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Authorship

Bernard Lo, M.D.

August 23 and September 2, 2010

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Survey of UCSF fellows

Omitted as author 20%

Co-author didn’t deserve it 38%

Asked to make someone author who

didn’t deserve it 37%

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Case 1: Prior agreements fail

Participants enrolled, data collected

and entered into statistical program

First author not analyzing data or

writing paper

You want to take lead, get paper out

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Case 1: Prior agreements fail

What would you do? Send an ultimatum to your colleague Get your mentor to pressure him Forget about the project and move on Not sure

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Case 2: Added author

Division chief asks to be author

Comments in seminars and on abstract

Not participate in design or analysis

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Case 2: Added author

What would you do? Hold your nose and do it Ask your department chair to intervene Refuse and stand up for your principles Forget about the project and move on Not sure

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Outline of session

Criteria for authorship

Problems with authorship

Practical dilemmas

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Why have authorship?

Recognition Job, grants, promotions

Accountability Vouch for results and conclusions Prevent fabrication, fraud, plagiarism

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Criteria for authorship

Conception and design or data

analysis and interpretation, AND

Drafting or revising article for

important intellectual content, AND

Approving final manuscript

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Criteria for authorship

Not merely

Funding or equipment

Collection of data

Supervision of research group

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Implications of authorship

Take responsibility for at least one

component

Identify who is responsible for each

component

Confidence in co-authors ability and

integrity

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Problems with authorship

1. Publish articles that shouldn’t be

published False, fabricated data Duplicate publications

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Duplicate publication

Articles in systematic reviews 1234

Duplicate 103 (8%)

No cross reference 63%

Translations 12%

JAMA 2004; 291: 974

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Types of duplication

Identical sample and outcomes

Combine several articles

Report different outcomes on sample

New data added to preliminary article

Part of larger trial, same outcomes

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What is wrong with multiple publications?

Inefficient transfer of information

Bias in evidence base for systematic

reviews

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Problems with authorship

2. Fail to publish articles that should be Negative results

3. Too many authors = honorary authors People listed who shouldn’t be

4. Too few authors = ghost authors People omitted who should be authors

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Advantage study (2003)

Randomized trial of 5557 patients

Refecoxib vs. naproxen

Discontinue Rx for GI reasons: 5.9%

vs. 8.1%

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Advantage study

MIs: 5 on rofecoxib vs. 1 on naproxen 3 additional rofecoxib deaths not reported

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Statement by 1st author

“Merck designed the trial, paid for the trial, ran

the trial. . . Merck came to me after the study

was completed and said, ‘We want your help

to work on the paper.’ The initial paper was

written at Merck, and then was sent to me for

editing”

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Requirements for industry-sponsored research

Full responsibility for trial Design of study Access to data

• Independent statistician

Data analysis

Control over publication Including data detrimental to product

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Requirements for industry-sponsored research

Disclose financial relationships Including payment for writing

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Ghostwriting

Asked by medical education company

to write a review paper on interactions

between warfarin and dietary

supplements sponsored by drug

company

JGIM 2005; 20: 546

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Ghostwriting

Received draft article, with name on

title page

Company developing oral

anticoagulant No mention of product Biased against warfarin

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Ghostwriting

Later asked to review same paper No mention of ghost author No mention of drug company sponsorship

Are these isolated cases?

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Problematic authorship

Honorary authors 21%

Ghost authors 13%

Ghosts acknowledged 0%

JAMA 1998; 280:222

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Problematic authorship

No substantial contributions26%

Provided subjects, materials,

lab, technical assistance 58%

Collected data 25%

JAMA 1994; 271: 438

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Preventing ghost authorship

All persons who had input into writing

must be author or acknowledged

All persons named as authors or

acknowledged must complete financial

disclosure

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Problems with authorship

5. Authors in wrong positions

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Who’s on second?

Less prestige than first

Middle authors contribute even less

Last author often senior

Not cited after 6th

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Survey of department chairs

Fictitious article and authors

Infer author’s contributions

Epidemiology 2004; 15; 125

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Contributions of authors

“Little idea of roles of any author”

If corresponding author, more credit

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Documentation of authorship

Describe specific contributions In manuscript In promotion packet

Relationships among authors

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Paper on predictive model for HIV genotyping

1. Medical student

2. Former industry scientist, now at FDA Lawsuit against former company

3. Biostatistician

4. Programmer

5. You

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2nd author

Demanding and persistent in opinions

Revisions a “marathon”

Decisions not to accept his advice =

disregard his opinion “Accusatory and insulting”

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Paper has 4 rejections

2nd author wants to reframe the paper More on advances in predictive models

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Concerns of senior author

Get the article published somewhere Want to influence practice guidelines

Get medical student a publication for

internship applications

Minimize time and hassle

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Plan

One round of discussions

Senior author writes revision

Give authors option of accepting final

draft or withdrawing as author

Suggestions

Like “problem patient” Listen to concerns and expectations Address emotional issues explicitly Set boundaries Get agreement on process

Dissenting section of paper An alternative interpretation …

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Suggestions

Mediation

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Concussions in NFL players

Retrospective review of data from team

physicians

Return to play not associated with

increased risk of second concussion

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Conclusion

“Might be safe for college/high school

football players to be cleared to return

to play on the same day as the injury”

“Keep an open mind to possibility that

present analysis of professional

football players may have relevance to

college and high school players.”

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Dispute among 5 authors

Two disagreed

One said passage added without her

knowledge

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Lead author

Proofs were sent to each author No need to point out new passage

“If people who are not scientists or

physicians are misinterpreting it, that

is not the responsibility of those who

wrote it.”

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Case 1: Prior agreements fail

What would you do? Send an ultimatum to your colleague Get your mentor to pressure him Forget about the project and move on Not sure

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Excuses

It’s in the pipeline

It’s next in the pipeline

BMJ 1994; 309: 1739

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Excuses

I’m reanalyzing the data

The data are on a Windows computer

I can’t find the right statistical test to

prove it worked

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Pragmatic concerns

Power differences

Future repercussions

Is it worth the hassle?

Can you live with yourself?

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Just do it, diplomatically

“I know you’re very busy. I’m willing to

take over as 1st author and write a

draft.”

“If I haven’t heard in 3 weeks, I’ll

assume you’re too busy to be first

author.”

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Case 2: Added author

What would you do? Hold your nose and do it Refuse and stand up for your principles Ask your department chair to intervene

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Just say no, diplomatically

“The journal insists that all authors

sign that they have met a list of

requirements. I would feel very

awkward signing this. I’d like your

permission to give you a big thank you

in the acknowledgments.”

Emotional impact of authorship disputes

After disputes commonly feel:

Angry

Hurt

Taken advantage of

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Take home points

Be explicit about authorship positions

and responsibilities

Spell out arrangements in advance