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International Journal of Nursing Studies 45 (2008) 12571260 www.elsevier.com/ijns

Editorial

Duplicate publication and salami slicing: Ethical issues and practical solutions
Keywords: Duplicate publication; Salami slicing; Publication ethics

One of the least agreeable aspects of editing an academic journal is dealing with alleged breaches of publication ethics. In this months issue of the International Journal of Nursing Studies (IJNS) one of the dilemmas and difculties that arise all too frequently is the subject of two Commentaries (Moon, 2008; Gtzsche, 2008). This case refers to a paper by Moon and his colleagues (Lee et al., 2006) which was accepted for publication in this journal after the usual peer review process. The article appeared in the Article-in-Press section of the journals website. Articles-in-Press are peer-reviewed papers which are made available online (through ScienceDirect) but which have not yet been published in the printed journal. The article has now been withdrawn from the Article-in-Press service because we judged it to be an unwarranted duplicate publication; this was brought to our attention by someone conducting a systematic review who noticed that most of the data in the paper was from a previously published study. In this age of computerised healthcare databases and Internet search engines there is good chance that such papers will be identied when they are screened by the editors prior to being sent for peer review, but sometimes, as happened in this case, a paper slips through the net. We do not propose to say any more about this particular paper here, but to comment more generally about the problem of duplicate publication and explain why we are concerned about it. Firstly, what is duplicate publication? Duplicate publication, in any form (on line or in print), has been dened as publication of a paper that overlaps substantially with one already published (URMSBJ, 1997). But what constitutes substantial? We are reminded of Judge Potter Stewarts famous denition of pornography: I know it when I see it (Jacobellis v. Ohio, 378 U.S. 184; 1964). For practical purposes, however, a paper which reports the same data as another

previously published paper to answer the same or similar research question or test the same hypothesis is a duplicate publication. Usually the authors of the duplicate manuscript are the same as the original authors, but not necessarily, and there are cases where another author has published the same material elsewhere, without knowledge of the original author. In some cases duplicate publication may be perfectly legitimate. Publication of a previously published paper in a different journal, perhaps in a different language or for a different readership, with the knowledge and agreement of the editors of both journals is not unwarranted duplicate publication. For example the publication of very similar versions of Cochrane Systematic Reviews in both the Cochrane Library and a traditional journal is a frequent occurrence with the intention of ensuring wide dissemination of the review. Indeed the IJNS has published a version of a Cochrane review (Grifths et al., 2004, 2005) after its publication in the Cochrane Library and would gladly do so again. Prior publication of the abstract of a paper or a report to funders with limited circulation is not generally problematic and would not be considered duplicate publication at all. However in all cases we, as editors, would want to know about this so we can make a judgement of the novelty of the full paper and how far its publication will contribute to what is already known. Crucially when legitimate duplication occurs it must be fully and explicitly acknowledged in the publication. Duplicate publication which is covert is clear scientic misconduct. A passing reference is not sufcient. It is worth considering how duplicate publication differs from the practice of salami slicing. Salami slicing or salami publication usually refers to submitting different manuscripts drawn from data collected from a single research study or a single data collection period. In some cases studies may draw on data that has been reported and analysed previously and largely repeat the

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analysis with the addition of some new data or analysis not previously reported. There is, in our opinion, considerable similarity between some salami publication and duplicate publication and no clear demarcation between the two practices. This is a world more often comprising shades of grey than black and white but in general salami publication is not acceptable when the aim is simply to get as many individual papers from a single project as possible. However, this said, there may be cases where reporting the results of a study in one paper is not possible; for example the results of large clinical or epidemiological studies which address a series of distinct research questions. A more debateable example is of studies usually involving collection of substantial interview, observational or survey data, which researchers split up and report in separate papers, perhaps under the different themes that have emerged from the analysis. Whats wrong with duplicate publication and why are we bothered about it? There are two major ethical objections to duplicate publication. First, particularly in this era of systematic reviews, duplicate publications can lead to exaggeration of research ndings and so threaten the evidence base of treatments. A convincing example is a systematic review of the effects of the drug ondansetron on post-operative sickness (Tramer et al., 1997) which showed that positive trials are more likely to be subject to duplicate publication than those with negative results, so exacerbating the existing problem of publication bias. In this case the authors found that data from nine of the 84 trials included in the review, appeared in 23 separate publications; this included four pairs of identical papers, but written by different authors. In only one paper was prior publication of the same data acknowledged. Failure to exclude duplicate publications would have overestimated ondansetrons efcacy by 23% (improving the number needed to treat from 6.4 to 4.9). Whilst most readers trust the veracity of healthcare publications Tramer et al.s (1997) paper and others suggests that the proportion of duplicate publications is higher than one would suppose. For example, Bailey, Editor of Archives of OtolaryngologyHead and Neck Surgery reports that of 1000 randomly selected authors from his journal, 201 published 644 papers which could be regarded as duplicates (Sun, 1989). Even in cases of salami publication (short of actual duplication) a misleading impression of the weight of independent evidence can be created. The second main ethical objection to duplicate publication is that it can displace valuable articles from publication, since publication space, whilst plentiful, is a nite resource and ought to be used judiciously. As editors we are particularly conscious of demands on our excellent international panel of peer reviewers, and the additional load duplicate publication imposes on them to no purpose. And we need also to spare a thought for

those working away to index articles for databases; the problem is so serious that MEDLINE has duplicate publication as one of its publication types. If, as suggested by Tramer et al.s (1997) paper, around 17% of the papers on MEDLINE are duplicates, just think of the time saved by indexers and by those searching the database, had they not been published in the rst place. So, why do authors risk it? The academic and research community must take at least some responsibility for the problem of duplicate publication through providing perverse incentives. The old adage publish or perish is true, in some countries and academic communities more than in others, and curriculum vitaes inated by a large number of publications is seen by many as the fast-track route for promotion and academic advancement. Quantity is emphasised at the expense of the quality, with the result that the mean contribution to knowledge of papers published in academic journals is diminished. In the UK the Research Assessment Exercise, went some way to countering this trend with its requirement that each member of faculty who were returned submitted up to four of their highest quality publications. The effects of its replacement with the Research Excellence Framework (Nolan et al., 2008), with its emphasis on citation counts as a measure of research quality, is, as yet, unknown. Authors are central to this whole issue. They need to respect the rights of academic journals to receive original manuscripts and failure to do this violates the trust which should exist between authors, editors and readers. Our advice for authors is to publish the results from a single study together in one substantial paper wherever possible. The generous word length of the IJNS compared to that of many other journals offers this possibility. Where a single publication is not possible full and open disclosure is required to ensure that there is full transparency. If in doubt the best advice to authors is to protect themselves through disclosure to the editor of any prior publications which draw on the same data set or address the same research questions. The IJNS requires authors to identify what is already known about the subject and specify the contribution of this paper to knowledge; if authors can provide a convincing answer to this question then it may be that publishing different papers drawing from the same data set is justied. Crucially, just as with cases where legitimate duplication occurs, full and explicit disclosure is important. This is not a matter of inserting a reference to prior publications in the paper. It is not uncommon for us to return manuscripts to authors for revision because a close reading suggests that the sources that they draw on are, in fact, other reports of the same study. We would not wish to impugn the integrity of authors in such cases although we have no doubt that on occasion there is a deliberate attempt to increase the

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appearance of novelty. Sometimes no reference to prior publication is made but we nd other studies while searching for reviewers. In these cases it is hard not to suspect that there is some attempt to deceive us. What is required is sufcient detail that the reader knows that aspects of a study have been published previously or, where future publications will address the same study, the condence that those studies will be reported in such a way that makes things clear. We recognise, of course, that delays in reviewing and publication can cause even the most assiduous of authors problems in cross referencing publications as additional manuscripts are prepared and submitted prior to the acceptance or publication of preceding ones. This is one reason we encourage single publication where possible. For randomised controlled trials prospective registration of the trial gives a unique trial identication number which can be used to report a study and links all publications from the study and we now ask authors to provide this detail where they have registered. For other study designs this is not so readily available but the principle can apply. An excellent example of good practice is the European NEXT study which explored factors related to early exit from the profession. The scale of this study and the large number of factors probably warranted several publications and indeed the authors have reported them in several journals including the IJNS (Camerino et al., 2008; Estryn-Behar et al., 2008; Flinkman et al., 2008; Simon et al., 2008). Where (on occasion) the authors have not cross referenced clearly related papers the reader can be left in no doubt that they are reading reports of the same study (e.g. Camerino et al., 2008; Estryn-Behar et al., 2008) and while we would be happier as editors if the later paper on work related violence referred to the earlier one it is clear that there is no attempt to deceive. What we advise is that those submitting a paper from a study where there will be several publications do the following:

Importantly these guides apply not just to publications with the IJNS but to subsequent papers that might be published elsewhere. Different editors may have different views about how studies should be cross referenced, where duplicate publication merits space and when multiple publications from the same study are genuinely warranted. However what is crucial is that neither the editors nor the subsequent readership of a paper are left in any doubt about the relationship between a series of publications and the sources of data upon which it draws.

References
Camerino, D., Estryn-Behar, M., Conway, P.M., van Der Heijden, B.I.J.M., Hasselhorn, H.-M., 2008. Work-related factors and violence among nursing staff in the European NEXT study: a longitudinal cohort study. International Journal of Nursing Studies 45 (1), 3550. Estryn-Behar, M., van der Heijden, B., Camerino, D., Fry, C., Le Nezet, O., Conway, P.M., Hasselhorn, H.-M., and the NEXT Study group, 2008. Violence risks in nursingresults from the European NEXT Study. Occupational Medicine (London) 58 (2), 107114. Flinkman, M., Laine, M., Leino-Kilpi, H., Hasselhorn, H.M., Salantera, S., 2008. Explaining young registered Finnish nurses intention to leave the profession: a questionnaire survey. International Journal of Nursing Studies 45 (5), 727739. Gtzsche, P., 2008. Covert duplicate publication and misleading sample size calculation: commentary on Lee et al (2006). International Journal of Nursing Studies 45 (9), 1398. Grifths, P., Edwards, M., Forbes, A., Harris, R., 2005. Postacute intermediate care in nursing-led units: a systematic review of effectiveness. International Journal of Nursing Studies 42 (1), 107116. Grifths, P., Edwards, M., Forbes, A., Harris, R., Ritchie, G., 2004. Intermediate care in nursing-led in-patient units: effects on health care outcomes and resources. Cochrane Database of Systematic Reviews 2004 (4), Art. No.: CD002214.pub002212. Lee, I.S., Moon, J.S., Yoo, Y.S., 2006. Effectiveness of bedding control instruction for patients with respiratory allergies: a randomized controlled trial. International Journal of Nursing Studies, doi:10.1016/j.ijnurstu. 2006.08.009 (Withdrawn). Moon, J.S., 2008. Response to Gtzsche (2008). International Journal of Nursing Studies 45 (9), 1399. Nolan, M., Ingleton, C., Hayter, M., 2008. The research excellence framework: a major impediment to free and informed debate?. International Journal of Nursing Studies 45 (4), 487488. Simon, M., Tackenberg, P., Nienhaus, A., Estryn-Behar, M., Maurice Conway, P., Hasselhorn, H.M., 2008. Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countriesresults from the European NEXT-Study. International Journal of Nursing Studies 45 (1), 2434.

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sure that any prior publications are both properly cited and referred to as being part of the same study. Give the fullest possible reference to in press papers but not those currently under review. Update the citations in all papers that are being prepared if the status of a paper changes while there is still opportunity during the publication processes. Submit copies of other manuscripts (including those under review or in press) so that we can assess the degree of overlap and the novel contribution. Identify your study in a distinctive way and refer to it in this way in all publications so that a reader can clearly and easily identify that all papers emanate from the same study.

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1260 Editorial / International Journal of Nursing Studies 45 (2008) 12571260 Sun, M., 1989. Peer review comes under peer review. Science 244, 910912. Tramer, M.R., Reynolds, D.J.M., Moore, R.A., McQuay, H.J., 1997. Impact of covert publication on meta-analysis: a case study. British Medical Journal 315, 635640. Uniform Requirements for Manuscripts Submitted to Biomedical Journals (URMSBJ), 1997. Annals of Internal Medicine 126, 3647.

Ian Norman, Peter Grifths Florence Nightingale School of Nursing and Midwifery, Kings College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK E-mail addresses: ian.j.norman@kcl.ac.uk (I. Norman), peter.grifths@kcl.ac.uk (P. Grifths)