Advertisement

The Fastest Way to Make an Enemy

      Recently, I received an e-mail from one of my colleagues, a distinguished professor of cardiology, here at the College of Medicine. He posed an interesting question: In a large-scale clinical trial or registry with many physicians entering patients, who should be included as authors on the publications resulting from the investigation? It seems that one of the manuscripts published from a specialized clinical registry had not listed as authors some of the physicians who had entered a number of patients into the registry. My colleague asked me, “What is the policy of The American Journal of Medicine in this regard; should we have listed these physicians as coauthors?”
      I told him that the Journal did not have a specific rule about who should be included as an author, except for the requirement that authorship should be granted only to individuals who had actually participated in the work that led to the publication.
      Often in the past, senior, distinguished members of the faculty were given authorship on a manuscript without actually having been involved in the work that led to the publication. This practice is termed “honorary authorship.” These days, such forms of authorship are discouraged but undoubtedly still go on. However, the physician who complained to my colleague in this case was definitely not someone asking for “honorary authorship.” This physician had indeed contributed data from a substantial number of patients to the clinical registry that was utilized for the scientific article. In this particular case, the total number of physicians entering patients into the registry was relatively modest, and so all involved could have been listed as authors.
      On the other hand, what should be the rule for authorship in massive clinical trials involving thousands of patients and literally hundreds of investigators? Should all of the investigators be listed as authors? I am not aware of any specific rules for authorship for this type of publication.
      Here is a common practice that I have personally been part of in the recent past. The first and usually most important article to be published from such a trial lists a number of the key investigators, for example, members of the steering committee, on the first page of the paper just below the title. Following the listing of these authors one often finds the phrase “and the xxxx trial investigators.” Then, at the end of the article, following the bibliography, a complete list of all participants in the trial is given, including the various members of the subcommittees that helped to run the trial, as well as all the doctors, and often the nurses, involved in recruiting and entering the patients into the trial. Subsequent articles from this trial might still use the phrase “and the xxxx trial investigators,” but this time the full list of investigators is not included in the Appendix. Nevertheless, some trials decide to list all participants in the Appendix for every manuscript published from that specific trial.
      Suggested rules governing authorship other than “active participation” have been promulgated by the International Committee of Medical Journal Editors,

      International Committee of Medical Journal Editors. Defining the role of authors and contributors. Available at: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed July 13, 2014.

      and based on these, our publisher, Elsevier, also has created a series of recommendations concerning authorship.

      Elsevier. Publishing ethics. Available at: http://www.elsevier.com/publishingethics. Accessed July 13, 2014.

      Elsevier. Ethics: publishing responsibilities of authors. Available at: http://www.elsevier.com/journal-authors/ethics. Accessed July 13, 2014.

      Nevertheless, and despite these suggested guidelines, there will be times, such as the event described by my colleague above, when disagreement about authorship arises. Consequently, I have always favored the policy of stating at the very outset of the trial exactly how authorship will be determined. Some of the trials that I have participated in have given front-page authorship to investigators who entered a specific number of patients into the trial. For example, in a large trial with thousands of patients, one might stipulate that any investigator entering 50 patients or more would be awarded front-page authorship, with all others listed in the Appendix, as described above. Some studies list authors in sequence dependent on the number of patients actually entered in the trial. In this latter case, authors are listed sequentially based on the numbers of patients entered. The decision concerning which authorship strategy to use is really up to the steering committee of the trial, and this issue should be discussed openly at the first investigators' meeting.
      Because there exist recommendations

      International Committee of Medical Journal Editors. Defining the role of authors and contributors. Available at: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed July 13, 2014.

      Elsevier. Publishing ethics. Available at: http://www.elsevier.com/publishingethics. Accessed July 13, 2014.

      Elsevier. Ethics: publishing responsibilities of authors. Available at: http://www.elsevier.com/journal-authors/ethics. Accessed July 13, 2014.

      but no laws to determine authorship, I would like to recommend the following simple guidelines:
      • 1.
        Authors listed on the first page of the article must all be active participants in either the design or some other phase of the trial, including writing or critically reviewing the manuscript, or both. In most cases, first-page authorship is not given to physicians whose only task is entering patients in the trial or registry. This latter group of participants is often listed in an Appendix to the article, as noted above.
      • 2.
        Rules for authorship should be stated up front and discussed openly with all participants before the trial or registry begins.
      • 3.
        It is generally advisable to list all study participants at some place in the article, on either the first or last page, as described above.
      Finally, I always try to abide by the authorship rule promulgated by my mentor, Dr. Lewis Dexter of the Peter Bent Brigham Hospital. He often told me that: “The fastest way to make an enemy is to fail listing someone as an author who thought they should have been included.”
      As always, I am happy to hear responses to this editorial on our blog at http://amjmed.org.

      References

      1. International Committee of Medical Journal Editors. Defining the role of authors and contributors. Available at: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed July 13, 2014.

      2. Elsevier. Publishing ethics. Available at: http://www.elsevier.com/publishingethics. Accessed July 13, 2014.

      3. Elsevier. Ethics: publishing responsibilities of authors. Available at: http://www.elsevier.com/journal-authors/ethics. Accessed July 13, 2014.