The purpose of scientific writing is to convey important research findings and clinical advances to the field and to academia. The altruistic reason, of course, is to help patients. Scientific publications, especially those like Advances in Skin & Wound Care that are subjected to the peer-review process, are highly regarded and are accepted as a negotiable product of academic achievement. A bibliography of peer-reviewed publications often translates to academic rank, promotion, peer recognition, and even bonuses. The stakes can be high and the competition for authorship and credit of a published work fierce.

In the old paradigm, independent authorship was more common; the independent investigator had few, if any, coauthors. The current trend, however, is toward a team approach in all aspects of a research project-taking the project from idea to implementation to writing to publication. In this contemporary model, we see multiple authors with partial ownership in the intellectual contribution.

Who Did the Work?

In most cases, authorship issues, such as order of authorship and credit, are informally or formally agreed on before a manuscript is submitted to a peer-reviewed journal. The authors should ask-and answer-2 simple questions: Who did the work? Who gets the credit? If that happens, there should be no problems.

However, authors are human, and problematic issues could arise when we add the publish-or-perish mentality, group dynamics, and possible miscommunication to the mix. This can grow into a serious authorship dispute, especially if the authorship issues are not formalized before submission.

A journal has no controlling authority or responsibility to mediate these disputes and no investigative role. The individual or the team submitting the manuscript has the responsibility to ensure that order of authorship, credits, and acknowledgments have been agreed on and that conflict of interest statements have been signed.

Disputes surrounding matters of authorship are becoming more prevalent. Some blame the extraordinary publishing pressures on investigators and the fast-moving, competitive nature of academia and health care today. The International Committee of Medical Journal Editors has attempted to resolve these emerging issues through publication of authorship guidelines. However, the guidelines have been criticized for being too prescriptive and have not been widely accepted.

Preventive Approach

As in every potentially dysfunctional situation, prevention is the best policy. To head off problems, I believe that authors or contributors should meet on a frequent and regular basis, with the overall goal of developing a document or contract to agree on order of authorship before submission of the final manuscript.

Of course, allowances must also be made for changes in roles and degree of effort as the project progresses. In addition, the editorial process itself may change the character or relative contribution of authors. Peer reviewers, for example, often recommended changes that could result in the original manuscript being revised to make it fit the style or space allocated to the manuscript. The work of an individual, therefore, could be de-emphasized in the final product and the order of authorship could be changed.

I also share the view that the ethical principles of malfeasance and beneficence are appropriate when making decisions about authorship and credit for work done. Under the concept of malfeasance, we should not distort the value of our intellectual contribution to a given work. Nor should we diminish the contribution of others. On the flip side, our decisions need to be driven by the ethical concept of beneficence (assistance) to patients and other members of the team. For example, more senior members of a given team may yield degrees of intellectual ownership to help junior members of the team become published.

Quantifying Contributions

Many journals have addressed the issue of intellectual contributions by asking authors to verify their role in the project. For example, JAMA instituted a procedure that explicitly identifies the role of each participant in the manuscript, eg, the role in writing, conducting the project, and collecting the data. Some journals require a statement of relative contribution, a copy of any agreement the authors signed among themselves regarding order of authorship or contribution, or a document from the authors stating that they accept responsibility for the scientific content of the manuscript.

This editorial has highlighted the issues related to authorship and suggested actions that potential authors should take before submitting a manuscript. A journal's editorial staff is not responsible for policing these issues. Our role is to recommend a proactive, preventive approach to establishing intellectual contribution and author attribution.

In doing so, we hope to avoid any nonhealing wounds.

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