Shakespeare vs Hippocrates

There is no mystery about the authorship of Shakespeare’s plays. They were not written by Shakespeare at all. They were written by a total stranger, about whom all we know is that he was called Shakespeare. This quote was delivered by Alphonse Allias.

The recent controversy set off by authorship issues surrounding some medical publications has created echo chambers that reinforce what we want to believe and not what we should believe. It is time to step back and look at the issue dispassionately and allow people to draw their own conclusions.

Although widespread throughout the biomedical sciences, the practice of honorary authorship—the listing of authors who fail to merit inclusion as authors by authorship criteria—has received relatively little sustained ethical attention.

Honorary authorship occurs when a person who has not earned authorship is listed as an author on a scientific paper. There are two well-known authorship criteria.
1. The first is a ‘substantial intellectual contribution,’ found in the World Association of Medical Editors guidelines and adopted by many universities (WAME, 2009). 

The second is the International Committee of Medical Journal Editors (ICMJE, 2010) criterion which requires each of the following three conditions to be met (ICMJE, 2010)
a. Substantial contributions to conception and design, or acquisition of data, 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.
 Despite the ethical implications, there is a lack of consensus, at a minimum, which leads to conflict between researchers about appropriate authorship (e.g. what norms are best, who should be named).
 An editorial in the legendary medical journal, The Lancet revealed that only 50% of authors of papers in The Lancet clearly meet the ICMJE authorship standards. Honorary authorship is, clearly, a significant problem in the biomedical literature.
Compromise on genuine authorship occurs in several shapes
1. Offering authorship to a senior or junior colleague in the blatant or surreptitious hope that they will return the favor.
2. Granting authorship to people in senior positions within the facility where the research occurred with an aim to secure funding. 
3. Guest authorship to senior authors who are included because of their influence in the hope that this will increase the likelihood of publication and/or impact of the paper once published. 
4. Gift authorship to further the career prospects of the recipient.

A particularly pernicious kind of honorary authorship occurs when distinguished academic researchers are listed as the authors of papers ghostwritten by industry. In these cases, the sham academic author is used to hide conflicts of interest and to give the resulting paper the appearance of impartiality.

No one would argue that determining authorship is always straightforward, particularly with the growth of larger and larger research teams and the emergence of large collaborative study groups. According to a study, honorary authors accounted for 26% of all authors listed in six leading general medical journals in 2008; the percentage of honorary authors varied from a low of 16% in the New England Journal of Medicine to an eye-opening 39% in Nature Medicine. A survey in Nature revealed that 10% of researchers had “inappropriately assigned authorship credit” in the last three years. It was also found that 19% papers had honorary authors, while a 2002 paper found evidence of honorary authorship in 39% of Cochrane reviews.

Editors all over the world know that it is a significant problem. Jane Smith, a Deputy Editor at BMJ suggested, ‘‘Perhaps most importantly, those who have really done the work have an interest in seeing their role is not devalued by the inclusion of many who have done so little’’. More recently, the bioethicists Smith and Williams-Jones stated, ‘‘Granting authorship to everyone who enables research would be an unrealistic and extreme extension of the notion of authorship…such authorship practices would arguably undermine the value of being named on a scientific publication.’’ Any author should have an adequate working knowledge of the content to publicly defend the work. Stewart and Feder extensively documented that honorary authorships falsify the assignment of responsibility for published research and increase the likelihood that inaccurate data will be published. ’Perhaps the most pertinent and apt description developed when Grist commented, ‘‘An author is responsible for what is written, for its truth and intelligibility’’

A recent development which has added to the grey area of medical publication has evolved after promotions and job opportunities have been linked to the number of publications. Feeding into this publication frenzy, the number of predatory journals has increased exponentially. This means money can be made from desperate authors by these journals. This is often achieved by gifting authorship to many individuals so that the article processing charges are shared around. Passion which is so central to any pursuit is sucked out and replaced by cold pragmatism. Pseudo authorship due to pragmatism might guarantee promotions and selections but science and the future of our medical science and academic leadership suffers.

I have published across a range of topics in the medical landscape, and I must admit with hindsight, that I have also been guilty of including zero contribution authors in a few of my own manuscripts. I write whilst straddling a fine line of hypocricy, guilt and experience. The recent controversy that triggered this article surrounds the gift authorship granted by one of the most accomplished medical researchers to his grandchildren. While the debate triggered by the act is valid but targeting the ability and achievements of the young children who might have contributed to the publications is unfair. I personally do admire any effort, however small, by children in the pursuit of research. It should be lauded without losing sight of the basic argument. To prevent gift authorship whilst promoting and acknowledging effort an alternate solution had been developed by some journals which have restricted the concept of authorship and embraced the concept of ‘‘contributorship’. Or as is often done, the name is added at the bottom in the acknowledgement section.

I will narrate a documented incident here which will help in illustrating the widespread nature of the problem. In a paper on the first cloning of a dog, Snuppy, a prominent researcher Schatten’s only contribution to the paper was to suggest the use of a professional photographer to take Snuppy’s photo. For this, he received credit as author.

In the pursuit of an improved and fairer scientific future, it is important to remember that authorship is the primary way in which the profession assigns credit and responsibility for scientific work. The problem is not merely a legalistic violation of a professional code of conduct; assigning credit for work you did not do is misrepresentation, and misrepresentation is incompatible with the integrity necessary to be a responsible researcher.

However, it is still a nebulous concept and a lot of work needs to be published and discussed before definite and stringent criteria can be put in place. Till then if ethics matter (and they do), the main authors have an obligation to ensure that the co-authors meet relevant authorship criteria. It still boils down to conscience. It is worth recollecting and learning from that famous line by Mark Twain ‘If the snake was forbidden, Adam would eat it too’.