Authors, authorship order, the moving finger writes.

There has been a phenomenal increase in the number of research papers with multiple authors. Increasing academic pressures and halo around individuals with prolific publications have made many aspirants to claim authorship. Increasing number of authors has brought its own issues of author credits, disputes, rivalry, and a degree of unwelcome scramble for credit sharing. Many unresolved issues about authorship and various guidelines and admonitions are more often infringed than adhered to. The position of the first and last author seem to be well recognized in medical and dental journals, but the fate of middle authors is left to guessing and often of inconsequential importance. Most of these issues, as well as fraud, misconduct in medical research publications, have been discussed amply but too of no avail. It is comforting to know that except for small shouts and whispers, dental research has been relatively free from scams and frauds. The complacency, however, needs to be tempered with constant vigil against fraud, falsification and fabrication of research reports. Honest authorship, vigilant editors, robust peer review, and a discerning readership are the sine qua non for a good research paper. Academic institutions and selection committees should be concentrating on the quality of research papers and not enamored of their number.

The Moving Finger writes; and, having writ, Moves on: Nor all thy Piety nor Wit, Shall lure it back to cancel half a Line, Nor all thy Tears wash out a Word of it.

Omar Khayyam, where ever he would be having a smirk on his face when sees what is it all about modern research papers and how his prophecy has come true.

While working on this paper, we came across several phrases, adjectives, and interesting captions in literature connected with this subject. We are delighted with the ingenuity and sometimes the anguish and lamentations of the authors of some papers bemoaning about several issues concerning the subject: “Authorship is dying: Long live contributorship,” publish or perish, “author inflation,” “Gift authorship: A poisoned chalice” “salami publications” “meat extenders” “Authorship: An occasional source of wounds,” “The vexed question of authorship,” “The demise of the lone author,” “The single author as endangered species,” “The write position,” “Writer's cramp,” “Goodbye Ghostwriters,” “The tyranny of alphabet,” Scientific misconduct: Tip of an iceberg or the elephant in the room?

WHY DO AUTHORS WRITE?

There has been an explosion of medical writing and a plethora of new medical/dental journals have emerged. The unofficial and often explicit guidelines of universities and medical and dental schools for research papers in the curriculum vitae-armory of faculty and the dictum “publish or perish” for career advancement has been the real cause of this trend. One author bemoaned when he wrote “If we don’t publish, we are academically dead.”[1] The knack of getting articles published in prestigious journals with high impact factors is a prerequisite for success in research.[2] Scientific papers bring their own aura of greatness and a sense of self-glow. Apart from career advancement, peer pressure, sense of achievement and more grants, a person with many papers to his/her credit gets invited as speaker, visit countries and continents and many a time gets a decent honorarium/speaker's fees. Researchers want to share their research findings with others, but it is not only this altruism which is behind the zest for publication.

AUTHORSHIP CREDIT

Authorship credit should be based on (1) Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3.[3] The term author was suggested to be replaced by contributor and one of the authors be designated as Guarantor, who will vouch for the work.[4]

While the guidelines by ICMJE are very idealistic and utopian, they are not often adhered to strictly. It has been reported that about 26% the total authors had not contributed to the intellectual content of research papers.[5] It is difficult to make rigid categorization such as authors and contributors; considerable transgressions do take place. During the several stages in the sojourn of a paper, many unforeseen developments and events may arise which would require a change in strategy and regrouping of the available arsenal. The issue of gift author, honorary authorship, paying obeisance to mentors, and returning favors to friends also often mar this canvas. Authorship should not be a reward for long hours of work.[6]

UNACCEPTABLE AUTHORSHIP

To be legitimately designated as an author one must have participated in research, writing of the manuscript, assume public responsibility and produce data whenever required.[7]

Good research and publication ethics deprecate the guest and gift authorship. Guest authorship is often resorted to, expecting the eminence of the guest author to enhance the publication prospects of a scientific paper. Many eminent and venerable scientists, indeed, refuse to be part of such a ploy and do not lend their names unless they have a substantial role in the paper's preparation. Also, the guest authors’ presence is unrecognized when the peer reviewer is made unaware of the authors or institution's identity to which the paper is credited.

There is an another issue regarding gift authorship. When an academic colleague is short of required quota of papers, he/she requests the original team to include his/her name in the list of authors. Although an ethical transgression, such favours are often exchanged. The proliferation of multi author papers in the Indian dental journals in recent times is an illustration of this disconcerting trend in publication ethics.

According to Washinton University in St. Louis “Ghost authorship is the failure to identify as an author, someone who made substantial contributions to the research or writing of a manuscript that merited authorship, or an unnamed individual who participated in writing the manuscript.”[8]

TECHNOLOGICAL INNOVATIONS IN MEDICAL WRITING

Recently, medical researchers have evolved innovative measures to report their research. Busy and extremely time conscious researchers often do the entire clinical/laboratory work and give the data and background material to a group of professional writers who will prepare the manuscript. The manuscript after being approved by the original researchers gets published in their names. The fact that the initial draft is prepared by professional writers is adequately acknowledged in the acknowledgement section.[9] While ghostwriting is unethical and recommended to be banned, professional medical writing assistance is an ethical and legitimate practice.[10]

MAGNITUDE OF PUBLICATIONS BY MEDICAL RESEARCHERS

Those who are in the higher echelons of academia have an impressive publications record. A list of top-20 of the most prolific scientific authors in the world was published for the period between 1981 and 1990.[11] Some of these luminaries are Nobel laureates. Their phenomenal success is attributed to the enthusiasm for compulsive work, selection of a new research arena and prevailing environmental conditions. Yury Struchkov, a Russian, was the most prolific author, with 948 papers to his name. It is incredibly astonishing that he produced a new paper every 3.9 days. It is not unusual to find prominent medical and dental researchers having more than 100 quality research papers listed in their CVs.

REVIEWS, LETTERS TO THE EDITOR, IMPACT FACTOR: ARE ALL PUBLISHED PAPERS OF THE SAME VALUE?

Single author papers highlighting original research published in prestigious peer-reviewed journal assume an important role. Critical reviews, case reports, being a co-author of a large multi-author paper assume lesser significance. Letter to the editor, contributing in Conference proceedings although indicate a scientific spirit are less crucial as such items are rarely peer-reviewed.[2]

Publications are compared to coins at the disposal of academicians The coins, however, have different denominations with original articles in prestigious journals counting most while reviews, case reports occupy the lower rungs of the ladder.[12]

DISAPPEARANCE OF THE LONE AUTHOR

Sole authorship was common earlier and some landmark studies traced the lineage of sole authorship. But the practice has slowly given way to shared authorship. Multiple authors or multitude authors have become the order of the day in medical journals. In a world, where merit is tantamount to weight and length of publication list rather than the quality of contents, there is always a race and rush to publish. The increased number of authors is best illustrated in the case of Nature. The numbers of papers almost remains the same but the authors have increased fourfold, and a single author has been spoken as an endangered species![13]

WHY THERE ARE MANY AUTHORS IN MEDICAL JOURNALS?

There is a reason and a compelling one at that as to why medical journals have more than one author. In basic sciences such as chemistry, physics, and mathematics the researcher needs laboratories, equipment, and intellectual inputs. The researchers can repeat, redesign, and redo the experiment and others in distant areas across countries can repeat the experiments and verify the authenticity and accuracy of the results. There are no patients, no adverse events, no ethical conditions, no waiting, or gestation time for the outcome to surface. On the contrary, medical research has all these components and in addition has to use technological developments and a cornucopia of devices to incorporate in their research. The present trend of medical authorship may be put aptly in the following lines from John Donne's poem “No man is an island, entire of itself; every man is a piece of the continent, a part of the main.”

LIMITING THE NUMBER OF AUTHORS

ICMJE suggests only the listing of first six names followed by et al. in reference lists while citing articles. This does not limit the multi-authorship but only makes it convenient for the purpose of citation. Another approach to curtail the zeal to publish was initiated by the Harvard University when it set a limit of just 10 articles as requirement for evaluation by those applying for the post of a full professor.[14]

It has also been suggested this type of author inflation can be discouraged if quality rather than quantity be the criterion for individual's assessment of merit and single author papers be given more credence than multiple author papers.[2]

RESPONSIBILITIES OF AUTHORS

Authors and co-authors have onerous responsibilities. Everyone whose name appears in the byline is expected to have a good knowledge of the subject, should have participated in the study in a substantial way. Just as they share the honors they also have a responsibility to be accountable for the research paper. Simultaneous submission to various journals is considered as a scientific misconduct, the so-called Inglefinger rule. The authors are required to keep the data for a prescribed period even after publication of the paper.

ACADEMIC FRAUD, RESEARCH MISCONDUCT, UNETHICAL PRACTICE

Academic fraud has been the Achilles’ tendon for some of the medical researchers, and few instances of monumental fraud are quoted here to focus on the magnitude of the problem.

John Darsee, a medical researcher, while at Harvard published several papers which the NIH found to contain fabricated data and based on experiments which were never conducted. Several of his papers were retracted from respective journals in 1983.[15]

Malcolm Pearce, a British gynecologist, had published two papers in the British Journal of Obstetrics and Gynecology describing work that had never taken place and his name was struck off from General Medical Council. Later investigation revealed that Pearce had tampered with computer records in an attempt to create a fictitious patient. The paper was peer-reviewed twice. It never occurred to the referees that the whole thing might be a lie. Jon Sudbø, a Norwegian dentist and physician, perhaps is a leading example of scientific fraud concerning a dental professional. He fabricated the data in the field of oncology and several leading medical journals published his papers over a period of some years. Both his licenses to practice medicine and dentistry were revoked, and the University of Oslo revoked his doctorate in medicine in 2006. Several of his papers were retracted by respective journals.

RESEARCH MISCONDUCT

Awarding co-authorship to friends, colleagues who need publications for career advancement and expecting rewards or return of favors at a later date is misconduct. Although frowned upon, there is no denying that this quid pro quo does often happen.

SALAMI AND MEAT EXTRACTOR STUDIES

Often a single research paper and data are conveniently split (“salami science”) and continued as another paper. In another instance, data from one study are blended with additional data to produce another paper, where the additional data alone would not have qualified for a full paper (“meat extenders”). This type of wasteful publications inflicts enormous burden on readers, journal editors, libraries and indexing sources.

Falsification, misdemeanor, and scientific misbehavior do occur, and only an astute editorial team, robust peer reviewing process and knowledgeable and discerning readers can stem this rot. This is in addition to highest standards of integrity and a punishing self-discipline by the author team. Reviewers can only examine the data presented before them and have no way to assess whether the data has actually been collected and collected properly. “Data fabrication by a sophisticated cheat is almost impossible to detect.”[16] “The peer-review process is good at picking up poorly designed studies, but it is not designed to pick up fabricated research.”[17] It has been suggested that submission of the original data (raw data) along with the manuscript and registering the trial protocol in a public trial registry might make it more authentic and lessen the chances of fraudsters daring to submit tampered data nonchalantly.[18]

While serious publication frauds have surfaced in medical and basic science arenas, it is comforting to know that the dental academia has not been involved in any major transgression of publication ethics. Dental journal editors have been benign toward multi-author papers and need to exercise a little more control and put them on a tight leash. Unless the attitude of “hiding their head in the sand, like an ostrich” is given up, multiple authors will be seen in galore and burgeoning research papers will clutter and choke the research milieu.

INDIVIDUAL CONTRIBUTIONS TO MULTI-AUTHOR PAPERS

An authorship credit is a complex matter. It has been suggested that the role of each co-author be clearly spelt so that a discerning reader will come to his own judgment and a funding agency will be able to realize who has a played crucial role and who has not. Several journal editors advise the authors to clearly demarcate their contribution under specific headings mostly at the conclusion of the paper as it happens in some movie credits.[19]

Journal American Dental Association stipulates that people listed of authors should be those who made an intellectual contribution to the manuscript. The editor and publisher reserve the right to ask for justification for each author's inclusion. The journal also reserves the right to ask for justification for each author's inclusion.[20]

An example of author contribution and the specific role of contributors the following paper may be cited: Mine Tezal, Maureen Sullivan Nasca, Daniel L. Stoler, Thomas Melendy, Andrew Hyland, Philip J. Smaldino, Nestor R. Rigual, Thom R. Loree, Arch Otolaryngol Head Neck Surg. 2009;135(4):391-396.

Drs Tezal, Sullivan Nasca, and Hyland had full access to all of the data in the study and take responsibility for the integrity of the data.

Study concept and design: Tezal and Loree.

Acquisition of data: Tezal, Sullivan Nasca, Stoler, Smaldino, and Rigual.

Analysis and interpretation of data: Tezal, Stoler, Melendy, Hyland, Smaldino, and Loree.

Drafting of the manuscript: Tezal and Smaldino.

Critical revision of the manuscript for important intellectual content: Sullivan Nasca, Stoler, Melendy, Hyland, Rigual, and Loree.

Statistical analysis: Hyland.

Obtained funding: Tezal.

Administrative, technical, and material support: Tezal, Sullivan Nasca, Stoler, Smaldino, Rigual, and Loree. Study supervision: Melendy and Loree.

AUTHORSHIP ORDERS IN SCIENTIFIC PAPERS

One of the most vexing, distressing, controversial, and often the cause of bitter feuds and hostility among academicians is the order of authorship in multiple authored papers. This results from varying stipulations by different journal editors, Universities, and medical and dental schools. Several individuals/bodies have tried to unravel this problem but with limited success. The order of authors is a collective decision of the authors or study group. It is not possible for the University to define the order of authorship. In conjunction with the lead author, co-authors should discuss authorship order at the onset of the project and revise their decision as needed.[8]

AUTHORSHIP IN MATHEMATICS AND THEORETICAL COMPUTER SCIENCE

In mathematics, the authors are usually listed in alphabetical order (Hardy-Littlewood Rule) which means authors are alphabetically ordered, and everyone gets an equal share of credit.

ALPHABETIC AUTHORSHIP OF PAPERS

The system of listing authors of the paper in order of their family/surname is not commonly practiced nowadays. It tends to place all the authors in one basket irrespective of their importance. Furthermore, those with their name starting, unfortunately, with the last letters of the alphabet are eternally destined to appear among the last in the order of names.[2122]

AUTHORING OF PAPERS IN ORDER OF CONTRIBUTION

Credit according to the extent of contribution is still practiced but to a limited extent. Persons who have contributed the most appear first and so on.

FIRST AND LAST AUTHOR

The first and last authors are considered the most significant ones.[221] The first author is the one who does most of the work in the lab or field, whereas the last author is the mentor, the intellectual face behind the study. The last author often gets as much credit as the first author, because he or she is assumed to be the driving force, intellectually, conceptually, and financially, behind the research. Nichani[23] while stressing the importance of first and last authors also conceded the common practice of explicitly giving authors equal credit in original research publications. Sholapurkar[24] lamented that the Head of the department usually usurps the first place, and the resident/graduate student is relegated to be the last author and this practice is unfair and disgusting. He can take solace from the fact that were the paper to be read by a discerning reader in international circles, the last author gets his/her due (but not on the home turf!) The Dental Council of India, the august body concerned with upholding the standards of academic and intellectual aspects of Dental education, in its own wisdom deliberated on this and advised that in any publication, first author will be given 100% points and remaining authors will be given 50% points. There is an imperative need to have a relook into this aspect in view of the international consensus on authorship credits.

IMPACT FACTOR, INCENTIVES AND CITATION EFFECTS

Quite often academicians take recourse to Impact factor to buttress their claim for academic recognition and sometimes monetary gains. It is not fair to claim total impact factor by authors who have a trivial or insignificant role in the preparation of the paper. To overcome such aberrations, Tscharntke et al.[25] proposed the following: “Sequence-determines-credit” approach (“equal contribution” norm “first-last-author-emphasis” norm and the “percent-contribution-indicated” approach). These suggestions are more relevant for sharing the impact factor than apportioning author credits.

MIDDLE AUTHORS-UNSUNG AND LOST

In the hierarchy of scientific circles, the first and last authors are recognised and corner all the credit and limelight associated with the paper. However, it is the status of the middle authors and their contribution which has been viewed with a certain degree of taken-for-granted attitude. When an author's name appears in the middle, rather than the beginning or end, their perceived role in the project diminishes quickly. The middle authors receive little credit, and as the number of authors per paper grow, the roles of authors listed in the middle increasingly blur.[26] Their roles have been described as varying from fairly significant contribution to virtually nothing at all.[562728] ‘Citation counts, however, are historically assigned only to the first listed author and later listed authors are often buried under the et al. monster’.[29]

AUTHORSHIP AND DENTAL JOURNALS

Most of the contentious issues about authorship have been dealt in medical journals like Nature, Lancet, JAMA, NEJM, and the subject was in the eye of a medical storm in earlier years. Much of the dust has settled down but the topic continues to simmer, and the last word has not been said in this matter and a solution to the conundrum appears to be distant. The Dental journal editors were not embroiled in this, probably because everything was dealt with by medical editors! Journal of Dental research did involve and evince some interest through editorials and commentaries.[303132]

CONCLUSION

The gusto to publish and be seen as successful in academics by whatever means and the concomitant career advances have been the real cause for the various infringements of otherwise well-meaning guidelines. Author disclosures are meant to be honest declarations but for a person determined to be included in a research paper or a determined gift-giver, it is easy to provide fabricated details to justify his/her inclusion and qualify for authorship.

The question of authors and authorship has been dealt with by several people. Regulatory agencies and their recommendations reflect platonic idealism and pontifical advice. The chasm between precept and practice has never been bridged. There is no uniformity regarding the number of authors and their appearance in the byline. Credit sharing by the undeserving and the unworthy continues in spite of clear guidelines. The field is vitiated by fraudsters and subterfuge by people who have taken advantage of the flexibility and freedom given in the processing of research papers. Compared to other disciplines dental research has been relatively free from fraud and misdemeanor.

Journals alone cannot stamp out scientific misconduct. It is the responsibility of all the stakeholders involved.[33] Having waded through endless labyrinths of information and maze of conflicting views, it appears that honest authorship, vigilant editors, robust peer review, and a discerning readership are the sine qua non for a good research paper.