At WriteSource Medical, we uphold accuracy, honesty, and ethical standards in everything we do. As part of this, our medical writing team supports author teams in ensuring the highest standards are implemented when developing manuscripts for publication in the peer-reviewed scientific press.
Clear authorship criteria protect research teams from conflict and ensure that credit and accountability are assigned fairly. Most medical journals follow the International Committee of Medical Journal Editors (ICMJE) guidance: an individual must meet all four ICMJE criteria to be listed as an author.
The ICMJE criteria specify that each author should:
These four requirements are cumulative, not optional. A senior supervisor who only provides general oversight or access to facilities, without substantial intellectual input or involvement in drafting or reviewing the manuscript, does not qualify for authorship. Similarly, a statistician who performs analyses but has no role in interpreting the findings or reviewing the manuscript also does not meet the full criteria.
Many journals now request a contribution statement describing what each listed author did. This increases transparency and helps readers understand why each person is an author.
Contributors who do not meet all four criteria should be listed in the acknowledgments, with their role described specifically. For example, a clinical trial coordinator who managed data entry but did not participate in analysis or manuscript review might be acknowledged as having “coordinated data collection and site documentation.” A professional medical writer who only provided editing support should be acknowledged for “medical writing and editorial assistance.”
ICMJE explicitly states that authors should not list AI and AI-assisted technologies as an author or co-author, nor cite AI as an author.
Two recurring problems in research publishing are honorary authorship and ghost authorship. Both undermine trust in the scientific record and are considered unethical by the ICMJE and major journals.
Honorary authorship (sometimes called “gift,” “guest,” or “pressured” authorship) occurs when someone is listed as an author even though they do not meet all four authorship criteria. Examples include adding a department head as an author out of gratitude, including a well-known researcher to increase the perceived impact of the paper, or listing a senior leader who insists on authorship despite limited involvement.
These practices distort the true distribution of responsibility. Studies in medicine have reported substantial rates of honorary authorship, particularly in large collaborative projects. Even when intended as a courtesy, honorary authorship can be considered a form of research misconduct because it misrepresents who is responsible for the work.
Ghost authorship is the opposite problem: an individual who does meet authorship criteria but is not listed as an author. Remember that there should be an author who can be held accountable for each aspect of the work.
Bottom line: If a contributor meets the authorship criteria - they should be included as an author.
Practically speaking, throughout the project, the contributions of team members should be consistently documented. Contributors should be reminded of the ethical standards expected by journals (and for company-sponsored research, this includes Good Publication Practices).
Once a team has identified who qualifies as an author, the next challenge is deciding author order. In many health and biomedical disciplines, the first and last author positions carry particular significance, while the corresponding author has a defined operational role.
The first author is usually the person who made the largest intellectual and practical contribution to the work. This role often includes leading the study design, performing key experiments or analyses, and being particularly involved in drafting the first version of the manuscript. Academically, first authorship is highly valued when evaluating research performance and career progression.
The last author is often, but not always, the principal investigator or senior supervisor who oversaw the project. In many institutions, last authorship is used as a marker of leadership and independence.
The corresponding author is responsible for communication with the journal. This individual submits the manuscript, manages revisions, ensures required documentation is complete, and responds to post-publication queries. The corresponding author is usually the first or last author, but some journals allow another team member to take this role if they are best placed to manage ongoing communication.
Authors between the first and last positions are usually ordered by their relative contribution, from greatest to least. However, practices can vary between disciplines and journals. Some teams use structured methods to make ordering decisions more objective.
One common approach is to identify the main components that will appear in the manuscript (for example: study design, data collection, statistical analysis, manuscript drafting, critical revision) and assign weights or percentages to each component. Each potential author’s contribution to these components is then estimated and combined into an overall contribution score, which guides the ordering from second to penultimate author.
This structured approach can be particularly useful in large collaborative studies. For example, in a 10‑author paper, the team might agree that data analysis and manuscript drafting are more heavily weighted than data collection. A statistician who led the analyses and co-drafted the results might then be placed ahead of several investigators who mainly recruited participants.
Equal contributions introduce additional complexity. Some journals allow an “equal contribution” note (for example, indicating that the first and second authors contributed equally). However, the first name listed is still more visible in citation lists and online search results. Similar challenges arise when two senior team members share last authorship, with one listed as the final author and another noted as equal last author.
Where contributions are genuinely similar, teams can:
The key is to document the rationale clearly and ensure all authors agree before submission.
Most authorship disputes arise because expectations were not discussed at the start of a project. Planning authorship from the outset can prevent misunderstandings and protect all contributors, particularly more junior researchers.
Best practice is to address authorship at the first substantive project meeting. This discussion should cover:
Having a documented plan also supports transparency when external reviewers or institutions ask how author order was determined, which is increasingly common in large, multicentre studies.
Even with early planning, projects can change. New contributors may join, roles can shift, and timelines may extend. Regularly revisiting authorship decisions helps maintain fairness and reduce conflict.
Teams should schedule authorship reviews at major milestones, such as completion of data collection, database lock, manuscript outline, and first full manuscript draft. At each point, the team can compare actual contributions with the authorship grid and adjust author list and order accordingly.
Certified Medical Publications Professionals are highly trained individuals who have undertaken an examination to confirm they have the expertise in both the technical and ethical aspects of publication development. A professional medical writer can help navigate authorship questions.
DeTora LM, Toroser D, Sykes A, et al. Good publication practice (gpp) guidelines for company-sponsored biomedical research: 2022 update. Ann Intern Med. Sep 2022;175(9):1298–1304. doi:10.7326/M22-1460
Herron C. Best practices to guide decisions of authorship and author order in a research manuscript. AMWA Journal. 2023;38(4)doi:10.55752/amwa.2023.250
International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Available from https://www.Icmje.Org/icmje-recommendations.Pdf. 2026