Rules for authorship must be clarified

April 11, 2018

Pär SegerdahlRecently, I wrote a post on honorary authorships in the academia. When I in that post tried to render the ICMJE criteria for academic authorship, I felt dull since I could not figure out how to express in my own words the fourth criterion:

”Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.”

To count as an author of an academic publication, it is not sufficient to contribute to the research, to drafting or revising the intellectual content of the text, and to approve the final version. You must also satisfy this fourth criterion, which has to do with responsibility for research misconduct.

What does the criterion actually say? After reading an opinion piece by Gert Helgesson and Stefan Eriksson in Learned Publishing, I realize that it was not just my stupidity that caused my difficulties to summarize the fourth criterion. The formulation is ambiguous, which may be due to disagreement among the authors of the authorship criteria!

Helgesson and Eriksson find three possible interpretations of the fourth criterion:

  1. Emphasizing the initial ten words (until the first instance of “work”), the criterion seems to say that all authors are responsible, or should be held responsible, for all parts of the article. If the work was fraudulent in some way, all authors should be held responsible, even if they were unaware of what was going on.
  2. Continuing to read the whole criterion, its meaning changes. The criterion then seems to say that if fraudulence is suspected, then all authors have the responsibility to facilitate the investigation of the suspicions (regardless of what part of the work the suspicions concern).
  3. A third interpretation goes further than the second interpretation. It says that an author should support investigations of fraudulence not only after the article was sent to a journal. An author should initiate such investigations him- or herself already during the research and drafting phase, if he or she suspects fraudulence.

It is impossible to determine which interpretation holds. Helgesson and Eriksson consider the third interpretation most reasonable from a research ethical point of view. If this is the intended interpretation, it should be made linguistically unmistakable in the next revision of the authorship criteria, the opinion piece concludes.

Pär Segerdahl

Helgesson, G. and Eriksson, S. Revise the ICMJE Recommendations regarding authorship responsibility! Learned Publishing 2018. doi: 10.1002/leap.1161

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Risks of discrimination in population-based biobanks

April 4, 2018

Pär SegerdahlEven good intentions can cause harm. Considerately treating certain groups as “vulnerable,” such as pregnant women and children, can cause discrimination against them. If we protect them from participation in clinical research, we know less about how they respond to medical treatments. They are therefore exposed to greater risks when they are patients in need of medical treatment. Thanks for your concern.

Deborah Mascalzoni points out possible discrimination patterns in population-based biobank research. She particularly highlights people with psychiatric conditions, who often are excluded from such studies. However, she also mentions children, who rarely are included in population-based biobanks, as well as people with early forms of dementia or addiction problems.

Mascalzoni thus asks how representative population-based biobanks really are. This is important, as results from such research are increasingly used in the planning of care. We need to see these potential discrimination patterns more clearly, so that people suffering from psychiatric conditions, for example, have similar opportunities to benefit from research as others.

However, the patterns are caused not only by how we think of certain groups as “vulnerable.” Even practical difficulties, to which you may not give much thought, can cause discrimination. It is ethically and legally cumbersome to recruit children as research participants. People suffering from depression may have suicidal thoughts, which requires special efforts. People with early symptoms of dementia may have difficulty understanding complex information, which complicates the process of informed consent.

Some groups are in practice more difficult to recruit to population-based biobanks. Not only our consideration of certain groups as “vulnerable,” then, but also practical obstacles to which we do not pay attention, may cause biased research results, which may lead to poorer care for certain groups. There is therefore reason to ask about representativeness.

Pär Segerdahl

Mascalzoni, D. 2017. Reverse discrimination for psychiatric genetic studies in population-based biobanks. European Neuropsychopharmacology 27: 475-476

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Two measures against the culture of honorary authorships

March 13, 2018

Pär SegerdahlIt is important in the academia to know who actually contributed as author to scientific publications. Partly because authorship is meritorious when researchers seek positions and funding. Partly to facilitate investigations of suspected research misconduct.

These are two important reasons why there are guidelines for academic authorship. These guidelines state that an author should not only contribute to design, data collection, or analysis behind the publication. An author should also contribute to writing and revising the text. An author should moreover approve the final version of the text, and agree to be accountable if there are issues of accuracy or integrity.

The number of authors listed on academic publications tends to increase. As an extreme example, I might mention that in 2011, 140 scientific articles were published listing more than 1,000 authors!

One reason for the larger numbers of listed authors is, of course, that research is becoming increasingly complex and requires collaborations that are more extensive. However, much suggests that the number of undeserving authors increases. One could speak of a culture of honorary authorships within the academia.

There are strong driving forces behind the culture of honorary authorships. It can be about supporting cohesion in a research group by avoiding the uncomfortable decision to exclude team members who contributed minimally to the work being published. It can be about creating good relationships with influential people in the research community by giving them authorship; which they sometimes demand. It can be about increasing the chances of being published by having a famous researcher’s name in the author list. And since big research projects are prestigious, a long author list looks good. It creates pressure on the journals to publish what apparently required the contribution of so many skilled researchers – one thinks.

What can we do about it? In a recent article with the, nowadays, modest number of four authors, it is emphasized that guidelines for academic authorship, which have been around for a long time and are well known, obviously do not suffice. In the journal Insights, Stefan Eriksson, Tove Godskesen, Lars Andersson and Gert Helgesson write that we probably need to create psychological incentives against the culture of honorary authorships.

More specifically, two simple measures are suggested that can reduce undeserving authorships within the academia:

  1. When researchers seek positions, interview them about their contributions to publications that they include in the list of qualifications. If they are only honorary authors, they may not be able to account for the articles or how they contributed to them. Knowing that this is part of the recruitment process can create a psychological pressure to avoid undeserving honorary authorships.
  2. Divide authorship and citations scores with the number of authors. Awareness that scores ​​are calculated in this way creates a psychological pressure not to include undeserving authors in the author list.

One might object that this proposal instead risks excluding collaborators from contributing as authors, although they could very well be invited to function as well-deserved co-authors. This objection is addressed in the article. Instead of explaining the authors’ defense, I hope that my silence on this point will motivate readers of the Ethics Blog to read the important article. So that I do not lure you into some sort of honorary readership! How often do we not intimate that we have read something very interesting, which we in fact only skimmed through or heard summarized?

The academic culture of honorary authorships will not disappear easily. Ethical guidelines are obviously not enough. Of course, the best thing would be if we all became saints. While waiting for it to happen, psychological incentives may be needed to behave well.

Pär Segerdahl

Eriksson, S., Godskesen, T., Andersson, L., Helgesson, G. (2018). How to counter undeserving authorship. Insights. 31(1), p.1. DOI: http://doi.org/10.1629/uksg.395

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Inequalities in healthcare – from denial to greater awareness

February 14, 2018

Pär SegerdahlSwedish law prescribes healthcare on equal terms for the whole population. Complying with this law is more difficult than one might believe, since discrimination tends to happen unknowingly, under our own radar.

Telephone nursing has been thought to increase equality in healthcare, because it is so easily accessible. However, research has demonstrated inequalities in telephone counseling. Callers are not treated equally.

Given the role of unawareness in the drama, this is not surprising. Despite the best intentions, treating people equally is very difficult in practice. What can we do about it?

If unawareness is a factor and discrimination largely happens unintentionally, I do not think we can conclude that it must be the result of a “bad system.” Even if discrimination arises unintentionally, it is humans who discriminate. Humans are not just their awareness, but also their unawareness.

In an article in the International Journal of Equity in Health, Anna T. Höglund (and four co-authors) investigates awareness of discrimination in healthcare, especially in telephone nursing. Swedish telephone nurses responded to a questionnaire about discrimination and equal treatment. The nurses’ answers could then be analyzed in terms of four concepts: denial, defense, openness and awareness.

Denial: some nurses denied discrimination. Defense: Some acknowledged that care was not always given on equal terms, but said that measures were taken and that the problem was under control. Openness: some of the nurses found the problem important and wished they could learn more about care on equal terms. Awareness: Some clearly saw how discrimination could occur and gave examples of strategies they used to avoid complex discriminatory patterns of which they were aware.

Rather than explaining unintended discrimination as the result of a “bad system,” these four concepts provide us with tools that can help us handle the problem more responsibly.

Anna T. Höglund proposes two complementary ways of viewing the four concepts. You can see them as positions along a line of development where a person can mature and move from denial or defense, through openness, towards the ultimate goal, awareness. But you can also imagine a person moving back and forth between positions, depending on the circumstances.

One recognizes oneself in these positions; unfortunately, not least in the positions denial and defense. The conceptual model developed in the article increases awareness of discrimination as largely a matter of our awareness and unawareness.

The authors add a fifth concept to the model: Action. If I understand them, they do not mean by “action” correcting a “bad system,” thereby controlling the problem. On the contrary, that would appear very much like expressing the defensive position above. (This indicates how much unawareness there is in many bureaucratic attempts to “control” societal problems through “systems,” to which one later refers: “We have taken appropriate measures, the problem is under control!”)

No, we need to continuously work on the problem; continually address ourselves and our patterns of acting. The conceptual model developed in the article gives us some tools.

Pär Segerdahl

Höglund, A.T., Carlsson, M. Holmström, I.K., Lännerström, L. and Kaminsky, E. 2018. From denial to awareness: a conceptual model for obtaining equity in healthcare. International Journal for Equity in Health 17. DOI 10.1186/s12939-018-0723-2

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New concept of consciousness challenges language

January 31, 2018

Pär SegerdahlA few weeks ago, I recommended an exciting article by Michele Farisco. Now I wish to recommend another article, where Farisco (together with Steven Laureys and Kathinka Evers) argues even more thoroughly for a new concept of consciousness.

The article in Mind & Matter is complex and I doubt that I can do it justice. I have to start out from my own experience. For when Farisco challenges the opposition between consciousness and the unconscious, it resembles something I have written about: the opposition between human and animal.

Oppositions that work perfectly in everyday language often become inapplicable for scientific purposes. In everyday life, the opposition between human and animal is unproblematic. If a child tells us that it saw an animal, we know it was not a human the child saw. For the biologist, however, the idea of ​​the human as non-animal would be absurd. Although it is perfectly in order in everyday language, biology must reject the opposition between human and animal. It hides continuities between us and the other animals.

Farisco says (if I understand him) something similar about neuroscience. Although the opposition between consciousness and the unconscious works in everyday language, it becomes problematic in neuroscience. It hides continuities in the brain’s way of functioning. Neuroscience should therefore view consciousness and the unconscious as continuous forms of the same basic phenomenon in living brains.

If biology talks about the human as one of the animal species, how does Farisco suggest that neuroscience should talk about consciousness? Here we face greater linguistic challenges than when biology considers humans to be animals.

Farico’s proposal is to widen the notion of consciousness to include also what we usually call the unconscious (much like the biologist widens the concept of animals). Farisco thus suggests, roughly, that the brain is conscious as long as it is alive, even in deep sleep or in coma. Note, however, that he uses the word in a new meaning! He does not claim what he appears to be claiming!

The brain works continually, whether we are conscious or not (in the ordinary sense). Most neural processes are unconscious and a prerequisite for consciousness (in the ordinary sense). Farisco suggests that we use the word consciousness for all these processes in living brains. The two states we usually oppose – consciousness and the unconscious – are thus forms of the same basic phenomenon, namely, consciousness in Farisco’s widened sense.

Farisco supports the widened concept of consciousness by citing neuroscientific evidence that I have to leave aside in this post. All I wish to do here is to point out that Farico’s concept of consciousness probably is as logical in neuroscience as the concept of the human as animal is in biology.

Do not let the linguistic challenges prevent you from seeing the logic of Farisco’s proposal!

Pär Segerdahl

Farisco, M., Laureys, S. and Evers, K. 2017. The intrinsic activity of the brain and its relation to levels and disorders of consciousness. Mind and Matter 15: 197-219

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The unconscious deserves moral attention

January 10, 2018

Pär SegerdahlLast autumn, Michele Farisco wrote one of the most read posts on The Ethics Blog. The post was later republished by BioEdge.

Today, I want to recommend a recent article where Farisco develops his thinking – read it in the journal, Philosophy, Ethics, and Humanities in Medicine.

The article will certainly receive at least as much attention as the blog post did. Together with Kathinka Evers, Farisco develops a way of thinking about the unconscious that at first seems controversial, but which after careful consideration becomes increasingly credible. That combination is hard to beat.

What is it about? It is about patients with serious brain injuries, perhaps after a traffic accident. Ethical discussions about these patients usually focus on residual consciousness. We think that there is an absolute difference between consciousness and unconsciousness. Only a conscious person can experience well-being. Only a conscious person can have interests. Therefore, a patient with residual consciousness deserves a completely different care than an unconscious patient. A different attention to pain relief, peace and quiet, and stimulation. – Why create a warm and stimulating environment if the patient is completely unaware of it?

In the article, Farisco challenges the absolute difference between consciousness and unconsciousness. He describes neuroscientific evidence that indicates two often-overlooked connections between conscious and unconscious brain processes. The first is that the unconscious (at least partly) has the abilities that are considered ethically relevant when residual consciousness is discussed. The other connection is that conscious and unconscious brain processes are mutually dependent. They shape each other. Even unconsciously, the brain reacts uniquely to the voices of family members.

Farisco does not mean that this proves that we have an obligation to treat unconscious patients as conscious. However, the unconscious deserves moral attention. Perhaps we should strive to assess also retained unconscious abilities. In some cases, we should perhaps play the music the patient loved before the accident.

Pär Segerdahl

Farisco, M. and Evers, K. The ethical relevance of the unconscious. Philosophy, Ethics, and Humanities in Medicine (2017) DOI 10.1186/s13010-017-0053-9

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Big questions do not have small answers

December 20, 2017

Pär SegerdahlSome questions we perceive are “bigger” than other questions. What does it mean to live, to be, rather than not to be? When does life begin and when does it end? What is a human being? Does life have a meaning or do we endow it with mere façades of meaning?

We do not expect definitive answers to these questions, except for a joke. They are wonderings that accompany us and occasionally confront us. We may then notice that we have an attitude to them. Perhaps a different attitude today than ten years ago. The attitude is not a definitive answer, not a doctrine about reality that dry investigations could support or falsify.

Bioethics sometimes comes close to these big questions, namely, when scientists study what we can associate with the mystery of living, being, existing. An example is embryonic stem cell research, where scientists harvest stem cells from human embryos. Even proponents of such research may experience that there is something sensitive about the embryo. I would not exist, we would not live, you would not be, unless once upon a time there was an embryo…

The embryo is thus easily associated with the big questions of life. This implies that bioethics has to handle them. How does it approach them?

Usually by seeking specific answers to the questions. Like super-smart lawyers who finally get the hang of these age-old, obscure issues and straighten them out for us.

Do you know, for example, when a human being begins to exist? Two bioethicists combined biological facts with philosophical analysis to provide a definitive answer: A human being begins to exist sixteen days after fertilization.

Incorrect, other bioethicists objected. They too combined biological facts with philosophical analysis, but provided another definitive answer: A human being begins to exist already with fertilization. The only exception is twins. They begin to exist later, but much earlier than sixteen days after fertilization.

The bioethicists I am talking about are proud of their intellectual capacity to provide specific answers to such a big question about human existence. However, if big questions do not have small answers, except for a joke, do they not deliver the answer at the cost of losing the question?

The question I am currently working on is how bioethics can avoid losing the questions we perceive are “bigger” than other questions.

Pär Segerdahl

Smith, B. & Brogaard, B. 2003. Sixteen days. Journal of Medicine and Philosophy 28: 45-78.

Damschen, G., Gómez-Lobo, A. & Schönecker, D. 2006. Sixteen days? A reply to B. Smith and B. Brogaard on the beginning of human individuals. Journal of Medicine and Philosophy 31: 165-175.

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