How industry uses the ICMJE guidelines to manipulate authorship--and how they should be revised

"Technical" Contributors and Authorship Distribution in Health Science

In health sciences, technical contributions may be undervalued and excluded in the author byline. In this paper, I demonstrate how authorship is a historical construct which perpetuates systemic injustices including technical undervaluation. I make use of Pierre Bourdieu's conceptual work to demonstrate how the power dynamics at play in academia make it very challenging to change the habitual state or "habitus". To counter this, I argue that we must reconceive technical contributions to not be a priori less important based on its nature when assigning roles and opportunities leading to authorship. I make this argument based on two premises. First, science has evolved due to major information and biotechnological innovation; this requires 'technicians' to acquire and exercise a commensurate high degree of both technical and intellectual expertise which in turn increases the value of their contribution. I will illustrate this by providing a brief historical view of work statisticians, computer programmers/data scientists and laboratory technicians. Second, excluding or undervaluing this type of work is contrary to norms of responsibility, fairness and trustworthiness of the individual researchers and of teams in science. Although such norms are continuously tested because of power dynamics, their importance is central to ethical authorship practice and research integrity. While it may be argued that detailed disclosure of contributions (known as contributorship) increases accountability by clearly identifying who did what in the publication, I contend that this may unintentionally legitimize undervaluation of technical roles and may decrease integrity of science. Finally, this paper offers recommendations to promote ethical inclusion of technical contributors.

Stepping beyond Counts in Recovery of Total Knee Arthroplasty: A Prospective Study on Passively Collected Gait Metrics

Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m/s, p = 0.063) and double support percentage recovered at week 24 (32%, p = 0.089). Asymmetry percentage was recovered at 13 weeks (14.0%, p = 0.23) and was consistently superior to pre-operative values at week 19 (11.1% vs. 12.5%, p < 0.001). Step length did not recover during the 24-week period (0.60 m vs. 0.59 m, p = 0.004); however, this difference is not likely clinically relevant. The data suggests that gait quality metrics are most negatively affected two weeks post-operatively, recover within the first 24-weeks following TKA, and follow a slower trajectory compared to previously reported step count recoveries. The ability to capture new objective measures of recovery is evident. As more gait quality data is accrued, physicians may be able to use passively collected gait quality data to help direct post-operative recovery using sensor-based care pathways.

A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration

Background

The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters.

Method

This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC).

Results

The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies.

Discussion

The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.

Perish and publish: Dynamics of biomedical publications by deceased authors

The question of whether it is appropriate to attribute authorship to deceased individuals of original studies in the biomedical literature is contentious. Authorship guidelines utilized by journals do not provide a clear consensus framework that is binding on those in the field. To guide and inform the implementation of authorship frameworks it would be useful to understand the extent of the practice in the scientific literature, but studies that have systematically quantified the prevalence of this phenomenon in the biomedical literature have not been performed to date. To address this issue, we quantified the prevalence of publications by deceased authors in the biomedical literature from the period 1990-2020. We screened 2,601,457 peer-reviewed papers from the full text Europe PubMed Central database. We applied natural language processing, stringent filtering and manual curation to identify a final set of 1,439 deceased authors. We then determined these authors published a total of 38,907 papers over their careers with 5,477 published after death. The number of deceased publications has been growing rapidly, a 146-fold increase since the year 2000. This rate of increase was still significant when accounting for the growing total number of publications and pool of authors. We found that more than 50% of deceased author papers were first submitted after the death of the author and that over 60% of these papers failed to acknowledge the deceased authors status. Most deceased authors published less than 10 papers after death but a small pool of 30 authors published significantly more. A pool of 266 authors published more than 90% of their total publications after death. Our analysis indicates that the attribution of deceased authorship in the literature is not an occasional occurrence but a burgeoning trend. A consensus framework to address authorship by deceased scientists is warranted.

Authorship Issues When Articles are Retracted Due to Research Misconduct and Then Resubmitted

In the last 20 years, there has been a sharp increase in the incidence of retractions of articles published in scientific journals, the majority of which are due to research misconduct. In some cases, researchers have revised and republished articles that were retracted due to misconduct, which raises some novel questions concerning authorship. Suppose that an article is retracted because one of the authors fabricated or falsified some data, but the researchers decide to salvage the useable data, make appropriate revisions, and resubmit the article for publication. If the person who committed misconduct has made a significant contribution to the research reported in the revised paper, should they be named as an author to recognize this contribution or should they be denied authorship because they committed misconduct? This is a challenging issue because it involves the confluence of two research ethics domains that are usually dealt with separately, i.e., resolution of authorship disputes and adjudication of misconduct findings, as well as potential conflicts among norms that underlie authorship practices and misconduct adjudication. In this paper, we (1) describe some actual cases involving articles that were retracted for misconduct and republished; (2) review policies from the International Committee of Medical Journal Editors, Committee on Publication Ethics, and top fifteen biomedical journals to determine whether they provide adequate guidance for cases like these; and (3) analyze the ethical and policy issues that may arise in these situations.

[Authorship and Inappropriate Authorship from an Ethical Publication Perspective]

Authorship is important for research integrity and publication ethics, acting as the basis for credit and academic achievement. Moreover, publication achievements have a significant impact on research grants and academic careers. Inappropriate authorship has been reported for several reasons, including complex interests and competitive environments. One form of this is representative authorship misuse, which includes honorary and ghost authorships. Kin co-authorship, such as parent-children authorship, is another form of inappropriate authorship that has recently emerged as a social problem in Korea. To address these issues, the International Committee of Medical Journal Editors (ICMJE) has established criteria for authorship. Similarly, many journals use the Contributor Roles Taxonomy (CRediT) and Open Researcher and Contributor ID (ORCID) systems to prevent authorship misuse and systematically evaluate author credit and responsibility. Herein, this article reviews authorship and inappropriate authorship, as well as introduces methods to avoid authorship misuse.

The relationship between endorsing reporting guidelines or trial registration and the impact factor or total citations in surgical journals

BACKGROUND

A journal's impact factor (IF) and total citations are often used as indicators of its publication quality. Furthermore, journals that require authors to abide by reporting guidelines or conduct trial registration generally have a higher quality of reporting. In this study, we sought to explore the potential associations between the enforcement of reporting guidelines or trial registration and a surgical journal's IF or total citations in order to find new approaches and ideas to improve journal publication quality.

METHODS

We examined surgical journals from the 2018 Journal Citation Report's Expanded Scientific Citation Index to quantify the use of reporting guidelines or study registration. We reviewed the "instructions for authors" from each journal and used multivariable linear regression analysis to determine which guidelines were associated with the journal IF and total citations. The dependent variable was the logarithm base 10 of the IF in 2018 or the logarithm base 10 of total citations in 2018 (the results were presented as geometric means, specifically the ratio of the "endorsed group" results to "not endorsed group" results). The independent variable was one of the requirements (endorsed and not endorsed). Models adjust for the publication region, language, start year, publisher and journal size (only used to adjust total citations).

RESULTS

We included 188 surgical journals in our study. The results of multivariable linear regression analysis showed that journal IF was associated (P < 0.01) with the following requirements: randomized controlled trial (RCT) registration (geometric means ratio (GR) = 1.422, 95% CI [1.197-1.694]), Consolidated Standards of Reporting Trials (CONSORT) statement (1.318, [1.104-1.578]), Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) statement (1.390, [1.148-1.683]), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (1.556, [1.262-1.919]), Standards for Reporting Diagnostic Accuracy (STARD) statement (1.585, [1.216-2.070]), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement (2.113, [1.422-3.133]). We found associations between the endorsement of RCT registration (GR = 1.652, 95% CI [1.268-2.153]), CONSORT (1.570, [1.199-2.061]), PRISMA (1.698, [1.271-2.270]), STROBE (2.023, [1.476-2.773]), STARD (2.173, [1.452-3.243]), and MOOSE statements (2.249, [1.219-4.150]) and the number of total citations.

CONCLUSION

The presence of reporting guidelines and trial registration was associated with higher IF or more total citations in surgical journals. If more surgical journals incorporate these policies into their submission requirements, this may improve publication quality, thus increasing their IF and total citations.

No room for ambiguity: The concepts of appropriate and inappropriate authorship in scientific publications

Authorship is the currency of an academic career. Scientific publications have significant academic and financial implications. Several standard authorship guidelines exist, and the International Committee of Medical Journal Editors (ICMJE) is the most popular amongst them. There are increasing concerns about the ethics of publications with the rise of inappropriate authorship. The most important reason appears to be a lack of knowledge and awareness of the authorship guidelines and what actions constitute unethical behaviors. There is a need to incorporate standard guidelines in medical curricula and conduct structured training and education programs for researchers across the board. The current perspective describes the significant concepts of appropriate and inappropriate authorship, and the possible measures being formulated to shape the future of authorship.

Investigating the division of scientific labor using the Contributor Roles Taxonomy (CRediT)

Contributorship statements were introduced by scholarly journals in the late 1990s to provide more details on the specific contributions made by authors to research papers. After more than a decade of idiosyncratic taxonomies by journals, a partnership between medical journals and standards organizations has led to the establishment, in 2015, of the Contributor Roles Taxonomy (CRediT), which provides a standardized set of 14 research contributions. Using the data from Public Library of Science (PLOS) journals over the 2017–2018 period (N = 30,054 papers), this paper analyzes how research contributions are divided across research teams, focusing on the association between division of labor and number of authors, and authors’ position and specific contributions. It also assesses whether some contributions are more likely to be performed in conjunction with others and examines how the new taxonomy provides greater insight into the gendered nature of labor division. The paper concludes with a discussion of results with respect to current issues in research evaluation, science policy, and responsible research practices.

Requirements for Study Registration and Adherence to Reporting Guidelines in Surgery Journals: A Cross-Sectional Study

BACKGROUND

Reporting guidelines and study registration can minimize bias and improve the reporting quality of biomedical research, but may not be fully utilized. The objective of this study was to investigate the policies of surgery journals as for reporting guidelines and study registration and explore associated journal characteristic variables.

METHODS

Study samples were obtained from the Expanded Science Citation Index of the 2018 Journal Citation Reports (surgery category). The online guides for authors were browsed to identify which journals endorsed reporting guidelines and study registration. The predictors related to the endorsement were explored by using Chi-square test and multivariate logistic regression analysis, respectively.

RESULTS

One hundred and eighty-eight surgery journals were included in our study. One hundred and sixty-three journals (86.7%) endorsed reporting guidelines and 103 journals (54.8%) endorsed study registration. About reporting guidelines, ICMJE (International Committee of Medical Journal Editors) recommendations were the most frequently endorsed (n = 155, 82.4%) by journals, followed by CONSORT (Consolidated Standards of Reporting Trials) statement (n = 94, 50.0%). About study registration, randomized controlled trial registration was endorsed by 101 (53.7%) journals, whereas the systematic review registration was endorsed by only 9 journals (4.8%). The results of multivariate logistic regression analysis revealed that not North America, higher JCR (Journal Citation Reports) rank journals were more likely to endorse reporting guidelines and study registration.

CONCLUSIONS

Surgery journals frequently use reporting guidelines, but nearly half of journals did not require study registration. Implementing these two mechanisms can prevent bias, and their adoption should be strengthened by authors, reviewers and journal editors in surgery.

Clinical Research Authorships: Ethics and Problem-Solving

The article helps resolve the intricate authorship issue based on global organizations’ regulations. It draws a fine line between authorship and contributorship from the research ethics perspective.

Study Protocol for Two-Steps Parallel Randomized Controlled Trial: Pre-Clinical Usability Tests for a New Double-Chamber Syringe

A new double-chamber syringe (DUO Syringe) was developed for intravenous drug administration and catheter flushing. This study presents a protocol for pre-clinical usability tests to validate the golden prototype of this new device, performed in a high-fidelity simulation lab by nurses. A two-steps parallel randomized controlled trial with two arms was designed (with standard syringes currently used in clinical practice and with the DUO Syringe). After randomization, eligible and consented participants will be requested to perform, individually, intravenous drug administration and flushing, following the arm that has been allocated. The procedure will be video-recorded for posterior analyses. After the completion of the tasks, nurses will be asked to answer a demographic survey, as well as an interview about their qualitative assessment of the device. A final focus group with all participants will also be conducted. Primary outcomes will concern the DUO Syringe's effectiveness, efficiency, and safety, while secondary outcomes will focus on nurses' satisfaction and intention of use. The pre-clinical protocol was defined according to the legal requirements and ISO norms and was reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing of the Nursing School of Coimbra.

Researchers' Perceptions of Ethical Authorship Distribution in Collaborative Research Teams

Authorship is commonly used as the basis for the measurement of research productivity. It influences career progression and rewards, making it a valued commodity in a competitive scientific environment. To better understand authorship practices amongst collaborative teams, this study surveyed authors on collaborative journal articles published between 2011 and 2015. Of the 8364 respondents, 1408 responded to the final open-ended question, which solicited additional comments or remarks regarding the fair distribution of authorship in research teams. This paper presents the analysis of these comments, categorized into four main themes: (1) disagreements, (2) questionable behavior, (3) external influences regarding authorship, and (4) values promoted by researchers. Results suggest that some respondents find ways to effectively manage disagreements in a collegial fashion. Conversely, others explain how distribution of authorship can become a "blood sport" or a "horror story" which can negatively affect researchers' wellbeing, scientific productivity and integrity. Researchers fear authorship discussions and often try to avoid openly discussing the situation which can strain team interactions. Unethical conduct is more likely to result from deceit, favoritism, and questionable mentorship and may become more egregious when there is constant bullying and discrimination. Although values of collegiality, transparency and fairness were promoted by researchers, rank and need for success often overpowered ethical decision-making. This research provides new insight into contextual specificities related to fair authorship distribution that can be instrumental in developing applicable training tools to identify, prevent, and mitigate authorship disagreement.

Allonymous science: the politics of placing and shifting credit in public-private nutrition research

Ideally, guidelines reflect an accepted position with respect to matters of concern, ranging from clinical practices to researcher behaviour. Upon close reading, authorship guidelines reserve authorship attribution to individuals fully or almost fully embedded in particular studies, including design or execution as well as significant involvement in the writing process. These requirements prescribe an organisation of scientific work in which this embedding is specifically enabled. Drawing from interviews with nutrition scientists at universities and in the food industry, we demonstrate that the organisation of research labour can deviate significantly from such prescriptions. The organisation of labour, regardless of its content, then, has consequences for who qualifies as an author. The fact that fewer food industry employees qualify is actively used by the food industry to manage the credibility and ownership of their knowledge claims as allonymous science: the attribution of science assisted by authorship guidelines blind to all but one organisational frame.

Perish or Publish Dilemma: Challenges to Responsible Authorship

Controversies related to the concept and practice of responsible authorship and its misuse have been among the most prominent issues discussed in the recent literature on research integrity. Therefore, this paper aims to address the factors that lead to two major types of unethical authorship, namely, honorary and ghost authorship. It also highlights negative consequences of authorship misuse and provides a critical analysis of different authorship guidelines, including a recent debate on the amendments of the International Committee of Medical Journal Editors (ICMJE) authorship definition. Empirical studies revealed that honorary authorship was the most prevalent deviation from the responsible authorship standards. Three different modalities of honorary authorship were distinguished: gift authorship, guest authorship, and coercive authorship. Prevalence of authorship misuse worldwide and in Europe was alarmingly high, covering approximately one third of all scientific publications. No significant differences were reported in authorship misuse between different health research disciplines. The studies conducted in North America highlighted the most effective means to cope with unethical authorship. These were training in publishing ethics, clear authorship policies developed by medical schools, and explicit compliance with the authorship criteria required by the medical journals. In conclusion, more empirical research is needed to raise awareness of the high prevalence of authorship misuse among scientists. Research integrity training courses, including publication ethics and authorship issues should be integrated into the curricula for students and young researchers in medical schools. Last but not least, further discussion on responsible authorship criteria and practice should be initiated.

Double-chamber syringe versus classic syringes for peripheral intravenous drug administration and catheter flushing: a study protocol for a randomised controlled trial

BACKGROUND

The prevention of catheter-related complications is nowadays an important topic of research. Flushing catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing should be carried out both pre- and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, and also increasing the need for manipulation of the venous catheter).

METHODS/DESIGN

A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration drugs with flushing procedures, with a double-chamber syringe (arm A) or with classic syringes (arm B). The outcomes assessment will be performed on a daily basis by an unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day.

DISCUSSION

The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of this medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate nurses' adoption of good clinical practices in intravenous procedures, reducing catheter manipulations.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04046770. Registered 13 August 2019.

Can self-regulation deliver an ethical commercial literature? A critical reading of the "Good Publication Practice" (GPP3) guidelines for industry-financed medical journal articles

Much medical journal literature is developed by the pharmaceutical and device industries, sometimes with assistance from marketing agencies, writers, and academics. This literature is vulnerable to commercial bias. The publications trade issues self-regulatory ethical guidelines for its production, called "Good Publication Practice" (GPP). I evaluated the most recent iteration, GPP3. The most progressive recommendations in GPP3 call for complete publication of all clinical trials, and full data sharing. GPP3 makes numerous further recommendations more directly concerning the publications trade. Many of these repeat existing editorial requirements, chiefly those of the International Committee of Medical Journal Editors, but readers are not adequately advised of this. Despite its emphasis on ethical and transparent reporting, the detail of GPP3 enables continued use of academic medical literature for drug marketing, on the basis of commercial steerage of content, coupled with the attribution of published articles to collaborating academic authors. As such, GPP3 provides a de facto manual for how marketing through academic journal content can be conducted in compliance with contemporary editorial standards. Consequently, the self-regulatory GPP3 guidelines are not a sound basis for the production of unbiased industry-financed medical journal literature. I suggest improvements for future iterations of these influential guidelines.

Substantial contribution and accountability: best authorship practices for medical writers in biomedical publications

OBJECTIVE

To provide clarity on the professional medical writer as author or contributor by examining what "a substantial contribution" and "accountability" mean with respect to authorship in a biomedical publication. These terms relate to criteria 1 and 4 of the International Committee of Medical Journal Editors (ICMJE) authorship guidelines.

METHODS

We reviewed the ICMJE and Good Publication Practice authorship guidelines, which recommend that individuals not meeting all four authorship criteria should be acknowledged as contributors. We also surveyed and assessed selected journals for published guidance on authorship versus contributorship.

RESULTS

We found that journals often vary in their authorship guidelines for medical writers. Notwithstanding, and to assist in determining the contribution made by the medical writer, we have expanded on current guidelines to develop recommendations for important intellectual contribution to the design of the work (developing the protocol, choosing endpoints) or the interpretation of data for the work (developing the discussion, interpreting new statistical output), which should result in inclusion of the medical writer as an author, as well as when accountability is relevant. If the medical writer does not qualify as an author, then their inclusion in the acknowledgements section is appropriate.

CONCLUSIONS

Authors and contributors have a responsibility to create a publication that is accurate and true to the study results, but only authors must provide a substantial contribution and are accountable for that contribution. Contributions made by authors and non-author contributors should be fully described in the publication, to enable the reader to assess credit and responsibility.

All for one or one for all? Authorship and the cross-sectoral valuation of credit in nutrition science

The passionate pursuit of authorships is fuelled by the value they represent to scholars and scientists. This article asks how this value differs across scientists and how these different processes of valuation inform authorship articulation, strategies, and publication behavior in general. Drawing from a qualitative analysis of authorship practices among nutrition scientists employed at universities, contract research organizations, and in food industry, I argue that two different modi operandi emerge when it comes to authorship. These different ways of working produce different collaborative approaches, different credit distribution strategies amongst collaborators, and different value placed upon (the pursuit of) authorship. These different valuation processes are neither explicit nor recognizable to those reading (and judging) author lists. As a consequence, in the politics of authorship, the names standing atop a scientific publication in nutrition science represent different types of value to both the individuals and employing organizations.

Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study

OBJECTIVE

 To examine the association between the presence of individual principal investigators' financial ties to the manufacturer of the study drug and the trial's outcomes after accounting for source of research funding.

DESIGN

 Cross sectional study of randomized controlled trials (RCTs).

SETTING

 Studies published in "core clinical" journals, as identified by Medline, between 1 January 2013 and 31 December 2013.

PARTICIPANTS

 Random sample of RCTs focused on drug efficacy.

MAIN OUTCOME MEASURE

 Association between financial ties of principal investigators and study outcome.

RESULTS

 A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers' fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9).

CONCLUSIONS

 Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base.

The ICMJE Recommendations and pharmaceutical marketing--strengths, weaknesses and the unsolved problem of attribution in publication ethics

Background

The International Committee of Medical Journal Editors (ICMJE) Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution.

Discussion

With respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves.

Conclusions

The ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry.

Mythbusting Medical Writing: Goodbye, Ghosts! Hello, Help!

To meet ethical and scientific obligations, authors should submit timely, high-quality manuscripts. Authors, however, can encounter ethical (e.g., authorship designation) and practical (e.g., time and resource limitations) challenges during manuscript preparation. Could professional medical writers-not ghostwriters-help authors address these challenges? This essay summarizes evidence countering three myths that may have hindered authors from considering the use of professional medical writers. Authors with sufficient time, writing expertise, and reporting guideline knowledge may meet their obligations without writing assistance. Unfortunately, not all authors are in this position. Decisions about writing support should be based on evidence, not myths.

Five-step authorship framework to improve transparency in disclosing contributors to industry-sponsored clinical trial publications

Authorship guidelines have established criteria to guide author selection based on significance of contribution and helped to define associated responsibilities and accountabilities for the published findings. However, low awareness, variable interpretation, and inconsistent application of these guidelines can lead to confusion and a lack of transparency when recognizing those who merit authorship. This article describes a research project led by the Medical Publishing Insights and Practices (MPIP) Initiative to identify current challenges when determining authorship for industry-sponsored clinical trials and develop an improved approach to facilitate decision-making when recognizing authors from related publications. A total of 498 clinical investigators, journal editors, publication professionals and medical writers were surveyed to understand better how they would adjudicate challenging, real-world authorship case scenarios, determine the perceived frequency of each scenario and rate their confidence in the responses provided. Multiple rounds of discussions about these results with journal editors, clinical investigators and industry representatives led to the development of key recommendations intended to enhance transparency when determining authorship. These included forming a representative group to establish authorship criteria early in a trial, having all trial contributors agree to these criteria and documenting trial contributions to objectively determine who warrants an invitation to participate in the manuscript development process. The resulting Five-step Authorship Framework is designed to create a more standardized approach when determining authorship for clinical trial publications. Overall, these recommendations aim to facilitate more transparent authorship decisions and help readers better assess the credibility of results and perspectives of the authors for medical research more broadly. Please see related article: http://www.biomedcentral.com/1741-7015/12/214.

Research funding and authorship: does grant winning count towards authorship credit?

It is unclear whether or not grant winning should count towards authorship credit in the sciences. In this paper, I argue that under certain circumstances grant winning can count for credit as an author on subsequent works. It is a mistake to think that grant winning is always irrelevant to the correct attribution of authorship.

Ethics of using language editing services in an era of digital communication and heavily multi-authored papers

Scientists of many countries in which English is not the primary language routinely use a variety of manuscript preparation, correction or editing services, a practice that is openly endorsed by many journals and scientific institutions. These services vary tremendously in their scope; at one end there is simple proof-reading, and at the other extreme there is in-depth and extensive peer-reviewing, proposal preparation, statistical analyses, re-writing and co-writing. In this paper, the various types of service are reviewed, along with authorship guidelines, and the question is raised of whether the high-end services surpass most guidelines' criteria for authorship. Three other factors are considered. First, the ease of collaboration possible in the internet era allows multiple iterations between the author(s) and the "editing service", so essentially, papers can be co-written. Second, "editing services" often offer subject-specific experts who comment not only on the language, but interpret and improve scientific content. Third, the trend towards heavily multi-authored papers implies that the threshold necessary to earn authorship is declining. The inevitable conclusion is that at some point the contributions by "editing services" should be deemed sufficient to warrant authorship. Trying to enforce any guidelines would likely be futile, but nevertheless, it might be time to revisit the ethics of using some of the high-end "editing services". In an increasingly international job market, awareness of this problem might prove increasingly important in authorship disputes, the allocation of research grants, and hiring decisions.

Scientific misconduct: also an issue in nursing science?

PURPOSE

Scientific misconduct (SMC) is an increasing concern in nursing science. This article discusses the prevalence of SMC, risk factors and correlates of scientific misconduct in nursing science, and highlights interventional approaches to foster good scientific conduct.

METHODS

Using the "Fostering Research Integrity in Europe" report of the European Science Foundation as a framework, we reviewed the literature in research integrity promotion.

FINDINGS

Although little empirical data exist regarding prevalence of scientific misconduct in the field of nursing science, available evidence suggests a similar prevalence as elsewhere. In studies of prospective graduate nurses, 4% to 17% admit data falsification or fabrication, while 8.8% to 26.4% report plagiarizing material. Risk factors for SMC exist at the macro, meso, and micro levels of the research system. Intervention research on preventing scientific misconduct in nursing is limited, yet findings from the wider field of medicine and allied health professions suggest that honor codes, training programs, and clearly communicated misconduct control mechanisms and misconduct consequences improve ethical behavior.

CONCLUSIONS

Scientific misconduct is a multilevel phenomenon. Interventions to decrease scientific misconduct must therefore target every level of the nursing research systems.

CLINICAL RELEVANCE

Scientific misconduct not only compromises scientific integrity by distorting empirical evidence, but it might endanger patients. Because nurses are involved in clinical research, raising their awareness of scientifically inappropriate behavior is essential.

Protecting our science

In response to a recent court decision, the Annals of Occupational Hygiene is reviewing our procedures to ensure transparency in authorship and direct and indirect conflicts of interest. These improvements are intended to help protect the integrity of the science presented in the journal.

SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials

High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.

Corporate Integrity Agreements: What They Say About Publications, Publication Planning, Transparency, and ICMJE

Corporate integrity agreements (CIAs) have become a significant means of compliance enforcement for the Office of the Inspector General (OIG) of the US Department of Health and Human Services. The objective of this review is to present in a factual manner common clauses from recent CIAs that affect publications, publication planning, and transparency. Fourteen CIAs issued to biopharmaceutical companies from January 1, 2009, through July 31, 2012, were reviewed. All documents were publicly accessible on the OIG website. Eight CIAs included similar verbiage relating to industry-sponsored publication activities and transparency. Each included specific recommendations for author agreements, publication plans, needs assessments, publication monitoring, posting of study results, and disclosure of relationships with authors. The publishing behaviors OIG seeks to effect are consistent with currently accepted guidelines described in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, as prepared by the International Committee of Medical Journal Editors (ICMJE) and Good Publication Practices for Communicating Company-sponsored Medical Research (GPP2), as well as added training, monitoring, and reporting requirements. By making clear the importance of publication planning, needs assessments, adherence to ICMJE, and reporting of physician payments, and by becoming readily accessible to everyone, CIAs provide the industry not only with clear direction for, but also an expectation of, responsible behavior when it comes to sponsored medical publications.

Challenging medical ghostwriting in US courts

Xavier Bosch and colleagues expand upon a recent analysis by Simon Stern and Trudo Lemmens in PLoS Medicine and outline areas in which authors participating in medical ghostwriting could be held legally liable.

Ghostwriting revisited: new perspectives but few solutions in sight

The PLoS Medicine editors discuss new perspectives on ghost writing and reflect on the suggested remedies put forth in this month's issue of the journal.