ISPOR Central

Assigning Authorship of Scholarly Publications: Guidance and Resources in HEOR

Steve Crow, MS, ELS

A commentary in the current issue of ISPOR’s Value in Health and an editorial in response highlight the importance of properly assigning authorship in scholarly publications. These contributions bring to mind established authorship guidance that has been provided by organizations across the publishing landscape. This article reviews core components of longstanding authorship recommendations within scholarly publishing generally and specific guidance in the field of health economics and outcomes research.


Proper acknowledgement of authorship is a key component of normative scholarly conduct. Indeed, the “designation of authorship is essential for published research to be represented by those who provide significant intellectual contribution to its development and execution.”1

While discussions regarding legitimate authorship assignment date back for centuries, the topic has seen a rapid escalation in the published research over the past dozen years. For example, in their 2020 literature review on ethical issues related to scientific authorship, Hosseini and Gordijn identified and analyzed 324 eligible articles. Of those, nearly two-thirds (212) had been published just since 2009 (Figure 1).2

Furthermore, their review categorized and ranked the 10 top authorship issues as indicated by the frequency of their occurrence in the literature. As shown in Figure 2, the top 3 issues stand apart numerically. The 3rd most commonly cited issue, bias, includes conflicts of interest (both financial and non-financial), biased use of language, biased interpretation of results, biased visual depictions, and gender bias. The 2nd most cited issue, violations of the norms of authorship, relates to both serious violations including fabrication, falsification, and plagiarism as well as questionable practices such as self-citation or exploiting subordinates to publish more. But the most frequently mentioned theme was attribution, relating to “factors that should be considered in recognizing contributors’ efforts and confirming their contributions to publications.”2

Hosseini and Gordijn go on to explain that the discussion of author attribution includes 2 discrete issues. The first is about recognizing both nonintellectual contributions (such as enrolling patients for clinical trials or providing writing assistance) and intellectual contributions (designing and conducting research, analyzing and reporting results, etc). The second issue within the attribution theme is the question of the amount of effort an individual must contribute in order to receive credit. The authors point out, for instance, that the notion of requiring “a significant or substantial contribution” as a prerequisite for authorship has triggered extensive discussions throughout the field.

“...gift authorships (granting undeserved authorship status to a well-known key opinion leader) is clearly inappropriate, and the common practice of having the gift recipient briefly review the final manuscript does not qualify them for authorship.”

- J. Jaime Caro, MDCM, FRCPC

Unfortunately, few if any of these thorny issues have simple or straightforward answers. Nevertheless, experts in many scholarly disciplines—and across the field of scholarly publishing broadly—provide guidance regarding who should and should not be listed as authors in academic works.

International Committee of Medical Journal Editors Guidelines

The International Committee of Medical Journal Editors (ICMJE) is perhaps the leading authority in the health sciences authorship landscape. According to its website, the editors of 14 journals are currently official members of the ICMJE, including those of Annals of Internal Medicine, British Medical Journal, JAMA (Journal of the American Medical Association), New England Journal of Medicine, and The Lancet. The ICMJE affirms the importance of properly assigning authorship: “Authorship confers credit and has important academic, social, and financial implications. Authorship also implies responsibility and accountability for published work.”

In its recommendations entitled “Defining the Role of Authors and Contributors,”3 the ICMJE explains why authorship matters, defines who is an author, and provides guidance regarding the treatment of nonauthor contributors. Importantly, the ICMJE has published standards for authorship that are widely recognized within healthcare publishing. The standards were first published more than 40 years ago “as a way of standardizing manuscript format and preparation across journals. Over the years, issues in publishing that went well beyond manuscript preparation arose, resulting in the development of separate statements, updates to the document, and its renaming to reflect its broader scope.”4

Today, hundreds of medical journals follow the ICMJE recommendations that authorship be based on 4 specific criteria:

1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

2. Drafting the work or revising it critically for important intellectual content; AND

3. Final approval of the version to be published; AND

4. 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.

In many respects, these 4 criteria represent the bedrock guidance regarding the designation of authorship in health sciences publishing. To be clear, ICMJE suggests that “all those designated as authors should meet all 4 criteria for authorship, and all who meet the 4 criteria should be identified as authors.”

Beyond the ICMJE, other publishing associations offer largely parallel guidance regarding authorship in healthcare:

• The Committee on Publication Ethics (COPE) manages a multifaceted website dedicated to authorship,5 with resources including case studies, guidelines, flowcharts, discussion documents, seminars/webinars, and e-learning. As part of its contribution, COPE has also published an excellent discussion document entitled, “Authorship,” which highlights COPE’s focus on transparency regarding who has contributed to a work (and in what capacity) and describes processes for managing potential disputes.6 Among its other contributions, the COPE paper provides a list of author resources for negotiating authorship, determining the order of authorship, and contracting among authors.

• The Council of Science Editors (CSE), another important resource on issues in the communication of scientific information, fosters networking, education, discussion, and exchange within the scientific publishing community. CSE’s White Paper on Promoting Integrity in Scientific Journal Publications offers an in-depth analysis aimed at developing and improving effective practices (including authorship practices) that promote probity in scientific publishing.7

ISPOR Authorship Guidance

The health economics and outcomes research community has taken great care to provide clear direction regarding authorship. ISPOR encourages its members to adhere to fair and equitable requirements for authorship and to respect their colleagues in the process. In its most recent Code of Ethics,8 ISPOR highlights these authorship themes:

The named authors formally take responsibility for the report of the research. Therefore, some study users view the identity of the authors as one indicator of the likely quality and reliability of the research, although when acting as editors or reviewers of papers for journals, ISPOR members should make judgments based solely on the quality of the research, not the identity or affiliations of the authors (if these are not already anonymized by the journal concerned).

Authorship also provides recognition of the researchers’ contribution. Therefore, it is wrong to include an author who did not make a substantive contribution due to their name recognition and perceived status. Similarly, it is wrong to exclude an individual who had made a substantial contribution because of their affiliation.

Furthermore, in the Instructions for Authors for ISPOR’s journals Value in Health and Value in Health Regional Issues, the instructions specifically note that the journals use the previously described 4-criteria guidance set forth by the ICMJE for defining the role of authors and contributors.9

“there is always the possibility that the contribution of a given individual may be overstated. For this reason, Value in Health, in common with many other journals, insists that every author completes the ICMJE disclosure form personally.”

- Michael F. Drummond, MCom, DPhil and C. Daniel Mullins, PhD
Value in Health

Value in Health Commentary and Editorial Contributions

The current issue of Value in Health tackles the authorship question in 2 brief but informative pieces.

First, in his commentary titled “Let’s Make Sure We Are Doing Authorship Right,”10 Jaime Caro asks and answers 2 core questions that the guidelines do not address directly: (1) Are there acceptable grounds for excluding from authorship anyone who meets the 4 ICMJE criteria (or for including some who do not)? (2) What is the appropriate author order?

Caro argues that there are no acceptable grounds for excluding from authorship someone who qualifies. “If someone meets the criteria, they should be authors,” Caro says. He goes on to address several subsets of the core question, contending, for example, that “gift authorships” (granting undeserved authorship status to a well-known key opinion leader) “is clearly inappropriate, and the common practice of having the gift recipient briefly review the final manuscript does not qualify them for authorship.” Caro also touches briefly on the legal and moral conundrum of “work for hire,” offering suggestions to prospective authors meant to help support their claim to authorship.

Finally, Caro observes that the order in which authors are listed can be particularly contentious and “driven by criteria for promotion, appearance in citations, and the perception that order conveys the author’s role in the work.” In the HEOR field, the person listed first is generally considered the principal author and the one listed second is the next most responsible, he notes. Historically, says Caro, the last author listed was often “the head of the laboratory or department where the work was principally done, even if that person contributed insufficiently. This is inappropriate and constitutes a type of gift authorship, clearly discouraged by the ICMJE guidelines.”

In response to Dr Caro’s commentary, the Value in Health Editors-in-Chief, Michael F. Drummond and C. Daniel Mullins, remind us in their editorial11 that while authorship decisions are important in any setting, they are particularly so in academia because they can affect promotion and tenure. They go on to note that because journals rely on self-report, “there is always the possibility that the contribution of a given individual may be overstated. For this reason, Value in Health, in common with many other journals, insists that every author completes the ICMJE disclosure form personally.”

Finally, Drs Drummond and Mullins point out that Value in Health recognizes the first author as the primary author unless the authors specify co-primary authors. Beyond that, there is no significance given to the subsequent order of authors, since some author groups list the coauthors alphabetically, whereas others may seek to list authors in order of contribution or seek to place the second most prominent author at the end of the list.


Taken together, the guidance described here can be largely reduced to a simple concept: all individuals who meet all 4 of the ICMJE specific authorship criteria—and only those individuals—should be listed as authors of a scholarly work. Finally, guidance regarding the order of authors is imprecise and each authorship group should carefully discuss and manage author order based on agreement within the group. •


1. Marušić A, Hren D, Mansi B, et al. Five-step authorship framework to improve transparency in disclosing contributors to industry-sponsored clinical trial publications. BMC Med. 2014;12:197. http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0197-z. Accessed July 2, 2020.

2. Hesseini M, Gordijn B. A review of the literature on ethical issues related to scientific authorship. Accountability in Research. 2020;27:5: 284-324.

3. Defining the Role of Authors and Contributors. International Committee of Medical Journal Editors (ICMJE). http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed July 2, 2020.

4. History of the Recommendations. International Committee of Medical Journal Editors (ICMJE). http://www.icmje.org/recommendations/browse/about-the-recommendations/history-of-the-recommendations.html. Accessed July 7, 2020.

5. Authorship and Contributorship. Committee on Publication Ethics (COPE). https://publicationethics.org/authorship. Accessed July 2, 2020.

6. Discussion Document: Authorship. Committee on Publication Ethics (COPE). https://publicationethics.org/files/COPE_DD_A4_Authorship_SEPT19_SCREEN_AW.pdf. Accessed July 2, 2020.

7. CSE’s White Paper on Promoting Integrity in Scientific Journal Publications. Council of Science Editors (CSE). Accessed July 7, 2020.

8. Santos J, Palumbo F, Molsen-David E, et al. ISPOR code of ethics 2017 (4th Edition). Value Health. 2017;20(x):1227–1242.

9. Value in Health Instructions for Authors. International Society for Pharmaceutical Outcomes and Research (ISPOR). https://www.ispor.org/docs/default-source/publications/vih-guide-for-authors_pdf-for-download.pdf?sfvrsn=37273455_4. Accessed July 2, 2020.

10. Caro JJ. Let’s make sure we are doing authorship right. Value Health. 2020;23(7): 885-886.

11. Drummond MF, Mullins CD. Yes, authorship is important. Value Health. 2020;23(7): 827-828.

About the Author

Steve Crow is a board-certified editor in the life sciences with more than a decade of real-world healthcare writing and editing experience.

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