In 2004, two of us (RAB and JDH) 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,”4-6 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 groups.7-9 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 Professionalism1-3: 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.”3 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.
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The Committee on Publication Ethics (COPE) report defines plagiarism as “the unreferenced use of others' published and unpublished ideas, including research grant applications to submission under ‘new’ authorship of a complete paper, sometimes in a different language.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.”7 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.”3 The mandatory standards of the AAOS3 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.
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 code3 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.
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:7
- Published studies do not need to be repeated unless further confirmation is required.
- 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.
- 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.
- 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 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 republished unless further confirmation is required.
The addition of a relatively small number of cases or the addition of a relatively small amount of followup may 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 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 sub-specialty 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 cited7-9 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 another.2 These grievances may be filed up to 10 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 appeal.8 (“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.”2) 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.
Richard A. Brand, MD
Editor-in-Chief, Clinical Orthopaedics and Related Research
Joshua J. Jacobs, MD
Consulting Editor for Research, The Journal of Bone and Joint Surgery-A
James D. Heckman, MD
Editor-in-Chief, The Journal of Bone and Joint Surgery-A
1. American Academy of Orthopaedic Surgeons. Professional Compliance Program, 2006. Available at: http://www3.aaos.org/
member/profcomp/profcomp.cfm. Accessed September 13, 2006.
2. American Academy of Orthopaedic Surgeons. Progessional Compliance Program Grievance Procedures. 2006. Available at: http://www3.aaos.org/member/profcomp/grievanceprocedures.pdf
. Accessed September 13, 2006.
3. American Academy of Orthopaedic Surgeons. Standards of Professionalism: research and Academic Responsibilities. 2006. Available at: http://www3.aaos.org/member/profcomp/research.pdf
. Accessed September 13, 2006.
4. Brand RA, Heckman JD, Scott J. Changing ethical standards in scientific publication. Clin Orthop Relat Res
5. Brand RA, Heckman JD, Scott J. Changing ethical standards in scientific publication. J Bone Joint Surg Am
6. Brand RA, Heckman JD, Scott J. Changing ethical standards in scientific publication. J Bone Joint Surg Br
7. Committee on Publication Ethics. The Cope Report 1999. 2003. Available at: http://www.publicationethics.org.uk
. Accessed April 13, 2004.
8. Council of Science Editors. Editorial Policy Statements. 2000. Available at: http://www.councilscienceeditors.org/editorial_policies/cse_
editorial_policies.cfm. Accessed July 5, 2006.
9. International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication, 2003. Available at: http://www.icmje.org
. Accessed April 13, 2004.