How clinicians should use the diagnostic laboratory in a changing medical world.

In developed countries, clinicians are faced with a plethora of diagnostic tests to apply to patients to guide their clinical management. The quality, effectiveness, and efficiency of patient care should be foremost in the clinician's mind. Laboratory directors should make every effort to guide clinicians in appropriate laboratory test ordering, interpretation, and resulting actions. Medicine, being at its center a moral enterprise grounded in a covenant of trust, and laboratory medicine being a subset of medicine, must first care and advocate for the patient, and consider clinical outcomes as most important.

Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals.

CONTEXT: Authorship in biomedical publications establishes accountability, responsibility, and credit. Misappropriation of authorship undermines the integrity of the authorship system, but accurate data on its prevalence are limited. OBJECTIVES: To determine the prevalence of articles with honorary authors (named authors who have not met authorship criteria) and ghost authors (individuals not named as authors but who contributed substantially to the work) in peer-reviewed medical journals and to identify journal characteristics and article types associated with such authorship misappropriation. DESIGN: Mailed, self-administered, confidential survey. PARTICIPANTS: A total of 809 corresponding authors (1179 surveyed, 69% response rate) of articles published in 1996 in 3 peer-reviewed, large-circulation general medical journals (Annals of Internal Medicine, JAMA, and The New England Journal of Medicine) and 3 peer-reviewed, smaller-circulation journals that publish supplements (American Journal of Cardiology, American Journal of Medicine, and American Journal of Obstetrics and Gynecology). MAIN OUTCOME MEASURES: Prevalence of articles with honorary authors and ghost authors, as reported by corresponding authors. RESULTS: Of the 809 articles, 492 were original research reports, 240 were reviews and articles not reporting original data, and 77 were editorials. A total of 156 articles (1 9%) had evidence of honorary authors (range, 11%-25% among journals); 93 articles (11%) had evidence of ghost authors (range, 7%-16% among journals); and 13 articles (2%) had evidence of both. The prevalence of articles with honorary authors was greater among review articles than research articles (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6) but did not differ significantly between large-circulation and smaller-circulation journals (OR, 1.4; 95% CI, 0.96-2.03). Compared with similar-type articles in large-circulation journals, articles with ghost authors in smaller-circulation journals were more likely to be reviews (OR, 4.2; 95% CI, 1.5-13.5) and less likely to be research articles (OR, 0.49; 95% CI, 0.27-0.88). CONCLUSION: A substantial proportion of articles in peer-reviewed medical journals demonstrate evidence of honorary authors or ghost authors.

A comparison of the opinions of experts and readers as to what topics a general medical journal (JAMA) should address.

CONTEXT: Journal editors are responsible to many publics, and their choices of articles to publish are a frequent source of dispute. OBJECTIVE: To assess the extent of agreement between topics identified by experts and by JAMA readers as most important for publication. DESIGN AND PARTICIPANTS: Modified Delphi process of polling of JAMA Editorial Board members and senior staff (ie, experts) in 1996, and masked direct mail survey of a stratified sample of JAMA readers in late 1996 and early 1997. MAIN OUTCOME MEASURES: Agreement between experts and readers on the topics most important for JAMA to deal with in 1997. RESULTS: Of 55 experts polled, the 40 respondents (73% response rate) proposed 178 topics. Editing to combine similar topics left 73. The same 55 persons were asked to stratify all 73 alphabetically arranged topics on a scale of 1 to 5 (85% [47/55] response rate). They were then given the results of this ballot and asked to vote again (76% [42/55] response rate). Of the 55 experts, 40 attending the annual editorial board meeting were given all results; 39 attendees voted on the final topics. In response to the mail survey, a single pass of the same 73 topics yielded a response rate of 41.6% (208 returns). Nonresponders were roughly equivalent to responders demographically. Readers agreed with the experts on only 3 of the top 10 subjects: managed care, cancer, and aging. CONCLUSION: Expert opinion and the opinion of readers as to what JAMA should emphasize vary widely.