Published 12/1/2009
Maureen Leahy

Maintaining the integrity of orthopaedic literature

AAOS addresses use of unethical practices in publishing

What do plagiarism and duplicative publishing have to do with orthopaedic surgeons? Plenty, it seems. Instances of these practices in orthopaedic circles have increased in recent years, putting the integrity of the scientific literature at risk.

“You don’t want to contaminate the body of knowledge that we as orthopaedic surgeons rely upon when making treatment decisions,” said James D. Heckman, MD, editor of The Journal of Bone and Joint Surgery–American (JBJS-A) and a former AAOS president. “That knowledge base is sacred.”

Closer to home, the issue also involves protecting the Academy, its authors, and readers, according to Mark W. Wieting, chief education officer.

Heeding the call to action
According to Mr. Wieting, members of the Academy’s Council on Education have been working on ways to combat plagiarism and duplicative publishing. They have focused their efforts on prevention, detection, and appropriate sanctions.

“Our experience is that many of the participants in our programs—authors, course faculty, and even editors—aren’t educated on these issues,” said Mr. Wieting. “This isn’t just a publications matter; it’s much broader than that. It affects all of our education committees.”

It seems pretty simple: Plagiarism occurs when an author presents the ideas or written words of another as his or her own. In medical literature, plagiarism also covers data, graphics, and scientific materials. But what appears to be a straightforward question of ethics can at times be downright fuzzy.

“Even if you are quoting someone else’s work and you cite the article, but don’t use quotation marks around the author’s words, that’s plagiarism,” Dr. Heckman said. “Reusing your own words without citing the original article is considered self-plagiarism,” he added. Self-plagiarism is also called duplicative publishing and undercuts the tenets of scientific publishing.

In the case of duplicative publishing—publishing the same material or portions of that material in more than one place—authors may not even be aware of the offense and its implications. When the same information is published multiple times, it misrepresents the amount of scientific literature that actually exists. In addition, if it is published by multiple publishers, it can lead to lawsuits and payment of damages.

“I don’t believe all authors fully understand that signing a publisher’s assignment of rights form means the publisher now owns the rights to that material and that it can’t be submitted by the author for publication elsewhere,” said Marilyn L. Fox, PhD, director of publications. “They don’t realize that if the Academy, believing the material to be original, publishes it in whole or in part, it is at risk for a copyright infringement lawsuit.

“The AAOS and all publishers must adhere to certain publishing standards; moreover, it is the Academy’s responsibility to produce honest, reliable, current, and original material that is helpful to the practicing orthopaedic surgeon,” said Dr. Fox.

Education is key
As part of a three-pronged approach to educate authors and reduce the incidence of unethical publishing, the Council on Education, under the leadership of Alan M. Levine, MD, developed an Intellectual Property Quiz designed to test members’ understanding of intellectual property rights.

“The Intellectual Property Quiz is a series of questions with very relevant examples that demonstrate what is legal and what is not,” said Mr. Wieting.

The quiz contains two modules—basic and advanced—and is posted on the Academy’s Web site. All contributors to AAOS educational materials and all faculty in CME courses are required to take the quiz once every 3 years to remain current on the law. The test is free and available to all members; you don’t need to be an author to take it. Plus, members receive one CME credit for each of the modules they complete, said Mr. Wieting.

The educational initiative also includes enhanced instructions for all authors who write for the Academy, including editorials in the Journal of the AAOS and on Orthopaedic Knowledge Online, and informational articles in AAOS Now. Also, the Academy’s Standards of Professionalism (SOPs) on Research and Academic Responsibilities outlines the standards to which Academy authors must adhere and specific actions they must take to protect the integrity of the scientific literature.

Until recently, staff editors have uncovered cases of plagiarism and duplicative publishing through careful analysis of references, illustrations, and previous exposure to similar topics. But on Jan. 1, 2010, the Academy plans to begin using the electronic screening system CrossCheck. CrossCheck works by screening a manuscript through its comprehensive database of already published scientific articles in search of word strings that identify similar or identical material.

“Submissions for all Academy publications will be screened to catch possible inadvertent as well as gross errors before the submissions are peer-reviewed,” said Dr. Fox.

The Council on Education has also established guidelines, approved by the AAOS Board of Directors, for dealing with the various types of infractions. These actions closely mirror the Committee on Publication Ethics guidelines used by many medical-scientific publishers. The infractions and their guidelines are divided into four areas:

  1. Minor duplicative publishing (eg, three to four paragraphs that are similar or exactly the same as what the author has published elsewhere): The editor will ask the author to revise the manuscript.
  2. Major duplicative publishing (eg, five or more paragraphs and/or several identical illustrations as those the author has published elsewhere): The Academy does not consider this new material and will not publish it; the editor will ask the author to withdraw the article.
  3. Minor plagiarism (eg, one illustration or one or two paragraphs of someone else’s work submitted as the author’s own): The editor, at his or her discretion, will require the author to either revise or withdraw the article.
  4. Major and intentional plagiarism: The responsible author is excluded from all Academy publishing and teaching activities for 2 years.

“We’re hoping that education and detection will be sufficient to deter use of these practices, and that there won’t be occurrences that result in punitive actions,” said Mr. Wieting.

In addition, the SOPs on Research and Academic Responsibilities empowers the reader to bring a grievance against another member if a violation, such as plagiarism, is suspected. It states, “An orthopaedic surgeon shall, while conducting research or academic activities, maintain the integrity of the profession by exposing through the appropriate review process those physicians who engage in fraud or deception.”

At the most basic level, eliminating these practices in orthopaedic literature often boils down to authors using common sense, according to Dr. Heckman.

“If it doesn’t feel right, it’s probably not. If it looks like it’s an easy way out, it probably is; writing scientific papers is hard work,” he said.

“When the AAOS Board of Directors authorized requiring our volunteers to take a quiz every 3 years,” said Mr. Wieting, “they weren’t terribly happy about doing so. But they felt the problem was real, and growing, and that an educational approach could help mitigate it. We’ve posted basic information on copyright on the Web site and tried to construct a quiz that is instructive, based on real-life situations we’ve encountered, and actually challenging.”

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org

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