Physicians like to be successful. Not just financially, they like to do what they say they’re going to do. This is why the annual release of the cancer mortality statistics proves so discouraging to all but the most giddy optimists, ie, oncologists.(1) It is also why doctors venture into distant territory; they seek success. If you can’t cure cancer, maybe you can attack an easier target and thus get better results. The prevention of nuclear war is a laudable social goal. It doesn’t seem to have much to do with medicine more than with anything else, but physicians band together to prevent it, arguing that the world’s health will be bearish after a nuclear war. No one can deny that, just as no one can deny that the cement industry will crack or that chicken farmers will be in deep you know what if the world blows up.

All these niggling quibbles notwithstanding, we haven’t had any nuclear wars since doctors decided to prevent them. Success is success. It’s a weekly column in one of the world’s leading medical journals. It’s a Nobel Prize. And you don’t even have to take night call. There is a world full of opportunities out there for frustrated doctors who are tired of trying to capture the entire gross national product for the diagnosis and treatment of untreatable diseases.

While I’m going to keep most of the good ones to myself I’ll give one away—Physicians Against California Breaking Off and Falling Into the Pacific Ocean. Think of all those potentially soggy west coast HMOs and of the high likelihood of success, at least for the short haul—all of which brings me inevitably to multiple authorship on medical papers.

I’ve written about multiple authorship before, never dreaming that anyone would really do anything about it.(2) It didn’t seem to offer the boffo opportunities innate in thermonuclear catastrophe or the San Andreas fault, but lurking in the “Uniform requirements for manuscripts submitted to biomedical journals” (a document that will be read in its entirety only by those with a truly empty calendar) is a brief section on authorship that appears as well thought out as the imposition of SI units on the medical laboratory.(3)

Consider this: “Authorship should be based only on substantial contributions to (a) conception and design, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; and on (c) final approval of the version to be published. “Conditions (a). (b). and (c) must all be met” (italics mine).(3)

Think about what this means. Suppose you’ve done some work with a fellow or a medical student and get around to publishing it with your usual deliberate speed and the journal you send it to reviews it with its customary dispatch; the fellow may be retired and the student is sure to be in practice. You’ve got to find them to get their final approval. If the student hasn’t graduated, he’ll probably be on a psychiatry elective in Ceylon trying to figure out why it’s now called Sri Lanka. One fellow will be back in Peru dodging the Sendero Luminoso, and thus impossible to locate, while another will have returned to France and will be refusing to speak English. So who will sign the copyright transfer form—yourself and three secretaries. But that’s not honest and “The issue is honesty.” That’s what the Journal of Laboratory and Clinical Medicine says in a brief but pious editorial.(4)

The honest alternative is to follow the rules and not publish anything you didn’t do all by yourself or with your Siamese twin or not to publish anything. On slight reflection the latter course doesn’t seem so bad, but a cessation of weekly ruminations on global incineration or ecologic calamity would force many of us to stagger back to patient care unable to prevent nuclear Armageddon or to give the Golden State a seismic vaccination. Not only would everyone miss our important intervention into the course of human events, but all this extra patient care would give the economy an enema that it needs as much as does a patient with cholera.

Finally, contemplate the requirement “for important intellectual content.” Most journals would be empty advertisement sandwiches if this one were enforced. Okay, your work is a vast Jupiter of intellectual content; but suppose you did it with a surgical colleague. Where does that leave him? Your brain may have conceived a grand design, but his hands made it possible. The new guidelines (rules?) indicate that he merits an acknowledgment at best. It would be interesting to observe his reaction when you tell him this. I mentioned above that these requirements seemed about as well thought out as SI units. When I looked at who had actually written them I discovered to my shock and amazement that they were largely the same. If I were good at finding morals I’d probably find one here.(5)


1. American Cancer Society: Cancer Statistics, 1988. CA Vol 38, No 1, 1988

2. Kurtzman NA: Important trends in medical journalism (ed). Semin Nephrol 4:193, 1984

3. International Committee of Medical Journal Editors: Uniform requirements for manuscripts submitted to biomedical journals. Br Med J 296:401, 1988

4. Daniel TM: Authorship: The International Committee of Medical Journal Editors offers guidelines (ed). J Lab Clin Med 112: 137, 1988

5. Kurtzman NA: Everything has a moral if only you can find it (ed). Semin Nephrol 3:167, 1983

Originally published:

Kurtzman NA (ed): Metaauthorship. Sem Nephrol 8:315-316, 1988.