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BMJ No 7110 Volume 315 Letters Saturday 20 August 1997 Authorship See editorial by Richard Smith Fierce disputes about order of authors sometimes occur in China Editor I agree with Richard Smith that the issue of authorship of biomedical papers needs reappraising.(1) In China only the first author is eligible for promotion, no matter what the nature of his or her position (academic, professional, or technical). So it is not surprising that many unpleasant (sometimes fierce) disputes regarding the order of the authors arise between senior and junior doctors and between doctors and technical assistants. I agree with Smith that the concept of `contributorship' is a good solution because it can reflect the concrete contribution of every participant. Accordingly, the `designer' of the paper or the `coordinator' of the `contributor team' should be indicated, to show who will be responsible for the scientific integrity of the whole paper. Ji-Dong Jia Associate professor of medicine Liver Research Center, Capital University of Medical Sciences, Beijing Friendship Hospital, Beijing 100050, China References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) Knowing who did what in studies is important Editor I am glad to see the topic of authorship being discussed.(1) In my work with trainees in public health medicine and on continuing medical education for public health doctors in New Zealand, publications are important in the presentation of projects and in providing points for recertification. It may be difficult to establish what role a person had. I look forward to seeing the development of a practical and realistic way of recognising and authenticating the work that is done. Its acceptance will require a shift in employers' and academic attitudes to the tasks involved in research and publication. Helen M Bichan Consultant in public health medicine 109 Bell Street, Tawa, Wellington, New Zealand hbichan@ibm.net References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) Without a putative contributor, would the integrity of the work change? Editor Richard Smith highlights the difference between novelists and scientific writers and examines the problems of crediting authorship to scientific writers.(1) The concept of authorship is, I think, satisfactory. Three elements merge inseparably in the formulation of a novel: inspiration, or ideas, which are developed into characters and a plot; research; and writing. Although scientific papers are quite different, the Vancouver criteria for authorship are comparable: conception and design of a study (inspiration) or analysis and interpretation of data (research) and drafting or revising critically (writing). The problem is not the concept of authorship but that multiple `authors' may be involved in producing scientific papers and may not meet all of the criteria. The solution is not to redefine authorship but to recognise in some other way important contributions by those who do not qualify as authors. The concept of contributorship-analogous to film credits-has the advantage of defining relative roles in collaborative, including multicentre, ventures. It would, for example, acknowledge the efforts of those whose contribution to research has been important yet whose diluted involvement or non-involvement in the conception of the study or writing the paper has precluded them from qualifying as authors. It may allow more eloquent dissection of contributions to a paper and clarify accountability. It should not, I think, necessarily replace authorship. Many genuine authors remain. Whether authorship or contributorship is used, the struggle for inclusion remains: almost everyone would like the `glory.' Writing is never completely original. Ideas are drawn from experience, from endless encounters. Research examines the work of others. Even the process of writing evolves through various admired styles. No achievement is entirely one's own, and potential acknowledgements are limitless. How far, then, should we go in acknowledging putative contributors? Clearly, this is not easy. We could be too dogmatic in our limits or too nebulous. It would be reassuring to think that common sense would prevail, but there is no definition of common sense. 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. Potential non-contributors may become obvious and may include departmental heads, nepotists, and inquisitive colleagues. There is, I suspect, a place for authorship and contributorship. There is doubtless a place for non-contributorship, and that is in readership. Tim Hall Registrar in neurology Fremantle Hospital, Western Australia 6010 References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) Assessment of authorship depends on culture Editor Strict adherence to objectivity and high ethical standards are defining virtues of science. Though scientists share a common language and culture of science, they are also influenced by values and norms in their societies.(1) Our perception that there were more Japanese than non-Japanese authors listed on research articles prompted us to investigate how culture might influence authorship criteria. We identified two qualitatively similar medical journals (criteria available on request): Circulation Research, which is published in the United States, and the Japanese Circulation Journal. We compared the number of Japanese and non-Japanese authors per article in the 1983, 1993, and 1996 issues of these journals. In each year there were 2-3 more Japanese authors per original article in the Japanese Circulation Journal than in Circulation Research (table). These trends were similar for other contributions too: there were 296 authors on 45 case reports in the Japanese Circulation Journal (mean 6.6 (range 2-12) authors/report) and 225 authors on 59 communications in Circulation Research (3.8 (1-11)). Comparison of number of authors per original article by Japanese and non-Japanese groups of authors in two similar medical journals Circulation Research Japanese Circulation Journal Japanese Non-Japanese Japanese Non-Japanese 1983: No of authors 24 423 446 0 No of articles 7 115 69 0 Mean No of authors/article (range) 3.4 (2-5) 3.7 (1-10) 6.5 (1-15) 0 1993: No of authors 138 702 632 20 No of articles 23 163 104 4 Mean No of authors/article (range) 6.0 (2-11) 4.3 (1-13) 6.1 (1-14) 5.0 (2-9) 1996: No of authors 116 849 512 19 No of articles 18 173 73 3 Mean No of authors/article (range) 6.4 (3-11) 4.9 (1-13) 7.0 (3-16) 6.3 (4-10) Though these data are from a limited sample, they suggest intercultural variations in crediting authorship. The Japanese penchant for `groupism'(2) and limited individual funding probably lead them to involve more people in research endeavours. Research groups in Japan possess a cohesive sense of unity and mutual reliance on the group and senior leader,(3) who typically is included on every paper from the laboratory. A professor who orchestrates funding and consensus building qualifies as an author because these contributions are critical for conducting(4) and publishing research. According to the requirements of the International Committee of Medical Journal Editors, such contributions qualify simply as an acknowledgement,(5) but such discrimination would be likely to disrupt group harmony. Firstly, greater value seems to be placed on the act of contributing than on the value of the contribution. Secondly, scrutinising the value of contributions may strain relationships and prove counterproductive to cohesiveness in the laboratory. These data and analysis imply that publication of research manifests the interface between the scientific method and the culture of contributing investigators. Scientific investigation is neither devoid of its own cultural milieu nor immune to the influence of the values and beliefs of investigators using scientific methods. While the criteria of the International Committee of Medical Journal Editors do not accommodate cultural variation in crediting authorship,(5) they reflect the cultural background of the majority of the members and not codification of undisputed scientific principles. The movement to credit only those who deserve authorship is noble, though the assessment of legitimate authorship is a cultural, not a scientific, judgment. {acknowl}This research was made possible in part by support from the Robert Wood Johnson Clinical Scholars Program (to M D Fetters). Michael D Fetters Lecturer Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, Michigan 48109-0708, USA mfetters@umich.edu Todd S Elwyn Fourth year medical student Medical School, University of Michigan References 1 Payer L. Medicine and culture. New York: Henry Holt, 1996. 2 Befu H. The group model of Japanese society and an alternative. Rice University Studies 1980;66:169-87. 3 Nakane C. Japanese society. Berkeley: University of California Press, 1970. 4 Fetters MD. Nemawashi essential for conducting research in Japan. Soc Sci Med 1995;41:375-81. 5 International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. JAMA 1997;277:927-34. Researchers' objective is to get the job done Editor Perhaps one explanation for the differences in how authorship is perceived by editors and researchers is these groups' different objectives. Editors, encouraged by a frisson of puritan zeal, wish to allocate responsibility for published work. Researchers, on the other hand, ultimately want to get the job done and push back frontiers. As Richard Smith indicates, modern research needs large multidisciplinary teams, and authorship, like the honours system, is a cost free way of getting many busy people to participate.(1) In clinical areas the person with the drive and ideas may not have the patients or the necessary skills in molecular biology, radiology, pathology, etc; and vice versa. Students of human relationships will recognise immediately their day to day contrariness; offering authorship slices through these difficulties and permits better and more innovative research. Surely editors should agree with the researchers' objective, which is to get the job done; all else, though important, is secondary. Robin K S Phillips Dean St Mark's Academic Institute, St Mark's Hospital, Harrow, Middlesex HA1 3UJ References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) Author saw fraud, misconduct, and unfairness to more junior staff Editor As a junior researcher who graduated six years ago, I find the issue of authorship the most frustrating of all the problems within the medical research community.(1) It is frustrating because it is remediable, and the main culprits are often experienced researchers. Two of the most interesting books that I have read are Follies and Fallacies in Medicine and Fraud and Misconduct in Medical Research.(2, 3) Both of these books document cases of unacceptable practice. During my career I have personally experienced events that constituted fraud, misconduct, or simple unfairness to more junior staff. These were notably: Plagiarism: I have witnessed a senior person submit a dissertation for a higher degree in which an appreciable part of the introduction had been copied verbatim from a published paper Important data were manufactured on two occasions Junior staff were omitted from published work A junior researcher conceived a study and wrote the first draft and much of the modification to the proposal, but was excluded from the final submission, which received funding of P100 000. This exclusion was considered to improve the chance of funding Token authorship Token supervision of higher degrees Destruction of computerised data when a funding body decided to scrutinise the work more closely Multiple applications for funding of essentially the same proposed work. Of the solutions to the problem of gift authorship that Richard Smith offered, the radical solution of a list of `credits' appeals most.(4) Editors should require authors to describe their input and demand justification if there is any doubt about someone's inclusion. I would go further and support the idea of an agency to police research.(5) Research and development of drugs undergoes this process because of the potential consequences of poor or bad research practice in the pharmaceutical industry and the large financial incentives involved. The difference between research and development of drugs and other clinical research may be a medicolegal one in that drugs can be fairly easily identified as a root problem whereas a deceptive paper that has influenced a doctor's clinical judgment is more difficult to identify. The vast majority of people whom I have encountered and practice that I have experienced have been perfectly acceptable. The remainder should be weeded out. Craig Currie Research officer Department of Medicine, University Hospital of Wales, Cardiff CF4 4XW Currie@CF.AC.UK References 1 Bhopal R, Rankin J, McColl E, Thomas L, Kaner E, Stacy R, et al. The vexed question of authorship: views of researchers in a British medical faculty. BMJ 1997;314:1009-12. (5 April.) 2 Skrabanek P, McCormack J. Follies and fallacies in medicine. 2nd ed. Chippenham: Tarragon, 1992. 3 Lock S, Wells F. Fraud and misconduct in medical research. London: BMJ Publishing, 1993. 4 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) 5 Klein DF. Should the government assure scientific integrity? Acad Med 1993;68:S56-9. Excluding authors may be impossible Editor I am glad that the definition of authorship is finally being addressed.(1, 2) The publication of original scientific articles may be a key to some recognition, but whether it necessarily leads to academic success is far from clear. As a trainee, I was able to do a few pieces of original research, most of which got published in professional journals, including the BMJ. During these years of training I came across some people who never hesitated to give help and support for any sort of research and some who had hardly been involved in the research but demanded to be listed as an author. I am sure that my experience was not unique. I remember a particular instance, when the editor of the BMJ had a major criticism-that there were too many authors for a paper of the size that this paper was. On further analysis, according to the BMJ's recommended criteria, one could exclude four coauthors, but was it possible? No, because any such attempt could possibly lead to a misunderstanding and cracks in relationships. Instead, a path of least resistance was taken and the article was published in another, less esteemed, journal. This reflects one side of the coin. The other side is when one gets intimately involved with all the practicalities of a piece of research but does not even get an acknowledgement in the paper, let alone inclusion in the list of authors. This experience again is perhaps not unique to me. It is important to have a clear policy on who should be included as an author, even before the start of the research. Researchers and editors need to develop a unanimously acceptable strategy for authorship. It would be appreciated by most researchers around the world. K Chakravarty Consultant rheumatologist Havering Hospital NHS Trust, Oldchurch Hospital, Romford, Essex RM7 0BE References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) 2 Bhopal R, Rankin J, McColl E, Thomas L, Kaner E, Stacy R, et al. The vexed question of authorship: views of researchers in a British medical faculty. BMJ 1997;314:1009-12. (5 April.) Number of publications given on curricula vitae should be limited Editor Authorship will continue to be a problem(1-3) while the curricula vitae of both senior and junior doctors are judged on the number of publications rather than the quality of a limited number of them. Only once in my career have I been asked to limit the number of publications on an application form, and even then it was to too high a number. I suggest that applicants for posts for preregistration house officers, senior house officers, and specialist registrars should be asked to choose their best two publications for inclusion in their curriculum vitae and to be prepared to discuss them at the interview. This would also allow interview panels to have copies of the publications available at the interview, so long as this was not at the expense of the candidate. Applicants for consultant posts should be asked to choose their best five publications and be prepared to discuss each paper, their personal contribution to it, and the impact that the paper has or will have on their specialty. For their annual assessments, specialist registrars should be asked to discuss one of two publications that they have submitted in the previous year. For consultants, discretionary points, merit awards, and continuing medical education points should be related more to quality and relevance than to number of publications. Multicentre trials give only a few people `authorship' but depend on the participation of many and lead to important steps forward in treatment of a wide range of conditions. Participation in such trials should be recognised. Authorship given to a member of the team for participating in only one aspect of a project (for example, collecting data or retrieving and reviewing case notes) has some advantages, in that it can be used as an incentive to get work done quickly and finish off a project started by others. This, in some cases, is useful as it allows publication of an important finding, which may otherwise be delayed or not submitted at all. Publication counting is rife and ingrained into medical thinking; thus any changes would take a long time to filter through to medical practice. Brian W Davies Specialist registrar in paediatric surgery St James's University Hospital, Leeds LS9 7TF References 1 Smith R. Authorship: time for a paradigm shift? BMJ 1997;314:992. (5 April.) 2 Bhopal R, Rankin J, McColl E, Thomas L, Kaner E, Stacy R, et al. The vexed question of authorship: views of researchers in a British medical faculty. BMJ 1997;314:1009-12. (5 April.) 3 Authorship [letters]. BMJ 1997;314:1046-7. 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