹, etc.

Why We Need Definitions?

Over the years, medical literature has witnessed a tremendous increase in literature volume, with an increase in the number of journals and printed pages.¹⁰ However, a quick appraisal of printed volumes makes us suspect that probably we have been encouraging publication of junk. Analysis of the Science Citation Index showed that over 55% of printed manuscripts are not considered worth citing even once by others.¹¹ Wasteful publication in the form of redundant and duplicate articles also plays a role in this volume inflation. On the other hand, there has been an increase in the number of authors listed in the byline of individual articles.^12-14 The complexity of research work and the necessity for multi-centre collaboration are not the only explanations for this trend.^15-18 Irresponsible authorship has its hand in this inflation. Authorship is often used as a vehicle for advancement on personal, social, academic and political fronts. For example, a long list of published manuscripts is sufficient to get a better job, promotion or grants. However, "authors" who use this fast and sure-success ladder, while accepting the credit associated with authorship, display reluctance in accepting the associated accountability and responsibility.^19,20 Hence, we need to define who has the right to be recognised as an author and what are the responsibilities when one gets this recognition.

Who is an Author?

ICMJE or the Vancouver Group has produced the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.²¹ These guidelines recommend that authorship be awarded to those who make a substantial contribution to (a) conception and design, or acquisition of or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; and (c) final approval of the version to be published.²² All three of these conditions must be met to satisfy the authorship criteria. In addition, one should have participated sufficiently in the work to take full responsibility for the content. One should be able to defend, without help from co-authors, the work, the results, and everything else that has been included in the manuscript.

Who is not an Author?

"I can only suggest that holding the door open while rats are brought into the laboratory does not constitute authorship."²³

Participation solely in the acquisition of funding or the collection of data or general supervision of the research group is not sufficient for authorship.²¹ Simply by virtue of being the head of the department or institute, one does not get an automatic right to be an author. Though excluding a non-contributing colleague or the head may at times be difficult,²⁴ authorship cannot be granted for departmental peace and amity.¹⁷ Authorship cannot be gifted as a means for appreciation or encouragement. Providing help in literature search, technically editing the manuscript, or helping with statistical analysis themselves do not deserve byline listing. Technical help, without intellectual participation in writing and reviewing the manuscript, that otherwise would have been done as per the work schedule, too, is not worthy of credit as an author.

The Order of Authorship

The credit associated with a manuscript is usually judged by the order in the byline. Traditionally, the first author is the one who does the maximum work and the last name is reserved for the head or the most senior colleague.²⁵ However, with the changes in literature indexing policies (listing only three, six, or twenty four names), and non-uniform policies of journals, even this aspect has been debated at length. The various suggestions have been to list authors by alphabet, by seniority and by importance of contribution.^17,26 The most accepted and the logical one is that the order should be based on the relative contribution: the one with the maximum contribution should lead the list while the one with the least input should bring up the rear. The ICMJE guidelines state that `the order of the authorship on the byline should be a joint decision of the co-authors. Authors should be prepared to explain the order in which authors are listed…'.²² To avoid ambiguity, it is best for journals to publish in the footnote the reasoning for the order of the authorship or have a fixed guideline. To avoid conflicts, institutions and departments should have a written policy in this matter.

Authorship For Multi-centre Studies

Having a consensus on the listing of authors for an original work in a department, without compromising on `relations', is a difficult task. One can imagine the enormity of difficulty in deciding on these issues in multi-centre studies. The alternatives to avoid a conflict are to list anyone and everyone (the list can run in pages) or name none (name the group) or name the principal investigators (the `group leaders'). Whatever the way chosen, all the members of the group whose names are included as authors should fully satisfy the ICMJE criteria for authorship and group members who do not meet these criteria should be listed, with their permission, in the "Acknowledgements" or in an appendix.²² Amongst the various guidelines, the one prepared by the National Psychosis Research Framework included the following additional points²⁷:

• A publication plan should be constructed early on to avoid overlap of contents and ensure fair allocation of authorship. It is desirable to have a prior written agreement amongst the principal investigators of all the centres, whose data is to be used in any paper. The policy on authorship, correspondence and acknowledgement for each paper should likewise be agreed upon.
• Individuals interested in data collected at a site should circulate their publication proposals to those at other sites, giving them a reasonable time to respond.
• All papers, which combine data from more than one site, should state the affiliation to the wider research collaboration.

Authorship For Student-faculty Studies

The relationship of a student with his senior faculty member is a very delicate one, built on trust, dependence and respect, and is vulnerable considering the benefits of authorship. Misuse of power by the teacher and ignorance of a student about his rights can be the basis for irresponsible authorship. Fine and Kurdek argued that the faculty and students are not meaningfully different with reference to the authorship decision-making process, because faculty and students (particularly graduate students) have the autonomy, rationality, problem-solving ability, and fairness to mutually decide on authorship credit.²⁸ Early in the collaborative endeavour, the supervisor should provide the student with information related to authorship, the meaning of authorship credit and order, and the importance of both the parties agreeing on what contributions will be expected of each collaborator for a given level of authorship credit.²⁸ Based on the specific abilities the collaborators should discuss and agree on what contributions and efforts are required of both the parties to warrant authorship and to determine the order of authorship.²⁸

Unarguably, the student should be the first author for a manuscript based solely on his dissertation topic.

Authorship For Other Manuscripts

There are set criteria for authorship based on the participation in the individual steps towards making a manuscript come into print. However, it is difficult to define these individual steps. For example, what constitutes substantial help in data acquisition in a case series of 50 patients? What kind of literature search is significant to be associated with a review article? Can a pathologist who diagnosed an unsuspected disease either ante-mortally or on post-mortem examination be the sole author for the case report or the referring clinician be a co-author? These questions will have to be tackled individually with the ICMJE definition in mind. Huth has elaborated on authorship guidelines for specific kind of articles.²⁹

Acknowledge Help and Support

The names of the contributors who do not meet the criteria for authorship, including those who provided purely technical help or writing assistance, should be listed in the Acknowledgement.²² The general support provided by the head of the department, if any, and financial and material support should be acknowledged. The groups of persons who have contributed materially to the paper but whose contributions do not justify authorship may be listed under a heading such as "Clinical investigators" or "Participating investigators", and their function or contribution should be described; for example, "served as scientific advisors," "critically reviewed the study proposal," or "provided and cared for study patients."

The readers may infer that all those whose names have been cited in the "Acknowledgement" or as "Clinical Investigators," etc. agrees with the contents of the study and may feel that the study findings and conclusions as well as the manuscript carry their endorsement. Therefore, a written permission should be obtained from all the persons before their names are acknowledged. The acknowledgements are, however, meaningless if they include people who were doing their jobs and who offered no intellectual contribution or technical expertise.³⁰ For example, acknowledging the permission of the head of institute or department to publish the manuscript.

How to Avoid Authorship Disputes

At least tentative decisions on authorship should be made, if possible, at the beginning of the study, after the potential authors have agreed on its design.²⁹

Make sure that no one is deprived of the deserving rights of authorship. A reasonable way to decide whether a contribution is important could be to consider whether, without the putative contributor, the integrity of the work would essentially change.³¹

If you are using data someone else obtained, who is not available for writing or is not willing to write, take his permission to use his data.

Do not change the order of authorship, or delete or add names once it is finalised, without the consent of all the contributors, the new as well as the old ones.

Acknowledge, with permission, all the help that made the study possible.

Discuss before disclosing: in case a dispute arises, discuss amongst you before disclosing the dispute to others.

Get a signed agreement. This is not always necessary; many would not argue against its use to avoid conflicts later on.²⁸

Misuse of Authorship

"Authorship is not simply a pleasant honor to be conveyed easily, such as calling a man slightly your senior, "sir"."³²

Any deviation from the set guidelines for authorship is misuse or irresponsible authorship. Giving an undeserving authorship in the form of `honorary authorship' or `gift authorship' promotes multiple-authorship, which dilutes the credibility and accountability associated with authorship and makes literature indexing difficult.²⁹ The `gifter' should be aware of the fact that the honorary author can snatch his credit in future.<sup>33</sup> The receiver should also be aware that he might in turn have to return something to the `gifter' and can even face problems in the event of a controversy coming up related to the manuscript. There is another form of gift authorship in which gift comes as a surprise to the receiving author. On many occasions the receiver may be happy to receive the gift; however, if not, there can be trouble for the `gifter'.⁸

`Ghost authorship' is the term used for a condition where the name of the original or deserving author does not appear in the printed version of the manuscript. These ghosts can be representatives of pharmaceutical companies hired to write specifically for their company product, who later disappear to avoid disclosing conflicts of interest, or can be a professional editor hired to save the authors' time and efforts.^20,34

One misuse of the authorship not commonly talked about is excluding the deserving author. Unfortunately, there are no guidelines or recommendations for this injustice. If the claim of the deserving author can be proved, a notice should be published in the immediate next issue of the journal, and the indexing authority should be informed and the name of the `missing' author should be included in the literature database.

The Guidelines on Good Publication Practice developed by the Committee on Publication Ethics has recommended sanctions ranging from an educative letter to informing the local medical council depending on the seriousness of the misconduct.³⁵ The sanctions recommended in the report are the maximum an editor can do. However, a dissatisfied colleague may take you to civil court for the misconduct.³⁶

Rights of an Author^33,37-49

Authors have the following rights:

• To have submitted manuscripts treated confidentially by the editors and the reviewers.
• To receive an acknowledgment of receipt of the manuscript.
• To get a timely reply from the editors on the suitability of publication of the submitted manuscript. The time limit varies amongst journals, but a period of eight to ten weeks is reasonable.
• To get an unbiased decision on the submitted manuscript.
• To get a courteous reply from the reviewers and the editors.
• To reply to the comments of the reviewers, even if the manuscript is rejected.
• To get the reviewers' comments, irrespective of whether the manuscript is rejected or accepted.
• To appeal against editorial decisions.
• Not to acquiesce to the editorial suggestions they believe are wrong.
• To reply to the comments published as a response to the manuscript. The authors' reply should be published in the journal.
• To withdraw from the editorial process at any time giving sound reason for it.
• To get back the manuscript, if the journal is unable to publish it for a long time.
• To get a reasonable time for replying to the referees' comments and for proof reading.
• To be informed about any non-technical changes done by the editors after the acceptance of the manuscript.
• Editors cannot change the decision of acceptance of a manuscript taken by the previous editorial board or taken by them, solely on technical basis, for example non-availability of space.
• Unless transferred, the copyright of published manuscripts is the right of the authors.

Responsibilities of an Author

"To a responsible writer, an article, with his name on it, is the highest product of mind and art, his property, as nearly flawless as he can make it, founded in his character and evidence of it."²⁹

It is the responsibility of authors:

• First and foremost, to qualify for the authorship.
• To determine authorship and specify the order in which two or more authors' names appear in the byline.²⁹
• To conduct well justified, well planned, appropriately designed, and ethically sound study, the data of which are analysed appropriately without fabrication and falsification.³⁵ This responsibility includes reporting the negative results as well as the results that were contradictory to their hypotheses.⁵⁰
• Not to send a manuscript based on careless, trivial, unsound, or unoriginal studies, with anticipation that it escapes rejection through some flaw in the review process.⁵¹
• To be able to defend the information presented in a manuscript. For this, it is essential to preserve the original data (for how long is unanswered as the questions on validity of a study can be raised anytime in future⁵²).
• To give due credit to previously published literature. Plagiarism is copying previously published or documented words or ideas without citing their source whether those ideas or words were originally expressed by others or by the same author.⁵³ "Plagiarism is a substitute for writing and so a substitute for thinking. At worst, it is a theft of intellectual property, and therefore represents a serious challenge to the integrity of any publishing effort."⁵⁴
• To check and verify the references with the original manuscripts. It is imperative that references are not quoted after reading only the abstracts; 18-68% of the abstracts of high-rate journals such as Annals of Internal Medicine, British Medical Journal, Lancet, etc. were found to be deficient in data.⁵⁵ The authors should not selectively quote others as per the suitability to their manuscript, should not misquote others and should not quote themselves unnecessarily. A special note should be taken of the accuracy of writing the references. Studies have shown that inaccuracy in citing references ranged from 8.7 to 28.2%.^56,57 If the cited reference contains errors in critical elements of a reference, readers will not be able to retrieve these references.
• To disclose conflicts of interest: A conflict of interest exists when an individual (author, reviewer or editor) makes a judgment concerning primary interest (publishing high-quality research), but is unduly influenced by secondary interest.⁵⁸ These secondary interests may be personal, commercial, political, academic or financial. They become an issue when they have the potential to inappropriately influence judgement, whether or not the judgement is actually altered.⁵⁹ The financial interests include employment, research funding, stock or share ownership, payment for lecture or travel, consultancies and company support for staff.³⁵ It is imperative for the readers to know about the existence of these interests related to a manuscript. This enables them to take a conscious decision about the information in the manuscript.
• To inform the editor about prior publication of an article substantially similar to the submitted one. The authors should also consult the editors about pre-publication press release of information to be published in the manuscript.
• To give due credit to the institute where the work was carried out, even if he does not belong to that institute at the time of submitting the manuscript.⁶⁰
• To suitably comply with the changes requested by the editors.
• To co-ordinate amongst themselves. The corresponding author has the responsibility to `correspond'; anyone or everyone else should not correspond with the Editors. This discipline is also necessary to preserve the confidentiality of the manuscripts under review process.⁴⁹
• To reply to criticism or queries arising from the article.
• To provide the data or cooperate in obtaining and providing the data on which the manuscript is based, if requested by the editors.
• To cooperate with the editors, their assignees or the investigative authorities, in case of any dispute.
• To follow the instructions of the journal carefully. A shabbily prepared manuscript not as per the instructions, with innumerable mistakes, is not just disgusting but it decreases the credibility and worthiness of the manuscript as well as the authors.
• To provide post-publication update.⁶¹ This is a newer concept, called aftercare of the article, wherein authors are responsible to provide update on their published review articles. It was seen that with the fast growth of science the reviews published in print media, after few years, served no purpose. Hence, to make sure that once published a single review article remains a good and up-to-date source of information, authors should send regular update on the subject. The updated information can be published as comments or Letter to Editor.

Newer Recommendations and Their Implications

The ICMJE Guidelines, though drafted in the 1980s, failed to control misuse of authorship. Authorship disputes continue to be the commonest of the reported instances of research misconduct.^62,63 Either the authors were not aware of the criteria or found them unworkable.⁵ A few considered it difficult to implement them in multi-disciplinary trials.⁶⁴

With this system of authorship, readers were not able to judge the actual contribution of each of the listed persons and hence the credit was not distributable amongst the authors.⁶⁵ Various suggestions have been given to allocate the credibility associated with a manuscript. Kapoor⁹ suggested calculating an "authors' contribution factor" (ACF), whereby a total ACF of 1.00 would be proportionately divided amongst the co-authors. More the number of authors, less is the credit each one gets. Marušic gave a similar proposal.⁶⁶ Jones⁶⁷ suggested a numerical score with a mathematical formula of ¹/_n+¹/_m (n = rank order of the author and m= total number of authors) for evaluating individual author's contribution in a multi-authored article. The total credit associated with a manuscript is the sum total of all individual authors' score and should be equally divided amongst the authors.

What was lacking in the system, in addition, was accountability for work, especially in multi-disciplinary and multi-centre studies. As early as 1969 there were recommendations that the actual contributions of the individual authors be revealed to others.^32,68-72 In 1997, Rennie et al⁷³ formally proposed a system whereby the authors will declare their actual work in the study and this information will be published in the journal. The concept behind the proposal is that a contributor is responsible for what he did and only for what he did. The proposal also recommended to have a guarantor for each study who will take responsibility for the integrity of the work. These recommendations have been variedly implemented by a few journals. Later, Rennie et al showed that using this system is easy, does not utilise much print space and gives meaningful information.⁷⁴ However, implementation of this system has not much affected the number of authors per article, as shown in a recent study.⁷⁵ Whatever be the proved utility of this system, it does help to allocate responsibility. In addition, the administrators involved in promotions and grant sanctioning will be able to judge the individual contribution of the applicants towards the studies cited in the résumé.

One thing we all will agree on is that in spite of the rules, regulations and recommendations, finally it is up to individuals to decide to follow them or not. It is only the authors whose principled behaviour can give these guidelines some meaning. Everyone should believe that manuscripts should be written to become a record of discovery, not just a curriculum vitae for every working scientist.⁷⁶

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