In 2004, two of us (R.A.B. and J.D.H.) along with Mr. James Scott, the
Editor-in-Chief of the British volume of The Journal of Bone and Joint
Surgery, jointly published an editorial, "Changing Ethical
Standards in Scientific
Publication,"1-3
in which we outlined various elements of publishing ethics, including
plagiarism and redundant publication. Our journals have adopted publishing and
reporting standards based on those of several international editors'
groups4-6.
We wish to again bring these issues to the attention of our readers because we
continue to identify violations of well-accepted publishing standards.
We highlight three ethical standards included in the new American Academy
of Orthopaedic Surgeons (AAOS) Standards of
Professionalism7-9:
ownership of intellectual property, authorship, and redundant
submission/publication. The first relates to ownership of intellectual
property. We quote from the mandatory standards outlined in Section VIII. B:
"Orthopaedic surgeons should not claim as their own intellectual
property that which is not theirs. Plagiarism or the use of others' work
without attribution is
unethical."9
Furthermore:
7. An orthopaedic surgeon shall claim as his or her own intellectual
property only research and academic articles for which he or she made
substantial contributions to the design, collection of and interpretation of
data, and final version of the report.8. An orthopaedic surgeon shall not present ideas, language, data, graphics
or scientific protocols created by another person without giving appropriate
credit to that person.9. An orthopaedic surgeon shall, while conducting research or academic
activities, maintain the integrity of the profession by exposing through the
appropriate review process those physicians who engage in fraud or
deception.
7. An orthopaedic surgeon shall claim as his or her own intellectual
property only research and academic articles for which he or she made
substantial contributions to the design, collection of and interpretation of
data, and final version of the report.
8. An orthopaedic surgeon shall not present ideas, language, data, graphics
or scientific protocols created by another person without giving appropriate
credit to that person.
9. An orthopaedic surgeon shall, while conducting research or academic
activities, maintain the integrity of the profession by exposing through the
appropriate review process those physicians who engage in fraud or
deception.
While the AAOS guidelines are intended for AAOS Fellows, these standards
apply to all individuals submitting to our journals and across the range of
reported scientific material including (but not limited to) oral
presentations, abstracts, exhibits and posters, advertising copy, newsletters,
and full archival publications.
The Committee on Publication Ethics (COPE) report defines plagiarism as
"the unreferenced use of others' published and unpublished ideas,
including research grant applications to submission under `new' authorship of
a complete paper, sometimes in a different language. It may occur at any stage
of planning, research, writing, or publication: it applies to print and
electronic
versions."4
Those reporting scientific endeavors must give full credit through appropriate
citations to others whose ideas they have used. Permission must be sought from
the copyright holder and acknowledged when any intellectual property or
material is reproduced, including that property or material of the authors
when the copyright is held by others.
The second issue relates to authorship. Section VIII. C of the AAOS code of
professionalism reads: "The principal investigator of a scientific
research project or clinical research project is responsible for proposing,
designing and reporting the research. The principal investigator may delegate
portions of the work to other individuals, but this does not relieve the
principal investigator of the responsibility for work conducted by the other
individuals."9
The mandatory standards of the
AAOS9 include:
10. An orthopaedic surgeon shall warrant that he or she has made
significant contributions to the conception and design or analysis and
interpretation of the data, drafting the manuscript or revising it critically
for important intellectual content and approving the version of the manuscript
to be published.
10. An orthopaedic surgeon shall warrant that he or she has made
significant contributions to the conception and design or analysis and
interpretation of the data, drafting the manuscript or revising it critically
for important intellectual content and approving the version of the manuscript
to be published.
Again, these guidelines are intended for AAOS Fellows but, regardless of
the individual, authorship entails a substantial responsibility and privilege,
and authors must make material contributions to the various elements of a
study and manuscript preparation and any revisions. The standards state that
authors should contribute to all of these elements, not merely one or two.
The third issue relates to duplicate or redundant publication (the latter
perhaps the better term, since authors sometimes submit or publish more than
two similar articles). The relevant mandatory standard of Section VIII. C of
the AAOS code9
states:
11. An orthopaedic surgeon shall disclose the existence of duplicate
articles, manuscripts or other materials that report his or her scientific or
clinical research.
11. An orthopaedic surgeon shall disclose the existence of duplicate
articles, manuscripts or other materials that report his or her scientific or
clinical research.
The COPE report states: "Redundant publication occurs when two or
more papers, without full cross reference, share the same hypothesis, data,
discussion points, or
conclusions."4
This statement suggests that an article need not contain all elements to
constitute redundant publication but rather individual elements. The report
further states:
1. Published studies do not need to be repeated unless further confirmation
is required.2. Previous publication of an abstract during the proceedings of meetings
does not preclude subsequent submission for publication, but full disclosure
should be made at the time of submission.3. Re-publication of a paper in another language is acceptable, provided
that there is full and prominent disclosure of its original source at the time
of submission.4. At the time of submission, authors should disclose details of related
papers, even if in a different language, and similar papers in press.
1. Published studies do not need to be repeated unless further confirmation
is required.
2. Previous publication of an abstract during the proceedings of meetings
does not preclude subsequent submission for publication, but full disclosure
should be made at the time of submission.
3. Re-publication of a paper in another language is acceptable, provided
that there is full and prominent disclosure of its original source at the time
of submission.
4. At the time of submission, authors should disclose details of related
papers, even if in a different language, and similar papers in press.
The keys to avoidance of redundant publication are novelty and
transparency. The COPE report's definition of redundant publication implies
that the key elements (hypothesis, data, discussion points, or conclusions)
should be new, and if they are not, publication is not warranted. Transparency
or disclosure, as suggested by the new AAOS standards, may take one or both of
two forms: disclosure in a cover letter to the editor and disclosure in a
manuscript. Disclosure in a cover letter to the editor is appropriate when the
material has appeared in an abstract published in a previous society
proceedings or when, for any reason, the material is under consideration or in
press at another journal. Full disclosure requires notation of those elements
of the manuscript that are redundant and of the reasons for republishing them.
In such cases, the editor will determine how to proceed with processing.
Disclosure in a manuscript is appropriate when the material has already been
published. In such cases, authors must acknowledge the specific material being
republished and the reasons for republication. Typically, such disclosure
should appear in the introduction to the paper (as a rationale) or, when
appropriate, in the materials and methods or discussion section. As noted in
the COPE report, data should not be re-published unless further confirmation
is required.
The addition of a relatively small number of cases or the addition of a
relatively small amount of follow-up do not constitute adequate grounds for
republication unless the conclusions differ as a result of those additions.
Since these judgments may be somewhat subjective, we urge authors to contact
the journal editor and/or explicitly address the issue in a cover letter
whenever the potential for redundant publication exists (for example, when
they are reporting on an identical or overlapping patient cohort). In
addition, the potentially redundant publication(s) should be submitted along
with the manuscript under consideration. This ensures the transparency of the
process and protects the authors from retrospective assertions of
duplicate/redundant publication. In addition, a department of orthopaedic
surgery can establish a manuscript review committee to evaluate such issues
intramurally and to advise authors on the appropriate steps to take before
manuscripts are submitted for consideration by medical journals.
Many authors are under the mistaken impression that publication of a
manuscript in a society proceedings as a full manuscript does not preclude
publication in substantially similar forms in other journals. The COPE
guidelines explicitly note that republication is appropriate only when the
proceedings contains the abstract alone (typically a few hundred words). Thus,
publication of full multiple-page manuscripts in a society proceedings
constitutes a publication in its own right, often with copyright transference
to another party. We recommend that the leadership of our professional
specialty and subspecialty societies develop policies and procedures for their
education and program committees that explicitly address the issue of
duplicate/redundant publication in the context of society proceedings. We
further recommend that the individual compiling these manuscripts for the
society (often a guest editor) work with the authors to ensure compliance with
the COPE guidelines. The policies of the societies should explicitly state
that there is no requirement to publish a full-length manuscript in a society
proceedings if substantially similar material has been published
elsewhere.
The international organizations that we
cited4-6
all have explicit policies and actions for violations of the various
standards. When editors are made aware of potential violations, they typically
contact the editor or editors of the other journals in question and jointly
establish which actions to pursue. When redundancy or plagiarism is obvious,
they typically send letters to the authors in question asking for an
explanation. When redundancy or plagiarism is not as clear, they may first
seek an independent review to ascertain whether there is substantial
similarity to, or appropriation of, the work of others. Further action depends
on the nature of the authors' explanation. When the explanation does not seem
reasonable, additional actions include (but are not limited to) sanctions
against the authors prohibiting them from making additional submissions to the
journals, typically for a specified time; publication of letters of apology or
explanation; and/or notification of the authors' institutions of the violation
of ethical practices. The AAOS has additionally instituted a procedure in
which one AAOS Fellow may bring a grievance against
another8. These
grievances may be filed up to ten years following the date of eligibility.
Following review by the AAOS, if the respondent is found in violation its
Board of Directors may institute one of the following actions: censure,
suspension, or expulsion from the AAOS. When the AAOS Board of Directors makes
a recommendation for action, either the grievant or the respondent may file an
appeal8. ("For
purposes of these professional compliance procedures, the `Judiciary
Committee' shall be the AAOS body responsible for hearing the appeal of either
the Grievant or Respondent of the recommendation made by the Committee on
Professionalism Hearing Panel and for developing a written recommendation for
professional compliance action to be taken by the AAOS Board of
Directors."8)
Our journals have not used these grievance procedures in the past, but we
fully concur with their institution and will, when we deem appropriate, file
grievance procedures with the AAOS.
We take these and other related ethical issues seriously. Readers or
authors who have questions regarding our policies should feel free to contact
us.