Letters to the Editor
readers of their similarity, I believe that Horton and Smith’s
Recent eLetters to the Editor are available at http://radiology
.rsnajnls.org. eLetters that are no longer posted under ‘‘Recent
eLetters’’ can be found as a link in the related article or by
browsing through past Tables of Contents.
The Authorship Dilemma: Will It Ever Be Solved?
From:
Anı́bal J. Morillo, MD
Department of Radiology and Diagnostic Imaging, Hospital
Universitario de San Ignacio
Piso 2, Cra 7, No. 40-62, Santafe de Bogotá, DC, Colombia
e-mail: amorillo@javercol.javeriana.edu.co
Editor:
I read with great interest the letter by Drs Probyn and Asch in
the May 2000 issue of Radiology (1) concerning the as yet
ineffective new guidelines for authorship of articles pub-
lished in Radiology. Many undeserving authors of scientific
papers may still be recognized as actual contributors to an
article although they do not meet any of the current well-
known standards that have been devised and periodically
updated by several of the most serious journals following
International Committee of Medical Journal Editors (ICMJE)
criteria (2). The contrary is also true: Contributors who be-
lieve that they deserve authorship have been excluded (3,4).
Working in a university-based program does not guarantee
that authorship policies are followed. It has not been uncom-
mon that the members of my department who have contrib-
uted noticeably to research projects are excluded from au-
thorship of articles written by those in other clinical
departments, even when they conceived the project. Another
frequent situation, already pointed out by Simon and Rose
(5), is that in which the diagnostician, who may be the first or
only one to solve a case, is not even acknowledged in an
article written by others in reference to that same case.
With the current level of information available I believe
that it is inexcusable for any member of an academic envi-
ronment to fail to comply with or to claim to be unfamiliar
with modern publication policies. As long as there are pro-
gram or laboratory directors who are more interested in in-
flating their bibliographies (6) than in applying these rules,
problems related to authorship will be recurrently reported.
Policy changes such as the commendable ones recently es-
tablished by Radiology will continue to show frustrating re-
sults, as described in the letter by Drs Probyn and Asch.
Irresponsible co-authors are rarely sanctioned as they deserve
(7). Even those dedicated to the development or follow-up of
guidelines for research integrity have been involved in mis-
understandings, to say the least, related to the ethicality of
their own surveillance procedures (8). In my opinion, an
excellent example of duplicate publication is that by Richard
Horton and Richard Smith, who, on March 23, 1996, co-
authored the editorials in the prestigious British Medical Jour-
nal (3) and The Lancet (4). Although their editorials are not
identical and although there is a note in each informing
Volume 217 䡠 Number 2
editorials are still a case of redundancy. Who watches over
the watchers?
Detection of duplicate publication requires extensive po-
lice work that has been compared to practices used during the
Inquisition (9). The availability of information can backfire
against those of us concerned with these issues. With the
wealth of information now available online, plagiarism may
be easier to perform, as Ryan has reported (10).
Indeed, the rules are difficult to apply, and, in some cases,
they may even be unrealistic. As long as there is subspecial-
ization, authors might not be able to respond publicly regard-
ing all that is written in their articles simply because some of
the material submitted will not be within their scope, which
is highly specialized. Such may be the case for statisticians,
who have already considered a method for their inclusion as
authors using criteria that, not surprisingly, use a math-
ematic approach (11). In 1993, the Association of University
Radiologists’ Ad Hoc Committee on Standards for the Re-
sponsible Conduct of Research tried reconciling the rules
with reality (12). Their interesting proposal might work at an
academic departmental level, but problems can still be ex-
pected when the time comes to publish the results of respon-
sibly conducted research, since these rules are not as strict as
the current editorial policies of many journals, which have
subscribed to the cited ICMJE requirements.
As the director of an academic program, I have long been
interested in the issue of authorship, plagiarism, and related
subjects. I am currently involved in a personal project in
which I am trying to explicitly state the publication rules for
all the research projects in which my department of radiol-
ogy is involved. This is not a minor task, indeed, but it may
be an initial step toward the local solution of a multifaceted
situation. Policies such as the one Dr Proto describes in his
response to Drs Probyn and Asch regarding the identification
of author contributions are inspiring and archetypical. For
those involved in academics, the time to attempt a solution
to the dilemma of authorship is long overdue.
References
1. Probyn LJ, Asch MR. The effect of changes in guidelines for
authorship on current Radiology publications (letter). Radiology
2000; 215:615– 616.
2. Uniform requirements for manuscripts submitted to biomedical
journals: International Committee of Medical Journal Editors.
N Engl J Med 1997; 336:309 –315.
3. Horton R, Smith R. Time to redefine authorship (editorial). BMJ
1996; 312:723.
4. Horton R, Smith R. Signing up for authorship (letter). Lancet
1996; 347:780.
5. Simon D, Rose C. Signing up for authorship (letter). Lancet
1996; 347:1412.
6. Anderson C. Authorship: writer’s cramp. Nature 1992; 355:101.
7. Court C, Dillner L. Obstetrician suspended after research in-
quiry. BMJ 1994; 309:1459.
8. Appleton BL, Mishkin B. Quis custodiet ipsos custodes? (letter).
Nature 1995; 378:432.
9. Rogers LF. Salami slicing, shotgunning and the ethics of author-
ship (editorial). AJR Am J Roentgenol 1999; 173:265.
10. Ryan JJCH. Student plagiarism in an online world. ASEE Prism
1998; 8:20 –24.
11. Parker RA, Berman NG. Criteria for authorship for statisticians
in medical papers. Stat Med 1998; 17:2289 –2299.
Radiology 䡠 597
12. Friedman PJ. Standards for authorship and publication in aca-
demic radiology: AUR Ad Hoc Committee on Standards for the
Responsible Conduct of Research. Invest Radiol 1993; 28:879 –
881.
Dr Proto responds:
My thanks to Dr Morillo for the many insights with respect to
the letter to the Editor by Drs Probyn and Asch (1) and my
response (2). Regarding the comment that the editorials pub-
lished in the British Medical Journal (3) and The Lancet (4) are
an example of duplicate publication, I must respectfully dis-
agree. Per the uniform requirements for manuscripts submit-
ted to biomedical journals (5), I believe that these editorials
fall under the category of acceptable secondary publication.
For such to occur, a footnote is needed to inform the readers
that the material has been published either in whole or in
part. Such a footnote accompanies each of these editorials in
both The Lancet and the British Medical Journal, as mentioned
by Dr Morillo.
In the letter, Dr Morillo also points out that authors might
have difficulty in responding to all that is written. This cer-
tainly is realized. Our author contributions information
found on the first page of each original research article iden-
tifies the types of contributions made by each author and
thus the areas of responsibility.
Clearly, Dr Morillo is highly committed to appropriate
designation of an individual as an author. We commend Dr
Morrilo for being dedicated to this important matter.
References
1. Probyn LJ, Asch MR. The effect of changes in guidelines for
authorship on current Radiology publications (letter). Radiology
2000; 215:615– 616.
2. Proto AV. Reply (letter). Radiology 2000; 215:616.
3. Horton R, Smith R. Time to redefine authorship (editorial). BMJ
1996; 312:723.
4. Horton R, Smith R. Signing up for authorship (letter). Lancet
1996; 347:780.
5. Uniform requirements for manuscripts submitted to biomedical
journals: International Committee of Medical Journal Editors.
Ann Intern Med 1997; 126:36 – 47.
Anthony V. Proto, MD
Radiology Editorial Office
1001 East Broad Street, Suite 310, Richmond, VA 23219
e-mail: proto@rsna.org
Authors Need to Be Educated on Authorship
Principles
From:
Christos A. Athanasoulis, MD
Department of Radiology, Massachusetts General Hospital
GRB 290A, 32 Fruit Street, Boston, MA 02114
e-mail: athanasoulis.christos@mgh.harvard.edu
Editor:
The listing of author contributions in Radiology is laudable. It
is an important step toward the education and improved
understanding of prospective authors about the privileges
598 䡠 Radiology 䡠 November 2000
and responsibilities of authorship. Additional measures may
be necessary. Honorary authorship, guest authorship, cour-
tesy authorship, and swap authorship (ie, the notion of “list
me in your article and I will include you in mine”) are, sad to
say, practices embedded in the fabric of academic depart-
ments.
The issue is particularly prevalent among clinical divisions
of large departments. If six physicians work in a division, the
established routine calls for all members of the group to be
listed as authors in all articles by the division. The first author
does the work, the second provides substantial input, the last
author is honorary, and the others are listed because they are
group members. The practice is considered rational, espe-
cially when the work is based on clinical material (retrospec-
tive clinical studies as opposed to laboratory research). Clin-
ical material carries the notion of ownership. If, for example,
the subject of an article is the placement of renal arterial
stents, all group members expect to be included as co-authors
regardless of the effort they expended in the preparation of
the paper. Since they performed some of the procedures, they
believe they own the material and are entitled to automatic
authorship.
Here are some of the reasons expressed in favor of this
system. A young member of the faculty was grateful to her
co-workers for freeing her from her clinical duties to work on
a paper. She felt obliged to include her colleagues out of
gratitude. For a more senior faculty member the matter was
straightforward. It was a philosophy, he declared. We are a
group, we perform procedures together, and everyone is in-
cluded in the paper regardless of intellectual contribution.
Senior authors, usually honorary and commonly division
heads, prefer not to discuss authorship principles as long as
the papers are being published, and all members are auto-
matically included. I hasten to add that these opinions are
expressed in good faith. The authors do not wish to circum-
vent the system. They do not think they are dishonest. They
believe that they are doing the right thing, and they fail to
see why the Editor of Radiology attempts to enforce rules that
disrupt the existing collegial authorship system. Thus, there
is a need for education.
In a letter to the Editor in the May 2000 issue of Radiology
(1), Drs Probyn and Asch underscored the risks and respon-
sibilities associated with authorship. They suggested that ar-
ticles might have an acknowledgment section for authors
with minimal contributions. This is reasonable; however,
acknowledgments are of no value for the purpose of aca-
demic promotion. In his reply to the same letter, the Editor
aptly stated, “[It] will undoubtedly require a period of edu-
cation and understanding” before we reach the point where
all authors of published articles meet the authorship criteria
established by the International Committee of Medical Jour-
nal Editors (2).
Education is necessary indeed. The listing of author con-
tributions will help. Also, here are possible additional steps.
First, scientific journal editors should endorse and promote
the inclusion of authorship as a required component in the
training of physicians in medical schools and in postgraduate
training programs. This can be accomplished through the
publication of relevant editorials, letters, lectures, workshops,