A study by Vera-Badillo et al., recently published in the European Journal of Cancer concluded that inappropriate authorship is prevalent in publications reporting systemic cancer therapy. Two-thirds (40/61) of evaluable papers were found to have evidence of ghost authorship and one-third (63/195) of honorary authorship.
The authors determined ghost authorship to be present when investigators/statisticians listed in the study protocol were not listed as authors or appropriately acknowledged in the article, or when the assistance of a medical writer was acknowledged in the publication. An article was defined as having honorary authorship if any of its authors did not meet three of the required International Committee of Medical Journal Editors (ICMJE) authorship criteria.
However, this study has several clear limitations. Firstly, ICMJE recommends that authorship is based on four criteria. Whether it is possible to determine if a named individual has fulfilled these criteria, or contributed significantly enough to be acknowledged, from reading a protocol or manuscript is questionable. Moreover, ICMJE criteria are kept intentionally broad to allow for the diverse nature of research, and therefore may be open to interpretation. Indeed, whether patient recruitment fully satisfies ICMJE criterion #1 (substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work) is open to debate.
The second major limitation is that acknowledged medical writing accounted for nearly half (45.5%) of the ghost authorship found in this study. However, it is generally accepted that the use of medical writers improves the completeness of reporting and the quality of published science, and is a legitimate option when preparing a manuscript, as long as their contribution is appropriately acknowledged. Several international guidelines, including from the ICMJE, specifically encourage transparency about the use of professional writers, and the Good Publication Practice (GPP) 3 guideline explicitly states that ‘properly acknowledged professional medical writers are not ghostwriters’.
Other studies with the same objective have used an arguably more reliable survey-based approach to obtain their data, that involves direct contact with corresponding authors. Such studies have found the prevalence of inappropriate authorship (this time in general medical journals) to be lower than that shown in this study and improving over time. Nevertheless, in light of the findings of previous studies, the main conclusion of this paper–that greater enforcement of guidelines is required to improve accountability–may still be valid, despite the questionable definitions used.