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Goldwyn, Robert M. M.D.

Plastic and Reconstructive Surgery: October 2004 - Volume 114 - Issue - p 11-12

Originally published in Plastic and Reconstructive Surgery in March 1983 (Plast. Reconstr. Surg. 71: 411, 1983).

An editor engulfed with manuscripts must contend with many problems. One of the more disagreeable is authorship: who, how many, in what order? Although, in theory, this matter should not involve the editor, in actuality, it occasionally does. He may find himself between or among warring authors, who should have resolved their dispute before they sought publication. From the conception to the birth of their paper, they took great care to avoid clarifying who would be the authors, how they would be listed, and who might appear in the acknowledgments.

The current Manual for Authors and Editors, compiled for the American Association, states that “generally, the maximum number of authors’ names in the by-line is six.”1 A differing view was Asher’s: “Six people can no more write an article than six people can drive a car. … Although heads of departments may provide inspiration, encouragement, and example, surely it is better to reward them with a polite acknowledgment at the end instead of a downright lie at the beginning.”2

Dr. Frank McDowell, my distinguished predecessor, had a rule that no paper could appear with more than three authors. I have been more liberal, but perhaps less wise. Having more than three authors is justified, particularly when the article has come from more than one institution.

Which author is first is no joke, but it does remind me of the Abbott and Costello baseball routine of “Who’s on first? No, he’s on second, etc.” The complaints that I receive from authors almost always involve an argument between a resident and a chief. The following are common situations:

1. The resident’s idea, work, and writing; the chief’s money and power. In this scenerio, the resident has thought of a new idea or technique. He or she has done all the work, including writing the paper. The chief may make a few changes in the manuscript and will pay the resident’s expenses to present it at a meeting. But the chief wants not just to be coauthor but first author. The resident may acquiesce because he or she fears the consequences: hostile acts during the remainder of training and a poor recommendation later. The chief has won the battle of power but not that of decency or truth. The effect of the chief’s piracy may devastate the younger person, who, disillusioned and angry, may flee academe. When the paper is presented, and if it is published, the irony is that many will realize that it is the resident’s achievement, especially if it has entailed a project in the laboratory, which “old Bill” would be as unlikely to visit as he would Albania.

2. The chief’s idea and patients; the resident’s work and writing. This situation, involving a clinical study, is more ambiguous than the preceding. The head of the service has initiated the project by giving the resident the idea as well as his or her own patients, and perhaps even the facilities and personnel of his or her office. The resident may recall the patients in order to examine them with his or her chief and the resident may write most of the paper. The resident then places his or her name first and the chief’s second. Although some senior physicians might not mind this decision, others would object, feeling that the resident has overstepped by reaping the harvest that was not his or hers. Acrimony replaces affection and their relationship will never be what it was. This is a pity, since deciding authorship at the beginning would have prevented this unpleasantness. Admittedly, it is awkward at the start of a project for a chief to specify who he or she thinks should do what and whose name should be first, but it is certainly better than to do so later. Furthermore, it offers the resident the opportunity to withdraw politely.

3. The chief’s department; the resident’s and younger associate’s idea, work, and writing. In this situation, the chief has had nothing to do with the paper. However, like the puppeteer, he or she holds the strings. The chief has the power and wants the glory. The others feel that they have no alternative but to add the chief’s name at the end. The editor then becomes a recipient of a paper with a plethora of authors. The editor and almost everyone else know what is happening but cannot do anything about it. To insist that a name or two be dropped may put the hapless author(s) at hazard. It is a shame that the egos of some require the gratification of a small slice of authorship. To thwart this practice of swelling one’s bibliography, the suggestion has been made that an author who is one of four receive credit for having written only a quarter of a paper. This more accurate method of reckoning would convert the “250-paper person” into perhaps a “70-paper person.”

The writing of a medical paper is an opportunity to communicate something that hopefully is new, but at least interesting, even if it is old. It should educate physicians and should benefit patients. The debut of a worthy study should be an occasion for happiness. When pettiness intrudes and dissension reigns, the celebration turns sour. The aftertaste is that of bitters, not champagne.

In the Middle Ages, the droit du seigneur allowed the feudal lord to have the sexual favors of his vassal’s bride. This custom has persisted in another form, still pernicious. Is it not time to reward solely and appropriately those who have the ideas and have done the work?

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1.Barclay, W. R., Southgate, M. T., and Mayo, R. W. Manual for Authors and Editors: Editorial Style and Preparation (Compiled for the American Medical Association). Los Altos, Calif.: Lange Medical Publications, 1981. P. 117.
2.Asher, R. Six honest serving men for medical writers. J.A.M.A. 208: 83, 1969.
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