- Email: [email protected]
Re: Ghost Writers in the Sky
788
LETTERS TO THE EDITOR
the individuals. The authors claim that this omission was due to the more sensitive nature of these items, supporting our concerns. Conversely, this method may increase the willingness of some patients to seek medical help for LUTS and sexual dysfunction, and may consequently affect the results. In our opinion these questionnaires should have been completed by the individuals involved. Although the physician administered version of the International Prostate Symptom Score has previously been used and observed to be reliable in other studies,1 no such studies have been performed for the IIEF, which was developed and validated as a brief and reliable self-administered scale for assessing erectile function.2 If the IIEF is to be used as a physician administered instrument, formal validation studies are necessary. Respectfully, E. C. Serefoglu, A. T. Ozdemir and M. D. Balbay Department of Urology Ataturk Training and Research Hospital Ankara, Turkey 1.
2.
Plante M, Corcos J, Gregoire I, Belanger MF, Brock G and Rossingol M: The International Prostate Symptom Score: physician versus self-administration in the quantification of symptomatology. Urology 1996; 47: 326. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J and Mishra A: The International Index Of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822.
Reply by Authors. We appreciate the thoughtful comments on our recent work examining the relationship between LUTS and erectile dysfunction. Serefoglu et al raise several interesting points. First, they question the originality of our findings, and then almost immediately indicate how our work is unique (by considering for the first time the individual symptoms of LUTS and also the symptoms of urinary incontinence, prostatitis and painful bladder syndrome). Replication (confirmation of earlier research findings) is an important feature of good science and, as Serefoglu et al indicate, our study goes well beyond mere replication. They raise another important issue concerning the validity of data gathering methods (interviewer administered vs self-administered questionnaires) and clearly prefer self-administered instruments. Unfortunately, we failed to mention— but our colleagues will be pleased to learn—that we did, in fact, use self-administered questionnaires (in English and Spanish) to gather information on the sensitive topics of abuse and sexual functioning. In addition, it is noteworthy that just 1 question concerning erectile dysfunction (asked by a well trained field interviewer) was used on the Massachusetts Male Aging Study,1 and this question has been validated by clinical urological examination. They are also concerned about missing data, a common problem when questioning randomly sampled individuals rather than conveniently available patients in a clinic or hospital setting. As is now common practice in statistics, we use multiple imputation to replace missing data with plausible values to use the data with minimal bias (assuming that the data are missing at random).2 If anything, multiple imputation adds noise to the data, yet we found a strong association of lower urinary tract symptoms and erectile dysfunction that was consistent across race/ethnic groups (the largest nonresponse was among Hispanics).
Finally, we are aware that the interview mode may influence the response to urological questions.3 However, it has not been shown that the association of sexual function with urological symptoms (the focus of this article) varies by interview mode. 1.
2. 3.
O’Donnell AB, Araujo AB, Goldstein I and McKinlay JB: The validity of a single-question self-report of erectile dysfunction. Results from the Massachusetts Male Aging Study. J Gen Intern Med 2005; 20: 515. Schafer JL: Analysis of Incomplete Multivariate Data. New York: Chapman and Hall 1997. Rhodes T, Girman CJ, Jacobsen SJ, Guess HA, Hanson KA, Oesterling JE et al: Does the mode of questionnaire administration affect the reporting of urinary symptoms? Urology 1995; 46: 341.
Re: Ghost Writers in the Sky J Urol 2008; 179: 809 – 810. To the Editor. In a recent editorial the Editors highlight the issue of “ghost writers” in urological manuscripts. They raise a number of thoughtful considerations for authors who contribute to manuscripts that are primarily drafted by a professional medical writer, and discuss the associated ethical issues for the authors. While I fully agree with all points mentioned in this editorial, I believe that there is an ethical side not only to being an author, but also to not being an author. In recent years many leading medical journals have defined policies of what does and does not constitute authorship of a scientific manuscript. While the various definitions differ somewhat, they all share that authorship primarily is defined by relevant intellectual contributions to the submitted manuscript. Typically, these criteria are used to ascertain that all people who are listed as authors have, indeed, made substantial intellectual contributions. It is now increasingly accepted that being named as an “author” without such contributions is unethical. On the other hand, those defining criteria of authorship also imply that people who, indeed, have made substantial intellectual contributions should be authors. While there is a gray zone, compiling all the data and writing the first draft of a manuscript clearly is a substantial intellectual contribution. Therefore, I would deem it appropriate if medical writers in most instances are made authors of the manuscript they have drafted rather than being relegated to the acknowledgments section. Respectfully, Martin C. Michel Department Pharmacology and Pharmacotherapy Academic Medical Center University of Amsterdam Amsterdam, The Netherlands e-mail: [email protected] Reply by Editor. The Editors of The Journal of Urology® appreciate the comments of Doctor Michel. We are in the process of formulating authorship criteria, and the role of medical writers, which we failed to mention in our editorial, will be considered.
LETTERS TO THE EDITOR
the individuals. The authors claim that this omission was due to the more sensitive nature of these items, supporting our concerns. Conversely, this method may increase the willingness of some patients to seek medical help for LUTS and sexual dysfunction, and may consequently affect the results. In our opinion these questionnaires should have been completed by the individuals involved. Although the physician administered version of the International Prostate Symptom Score has previously been used and observed to be reliable in other studies,1 no such studies have been performed for the IIEF, which was developed and validated as a brief and reliable self-administered scale for assessing erectile function.2 If the IIEF is to be used as a physician administered instrument, formal validation studies are necessary. Respectfully, E. C. Serefoglu, A. T. Ozdemir and M. D. Balbay Department of Urology Ataturk Training and Research Hospital Ankara, Turkey 1.
2.
Plante M, Corcos J, Gregoire I, Belanger MF, Brock G and Rossingol M: The International Prostate Symptom Score: physician versus self-administration in the quantification of symptomatology. Urology 1996; 47: 326. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J and Mishra A: The International Index Of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822.
Reply by Authors. We appreciate the thoughtful comments on our recent work examining the relationship between LUTS and erectile dysfunction. Serefoglu et al raise several interesting points. First, they question the originality of our findings, and then almost immediately indicate how our work is unique (by considering for the first time the individual symptoms of LUTS and also the symptoms of urinary incontinence, prostatitis and painful bladder syndrome). Replication (confirmation of earlier research findings) is an important feature of good science and, as Serefoglu et al indicate, our study goes well beyond mere replication. They raise another important issue concerning the validity of data gathering methods (interviewer administered vs self-administered questionnaires) and clearly prefer self-administered instruments. Unfortunately, we failed to mention— but our colleagues will be pleased to learn—that we did, in fact, use self-administered questionnaires (in English and Spanish) to gather information on the sensitive topics of abuse and sexual functioning. In addition, it is noteworthy that just 1 question concerning erectile dysfunction (asked by a well trained field interviewer) was used on the Massachusetts Male Aging Study,1 and this question has been validated by clinical urological examination. They are also concerned about missing data, a common problem when questioning randomly sampled individuals rather than conveniently available patients in a clinic or hospital setting. As is now common practice in statistics, we use multiple imputation to replace missing data with plausible values to use the data with minimal bias (assuming that the data are missing at random).2 If anything, multiple imputation adds noise to the data, yet we found a strong association of lower urinary tract symptoms and erectile dysfunction that was consistent across race/ethnic groups (the largest nonresponse was among Hispanics).
Finally, we are aware that the interview mode may influence the response to urological questions.3 However, it has not been shown that the association of sexual function with urological symptoms (the focus of this article) varies by interview mode. 1.
2. 3.
O’Donnell AB, Araujo AB, Goldstein I and McKinlay JB: The validity of a single-question self-report of erectile dysfunction. Results from the Massachusetts Male Aging Study. J Gen Intern Med 2005; 20: 515. Schafer JL: Analysis of Incomplete Multivariate Data. New York: Chapman and Hall 1997. Rhodes T, Girman CJ, Jacobsen SJ, Guess HA, Hanson KA, Oesterling JE et al: Does the mode of questionnaire administration affect the reporting of urinary symptoms? Urology 1995; 46: 341.
Re: Ghost Writers in the Sky J Urol 2008; 179: 809 – 810. To the Editor. In a recent editorial the Editors highlight the issue of “ghost writers” in urological manuscripts. They raise a number of thoughtful considerations for authors who contribute to manuscripts that are primarily drafted by a professional medical writer, and discuss the associated ethical issues for the authors. While I fully agree with all points mentioned in this editorial, I believe that there is an ethical side not only to being an author, but also to not being an author. In recent years many leading medical journals have defined policies of what does and does not constitute authorship of a scientific manuscript. While the various definitions differ somewhat, they all share that authorship primarily is defined by relevant intellectual contributions to the submitted manuscript. Typically, these criteria are used to ascertain that all people who are listed as authors have, indeed, made substantial intellectual contributions. It is now increasingly accepted that being named as an “author” without such contributions is unethical. On the other hand, those defining criteria of authorship also imply that people who, indeed, have made substantial intellectual contributions should be authors. While there is a gray zone, compiling all the data and writing the first draft of a manuscript clearly is a substantial intellectual contribution. Therefore, I would deem it appropriate if medical writers in most instances are made authors of the manuscript they have drafted rather than being relegated to the acknowledgments section. Respectfully, Martin C. Michel Department Pharmacology and Pharmacotherapy Academic Medical Center University of Amsterdam Amsterdam, The Netherlands e-mail: [email protected] Reply by Editor. The Editors of The Journal of Urology® appreciate the comments of Doctor Michel. We are in the process of formulating authorship criteria, and the role of medical writers, which we failed to mention in our editorial, will be considered.