Literary meanings of an author is “A writer of a book, article, or document” or “Someone who writes books” or “An originator of a plan or idea”. Earlier in the eighteenth century till the start of twentieth century, single authorship was the rule that prevailed. In this new era of scientific research and development, importance of research papers cannot be overlooked. Hence, ethical issues regarding authorship arose. This problem posed a great threat to public health and a fraud in research field. To combat such ethical issues, International Committee of Medical Journal Editors (ICMJE) made recommendations for standardizing the ethics, preparation and formatting of manuscripts submitted for publication by biomedical journals. Its initial version was called “Uniform Requirements for Manuscripts” (URMs) and was submitted to Biomedical Journals in 1978. URMs was revised in 1997 and some of the sections were updated in May 1999 and May 2000. Now it has been renamed as “Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals”. This document was revised in 2013, 2014, 2015 and 2016. The members of ICMJE meet annually and discuss the matters related with publications.

The ICMJE recommends that authorship be based on the following 4 criteria:

· Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

· Drafting the work or revising it critically for important intellectual content; AND

· Final approval of the version to be published; AND

· Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

All four criteria must be met to get a designation of an author. Those who meet lesser criteria should be acknowledged or included in the list of contributors.

With the new standard definition of “authorship” other terminologies of authorship were also introduced; which included, ghost authorship, honorary authorship, guest authorship and gift authorship. Unfortunately, these terms are not very well known to the authors in our part of the world.

Ghost authors are the persons who have worked in research planning, data collection, data analyzing and manuscript writing, but their names are not written in the list of authors. These authors may take their origin in one of the following forms. Firstly, junior colleagues and workers, who are the real authors but their names do not appear in the list of authors because their seniors want their own names to be credited instead of the real authors. Second type of ghost authors are the personal writers of researchers, they write the manuscript and save researcher’s time. Third one is the most notorious in which, a pharmaceutical company hires some writers to write a research paper and after that, name of a well known scientist is used as author, who didn’t even know the real work. This is the most dangerous form of ghost authorship. Gotzsche¹ found that 75% of the pharmaceutical company sponsored trials were written by ghost authors, which is a serious concern. Most of the time, such trials are in favor of the sponsor and patient’s benefit is kept at a side.

Contrary to that there are honorary authors, who are not involved in any of the activities of paper writing but they are given credit as a coauthor. Guest and gift authorship come under the heading of honorary authorship. Guest authors do not have any contribution in the paper writing but they are considered coauthors for example, junior colleagues add the names of their seniors to gain some extra benefits, or to increase the chance of publication. The guest authorship is very common in our part of the world where head of the department or institution expect and pressurize their juniors to write their names to get false credit of something that they do not even know or as a part of “you write my name, I write yours” process.

There is another authorship called gift authorship in which, authors have some relationship with the study or have contributed to a level which does not meet the criteria of authorship by International Committee of Medical Journal Editors (ICMJE) guidelines. Co-authorship is gifted to those persons who have done non-author tasks such as reviewing or approving manuscript before submission or data collection.

In Pakistan, ghost authorship is not a problem, as clinical trials by pharmaceutical companies are not very common. However, honorary authorship has become a nuisance. So much so, if a departmental head allows access to the patients, there is a demand to add his name as a coauthor. This does not end here. Sometimes the heads of departments try to influence the list of authors. They think it their right to be in the list of first three authors. These unethical issues arise because honorary authors want authorships for their promotions or peer recognition. Lack of interest in research, lack of basic knowledge of paper writing and lack of incentives and funds in the research field has led to increase in the number of honorary authors. The result is a long list of authors. This phenomenon of long list of authors is not only endemic in our settings, rather it has acquired the shape of a Pandemic. Not far in the past, a paper on Drosophila was published in “G3: Genes, Genomics, Genetics” with 1014 authors². In the same year, world-record was made for the largest number of contributors in a research paper with 5154 authors. In this 33 page article, 24 pages were meant to mention the contributors and their institutions. Such kind of studies were justified by the authors as these were joint ventures with large number of people working on a single large project. This cannot be applied in our setups where a single case report has so many authors.

In the post ICMJE era, prevalence of articles with honorary and guest authorship was reduced from 29.2% in 1996 to 21%. Ghost authorship was reduced from 11.5% in 1996 to 7.9% in 2011⁴.

ICMJE recommendations have their pros and cons. The advantage was that the number of authors was reduced. The disadvantage was that the persons who did not meet all the four criteria were denied of their due credit. This problem was addressed by Paneth who suggested that there should be categories of persons involved in paper writing⁵. Those who meet all four criteria should be called authors, those who satisfy less than 4 criteria should be listed as contributing authors, and those who qualify only one criterion should be called acknowledged contributors.

The problem, no doubt, is there. The question is; what is the solution? The responsibility lies in the hands of the PMDC, editors of journals, institutions and at the individual level as well. Recently, PMDC has decided to give equal credit to the first three authors. No credit is given to the authors after three. Although, it is a good step to discourage honorary authorship but problem still exists when multi-institutional studies have more than three persons who qualify authorship criteria but will be denied of any credit at PMDC level. This gives rise to unfairness. The departmental head or the senior uses his or her influence to get his name written in the first three authors and the juniors who deserve the authorship are left unaccredited.

On part of the journal editors, restricting the author count can be helpful but again it raises the possibility of injustice against true authors, especially if the study is done at multiple centers.

Ethical issues are best tackled by good grooming. Hence, the heads of the institutions and departments should adopt a fair way by not pressurizing their juniors for writing their names as authors. Setting good examples by the seniors will bring about a definite and long lasting change.

Author’s Affiliation

Dr. Tayyaba Gul Malik

FCPS, Professor of ophthalmology

Rashid Latif Medical college, Lahore.

REFERENCES

1. Gotzsche PC, Hrobjartsson A, Johansen HK, Haahr MT, Altman DG, Chan AW. Ghost authorship in industry-initiated randomised trials. PloS Med. 2007 Jan; (4): e19.

2. Sarah Elgin et al. Drosophila Muller F Elements Maintain a Distinct Set of Genomic Properties Over 40 Million Years of Evolution. G3: Genes, Genomes. Genetics, 2017 Mar; (7).

3. Ad G. et al. ATLAS Collaboration, CMS Collaboration. Phys. Rev. Lett. 2015; 114: 191803.

4. Wislar JS, Flanagin A, Fontanarosa PB, DeAngelis CD. Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey. BMJ. 2011: 343.

5. Paneth N. Authorship: readers and editors respond. Am J Public Health, 1998; 88: 824–826.