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Health Or Smoking Those with the Most to Lose from a Devalued Coinage Are Those Who Have Worked Hardest to Earn It

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Health Or Smoking Those with the Most to Lose from a Devalued Coinage Are Those Who Have Worked Hardest to Earn It 1570 BRITISH MEDICAL JOURNAL VOLUME 287 26 NOVEMBER 1983 Br Med J (Clin Res Ed): first published as 10.1136/bmj.287.6405.1570 on 26 November 1983. Downloaded from that section having been prepared by one of the other authors. boundaries and, in clinical medicine, more multicentre trials. The explanation is clear enough: authorship is impertant in Clearly it is unrealistic in such papers to expect all the authors getting grants and jobs and some names count more than others; to have a detailed knowledge of each other's disciplines or data. and the conclusion must be that the names on a paper can no Nevertheless, they should each understand and be prepared to longer be taken at face value. defend the intellectual framework of the study and the way it The related problem of the ordering of authors is discussed was performed as well as that part of it for which they were by Dr Moulopoulous and his colleagues on page 1608. Even responsible. if the contribution is real and the authorship genuine, how do Editors may provide guidelines but the solutions must rest those who grant the money and the jobs assess an individual's with authors themselves. At its simplest an author should ask contribution to a long list of multiauthor papers ? There is no himself whether-speaking alone-he would be willing and convention for indicating the extent of each author's contribu- able to defend the paper, its contents, and its integrity against tion. Sometimes the first author is the most important; its critics. If he hesitates at all he should have very good reasons sometimes he is merely the most junior. Sometimes the last before putting the article and his name into print. author is the technician; sometimes he is the professor. Many units always put the head of the department's name last (sometimes known as "noblesse oblige"). This is acceptable Durack DT. The w^eight of medical N 7 Mcd 1978;298: 613-4. knoxwledge. En,i if he has actually conceived the study and guided his juniors 2 Burman KD. "Hanging from the nmasthead': reflections on authorship. through it,- but an unwarranted (though not always resented) Ann Intern Mcd 1982;97 :602-5. Huth EJ. Authorship f'rom the reader's side. Anin Intirte iMlcd 1983;97: intrusion if he has had little to do with the work. Some 613-4. journals avoid the problem by listing authors in alphabetical Garfield E. The ethics of scientific publication: authorship attribution and order-but then they receive disproportionately few articles citation amnesia. Cuirrent Conitents 1982 July 26:6-10. Zuckerman H. Scientific elite. New York: The Free Press, 1977. from people whose names begin with letters late in the Over R, Smallnman S. Citation idiosyncrasies. Natire 197/0;228:1357. alphabet." Huth EJ. Responsibilities of' coauthorship. Ann Intern ,Wcd 1983;99: 2 66-?. Where does all this leave the reader ? Huth has argued that Altman L M\elcher L. Fraud in science. Br Mced] 1983;286:2003-6. authorship is a responsibility and not a right or a reward,7 Nutter DO1 Heymsfield SB, Glenn J F. Retraction: Darsee JR, HevNmsfield and certainly readers should be able to assume that authors will SB, Nutter DO. Hxpertroplic cardiomvnopathy and humani lcukocvte ' antigern linkage: differentiation of two Forms of hypertrophic cardio- take public responsibility for the content of a paper. And the mvopath \ En',1l -7 led 1983 ;308:1400. responsibilities are serious: recent cases of fraud have high- " Hevmsfield SB Glenn JF. Retraction: Darsee JR, Hevmsfield SB. lighted the more extreme consequences of a too casual attitude Decreased mvocardial taurine levels and hvpertaurinuria in a kindred with mitral valxe prolapse and congestive cardiomvopathv. .N' E,,l 7 towards authorship. After the exposure of the systematic frauds Mcd 1983 ;308: 1400. carried out by Dr John Darsee at Emory and Harvard uni- Nutter DO, (Glen Li. Questions on the validity otf papers on nitral valve prolapse and on cardiomyopathy. Annii Intcrn lied 1983;99 :275. versities, several of Darsec's coauthors wrote to m'ajor medical 12 Hevmsfield S Hopkins LC. Wenger NK, Glenn JF. Questions on the journals retracting their papers. Though conceding that validity ot papers on nsitral valve prolapse and on cardiomyopathy. Ann deliberate fraud by a colleague may be hard to detect, the Iwtrt,l d 1983 ;99 275. Darsee JR. Questions orn the validity of papers on rnitral valve prolapse editor of the New England _7Joinal of AMedicine (one of the ndl on cardiomyopathy. Ann Intern Mcd 1983;99:275-6. affected journals) argued forcefully that coauthors should know Relman AS. Lessons from the Darsee affair. .\' En,,sl iMcd 1983;308:141 i. what was being done, why it was being done, and how it was HutlsJ.Ho. t h and piulish pap inthe medicl scies. PhiladelphHia: ISI 1'ress 1983:37-40. being done and take some responsibility for the integrity of the Anonvmoues. Aiithlir! I.ancet 1982 ;ii :1473. work.'4 At least one of the retractions suggests discrepancies in the original article that should have been spotted by anyone concerned at all closely with the work-surely the least that http://www.bmj.com/ can be demanded of an author. Both Relman and Huth have suggested that editors should take the initiative in dealing with the problem of multiple authors,3 14 and authors themselves would welcome guidance- Health or smoking those with the most to lose from a devalued coinage are those who have worked hardest to earn it. The Vancouver group of WVhy do we need another report from the Royal College of medical editors is considering issuing guidelines, and others Physicians on smoking' when so few doctors smoke and the on 6 October 2021 by guest. Protected copyright. have already done so.2 :1 1' Suggestions have ranged from harmful effects of tobacco are so widely acknowledged? The complete anonymity of all authors'* to lists of contributors with answer lies in the obdurate refusal of the government to their individual contributions, like film credits,' but the recognise the force of the evidence and in the urgent need for common ground is that authors should have made a significant new initiatives to stem the growing numbers of smokers among contribution to the scientific formulation or execution of the schoolchildren and young adults. Furthermore, new research study. In practice this means having taken part in conceiving findings and perspectives have changed the picture in many and designing the study, collecting the data, or analysing and ways and doctors need to be fully informed if they are to interpreting them (and perhaps too in writing them up). function as convincing, credible health educators. Guidelines produced by the Swedish Medical Association and Despite some decline in smoking by adults tobacco still its journal emphasise the importance of deciding who will be accounts for 15-20",, of all deaths in Britain; of every 1000 an author at the outset and not at the last moment, getting the young men who smoke one will be murdered, six will die on consent of all authors to publication, and not granting author- the roads, but 250 will be killed before their time by tobacco. ship simply for the sake of departmental peace. Work that Aside from cancers (of the lung, mouth, larynx, oesophagus, falls short ofthe contribution demanded for authorship should, pancreas, and urinary tract) and hcart disease, smoking also of course, be acknowledged. kills thousands of patients with chronic bronchitis and One of the legitimate reasons why numbers of authors have emphysema and peptic ulcers-and it is an important avoidable increased is that there are more studies across interdisciplinary hazard to the fetus. BRITISH MEDICAL JOURNAL VOLUME 287 26 NOVEMBER 1983 1571 Br Med J (Clin Res Ed): first published as 10.1136/bmj.287.6405.1570 on 26 November 1983. Downloaded from The tobacco industry claims that its current low tar cigar- declining rapidly with the development of better formulations. ettes are less dangerous than the untipped high tar cigarettes Once the changeover to 100 unit/ml insulin has been completed that were popular a generation ago. Almost certainly low tar all insulins will in varying degrees be "purified." Insulins are cigarettes do cause less lung cancer-but the college report made from beef or pig carcases, and their structure differs emphasises that there is no evidence that the smoking of from that of human insulin by three and one amino acids cigarettes of reduced tar or nicotine yield reduces deaths from respectively. Recently, preparations with the structure of coronary heart disease, which numerically is the greatest human insulin have been manufactured either by genetic killer among the smoking related diseases. Just how complex manipulation of bacteria or by laboratory manipulation of are the effects on heart disease of the constituents of cigarette porcine insulin. "Human" insulin derived from bacteria by smoke is shown in the paper by Professor Geoffrey Rose and the brilliant new method of recombinant DNA technology is his colleagues at p 1583. In its futile pursuit of a safe cigarette described by the epithet chain recombinant DNA bacteria the tobacco industry is chasing a will o' the wisp. (crb), and the semisynthetic human insulin derived from pig The college report also draws together material on two topics insulin is described as enzyme modified pork (emp). that have come into the public eye recently: passive smoking Insulins from different sources may have different effects and smoking in the Third World. Even low concentrations of at the site of injection, on antibody formation, and vary in smoke may affect the exercise tolerance of patients with their duration of action, and so these aspects must be con- coronary heart disease and chronic obstructive lung disease, sidered in the choice of an insulin preparation.
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