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Gert Helgesson, Søren Holm, Lone Bredahl, Bjørn Hofmann & Niklas Juth, Misuse of Co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey, J. of Acad. Ethics (2022).

The International Committee of Medical Journal Editors (ICMJE) has set out guidance on the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals since 1978. The 2022 version recognises that “authorship confers credit and has important academic, social and financial implications” as well as implying “responsibility and accountability for published work.”

In Misuse of Co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey, published in the Journal of Academic Ethics, Gert Helgesson, Søren Holm, Lone Bredahl, Bjørn Hofmann and Niklas Juth survey the experiences and attitudes to authorship in Ph.D. theses in Denmark, Norway and Sweden. The article makes difficult but important reading. It points to a high level of acceptance and support for the ICMJE recommendations but a perpetuation of poor authorship practices.

Though the study focuses on scientific authorship, it is important reading for health lawyers for two principal reasons.

  1. As initiatives to foster interdisciplinary research proliferate, we might hope for greater consistency in the norms guiding co-authorship. Until that happens, academic health lawyers publishing co-authored work in biomedical journals or working with clinicians to publish in law journals must understand relevant norms or risk the misappropriation of both benefits and responsibilities.
  2. There are common themes that apply in relation to all academic co-authorship that are drawn out in this piece. One is that the risks of inappropriate co-authorship attribution are particularly high when there is an imbalance of power between co-authors. In the humanities and social sciences, where guidance on how to establish co-authorship is less clear and established than is the case in medicine, the risks of misuse may be accentuated. It is increasingly the norm in the social sciences and humanities for work to be co-authored. And emphasis on publication and citations play a burgeoning role in grant application success, promotion, and reputation across all academic areas.

The Committee on Publication Ethics is an international organisation that produces guidance cutting across academic fields. It recognises variation across disciplines on the norms governing authorship and, as consistency is too much to hope for, it calls for journal editors to put in place clear guidance. However, as Helgesson et al demonstrate, even when the norms are understood and supported, they are not consistently upheld.

The researchers collected quantitative and qualitative data from 287 questionnaires returned by medical Ph.D.s from faculties in Scandinavian universities in the second half of 2020. They report that nearly half of the respondents did not consider the authorship criteria set out by the ICMJE to have been respected. The failures involved inclusion of author/s who had not

  • made a substantial contribution to the work (34.4%)
  • drafted or critically revised the paper (32.6%)
  • given final approval of the submitted paper (10.5%)

A further 24.4% reported that in at least one paper for their degree, the authorship order did not reflect the authors’ expectations given their relative contributions. Women were more likely to make this complaint than men.

As for the reasons for circumventing the guidelines, the authors give several examples of inappropriate exclusions and inclusions. Regarding the latter there were cases

by supervisors and others making sure they end up on papers they have power over, or because departments have such a policy; by influential researchers including friends or distributing benefits for pragmatic reasons, such as making sure PhD students get the final paper needed to defend their thesis.

The article contrasts the results of similar surveys in 2009 and 2016 and depressingly finds no meaningful differences, notwithstanding increased attention to the teaching and promulgation of authorship guidance and norms in medicine. The incentives to breach the guidelines are high and educational efforts alone are unlikely to resolve the issues. As methods of health research change to incorporate co-produced research, the issues intensify.

Equitable academic co-writing and co-authorship are goals we can all endorse but power differentials, incentives and unclear and inconsistent guidance across disciplines frequently frustrate.

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Cite as: Emma Cave, Ethical Co-Authorship, JOTWELL (April 3, 2023) (reviewing Gert Helgesson, Søren Holm, Lone Bredahl, Bjørn Hofmann & Niklas Juth, Misuse of Co-authorship in Medical PhD Theses in Scandinavia: A Questionnaire Survey, J. of Acad. Ethics (2022)), https://health.jotwell.com/ethical-co-authorship/.