Science and Engineering Ethics (2004) 10, 493-502

Authorship in a Small Medical Journal: A

Study of Contributorship Statements by
Corresponding Authors
Matko Marusic^ Jadranka Bozikov^ Vedran Katavic^ Darko
Hren^ Marko Kljakovic-Gaspic^ Ana Marusic
Croatian Medical Journal, Zagreb University School of Medicine, Zagreb, Croatia

Keywords: authorship, ethics, publications

ABSTRACT: The authorship criteria of the International Committee of Medical

Journal Editors (ICMJE) are widely accepted in biomedical journals, but many studies
in large and prestigious journals show that a considerable proportion of authors do
not fulfill these criteria. We investigated authorship contributions in a small medical
journal outside the scientific mainstream, to see if poor adherence to authorship
criteria is common in biomedical journals. We analyzed statements on research
contribution, as checked by the corresponding author, for individual authors of 114
research articles, representing 475 authors, submitted to the Croatian MedicalJournal
(CMJ) from 1999 to 2000. Only 40% of authors fulfilled the ICMJE authorship
criteria. The authors listed first on the by-line were more likely to fulfill the authorship
criteria than all other authors on the by-line. The percentage of authors fulfilling the
ICMJE criteria of authorship decreased with the increase in the number of authors
listed on the by-line. These results indicate that poor adherence to ICMJE authorship
criteria is poor across biomedical journals, regardless of the size of the scientific
community. Authorship and contributorship in biomedical journals, as well as editorial
ethical responsibilities towards authorship criteria need critical redefinition and
education of both editors and authors.

Introduction
The guidelines/criteria for reporting investigator contributions have been established by
the Intemational Committee of Medical Journal Editors (ICMJE) first in 1979, with

Address for correspondence: Vedran Katavic, Zagreb University School of Medicine, Department
of Anatomy, Salata 11, HR-10000 Zagreb, Croatia, vkatavic@mefhr.
Paper received, 3 September 2003: revised, 26 March 2004: accepted, 16 April 2004,
1353-3452 2004 Opragen Publications, POB 54, Guildford GUI 2YF, UK, http://www,opragen,co,uk

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M. Maruic, J, Bozikov, V. Katavic, D. Hren, M. Kljakovic-Gapic, A. Marusic

several modifications and regular updates roughly every 4 years.'"* There were many
reasons for drawing up a set of such criteria, including an increase in the number of
authors listed on biomedical papers, and practices of gift or guest authorship.^'''' These
standards have been adopted by more than 500 journals worldwide. The ICMJE criteria
for authorship are:*
Authorship credit should be based only on 1) substantial contributions to
conception and design, or acquisition of data, or analysis and interpretation of
data; 2) drafting the article or revising it critically for important intellectual
content; and 3) fmal approval of the version to be published. Conditions 1, 2,
and 3 must all be met. Acquisition of funding, the collection of data, or general
supervision of the research group, by themselves, do not justify authorship.
Authors should provide a description of what each contributed, and editors
should publish that information. All others who contributed to the work who
are not authors should be named in the Acknowledgments, and what they did
should be described.
The ICMJE criteria are accepted by many editors of scientific journals, but the
discussion on authorship still continues.'^''^"^^ At the same time, many
authors/contributors are either not familiar with these criteria or simply do not accept
them,^"*'^^ making the actual publication practices of authors in biomedical journals
somewhat different from those expected by the standards of the ICMJE.
Several studies have shown that a substantial fraction of authors of articles in
biomedical journals did not satisfy the authorship criteria of the ICMJE.^ "^ These
studies were performed in large and prestigious journals and it is not clear if the results
could be generalized across the majority of biomedical journals. We therefore analyzed
the authors' contributions described by the corresponding author in the Croatian
Medical Journal (CMJ), a small general medical journal outside the scientific
mainstream.^"

Methods
CMJ is an intemational peer reviewed journal established in 1992, and published in
English.^' Since 1998 it is fully indexed in Index Medicus/MEDLINE, and since 1999
in Current Contents/Clinical Medicine. It is also indexed in Biosis, Excerpta Medica,
and ExtraMed. CMJ's rejection rate is approximately 60%, and the impact factor for
2002 was 0.71.

Authorship Contributions
We analyzed statements on the contribution of individual authors of research articles
submitted to the CMJ in 1999 and 2000. The sample consisted of manuscripts sent out
for peer review. The data were collected on 114 articles written by 475 authors.

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Authorship in a Small Medical Journal: A Study of Contributorship Statements

CMJ subscribes to the ICMJE authorship criteria and routinely asks corresponding
authors of all papers which are sent for extramural review to specify the contributions
of each co-author in terms of:
A) (a) Conception and design of the work that led to the paper, or (b) analysis and
interpretation of data;
B) (c) Drafting of the article or (d) critical revision of the manuscript for important
intellectual content; and
C) (e) Final approval of the article.
The authorship statement also provides the ICMJE definition of authorship, where
it is defmed as fulfillment of A AND B AND C criteria. In this study we also
considered lenient authorship criteria: A AND B, where the fulfillment of criterion C
was awarded to all authors.^'

Non-Authorship Contributions
To assess the roles of all co-authors and their contributions not related to authorship, as
well as to assess their understanding of the criteria of authorship the corresponding
authors could choose the contributions from the list that included the items (a) to (e), as
well as contributions not related to authorship: (f) provision of study materials or
patients; (g) collection, assembly and possession of raw data; (h) statistical expertise;
(i) obtaining funding; (j) administrative/technical/logistical support, and (k) guarantor
of integrity of the entire study.

Order on the By-line

Interpreting the by-line, without specific descriptions of contributions, should generally
be avoided because there is no clear rule that the authors follow.^''^''^^"^'' The
authors/contributors were ranked according to their position on the by-line as being the
first, second, or last, to address the issue that a certain position on the by-line
corresponds to a specific job.'^' These stratifications were mutually exclusive (e.g.,
authors were considered as last on the by-line when there were three authors or more
on the by-line). The interpretation of the placement on the by-line was limited only to
authors appearing last, which we considered as persons in charge of the entire study;
for lack of a better term we called them team leaders.^' ^^' ^*

Statistical Analysis
Data were analyzed using SPSS 10.0.1 software (SPSS Inc., Chicago, IL).

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Results
A total of 114 research articles by 475 authors submitted to the CMJ in the 1999-2000
period were analyzed for their authors' contributions. The majority of manuscripts had
2 to 6 authors (82%), whereas 8% of the manuscripts had a single author, and 10% had
7 to 10 authors (Table 1). The mean number SD of authors per article was 4.22.0;
i.e., the majority of manuscripts, with 2 to 6 authors, also represented the majority of
authors (78%, Table 1).
Out of 475 authors, only 184 (38.7%) fulfilled full ICMJE criteria. If criterion C
was awarded to all authors,^' the lenient criteria were satisfied by 194 (40.8%) of the
authors (Table 2). We present only the data concerning the lenient criteria, for the sake
of comparison with studies of other journals.^'
For a more detailed view of authorship compliance with the lenient ICMJE
authorship criteria we divided those criteria into 2 parts; one comprising conception
and design of a study as well as the analysis and interpretation of data, and the other
comprising drafting and critical revision of the manuscript. The fulfillment of both
requirements depended on the position of the author on the by-line, with authors listed
first or second meeting these requirements more often than authors listed last on the
by-line (Table 2).
Table 1. Number of manuscripts and authors according to the number of authors on the byline of manuscripts sent out for peer review in Croatian MedicalJoumal 1999-2000
Authors on
by-line
1
2
3
4
5
6
7
8
9
10
Total

No. of
manuscripts
9 (7.9)
20(17.5)
17(14.9)
17(14,9)
21 (18.4)
18(15.8)
7(6.1)
1 (0,9)
3 (2.6)
1 (0.9)
114(100.0)

No, of
authors
9(1.9)
40 (8.4)
51 (10.7)
68(14.3)
105(22.1)
108 (22.7)
49 (10.3)
8(1,7)
27 (5.7)
10(2.1)
475 (100,0)

According to the number of authors on the by-line, only the authors listed as single
authors of a manuscript fulfilled the authorship criteria (Table 3). The percentage of
authors fiilfilling the authorship criteria decreased with the increase in the number of
authors listed on the by-line, with the only exception of the papers with 9 authors on
the by-line. None of the authors of the single manuscript with 10 authors on the by-line
fulfilled the lenient ICMJE criteria (Table 3).

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Authorship in a Small Medical Journal: A Study of Contributorship Statements

Table 2. Fulfillment of ICMJE authorship criteria* of authors of manuscripts sent out for
peer review in Croatian Medical Journal from 1999-2000
ICMJE criteria

Conception and design OR

analysis/interpretation of
data
Drafting of the article OR
critical revision of the
manuscript
Fulfillment of both
conditions

All authors on
the by-line (%)
(n=475)
313(65.9)

Order on by-line (%)

First
Second
Last
(n=114)
(n=105)
(n=85)
114(100.0)
79 (75.2) 36 (42.4)

259 (54.5)

77 (67.5)

66 (62.9)

43 (50.6)

194(40.8)

77 (67.5)

52 (49.5)

22 (25.9)

* Conception and design or analysis/interpretation of data AND drafting of the article or critical
revision of the manuscript (final approval of the article was awarded to all authors, according to
Yank and Rennie, ref 29)

Table 3. Fulfillment of lenient ICMJE authorship criteria* in all manuscripts sent out for
peer review in Croatian Medical Journal according to the number of authors on the by-line
1999-2000
No. of
authors on
by-line
1
2
3
4
5
6
7

8
9
10

Authors fulfilling lenient

ICMJE authorship criteria
(% of authors for that rank)
9 (100.0)
24 (60.0)
23 (45.1)
30(44.1)
42 (40.0)
40 (37.0)
14 (28.6)
1 (12.5)
11 (40.7)
0 (0.0)

* Conception and design or analysis/interpretation of data AND drafting of the article or critical
revision of the manuscript (according to Yank and Rennie, ref 29)
To further investigate the contributions of authors on the by-line, we broke the
ICMJE criteria down to single concepts, dividing them into criteria determining
authorship, and non-authorship contributions. The authors listed first on the by-line
fulfilled most of the criteria more often than others on the by-line. Authors listed last
on the by-line contributed to the manuscripts the least by the criteria determining
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authorship, except by the critical revision of the article, where they were comparable
\yith the authors listed first and second (Table 4). Since those listed last on the by-line
were expected to be team leaders,^^'^^ it is surprising that they failed to fulfill the
largest percentage of non-authorship criteria (e.g., 7% and 14% for obtaining funding
and guarantor for the integrity of the whole study, respectively). At the same time, 2 1 %
and 48% of the first authors claimed responsibility for the obtaining of funding and the
integrity of the study, respectively. Also, first authors were more than twice as likely to
have been involved in the conception and design of a study, analysis and interpretation
of data, as well as in the drafting of the article than the authors placed last on the byline. Critical revision of the manuscript was the only criterion of authorship and the
administrative/technical/logistical support was the only non-authorship criterion where
all investigated authors' contributions were comparable, irrespective of their placement
on the by-line.
Table 4. Contributions of authors of manuscripts sent out for peer review in Croatian
MedicalJournal according to the ICMJE criteria in papers reviewed from 1999-2000
All authors
(n=475)

Order on by-line (%)

First
Second
Last
(n=114)
(n=105)
(n=85)

212 (44.6)
243(51.2)
159(33.5)
182 (38.3)

111 (97.4)
84 (73.7)
67 (58.8)
48 (42.1)

45 (42.9)
62 (59.1)
38 (36.2)
46 (43.8)

21 (24.7)
28 (32.9)
18(21.2)
35(41.2)

184(38.7)

63 (55.3)

37 (35.2)

32 (37.6)

199(41.9)

60 (52.6)

38 (36.2)

22 (25.9)

199(41.9)

62 (54.4)

39(37.1)

29(34.1)

98 (20.6)
58 (12.2)
98 (20.6)

37 (32.5)
24(21.1)
25(21.9)

20(19.1)
11 (10.5)
21 (20.0)

17 (20.0)
6(7.1)
19 (22.4)

86(18.1)

55 (48.3)

15 (14.3)

12(14.1)

ICMJE criteria:

For authorship:
conception and design
analysis/interpretation of data
drafting of the article
critical revision of the
manuscript
final approval of the article
Non-authorship contributions:
provision of study materials or
patients
collection, assembly and
possession of raw data
statistical expertise
obtaining funding
administrative/technical/logist
ical support
guarantor of integrity

Discussion
The results of our study showed that the adherence to the ICMJE authorship criteria
was poor in a small medical journal outside of the mainstream science. Such results are
comparable to a poor adherence to the ICMJE authorship criteria in large and
prestigious biomedical journals^'"" suggesting that this problem is common across
biomedical journals. It seems that corresponding authors either do not read or do not
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Authorship in a Small Medical Journal: A Study of Contributorship Statements

care about the authorship definitions provided on the contributorship form, but rather
distribute offered categories of contributions among the authors on the by-line guided
by their own views on authorship/contributorship.
Our data showed that approximately 60% of our authors failed to fulfill the lenient
ICMJE authorship criteria. Authors listed first on the by-line fulfilled more ICMJE
authorship and non-authorship criteria than all other authors on the by-line. Only 20%
of all last authors, usually considered as team leaders^'^^'^* fulfilled the authorship
requirements. It is interesting that only 58 authors (12%) were responsible for
obtaining funding, and only 86 authors (18%) were guarantors of the integrity of the
study, both criteria usually the responsibility of at least one author per manuscript,
most often the team leader. This indicates that our authors did not consider these items
important, which is not surprising in a poorly defined and controlled system of funding
and performing research in the scientific periphery.^" In small scientific communities,
especially in post-communist countries, small research grants and (almost) permanent
academic positions do not stimulate competition and responsible authorship.
It would be interesting to compare the contributions declared by the corresponding
authors (standard practice in our journal up to 2000) to those declared by each author
on the by-line (practice in most leading journals, e.g.. Journal of the American Medical
Association). A similar study has already been performed in a non-English journal Dutch Journal of Medicine, also a member of the ICMJE.^* Their results indicated that,
although largely unfamiliar with the ICMJE authorship criteria, almost two thirds of
the authors flilfilled those criteria. However, their scoring of both their own
involvement and the involvement of other authors on the paper showed a discrepancy
for 20% of the authors.
We believe that our results on authorship practices, as well as findings from other,
larger joumals,^*"^^'" showing poor adherence to the authorship/contributorship
criteria, should be a warning signal for editors from all journals, be they large or small,
influential or outside the scientific mainstream, and especially for the ICMJE. Such
authorship practices call for changing either the authors or the criteria, leaving,
obviously, only the criteria for re-assessment. But then again, re-assessment alone
would not be enough. The ICMJE criteria have been assessed and reassessed several
times,''^ with little impact on authorship practices. The ICMJE can change the rules
and the criteria, but if they are not known or are even ignored by the ones expected to
adhere to them (i.e. the authors), fair award of authorship credit will again be missed.
The journal editors are currently in a position where they have the responsibility, but
cannot implement the rules they have set themselves. Are they to police the
manuscripts, investigating and analyzing every single author's contributions? And once
they find someone who does not qualify to be listed on the by-line are they to delete
such author(s) from the by-line? The ICMJE declares that "Authors should provide a
description of what each contributed, and editors should publish that information."* To
what end? So that the readers would know that some of the authors are gift or guest

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authors? Or that the majority of authors do not follow the ICMJE rules, and that editors
are powerless/reluctant to change the by-line?
For these reasons, we at the CMJ have chosen to ask the authors to describe their
contributions, but not to publish this information until we can exercise our editorial
responsibilities in full. The ethics of publication lies in the inherent trust between the
editor and the authors,^"* but instances of gift and guest authorship, however rare, are
still very much a harsh reality of biomedical publishing. We believe that the best
approach to this problem is education of both authors and editors about the importance
of authorship and criteria for awarding authorship credit to researchers. In our small
scientific community, we have approached this problem at several levels: including this
topic in a mandatory course on research methodology for medical students, teaching
our authors at special workshops on scientific writing, and teaching a wider physician
community through continuing education courses.^''^^ We also call on fellow editors to
do more research into this field, so that joumai editors can make evidence-based
decisions.

Acknowledgement: This research was funded by a research grant from the Croatian Ministry of
Science and Technology No., 108182 to MM.

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