Ethics in medical writing.

Research is a must for the progress of medical science and a well-written research paper adds to the knowledge of medical fraternity, apart from bringing accolades to its authors. Emphasis on interest in upholding of ethical conduct in the pursuit of high-powered scientific investigation is more prevalent and of more concern now than ever before.[1] Scientists, including medical researchers, are increasingly coming under the watchful eyes of public to dissuade them from adopting unethical means. Before embarking on clinical research/writing in medical scientific journal, one should have clear knowledge of what constitutes unethical behavior. According to the Webster dictionary, the definition of Ethics is principles of conduct governing an individual or a group. Writing a scientific paper involves a high burden of responsibility on the shoulder of its authors. It is, therefore, extremely important to uphold the standards of ethical conduct while writing for a biomedical journal. Scientific misconduct was defined by the US department of Health and Human Services in 1990[2] as plagiarism (presenting author's ideas without attribution); fabrication (presenting unsubstantiated facts or data); falsification (changing or selecting certain data to achieve a desired result, misrepresenting evidence, facts, or authorship); or other serious deviations from accepted practice in proposing, conducting, or reporting research. The author may be dragged to the court of law if he/she indulges in unethical behaviour of plagiarism. Therefore, never get tempted to take credit for someone else's work. Now issues as conflict of interest and protection of patients’ rights have also assumed significance; editors are extremely sensitive to the maintenance of high ethical standards and only manuscripts that meet their ethical guidelines are accepted for publications in biomedical journals. In 1978, International Committee of Medical Journal Editors (ICMJE) evolved consensus statements on publication ethics issues such as confidentiality, competing manuscripts based on the same study, statement on retraction of research findings, order of authorship, guidelines for the protection of patients’ rights to anonymity, and conflict of interest.[3] Always adhere to the authorship criteria of the ICMJE and acknowledge lesser contributions to the manuscript who did not meet the criteria. The ICMJE states that authorship credit should be based on the following.

Substantial contribution to conception and design, acquisition of data, or analysis and interpretation of data.

Drafting the article or revising it critically for important intellectual contents.

Final approval of the version to be published.

Authors should meet all the above conditions; however, there are no objective guidelines to determine authorship. Contribution of those who assisted in conducting study/writing manuscript, including biostatistician, must be acknowledged.

According to ICMJE, patients have a right to privacy that should not be violated without informed consent. Identifying information including names, initials, or hospital numbers, should not be published in written description, photographs or pedigrees, unless the information is essential for scientific purposes and the patient (or parents or guardians) give written informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown the manuscript to be published. Nonessential identifying details should be omitted. For example, masking the eye region in photographs of patients is inadequate.

Scientific misconduct, that is, fabrication and falsification of data, is now considered similar to other criminal offences and often committed by the same offenders.[4] If there is missing data, do not try to fabricate it. A biostatistician's opinion must be sought in such case because statistical methods exist to deal with missing data, but authors must describe any such methods used and apply them in consistent manner. Do not try to misuse statistics to achieve a preconceived result. One should pick up a published photograph/images or tabulated data only after obtaining written permission from the original author, otherwise it will be considered as an act of plagiarism. The permission should be acknowledged as a footnote.

If an author is contemplating a trial conducted on a new drug or new indication of an existing drug, he/she should be transparent in declaring his/her conflict of interest (COI) in both financial and otherwise. A COI has been defined “as a set of conditions in which professional judgement concerning a primary interest (such as patient's welfare or the validity of the research) tend to be duly influenced by a secondary interest (such as financial gains).”[5] If the work was financially supported by some commercial organization or pharmaceutical company, the source of funding must be acknowledged. ICMJE explicitly recognizes that COI is a two-way-street, that is, authors are not alone in being influenced by their relationships.

When presenting results of randomized controlled trials, authors should follow guidelines such as consolidated standards of reported trials (CONSORT) statement and indicate clearly how many patients were screened, randomized, assessed, and included in the study.[6]

Finally, all the citations mentioned in the write up should be stated in the reference list and they should be checked carefully for their accuracy in all respects, to help readers locate various articles, and their serial numbers in reference list should match with the serial number in the text. Though this is not necessarily an unethical practice but an innocent error on the part of the author, it is a source of considerable inconvenience to its readers.

The authors must keep in their mind that their statement on conclusion derived from the study will determine the treatment of countless number of patients. Therefore, they should act honestly for the benefit of patients and public at large, and they should write only the facts which have emerged from the study.