Ethical dilemmas in journal publication

Clinics in Dermatology (2012) 30, 231–236

Ethical dilemmas in journal publication Olubukola Babalola, BS a , Jane M. Grant-Kels, MD b,⁎, Lawrence Charles Parish, MD, MD(Hon) c a

University of Connecticut School of Medicine, Farmington, CT, USA Dermatology Department, MC 6230, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA c Department of Dermatology and Cutaneous Biology, Jefferson Center for International Dermatology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA b

Abstract Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. Editors also face ethical challenges, including how best to manage peer-review bias, to address reviewer tardiness, and to locate reviewers with appropriate expertise and professionalism. Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae (“salami factor”), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process. © 2012 Elsevier Inc. All rights reserved.

Introduction Publication of a scientific manuscript is the ultimate affirmation of scholastic achievement.1 It affords the investigator an opportunity to put forth the result(s) of hard work and time investment into a journal to advance knowledge in a given field. It is a significant accomplishment, imparting respect and pride to the physician. In addition, publication not only can translate into academic advancement, but it can also offer secondary monetary rewards; ie, granting the researcher a higher income via academic promotion and creating an avenue for further research funding.1 Physicians often face major pressures to publish for a number of reasons. Whether this is for career advancement, intellectual curiosity, practice enhancement, or pecuniary interests, there is an impetus to publish. Such pressures may even lead to corner cutting.2 ⁎ Corresponding author. Tel.: +860 679 3474; fax: +860 679 1267. E-mail address: [email protected] (J.M. Grant-Kels). 0738-081X/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.clindermatol.2011.06.013

We discuss some of the ethical dilemmas physicians, as well as editors, may face in publishing. Examples are included to highlight the issues. The areas examined include the following: Authorship challenges • Authorship—what constitutes authorship, avoidance of ghost authorship • Duplication—self-plagiarism and duplicate publication. • Plagiarism • Falsification and fabrication • Mechanism of dealing with alleged misconduct (ie, falsification of data) by submitting authors that is fair and balanced Editorial challenges • Management of peer-review bias, promptness, expertise, and professionalism • Management of authors who fragment their work into multiple publications to enhance their curriculum vitae (“salami factor”)

232 • Management of financial benefits of advertising and conflicts of interest of the journal • Conflicts of interest

Authorship Case: A resident pens the results of a clinical trial she has undertaken. When the paper is submitted for publication with her mentor, the resident's name is not listed first even though she wrote the paper. In addition, there are authors listed whom the resident never met and who had nothing to do with the clinical trial or with writing of the paper. Authoring a scientific publication is a privilege and a gratifying moment in a physician's career.3 Aside from the respect and honor it confers, it can open many doors to advance further the physician's career; however, authorship involves a great deal of responsibility. As one writer stated: “It is this amalgam of credit and responsibility that forms the precious foundation for the esteemed moniker of ‘author.’”3 An author may be defined as “someone who has made a substantial intellectual contribution.”1 Although this definition serves as a guide in identifying who qualifies as an author, it may become inadequate when determining whether a contribution is substantive or not. Assigning authorship may become a contentious and difficult task. According to the International Committee of Medical Journal Editors (ICMJE), the most frequent disputes center on the following questions: 1. Which members of a research team merit authorship? 2. Who is designated as the senior author of the resulting journal contribution? 3. How is the rest of the authorship order determined? In an effort to resolve disputes surrounding the first question, some criteria for authorship have been proposed by the ICMJE.4 A would-be contributor should: • Provide substantial contributions to conception and design, data acquisition, or analysis and interpretation of data; • Be involved in document drafting or provide critical review for important intellectual content; • Give final approval of publication. The ICMJE also comments on what criteria, taken alone, do not qualify an individual for authorship4: • Securing funding; • Collecting data; • Supervising the project. Concerning the question of senior authorship noted previously, the National Institutes of Health has stated some duties to be carried out by the qualifying senior author. He or she should coordinate the completion and submission of the manuscript and attend to all the rules of submission. He or she should also be

O. Babalola et al. responsible for all communication regarding the manuscript (with the journal and its reviewers), where appropriate. This person should also ensure that the contributions of all those involved in the study are recognized. More to the point, he or she must confirm that each coauthor has reviewed and approved the paper for submission at all points in the process. The third issue, the order of authorship, has no preset guidelines. Many different ways of ethically arranging the authorship order have been proposed. These include descending order of contribution, alphabetical listing, and random order. Although the significance of a particular order may be understood in a given setting, widespread agreement has not been reached.5 To avoid disputes surrounding this, Drummond Rennie, the distinguished Deputy Editor of the Journal of the American Medical Association, has suggested that each “contributor” list his or her explicit role in the project. The authors should also decide on the order of authorship together.3 Ethical problems about authorship of scientific manuscripts are twofold:6 • Inclusion of authors who did not contribute substantially to the study (gift authorship); • Exclusion of authors who did contribute significantly to the study (ghost authorship). Gift authorship typically involves the addition of people, hierarchically above the author(s), such as the head of the department or a program director. Such names may be included out of a sincere desire to acknowledge the individual's contribution to the project, financial backing, or moral support.6 Going by the guidelines, such contributions do not meet the criteria for authorship. Involved persons may be more appropriately recognized in the acknowledgment section. Another form of gift authorship6 takes place between colleagues. In such a situation, a name of a colleague is added to the manuscript with the expectation that this gesture will be reciprocated. This creates an avenue for both colleagues to improve their publication records and curriculum vitae; needless to say, such gifts should be discouraged.6 On the other end of the spectrum, an individual may be omitted unjustifiably from the authorship list; this is often the case with ghost authorship. This tends to involve people hierarchically below the author. The author hopes to attain a greater acknowledgment for his or her work by failing to credit the work of others. The author may paint the contribution of others as insignificant enough to merit authorship, when, in actuality, this may not be the case.6 Authorship should be regarded as a privilege and not a right.1 Authors have an ethical duty as guarantors who hold responsibility for the work. This includes not only the validity of the study but also fairness in assigning authorship.1 Finally, all persons designated as authors should merit authorship, with all qualifying authors listed. Conversely, people who do not qualify as authors should be excluded. Fair play, responsibility, and integrity should be at the forefront of ethical authorship decisions.1

Ethical dilemmas in journal publication

Duplication—self-plagiarism Case: A reviewer notified the associate editor of a peerreviewed journal that the paper being asked to be reviewed was remarkably similar to a paper the author's group had previously published. When the associate editor obtained the already published paper, it was obvious that the author was guilty of self-plagiarism. The author was notified but denied awareness of such a deed. The editor-in-chief of the publication found the situation serious enough to warrant notifying the author's chairman of the episode. Duplicate publication is the publication of a contribution that is identical to or significantly overlaps an already published contribution by the same author, with or without acknowledgment.3 It is also a subset of redundant publication in that 2 papers share the same hypothesis, results, and conclusions. Both situations have also been termed selfplagiarism.3 Despite this definition, it is often difficult to define duplication, and confronted with inducement to publish, investigators may gravitate toward publishing when meeting head-on with such a situation.7 The concept of self-plagiarism tends to be less readily apparent. Self-plagiarism occurs when an author reuses text in subsequent writings without attributing it to the previous publication.2 Arguments have been made that it is impossible to steal one's own words; others suggest that there are limited ways to say the same thing. In fact, it may even be challenging to restate one's own previously published words when writing on the same subject repeatedly. This might be valid, but when substantial portions of a paper are a verbatim copy of an existing contribution, credibility of the author becomes questionable.2 Duplicate publication is ethically and legally problematic.1 For example, readers trust that the work being read is original and may fail to detect a duplicated work. In addition, duplication may also be a violation of a copyright. From another view, these duplications waste resources, ranging from the readers' time to the wasted print. Duplications can also lead to double counting and weighting of results of a single study.1 It, needlessly, expands the already extensive body of published literature.3 Several steps may be taken to identify duplicate publications.1 Editors may perform literature searches to assess duplication, if the question arises. Authors are often asked to affirm that the contribution is original before submission. Violations have resulted in authors being banned from publication in that particular journal. A violation can also result in a complaint being put forward to an ethical and professional conduct committee,1 such as that of the American Academy of Dermatology or a similar committee of another society.

Plagiarism Case: A book is being threatened with rejection by the publisher because the authors of a chapter took a table from

233 a journal without asking and without appropriate referencing. The senior author never answered the book or journal editor's queries, and the junior author, a resident, was assumed to be following instructions. Plagiarism is the “stealing of words or ideas from the true author and claiming the work as one's own.”8,9 The Office of Research Integrity (ORI) amplifies the definition of plagiarism: “theft or misappropriation of intellectual property and the substantial unattributed textual copying of another's work which materially misleads the ordinary reader regarding the contributions of the author.”10,11 Plagiarism can result from the flagrant intent to mislead by claiming another's work as one's own to receive credit to unintentional carelessness in citing the original source.10,12 Appropriate citation is required when using the words or ideas of others. This allows the reader to know the exact source of the information. Unreferenced paraphrasing and crediting only a portion of another's work are misappropriation of the original author's work as one's own original work.8,13 Plagiarism can be sometimes difficult to detect, but some strides have been made in the way of technology to detect a plagiarized work. An example is the algorithm of the eTBLAST search engine that allows users to detect duplicate citations and text similarity.14 Reviewers can also play a significant role in detecting plagiarism owing to their familiarity with published material in their area of expertise. If a contribution is detected to be plagiarized, it should be rejected promptly. Plagiarized work detected after publication will result in the process of retraction.10 When in doubt, it is better for an author to cite than risk plagiarism accusations. Plagiarism can result in penalties ranging from shame, humiliation, damaged reputation, and letters of reprimand to forced resignation, loss of academic credentials, termination of duty, and law suits.8 For example, a department chairman incorporated a significant portion of copyrighted material from a book he helped edit into another book he later wrote without attribution or permission. He subsequently lost his departmental chairmanship but continued as a tenured professor and successfully authored other publications.15 Some strategies for the ethical prevention of plagiarism have been suggested:8 • Use other words to express the author's idea, • Paraphrase ideas but reference the original sources, • Obtain written permission for the use of all cartoons, drawings, or figures.

Falsification and fabrication Case: A researcher was reviewing his data and before publication eliminated outlying results to strengthen his hypothesis and conclusion. His fellow was the only other person aware of the manipulation of the data. The fellow was

234 frightened of possible retribution and, therefore, never relayed this information to the journal or department chair. Falsification can be deleterious, summoning the veracity of the entire contribution into question. Publications of fallacious information are unethical, detract from the truth, weaken trust in scientific investigations, may lead to adoption of inefficient interventions, and destroy reputations.16 One group has studied contributions retracted from topcited journals with an allegation of falsification.16 The study targeted 21 journals that received over 30,000 citations annually and have ISI (Institute for Scientific Information) impact factors above 10. The impact factor was used to measure the relative importance of a journal, as it is a gauge measuring the number of citations of contributions published in that journal. The results revealed it took more than 2 years, on average, to retract these contributions, but there was considerable variation. Apparently, there was strong resistance to retracting articles where senior investigators were involved. Articles involving junior researchers were retracted much sooner than those in which senior investigators were the culprits. The study also showed that detection of falsified articles can pose a challenge. Fraudulent articles had no strong alerting signs. Overall, fraudulent contributions looked nearly identical to nonfraudulent ones; therefore, a falsified paper can easily go undetected by thorough peerreviewers and journal editors.

Mechanism of dealing with alleged misconduct There should be a fair, ethical, and balanced way to deal with misconduct accusations. Once an allegation is put forward, committee members who are free from bias and have no conflicts of interest should be selected.17 The institution should make an inquiry to gather information and make findings of facts to determine whether the allegation has substance.17 The respondents should be given an opportunity to provide written comments on the institution's inquiry report.18 In a situation where no finding of research misconduct is found, it is not only appropriate but necessary that all reasonable and practical efforts be made to protect and restore the reputations of such persons alleged to have engaged in research misconduct.18

Management of peer-review bias, promptness, expertise, and professionalism Case: A well-known guest editor of a peer-reviewed journal was disliked by another equally well-known academic physician in his country; the two had been at lager-heads for years. The editor-in-chief of the journal received hate mail about the guest editor from this colleague. It was suspected that the accusations were unsupported. The editor-in-chief could not substantiate the claims and chose to ignore what he considered to be hate mail.

O. Babalola et al. Reviewing manuscripts is a crucial part of the editorial peer-revision process. An editor or a member of the editorial team of the journal usually extends the invitation to review, and the invitation is based on the reputation and subject matter expertise of the prospective reviewer.19 An ethical issue in the peer-review process is conflict of interest. Such conflicts of interest can taint the review process by introducing bias, either positive or negative, at the crucial step of deciding the appropriateness of a manuscript for publication.19 The presence of competing interests can provide insight into the possibility of conflicts. Examples of competing interests include financial ties that could be influenced by the detail of the manuscript, academic commitments, institutional affiliations, previous or current ties with the authors, competing research, and strong political or religious beliefs (if affirmed or challenged in the manuscript), or strong scientific beliefs. 19 Obviously, reviewers may have prejudices that often cannot always be identified. If a reviewer has no known conflicts of interest, the reviewer should carefully determine his or her ability to complete the review process in a timely manner.19 The individual should ask the following questions19,20: 1. Do I have expertise in the content or methods, or a valuable perspective on the issue? Unless the answer is an unequivocal “yes,” the invitation should be declined. 2. Do I have time to devote to this review and complete it by the requested date? If there is any uncertainty, the invitation should be declined. Reviewers have ethical obligations and delays can disrupt the publication process.19 Authors deserve prompt, written, and unflawed feedback that is free of personal attack or criticism. Reviewers should avoid disclosing information to uninvolved parties. Editors seek fair, constructive, and informative evaluation with suggestions aimed at improving the work. Readers need protection from inaccurate and falsified information.19

Management of authors who fragment their work into multiple publications to enhance their curriculum vitae (“salami factor”) Faced with incentives to publish, investigators may sometimes slice the data taken from a single research project or accumulated from a single study period into different pieces, generating multiple manuscripts from the pieces, and publishing these in different journals, a practice called salami slicing.21 This is often done to boost their publication record and enhance their curriculum vitae. Although this practice is generally considered unethical, there are exceptions to this rule. If it is a large clinical or epidemiologic study where results cannot be published together, or the study addresses 2 different and distinctly important questions, then an additional paper would be

Ethical dilemmas in journal publication appropriate.21 Similarly, a case report containing a lengthy review of the diagnosis and/or treatment might well be divided into 2 contributions.

Management of financial benefits Scientific journals sometimes realize financial benefits from sponsors and advertisements. Contributions made by sponsors may influence editorial decisions and may lead to the publication of biased works; however, a sponsored publication may indeed have educational benefits. At times, it may even be difficult to publish without such financial backing. How should financial benefits be ethically managed? The World Association of Medical Editors (WAME)22 sugests that journals adopt a formal and transparent advertising policy. Also, advertisements should clearly identify the advertiser and the product or service being offered. The WAME further suggests that products or services being advertised should be pertinent to the practice of medicine, medical education, or health care delivery.22 Journal advertisements do not necessarily have to result in compromise of virtue. Advertisements can be in good taste, and editors should ensure that a quality journal is produced despite financial demands. Sponsors should have limited control over the publications as much as possible.

Conflicts of interest Case: A group of dermatologists have personally invested in a new technology to help diagnose melanoma at its earliest stages. They sincerely believe that this technology will advance the early diagnosis of melanoma and will, thereby, save lives. This same group of dermatologists is involved in the clinical trials to test this new technology; however, the study is truly double blinded and the authors' conflict of interest is clearly noted in the submitted paper. According to the International Committee of Medical Journal Editors (ICMJE),23 “conflict of interest exists when an author (or the author's institution), reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions.” These relationships may have a variety of effects on judgment. Financial reward tends to be the most crucial and obvious conflict of interest (COI); however, conflicts can also stem from intellectual passion and academic rivalry, among others.23 Participants involved in the publication process should reveal potential sources of conflict. Authors have an obligation to reveal financial and personal relationships that may influence their work. Investigators should disclose potential conflicts to research subjects and should state in the manuscript whether they have done so. Editors may then use disclosed COIs in making necessary decisions.23

235 It is obviously not feasible to eliminate all COIs. Editors should ensure, where possible, that those selected to review a manuscript have no significant COI. As mentioned earlier, reviewers may be asked specifically before they review a contribution to enumerate if and what their COIs might be.23 Caution must be used in eliminating all reviewers such as those with a known COI with a drug company; however, often these same individuals have the most expertise regarding the medication being studied. Without expert reviewers, one cannot sustain a peer-review journal.

Conclusions Although the pressures to publish are great, integrity and ethics in publication are paramount. Diligence to detail and vigilance are required. Accomplishing this will not only uphold the public's trust in medical publications, but it will also help maintain a sense of personal integrity.

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