Authorship: from credit to accountability.

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Reflections from the Editors´ Network
Fernando Alfonso MD1*, Parounak Zelveian MD2, Jean-Jacques Monsuez MD3, Michael Aschermann MD4, Michael Boehm MD5, Alfonso Buendia Hernandez MD6, Tzung-Dau Wang MD7, Ariel Cohen MD8, Sebija Izetbegovic MD9, Anton Doubell MD10, Dario Echeverri MD11, Nuray Enç MD12, Ignacio Ferreira-González MD13, Anetta Undas MD14, Ulrike Fortmüller MD15, Plamen Gatzov MD16, Carmen Ginghina MD17, Lino Goncalves MD18, Faouzi Addad MD19, Mahmoud Hassanein MD20, Gerd Heusch MD21, Kurt Huber MD22, Robert Hatala MD23, Mario Ivanusa MD24, Chu-Pak Lau MD25, Germanas Marinskis MD26, Livio Dei Cas MD27, Carlos Eduardo Rochitte MD28, Kjell Nikus MD29, Eckart Fleck MD30, Luc Pierard MD31, Slobodan Obradović MD32, María del Pilar Aguilar Passano MD33, Yangsoo Jang MD34, Olaf Rødevand MD35, Mikael Sander MD36, Evgeny Shlyakhto MD37, Çetin Erol MD38, Dimitris Tousoulis MD39, Dilek Ural MD40, Jan J. Piek MD41, Albert Varga MD42, Andreas J. Flammer /François Mach MD43, Alban Dibra MD44, Faiq Guliyev MD45, Alexander Mrochek MD46, Mamanti Rogava MD47, Ismael Guzman Melgar MD48, Giuseppe Di Pasquale MD49, Kanat Kabdrakhmanov MD50, Laila Haddour MD51, Zlatko Fras MD52, Claes Held MD53, Valentyn Shumakov MD54 On behalf of the Editors’ Network, European Society of Cardiology (ESC) Task Force.

1 Chairman Editors´Network; 2 Editor in Chief Armenian Journal of Cardiology, 3 Editor in Chief Archives des maladies du cœur et des vaisseaux-Pratique, 4 Editor in Chief Cor et Vasa, 5 Editor in Chief Clinical Research in Cardiology, 6 Editor in Chief Archivos de Cardiologia de Mexico, 7 Editor in Chief Acta Cardiologica Sinica, 8 Editor in Chief Archives of Cardiovascular Diseases, 9 Editor in Chief Medicinski Zurnal, 10 Editor in Chief SA Heart, 11 Editor in Chief Revista Colombiana de Cardiologia, 12 Editor in Chief Kardiyovaskuler Hemsirelik Dergisi, 13 Editor in Chief Revista Española de Cardiología, 14 Editor in Chief Kardiologia Polska, 15 Editor in Chief Cardio News, 16 Editor in Chief Bulgarian Journal of Cardiology, 17 Editor in Chief Romanian Journal of Cardiology, 18 Editor in Chief Revista Portuguesa de Cardiologia, 19 Editor in Chief Revue Tunisienne de Cardiologie, 20 Editor in Chief The Egyptian Heart Journal, 21 Editor in Chief Basic Research in Cardiology, 22 Editor in Chief Austrian Journal fo Cardiology, 23 Editor in Chief Cardiology Letters, 24 Editor in Chief Cardiologia Croatica, 25 Editor in Chief Journal of the Hong Kong Colleage of Cardiology, 26 Editor in Chief Seminars in Cardiovascular Medicine, 27 Editor in Chief Journal of Cardiovascular Medicine, 28 Editor in Chief Arquivos Brasileiros de Cardiologia, 29 Editor in Chief Sydänääni (Heart Beat), 30 Editor in Chief Der Kardiologe, 31 Editor in Chief Acta Cardiologica, 32 Editor in Chief Heart and Blood Vessels, 33 Editor in Chief Revista Uruguaya de Cardiologia, 34 Editor in Chief Korean Circulation Journal, 35 Editor in Chief Hjerteforum, 36 Editor in Chief Cardiologisk Forum, 37 Editor in Chief Russian Journal of Cardiology, 38 Editor in Chief Anatolian Journal of Cardiology, 39 Editor in Chief Hellenic Journal of Cardiology, 40 Editor in Chief Archives of the Turkish Society of Cardiology, 41 Editor in Chief Netherlands Heart Journal, 42 Editor in Chief Cardiologia Hungarica, 43 Editor in Chief Cardiovascular Medicine, 44 Editor in Chief Revista Shqiptare e Kardiologjisë, 45 Editor in Chief Azerbaijan Journal of Cardiology, 46 Editor in Chief Cardiology in Belarus, 47 Editor in Chief Cardiology and Internal Medicine (Georgian International Society of Cardiomyopathy), 48 Editor in Chief Revista Guatemalteca de cardiologia, 49 Editor in Chief Giornale Italiano di Cardiologia, 50 Editor in Chief Journal Terapevticheskiy vestnic, 51 Editor in Chief Revue Marocaine de Cardiologie, 52 Editor in Chief Slovenska kardiologija, 53 Editor in Chief Svensk Cardiologi, 54 Editor in Chief Ukrainian Journal of Cardiology

Abstract: The Editors´ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial dis-cussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scienti fic quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices. Keywords: Editorial ethics, scientific process, authorship, accountability, scientific journals, journals.

The Editors´ Network of the European Society of Car-diology (ESC) is committed to foster implementation of high-quality editorial standards among ESC National Societies Cardiovascular Journals (NSCJ)1-6. NSCJ play a major role in disseminating original scientific research worldwide, but also in education and harmonization of clinical practice2-6. Promoting editorial excellence is paramount to increasing the scientifi c prestige of NSCJ1-6. In this regard, the Editors´ Network endorses the recommendations of the International Committee of  Medical Journal Editors (ICMJE)1. The ICMJE continuo-usly updates its document on uniform requirements (previously known as the Vancouver guidelines) for manuscripts submitted to biomedical journals. These include recommendations for the conduct, reporting, editing and publication of scholarly work. Notably, ve-xing ethical issues are gaining increasing editorial re-levance1. Biomedical research relies on trust and transparen-cy of the scientific process where authors remain cen-tre stage1,7-9. This review will discuss the new recom-mendations on authorship issued by the ICMJE1,10,11 with the aim of providing further editorial insight to be progressively implemented by the NSCJ.


In August 2013 an important revision of the ICMJE recommendations included a fourth criterion for authorship to emphasize each author’s responsibility to stand by the integrity of the entire work1,10,11. Clas-sically, the ICMJE requirements for authorship inclu-ded: 1) Substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work; and, 2) Drafting the work or revising it critically for important intel-lectual content; and, 3) Final approval of the version to be published. In the updated ICMJE requirements a new (fourth) criterion also should be met1. This novel requirement for authorship includes agreement to be accountable for all aspects of the work and ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved1. The essence of this new requirement is that it helps to balance credit with responsibility10. With this revision the ICMJE emphasizes that authors-hip is a serious commitment to accountability. Now all 4 conditions must be met by each individual author1. The addition of a fourth criterion was motivated by situations in which some authors were unable to, or refused to, respond to inquiries on potential scientific misconduct regarding certain aspects of the study or by denying any responsibility1,10-14. Editors occasionally face reluctant authors who try to distance themselves from a conflictive publication and shift responsibilities elsewhere11. The main novel idea is to emphasize the responsibility of each author to stand for the integrity of the entire work. Each author of a scientific paper needs to understand the full scope of the work, know which co-authors are responsible for specifi c contri-butions and have confidence in co-authors’ ability and integrity1,10-14. Should questions arise regarding any as-pect of a study, the onus is on all authors to investigate and ensure resolution of the issue, which is then to be presented to the corresponding Editor1,10-14.
To better appraise this 4th criterion the precise meaning of responsibility and accountability should be revisited. Responsibility is defined as the moral obli-gation to ensure that a particular task is adequately performed15-16. Accordingly, responsibility relates to tasks that have been assigned to an individual15,16. By contrast, accountability denotes the duty to justify a given action to others and to respond for the results of that action15,16. Therefore, accountability mainly re-lates to the awareness and assumption of the role of being the one to blame if things go wrong15,16. Nevertheless, oftentimes responsibility is used interchangea-bly with accountability15,16.
Claiming that each individual author is held morally responsible in every case that misconduct is detected would appear unreasonable considering the comple-xity of current research. Rather, the fourth criterion suggests that each author must cooperate to clarify misconduct related issues if the paper is called into question1,16.

Research credits
Acceptance and publication of a scientifi c paper is always a cause of major celebration among authors11. Authorship provides prestige, credit and scientific re-cognition. Authorship has important academic, social and financial implications1,11. Currently, authorship remains a major criterion for promotion and career advancement among scholars. Publication records are revised in depth for university tenures and job appointments. Total number of publications and ci-tations remain currencies widely used to ascertain the academic value of individual investigators. In this regard, the ICMJE recommendations on authorship are intended to ensure that anybody who has made a “substantive” intellectual contribution to a paper is given credit as an author1.

Potential Problems Derived From Publication of Research
Publication of a scientific paper usually marks the end of a research project and opens a time for discussion and criticism or acceptance by the scientific commu-nity11. Occasionally, the healthy scientific debate fuel-led by the publication of the paper raises serious con-cerns. In rare cases, even the integrity of the research or published paper is brought into question11. In these situations authors may try to escape from the embarrassment of publishing a scientifically flawed study. This explains why the new fourth criterion is so per-tinent to address issues related to scientifi c miscon-duct. Should irregularities be confirmed, editors must report to the authors´ academic institution and, even-tually, to the readers, with expressions of concern, or, in the worst case scenario, with a retraction of the published paper1.

Any researcher listed as an author should have made a “substantive” intellectual contribution to the study and be prepared to take public responsibility for the work, ensure its accuracy, and be able to identify his/ her contribution to the study1. However, a problem with the definition of authorship involves the subjec-tivity in what constitutes a ‘substantial’ contribution to the research or the manuscript. In fact, the pre-cise threshold of involvement required to qualify for authorship remains unclear. As the real problem lies in defining what represents a “substantial” contributi-on, means to quantify the actual work performed by individual authors have been proposed. In this regard it has been suggested17 that substantial contribution to a publication consists of an important intellectual con-tribution without which, a part of the work or even the entire work, could not have been completed or the manuscript could not have been written17.
According to the ICMJE(1) persons who do not qualify as an author include those who “only” provide:

  • recruitment of patients to a trial, 2) general data collection, 3) obtaining samples for a study, 4) acqui-sition of funding, 5) general supervision of the resear-ch group by the department chairperson. Conversely, persons who significantly contributed to the paper but do not meet the 4 criteria for authorship should be listed in the acknowledgement section after obtaining their consent.

The ICMJE authorship guidance is intentionally broad and open to accommodate the diversity of scientific research and allow space for the specific editorial policies of individual journals1. However, many have requested a more structured authorship framework to improve consistency and clarity in authorship re-quirements. The best means to present the relation-ship between authorship and intellectual involvement in research remains an issue of ongoing debate. Cur-rently, the ICMJE does not mandate that all authors communicate exactly what “contributions” qualify them to be an author1. However, unless authorship reflects to what extent individual researchers have been intellectually involved in the work it will remain misleading regarding relative research merits. Honesty and openness in attribution ensures fairness in credit. Many editors argue that authorship criteria should be revised to request a contribution declaration, in or-der to fully capture deserving authorship and credit. Accordingly, to promote transparency and remove ambiguity on specific contributions, editors are now strongly encouraged to develop and implement con-tributorship policies in their journals1. As discussed, however, the question regarding the quality and quan-tity of contribution required to qualify an individual for authorship remain unresolved1. An interesting propo-sal in this regard suggests including contributorship badges. These badges are designed to fully capture the different types of collaboration in the submitted work that, otherwise, will be difficult to recognise with tra-ditional credentials. Contributors listing allows a more accurate and granular assessment of credit. In additi-on, this strategy provides additional insight on con-tributor-adjusted productivity18. Ideally, each ICMJE criterion should have at least one badge. Each badge includes a list of authors making a contribution to that specific role18-20. Others have proposed the value of assigning a numerical value to better evaluate the de-gree of relative contributions and, eventually, to cre-ate a contribution-specific index for each author to better assess research productivity18-20.
Detailing authors´ contributions inform the readers of the nature of the individual work and avoids diluting credits by precisely allocating merits. In multi-autho-red papers it is particularly important that authors sta-te the specific role they played in the research. Each research represents a significant amount of effort and, on average, the larger the number of authors the smal-ler percentage of effort for a given author. Other forms of contributions, not fulfilling criteria for authorship, may be recognized in the acknowledgement section or by listing these people as collaborators. This is an im-portant issue considering the ever increasing number of authors seen in recent publications that represents a paradigm shift resulting from team-work resear-ch18-24. Contributors credited as authors should take full responsibility and remain accountable for what is published1,18. In this regard, contribution-adjusted credits can be further weighted by other factors to derive more effective parameters for measuring re-search productivity. Currently, every co-author gets the exact amount of citation credit regardless of their contribution. Therefore, an “author matrix” (including participation in ideas, work, writing and stewardship), has been proposed to “quantify” individual contributi-ons and roles in multi-authored papers18-24.

There is no adequate guidance for author sequence in the by-line. In fact, practices to clarify the relati-ve merit of the different coauthors in a manuscript vary significantly among scientific disciplines18-22. For biomedical journals, the first author is the most im-portant position, followed by the last author and then the second author. The first author is reserved for the person who made the largest contribution (inves-ting most time in the project) usually the author who wrote the fi rst draft of the paper. Then the sequen-ce of authors tends to represent progressively lesser contributions18. Following this approach, where the sequence determines credit, the last author receives the least. Accordingly, the last position might be con-sidered as a rather generous option. Actually, the last position is currently considered as very important in biomedical research and, in fact, it is frequently associ-ated with the corresponding author or the guarantor of the entire work18. However, many argue that se-nior scientists should grab the pen (keyboard) more often as writing remains essential for advancement in knowledge19. Senior authors have the responsibility to promote the academic career of new generation scientists. Many journals allow authors to declare that 2 or more individuals have made “equal contribution” to the research25-29. In the last decade the percentage of articles with equal contribution statements has incre-ased dramatically both in basic and medical scientific journals25. Notably, the designation of “joint first-authors” should be based on the quality and quantity of the work25-29. Thus the “contributed equally” desig-nation should be reserved to honestly reflect similar scientific contributions and not to infl ate a curriculum vitae25-29. Interestingly, the practice of listing two indi-viduals as “joint last author” is used less frequent but steadily increasing. These publications should include a foot note clearly indicating that both authors equally contributed to the work25-29. The corresponding author takes primary responsibility for communication with the journal during the submission, peer-review, publication and post-publica-tion periods1. Currently, most journals require con-tact e-mail addresses from all listed authors who then will be contacted to inform that the corresponding author submitted the paper. This ensures that they are aware that the paper has been submitted in their name. The systematic implementation of this electro-nic warning system paves the way to guarantee that the 3rd authorship criterion has been met. Therefore, the policy now may be considered as a mere administrative requirement similar to signing of a copyright transfer.
The “guarantor” of the study may be different from the first or corresponding author and frequently is the principal investigator or more senior person in the group. The guarantor takes full responsibility for the integrity of the work as a whole from inception to the published paper. Accordingly, the guarantor must be fully prepared to defend all parts of the research project and final manuscript. Guarantors vouching for the integrity of the entire work are of special value for multi-author articles particularly when many instituti-ons are involved. All authors should also disclose po-tential conflicts of interest1,5. The ICMJE uniform con-flict of interest disclosure has been recently updated and all authors should complete the corresponding standardized individual electronic document1,5. In par-ticular, authors of sponsored studies should indicate that they had full access to the data and take comple-te responsibility for the accuracy and integrity of the analysis. This is important as roles and interests of di-fferent stakeholders may remain elusive or misleading in this type of study1.
The subjectivity and emotionality of authorship may explain why disputes among investigators are not uncommon. Authorship disputes amongst research teams should be avoided by deciding roles and res-ponsibilities beforehand. Ideally, the order of authors should be collectively decided by the research team at the onset of the project30. Then, the definitive author order should be revised when the work is comple-ted, taking into account the actual level of individual contributions17. Editors are unable to judge whether authors have met the authorship criteria. The COPE (Committee on Publication Ethics; guidelines are useful to solve publication disputes9. Editors should seek explanations and signed agreement of all authors in case of a request for a change in the author list1.

Scientific collaboration has become increasingly important because the complexity of modern research involves different competencies16. Moreover, a large number of patients and centres may be required to adequately address clinically relevant questions16. In addition, multidisciplinary research groups offer the opportunity of cross-pollination16. Therefore, team-work is currently common place in biomedical re-search. Co-authorship is the most tangible result of multilateral scientific collaboration. Group (corpo-rate) authorship has become increasingly common with variations in how individual authors and research group names are listed in the by-line. Notably, citati-on impact is greater in papers with multiple authors coming from international cooperation. The problem of inflating publication and citation records of authors participating in multicenter studies has been a cause of concern18. This is due, at least in part, to collaborati-on-induced self-citation31. Salami publications, or least publishable units strategies, are initiatives that infl a-te the number of publications on the same research project by dividing the work (that could have been presented in a single main paper) into smaller compo-nent parts, then publishing them as several different articles. Such strategies may be detected in some multicenter studies31. The use of coauthor-adjusted cita-tion indexes have been suggested to account for this phenomenon31.
There is evidence that the number of coauthors per paper in medical literature has increased exponentially over time22,32. The reason for this increase is proba-bly multifactorial and includes, increasing complexity of research, as discussed, but also author infl ation. Inappropriate authorship is not ethical and eventually leads to diminish the value of authorship, generating a situation where undeserved coauthors cannot take responsibility for the research22,32. Interestingly, the correlation between research quality and number of authors is poor, suggesting that the component of author inflation plays a greater role than that of re-search complexity32.
Until now the number of authors in the by-line was not considered in the evaluation of the relative acade-mic merit of individual authors3. However, as a resear-ch project involves a defined amount of work, the lar-ger the number of authors in a paper the smaller the merit that deserves any given author. Major efforts are made by some individuals whereas others contribute significantly less. The credit received by people doing the work becomes diluted by the inclusion of many authors with little, if any, contributions. Eventually this “free lunch” strategy undermines the value of being named on a scientific paper33.
Authorship guidelines should be updated to adapt to the growing trend of collaborative research. The lar-ger the number of authors the more opportunities for contentious arguments and disputes. Every author of a “group authorship” work must meet the 4 criteria for authorship. Otherwise they should be identified just as investigators or collaborators rather than authors1. Given the complexity and multiple tasks involved in current research it is clear that most authors cannot participate in every aspect of the work. Accordingly, specific responsibilities should be tied to different research roles. Authors should refrain from collabo-rating with colleagues whose quality or integrity may inspire concerns1. Last, but not least, with a growing number of authors it is increasingly diffi cult to identify those who may be held morally responsible should sci-entific misconduct be detected22,32. Holding everybody responsible is unfair to the researchers that are not guilty of misconduct.

Breaches in authorship are a form of deception. Guest or gift (honorary) and ghost (hidden) authors repre-sent a form of authorship abuse that should not be permitted34-39. Ghost authorship is omitting authors that have made relevant contributions to a paper. Ghost authors provide contributions to a manuscript that do merit authorship but, for different reasons, are not included in the author by-line. Some ghost authors may have major conflicts of interest or are paid by a commercial sponsor. This should be differentiated from ghost writing. Ghost writers are writing contri-butors to a manuscript that do not fulfill authorship criteria, but their contributions are not disclosed in the acknowledgements17,38. Ghost writing is also an unethical practice as it keeps hidden the involvement in the manuscript. The concern is that writers hired by the industry might infl uence the content of the pu-blication or hide unwelcome results, which introduces potential bias that is obscured when relevant academic guest authors are accredited with authorship17. Pro-fessional medical writers should follow ethical publica-tion practices and should openly disclose their invol-vement in the acknowledgement section38.
The inclusion of individuals with minimal or no input reflects ‘‘loose authorship” practices34-39. Guest, gift or honorary authorship is defined as co-authors-hip awarded to people who do not meet the authors-hip criteria and have not contributed substantially to take public responsibility for the work1. This may be offered in the belief that the prestige of a scientifically respected person will increase the likelihood of publi-cation or the impact of the work30. Oftentimes, a well-known academic senior name is used to conceal ghost authors with industry-related conflicts of interest30. Both, the gift-author and the remaining co-authors may benefi t from this practice (a win-win situation) that, nevertheless, remains unethical. The increased pressure for publishing among scholars seeking pro-motion and career advancement (the “publish or pe-rish” culture) may also help to explain these practices. This pressure explains why some researchers accept the ‘gift’ authorship in papers to which they have not contributed intellectually. This abuse in authorship devalues the merit of being named as an author in a scientific paper. As previously discussed, quantitative contribution helps to prevent granting undeserved credits to guest authors who take away well-deserved credits from the authors who actually did the work39-42.
Studies suggest that breaches of authorship gui-delines are frequent. In a recent survey one-third of authors believed that they had been excluded from deserved authorship and a similar number declared that they had experienced pressures to include unde-served authors in their papers20. Another recent study of journals included in the Journals Citation Reports da-tabase suggested that 85% of them included in their policy guidance the requirement that authors should be accountable for the research as a whole, 32% ex-plicitly prohibited guest or ghost authorship but only 5% required authors to describe their individual contributions25.

Authorship confers credit but also involves responsibi-lity. Authors should be accountable and vouch for the integrity of the entire work. The Editors´ Network of the ESC endorses the ICMJE recommendations on authorship and encourages individual NSCJ to adapt their editorial policies accordingly.
Disclosures: None of the Editors authors of this pa-per have any potential confl ict of interest that needs to be disclosed in relation to this manuscript.
This is a joint simultaneous publication initiative in-volving all interested National and Affi liated Cardio-vascular Journals of the European Society of Cardiology (ESC).
Acknowledgements: We are grateful for the support and assistance of Michael Alexander and Mar-got Bolard, from the ESC Publications Department, at the European Heart House.

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