J. Antonio Aldrete*

Recently, with the great abundance of publications, a noticeable number of scientific papers that have been previously published partially or in whole, by other author or authors have appeared demonstrating plagiarism. When either a paragraph or complete article is reproduced, it is considered that the content has been stolen from the author and the original publication. Different degrees and varieties of plagiarism have been defined, and even “auto plagiarism” has been defined which is not so alarming. However, including more than 6 exact consecutive words from another text written by other author should be considered plagiarism. Once identified and checked, several medical journals and scientific organizations have sanctioned plagiarism in different ways; in some countries plagiarism is not even considered a crime and it is simply assumed as a conceptual problem. However, in other countries, in some universities, and medical organizations, it has been sanctioned with the retraction of the published paper, and notification of the plagiarist’s employer (for example the University, hospital, government agency and scientific or trade organization). Commonly, the punishment is the retraction of the paper in the journal, dismissal of the plagiarist from the academic center (University) and or destitution in one or more appointments he may have had. Maybe in the future, fines or lawsuits resulting in economic compensation to the original author could be instated. Another issue is the responsibility of editors who allow such actions, particularly if it is a common event.

Websites like Wikipedia have included serious debates on topics which frequently trespass scientific ethics, specifically the respect of the initial authorship about scientific findings, descriptions of original works, clinical case reports, and conclusions obtained from scientific observations or experiments performed in research facilities. Such reports seem to antagonize the current trend of "information no matter how or where it is". Almost simultaneously, multiple scientific journals have addressed a rarely discussed an undesirable topic like plagiarism (1).

However, the current trend of “publishing at any cost” as well as the common style of writing medical books using the popular technique of “cut-and-paste” that has been promoted as the easiest, albeit little original and very dishonest scientific writing which has allowed the publication of books by physicians who are neither experts in the subject nor have participated in the research described (2).

Without doubt, plagiarism is an ethics subject that has generated debate and controversies particularly around concepts previously considered unethical, maybe because of changes in the culture, with the different perceptions of what is considered good and which after wards is taken as evil. Examples are contraception with drugs, discretional abortion, and organ transplantation, just to mention a few scenarios where the ethical frontiers have extended.

Quoting Wikipedia, it is interesting that the word plagiarism is derived from the Latin word plagiarius, which means kidnapper, related to plagium which means “to steal” or kidnap.

The publications ethics committee of the British Journal of Surgery (3) considers that plagiarism has been committed "when manuscripts by others, published or not, are used in part or whole, without references, that includes scientific research and even applications for research funds, even if they are in a different language. Such definitions include manuscripts in any phase of development, be it in the process of planning, during research, or already published including electronic media”.

Trying to clearly define these concepts some scholars have defined plagiarism as "literary theft” (4), and have even suggested a threshold: “the copy of more than 6 consecutive words from a previous publication without a reference from where it was extracted constitutes plagiarism". It has also been defined as “stealing or presenting someone else's original idea as his own” (5). In the United States the office for research integrity (ORI) demands that publications resulting from funding by the NIH (National Institute of Health) be screened for this crime, defining plagiarism as “the theft and improper appropriation of intellectual property, as well as direct copy from other author of topics, concepts or ideas as well as the exact copy of sentences and paragraphs of ideas or methods previously published. In such case plagiarism is considered when phrases, sentences or paragraphs are exactly or almost exactly copied about ideas and conclusions previously expressed a published, in such a way that could lead readers to believe they were original. Such misinterpretations can be avoided when the authors properly quote the original authors and provide references from where the ideas, concepts expressions or conclusions were taken” (6).

Plagiarism in ancient times

This problem has existed ever since writing began. It could be accepted then, that plagiarism occurred inadvertently, as communication was primitive, traveling was infrequent and different languages were not known in distant locations of inhabited areas. This could explain that two authors could have written almost simultaneously, although somewhat differently, in distant countries almost the same thing (7,8). This rare coincidence could be attributed to an honest mistake of not knowing that what author X published had previously been published by author Y (9). This could be accepted in a time where libraries were a scarce commodity.

Republishing was common in antiquity and it was not unusual to omit crediting the original authors. Probably this infraction has occurred in the literature of all languages, and maybe in all of the countries ever since writing was used to describe events, recipes, histories, rules, laws and any other stories.

Current Plagiarism

Undoubtedly with the advent of Internet and online publishing, many journals and information sources are not indexed, and some colleagues may have access to similar sources and therefore have the same conclusions without quoting the other author that has published almost simultaneously the same (4,6). However, with the current availability of media, some consider this infraction as unacceptable, to a degree that a new blog created in August 2010 called "Retraction Watch” has identified a number of plagiarisms that have been retracted. Also in “The Scientist” they include since 2007, a list of retractions with sanctions that span from letters to the authors involved up to retraction of the paper without the author's permission. It is possible that somehow two authors do not know that at the same time they're working on similar topics, and could even reach the same conclusion in a way that an “accidental plagiarism” could be considered. However this does not happen frequently and is currently considered unexplainable (10).

However, to the classic concept of plagiarism, new ways and degrees of copying could be considered not only including the typical “six word “definition, but also the use of different titles, which in the end represents dishonest publication (11).

Varia tions of plagiaris m Variations of the classic model of plagiarism can be:

a. Copying a complete paragraph without crediting the original author.

b. Copying several phases of a published paper (verbatum) including them in the manuscript to be published without crediting the original author. This is not only suggests lack of grammatical skills, but also the boldness of copying directly from other published paper without providing the reference (12).

c. The inclusion of drawings, photos, sketches or any type of illustration taken from other articles without mentioning the original publication. In this case, plagiarism can be avoided by saying “reproduced with permission of the author” or ”modified from…..”

Auto plagiarism

Auto plagiarism occurs when a publication includes parts of previous articles about some topic without quoting them as references (13). Apparently, there is no official agreement to consider this as improper, as there are doubts about how to determine “how many own words can one steal from oneself before it be considered plagiarism“ (13). This is the reason for which auto plagiarism has not been considered as plagiarism of our own ideas expressed with our own words. The strongest criticism of this practice is that the abuse of this style leads to the creation of a “salami science”.

It should be considered however, that the repeated duplication of ideas and words of already published texts is probably ethically problematic, as authors usually transfer the property of their articles to the editorial boards of the journals in which they are published, which technically could be considered as a breach of the intellectual property agreement with the journal’s publishing company (13).

Scientific fraud

In addition to plagiarism there can be fictitious results that include:

a. Nonexistent clinical cases (14).

b. Clinical cases previously published in another paper, without referencing the source from which they were included. c. Published research projects that were never performed, but were published with fictitious data.

d. Partially completed research projects, supposedly using the same methodology including the initially planned number of patients. This produces modified results (13,14).

e. Research projects that had negative results but are published with favorable outcomes (15).

The examples of plagiarism in the scientific literature are abundant specifically in the last 50 years. Although they have been denounced in medical publications and among academic institutions, these crimes do not carry a prison sentence or legal consequences. They rarely become known to the public.

Besides, only rarely do institutions or editorial boards are willing to undertake punitive or legal actions and denounce them before the University authorities or professional associations of which the accused are active members (16).

This passivity could have led to these 3 facts:

1. Plagiarism is more common than the frequency that has been reported (17).

2. The readers of medical scientific journals are neither commonly informed in detail about these infractions nor of the strategies implemented by the editorial boards to prevent them in the future.

3. Many of the papers that contain some plagiarism are related to pharmaceutical products, devices or supplements announced in the same journal, which sometime include full-page ads which are vital to its economic survival (18,19).

Anyway, the editors have the responsibility of verifying the truthfulness of such writings, specifically in the cases where the authors seem to publish more than commonly possible, when at the same time they keep a position as physicians in any specialty. Journals should request the original formats in which the results were written, and communicate with the co-authors who supposedly did the tabulation and performed the mathematical steps necessary to perform the statistical analysis of the results among other aspects.

For this purpose, it would be advisable that the authors keep for posterity the dated ver - sions of the same manuscript, including the versions or corrections by co-authors on the same file, in case there are disagreements about the authorship order. It is important to keep the correspondence with the reviewers and editors regarding every version of the submitted manuscripts to the editorial board.

The journal Anesthesia & Analgesia recently insisted in retracting more than 30 papers published by authors from different countries. In these papers criminal misrepresentation of studies that were either partially or not even done at all, was found. This could be interpreted as a style of delinquency in scientific publications. Besides, the editorial boards, in my opinion, have not adopted serious and specific resolutions to ban these authors to publish anymore in this journal or any other similar publication. No major effort has been done disseminate this information about these acts to every university and medical journals apparently for fear of lawsuits, which with the exception of sporadic cases in the United States, Malaysia, England and Germany, have not generally resulted in actions that sanction the guilty party (21). The proliferation of electronic journals has favored the duplication of manuscripts that appear years after the original publication in a conventional journal. It seems that Internet journals do not consider themselves ruled by the same standards as conventional journals, for which they do not consider plagiarism as critical.

It has been proposed that before accepting a article for publication, the editorial board should send the authors of all the papers a document to be signed by each one in which they certify that no plagiarism has occurred, and that all the included cases were really studied, as well as a statement saying that the results to be published are really the ones obtained in the study (22).

The most commonly known secret, but little debated is the fact that drug manufacturers hire professional writers to write papers that eventually are published including artists that create illustrations as required by the company. These ghostwriters are hired professionals by sponsoring companies to write and illustrate manuscripts related to studies supposedly performed by “research physicians”.

Clearly, the editorial boards of medical journals tolerate this style of scientific manipulation which rules and supervises the essential parts of a paper like the methodology, interpretation of results, conclusions, as well as a good part of the discussion of the results of studies done by presumably impartial authors (24, 24).

Maybe one way to avoid this kind of “phantom authors” would be to have a document ask the authors if they personally wrote and illustrated their manuscripts.

Even though the companies involved in medical research indicate that their participation did not influence the results, such support does not come without bias or influence, which could affect the publication of a study carried to perfection, written masterfully, and that ends up being published with minor editorial modifications. It was usually considered that this happened -and probably still happens- in journals with little circulation, especially those supported by pharmaceutical industry.

However, such missteps have been identified in well-respected journals like Nature, British Journal of Anesthesia and Anesthesia & Analgesia (in this last one there have been multiple retractions of papers fraudulently performed or interpreted). In these cases not only the pseudo authors must admit their fault, but the editors also have the responsibility of establishing a reviewing strategy to verify if the manuscripts have been previously published. Supposedly all current manuscripts submitted to be considered by the editorial boards are subject to plagiarism identification strategies, reference correction and verification of the methodology used to statistically interpret the results. However, there still cases of literary plagiarism published, fictitious results, and republication of previously done studies. Probably the greater frequency of these missteps happens because of the Internet, and in general because computers make the copy of whole paragraphs from one publication to another very easily. The editors of books and journals should assume the responsibility to minimize the frequency of these literary crimes in scientific journals, and that the wrongdoers be identified and sanctioned (25). Preferably a committee of the Editorial group of both general and specialties journal editors existed, these problems could be identified before they were published. If they are identified after published, an ample publicity of this “civil crime” should be made so that these authors be identified and their texts not accepted in the future. Any other punitive measure could lead to costly legal conflicts questioning even the legitimacy of the “6 consecutive words” definition, by simply asking why 6 words and not 3, or 9, which would be very easy to debate and difficult to demonstrate.

The rest of the literary infractions mentioned here should be investigated by the editorial boards, as it is time that they assume the entire responsibility before the readers who spend valuable time reading the papers included in every issue of the journals who expect to read new information.

Detection of plagiarism

Several cases of evident plagiarism in the last decade have generated the need to create a system that identifies articles already published that have not been quoted in the appropriate way. Clearly this problem occurs with some frequency (26), and there are several options to solve this problem, specifically creating computing systems that:

a. Consider the possibility of plagiarism

b. Identify the possible duplicity of a previously published paper

c. Identify if similar or identical manuscripts have been submitted previously to the same journal or to the editorial boards of other publications

Currently there are computer resources that can be used to define if the manuscripts submitted to an editorial board have been previously published, and also to define if identical paragraphs have been taken from a previous publication (for example the program WCopyfind) and can detect plagiarism using a system that identifies phrases with more than 6 identical consecutive words.

Using similar or other strategies, the reviewers can use databases to identify similar phras es or words organized in the same order (27). Some systems have been designed with the purpose of avoiding plagiarism or duplications of the paper. Among several options is the powerful anti-plagiarism program available in iParadigms, better known as iTenticate® which detects plagiarism of the original paper and lists its sources. The system also allows the identification of other papers related to the topic (28).

The journal Nature has published the details of other systems useful for this purpose¹.

Another resource that can be useful for this purpose is the search engine sTEBLAST which identifies the language and use of similar words. The obtained information can be stored in “déjà vu” and together can identify almost 100,000 similar manuscripts. It should be mentioned that there are complaints about this tool because of false positives (29).

However, the routine of not verifying similar manuscripts have led to the submittal of several manuscripts each almost the same as others by different authors. A verification of plagiarism can be performed at www.grammarly.com.

Within the editorial boards, the reviewers have the responsibility of discretion and confidentiality before the publication, and also of not allowing that personal rivalry influence or determine a favorable or unfavorable concept of the reviewed paper. In the meantime, the editors should maintain absolute discretion to protect the integrity of the publication and of each of the manuscripts submitted for publication. If the editors accept that one or more authors oublished a paper that was written in part or in whole by ghostwriters (28-30), it is my opinion that a notice be included to the readers on the 1st page of such paper.

Plagiarism has received much attention, although some believe that there is not enough interest to clean up the medical academic literature from this literary delinquency (2, 4, and 10). Several types of plagiarism have been defined: servile, smart, intentional, accidental (25), auto plagiarism and others.

Even though plagiarism has been called “a crime with no victims”, it should be avoided at any cost; and the best punishment is the exclusion of all the material written by the same author as long as there is no doubt that the crime has been committed.

¹ . Nature 2008;455:751. Nature 2008;397:451. Nature, 2008:453:980-2.

1. Caon M. Plagiarism in scientific/medical physics publishing. Australas Phys Eng Sci Med. 2007;30: xi-xii.

2. Ramaswamy M. It is not just the work--it is also the words. Indian J Crit Care Med. 2007;11:169-72.

3. Guidelines on good publications practice. Committee on Publications Ethics (COPE). Br J Biomed Surg. 2000;57:2-6.

4. Butler D. Entire-paper plagiarism caught by software. Nature. 2008;455:715.

5. Sox HC, Rennie D. Research misconduct, retraction, and cleansing the medical literature: lessons from the Poehlman case. Ann Intern Med. 2006;144: 609-13.

6. Office of Research Integrity (ORI). Policies: ORI policy on plagiarism [internet]. Rockville, MD; 1994 [citado: 8 diciembre 2008]. Disponible en: www.ori.Dhhs.gov/policies/plagiarism.shtml.

7. Arabi YM. Scientific misconduct and medical publishing. Ann Thorac Med. 2007;2:147.

8. Mello MM, Brennan TA. Due process in investigations of research misconduct. N Engl J Med. 2003;349:1280-6.

9. Al-Muharraqui MA, Fedorowicz Z. Plariagism – Part 11: Finding and dealing with a Fraudster. Bahrain Med Bull. 2009;31:1-4.

10. Peh WC, Arokiasamy J. Plagiarism: a joint statement from the Singapore Medical Journal and the Medical Journal of Malaysia. Singapore Med J. 2008;63: 965-6.

11. Lindey A. Plagiarism and originality. Westport, CT; Greenwood Publishing; 1974.

12. Skandalakis JE, Mirilas P. Plagiarism. Arch Surg. 2004;139:1022-24.

13. Bretag T, Mahmud S. Self-plagiarism or appropriate textual re-use? J Acad Ethics. 2009;7:193-205.

14. White C. Suspected research fraud: difficulties of getting at the truth. BMJ. 2005;331:281-8.

15. Smith R. Investigating the previous studies of a fraudulent author. BMJ. 2005;331:288-91.

16. U.S. Department of Health and Human Services (HHS). Public Health Service policies on research misconduct: final rule. Fed Regist. 2005;70:28369- 400.

17. Kennedy D. Editorial expression of concern. Science. 2006;311:36.

18. Shaffer SL. Editorial notice of retraction. Anesth Analg. 2010;110:1350.

19. Neligan P, Williams N, Greenblatt E, et al. Retraction letter for Neligan P, Malhotra G, Fraser MW, Williams N, Greenblatt EP, Cereda M, Ochroch EA. Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesthesia & Analgesia 2010;110:1360-5. Anesth Analg. 2010;111:576.

20. Struys MM, Fechner J, Schüttler J, et al. Requested retraction of six studies on the PK/PD and tolerability of fospropofol. Anesth Analg. 2010;110:1240.

21. Marcus A. Massive breach of trust. Anesthesiol News. 2010;24-8.

22. Noble DW. Preventing scientific fraud. Ann Intern Med. 2006;145:472.

23. Lowes R. Anesthesiologist sentenced to 6 months for faked research. MedScape Today. [Sin lugar]; 29 junio 2010.

24. Rosoff PM. Industrial collaboration. N Engl J Med. 2003;348:863-4.

25. Rojas Chavarro MA, Olarte Collazos JM. Plagio en el ámbito académico. Rev Col Anesth. 2010;38:537-8.

26. Emanuel EJ, Emanuel LL. What is accountability in health care? Ann Inter Med. 1996;124:229-39.

27. Wends DA. Our view: Gifts from drugmakers damage doctors’ integrity. USA Today [internet]. 8 febrero 2006 [citado: 15 febrero 2011]. Disponible en: http://www.usatoday.com/news/opinion/editorials/2006-02-07-our-medical-ethics_x.htm.

28. Mychaskiw G 2nd, Badr AE, Calimaran AM. Ethics, marketing and the medical literature. Anesth Analg. 2006;103:488.

29. Stossel TP. Regulating academic-industrial relationships- solving problems or stifling progress? N Engl J Med. 2005;353:1060-5.

30. Elliot C, Landa AS. Commentary: What’s wrong with _ ghostwriting? Bioethics. 2010;24:284-6.

10. Peh WC, Arokiasamy J. Plagiarism: a joint statement from the Singapore Medical Journal and the Medical Journal of Malaysia. Singapore Med J. 2008;63: 965-6.         [ Links ]

11. Lindey A. Plagiarism and originality. Westport, CT; Greenwood Publishing; 1974.         [ Links ]

12. Skandalakis JE, Mirilas P. Plagiarism. Arch Surg. 2004;139:1022-24.         [ Links ]

13. Bretag T, Mahmud S. Self-plagiarism or appropriate textual re-use? J Acad Ethics. 2009;7:193-205.         [ Links ]

14. White C. Suspected research fraud: difficulties of getting at the truth. BMJ. 2005;331:281-8.         [ Links ]

15. Smith R. Investigating the previous studies of a fraudulent author. BMJ. 2005;331:288-91.         [ Links ]

16. U.S. Department of Health and Human Services (HHS). Public Health Service policies on research misconduct: final rule. Fed Regist. 2005;70:28369- 400.         [ Links ]

17. Kennedy D. Editorial expression of concern. Science. 2006;311:36.         [ Links ]

18. Shaffer SL. Editorial notice of retraction. Anesth Analg. 2010;110:1350.         [ Links ]

19. Neligan P, Williams N, Greenblatt E, et al. Retraction letter for Neligan P, Malhotra G, Fraser MW, Williams N, Greenblatt EP, Cereda M, Ochroch EA. Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesthesia & Analgesia 2010;110:1360-5. Anesth Analg. 2010;111:576.         [ Links ]

20. Struys MM, Fechner J, Schüttler J, et al. Requested retraction of six studies on the PK/PD and tolerability of fospropofol. Anesth Analg. 2010;110:1240.         [ Links ]

21. Marcus A. Massive breach of trust. Anesthesiol News. 2010;24-8.         [ Links ]

22. Noble DW. Preventing scientific fraud. Ann Intern Med. 2006;145:472.         [ Links ]

23. Lowes R. Anesthesiologist sentenced to 6 months for faked research. MedScape Today. [Sin lugar]; 29 junio 2010.         [ Links ]

24. Rosoff PM. Industrial collaboration. N Engl J Med. 2003;348:863-4.         [ Links ]

25. Rojas Chavarro MA, Olarte Collazos JM. Plagio en el ámbito académico. Rev Col Anesth. 2010;         [ Links ]38:537-8.

26. Emanuel EJ, Emanuel LL. What is accountability in health care? Ann Inter Med. 1996;124:229-39.         [ Links ]

27. Wends DA. Our view: Gifts from drugmakers damage doctors' integrity. USA Today - Internet. 8 febrero 2006 citado: 15 febrero 2011. Disponible en: http://www.usatoday.com/news/opinion/editorials/2006-02-07-our-medical-ethics_x.htm        [ Links ]

28. Mychaskiw G 2nd, Badr AE, Calimaran AM. Ethics, marketing and the medical literature. Anesth Analg. 2006;103:488.         [ Links ]

29. Stossel TP. Regulating academic-industrial relationships- solving problems or stifling progress? N Engl J Med. 2005;353:1060-5.         [ Links ]