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The slippery slope of authorship

Filed on: August 25, 2010 | Written by | Add new comment

ICMJE, the International Council of Medical Journal Editors, asserts that only those who have made substantial intellectual contribution to a study qualify as authors. The Council lays down three criteria, namely substantial contribution to the study, a role in drafting or revising the article critically, and a share of responsibility in approving the final version [1]. Generally, an author takes public responsibility of the work.

Although many journals accept these criteria, it is hard to clearly define substantial intellectual contribution, which makes it difficult for journal editors caught in disputes over authorship to interpret the criterion. In fact, COPE, the Committee on Publication Ethics, suggests the best way forward is to ask the institution(s) with which the authors are affiliated to investigate the matter and suspend the review process until the matter is resolved. While the issue of who qualifies to be an author was hotly debated at the conference of the European Association of Science Editors in 2009, the consensus was that journals should move toward contributorship rather than authorship [2]. For instance, The Lancet asks authors to provide details of the exact role and contribution of each author. However, even this is not a perfect system and is difficult for journal editors to police. At the end of the day, we have to trust the authors to do this themselves and be transparent about it.

Two other problems related to authorship are guest authors and ghost authors. A guest author is somebody who is an author not because of direct involvement in the study but because of his or her position in the institution or involvement in acquiring funds for the study. According to a recent post on the COPE website by Virginia Barbour, medical students are taught – or rather led to believe – early in their career that guest authorship is acceptable [3]. Clearly it is not! A study by Flannette and co-workers revealed that 21% of the papers published in 2006, and 19% in 2008, listed guest authors [4]. In some countries, especially in Asia, it is acceptable for the head of the department to be included as an author as a mark of respect, which is both a problem of culture and ignorance. There have been a few cases when a well-known academic has been approached to lend his or her credibility to a study funded by a commercial sponsor without any involvement in the actual study. When data are analysed post-publication and such a person asked to defend the study, they might deny any involvement in the study.

A ghost author, on the other hand, is somebody who helps researchers in writing the paper or even writes the entire paper but is seldom acknowledged, let alone considered for an authorship.  The proportion of ghost writers and guest authors reported by authors who publish in the Chinese Medical Journal is similar to those previously reported in general medical journals in the USA [5]. Many authors may be unaware of the authorship criteria defined by ICMJE, but the culture in many countries considers guest authorship as acceptable.  Although the proportion of guest authors has not changed significantly since 1996, that of ghost authors has declined significantly, as reported in a study of six general medical journals [6]. In the meantime, guest and ghost authors continue to be of concern to journal editors and institutions. A recent paper in PLoS Medicine showed that only 13 of 50 (26%) academic medical centers in the USA publicly prohibit their faculty from participating in ghost-writing [3].

Problems often come to light when authors disagree among themselves and contact the journal editor after a paper is published. COPE publishes several such cases along with helpful flowcharts on what journal editors can do. However, the deeper issue is the attitude to authorship in research institutions and differences about who qualifies as an author. The solution perhaps is to teach students early on in their research career about authorships and the pitfalls of guest and ghost authorships. COPE has developed some useful guidelines for students or young researchers, who often face this problem. Education, awareness, and ethical standards are the way forward. Authors should consider authorship a serious issue, and all those involved in a study should participate in deciding on who should qualify as the authors of papers based on that study.


1.   Uniform requirements for manuscripts submitted to biomedical journals: ethical considerations in the conduct and reporting of research: authorship and contributorship. http://www.icmje.org/ethical_1author.html

2.   D Sambunjak, R Hurley. Integrity in science communication: EASE conference report. European Science Editing 2009; 35(4): 99 http://www.ease.org.uk/artman2/uploads/1/ESE_nov09.pdf

3.   V Barbara. Medical students are taught early guest authorship is acceptable. http://publicationethics.org/blogs/medical-students-are-taught-early-guest-authorship-acceptable

4.   Flanagin A, Carey LA, Fontanarosa PB, et al. Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals. JAMA 1998; 280:222-224. 

5.   Hao X, Qian S, You S, and Wang M. Ghost writers and honorary authorship: a survey from the Chinese Medical Journal. http://www.ama-assn.org/public/peer/abstracts_2009.html#6

6.   Wislar J, Flanagin A, Fontanarosa PB, DeAngelis CD. Prevalence of honorary and ghost authorship in 6 general medical journals, 2008. http://www.ama-assn.org/public/peer/abstracts_2009.html#7

[Shehnaz Ahmed is the Managing Editor of Rheumatology.]