CTSI Blogs

The Research Ethics Blog by Bernard Lo, MD

When Authorship Turns Sour

A friend e-mailed me about a difficult authorship dispute he was having – a research collaboration gone sour. Being an author on a paper in a major journal can provide tremendous satisfaction and prestige, but authorship can also produce painful disputes over responsibilities and positions in the list of authors. Dilemmas over authorship are common, can cause great emotional pain, and require huge time commitments. Imagine such a situation: A group of investigators has completed a project on a predictive model of genotyping cancer specimens. The team (in order of authorship) consists of:

  • A medical student
  • A former industry scientist, now at the FDA
  • A biostatistician
  • A programmer
  • An associate professor who is the corresponding and senior author, has mentored the medical student, and led the project. She requested the consultation.

The senior author describes the second author as demanding and persistent in his opinions. Revisions have been a “marathon” because the second author is accusatory and insulting when others do not accept his suggestions.

The second author, after discussing the paper with several colleagues, wants to reframe the paper to give more attention to advances in predictive modeling. The senior author wants to get the paper published somewhere, and quickly. She wants the medical student to have a publication to mention in his/her internship applications. The senior author thinks that the suggestions of the second author will improve the paper. She knows that she will be doing the lion’s share of the rewriting. She would like to minimize the time and hassle she needs to spend on this project and to move on to other projects. The medical student, biostatistician, and programmer are willing to do anything the senior author proposes. They do not want to get involved in more unpleasant discussions with the second author.

The senior author proposes the following: After one more round of discussions, she will revise the paper extensively. At that point, the other authors will have the option of accepting the final draft or withdrawing as an author. Is this an acceptable and optimal approach to this difficult situation? What about the criteria for authorship?

To earn authorship, a researcher should have made substantial intellectual contributions to a project. Major medical journals require that every author contribute to each of three major stages of a project:

  • Make substantial contributions to the conception and design of the project, data acquisition, or data analysis and interpretation AND
  • Draft the article or revise it critically for intellectual content AND
  • Approve the final manuscript

The International Committee of Medical Journal Editors published a comprehensive list of recommendations for authorship.

Thus, all authors need to approve the final manuscript. If the second author does not agree with the decisions about the paper made by the other authors, he cannot in good faith be an author. If this occurs, his contributions to the paper need to be recognized in an acknowledgment. However, having spent considerable time and effort on the paper, he may be unwilling to withdraw as an author. An option that sometimes is useful when authors cannot agree among themselves on the analysis or interpretation of the data is to present the minority views, labeled as such. For instance, the paper might say, “An alternative interpretation would be …One author favored this approach because…   However, the other authors did not accept this approach because …” The merit of this approach is that it allows readers to consider alternative interpretations, to weigh the strengths and weaknesses of each, and to decide for themselves.

Address emotional issues directly.

In many group projects, interpersonal issues and group dynamics can have more impact on the project than the technical aspects of the work, such as collecting the data and carrying out the data analysis. Investigators who spend time and effort on the research may develop strong feelings about how the findings should be presented and interpreted. Feelings can run high on both sides. Different people may interpret the situation radically differently. One may feel that he has been slighted and unappreciated, while another may feel that she has gone many extra miles to accommodate what seem to her to be unreasonable demands.

Often it is useful to address the emotional and interpersonal issues directly, rather than letting them fester under the surface. Authors might draw on their other experience as physicians to consider the value of addressing emotions directly. In clinical care, physicians commonly encounter “problem patients” who seem demanding, uncooperative, and difficult to deal with. Experienced physicians recommend eliciting the “problem patient’s” emotions and addressing them directly, starting by asking open-ended questions.

Elicit the problem author’s emotions: “I sense that we both are frustrated with the process of writing and revising this paper. Can you tell me your experience of this situation?”

Acknowledge the problem author’s emotions: “I can understand that you feel angry (frustrated, upset, etc.) about what has happened.” The senior author in the case described earlier might feel that she has already spent more time than she wants listening to the second author. Moreover, she may feel reluctant to give attention to a person who has already caused her distress.  However, it may well be a fruitful strategy to invest additional time up front in order to save even more time and trouble later.

At this stage, it is useful to address the emotions and not the substantive issues regarding specific revisions. The goal is to listen to the other person’s concerns and expectations and to give him the sense that his concerns and emotions have been heard and understood. Often being heard initiates a process, in which an author is more willing to listen to the perspectives of the other authors. After being heard, the person may also be willing to find common ground with the other authors.

Express your own emotions as “I feel …”: It may be appropriate and therapeutic for the senior author to express later her own emotions and concerns. “I also feel frustrated …” It is useful to frame these statements as “I feel frustrated (angry, disappointed, taken advantage of) …” rather than “You are demanding (insensitive, selfish) …” or “You have been …” These latter constructions are usually interpreted as accusations and commonly elicit defensive reactions or counterattacks rather than focus on solving the problem at hand.

Set boundaries: As in patient care, it is useful to set limits on what you are willing to do. “My goal is to get this paper resubmitted in the next three weeks… After that, I’m going to have to move on to other projects. I just can’t keep putting in the time it’s taken to do these revisions.” It is important to be certain that you are willing to live with the implied threat – that you and the other authors will abandon the project if the limit is violated.

Try to find common ground: “We have a problem …” It is useful to try to reach an agreement on goals for the project. “I think we all want to have as strong a paper as possible, and I think your suggestion on discussing advances in predictive modeling will improve the paper. But we need to finish this project in a reasonable period of time and not have it eat into other projects we all are doing. Let’s face it; it hasn’t been accepted by a top-tier journal, and we need to get it into press.”

Get agreement on process: With this background, the “problem author” may likely agree to a process of limited revisions and conference calls, as proposed by the senior author. Moreover, it is important to reach agreement on roles. For example, if there were residual disagreement, the senior author could have authority to decide on wording.

Involve a neutral third party: Many universities offer a mediation service in which a neutral, third-party mediator assists the parties in the disagreement reach a mutually acceptable agreement. Mediation can relieve the stress of the conflict, help people to assess their opinions realistically, and improve understandings of opposing perspectives.

So how can similar problems be prevented in the future? Because authorship disputes can become bitter, it is important to try to prevent them and address them when they become apparent rather than hoping things will work out later by themselves – they generally don’t. It is a good idea to clarify authorship at the beginning of a project. Sometimes friends decide to do a joint project, without specifying who will take the lead and be first author and what each person will contribute. Although it may seem inconsistent with friendship to make these expectations explicit, it is usually better in the long run to agree in writing at the onset of the project on roles, expectations, and deadlines. If there are signs that the authorship arrangements are not working, it is better to address the problems directly when they arise than to delay addressing them and hope things will work out. Bringing up concerns early can prevent future problems by clarifying expectations, setting realistic deadlines, and agreeing explicitly on how roles will change if someone cannot meet a deadline. What do you think? Have you had similar authorship experiences? What suggestions do you have for working out authorship disputes?


I was the senior author in this case. It was a very challenging and uncomfortable situation, not least because of the highly-charged emotions and what I felt was my responsibility to protect my medical student mentee, myself, and the scientific integrity of our work (as the second author had important financial conflicts of interest with the subject matter). After much back-and-forth, I was feeling stuck and requested an ethics consult to provide an independent perspective on the situation. Frankly, another reason for requesting the consult was to obtain backup for imposing a unilateral decision to stop discussion and offer the problem author a “take it or leave it” option to the manuscript should other reasonable alternatives be exhausted. The consult was very helpful, and identified several options I hadn’t thought of (such as the option of creating a “dissenting minority opinion” section within the manuscript). It also provided an opportunity to step back from the emotions. In the end, I decided to request mediation with the second author as a way of coming up with a mutually workable plan forward. We ended up bringing the biostatistician into the mediation, since both of us trusted him and he could provide a relatively neutral perspective. This worked well, as we came up with a process which was acceptable (though hardly optimal) to me and we were able to finish up and submit the paper. It is now in the revise-and-resubmit stage. It sets me on edge to interact with this author again, but the presence of a mutually-agreed-upon work plan has been very helpful about identifying the path forward and reducing the emotional overlay to the interactions. I learned many lessons from this experience, but perhaps the most impactful was the central role of emotion and communication in this case. I think of myself as level-headed and reasonably skilled at communication, yet this situation struck a deep chord in me which has been hard to overcome. Getting an outside party involved – in this case, both the bioethics expert and the mediator – was key to restoring communication and allowing us to resolve this problem.

This is a rich discussion and an important area! I have found myself on the other side of the story (being a disgruntled middle author where the 1st author doesn't take my comments seriously or make adequate changes), and always wonder when to give up and let the paper get submitted even if imperfect or even deeply flawed, versus dropping myself from the author list, which is not usually easy to do gracefully...

I agree. As a student, I was recently presented with an opportunity to do a secondary analysis on the preexisting data of a junior faculty. Of course, as you could imagine, I was thrilled to be offered this opportunity. Unbeknownst to me at the time and much to my chagrin, the opportunity was only an offer if the junior faculty was listed as first author. No offer to assist in the writing, editing or submission of the manuscript, once completed was extended, just the offer of use of their data with this stipulation. Of course this did not resonate well with me and I declined the offer. I understand the pressure of junior faculty's need to write and submit manuscripts to gravitate up the academic ladder but this seemed wrong on several different levels. Giving credit where credit is due seems to be what should occur yet often its not the case.

As an early trainee at an institution in the Northeast, I was first author on a publication. Given what I now know about the recommendations for authorship as listed on the website referenced above (http://www.icmje.org/ethical_1author.html) I think our (my) authorship decisions were incorrect in two cases. Case 1: Someone listed as an author did not contribute intellectually, but merely provided space for me to work, helped me locate charts, gave me a couple of references and answered several patient-related questions when they came up. I now realize that this person should have been acknowledged rather than listed as an author. However, early on when my senior author was introducing me to the staff and showing me around, he offered to make this person an author in exchange for facilitating my efforts to review the charts. Space was tight and everyone was busy, and the arrangement made me feel that I had permission to ask for help when needed - that I wasn’t a burden. This person should not have been offered authorship at the outset without a more consideration of what that entails. Instead s/he should have been asked (nicely) to facilitate my efforts, and told that s/he would be acknowledged in the publication. We could also have offered this person the opportunity to become more deeply involved in the project if s/he wanted to be listed as a co-author. Either way, in the end we should not have felt obligated to include this person as an author once it was clear that his/her contributions did not warrant the title. Case 2: The second case is similar in that someone received more credit than was deserved. When we were in the final stages of submitting the manuscript, this co-author contacted my senior author and insisted on being a co-senior author, reasoning was that the study was originally her idea, and that we were dealing with her patients. However, she had not been involved in submitting the IRB application, did not come to research meetings, did not help with data collection/analysis, and did not draft the manuscript. Though she answered a few questions by email and offered some editorial comments when the final draft was circulating, her contribution was nowhere near that of the senior author. Clearly she deserved to be an author, but not a co-senior author. Not wanting to make any waves as a young trainee, and not fully understanding the situation, I told the (true) senior author that I would be happy to go along with whatever he decided regarding the matter. He decided to make her a co-senior author in the name of maintaining good relations between his division and the co-author’s division, and felt that it was not worth arguing over, even if it wasn’t deserved. Case 2 highlights the importance of agreeing on authorship early on. If I knew that this person was going to be a senior author, I would have expected a higher level of participation throughout the project. There are several other issues to consider with these examples. First, it is extremely difficult for an early trainee in a non-funded project to stand up to senior authors, and in this case the decisions were made without my input, even though I am ultimately responsible for all of them. It is important for senior authors to recognize the importance of complying with authorship standards, even if it is uncomfortable at times. In addition to being ethical, this sets a good example for the rest of the research team, and in particular the young investigator. Trainees are in a vulnerable position because there is really no non-retaliation policy to protect them if/when they take a stand about authorship. We rely on relationships made during research projects, recommendations from our collaborators, etc..., whereas senior authors are more likely to be in a position to confront others about these ethical issues. This is not meant to give young trainees permission to ignore standards of authorship; the point is that there are elements of the system that may prevent honest people from doing the right thing. Unfortunately, the academic environment, obsessed with publications and full of politics, is a set-up for ethical white lies, such as using authorship as leverage, or “if you scratch my back, I’ll scratch yours” arrangements. My suggestions, in addition to those listed in the posting (such as agreeing ahead of time on authorship issues, etc…), are as follows: 1. Though the first author is ultimately responsible, perhaps the senior author should be more involved/empowered regarding issues of authorship and other ethical aspects of the study. 2. Since professional relationships are at stake, it is imperative that the authorship guidelines provided by governing institutions (the IRB, the journal, or the academic institution itself) are rigorous and clear, and that there is an institutional culture which promotes strict adherence to the guidelines. 3. Journals should take a more active role in issues of authorship. Instead of a blanket statement that all authors contributed to the paper, all journals should require specific information about the contribution of each author. For example, the first author (or perhaps the other authors themselves) should complete a checklist describing each individual’s contributions. The journal editors would likely recognize instances when people were receiving undeserved credit. It would be more difficult for people to look the other way if more details were required. Stricter monitoring from the journals would empower the first author, because s/he could point to the journal requirements instead of feeling like a whistle-blower. 4. The website listed above indicates that the approach to monitoring authorship in large, multicenter studies is different from that in small studies; perhaps the standards should be the same no matter the size of the study. Given the amount of time it takes to design, implement, and write-up a study, a little bit more paperwork at the end seems reasonable.

This case highlights several important problems which may arise with authorship. Based upon the provided information from Dr. Lo and the response from the senior author, the primary issue seems to be related to interpersonal skills and conflict resolution. Considering the information provided, the second author in this case was an obstructionist and quite unreasonable. Whether it is authoring a manuscript, building a bridge or getting married, interpersonal interactions are key in developing a successful product and choosing your partners is of central importance. I believe it is the responsibility of the senior author to consider potential conflicts and obstructions when assembling a "team". Clearly, it is not always possible to have a perfectly agreeable and in-tune group working together, but often, certain individuals have a reputation which precedes them, and this needs to be considered early by the senior author, during the experimental design phase. Also, realistic and achievable goals for a project/manuscript should be set forth early and regularly updated as a project progresses. One additional scientific authorship issue not directly related to this scenerio is what I consider the 800 pound gorilla in the room, which no one likes to talk about. The increasing complexity of science over the past century has lead to the advent of multi-authored manuscripts which are now, of course, the norm. While this is good in that it allows for the recognition of all legitimate contributors, the ever increasing list of authors makes it very easy to include multiple members with negligible contributions. In my experience, this is the rule rather than the exception. As an MD/PhD with experience working with both basic science and clinical researchers, I find this is particularly true in clinical departments where time is split between busy clinical demands and research obligations. "Publish or perish" mentality feeds this problem with departmental chairmen who are expected to be included on every manuscript from their department, departments which include as many faculty within the department on every manuscript, etc. etc. Unfortunately, in the end, this cheapens authorship such that the only manuscripts on a CV considered valuable to many reviewers are those on which you are first or last author.

I feel ethical issues regarding authorship is an increasing problem. In this case, clearly the senior author has the best interest in the medical student educational objectives as well as the scientific merit of the research. It is unfortunate that an arbitration meeting was needed but was necessary given the attitudes and unwillingness of the second author. Ethically I feel like the ultimate ownership of the article is up to the first and senior author, and a "your with us or against us attitude" towards the second author is not unreasonable. Any objections and further clarity can be made with the second author writing another manuscript that deals with these issues.

In some ways I agree with Dr. Hoffmayer and in other ways I disagree. It is clear that the second author has significant contributions to this paper. Although I agree the senior author has been magnanimous in attempting to help the first author/medical student, it is important as described to "find common ground". All means of calming disputes as described in the above passage should be utilized. We have all dealt with difficult personalities. Difficult personalities can still produce sound science. Given the fact that our careers will entail running into these difficult personalities time after time, we have to learn skills to address these personalities and resolve conflicts all while furthering science and giving credit where it is due.

I agree with Dr. Hsu and Dr. Hoffmayer that the senior author and first author have ultimate decision making capacity with regard to the paper. This includes which journal to submit to as well as the message and time-frame of publication. Difficult co-authors often do make significant contributions however, and early communication is critical. I guess one lesson to be learned is to collaborate only with people that you would feel comfortable working with.

I particularly agree with Prashant in his comment that "being difficult is much easier on paper or via e-mail than during face-to-face meetings," and with Vijay in his statement that it is important to "collaborate only with people that you would feel comfortable working with." When I started an internship at UCSF in 2008 the main objective I had was to work hard so I could get published, but I never really thought about authorship order. It was only after countless revisions and a week or two before we were to send out our manuscript that authorship issues arose--I was listed as second author behind my PI. I had done a significant amount of the work, including building the testing setup, carrying out the tests, collecting/organizing the data, and did a lot of writing of the actual paper. Thankfully I worked in a lab with very supportive people and I set up a meeting to talk to my PI (in person). I had enjoyed working with him in the past and we got along well, which is probably why our meeting went smoothly. The authorship dilemma was worked out and we still collaborate to this day. To anyone starting out in a new internship/job/etc. I would highly recommend that you not only like your research, but that you make sure you are happy to be working with those around you, especially your PI and lab colleagues.

I agree that the corresponding authors and the first author should take the responsibility of decision making with regard to the paper. If the co-authors hope to make significant difference, the corresponding authors should communicate with them and try to let every author acceptable. If the 2nd author still disagrees the final revision, he should decide whether he will accept or refuse to put his name as co-authors.